SPEECH BY THE PRIME M1INISTER,
T1IlE HON. E. G. WH ITLAM1 Q. C. M. P.
AT THE 1611l ANNIVERSARY OF THE OFFICIAL OPENING OF THE
LIVERPOOL DISTRICT [: oSPIIAL,
SYDNEY FRIDAY 296 JULY 1974i
TtHE LIVERPOOL DISTRICT HOSPITAL STANDS AS
SOMETHING OF AN OASIS IN A DESERT OF HEALTH CARE FACILITIES
IN THE IWESTERN SUBURBS OF SYDNEY. IT IS ONE OF ONLY
1' 4 PUBLIC AND 6 PRIVATE HOSPITALS IN ONE OF THE MOST POPULOUS
AND RAPIDLY GROWING AREAS OF AUSTRALIA. THE WESTERN
METROPOLITAN AREA OF SYDNEY, WHICH INCLUDES LIVERPOOL AS
~ NE OF ITS FOCAL POINTS, HAS A POPULATION OF NEARLY ONE
MILLION,. OR NEARLY ONE QUARTER OF THE POPULATION OF THE
STATE. IT IS EXPERIENCING A RAPID POPULATION GROWTH OF
MORE THAN 10 A YEAR AND YOUNG FAMILIES COMPRISE MOST OF
THIS INCREASE. DESPITE ITS SIZE AND RATE OF GROWTH, THE AREA IS
DEFICIENT IN MOST HEALTH SERVICES. THIS APPLILS PARTICULARLY
TO HOSPITAL SERVICES. THE AREA HAS ONLY 3.3 BEDS FOR EVERY
THOUSAND PEOPLE COMPARED WITH THE STATE'S AVERAGE OF 6.4# BEDS
PER THOUSAND. THE DEFICIENCY IS EVEN GREATER WHEN ONE CONSIDERS
THE SHORTAGE OF MATERNAL AND PAEDIATRIC SERVICES WHICH EXISTS
IN AN AREA WITH SO MANY YOU1NG FAMILIES.
-2
THE PROVISION AND PLANN~ ING OF HEALTH CARL FACILITIES
IN AUSTRALIA FOR TOO LONG HAS BEEN CHARACTERISED BY SHORTCOMINGS
OF THIS KIND. INDEED IT IS A LACK OF PLANNING WHICH IS THE
FAULT. MY COLLEAGUE, THE MINISTER FOR SOCIAL SECURITY,
AM. BILL HAYDEN, HAS POINTED OUT TH-AT IN SYDNEY, FOR EXAMPLE,
THE CITY I5 7 TEACHING HOSPITALS ARE LOCATED WITHIN AN
EIGHT MILE RADIUS OF THE G. P. O. AND 5 OF THEM ARE WITHIN
A FOUR MILE RADIUS. YET THE GREAT MAJORITY OF SYDNEY'S
POPULATION LIVES A CONSIDERABLE DISTANCE OUTSIDE THESE
PARAMETERS, BEYOND HOSPITALS, THERE IS A MALDISTRIBUTION OF
DOCTORS AND OTHER SKILLED MEDICAL MANPOWER. THE RESULT IS
THAT PEOPLE WHO LIVE IN LONG-ESTABLISHED AND GENERALLY
AFFLUENT AREAS HAVE ACCESS TO THE FULL RANGE OF HIGH QUALITY
HEALTH CARE. IN CONTRAST, PEOPLE WHO LIVE IN NEWER AND
FREQUENTLY DISADVANTAGED AREAS DO NOT. HAVE SUCH ACCESS.
IT IS MONSTROUSLY INEQUITABLE THAT PARENTS ON A
LOW INCOME LIVING IN THE WESTERN SUBURBS SHOULD HAVE TO SPEND
HOURS TRAVELLING AT RELATIVELY GREAT COST 20 MILES OR MORE
BY TRAIN AND BUS TO VISIT A SICK CHILD IN A PAEDIATRIC HOSPITAL
WHILE AFFLUENT PARENTS LIVING IN, SAY, THE EASTERN SUBURBS
OF SYDNEY FACE ONLY A SHORT CAR TRIP TO VISIT THEIR CHILD.
IT IS EQUALLY INEQUITABLE THAT THE WESTERN SUBURBS FAMILY
SHOULD SUFFER A DEARTH OF DOCTORS TO TREAT THEIR ILLNESSES AND
INJURIES WHILE THE EASTERN SUBURBS FAMILY SHOULD LIVE IN AN AREA
WHICH ABOUNDS IN MEDICAL AND HOSPITAL SERVICES. IT IS NOT THAT
WE SHOULD DENY THE AFFLUENT ACCESS TO THE BEST HEALTH CARE;
BUT WE MUST ENSURE THAT EVERYONE IN THE COMMIUNITY RECEIVES THE
BEST POSSIBLE TREATMENT, IRRESPECTIVE OF THEIR FINANCIAL MEANS
AND THEIR PHYSICAL LOCATION. s. m1/ 3
IT IS FOR THIS REASON THAT THE PRESENT
GOVERNMENT SAW THE NEED FOR AN URGENT AND THOROUGH EXAMINATION
OF THE DELIVERY OF HEALTH SERVICES THROUGHOUT 4USTRALIA.
A HOSPITALS AND HEALTH SERVICES INTERIM COMMITTEE, WHICH
LATER BECAME BY STATUTE THE HOSPITALS AND HEALTH SERVICES
COMMISSION, WAS APPOINTED LAST YEAR TO INVESTIGATE,
REPORT ON AND RECOMMEND NECESSARY ACTION TO OVERCOME BOTH
IMMEDIATE AND LONG-TERM PROBLEMS. THE OBJECTIVE OF THE
COMMISSION IS " THE PROVISION OF HIGH QUALITY, READILY
ACCESSIBLE, REASONABLE COMPREHENSIVE, CO-ORDINATED AND
EFFICIENT HEALTH AND RELATED WELFARE SERVICES AT LOCAL,
REGIONAL, STATE AND NATIONAL LEVELS." fN THE COMMISSION'S
RECOMMENDATIONS WE ALLOCATED $ 4t. 5 MILLION IN 1) 131/ 4
TO MEET URGENT NEEDS FOR ADDITIONAL HOSPITALS IN SYDNEY,
MIELBOURNE AND BRISBANE. OF THAT AMOUNT, 14 MILLION WAS TO
BE PROVIDED TOWARDS THE COST OF PLANNING AND COMMENC. ING
THE HOSPIT AL PROPOSED FOR WESTMEAD SINCE 1968. TO DATE
ONLY $ 577,000 HAS BEEN USED FOR THE WESTMEAD PROJECT. THIS
MEANT THAT THE GOVERNMENT WAS ABLE TO ALLOCATE FROM THE UNUSED
PFUNDS $ 500,000 TOWARDS THE COST OF A NEW WARD BLOCK AT
THE LIVERPOOL DISTRICT HOSPITAL. INEARLY $ 112,0J00 OF THIS HAD
BEEN SPENT BY THE END OF THE FINANCIAL YEAR. ms i
THIS IS ONLY THE BEGINNING OF A MAJOR OVERHAUL
OF HOSPITAL SERVICES ENVISAGED BY THE AUSTRALIAN GOVERNMENT,
ON 10 APRIL THE MINISTER FOR HEALTH, DR EVERINGHAM, TABLED
IN THE HOUSE OF REPRESENTATIVES A " REPORT ON HOSPITALS IN
AUSTRALIA" PREPARED BY THE HOSPITALS AND HEALTH SERVICES
COMMISSION. THE REPORT PROPOSES THAT OVER A FIVE YEAR
PERIOD BEGINNING ON 1 JULY 1974 A PROGRAM BE IMPLEMENTED
FOR THE DEVELOPMENT AND CONSTRUCTION OF HOSPITALS, MENTAL
HEALTH FACILITIES, PUBLIC NURSING HOMES AND HEALTH HOSTELS
AT A TOTAL COST OF $ 1,160 MILLION. THE REPORT HAS YET TO
BE CONSIDERED BY CABINET, SO IT IS TOO EARLY FOR ME TO
DEFINE THE EXACT EXTENT OF THE AUSTRALIAN GOVERNMENT'S
INVOLVEMENT IN SUCH A PROGRAM. HOWEVER, IT IS QUITE CLEAR
THAT, IF VIE ARE TO HAVE ADEQUATE HOSPITALS, THE 1USTRALIAN
GOVERNMENT WILL HAVE TO BECOME MORE INVOLVED IN THEIR PLANNING
AND FINANCING THAN IT HAS BEEN IN THE PAST, THE STATE
GOVERNMENTS SIMPLY DO NOT HAVE THlE RESOURCES TO OVERCOME THE
DEFICIENCIES THAT EXIST AT PRESENT. U\ AUSTRALIAN GOVERNMENT
INVOLVEMENT IS ESPECIALLY NECESSARY IF WE ARE TO SOLVE THE
PRESENT GROSS MALDISTRIBUTION OF FACILITIES. SINCE THE 1946
REFERENDUM THE AUSTRALIAN GOVERNMENT HAS POSSESSED, BUT
HITHERTO HAS NOT EXERCISED, THE CONSTITUTIONAL RESPONSIBILITY
TO PROVIDE HOSPITAL BENEFITS AND MEDICAL SERVICES; IN OTHER
WORDS, THE AUSTRALIAN GOVERNMENT CAN ITSELF BUILD, FINANCE
AND MANAGE HOSPITALS AND HEALTH CENTRES. 1611
THE INVOLVEMENT OF THE AUSTRALIAN GOVERNMENT
IN THE FINANCING OF PUBLIC HOSPITALS MUST EXTEND BEYOND
CAPITAL COSTS. THE RUNNING COSTS OF HOSPITALS REPRESENT
A EVER-INCREASING PROBLEM. THE HOSPITALS AND HEALTH
SERVICES COMMISSION REPORT IN APRIL POINTED OUT THAT,
AS TECHNOLOGICAL CHANGE AND THE COMPLEXITY OF INSTITUTIONS
INCREASE, SO THE HOSPITAL SYSTEM BECOMES MORE LABOUR INTENSIVE.
" THIS TREND MAY BE PECULIAR TO HOSPITALS AND IS UNLIKELY TO
BE REVERSED," I THE REPORT SAID. THIS PROBLEM EXTENDS INTO
OTHLR HEALTH SERVICES AS WELL AS HOSPITALS. AT PRESENT
HEALTH SERVICES COST OUR NATION MORE THAN $ 2,000 MILLION A
YEAR, OR ABOUT 5.3Z' OF GROSS DOMESTIC PRODUCT. THEIR COST
IS INCREASING SO DRAMATICALLY THAT IT HAS BEEN ESTIMATED THAT
OUR EXPENDITURE ON HEALTH SERVICES COULD BE MORE THAN 12% OF
GROSS DOMESTIC PRODUCT BY THE YEAR 2-000. THE RESULT OF THIS
INCREASE HAS BEEN ESPECIALLY REFLECTED IN HOSPITALS.
HIGHER CHARGES AND GROWING DEFICITS HAVE BECOME A FEATURE
OF OUR HOSPITAL SYSTEM IN RECENT YEARS.
THE AUSTRALIAN GOVERNMENT WILL IN FACT ASSUME A MUCH
GREATER ROLE IN THE MEETING OF RUNNING COSTS UNDER ITS PROPOSED
HEALTH INSURANCE PROGRAM. UNDER THE PRESENT SYSTEM IT PAYS A
SUBSIDY OF ONLY $ 2 A DAY FOR HOSPITAL PATIENTS, ALTHOUGH THERE
ARE INEVITABLY OTHER BENEFITS WHICH DERIVE FROM TAXATION
CONCESSIONS. IT IS ESTIMATED THAT IN 1974/ 75 THE AUSTRALIAN
GOVERNMENT WILL HAVE TO PAY ONLY $ 165 MILLION TOWARDS THE
OPERATING COSTS OF PUBLIC HOSPITALS. THIS COMPARES WITH AN
ESTIMATED EXPENDITURE OF $ 5410 MILLION BY STATE GOVERNMENTS AND
$ 2' 40 MILLION BY INSURED AND UNINSURED PATIENTS. 16
THE HEALTH INSURANCE PROGRAM INVOLVES A GREAT
AND CONTINUING IMPROVEMENT IN THE FINANCING OF PUBLIC
HOSPITALS, UNDER BILATERAL AGREEMENTS WITH EACH STATE,
THE AUSTRALIAN GOVERNMENT WOULD BE PREPARED TO MEET 50 PER CENT
OR,' fHE NET OPERATING COSTS OF PUBLIC HOSPITALS, THE
AUSIRALIAN GOVERNMENT PAID BENEFITS APPROACHING 50 PER CENT
OF OPERATING COSTS FROM THE INTRODUCTION OF THE HOSPITAL
BENEFIT ACT IN 1945 UNTIL THE ACT'S REPLACEMENT BY THE
LIBERAL/ COUNTRY PARTY GOVERNMENT IN 1952, HOSPITALS IN
ALL STATES WILL BENEFIT FROM THE NEW ARRANGEMENT, THE TOTAL
GAIN TO STATE GOVERNMENTS IN 1974/ 75, IF THE PROGRAM HAD
BEEN INTRODUCED IN TIME, WOULD HAVE BEEN $ 80 MILLION, IN
NEW SOUTH WALES THE GAIN WOULD HAVE BEEN $ 15 MILLION,
THE IMPROVEMENT IN THE FINANCIAL SITUATION OF
THE STATE-PUBLIC HOSPITALS SYSTEMS WILL NOT OF COURSE BE
THE ONLY BENEFIT FROM THE HEALTH INSURANCE PROGRAM, THE
PROGRAM WILL OVERCOME THE INEQUITIES AND LACK OF COVERAGE
WHICH EXIST AT PRESENT UNDER THE PRIVATE HEALTH INSURANCE
SYSTEM, FOR A START, THE PROGRAM WILL AUTOMATICALLY COVER
ALL RESIDENTS OF AUSTRALIA, IRRESPECTIVE OF THEIR MEANS OF
THEIR BACKGROUNDS, IT WILL BE FINANCED IN THE MOST EQUITABLE
MANNER AS THE PAYMENTS TO BE MET BY INDIVIDUALS* WILL BE
BASED ON THEIR CAPACITY TO PAY, THE PROPOSED LEVY OF
1,35 PER CENT ON TAXABLE INCOME WILL PROVE CHEAPER THAN THE
PRESENT HEALTH INSURANCE SCHEME FOR THE GREAT MAJORITY OF
AUSTRALIANS, 117
-7-
FOR THEIR CONTRIBUTIONS, AUSTRALIANS WILL RECEIVE
A COMPREHENSIVE RANGE OF MEDICAL AND HOSPITAL TREATMENT,
IF A DOCTOR SENDS HIS BILL DIRECT TO THE PROPOSED HEALTH
INSURANCE COMMISSION, HIS PATIENT WILL NOT HAVE TO PAY ANYTHING
FOR MEDICAL TREATMENT, EVEN IF THE DOCTOR SENDS HIS BILL
TO HIS PATIENT, THE COMMISSION WILL PAY AT LEAST 85 PER CENT
OF THE SCHEDULED FEE, AND IN NO CASE, WHERE THE SCHEDULED FEE
IS CHARGED, WOULD THE PATIENT HAVE TO PAY MORE THAN $ 5 FOR ANY
MEDICAL SERVICES, TO DISMISS IMMEDIATELY ONE PHONY ISSUE
THAT HAS BEEN RAISED BY OUR OPPONENTS, THESE ARRANGEMENTS
WILL APPLY TO SERVICES PROVIDED BY ANY DOCTOR THAT ANY PATIENT
CHOOSES TO CONSULT, FOR HOSPITAL TREATMENT, EVERYONE WILL BE
ENTITLED TO FREE STANDARD WARD TREATMENT: ADMISSION TO THESE
WARDS WILL NOT BE RESTRICTED TO PEOPLE WHO SATISFY THE
SAVAGE MEANS TESTS WHICH APPLY IN SOME STATES AT PRESENT,
THE PROGRAM WILL ACHIEVE. THIS GOAL WITHOUT DESTROYING THE
VIABILITY AND INDEPENDENCE OF RELIGIOUS, CHARITABLE AND
COMMUNITY HOSPITALS, PATIENTS IN PRIVATE WARDS OF PUBLIC
HOSPITALS OR IN PRIVATE HOSPITALS WILL ATTRACT A BED SUBSIDY
OF $ 16 PER DAY FROM THE AUSTRALIAN GOVERNMENT. A CONSIDERABLE
IMPROVEMENT ON THE $ 2 A DAY WHICH IS CURRENTLY PAID, THE
GOVERNMENT AIMS TO ENSURE THAT PRIVATE INSURANCE IS AVAILABLE
AT REASONABLE COST TO COVER ANY EXTRA CHARGES FACED BY
PRIVATE PATIENTS, 1, ,/ 8
-8-
THE FAIRNESS, THE UNIVERSAL COVERAGE AND THE
OTHER BENEFITS OF THE HEALTH INSURANCE PROGRAM HAVE
COMPELLED US TO PERSEVERE WITH ITS IMPLEMENTATION IN
THE FACE OF SOME BITTER OPPOSITION, THIS IS NOT A BLIND
DOCTRINAIRE PERSEVERANCE, THE GOVERNMENT HAS WON TWO
ELECTIONS IN WHICH THE PROGRAM HAS BEEN AN ESSENTIAL PART
OF OUR PLATFORM, IN FACT PROBABLY NO CURRENT ISSUE IN
AUSTRALIAN POLITICS HAS RECEIVED A MORE THOROUGH AIRING,
WE BELIEVE THAT, IN ELECTING US TO GOVERNMENT, THE
AUSTRALIAN PEOPLE HAVE INDICATED A DESIRE FOR THE SORT OF
CHANGE TO WHICH WE ARE COMMITTED,
THE HEALTH INSURANCE PROGRAM IS COVERED BY TWO
OF THE SIX BILLS WHICH WILL BE PUT TO A JOINT SITTING OF
BOTH HOUSES OF THE AUSTRALIAN PARLIAMENT IN THE WEEK
AFTER NE*( T. BECAUSE OF THE RENEWED SUPPORT GIVEN TO IIS
BY THE AUSTRALIAN PEOPLE ON 18 MAY, THE GOVERNMENT WILL
HAVE A MAJORITY TO ENSURE THEIR PASSAGE AT THE JOINT
SITTING, DESPITE THIS RENEWED SUPPORT, OUR OPPONENTS PERSIST
IN TRYING TO PREVENT THE PROGRAM FROM COMING INTO OPERATION#
THEIR SPOKESMEN IN THE PARLIAMENT SAY THAT THEY WILL OPPOSE
ANY COMPLEMENTARY LEGISLATION, WE ARE EQUALLY DETERMINED
NOT TO BE THWARTED YET AGAIN BY THESE PROPONENTS OF A
MORIBUND AND UNJUST SYSTEM, IT REMAINS THE GOVERNMENT'S
FIRM INTENTION TO INTRODUCE THE PROGRAM, OBSTRUCTION IN
THE SENATE MAY HAVE DELAYED ITS INTRODUCTION, BUT WILL NOT
PREVENT IT, WE EXPECT THE HEALTH INSURANCE PROGRAM TO
BECOME A REALITY IN 1975,
THE PROGRAM WILL NOT IN ITSELF OVERCOME ALL OF THE
FAILINGS OF HEALTH CARE IN AUSTRALIA., THE WORK OF THE
HOSPITALS AND HEALTH SERVICES COMMISSION MUST PLAY A MAJOR PART
IN THIS PROCESS0 I HAVE ALREADY DESCRIBED ITS ACTIVITIES IN
RELATION TO HOSPITALS. MUCH NEEDS TO BE DONE IN THE PROVISION
OF OTHER COMMUNITY HEALTH SERVICES. IT IS FOR THIS REASON
THAT IN 1973174 WE ALLOCATED $ 10 MILLION TO ASSIST THE STATES
AND ELIGIBLE ORGANISATIONS TO MEET THE CAPITAL AND OPERATING
COSTS OF REGIONAL ORGANISED COMMUNITY-BASED HEALTH SERVICES.
COMMUNITY HEALTH FACILITIES, PROVIDED AT CENTRES AND THROUGH
DOMICILIARY SERVICES, OFFER A GREAT OPPORTUNITY FOR COMBATING
THE UNEVEN DISTRIBUTION OF DOCTORS AND OTHER HEALTH WORKERS
IN OUR COMMUNITY. IN ADDITION, WE HAVE PROVIDED 7.5 MILLION
TO ASSIST THE STATES TO DEVELOP COMMUNITY-BASED MENTAL HEALTH.-
ALCOHOLISM AND DRUG DEPENDENCY SERVICES.
COMMUNITY HEALTH SERVICES WILL NOT ONLY BENEFIT
THE PUBLIC BUT WILL PROVIDE MORE EXCITING NEW POSSItlILITIES
FOR HEALTH WORKERS. ALL GOVERNMENTS ARE CURRENTLY UNDERGOING
A RETHINKING OF THEIR ATTITUDES TOWARDS THE IMPORTANCE OF
ANCILLARY MEDICAL STAFF. RECENT INCREASES GRANTED TO
NURSES IN NEW SOUTH WALES ARE ONE INDICATION OF THIS.
BUT THE RETHINKING MUST INVOLVE MORE THAN A QUESTION OF MONEY.
IT IS IN THIS CONTEXT THAT COMMUNITY HEALTH FACILITIES PROVIDE
GREAT OPPORTUNITIES, THERE IS EVERY INDICATION THAT NURSES
AND OTHER ANCILLARY STAFF WILL FORM A NEW " IFRONT LINE" I OF
MEDICINE, OPERATING FROM HEALTH CENTRES THEY WILL PLAY A
VITAL ROLE IN THE IMPROVEMENT OF HOME CARE SERVICES. AT THE
CENTRES THEMSELVES THEY WILL BE ABLE TO PERFORM MANY FUNCTIONS
AS A VALUABLE SUPPLEMENT TO THE WORK OF DOCTORS.
10
THE PROVISION OF A COMPREHENSIVE HIGH QUALITY SYSTEM
OF HEALTH CARE IN AUSTRALIA DOES NOT REPRESENT AN EASY TASK.
WE SUFFER FROM YEARS OF NEGLECT IN PLANNING AND FINANCE,
BUT THE GOVERNMENT BELIEVES THAT WITH THE TWIN WEAPONS
OF THE HEALTH INSURANCE PROGRAM AND THE HOSPITALS AND
HEALTH SERVICES COMMISSION WE CAN MEET THE NEEDS OF ALL
AUSTRALIANS.