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Legislative Assembly for the ACT: 1995 Week 9 Hansard (23 November) . . Page.. 2418 ..

MS TUCKER (continuing):

Mr Osborne's proposed amendment did not say that no nursing positions can go. He was saying that they cannot go until agreement is reached with the unions representing the nurses. The Greens support this position, as it is the people on the ground who will have the best idea about the quality of care issues, about the merits or otherwise of overlaps in roster times - despite Mrs Carnell's arguments, there are some very good arguments for the current rostering system - and about how efficiencies can be achieved without compromising quality of care.

As far as the mental health budget is concerned, the very real social justice issue of continued underresourcing of this critical area was not addressed in this budget, and most of the claimed increase in expenditure can really be attributed to Commonwealth funding. Mrs Carnell says that we cannot spend more because we cannot fill positions anyway. This argument, and the response to the Estimates Committee recommendation, is based on a rather narrow view of where to spend money in the area of mental health. Mr Connolly talked about the community-based programs that exist already. The Mental Health Advisory Council has recently recommended that at least $1.5m could be channelled immediately into community-based projects. The Government could also take a more creative approach towards recruitment.

Mr Speaker, I would like to conclude by pointing out another very disturbing aspect about the health budget; namely, the fact that the savings that are supposed to be achieved through operational efficiency are not being channelled into preventative or primary health care. It is hardly surprising, given the simplistic methodology of the operational efficiency review and the fact that the opportunity costs of doing too little to prevent ill health are not factored into the analysis at all. If anything, there will be less, not more, primary health care in the ACT. For example, there is a proposal to sell two health centres in the ACT, despite widespread community opposition to these sales. Mrs Carnell talks about a strong community health system; yet she is dismantling it, once again in the name of efficiency. So much for access and equity, let alone the long-term financial costs of not adequately supporting primary and preventative health care.

MS FOLLETT (Leader of the Opposition) (8.04): I want to speak briefly on the issue of health and community care. Mr Speaker, the first thing I would like to point to in addressing this line of the Schedule to the Appropriation Bill is the amount of money that we are asked to appropriate for this purpose. It is well over $300m. In other words, it represents about a quarter of the budget. This is a massive amount of money. I believe that there is a continuing problem for all State and Territory governments in the provision of adequate health care for the communities that they serve because of the rapidly escalating costs of health care.

I think the problem here is twofold. Obviously, health care is entirely demand driven, so in many ways it is extremely difficult, if not impossible, to contain costs. The demand on the health side is obviously driven by patients' needs for health treatment and by doctors' willingness to provide it, and at times to provide well beyond what may be needed, in my opinion. But, Mr Speaker, it is entirely a demand driven area of the budget, and that makes it very difficult to contain the costs. I did want to point out that

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