18th Parliament · 2nd Session
The President (Senator the Hon. Gordon Brown) took the chair at 11 a.m., and read prayers.
– I address a question to the Minister representing the Minister for the Interior with regard to the train service from Melbourne to Canberra, particularly the section from Goulburn to Canberra. The sleeping cars provided on the service are urgently in need of attention; but the main complaint is that the journey from Goulburn to Canberra is unduly protracted. The express from Albury arrives at Goulburn at about 6 a.m., where the Canberra carriage is detached from it. After the Canberra carriage has been shunted about the Goulburn yards for an hour or two the Canberra train is made up ; but, even if it is running on time, it does not arrive here until 10.50 a.m., although the distance between Goulburn and Canberra is only about 60 miles. The rail service to the National Capital is absolutely appalling. I ask the Minister to make urgent representations to the New South Wales Railways authorities to improve the service. If an efficient service is not provided, many people who prefer to travel by train will be forced to abandon rail travel and will travel by air.
– I shall bring the honorable senator’s observations to the notice of the Minister for the Interior, with a view to having an improved railway service provided between Goulburn anc! Canberra.
– Recently, Senator Sandford asked a question relating to the allocation of moneys to the States for country road construction. In his reply, the Minister representing the Minister for Works and Housing stated that the grants for road construction to the States had increased from £532,322 in 1945-46 to £1,097,696 in 1947-48. He also stated that the Australian Government exercises no control over the expenditure of such grants. Can the Minister inform the Senate whether the grants made to the States for this purpose, especially to Victoria, have been fully expended? My reason for asking the question is that I have received a copy of a circular, signed by Mr. Kennedy, Minister for Public Works, which was sent to a number of shire councils in Victoria, stating that the whole of the grant made available to Victoria by the Commonwealth for road construction has been expended, and that no money is available to those shires which urgently need it.
– State governments have the sole responsibility for distributing the roads grants allocated to them. Only when strategic roads or approaches to munitions works and other Commonwealth undertakings are to be constructed, does the Commonwealth issue any direction to State governments concerning road construction. However, in such instances, special grants are usually made to cover the cost of construction. I shall request the Treasurer to supply, for the information of the honorable senator, a statement showing the amount which has been expended on the construction of roads in Victoria.
– Because of the tragic situation which exists in China I understand that three vessels which have been used in the transportation of migrants from Europe to Australia are to be diverted to China to evacuate certain nationals. Can the Minister representing the Minister for Immigration say whether there is any possibility of the evacuated nationals being brought to Australia, and, if so, what conditions will be imposed before they are admitted to this country?
– If the honorable senator will place that question on the notice-paper I shall obtain an answer to it from the Minister for Immigration. I know that the matter referred to by the honorable senator is occupying a good deal of the Minister’s time at the moment, and, as honorable senators are aware, large numbers of migrants have already come to Australia from that part of the world.
loss of Aircraft “ Lutana “ : Report of Air Court of Inquiry.
– Has the Minister representing the Minister for Civil Aviation seen the report submitted by Mr. Justice Simpson, who inquired into the Lutana air disaster, in the course of which the judge recommended that two magnetic compasses should be installed in all civil aircraft? Since the adoption of that suggestion would tend only to create confusion in the minds of pilots if , one of the compasses were out of order, will the Minister examine the report critically to discover whether the other recommendations contained in it are equally impracticable ?
– I have not seen the report to which the honorable senator has referred, but I shall bring his question to the notice of the Minister for Civil Aviation and request him to examine the report in the manner suggested by the honorable senator.
– Can the Minister representing the Treasurer say whether the Government has considered the necessity for providing amenities for coalminers at Collie, Western Australia? Has any proposal been made that the Commonwealth should assist the State to supply amenities, and, if so, what is the basis of the proposal? Can the Minister supply any further information in the matter?
– The provision of amenities for coal-miners at Collie, Western Australia, is the responsibility, in the first instance, of the Government of Western Australia. However, before any recommendation could be implemented it would be necessary for agreement to be reached between the Commonwealth and the State Government on similar lines to the agreement for the provision of amenities in coal-mining areas in New South Wales. I understand that coal-miners at Collie, Western Australia, have decided to discontinue membership of the miners’ federation and to place themselves under a coal authority which will be appointed by the Government of Western Australia. If they adopt that course they might not be able to participate in amenities provided by the Joint Coal Board.
– I desire to ask a question of the Minister for Shipping and Fuel, and I preface it by referring to a report in the CourierMail of the 1st December, headed “ Dispute over Coal J ob “. The report contains the following passage: -
The Coal Owners’ Association will go to the Commonwealth Arbitration Court and/or the High Court if necessary to challenge the appointment of Mr. J. A. Murray, S.M., as Board of Reference chairman. The association secretary (Mr. W. Thomas) said that to-day.
Has the Minister seen the statement of the secretary of the Coal Owners Association of Queensland, Mr. W. Thomas, that the association will go to the Commonwealth Arbitration Court, or to the High Court, if necessary, to challenge the appointment? Is it a fact that clause 15 (b) of the consolidated coal-mining industrial award provides that the chairman shall be appointed under the hand of a judge of the Commonwealth Court of Conciliation and Arbitration, and that Mr. Walsh, having been appointed by a judge of the court, is still chairman of the board as his appointment has not been validly terminated?
– I thought I had explained the position clearly yesterday. The same question was asked of me by press representatives, who wanted to know whether Mr. Murray had been legally appointed, and whether the appointment was likely to be challenged in the High Court. The honorable senator being a legal man, should know more about these matters than I do as a layman. The Government accepts full responsibility for the legality of the appointment of Mr. Murray, and is prepared to meet any challenge from the owners.
– In view of the political crisis which has arisen in Victoria consequent on the State Government’s policy of appeasing the Communists in order to settle the recent strike in that State, will the Leader of the Senate do everything possible to complete the business of the chamber so that members of the Opposition may be able to go to Victoria and assist their colleagues in distress ?
– I am not clear what the honorable senator wants.
– I should have said in the event of an election eventuating.
– I cannot discuss that matter now, but should such a situation develop we shall do our best to meet it.
Bill presented by Senator McKenna, and read a first time.
Motion (by Senator Ashley) put -
That so much of the Standing and Sessional Orders be suspended as would prevent the bill being passed through its remaining stages without delay.
– There being an absolute majority of the whole number of senators present, and no dissentient voice, I declare the question resolved in the affirmative.
– I move -
That the bill be now read a second time.
The purpose of this bill is to authorize the Commonwealth Arbitration Court to fix a foundational or basic rate of pay for adult females. Paragraph d of section 25 of the Commonwealth Conciliation and Arbitration Act, as at present in force, provides that the court may alter the minimum rate of remuneration for adult females in an industry. In a judgment of the court delivered on the 29th July last, it was held by a majority that that provision refers only to the basic wage element or factor in any prescribed female rate. Where any such prescribed rate did not specifically fix or disclose the basic wage element or factor, the fixation thereof was in the jurisdiction of the appropriate conciliation commissioner. Once, however, such a fixation had been made, the question of its alteration became a matter for the court. The industries concerned in the court’s judgment were the metal trades, motor-body and coach-building, furniture trade and rubber workers, and in each instance the court decided that there had been no fixation of an adult female minimum rate, and that, accordingly, the matter was one for determination by a conciliation commissioner. There are, however, many other industries involved in the court’s decision.
There are fifteen conciliation commissioners, >and each commissioner has had assigned to him certain industries in which females are employed. The views of the commissioners may differ as to the element of the rates of pay of adult females which could be ascribed to an adult female basic wage analogous to the basic wage for adult males. It is desirable that there should be a uniform approach to such an important matter and, therefore, this :bill proposes to authorize the court - and the court alone - to fix what will be, in effect, a basic wage for adult females. The necessary alteration of section 25 involves a corresponding alteration of section 13.
Question’ resolved in the affirmative.
Bill read a second time, and passed through its remaining stages without amendment or debate.
Motion (by Senator McKenna) agreed to -
That leave be given to bring in a bill for an act to amend the Hospital Benefits Act 1945-1947.
Bill presented, and read a first time.
Motion (by Senator Ashley) put -
That so much ‘of the Standing and Sessional Orders be suspended as would prevent the bill being passed through its remaining stages without delay.
– There being an absolute majority of the whole number of senators present, and no dissentient voice, I declare the question resolved in the affirmative.
– I move -
That the bill be now read a second time.
The object of the bill is to authorize the execution of an agreement with any State to amend the Commonwealth-State hospital benefits agreement. By the original agreements between the Commonwealth and the States under the Hospital Benefits Act 1945-1947, 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 State was obliged to place in trust account 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 (Mr. Chifley) proposed that the benefit rate for public and non-public wards be increased from 6s. a day to 8s. a day, and that in respect of public wards the full amount of the benefit rate 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 approximately £420,000 a year that was hitherto placed in the trust accounts for capital expenditure on public hospitals. The increase of the benefit rate for public wards by 2s. a day will provide an additional sum of approximately £865,000 in a full year for hospital maintenance. Thus, the States will have available an additional £1,285,000 a year 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 that purpose.
In addition to providing for the increase 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 of “ public hospital “ is being amended to exclude any such ward from the provisions of the 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 not 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 portion of his hospital fees are payable, for example, by the Commonwealth or under a law in force in the State. In cases in which, 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 person shall be determined as if the direction so revoked had not been given. Any necessary adjustment of 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 increasd 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 for me to mention what is being done in respect of private hospitals. By an amendment of the Hospital Benefits (Private Hospitals) Regulations, the Commonwealth hospital benefits 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. a day Australian currency 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. I commend the bill to honorable senators.
Debate (on motion by Senator O’Sullivan) adjourned.
Motion (by Senator McKenna) agreed to -
That leave be given to bring in a bill for an act to amend the Acts Interpretation Act 1901-1947.
Bill received from the House of Representatives.
Standing and Sessional Orders suspended.
Bill (on motion by Senator Ashley) read a first time.
.- I move-
That the bill be now read a second time.
The General Assembly of the United Nations in the second part of its first session adopted a convention dealing with the privileges and immunities of the United Nations, including provisions relating to officials of the organizations, and to representatives of members. This convention was recommended for accession by the members of the organization, and has already been accepted by about twenty nations. The convention requires that, before accession, a member
State must be in a position under its own law to give effect to it. The purpose of the bill now before the Senate is to make appropriate legislative provision to enable accession on the part of Australia to be effected, and also to seek the approval of the Parliament to this accession. Honorable senators will find the convention set out in full in the schedule to the bill. The bill will also give authority to implement other similar conventions relating to other international organizations. In this respect draft conventions relating to the privileges and immunities of the specialized agencies, such as the World Health Organization and the International Civil Aviation Organization, have already been prepared in terms almost identical with that relating to the United Nations.
The General Assembly of the United Nations when it adopted the convention to which I have referred, also called upon all members to take legislative steps to prohibit the unauthorized use, for commercial and other purposes, of the name, seal and emblem of the United Nations. The World Health Organization has taken similar action, and other specialized agencies will doubtless do likewise. The bill, therefore, will enable appropriate action to be taken to prevent any infringement of these resolutions. As additional requirements to implement the convention a bill bas been submitted to amend the Income Tax Assessment Act and in due course the Defence Act will be amended. The enactment of this legislation will ensure that Australia shall be in a position to comply with its international obligations to accord appropriate privileges and immunities to officials of international organizations visiting Australia and also in the event of a permanent office of these organizations being established here.
Debate (on motion by Senator O’sullivan) adjourned.
Bill received from the House of Representatives.
Standing and Sessional Orders suspended.
Bill (on motion by Senator Ashley) read a first time.
.- I move-
That the bill be now read a second time.
The purpose of this bill is to continue in operation the existing National Security (War Damage to Property) Regulations, which are at present in force by virtue of the Defence (Transitional Provisions) Act 1946-1947. Further legislative authority is necessary to cover the period during which the war damage scheme is to be wound up, and as some outstanding matters may not be brought to finality for some considerable time, it is thought that substantive legislation is preferable to a further extension of the regulations under the Defence (Transitional Provisions) Act. Until the end of September last, the scheme was administered by the War Damage Commission which was set up shortly after the regulations were promulgated early in 1942. As, by September, the volume of outstanding claims did not warrant a continuance of the commission, it was disbanded, and its powers and functions were transferred to the Treasurer. The claims in respect of which action is incomplete will be finalized by a war damage section within the Treasury. The final report of the commission will be tabled in the House as soon as possible.
Debate (on motion by Senator O’sullivan) adjourned.
Debate resumed from the 1st December (vide page 3726), on motion by Senator MCKENNA -
That the bill be now read a second time.
Upon which Senator O’sullivan had moved, by way of amendment -
That all words after “That” be left out, with a view to insert in lieu thereof the following words: - “the bill tie withdrawn and re-drafted and re-submitted to the Senate 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 Senate in respect thereof “.
– Before the Senate adjourned last evening I had discussed the merits of this measure at some length. I do not intend to traverse the ground again. In Great Britain, New Zealand, and many other English-speaking countries measures such as this have existed for a number of years. Australia has trailed behind in provisions for the health of its people. I commend the Government for having introduced this measure, because a great need exists for a scheme such as it envisages. I am supported in that contention by a letter written by the Federal Council of the British Medical Association in Australia. The relevant portion reads -
The result has been piecemeal and fragmentary growth rather than consistent and systematic development. The public is often served by unrelated and competitive agencies. The individual passes from consulting room to clinic or hospital, from private to official doctor and often back again, to obtain from many unrelated agencies a service which could be more efficiently provided as one co-ordinated whole. . . .
A properly planned health .service is urgently needed to secure co-ordination and co-operation.
Even the members of the executive of the medical profession realize the urgency that exists for a measure of this kind to be brought down. The scheme suggested by the National Health and Medical Research Council was not received by the medical profession in the spirit in which it was presented. Somebody has asked me whether this body is an authoritative body. That council is composed of three representatives of the Commonwealth Department of Health, the director of each State Department of Health, one representative each of the British Medical Association, the Royal College of Surgeons and Physicians of Australia, and the combined Australian universities having medical schools, and two lay representatives. I suggest that this council is composed of highly skilled men. It is well qualified to place before this Parliament and the people of Australia a health scheme that may well receive earnest consideration and discussion in an atmosphere of goodwill and freedom from suspicion. That council proposed a workable scheme, but as I pointed out last night, members of the medical profession have seized upon it to allege that the scheme recommended was the beginning and end of any scheme, when in fact it was the mere skeleton of a scheme and was presented for discussion and development. I draw the attention of the chamber to the recommendations that were made by the Joint Committee on Social Security in 1943. That committee was composed of three members from the Government side and three from the Opposition side. The three members of the Opposition were very worthy gentlemen who rendered great assistance to the committee and had the complete confidence of their party. I am happy to find that this measure gives expression to one of the unanimous recommendations of the committee. The committee stated in its report -
We feel that the existing deficiencies in the nature and availability of medical services can only be remedied by a substantial reorganization. . . .
The report continued -
We believe . . . that the ultimate solution will probably be found in a full-time salaried medical service with standarized uniform hospital provision, within which complete medical, hospital and public health services will be available to all and will be financed by a tax on incomes for this purpose. . . .
Having regard to all the circumstances and to the need for early and substantial reorganization of, and improvement in, health services generally . . . we consider that . . such services should now be planned, for introduction as and when the war situation permits.’ . . .
That recommendation was made four years ago. It recommended that -
For remote areas (i.e., areas which now have difficulty in maintaining one general practitioner . . .) a voluntary full-time salaried medical service under a limited-term appointment; with improved hospital and transport services, including extended ambulance and flying doctor services, and facilities for consultant services; such services to be established and extended as necessary.
The bill provides for payment of salaries to medical men in remote areas and thereby follows the unanimous recommendation of the committee. The committee anticipated that there would be some hostility on the part of practising medical men against any revolutionary change in the system, and because of that it added this further recommendation -
For all oilier areas (i.e., cities and country towns) a part-time salaried medical service, under a system of voluntary participation by general practitioners who would retain their private practices, and would nominate the number of half-day sessions they would be willing to devote to a general medical service on a part-time salaried basis.
It went further and set out how it considered this scheme could best be implemented-
– What was the committee’s recommendation regarding administration ?
– There was no specific recommendation on administration, but the committee considered that on the weight of evidence presented to it the scheme would obtain the greatest co-operation from the medical profession if it were controlled by the medical men themselves. The committee gave great consideration to that point. It was most sympathetic to the medical profession. It considered that medical men should largely control the technical nature of the scheme, and had there been goodwill and co-operation on the part of the British Medical Association I have no doubt that the Government would have adopted a scheme that would have given doctors a far greater measure of administrative control than the bill provides. The bill itself makes provision for joint committees. The Minister in his second-reading speech said that the Government intended to set up certain committees whose function would be to advise on technical, medical and dental aspects. I hope that the Government will be able to obtain the assistance, cooperation and goodwill of the medical profession in the operation of those committees and that they will become powerful factors in the scheme. As the Government will be expected to provide millions of pounds of the taxpayers’ money to finance the scheme, it is right and proper that it should maintain an overriding control over the organization. I agree that if we can get the wholehearted co-operation of the medical men, we shall be largely guided by their wishes in regard to the supply of the service, the staffing of hospitals, the salaries that might be paid and a hundred and one other details. So when the Deputy Leader of the Opposition (Senator O’sullivan) asks me what the Social Security Committee recommended in regard to administration, I reply that we hope for and have strenuously tried to obtain the co-operation of the medical profession, having in mind all the time that we should induce them to come into the scheme, give to the Government the benefit of their knowledge and help to guide and direct the scheme in order that we may supply a worthwhile health scheme to the people of Australia. That is our only concern. I hope that the profession will even at this late stage decide to co-operate with us and give to the Australian people the benefit of their knowledge. The Social Security Committee recommended a salaried medical service, and despite what has been said in the press of this country and what members of the Opposition have alleged against the Government, the legislation does not seek to nationalize the medical profession. It is a scheme under which we believe that the members of the profession and the people of Australia will be best served. The old system under which medical men are called upon to render free service to the poor should go. The time when medical men had to give 24 hours’ service a day has already gone. The tempo of life has so increased that the old system is top heavy with bad features that it is breaking down day after day. One sees throughout the nation group practices with medical men grouping in bands of three, four, ten and even more in order that they may have some respite. They roster themselves, as it were, to obtain week-ends off and have some rest. Group practices are so arranged, too, that members specialize in various directions and patients are directed to the medical men skilled in the treatment of the individual ailments from which they are suffering. The practice of medicine is becoming so specialized that the ordinary general practitioners cannot cope with modern health demands. It is desirable and imperative for the sake of the health of the ‘ people, that the whole of the health services should be properly co-ordinated and made available to those who need medical attention. I remember that when we were discussing this very question one of the children of the chairman of the Social Security Committee was in a desperate plight with a serious head injury. Great difficulty was experienced in getting proper medical attention for the child. One reason, we were told, was that the specialist attending to the case had booked so many appointments of a minor nature that he was not available, with his great skill, to do the highly technical jobs that were waiting to be done. We waste medical service in that way. Wealthy people are able to call on the great technical skill of specialists for the treatment of relatively unimportant ailments when such nien should be devoting their time to the urgent and delicate jobs that arise from time to time. I shall not delay the Senate by discussing that aspect at greater length.
The committee was impressed by the fact that the medical profession in Australia sadly needed re-organization. We believed that the nation would have been much better served under a. plan such as was laid down by the National Medical Health and Research Council. Under that scheme, medical men throughout Australia would have given up their practices and would have been compensated by the Government for doing so. They would have received full-time salaried appointments. The salaries would have been commensurate with the amount of study that they had devoted to qualifying as doctors and the degree of technical skill that they possessed. In addition to that, they would have been provided with a superannuation scheme, with proper holidays, and proper hours of work. They would have been given facilities for post-graduate study and their services would have been made available for the benefit of students at medical schools. Also there would have been co-ordination between all health officers in Australia and the medical profession. Such a scheme would be of outstanding value to the people of Australia. Unfortunately, the council’s plan was destroyed at birth because the doctors were afraid of change. I suppose that they were entitled to have their doubts. Many people fear change. The Deputy Leader of the Opposition frequently worries me because he is so afraid of change. But I say to the doctors that the Government wants their co-operation. It has tried desperately over the last five years to win their co-operation at conference after conference. Yet now we have before us an amendment proposed by the Deputy Leader of the Opposition, who asks that the Government’s plan be set aside so that we may have further consultations with the representatives of the medical profession.
What purpose could further consultation serve? Of what use would it be to go on, year after year, without being able to obtain any assistance from the doctors’ without the mutual goodwill that the Government has tried to foster, with suspicion amongst the doctors that the Government is not prepared to play fair with them? In such an atmosphere, unfortunately, it would be useless to continue endless discussions. We should get nowhere. The Government has every right at this stage to proceed with its scheme in the earnest hope that the doctors, who, after all, occupy a very important position in our country, will 2-ealize that they have a responsibility to the people. They are intelligent men, and I believe that they are uninformed on this subject. We have every right to expect them to render to the nation a service that they are capable of rendering and to give to the people of Australia a chance to enjoy in the future the greatest possible degree of good health and happiness.
– I support the bill and commend the Government for introducing a measure of this kind. At the outset, I take the opportunity to congratulate Senator Arnold upon the able discourse that he has just delivered to the Senate. This is a subject in which he is well versed. Obviously he took full advantage of the opportunities that were afforded to him a few years ago to travel throughout Australia in order to secure information for the Government and himself on the very important subject of medical services. One of the vital matters upon which the honorable senator touched was the desire among certain sections of the press to create a fear in the minds of the people with regard to the proposals of the Government embodied in this bill. Some sections of the press would have the people believe that this proposal aims at nothing short of the nationalization of the medical profession. It does nothing of the kind.
This bill has been framed solely in the interests of the people. Since I have been a member of this Senate I have said on many occasions that a government which does not accept its responsibility to care for the health and welfare of the people has no right to remain in office. In the past, I have expressed in very strong language my utter contempt for the manner in which some of the newspapers- of this country have tried to mislead the people of Australia about the policy and aims of this Government. Among disreputable journals, the Sunday Sun is no exception. In its issue of the 14th November last that journal was guilty of flagrant misrepresentation of the intention of the Government in this bill. At that time the members of this Parliament were not in possession of the details of the proposals contained in this measure; but that did not deter the Sunday Sun from publishing an untrue and completely misleading story regarding them. Propaganda of that kind is not conducive to the best interests of Australia and to the maintenance of the parliamentary system of government. Certain sections of the press have set themselves out to destroy the system of parliamentary government in this country. In its issue of the 14th November, the Sunday Sun had on its front page the heading, “ No more secrecy between doctor and patient “. Under the sub-heading, “ Government’s Gestapo Plan - Drastic bill on National Health Soon”, the article states -
Secrecy between patient and doctor will be discarded under the Commonwealth national health scheme, to be introduced in the Senate next week.
The Government will pay half medical costs, but it will insist that patients’ complete medical histories be open to inspection by officers of the Federal Health Department.
Those officers will be doctors, who will pass on the records to clerical employees.
I do not intend to read the whole of the article. Honorable senators will, I am sure, agree with my condemnation of publications such as this. The concluding paragraph of the article reads -
The pvovision designed to institute a sort of gestapo into the private and confidential relationship between doctor and patient will, no doubt, be hotly attacked by the Opposition.
Every public man in Australia, whatever his political convictions may be, hopes that the day will never come when the secrecy of the relations between a doctor and his patient will be invaded. It is upon the basis of the strictest secrecy between the patient and his- doctor that the confidence of the patient rests, and to some degree, his recovery depends. Unfair, untrue and misleading propaganda of the kind published by the Sunday Sun is beyond contempt. The story was published long before the bill was introduced into this chamber and members of this Parliament became aware of its contents. The sole objective of distortions of that kind is to instil in the minds of the people fear and distrust of this Government which, in bringing this bill before us, is animated solely by a desire to improve the health of the people of this country. I have heard in this Capital Territory, and when travelling to and from it, expressions of the deepest disgust voiced by people who had the misfortune to read the article to which I have referred.
– That is the freedom of the press.
– I leave it at that. I believe that I voice the sentiments of every honorable senator when I say that misleading propaganda of that kind is to be greatly deplored. Certain sections of the press would have the people believe that the Government intends to make inquiries into every financial aspect of a doctor’s practice. They would have us believe that, without exception, Government members and supporters regard the members of the medical profession as parasites on society, and the greatest “ go-getters “ the world has ever seen. How untrue that is ! Who among us has not the very highest regard for the members of the medical profession? We all are aware of the work they have done to improve the health of humanity and of the very high place they occupy in our communal life. With few exceptions in special cases the fees charged by them are reasonable and they have invariably been as generous in their financial relations with their patients as they have been in their treatment of them. In order to illustrate my point I propose to recount a personal experience which I shall never forget. I trust that when I have done so my genial friend, the Deputy Leader of the Opposition (Senator
O’Sullivan), will not have cause to regret his friendship with the distinguished Australian medical man who was responsible for my cure and, in that way, for my presence in this chamber.
– Do we have to blame him?
– I hope that the honorable senator’s friendship for him will not be diminished as the result of the experience which I am about to recount. I am well aware that, politically, the honorable senator would like to see me assassinated. As honorable senators know, the conditions operating in medical practices in country centres and in areas remote from the large centres of population were not always as good as they are to-day. Even in these comparatively enlightened times great and constant demands are made upon members of the medical profession. We all pay tribute to the unselfish service provided by general medical practitioners, who are available at all hours of the day and night for the relief of suffering humanity. I, myself, owe a great debt to one member of the profession, as I have already indicated. While I was travelling on my honeymoon I was stricken with pleuro-pneumonia on one of the bleakest nights imaginable. I was taken to a small town which was many miles distant from any medical practitioner. I was dangerously ill, but when word was sent in the middle of the might to a doctor in another town, who had been working hard all that day, he did not hesitate to make a long and unpleasant journey to reach me. He did everything possible for me, and because of his skill and zeal my life was saved. Of course, I realize that that instance is merely typical of many thousand cases of prompt and unselfish devotion to duty by members of the medical profession. The suggestion, therefore, that members of the Australian Labour party are hostile to the medical profession, and regard them as mercenary and avaricious, is totally unfounded. There is scarcely one member of the Australian Labour party who has not had occasion, like all other members of the community, to be grateful to the members of the medical profession. The suggestion that Labour has introduced this bill because it wants to nationalize the profession is a wicked invention.
The Deputy Leader of the Opposition left us in doubt about where he stands in this matter. In the first portion of his speech he gave his blessing to the Government’s proposals, but he then proceeded to find fault with them.. In an effort to discredit the Government’s medical scheme he quoted at considerable length from English journals which criticize the British Government’s attempt to nationalize medical services. But in reading some of those excerpts he obviously experienced considerable political discomfiture because of the incidental facts mentioned in them. In discussing the proposals of the Australian Government the honorable senator was fair enough to say without any hesitation that the administration of the national health services is a matter of such importance that it has passed entirely out of the ambit of private enterprise. I give the honorable senator full marks for frankness, and I have no doubt that even after reflection he still adheres to the point of view which he expressed. I also agree with many of the statements expressed by Senator Rankin. Like the honorable senator I believe that economic relief will prove of more benefit to the physical and mental health of the community than the provision of medical services. Like many others who have come in contact with large numbers of people in the lower income groups, I am convinced that the economic vicissitudes of many people in this country in the last twenty years have taken considerable toll of their health.
To return to the bill itself, I am particularly gratified that it proposes to apply to the improvement of the national health many of the latest developments of science. Unfortunately, we all realize that in the past science has tended to concentrate rather on the destruction than on the preservation of human life. Subclause 2 of clause 7 of the bill provides -
Without limiting the generality of the last preceding sub-section, the services referred to in that sub-section may include -
generalmedicalor dental practitioner services;
convalescent and after-care services; (i)medical services and dental services in universities, schools and colleges.
What fair-minded member of the community could possibly object to the provision of such services for the relief of the sick and suffering? Indeed, the only explanation of the hostility of certain elements to the Government’s proposals lies in their obsession that they must get rid of the present Labour Government. In their desperate efforts to discredit Labour they endeavour to create fear in the minds of the people. It is evident that no propaganda can be too foul or unscrupulous for their purposes. That accounts for the vicious suggestion that the Government has introduced this bill because it believes that members of the medical profession are avaricious moneyseekers. Clause 7 also provides - (3.) 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 service or dental service under this section. (4.) 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;
provide, or assist in the provision of, scholarships or training for university graduates in medicineor dentistry and for persons who have completed courses of training, approved by the Director-General, in, or in relation to, medicine or dentistry;
establish, maintain or develop, or assist in the establishment, maintenance or development of, courses of training in nursing (including dental nursing), dental hygiene, radiography, radiation-therapy, physiothera py, bio-chemistry, dietetics and other matters related to medicine or dentistry;
undertake or develop, or assist in the undertaking or development of, measures (including research and epidemiological investigations) for the improvement of health (includingmaternal and child health) and for the prevention of disease.
encourage group practice by medical practitioners and dentists, and
disseminate information relating to health and the prevention of disease.
Honorable senators will realize the comprehensive nature of the Government’s plans, which are designed to prevent and to relieve, if not to cure, sickness of almost every kind. By introducing the measure the Government has done its part to improve the health of the community, but the success of its efforts must depend on the co-operation of the community and on the goodwill of the medical profession. I appeal particularly to members of the profession not to allow their judgment to be warped by the foul and insidious propaganda of our enemies.
In the course of his remarks the Deputy Leader of the Opposition quoted from articles published in the Tablet, an English periodical, but he did not once refer to the articles contributed to the British press by the president of the British Medical Association, Sir Lionel Whitby. As Senator Katz pointed out last night, the importance of the statements made by Sir Lionel Whitby is too great to be passed over lightly. At the 116th annual meeting of that association held at Cambridge, Sir Lionel said -
Changes in medicine itself have tended to increase the cost of medical treatment so that most people can no longer afford to be ill. . . None can doubt that, with the advance of science and the high degree of specialization, the cost of an illness is beyond the purse of the average person. This factor - the economic one - has been potent in hastening the inevitability of a State medical service . . .
In the interests of humanity, such treatment cannot be withheld on economic grounds. It would be a travesty of justice were such treatment to be available to only the few rich people . . .
Such a statement, coming from so distinguished an individual, should not be passed over lightly. The Government has acted with wisdom in bringing down this legislation. I trust that . Senator McKenna, who is in charge of this bill, will no longer be troubled by hostile press articles and that the executive officers of the British Medical Association will co-operate with the Government. I believe that, even among those officers, there must be men who are alive to the requirements of good citizenship. They must be aware that the medical profession owes a great deal to the democratic system under which we live. I trust that those medical men who have expressed opposition to the Government’s scheme will abandon their narrow and parochial attitude. The success of the scheme will depend very largely upon the press refraining from publishing hostile and objectionable articles.
I offer to the Deputy Leader of the Opposition (Senator O’Sullivan) and to the Opposition Whip (Senator Rankin) some good advice. I do so only because of their generous and almost unqualified support to the Minister for Health, which was qualified only by party political needs. I advise them to explain the scheme fairly to the political council which they serve. If, by doing so, they succeed in disturbing the slumber of their friends, and galvanizing them into action, they will have done something to erase the bad impression created by the inactivity of anti-Labour parties in the field of national health over so long a period. I am not so optimistic as to believe that they will succeed entirely, but if they are able to win some measure of co-operation from their political friends, it should be possible to achieve even more than it is proposed to do in this bill. The Labour party has always maintained that the health and well-being of the people should be a national concern, and above party politics. I repeat that I view with disgust newspaper articles of the kind that the Opposition has quoted. I hope that the Minister, in spite of the unfavorable atmosphere created by press criticism, will be able to command the co-operation of the medical profession, and to induce its members to act in the humane and Christian spirit which has prompted the Government to introduce this legislation.
– I support this bill, the purpose of which is to establish a national health service. Its introduction is a milestone on the road towards the provision of a complete national medical service for the people. Health is a matter of the utmost importance to the community, and proper medical services should be available to every one. A national medical service is a particular necessity in Australia, with its vast area, sparse population, and poor communications in outback districts. The Opposition has not offered any honest criticism of the bill. Indeed, it commends what the bill proposes to do. It has no fault to find with any of the services which it is proposed to provide but, by innuendo, it suggests that the introduction of a national health scheme will disturb the existing relations between doctor and patient. The Opposition says that we are not ready for a scheme of this kind. In the opinion of the Opposition, we never have been ready for any progressive move. Health is so important to every member of the community, even from the point of view of national production alone, that the Government is fully justified in bringing down this legislation. Health is of supreme importance to the children over whom the Opposition weeps, to the aged for whom it expresses concern but does so little, and to the workers upon whose efforts our national well-being depends. The Government’s medical scheme is of importance to every one who needs medical attention of a kind which is too expensive for him to provide for himself.
I have no doubt that a majority of medical practitioners is in favour of a national medical service. The Opposition advocates the policy of laisser-faire. It does not object to a scheme of the kind suggested, but it wants the Government to keep out of the field. However, if we examine the history of schemes that have proved of benefit to the community, we find that they have all been associated with governments. They probably began under the auspices of local governments, and developed until they became national services. I have before me an interesting booklet by Sir Leslie Mackenzie, who was a member of the Local Government Health Board for Scotland. He was an eminent medical authority over a period ranging from the late 1800’s to 1929. His association with the development of public health services was in 1906 and 1907. He held the diploma of public health of the University of Oxford. His aim was the introduction of a public health scheme to promote the use of antitoxins and serums.
His proposals were criticized by the medical profession and in this book he quotes the example of the United States of America, and points out that in Chicago in 1895 a public health scheme involving the use of antitoxins was adopted. He criticizes the local government authorities of Great Britain because of their policy of non-interference with the medical profession, and their reluctance to follow America’s example. The lead in the field of public health at that time had been taken by America, a young country, as Australia is now. The people of Chicago were prepared to support schemes which provided health services for poor people, at the expense of the Government. The result was a reduction of the mortality rate from 35 per cent, to 6 per cent. Sir Leslie Mackenzie traces the history of medical services in Scotland at that time, and states that although medical practitioners generally were doing a good joh, their primary consideration was for paying patients. They were also rendering certain honorary service to those who could not pay fees, but that was a secondary consideration. He then goes on to state -
Let us look for a moment into one hospital more - the Infirmary belonging to an English Workhouse or the Sick Wards of a Scottish Poorhouse. In these are collected diseases of destitution, and the patients are a vast multitude. A glance proves that they have lived on a lower plane of health; they are living now among more chronic diseases. Acute illnesses, like rheumatic fever, or appendicitis, are conspicuous by their rarity. Here the da) is filled with the superabundance of oldstanding heart disease, incurable paralysis of many varieties, incurable affections of the bones and joints, incurable blindness, incurable kidney disease, incurable results of syphilis, old leg ulcers that need constant cleaning, running sores of bone that need constant dressing, the decrepitude of age, or the feeble-mindedness of youth, sometimes idiocy or imbecility in many grades and varieties, or epilepsy, or harmless forms of insanity, or disabling and incurable gout, or rheumatism, or brain disease, or spine disease, or some other of the thousand and one varieties of chronic disorder. There are, too, many malignant diseases, which are long beyond surgical ormedical aid. All these diseases can be classified under the same heads as in the other hospitals.
Eminent medical men have fought for generations for the removal of those conditions but they still exist, and it is with the object of their ultimate elimination that this measure has been introduced. Throughout industry to-day, one can still find many people who are suffering from chronic diseases. .Some are beyond medical aid, but had they been given treatment when their ailments were still in the curable stage, not only would the Government’s present expenditure on pensions, about which .Senator Rankin has expressed some concern, be can.siderably less, hut also, much human suffering would have been eliminated. In many instances, those people have been unable to afford medical treatment, and have had to continue in their employment. To-day, however, the Government is taking increased interest in the health of the community generally, and so far, there has been little objection to that interest; but now when an endeavour is being made to provide an adequate medical service for the whole of the community, all sorts of bogies are being raised. Opposition speakers claim that more provision should be made for preventive treatment, particularly of children. That can only be accomplished through close contact between medical men and patients. No national health scheme can be complete without .provision for the examination of school children and workers in industry. Advanced clinical research must also be undertaken. Medical men must be ever vigilant. Only a doctor can detect the presence of many illnesses. That is not the task of the layman. Periodical examinations must be made if preventive medicine is to be applied in the national sense. The Government has already taken steps to reduce the incidence of tuberculosis in the Commonwealth. No objection has been raised to that proposal. In fact it has met with great national interest, and has drawn the commendation of all political parties. We have only made a beginning. There has been no suggestion that tuberculosis should not be tackled on a national basis ; but that is only one of the many dread diseases that are suffered by humanity. In the. book to ‘which I have already referred, Sir Leslie Mackenzie recites his experiences in his endeavours to place public health on a national basis. He says -
Then looking backward, I remembered just such a beautiful fairy, nine years old. She came of a highly tubercular family, father and mother being like affected. One day swellings caine on in the cheeks, and the doctor diagnosed mumps, which was then going round. But ultimately lie found that the (swellings were due to diphtheria. She then came into my hands; but too late for antitoxin to save her. She died of cardiac collapse at the end of three days. All her tissues were eminently “vulnerable”. The needle of the syringe caused a considerable haemorrhage under the skin. Her “ tissue-resonance “, as it were, was very high. After she died I found diseased glands in the chest and in the abdomen: some of them were well on the way to considerable abscesses. Yet the child had been at school until the day her cheeks began to swell, and hari shown practically no symptom of serious ill-health.
The child had been treated for a disease that she did not have. Upon medical examination, she was found to be riddled with tuberculosis. All the glands were affected. She had a “fairy-like” appearance which led people to believe that she was in perfect health, but she had not been in contact with medical men who could easily have diagnosed her condition. Under this scheme it should not be possible for diseases to reach serious stages undetected. The bill will make a réal national health service available to the people while maintaining the human dignity of the medical practitioner. The close doctor-patient relationship will be preserved. A patient will consult a doctor and the doctor will collect his fee in accordance with the schedule of charges to which his representatives have agreed. He will treat his patient exactly as he would in the absence of a governmentassisted scheme. The present relationship between doctors and patients will not be disturbed. In addition, provision is made for certain medical services which are beyond anything that the British Medical Association is interested in. Certainly members of the British Medical Association to-day render honorary service, but they do not provide the progressive, protective, preventive services which the community requires, and which it is the intention of the Government to provide. The bill is not revolutionary, and it is certainly not socialistic. It provides for co-operation between the Government and the medical profession. It has been alleged in the press that the national health service will be governed by laymen, but clause 4 of the bill makes it clear that that is not correct. The clause provides that the Director-General of Health shall have the general administration of the legislation, and clause 3 states that a person shall not be appointed as Director-General of Health unless he is a legally qualified medical practitioner of not less than ten years standing. The Minister has certain powers of direction, but they are mainly concerned with matters appertaining to the economic aspects of the scheme.
Clause 6 deals with the medical benefits scheme. The charges made for professional services by medical practitioners will be in accordance with a scale agreed upon by the medical profession and the Government. Scales of charges have been submitted by the British Medical Association in regard to schemes that it has formulated from time to time. Those schemes were not nearly so efficient as this one will be, but they were based upon the same basic principle as that which underlies this scheme.
It has been said that this bill does not provide for anything positive to be done in regard to health. It is an enabling bill. Clause 7 (1) provides that the Director-General may, on behalf of the Commonwealth, provide or arrange for the provision of prescribed medical services and prescribed dental services. Subclause 2 of the clause, without limiting the generality of sub-clause 1, contains a list of the services that may be provided. It refers, first, to general medical or dental practitioner services, and, secondly, to consultant and specialist services. When a general practitioner is unable to diagnose or to treat a disease from which a patient is suffering, he invariably refers the patient to a specialist, and quite rightly so, but a man on the basic wage or with a small income cannot afford to pay the specialist’s fee. When I was earning a small income, my daughter was thought to be suffering from a serious complaint. My medical practitioner called in a specialist, whose fee was £3 3s.; he consulted a pathologist, whose fee was £4 4s. The fee was well earned by the pathologist, but it was difficult for me to raise the money to pay it. I was able to do so, but there are thousands of people in Australia who cannot pay such an amount and they are, therefore, not able to avail themselves of the services of specialists. The sub-clause goes on to refer to ophthalmic services. The British Medical Association* has been severely critical of the unqualified persons who treat sufferers from eye diseases. The public does not go to such people because it wants to go to them. It would prefer to go to a properly qualified specialist, but it cannot afford to do so. Therefore, the advice of unqualified persons is sought. Under this bill, if a man’s eyes begin to fail, he can, if it is necessary, have the advice of the best available eye specialist. Then reference is made to maternal and child health services. Senator O’Byrne quoted statistics which showed that in this connexion great improvements have been made in this country, and that, in comparison with Australia, other countries are backward. Senator Rankin made an appeal on behalf of the children. This bill will make it possible to provide adequate pre-natal and ante-natal care in properly constructed hospitals in the rural areas as well as in the suburban areas. The women who bear children in the outback will not receive proper care unless legislation of this kind is passed. Sub-clause 2 of clause 7 goes on to refer to aerial medical and dental services. On many occasions Queensland senators have appealed for the .provision of adequate medical and dental services in outback areas. This bill will enable them to be provided. I have listened to messages received at Alice Springs from pedal radio sets in remote districts. A woman may radio to say that her baby is sick and to ask what she can do. She is asked te describe the symptoms of her baby’s illness. If the trouble is sufficiently serious, a flying doctor is sent to her. If the trouble is not so serious, she is instructed how to treat it. The system, however, has not been developed to the highest pitch of efficiency. It is a grand experiment, and I pay high tribute to those who are engaged in it. The subclause then refers to diagnostic and therapeutic services, convalescent and after-care services and nursing services. How often has it been said that better provision should be made for the training of nurses ? They should not have to wait until they are eighteen before they can begin to serve a long and weary apprenticeship, at low wages and under bad conditions. I was instrumental in assisting to obtain better conditions for nurses in Western Australia by recommending to the union that a claim be made to the Arbitration Court. The conditions under which nurses worked in that State were, for a time, deplorable. It was only the keenness of the girls for their work that kept them going. There was no economic encouragement. This bill will enable us to provide the nurses with better training facilities, and proper amenities and quarters. They rarely enjoy those outside of the metropolitan areas, and sometimes not even in those areas. By co-operation between the Australian Government and the State governments, many of the present causes of discontent among nurses will be removed. Honorable senators opposite have often urged that that be done, and so, many of their arguments in opposition to this bill fall flat. The sub-clause concludes by referring to medical services and dental services in universities, schools and colleges. Statistics show that there are not enough medical practitioners in Australia to provide an efficient medical service, and the position is worse in regard to dental practitioners.
The statistics in relation to the dental treatment of children reveal an appalling state of affairs. There is no doubt that defective teeth, infected tonsils and diseases of the eyes, nose and ears make great inroads upon the health of children. A child can go to school and perform its normal school tasks, but, because of the effects of these maladies, its scholasticprogress may be retarded. Because it is not obviously sick, it is not sent to a doctor. Under this scheme, if a child is suffering from adenoids or bad teeth, if its eyes are affected or its tonsils are infected, the disease will be noticed at an early stage and will not be allowed to develop to such a degree that the child is forced to take to its bed. That is one of the progressive measures to which Senator Rankin referred. I assure her that the matter is covered in this bill. An effective health service must begin at that stage and, with the proper co-operation of the medical profession, it will do so when this bill becomes law.
This is a measure which will be of great benefit to the people of Australia. It provides for co-operation and negotiation between the Australian Government and the State governments. The State governments will have full freedom to express their opinions. It provides further, for management. committees, and advisory committees. Nominees of the British Medical Association or other medical associations will be permitted to serve on those bodies, and in that way the medical profession will be able to express its views on all matters pertaining to national health, and those views will be taken into consideration by the DirectorGeneral of Health.
Sitting suspended from 12.J/S to 2.15 p.m.
– Before the sitting was suspended, I had dealt with many phases of the bill and indicated the great benefits which it will confer upon the people of Australia, particularly those who, at present, cannot afford to pay for efficient and sufficient medical attention. The bill not only provides for a comprehensive health service but also enables the Minister for Health, on behalf of the Government, to undertake the manufacture of medical and dental supplies, appliances and equipment, including visual and hearing aids. Most people in the community are aware of the lack of supplies of those articles due to the present dollar position. A valuable feature of this scheme is that it will help to overcome those shortages. The bill also provides for the classification of specialists. That provision has been criticized in the press, but it will be effected in accordance with the ethical standards of the British Medical Association. Therefore, it will offer thorough protection to both doctor and patient. The advisory committee which will be set up under the measure will consist of medical men. and through that body the medical profession will have ample opportunity to make known its views with regard to national health matters, including research work. The bill is broadly based, but that is to be expected because it is pioneering legislation. The
Minister for Health has worked untiringly to achieve the objectives at which this legislation aims, and I believe that he will bring the negotiations with the British Medical Association to fruition. We need not be too pessimistic about the outcome of those negotiations. I recall that when compulsory notification of contagious and infectious diseases was first proposed in 1906 the view taken by the medical profession’ as expressed by Sir Leslie Mackenzie was that such a proposal was not popular, that it would probably cause hardship to individuals and would be boycotted. It was said that it would interfere with the relationship between doctor and patient. Bui what is the story of compulsory notification of contagious and infectious diseases ? Notification of such diseases was voluntary in Scotland in 1906, but of the 313 health authorities in that country at that time not one adopted it. In the following year, when the subject became a national issue following an epidemic, eight health authorities adopted compulsory notification, and in 1920 the idea gained such general acceptance that it was necessary to introduce national control of health in respect of matters with which the private practitioner could not adequately cope. I commend the bill. It will lay the foundation of a very fine medical scheme. It observes inherent democratic, principles, and will not only prove of advantage to medical practitioners in the advancement of medical science but also will enable them to give better service to the community than they are able to give in existing circumstances.
– I was struck most forcibly by the second-reading speech by the Minister for Health (Senator McKenna) in introducing the bill. In the course of his remarks he said -
Health means more than the treatment and cure of illness and disease.
That statement should impress itself upon the minds of all honorable senators. The Minister went on to show us what the Government has in mind in the provision of better housing, better working conditions, better food and more balanced diet. Any one who pays any attention at all to the requirements of the people envisages Australians developing into a race of which we can be proud, and, to go. further afield, would like the human race at large to be something of which all human beings can be proud. The Minister was more than justified in giving credit to the Government for the part which it has played in bringing about better conditions for the workers of this country. He pointed out that the Government, since it assumed office, had dealt with many vital problems affecting national health. He reminded us that it had trebled child endowment and maternity allowances, had introduced widows’ pensions, and, in co-operation with the States, had established better housing schemes. All of those achievements indicate that the Government is implementing a well-considered plan for the betterment of the citizens of this country. Now, it has presented this legislation to the Parliament.
This bill is something more than Senator Rankin said it was. It does not merely provide for better economic conditions for the people. Its main objective is not the payment of doctors’ fees on behalf of patients, or the provision of free medicine for the aged and infirm. Whilst such improvements are very laudable, they do not represent the main objects of the measure. Indeed, if that were so, the bill would not fulfil the desires of the community. It is very laudable to enable the poor to obtain the best medical advice. However, such help is not at present denied to the poor. I readily appreciate the wonderful work that is being performed by medical practitioners who give their services without fee or reward in public hospitals throughout Australia. As a matter of fact, it has been said that the best medical services can be obtained by either the very poor or the very rich. The very poor are able to take advantage of modern hospitalization schemes, whilst the very rich have the means to obtain the best medical attention. There is another section of the people to whom sickness is a very serious matter. I refer to the people who are unable to take advantage of the conditions offered in our hospitals because they cannot pay the expense incurred in having at their disposal eminent sur geons and doctors. I believe that that middle section of the community is likely to gain more as the result of the operation of this measure than are the other sections that I have mentioned. The bill is a charter to develop a scheme whose full value will not become available immediately but that will take some years to reach fruition. I am quite sure that Senator Rankin had not studied the bill when she spoke last night, and did not know exactly what was provided in it. I am certain she had not read clause 7, which provides for a general medical and dental practitioner services. That clause 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-
All honorable senators know that in the past most great research work has been dependent on the generosity of private individuals and on occasional government grants. Such grants have usually been made to assist in research in some particular disease. Those who have given attention to this matter have always pointed to the fact that the lack of finance has been responsible for retarding the development of medical science.We may have some very eminent research workers who desire to pursue their studies but are unable to do so because of the lack of facilities. This bill provides that the Government will be charged with the responsibility of providing what might be termed the “ sinews of war “ to enable those workers to proceed with research. What a wonderful feeling of assurance it will be to young scientists or research workers to know that henceforth they will be able to go forth and develop their ideas. Under this scheme it will be possible to provide all facilities necessary for research, justas in the past the Government has introduced measures to provide laboratories for all types of research. The fact that to-day certain important drugs are being manufactured in government-controlled laboratories has made it possible for such drugs to be used to a much greater degree than they would have been if the Government had not become interested in their manufacture. There is every indication, therefore, that what is envisaged in this plan is well worth while. We are all familiar with the fact that difficulties have beset scientific workers in the past. Great research workers like Pasteur met great difficulties and had to work without necessary facilities. They even had to contend with opposition from others of their own profession. How much easier it will be in the future for research workers to develop their scientific theories. We may take a lesson from what the Government did during the war, when it provided medical facilities and opened many kinds of institutions soas to ensure that the men in the armed forces had the benefit of the latest developments of medical science. As I have stated before, the Government, in this scheme, will provide for the development of a nation of healthy and vigorous people. The treatment of disease is not the sole objective of the scheme. The Minister, during his secondreading speech, deplored the dental condition of the children of this country today. The bill provides for the services of the necessary dentists and other workers to be available to assist in retarding the onslaught of dental disease, and for research into the cause of the great degree of dental decay among Australian children at the present time. It would not be sufficient if we were to provide only that there would be dentists available to extract or fill teeth. Something more is required. We shall get down to fundamentals and ascertain what has happened to so affect the teeth of the growing generation of Australians. In the early days of settlement in Australia, many people reached old age with a full set of natural teeth, but to-day one. rarely sees a young man or woman with all of the teeth that nature provided. This scheme, in addition to helping those who have gone beyond the reach of preventive treatment, will enable the development of means of guarding against ill health and disability, so that Australia will be restored to the position that it formerly occupied as a healthy nation. Deterioration has also occurred in the general standard of eyesight in the community. Not long ago it was a rarity to see a young person wearing corrective lenses. Many people lived to old age with their eyesight unimpaired, but to-day it is not uncommon to see people wearing spectacles. Research conducted under the Government’s plan may enable us to ascertain the cause of these unnatural disabilities. The scheme envisages investigation of industrial conditions, and perhaps such research will enable us to prevent various ailments that have developed in the community in relatively recent times. If this bill did nothing else than to provide for research of that character, it would be a worthy measure. Consider the difficulty of establishing institutions necessary for such work. Could private* industry establish them? Certainly not. The great cry to-day is for the construction of more and better hospitals. Private enterprise could not satisfy that demand. No doubt the Government will experience considerable difficulty for several years, but, having set its hand to the plow and created the necessary administrative organization, it will be able to go forward steadily and provide facilities for the pursuit of scientific investigations and the improved practice of medical and surgical work.
Scarcely anything included in the ambit of public health will fall outside the scope of this bill. Opponents of the measure have suggested that it will destroy the goodwill between patients and doctors.. Good gracious, has not every enlightened development in history interfered in some way with previously accepted standards? Every new law has affected individual rights in some degree. Every health law enacted by a municipality or a State requiring certain things to be done in the interests of public health has caused some such interference. For instance, there was a great outcry when various governments introduced measures to compel dairymen to have their herds tested for certain diseases. Whenever an infectious disease spreads through a community, the responsible government interferes with the rights of individuals in order to protect all of the people. State governments have passed laws which give them authority to destroy animals in order to protect the health of the community. I cannot see anything in this bill that might adversely affect the confidence which exists between doctors and their patients. I believe, therefore, that the argument in that connexion has been introduced solely for the purpose of stimulating opposition to the bill. Why should there be opposition to a measure of this kind? Why should individuals who claim that they have the interests of the people at heart object to this plan? We can only believe that the objections arise from a trait of human nature. The world hates change, it has been said. Individuals do not like to be thrown out of their accustomed stride. They like to pursue their routine without interference. But society was not built in that way. Society demands that certain individuals must surrender some of their individuality in the interests of the whole of the people.
After examining the bill in detail I believe that future generations will benefit most from its provisions. The children of to-day will, in later years, reap the benefits of the research that will be carried out under the measure and of the facilities that will be provided for the people. We may participate in seme of those benefits, but the bill is directed more to the future than to the present. This plan, operating in conjunction with other schemes that the Government has already introduced, will lead to advances in the realm of public health that will benefit not only our own nation but also other nations. The attitude of certain members of the British Medical Association to the proposal was discussed very moderately and wisely in a leading article recently published in the Melbourne Age. After the bill had been introduced in this Parliament by the Minister for Health, various medical practitioners met and it was reported that, they would unanimously oppose the measure. The Age, in drawing attention to that report, suggested that the bill was worthy of consideration by all concerned and that, although time would no doubt disclose anomalies in it, they could be rectified as a result of discussion between the medical authorities and the administrators of the scheme. That is the .proper approach to the subject. If we can foster a spirit of co-operation between the Government and members of the medical and dental professions, the scheme will work efficiently. It would be a sad commentary upon people who have been gifted by nature with intelligence and the ability to acquire skill in remedying disease and disability if they were to hold themselves aloof from the plan simply because they happen to be rather timid about it now. Propaganda about socialization has been used and appeals have been made to the vanity of individuals in order to prevent them from fulfilling their proper functions .in the community. During this debate, attention has been drawn to the fact that few women are prepared to enter the nursing profession. The reason for the present acute shortage of nurses in the community is the unattractive pay and the poor conditions provided for them. Young women who entered the nursing profession were persuaded that it was most undignified for them to form a trade union because they were socially apart from the rest of the community. One particular argument advanced by opponents of the suggestion that they should form a union was that many public hospitals and institutions functioned under royal patronage, and it was contended that persons employed in those institutions were servants of royalty. Of course, those specious contentions had absolutely no relation to fact. It was also contended that young women entered the nursing profession, not because they sought a means of livelihood, but because they had a special vocation. That was, of course, a most altruistic and praiseworthy motive to assign to them, but it had no relation to actualities. The result is that instead of members of the nursing profession enjoying reasonable conditions to-day, their conditions of employment are greatly inferior to those of other women engaged in industry.
The bill proposes to assist public hospitals and other institutions which complain that they cannot pay the proper wages and provide appropriate conditions for their employees. Passage of the bill will provide funds to enable adequate staffs to be employed at proper rates of remuneration. The great improvement which will result in the conditions of hospital employees should result in attracting a large number of young people to the profession of caring for the sick, and overcome the present shortage of staff. The generous provisions of the bill should also encourage young men and women to enter the medical profession because public institutions will be enabled to engage an adequate number of doctors, who will not be required to remain on duty for inordinate periods, or to work under unreasonable conditions. I point out that the present Government is the first national or State administration which has realized the necessity for providing proper conditions for those engaged in the care of the sick. Another interesting feature of the bill is the special provision it contains to encourage students and university undergraduates to enter the medical profession. Those who enter the medical profession will be assured, on graduation, of profitable employment. “We all know that in older countries of the world many eminent physicians and scientists, who devoted their lives to the prevention and the cure of human suffering, had to endure the direst poverty because of the failure of the communities in which they lived to provide for them. The present measure is inspired by a great humanitarian ideal. No longer will people who are ill and suffering be prevented from obtaining proper medical assistance because they cannot afford the money to obtain it. No member of the community will be denied proper medical facilities because of pecuniary considerations.
I particularly commend to the Senate the special provision for research into matters relating to the national health. Who knows whether as the result of the vast amount of research which will be conducted some great new discovery may be made that will benefit, not only the people of Australia, but the human race as a whole? Members of the Government have realized that if such a result is to be achieved proper encouragement must be given to physicians and scientists to pursue their researches free from the distraction of obtaining a livelihood. Scientists must be able to concentrate on their work without being distracted by material considerations.
Reference has been made to the higher incidence of disease in certain parts of Australia, and we know that ill health is probably more prevalent in the remote portions of Australia. That condition of affairs might be regarded a3 a contamination of the blood stream of the nation, but the passage of this measure should result in the elimination of that contamination, so that the blood stream will be pure and free. Instead of debating minor details of the bill, I invite honorable senators to consider the great humanitarian ideal which has inspired this legislation. It is consoling to think that at the present time of international disturbance at least one national government is prepared to make an effort to combat the scourge of ill health which has taken so much toll of humanity. I do not for a moment deprecate the part played by charitable individuals and institutions in the treatment of the sick, but it must be obvious to all that not only the treatment of the sick, but also the prevention of disease and the improvement of the national health must be the concern of the National Government. In the light of our experience of present-day conditions we must all regret that the older nations of the world, many of which had at their disposal the services of scientists and humanitarians of great distinction, did not heed the advice of those individuals’ and take action to promote the welfare of their peoples such as that which is now being taken by the present Government. I commend the bill to honorable senators.
.- The Deputy Leader of the Opposition (Senator O’Sullivan) said that public health had long passed beyond the range of private endeavour. With that sentiment I am in entire agreement. The honorable senator then went into the details of this bill, drew attention to what he considered to be some of its pitfalls, and offered suggestions for their removal. Then he moved an amendment to the motion of the second reading asking that the bill be - withdrawn and redrafted and resubmitted to the Senate 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 Senate in respect thereof.
That suggestion is in complete accord with the attitude that has always been adopted in this Parliament by the anti-Labour parties. It is a remarkable demonstration of their desire to leave things as they are. The honorable senator wants the bill withdrawn, reconsidered and redrafted after further negotiations. That would involve delay and more delay. I understand that the Minister has already met the representatives of the various bodies mentioned in the amendment. He has had protracted negotiations with the British Medical Association. I do not know to what degree the friendly societies have been consulted. Perhaps they have not been given much consideration so far. The obvious inten tion behind the amendment is to cause further delay. This measure is simply an enabling bill permitting certain things to be done. The Government wishes to introduce a national health service for the people of this country, including not only city dwellers, but also those living in the far-flung outback. The Minister said in his second-reading speech that the bill would also authorize the making of regulations for the establishment of a medical and dental scheme. I realize that, in view of the state of the negotiations with interested parties, it was not possible for the Minister to introduce, at this stage, a complete, detailed measure. Therefore, he has placed before us a skeleton upon which the body has yet to be built. That -will take time. I am rather concerned at the intention to take certain action under this measure by means of regulations instead of by legislation. I should have preferred the bill itself to contain something more definite about the scheme, but apparently it is the desire of the Government that the scheme should be launched as soon as possible. At the 1946 referendum, the people of this country empowered the Commonwealth Parliament to legislate in respect of social services including medical and dental services and the Government would be recreant to its trust, or neglectful of its mandate, if it did not make an early attempt to provide a comprehensive health service for the people of Australia. As I have said, this measure is merely the skeleton. As negotiations with the interested parties proceed, regulations will be introduced to provide the detailed services for which principles are laid down in this measure.
Senator Rankin stressed the necessity for emphasis upon prevention rather than cure. With that sentiment I am entirely in agreement. It may be that in the past we have paid too much attention to the curative aspect of medicine, and neglected the preventive side, but the honorable senator will admit that a valuable foundation for the prevention of disease has been laid by State authorities including local governing bodies, in the establishment of health clinics and other like services. Those services represent a direct endeavour to reduce the necessity for curative treatment and medicine.
Probably the best way to prevent illness in any country is to provide for the people of that country a high standard of living. When people are well housed, well fed and well clothed, and are free from economic insecurity the effect on their general level of health is remarkable. In that field, this Government can claim to have taken a tremendous step forward with its full employment policy. Nobody is starving in this country. Certainly we have not been able to provide all with houses that are required but, looking at the matter fairly and squarely, I believe that it will be generally conceded that this Government, in collaboration with private enterprise, has made available many thousands of homes in a remarkably short period of years. Obviously, no government, in a matter of months, could have overtaken the building leeway caused by the cessation of construction during wartime. The task involves real physical difficulties which must be overcome; and they are being overcome. I concede to Senator Rankin that the prevention of disease is a fine objective but, throughout Australia to-day, there are hundreds of thousands of people who urgently require medical and dental services. In spite of the high standard of living in this country, and the general upward trend in wages and salaries, there are many people, particularly those rearing young families, who have not been able to avail themselves of existing services because of their high cost. The Government’s proposal to pay 50 per cent, of medical and dental fees is a worthwhile contribution to the general health of the people of Australia. What is more, no means test will be associated with the provision of that financial assistance. Payment will be made in respect of services rendered. It appears that the most vital immediate issue arising out of this measure is the necessity to establish co-operation between the Government and those who will be directly interested in its implementation, namely, the State governments, the British Medical Association, and the dental and nursing professions. The success of the scheme will depend upon the degree of co-operation that can be secured among them. However, it is unfortunate that even before this legislation has been passed articles have already been published in the press with the definite intention to sabotage the scheme. Such articles are unfair to the Government and to the hundreds of thousands of people who are waiting to obtain the relief and assistance which it hopes to provide under this legislation. One would think that responsible newspapers would ascertain the facts before publishing articles of that kind. I listened attentively to the second-reading speech of the Minister and I have carefully studied the bill itself. I have not found the slightest evidence that would indicate that the Government under this legislation is seeking to nationalize, or socialize, medicine. It has been said that the scheme will interfere with the traditional doctor-patient relationship. All of us are aware of the high standing in the community of the family doctor. His relationship with patients whom he has treated over the years often as a family unit is most intimate. I agree that nothing should be done that would impair that relationship. However, there is another side to the picture. Daily, hundreds of people attend the general hospitals in all the capital cities and the larger towns for medical attention. For instance, at the outpatients’ ward at the Perth general hospital I have seen hundreds of people waiting to receive treatment. In many instances those people do not know the doctor who will eventually treat them. However, after receiving treatment they return to their homes. Where is the doctor-patient relationship in those circumstances ?
I am also concerned at the development of a practice in the medical profession which is to be deplored. A person consults a medical practitioner who will diagnose the complaint, but will suggest that the patient also consult a specialist whom the patient has never met before. It often happens that the specialist will agree with the private medical practitioner’s diagnosis, but will suggest that the patient see another specialist. In none of those instances does the doctor-patient relationship, of which we hear so much, exist. Finally the patient is faced with a tall bill even though he, or she, may not subsequently require to undergo treatment in a hospital. I regret that that practice Ls increasing. In all the capital cities the consulting rooms of medical specialists are located in a particular area. We know of St. George’sterrace, in Perth, Macquarie-street, in Sydney, Collins-street, in Melbourne, and North-terrace, in Adelaide. However, people who live in the outback areas must find the wherewithal to travel to the cities if they wish to consult a specialist. Under this measure, the Government will pay half the doctor’s fees, but that payment will not recompense people for expenditure incurred in travelling long distances to obtain medical attention. Under this legislation it is proposed to meet the needs of such people by providing aerial medical and dental clinics. Prom the facts I have given it is clear that specialists and first-class medical practitioners are only concerned with practising in densely-populated centres. So far as they are concerned, the people living in the outback can “go hang”. This legislation will come to the assistance of those people.
The Acting Leader of the Opposition (Senator O’sullivan) described the Government’s pharmaceutical benefits scheme as a fiasco. That may be so ; but if it has proved a fiasco, who has been responsible for that? Not the Government, but the executive officers of the British Medical Association. It appears to me that many members of that association are not using their own intelligence in deciding what attitude they shall adopt towards the Government’s health services but prefer to allow its executive officers to make up their minds for them. Certain members of the British Medical Association are co-operating with the Government under its pharmaceutical benefits scheme. I know of a doctor in one centre in Western Australia who is doing so, and hundreds of people from miles around are consulting him simply because they desire to obtain the benefits provided under that scheme. What is the net result of the attitude of the British Medical Association towards the Government’s pharmaceutical benefits scheme? Their boycott of the scheme is depriving over 300,000 age and invalid pensioners of the right to obtain free medicine, simply because many doctorswill not prescribe for their patients underthat scheme. I cannot understand a body like the British Medical Association adopting such an attitude. After all, theGovernment has no desire to regiment medical practitioners. When the peopleagreed to alter the Constitution to giveto the National Parliament power to legislate in respect of health, the Government proposals submitted to them by way of referendum specifically provided that the Government should not have power to conscript medical practitioners in any way whatever. It is not possible for the Government to nationalize medicine, even should it desire to do so. It cannot say to the doctors of this country, “From now on you will work for the Commonwealth Government, and you will do as we tell you”. The people generally, including members of the Opposition parties, know that that is so: However, despite the injustice which is thereby done to so many citizens, the British Medical Association refuses to alter its attitude. Recently, I had brought to my notice the case of a person who was obliged to pay 18s. 6d. for a small jar of penicillin ointment simply because he could not obtain a prescription for the free supply of the ointment. That practice is being indulged in extensively in the community simply because the majority of the members of the British Medical Association will not “ play ball “ with this Government. I do not know whether they would co-operate with an anti-Labour government, but it is apparent that they will not co-operate with this Government. I can only say that that attitude on the part of the medical profession is most unfortunate, because the interests of the people as a whole are more important than those of any section of the community. That has been the basis of my approach to all public questions.
However, the problem will not be solved by recriminations. We must endeavour to persuade the British Medical Association to have another look at these matters as a whole, and to win the faith of doctors in the sincerity of the Government in its- endeavours to make essential benefits available to the people. After all, what does the Govern.ment get out of schemes of this kind? If the Government is prepared to expend £.10,000,000, which this scheme is estimated to cost during the first twelve months of its operation, in order to provide medical and dental benefits to the people, I fail to understand why the British Medical Association should be the first organization in the community to oppose it. Any one who examines it will agree that the scheme is most worthy and deserving of the co-operation of all sections of the community. That is all that the Government seeks. It does not wish to drive members of the British Medical Association to do something against their will. The Minister, in his second-reading speech, said there is still room for further negotiations with the association, and that the Government is prepared to do all in its power to ensure the success of the scheme. The Deputy Leader of the Opposition quoted from a British journal giving the views of medical men in Great Britain towards national health schemes. However, so far as I know, the majority of the members of the British Medical Association in the United Kingdom are co-operating with the British Government under its national health scheme. Any doctor in that country who is not prepared to do so is simply told by the Government that he can remain outside the scheme. The result in that the Government already lias the co-operation of sufficient doctors to ensure its success. At present, there is a shortage of medical men and dentists. In order to overcome that shortage the Government, under this measure, will establish medical and dental training courses. I repeat that medical men have nothing to fear from this scheme. Indeed, their attitude towards it completely confounds me. One is almost forced to conclude that the great majority of them are being influenced by a force which i9 prepared to do anything but co-operate with the Government.
– Utter conservatism !
– It may be. I know that people do not like changes. I am conservative myself in some things. I cannot see anything objectionable in what the Government proposes to do by the measure. It desires to give the people the very essential services that they require, and it wants the co-operation of the British Medical Association and of the dental and nursing professions to enable it to do so. It desires to establish clinics and hospitals to assist in improving the health of the nation. The only interest that has delayed the implementation of the Government’s policy is the British Medical Association. I cannot, understand why. If that association can produce some argument, and substantiate it, to show that this Government is attempting to act to the detriment of doctors, it is surely up to it to do so. Let it show to the Senate what it considers are the Government’s ulterior motives. I challenge the British Medical Association to substantiate any such argument. In doing so, I speak as an ordinary member of this Senate with no ministerial authority. But I have sufficient faith in the Government with which I am associated to know that it does not intend to do anything to the detriment of the British Medical Association, or to nationalize medicine in this country. All it desires to do is to act in the interests of the people’s health. Honorable senators last night heard the Minister, in his second-reading speech, describe the appalling state of dental decay among Australians. He said that a large proportion of Australians had to have recourse to artificial dentures at an early age. There must be some physical reason for that condition among the people of a nation. It is perhaps due to dietary deficiency, or possibly people who suffer from dental decay are the victims of their own previous riotous living. The reason may possibly be traceable to the depression years, when many children and young people suffered from malnutrition. Dental care is important to national health. The Government desires to set in motion a scheme whereby we can start to provide dental care for school children. I understand that the dental association is not opposed to the scheme and that dentists are prepared to co-operate in it. They are showing the right national spirit. Why cannot the British Medical Association adopt the same attitude? If that association feels that the Government is intending to “ put anything over “ doctors, and can prove that there is a good ground for that fear, I repeat, let it come forward and tell honorable senators about it, so that we can deal with it and take the necessary steps to remove the fear.
I do not like to have to say so, but the attitude of the British Medical Association appears to me to be purely political. As far as the British Medical Association is concerned, the people of this country can “ go hang “ as long as this health service is being proposed by a Labour government and not by a Liberal government. That is the conclusion I have formed from what I have heard and read of the association’s attitude to the Pharmaceutical Benefits Act and from what I understand is the attitude of a section of the British Medical Association towards the present measure. I hope that I am wrong, and that the members of the British Medical Association will see to it that either the executive of the association reflects the wishes of the majority of members or that they themselves will individually have the courage and initiative to decide whether the scheme is in the interests of the people or not. I believe that if the members of the association adopted that attitude the majority of medical practitioners would give only one answer, which would be that the desire of the Government to make something worth while available to improve the health of the nation is good and that they would be prepared to give their whole-hearted co-operation to the Government. The Government has no desire to deprive doctors of anything. I do not like regulations and I regret the provision in the bill for the administration of the scheme to be carried out by regulation, although I can understand that it might be necessary to take urgent measures at any time and to make regulations at short notice for that purpose. But I believe that wherever possible we should always have substantive legislation to cover such important matters. I have no fear of any abuse in the making of regulations. I am more concerned that there should be a more common-sense attitude on the part of the medical profession which, if it considers the Government wrong, should let honorable senators know its views. If the Government is wrong and the British
Medical Association can show that it is, I and many of my colleagues in the Parliament would ‘be glad to know so that we could raise the issue with the Government. I believe that the Government is approaching this matter in the best possible spirit. It desires the cooperation of the British Medical Association without which it cannot achieve much in this particular field. It could make a start without that co-operation, but how far it could go would be limited because of the lack of assistance from the medical profession. During the war many of our people went overseas and gave their lives, or suffered injuries, in the cause of the ideals of democracy. Some honorable senators lost kith and kin in the war. It is just as important to wage a war in our own midst to obtain improved health and living conditions for the people, but those to whom the Government looks to for help to achieve these improvements, do not cooperate. I trust the British Medical Association will further examine its attitude to the scheme and satisfy itself that the Government has no ulterior motive. I am sure that if it does further examine it with good intent, a way out of any impasse will be found.
– I have great pleasure in supporting the measure. I believe that it will represent another leaf in the book of progress that was started by the Australian Government in 1901. It is in the interests of the people whom we represent. In my opinion there has been no real opposition in this chamber to the measure. The only fault that Senator Rankin could find with the measure was that it did not go far enough, and the only fault that Senator O’Sullivan could find with it arose from the fact that he had not read or listened to the secondreading speech of the Minister for Health (Senator McKenna).
– That is absolutely untrue.
– Had he done so, I am quite sure that we would have had no opposition to the bill from the other side of the chamber. It is quite possible that members of the Opposition are not aware of the amount of research and the time that have been given to this class of legislation by the Labour party and the trade union movement of Australia. We have spent our lives in trying to impress previous governments with the need for action to prevent disease and to treat and control diseases of a kind that have been rampant in this country for the last century. Until 1941 we were unable to convince any government that what we proposed should be implemented by legislation. During the war years we could see that what would be necessary to ensure national health were the same medical and dental treatment facilities as are available to the armed forces in war-time. With that in mind, the Government, realizing that it had no constitutional powers to control health services, submitted a referendum to the people asking them for the power required to give the people the facilities they so sorely needed. In reply to the Deputy Leader of the Opposition, I say that as the Government has consulted the people it is under no obligation to consult the medical or dental profession, or the gas-workers, coal-miners, or anybody else as to what should be done in this connexion. If the Deputy Leader of the Opposition had read the Minister’s second-reading speech he would have known that the Minister and his officers conferred with the medical, dental and nursing professions. The power which the Parliament will possess under this legislation was given to it by the people when they decided that its authority should extend to “ the provision of medical and dental services “. There was no “ tag “ as Senator O’Sullivan and members of the Opposition parties say there was, about nationalism or socialism, because we proved to the people conclusively that the Labour party was in no way desirous of nationalizing or socializing the medical profession, but was concerned with the health of the people. There has been little real opposition to the measure. Senator Rankin said that it did not go far enough. It is necessary to start somewhere and the fact is that the political party to which she belongs never knew that there was any starting point at all. In the years when it controlled the Commonwealth, it did nothing, from a national point of view, to preserve the health of the people. I well remember the unfortunate situation of many people in the days when I was a youth. I lived in a mining area when conditions in the coal industry were somewhat worse than they are to-day. My mother could not afford to take her children for a quarterly, half-yearly or even yearly examination by the local dentist or doctor because her husband, as a miner, was very poorly paid. Therefore, we had to go without treatment when rich people were able to secure all the attention that they wanted. This bill will go a long way in the direction of improving national health because it provides for prevention, but it will not go as far as I should like. I hope that some day we shall be able to provide medicine for everybody free of charge.
The Opposition has said that, under this scheme, there will be no incentive for boys and girls to train for the medical, dental or nursing professions. I consider that the incentives will be increased by the bill. In my youth, it was impossible for a boy or girl in a miner’s family to train for any profession. I knew lads who had great mental capacity but, although they passed all examinations with great credit, they had to leave school early in life to work in the mines, in the fields or in some other poorly-paid occupation. Their parents could not afford to send them to the private schools of those days and afterwards to universities. Therefore, society lost the advantage that it might have gained from the scientific training of some of the best brains in the community Clause 20 of the bill provides: -
The Minister may, subject to the approval of the Treasurer, make payments to universities or other appropriate bodies for the purposes of -
That is a noteworthy step towards the prevention of ill health in the community. The Opposition has complained that the bill will do nothing to eliminate conditions which cause ill health. I have lived in such conditions for the greater part of my life. They are a disgrace to a young country like Australia. Senator Rankin said that when she travelled through the suburbs of Sydney from Mascot airport, she was appalled to see so many poor dwellings. She almost shed crocodile tears. I believe that is what she does. I assure her that, throughout my life, I have been trying to convince the parties now in Opposition in this Parliament that they should do something to help the people who are forced to live in hovels. We have paid very dearly for the maladministration of anti-Labour governments in the years before World War II. In those days one did not have to go to Mascot to see shocking living conditions. Poverty and misery could be seen in any part of the Commonwealth, except perhaps in such areas as Toorak and other luxury suburbs where the rich live in palatial homes. Thousands of people died of malnutrition. Yet the members of the parties which were then in power now have the audacity to tell this Government that it is not doing the right thing for the people. I might believe that they were sincere if they were not members of the Opposition parties.
A great deal has been said about opposition to this measure by the British Medical Association. There has been no organized opposition by the doctors. The only organized effort against this bill and the pharmaceutical benefits legislation has been made by the daily newspapers. I warn the British Medical Association and all those other organizations that are led by Communists that, in Victoria, the Labour party has fought the scourge of communism for many years and at last, I am proud to say, has eliminated the “ commos “ from the tramways union. I warn the British Medical Association and other organizations that they must be prepared to accept the will of the people. I am friendly with a number of doctors, with whom I have discussed this hill. All of them are in favour of the measure, and the pharmaceutical benefits scheme which this Government has introduced. However, they are unionists and their organization takes a long time to wake up, just as the tramways union took a long time to wake up. The doctors will see the light eventually, and then they will look for new leadership <and <k> what they know to be right. Honorable senators in opposition have spoken of the great bond of friendship between family doctors and their patients. I know all about that. Our family’s doctor, a great old gentleman, who is dead and gone now - God rest his soul - attended my home on many occasions but never received any .fees for his services. Do honorable senators opposite think that such a state of affairs should be permitted to continue? That doctor gave his services for 24 hours a day and undermined his own health in the interests of the people he served. I have not forgotten that friendship, and I shall never forget it.
– Is that why the honorable senator sneers at the medical profession ?
– I do not sneer at it.
– I thought that the honorable senator did so last night.
– Not at all. If the Deputy Leader of the Opposition would listen to what other honorable senators say and would read what he ought to read, he would understand what is happening. He did not listen properly to the second-reading speech of the Minister for Health, and that is why he does not understand this bill. I repeat that I have not forgotten the sacrifices made by my family’s doctor.
We must not allow such conditions to continue. This Government is trying to relieve the situation. Many doctors, especially those who work in industrial areas, forgo as much as 50 per cent, of their fees. At least under this measure they will forgo only 25 per cent, of their fees. The scheme will operate in the interests of everybody. Any assertion that it will destroy the relationship between doctors and patients or will lead to nationalization or socialization is ridiculous. One honorable senator said earlier in the debate that there is plenty of medical attention for the poor as well as for the wealthy. That is not so. In any public hospital in the Commonwealth one can find on any day of the week dozens of men, women, and children, sometimes even hundreds, waiting to consult doctors. The Deputy Leader of the Opposition said that a dose association springs up between a doctor and a family, and that people often have a fancy for a particular doctor. I assure the honorable senator that the class to which I belong has rarely been able to gratify its fancies. It has been forced to take what it could get, which has been remarkably little. Even to-day, workers are still forced to go where they can get medical attention. They cannot pick and choose. Those who suffer from illness or injury have to take their turn at public hospitals, where they sometimes have to wait for four or five hours to receive treatment.
The Deputy Leader of the Opposition has no real opposition to offer to this bill because it is a good one., His criticisms have been directed at it merely because it has been introduced by a Labour government. He said that doctors should not be classed with men who lay gas and water mains or hew coal. That comment is typical of the class that he represents. It does not represent the views of many doctors. It is just as important to have good men in the coal industry, the plumbing trade or any other occupation, as it is to have good doctors.
– I did not say anything like what the honorable senator has attributed to me.
– The honorable senator said that we should not refer to doctors as we refer to people who lay water mains, but should give them the credit that is due to them. The Labour party gives proper credit to all sections of the community. It is not prepared to take away from anybody the rights to which he is justly entitled. The British Medical Association should take heed of the fact that this Government has never sought to do anything unconstitutional or to evade the law in any way. The people gave it a mandate to legislate for national health in 1946, in spite of organized opposition by the newspapers. The people said, “We trust this Government and will give it a mandate to provide us with social services “. Therefore I warn the British Medical Association, the Opposition, and any other body that shows hostility to legislation introduced by this Government that they may suffer the fate that befell former officials of the tramways union in Victoria. I have much pleasure in commending the bill to the Senate.
– I direct my remarks to the amendment submitted by the Deputy Leader of the Opposition (Senator O’Sullivan). The honorable gentleman moved -
That all words after “That” be left out, with a view to insert in lieu thereof the following words : - “ the bill be withdrawn and re-drafted and re-submitted to the Senate 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 Senate in respect thereof “.
I make two general observations upon that amendment. The first is that the bill, as I said in my introductory speech, is an enabling measure. It will merely confer powers upon the administration to do certain things. If I were asked to describe the bill in one sentence, I should be disposed to say that it is a recognition of vast needs and an acceptance of a great responsibility. When seen in that perspective, it will be recognized as a starting point from which must grow and flow all sorts of activities. Without this enabling measure, there could be no beginning of action. There could be no establishment of staff, provision of accommodation, or development of a blue-print, whether in association with other bodies or solely by governmental activity. The second observation is that the amendment spells delay, procrastination, inaction. It represents the old policy of laisser-faire. I say without hesitation that, whatever criticism may be levelled at this Government and previous Labour governments, nobody can justly accuse them of having been inactive. The inaction of the consolidated Opposition parties when they were in office led to their dismissal by the people. Moreover, if one may draw any conclusions from events of the last 24 hours in another sphere, they are not very successful when they do go into action. Apparently they encounter trip wires, fall over precipices, and bring about their own destruction.
I refer now to a point that was made very powerfully by Senator Hendrickson. He drew attention to the fact that this Government submitted two proposals to the people in 1946. The first was that they should confer upon the Parliament power to make laws for the provision of pharmaceutical benefits, for the provision of unemployment and sickness benefits - and I emphasize the words “sickness benefits” - and for the provision of medical and dental services, “but not so as to authorize any form of civil conscription “. By a vast majority the people of Australia conferred these powers on the Government. They said to the Australian Labour party, in effect, “ Go back to the treasury bench and implement the powers which we have conferred upon you “. If ever a government could claim to have been authorized by the electors to execute a specific measure the present Government can claim to have been authorized to introduce this scheme. However, time marches on. Although the Government has done ite part by implementing its promise to introduce legislation in accordance with the specific powers conferred upon it by the people, the unpleasant foot is that the great majority of the people of Australia have still to pay for penicillin, sulfa drugs, liver extract0 and other biological products, and the price of those drugs is undoubtedly higher than most of them can afford. Of course, we all know who is responsible for that situation. When the pharmaceutical benefits scheme, which is only one element of the national health scheme, is in operation people will not need to pay for more than one-half of the pharmaceutical preparations which they now purchase at retail prices.
The DEPUTY PRESIDENT (Senator Nicholls). - Is the Minister dealing with the amendment moved by the Deputy Leader of the Opposition ?
– The Deputy Leader of the Opposition referred particularly to the delay which has occurred in the implementation of the scheme, and I am stressing the need for speed in bringing the scheme into operation. All bodies in the field of public health must combine to give effect, not to the will of the present Government, but to the declared will of the people of Australia, and those who attempt to frustrate the execution of that will come to their accounting in due course.
I propose to say something with regard to the consultation which has taken place between the Government and the medical profession, and I shall also refer briefly to the negotiations which are still in progress. In the course of a very thoughtful contribution to the debate, Senator Arnold pointed out that discussions between representatives of the Government and the medical profession had continued for many years. Although no cooperation has been forthcoming from the medical profession, the bill proposes that separate directorates shall be established to deal with the various phases of national health, such as hospitals, nurses, radiology and pathology. Advisers drawn from practising members of the profession will be available to supply advice. At the last conference with the British Medical Association in November I invited it to appoint representatives to sit on a joint committee to deal with any of the details involved in the execution of the broad principles of the scheme. That was a full and complete offer, and I did not bar discussion of any single matter; I deliberately left the entire field open for discussion. However, as I have already said, time marches on, and we cannot procrastinate indefinitely. The people have been promised that certain benefits will be conferred upon them, and that promise must be honoured. To indicate the degree of consultation which ha9 taken place between the Government and the medical profession, and the willingness to cooperate with the profession exhibited by the Government, I propose briefly to refer to what transpired at a conference held in July, 1947. On that occasion I met the full council of the British Medical Association, and that body presented to me a programme which it believed should be undertaken to inaugurate a national medical service. So that the Deputy Leader of the Opposition may understand the degree of consultation that has already taken place, and the extent to which the Government has acted upon the advice of the medical profession, and to demonstrate the absence of any spirit of procrastination on the part of the Government, I shall read to the Senate the actual proposals made by the council of the British Medical Association and comment upon them. The document begins -
British Medical Association in AustraliaforImprovementoftheMedical Services to the Community.
There was no issue between the Government and the association on that statement. The document continued -
The existing consultant, general practitioner and hospital services, with all adjuncts, and these necessary additions -
I pause here to indicate that the scheme will not disturb the existing consultant, general practitioner or hospital services to the community. The document continued -
I propose to deal with that paragraph point by point. The Institute of Anatomy has for years been concerned with the maintenance and improvement of nutritional standards. It has prepared many excellent theses, and the only thing lacking is proper publication and publicity of the institute’s advice. I admit that that is a matter for the Government. With regard to housing, I pointed out how completely the Government has cooperated with State administrations in a concerted effort to improve the housing conditions of the people. As honorable senators know, it has spent millions of pounds to that end. With regard to educational standards, although education is not primarily a function of the Commonwealth, I point out that through the Universities Commission and the Office of Education the Government has given practical effect to its belief in the broad concept of improving public health by enlightenment. I referred to that matter in my second-reading speech. The improvement of sociological standards, referred to in the document, is a matter which has been the special concern of the present Government. As an indication of the earnestness of its efforts I point out that £88,000,000 is being expended on social services during the present year, compared with an expenditure of only. £17,000,000 in 1939. I shall not embark on a dissertation upon the details of that development, because I am confident that honorable senators are sufficiently aware of the magnitude of the Government’s efforts to improve social conditions. The next paragraph is -
A national government established the Council for Scientific and Industrial Research many years ago, and the present Government contributes £60,000 per annum to its maintenance. In addition, the Government has provided £325,000 per annum for research work to be undertaken by the Australian. National University, and much of that money will be expended on medical research. Provision was made in the Tuberculosis Bill passed by the Senate a few days ago for the compilation and maintenance of proper statistical records of the incidence of tuberculosis. On that occasion I informed the Senate that on the enactment of the measure one of the first tasks of the Government would be to establish an epidemiological research bureau to obtain and collate exhaustive statistics of the incidence of disease in the community. The next recommendation of the council was -
The Government has already established’ sixteen laboratories throughout Australia, including laboratories at Cairns, Townsville, Toowoomba and Rockhampton in the State of Queensland, which the members of the Opposition in this chamber represent. The Government realizes the present shortage of pathologists, and in order to provide proper diagnostic facilities it has made provision for the training of as many pathologists as possible. The next suggestion was -
That is exactly what the Government proposes to do under the medical benefits scheme. Paragraph e of the document is : “ Group practice initiated by members of the profession themselves”. The bill contains special provision for that. If doctors will como together and provide proper diagnostic facilities the Government is prepared to assist them to some degree. Moreover, as I intimated in my second-reading speech, the Government plans to establish health centres in various parts of the country. In my view, *hat represents the natural and complete development of a national health service. Paragraph / of the document is as follows : -
Extension of flying doctor service.
Provision for that has already been made. The Government subsidizes the flying doctor service by the payment «o’f £7,500 per annum. In addition, it provides its own doctors and aircraft for the Northern Territory, and those doctors also serve areas in the States. Paragraph 9 of the document recommends -
Increased subsidized practitioner service to outback centres.
The Government has acknowledged the need for that, and has undertaken to subsidize medical practitioners as soon as it obtains the constitutional power to do so. Paragraph h of th’e document suggests -
Extension of industrial, venereal, immunological and other preventive medical services.
We acknowledge the need for that. Not very long ago, the Government arranged for the School of Tropical Health and industrial Hygiene in .Sydney to make complete investigation of all diseases that affect workers in industry. The Division of Industrial Welfare of the Department of Labour and National Service is also co-operating in research into the effects of noise, smell, dust, vibrations and the hundred and one other factors which affect the health of industrial workers.
Concerning immunology and other modern medical services, let me remind the Senate that the present Government has arranged for the supply, free of cost, of serum and vaccine for the treatment of diphtheria, “whooping-cough and other diseases. It has also made available without charge iodine tablets for distribution throughout the goitrous belts of the country. Paragraph i of the programme reads -
Extension of the present maternity services, with the establishment of hostels for waiting mothers.
I undertake, as soon as the necessary power is vested in the Government, that a survey will be made of the service at present provided for the welfare of mothers and infants. When the bill is enacted, one of the first obligations of the Government will be to fill whatever gaps exist in the present arrangement. I admit that at present the gaps are many and serious. Paragraph j of the recommendations is as f ollows : -
Extension of hospital construction and equipment with special reference to the treatment and care of sufferers from tuberculosis and mental diseases, and crippled, bedridden and the aged; and the provision of private and intermediate wards to all public hospitals and elsewhere as required.
I have only to remind the Senate of what has already been done in the field of tuberculosis. Honorable senators will recall that a bill was introduced a few days ago to relieve the relatives of mental patients of the need to contribute to the cost of maintenance of patients. Paragraph h is as follows : -
The organization of regular post-graduate training.
Power to provide special research facilities for graduates in science and medicine is provided by the present bill, as I explained at some length in the course of my second-reading speech. Paragraph I states -
Increased infant and child welfare services.
As the Senate is aware, we have recently set up a Division of Child Health within the Department of Health. We have also established at the University of Sydney, with the concurrence of that university, a chair of child health, and at that institution specialists in diseases peculiar to children will be trained. The whole field of maternal and child welfare will he given very special attention. I come now to the last item -
The medical benefit scheme proposed under this measure will go a long way towards achieving that objective. It can be seen, therefore, that of the proposals for a national health service that were submitted by the British Medical Association itself, in every instance the Government has either already acted to a substantial degree, or has made provision in this measure for steps to be taken forthwith. Therefore, if one can accept the charter submitted to me by the British Medical Association as being the genuine desire of medical men, there can be no real reason why the Government and the medical profession should not co-operate in their efforts for the betterment of the health of the people of this nation. I assure the Deputy Leader of the Opposition, that the Government would welcome the co-operation of the British Medical Association. It has sought that cooperation for a long time. However, we propose now to go ahead with the scheme. lt is not intended to delay the measure pend ing further discussions, because already very complete discussions have taken place: I have shown clearly that the British Medical Association and the Government are in complete accord on the main principles. I have in my hand a document which was submitted to me in February of this year by the British Medical Association, dealing with the question of fee for service. 1 propose to read a few brief extracts from that document, and the Senate will not have any difficulty in recognizing the similarity between the views of the British Medical Association and the medical benefits scheme proposed in this measure. Paragraph 17 of the document states -
The fee-for-service method envisages the payment for each service rendered. The service might be a medical consultation or operation, an X-ray investigation or a pathological examination.
Paragraph IS states -
Payment would be made in accordance with a schedule of fees drawn up for the purpose. This schedule would apply to all surgical operations, administration of anaesthetics, treatment of fractures and dislocations, X-ray and pathological examinations, maternity work and physiotherapy. Where the services are performed by a specialist practising his specialty the schedule would be on a higher scale, such as satisfactorily operates in New Zealand in regard to X-ray and maternity services.
The first sentence of paragraph 23 is -
Abuse by a doctor could be stopped by making the patient pay part of the fee.
In paragraph 27, we find these words -
Should a suitable body of doctors be constituted under fee-for-service, it could recommend disallowance of such medical fees which it deemed excessive or of medical fees for consultations which resulted in unnecessary or excessive prescribing.
I defy anybody who followed my secondreading speech and read this bill to find any point of essential difference between the scheme propounded by the Government and that enunciated by the British Medical Association as recently as February of this year. The Government cannot consider for one moment accepting the amendment. It has given to the medical profession the fullest possible opportunity for discussion and consultation.
– It has been too< tolerant altogether.
– Perhaps its5 tolerance has not been wasted. The Government realizes that all human beings* react rather badly to changes and must be given time to assimilate new ideas. Perhaps we are all rather like members of the Opposition in that we are conservatives at heart, and. it takes us a while to accustom ourselves to new ideas and to accept them as part of our ordinary live9. The Government realizes that something new is contemplated in this measure. The fact that some people -are disturbed does not surprise us. That is to be expected, and the Government has endeavoured to be tolerant of that attitude. I am hoping, however, that the need for further tolerance will very soon disappear, and that this period of mistrust of which the Deputy Leader of the Opposition has spoken will speedily come to an end.
Before concluding on the question of consultation, let me say with regard to the dental aspects of the scheme that consultations have been held with the body which governs the dental profession in Australis, and that the Government, and that body see entirely eye to eye on the four essenttial principles of approach that should be made to the improvement of dental health. The first principle is the necessity for concentration upon nutrition and dental hygiene, and education in those fields. The second is the provision of dental services in outback areas where such services are entirely lacking at present. The third is the necessity for maternal and child care, so that natural healthy teeth may be preserved throughout life. Unfortunately the general condition of teeth amongst our adult population is beyond remedy. The fourth principle is provision for the indigent and needy, and the development of out-patients services at existing public hospitals. There are still some matters to be discussed with the dental profession. One is the degree of autonomy, and another is the provision of dental hygienists in the event of insufficient doctors not being available. The Government has received substantial co- operation from the dental profession and I am convinced that the few remaining points to be discussed will be resolved to the benefit of the nation, and with complete harmony between the profession and the Government.
I have already indicated that this is purely a skeleton bill and that the blueprints for the various services will have to be made as time goes on. At each of those stages, the full benefit of the advice of the professions will be sought, but there can be no delay in laying the foundations that this measure provides, so that we may proceed with the structure which will safeguard the health of the people generally. Already this proposal has been too long delayed and the Government intends that it shall be implemented forthwith.
Question put -
That the words proposed to be left out (Senator O’Sullivan’s amendment), be left out.
The Senate divided. (The President - Senator the Hon. Gordon Brown.)
Majority .. … 20
– Obviously, there are two to be counted.
– But one is a teller.
– The honorable senator who is a teller still has to be counted in the division.
– I accept your ruling, Mr. President.
Question so resolved in the negative.
– in reply -I propose to deal with various matters that have been raised by honorable senators in the course of the second-reading debate. Most speakers indicated that they had given a great deal of thought to the measure, and to the proposals that the Government has in mind. It is most cheering to one who has devoted much time and attention to a measure to find that his colleagues, and other members of the Senate, have also given considerable thought to the principles involved. As I have already indicated, the bill is merely an enabling measure, setting out the general powers enabling various steps to be taken as the need arises. “We must be realistic and face the fact that to-day there is a substantial shortage of personnel in the medical and dental professions, and in the ranks of auxiliary workers. We must also face the fact that it will take some years to provide all the hospitals and institutions that will be required under this scheme. Facing, realistically, those factors the Government determined someorder of priority for the different activities that may be undertaken, and I am sure that the Senate will agree that the development of facilities in the outback areas of Australia is a matter of prime importance; that we should develop our Flying Doctor service and mobile dental service; that doctors should, where possible, be placed where they will be able to make their services available to people who live under the great disabilities of vast distances and climatic troubles doing the pioneering work of those areas.
The second activity will be the development of training facilities, and here lies the greatest need. We need far more radiologists, pathologists, biochemists, radiographers and all the ancillary personnel who go to make up a complete and efficient medical service. We need pathologists and radiologists for our diagnostic centres, and, perhaps, radiographers to assist at such centres. We also need to establish post-graduate training and refresher courses of all conceivable kinds for general practitioners. The Government will help with undergraduate training, and courses in industrial hygiene, child health and pediatrics, and post-graduate courses for nurses, and will establish training facilities for dentists, physiotherapists, optometrists, almoners, hospital secretaries and all other types of skilled personnel who go to make up a medical service.
The third activity is one which is incorporated in the bill, and to which perhaps undue prominence has been given, namely, the medical benefit scheme. That is only one scheme, and it is entirely apart from the national health service. It is only one element directed to one purpose, and that is to ease the economic burden which debars the patient from receiving the best possible treatment. It is proposed to implement that scheme at the earliest possible date. I have seen statements in the press that the medical profession is opposed to that scheme. I am very reluctant to believe that that is the case. As I have already indicated to the Senate, the broad principles of what the Government proposes to do are completely in line with the written proposals of the British Medical Association itself, and any details not yet resolved have been listed for discussion and determination at further conferences. It is proposed to establish health centres, one in each State for a
Start. The Senate will appreciate that we are desperately short of laboratories. The competitive demands of housing are well known. It is most desirable that every assistance possible should be given to private practitioners in relation to diagnosis. At the same time, it is necessary to provide the most modern facilities not only for the treatment but also for the prevention of disease. Consultant services will be provided to ensure that wrong practices shall be arrested. It is proposed that that service will be developed at the main hospitals throughout Australia. Ancillary to that proposal is the proposal mentioned in the bill and in my second-reading speech, namely, the encouragement of group- practice. The doctors of Australia in the various parts of the Commonwealth like to get together, acknowledging the principle, as the Federal Council of the British Medical Association does, of the desirability of group practice. The Government is taking the power under the bill to encourage that practice in every way. What form that encouragement may take is a matter to be determined as a matter of policy. It may cover the provision of buildings, and, in particular, it may include the provision of a government pathologist or a consultant dentist and, perhaps, a radiologist at certain places; but thb Senate can be assured that that is one of the early developments we have in mind, Apart from those particular activities, general assistance will be given to the States and non-State bodies as well as to universities. All of those bodies will need assistance from the Government if a national health service cn a proper basis is to be developed. I assure the honorable senator who raised the point that under the bill there will be no compulsion in taking over anything from the States or from denominational or other bodies in the health field. If a careful perusal is made of the bill it will be seen that those things can be done only by agreement with the States or with the other bodies, denominational or otherwise. In the private field a likely development will be that the Commonwealth will make approaches to hospitals that are conducted by private bodies that the Commonwealth at its own expense should provide and maintain diagnostic facilities where they do not exist at present. The Senate can be assured that that will involve no dislocation of the services being rendered by those particular institutions. All I can envisage for them pursuant to the exercise of the power given under the bill is that whatever assistance is provided will be given to enable them to discharge their functions in a .way useful to the community.
The Deputy Leader of the Opposition mid that there should be easy access to diagnosis. What I have already said indicates that we shall proceed along those lines. I have indicated the establishment of diagnostic laboratories and the provision that will be made for the training of ‘pathologists. We must increase the provision of diagnostic units at health centres. The Deputy Leader of the Opposition also sought information upon certain matters connected with the medical benefits scheme. He asked whether doctors who come into the scheme are to be wholly in or wholly out of it. He also inquired regarding the provisions with respect to the maintenance of secrecy as to a patient’s ailment and asked what would be the nature of the details which would be supplied on the forms. I can nay broadly, at first, that all these matters are matters of detail upon which the Government has not made any final determination. It has left them open for discussion in detail with the medical profession itself, and the Government hopes that that discussion will take place in the near future. With respect to secrecy I make it perfectly clear that the Government has not the slightest desire to know what is wrong with any person in Australia. Secondly, I do not believe that under this scheme there will be any need for the Government to know what is wrong with any person. It will he necessary for i ho Government to be informed whether an attendance has taken place or whether a minor or major operation has been performed so that the Government may know into which particular class each charge will fall, lint we are not concerned about the particular ailment of any individual. I assure the honorable senator that we are is anxious as he is to develop a scheme under which details of complaints will he kept secret and the confidential nature of the patient’s ailment will be preserved. I agree with the remarks of the honorable senator who drew my attention to what appeared in a Sunday newspaper published in New South Wales. I regret that publicity of that kind has been given to the scheme. I am sure that such publicity has been inspired by some hysterical medico to whom everything the Government does is repugnant. If that medico looks at the formulary provided under the pharmaceutical benefits scheme he will find that there are certain excellent hypnotics provided in it for people who suffer from hysteria. I should certainly regard that article as the product of some hysterical mind. I repeat the assurance that every endeavour will be made to ensure that there shall be no breach of secrecy between doctor and patient. A case may arise in which the charge made by a doctor is disputed, and I say tentatively that it may be necessary to appoint an adjudication committee to determine points of that kind. That is one of the committees which may be set up under the bill. That committee will consist of practising members of the profession. The clinical details of the patient’s complaint or disease will be examined by that committee. That will be done in the rare cases in which an account is disputed. In such circumstances the account will most likely be disputed in the first instance by the patient himself. That will remove the need for secrecy. Even then the matter will be dealt with in a proper atmosphere and by the particular doctor concerned in conference with his brother doctors only. The Government is anxious to see that that position is preserved. With regard to the form to be provided the Government has not made any firm determination pending the conclusion of the talks which it has offered to have with the British Medical Association, but my thought is that all that will be required under the scheme in the way of forms for the medical benefit scheme will be a document which will list the patient’s name and address and the quantum of the charge made against him. That charge will be rendered once a month by the doctor to the Government. I cannot imagine that any one could legitimately complain about the burden of clerical work involved in that procedure. Under this scheme the doctor will, be paid at least half of his fee in respect of every attendance, whereas I doubt whether the average doctor now gets paid for two in every five attendances.
The Deputy Leader of the Opposition also referred to the fact that there was mistrust and suspicion on the part of the medical profession towards the scheme and their fear that the bill contains some hidden trap9. I appreciate the honorable senator’s keenness of mind and I am perfectly certain that if the bill contained any hidden traps he would have sought them out and laid them before us. The fact that he has not done so is the clearest indication that not only he himself but also the medical profession which might be expected to put its views through him has not been able to do so. I follow up that statement with the assurance that so far as the Government is con- cerned, the bill does not contain any traps. Nationalization, as I have pointed out, is not possible and I do not propose to develop that theme further.
Senator Rankin referred to several matters to which she urged attention should be given. She referred particularly to nutrition and to the working conditions of our people. I repeat that the Government has already shown its very live interest in the field of nutrition and realizes the need to develop trained personnel to look adequately and properly to the industrial sphere of working conditions. It would be a grave mistake if any government took a small view of the health of the people and did not realize that apart from the very necessary treatment of a diseased condition it must concern itself with the active promotion of positive health and erect barriers to prevent disease. The honorable senator will find in clause 7 a most complete charter of power enabling all the things she mentioned to be done. Sub-clause 1 in that clause provides - ‘
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.
That is as wide a power as can be conferred and is explained in some detail in the next sub-clause. Sub-clause 3 of clause 7 gives the Director-General power to do anything “incidental to the provision of any medical service or dental service “.
So that the responsibility of the administration will be clearly defined, sub-clause 4 of clause 7 refers to specific matters. J particularly direct attention to paragraph d of sub-clause 4 because of the points raised by the Deputy Leader of the Opposition. That sub-clause provides that the Director-General may, on behalf of the Commonwealth - undertake or develop, or assist in the undertaking or development of, measures (including research and epidemiological investigations) for the improvement of health (including maternal and child health) and for the prevention of disease;
Where that paragraph refers to “ measures “, it means all measures. If the bill had no other provision than this it would be of great value. That sub-clause grants a great deal of power to, and throws a vast responsibility upon, the administration and its operation alone would make a vast difference to the health of the people. Senator Nash referred to the fact that great power had been taken under the bill to make regulations. He acknowledged also the real need for some such provision. In effect, he recognized that in a bill of this nature one could not possibly incorporate a blue-print for radiological, pathological and all the other services, for a hospital programme, post-graduate studies, &c. I assure him that there will be two safeguards against abuse of the power to make regulations. In the first place, I can assure him that if legislation is required to deal with any special phase of this scheme or its administration a bill will be introduced into the Parliament. The second safeguard, with which, as chairman of the Regulations Committee, he is probably conversant, is that regulations, when made, must come before the Parliament. They are laid upon the table of each House and either House may disallow them within a certain period. The mere making of regulations does not put a matter beyond control by the Parliament. Where possible and necessary we shall introduce separate bills to cover various phases of the scheme. For example it may be necessary to introduce a bill to cover the development cf a hospital policy. I do not propose to delay the Senate, as I know that all honorable senators are anxious te complete the passage of the bill since there are reasons why its passage should be accelerated, but I desire to thank honorable senators for the keen interest they have taken in the measure. I agree with the honorable senator who described its introduction as “ an historic occasion because I believe that, stemming from this bill, will grew a sense of broad community responsibility in the matter of health, not only in the minds of the people at large, but also of the medical profession. It is neither my purpose nor desire to criticize the medical profession. I agree with every wordof praise that honorable senators have uttered about the devotion of doctors in their service to individual patients and the great amount of self sacrifice they put into their work, their unyielding efforts - many of them work round the clock - and the fact that, in many cases, they refrain from charging for their services. Nobody could assail the fine way in which doctors direct themselves to the treatment of individual patients. I think it remains, however, for the medical profession to demonstrate, by its acceptance of the opportunity to co-operate with the Government in matters now before the Parliament and that were recently before it, that in addition to its sense of responsibility to individuals it can go to the heights and survey the position broadly and develop a sense of community responsibility. Perhaps I should have used, instead of the word “ develop “, the words “ give expression to “ a sense of community responsibility. I trust that when the deliberations of the British Medical Association Federal Council and allied bodies are concluded the medical profession will extend the hand of co-operation to the Government. The Government will be happy to take it, and to work in concert with the medical profession, which can be certain that in any technical and purely medical matters there will be no interference by the political machine. Any one will acknowledge that the Minister must, however, as the mouth-piece of the people, retain the final power over such a scheme. When vast sums are to be expended he must have final control of their disbursement. One could well imagine a situation when ministerial interference would be called for. For example, too large a proportion of the funds made available might be devoted to purely abstract research, to the detriment of other phases of the scheme. It would be not only proper but incumbent, upon the Minister to intervene and advise the administration not to spend so much on research but to do more, for instance, about tuberculosis or maternal and child health. [ am certain that no Government, however, will interfere with the treatment of patients or in technical matters. This bill will do a great deal in the interests of the welfare, general health, and, above all, the peace of mind of our people. - Question resolved in the affirmative.
Bill read a second time.
In committee :
Clauses 1 to 3 agreed to.
Clause 4 (Administration).
– This clause reads -
The Director-General shall have the general administration of this Act hut the exercise of any power or function by the Director-General under this Act shall be subject to any directions of the Minister.
I hope that that provision will work. The question of administration will be probably the most vital factor in determining the success or otherwise of the scheme. There would be much more likelihood of obtaining the essential degree of co-operation if instead of the general administration being exclusively given to the Director-General subject to the Minister, it were provided that the Director-General acted as a member of a commission that would be answerable to Parliament as distinct from the Minister. For too long, in our legislation, we have passed too much power to the Executive. If there were a commission presided over by the Director-General that was answerable to the Parliament, it would have a degree of independence which would be both salutary and desirable and, I am sure, would guarantee the successful working of the scheme and give to the medical profession and to the people a guarantee of immunity from arbitrary political interference.
Senator McKENNA (Tasmania- Minister for Health and Minister for honorable senator in hoping that that particular provision will work. As he knows, it is a provision that is common in legislation. It provides for departmental administration over which the Minister has full control. That is a fundamental principle. I invite the honorable senator to consider the nature of the work that will be undertaken by the department. It will be largely of an administrative and financial character, and will concern also the provision of staff, accommodation, assistance to universities and undergraduate and post-graduate bodies, assistance, to students, and the running of the medical benefits scheme which is purely a financial arrangement that could be run by laymen who had never met a doctor. The whole medical scheme does not require the services of doctors in its administration, and although administration by medical persons is provided for in the bill, the most efficient and appropriate method of administration of the scheme as it is, and will be for a considerable period, is administration by departmental experts. Acts of Parliament are not immutable and if the need arises, as it may arise, to develop numerous directorates in the field of medicine and dentistry, it may he possible and desirable to have a commission to which the Director-General himself will be responsible and of which he would be a member. Those are matters for the future. Realistically taking into consideration all that can be done in the next few years, the Government is completely convinced that this is the proper form of administration at the present time.
Clause agreed to.
Clause 5 (Delegation).
Senator COOKE (“Western Australia; [4.46]. - I take it, from the assurance given by the Minister, that there have been discussions with the DirectorGeneral to ensure that properly qualified medical personnel only will examine the accounts of patients and that the work of examining these accounts will not be delegated to any person not equally qualified.
– There are two kinds of functions that the DirectorGeneral will perform. Insofar as the exercise of the power involves the intimate” relationship between the doctor and the patient there will be no delegation to laymen. I shall be as concerned at the honorable senator to preserve that position and to ensure its preservation in the future. Laymen will not be allowed access to details of the illnesses from which patients suffer.
Clause agreed to.
Clause 6 (Medical benefits scheme).
– I asked the Minister for particulars of this clause but I did not gain a full understanding of the proposed relationship contemplated in it. The question I asked earlier, and upon which I am not quite clear, concerned the claim for payment by doctors. I take it that in order to belong to the scheme a doctor would apply for registration and fill in a form which he would submit to the Director-General or to the DirectorGeneral’s deputy in a particular State.
He would then become a participant in the scheme. Would that throw on him any particular obligation other than that, at the end of each month, he would send in his account to the Director-General or his deputy? Would it interfere with his normal private practice? Would he be obliged to send in an amount in respect of every patient who consults him or only in respect of such patients who asked him to send in particulars of the account to the Director-General ?
– The question of whether a doctor should apply to participate in the scheme or whether all doctors would automatically become part of the scheme and whether, having entered the scheme, they must confine themselves to it and not have patients outside of its scope, are all questions upon which the Government has no fixed determination. Those problems were posed by me to the doctors at my last conference with them in October. The Federal Council at that stage was not prepared to express opinions upon the problems, and for that reason, amongst others, I suggested that they might be disposed to appoint a joint committee to iron out these things. The findings of such a committee could be the subject of further discussion between the Government and the council. The council heard the Government’s proposals at that conference for the first time. I point out that the Government did not make any decisions on the form of a national health service until very recently. When the decisions were made, both as a matter of courtesy and for the purpose of obtaining advice, the viewpoint of the Government was put to the Federal Council of the association even before it was submitted to the Parliament. The council’s views about these details of the scheme are not yet available. I realize that a patient must know beyond any question when he goes to a doctor whether that doctor is operating within the scheme or not. That could be provided for in either of two ways. Doctors who are operating within the scheme could display notices to that effect, or those who are operating outside the scheme could display notices so that any doctor not displaying a notice could be deemed to be operating within the scheme. I have not decided yet whether there should be a form of application for doctors to fill in. I should like to know the opinion of the profession upon that subject. The Government desires to know the views of the doctors if they are willing to co-operate. If those views accord with the Government’s desire to protect patients, we shall be happy to fall in with them. I can only say that these problems have been left open for discussion. I envisage that doctors will render accounts at the end of each month, and I believe that that will he the only form required of them in the operation of the scheme. I do not want to reach an arbitrary decision on those details, and that is why I have referred them to the joint committee in order to ascertain the views of the profession. I regret that I cannot carry the matter any further for the information of the honorable senator.
– I should like to have a firm assurance from the Minister for Health (Senator McKenna) that secrecy will be preserved in relation to the ailments of patients. This, I feel, is most impor tant. The Minister has already touched upon the subject, but I know that many people entertain genuine fears that their confidences will not be preserved. Unless such fears are allayed, some of the value of the scheme may be lost because people may be diffident about having consultations. Will the Minister give a definite assurance on this point?
– I have indicated the Government’s attitude towards ordinary examinations. All that the Government will need to know will be that an examination has been made or that treatment has been given. It will not be even faintly interested in the nature of the examination or treatment. That sort of consultation will cover most of the payments made under the scheme. Apart from that, there will be all kinds of operations, such as the amputation of a finger, the amputation of a leg, or the removal of gallstones. We have not yet attempted to determine a schedule of fees for such work. We propose to discuss that subject with the profession before we resolve our minds. However, a schedule of fees will be prepared in due course. As an example, there will be a category of operations in, say, the 25 guineas class. All that the Government will need to know in relation to any case will be that a doctor claims to have performed upon a patient an operation that comes within that category. Difficulties will arise, of course. A doctor may begin to operate for a particular complaint and find other conditions of which the patient knew nothing at the time of submitting to the operation. If he treats those conditions, arguments may develop between the patient and the doctor as to whether a charge should be made only for the original operation or for the incidental treatment as well. A matter of that kind will involve detailed consideration of what was done to the patient and the question whether it was proper for the doctor to give the extra treatment. Departmental officers will not be even faintly concerned in any such consideration. Any issue of that character will, of course, be raised by the patient concerned, and, having disclosed the matter, he cannot expect secrecy to be preserved. Nevertheless,I assure the honorable senator that an argument . of that kind would be considered, not by laymen, but by medical practitioners alone. As I foresee the position, the question would be considered by a committee of fellow practitioners of the doctor whose account was under question. That explanation should reassure the honorable senator. The Government has no desire to know the details of the illnesses of people.
– In view of the remarks made by the Minister for Health (Senator McKenna) during the second-reading debate and also during the committee discussion,I refer to the newspaper report that was mentioned by SenatorCritchley. I have just read itfor the first time. I consider that loose, irresponsible criticism like that is calculated to do no good whatever. On the contrary, it can cause a tremendous amount of mischief and harm to the people of the Common wealth. Loose newspaper stories of that kind are most reprehensible and cannot be too strongly condemned.
Clause agreed to.
Clause 7 (Provision of medical and dental services).
– The clause states - (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.
Sub-clause 2 sets out nine different categories of medical service which may be embarked upon by the Director-General of Health. I should like to see included in the list a reference to mental hygiene and neurosis. I believe that the clause is intended to have a certain degree of elasticity, but mental hygiene is coming increasingly into prominence under modern conditions, because of the stresses under which people live, and deserves special attention in the scheme. More people are receiving medical attention for neurotic ailments than is generally known. I assume that psychiatric consultations will be provided for as required.
– I assure the honorable senator that provision is made for mental hygiene services. As I have previously indicated, sub-clause 1. of this clause covers as wide a field as possible. The Director-General of Health will have power to arrange or provide prescribed: medical services and dental services. That sub-clause will satisfy the honorable senator’s requirements, even without reference to sub-clause 2, which states - (2.) Without limiting the generality of the last preceding sub-section, the services referred to in that sub-section may include -
Mental hygiene and the treatment of neurosis by psychiatrists will be covered by paragraph b, because treatment of mentally deficient people will be the responsibility of specialists in mental diseases. That was in mind when the Government included paragraph b in subclause 2.
– I draw attention to the need for treatment centres for spastic children. This may come under one of the general terms of the clause, but the need for assistance for spastic children is so great and urgent that I am anxious to ensure that there shall be no doubt. Will the Minister give an assurance to me on this subject?
– I undertake that consideration will be given to the honorable senator’s request. There is a particular pointer to any diseases of children in paragraph d of sub-clause 4, which refers specially to the improvement of health, including maternal and child health.
– There are three points in this clause with which I wish to deal. I shall take them in turn. Is it intended that the Government shall charge patients who are treated by medical attendants or dentists employed as full-time salaried officers in any service that is conducted entirely by the Government? If such charges are contemplated, I see no provision in the bill for their recovery. .Sub-clause 3, which provides that tho Director-General of Health may, on behalf of the Commonwealth, do, or arrange for the doing of, anything which is incidental to the provision of any medical service or dental service under this clause would hardly cover the situation. Clause 2.2 (e) provides for the making of regulations for various purposes, including the collecting of fees. However, the regulations must apply only to matters contemplated in the bill. Paragraph e of clause 22 makes no provision for fees for services provided entirely by ° the Government. There is provision for charges for materials supplied in the course of rendering a service, but there is no provision for a charge for the service itself. Can the Minister indicate the intention of the Government in this connexion?
The next point relates to the aerial medical and dental services. We have in Queensland an excellent branch of the Flying Doctor service. It has bases operated by doctors at Cloncurry and Charleville. That branch, in the words of the last annual report, has thrown a mantle of safety over the far outback areas and has also done a tremendous amount to break down the loneliness and isolation of the women of the inland regions by introducing the pedal wireless system. According to the report, the amount of Commonwealth subsidy paid to the branch for the year was only £1,700. The State subsidy was about £7,900. The service is conducted on the £l-for-£l basis, plus Commonwealth and State subsidies. The most that the Commonwealth can do to help is to provide money. That service is to be taken over and placed under the control of a government department. In my opinion, that will entirely destroy the splendid spirit which is responsible for the provision of funds. Last year, the service flew 85,000 miles, which is a vast distance to cover in one year. Over 30,000 telegrams passed through the service during the year. The number of patients treated was 2,333, of whom 1,287 were white and 1,046 coloured people. The service was made possible not so much by the money provided but by the self-sacrificing enthusiasm of those engaged in it. The organization is a voluntary one, and the only expenditure it incurs, in addition to the salaries of the field staff and two doctors, is in the provision of an office in Brisbane where two clerks are employed. The service has been exceptionally fortunate in obtaining the services of two very fine doctors. They are most able medical practitioners and could earn much more money than the organization pays them. However, the present service can be extended only by the provision of additional money, and certainly not by any interference with the system. I should like the Minister to give that service the most sympathetic consideration possible. In my speech in the second-reading debate I said that it is most important that dentists should be given separate consideration, and that dental services should be provided only after consultation with representatives of the dentists.
, - In any service provided by the Government it is necessary to prevent abuse by patients, and for that reason clause 22 has been included in the measure. The relevant portion of that clause 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 he prescribed, for carrying out or giving effect to this Act, and in particular -
for prescribing matters for or in relation to -
the terms and conditions (including terms and conditions as to payment) subject to which a national health service may be made available ;
With regard to the aerial dental and medical services, I join with the Deputy Leader of the Opposition (Senator O’Sullivan) in paying an earnest tribute to the personnel of the Flying Doctor service. I recently had an opportunity to examine at first hand the excellent work which the Flying Doctor service is doing in northern Queensland and the Northern
Territory. The use of the pedal wireless by settlers in the far north enables them to obtain the services of the Flying Doctor in an emergency, and also to despatch telegrams and conclude business swiftly. In addition, the settlers are able to communicate with each other. I have a very real appreciation of the Flying Doctor service, and the last thing I intend to do is to disrupt it. Although the particular service operating in northern Queensland receives only £1,700 from the Government, I point out that the Government makes a grant of £7,500 to the Flying Doctor service. The Government has itself entered the field of aerial medical and dental services, and it operates its own aircraft from Darwin and Alice Springs. I can assure the Deputy Leader of the Opposition that the Government envisages the expansion of aerial medical and dental services and mobile land services in north Australia. We shall not confine ourselves to the Northern Territory hut shall provide a service wherever the need exists. I regret that I omitted to deal with that matter in the course of my speech in reply, but the honorable senator can rest assured that we shall not overlook the importance of the work done by the Flying Doctor service.
The dentists’ representatives asked that a degree of autonomy be conferred upon them, and that can be achieved by the establishment of a separate directorate in the Department of Health. It is intended that that directorate shall be staffed by dentists, and a chain of communication can be established which will give to them practical autonomy. They asked ‘for the establishment of a separate organization in the belief that the Government was contemplating the establishment of a special medical organization, apart from the departmental organization. Although the dentists have not completely placed their views before me, I have already indicated that we are prepared to provide a separate dental service.
.- Clause 7 (4) (c) which provides for the establishment, maintenance and development of courses cf training in nursing, dental hygiene, radiography, radiation-therapy, physiotherapy bio chemistry, dietetics and other matters related to medicine or dentistry, does not provide for almoners. I should like
Borne information from the Minister for Health (Senator McKenna) on that aspect of the matter, because of the very valuable work they do. I am also interested in the details of the proposal to establish national training centres for nurses. I understand that it is proposed to make a special grant to Victoria for the establishment of a training centre for nurses, and I should like the Minister to inform me whether it is proposed te establish centres in each State or whether it is contemplated that only one centre shall be established for the Commonwealth. In the interests of patients, apart from those of the nurses, I think that it would be of great value to decentralize training as much as possible. I believe that training centres should be established in the several States to assist the nurses by obviating the necessity for them to travel to distant States for their training.
– Provision is made in the bill for the training of physiotherapists, radiographers, bio-chemists epidemiologists, dietitians and other specialists and technicians, including, of course, almoners, and I intended to embrace all those classes of persons when I referred to “ auxiliary services “ in my second-reading speech. I readily admit the need to provide proper training for such persons. At the moment I cannot undertake that post-graduate schools for nurses will be established in each State. In raising the matter cf the location of the post-graduate schools Senator Rankin has, knowingly or otherwise, touched upon a controversial subject. When it was suggested that a national post-graduate school should be established in Victoria, immediate representations were made by certain interests in New South Wales, but no decision has yet been made. In deciding that matter regard will be had to the national requirements, without considering State boundaries. However, I should not imagine that it would be necessary or desirable to establish a postgraduate school in each State.
– Clause 7 (4) (c) provides - (4.) In particular, and without limiting the generality of the last preceding sub-section, the Director-General may, on behalf of the Commonwealth -
An officer nf the Commonwealth who is registered as u 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, relates only to exclusive employment by the Commonwealth. It occurs to me that when the proposed scheme is launched it may be an ideal opportunity to inaugurate uniform standards of training and qualification throughout Australia. Uniformity of training, qualification and recognition is necessary, not only in the interests of nurses and members of the other professions concerned, hut also in the interests of patients, and I suggest that the Government should introduce legislation to that effect.
.- I rise to seek enlightenment on the statement made by the Minister for Health (Senator McKenna) that separate councils of doctors, dentists and nurses are to be appointed. Is it contemplated that the public shall be represented on those councils ?
– Reverting to my observations on the desirability of decentralizing the post-graduate training of nurses, can the Minister for Health (Senator McKenna) say whether all States will he represented, on the council which is proposed to be appointed to arrange post-graduate training for nurses?
[5.20]. - I shall deal with the various points raised by honorable senators in the order in which they were made. The Deputy Leader of the Opposition (Senator O’Sullivan) spoke of the desirability of providing for mutual recognition by the States of nurses’ qualifications, and I agree entirely with the principle contained in his suggestion. If the Government had the constitutional power to do so it would introduce legislation to provide for national uniformity in the matter. Indeed, my first inclination when the matter was mentioned was to introduce separate legislation to enable nurses and medical technicians to obtain recognition of their qualifications and the right to practise throughout Australia. It is very doubtful however, whether the Government possesses constitutional power to introduce such legislation or the Parliament to enact it. Of course, no difficulty would be encountered from the medical profession; indeed, the Federal Council of the British Medical Association has urged me to introduce such legislation. I should very much like to do it but again, it is a question of infringing State prerogatives, and if there were to be an attack on any such measure, it might well be made at the instance of States, rather than by any member of the professions. It is a problem that inevitably crops up under any federal system where States are jealous of their sovereignty and national needs sometimes have to be set aside. However, I can assure the honorable senator that before the idea is completely abandoned, 2->articular attention will be given by the administration to the possibility of Australiawide registration in all these categories.
asked whether there would be public , representation upon a directorate of dentistry should such be established as a division of the Department of Health. No decision has been made on that matter but, quite frankly, the type of body that I had in mind would be composed entirely of persons with technical qualifications. The public, as
I view the matter, expresses itself through this Parliament, and holds each one of us, including the Minister, responsible for what is done. The Minister hands control down to the DirectorGeneral who, in turn, is advised by people technically qualified to so advise. I doubt whether on that body, and at the level that. I have in mind, there would be any useful function for a lay person. I do not rule out the possibility entirely because I recognize the need for the representation of the “ consumer “ on these bodies, but in this instance his interests would be protected at higher levels.
asked whether in the event of only one post-graduate body being set up, and only one institution being provided in Australia, representation on that body would be accorded to State organizations. I have not considered that matter, but I have no doubt that if there were truly representative bodies in that field in the different States, they would unquestionably be given representation. There is power under the bill to form advisory committees. It will rest with the administration to determine their composition after consultation with the bodies that are in the field, Sympathetic consideration will be given to the honorable senator’s suggestion.
Clause agreed to.
Clause 8 agreed to.
Clause 9 (Arrangement with States).
– I direct the attention of the Minister for Health (Senator McKenna) to subclause 3 which reads - (3.) Any arrangement entered into under this section which provides for payments hy the Commonwealth to a State in respect of any expenditure referred to in the last preceding sub-section shall provide for information to be supplied to the Minister by such persons, at such times and in such manner and form as lie requires.
I point out that although near the end of the clause the words “ by such persons “ are used, there are no persons referred to earlier. I should like the Minister to explain the reason for that wording.
– The words by such persons “ are governed by the concluding phrase “ as he requires “ - in other words, such persons as the Minister requires.
Clause agreed to.
Clause 10 agreed to.
Clause 11 (Arrangements to take over other services and hospitals).
– It would appear that, under this clause, a hospital could be taken over by the Commonwealth without negotiation, and without the consent of that institution. I should like to be assured that it is not the intention of the measure that the Commonwealth should have power to take over a hospital without the consent of, or without negotiation with, the authorities controlling that institution.
– I assure the honorable senator that the clause does not authorize any action in which a private body or an individual concerned does not completely concur. Any arrangement for the taking over of an establishment, pursuant to this clause, could only be made by agreement. If the authorities controlling a particular institution were not prepared to hand it over to the Commonwealth there would be no agreement, and therefore the clause would not authorize the Director-General to assume control of the institution.
Clause agreed to.
Clauses 12 to 18 agreed to.
Clause 19 (Reciprocal agreements).
– I cannot quite understand the importance of this clause. Can the Minister for Health (Senator McKenna) give an illustration of the circumstances in which its provisions would apply?
– In recent years, particularly amongst countries in the British Commonwealth, an endeavour has been made to promote reciprocal arrangements for the payment of many forms of social services. However, although a similar type of service may exist in, say, Australia and in Great Britain, in this country there may be a five-year residential qualification, whereas the qualifying period in Great Britain may be two years. In those circumstances it might bc necessary for this country to reduce its qualifying period to that applying in Great Britain. In the negotiation of agreements for reciprocal treatment of the nationals of two countries there must be some element of equipoise. One country does not automatically accept the laws of another. Those laws are the subject of bargaining.
– Would Australia withhold its medical services from a foreigner just because he was a foreigner ?
– I should think not. For instance, under this bill medical benefits will be available to residents of this country, but not to somebody who is merely passing through this country. That does not mean, however, that such a person will not receive medical attention in a public hospital. It simply means that he would not be entitled to the benefits of the medical benefits scheme. He will be contributing nothing to our revenues, and it would be sheer charity to entitle him to medical benefits.
Clause agreed to.
Clause 20 (Payments to universities).
– Is it the intention, under this clause, to sot up entirely new faculties in new universities, or to use existing faculties in universities already established, and have specialties in those faculties?
– The clause does not authorize the Minister or the Treasurer to set up courses of training. It may authorize the making of payments to universities or other appropriate bodies to provide courses of training in medical or dental science.
– These are already provided.
– Not on an adequate basis. We might want a number of doctors trained in a particular specialty which at present is not covered by any university. Also, the clausewill enable the Commonwealth to make payments to bodies such as the Royal College of Surgeons.
– There will be specialties within existing faculties ?
– It is something than can only be done in conjunction with the universities or other appropriate bodies.
– What would be the position of the University of Western Australia under this clause? That university i» endeavouring to establish a full chair cf medicine, but so far has only been able t” provide a course covering the first two years studies in that faculty. Would it be possible for the Commonwealth under this clause to assist it to establish a full faculty?
– This provision undoubtedly would enable the Australian Government to provide the whole of moneys required for the purpose cf establishing a full medical faculty at the University of Western Australia. A considerable time ago the Government made an offer to the Government of Western Australia to pay half the total cost involved, amounting to £125,000. I think that there was a change of government in that State at the time that offer was made. The offer has not been taken up, hut I believe that it still stands. So, apart from this provision a proposal has already benn made to Western Australia along the lines which the honorable senator na.« in mind.
Clause agreed to.
Clause 21 agreed to.
Clause 22 (Regulations).
– This clause provides for the making of regulations for prescribing matters in relation to “ persons or classes of persons to whom a national health scheme may be made available “. That provision implies that some people may be entitled to assistance and that others may not be so entitled. What is to he the test? What is to be the line of demarcation ? Would it not be better to make the service available to all who desire to avail themselves of it? Inherent in this provision is the powerof discrimination, and discrimination is always unfortunate.
concentrates on the subject of dental health he will realize the need for this provision. I have already outlined the programme under which the first approach will be made in respect of children. It is necessary to discriminate between children and adults for purposes of a dental service.
– Is that all that the provision implies?
– It may go further than that. It may be necessary to exclude from the benefit of free treatment people whose medical expenses are to be paid by an insurance company or pursuant to a claimant’s rights under workers’ compensation. There is no reason why insurance companies or employers should not contribute to the cost incurred by individuals coming within those classes.
– Are they not all contributing to the scheme as taxpayers?
– That may be a point, but it is not immediately related to the bill. The honorable senator is inquiring what are the classes of persons to whom a national health service may be made available.We must distinguish sometimes between sexes, ages and classes of people who otherwise would be recouped for the expense to which they may be put.
– Would it be possible to have discrimination between people in the same class?
– That is an abstract question; I suppose that would be possible. However, the honorable senator need have no fear that the Government will seek to discriminate between people according to their facial expression, religion or anything else. Icould not imagine that any government would want to do that.
– There is no possibility of discrimination on political or religious grounds?
– No; in any event any regulation made under this measure would be subjectto approval by the Senate.
– I revert to sub-paragraph iv of paragraph a. Regulations may be made prescribing matters in relation to “ the duties and functions of persons performing any service in connexion with a national health service “. I presume that that also is a matter with regard to which there will be full consultation with the professional men who will be called upon to perform their functions under the measure. It would be futile to promulgate regulations governing the terms and conditions of employment of persons without having a reasonable idea of the terms and conditions under which they would discharge their duties. Paragraph b provides for the making of regulations -
for providing for the payment of compensation to a medical practitioner or dentist who -
I am not clear whether those subparagraphs are alternative or cumulative. Must all those conditions be complied with before a person will become entitled to compensation ?
– They are intended to be cumulative; all three conditions must be fulfilled.
– If that be so, a slight drafting difficulty appears to arise. Sub-paragraphs i and ii do not appear to be connected.
– The word “ thereby “ is the connecting link between paragraphs ii and iii.
– There is no connecting link between sub-paragraphs i and ii. There is a semi-colon after paragraph one. There should be some connecting link between those subparagraphs if they are to be made cumulative as distinct from alternative.
– The matter which the Deputy Leader of the Opposition (Senator O’Sullivan) has raised is a matter to which the draftsman gave particular attention and I am assured by him that the way in which the subparagraphs are presented means that the three conditions are cumulative, and that it is not essential to insert “and” after “ place “ at the end of sub-paragraph i. The word “thereby” in sub-paragraph iii in my view links the three subparagraphs and the presence of the word “ and “ at the end of sub-paragraph ii could surely not be taken to preserve a link solely between sub-paragraphs ii and iii. The three conditions must be taken together.
– There must be two conjunctives joining the three propositions.
– One would have to interpolate something that is not there if “ or “ were inserted between subparagraphs i and ii.
– The word “ and “ should be inserted there.
– I am advised by the draftsman - and I bow to his view in such matters - that the three subparagraphs are cumulative; the whole three conditions must be fulfilled, and, in effect, the word “ and “ is understood between the first condition and the second condition.
Clause agreed to.
Title agreed to.
Bill reported without amendment; report adapted.
Bill read a third time.
Sitting suspended from 5.45 to 8 pm.
Bill returned from the House of Representatives without amendment.
Bill received from the House of Representatives.
Standing and Sessional Orders suspended.
Bill (on motion by Senator Ashley), read a first time.
– I move -
That the bill be now read a second time.
This bill is concerned with Australian acceptance of two distinct, but related, documents, the charter for an international trade organization (termed the Havana Charter) and the General Agreement on Tariffs and Trade. The charter was laid on the table of the Senate on the 17th June, 1948, and a copy has been circulated to all honorable senators. It proposes the establishment of the International Trade Organization which will, if established, encourage and, to some extent, supervise and regulate international action aimed at increasing the volume of world trade as a contribution to full employment in and rising standards of living of member nations and will assist in the creation of the conditions of stability and wellbeing necessary for peaceful and friendly relations among nations. It will be essentially a rule-making and supervising body.
Honorable senators will probably recall that a draft of the charter which was prepared in Geneva last year by the preparatory committee was discussed in the Senate early this year. The charter gives effect to principles which were included in the Mutual Aid Agreement, particularly Article 7, which was comcluded by the Government of the United States of America with Australia and many other countries, including the United Kingdom, in September, 1942. In that agreement the Governments undertook to participate in agreed action directed to the expansion, by appropriate international and domestic measures, of production, employment, and the exchange and consumption of goods, to the elimination of all forms of discriminatory treatment in international commerce, and to the reduction of tariffs and other trade barriers. Australia has been closely connected with the negotiations since the proposal for an international trade organization was adopted by a resolution of the Economic and Social Council in February, 1946. The council set up a preparatory committee representing nineteen countries, in which Australia participated actively, and subsequently convened the World Conference which drafted the Havana charter.
Prior to and throughout the negotiations, which commenced in October, 1946, there have been continual discussions between members of the British Commonwealth on matters of common interest which were affected by the negotiations.
The charter will enter into force on the sixtieth day following the day on which a majority of the Governments which signed the final act at Havana have deposited instruments of acceptance with the Secretary-General of the United Nations organization. If, however, by the 24th March, 1949, it has not so entered into force it will enter into force on the sixtieth day following the day on which twenty of the Governments that participated in the conference at Havana have deposited their instruments of acceptance. It is likely that most of the countries which participated in the conference will defer the deposit of instruments of acceptance until the Congress of the United States has considered the charter. This is not likely to occur before January, 1949.
The General Agreement on Tariffs and Trade, the second document with which this bill is concerned, is closely linked with the Havana charter. It contains the tariff rates negotiated at Geneva in 1947 on the basis of mutual concessions between the participating countries. Honorable senators will recall that the agreement was laid before them earlier this year and debated during March and April. That debate was followed by legislation ratifying changes in the rates of duty to bring them into accord with the agreement. The agreement is at present being operated provisionally by some 22 countries that were concerned with its construction. While operation is provisional, any member country may withdraw on 60 days’ notice and need not take the full legislative steps regarding trade policy which are required by full adherence. Full adherence pledges member countries not to withdraw before 1951. ft is, I think, unlikely that any country will make full acceptance of the General Agreement on Tariffs and Trade, as distinct from applying it provisionally, until a decision has been -made on the entry into force of the charter. I point out that once a sufficient number of countries is applying the agreement definitely, they are empowered to declare that a country which’ is applying it only provisionally is no longer a contracting party to the agreement.
Some amendments were made to the terms of the general agreement at sessions of the contracting parties at Havana in March of this year and again at Geneva in August and September. The main purposes of these amendments, which were effected by a series of protocols, was to bring the general agreement, on its rulemaking and structural sides, into line with amendments made at Havana to the text of the charter. Two cf those protocols are concerned entirely with rectifications of the tariff schedules contained in the general agreement, but these only adjust errors between the schedules as negotiated and as originally printed. The contracting, parties to the general agreement also came to certain decisions not involving any alterations to the agreement. Copies of all these latest documents, together with copies of the articles of the general agreement, have been supplied to honorable senators. I have also placed several copies of the original three volumes of schedules cf tariff concessions which form part of the general agreement, previously dealt with by the Senate, in the Parliamentary Library, as there are insufficient copies of that large item for me to be able to supply sets to each honorable senator.
As honorable senators will observe when reading clause 7 of the bill, Australia signed the protocol modifying Part II. and Article XXVI. with a reservation as to acceptance. We did this because the United Kingdom also signed with a reservation as to acceptance. We have asked the United Kingdom for its views on the reservation, and we desire to consider further the matters arising from them. There is provision in the terms of the protocol for those countries who signed with reservation to deposit an instrument of acceptance with the United Nations organization, and the Government accordingly asks in this bill for approval to deposit such instrument when thoroughly satisfied. Honorable senators have been supplied with a copy of this as of all other protocols.
I desire now to say something about the charter of the International Trade Organization. It is designed -
I have supplied honorable senators with a detailed statement describing the provisions of the charter and the manner in which they will operate, and shall therefore confine my remarks to an outline of the broad implications confronting Australia in accepting or rejecting them. Throughout its participation in the negotiations, the Australian delegation sought to secure a charter adapted to the interests of this country. It particularly sought to establish the importance of maintaining employment and effective demand, particularly in the major industrial countries of the world which will continue to represent the biggest markets for our exports; also the need for greater stability of prices for primary products so as to stabilize the incomes of primary producers and re duce the undesirable economic fluctuations resulting from extreme variations in prices for these goods.
It also sought freedom for Australia to deal with economic problems of particular concern to this country, for example, with respect to industrial development by tariff protection ; protection of the balance of payments; and stabilization plans for primary industries. The delegation also sought to establish the principle that British Commonwealth countries should not be required to reduce or eliminate preferences except in return for compensating concessions, and the recognition that these preferences are an exception to the general mostfavourednation principle. Australia also sought the adoption of limitations on the use of restrictions on imports of agricultural products by countries which in the past maintained domestic agriculture at uneconomic levels by import quotas and other impediments to importation, and by so doing reduced their demand for Australian exports. Australia also desired the recognition of the necessity to promote actively the development of under-developed areas and by raising living standards in these territories to increase the demand for imported goods.
I believe that the charter, if examined in the light of the foregoing objectives will be found to meet them.
It has been the policy of the Australian Government that no commitments in relation to commercial policy, particularly those which required a reduction in restrictions, on imports, could successfully be maintained unless the conditions under which Australia could continue to export to the full capacity of its industries are maintained. Primarily this requires conditions of full employment and high levels of effective demand in the major industrial countries of the world. In recognition of this the charter contains a chapter devoted to employment and economic activity and in Article 3 each country accepts an obligation to take action designed to maintain full employment and a large and steadily growing demand. In the event of a failure of others to maintain employment and demand, the provisions of the charter enable a country, such as Australia, whose exports would be affected, to seek from the organization a review of its obligations on commercial policy, or even to obtain release from continuing obligations to maintain low levels of tariffs or from other responsibilities under the charter, [n any event there is provision in the charter for a country to take emergency action with respect to tariff concessions granted if conditions threaten domestic industry.
One of the principal duties of the organization will be the promotion of agreements between governments relating to the international marketing of primary commodities. The purpose of these agreements will be to ensure that producers can plan their production ahead in the knowledge that they will obtain a reasonable return for their exportable surpluses. Such agreements will be for the purpose, not of reducing the return to producers, but of overcoming the wide fluctuations of the actual returns to growers and consequently giving to them a greater stability of income. Commodities for which such special international agreements are completed will then be exempt from the other provisions of the charter which might conflict with any undertakings in the agreements.
The development of Australian industry has for many years been encouraged by tariff protection granted by the Parliament after inquiry by the Tariff Board. The charter does not expressly forbid the raising of tariffs, and the only obligation is in respect of duties that are bound against increase for a period of time under the general agreement. It was the policy of the Government in the course of the Geneva negotiations to refrain from negotiating items whose future industrial development might require the raising of the tariff sooner than the expiration of the three-year period for which the general agreement will initially be in force. Moreover, the charter recognizes the right of a country to seek to withdraw from the general agreement its commitment under any tariff items before the end of a threeyear period in order to raise the duty for the purpose of assisting industrial development. Whilst this procedure requires the consent of substantially all of the affected parties, it is a clear and important recognition of the right to seek to re-negotiate a duty in special circumstances.
Experience has shown that countries must, at times, take immediate action to protect their international monetary reserves. Balance of payments difficulties are, at present, a matter of concern to most of the countries in the world and the use of quantitative restrictions to control a decline in their foreign exchange reserves is an essential part of the policies of their governments. The charter recognizes completely the need of countries to use quantitative restrictions to safeguard their balance of payments, and a special exemption for this purpose is contained in Article 21. This article, and the provisions of Article 23, relating to the discretionary use of quantitative restrictions, are admittedly technical and complex. However, they cover our need to apply and maintain quantitative restrictions if there should be a decline, or a threatened decline, of our international reserves.
For many years domestic marketing schemes, such as those covering butter and wheat, have operated in Australia for the purpose of stabilizing returns to primary producers. These schemes, with which honorable senators are fully familiar, have resulted at times in the payment of higher prices by Australian consumers than by overseas purchasers, whilst at other times the reverse has happened. Recognition of this type of marketing scheme has been obtained for the purposes of the charter, and the provisions of the charter restricting export subsidies do not apply to these Australian stabilization arrangements.
Article 16 of the charter, which contains a statement of the mostfavourednation principle, specifically excludes from that generalization preferences exchanged between members of the British Commonwealth which were in force on certain specified dates. There is no obligation for these margins of preference to be reduced, except by agreement of all of the parties concerned. Any such action would be taken only in return for tariff concessions made by other countries as part of a bargaining process having mutually advantageous
Experience has shown the extent to which overseas markets for Australian exports or agricultural products have been closed by the imposition of quantitative restrictions. These restrictions have been imposed by the older industrial countries, which have sought by this means to protect high-cost agricultural production. The charter provides for a general prohibition on the use of import quotas in this manner, except in temporary circumstances or under conditions in which the domestic production of the article is also restricted.
Rising living standards in the underdevoloped countries of the world would increase the demand for imported goods, particularly foodstuffs. More than a recognition of this need for development is required, and the charter places on the organization the responsibility for actively encouraging the development
I think that honorable senators will agree that I have shown that the charter includes provisions which meet the main requirements of Australian interests. In deciding whether it would be advantageous to become a member of the International Trade Organization, however, we can examine the following aspects a little further : -
I shall deal with them seriatim. The charter requires, as a condition for freer commercial policies, an undertaking by all countries to pursue policies designed to maintain high and stable levels of employment and effective demand. The present world conditions of shortages of goods and scarcity of hard currencies mask the ultimate need to ensure that steady levels of employment shall be maintained in our overseas markets with consequent increasing demand for cur primary exports. If these obligations are successfully carried out, these market conditions for all internationally traded goods will be assured. If the major marketing countries should fail to carry out these undertakings, Australia and other countries adversely affected would have strong justification, under the terms of the charter, for taking emergency action to protect their own economies against the impact of adverse economic conditions overseas and also a sound basis for urging, within the organization, international action to correct the decline of demand.
Each member of the organization undertakes, in Article 4, that, if its balance of payment shows a persistent excess of exports over imports and is thus creating balance of payments difficulties for other member countries, it will play its full part in restoring equilibrium. This, for instance, would require a country such as the United States actively to pursue policies designed to correct a disequilibrium between dollar and nondollar currencies. The absence of successful action would provide a basis for complaint by affected countries and for the urging of international action through the organization. On the other hand, for countries whose balance of payments is unfavorable, provisions have been inserted to ensure that measures be taken to prevent a continuing decline of monetary reserves.
Although some of the principles set out in the charter are subject to exceptions which may be applied to meet specific needs - for example, the needs of underdeveloped countries, countries in balance of payments difficulties, and countries dependent on primary exports - the general effect of the charter will be to secure recognition of the need to follow non-restrictive trade policies to the fullest practicable degree. Some of the main industrial countries may require to make use of the exceptions until the war damage to their economies has been overcome, but others, notably the United States, will be in a position to apply the charter terms from the beginning practically without recourse to exceptions. This alone will undoubtedly benefit the rest of the world because of the expanding market which the United .States provides for exports from other countries, especially in view of the restraint imposed by the charter upon the adoption of restrictive practices which may have the effect of providing unreasonable protection for domestic industries and so limiting competition with those industries. Honorable senators are well aware that in the past international trade disputes have frequently had widespread and detrimental effects resulting from action taken by individual countries without regard to the effects upon others. The establishment of the International Trade Organization will provide a forum in which there can be prior consultation which will tend to limit the scope of trade disputes and lead to their earlier settlement. For thisreason Chapter VITI, of the charter provides for extensive consultation and arbitration. It will also be possible for members to refer to the organization for advice and study developments mimical to international trade as they become evident. The adoption of a generally accepted code in international trade which will provide adequately for the realization of legitimate national and commercial objectives will also tend to eliminate tha detrimental effects resulting from the grosser forms of national self-sufficiency.
Australian exports will benefit directly from the maintenance of a good demand throughout the world, and particularly from the adoption of non-restrictive trade policies by highly developed countries such as the United States of America. Future tariff negotiations of the kind concluded in Geneva can lead to further benefits for our industries. The development of new export markets for Australian goods will increase the benefits to be obtained from direct negotiations with those countries. The establishment of such markets will also confer indirect benefits on Australia by the influence that they will exercise on negotiations whichmay be undertaken with other countries.
The limitation on the imposition by importing countries of quantitative restrictions, from which Australian exportsof primary products have suffered in thepast will also strengthen our export position. Moreover, our existing schemes forthe stabilization of primary export industries are fully protected. On the other hand, the charter leaves the main structure of existing imperial preferences substantially preserved. Although new preferences cannot, except as provided in the charter, be established by any country, existing preferences obtain international recognition, and we are not required to surrender the preferences weenjoy except in return for compensating benefits in other countries’ markets as a result of the conclusion of mutually satisfactory bargains. The need to develop- sound export markets for Australian manufacturing industries increases the interest of this country in the provisions of the charter which provide for freer trade and a reduction of trade barriers. “With regard to the effect of the charter on Australian policy, I have already dealt at some length with the relationship of the charter to Australia’s particular interests. It is evident from what I have said that the Australian delegation has secured recognition in the charter for the basic elements of policy followed by Australia in connexion with international trade. This relates particularly to the protection for Australian manufacturing industries, stabilization plans for primary industries, and restrictions necessary for the protection of the balance of payment. It can be said that the charter requires no change in Australian policies, and only a few minor changes in the present Australian commercial legislation or practices. It will not prevent our dealing adequately with any economic problem likely to arise in the future as a result of our adherence to the charter.
Of the fifty-six governments represented at Havana all except Argentina and Poland have signed the final act of the conference authenticating the text of the Havana Charter. The United Kingdom delegation stated that their Government, in deciding to sign the final act, had also decided to submit the charter to Parliament with the Government’s support. It seems likely that the charter will not be submitted to the United States Congress until 1949.
This bill makes Australian acceptance of the International Trade Organization membership conditional on United States and United Kingdom acceptance. The bill provides that Australia shall not deposit an instrument of acceptance of the charter until similar action has been taken by the Governments of Great Britain and the United .States of America. The usefulness and success of the organization will depend upon the willingness of such major trading nations to accept membership. As joint sponsors, the United Kingdom and the United States of America are indispensable to the effectiveness of the organization. For this reason I feel that all honorable senators will agree that the Government has acted wisely in making our own acceptance of both the charter and the agreement conditional in that respect. On the other hand, it would almost certainly be disadvantageous for us to decline membership if British and American acceptance is forthcoming. The organization and its members will, in fact, constitute a large and powerful trading group, whose members will exchange most-favoured -nation treatment from which we would be excluded.
Concerning Australia’s part in the functioning of the International Trade Organization, 1 do not propose now to enter into details of the International Trade Organization itself. As honorable senators are aware from previous debates, the powers and duties of the organization given to it by the charter will be carried out by the conference of the members. The conference will also determine the policies of the organization. It may, by a simple majority decision, assign to the executive board any power or duty of the organization. The executive board is to consist of eighteen members selected regularly by the conference. In the event of our accepting membership of the International Trade Organization, Australia would appear to have an excellent chance of election to this executive board.
There should be ample room, therefore, for Australia to take an active part both in the conference and in the executive board in the formulation of the policy of the International Trade Organization when it is established. Outside the organization we could have little or no voice at all in formulation of world trade policies.
I turn now from the International Trade Organization Charter to the distinct but related General Agreement on Tariffs and Trade. In pursuance of the principle of reductions of tariffs the members of the Preparatory Committee present in Geneva negotiated last year the General Agreement on Tariffs and Trade. The agreement is in practice intimately linked with the charter. Any tariff concessions which may be agreed upon as a result of any future negotiations completed under the charter will be fitted into the framework of the general agreement on terms to be agreed to by the parties concerned. By the operation of the general mostfavourednation treatment provided for in the charter, Australia stands to gain from such negotiations even though it may not participate in every one of them. Originally it was thought that the general agreement would incorporate only the schedules of concessions, the statement of most-favoured-nation treatment and certain administrative provisions. Pending the implementation of the charter, however, it is necessary also to incorporate some of its provisions in the general agreement in order to prevent the schedules of tariff concessions from being circumvented by other measures. When the charter comes into force these provisions of the agreement will be superseded by the corresponding provisions of the charter. The agreement will then consist if the tariff concessions and the unconditional most-favoured-nation clause, together with Part III. which contains certain machinery provisions directly related to the operation of those concessions.
If the charter is accepted by the Australian Government there would be no purpose in failing to accept the General Agreement on Tariffs and Trade which has been provisionally applied by Australia since the 1st January, 1948. The period of the agreement is initially for three years hut may run on thereafter, subject to withdrawal by individual contracting parties on six months’ notice, or to the re-negotiation or withdrawal of individual tariff concessions. The Government is now seeking authority for definitive, as distinct from provisional, application of the general agreement at such time as the Governments of the United Kingdom and the United States of America shall have taken action to apply the agreement definitively in their respective countries. I have explained earlier in my speech the practical distinction between provisional and definitive acceptance and application.
In preparation for the first conference of the organization an interim commission has been established and an executive committee of eighteen members has been elected. Australia was one of the coun- tries elected and is participating actively in the work of the interim commission, thus preserving a link that was established when the project was commenced. A session of the executive committee of the interim commission has just been concluded at Geneva this month. It is hoped in that way to assist in the determination of the early policy of the organization so as to ensure that its development will be on sound lines and in the interests of Australian development in international trade.
In conclusion, the charter should provide conditions favorable to the expansion of international trade, and Australia, as a large and growing export country, has a very material interest in such development. The charter does not require important changes in our present practices. If our hopes for expanding world trade are not realized, then the conditions which restrict our exports will provide an acceptable reason for a review of our own commitments in respect of the charter, and we will, therefore, be no worse off for having attempted to cooperate with other countries in the achievement of this objective. The price of isolationism will involve at least a failure to derive benefits from tariff concessions exchanged between the major trading countries of the world which belong to the organization. Furthermore, there are equally compelling and wider reasons to justify the International Trade Organization being given every opportunity to prove itself. As 1 suggested earlier, the success of that body should go very far towards creating conditions of stability, co-operation and trust among the nations. ‘ Only under such conditions can Australia and other nations live together in freedom and good neighbourliness. For these reasons the Government has decided that, on balance, it will be in Australia’s interest to accept membership of the organization, and to accept the general agreement. I therefore commend the bil) to the Senate.
Debate (on motion by Senator 0’ Sullivan) adjourned.
Bill received from the House of Representatives.
Standing and Sessional Orders suspended.
Bill (on motion by Senator Armstrong) read a first time.
– I move -
That the bill be now read a second time.
The existing immigration law provides for the deportation of an alien who is convicted of a crime of violence against the person or of extorting any money or thing from any resident of the Commonwealth by force or threat, or of any attempt to commit such a crime, or who is convicted of any other criminal offence for which he is sentenced to imprisonment for one year or longer. Admittedly these powers are fairly wide and at first glance would seem sufficient to cope with aliens who are proved undesirables. Unfortunately in practice this has not been the case. In the first place, before an alien can be deported under this provision an order for deportation must be signed by the Minister for Immigration upon the expiration or during the term of imprisonment imposed on the alien. In a number of cases the department receives notification of the conviction after an alien has been released from gaol and it is then too late to effect his deportation. It has also been found that some aliens have been convicted on a number of occasions, clearly showing that they are undesirables, but none of the offences has been punished by imprisonment for one year or longer, and does not, therefore, bring such aliens within the scope of the act. Lastly, and what is most important, the Commonwealth’s immigration power is limited by the Constitution.
The Immigration Act does not place any limitation of time during which action may be taken for deportation on tho grounds that I have previously mentioned, but the High Court has ruled that the immigration power does not authorize the Parliament to legislate with respect to persons, who, having immigrated to Australia, have made their permanent homes here and so have become members of the Australian community. The Commonwealth also has power under the Constitution to legislate in respect of aliens resident in Australia, and this power is not limited in respect of time, as is the immigration power. By making use of this power, the Government will be able to take effective action in regard to those aliens whose character and conduet are such that they should not <be allowed to continue to reside here, but whose deportation cannot be effected at present because of the limitations upon the Commonwealth’s immigration powers. Action for deportation under the bill will not depend solely on the issue of an order by the Minister, and every alien against whom such action is contemplated will be given an opportunity to have his case thoroughly investigated by a commissioner who is, or has been, a judge of the Supreme Court. If the commissioner reports that, as the result of his investigation, he considers the alien is not a fit and proper person to be allowed to remain in Australia, or if the alien fails to appear before the commissioner, then the Minister may issue an order for deportation and the alien will be deported.
Special provision has been made in the bill to enable the wife and dependentchildren of a deportee to accompany him, if the wife notifies the Minister that it is her desire to do so. If the wife and children are aliens, their names will be included in the deportation order, but this cannot be done if the wife and children are British subjects. The Government will, however, arrange to provide passages for them. All expenses incurred in connexion with the provision of passages for a deportee, his wife and children will be borne by the Government.
The remaining clauses of the bill call for no special comment. They are machinery clauses designed as safeguards to ensure that a deportation order, having been issued, shall not bo rendered ineffective by any action on the part of the deportee or any other person, and that a shipping company, when called upon to provide passages for a deportee and his wife and children, shall do so within a reasonable period. Aliens who have been admitted as permanent residents of Australia have on the whole proved worthy and law-abiding settlers whose aim has been to improve their lot and fit themselves to take their proper place in the Australian community. Over the years, they and their children have contributed in no small measure to the progress and prosperity of our country. However, there is some percentage of undesirables in every community, and no matter what precautions we may take in the selection of our migrants, it is inevitable that some of those misfits will succeed in crossing our shores. That is the experience of every immigration country. The only remedy at our hand3 that will enable us to deal effectively with those aliens who, having succeeded in crossing our shores, show that they are not amenable to our laws and institutions is by strengthening our deportation provisions in such a way that action can be taken against them, irrespective of the length of their residence here, on the grounds of their character and conduct being such that .they should not be permitted to remain. This is the end the bill seeks to achieve.
Debate (on motion by Senator O’Sullivan) adjourned.
Debate resumed from the 1st December (vide page 3697), on motion by Senator Ashley -
That the bill be now read a second time.
– I have no desire to delay or impede the passage of this measure. It is in keeping with the rising spiral of costs that more money should now be needed for the building of homes. I shall anticipate criticism by honorable senators opposite by saying that since the rents and prices referendum building costs have risen infinitesimally. There was a steady rise of those costs between the time when the maximum advance was fixed at £1,250, and the date of the referendum. I am one of the fortunate people who have a home, but there are many thousands who have not, and upon whom the continually increasing costs are placing an intolerable burden if they wish to own their own dwellings. I am in a position to see the money that is being advanced by certain insurance companies and building societies for the erection of houses, and it is tragic to realize the large sums that are now required for this purpose compared with 193S-39 costs. I also doubt very much whether home builders to-day are getting as high a standard of workmanship and quality as that which ruled in the pre-war years. No good purpose can be served by endeavouring to apportion the blame for increased building costs. We can only accept the fact that costs have increased substantially. As I have said, I am not affected, because I already have a home, and I have no doubt that other honorable senators are in a similar fortunate position. Those who are affected most are the rank and file of our people who are anxious to own their own homes, and we should be prepared to do whatever lies within our power to assist to keep the prices down. I agree with the Prime Minister (Mr. Chifley) that prices will come down if there is better production and more willing hands. Some people seem to be anxious to get back to the days of the early industrial revolution. That would get us precisely nowhere except back to an atmosphere of grime and smoke, and unpleasant memories. We must face the position that exists today and do whatever we can to make essential commodities more readily available at more reasonable prices. Increased building costs have made it necessary to increase housing advances by the Commonwealth Bank. I have no objection to that, but in the introduction of this measure, there is involved a principle to which I have referred in this chamber frequently. Although statutory authority is being sought only now for this increase, it has been in operation for some time, without parliamentary approval. This is a most irregular practice and we. as the custodians of the public purse should express our disapproval of it. As I have said, I agree that the increase is necessary, but’ it should have been made in the proper way. Public money should be expended only after parliamentary approval has been given.
– I support the bill which provides for an increase of Commonwealth Bank housing advances from £1,250 to £1,750.
We should realize however that a home costing £1,750 is beyond the reach of the ordinary working man. Housing costs, have risen considerably during the last six months, and that is the reason for the introduction of this measure. Recent increases of the prices of building materials have resulted mainly from the defeat of the prices referendum. A “ No “ vote was advocated by the Opposition parties in this Parliament. Their campaign succeeded, but now they complain that homes of a reasonable standard are beyond the economic means of the working man. That is something that Opposition members can explain, if they are able, to the people of this country at the next elections.
– There are several aspects of this measure to which I should like to refer. I regret the necessity to raise the housing loan limit from £1,250 to £1,750 because obviously, most working people will not be able to buy houses at that price. I calculated once, when the maximum advance was less than £1,000, that, at the rate of interest then operating, a man who purchased a house on a 40-year repayment plan would pay a total of £1,911 for his home. Even with interest at 4 per cent, the repayment of £1,750 by working class people will take many years. I do not agree with the Deputy Leader of the Opposition (Senator O’Sullivan) that workmanship to-day in homebuilding is not as good as it has been in the past. I think it is quite as good. Unfortunately due to greatly increased costs, the beautiful craftsmanship that one sees in many of the older homes cannot be carried out. Designs to-day are more simple, but the workmanship is just as good.
The bill proposes to increase Mortgage Bank Department advances from £5,000 to £10,000. I am rather concerned about the future of the Mortgage Bank Department. There seems to be a restriction of the activities of that bank, because it does not appear to be doing the work for which it was constituted. Its business is not being expanded to the degree that it should be. Whilst the maximum amount of loans that can be made by the Mortgage Bank Department is being increased from £5,000 to £10,000, there are thousands of primary producers who do not require anything like £5,000 to enable them to redeem mortgages on their properties held by private banks. They should be helped to remove themselves from the control of those institutions. It would appear, unfortunately, that the Mortgage Bank Department is not extending its operations to help the small man. In many towns throughout Australia the Commonwealth Bank has not established a branch, and residents and primary producers in such areas cannot do business with it except through correspondence with its head-quarters in the respective States. It is not unusual for such applicants to be disappointed with the response of the bank to their applications. The bank is not going out after that sort of business. That is the only conclusion I can draw. Apparently, because of the additional expense that would be involved in inspecting small properties in remote country areas, the owners of which may require loans from £1,500 to £2,000, the bank does not do anything to help them. I urge that the Mortgage Bank Department should enter into fierce competition with the private banking institutions which have shown that they are not only out to compete to the greatest possible degree with the Commonwealth Bank but also to “ knock “ everything that the Government does. For instance, I hold in my hand a circular which has been issued by “The Combined Trading Banks Staffs Committee “. This circular is not issued or circulated indiscriminately but only to members of certain citizen’s committees which, apparently, work in conjunction with the authors of the circular. My point is that the main object of the circular is to advise recipients of the action they should take for the purpose of beating the Government with the ultimate purpose of defeating its policy as expressed through the Commonwealth Bank. Such expressions as “ The Government has grabbed the Commonwealth Bank, and it is going to take every one’s bank “, appear in the circular. I am wondering whether such propaganda is having an effect upon the operations of the Mortgage Sank Department. It should go out into the highways and byways and establish .branches wherever it is possible to do so, and do everything in its power to provide financial assistance to primary producers. I know of primary producers who are .paying interest up to a rate of 7 per cent, cn mortgages effected prior to the war, the principal being from £2,000 to £3,000. Whilst the mortgagors have been able to meet their interest payments they have never been able to pay off much of the principal. The Mortgage Bank Department should take over such mortgages and in that way help small primary producers who would thus be made more contented and, consequently, tetter producers. 1 hope that the Minister can assure me that the Mortgage Bank Department of the Commonwealth Bank will be progressively expanded and that it will set out to meet the needs of the small man before it concerns itself about clients who want loans up to £10,000.
. - in reply - The Acting Leader of the Opposition (Senator O’Sullivan), whilst supporting the measure, criticized the
Action of the Government in authorizing the Commonwealth Bank to increase the limit .of housing loans to £1,750. In taking such action, with the intention to have the Parliament confirm it subsequently, the Government has not adopted a new procedure. Indeed, it has followed that practice in providing through the Commonwealth Bani for the financing of crops before the crops are sold. I am sure that upon reflection the Deputy Leader of the Opposition will admit that such a practice has been to the benefit of primary producers. I shall bring .the representations made by Senator 0’Flaher.ty to the notice of the Treasurer.
Question resolved in the affirmative.
Bill read a second time, and passed through its remaining stages without amendment or debate.
Bill received from the House of Representatives.
Standing and Sessional Orders suspended.
Bill (on motion by Senator ARMSTRONG) read a first time.
– I move -
That tha .bill be now read a second time.
The bill is complementary to the Nationality and Citizenship Bill, which is to create the new status of Australian citizenship. As .was made clear during the debate on that bill, it forms part of a scheme of citizenship legislation .agreed upon by the nations of the British Commonwealth, and all the peoples of those nations are now to have, in addition to the common status of British nationality, an additional distinctive status of citizenship of their own country. The bill proposes that the Passports Act 1938 be amended to -conform with the .new scheme of nationality legislation. The amendments involved are very brief and are a natural and necessary consequence of the Nationality and Citizenship Bill.
The first amendment proposed in the hill, is that there should he inserted in the Passports Act a definition of the title of “ Australian citizen “, based on the definition embodied in the Nationality and Citizenship Bill. In the second amendment, it is provided that the definition of tho term “ British subject “ in the Passports Act should refer to the Nationality and Citizenship Act, instead of the Nationality Act 1920-1946, which is now to be repealed. Next, the definition of an “ officer “ in the Passports Act 1938, which refers to the Department of the Interior, is to be brought up to date by having it refer instead to the Department of Immigration, which took over the administration of passports matters from the Department of the Interior in 1945. Finally, it is proposed that Section 7 of the Passports Act, which at present authorizes the issue of passports to British subjects, should he amended to enable passports ‘ to he issued to Australian citizens, in a form which will readily enable Australians travelling abroad to secure recognition of their Austraiian citizenship as well as of their British nationality.
It will be observed that the bill is to commence on the same day as that on which it is proposed to proclaim the Nationality and Citizenship Bill, that is, on Australia Day, 1949. After that date, each Australian citizen’s passport will declare the bearer to be both an Australian citizen and a British subject, so that there will be no mistaking his national status. It is expected that in due course all of the nations of the British Commonwealth will authorize their own representatives in Australia to issue passports to their citizens. However, until that stage ia reached, and until all the countries of the British Commonwealth have enacted citizenship legislation, Australian passport officers will continue to issue passports to British subjects other than Australian citizens. Such passports will indicate clearly that the bearers are British subjects, and in fact they will be in exactly the same form as passports which have been issued in the past to all British subjects. The bill then does not raise any question of principle or policy which has not already been debated in connexion with the Nationality and Citizenship Bill. The amendments proposed are, however, necessary to bring the Passports Act into line with the new nationality legislation, and to permit passports administration to be changed to suit the new conditions.
Debate (on motion by Senator O’sullivan) adjourned.
Motion (by Senator Armstrong) agreed to -
That the Senate, at its rising, adjourn to Tuesday next, at 3 p.m.
The following papers were presented : -
Commonwealth Public Service Act - Regulations - Statutory Rules 1948, No. 149.
Defence (Transitional Provisions) Act - National Security (Prices) Regulations - Orders- Nos. 3414-3410.
Hospital Benefits Act - Regulations - Statutory Rules 1948, Nos. ISO, 151.
Senate adjourned at 9.14 P/11
Cite as: Australia, Senate, Debates, 2 December 1948, viewed 22 October 2017, <http://historichansard.net/senate/1948/19481202_senate_18_200/>.