18th Parliament · 2nd Session
Mr. Speaker (Eon. J. 8. Rosevear) took the chair at 10.30 a.m., and read prayers.
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Motion (by Mr. Chifley) agreed to -
That the Bouse, at its rising, adjourn to to-morrow, at 10.30 a.m.
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– -The provision under the Social Services. Consolidation Act that no pension shall be payable to a widow who has not resided in Australia for five years gives rise to an anomaly in respect of numbers of widows of ex-servicemen who married in England, Canada and the United States of America and whose husbands have died from causes not due to war service. The widows of such exservicemen cannot qualify for a war pension and they are not eligible for the widow’s pension until they have resided in Australia for a period of five years. Will the Minister representing the Minister for Social Services see whether this anomaly can be rectified?
– I have some doubt whether the anomaly which the honorable member has referred to really exists, but I shall bring his question to the notice of the Minister for Social Services.
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Reconstruction Training Scheme
– As a preface to a question which I desire to address to the Minister for Post-war Reconstruction I point out that I have received representations from numbers of ex-servicemen’s organizations requesting that the allowance payable to trainees under the reconstruction training scheme be increased to the equivalent of the basic wage. Whilst T am aware that the Minister has replied to similar questions on previous occasions, I now ask him to have further investigations made into this matter to see whether the increase of the cost of living does not warrant the allowance paid to these trainees being increased to the equivalent of the basic wage?
– The matter raised by the honorable member has received deep consideration by the Government on many occasions. When the living allowances were first decided upon they were not related to the ‘basic wage for that was never intended, but they were related to other classes of benefits particularly those paid by the Repatriation Department to ex-service personnel. The scale of allowances payable to trainees has been reviewed on two occasions and on each occasion the rate has been increased by 5s. a week. Whilst it is true that single trainees without dependants are not paid an allowance equivalent to the basic wage, married trainees with a certain number of dependants receive an allowance which exceeds the basic wage. I also point out that quite a large number of exservicemen’s organizations have made representations to me on this matter, and I have replied to all of those communications. However, the congress of the Returned Sailors, Soldiers and Airmen’s Imperial League of Australia held recently in Brisbane removed a proposal from its agenda which suggested that this matter should be dealt with along the lines advocated by the honorable member. Therefore, the request is not supported by the federal council of the league.
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– Will the Minister for Immigration inform the House whether an officer of the Department of Immigration has been appointed as the representative of the Australian Government in Shanghai, and, if so, in what capacity? Will that officer he directly under the control of the Australian Ambassador to China, Mr. K P. Officer, or will he still remain under the control of the Minister 1
– The Commonwealth Immigration Officer in Melbourne, Mr. F. R. Penhalluriack went to Japan with the Australian Mission and acted as advisor to the honorable member for Parkes when, at my request, that honorable member went to Shanghai to investigate the situation in that city. Mr. Penhalluriack returned to Australia, but, as the situation in China was deteriorating rapidly, I sent him back again to China. By arrangement with the Minister acting for the Minister for External Affairs, he was given the rank of consul and is consul for Australia in Shanghai. For some time past Mr. Fuhrmann had been the Consul-General for Australia in Shanghai. He has now left Shanghai to act as Consul-General at
Nanking, and Mr. Penhalluriack has taken his place at Shanghai. Mr. Penhalluriack, although an officer of my department, is under the control of the Australian Ambassador to China, Mr. Keith Officer. When such officers are abroad they are for administrative purposes, under the general control of the head of the Australian Mission in the country in which they are serving, but for matters connected with the carrying out of policy, they are under the direction of the Minister in Australia.
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Promotions
– My question relates to Australian Imperial Force personnel who were promoted while in Japanese prisoner of war camps, and to the statement by the Minister for the Army recently that such promotions would not now be recognized. Is .the Minister aware that during the three and a half years of incarceration in Japanese prisoner of war camps, members of the Australian Imperial Force who were promoted to non-commissioned rank received numerous bashings by the Japanese, and that those non-commissioned officers performed vitally important work relating to the administration of the Australian Imperial Force in the prisoner of war camps? Is it a fact that promotions tocommissioned rank and the further promotion of commissioned officers in the same circumstances have been confirmed ‘< Will the Minister give further consideration to this matter, which concerns n number of worthy ex-servicemen?
– From my written communication to the honorable member on this subject, he should realize that every consideration has been given to the matter. The decision was not hurriedly made. Although, as the honorable members knows, some promotions were made under certain conditions, I do not feel that any further consideration can be given to this matter. Effect was given to recommendations for promotions that were made prior to thosemembers of the Australian Imperial Force concerned becoming prisoners of war. If it could be proved that they -were recommended for commissioned rank they received -their commissions, and I do not feel that any further consideration would achieve any different results.
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– Will the Prime Minister inquire whether insistence on a university degree as a requisite for government employment has not become a fetish? I am not in any way questioning the specialist qualifications required for specialist appointments such as those which are obviously required for the appointment of for instance, a doctor, an engineer or a lawyer - if a lawyer can be said to be necessary at all - but is there not a growing tendency, as appears from advertisements calling foi applications for such a position as a head cook or bottlewasher which, after listing the other qualifications required, throw in for good measure the proviso that applicants should possess a university degree in arts or commerce? If that is so, I ask the Prime Minister to inquire whether this system, by being carried to extremes, is debarring the Commonwealth from obtaining the services of many practical and intelligent men and women whose parents were unable to afford a university course for them, and that it may mean that some branches of the Commonwealth Public Service can become a haven for graduate goats unable to fit in elsewhere ?
– I cannot say that 1 have seen any advertisements for bottlewashers stipulating that they must have a university degree. It is quite natural that the Public Service Board, in making a selection from a number of candidates for an appointment, pays some regard to the scholastic qualifications of each candidate. It is not of much use te give higher education to great masses of people if after that has been done there is argument by certain people against university graduates, who are referred to as “ long-haired professors “ and the like. I do not speak from a personal point of view in this matter, as I did not have the privilege of a university education. I can understand the honorable member’s submission that many excellent young men and “women can he lost between the intermediate and the leaving certificate stages in New South Wales because of the inability of their parents to keep them at school and allow them to go on to receive a university education. That is a matter to which the Government has given a great deal of consideration. The Government provides a subsidy to give university training to those who have qualified for it, but whose parents were unable to afford the ‘expense. I suggested to the Premiers of the States that a subsidy should be provided for boys or girls who had gained their intermediate certificate and whose parents were not financially able to allow them to go on to the leaving certificate stage. The Minister for Post-war Reconstruction and I were prepared to recommend to the Government that it provide a subsidy, in conjunction with the States, to enable such youths to have a university training. The question raised by the honorable member is one that can easily give rise to a feeling that the less fortunate boys and girls in the community, whose parents are unable to afford a university training for them, might be debarred from public service employment despite their latent ability. That is a very debatable point, and I cannot bring myself to believe that in the selection of individuals for appointments scholastic qualifications should not be given some weight. However, as the honorable member has raised the point, I shall discuss it with the Chairman of the Public Service Board.
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Loss of Am craft “ Lutana “ : REPORT of Ant COURT of Inquiry - Service to Smithton.
– As the Minister for Civil Aviation has now returned from New Zealand, I ask the Prime Minister to say definitely whether there will, or will not, be a debate during the present session upon the loss of the airliner Lutana, and, if not, why not ?
– I mentioned this matter recently. The Minister for Civil Aviation has been attending an important conference in New Zealand. The session is, I hope, drawing to a close, although if any honorable member is anxious to continue it and to make Christmas a movable feast, I am quite agreeable. I understand, from the Acting Leader of the Opposition, that there would probably be a number of speakers from the Opposition side on this particular subject, and I would not wish a debate, once started, to be half finished when the session concludes. I also do not want it to be thought that the Government is running away from anything. We do not do any running away; we keep running straight ahead. My feeling is all against entering now upon a discussion that might go on for some time. In such circumstances the Minister for Civil Aviation could be deprived of the opportunity of replying in full to all speeches on the subject. It is not our intention to provide time, at present, for such a debate. Honorable gentlemen will be back here early in the new year and they will be given a full opportunity then to debate the matter. I am prepared to make it the first item on the noticepaper.
– Can the Minister for Civil Aviation say whether an application was made recently for permission to operate an aerial service to Smith ton, Tasmania? Is it a fact that although certain aerodromes do not conform to the standard set by the Department of Civil Aviation, they are licensed for use by certain aircraft? If so, can the Minister say whether Smithton conforms to the lower standard required for the issue of such a permit?
– Unless application was made during my absence in New Zealand, where I attended the South Pacific Air Transport Council, no such application has been made recently. Concerning the second part of the honorable member’s question, whether aerodromes which do not comply with International Civil Aviation Organization standards are permitted to be used by the department, I point out that the size of the runway at Smithton will permit Anson aircraft, but not Douglas aircraft to use the aerodrome. In any event, another aerodrome exists at Wynyard, which is only about 40 miles distant. Both towns are anxious to have airports established, but I have adopted the attitude, and I believe it to be correct, that we cannot afford to have two airports operating, at considerable expense and employing large numbers of staff, within 40 miles of each other. I have informed the honorable member on a previous occasion, and also other honorable members from Tasmania who have raised the matter, that the possibility of another full standard aerodrome being established at Smithton is remote. It is not the policy of the Department of Civil Aviation to provide an aerodrome close to another one. If a service to Smithton is desired, either the State Government or the municipality must undertake whatever work is required to be done to bring the aerodrome to the standard required.
– Would an application for a passenger service be considered under present conditions?
– I should not like to express an opinion upon that matter until I have seen the application.
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– In view of the fact that an industry that I was instrumental in having retained for South Australia is short of plate steel, I ask the Minister representing the Minister for Shipping and Fuel whether the Australian Government has any control over coastal shipping? Is steel at Port Kembla ready to be shipped to South Australia ? If so, can the Minister take some action to have it delivered ? Is there any priority in the handling of plate steel? If so, will the Minister make the priority list known to me?
– May I first congratulate the honorable member for Boothby on retaking his seat in the House ? The Australian Government does not control coastal shipping.
– It controls a great deal of shipping on the coast.
– Order ! The Minister can reply without the honorable member’s assistance.
– Not accurately.
– Order ! The Chair will decide that.
– I take exception to that remark.
– I ask the honorable member for Corangamite to apologize and withdraw that remark. After all, parliamentary courtesy requires that honorable members shall be allowed to state their views without criticism of that kind.
– I withdraw.
– The Australian Government does not control coastal shipping; it owns, and has under charter, a considerable tonnage of coastal shipping. In collaboration with private owners and through the medium of joint traffic committees that have been set up in conjunction with private owners, the Government seeks to formulate a programme for the movement of coastal shipping generally. The most important materials to which the joiut traffic committees give consideration are the basic materials like coal, sugar, iron ore and steel products. The cargo space is allocated to the various States after close consultation with the representatives of the State governments concerned. There is approximately 17,000 tons of steel casting awaiting shipment at Port Kembla. Of that quantity 11,000 tons is awaiting shipment to Melbourne and Adelaide. It is proposed that half shall go to Melbourne and half to Adelaide. There is a vessel loading at present that will take 7,000 tons of that 11,000 tons and the residue left at Port Kembla will only be about 4,000 tons. There is no actual priority in the handling of steel plate. As far as the shipping interests are concerned allocations for various vessels are made by the Broken Hill Proprietary Company Limited in collaboration with the Department of Supply and Development. Those allocations are made having regard to the needs of the respective States.
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– I ask the Minister representing the Minister for Health whether free medicine is available to patients in public and intermediate wards at hospitals in New South Wales under the Australian Government’s pharma.ceutical benefits scheme? Is it a fact that in some hospitals in New South Wales certain doctors are prepared to prescribe free medicine to patients but the hospitals refuse to co-operate in the scheme? If this is so, will the Minister take appropriate action to relieve the financial hardship imposed on the community by such action ?
– Free medicine is available to patients in hospitals and te other sick people in the community and would be provided if doctors would cooperate with the Government in the freemedicine scheme. The Government desires to provide free medicine for the people. The law of the land provides that they are entitled to the benefit; but because of the unco-operative attitude adopted by the British Medical Association it is not being provided. In his efforts to ensure that the people shall obtain the benefit to which they are entitled, the Minister for Health is still negotiating with the association and is hopeful of securing its co-operation in the near future.
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WAR Neuroses - Reports of Tribunals.
– Has the Minister for Repatriation seen a statement by the federal president of the Air Force Association in to-day’s issue of Smith’s Weekly that some members of that association suffering from war neurosis have had to be admitted to Callan Park Mental Hospital because there was nowhere else for them to go? Will the honorable gentleman institute immediate inquiries into these cases with a view to remedying the position? Will he also inform the House what progress has been made with the survey of State mental institutions to ascertain the number cf ex-servicemen in such places?
– I have not seen the article to which the honorable member has referred. If I had seen the article, it does not necessarily follow that I would accept it as an accurate report of anything that has happened in relation to the Repatriation Department. Only last night I received a copy of a letter from ex-servicemen’s organization contradicting an article which had appeared in Smith’s Weekly which that, newspaper had refused to publish. I have received a progress report on the survey of mental institutions throughout Australia hut I shall not be in a position to make a statement on the subject until the survey has been completed. I accept with a good deal of mental reservation the allegation that war neurosis cases have been sent to Callan Park Mental Hospital.
– Will the Minister for Repatriation give an assurance to the House that in future reports forwarded te him by the War Pensions Entitlement Appeal Tribunal will be presented to the Parliament in the form in which they are presented to him? Will he give an assurance that he will discontinue the use of duress in order to have such reports altered so as to express his opinions instead of the opinions of the tribunal ?
– The reports that are presented to me by tribunals are presented to the House in the form in which theycome to me. No duress is applied to the tribunals. No duress has ever ‘been applied to them. The suggestion made by the Acting Leader of the Opposition is simply a continuation of his campaign of misrepresentation with the object cf scoring some political advantage by climbing on the hacks of ex-servicemen.
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– In view cf the urgent necessity for the extension of technical and scientific training in order to meet rapid developments within Australia will the Prime Minister have inquiries made to ascertain whether the percentage of failures at annual university examinations is unusually high, and whether that is due to the standard of instruction or to a deliberate policy on the part of the universities to restrict the number of persons who may qualify? Following such inquiries, will the right honorable gentleman consider the possibility of the Australian Government taking a more active interest in the operation of universities and providing funds to ensure adequate tuition facilities to meet our national needs ?
– Many statements have been made about the failure of many university students to pass their qualify ing examinations. One such report related to medical students. It was suggested that the universities had unjustly rejected a number of students who sat for examinations. I asked Professor Mills, who is in charge of Commonwealth Office of Education, to find out for me what had happened at the University of Sydney last year. Although it is true that the number of rejections of candidates at the first examination at the end of the year was fairly substantial, many of those candidates had the opportunity to sit for later supplementary examinations. An inspection of the final results showed that the percentage of candidates who .passed was fairly high. I have the precise figures in my office, and I shall supply them to the honorable member later. It is natural for examiners to be a little more exacting than usual when there is a large number of candidates. It is a human failing to be more selective when there is a surplus of material. The figures that have been shown to me do not indicate that the percentage of rejections, taking into account the results cf post examinations, is any higher than it was formerly. The second portion of the honorable member’s question related to Commonwealth assistance to universities. The honorable gentleman knows that the Government makes available £.100,000 a year for the assistance of universities in connexion with certain classes of work. I have received deputations from the Senate of the University of Sydney, including its Vice-Chancellor, and I understand that the ViceChancellor of the University of Melbourne also has an appointment with me for this week. Representations have also been made to the Minister for Postwar Reconstruction, whose department deals with education in the Commonwealth sphere, and he has given a great deal of thought to the subject. I said in reply to a question in this House recently that I believed that, within the next couple of years, when Commonwealth assistance under the reconstruction training scheme ended, universities would probably find themselves in very difficult financial circumstances. Apparently I looked too far ahead because, on the following day, I received a deputation from the University of Sydney at which [ was told that that university _ was already heavily in the “ red “ financially. The Commonwealth has no jurisdiction over education or over State universities, but the Government realizes that there are serious shortages of engineers, certain classes of scientific research workers, veterinary surgeons, doctors and dentists. It considers that, if it provides large sums of money to assist educational work in the States, it should at least have some right to decide hew that money shall be expended. However, [ believe that some of the States would object to any Commonwealth interference in the administration of their educational systems. The most that I can say to the honorable member at the moment is that the Government intends to arrange for departmental officers to make a complete examination of the affairs of universities so that it may have accurate facts to guide it instead of mere statements that may be made from time to time.
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– I wish to ask a question of the Minister representing the Minister for Supply and Development. En north-western Tasmania, dairyfarmers are under contract to supply milk to a very large factory which is engaged in the manufacture of milk products. Farmers have only until February to install watercooling facilities, for which they need lj-in. galvanized iron piping, which is at present unobtainable in Tasmania. Will the Minister expedite shipments of such piping to Tasmania? Can he say whether the production of galvanized piping is back to the pre-war level ?
– I realize the need for getting as much piping as possible to dairy-farmers in Tasmania, and to those engaged in primary production generally. The production of piping is not yet up to the pre-war level because of the shortage of coal and of labour in the steel industry. I shall consult with the Minister for Supply and Development, and try to arrange for the carriage to Tasmania as soon as possible of as much piping as Tasmania is entitled to. The Premiers have agreed among themselves
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upon an allocation of available piping between the States, but distribution within a State is the responsibility of the State government concerned.
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– Has the Minister for Immigration seen in a Sydney newspaper a statement attributed to an Italian who is resident in Sydney, and allegedly made at a reception to the Italian Opera Company? According to the report, this Italian attacked Australia and democracy in general, and drew a most unfavorable comparison between Australia under its present administration and Italy under the Fascists. Can the Minister say whether the report is correct? Has an investigation been made of the matter? Is the person naturalized, and, if not, what are the terms of his residence in Australia? If he so much prefers Italy to Australia, will the Minister have him returned to his native land without delay ?
– The honorable member asked me for the facts, and then on the strength of a newspaper report, proceeded to tell me what to do with the person concerned. I was in Sydney over the week-end, and when I saw the newspaper report of the incident referred to. I had an immediate investigation made. I discussed the matter with people who were at the reception, and they are not Italian nationals, nor were they born in Italy, although they speak the Italian language. They heard the address, and told me that the man was a little political in what he said, but not very much so. The day afterwards, a pressman came along and asked certain people what had been said, and then proceeded to write a story at variance with the facts.
– At variance with what the Minister was told?
– At variance with what people who heard the address told me. The newspaper story was written the day after the address was given, and by a man who did not hear the address, but who had been given an account of it by others. I have been told that the newspaper story was greatly exaggerated. If the story were true, the person concerned would be sent out of Australia.
We want no one here praising Mussolini’s methods, or extolling the virtues of fac.cism. My experience of Italians for a considerable time now is that there is not one among them who believes that fascism or any form of totalitarianism is good for any country, and certainly not for Italy. 1 believe that the vast majority of Australians are satisfied with our democratic system. If any one who was present at the reception can supply me with authoritative evidence that the person referred to made the statements attributed to him, action will be taken; but, from what I have been told by people who heard the address, and who I believe are perfectly honest, I am convinced that the newspaper report of the incident, like many other newspaper reports, was greatly exaggerated.
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– I recently asked a question concerning the hardship suffered by unemployed seamen, many of whom are deprived of unemployed benefits because they cannot attend at the Commonwealth Employment Service office every week and also be in attendance each day at the seamen’s bureau to seek employment on a vessel- I received a reply from the Minister for Social Services to the effect that unemployed seamen are not greatly inconvenienced by having to report once a week to the office of the Commonwealth Employment Service. The Minister has obviously missed my point, and I now ask the Minister representing the Minister for Social Services whether he will request his colleague to direct the officials of the Commonwealth Employment Service that when they have established beyond doubt that an applicant for unemployment benefit is a -bona fide seamen, he be not sent to seek another job while he is awaiting engagement on a ship?
– I shall certainly ask the Minister for Social Services to review the matter in the light of the question asked by the honorable member. Considerable difficulty often arises in cases of the kind mentioned by the honorable member. Men who are unemployed are entitled to payment of unemployment benefit while they are seeking work. At the same time the Commonwealth Employment Service endeavours to obtain employment for them which approximates to their avocation as closely as possible, and if work of the exact type requested by an unemployed applicant cannot be obtained, he must be prepared to accept work of a similar character in order to be entitled to payment of unemployment benefit. If a seaman is unemployed for months on end and he is not pressing to go to sea he is not entitled to unemployment relief if he refuses to accept suitable work on shore. I have asked officials of the Department of Social Services to endeavour to overcome the difficulty experienced by an unemployed seaman who has to attend the picking-up places for seamen each day and is also required under the present social service regulations to report to the Commonwealth Employment Service every week. Under the regulations a person must be unemployed for at least seven days before he becomes entitled to payment of unemployment benefits. I point out to the honorable member that there are, undoubtedly, seamen who do not go to sea. Such men must accept work on shore.
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– I have received a letter from the Plympton sub-branch of the Returned Sailors, Soldiers and Airmen’s Imperial League of Australia regarding the post office at Plympton. It is claimed that the building is constructed with a galvanized iron encasement, that it is 15 feet wide and 30 feet long, that it has no windows in it, that a staff of thirteen is employed, and that no lavatory accommodation is provided in the building. Will the Minister representing the Postmaster-General request that inquiries be made to ascertain the conditions under which the staff of this post office is working, so that, if necessary, action may be taken to improve them ?
– I shall bring the honorable gentleman’s observations to the notice of the Postmaster-General and ask him to furnish a reply at the earliest possible moment.
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Call from the Chair.
– My question is addressed to you, Mr. Speaker. For the first 40 minutes of the proceedings of this House last Friday, on every occasion when an honorable member resumed his seat I rose in my place in an endeavour to obtain the call to ask a question but without success. I followed the same procedure yesterday, but was again not successful in obtaining the call. I have continued to rise to-day for almost 40 minutes, again without success. I have always understood that honorable members are called in rotation, especially as the first 35 minutes of question time are rebroadcast. I ask you, Mr. Speaker, whether you have adopted a new system since your return from the United Kingdom? If so, what is the system which you now follow?
– I am, as a rule, as unchanging as the sea. The policy that I adopt during question time has been to call the Leader or the Deputy Leader of the Opposition first, and then to call the members on the Government side of the House and members on the Opposition side alternately. It has been my custom to share the calls that are available to the Opposition between members of the Australian Country party and the Liberal party. I keep a list of the honorable gentlemen who have been called each day so that no one will be unduly favoured by rising repeatedly. It is clear that on recent sitting days the honorable member for Parramatta has not been called during the first 35 minutes of question time, but I point out that yesterday only seven members of the Opposition were called before that period expired and that has been t.he case also to-day.
– Some members on this side of the House received the call twice.
– In my opinion, the honorable gentleman is wrong in saying that. I keep a very careful list so that I may give consideration to those honorable members who were not called on the previous day. I cannot do more than that. Only seven members of the Opposition received the call during the first 35 minutes of question time yesterday andto-day. That accounts for only onehalf of the members on the Opposition side of the House. Those who missed the call yesterday and to-day will probably be more fortunate to-morrow and Friday.
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– I move -
That the bill be now read a second time.
This is a minor measure, and I hope that the Acting Leader of the Opposition (Mr. Harrison) will permit its passage without delay. I am certain that there will not be any opposition to the matter contained in it. Its object is to make an amendment of the Acts Interpretation Act which has become necessary because many public and private offices are now closed on Saturday mornings. Sub-section 2 of section 36 of that act provides that when the last day allowed for the doing of any act in the law falls on a Sunday or on a holiday, that act may be done on the first day following which is not a Sunday or holiday. In view of the closing of Commonwealth offices, solicitors’ offices and other offices on Saturday, it is desirable, in order to prevent public inconvenience, that this provision should be amended to provide that when the last day for doing any such act falls on a Saturday, it may be done on the next business day, which is not a Sunday or a. holiday. The proposed amendment is supported by the Law Council of Australia, and there is no doubt that it will be advantageous to the business community and to the general public.
Question resolved in the affirmative.
Bill read a second time, and reported from committee without amendment or debate; report adopted.
Bill - by leave - read a third time.
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Second Beading.
– I move -
That the bill be now read a second time.
The object of this bill is to authorize the execution of an agreement with any State to amend the Commonwealth and States Hospital Benefits Agreement. By the original agreements between the Commonwealth and the States under the Hospital Benefits Act 1945-47, each State undertook to provide free treatment to qualified persons in public wards in public hospitals in return for the Commonwealth paying by a flat rate what was previously collected by way of fees from those patients. This flat rate was available to the State for maintenance expenditure on public hospitals. The Commonwealth paid the benefit rate of 6s. a day in respect of those patients, and as this benefit rate was greater than the flat rate, there was a balance which the States were obliged to place in trust accounts for capital expenditure on public hospitals. Each State was also entitled to recoup out of this balance the amount of any decline in charitable donations from an agreed base figure. A deduction of the benefit rate of 6s. a day was made from the hospital accounts of patients in non-public wards of public hospitals.
At the conference of Commonwealth and State Ministers in August of this year, the Prime Minister proposed that the benefit rate for public and non-public wards should be increased from 6s. a day to 8s. a day, and that in respect of public wards the full amount of the benefit rate should be available to the States for expenditure on hospital maintenance. It was proposed also that the Commonwealth’s undertaking to recoup to the States the amount of any decline in charitable donations be terminated. At the conference, the Premiers agreed to recommend approval of these proposals to their governments. Notification of agreement has since been received from the majority of States. The proposals for public wards will operate as from the 1st July, 1948. For non-public wards the increased rate commenced on the 1st November, 1948.
These proposals will make available to the States for hospital maintenance the balance of about £420,000 per annum hitherto placed in the Trust accounts for capital expenditure on public hospitals. The increase of the benefit rate for public wards of 2s. a day will provide roughly an additional £865,000 in a full year foi hospital maintenance. That is, the States will have available an additional £1,285,000 per annum for hospital maintenance. The amounts which have accumulated in the trust accounts for capital expenditure under the original agreements will be retained and used for this purpose.
In addition to providing for the m crease of the rate of the hospital benefit for public wards and non-public wards in public hospitals, the amending agreements will clarify some of the definitions in the principal agreements and thus facilitate the administration of the scheme. Before an agreement made in accordance with the Second Schedule may become effective, it will require authorization or approval by the Parliament of the State concerned. Where a State’s maintenance expenditure on a public ward in a hospital or part of a hospital is the subject of an agreement under the Tuberculosis Act 1948, the payment of hospital benefits will not be necessary in respect of daily occupied beds in that ward. Accordingly, the definition cf “ public hospital “ is being amended to exclude any such ward from the provisions of th, agreement.
A new clause will be added to each agreement defining more clearly the persons excluded from being “ qualified persons” for the purposes of the agreement. For example, in a workers’ compensation case or a motor vehicle accident case where the whole of a person’s hospital fees are payable by the Commonwealth or under a law in force in the State, he would net be a qualified person. This clause provides also the method of ascertaining the number of days during which a person shall be a qualified person when a portion of his hospital fees are payable for example by the Commonwealth or under a law in force in the State.
In cases where for the time being it cannot be satisfactorily determined whether a person is or was a qualified person, the Minister of State for Health or an officer authorized by him may give a direction in writing that the person shall not be treated as being or as having been, during a specified period, a qualified person. That direction may be revoked by the Minister or an officer authorized by him, and thereupon the question whether the person concerned is, or was during any period, a qualified personshall be determined as if the direction so revoked had not been given. Any necessary adjustment in payments by the Commonwealth and in respect of hospital fees shall then be made. This provision will relate to cases such as workers’ compensation and motor vehicle accident cases which are the subject of legal proceedings.
The amending agreement will authorize the Treasurer of the Commonwealth to enter into arrangements with the Treasurer of a State to provide for hospital benefits to be made available to any inhabitants of another part of His Majesty’s dominions or of any foreign country, should the Government of the Commonwealth enter into an agreement with the government of that part of His Majesty’s dominions or with the government of that foreign country, providing for reciprocity in matters relating to hospital benefits. Before concluding an agreement with another country for reciprocity, the States will be consulted so far as the proposals for reciprocity affect their hospitals. The bill provides that the regulations may authorize the execution of amending agreements, which must deal only with the provision of hospital benefits. If an agreement is executed before the time at which the regulation authorizing its execution ceases to be subject to the possibility of disallowance by Parliament it must contain a provision that its operation will terminate upon the disallowance of the regulation. It is estimated that the annual cost of the increase in payments to the States for public wards will be £865,000 and for patients in non-public wards £202,000 a total of £1,067,000. The estimated total cost for the current financial year is £1,000,000.
Although this bill relates only to public hospitals, it is appropriate to mention what is being done in respect of private hospitals. By an amendment of the Hospital Benefits (Private Hospitals) Regulations, the Commonwealth hospital benefit for private hospitals has been increased to 8s. a day from the 1st November, 1948. The Hospital Benefits (Temporary Absence from Australia) Regulations also have been amended to increase the Commonwealth hospital benefit for persons temporarily absent from Australia to 8s. Australian a day from the same date. The cost of these increases is estimated at £336,000 per annum and the cost for the current financial year at £224,000.
Debate (on motion by Mr. Harrison) adjourned.
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Debate resumed from the 2nd December (vide page 3935), on motionby Mr. Hollow ay -
That the bill be now read a second time.
.- The Minister for Labour and National Service (Mr. Holloway) in his secondreading speech gave a rather extraordinary dissertation upon the actions that had been taken by the Government in respect of national health. His speech was quite a publicity sheet. He went into some detail to show just what the Government has achieved and then, as an afterthought, he dealt with the measure itself. He described the bill as “ an enabling measure, in which may be seen only the broad outline of a proposed national service “. I believe that I shall convince honorable members that it is something more than a broad outline. Indeed, it is somewhat specific with regard to certain matters. When introducing the bill in the Senate, the Minister for Health (Senator McKenna) gave expression to a number of commendable principles which, incidentally, are sharedby all political parties in Australia and are set out particularly in the platform of the Liberal party. He said that the Government had taken action in respect of the following matters : -
In co-operation with the States, the extension of medical research, the raising of hospital standards, the increasing of hospital accommodation. A nation-wide attack upon such problems as those of tuberculosis, cancer and tropical diseases, and the encouragement of the campaign for national fitness. . . .
The widest possible provision of medical facilities within the reach of all citizens. . . .
Establishment throughout the Commonwealth in conjunction with the States of modern and efficient area diagnostic clinic” to ensure the early diagnosis and treatment of disease.
Provision of complete area maternity services throughout the Commonwealth.
All those matters are provided for in the Liberal party’s platform and seem to. embody principles which are espoused by all political parties. I mention that fact in order to point out that the Government has no pre-emptive right to credit in respect of the matters set out in the general publicity in which the Minister for Labour and National Service indulged before dealing with the bill itself. I shall put those matters in their true perspective. The Government has no preemptive right in this respect, because in the main all those matters were recommended by the Social Security Committee.
– Hear, hear!
– The Minister for Repatriation (Mr. Barnard) was a member of that committee ; but the honorable member for Flinders (Mr. Ryan) and other members of the Opposition were also very distinguished members of it. All the flap-doodle spoken hy the Minister was designed to create a party political atmosphere on this measure. He did not even have the courtesy when he was eulogizing the Government to point out that that committee was set up by the Menzies Government in 1941 and did excellent work. The Minister also said -
The work of the Joint Parliamentary Committee on Social Security, which continued its investigations from 1941 to 1945, was followed with close interest by the Government, and I may point out that in the formulation of health proposals under this bill particular regard has been paid to the report and recommendations of that committee.
– I did not overlook the committee.
– But the Minister’s statement is not quite correct. At best it is belated recognition of that committee, because we remember that Senator Fraser, when he was Minister for Health, by-passed the committee completely and commenced direct negotiations with the British Medical Association and the Royal Australasian College of Surgeons with the obvious object of giving effect to the Labour party’s policy of nationalization of medical services. By that action he sabotaged the good work done by that committee; and the Minister for Labour and National Service is now taking credit for even mentioning the committee in his speech.
– Most of the committee’s recommendations are already law.
– I shall have something to say on that point. The Minister is getting deeper into the mire. It is interesting to note the re-action of the committee to the arbitrary action taken by Senator Fraser when he was Minister for Health; and my remarks on this point will curtail the Minister’s enthusiasm in interjecting. The committee in its eighth interim report, dated the 27th June, 1945, made the following statement which was subscribed to by the present Minister for Repatriation, the honorable member for Parkes (Mr. Haylen), the honorable member for Martin (Mr. Daly) and Senator Tangney, all of whom are Government supporters : -
The Joint Committee desires to state that it cannot but regard the action of the Minister in calling the conference as being otherwise than discourteous to the committee and unfortunate in its results.
– That has nothing to do with the bill.
– I ask the honorable member to confine his remarks to the question before the Chair.
– I am referring to the remarks made by the Minister in his second-reading speech on the Social Security Committee, and I propose to point out that they are not correct.
– The measure does not deal with free medicine,
– The measure embodies a national health scheme and the Minister claimed that it gives effect to the recommendations made by the Social Security Committee.
– The measure deals with specific proposals, and I ask the honorable member to confine his remarks to those proposals.
– I wish merely to answer the statements made by the Minister in his second reading speech. The Social Security Committee in its report further stated -
The action of the Minister in convening the conference . . . was taken without prior consultation with the Committee and, indeed, without even informing it of what was taking place. The action has side-tracked the work of the Committee and it is now evident that no useful purpose can be served by further investigation by the Committee while the matter is being handled by the Government directly with the medical profession.
The following recommendations of the committee, in its eighth report,- appear to have received scant consideration by the Government -
– The honorable gentleman should confine his remarks to the bill now being debated.
– I submit that my observations are directly connected with the provisions of the bill. If I say that in my opinion these are the matters which should be contained in the measure, rather than the present provisions of the bill, surely I am within my rights.
– The matter of free medicine has been dealt with in another bill. It is not dealt with in the measure before the House, which deals with general medical or dental practitioner services, nursing services, and other related matters. The honorable gentleman should confine his remarks to these matters.
– With great respect, [ am dealing only with matters contained in the bill before the House. The second recommendation of the committee was -
That is contained within the bill, because the Government proposes to take over certain hospitals. Another recommendation was -
That is contained within the bill, because the Government is endeavouring to bring about goodwill. The Government has failed to implement the recommendations of the joint committee. The committee stated that Senator Fraser’s action was discourteous to the committee, and had had unfortunate results. It is necessary for me to make passing reference to these matters because of the observations that were made by the Minister in his second-reading speech. The negotiations that were started by Senator Fraser and continued by Senator McKenna have been directed toward,s the control of the medical profession by the Minister, through a government department. An analysis of the provisions of this bill, will show the wisdom of remarks that were made by the Leader of the Opposition (Mr. Menzies) in 1946, when, during the debate on the referendum bill, relating to medical and dental services, he moved an amendment to insert the qualification, “ but not so as to authorize any form of civil conscription “. Honorable members will see that although the introduction of legislation in respect of health was approved by the people at the referendum, the Government, by divers and nefarious means, now seeks in this measure to nationalize medical services. The powers contained in the measure are very wide, and administrative direction will follow by way of regulation. “Clause 4 reads -
The Director-General shall have the general administration of this Act but the exercise of any power or function by the Director-General under this Act shall be subject to any directions of the Minister.
Although the Director-General will be responsible for the general administration of this measure, I point out that the Minister will exercise final administrative direction, and will thereby be enabled at all times to implement Government policy. I should like honorable members to read clause 4 in conjunction with clause 22, which relates to regulations that may be prescribed. Paragraph b of clause 22 provides that regulations may be made - for providing for the payment of compensation to a medical practitioner or dentist who -
The Government proposes to take certain action with relation to instrumentalities, or to establish group practices, closely adjacent to present practices of medical practitioners. It is thought that the doctors themselves, because of the diminution of their practices, will then either apply to come under the scheme, or move to some other area to continue their practices. Of course, the Government will compensate them for such diminution of their practices. In other words, economic pressure is to be applied to the medical profession. The Government proposes to nationalize the medical profession and health services by economic methods rather than by direct legislative methods. It will thus achieve indirectly what it could not achieve by its constitutional powers. Those who oppose the nationalization of the medical profession and the provision of health services must be concerned with the Minister’s intention. I should like to know how the Minister intends to use the wide powers that he will enjoy under this measure.We know, of course, that he has already committed himself to the socialization of many matters in accordance with the policy of the Australian Labour party. A further important and significant aspect is the manner in which caucus may instruct the Minister to use his powers. Conceivably, caucus may, in effect, say to the Minister, “ Your powers are very wide. We want you to do such and such “. In this connexion clause 1 6 provides -
The Minister may establish such advisory committees as he thinks fit for the purposes of this Act.
And clause 12 provides -
The Minister may establish a committee to manage, on behalf of the Commonwealth, but subject to any directions of the DirectorGeneral, the whole or any part of any medical service, dental service, hospital, laboratory health centre or clinic taken over by the Commonwealth under either of the last two preceding sections.
The organizations vitally concerned will not enjoy any right relating to the nomination of the members of such committees, and will have no right to make even recommendations with regard to the establishment of advisory committees. The Minister will have complete power. The medical profession will be absolutely ignored. It violates all the principles of the establishmentof committees in which the professions usually have a right to nominate members or to make recommendations. But in this instance the medical profession has no power or right to decide who will sit on these advisory committees or make recommendations to the Minister. All this means that the proposal of the Government, as contained in this clause, subjects the medical profession to the control of the Department of Health which is under political direction. Let us consider clause 6, which deals with the payment of fees. It give? power, by way of regulations that can be made under the act, to provide for the Commonwealth to make payment, on behalf of persons who have received services from medical practioners who are participants in the scheme “of a prescribed proportion of the fees prescribed in respectof those services “. “ Payment on behalf of persons “ presumably means payment by the Commonwealth to the practitioner rendering the services. “ Prescribed proportion “ could mean any part, or all of the fees, and “ fees “ could mean that the Government will provide a scale of fees or in some other way limit its liability to pay a proportion of the payment. All those considerations are inherent in this clause. Clauses 7, 13. 15 and 22 give wide powers for arranging for the provision of services, performance by personsof any services, the listing of specialists, and the making of any regulations. The Government proposes to pay 50 per cent. of the fees charged by the doctor for services to the patient, and to pay this amount en behalf of the patients direct to the doctor in accordance with a prescribed schedule of fees chargeable by the doctors who participate in the scheme. That is clear, and leaves no doubt in the minds of the people concerning just what the Government is aiming at. What are the objections to the presentation of claims by doctors on behalf of their patients? I think we should examine this point, because it seems to me that if the Government can destroy the close contact between patient and doctor and intrude some government instrumentality between them, then it has achieved, to a large degree, what it has set out to achieve by this bill - the first long step towards the nationalization of medical services. The first and most important point is that doctors are required te enter into what is, in effect, a contractual relationship with the Government, in which all kinds of conditions may bc prescribed.
– Was not a similar arrangement intended under Mr. R. G. Casey’s measure?
– No, that was entirely different. Under that scheme the relationship between the patient and the doctor was not destroyed, but under the present scheme the Government will intrude between patient and doctor. The second point is that doctors will be called upon to do administrative work that should be done by department officials. Doctors in the metropolitan area average between 40 and 50 consultations a day and in the country area about 30 consultations a day. If this scheme comes into operation, doctors will 3pend approximately two hours a day filling in claims or supplying information for their clerical assistants. That is a rather important point. This scheme is not peculiar to Australia, but is in operation in other countries of the world. I quote from a recent report in the Melbourne Argus -
page 4137
Adelaide, Sunday. - “ Government free mediJ service schemes in Britain and Sweden are so overtaxing doctors with trivial treatment demands and form filling that they have in sufficient time left to cope with their real objective - treatment of serious illness “ said Sir John Newman Morris, a leading Melbourne surgeon, who passed through Adelaide yesterday on his return from overseas.
Honorable members will see that this form-filling epidemic is not peculiar to Australia, and that, as has been shown by results of a very adverse nature in other parts of the world it can have a bad effect on the treatment of patients. Doctors should not be called upon to carry out administrative work that should be done by a government department and that they would normally not be called upon to do. Let us look at the form that the doctors are called upon to complete. I hold in my hand the form that is appended to the report of the medical services committee and it is headed, “ Suggested Form of Claim on Fund by a Medical Practitioner “. Honorable members will see on the form that I am displaying the mass of verbiage it contains. Here is some of the information that it seeks - Date of attendance; code; serial number; address of practitioner; name of patient, and, if a child under sixteen, name of parent or guardian; total fees charged ; amount claimed ; ledger references; whether consultation was held in the morning between 7 a.m. and 12 noon, In the afternoon between 12 noon and 9 p.m., or at night between 9 p.m. and 7 a.m., or whether it was on a Sunday or public holiday; telephone conversations; domiciliary; visit in private hospitals; materials, &c. All that on top of his ordinary card system and accounting system ! The Minister in his second-reading speech stated that the medical service was understaffed and that there were not sufficient doctors to carry out the ordinary work demanded of them. Yet every doctor who subscribes to this scheme will be forced to work two hours a day supplying this information. Insofar as a doctor does so his services will be denied to his patients for a corresponding time. Clause 7, which deals with the provision of medical and dental services, reads - (1.) The Director-General may, on behalf of the Commonwealth, but subject to this Act. provide, or arrange for the provision of, prescribed medical services and prescribed dental services. (2.) Without limiting the generality of the last preceding sub-section, the services referred to in that sub-section may include -
general medical or dental practitioner services;
consultant and specialist services;
ophthalmic services;
maternal and child health services;
aerial medical and dental services;
diagnostic and therapeutic services;
convalescent and after-care services;
nursing services; and
medical services and dental services in universities, schools and colleges.
This clause covers every form of medical and dental service. Doctors say that to comply with the regulations that will be drafted to cover this, they will be forced to engage additional staff. That will be necessary over and above the time that the doctors themselves will spend on the supply of information. The doctors put forward an alternative suggestion that the Government must consider if it really desires the cooperation of the medical profession. The suggestion was that the patient should pay the whole fee to the doctor, and the Government should refund half the fee on the presentation by the patient of an authorized, itemized account. Under the scheme as it is now designed an account has to be sent to the patient so that medical practitioners may recover the 50 per cent. of their fees. There should therefore be no serious objection to the alternative suggested by the doctors. I do not see that the Government can produce any argument against the suggestion, as a precedent for such a system already exists in the payment of benefits by the Government to patients, for example, under the Workers’ Compensation Act. As I have said, the Minister stressed the shortage of doctors in his second-reading speech, and in my opinion if a fully authorized and itemized account is presented by a patient then, on presentation of that account to the government instrumentality, as is done under the Workers’ Compensation Act, he could receive the necessary refund. But instead of that it is intended to obtrude a government department between the patient and the doctor. Once that has been done the last bulwark against nationalization will have been broken down. The Minister says that the method is based upon the New Zealand scheme and, in effect, that what is good enough for New Zealand is good enough for Australia, but I remind him that in New Zealand the Government pays mileage to doctors. As they have to submit a detailed claim for that mileage, it is no trouble for them to submit at the same time their claim for fees in respect of the treatment of patients. The position is different in Australia because it is not proposed to pay mileage to doctors. The Minister has promised that there will be no conscription of medical services and that doctors may freely decide for themselves whether they will, as he says, come into or stay out of the scheme. He has also said that the Government has no constitutional authority to force doctors into the scheme. I remind him however of the old saying that there are more ways of killing a cat than by drowning it. Many features of this bill could in the long run bring about a nationalized salaried medical service with a bureaucracy of about 20,000 medical officers. For example, should a medical practitioner elect to enter the scheme, his neighbouring medical practitioners would have to enter it too, or suffer the loss arising from a diminution of practice. Let us examine clause 7 again. It covers almost every aspect of medical service, dentistry and ophthalmic services. Sub-clause 4 provides that the Director-General may -
establish, maintain and manage hospitals, laboratories, health centres and clinics.
If the result of the establishment of government health centres should be, as it almost certainly will be, that patients will transfer to them, or to group practices, from private practitioners, the private practitioners will suffer a reduction of income. They will have the choice of two courses. They may accept compensation under clause 22, which is most conveniently placed in the bill and reads -
The Governor-General may make regulations, not inconsistent with this act prescribing all matters which are by this act required or permitted to be prescribed, or which are necessary or conveniently prescribed, for carrying out or giving effect to this act, and in particular -
for providing for the payment of compensation to a medical practitioner or dentist who -
on the date on which hospital, health centre or clinic is established at any place in connexion with a national health service, is in practice in or near that place ;
undertakes to make his professional services available exclusively for the purposes of a national health service; and
has thereby suffered or will suffer loss arising from a diminution in the value of his practice;
Or they may move to other districts to practise. Clauses 9, 10, 11 and 12 provide means by which, through arrangements with the States, the Commonwealth will be able to take over and manage medical services or dental services, hospitals, laboratories, health centres or clinics for the purpose of a national health service. Honorable members must see how easy it will be for the Government; after the passage of this measure, to nationalize Australia’s health service by economic pressure. Once the instrumentalities referred to in those provisions have been taken over by and have come under the management of the Commonwealth, doctors, who hitherto have enjoyed the untramelled use of those instrumentalities, may, unless they agree to enter the national health scheme, be refused their use, and from time to time the Minister may decide the basis upon which they may he used. For example, admission to the scheme could by regulation be conditional on a doctor’s practising in a particular district. The Minister might say to a doctor “If you want to enter the scheme, all right; but you must practise here, there or in some other place, or not be allowed to enter the scheme “. That is regimentation in accordance with the Government’s policy of applying economic pressure. Clause 13 gives power to the Director-General to appoint, on a salaried or other basis, as many professional officers as he may require for the performance of any service in connexion with the national health service. I point out that the establishment of any experimental health centres under the control of the Government is not only unnecessary but also undesirable in the public interests, because it would result in the replacement of private doctors by doctors employed by the Government and would prevent the free choice of a doctor by a patient. That is most important. No patient could be satisfied if he were told that he had to accept treatment from doctor “ A “ or doctor “ B “ when he would have chosen doctor “C “. Patients must be allowed free choice of doctors. That is well established. This bill will destroy the free choice of doctors.
I must deal with these matters briefly because the measure is full of implications. If I elaborate to too great a degree on those matters, I should have to exclude from my comments reference to other matters. I direct attention of honorable members to clause 15, which provides that the Government will select from medical and dental practitioners those who shall be specialists. Nothing more absurd could be conceived. The medical profession has the right to laugh the Government out of court on that point alone. Specialists are determined by their confreres. They decide who have the qualifications of a specialist. It is proposed that hereafter the Minister, after having listened to a committee’s report will make that decision. That is only another part of the pattern for the destruction of the recognized medical service in Australia. Another important point arising out of the supply of records for payment is that the traditional secrecy between doctor and patient will be destroyed in the inspection of records. The doctors’ card systems will be open to “ snoopers “ who will not be able to resist the temptation to see from what illness Mr. or Mrs. So and So is suffering. Once officials check the doctors’ card systems there will be a complete breach of professional secrecy.
Another aspect not covered by the Government is the position of friendly societies. Honorable members know very well that this legislation will destroy not only the free practice of medicine in Australia but also, and overnight, the friendly societies movement. I understand that at present the friendly societies represent a membership of 700,000 people, all of whom contribute voluntarily for medical services. Each member represents 2.7 dependants who also benefit from these voluntary contributions. In addition, approximately 500,000 people in Australia are already covered by voluntary medical benefit schemes. In all, at least 2,000,000 people in Australia are already covered by free medical provisions in voluntary health benefit schemes. Although most of the people contribute to or share in voluntary medical schemes they are taxed by this “ beneficent “ Government an amount of ls. 6d. in the £1 in order to buy benefits for others who make no voluntary arrangements whatever. Members of friendly societies who contribute for medical services will receive no benefit from the Government under this bill. They cannot claim a refund of one-half of their membership fees in the societies to which they belong, and they are already receiving free medical treatment. If they come under this scheme they must abandon the friendly societies. By this legislation the Government proposes to smash the great friendly society movement which has been developed in Australia throughout the years. Members of friendly societies will no doubt have much to say to the Government about this proposal to take away from them their voluntary scheme of medical benefits. In this bill the Government says to members of friendly societies, in effect, “You must abandon your membership of your friendly society and come under this scheme or you will get nothing”. Objections to this legislation are by no means confined to the medical profession. I have received a letter in relation to it from the federal president of the Federated Pharmaceutical Service Guild of Australia which reads as follows : -
I desire to bring before your notice one or two points which the Guild feels should he clarified when the National Health Bill is being debated in the House of Representatives. From the pharmaceutical profession’s point of view, they are of supreme importance and are as follow: -
What directorates are to be set up to administer the national health scheme?
What will be the powers and functions of such directorates?
Pharmacy will insist that the administration of the pharmaceutical section should be in the hands of a pharmacist, and that the pharmaceutical section should have equal standing with all other sections.
We feel that you will see the reasonableness and justice of these claims, and invite you to refer to them, and to make them known to your colleagues so that they can also refer to them, in tine course of the debate on thic measure.
As you are aware, pharmacy only undertook to co-operate in the Pharmaceutical Benefits Scheme because it has ensured the recognition of the status and freedom of its members. Cooperation under the National Health Bill would be conditional upon the pharmacists being given similar or equal assurances to those obtained under the Pharmaceutical Act.
It will be seen that members of the guild have very great doubts whether their freedom will still be recognized if this bill becomes law. In essence this bill is socialistic in concept, and pharmacists are concerned about the maintenance of their freedom in the future. I have also received a letter on this subject from the matron in charge of one of our principal hospitals. I propose to read a portion of it because it is not only interesting but also it deals with the foolishness of the Government in endeavouring to placate one section of the community without considering the effect of its proposals upon the community generally In. part, the letter reads -
The tilings that concern us here in New South Wales are as follows: -
Senator McKenna promised that before any plans were made for the future of nursing in Australia, he would consult the Matron’s Institute and the New South Wales Nurse*’’ Association (which itself has 5,000 of the 7.000 active people engaged in nursing in this State on its membership). We have this in writing and yet the only people who were consulted up to the end of last week, al any rate, was the Florence Nightingale Foundation. This body does not represent nurses in Australia, because it has a committee half lay, half nursing and no membership. On the committee are about 10 nurses who are setting themselves up to represent all the nurses in their State. The very fact that there has been such an outcry from the N.S.W. Nurses’ Association, and I, myself, have received from the members of the Matrons” Institute letters from over 80 per cent, stating they have sent letters of protest to Senator McKenna, illustrates this. (2.) The whole outcry in this State centres around plans to bring in a regulation after this Act is passed to set up in Victoria n national postgraduate school.
As you know, these postgraduate school - deal with the further education, of the nurse.-. i.e. they run courses for nurses wishing to become sister tutors, matrons, theatre sisters, industrial nurses, and so on.
Now Zealand, with 1,500,000 people, runs such a postgraduate school. New South Wales, with 2,500,000 people, wants its own postgraduate school. We neither want to dominate Victoria nor do we want to be dominated by Victoria. Wc congratulate them if they are ready to set up their own postgraduate school, but we do not congratulate them when it comes to wanting to dominate the rest ot Australia. It is the fact that a. regulation is being made giving Victoria £G,000 to run the national school, that alarms us.
Therefore, sir, I would be very grateful if you asked the Minister whether he is aware of the outcry in New South Wales, also whether ho is aware that the Florence Nightingale Foundation does not represent the nurses in this State and therefore cannot pledge them. Whether he is aware too, that the branch of the Australian Nursing Federation in this State, i.e. the A.T.N.A., has only 700 members who pay in yearly, and whether he is aware that the New South Wales Nurses’ Association and 80 per cent, of the members of the Matrons’ Institute are most hostile about this proposed regulation?
The Government has failed to summon the necessary conferences to enable thu British Medical Association properly to consider this proposal. It has failed to advise the pharmacists of what it proposes to do. It has failed to bring the nurses in the various States into close liaison so that some co-operation may be expected from them. In short, it has adopted this measure as the only means of blocking the economic pressure applied by the medical profession to its socialistic proposals. Because the Minister has not succeeded in securing the united consent of the medical and associated professions to thi* scheme, I move -
That all words after “That” be left out, with a view to insert in lieu thereof the following words: - “the bill be withdrawn and redrafted and resubmitted to the House of Representatives after the Minister has completed his negotiations with accredited representatives of the medical, dental and nursing professions and registered friendly societies and reported fully to the House in respect thereof “.
– This bill is one of the most important pieces of social legislation that has ever been introduced in the Parliament because it deals with human health and well being. The Acting Leader of the Opposition (Mr. Harrison) ascribed certain motives to the Government in presenting the bill, and one would gather from his remarks that he was in some doubt as to what is the real purpose of the bill. The Government is putting into operation a longrange plan to provide for a preventive and curative medical service for the people according to their needs, instead of, as at present, according to their ability to pay. The Minister (Mr. Holloway) who introduced the bill described it as an enabling measure, the purpose of which was to empower the Government to give effect to its policy in regard to medical services. The bill merely lays down the broad outlines of the plan, the details and methods of administration to be fixed by regulations. There may be room for criticism of the proposal to implement the plan by regulation, but the Minister was quite frank in explaining that its purpose was to empower the Government to put its plan into operation over a period of years. The Government has already made some progress with its general plan. For instance, it has provided assistance to hospitals, it has inaugurated a campaign against tuberculosis, and has introduced a child welfare scheme under which Lady Gowrie centres have been established in various places. The Government has also been responsible for the introduction of legislation to provide free medicine for the people. It is true that the system is not operating as well as we could wish. If similar obstruction had been practised by the waterside workers honorable member? opposite would have described it is a strike.
– Order! The Minister may not discuss that matter.
– It may be said that the Government’s plan for a national medical service is not the right way to achieve our purpose, but honorable members opposite always say that. The opposition to the plan comes from vested interests, or from those whose opinions are hopelessly conservative. In his second-reading speech, the Minister said -
It marks the beginning of a period in which the resources of the Commonwealth can, and will be, directed to the prevention of disease, the promotion of positive health and to the treatment and cure of disease and disability. It is, in effect, the source of a charter of national health for the future.
That is a very laudable objective. The Government’s plan follows the general lines of the recommendations of the Joint Parliamentary Committee on Social Security, to which the Minister paid the f ollowing tribute : -
The work of the Joint Parliamentary Committee on Social Security,which continued its investigations from 1941 to 1945, was followed with close interest by the Government, and I may point out that in the formulation of health proposals under this bill particular regard has been paid to the reports and recommendations of that committee.
As the honorable member for Flinders (Mr. Ryan) will recall, the committee made certain recommendations which are somewhat at variance with the Government’s plans for medical services. The committee directed the attention of the then Minister for Health to something which it regarded as not quite the proper thing to do, but the fact remains that, in general, the Government’s plan is in accord with the committee’s recommendations.
– Does the Minister believe that?
– I agree that, in a general way, it is so. The honorable member for Flinders will recall that the committee had a long discussion on the subject of control of a national medical service. Perhaps we ought not to expect that the recommendations of the committee would be accepted entirely by the Government, and although the Government’s proposals differ in some respects from the recommendations of the committee. I do not believe that the difficulties are insurmountable. The perfect system must be reachedby a method of trial and error. The bill will provide the basis of a plan that will be put into operation over a period of years. It cannot be implemented over-night. Its details were recommended as the result of expert investigation. The Social Security Committee was composed of lay members of this Parliament, but it did not rely entirely upon its own observations or upon the deductions that could be made from the evidence tendered to it by medical authorities. It per suaded the then Treasurer (Mr. Chifley) to provide expert assistance for it. Eminent medical men like Dr. Allan Lilley, Sir Raphael Cilento and Dr. Arthur Brown, who has written some very fine works on national health, were co-opted to make a survey of Australian health services. They presented detailed reports, which were strongly condemnatory of health services in many parte of Australia. The committee’s recommendations were intended to prevent a continuation of such unsatisfactory services. It stated in its sixth interim report -
The Committee believes that the issues of primary importance arising from its inquiry and the foregoing proposals are -
Whether a general medical service available for all is in the best interests of the community;
whether such a service can be provided under existing conditions of private medical practice; and
if not, under which of the following alternative systems of payment to medical practitioners should such a service, if any, be introduced: -
a capitation fee under the panel system;
a fee-for-service under a system of private practice;
a salary for full-time employment ;
a salary for part-time employment, with the right of private practice; or
a combination of any of these systems.
Medical witnesses generally have been more directly interested in the nature of and conditions under which medical services would be provided than in the policy of providing a general medical service to all in the community.
The need for, and desirability of, such a service is questioned by some, who consider it would not be in the best interests of the community as a whole, and that if the services were rendered entirely gratuitously to such patients it would be unfairly used by many. Against this, however, is the general acknowledgment that the best medical attention should be available to all in the community, irrespective of financial circumstances. The best medical service, including specialist service, is now available to the rich who can pay for it, and to the poor to whom it is provided free. Upon the large middle-income group, prolonged illness or major surgery frequently imposes very considerable hardship, and, in consequence, a lowering of living standards and results in a failure to seek advice in early stages of illness when treatment is relatively easy. In our opinion, such conditions are unjustified and inequitable. Moreover, it is unreasonable that the doctor, be he general practitioner or specialist, should be expected to give his services free to any section of the people.
We consider, therefore, that a general medical service should be instituted as the best and most equitable means of providing medical care for the community as a whole, and that this should be financed from a central fund specifically raised for the purpose by a tax on income, having regard to the capacity of the individual to pay.
That stated the committee’s views on general policy and the means of financing a national scheme.
It is all very well for the Acting Leader of the Opposition to draw upon his imagination as he did to-day, and as he has often done before, in order to criticize the scheme of group practice provided for in clause 22 of the bill. He said that the clause provided for nationalization of medical services by economic means. The honorable gentleman must be completely out of touch with modern thought, even within the medical profession. The Social Security Committee was told by witnesses from all parts of Australia, including medical experts, that the Commonwealth should immediately, or as soon as possible, establish group centres in the capital cities so that such a plan could be tested thoroughly. They suggested that all services which normal medical practice provides should be housed in modern buildings. The honorable gentleman may have been in contact with some disgruntled conservative doctors who, because they have reached the peak of their profession, are able to make very handsome incomes but are out of touch with the needs of people who require specialist treatment but cannot obtain it because, under modern methods of practice, they cannot afford it. The Social Security Committee was told how-, at a group centre, a patient could secure proper attention for any complaint in the one building. Under the existing system, a person who needs special medical attention is referred by his family doctor to an expensive specialist. Very often he cannot afford to pay for the specialist’s services. That is the result of the growth and development of medical practice along specialized lines. The Acting
Leader of the Opposition is completely out of touch with modern trends and the views of the medical profession. I do not claim that all doctors favour the Government’s plan, but I assert that a substantial proportion of them agree that group centres are needed.
He complained that patients would lose contact with their family doctors. What happens to-day? As an illustration, I refer to the fact that there is a general clamour among ex-servicemen not suffering from war-caused disabilities to be granted permission to obtain treatment in repatriation hospitals. The Repatriation Commission has been operating hospitals for the past 25 years, and those establishments render a service comparable with that which will be provided by the proposed group centres. The ex-servicemen whom I have mentioned are not concerned about retaining their connexion with family doctors. They want to be transferred to repatriation hospitals where they can obtain modern treatment for their various ailments. Specialists who work in those hospitals are paid on a fee-for-service basis and on a salary basis. I have received many letters from men who are deeply appreciative of the treatment that they have obtained in repatriation hospitals. Relatively few complaints are received. Apparently ex-servicemen generally are well satisfied with that system. Because the modern practice of medicine has been transferred from general medical practitioners the responsibility for the treatment of most serious complaints, it is idle for honorable members to speak now of the relationship between patients and local practitioners as being all-important. Admittedly a person’s right to choose the general practitioner whom he wishes to consult is of some psychological, or, even real, value, but the actual diagnosis and treatment of serious complaints is almost invariably carried out by specialists. Local medical practitioners who, after examining their patients, decide that their condition of ill health may be serious or complicated, invariably refer them to radiologists for examination, to specialists for treatment or to hospitals for admission. In many instances the patients lose all contact with their local doctors after the first visit to them. In saying that I want to make it clear that I am not criticizing local practitioners, who are, in the main, very good doctors; I am merely pointing out that, generally speaking, their function is confined to examination of patients and the treatment of minor day-to-day ailments.
Page 44 of the sixth report of the Joint Committee on Social Security makes it clear that the committee had the benefit of hearing at length the opinions of such eminent medical authorities as Sir Raphael Cilento and Dr. Allan Lilley, and representatives of the British Medical Association, such as the president of that body, Sir Henry Newland, Sir Charles Blackburn and Dr. Arthur Brown. On the 15th March, 1943. the British Medical Association set out its considered views in the course of a letter, part of which stated - theprincipleswhichshouldgoverna GeneralMedicalserviceforAustralia.
Health is a precious possession, so precious that one does not ordinarily set a money value upon it. It is not exchanged in the market place. It is personal and intimate, something cherished for the pursuit of happiness.
An efficient health service is essential to the welfare of every progressive nation. The principle that a health service should be complete and available to all citizens is supported by modern developments in medicine, by the universal trend towards co-operative social effort and by the better standard of physical fitness required for national survival in the highly competitive world of to-day.
The past 30 years have been characterized by a widening and a deepening of the public interest in the problems of personal and public health. The establishment of the systematic medical examination of school children, the organization of tuberculosis, venereal disease, maternity and child welfare, mental and mental deficiency services, and the development of the public hospital system, all illustrate the greatly increased interest which the community, through the State, has manifested in health and sickness provision asa form of social service. The press, the radio, and the public platform have combined to keep continuallybefore the public as a liveand personal issue “ The Health of the People “.
The main basic principles are four in number -
That the system ofmedical service should be directed to the achievement of positive health and the prevention of disease no less than to the relief of sickness.
The system of medical service should be directed to the achievement of positive health and the prevention of disease no less than to the relief of sickness.
Health is something more than the absence of disease. While provision for the treatment of disease is an essential part of any satisfactory health service, the emphasis should rest on the positive prosecution of measures to maintain and enhance mental and physical health.
Honorable members will realize, therefore, that the principles of the bill are in accordance with the recommendations made by the British Medical Association itself, and I commend the portion of the letter which I have just read to the particular notice of the Acting Leader of the Opposition (Mr. Harrison), who criticized the Government’s proposals as not having the support of the medical profession. The objects of the present measure are set out in clause 7, sub-clause 3 of which reads -
The Director-General may, on behalf of the Commonwealth, do, or arrange for the doing of, anything which is incidental to the provision of any medical or dental service under this section.
The Acting Leader of the Opposition complained of what he called economic conscription. I remind him that no such criticism is made of the treatment provided for ex-servicemen by the Repatriation Commision, and there is no reason why a planned medical service for the community should not be developed along the lines of that provided by the commission. The number of applications received from various bodies to extend the scope of the benefits of medical treatment from the Repatriation Commission, and the pressure exerted upon me by those organizations towards that end, indicate that the service provided by the commission is thoroughly appreciated. Bequests have been made by ex-servicemen’s organizations, including an association of war widows, that the children of ex-servicemen should be treated in repatriation hospitals. I have given sympathetic consideration and support to many of the requests made for the extension of the service, and the representation that the children of ex-servicemen should be treated in repatriation hospitals has been successful. Children are now admitted to those hospitals, and it is evident that their parents are more than satisfied with the treatment which they receive. Altogether approximately 8,000 beds are provided in repatriation hospitals. In addition, the Government is providing considerable financial assistance for those who are accommodated in public hospitals. It is evident, therefore, that we are marching slowly but surely - perhaps, a little too slowly - to the implementation of a complete national health service. It is hardly necessary for me to point out that that trend is advocated not only by members of the Australian Labour party and by the Social Security Committee, which thoroughly investigated the provision of health services in Australia, but it is also supported by a resolution of the Forty-fourth Convention of the International Labour Organization, which I attended as a delegate of Australia. The fears expressed by opponents of the scheme that the Government is endeavouring to nationalize the medical profession and to achieve other “socialistic “ aims which will interfere with the rights and liberties of members of the community are obviously groundless.
Sitting suspended from 12.45 to 2.15 p.m.
-The general conference of the International Labour Organization adopted, by substantially more than a two-thirds majority, several recommendations relating to the improvement of medical care throughout the world. I do not propose to read the recommendations, which cover a wide field. They were considered to beof such interest and value that they were printed as an appendix to the eighth interim report of the Social Security Committee.
The Acting Leader of the Opposition (Mr. Harrison) criticized the suggestion that effect should be given to some aspects of the National Health Service by means of regulations. I discussed that matter with the Minister for Health (Senator McKenna), who told me that, although it is proposed to give effect to some parts of the scheme by means of regulations, any proposals that are of major importance will be made the subject of legislation. Honorable members will, therefore, be afforded an opportunity to examine and criticize them. The honorable gentleman talked of scant consideration having been given to this measure and to the views of the medical, pharmaceutical and other interested professions. If a government does not make up its mind to proceed with legislation to provide social services for the people, it will never get anywhere. The Opposition has talked about these matters, but it has not done anything about them.
The amendment that was moved by the Acting Leader of the Opposition refers to the withdrawal, re-drafting and resubmission of the bill to this House. It does not state in what amended form the measure should he resubmitted. What positive proposals has the Opposition to improve the bill? In what way does it suggest that the Government should redraft the measure? In my view, this is one of the most remarkable amendments ever moved in this chamber.
– It is a real blank.
– The Acting Leader of the Opposition was full of complaints regarding the bill and its objectives. He said that this and that were not right, and that this and that should not be done, but his approach to the matter was a purely negative one. The amendment that he has moved proposes that the bill be withdrawn and redrafted and resubmitted to the House at an indefinite date, after the Minister has completed negotiations with the representatives of various professions and organizations and reported fully to the House in respect thereof. It does not specify what the redrafted measure should provide for. It does not state that any of the present provisions of the bill are undesirable or mention any omissions that should be made good. It merely requests that the measure be withdrawn. redrafted and resubmitted. In what way does the honorable gentleman suggest that it should be redrafted ?
– If the Minister will read the amendment, he will see what I mean.
– I have read the amendment. So far the Opposition has not suggested in what way the bill should be redrafted. It has not made a single suggestion for its improvement. It has proposed merely that the benefits that the people will derive from the operation of the measure in its present form should be withheld from them for an indefinite period. I do not wish to be unfair to honorable members opposite, but that seems to be the motive that is actuating them in their opposition to the bill. Their attitude is a purely negative one. It is that the Government should do nothing to establish a national health service and should withhold the benefits of this measure from the people. Possibly the idea of the Opposition is that outside interests should be allowed to determine what shall be contained in a measure that has been introduced by the Government.
The Acting Leader of the Opposition suggested that I should read the amendment, and I shall do so. It reads as follows : -
That all words after “That” be omitted, with a view to insert in lieu thereof the following’ words: - “the bill be withdrawn and re-drafted and re-submitted to the House of Representatives after the Minister has completed his negotiations with accredited representatives of the medical, dental and nursing professions and registered friendly societies and reported fully to the House in respect thereof “.
In my experience as a member of this House, I have never before heard an amendment of that nature moved. It contains no positive proposals for the improvement of the measure, and shows that in the ranks of the Opposition there is the same cleavage in regard to this bill as there has been in regard to many others that have been brought before the Parliament. There is no agreement among honorable members opposite on these proposals. I do not suggest that every member of the Opposition does not wish this service to be provided for the people, but I do submit that there are so many honorable members opposite who do not wish the Government to do anything to improve social conditions in Australia that they outnumber and outvote those who desire to do so.
I regard the measure as an excellent start. This is a long-range plan. It is proposed to implement it when negotiations have reached the stage at which positive action can be taken. Negotiations with interested organizations have not yet been concluded, but the opinion of the Government is that they have gone far enough to enable it to bring down a bill and to proceed to implement that part of the platform of the Australian Labour party which deals with complete medical care for the people. It is for that reason that the measure has been introduced.
.- This baby, which the Government has produced after a long period of gestation and which it now brings before us to bless, is an ill-conceived and very ill-featured child. It is quite clear tbat .it has been helped into the world by an unregistered midwife and not by a recognized member of the medical profession. 1 am sorry to have to say so, but that, in my opinion, is the position.
– “Would the honorable member have preferred the child to be still-bom ?
– I think the position would have been much better if it had been still-born. I should welcome a well-thought-out scheme for a national health service which was based on the interests of the community and which, at the same time, had the approval of the medical profession as a whole. Undoubtedly there is a great need in this country to-day for a community medical service. There is a need for the people generally to pool their risks and resources in this regard. At present the poor, and the very rich-
– There are no very rich to-day.
– They are hard to find I agree, but I suppose that there are some. I shall say that the so-called rich, and the poor are able to get the best medical attention. However, the great majority of our people find the expense of a serious illness so great that their fortunes are almost broken by it. I have had this brought home to me recently by a number of cases in which I have been personally interested. There is general recognition that a national medical service should be introduced at a reasonably early date. The Menzies Government recognized that need when it introduced the National Health and Pensions Insurance Bill in L94S. Unfortunately, that bill, although passed by the Parliament, was never proclaimed. The need for a community medical service was also recognized by the National Health and Medical Research Council in a report that it made in November, 1941. It was recognized, too, by the Federal Council of the British Medical Association in two reports, dated September, 1941, and March, 1943, respectively. Further recognition was given to it by the Menzies Government when, in 1941, it appointed the Social Security Committee of which the Minister for Repatriation (Mr. Barnard), and I were members. I was disappointed, although not astonished to hear the Minister’s remarks on this bill. I had expected from him some objective criticism of what the measure contains because I know that his views correspond, or they did, very closely to mine. However, I realize that the Minister, like so many of his colleagues, is always torn between two loyalties - loyalty to his own views, and loyalty to caucus. Unfortunately the latter loyalty seems always to prevail, although I cannot understand why. In 1941, the Social Security Committee’ was given the task, amongst others, of reporting to the Parliament on a community medical service, including hospitalization. In pursuance of that mandate, the committee, over a period of three years, visited every State and took evidence from people in all walks of life, including many members of the medical profession. The results of the committee’s inquiries may be found in two reports that it submitted to the Parliament, the sixth interim report made in 1943, and the eighth interim report made in 1945. Every member of the committee will agree that, as the result of long talks with members of the medical profession and others, a considerable degree of unanimity was reached with the British Medical Association on the main principles of any medical scheme. There were, of course, differences on the details of such a scheme, but when the committee, in pursuance of its mandate, was about to make a final report, there was every prospect that a scheme would be devised which would be acceptable to the British Medical Association, to this Parliament, and to the people of Australia generally. However, just when things seemed to be going along very well, the then Minister for Health (Senator Fraser), stepped in. and opened his own negotiations with the British Medical Association. Commenting _ upon this unaccountable intervention, the committee reported that it could not but regard the action of the Minister in calling a conference, as being extremely discourteous to the committee, and unfortunate in its results. The committee added that the Minister had acted without prior consultation with it, and without having informed it of what was taking place. The committee naturally came to the unanimous decision that continuance of its discussions with the British Medical Association would not be of any value, as obviously it was impossible for two sets of talks to be carried on simultaneously with the one body. Since then, the committee has not been informed officially of what has been happening. However, some members of it, including myself, have endeavoured to follow closely the negotiations, first between Senator Fraser and the British Medical Association, and subsequently between the present Minister for Health (Senator McKenna) and that organization. Those negotiations have been continued in a desultory fashion and without much result. The latest meeting between the Minister for Health and representatives of the British Medical Association took place in October of this year - only a few weeks ago. One would have thought that, at that meeting, the Minister would have acquainted the association of what the Government proposed to do, but, so far as I can ascertain, he only indicated that he had some plan in mind. He started his earlier negotiations by saying that the Government had a mandate to introduce a free medical service for the people of Australia. He insisted that the service should be free ; in uther words, that no charge should be made to the public by doctors. Then, in October, he said that he had another mandate, on that occasion to introduce a scheme providing that doctors should charge half fees to patients, the remainder to be paid by the Government. Both mandates were conceived entirely in the Minister’s own mind, and had no relation to any power that had been conferred upon the Government by the people at any time. The result of the desultory discussions between the Minister for Health and the British Medical Association is that the medical profession, as a whole, which, at one time, was “ on side” with the Government through the Social Security Committee, is now “ off side” completely. Certain implied undertakings given by the Minister in the course of his negotiations have not been fulfilled in this measure. In his second-reading speech, the Minister for Labour and National Service (Mr. Holloway) said that, in preparing the scheme, the Government had considered the recommendations of the Social Security Committee. On that statement I have one or two comments to make, because all members of the committee know, and the Government, particularly the Minister for Health, should very well know, that the medical profession laid down what it considered to be three essentials for any national medical service. The first was that the scheme should be administered by a body composed in the main of professional men. The second was that the relationship between doctor and patient should not be challenged in any way, but should remain as it has been for centuries past. The third was that some agreement should be reached about the method by which the doctors should be remunerated.
Before dealing with the matter of administration I should like to refer to another submission by the medical profession to which all members of the Social Security Committee agreed, namely, the principle of gradualness. In other words, no medical scheme should be introduced which cuts off abruptly the past from the future. The past embodies centuries of practice and tradition in the medical profession, and, as all honorable members know, has yielded beneficial results to patients. The Social Security Committee considered that the principle of gradualness was very sound. Paragraph 143 of its sixth report reads -
Wo believe . . . that the ultimate solution-
I stress the word “ ultimate “ - will probably be found in a full-tune salaried medical service with standardized uniform hospital provision.
Later in the same paragraph, the following words appear: -
Such solution, however, must be regarded uthe long-range objective, since, apart from the insuperable obstacles to its introduction at this stage it is opposed, at present, by a large majority of the medical profession whose cooperation is vital to the success of any plan.
We know what has occurred in other countries, when the established practice of medicine has suddenly been upset by government intervention. I cite New Zealand, where the whole medical profession has been disorganized and general practice is, in a measure, running riot as the result of the somewhat ill-conceived and hasty measures taken by the New Zealand Government. I have received a report on the matter as follows :-
In 1947 the annual report of the- Depart ment of Health showed the cost of medical benefits-
That is to say, treatment and attendance by doctors - at £1,700,574, representing 28.3 per cent, of the annual medical expenditure.
For the same period, the cost of pharmaceutical benefits amounted to £1,439,000, or 23.2 per cent, of the total cost. The cost of pharmaceutical benefits was nearly equal to the total payment for the services of doctors. That illustration reveals one of the extraordinary anomalies that may arise in government medical schemes. I refer again to the position in the United Kingdom since the introduction of the free medical scheme in that country. The services of doctors have been in far greater demand under the free medical scheme than they were under the previous practice. Doctors are being overworked, and the amount of money they are earning has increased to an extraordinary degree, but the services that they render to their patients have deteriorated, because they are unable to afford the time required for the thorough treatment of sick people. The dental profession has had a similar experience. According to the latest report which I read yesterday, thirteen dentists in the United Kingdom are earning £2,000 a month for extracting teeth and rendering other dental services. The expenditure on dental treatment has risen to such a degree that the Government recently introduced a regulation prescribing that all moneys which dentists earn in excess of £4,800 a year shall be reduced by 50 per cent. The dentists are working twelve hours a day, including Sundays. That illustration also shows the excesses to which government medical schemes can run unless they are properly conceived.
The next proposal in the bill - the method of remuneration - was the subject of long discussions between the Social Security Committee and the members of the medical profession. I do not desire to deal with that matter at length, but I remind those honorable members who have had the good fortune and good sense to read the reports of the committee that there was a great divergence of opinion about the manner in which the remuneration of doctors should be effected. Three proposals were made : first, a salaried scheme; secondly a fee-for-service scheme; and, thirdly, a panel scheme. Those three schemes, whether taken singly or in conjunction with one another, have some advantages and some grave disadvantages. In this bill, the Government has broken new ground by proposing to pay one-half of the fee and allowing the patient to pay the other hair. That proposal probably will constitute a reasonable approach to the problem of remuneration, provided the details are worked out satisfactorily, and, above all, in consultation with the doctors themselves. Such a scheme will obviate, quite definitely, the excesses which have occurred in schemes that have been introduced in other countries. It will give to patients a sense of responsibility which, otherwise, they will be apt to lose, whilst giving to doctors a proper form of remuneration. Without examining the details, I believe that the doctors themselves fear the proposed scheme will cause them to be overworked, and will in volve them in an undesirable contractual relation, with the Government. They believe that the whole scheme will mean that the hours which they normally spend in visiting and examining patients will be reduced by the additional office work that will be imposed upon them. Those doubts must be satisfactorily resolved. The inspection of doctors’ records mus mean some degree of interference in the relations between doctor and patient, and impose additional work on medical practitioners. Before the Government takes further action, this matter must . be settled in consultation with the doctors.
Those are the two features in the pro- posed scheme upon which the Governmenas followed the advice or the general recommendations of the Social Security Committee, and I believe that,, on the whole, they are assets rather than liabilities. I emphasize again thinecessity for the gradual introduction of the new arrangement. The Minister for Labour and National Service has indicated that the Government recognizes the importance of the element of gradualness, but his statement does not make it certain that the new scheme will be introduced gradually. The bill should make specific provision in that regard instead of leaving tin? matter to the discretion of the Minister of the day.
I turn now to the most objectionable part of the scheme, namely, administrative control. I am surprised that the Minister for Repatriation (Mr. Barnard), who was formerly the Chair man of the Social Security Committee, has not directed attention to it. I remind the Minister that this matter was very carefully considered by the committee, which made strong recommendations to the Government in regard to it. As the committee stated at page 7 of the report, it was of the opinion -
That there is practical unanimity of opposition from all private medical witnesses to any proposal for control of any general health service by any government department; . . .
In its recommendations that are set 0U on page 17 of the report, the committee put forward two proposals with regard to the personnel of the commission. The first was that it might consist of a chairman and a medical hospital administrator. both selected from a small panel nominated by the medical profession, and the Commonwealth Director-General of Health. The alternative proposal was that the commission might consist of a chairman and two medical members, selected from a panel nominated by the medical profession, the Commonwealth DirectorGeneral of Health, and one lay representative, with special qualifications and wide experience of finance. It will be noted that it was stressed in both instances that the members of the medical profession should be in the majority. I believe that that is of absolutely fundamental importance in any scheme of this kind. But what has the Government done? Not only has it not adopted the recommendation of the committee, but has acted to the contrary. It is proposed that this scheme shall be administered by the Director-General of Health under the control of the Minister, entirely as a public service. The medical profession comes into the scheme only by way of advisory committees. That is the general outline of what the Government proposes. The advice of those committees may or may not be accepted by the Director-General of Health, and, therefore, by the Minister. The implementation of this scheme would convert the medical services into a glorified public service, which is anathema to every medical man in this country. I believe that as long as the Government persists with this line of action no agreement with the medical profession will be possible. The Minister has said that this is an enabling measure. Certainly it will enable the Government to do anything it wishes in connexion with the subject with which it deals. It does not lay down details of and action to be taken, except in relation to the most objectional principles to which I have already referred. What is to be done lies in the lap of the future. Although the Minister has told us what he intends to do, he is only a transient creature who, although here to-day, may not he here next year. Even if, by some unfortunate chance, he is here next year-
– What, does that nasty remark mean?
– I am not speaking personally of the Minister, for whom I have a high regard. But he might be replaced’ by another Government supporter whose qualities are not so admirable and whomight implement, under the regulation, any scheme that he thought should be brought into effect. Therein lies a very great danger. I point out that not only the committees, hut also the nursing, hospitalization, and general medical services will Decontrolled by regulations, based on this legislation. There would be nothing toprevent the Government, if it so desired, from introducing any measure without the Parliament having any voice in the matter. That is a completely wrong approach to this problem, and so long as the Government persists along the lines that it adopted in connexion with the free medicine scheme, it will get nowhere. I believe that the people of this country want some form of medical service, but the scheme should be drawn up as the result of discussions and the closest co-operation with the doctors who will be called upon to operate it. I do not consider that it is necessary for the Government to bring down this bill at this stage, because the problem is not new. The medical profession has done wonderful work in the provision of health services in this and other countries for many years. Why, at a moment’s notice, and by unilateral decision of the Government, has this bill, which is offensive to and is calculated to restrict the medical profession, been introduced? As I have already said, for a scheme to be of value it must be drawn up in cooperation with the medical profession. The amendment that has been moved by the Acting Leader of the Opposition (Mr. Harrison) should he adopted. There is no great urgency for the introduction of such a scheme. It would be far better if the bill were withdrawn and re-drafted in a different form, after full consultation with the profession as has been proposed. If that were done doubtless agreement could be arrived at between the Government and the doctors, because many of the Minister’s principles are sound, although they have not been specifically explained or embodied in the bill.
– That is what the bill is for.
– As the measure stands, it must put the fear of God into the members of the medical profession, because they know that under it the Government will be able to do anything it likes, without having the slightest regard for their views. What is the reason for the haste that is being displayed? Is it merely that the Government wants to give itself a Christmas present ? I contend that this measure will be of no value at all. I urge the acceptance of the amendment. Let lis have a measure on which we all can agree.
.- The honorable member for Flinders (Mr. Ryan) has covered the field of this bill very well, and has relieved me of the necessity to do more than direct attention to what I regard as the essential features of it. I remind honorable members that when the Constitution Alteration (Social Services) Bill was passed in 1946, it was as the result of an amendment moved from this side of the House that the power given to the Parliament to introduce legislation to provide, amongst other things, for dental and medical services, had attached to it the stipulation “ but not so as to authorize any form of civil conscription “. The intention was that we should protect people engaged in the profession of medicine or of dentistry from being conscripted into the service of the Government. The Government has had a good look at the provision and, as I expected, it has found that it is fairly wide and that it can use other methods, which do not bring themselves within the letter of the prohibition within the Constitution, but certainly defy the spirit under which that amendment was moved, namely, that it should not be open to any government, directly, or indirectly, as this bill proposes, to impose its will upon those two great professions. I know of many medical men who have given their services to the Commonwealth and are in a strict sense civil servants. Most of them have given exceptionally good service. But I assert that the medical and dental professions cannot develop if they are always to be under the clammy hand of official control. It is to that aspect of the bill that I particularly direct my attention. It has been said that the bill is an enabling bill. Both the Acting Leader of the Opposition (Mr. Harrison) and the honorable member for Flinders described it in those terms. The truth is that it is a bill that does nothing more than confer power on the Government. It does not advance any concrete proposals for dealing with the health of the community, but it takes from the Parliament the whole or almost the whole field of medical service legislation, which is a field that the Parliament should control, and hands it to the Director-General of Health, who, in turn, at every stage,, is subject to the will and direction of the Minister for Health. First, I again direct attention to what I have failed to awaken the Parliament to on more than one. occasion, namely, the dangerous tendency of the Government and to which we are lending ourselves to subtract whole fields of legislative power from the Parliament and give them to public servants under ministerial control. This bill aims at transferring from the Parliament to a public servant under ministerial control legislative power in the field of the health of the community. It advances not one specific proposal for dealing with Australia’s medical problems. The gist of the problem confronting Australia is not so much the giving of assistance to persons by way of payment of doctors and dentists as the development of preventive medicine and preventive dentistry. Steps towards its solution would be the establishment of proper diagnostic, therapeutic and after-care treatment centres. I have no doubt that had the Government approached the medical profession, without whose assistance a scheme like this will break down, for members of the profession are the best qualified in their composite knowledge to say what is most needed from the medical point of view, and proposed the establishment of some of the services referred to in clause 7 of the bill, it would have received the most enthusiastic support of the profession. What I believe is essential - and this, I think, is right on the centre of the problem - is the establishment of consultant and specialist centres in every part of the country. In the provision of those centres there is work for another fifteen or twenty years. Clause 7 refers to general medical or dental practitioner services; consultant and specialist services; ophthalmic services; maternal and child health services; aerial medical and dental services; diagnostic and therapeutic services ; convalescent and after-care services; nursing services; and medical services and dental services in universities, schools and colleges. Those services are needed everywhere.
– In the outback.
– They are needed, not only in the outback, but in the cities, too, where they are unavailable to the public. The special need exists for more diagnostic and treatment centres. The provision of them alone will make an enormous demand on material and man-power for many years. I have little doubt that not much more would be needed to give to this country a proper and efficient medical service; but that is not what the bill is designed to do. It is true that it will give power to the Government to provide them, but it removes from the control of the Parliament the determination of what shall be done and the order in which it shall be done. Apparently that is of no significance to honorable members. They 3ee their powers being whittled away without protest. That power is to be given to the Director-General of Health, subject to the Minister’s control. The matter is of great importance. What is far more important, however, in its serious implications for the medical profession and the health services of this country is that the bill, no matter in what words it is wrapped up, is designed ultimately to destroy private medical practice in Australia. There is not the slightest doubt that, if this bill is fully implemented, within ten years private practice for all practical purposes will have disappeared. Some people say that that will he a good thing. But the Government will find it very difficult to convince the women of Australia that they will benefit from ultimately having to accept a civil servant as their medical adviser and attendant. [ suppose that, with the 40-hour week in operation, when the 5 o’clock whistle blows, the doctor going off duty will say to his confrere coming on “ I am not on, it is your shift now “. Then we shall not get in the field of maternal care and the delivery of children the same personal attention as is given now by doctors, because, regardless of 40-hour week or 80-hour weeks, many doctors nowadays, after having attended to women for six or seven months of their pregnancy, will sit all night at their bedside, if need be, so as to ensure that they shall be with their patients at the critical moment of childbirth. Doubtless, under the system of government control, a different doctor -will attend at the delivery of the child than the doctor who attended the woman immediately before.
If one examines how the bill is framed, one sees how the Government proposes to open the door to complete socialization of the medical profession. If socialization of the medical profession would benefit the people, it would be proper to socialize it, because the benefit of the people is the determining factor; but, in my view, once the medical profession has been socialized, the consequences to the country will be most serious. Socialization of the profession will kill the creative effort and urge that permeate so gi-eat a number of the men and women who serve in it to-day. Two clauses of the bill show clearly how extensive are the powers that are to be given to the Government and how they will operate. I take clause 6 and clause 22 together. Clause 6 states -
The regulations may make provision for and in relation to the establishment, maintenance and conduct of a scheme for the payment by the Commonwealth, on behalf of persons who have received professional service? from medical practitioners who are for the time being participants in the scheme, of the prescribed proportion of the fees prescribed in respect to those services.
The Director-General of Health will say that patients of medical practitioners are to be reimbursed 10 per cent., 50 per cent.. 75 per cent., or, for all we know, 99 per cent, of the fees charged by the doctors. I leave aside for the moment the degree to which this provision has revealed itself in England and New Zealand to be an encouragement to those people who always think that they are ill with some malady, though that in itself might be sufficient to damn this aspect of the bill. There is no doubt that the Government cannot afford to and will not provide large sums of money by way of payment to doctors, whether directly to the doctors themselves or indirectly by the subvention of the patients, unless it has supervisory control over the payments. How can that supervision be exercised? This matter was adverted to by the Acting Leader of the Opposition. Obviously, it can only be exercised by demanding the furnishing of the information on more and more forms. Heaven alone knows we are so much submerged under forms in this country that our economy is being largely suffocated by them. Apparently we are to have more forms upon which a doctor is to furnish particulars of the time of treatment, the type of treatment given and the disease from which his patient was suffering, so that the fees charged by him may be checked. We shall develop another horde of officials who will snoop into the affairs of doctor and patient. I use the word “ snoop “ in the sense that they will inquire into one’s health, which is one of the most private of all things, and the diseases from, which one suffers. All of these matters are to come under the prying eyes of the officials. How can that be avoided if this scheme is to be put into operation? As the Minister in charge of the bill 3aid in relation to the free medicine service that there can be no control of a doctor without providing prescription forms, so in this case there can be no control without a host of forms. Under the Pharmaceutical Benefits Act only £2,000,000 was involved. A much larger sum is involved in this scheme. Unless the officials have the right to inspect the books and records of a doctor the Government will be unable to exercise the controls necessary for the proper working of this measure. How could they check expenditure except by reference to the records of the doctor and his patient? I regard this bill as presently framed as constituting one of the most serious infringements of our liberty. If such an infringement were necessary for the preservation of the health of the community we should have to bow to that necessity. But there is no need to do so. If the Government gave its attention to the establishment of diagnostic, therapeutic, X-ray and pathological treatment centres in which the most modern equipment was provided for the detection, prevention’ and treatment of disease, it would have enough on its hands without coming through the back door, as it were, and conscripting the medical profession. An examination of the provisions of this bill clearly shows what the Government has in mind. Under regulations to be gazetted it will provide that doctors who voluntarily come into the scheme will be granted compensation, but that those who are forced into the scheme by reason of competition from medical centres established by the Commonwealth, will receive no compensation at all. We know the methods that have been adopted by this Government in the past. We learned during the war how administrative blackmail was used to achieve ends which the Government had no constitutional power to achieve by direct means. It is on that feature of legislation of this type that I take my stand. Regulations will constitute one of the most vital features of this law Under a regulation the Director-General of Health may say to a patient, in effect, “ You must make a return as a person claiming the benefits of this scheme “ ; or, to a doctor, “ You must make a return covering all aspects of the treatment given by you to your patients “. If a doctor is called on the telephone the departmental officials will want to know for how long the telephone conversation lasted. If he is called out to visit his patient they will want to know how many miles he had travelled. All of us are aware of how difficult it is sometime? to get a medical man to attend a patient quickly. To-day, because all medical men are hopelessly overworked, I object very much to any portion of their time having to be taken np in the unnecessary provision of details relating to their practice or their patients in order to enable a scheme such as this, which is in no way necessary for the health of the community, to be put into operation. If the Government now says it will pay from 25 te 50 per cent, of the doctor’s fee, its next step will be to provide 75 per cent., and ultimately to pay the whole of tie fee. Bit by bit, by establishing its own medical services, the Government will strangle those medical men who do not come into the scheme. All the necessary power? are in the bill to enable it to do so. It is that concatenation of power to which I object. The bill will affect not only the medical but also the nursing profession.
Power is taken by clause 9 of the bill to make arrangements with a State for the performance by it of any service in connexion with a national health service. The Government may provide money for r.he establishment of a hospital or a nursing centre or any other facility that comes into the sphere of a national health scheme. The bill provides that if any money is made available to a State for any of these purposes, the Commonwealth may ultimately take over the institution or service without additional payment. Sub-clause 4 of clause 9 provides that in the event of the acquisition by the Commonwealth of property, the cost of which has been paid for by the Commonwealth, either in whole or in part, the Commonwealth may, at any time, without paying any additional money, acquire that property. That provision of itself is not what I am striking at; I am more concerned about the intention behind it. It constitutes a clear indication that the Government aims at achieving what it has been striving for for a long time past - the socialization of the medical and dental services of this country. Under clause 10, wide power is given to the Government to take over State hospitals and services. Under clause 11 the Director-General may, on behalf of the Commonwealth, enter into an agreement for the taking over by the Commonwealth of any medical or dental service and the whole or any part of any hospital, laboratory, health centre or clinic, or any property used in or in connexion therewith, not being a service, hospital, laboratory, health centre, clinic or property owned or provided by a State. lt is clearly the intention of the Government that it shall have power to acquire any integer that forms a part of health facilities, whether it be conducted privately or by a State. Such wide powers will give to the Government a complete stranglehold over the whole of the medical and dental services of the Commonwealth.
One feature which intrigues me and one to which, as far as I know, attention has not been drawn, is the provision in clause 14, which reads -
The Minister may, on behalf of the Com- monwealth, arrange for, or undertake, the manufacture-
And this is a very important matter - for the purposes of a national health service, of medical and dental supplies, appliances and equipment, including visual aids and-
As the right honorable member for North Sydney (Mr. Hughes) will be glad to know - hearing aids.
Shortly we shall be able or perhaps compelled to go to a government shop to purchase our hearing aids. Heaven alone knows what the price will be! Under this clause the Government takes power to manufacture the whole range of medical and chemical supplies, appliances and equipment. What is the reason behind its desire to obtain this extraordinary power’ It obviously is part of a scheme to give to the Minister power to control the whole field of manufacture of medical and dental supplies.
Now we come to clause 15, which states - (1.) The Director-General may, for the purposes of this Act, compile and publish a list of medical practitioners or dentists recognized by him as being specialists in any field of medical science or dental science.
Who is better qualified to determine who should be regarded as a specialist in the medical and dental professions - the Government or a man’s peers in his profession? Why cannot the Government establish something comparable to a university commission consisting of eminent professional men to prepare a register of specialists, rather than have the Minister or an official undertake the task? I know that the bill provides that the register shall be prepared for the purposes of the act, but I cannot see anything in it which explains the real purpose of the provision. Here, again, the iron hand of the Government is to descend on the medical and dental professions, and all will have to submit. Clause 22 gives the widest possible power to control the health services by regulation.
The only other clause requiring discussion is clause 18, which provides -
An officer of the Commonwealth who is registered as a medical practitioner, dentist, nurse, pharmacist, physiotherapist or otherwise under the law of any State shall be entitled to perform his duties, in relation to any national health service, in any other State or in any Territory of the Commonwealth, notwithstanding that he is not registered in that other State or in that Territory.
This clause, also, is designed to further the Government’s general purpose to assume complete control over the nation’s medical services. The Government is to take power to make regulations controlling health services, and practitioners are to he required to make returns upon which payments to them will be based. If the whole or almost the whole of their income is derived from the Government under these provisions they will become, to all intents and purposes, public servants. The Government is also to assume control of all State hospitals and private hospitals, as well as over the manufacture of drugs, and medical and dental appliances. These farreaching powers, combined with the provision that the Minister shall determine who are to practise as specialists, and with the further provision that medical practitioners nominated by the Minister shall be permitted to practise in any State, irrespective of the State law, make the bill a most objectionable one. I have no objection, and neither has my party, to a concrete plan based on clause 7, subclause 2 of which authorizes the DirectorGeneral to provide or arange for the provision of the following prescribed medical and dental services: -
For such a scheme there would be full support from this side of the House, but I am not prepared to give to the Government, or to officials acting under the direction of the Government, such farreaching power as would, in practice, reduce every man and woman associated with the medical and dental professions to the status of civil servants subject to economic compulsion.
– I am really astonished that a man of the intelligence of the honorable member for War- ringah (Mr. Spender) should make statements of the kind that he has made this afternoon. Take, for instance, his reference to specialists. Who now decides whether a man shall become a specialist? Except in the State of Queensland, where there is an official register of specialists, any medical practitioner may put up a plate and call himself a specialist.
– What is wrong with that?
– I am replying to the honorable member for Warringah, from whom one might have gained the impression that, at the present time, the register of specialists is compiled by a body of qualified professional men.
– The public decides.
Mr. ACTING DEPUTY SPEAKER (Mr. Sheehy).- Order! The last two Opposition speakers were heard in complete silence, and I insist that a similar courtesy be extended to the Prime Minister.
– Macquarie-street, Sydney, is choked with specialists, many of them highly skilled in their profession, but many who came from the ranks of ordinary medical practitioners, merely put up a plate and called themselves specialists. As I have said, only in Queensland is there an official register of specialists, and that is compiled under a Labour government.
Let us now consider one or two other observations of the honorable member for Warringah which were greeted with applause by the Opposition. He spoke about the doctor sitting all night at the bedside of a woman who was going to have a child. That is sheer nonsense. He also spoke about the doctor being on duty all day and all night, waiting for a call. That, too, is sheer nonsense. I know personally three doctors who were in the armed forces during the war, and they make a point of having every second week-end off duty. They do not wait about for sick calls. They make out a. roster for themselves, because when they were in the services they became used to having week-end recreation. They are not in the habit of waiting around for 24 hours on end for somebody to get sick or for a woman to have a baby. It is also true that in many country towns the doctors have prepared a roster which enable all except one to go off duty at certain times. If a person rings for a doctor who is off duty he is told to ring one of the others. If there is an ambusince service in a district the doctors almost inevitably direct that a person who is suddenly taken ill shall be taken to a hospital, where in most instances there is a resident medical officer. I am not qualified to speak of the professional work of doctors, but I have taken the trouble during the last six months to learn what goes on in at least four of the States. As a matter of fact, I warmly approve of what the doctors are doing. I do not believe that it is right that a doctor should stay on duty for 24 hours at a stretch, and they are not doing so. Quite recently, in a country town not very far from here, a woman who was in great agony rang for a doctor, and the doctor ordered the ambulance to take her to the hospital. During the war, when doctors were overworked and very tired, they often refused to turn out at night, and I do not blame them, because they were already exhausted. The medical profession is one in which a man needs to be in good condition, and to be in possession of all his faculties. A medical practitioner should not be asked to remain on duty for 24 hours a day. As to the story of medical men sitting by some one’s bedside, all I can say is that it is sheer bunkum. That kind of talk goes back to the days of Queen Victoria, and perhaps even farther back than that.
It is now almost impossible for men in the lower income groups, and perhaps in the middle income groups as well, to provide for their families the medical attention that they received formerly. The cost of such attention is approximately four times what it was previously. [ do not criticize the increased costs, because it may be that the community is now receiving more highly skilled medical attention than it wa9 given hitherto. A comparison of the number of specialists in Macquarie-street and Collins-street now and twenty years ago shows what has happened. There has been specialization in medicine. I pay great tribute to the work of the medical practitioners in the country. What I am about to say is also, I think, true of the general practitioners in the towns. Thousands of them gave their services free of charge during the depression, when times were bad, and they do so now when people are in need. In my opinion, of all the branches of the medical profession they render the greatest service to the community. Those remarks do not apply with equal force to the highly paid specialists, who work only for certain hours.
– Most specialists give a great proportion of their time to public hospitals free of charge.
– I admit at once that many specialists give their services free to hospitals and other institutions. I am not taking that credit from them.
– What is the right honorable gentleman doing? Is he sneering at them or praising them?
– Let me refer to a specific instance which was brought to my notice recently. It is only one of hundreds of similar cases. A man who had something wrong with his inside consulted his local doctor, who was not able readily to diagnose the cause of the trouble. He paid his doctor the ordinary fee of 10s. 6d. The doctor sent him to a hospital within a reasonable distance of his home to have a number of X-ray photographs taken. The cost of the photographs was £2 2s., and the man had to pay another £1 ls. to a radiologist to have the photographs read. Subsequent to that, it was decided to send him to a specialist in Sydney. He went to Sydney and consulted the specialist, who charged him a fee of £2 2s., and then sent him to an X-ray specialist. By this time the man had lost four days’ work. He went to the X-ray specialist, who. charged him £10 10s. for special X-ray photographs. He was instructed to take the plates to the specialist to whom he had gone previously. The specialist charged him another £1 ls. and then wrote out some instructions. Those instructions were sent to the local practitioner, to whom the man went again and by whom he was charged another 10s. 6d. Let me cite another example that was brought to my notice yesterday. An artisan, who had something wrong with his foot, consulted his local doctor. The fee for that consultation was 10s. 6d. The doctor, having examined him, decided to send him to a specialist in Sydney. He went to the specialist, whose fee was £2 2s. By this time the man had lost two days’ work. He was then sent to another specialist to have a cast of his foot taken. The cost of that was £2 2s. He returned to the first specialist, and was charged CI ls. Those are facts.
Although the development of medical knowledge may have been very great, the cost of medical attention now imposes an almost intolerable burden upon people in the lower income groups. That is all that I desire to prove. If that be admitted, there is complete justification for the Government’s action in setting out to reduce that burden. I could give other instances of what it costs ordinary working men in lost time and fees to attend all these specialists. Some cases that I know of are worse than those to which I have referred. The Government, realizing that the cost of medical attention and medicine has greatly increased, proposes to pay 50 per 3ent. of the cost in order to lighten the burden on the community. It is almost an intolerable one for a man in the lower income group who has a wife and family. Reference has been made to doctors filling in forms. Does any honorable member know of a doctor who has not an assistant to prepare his accounts and deal with his correspondence?
– What about the country doctors? One never sees a girl assistant in a country doctor’s office.
– One of the complaints of the city press is that I am too much of a country man. I do know something about the country, but I do not know of a single country doctor who has not got an assistant to prepare his accounts and do similar work.
– If the right honorable gentleman will come with me to the north of New South Wales, I can introduce him to many doctors who have no assistants.
– The English doctors in Harley-street could tell us something about filling in forms.
– I know something about them, too. All that a doctor will be asked to do is to furnish a return showing the people he’ has attended and what they have been attended for. Is that too much to ask of the medical profession of this country?
– Does the right honorable gentleman say that the return must specify what the patients have been attended for?
– The honorable member for Warringah and the Acting Leader of the Opposition (Mr. Harrison) referred to the details of the form, and 1 do not propose to read them to the House again.
– Did I understand the Prime Minister to say that the doctors-
Mr. ACTING DEPUTY SPEAKER (Mr. Sheehy). - The honorable member for Fawkner (Mr. Holt) must not interrupt.
– This is a very important matter, and I think the House is entitled to a frank answer to the question that I have asked.
– Order! The Prime Minister has the floor.
– If the Prime Minister does not wish to answer my question, we shall have a debate on it.
– The honorable gentleman may debate it for as long as he likes.
– Why is the Government not frank about it?
– The Acting Leader of the Opposition read the details of the form. Doubtless the honorable member for Fawkner has a copy of it in front of him now, although he is asking me to go through it again.
– The form does not say what the Prime Minister said.
– Order! The honorable gentleman is not entitled to interrupt. He will not be warned again.
– Is the Government to stand idly by and allow this burden to continue to be placed upon the people ? Is it to make no attempt to ensure that the people are able to secure medical attention at a reasonable cost? In Britain, the medical profession has accepted Mr. Bevan’s health scheme by a decision of its own executive.
– They are not very happy.
– Many people are not happy. For example, members of the Opposition are not happy because they do not occupy the treasury bench. I have heard complaints that wharf labourers and coal-miners display no logic when they stop work for allegedly trivial reasons, but never in the history of this country has there been a stand less defensible than the attitude of the medical practitioners who have contested the Government’s proposals in this bill. I am not able to deal with the details of free medicine, because the Chair has ruled that it will not be in order to discuss that subject on this bill, but I point out, in passing, that younger doctors do not prescribe in the way that older doctors did. They recommend to patients proprietary medicines and tablets for certain complaints, Insulin. penicillin and liver extract were unknown to doctors years ago. A younger doctor diagnoses the disease from which a patient is suffering, and gives him, not a prescription, but an indication or direction of what to obtain from the chemist. The formula for that drug or medicine may have not been discovered by a doctor. The honorable member for Warringah has referred to the .nationalization or socialization of the means of production. Probably the greatest romance in the history of Australia is the development of the Commonwealth Serum Laboratories, which supply drugs to the public at a cheaper rate than they are being sold in the United Kingdom to-day.
– That statement does not apply to penicillin.
– For the purposes of illustration, I shall cite a few examples such as insulin for diabetes and liver extract for anaemia. Suppose a working man suffers from diabetes. The doctor requests him to call at his consulting room for examination once or twice every two months. The doctor does not write a prescription for that patient, but gives him a direction to the chemist to supply insulin, or protomine zinc insulin. I emphasize that the doctor does not write a prescription for the diabetic. He only diagnoses the disease, and the patient obtains the drug from a chemist. It is to the discredit of the medical profession in Australia that its members are not prepared to give that kind of treatment to such sufferers. A doctor has prepared a list showing the cost of insulin treatment. If the doses are large the cost may be 6s. 8d. a week.
– Was the list prepared bv a “ scab “ doctor ?
– The honorable member for Wide Bay (Mr. Bernard Corser) may obtain this information from diabetics. The list of costs was prepared, not by a departmental officer, but by » doctor. The cost of insulin treatment ranges from 3s. to 9s. 4d. a week. Can anybody say that the doctors are justified in denying workers the right to be supplied, at government expense, with such drugs? Persons who are suffering from anaemia require certain kinds of liver extract. The modern doctor has abandoned the old idea of the bottleofmedicine treatment, and issues an order or instruction to the chemist to supply « proprietary line.
– Does this bill deal with free medicine?
– Order! Members of the Opposition claim the right to be heard in silence, and they must extend a similar courtesy to the Prime Minister.
– The Chair has ruled that members of the Opposition will not be in order in referring to free medicine.
– I have not mentioned free medicine. I have been referring to doctors’ prescriptions. The bill proposes that such unfortunate persons as those suffering from diabetes and anaemia shall pay for medical attention only one-half the fee that the doctors require for their services. The particular drugs that doctors will order will be supplied to patients free of charge if the doctors will co-operate. Are doctors being humane when they refuse to co-operate in such a scheme? Members of the Opposition frequently deplore the introduction of socialization schemes. I hope that, one day, the story of the Commonwealth .Serum Laboratories will be told.
– The Commonwealth Serum Laboratories were established after World War 1.
– I am not seeking to take the credit for the establishment of the Commonwealth Serum Laboratories. I am merely pointing out that it is a socialized organization for the benefit of the community, and that it supplies the drugs which sick people require at the cheapest possible rate. While paying its own way, it makes drugs available to the community at a rate which private enterprise would regard as too low. In my speech, I have been dealing with the human aspect. I desire to explode the idea that doctors sit in their surgeries for 24 hours a day awaiting telephone calls from patients.
– I did not make that statement. The Prime Minister is deliberately exaggerating my words.
– There is another development in medical services. Years ago, the spectacle of two or three doctors calling on patients in the one street was a common sight. That has disappeared. One town in my electorate has a population of approximately 16,000 people, and fourteen years ago the daily average number of beds occupied in the local hospital was twenty. To-day, the average is 128. The reason is that doctors send sick people to hospitals for treatment instead of attending them in their own homes. Such a system has many advantages, and, for that reason, the Government is providing hospital benefits.
– Doctors have difficulty in obtaining hospital beds for their patients.
– The honorable member for Wide Bay does not go around with his eyes closed. He is perfectly well aware of what is happening. If a patient has an ailment more serious than a cold 1 in the head or some other minor complaint, the doctor secures his admission to hospital, provided a bed is available. I have studied the matter closely. Some honorable members opposite have stated that the Government has not the constitutional authority to take the powers proposed in this bill. I remind them that at a referendum a couple of years ago, the people conferred such powers on the Parliament of the Commonwealth. Evidently, the Opposition objects to the Government exercising power which the people grant ro the Commonwealth at a referendum, just as strongly as they object to the Government exercising power which it considers it possesses under the Constitution.
– The power was given to the Parliament and not to a Minister.
– Although that is really funny, the people decided, at the tine time that they carried the referendum, that the Australian Labour party should continue to be the govern ment of this country. As honorable members know, the Government is the Executive of the Parliament. The point that I make is that at the time that the referendum was carried, the .people of this country overwhelmingly returned the Labour Government to office. I rose to speak only on the humane side of thismatter, not of the technicalities that have been mentioned by some honorable members opposite. It ha? been suggested by the Opposition that in many instances doctors sit beside sick beds day in and day out, and do not have time for recreation. No one knows better than the honorable member for Franklin (Mr. Falkinder), who was in the services, that when the time comes for doctors to take recreation leave, they invariably do so. I know of three doctors who were in the Royal Australian Air Force, who always managed to obtain recreation leave when it was due to them.
– I happened to’ be in the Royal Australian Air Force, and know that in many instances medical officers could not take their recreation leave.
– If the honorable member does not behave himself he will happen to be outside this House. He is a perfect nuisance, and interrupts every honorable member who speaks.
– This Government hopes to give to the great mass of the people free hospital treatment, subsidized medical treatment, and free medicine. Is not that a commendable objective for a democratic government? If any honorable member opposite, who opposes that objective, is prepared to go on the hustings and speak accordingly, I should be glad if he would announce himself. The other day there was a meeting of 350 doctors in Macquarie-street, Sydney. I wonder how many of them, were general medical practitioners? 1 strongly suspect that the majority of them were Macquarie-street specialists. They decide that they are specialists. Nobody else does that. I have read a lot of articles about co-operation. Never before has a Minister of the Crown in this country made such efforts to achieve cooperation with the medical profession as has the Minister for Health (Senator McKenna). I am not referring todentists, because it is well known that there is an acute shortage of dentists in this country. If any honorable member should doubt that assertion, he will readily find it to be the truth if he has occasion to seek the services of a dentist. I point out, also, that many children are’ not receiving adequate dental attention, because of the shortage of dentists. The Minister has attended conference after conference, many of which have lasted throughout the day. Although I do not know whether my thought is wellfounded, I suspect that the people who represent, or claim to represent the British Medical Association, are shell-backed old conservatives. That spirit is not confined to doctors’ organizations. To my knowledge the same thing happened in connexion with engine-drivers years ago. It is the creed of the old craftsmen in industry that nothing new is wanted. The claim is made that the miners do not want mechanization of the mines by the introduction of new types of machinery. The old men in the profession do not want anything changed. They want everything to remain as it is. But it is not going to remain as it is. An honorable member has said something about consultation. The British Medical Association has been offered representation on every committee which has dealt with these matters. Although the association was offered representation on the committee which drew up the free medicine formulary, it refused to be represented. It even refused to appoint nominees. “With regard to the schedule of fees, to which the honorable member for Reid (Mr. Lang) referred, the British Medical Association was asked to endeavour to reach agreement by conference. In every instance the association has been asked to co-operate with the Government. In pointing this out, however, I also pay high tribute to many members of the medical profession who have done much for the people of this country. In many instances they have charged reduced fees, and in some cases they have made no charge whatever. It will be a disgrace to the British Medical Association if that organization refuses to co-operate with the Government in the interests of humanity, to put this scheme into effect.
The honorable member for Warringah (Mr. Spender) spoke about the establishment of health centres. I do not propose to deal with that aspect at present, although it is inevitable that finally, as a. result of the high cost of specialist treatment, there will have to be established big centres where people may, by appointment, be thoroughly examined, irrespective of whether they suspect that there is anything the matter with them or not. Following such examination they would be issued with a card containing full particulars of their medical history and condition at that date. Those cards could then be taken to a medical practitioner in any part of the world, if the persons desired to obtain medical attention. Until that stage is reached, it will not be possible for people seeking treatment to avoid the very high expense associated with their having to go from specialist to specialist to receive medical attention. I know of one instance when it was necessary for a man, in connexion with the one complaint, to visit nine different specialists, at a cost of £18 18s. for the first visit to each of them. I do not say that the medical specialists do not provide good service. But matters have reached such a stage that, in the majority of instances, it is too expensive for the average person in this country to obtain proper medical attention. If the British Medical Association continues in its present attitude, I have no doubt about long-term plans that will have to be adopted. Ultimately the Government of this country, and those of other countries, will have to undertake the initial training of their own doctors, and, if necessary, send them abroad for additional training. The attitude of the British Medical Association in refusing to co-operate with the Government is difficult to understand, because it is not intended that the doctorpatient relationship shall be affected in any way. In the long run the people of Australia will demand that the government of the day shall provide many things, such as those that the honorable member for Warringah now condemns. The first requisite is that a proper medical service should be provided for the people at a reasonable cost.
.- The “ give them a fair go “ attitude that the Prime Minister (Mr. Chifley) adopted in the later stages of his speech, is a very formidable weapon when used in this House and in political broadcasts. The real sting in the Prime Minister’s remarks was contained in its opening sentences. He quite clearly showed that this legislation is the forerunner of other legislation to nationalize all the medical services of this country. The right honorable gentleman clearly showed, by his spleen, his distrust of doctors. It is indeed regrettable that the Prime Minister has seen fit to so attack the medical profession of this country. That augurs ill for future co-operation between the medical profession and the Government. The right honorable gentleman also saw fit to make sneering remarks about specialists. He said that a doctor himself, by deciding that he is a specialist and by putting his plate up in Macquariestreet, Sydney, can proceed to rob the public. That is anything but the truth. A specialist is chosen as a result of the esteem of his fellow practitioners. Other doctors decide whether a medical practitioner has a sufficiently wide knowledge to entitle him to specialize in certain treatment, and the general practitioners then send patients to such specialists.
The honorable member for Warringah (Mr. Spender) voiced a fear that is very much in the minds of the people of this country, and, indeed, of some honorable members, about the severe limitations that will be placed on our medical services should they be nationalized. The honorable member instanced particularly the cases of people who are very sick, and of women awaiting confinement, who may require the services of doctors at all hours. The Prime. Minister ridiculed that idea, and said that it was all nonsense and bunkum to suggest that doctors were available at all times. Having had a good deal to do with doctors in the past, I take this opportunity to say how very unfair that suggestion is. If there is any section of the community that gives as much service to the people as do
[HO]
the medical practitioners in this country, I have yet to hear of it. It is quite clear that the Prime Minister’s attitude is that the doctors must be compelled to give better service. He spoke about doctors refusing to go out at night, and taking week-ends off. Is that a crime ?
– The right honorable, gentleman said that he did not disagree with that.
– If the Minister for Commerce and Agriculture (Mr. Pollard) wants .to contribute to the debate, perhaps he may have an opportunity to do so later. The Prime Minister attacked the medical profession in a most deliberate way. He referred to doctors who take the week-ends off, and said that they learned that habit in the Army. I point out that the Army and the Air Force provided examples of nationalized medical services. Having served in the Army, I have some knowledge of the conditions of service of medical officers. I shall comment further in this connexion at a later stage. The Prime Minister also spoke of mythical creatures walking around from specialist to specialist to be X-rayed, and to seek treatment. If I may say so, such people exhibit very little nous. The right honorable gentleman also said that, to his knowledge, . a man had had to pay £5 5s. to receive specialist attention in order to rectify some trouble that had developed in his foot. Although that is quite a substantial payment for a person on the basic wage to have to make, conceivably that man had spent far more than £5 5s. on beer and cigarettes over a few months. On what basis is it suggested that everything connected with medical services should be provided free ? Ultimately, the burden must be borne by the taxpayer. Whether this contention be popular or not, there is no reason why people should not pay some portion of the cost of medical attention provided for them, just as they have to pay for haircuts and other services. So far as the Minister’s reference to shell-backed old conservatives is concerned, I point out that the British Medical Association must be very happy that such an opinion should be held about its executive by those with whom they are expected to work. However, I should like the right honorable gentleman to glance at the members of his Cabinet. The truth of the matter is that those gentlemen cannot change ideas that they held 20 or 30 years ago, when socialism was all the rage. They acquire a certain bitterness and dislike of institutions which are a feature of our life. That is emphasized in the nationalization legislation with which we are so familiar to-day.
Leaving that aside, I take it that there are two reasons for the bill. The first is that the Government considers that there is a general shortage of medical services in Australia, and, the second, as the Prime Minister (Mr. Chifley) was at pains to point out, is that many people in the community are unable to pay for adequate medical services. Let us consider the primary consideration, that of shortage. We do not need to embroider that. There is a shortage of doctors, dentists, nurses and everything to do with medicine. If a woman wishes to bear a child, she has practically to go to a gynaecologist to learn whether she will be able to have it with proper attention and in proper comfort, so great is the call on hospitals and the shortage of hospital facilities. This bill is not primarily a bill to deal with shortages. The Labour party has been in office for eight years and the position in relation to hospital accommodation and medical service has never been so difficult as it is at present. The truth is that there are fewer hospital beds now than there were before this Government came into power.
– Bosh!
– The Minister says “ bosh “. Let him look around. In this capital city, there were two hospitals a little while ago, but now there is only one. Let him go to Melbourne where hospital after hospital is closing down as a direct result of the policy maintained by the Government until a few months ago. If the Government had been sincere in its desire to overcome shortages, it should have done something long ago. But it uses the shortages as an excuse to reach out and grab control of every aspect of medical service in Australia. That is the first point I wish to make. The bill does not provide a means of overcoming the shortage of doctors, nurses, hospitals, clinics or anything of that sort. The honorable member for Warringah drew attention to the ease with which the Government, by means of this legislation, will be able to take control of every branch of medical service in Australia. I direct attention to one or two aspects of that matter. The Minister told us that government dental trainees were prohibited from engaging in private practice at any time. Under the bill, the Government will have the power to take over any hospital at any time. It will have the power to take over institutions that train doctors. In other words, in the not far distant future, if the Government takes over training hospitals - and we know that it intends to take over certain of them very soon - the young trainee doctors will be in the position of government doctors, because they will be working in government training institutions, and they will be subjected to the same conditions as the dental trainees are now subjected to under the Commonwealth reconstruction training scheme. They will be forbidden to engage in private practice. It is quite easy to foresee that soon private practice will -be forbidden in this country. If that is not so, why does the Government propose to take the power into its hands to make this provision for dental trainees?
What is the real purpose of the bill? It is primarily a bill to nationalize in a particularly odious form by regulation and not by an act of parliament every doctor and every nurse. Every hospital, whether it is owned by a church, by the Freemasons or by private persons, will be taken over regardless of how well it is being run. It is proposed to take over every facility of that character in the country and it is to be done in a particularly underhand way, because it is proposed that it shall be done although it is forbidden by the Constitution. By economic pressure the hospitals will be forced out of business or forced to accept government domination. The real purpose of the bill is to nationalize the medical services of Australia. Medical service will be under the control of the Government in exactly the same way as the repatriation medical service is under its control. The Prime Minister referred to army doctors. I propose to say something about them and also about repatriation doctors. In the army, where people were without freedom in the real sense, there was a perfect example of a national medical establishment. On the whole, it was good; but certain aspects of it I should not like to see extended to the whole community. First, the patient had no choice and, secondly, he had no privacy. If anything went wrong with a man, it became known immediately among his friends and officially from the top to the bottom of the organization. That is a condition without which nationalized medicine cannot operate.
– Nonsense !
– The Minister, who again interjects disparagingly, knows perfectly well that the forms that are to be issued require that all facts must be stated on them. I shall come to that phase later. In the army, if one had the services of a good doctor, one was fortunate, but, if one did not, nothing could be done about it, because there was no appeal and no choice. Let us examine the repatriation medical service. I do not enjoy speaking against the medical side of repatriation, and I would not do so unless I had consulted eminent men associated with it. I have talked with experts, one of whom is a leading surgeon in Victoria, who has been, praised in the highest terms in this House. By a recent act of this Parliament, the Repatriation Department was brought under the control of the Public Service Board. Repatriation hospitals also came under that control. So the repatriation hospitals are administered by public servants. In other words, a medical service is being administered by laymen. I am assured by doctors, who, in a voluntary capacity, give of their best for a very meagre fee, or no fee at all, that the service given by the repatriation hospitals is deteriorating under the present administration. [ am assured, too, that owing to lay administration and the general Public Service rules and regulations, many of the repatriation hospitals are in difficulty. One in particular that used to attract first-rate men can attract them no longer. They will not put up with such control. Consequently, that hospital, and others like it, are attracting only second-rate men and the patients are getting only second-rate treatment. I am assured on the highest authority that patients are being inconvenienced unnecessarily because the medical service, which formerly had a strong voluntary tinge, has been taken over by the Government in exactly the same way as it will be taken over in other hospitals when this bill become law. Standards have fallen. I know men who, rather than go to repatriation hospitals for treatment, go to private doctors. I am one of them. I would not tolerate the waste of time at repatriation hospitals. I would sooner go to some one I know and can rely on. No outcry has been raised, I am told, ‘because the Repatriation Department is now a government department. The forms are carried out and, if anything goes wrong, the death certificates are filled in in the same order. That system is proposed to be introduced all over Australia, even in hospitals conducted with great success by religious orders. It is proposed to subject those hospitals to departmental control. It is utterly fantastic to pretend that the community can reap any benefit from that procedure which will ultimately reduce every hospital to the generally low level that has become apparent already in certain quarters. This legislation cannot raise the medical standard of Australia. In fact it will reduce it to the disadvantage of a great many people in the community. To-day, if we need to go to a doctor, we go to his home or to his rooms in the city. To-morrow, when this scheme comes to fruition, the people will have to go to a government office. We know the procedure. They will have to queue up, go to a grille, answer questions and fill in forms in triplicate and quadruplicate. Those forms will be available to every one who wants to look at them. It is useless to deny that. We have had an example in this House of people looking at confidential documents and divulging their contents. The Minister says, “ Medicine for the People “. When the public official is the main person, it will be hard for ;a private citizen to get service. Ministers will be all right. So will senior public servants. Every one with a little influence will be ,able to get his just dues through the nationalized service, but the ordinary person will he in the same position as when he is seeking repatriation benefits, age pensions or unemployment benefits. In other words, he will be treated as though he were trying to get something for nothing. That is the way in which the ordinary citizen, the alleged beneficiary, is always treated under these schemes.
I know that the medical service for the people of Australia is not uniformly good and I do not pretend that it is. Honorable members rise and talk about the sanctity of the doctor-patient relationship and the choice of medical advisers and what a good thing that is for many people in this community. I recognize the truth of the claim of honorable gentlemen opposite that, because of economic circumstances, many people do not have the benefit of that relationship or that choice at all. Therefore they, in a sense, have nothing to lose. Many people have to take what they can in medical attention, and what they get, I admit, is, to a large degree, rough and ready and devoid of consideration, dignity and human feeling. This bill will not alter that. On the contrary, it will merely intrude those unpleasant institutional characteristics into the whole field of medical service. But most people in Australia have something to Jose as far as medical standards are concerned, because internationally our medical service has a good reputation. I believe, despite what the Prime Minister has said, that most medical men in Australia give great service willingly and, to a large extent, freely. We have something to defend and something to lose, and we should look twice before we assign such an important aspect of our lives to the mercy of the man at present administering the Department of Health. If the Government wishes to improve medical services, let it, by all means, proceed with the establishment of the services set out in clause 7 of the bill. Of that I heartily approve. Let it provide dental services and, in certain areas, .medical services for children. No one would challenge the correctness of the Government’s action in proposing to engage in activities of that kind. If the Government is sincere, it .should take notice of .the suggestion made by the honorable member for Darwin (Dame Enid Lyons) that it should establish throughout the Commonwealth hospitals specially devoted to the care of maternity cases. There is .a great shortage of such hospitals to-day. Obviously the reason why the Government ignored that suggestion is because it is imbued with the desire to reach out and .grab control of everything. Let it consider increasing the allowable tax rebate in respect of payments made for medical services. At present a taxpayer is permitted to claim a rebate in respect of medical services for himself and for dependent members of his family of a maximum of £50 each-
-Order! The hill provides the honorable member with sufficient scope to discuss this subject thoroughly without going into the matter of tax rebates.
– I merely wish to say that if this bill is passed taxpayers will presumably be able to claim a rebate in respect of only half their medical expenses. What will happen to the other half’? If a taxpayer now receives a bill from his doctor for £10 10s., presumably he has received medical attention of that value. If this measure be passed, he will get £5 5s. worth of medical attention and £5 5s. worth of administration-
– The tax would not be-
-Order ! The Minister should not provoke a discussion on taxation which is irrelevant to the bill.
– I cannot see how the people will benefit from this legislation. It will not benefit those whom the Prime Minister claims cannot afford to pay for medical attention. In these days doctors are so busy that they have no time to devote to the filling in of forms. Eminent medical men will not be attracted to the scheme by the prospect of having to subject their professional conduct to the supervision of bureaucratic laymen in the Public Service. Good doctors will be so busy that they will not be able to find time to see all the people who will want to consult them if this scheme be given effect to. They will not be bothered treating people who come under this scheme because they will not have the time to do so. They will have to take their choice between medical duties and clerical duties. I see in this proposal an attempt to reduce the medical profession to the basis of a branch of the civil service. If this bill becomes law doctors will lose the feeling that they owe certain free services to the community which form a not insignificant part of the medical services of this country. Everybody knows that most of the specialists at whom the Prime Minister so obviously sneered . are honorary -officers at public hospitals and give the benefit of their skill and treatment for the most part free of charge to the patients concerned. Nobody wants this bill. There has been no public demand for a national health service. The doctors do not want it; the nurses do not want it; and the hospitals do not want it. So far as I can see, the only people who want it are those who support the socialistic aims of this Government.
– This is the kind of measure about which, normally, most people are reluctant to talk. That reticence is due to the fact that it deals largely with members of the medical fraternity, whom most people are unwilling to criticize because they never know when they may find themselves on the surgeon’s table or in a hospital bed, where they are beholden to the very medical men they have criticized. I have benefited greatly by medical care and attention and I, and, in fact, the people generally, hold the highest opinion of members of the medical fraternity. It was most obnoxious to me to hear the honorable member for Henty (Mr. Gullett) so completely misconstrue the speech of the Prime Minister (Mr. Chifley) on this bill. The right honorable gentleman did not make one remark derogatory to the medical profession. He referred to the fact that fees for their services are usually so high that the ordinary working man with a family to look after cannot possibly afford to pay without involving himself in serious financial difficulties. That in itself does not constitute a reflection on the medical profession. A fortnight ago, I had the good fortune to be invited to attend a dinner given by a branch of the British Medical Association. One speaker at the function referred to the four freedoms as set out in the Atlantic Charter, without specifically mentioning them. Later, another speaker specifically men.tioned the four freedoms as freedom of worship, freedom of speech, freedom from fear and freedom from want. He pointed out that, because of its earnest belief in the four freedoms, particularly in freedom from want and freedom from fear, the Labour Government of this country, and this Government, had sponsored the bill now before us. For the same reason it sponsored the pharmaceutical benefits legislation so that people in receipt of moderate incomes, as well as those on the higher income brackets, if they so desired, might be assured of freedom from fear and freedom from want in their hour of sickness and trial. General Norris, whose name was mentioned in the debate to-day, who has rendered magnificent service to the medical profession and, through it, to mankind generally, was present at that function and addressed the gathering. As I listened to his speech I could not but be impressed by his belief in the infallibility of the medical profession. His belief in the infallibility ‘of the profession was as strong as the belief of some of the older members of our community in the infallibility of the conservative policy adopted in this country some years ago, about which the Prime Minister had something to say this afternoon. Many workers in the community, whether they be engineers, artisans, or doctors, have a strong belief in the infallibility of the practices of their calling or profession. The honorable member for Henty characterized this bill as a step towards the nationalization of the medical profession. He is well aware that under its constitutional powers the Government has no authority to nationalize the medical services of this country. He knows that under the powers granted to the Commonwealth as the result of the referendum on social services the Government has no authority to conscript members of the medical profession. The honorable gentleman said, and I contest his statement with considerable feeling, that following the passing of the bill which placed the Repatriation Department and all its officers under the Public Service Act, there had been a serious deterioration of the repatriation services to ex-servicemen in this country-
– His statement was absolutely untrue.
– That is so. As a matter of fact, the legislation to which he referred has been in operation for only six months. To say that because some change has been made in the control of the Repatriation Department exservicemen and the inmates of repatriation hospitals do not now receive the same efficient medical attention as they received in the past is a gross reflection on members of the medical profession. The honorable member covered himself by saying that he had been told that that was so by a medical practitioner who had formerly practised at a repatriation hospital. I challenge the honorable member to state the name of the gentleman concerned and to produce evidence to prove his statement. Our repatriation hospitals are conducted in a highly efficient manner. The standard of efficiency to-day is as high as it was under the earlier form of control. Medical practitioners and specialists are still giving their aid and providing their services to repatriation hospitals with the same generosity and efficiency as in the past. I have heard a good deal about the so-called objectionable features of the treatment received by wounded, injured or sick servicemen in field hospitals during the war. Nowhere, at any time, has suffering humanity been better cared for than in the hospitals established by the Army, Navy and Air Force during the war. I was more than astonished that the honorable member for Flinders (Mr. Ryan) should criticize this proposal for the provision of a national health service. I had the good fortune to be a patient of the honorable gentleman’s late famous father, Surgeon-General Sir
Charles Ryan, who rendered distinguished service in restoring to health wounded and sick soldiers. His services to the Australian forces in the field and his direction of the army medical service remain unexcelled. The specialist service provided by the Army Medical Service is equal to that provided in any public or” private hospital in Australia to-day. I was astonished at the conservatism exhibited by some honorable members opposite, who feared that disasters would occur if portion of the fees charged by medical practitioners were met from the Consolidated Revenue Fund. I have not heard any complaints by ex-servicemen about the treatment they have received in repatriation hospitals.
– That treatment is provided solely by doctors acting in a temporary capacity.
– The repatriation hospitals are staffed with permanent doctors who have the services of honorary doctors to assist them on a temporary basis. Does the honorable member say that the doctors who render such voluntary service would become less efficient or less conscientious if they were full-time officers in the employment of a department ?
– But they are not civil servants.
– It makes no difference. Would the honorable member admit that if he were laying bricks on the building job at Parliament House he would render less efficient service if he was working for the Government than if he were working for a private contractor ? I am sure he will not make such an admission, and he is not entitled to assume that he would be more conscientious in this respect than would other members of the community. We do not hear complaints from patients in the Canberra Community Hospital about the service rendered to them by the nursing staff and the medical superintendent, Dr. Nott, all of whom are salaried officers of the Commonwealth Health Department. I know that Dr. Nott does not practise much, but is it asserted that the service which he renders to his patients is less efficient than that rendered by the honorary medical officers who visit the hospital? I know, of course, that no one likes to criticize his family doctor for not accepting the free medicine scheme under the Pharmaceutical Benefits Act, or for showing hostility to the Government’s plan for a national medical service. Every one is, of course, entitled to his opinion, and a great many people are not prepared to criticize their doctor. A person never knows the moment when he may have to call upon his doctor for help. I do not suggest that a doctor would be likely to do less than his duty because he differed from his patients on a matter of policy. The fact remains, however, that this general reluctance to criticize the behaviour of their doctors would prevent most people from signing a petition protesting against the non-co-operation of the medical profession, which is preventing people from getting free insulin or penicillin or other drugs. It is true that members of the medical profession have given wonderful service to the community, much of it free, and much of it at a very low cost. It is left to the doctor himself to determine what he shall charge. I point out that many people who put a good face on things, and appear prosperous, are not really so well-off as they appear to be. Such persons may be charged by their doctors higher fees than they can afford to pay in order to make up for the free service which is given so generously to those who cannot afford to pay. That sort of thing could not happen under a national medical scheme.
I trust that this bill will be passed. I am sure that it will be, and I do not think that the doctors have anything to fear from it. Bather will it improve their position, give them more opportunity for recreation, and ensure to the people a better service. It has been claimed that, father than introduce a scheme of this kind, the Government should concentrate upon providing facilities for the education of more doctors. As a matter of fact, because of the Government’s reconstruction training scheme, and because of assistance to parents, more young people are receiving the necessary education at the universities to enable them to become doctors than has ever been the case before, and I hope that the shortage of doctors, arising out of the war, will soon be overtaken. At present, there is a deep gulf between the British Medical Association, which believes itself to be infallible, and the Government, which is convinced that a national medical service is in the best interests of the community. I hope that it will be found possible to bridge this gulf in the interests of the people generally.
– I greatly regretted to hear the Prime Minister (Mr. Chifley) attack the members of the medical profession, and I appreciate the tribute paid to specialists, and to medical practitioners generally, by the honorable member for Henty (Mr. Gullett). One reference by the Prime Minister leads me to mention the Canberra Community Hospital. The right honorable gentleman said that at that hospital the public could obtain all the medical atention they needed. In the last few weeks, I have suffered from an illness, sufficiently severe to cause me to become a patient at the Canberra Community Hospital for one night and I pay a high tribute to the nursing staff and the medical superintendent for the attention I received. That, however, is not the last word on the subject. Canberra doctors will themselves admit that the equipment at the hospital is not in all respects so good as that which is available in the consulting rooms of some specialists in Macquarie-street, Sydney. I had been X-rayed at the Canberra Community Hospital with inconclusive re* suits. I was advised to visit a Macquariestreet specialist and did so. There, after many X-ray photographs had been taken, satisfaction was secured. The Prime Minister has suggested that specialists charge more for their services than they are entitled to receive. I point out, however, that specialists have a great deal of expensive equipment, which includes, not merely one couch upon which patients lie for X-ray examinations, but six. Surely a specialist, who has invested a large amount of capital in equipment, is entitled to an adequate return ! The Prime Minister complained that penicillin treat. ment, which he claimed should cost about
Idi. a week, cost a great deal when administered by specialists. It ought to be evident to the right honorable gentleman that the specialists are charging, not merely for the penicillin treatment, but also for the skill and experience which enable them successfully to diagnose the patient’s disease. Therefore, I very much regret that the Prime Minister has seen fit to make so vicious an attack upon the medical profession. I fear that, if the people are encouraged to believe that they are being taken down by specialists, there will be less inducement for young men to qualify as specialists in the various branches of medicine.
The Minister for Commerce and Agriculture (Mr. Pollard) said that patients in repatriation hospitals receive excellent attention from salaried medical officers. I remind honorable members that many of the doctors who attend repatriation patients are not salaried officers. Indeed, the staffing of repatriation hospitals has been made possible by the co-operation of eminent specialists, as well as of some of the youngest and humblest members of the medical profession. Experience has shown that, both in war and in peace, the best interests of the community can be promoted, so far as medical services are concerned, under the system which the Government is now seeking to abolish.
.- At the 1946 general election, the Prime Minister (Mr. Chifley) said in his policy speech -
When the people confer the necessary power on the ‘Commonwealth Parliament at the referendum, my Government will not he satisfied until it has provided for the people of Australia a medical and dental service that is complete, free and of the highest technical efficiency.
Speaking on the 26th October, 1948, two years later, to the British Medical Association conference, the Minister for Health (Senator McKenna) said -
Surveying the whole field and its complexities, and realizing, too, the abuses and difficulties that are more readily possible in a completely free scheme, the Government comes to the conclusion that it is not necessary or possible that the scheme at its inception be complete or free.
No one would suggest for a moment, after perusing this bill, that it provides for any technical efficiency at all. It is hard to find any machinery provisions in any of its clauses. Therefore, as a result of the Government’s cogitations for two years after the Prime Miniter made the definite statement that the scheme would be complete, free and of the highest technical efficiency, we have a scheme which is hopelessly incomplete, half free and technically inefficient. The Government can have a free, complete and technically efficient scheme immediately if it will modify and simplify its plans, if the proposals in this measure can be termed plans, in accordance with the experience of this and other countries., and adopt the considered advice of the Australian medical profession. The indispensable elements of such a complete, free and efficient scheme are an attempt to prevent disease by the safeguarding and improvement of nutritional, housing, educational and othe sociological standards, the use of existing State health organizations, of which we should be proud, to the greatest possible degree, a trust of the people, based on the assumption that they are not rogues, and the preservation of the existing doctor-patient relationship, which has grown up over centuries.
Eighteen months ago the British Medical Association in Australia was asked by the Minister for Health to put forward constructive suggestions for the establishment of a national health service. The association prepared a proposal which contained approximately fourteen points. The major points were, first, the preventing of disease by improving nutrition, housing, education, Sac.; secondly, the securing of the maximum efficiency in medical treatment through the fullest use of the existing medical and hospital structure, which it was pointed out, had been established by a process of trial and error over scores of years ; and, thirdly, the subsidizing of State organizations to enable them to extend their existing services, to inaugurate necessary new services, to build modern hospitals and to provide ample modern equipment for them. So far as nutrition is concerned, the Government could, without this bill, subsidize fresh milk, fresh fruit juices and other vitamin-containing products as easily as it subsidizes tea at the present time, and make them available to the Australian people as cheaply as they are now available to the people of hard-pressed Britain. The co-ordination of Commonwealth and. States health programmes could best be secured by the creation of a federal health council, on the lines of the Loan Council and the Australian Agricultural Council. By that means we could create a unified health policy in Australia, eliminate duplication of effort and ensure decentralization, which is the very essence of success in health administration.
If the Government desires to pay part or whole of the doctor’s fees for medical treatment, let it follow the 40-year-old policy of the maternity allowance. That scheme has worked well. The money that is provided by the Government is paid direct to the mothers, who make their own arrangements with their doctors. That avoids the necessity for a “schedule of fees, which is a matter on which there is a great difference of opinion between the Government and the medical profession. Some patients like to go to an expensive obstetrician with a great reputation, because they can afford to pay his fees or because they think that their lives are worth the extra money. Others would rather be attended by their family doctors or go to the women’s hospitals. The same allowance is given to all of these mothers, whatever method of treatment they choose. I suggest that a scheme such as that, which has worked well in practice, is one that is well worth following, because it would remove almost entirely the whole of the argument that centres around the doctor-patient relationship. The Government could, if it so desired, pay all, half or any part of the doctor’s fees without reference to any body other than the Parliament. It need only bring down a measure appropriating a certain sum for the purpose. The Parliament could, if it so desired, fix standard rates of payments as has been done in regard to maternity allowances.
The only objection of the Government to this simple plan, which would secure immediate acceptance by the doctors, is that the Government and not the doctors would have to bear the cost of its administration. The Minister for Health was quite frank on this point in one of the speeches that he made to representatives of the medical profession. He said that there were approximately 7,000 doctors and many hundreds of thousands of patients, and that it would be better for the doctors to bear the cost of the administration of the Government’s scheme. He went on to say that, on the basis of the New Zealand national health scheme, the cost of administration would be approximately 11 per cent, of the total amount involved, but if the doctors undertook the administration it would cost the Government approximately 1 per cent, of the total amount. In other words, he proposed that the doctors should bear the difference between 1 per cent, and 11 per cent., without being given any compensating advantage. Quite apart from that, the doctors have an inveterate objection to being the financial agent for the patient or the Government in regard to fees. They would be quite content for the Government to pay the money to the patient and to collect their fees from the patient in the ordinary way. They say that if the Government wishes to pay the whole of the fee, it can do so, or it can, if it so desires, pay only a half of it. They contend that that matter does not concern them. They wish to treat people, and not to run a government detective agency or an accountancy business to prevent the Government from being defrauded. Medical records and medical treatment are private and personal matters, and it is a moot point whether an action would lie against a doctor if he revealed information about them. The system that I propose would give patients an absolute freedom of choice of doctors, and would avoid all arguments about schedules.
– Do members of the medical profession not take an oath of secrecy?
– The Hippocratic oath covers that. Even in a court of law, doctors will not, except under extraordinary pressure, divulge information about their patients, and when they are forced to do so they feel they have been badly treated. If one reads the report of the Minister’s discussions with the British Medical Association on this matter and his reply to the debate on the motion for the second reading of this bill in the Senate, one realizes that his mind is in an absolute fog about it. He does not know where he is. He has said that the Government has no definite opinion about this, that or the other matter. If the Government intends to deal with this scheme in the same way as it has dealt with others, it will cost a great deal of money. However, it need not cost so much if the Government will make full use of the friendly societies, which have been helping to give the Australian people reasonable medical treatment for many years. The membership of the friendly societies is approximately 750,000. Taking into consideration the families of members, it is estimated that over 2,000,000 people in Australia are assisted by them. No other justification is needed for accepting the amendment that has been moved by the Acting Leader of the Opposition (Mr. Harrison) than a statement in the Report of the International Conference of Friendly Societies of Australia and Overseas. Mr. Eade, the Grand Secretary of the Manchester Unity Independent Order of Oddfellows, spent eight and a half months in travelling around the world for the purpose of examining various national health schemes. In the report to which I have referred, he made the following statement with regard to the British scheme: -
The new social service scheme came into operation on the 5th July, and it is the most complete system of social service in the world. It is on a contributory basis, and the contributions are high for the benefit received. It will lose a great deal of its value because it will not now be administered by approved societies. I went into a number of local offices, saw their systems, and I found in one instance that sixteen employees were being put on to do the job that three district secretaries were doing. I hope that this willbe taken notice of in other quarters.
One of those quarters should be this Parliament, because I notice that sixteen persons are to do a job which three have done in the past. Therefore, I suggest that a few months’ delay, and a full discussion, are worth while if they can pre vent a similar waste of public money in Australia.
Before I examine the details of this bill for the establishment of national health services, I should like to indicate the general principles that should underlie a national health service in a continent the size of Australia that is governed under a federal system. In order better to understand those fundamental principles, we should analyse the reasons that have caused the Australian Labour Government’s proposals on health generally to he received so coldly and apathetically by the public, the medical profession and persons who are interested in the administration of health. It is obvious from the cold reception that the Labour Government’s proposals have received in Australia that its whole approach to the problem has always been wrong. The Government has consistently endeavoured to make a national health service a matter of party political propaganda. In fact, I have no doubt that the Government will not accept an amendment to this bill, regardless of its merits.
– The right honorable gentleman is a prophet.
– The Prime Minister should be aware that all political parties in the United Kingdom applaud the national health scheme in that country, because the system has been developed by successive stages by the Liberal party, the Conservative party and the Labour party. Consequently, the British scheme is really the product of the efforts of the three main political parties in the United Kingdom. The establishment of a national health scheme in Australia should similarly embody the views of the Labour party, the Liberal party and the Australian Country party, but the Australian Labour Government has gone completely off the track in many respects. In the United Kingdom, the government of the day has always until recently utilized all voluntary organizations, with conspicuous success.
– Did the British Medical Association play ball with the British Government?
– The British Medical Association is playing ball now, to its great regret. The working conditions of medical practitioners are worse than those of the ordinary manual worker, despite the fact that doctors must also work extraordinarily long hours.
– Do not believe it.
– The honorable member for Griffith (Mr. Conelan) will realize that my statement is true when trouble occurs in the United Kingdom scheme. In Australia, tremendous advances have been made in improving our national health services by the action of State governments, the researches of medical scientists, the co-operation of doctors and friendly societies, and the spontaneous co-operation of local people in voluntary aid proposals, lt will be a national disaster if that great foundation is scrapped under the Government’s general proposals to nationalize medicine. The deadness of the Government’s free medicine proposals indicates clearly that the people, as individuals, do not desire free medicine or free doctors just for the pleasure of having them gratis. “What the people urgently desire is health and a sound life. They feel that they will most likely enjoy health and a sound life with the services of their own doctors whom they know and like, and to whom they trust the care of their health and even their lives. In any event, free medicine and a free doctor are not of much use except for slight ailments, if neither a hospital bed nor satisfactory equipment is available when a patient becomes seriously ill and his life is in danger. The public instinctively feels that the provision of hospital accommodation and satisfactory equipment constitute the first indispensable step in any national health scheme. That statement is true in war and peace. In war-time, we get our equipment ready before we ask our troops to fight. I was greatly impressed by a reply by Dr. George Crile the great discoverer of the method of shock-free operations, in his advice to the advisory committee of the Council of National Defence of America as that country was about to enter World War I. The president of the American College of Surgeons asked Dr. Crile to make five suggestions of practical value for preparedness, in order of priority. Dr. Crile said that his first suggestion was to lay in a stock of gauze, cotton wool, instruments and all the necessary equipment sufficient for six months of a major wan He added that the second, third, fourth and fifth suggestions were to “ do it now That maxim should be taken to heart in Australia, when the Government is considering establishing a national health service, because the ultimate success of the scheme depends to a large degree on the foundation that we lay. I discussed this matter with Sir Hugh Cairns when he was in Australia, and he expressed the view that the success of any national health service must, in the final analysis, depend upon a fully equipped organization including hospitals, staff and instruments. That fundamental basis is equally true in the peace-time fight against disease. We must have a full supply of the proper equipment, and Australia can proceed to meet that requirement without the necessity for this long bill. That is one of the few matters in a national health scheme in which the Parliament can render a really great service, without interfering with the intimate relations between sick persons and their medical advisers. The Government can proceed with the erection of hospitals and the acquisition of instruments on an extensive scale. The fact that the Government is not taking any action to supply those vital needs is one of the reasons for the public apathy to the national health scheme. The people feel that the Government tends to deal with the whole problem en masse, but lacks a real sense of human values. The Government’s scheme does not deal with personnel and is too mechanical in implementation.
The public has an instinctive feeling that because health is an individual and personal matter, the proper authority to deal with the problems of individual health is an authority on the spot. If there must be some form of governmental authority, I consider that the responsibility should he vested in either the local governing authority, which is closest to the people. If the local authority lacks the necessary finance for the task the next best authority is a State government. In my opinion, the best authority is a voluntary community authority. The Commonwealth should come into the picture only to provide money for the scheme, and to co-ordinate policy. This matter is properly appreciated in England where a national health service has been in operation for 40 years. England is onesixth the size of New South Wales, and one-sixtieth the size of Australia. For the control of medical services, England has local executive councils for every county or borough to deal with the family doctor problem. In an area of 40,000 or 50,000 square miles, there are fourteen regional hospital authorities dealing with hospital administration. They are on the spot. We, in Australia, have a vast continent to develop, and the disadvantages of immense distances to overcome, but the Government prefers to control the national health service as a central authority instead of remitting it to the local authorities.
A further reason for public apathy, and, in fact, resentment to some degree, is that Commonwealth control and policy, at any rate up to the present time, have involved too much regimentation. That position has led to an inevitable destruction of voluntary co-operative effort on the part of the people themselves, which, psychologically, is so valuable in the treatment of disease. For instance, Commonwealth aid to hospitals has destroyed hospital insurance societies and has largely destroyed local interest in the well being of hospitals. When moving the second reading of this bill in the Senate, the Minister for Health (Senator McKenna) stated that he had not given any thought to the position of friendly societies. Yet such societies have been the greatest agency in Australia in assisting in the medical care of the general mass of the people. Approximately 2,000,000 persons, or 27 per cent, of our population, are interested in and deriving benefits from friendly societies. Before we make a deliberate decision in this Parliament so vital to the health and well-being of the people, we should take into consideration the views of the friendly societies, and examine the methods under which they have worked so amicably with the doctor’s. It is true that the Minister for Health has had conferences with the British Medical Association on the Government’s national health scheme. He has spoken at great length and the doctors have spoken briefly. They have submitted their particular proposals, and have not bothered to argue the matter. They are willing to act in the national health scheme as they are willing to act in the free medicine scheme. They say that if the Commonwealth formulary will cover every drug which they require in writing prescriptions, they will co-operate, and that if the Government meets the patients’ expenses, they will do the treatment.
I have now given the major reasons for public apathy to the Government’s proposals. Another important reason why the scheme should be postponed is the indefinite nature of the Government’s proposals, as exemplified in the bill and in the Minister’s speech. I shall deal with those aspects later. If I may use a simile, the Government scheme may be likened to a huge barn. We do not know whether the structure has a roof. All we can see are the outside supports. Apparently there is nothing inside the building. I have analysed the reasons why the public has instinctively reacted unfavorably to the proposal. I shall now examine the general principles that must underlie a national health service. The practice of medicine or the art of healing, is an individual process. It is a personal and vital matter. Every case of disease is different. Every patient has a different psychology, mental background and constitution. Health cannot be dealt with en masse. Perhaps the vocations of the two principal inspirers of the Labour Government’s plan are responsible for this weird idea of the mass treatment of sickness which is, in turn, responsible for the lack of appeal of their proposals to the public. For a considerable part of his life, the Prime Minister was associated with mechanical contrivances, including locomotives. He knows that if the enginedriver opens a valve, the release of steam will begin to turn the wheels, and the locomotive will move, regardless of human whims, wishes or obstacles. If a passenger is still on the platform when the train moves out, he will miss it. The Minister for Health, who is a lawyer, is accustomed to dealing with legal generalizations, fusty documents and” meticulous points of law- which, to the layman, frequently do not seem to have a close relation to practical matters. I suspect that their respective- backgrounds have caused them to f avour the mechanical method of introducing a national- health scheme. We must realize that there is a personal relation between doctor and patient which really counts. There is more in surgery than mere mechanics. Surgery is; not simpl’y human carpentry. There is the saving of’ the function of organs or Timbs to- enable the patient to make the best use of his life. There is more in medicine than physical diagnosis and drugs. There is the intimate personal contact between doctor and patient, which begets confid’ence. The patient knows that the doctor is fighting for human life, and will stay all night with women in their dangerous childbirths. The doctor fights without intermission for the patient’s recovery while the slightest spark of life and hope remain. This is a relationship that cannot work to a definite schedule of hours. It is a contract that does not end with the giving of service in an office, or the receiving of payment. This service comes from real interest in the work, not from the compulsion of a regulation. To introduce a biblical reference, although doctors cannot be driven, in very truth a little child can lead them. That is what is wrong with the Government’s approach to this problem. It forgets that the matter of medical treatment must be approached from the point of view of the individual doctor and the individual patient who cannot be dragooned en masse. I emphasize, however, that what the Government can get en masse is equipment. The Government can and should get a supply of equipment ready as soon as possible. My point is exemplified by the contrast between the relationship between army medical officers and soldiers, on the one hand, and between a doctor and women and children or families that he is accustomed to treat, on the other hand. Neither in the bill nor in the Minister’s speech is there any realization of the importance of this personal relationship in another sense. There ha9 been blithe talk of the formation of medical groups and partnerships, &c, as if government regulation and suggestion can command them out of the vasty deep. How do these come into being? Compatible doctors are drawn together as naturally and automatically as particles of steel are attracted! to a magnet. The magnet in medical groups or partnerships is1 the compatibility of those comprising it, their capacity to get on together, their similarity of personality, and the identity of their outlook and ideals. If these requisites, are not present, the partnerships will soon break up. They cannot be manufactured from within. I was a member of such a partnership before I entered this Parliament. The remaining three members of that group thought that after three yeai’3 I would rejoin them. However, as time went on, I became Leader of the Australian Country party. Subsequently, they said to me, “ The partnership cannot work harmoniously without you “. Shortly afterwards the partnership was dissolved.
I point out that the whole history of the development of new drugs and of research is that of medical men teaming together in the pursuit of common objectives. In its approach to this problem the Government has shown that it does not understand the mentality of doctors, the things that matter to them, and their attitude towards the saving of life. It does not understand the mental and social relationship of doctor and patient, any more than it can understand that of the doctor and the sick patient or anxious relative. This lack of understanding leads the Government to suggest subtle methods of training medical robots, who will he so much alike as not to mind working together, and who will be content to work 40 hours a week, and leave dangerously ill patients to some one else to look after when their day or night shift has been completed. This attitude can lead only to the disappearance of voluntary effort, friendly societies, hospital aids and hospital insurance schemes. The terms that will have to be imposed on hospitals will lead to their bankruptcy and so control will proceed along governmental lines.
As I have already said, the Government can deal with supply and equipment aspects. This is not a personal matter. The provision of buildings could be handled by hospital architects and contractors, whilst instrument and equipment makers could provide specialized equipment. The Government lias admitted that there are not enough doctors, and that it would take many years to train additional practitioners, under the scheme. Surely it is but common sense, during that period, to use most wisely and efficiently the dentists and doctors we have. Modern, up-to-date, handy, and efficient hospitals and equipment should be provided. This is a job that the Labour Government should get on with at once. Orders could be given, and plans worked out. As the State health authorities already have plans and organizations available to deal with the whole aspect of supply, why create another organization to superimpose duplicated control upon the States? In the Government’s proposed drive against tuberculosis, it is intended to use the State organizations. The ‘Government should forget about its proposed activities in connexion in this matter, and use the services of the States.
Another large field that the Government could very properly enter without delays and without waiting to come to some agreement with doctors, States, or hospital committees, is that of preventive medicine. The biggest factor in ensuring national health is the prevention of disease and the safeguarding and improvement of nutritional, housing, educational, and other sociological standards.
Records maintained in England during the war show the extraordinary value of free milk and free fruit juices with strong vitamin content, in improving the standard of health of children and nursing women. In this respect, the Government has a wonderful starting point from which to work, because, despite all the odium that it throws upon our medical system, Australia is one of the healthiest countries in the world, and has the lowest mortality and sickness ra tes in the world.
Therefore we can see that the fundamental principles in national health services in their order of priority are - (1) An intensive preventive medicine campaign; (2) improvement of the supply side by extension of hospitals, equipment, trained personnel, &c. ; (3) decentralized control to ensure that control shall be as close as possible to the job, through the local or State authority, the federal authority to finance new and improved services and equipment; (4) provision of incentive to research; (5) maintenance of the personal relationship of doctor and patient as it has grown up over the ages; (6) encouragement of voluntary organization of the public in as many ways as possible to interest itself in the problem of dealing with disease; and (7) provision of inducement for patients to think of health and recovery rather than of drinking free medicine.
I point out that following the introduction of the New Zealand scheme, people began to drink medicine as they would a beverage. What does the bill do about these fundamentals? An examination of the bill and of the speeches of honorable members on the Government side of the House indicates one or two alternatives. The measure is meant as a placard, or else it is a subtle way of bringing in nationalization of medicine and the regimentation of medical treatment, doctors, and dentists by regulation, despite the constitutional limitations.
The only two clauses that matter in the bill are clauses 1 and 22. Clause 7 gives the Government power to provide, or to arrange for the provision of prescribed services, and gives a long list, without limiting the generality of the preceding clause. Clause 22 provides that the Government may make regulations prescribing all matter which are by this measure required, or permitted to be prescribed, or which are necessary or convenient to be prescribed. Then follows a list of specific matters. Every one of these is already being carried out by the States to some degree, and one may be pardoned for thinking that this measure has been brought down merely to make a show. This new machinery for a Federal government directorate is not needed. The States need financial help. The most urgent need of Australia, from a governmental point of view, is the formation of a Federal Health Council, along the lines of the Loan Council and the Australian Agricultural Council, that could secure a uniform policy on the whole health problem. The National Medical and Health Research Council, which was set up by my own Government in 1935, to some degree deals with this position on r,ho departmental plane. A federal health council on a higher ministerial plane is needed to co-ordinate policy.
No special machinery is needed to pay half the cost, a quarter of the cost or the whole cost of medical treatment by doctors. The attitude of the doctors is that the Government should pay the patient direct, and not try to use the doctor as their agent. The Government can give money to patients, just as it gives money to mothers, pensioners or any other recipients of public money. The only excuse offered so far by the Government for attempting to use the doctor either as the agent for the Government or the patient is to save administration costs, and make the 7,000 or 8,000 doctors carry the whole burden of administration. The Government, of course, tries to make out that the doctor will gain by having fewer bad debts ; but the doctor may easily lose more by bad debts through the Government paying half, because the patient may not think it is worth while paying the other half. Doctors are willing to take the risk of collecting their own fees, as they have always done, and the Government can make any contributions it. desires to the patients themselves.
In the depression the doctors’ attitude to their patients was that they looked after up to 10 per cent, of their lodge patients for nothing. In mining districts, the doctors contract to let their payments lapse while miners are out of work or on strike. Even though there is no medical examination of unemployed or unemployable persons, which immensely increases the treatment necessary, doctors have been willing, under agreements with the States, to treat such people on the same basis as friendly society patients who are medically examined before admission. Practically all age pensioners are treated either without charge, or for a. very small charge. Briefly, what we should do is to try to ensure that a plan shall be adopted which will really work. Let us take out of ‘this measure anything that will hinder immediate action. The Government should make the best possible contact with the States, make arrangements to pay what it desires to pay to patients throughout Australia, and concentrate on the care of the health of the women and children of this country. Early efforts should be made by the Government to establish additional modern hospitals and other facilities so necessary to preserve the health of the people of this country.
.- We are debating -
A bill for an act to provide for the establishment of national health services, and for other purposes.
Every one, whether he be a member of the Parliament or a civilian, recognizes at once that the health of the community is the most important thing in daily life and the most important factor in the development of the nation to greatness. The bill seeks to provide, first, for the alleviation of the heavy financial costs of medical treatment; and, secondly, machinery, yet to be devised, to encourage medical advances in Australia by means of research, diagnosis and treatment. The Government was prompted to introduce the measure by the realization reached over the years that Australia cannot afford avoidable illness and avoidable accidents. No country can afford them. The lifting of the financial burden on people should really be the secondary consideration. The humane consideration of relieving people of illness should be primary. Sickness causes a vast loss of production. No statistics can portray the loss of production caused by avoidable sickness and curable diseases that are not avoided and are not cured. The bill is a major step forward. It may well be argued that it does not provide the ultimate in a medical system for Australia, but it is a reflection upon political life that when the Government introduces a bill that is. the first step towards a saner and more realistic approach to health problems, it is bitterly opposed by the organized medical practitioners and by political opponents, whereas both the medical practitioners and the Government’s political opponents should direct themselves to suggesting means by which the measure might be improved. Throughout Australia, and especially in Sydney and the country districts of New South Wales, with, I am proud to say, the exception of my own State, Western Australia, the organized medical practitioners have refused to co-operate with the Government or to suggest improvements that perhaps could he made before the measure goes on to the statute-book. I follow, in this debate, the right honorable member for Cowper (Sir Earle Page), a surgeon of great distinction. I once read a history of the Commonwealth written by A. N. Smith, who described how the right honorable member for Cowper had foresaken one of the most successful surgical practices in Australia in order to enter the Australian Parliament as Leader of the Australian Country party. I regret that, in debating the bill, the right honorable gentleman, whose deep knowledge, experience and humane feelings are undoubted, chose to speak with the guile, wiles and trickery learned in a lifetime of politics rather than with the experience of a medical practitioner. Doubtless, had he chosen the latter role, he would have said words to this effect, “ I do not accept the bill in its entirety, but we must and will take it as the first step in the establishment of a comprehensive medical service for Australia that will ensure to the medical practitioners, who give devoted service to the men, women and children of Australia, the opportunity of fundamental research in order that Australian medical science shall know all the secrets of medicine that it is possible for it to know and also help to lessen the great economic loss that day by day, week by week, and year by year is caused to the Australian productive effort by avoidable sickness and avoidable early deaths”. But what did the right honorable gentleman say, except that the bill is not perfect? No one doubts its imperfection. No man in his right senses, in or out of the Parliament, would dare to say that any health scheme proposed by a government would provide the ultimate in a health service for the Australian people. No one could be so blind or foolish as to say that. “What we do say is that the bill proposes a great step towards that end. Would any one deny that many breadwinners, because of the fear of debt, have neglected to incarcerate themselves in hospital for perhaps long periods in order to recover from an illness? A man confronted with the prospect of the cost of hospital treatment and of a doctor’s bill of 20, 30 or 40 guineas for an operation very often decides that he cannot afford either and tries to carry on so that his family may continue to eat and be sheltered and clad.
– Has the honorable member never heard of public hospitals?
– That is an inane interjection, like many that the honorable member makes. Of course I know that there are public hospitals, and I have seen patients waiting at public hospitals in the capital cities. In some instances they are a disgrace to the Australian community and to” the Australian Parliament, especially in the out-patients’ departments. The right honorable member for Cowper said in many words that the States can provide hospital beds and equipment. That may apply to New South Wales, which has a large population in a fairly compact area, and even more to Victoria, where the area is still more compact and the community is wealthy, but in Western Australia the population is small and is grouped in small companies. No government of Western Australia, whether it be Labour, Liberal or Country party, could afford to provide hospitals suitable to meet the needs of the people.
– Western Australia is provided with special grants to bring its social services up to the level of Victoria and New South Wales.
– Yes, to bring. Western Australia’s standard up to that of the three standard States, New South Wales, Victoria and Queensland. But because the State from which the honorable member comes has failed to provide a decent standard of health and social services, Western Australia and Tasmania are dragged down.
– What nonsense! And we are not on the air.
– Order ! The honorable member for Henty will be out in the air if he is not careful.
– The interjections of honorable members opposite have caused me to digress from the theme of my speech. There is a vital need in the Australian community for a better health service on grounds of humanity and pure economics. The right honorable member for Cowper said that our first need is preventive medicine and increased supplies of milk. For the first time for many years there is a sufficient degree of prosperity among the people of this country to enable them to provide proper nutrition for themselves and their families. The right honorable gentleman speaks as a medical practitioner of high repute and with that great sense of humanity which he has manifested towards honorable members of the House who have sought his services. I speak not on behalf of the medical profession but as the father of a family who has had to incur heavy expenditure for medical advice and treatment and medicines for my family group.
– The honorable member is not alone in that.
– I am well aware of that. I was about to add that, on the basis of the expenditure that I have incurred in this respect, proper medical care and attention to maintain reasonable standards of health is beyond the ability of the average basic wage earner or those in receipt of a little above the basic wage.
– “We all are aware of that.
– The honorable member for Flinders (Mr. Ryan) says, “ We all are aware of that “ ; yet when the Government brings down a bill to relieve the people of one-half of that expenditure, honorable members opposite oppose it.
– Where does the Government propose to obtain the money with which to finance this scheme? It must obtain it from the people. The honorable member talks about relieving the people of the burden of heavy medical expenses. The Government must obtain the money to do so by taxing many of the commodities they buy, including beer and cigarettes.
– The honorable member asks, “ Where does the Government propose to obtain the money with which to finance this scheme ? “ It will take the money from wealthy people like the honorable member himself, whose income tax rate is approximately 15s. in the £1. From low wage earners in the community who have family responsi bilities the Government will take nothing. Out of the proceeds of the taxes levied on the more fortunate members of the community, it will provide free medicine and less costly medical attention and advice for all members of the community. We do not dispute that some one has to pay for every benefit conferred on the people by the Government. Under this bill the Government proposes that medical attention and advice shall be provided at low cost, for those who can well afford to pay for such services, for those who can ill afford to pay for them, and for those who cannot pay at all. Those who cannot afford to pay will be assured of medical advice and treatment on the highest plane that medical science can provide in exactly the same way as the honorable member for Fawkner or the most wealthy member of this Parliament or of this community. That some one must pay for hospitalization or medical services is a self-evident fact, so we can discard the interjection of the honorable member for Fawkner. Throughout the years many people in this community have been unable to obtain medical treatment and hospitalization for themselves or their dependants, either because they could not afford the cost involved or because they could afford it only by doing without the necessaries of life. That is a state of affairs which the Government seeks to remedy. Under this bill it proposes to pay fifty per cent, of the cost of hospitalization and doctors’ fees. The Government intends that expenditure on this account shall be met by the taxpayer, according to his circumstances. Every person involved in heavy expenditure for hospitalization and medical treatment is taken out of the group of effective purchasers of the products of this country.
I pass on to the statement by the right honorable member for Cowper that the purpose of this bill is to nationalize health and medical services. Its purpose is just the reverse of that. At the instigation of my friend, the honorable member for Fremantle (Mr. Beazley), I discussed with an eminent medical man in Perth what medical services the Government should provide. He said that what doctors want is a service that will allow them to provide for their ordinary patients, but. which, will also ensure that no patient shall be prevented from consulting his medical adviser because the expense involved may be too great. What is suggested, in this measure, but that very thing ? Under this bill every sick person in the community will be entitled to consult the doctor of his own choice and be able to obtain the benefits of medical ‘science with a knowledge that, no matter what expense may be involved, the Government, and not some abstract person or organization divorced from the Australian community, will pay half the expenditure incurred. If he is in receipt of a remuneration more than sufficient to provide for his needs, the Government, on behalf of the Australian people, will take from him a contribution towards the financing of this scheme. Could anything be more equitable or in accord with common sense than such a proposal? If the Government proposed to bring down a bill for the institution of a national health scheme which restricted patients in the choice of their doctor, it would not need to be rejected by honorable members opposite. Such a proposal would be rejected by caucus, which is the most democratic force in this Parliament, as it consists of the elected members of the Australian Labour party.
– Just as was the proposal of the nationalization of banking?
– If any proposal was forced upon the cabinet by caucus it was the proposal to which the honorable member for Wakefield (Mr. McBride) has referred.
– The honorable member did not even get a look at the Banking Bill until after he had been told what to do about it.
– In providing that there shall be no restriction on the choice of doctors the Government has given expression to the wishes of the members of the Labour party. The right honorable member for Cowper said that a doctor always seeks to do the best he can for his patient. No one doubts that. Every one of us who has family responsibilities knows that his medical adviser invariably gives the most careful attention to the health a.nd well-being of his patients. Under this bill, the Government proposes to aid doctors in the practice of their profession by providing diagnostic centres. As we proceed to implement the measure we shall seek to enable medical men to gain greater knowledge of medical science and to extend the humanitarian work in which they are engaged. The Government does not propose to hamper the work of medical practitioners in any way. The right honorable member for Cowper said that doctors could not be driven, but thai a little child could lead them. Despite their arduous labours doctors are always prepared to attend to patients suffering from even the most trivial ailments. Very often parents do not know whether the symptoms of an illness exhibited by their children are of minor or major importance. Epidemics of infantile paralysis have continued in Western Australia for many months. Every parent in that State whose child exhibits some unusual symptoms fears that the child may be suffering from infantile paralysis. At all hours of the day doctors are prepared to visit the sick and the suffering and give them such treatment as may be necessary. This bill will not detract in any way from the splendid service that doctors render to the community in this respect. It merely seeks to ensure that people who might be deterred from seeking treatment because of the financial obligations involved may consult their medical practitioners with full confidence that the Government will shoulder a portion of the burden. As the Prime Minister (Mr. Chifley) said this afternoon, this measure cannot be opposed on logical grounds. Opposition to it comes from vested interests or pure political bias. The right honorable member for Cowper said that the Government does not understand the doctor-patient relationship. Every honorable member on this side of the House knows from his own experiences the value of the doctor-patient relationship. Not one of us would do anything to imperil it. The working people of this country are as jealous of the preservation of that relationship as are honorable members opposite. We do not seek to destroy that relationship, even for the sake of establishing a modern health service. The right honorable member said that the Government should provide more hospital beds, and also free milk, fruit juices and better housing. How unreal is his approach to the matter. Because of the increased purchasing power of the people to-day, the demand for bornes is greater than ever. Even if r El e building of warehouses, factories, &c, were entirely discontinued, it would take years to overcome the lag in house construction. Presumably, the. right honorable gentleman advocates the abolition of slums, which tend to create ill health. However, if the existing slums were destroyed, it would be necessary to provide temporary accommodation for the people at present living in them and it would be little better than the slums themselves. The demand for houses cannot be satisfied for many years because insufficient building materials and labour are available.
The right honorable member for Cowper also referred to hospital accommodation. For many years, hospital accommodation in Perth was most unsatisfactory, and the position in many country towns of Western Australia was no better. During the war, the Australian Government, in spite of the many demands upon its resources, was able to provide modern, well-equipped hospitals in Western Australia almost overnight. State governments, of various political complexions had been unable to do so because of their limited resources, l t may be that New South Wales, Victoria and, perhaps, Queensland, through the agency of the Golden Casket lottery” could provide for their own hospital needs, but, without Commonwealth help, the people of Western Australia, South Australia and Tasmania would have to put up with inferior hospital services.
The right honorable member also mentioned free milk and fruit juices. The mothers of Australia are quite capable of deciding the proper diet for their children if they are given some advice, but the doctors are not always able to agree among themselves. For instance, a. controversy has been raging in Western Australia for some time on the subject of pasteurized milk. It has been stated that much of the milk supplied to the public, and fed to children, perhaps to my own, amongst others, comes from tubercular cows, and is therefore dangerous to health. Some scientific authorities say that the milk could be rendered safe for human consumption by pasteurization, while others declare that the process of pasteurization destroys, not only germs and bacteria, but also the most valuable food properties of the milk.
The right honorable member also said that the immediate acceptance of a national health scheme by the medical profession could be obtained. I am afraid that that is not so, because, at the top of the British Medical Association there are men who are doctors and politicians in almost equal degree. If that were the whole of the matter it might not be of any great importance, but it becomes serious when we have in this Parliament men who are prepared to make political capital out of the situation. The right honorable member said that the British Medical Association had an inveterate distrust and hatred of the proposed national medical health service. Why is this? Is it because the leaders of the British Medical Association have got into a groove from which it will take a severe jolt to move them? All we ask is that the doctors should consider what a heavy burden the provision of medical service throws upon many members of the community, and that the cost of the service to the public should bc lightened. It is also expected that members of the medical profession should consider proposals for improving group health services, diagnostic services, and research. It is well known that most scientific discoveries in the field of medicine were condemned by leading doctors at the time they were made. We remember how Louis Pasteur was ostracized and vilified by the medical practitioners of his day, but because he continued to fight for his ideas medical science benefited enormously. We believe that if some doctors were relieved of the need to practice, and were encouraged to engage in scientific research, further important discoveries would be made. It would appear that, because some doctors over a period of years, have, been able to establish lucrative practices or, having inherited money, were able to buy them, they regard any proposal for improving medical services as a threat to their security. It ill behoves members of this Parliament to support the doctors in that attitude. When honorable members opposite argue in favour of retaining the best in the doctor-patient relationship, we support them, but we condemn their attitude when, for the sake of scoring a political point, they suggest that the bill be withdrawn and redrafted after consultation with the British Medical Association. Does any one believe that the British Medical Association will agree to depart from its present attitude towards the Government’s proposal? I do not think any one does. We should endeavour to establish a national medical health service into which the doctors may eventually be drawn. At the present time, the work of doctors is heavy, and their remuneration relatively good. It is not desired that any doctor should be coerced into joining a national health scheme, but it is important that every doctor should be made to realize that Australia and the world have lost too much through haphazard health services and lack of scientific research. We must lighten the burden on the public, and offer every inducement to qualified scientific men to engage in medical research. That is what the Government is trying to do. It is objected that the Government is seeking to nationalize medicine. Nothing could be further from the truth. The only justification for substituting nationalization for free enterprise would be that free enterprise was not giving the maximum service to the people. If under the Government’s health scheme it is possible to provide an efficient medical service for the public at reasonable cost, as well as to ensure that adequate scientific research is undertaken, there will be no occasion to nationalize medicine. If a situation arises in which doctors cannot provide adequately for the health of the community and economic loss is thereby occasioned it will inevitably lead to nationalization.
Mr. ACTING DEPUTY SPEAKER (Mr. Sheehy). - Order! The honorable gentleman’s time has expired.
.- After the long and, as I think the House will agree, tedious speech of the honorable member for Perth (Mr. Burke), I intend to speak only briefly. I sat here patiently while almost every other honorable member left the chamber. When the honorable member for Perth began his speech three-quarters of an our ago, he presumed to criticize the right honorable member for Cowper (Sir Earle Page). It is true that later, as an after-thought, he said something in the right honorable gentleman’s favour. That was very generous of him. The right honorable member for Cowper is an eminent surgeon. The honorable member for Perth has had the audacity to say that those who oppose this bill, which hae been brought down by the Government of which he is a supporter, do so because there is something wrong with their logic or because they are political opportunists. He alleged that those were the only reasons why so eminent a man as the right honorable member for Cowper would dare to criticize this measure. The right honorable gentleman praised parts of it, and every one will admit that it is not bad all the way through. Honorable members on this side of the House are not fanatics like the socialists. When a bill is brought down we endeavour to find out what is good about it. We do not condemn it merely because it emanates from those who want to socialize everything. The honorable member for Perth subordinates his reasoning and his arguments to his social and political philosophy. He is, therefore, amazed when any one criticizes this bill or finds fault with it. In his opinion, we should accept it holusbolus because caucus or the wizard Minister in another House has thought of it.
Much more is needed in Australia in the way of medical services. There are many ways in which an improvement can be achieved. The need is for collaboration and co-operation, and not for political antagonism. The Social .Security Committee on which the honorable member for Flinders (Mr. Ryan) and members of the Labour party served, made the following recommendations in its eighth interim report : - ‘
We all agree with those recommendations, but they have been ignored. If the Minister for Repatriation (Mr. Barnard) is trying to encourage me to sit down toy waving his hand, he will only succeed in encouraging me to speak for three-quarters of an hour. It would be better to allocate more money to the States to build hospitals and sanatoriums than to spend millions of pounds to pay a half of patients’ medical bills. The Sydney Bulletin, which I hope honorable members opposite read occasionally because it contains some very statesmanlike articles and indulges in some strictures on their activities, published the following article on the 1st December: -
Among other foolish pretences, the ridiculous underestimation of the cost of the outlined National Health Service ought to be abandoned at once. Senator McKenna estimates that with “ full participation “ in the scheme by the doctors, the cost to the Government of meeting half of all patients’ fees will be £6,000,000 a year, and of the dental service £4,000,000. That is £10,000,000 in all, and puts the total cost (patients paying the other half) at £20,000,000- or only £2 13s. 4d. per annum for every man, woman and child in Australia.
There are round about 2,000,000 taxpayers in the Commonwealth - a conservative figure - and they are allowed annually £40 rebate by the Taxation Department for medical expenses and £10 for dental expenses - £50 in all - for the taxpayer, and the same for his wife and for each child under 21. Even limiting the £50 rebate to taxpayers only, the Taxation Assessment Act’s estimate of a fair thing for annual doctor and dental fees is £100,000,000 a year. A “ free “ - or partly “ free “ - ^medical service will bring a spate of real or imaginary sick people to the doctors’ doors, :as British experience has shown. And Senator McKenna tells us that here the annual expenditure on medical and dental care is not only going to diminish, but will shrink from £50 a head annually to £2 13s. 4d. !
Can more “ nationalization “ of treatment work that miracle? “That is a fair criticism, based on figures relating to tax rebates. The honorable member for Perth has argued that the proposal to pay a half of patients’ medi.cal bills is necessary because there are people like himself and other fathers in Western Australia who cannot pay their doctors’ bills, and that men who are in receipt of the basic wage will welcome :the proposal. That is a very subtle and specious argument, but those people are already paying something because the Government is taking money from them by means of various indirect taxes. It is true that many people in the lower income groups were recently relieved from the necessity to pay income tax, but the Government continues to extract money from them indirectly by primage duties, sales tax, import duties and the like. This scheme is merely political propaganda. The Government hopes to attract political favour by saying that it will pay half the patient’s medical bills.
Honorable members who saw the film Men of Medicine that was shown in Parliament House to-night may have noticed the caption, which reads as follows : -
Medicine must remain a profession; it must never become a trade or industry, nor the subservient tool of a government or bureaucracy.
The Government might ponder that. The film was shown by the Department of Information. I hope that the Minister for Information (Mr. Calwell) and other Ministers will see it again and take note of the caption to which I have referred. Judging by the way in which the Government is treating the medical profession it might be an association of herbalists or witch doctors. The Government intends to trample upon all the traditions of the profession.
In my opinion, this measure is a very subtle one, and the followers of the Prime Minister (Mr. Chifley) may not have seen through ‘it. I believe that by means of this bill the right honorable gentleman is implementing part of his plan for the complete socialization of Australia. Honorable members opposite have tried to show that this is not complete socialization, but only half socialization. If it is half-baked, it is the worse for that. When the Constitution Alteration (Social Services) Bill was before the Parliament in 1946, the Leader of the Opposition (Mr. Menzies) pressed for an amendment to the proposed new provision in the Australian Constitution, by adding to the words “ with respect to the provision of . . . medical and dental services “ the qualification “ (but not so as to authorize any form of civil conscription) “. The Government accepted the amendment, and, as a result, honorable members on this side of the House did not oppose the grant of the social services powers for which the Government asked. I was one of those who said that the Government would use the power unfairly, and this bill proves that I was correct in my statement. On the hustings, the Liberal party and the Australian Country party urged the people to vote against the grant of the other two powers that were sought by the Government and advised them to use their discretion in regard to this power. The Government was given the power for which it asked in respect of social services. How is it using it? It has introduced the so-called free medicine scheme, on which it has fallen out with the British Medical Association. Now, by this measure, it seeks to inveigle the Australian people into participating in a scheme for which they have not asked. If honorable members opposite are so simple that they cannot see now that this is part of the plan of that very earnest, sincere, dogged and obstinate socialist, the Prime Minister, sooner or later they will realize that it is. I hope that most honorable members of the House listened to the right honorable gentleman’s speech this afternoon, and that theywill read the report of it. It had little relation to the bill.
Mr.Fuller. - They will enjoy reading it.
– I am sure that the honorable member for Hume (Mr. Fuller) will enjoy readingit, because it is his tune. I should have thought that the Prime Minister of a great country would have paid tribute to some of the medical men who have raised Australia’s prestige in the eyes of the world.
– He did.
– He did nothing of the kind. When the honorable member for Henty (Mr. Gullett) drew attention to that omission, honorable members opposite tried to rectify it. The right honorable gentleman said that the doctors did not work the long hours that it was alleged they worked because they had learned in the Army and the Air Force that they could get their recreation leave and their week-ends off when they wanted them. I interposed to say that the doctors did not learn that in the Air Force, and the honorable member for Henty and the Prime Minister said the same of the Army, and went on to say that if the medical fraternity had any faults to-day it had learnt them in the service of the Government. I did not believe the Prime Minister when he said that these men worked with one eye on the clock and that they were ordinary workers. Every honorable member who has had anything to do with doctors knows that they give self-effacing service. Most medical men of note give their services free of charge to public hospitals on one or two days a week, and often give free attention to poor people for which they normally charge large fees. Notwithstanding that, the right honorable gentleman did not say a word in praise of them. He might have referred to the fact that a distinguished Australian from an Australian medical school, Sir Thomas Dunhill, is surgeon to His Majesty the King, and that Sir Hugh Cairns, the greatest brain surgeon in the world, is also an Australian, and one who, like many other members of his profession, gives much of his time to the people free of charge. Almost every doctor has either refused to send in a bill or has reduced his charges to a patient whom he knew was in indigent circumstances. Yet the Government would try to pauperize the people by saying that it will pay a half of their medical bills, whatever they may be. It is attempting to lead the people to believe that it is doing something of an advanced nature, but it would be infinitely better if it allowed the people to retain their self respect and concentrated its efforts upon improving hospitals and medical services. There is provision in the bill for money to be given to hospitals for research work, and I agree with that provision. It is a poor state of affairs when the Prime Minister makes sneering and contemptuous remarks about the British Medical Association simply because it does not come to heel when the thrusting senator who is in charge of this legislation wants it to do so. The right honorable gentleman said that the British Medical Association was composed of shell-backed old conservatives. It is an unfortunate trait in his make-up that when he cannot get his way with a body of people or an organization, he develops a phobia against it. “When the Melbourne City Council brought an action in the High Court to test the validity of part of the 1945 banking legislation and won its case, the right honorable gentleman immediately said that the Government would nationalize the banks. So it is with this bill. The British Medical Association is, after all, an authority on medicine. If one wants an opinion on railways or locomotives, one goes to the people who understand them. Because the Government cannot make the principal physicians and surgeons of Australia, who were trained in the best medical schools in the world, come to heel and adopt its semi-socialism, the Prime Minister wishes to liquidate them.
Although the Government may win favour with some people by saying that it proposes to meet half of their medical bills, what will in fact happen? Honorable members know what is happening in New Zealand to-day, and also what is happening in the Repatriation Department in Australia. 1 am glad that the Minister for Repatriation did not leave the chamber when I drew attention to him. Although there are doctors of repute in the Repatriation Department, they are fettered by red tape, officialdom and all the delays that are associated with bureaucratic control, even in the best managed departments, irrespective of what government is in power. The Minister has a knowledge of the case to which I am about to refer. The unfortunate victim has written a number of letters to me about it. I shall not read all of them, because they would embarrass the honorable gentleman, hut I shall read an extract from one of them. When we direct a question to the Minister about these matters, he gives some extraordinary replies. For example, he made an extraordinary reply to a question asked this morning by the Acting Leader of the Opposition (Mr. Harrison) about entitlement tribunal reports. Perhaps the Minister will examine the case which 1 have in mind and furnish a reply. An extract from one of the letters reads -
On the 5th September, 1948, I reported to my local repatriation doctor for stomach trouble. My doctor prescribed for me and instructed me to report again four weeks later, which I did. I was then much worse, and was losing weight and strength and in pain. The doctor said that he would contact the commission immediately and have an X-ray taken, adding that there was not much use prescribing further until he discovered the cause.
I shall inform the Minister of the patient’s name later.
– I know all about the patient, including his name.
– He was subjected to delays from the 5th September until the loth October. Finally, he was admitted to .St. Vincent’s Hospital, and underwent an operation yesterday. I do not blame the Minister, but I cite the case as an instance of the slowness of departmental administration. The Repatriation Department is entangled with red tape. The Minister may have a perfectly valid explanation of the circumstances, but the patient has written from his sick-bed about the departmental delays, and the prompt treatment that he bas since received.
In its scheme for the establishment of a national health service, the Government intends to copy the New Zealand pattern. I have in my hand a form which New Zealand doctors are required to complete and submit to the Department of Health. It is the kind of form which will be adopted under the Commonwealth national health service scheme.
– That is not so.
– Perhaps the Government will be able to devise a more satisfactory form. However, the New Zealand form will fit in admirably with the Government’s policy of full employment. No person engaged in the paper industry will be unemployed if such a form is adopted here. Our paper mills will need to produce vast quantities of paper in order to supply numerous forms to every doctor throughout the Commonwealth. Honorable members will be interested to know the kind of information that a New Zealand doctor is required to submit to the Department of Health. He must supply the name and address of the patient, and, if the patient be a child under sixteen, the name of the parent or guardian. He must show whether he examined the patient between 7 a.m. and noon, between noon and 9 p.m. or between 9 p.m. and 7 a.m. He must state whether he saw the patient on a Sunday or a public holiday. He must show whether there was a telephone conversation, and, if so, whether it exceeded 30 minutes. He must state whether he visited a private hospital and whether the consultation was short or long. Other information which he must supply is the total fee charged and the amount claimed from the fund. I invite honorable members to consider the position of a busy physician or surgeon who hastens from one hospital to another to attend to patients. Will he be required to fill in a nonsensical form of that kind ? I suspect that he will be bound to do so. The form-filling industry is very prominent at the present time.
– It is the No. 1 industry of this country.
– It was a prominent industry in Nazi Germany, and no doubt is in Soviet Russia and other totalitarian or near-totalitarian countries. Socialism leads to communism and communism leads to the police state, with servile subjects. Form-filling is an essential part of the Communist regime. The Australian Labour Government proposes to clamp further form-filling on the long-suffering medical fraternity, who have resisted its national health scheme.
– The honorable member knows that the form to which he has referred has been accepted by the British Medical Association in New Zealand.
– That is an extraordinary statement. If anybody but the Minister had given me that information, I would have believed it. If the British Medical Association of New Zealand has approved of that form, its action deserves criticism. I should like to know whether the Minister has ever examined the medical services scheme in New Zealand. If a person wants a prescription or a patent medicine, he goes, not to a chemist, but to a doctor from whom he receives a prescription for 7s. 6d. or 10s. 6d. The Government pays the bill. The patient then goes to the chemist and pay any amount from 2s. to 3s. for a concoction which he can buy over the counter of a chain store for ls. The Government has referred enthusiastically toits free medicine service. Of course, the service will not be free. The people will pay the cost in other ways. The present proposed national health scheme will bea big impost upon the people of Australia It has some good points. There is considerable merit in the dental proposals.. In that instance, the Minister for Health displayed some common sense, because heaccepted, almost in its entirety, the plan which representatives of the dental profession submitted to him. However, I direct attention to sub-clause 1, of clause 15 of the bill which reads as follows: -
The Director-General may, for the purposesof this Act, compile and publish a list of medical practitioners or dentists recognized by hin» as being specialists in any field of medical: science or dental science.
The Prime Minister (Mr. Chifley) has an antipathy to specialists. He told us of a man who consulted nine specialists about a foot trouble. I do not know whether the man was suffering from corns or cold feet. Of course, that was an important incident to mention in the House, but the Prime Minister used it as anargument in favour of reducing the number of specialists. I remind honorablemembers that the specialists are thedoctors who have specialized in certainbranches of medicine or surgery. They would not be able to continue in practiceif they were not most proficient. Under clause 15, the Minister for Health, perhaps in consultation with the Minister for Repatriation, may decide thephysicians, surgeons and dentists whoshall he specialists. The Prime Minister may even intervene in order to ensure that none of the nine specialists who treated the man suffering from foot trouble shall be allowed to practise as a specialist infuture. The doctors and dentists’ organizations are the only authorities that are competent to determine whethera medical practitioner or dentist shall beallowed to describe himself as a specialist. This matter must be discussed with doctors and dentists’ organizationsin each State. It would be their object to ensure that only the most skilful men inthe respective professions should be entitled to describe themselves as- specialists. If the Government insists upon determining who should be specialists, the standard of medicine and dentistry will be lowered. I support the amendment which the Acting Leader of the Opposition has moved.
– I should like the Minister for Labour and National Service (Mr. Holloway) to clarify a statement by the right honorable member for Cowper (.Sir Earle Page). The right honorable gentleman said that the Minister for Health (Senator McKenna) admitted that, in the formulation of the national health scheme, no consideration had been given to the position of friendly societies. I do not know whether that statement is correct, but if it is, something is radically wrong.
– The statement by the right honorable member for Cowper is not correct.
– Is provision made for friendly societies?
– Yes, I refer the honorable gentleman to clause 13.
– I should like the Minister to place the matter beyond doubt when he replies to the second-reading debate, because I shall not be happy if the bill does not make provision for friendly societies. I do not agree with some of the remarks by the honorable member for Perth (Mr. Burke), who has stated that, under this legislation, a person may choose any doctor he desires in the knowledge that the Government will pay onehalf of the account. Thousands of people will not be able to go to leading specialists for operations, and pay half the surgeons’ fees. Therefore, I am not misled into believing that the bill will enable every individual to go to the best doctors in the country, simply because the Government will pay half their expenses. However, I realize that the bill will assist many people. The attitude of members of the Opposition to this bill has surprised me. In my opinion, the greatest benefit from this legislation will be derived, not by the basic wage worker or workers on a marginal rate of £1 or £2 a week, but by persons in the higher income groups who go to expensive doctors for treatment.
– There is a limit to the -payment which they may receive.
– Many persons in the lower income groups are members of friendly societies. I have not the exact figures, but I understand that a man with a family pays to a friendly society 50s. a year for the services of a doctor. I should like to know whether the Government will pay one-half of that amount when this bill becomes law.
– Yes, there is no limit at all.
– In what clause is that provision made?
– This legislation is really an enabling bill. In the Parliament of South Australia and in the Parliament of the Commonwealth, I have had experience of this kind of legislation, which gives to the government of the day power to make regulations to do all kinds of things not inconsistent with the act.
– A blank cheque.
– I realize that it is not possible to incorporate all the details in a bill, and that, therefore, the Government must have the regulationmaking power. The framework of the bill must be sufficiently wide so that regulations may be made dealing with all the details. We know that this Parliament is not able to legislate on matters which are not prescribed in the Constitution. If the framework of this bill is too narrow, I fear that some people may be excluded from certain benefits. The right honorable member for Cowper regarded clauses 7 and 22 as the two most important provisions in the bill. In my opinion, clause 6 is the most important. It reads as follows: -
The regulations may make provision for and in relation to the establishment, maintenance and conduct of a scheme for the payment by the Commonwealth, on behalf of persons who have received professional services from medical practitioners who are for the time being participants in the scheme, of the prescribed proportion of the fees prescribed in respect of those services.
I direct attention to the words “who have received”, and emphasize that the words are not “ who may receive “. The point on which I want to be” clear concerns the clause relating to persons who receive services from medical practitioners. I have had a lot to do with friendly societies work and have been secretary of various lodges. As a result, I have an intimate knowledge of the working of benefit lodges. Many lodge members who are on doctors’ lists do not have occasion to seek medical attention even once in years. However, they continue to pay their medical contributions, so that, should sickness overtake them, they may obtain medical treatment without payment. Many people who are interested in the friendly society movement are somewhat concerned about the provisions of this bill. 1 should like to be in the position, whenever I meet people connected with friendly societies, to be able to tell them what the Government intends to pay them. From my understanding of this measure, there will be a schedule, and payments will be prescribed- in respect of certain types of treatment. The query raised in my mind relates to the method to be adopted for computing halfpayments in respect of every member of friendly societies. Is it intended that at the end of each quarter every member of a friendly society will be required to apply for reimbursement of half of the amount that he has paid into the medical fund, or will the society be required to furnish a statement of what it has paid to the various doctors? If, for example, the amount due to a lodge doctor for a quarter was £40, would the society pay the doctor £20, and the Government the remaining £20? Although to some honorable members this aspect of the matter may not appear to be of very great moment, I regard it as a most important item. It has been said that over 1,000,000 people in Australia are members of friendly societies. All of those people will be vitally interested in the method by which medical fees will be payable.
Over the years, I have had a close association with people who have frequent dealings with members of the medical profession, in connexion with both friendly society work and private attendance by medical practitioners. It has been my experience that members of the medical profession have done a wonderful job in this country. In many instances they have attended to serious cases at night. I know, however, that many doctors have now issued requests to friendly societies and private patients asking not to be called during the night. They have requested patients to advise them before 9 a.m. if they wish the doctor to call on them, so that the call can be made in the day-time. I have no objection to that practice. It must be remembered that in the past the doctors have been willing to attend patients at all hours. I agree with the right honorable member for Cowper, who said that in the past many persons in poor circumstances had been treated by doctors at reduced fees, and, in many instances, doctors have not charged those people any fees for medical attendance. I have heard members of the medical profession say that when a patient is in a good financial position they charge him the full fee, but when people are not so well situated financially, that fact is kept in mind by the doctor when deciding on the amount of fee that he will charge.
– The doctors have always done that.
– The danger that I see in this measure is that in connexion with the treatment of patients whom the doctor would not normally charge, an account may now be rendered, as a result of which half of the amount will be paid by the Government. Generally speaking, the person who will benefit most will be the one to whom a doctor may say, “ You can pay a fair fee for what I am doing. The charge will be heavy “. I assume that the Government will make an arrangement with the British Medical Association for a schedule of charges.
Several years ago I had an interesting experience in connexion with friendly society work. A special fund was established, into which members paid contributions monthly. If a member found it necessary to obtain treatment or services beyond those provided under the normal friendly society’s scheme, half of the cost of that treatment was met from that fund. The society soon found that some of its members were taking unfair advantage of the scheme. In one instance a member of the lodge who required upper and lower dentures, ordered a full set at a cost of 40 guineas. Had that member been paying the full amount to the dentist out of his own pocket, he would have ordered a set priced at 15 guineas. As a result, a limit was placed on the payment that could be made to any particular member. I am not casting any reflection on the dentist in that instance. I consider that provision should be made to meet cases such as the one that I have described. My view is that there are many aspects of this matter that we do not know very much about. Even if many honorable members on both sides of the House were to debate this measure for the full allowable time, I consider that interpretations upon what might be done under its various provisions could be wide of the mark. It must be emphasized, however, that the desire of the Government is to provide better health treatment for the people of this country. This bill seeks to do so. “Whilst it has not been specifically stated in the bill, it has been explained that half of the amount specified in the schedule will be paid. I point out that under that provision of the bill the Government may pay such proportion as is agreed upon with the medical profession. On the other hand the Government may not pay anything at all. An Opposition member, in reading to the House what the Prime Minister (Mr. Chifley) is reported to have said two years ago with relation to the provision of a free medical service, said that, by this measure, the Government intends that this service shall be only half free. I point out that this bill does not say that this is to be a half-pay scheme. It says that the Government may pay such proportion as it determines. We have been told that the intention of the Government is to defray half of the cost, but there is nothing in the bill to prevent the Government, if it so desires, from making full payment. I think it is obvious that something more must be done for the health of the people, and this measure seeks to assist the people in regard to medical treatment. The section of the community that is likely to gain most benefit from this measure is the section that pays large amounts in social services contributions. It has been claimed on behalf of that section that, many of the people who make social services contributions will be eligible for age pensions, because of the operation of the means test. Under this measure, however, such persons, in the event of serious illness, will be eligible to receive a proportionate payment of the amount incurred for medical treatment. In this measure the Government is being given practically a blank cheque so far as health services are concerned, in order to enable it to do the best thing possible for the people of this country. It has been stated that at present the payment will be 50 per cent, of the amount agreed upon, as enumerated in the schedule. Later, no doubt, the Government will liberalize that payment.
What will be the position of optometrists under this measure? Big firms such as Messrs. Laubman and Pank in Adelaide have trained men in sighttesting. Under this bill it appears to me that no provision has been made for those men. I should like the Minister to explain what provision is contemplated in this regard. If a man should go to a specialist to have his eyes tested, he may have to pay £3 3s. for that service. He then has to obtain his glasses from the optician, as a separate transaction. Under this scheme he will be entitled to a refund of half of the £3 3s. charged for the sight-testing. If, however, he should go to to an optician who himself carries out the sight-testing, for which a charge of £1 ls. is made, with a separate charge for the frames and lenses he will not be entitled to any refund. I know that men in the trade are very concerned about whether this will have a bad effect on what they have been doing, in a professional sense, for about a quarter of a century. Certain firms encourage young men to become proficient in the matter of sight-testing by undertaking university training. It is no wonder that they are concerned what the effect of this legislation will be. I do not know whether, under the amendment to the Constitution in relation to medical and dental services, general provision is made for anything else. I should like the Minister, in reply, to give me some information on this aspect of the matter.
I believe that this bill is an honest attempt to help people who require assistance in connexion with medical expenses. I am not dealing with other phases concerning scholarships, and measures for the more efficient training of men. I regard the bill as a framework only, and although I should like to see something more definite in it, I consider that the Government has brought it down in this manner in order to enable subsequent action to be taken to do the best possible for people who require assistance.
.- I listened with interest to the temperate statement of the honorable member for Hindmarsh (Mr. Thompson), and I am sure that ali honorable members are obliged to him for having directed their attention to some matters which are causing them anxiety. I think that this measure is bad, because it has been brought down in circumstances which do not give this House a proper opportunity to debate it. I suppose there could scarcely be a more important piece of legislation than that which proposes to establish a national health service. Yet this measure has been brought down, not in the form of a code of detailed provisions covering the whole of the machinery which is to be set in motion, but merely as an enabling bill. It contains only a few skeleton clauses setting out the regulationmaking power, and leaves it to the Executive to daft the regulations. As one honorable member has said, this bill means that we are signing a blank cheque. “We are buying a pig in a poke. We are criticizing in the dark. Except for tho statements of the Minister in charge of the bill in this chamber (Mr. Holloway) and the Minister for Health (Senator McKenna), who introduced it in the Senate, we have no guide to what the Government proposes to do under the regulations. It may do anything. The House will have no adequate opportunity to debate the regulations yet they will actually be the act. They will probably consist of hundreds of provisions containing the detailed rules for the scheme. We shall know nothing about them. They will be tabled in the usual way; but, as we know, the rules of the House give honorable members no adequate opportunity of dealing with the regulations, which may be far-reaching and signifianct. For a skeleton of a scheme to be brought into being by such a bill as this and for that measure to be followed by numerous regulations is an absurd and totally wrong way to treat this important matter. Furthermore, the bill has been brought down in the last hours of almost a record series of sittings.
– The Opposition always says that.
– We may always say it. I say it now because the House will rise, no doubt in a day or two. This legislation has been on the stocks for months, if not years. Yet, a measure of so widespread national importance is brought before us in the scramble of thi> last hours of the sessional period. If we did our proper duty to the bill, each of us would speak on it to the same length as we spoke on the banking bill, because, in its own way, it is equally important. It will be remembered that almost every honorable member exercized his right on the banking bill and that the debate lasted a long time. To do our duty to the people of Australia we should debate this bill for a long time, but typically the Government has “ bunged “ it in at the last minute. Its attitude is “ It does not matter ; we will shove it through anyhow. The opinions of honorable members do not matter. We can snap our fingers, because the bill is going through anyway.” That is an additional condemnation of the bill which can be criticized on other grounds, insofar as a skeleton can be criticized. If the scheme is to be brought into being as foreshadowed, it will tend to destroy voluntary effort. I say now, as I have said many times before throughout Australia, that voluntary effort, in whatever the field, is vital to Australia’s welfare. It is a part of the social cement that, keeps the nation together. But the bil! will diminish voluntary effort. It will’ discourage medical practitioners from giving free treatment. It will diminish the importance of friendly societies. It will take away from people the urge togive expression to charitable impulses. Australia will have cause to rue its passage. It is a bad measure. It will tend to destroy the incentive of patients to- get well and of other people to stay well. It may be said that most people in this chamber are normally healthy and dc not want to go to doctors’ surgeries for treatment, but any one who knows that he can get something for nothing or for next to nothing he will go after it. People will have the -urge to go to doctors’ surgeries far treatment and medicine that they will not need and that will breed hypochordrines. It will also add to the burden on practitioners. I deplore the tendency to give people something for nothing and I make no bones about saying it. T yield to no one in my desire to shelter and protect people in need, because it is our duty to shelter and protect them, but it is not our duty to sap the vitality of the people by giving them something for nothing and by discouraging them from fending for themselves. I repeat that we shall have cause to rue the day on which we pass this legislation. I think I do not disclose any secrets when I say that many members of the Labour movement are becoming disturbed at the trend of present-day economics. A halt must be called. The instinct of self-reliance must be revived in people. “We all agree with the system proposed in the measure insofar as it concerns preventive medicine. To that extent the measure has the warm approval of all of us. We approve of government assistance in many fields. The Prime Minister (Mr. Chifley) mentioned new drugs. It is obvious that drugs like penicillin, the sulpha group, streptomycin and insulin cannot be produced by private laboratories at a price within the reach of the public, because they are so expensive to make. That is a field into which the state must step. I agree with what the Prime Minister said about institutions like the Commonwealth Serum Laboratories. They are good. I am glad that the right honorable gentleman did not take credit for having established them, because they have been in existence for a generation or more. Those are fields into which the state should rightly step and, as far as this bill will help in that direction, it has my support, There is a distance that we can go in the direction of helping patients to meet medical expenses, and so long as we do not go to the length of providing everything for nothing, I am prepared to accept this proposal. The provision of better hospitals is something that we can give our blessing to. In short, if this skeleton legislation is properly clothed, it can turn out to be good, but the secondreading speech of the Minister for Health and some speeches of honorable gentlemen on the Government side threaten things that we cannot give our blessing to. I propose to say something about those matters. Are we to introduce a system under which the Government will run the lives of the doctors, because it will operate the entire health scheme and will be able to decide what medical practitioners shall be entitled to practise as specialists, instead of allowing members of the profession to decide that for themselves?
– The honorable member does not really think that?
– I am obliged to the Minister for Labour and National Service (Mr. Holloway) for his interjection. I know something about the medical profession, and I have no objection to the members of that profession deciding for themselves who shall function as specialists. If a member of the profession who does not possess the necessary skill or knowledge sets himself up as a specialist his professional brethren and the community generally will soon find him out. I mention that particularly because from the remarks made by the Prime Minister this afternoon I gathered the impression that the right of members of the profession to establish themselves as specialists has got into hie hair. He seemed to be particularly concerned that a medical practitioner who did not possess unusual qualifications might set himself up as a specialist and thereby earn higher fees for a short time. Of course, that contention does not condemn the entire system. One swallow does not make a summer, and it is proverbial that hard cases make bad law. By introducing the present measure, which will empower the Government to decide who shall be entitled to practise as a specialist, the Government is using a naismith’s hammer to crack a nut. That is characteristic of the doctrinaire approach which the Government has adopted in this scheme, and I condemn that approach.
– I think that the honorable member for Parramatta (Mr.. Beale) misunderstood my interjection. He suggested that under the proposed scheme the Government will be empowered to decide who shall practise as specialists, and I interjected that he surely did not believe that.
– The fact remains that the scheme will operate under ministerial control. The Director-General will be under ministerial control, and he will decide who may practise as a specialist. That is wrong. There are only two sections in the community who should decide that; the doctors who set themselves up as specialists, and the members of the medical profession. If. therefore, the proposed scheme is, as it seems to be, merely another example of the present Government’s policy of giving something for nothing, and if it will entail medical practitioners having to fill in Form 44 forty-four times, then members of the Opposition oppose the scheme. That is our main criticism of the bill.
However, I rose primarly not to discuss those matters because I consider that they have already been adequately covered by members of the Opposition who have already spoken. I rose to protest against what I consider to be a very mean attack on members of the medical profession. My protest does not apply to the speech of the honorable member for Hindmarsh (Mr. Thompson), who was generous to the medical profession, nor to the speeches made by the honorable member for Perth (Mr. Burke) and the Minister for Commerce and Agriculture (Mr. Pollard). Unfortunately, the Prime Minister, who spoke on the bill this afternoon, was not so generous. Indeed, I was shocked to hear what I thought was a very mean speech from him. In the Senate an honorable senator referred to the bill-
– Order! The honorable member is not entitled to refer to the debate which has taken place in the Senate.
– Very well, sir. However I have heard it said by Labour men elsewhere that the doctors are dipping into the pockets of their patients, and that contention has been put forward as a justification for the introduction of the bill. No meaner or more unjustifiable assertion could have been made. When the Prime Minister spoke he had “ a bit each way “. First of all he said that the ordinary medical practitioner was all right and did a good job. Then he referred to doctors’ working hours and to the Macquarie-street practitioners, and seemed to have a grievance against them. He seemed to think that they should not be able to elect whether they should function as specialists or not. There was an undercurrent of criticism of members of the profession, and when members of the Opposition interjected the right honorable gentleman corrected himself somewhat and said that they were all right. As soon as we ceased interjecting, he recommenced his criticism of the profession, and it is plain that he has a grudge against them. I am sick and tired of hearing honorable members attack individuals because they do not follow the same occupation or occupy the same walk of life as their critics. Sometimes it is the accountants, sometimes the lawyers-
– With complete justification !
– That is the kind of class-conscious bitterness which permeates the utterances of so many honorable members opposite. They seem to bear a particular grudge against professional men who are successful and enjoy certain privileges because of their success, and I protest against the habit of members of the Australian Labour party of sneering at doctors and other professional persons. In the course of his remarks the Prime Minister referred to the British Medical Association. He ground out the title of that body in halfcontemptuous tones. But what is the Australian Medical Association but a trade union? In this House 1 have heard the Prime Minister warmly defend nearly every trade union in this country. Of course, it always depended on whether the organization was a trade union of what the right honorable gentleman regarded as ‘ workers “, a term which, incidentally, I do not agree is all-embracing. When the body under discussion at any particular time happens to be a union of professional men, then in the view of the right honorable gentleman it is all wrong. Such criticism of one section of the community by another does no good to Australia, and it is no credit to the Prime Minister that he permits himself to make such attacks. In the course of his speech this afternoon the right honorable gentleman said a number of things that may read all right ; but the reaction of almost every member of the Opposition was that the speech was unworthy and mean. If the right honorable gentleman is attempting to persuade the House that the doctors are an unworthy group of professional men, that a considerable number of them exploit the people, and that they are not doing a good job-
-ley. - I did not say a single word about them exploiting anybody. I said that the fees charged by the medical profession now are higher than ever before.
– That is a retraction of the right honorable gentleman’s original statement.
– Order ! I think that the honorable gentleman should confine, himself to the subjectmatter of the bill.
– I am confining myself r,o the bill as far as I am permitted to do by the interjections of honorable members opposite.
– Order ! There is no need for the honorable member to answer the Chair in that manner, f merely said that he should confine himself to discussion of the subject-matter of the bill.
– I beg leave, Mr. Deputy Speaker, to say that, like the Minister for Commerce and Agriculture, and one or two honorable members opposite, who have not been ashamed to stand up for the medical profession-
– Everybody sticks up for them.
– Except the Prime Minister.
– The honorable member is a miserable humbug. Why does he not speak the truth?
– I am not such a humbug as the Prime Minister, who attempted to “have a bit each way”.
– The honorable member is a miserable humbug and a perverter of the truth.
– An honorable member has suggested that I should ask the Chair to direct the Minister for Commerce and Agriculture to withdraw his offensive remark. However, I shall not waste my time by making any such request.
– The honorable member might accept the advice of the Chair and confine himself to the subject-matter of the bill.
– “ Billy’s “ activities in Bradfield are giving the honorable member “ nerves “.
– What gives me “ nerves “ is the class-conscious bitterness that emanates from honorable members opposite at times. I know something about medical practitioners. Possibly I know as much about them as does any other honorable member in this House. During my lifetime of nearly 50 years I have known doctors in cities and country towns; I have known specialists; I have doctors as members of my family and among my friends. My experience of them is as good as that of most other people. Although I concede that some doctors do not give satisfaction to their patients, I have never during my lifetime consulted a doctor who did not give me a fair deal and the full benefit of his skill and experience.
– We, too, have said that.
– That statement had better be made clearly by some honorable gentleman opposite and not in the “wishy-washy” fashion in which it was made by the Prime Minister this afternoon.
– Order ! The honorable member has gone far enough in that direction. I ask him to return to the bill.
– I believe that it is the experience of all of us that the overwhelming majority of members of the medical profession are honorable, hardworking, skilful and self-sacrificing men.
– Hear, hear !
– I am glad that the Minister for Commerce and Agriculture agrees with me. Australia has good cause to be grateful to the members of the medical profession. Insofar as this bill and the regulations that will be promulgated under it will tend to diminish the prestige of the medical profession and interfere with the relations between doctor and patient in such a way as to discourage doctors from giving the same self-sacrificing care and attention to their patients that they have hitherto given them, it is a bad bill.
.- Before the second-reading debate is closed I wish to deal with one or two matters in relation to this bill. It is unfortunate that a measure which should herald the introduction into the Commonwealth of a national medical service should not have found greater support from the members of this Parliament, and what is perhaps even more serious, from those whose co-operation with the Government will be indispensable if the legislation is to succeed. It is almost incredible that a government, however it may be constituted politically, would seek to impose on the Australian community, a national medical service without first having obtained the willing co-operation of the medical profession and without, so far as I can gather, having enlisted the support of the friendly societies movement. Perhaps the Minister will be able to give us more information about friendly societies than we have so far received. But important as their co-operation may be, if this legislation is to be worth anything to the Australian people the Government must secure the co-operation of the medical profession. I do not know why the Government has given up its attempt to gain the co-operation of the medical profession. From the published statements of policy which I have read from time to time I am quite certain that the medical profession favours, as does every member of this Parliament, the provision of improved medical and health services in this country. In the past the provision of better health services has not been practicable largely for financial reasons. The State governments have not been able to provide the hospital facilities required by the community. We have heard from those honorable members who come from States with very large populations that even those States have experienced difficulty in providing adequate medical services because the facilities already established cannot be improved merely by the provision of additional finance. Within this Parliament there is complete agreement about the need for improved medical services, and we can take it that the medical profession as an organized body recognizes that need. Indeed, the British Medical Association has indicated the directions in which an improved health service should take. That being so, it is folly for the Government to embark on a service which, according to the Minister’s second-reading speech, will involve an expenditure over the next few years of approximately £10,000,000 per annum, but which, as far as the medical profession is concerned, will not provide those medical requirements of which the public is in the greatest need in the order of priority considered best by eminent medical men. If honorable members wish to know where the medical profession stands on this matter I refer them to the official record of a conference held in July, 1947, between the Minister for Health and the Federal Council of the British Medical Association in Australia regarding this national medical scheme. I do not intend to detain honorable members by quoting from the report extensively. I merely ask them to note some of the proposals which the association submitted to the Minister as constituting what, in its view, would be an improved medical service. Honorable members will find that the association proposed a constructive proposal. It submitted a comprehensive series of items to which it directed the attention of the Minister. Many of those items have been incorporated in the text of this bill ; but, as I shall seek to show in a moment or two, it is unlikely that the items which the association regard as being of the highest priority will in point of fact receive priority when the moneys proposed to be appropriatedby this measure are being expended.
– The honorable member knows that two or three conferences have been held between the Minister and representatives of the British Medical Association since then.
– That may be so. I am specifically referring to the conference which took place in July, 1947, because at that conference proposals were submitted by the British Medical Association which it regarded as necessary to the inauguration of a better health service. I do not imagine that those proposals have since been departed from substantially.
– The representatives of the association have discussed these matters with the Minister since then.
– I do not think that the Minister suggests that the association has since departed substantially from the proposals it submitted in July of last year as constituting the basis for an improved health service.
– I do not know whether they have been substantially departed from.
– The report states that the federal council had arrived at the following fundamental basis of its policy: -
That the optimum efficiency of medical service to the people will be provided by the following structure: the existing consultant, general practitioner and hospital services, with all adjuncts and these necessary additions :
It is to the necessary additions that I invite the attention of the Parliament because we are all familiar in a general way with the existing consultant, general practitioner and hospital services which operate at the present time. The first item is -
To-night the honorable member for Perth (Mr. Burke) was inclined to scoff at the right honorable member for Cowper (Sir Earle Page), who stressed the importance of nutrition. I do not think that any honorable member can over-emphasize the importance of nutrition and its effects upon the health of the community. It is no answer to the right honorable member for Cowper to say, as the honorable member for Perth said, that because the people of Australia at present have more spending money, the importance of nutrition has in any way been diminished. Any one who has studied the results of the nutritional investigations that have been carried out under the auspices of the Commonwealth Department of Health, will know that wealth and poverty do not have the bearing upon nutrition that many people imagine. Many well-to-do people in the community have not the least idea of what is a satisfactory nutritional standard for themselves or their children. For instance, speaking as a layman, I venture the opinion that probably not 10 per cent. of the population of Australia to-day have an adequate intake of vitamin B complex. I suggest to honorable members that this study of nutrition and the improvement of nutritional standards in Australia is one of the most important and constructive approaches that can he made to a better health standard for the community. The next item specified by the British Medical Association is -
Without knowing anything about that matter, I infer from the emphasis that has been placed upon it that, in the view of medical men, not sufficient is being done on those lines at present. The next item on the list is a matter which has figured largely in this debate. It is -
If the Government is to spend some millions of pounds upon an improved health scheme, it could not select many more important services than that. Considerable expense is incurredby patients who have to undergo both X-ray and pathological examinations, and have then to consult a specialist for the treatment of whatever ailment is discovered. It is particularly true of the remote areas of the Commonwealth, and even of some capital cities including Perth, that additional diagnostic services have become essential if adequate treatment is to be given and early cures effected. The next items on the list are -
The final item, and apparently the most important in the eyes of the Government because it is the one upon which emphasis has been laid in the course of this debate, is -
I have no brief for the British Medical Association on this matter. I approach the problem as one who wishes to see the best possible service made available to the citizens of this country. But the British Medical Association has not adopted a negative or hostile attitude to this problem. It has given a great deal of thought to it, and has put forward officially to the Minister a series of proposals which, in its view, would be valuable adjuncts to the general medical services at present available. No one can accept therefore, without considerable regret, the introduction of legislation which has not the full approval of the men who will be called upon to give effect to it. I believe that the Government should give far more consideration than has been apparent in this debate, to the amendment that has been moved by the Acting leader of the Opposition (Mr. Harrison). The object of the amendment is to give the Government an opportunity to cooperate with the medical profession and the friendly societies in devising a plan which would represent the pooling of their collective wisdom, and would come to us for legislative enactment, as an earnest of the combined effort which should be put into the national medical scheme. What harm could possibly be done to the community if the bill now before us were allowed to remain in abeyance until the new year so that in the interval, the Government might endeavour to secure the fullest cooperation of the British Medical Association? It would be preferable also that the great friendly societies which have behind them a long tradition of community service, to be brought into the scheme. However, the Government apparently is determined to pass this legislation as quickly as possible, and to press on with a service which has provoked the hostility, rather than won the co-operation, of those who will be called upon to give effect to it. I said earlier that apparently although a whole list of items had been submitted by the British Medical Association, and the Government had embodied some of them in its legislation, very little finance would be made available, other than that required to ensure that 50 per cent. of the fees paid by members of the community, will be reimbursed to them. I say that on an examination of the figures which the Minister himself has quoted. In his second-reading speech he stated -
We may be fairly confident that, with the full participation of practitioners in the medical benefits scheme, the cost will eventually be approximately £6,000,000 a year. As to the programme of dental service which has been outlined, the speed of introduction, and, therefore the cost, will be governed by the facilities and trained personnel which are available. Within a few years the service may have developed to a stage at which the annual costs will be in the vicinity of £4,000,000 a year.
That is an overall government expenditure of approximately £10,000,000. I wonder if the Minister has any figure in his mind of the cost to the community at present of the services in respect of which a 50 per cent. payment is to he madeby the Government under this scheme. My only guidance on this matter comes from the Taxation Branch. As honorable members are aware, under our income tax legislation, a rebate is permitted in respect of medical expenses incurred by a taxpayer or a dependant up to a maximum amount of £50 in the one taxable year. I have been advised by the representatives of the Commissioner of Taxation that for income tax and social services contribution purposes, it was estimated that between £14,000,000 and £15,000,000 was claimed for rebate purposes in respect of medical, dental, optical and kindred expenses in income tax returns for the year ended the 30th June, 1948. Obviously, the full amount of the fees paid would not be included. Some persons who paid medical fees would not be required te send in an income tax return. Perhaps their incomes would not reach the taxable level, or perhaps, because of unsuccessful trading operations, they might have had no taxable incomes, and so could not claim rebates. Also, quite a considerable amount of medical attention is given to persons who themselves are not required to pay for it. I refer to persons whose employers pay for medical attention in respect of illness and accidents. Then there are medical expenses exceeding £50 in any one year, in which case a rebate cannot be claimed for the whole amount. Therefore, it appears that more than £15,000,000 a year is paid by the community for medical and dental services. If the Government is to contribute only £10,000,000 under its medical scheme, I cannot see hew it can do very much in respect of those other very important items to which reference is made in the bill.
Undoubtedly, the scheme will break down very seriously the tradition of privacy existing between doctor and patient. I can sympathize with the Government in its desire to lighten the burden upon those who have the misfortune to have serious illness in their family, involving operations or long periods in hospital. Almost every family, at some time or another, has had such an experience. One way to overcome the difficulty would be to liberalize taxation rebates in respect of medical expenses. It might be argued, of course, that such provision would not benefit those on small incomes. I suggest, then, that the Government, instead of chasing every little fee of half a guinea or so, might limit its aid to those who incur heavy expenses for serious opera tions or long periods in hospital. In that way, some of the money which will now be expended on subsidizing the payment of trivial fees could be devoted to helping those on lower incomes who aro really in need of help, and it would 0not be necessary to destroy privacy between the doctor and his patient. I cannot see how, under the proposed scheme, such privacy can be preserved. I have seen a copy of the form which it is proposed to use, and although there is about it a certain amount of ambiguity-
– That is a copy of the form used in New Zealand. We need not follow it in all particulars.
– It will inevitably happen, from time to time, that accounts submitted by medical practitioners will be questioned by officials. The people who have to authorize payment of the bills will sometimes want to know something more about a particular bill. It will seem to them to be excessive, and they will take the matter up with the doctor, asking how he can justify a charge which seems to be excessive. The only practical way in which the doctor can justify his charge is to explain the nature of the patient’s disease, and how he treated it. He cannot do that verbally, because the person who collects the information will not be the person who makes the final decision. . The first official will have to make some kind of written report to a superior. Thus, there will be established a body of correspondence regarding matters which used to be regarded as strictly private. It sometimes happens that persons^ for understandable and valid reasons, do not wish particulars of their illness to be known to members of their family. The oath of Hypocrates, which is taken by all members of the medical profession, binds them to maintain secrecy regarding the diseases of patients and their treatment; yet under the proposed scheme, doctors will be called upon, from time to time, to supply secret information regarding those matters to a government department, and heaven knows how many hands it will pass through.
– The honorable member is of opinion that, under the Government’s scheme, doctors may be required to break their oath?
– I cannot see how the difficulty can he overcome. I am sure that, with the co-operation cf the doctors and of the friendly societies, a scheme could he worked out that would not involve such endless form filling, and would not require doctors te disclose confidential information to government officials. Why not ignore altogether cases in which fees of one, two, three or four guineas only are paid, and concentrate on those cases in which medical expenses are likely to he a real burden? Let the doctor who has treated the patient give his own certificate that treatment has been given, and that a particular charge has been made. It should be possible for the British Medical Association te police such a scheme, and the Government is far more likely to get the scheme effectively policed through the British Medical Association than through one of its own departments. Apart from that very important aspect of privacy, I am certain that no honorable member can contemplate with any sense of satisfaction the creation of another vast department to be engaged in checking the multitude of forms which will flow in if the scheme announced by the Government is carried out in full. I make these comments because I. believe that an admirable objective which is supported by all parties is not being well served by the legislation now before us. The Government is getting away to a bad start on a programme which should be a programme of aid, relief and benefit to the community as a whole. I conclude as I began by expressing my regret that the Government should seek to force through at this stage a scheme which still awaits the approval and co-operation of the medical profession. I refuse to believe that there is not a sufficient sense of responsibility or a sufficient degree of co-operation on the part of the representatives of the organized body of medical practitioners in this country to enable them to join with the Government in a scheme which could be of really worthwhile benefit to the nation as a whole.
– in reply - As the measure can be considered in committee, I do not propose to prolong the debate unnecessarily at this stage. However, as I promised to do, I shall reply to a number of points raised by various honorable members. First. I shall state what the hill does not do; and, secondly, show what it aims to do. The Acting Leader of the Opposition (Mr. Harrison) contended that the measure represents an attempt to nationalize the medical profession, but other honorable members opposite disagree with that view. For instance, the honorable member for Warringah (Mr. Spender) said he knew very well that the measure was not a means by which the medical profession could be nationalized. The Constitution, as amended as the result of the referendum of 1946 provides that the medical profession cannot be nationalized. The relevant placitum reads -
The Parliament shall, subject to this Constitution, have power to make laws for the peace, order and good government of the Commonwealth with respect to - (xxiiiA. ) The provision of maternity allowances, widows’ pensions, child endowment, unemployment, pharmaceutical, sickness and hospital benefits, medical and dental services (but not so as to authorize any form of civil conscription), benefits to students and family allowances:
Without some form of conscription, the Government cannot possibly nationalize medical services.
– This measure is a means of indirectly nationalizing the medical profession.
– It is nonsense to describe this bill as a means of nationalizing medical services. The Government could not nationalize those services even if it wished to do so; and it has no intention to do so. . I am certain that every person knows that the Government cannot nationalize medical services. Now, let us see what the bill aims to achieve. There is a good deal of truth in what many honorable members have said, and to that degree my task in” replying to the debate is made correspondingly more difficult. This is an unusual bill. It is purely an enabling measure to authorize the Government not only to continue the negotiations which are still going on, but also, as arrangements or agreements are made with the dental profession, hospital authorities, friendly societies or any group of medical practitioners or the British Medical Association as a whole, to implement such agreements. These proposals cannot be carried out in the absence of such agreements. Under the measure the Government does not propose to take over hospitals from the States or to take over anything from private groups or the British Medical Association. The Government will follow the procedure which it followed in respect of medical and hospital benefits. It will simply provide benefits to people whom it wishes to help. For instance, under the hospital benefits legislation the Government provided relief to people who could not afford to pay for hospitalisation. At the same time, however, managements of hospitals carried on as they had carried on previously. Now, the Government says to the medical profession and other professions involved that it will enter into agreements with them for the purpose of establishing some system whereby it will be enabled to relieve people of the cost of medical services. The people are paying taxes for such services ; but the Government cannot provide such services to them in any other way than with the co-operation of the British Medical Association. The proposals read out by the honorable member for Fawkner (Mr. Holt) form the basis of the scheme. Many of them are embodied in the bill as well as others which have been suggested by the British Medical Association since the conference to which the honorable member referred took place. The Minister for Health (Mr. McKenna) readily agrees that it is impossible to do any of these things without the cooperation of the British Medical Association. Consequently, he is continuing negotiations with that end in view. He has reached the stage where the British Medical Association itself has made proposals. Those proposals are* being considered; indeed, 99 per cent, of them are embodied in this measure, under which they will be implemented if agreements can be made with the people concerned to carry them out. They cannot be carried out without the co-operation of sufficient numbers of members of the British Medical Association. For instance, medical services in outback areas will be provided on a salaried, or partly salaried, basis. One honorable member said that no services of that character exist in Australia to-day. That is incorrect, because there are quite a number of them in operation. We shall allow members of the British Medical Association to carry on as they do to-day, but, at the same time, we must give relief to people from some of the cost of obtaining medical treatment. That will be done without disturbing the management of the British Medical Association or interfering with the individual practices of members of the British Medical Association. We want to set up clinics and diagnostic facilities in outback areas. Every honorable member will agree with that proposal. We want to extend those services where they already exist. Such action will not interfere with the practices of individual doctors. Indeed, the bill provides for compensation to be paid in certain circumstances to any medical practitioner who can show that the provision of these modern services in the area in which he practices has resulted in a reduction of his earnings. It may be necessary to provide such services in a one-doctor town where an adequate service is not being rendered, not through any fault of the doctor, but because it is beyond his resources to establish clinics, diagnostic facilities and X-ray facilities which should be available to every one. We want to establish such services in outback areas where no specialist could afford to practise: In such circumstances, we ask the medical profession to co-operate with the Government in rationalizing these services. The Government will staff and equip such establishments in areas where no one else could afford to provide them. I say frankly that the provision of such services will mean increasing the number of doctors who are already giving service to the community on a salaried basis. Hundreds of first-class doctors are carrying on their work on a salaried basis to-day. We contemplate the extension of that principle in order to provide adequate medical services in outback areas where a resident medical doctor could not earn a livelihood.
There is no harm in that proposal which will give to the people services which they cannot get in any other way. But some honorable members and certain people outside are sobiased against any progressive change that they consider these proposals represent an encroachment upon the preserve of some private monopoly and, therefore, are dangerous. Some persons always adopt the attitude that medical services should he allowed to remain static even though under such conditions many people are deprived of medical services. This measure is a step forward. It will not enable the Government to do any of the things which honorablemembers have urged against it. It is not a form of nationalization. It will not interfere with the present methods of members of the British Medical Association. In fact, none of these proposals can be implemented without the cooperation of the medical profession. The Government fully realizes that fact, and that is why the Minister for Health is continuing the negotiations with the British Medical Association which have been going on for the last two years. As I have said, those negotiations have now reached the stage where the British Medical Association has agreed to submit proposals which it considers will result in the Government obtaining the co-operation of medical practitioners. That list was prepared nearly eighteen months ago. Since then, further conferences have been held. The list has been examined and other offers have been made. Almost the whole of the provisions of this bill have been copied from the proposals that were submittedby the British Medical Association.
Objection has been raised to the extension of salaried service. When I was Minister for Health I had friendly roundtable discussions with many of the leading medical men in Australia. During the war the Government promised them that it would not take any major steps towards nationalization. The doctors required that assurance to be given before they would agree to help us by going into country districts which, owing to the enlistment of medical practitioners into the armed forces, were without doctors. That promise was given, but the Government said that some steps would have to be taken to meet conditions with which the old order could not deal. One step that was taken was to utilize the services of foreign refugee doctors in areas in which there were no Australian doctors at all. Many country and city practitioners volunteered for service in the armed forces, and some of the lucrative practices in the cities were taken over by the old country practitioners, who are worth their weight in gold. Some country towns were left without a doctor. At one time, nearly 3,000 Australian medical men were serving in the Australian armed forces.I think that fully half of the doctors in Australia enlisted. The Government appealed to the British Medical Association again and again to permit refugee doctors to practise in country towns, and finally it agreed to do so. It appointed committees to investigate the character, political philosophy - because it was necessary to ensure that they were not spies - and the medical knowledge of the refugees. When the committees had approved 60 or 70 of these doctors, they were placed in country towns, having entered into agreements with the Government not to leave those towns until the war ended. At the conclusion of hostilities they were free to seek registration in Australia, if they wished to remain here, and to practise in the same way as any other medical practitioner. As a result of those conferences, I know how difficult it is to deal with some of the men who are in charge of the affairs of the British Medical Association, but are no longer in practice. The late Sir James Barrett, who used to have a lot to say about these matters, was not in practice at that time. I do not think that the views of such men coincide with those of the younger medical men, particularly those who served in the armed forces. It is only grudgingly that they will agree to take a step forward.
Honorable members opposite criticized the Prime Minister (Mr. Chifley), I think wrongly. The right honorable gentleman has been associated with hospitals for the last 20 or 30 years. I am certain that he knows and has fraternized with more medical men than have most honorable members of this House. He has been a director of the hospital in his own district for a long time. The right honorable gentleman has always desired that adequate medical services should be. provided for the Australian people, but he does not want to fall out with the British Medical Association, because he realizes that the co-operation of that organization is essential to the success of the national health scheme.
– The right honorable gentleman said that the members of the British Medical Association were a lot of old shellbacks.
– That is so. 1 would say that there are also some young conservative shellbacks amongst the members of the British Medical Association. The men to whom the Prime Minister referred are those who have ceased to practise. They are conservative-minded and will not willingly take a step forward. The right honorable gentleman meant something like that, and he did not intend to be disrespectful to the doctors, Indeed, he paid tribute to them, and said that in thousands of cases they did not receive payment for their services.
– He said nothing of the kind.
– He did. I think that every honorable member who was present in the chamber when the right honorable gentleman delivered his speech will agree that that is so. The doctors say that, on the average, they are paid for only three of every five of their cases. We all know that, at any rate in bad times, medical practitioners are often not paid by their patients. I have no doubt that many thousands of pounds are still owing to medical practitioners in respect of medical attention that they gave to men and their families during the depression years.
I agree that this is a difficult measure, it is purely an enabling bill. It does not seek to do anything “other than ask permission for the Government to enter into agreements with medical practitioners and their associations, friendly societies and other organizations, for the conduct of medical services on the lines envisaged by the bill so that the people who take advantage of the services will have 50 per cent, of their expenses paid for them. All the requests of the British Medical Association that were contained in the list that was read out by the honorable member for Fawkner (Mr. Holt) are provided for in this bill or have already been implemented. The British Medical Association asked that more attention should be given to tuberculosis. A bill was passed recently dealing with the treatment of that disease, and money has been appropriated to do what the British Medical Association has asked should be done. It was suggested that maternity facilities should be extended. The amount that is paid to women so that they may take advantage of these facilities has been increased from £5 to £17 10s. The right honorable member for Cowper (Sir Earle Page) asked why the Government did not build more hospitals, provide more equipment, establish clinics here, there and everywhere, increase hospital staffs and make more beds available. It will be agreed that it will be a long time before many more hospitals can be built. Surely the Government is not expected to remain idle in the meantime. It is proposed to alleviate those shortages by rationalizing the facilities that already exist and making the best use of them. The honorable member for Warringah (Mr. Spender) has admitted that this is an enabling bill. In my opinion, he dealt with it very fairly. The honorable gentleman is afraid that too many regulations will be made under it, but he understands exactly what it means. It does not mean what the Acting Leader of the Opposition (Mr. Harrison) has said that it means. The honorable gentleman has said that it is straight-out nationalization and will destroy the existing doctor-patient relationship. He has said that there is discrimination between groups of nurses by paying £6,000 to the nursing group in Victoria. I have received a communication denying that such a thing was ever done or is likley to be dene. Almost everything that the honorable gentleman said was without foundation in fact.
The right honorable member for Cowper suggested that, because of its nutritional value, free milk should be given to school children. He has said that on three or four occasions during the present session, and has, in fact, been saying it since he has been a member of the Opposition. When the Labour party was in opposition prior to the war, the late Dr. Maloney pleaded with the Government on almost every sitting day to take steps to supply free milk to school children. He repeated that appeal time after time until we got sick and tired of hearing it but there was not one blink of an eyebrow from the right honorable member foi- Cowper, who never once attempted to help him. Now that he is in opposition, the right honorable gentleman asks for better housing and food and free milk and so on although he himself did nothing about such matters.
– It is operating now in any case.
– Yes, but it did not operate when the right honorable member for Cowper was in office. I have stated that this is largely an enabling bill. The honorable member for Hindmarsh (Mr. Thompson) was afraid that friendly societies would be left out cf the scheme or had not been consulted. No approach has been made by the friendly societies, but they are not worried about the measure because I think that they are satisfied, as a result of the way that they were treated and consulted in connexion with the Pharmaceutical Benefits Bill, about what the Government is going to do. Clause 13 covers friendly societies although it does not mention them specifically. It mentions “ any person “, which can mean groups of persons and the DirectorGeneral assures me that the friendly societies will come into the scheme and that we will be able to enter into agreements with them so that their members will receive the advantage of the 50 per cent, subsidy of their medical costs.
– The Australian Natives Association condemned the scheme.
– I do not know whether they did or not. I can only say that friendly societies will not be outside the ambit of this scheme.
-What about optometrists?
– They are covered bv the list.
– I am referring to opticians.
– Every branch cf that profession is covered. Clause 1 which deals with ophthalmic services covers all branches of optical science.
– Clause 13 does not cover them.
– Clause 6 covers them. Every section of optical science is covered, so long as we can get agreements with the members of that profession. I admit that everything depends upon getting agreements. I said that there were a lot of medical men to-day doing excellent work for the people of Australia on a salaried basis and I desire to say that every doctor, except perhaps an odd one or two, who is working for the Repatriation Department, is either a salaried man on a permanent or partial basis, and when the honorable member for Henty (Mr. Gullett) talks about sneering at the medical profession I remind him that he made some remarks about the treatment people received in the Repatriation Department which were an insult to the doctors who were doing that work.
– The Minister may think what he likes.
– I always think what I like.
– So do I, and I always say what I like.
– I think that the honorable member will be sorry for what he said about friendly societies when he sees it in cold print. He said that services were going down and down as a result of government interference and even hinted that death certificates were tampered with. I do not know whether he meant it, but he said it, and when he reads his words he will be sorry.
– I did not mention friendly societies.
– I did not refer to friendly societies, either.
– The Minister did refer to friendly societies.
– Then I withdraw my remark. I meant the Repatriation Department. The statement I desire to make is that men carrying out work in repatriation hospitals throughout Australia are either salaried men on a permanent or partialbasis, and I said that the statement madeby thehonorable member for Fawkner about the work done in this department-
Honorable Members. - The honorable member for Henty!
– I know what I am saying. The honorable member for Fawkner spoke about the work done in these departments and he will be sorry when he reads his words. I think that any one who knows anythingabout it will agree that the work carried outby the Repatriation Department has won the admiration of all visitors from other countries of the world. I took some of the leading American surgeons through the Heidelberg hospital in Victoria and they said that they had never seen anything like the plastic surgery that was being carried on there.
– The man doing it is an honorary surgeon.
– The men carrying on that work are either permanent, salaried men or are paid for the time they spend at it. The men carrying out our lighthouse, customs, and dozens of other services as well as pioneer medical services at Darwin and Alice Springs, where it would not be profitable for an up-to-date doctor to carry on and the work has tobe done by salaried men, are also salaried men on a permanent basis. Some of the work to he done under this bill could he done probably without a fully-fledged agreement with the British Medical Association,by getting salaried men to go out into those pioneer places and give those facilities to the people who need them, but the bill cannot be implemented unless agreement can be entered into with the British Medical Association, and the friendly societies. That is why this is an enabling bill. It is a difficult one to deal with because it is a skeleton-
– “ Skeleton “ is a good name to apply to this measure.
– All enabling bills are skeletons and have to be filled in by agreement by those who implement them.
– The bill enables the Government to nationalize medicine.
– Medicine cannot be nationalized. The honorable member knows very well what the Constitution says. Why does he harp on something that he knows is not correct?
Question put -
That the words proposed to be left out (Mr. Harbison’s amendment) stand part of the question.
The House divided. (Mr. Speaker - Hon. j. S. Rosevear.)
AYES: 35
NOES: 17
Majority . . . . 18
AYES
NOES
Question so resolved in the affirmative.
Amendment negatived.
Original question resolved in the affirmative.
Bill read a second time.
In committee:
Clauses 1 to 3 agreed to.
Clause 4 (Administration)
– When replying to the second-reading debate, the Minister for Labour and NationalService (Mr. Holloway) carefully explained that this bill is merely an enabling measure. He added that the fears which members of the Opposition had expressed that the bill would, in effect, nationalize medicine, were groundless. I now ask him to explain to the committee the meaning of clause 4, which reads -
The Director-General shall have the general administration of this act but the exercise of any power or function by the Director-General under this act shall be subject to any directions of the Minister.
The administration of this so-called enabling bill will be completely under political direction. The Director-General of Health will not have any freedom of action, because the exercise of any power or function by him under this act will be subject to any directions of the Minister. Who will be the Minister for Health ? Will he be a medical practitioner, who will understand what he is doing? Or will he be a person who, by chance, occupies the position of Minister for Health, and will usurp the whole of the powers of the Director-General of Health, and, in short, play havoc with the entire medical system? This power, which is exceptionally wide, is unnecessary. If the Minister has any confidence in the Director-General, he should not require this power. He has gone to considerable pains in this bill to specify the qualifications that the Director-General of Health shall possess. For example, he must be a legally qualified medical practitioner of not less than ten years’ standing. But the Minister for Health, who may he the secretary or organizer of a trade union and have no knowledge of medicine, will have complete power to direct the Director-General of Health in the exercise of any of his powers or functions under this act. This bill is not so innocent as the Minister has explained.
The Minister has also stated that the bill is essentially a measure that should be considered in committee. The Opposi tion should move amendments to almost every clause in order to preserve to the medical fraternity some of the freedom which they now enjoy. I ask the Minister whether he is prepared to accept any amendments which honorable members of the Opposition may submit. If he is not prepared to do so, why has he described the bill as essentially a measure for consideration in committee?
– What amendments does the Acting Leader of the Opposition suggest?
The CHAIRMAN (Mr. Clark).Order ! The Acting Leader of the Opposition is not to be cross-examined.
– Amendments should be moved to almost every clause. I do not propose to move an amendment to this clause.
– Order ! I ask the honorable gentleman to confine his remarks to clause 4.
– I am doing so.
– The Chair rules otherwise.
– The Chair may rule otherwise, but words can only mean what they mean. I do not propose to move an amendment to this clause. That should be clear to the Chair.
– Order ! Is the Acting Leader of the Opposition reflecting upon the Chair?
– No.
– I ask the honorable member to withdraw his remark.
– I have not reflected upon the Chair. You, Mr. Chairman, have ruled that a statement which I have made is out of order, but I believe that the statement is not out of order. I do not propose to move an amendment to clause 4. This bill violates the principles for which members of the Opposition stand, and, therefore, we should divide the committee on every clause in order to emphasize our opinions about the provisions of this measure.
– The Acting Leader of the Opposition knows that this clause follows the practice that is adopted in all bills involving the expenditure of public money.
– That is not so. The clause provides that the exercise of any power or function by the DirectorGeneral under this act shall be subject to any directions of the Minister. I have never seen a similar provision in any other bill. I should like to hear the Minister attempt to explain how the Minister for Health can control any power or function that might be exercised in the administration of the scheme merely to cover the expenditure of public money.
.- The question proposed by the Acting Leader of the Opposition (Mr. Harrison) raises a fundamental principle. It is necessary to go beyond the words used by the honorable gentleman in order, to understand the clause. It provides that the Director-General of Health shall have genera] administration of national health services but, in the exercise of his powers, shall be subject to the Minister. Consider what would happen if the DirectorGeneral were given such wide powers without being subject to the directions of the Minister, the Government or the Parliament. He would be in a position that has never yet been occupied by a public servant in any democratic country. If we accepted the argument of the Acting Leader of the Opposition, we should in fact establish a superbureaucracy. We should take from the Parliament, the Government and the Minister the power to ensure, on behalf of the people, that the Director-General observed the ordinary standards of conduct laid down for such officers. We should say to him, in fact as well as in theory, “You, as Director-General, may do anything at all without let or hindrance under the power which we repose in you “.
– Who suggests that ?
– That is what would happen if we removed from clause 4 the provision that the Director-General shall exercise his powers subject to the directions of the Minister.
– That is not what the Acting Leader of the Opposition suggested.
– That is exactly what he suggested. If we accepted that proposal, the Director-General would be in supreme control of the national health services. What other conclusion can be drawn ? The Minister for Health would have no right to override any decision of the DirectorGeneral, no matter how extreme it might be. The Director-General would have bureaucratic authority such as has never been envisaged in any democratic country. That is the simple fact that lies behind all Opposition arguments against the placing of general responsibility in the hands of Ministers.” We have heard such arguments time after time, but the unanswerable fact is that, unless a departmental head is responsible to his Minister, he has unlimited powers. Do honorable members opposite say that that should be so? Surely nobody would argue such a case. In essence, the Acting Leader of the Opposition has suggested that the Director-General of Health should be placed above the Parliament and the Minister. We believe that, in the interests of responsible government, public servants must be held responsible ultimately to the Parliament or a Minister. Responsibility to the Parliament would mean that an officer would not be bound to accept the directions of any specific member of the Government, and thus the power of direction would be dissipated over too wide a field. In order to ensure a particular and real political responsibility, in fact to ensure democratic government in every sphere of governmental activity, each departmental head should be responsible to the Minister in charge of his department.
– The honorable member has put up his own Aunt Sally.
– I ask very seriously what would happen if the DirectorGeneral of Health were not held responsible to the Minister for Health.
– That is not my proposition.
– It is the proposition advanced by the Acting Leader of the Opposition, presumably on behalf of members of the Opposition. The DirectorGeneral should be responsible either to the Parliament or to the Minister, and I say that if he were held responsible to the Parliament, the responsibility would be too widely spread. When a departmental head is responsible directly to his Minister, that Minister is then responsible for any errors of omission or commission of the officer. That is essential in a democracy. Otherwise a superbureaucracy would be established, and no member of Parliament could view such a state of affairs with equanimity.
.- The Minister for Labour and National Service (Mr. Holloway) has stated something that we all know, namely, that the national health services scheme cannot function without the co-operation of the medical profession. The Minister must know that an absolutely essential requirement of the scheme is that members of the medical profession shall not be engaged” as public servants. Nevertheless, this clause will place everybody connected with the scheme under the administration of the Director-General of Health, subject to the directions of the Minister. In other words, it will make the whole scheme a part of the Public Service. How can the Government expect co-operation from the doctors in the light of that provision? No reasonable person would expect their cooperation in the circumstances. The honorable member for Perth (Mr. Burke) has emphasized my point by declaring that the whole scheme must be under the direction of the Minister for Health, who is responsible to the Parliament. The Minister for Labour and National Service has said that ministerial control must be exercised because public moneys are involved. But the Government must know perfectly well that the expenditure of public moneys is often administered by corporate bodies in semi-independent positions. As an example, I refer to the Council for Scientific and Industrial Research, an independent body that expends public funds. In the United Kingdom there are dozens of corporations which operate in the same way in the conduct of transport, power and water supply systems. If the system operates satisfactorily there, surely it can operate satisfactorily in Australia.
Clause agreed to.
Clause 5 agreed te.
Clause 6 (Medical benefits scheme).
.- This clause provides for the payment of fees. The Minister has stated that 50 per cent. of the payments by the patients to the doctors for their services shall be paid by the Government. As he knows, the fees charged by doctors vary considerably. A doctor with a wide range of experience, and a high degree of skill, usually charges fees at a considerably higher rate than are charged by the ordinary members of the medical profession. What does the Government propose to do about the manner of prescribing these fees ? Is there to be a flat-rate, so that a surgeon who normally charges 100 guineas for removing an appendix, will receive the .same amount as the doctor who normally charges 10 guineas ?
.-Many matters which arise under thi9 provision have not yet been explained, and require clarification. I have in mind the case of a doctor who gives his professional services as an honorary surgeon at a hospital. Does the Government propose that there shall be any change in the practice there, or will the fact that the surgeon renders those services make him entitled to the payment of a fee? Again, there are cases in which doctors may render services to companies or employers whose employees have become ill or injured. Is it intended that the payment of a fee, or portion of that fee, shall be made only to a private citizen, or will that right also extend to the persons who pay the fees, who may not be the sick, invalid, or injured person, but the employers of those persons? That represents quite a substantial portion of the total medical services.
– It is quite obvious that all of these little details will have to be arranged at a round table conference, at which all parties will be represented
– Then the Government has no scheme at all?
– The honorable member for Flinders (Mr. Ryan) asked who shall decide the fees, and whether they shall be payable at a flat rate.
– Do not forget the skill of the doctor.
– All fees will be fixed by an advisory committee, composed pf the representatives of the College of Surgeons, or whosoever the British Medical Association likes to nominate. It will be decided by men who know all about it, and if they agree to come into the scheme they will lay down the fees.
– Is that definite?
– Yes. If the doctors come into the scheme they themselves, in conjunction with the DirectorGeneral, will be the men who shall fix the range of fees, which will be known by certain codes, such as operation A, B, or C.
– Does that mean that a toprank surgeon will charge the same as a comparatively junior surgeon?
– No ; they would know all about that.
– The Minister will find himself in difficulties if he attempts to do any price-fixing.
– A fee will be fixed for a service.
– Irrespective of the skill of the surgeon?
– The surgeons will agree themselves. It does not matter who does it, because the fee will, be 50 guineas, or whatever is decided. That is the way in which the fees and the range of classifications or charges are to be fixed.
Thursday, 9 December 194S.
– I am much confused by what the Minister (Mr. Holloway) has said. It was certainly not a clear explanation. He said that operations are to be graded as operations in A class or B class. If an operation in A class is estimated to be worth a certain fee, the amount will be fixed accordingly. When the honorable member for Fawkner (Mr. Holt) asked by interjection, “ Irrespective of the skill of the surgeon?”. The Minister said, “ No, the surgeon would fix his own fee “. The Minister cannot have it both ways.
– I did not say that.
– If an operation comes within A category, for which a cer tain fee is authorized, if the skill of the surgeon is to be allowed for, and if the surgeon is to fix his own figure, there will be a number of charges for operation A. That is the very thing that happens to-day. A specialist surgeon may only be willing to perform a certain operation for 100 guineas. Another surgeon may be prepared to carry out that operation for 50 guineas. Yet another may be prepared to do it for 20 guineas. It is possible, also, that in a friendly society the operation may be performed at no cost to the patient. A most impor’tant point arises with regard to friendly societies. How does the Minister propose to treat the medical fraternity in relation to services that they render to friendly society members? Is he going to say to the doctors who treat friendly society subscribers, “You must now charge friendly society patients a certain fee”, or will he say to them, “ Under this scheme you will have no need to render the service to friendly societies that you have done in the past, because you will no longer be dependent on the friendly societies for payments “. There is danger that the doctors will leave the friendly society practice, and that would smash the friendly societies. Is it the intention of the Government to give any consideration to subscribers to friendly societies? Are they to get a remission of the fees paid for medical services? If so, what remission will be made to them? Will the total amounts of their subscriptions be remitted ? If so, will friendly society members be in the same position as people who obtain medical services and receive a 50 per cent, reduction of fees? These are very pertinent questions which must be answered by the Minister, if he has any answer to them. What he has already said certainly makes the confusion worse. The Minister must get down to facts. If he has an explanation, he should now give it to the committee. If he has not an explanation, let him say, “We have no ideas with regard to this. It will simply have to flow from a consultation with the British Medical Association at some conference which may be held in the future, if the British Medical Association agrees to the scheme “.
– Provision is made for specialists. If there were no provision for a specialist to be recognized, why mention him if he is to be regarded as in the same category as any other medical man?
– We shall deal with specialists when we come to the appropriate clause.
– I take it that provision would be made for a specialist performing a highly skilful operation. However, I point out that operations are not performed free for friendly society members. Any friendly society member who undergoes an operation has to pay the same fee as is charged to non-members.
– I repeat again, but for the last time, for the benefit of the Acting Leader of the Opposition (Mr. Harrison) that all the fees payable will have been worked out around the table by the people who become parties to the scheme before they become parties to it.
– The Minister says “the people who become parties to the scheme “. He means, presumably, the spokesmen of the doctors, not the individual doctors.
– I mean the British Medical Association.
– The British Medical Association does not control the fees charged by its members.
– The doctors will nominate their representatives who will sit around the table and decide the fees.
– It is not constitutionally possible for the Government to say what fees doctors shall charge.
– It will all be done by agreement. The doctors will not come into the scheme unless they are satisfied with it.
– This is revolutionary. It appears that the Government intends to invite the British Medical Association and other bodies to decide on certain charges. In other words, it is proposed to apply pricefixing to medical fees. Appendectomies will cost, say, 10 guineas, and tonsilec- tomies some other figure, and other operations will be charged for at fixed fees up and down the scale.
– If the doctors do not agree, there will not be any scheme.
– Earlier, by interjection, I asked “ Is this definite ? “ and the Minister said, “ Yes “, but every time he speaks he becomes more indefinite. Apparently there is no plan. The Government will get hold of the DirectorGeneral of Health and say to him, “ Can you find a way out?”. We should know where we stand now. Is it proposed that the skilled surgeon, who charges high fees to those able to pay for operations, but performs similar operations in public hospitals free of charge, shall be forced to reduce his fees to the level of those charged by doctors in country towns like Bathurst, or suburbs like Footscray? The philosophy of socialization has been put before common sense. Let the Minister be frank and say, “ I thought we had a plan, but we haven’t one “.
.The Minister in charge of the bill (Mr. Holloway), has made it quite clear that the Government has no definite arrangement as to what the fees shall be and that it proposes to reach a scale of charges preferably after consultation with the representatives of the British Medical Association. He has also made it clear that the scale of charges, when reached, will become the standard regardless of individual skill, experience and standing in the medical profession. No provision is to be made for flexibility. If that is so - and it appears to be from what the Minister said - I remind the Minister that surgery began in the barber’s shops hundreds of years ago. It needed the Minister to bring it back to the atmosphere of the barbers’ shop. The surgeons will have to state their charges for various operations as the barbers state their charges for haircuts and shaves. I do not know how the Minister expects the medical profession to accept this scheme.
– That shows how little the honorable member knows about the bill.
– I confess that I know nearly as little about it as the Minister does. Will the Minister give us a frank answer to the question whether doctors will he able to make varying charges for the same services?
– I emphasize the seriousness of what is being done. We have not been told anything definite about what the charges may be. Are eminent surgeons with great practices who charge high fees but give free service in hospitals to have their salaries pared to standard and are they to stand in the queue with other doctors to see who will do the next half-price operation? I think the Minister should have had the answer to those questions ready before he introduced the bill.
– I rise to point out the inconsistency of the honorable member for Balaclava (Mr. White) and the honorable member for Fawkner (Mr. Holt). In 1938, the then Treasurer, Mr. R. Q. Casey, introduced into and had enacted by this Parliament the National Health and Pensions Insurance Act.
– I rise to order, Mr. Chairman. The clause has nothing to do with the national insurance scheme and no reference ought to be made to it.
– I hope that all honorable members will confine their remarks to the clause. The Minister for Commerce and Agriculture must do so.
– I will. Mr. Casey pointed out that it was intended to confer with the medical profession in order that an agreement might be arrived at. The inference is that that agreement referred to the fixing of fees and salaries of medical men. That act covered nearly 2,000,000 people. Yet, when this Government brings down a plan providing the basis for, but not the details of, an arrangement honorable members opposite have the effrontery to condemn it.
Clause agreed to.
Clause 7 (Provision of medical and dental services).
– The clause deals with the provision of medical and dental services, and I ask the Minister for Labour and National
Service (Mr. Holloway) to explain how he reconciles the powers contained in the clause with the statement which he made earlier that the Government did not intend to take over any hospitals or medical institutions. The provisions of the clause are most far-reaching. Subsections 1 and 2 read as follows : - (1.) The Director-General may, on behalf of the Commonwealth, but subject to this Act, provide, or arrange for the provision of, prescribed medical services and prescribed dental services. (2.) Without limiting the generality of the last preceding sub-section, the services referred to in that sub-section may include -
Sub-clause 4 reads -
In particular, and without limiting the generality of the last preceding sub-section, the Director-General may, on behalf of the Commonwealth -
establish, maintain and manage hospitals, laboratories, health centres and clinics;
That provision is quite specific. Other clauses in the bill provide that the Commonwealth may make arrangements with the States to take over control of State instrumentalities, and provision is also made for the Commonwealth to take over institutions other than State instrumentalities. I should like the Minister to state whether the Government intends to take over State instrumentalities and also to assume control of institutions which are not operatedby the States If it is true that the Government intends to assume the control of all institutions, whether owned by the State or by private concerns or individuals, the criticism made by the Opposition of the measure that it will lay the foundation stone for a nationalized medical service, not by civil regimentation but by economic regimentation, will be established. If the Government does not intend to acquire control ofmembers of the medical profession, it is difficult to understand why it has included in the hill specific provisions to enable it to acquire not only institutions conducted by the States but also other institutions.
.Subclause 2 of the clause itemizes the services which the Commonwealth may provide. Has the Government any definite programme in regard to the provision of those services ? If so, can the Minister for Labour and National Service (Mr. Holloway) indicate the expenditure that will be involved on each of the’ enumerated items during the next twelve months?
– No sensible person would imagine that such a comprehensive scheme could be implemented in the next twelve months.
– Has the Government a definite programme?
– No. Only half the enumerated services, or, even none at all may be possible in the next twelve months, and no statistics of the estimated expenditure are available. The provision of such a comprehensive service must necessarily be a slow development, and some of the services enumerated are not now provided by any State or private instrumentality. For example, the provision of dental services for school children and the establishment of clinics at Cape York and other remote places will be an entirely new departure. The estimated expenditure of £10,000,000 a year which I mentioned in the course of my second-reading speech will probably not be reached for another ten or twelve years. Although the provision of such a comprehensive medical service as that proposed in the bill has been ridiculed, I point out that the British Medical Association has for some years provided a large public medical service in New South Wales on a basis of fixed fees and charges for various services. That is one of the finest schemes in Australia.
– Does the Minister intend to answer the observations that I made on that clause?
– Yes. In the course of my second-reading speech I made the following remarks concerning health centres: -
Recognizing the value of group practice, the Commonwealth proposes to establish a number of health centres in different areas. These will correspond in their functions to the surgeries of the larger medical partnerships of the present day, and will provide general practitioner service, specialist service and diagnostic facilities. It is contemplated that these health centres will be established on. varying administrative and staffing bases, sothat there will be opportunities for observation and comparison for future guidance. Thebill authorizes the making of regulations providing for the payment of compensaton to a practitioner who undertakes to make his professional services available exclusively for the purpose of the National Health Service, where the establishment of such a health centre results in loss arising from the diminution in value of his private practice.
The Government proposes to achieve that in a manner similarly to that in which it proposes to achieve the other aspects of the scheme, namely, by consultation with the persons concerned.
– This clause provides that the DirectorGeneral may, on behalf of the Commonwealth, arrange for the provision of aerial medical and dental services. Can the Minister state specifically what theGovernment intends?
– That provision refersto the “ Flying Doctor “ service.
– I have been a member ->f the council of that service since 1927, when the service from Cloncurry toCharleville was commenced. At that time it was financed from denominational’ sources. Later, it received a subsidy from the Lyons Government. Todaymany thousands of people subscribe to it, and the service caters for aborigines as well as white people. It serves an area with a radius in each instance of 400 miles, which embraces Port Hedland, Wyndham, Kalgoorlie, Broken Hill’ and Alice Springs. Does the Government propose to establish a rival scheme, or does it intend to supplement the present scheme ?
.I rise again to clear up the financial’ implications-
– I cannot furnish any estimate of the expenditure that will heinvolved.
– But the Minister for Labour and National Service (Mr. Holloway) said that the estimate of £10,000,000 per annum, which he mentioned in the course of his second-reading speech, might not be reached for more than ten years. Will the Minister state whether that estimate was based on the taxation rebates claimed in 1948 on £15,000,000 of medical and kindred expenses, which would not cover the complete range of medical fees earned during that year?
– Order ! The honorable member is going beyond the scope of the clause. Payments are dealt with in an earlier clause.
– I have been informed that claims for rebates amounting to £15,000,000 were submitted. If the Government paid half the total fees, the amount rebated would be only £7,500,000.
– It would be a great deal more than that.
– I have cited the figures furnished by the taxation branch. I have been informed that rebates were claimed in respect of medical fees amounting to £15,000,000.
– Order ! The honorable member’s remarks relate to clause 6.
– With respect, sir-
– That is the ruling of the Chair. The clause now before the committee deals with the provision of medical and dental services.
– I assure the honorable member for Balaclava (Mr. White) that the Government subsidizes the services which the has mentioned. The people engaged in them are doing excellent work. The subsidies amount at present to approximately £7,500,000 per annum. The Government has no intention to interfere with them in any way. On the contrary, it will co-operate with them and consult them in every way possible.
Clause agreed to.
Clauses 8 to 11 agreed to.
Clause 12 (Management committees).
– I should like an assurance from the Minister relative to the establishment of management committees. In another part of the bill, provision has been made for the establishment cf advisory committees. I should like the Minister to give an assurance that such committees, whether they be for the purpose of management or advice, will be established by the Minister only after consultation with the responsible bodies. Is it proposed that a panel of names shall be submitted to him from which he will make appointments to the committees, as is done in connexion with the War Pensions Entitlement Appeal Tribunal under the Australian Soldiers’ Repatriation Act? Will authoritative bodies recommend to the Minister those persons who, they think, should represent’ their interests on the management and advisory committees, or will the Minister make arbitrary appointments to such committees ?
– The committees will be appointed in consultation with those institutions and organizations in the States which are co-operating with the Government in the implementation of this scheme. The Government will appoint a representative to each of the committees in order to watch its interests and the expenditure of public moneys. The management committees will be left largely as they were previously.
Clause agreed to.
Clause 13 (Agreements for the provision of services).
.In the course of his secondreadingspeech, the Minister for Labour and National Service (Mr. Holloway) stated that under this clause certain arrangements could be made with friendly societies. I understand he made that comment by interjection when the honorable member for Hindmarsh (Mr. Thompson) was pressing him for someassurance on that point. Has any agreement yet been reached with the friendly societies? If not, is it proposed to seek an agreement with them, and how and! when is it expected that such an agreement will be reached ?
– This clause, when read in conjunction with clause 14, gives a complete picture of what the Government has in mind. This clause reads -
The Director-General may, on behalf of the Commonwealth, make an agreement with any person for the performance by that person of any service in connexion with a national health service.
That provision simply means that the Director-General may make arrangements with any medical officer or person to come under this scheme; but in the next clause, the Minister goes further and pro poses te engage in or undertake the manuture of medical supplies. The clause reads -
The Minister may, on behalf of the Commonwealth, arrange for, or undertake, _ the manufacture for the purposes of a national health service, of medical and dental supplies, appliances and equipment, including visual
Kids and hearing aids.
The Government has in mind not only the economic regimentation of the medical profession but also the manufacture of medical supplies. How does the Minister propose to make arrangements in respect of those people who have no intention to come into this scheme?
– I inform the honorable member for Fawkner (Mr. Holt) that no arrangement has yet been made with friendly societies, but I hope that such an arrangement will be made in the near future. In reply to the Acting Leader of the Opposition (Mr. Harrison), may I say that honorable members will recall that, on several occasions, questions have- been asked in the House whether the Government has any intention to assist people suffering from deafness by supplying them with hearing aids. Some of these devices are being imported from England, but supplies are not available from the United States of America. The supply of hearing aids is not nearly sufficient to meet the demand for them. As the national health scheme progressively develops- tha Government proposes to provide amenities of this kind if they are unobtainable from other sources. The Government does not intend to manufacture medical supplies if adequate supplies are available at reasonable prices. It will only engage in the manufacture of such supplies, as it did in connexion with serums, when supplies from other sources are insufficient to meet the demand.
Clause agreed to.
Clause 14 agreed to.
Clause 15 - (1.) The Director-General may, for the purposes of this Act, compile and publish a list of medical practitioners or dentists recognized by him as being specialists in any field of medical science or dental science.
– This clause, which is very contentious, has been framed in an interesting way. It reads - (1.) The Director-General may, for the purposes of this act, compile and publish a list of medical practitioners- or dentists recognized hy him as being specialists in any field of medical science or dental science. (2.) A person shall not he recognized, for the purposes of the last preceding sub-section, as being a specialist in any field of medical science or dental science, unless the DirectorGeneral is satisfied -
The sub-clause then indicates the qualifications that a person shall possess in order to satisfy the Director-General that he may be regarded as a specialist. Subclause 3 reads -
For the purpose of satisfying himself an provided in the last preceding sub-section, the Director-General may have regard to any list compiled by the appropriate authority of a State, or by an appropriate professional body, of medical practitioners or dentists who are recognized by that authority or body as being specialists in any field of medical science or dental science.
A person who wishes to be recognized as a specialist will, after this bill is passed, be required to make application to be recognized as a specialist, and the Director-General may refer him to one of the advisory committees, or take such other action as may be necessary to satisfy himself that the person concerned is a fit and proper person to be recognized as a specialist. The power which will be given to the Director-General under this clause will cut across the established practice of medicine to a degree which, I feel, will not benefit the medical profession generally. From my discussions with a number of medical men, specialists in any branch of medical science are accepted as such solely on the value of their work as assessed by their colleagues in the medical profession. No doctor would describe himself as a specialist unless his professional colleagues were satisfied that he possessed specialist qualifications. The determining factor is the value placed upon a medical practitioner by his own colleagues. The Government proposes something different from that. It proposes that doctors who have attained certain academic qualifications should become specialists regardless of their standing in the eyes of their profession. I suggest that some arrangement should be made by which the long-established practice in medicine should be recognised. When negotiations are entered into with the British Medical Association for the acceptance of proposals such as these, surely the spirit of compromise should prevail, and an endeavour should be made to devise a scheme which would be satisfactory to both the Government and to the British Medical Association. But the Government is saying, in effect, “ We shall determine who are to be specialists regardless of what may be the established practice “. Such an uncompromising attitude destroys whatever spirit of reasonableness may have existed. I hope that the Minister will give this matter further consideration because I believe that precedent and tradition are most important in professional services.
– The Acting Leader of the Opposition (Mr. Harrison) has answered his own question. What he has suggested is exactly the method that will be adopted. The State medical authorities already have lists of recognized specialists. If other medical men <eek recognition as specialists, and we are in doubt about their qualifications, the profession itself will be asked to determine the matter.
Mr. Harrison. Queensland is the only State that registers specialists.
– Existing lists will be accepted, and any additions will be decided by the Boy al College of Surgeons, or whatever the appropriate body may be. That is what the honorable member has suggested.
– My objections and those of the Acting Leader of the Opposition (Mr. Harrison) would be met by substituting the word “ shall “ for the word “ may “. “ Shall “ is obligatory, whereas “ may “ is optional. Sub-clause 1 would then read - (1.) The Director-General shall, for the purposes of this Act, compile and publish a list of medical practitioners or dentists, recognized by him as being specialists in any field of medical science or dental science.
There would then be an obligation upon the Minister to consult with the medical and dental organizations. I have discussed this matter with some professional men, and they have informed me that the substitution of the word “ shall “ for the word “ may “ would ensure the necessary consultation. This alteration would be necessary throughout the clause. The Prime Minister (Mr. Chifley) spoke of specialists as if they were, if not unnecessary, at least too numerous. That is not the way to look at these men who ure at the head of their profession. They have achieved their present prominence because their knowledge of certain branches of medical science is greater than that of general practitioners. The best authority to determine the status of these men is the British Medical Association. Therefore, I move -
That, in subclause (1.), the word “may” be left out, with a view to insert in lieu thereof the word “ shall “.
– “ May “ means “ shall “ and “ shall “ means “ may “. I cannot accept the amendment. I do not think there is any need for it. What the honorable member for Balaclava (Mr. White) and the Acting Leader of the Opposition seek is absolutely assured by the bill as at present drafted.
Amendment negatived.
Clause agreed to.
Clause 16 agreed to.
Clause 17 (Officers).
– I warn medical men that once they participate in this scheme, they will immediately become Commonwealth officers, and will come under the Commonwealth Public Service Act. They will then lose their freedom as far as their general medical practices are concerned, because they will be controlled by a department which is under political direction. Once control of the medical men by a politically directed department is established the biggest step towards the regimentation of the medical profession will have been taken.
– This deals with administrative officers.
– It does not say so. It says “ officers and other persons “. That could include medical men. A doctor who is under the control of the State is referred to as a medical officer. I ask the Minister whether doctors participating in this scheme will be classed as medical officers and come within the scope of the Public Service Act.
– No.
– I am satisfied with that assurance.
Clause agreed to.
Clauses 18 to 21 agreed to.
Clause 22 (Regulations).
– This clause is rather interesting. The bill applies force in one clause, and offers enticement in another. I ask the committee to notice the wording of the clause, which is as follows: -
The Governor-General may make regulations, not inconsistent with this Act, prescribing all matters which are by this Act required or permitted to be prescribed, or which are necessary or convenient to be prescribed, for carrying out or giving effect to this Act, and in particular -
for providing for the payment of compensation to a medical practitioner or dentist who -
i) on the date on which a hospital, health centre or clinic is established at any place in connexion with a national health service, is in practice in or near that place;
undertakes to make his professional services available exclusively for the purposes of a national health service; and
has thereby suffered or will suffer loss arising from a diminution in the value of his practice;
The Government is to take power to compensate a doctor if the establishment of a health centre in his district adversely affects his practice. It also proposes to take power to compensate a doctor who, having a good practice, decides to come under the health scheme, and thereby suffers some financial loss. Thus, the Government is prepared on the one hand to use force to injure a doctor’s practice in an attempt to force him to enter the scheme; and, on the other hand, it will attempt to bribe the thriving practitioner into joining the scheme by offering to compensate him for any loss thereby incurred. The Government appears to have closed every possible loophole. It is to have power to establish clinics, take over hospitals, or arrange for the States to take them over. Finally, it is taking power to destroy a doctor’s practice, or to bribe him into joining its health service. This is regimentation, not so much by law as by economic pressure. This is really a delightful umbrella clause, which provides against the storm as well as the sunshine. It provides for the regimentation of the whole of the medical profession.
– This is the feature of the bill which most honorable members opposite have praised. It is the clause which provides for the extension of health centres, a provision which honorable members have welcomed, yet it is the provision that the Acting Leader of the Opposition (Mr. Harrison) now pretends to oppose so frantically. It is possible that the establishment of a health centre in a district served by only one doctor might cut into his practice, hut surely it is not suggested that the welfare of a population of several thousand people should be jeopardized because a doctor might be inconvenienced. It is proposed to overcome this difficulty by taking power to compensate the doctor in such circumstances. He may be offered a position in the health centre, or he can be compensated if he does not choose to take such a position.
– This clause is probably the principal clause of the bill. It proposes to enable the Governor-General, which means, in fact the Minister, to make regulations to implement the Government’s health scheme. The clause provides that regulations may be made -
for prescribing matters for or in relation to-
There has been much debate about this provision, but we have not been informed of how it is proposed to implement these various provisions. It would appear that the Government intends to put the steam roller over members of the medical profession in order to force them to conform to its proposals.
Clause agreed to.
Title agreed to.
Bill reported without amendment; report adopted.
Bill - by leave - read a third time.
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Bill received from the Senate and (on motion by Mr. Dedman) read a first time.
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Bill returned from the Senate without amendment.
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Bill returned from the Senate without amendment.
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The following papers were presented : -
Commonwealth Public Service Act - Appointment - Department of Civil Aviation - J. E. Schofield.
Lands Acquisition Act - Land acquired for Postal purposes - Gulnare, South Australia.
House adjourned at 12.57 a.m. (Thursday).
page 4213
The following answers to questions were circulated: -
Public Service: Promotions Appeal Committee.
e asked the Prime Minister, upon notice -
– The answers to the honorable member’s questions are as follows : -
The future life of the Commonwealth Disposals Commission was examined by the Government in August of this year when it was decided that the Commission would carry on in its present form until 31st December, 1948. The question of continuance beyond that date will shortly be reviewed by the Government.
t asked the Minister for External Territories, upon notice -
– In the absence of the Minister for External Territories the following answers are furnished to the honorable member’s questions: -
y. - On the 5th November, the honorable member for Henty (Mr. Gullett) addressed a question to the Minister for External Territories concerning comments made regarding the administration of the Territory of New Guinea by the Soviet delegate on the Trusteeship Council of the United Nations. The honorable member considers that the comments revealed con siderable knowledge of conditions generally in New Guinea, including such transactions as land deals and asked whether the Minister had any idea where the Soviet delegate got his information and whether the Minister would institute an inquiry into what the honorable member referred to as leakage of information. The honorable member asked also what Communists are now at present residing in New Guinea ; what facilities they have for obtaining information; whether any member of the Russian Legation in Australia has recently visited New Guinea, and what Commonwealth public servants have visited New Guinea recently and what is their background in this regard. I replied to the honorable member and stated that I would request the Minister for External Territories to supply the honorable member with further information. In the absence of the Minister I advise the honorable member that a representative of the Union of Soviet Socialist Republics is on the Trusteeship Council of the United Nations including the territory of New Guinea. Full information regarding the administration of New Guinea was supplied to the Trusteeship Council in the annual report and by the special representative of Australia who appeared before the council when the report was being examined. Such information is available to all members of the council and detailed comments by a member of the council would be based upon such information and would not be the result of any leakage of information. With regard to the other questions’ by the honorable member I wish to state that persons desirous of proceeding to the territory of New Guinea must obtain an entry permit and a permit has not been issued to a member of the Soviet Legation in Australia. Officers of the Department of External Territories and other Commonwealth departments have recently visited New Guinea on official duties.
r asked the Treasurer, upon notice -
– The answers to the honorable member’s questions are as follows : -
Cite as: Australia, House of Representatives, Debates, 8 December 1948, viewed 22 October 2017, <http://historichansard.net/hofreps/1948/19481208_reps_18_200/>.