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Legislative Assembly for the ACT: 1995 Week 9 Hansard (23 November) . . Page.. 2417 ..

MS TUCKER (7.58): Mr Speaker, the Booz Allen and Hamilton operational efficiency review is the centrepiece of the health budget. Based on the findings of the first stage of the operational efficiency review, Mrs Carnell has built expected savings of $5.5m into the 1995-96 budget and $10m in 1996-97 for efficiencies expected from the findings of the diagnostic stage of the Booz Allen and Hamilton report.

There are a number of concerns about the Booz Allen and Hamilton review, and the Greens and others have spoken about these at length in earlier debates. The methodology was highly questionable. For example, it is all about benchmarking to national standards that may or may not be relevant to the ACT and are rarely based on qualitative factors. In one of the responses to a question taken on notice at the Estimates Committee, Mrs Carnell acknowledged that the development of outcome measures is still in its infancy in Australia and overseas; yet here we are moving to outcome-based funding models and measuring efficiency and effectiveness of service delivery against these models. Despite the fact that this was only the first stage of the Booz Allen and Hamilton consultancy, the recommendations from the first report have been built into a three-year budget. Reforms that are still being negotiated, so-called opportunities for efficiency gains, are included in the budget and are non-negotiable.

Mrs Carnell has been to New Zealand, and many of the key reforms that are central to the health budget, notably the purchase-provider split, are modelled on the New Zealand experience. We have heard a lot about the benefits of these reforms but, as usual, very little about the costs. Many in the health profession are much more sceptical about separating out components of the health system in order to price them so that they can then compete against each other. Despite Mrs Carnell's claims to the contrary, there has been very little informed debate about the appropriateness or otherwise of establishing a market-based system to run aspects of our health service.

In the Booz Allen and Hamilton report, one of the key concerns is the rationalisation of nursing hours - a proposal which, despite Mrs Carnell's claims, can only mean a reduction in nursing staff. This raises two issues. One is about jobs and the other is quality of care. Even if we can achieve costs savings by contracting out some services and other rationalisations in urban services, for example, we may well question such changes because of the loss of jobs. As a society, we need to have a good, hard look at whether State governments should be in the business of shifting employment costs at a State level to unemployment costs at a Federal level in the name of achieving efficiencies. Someone has to pick up the tab somewhere, and it is not only the financial costs. There are all the associated long-term social costs of unemployment which are not factored into the equation when decisions are made.

When nursing jobs are at stake the question is not only one of jobs. There is also, of course, as Mr Osborne has spoken about, an issue of quality of care - something that was largely overlooked by the Booz Allen and Hamilton consultancy team. The nurses are prepared to look at ways of achieving efficiencies - they are prepared to look at the senior nursing structure, for example - but they are not prepared to agree to anything that will result in a reduction in service delivery, and neither should they. The people we employ to deliver services should not be in a position of having to prioritise and ration the delivery of their services. They are there to deliver care, and any action which could threaten this is bad management.

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