Published: 27 August 2015

Ms  FORREST (Murchison ) - Mr President,  when I first read this bill, the second reading speech, and the letter from the acting secretary Mr Pervan regarding this bill, I was confused.  The offer was there for a briefing.  I thought, 'I am sure we are all having a briefing, so that is fine.'  I thank the officers for the briefing.

It is much easier to have a briefing and ask questions across the table than get it all from the paper.  It was not clear in my mind from the second reading speech, or from that letter, what the circumstances were and are.  I thank them for that.  It has made it clear to me. 

I have read all the documents a couple of times.  I could not figure out the sequence of events properly.  This is important because the member for Launceston talked about the unfairness.  I think the only unfairness is that some people are not paying.  That some people pay as much as they should have done is not unfair.  They were paying before, and they will pay afterwards.  The ones who are being unfair are those who are not paying.  They are not paying because we need to fix it.  It took a while to get to that point. 

Mrs Taylor - It is a lucky break for them. 

Ms FORREST - It is a lucky break for them.  The Government has committed to a period of time to - 

Mr Valentine - Mr President, there was one with - 

Ms FORREST - I will get to that.  Now I have lost my train of thought. 

Mr Valentine - Apologies. 

Ms FORREST - We were talking about - some have paid and some have not.  I will talk about the process.  This is what was helpful during the briefing.  Prior to 2007, patients who were admitted as nursing-home-type patients, and involuntary patients on a mental health order - not from the police or the doctors, but from the Mental Health Act, that is where the order comes from - under an order were paying after 35 days if they no longer required acute care. 

I asked questions during the briefing.  The Leader has provided some information.  I am sure she will read out her responses.  I am not going to go through all those.  The purpose is for her to respond to these questions.  Those patients were paying after 35 days unless they had a discharge for more than seven days, and a few other criteria, that meant they would then be readmitted as acute patients; or, if the nature of their care required them to have acute treatment again because of a deterioration in their condition or some other process like that.  That was the situation. 

In 2007 the Commonwealth, in an attempt to streamline things, which the Commonwealth could do with in their legislation at times, sought to change the way that was worked out and avoid the need for the certificate that was required to indicate that their patients required acute care.  They changed that process.  As I understand it, following that, not only in Tasmania but other states believed that the process of charging patients, not nursing-home-type patients and those patients on involuntary mental health orders, could continue after 35 days, as they had. 

In 2013 it appears that a patient - I would like to hear more from her about how this actually happened - went to the Health Complaints Commissioner in the Ombudsman's office with a complaint.  I am interested in why they went there with that complaint.  What was the thing that triggered that; was there some other complaint about their care, so that then it became apparent?  What happened?  I find it hard to imagine how a patient would say, 'I shouldn't have paid for that care,' when everyone else had.  I am interested in how that process unfolded if we know that, provided it does not identify anybody. 

When that happened, through the Health Complaints Commissioner's office, it came back to government as 'we have a problem here, Houston'.  The problem had to be rectified.  It was apparent at that time, because of the changes at the Commonwealth level, using language such as the 'as an end in itself' test, we were collecting fees that are outside the provisions of our legislation.  The government of the day, which would have been the former government, stopped charging patients.  These patients have the benefit of that process.  It seemed to take a little while to get to fix this problem.  I guess we have had a change of government, we have had a few things that have got in the way of that.  That probably explains that delay. 

Here we are now, trying to fix a problem that is retrospective in nature, yes, but it does not change anything.  When I first read it I thought we were not charging patients before, then we were charging them inappropriately, now we are not, and then we are going to.  That was not it.  We were charging them, we kept charging them, and we realised at that period it was not quite right so we have stopped charging them, luckily for those patients.  Now we are going to fix that and do it as we always intended. 

In view of that retrospective nature, I do not have issues with that.  It was not as though we were disadvantaging a group of people; we are actually advantaging a group of people.  Therein lies the difference. 

With the one person who made a claim and received $2 059.01 back, I would be interested to know more about how that actually occurred.  This will close the door for others to claim fees back.  Again, those patients, if this had been rectified or noticed at the time of the Commonwealth's changes, they would have been charged anyway.  We are not really treating them unfairly or inappropriately.  The fact that this person got the money back is their lucky break in that regard.  I would like to hear more about that. 

It took me a while to work through this process but I have, and much of it is because of the briefing we had with the opportunity to ask those questions.  I did also ask, in my questions to the Leader after the briefing yesterday, for some more information on the granting of fee waivers and exemptions.  The answer the Leader has provided in her response, which she will read out, is not really adequate.  I might need to drill down into that a little bit more. 

I will give her the heads up about what I also wanted to know about that area.  The Public Health Act 1997 provides that the secretary can waive fees and copies of these decisions can be provided.  I am happy to have copies of the decisions.  I want to know how patients are made aware.  When are they made aware that they can seek exemptions if they are suffering hardship or finding it difficult to pay?  Is it widely known?  How often is it accessed?  Some of the people we are talking about here, particularly those on involuntary mental health orders, often have limited means.  These people are very unwell and often require long term care of a non acute nature to keep them well enough.  They will probably remain in hospital but out of the acute care setting as such.  I would like more information about how patients themselves are informed of that. 

I will ask the Leader to explain more fully the Commonwealth term about nursing care 'as an end in itself'.  That wording was actually what caused the problem, as I understand it.  It created confusion and changed the capacity to collect these fees. 

Looking at our health services generally, we know what a money hungry beast our health services are.  We know that patients who are in hospital for a long time cost a lot of money too.  Should they pay after 35 days if they are receiving non-acute care?  Someone has to pay, I guess.  If there are waivers available and that sort of thing for those who cannot pay, then that seems like a reasonable thing.  Over the years I have been here I have often asked in Estimates about the collection of fees through the department of Health.  It has been fairly ad hoc and poor at times. 

If we make that provision for fees to be collected, they should be.  It should be done in a way that is fair and equitable.  When there are genuine cases for the provision of fee waivers and exemptions, that should be exercised. 

Overall, I do not have any real concerns about this, as I have explained.  I would like a bit more information about those couple of points I have raised.  It is important to have very close scrutiny of retrospective legislation to ensure what the retrospectivity achieves. 

I am satisfied that it does not disadvantage anyone.  The nature of it has advantaged a few people and that is their good luck.  Other than that, I will follow up some of these other matters in the Committee stage, and ask if the Leader could provide that information in her reply. 

[3.01 p.m.]




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