Speech by Mr Brendan Smyth

Liberal Member for Brindabella (ACT), Deputy Leader of the Opposition and Shadow Minister for portfolios including Health and Community Care

4th Shed A Tier Congress

Canberra, 24 May 2002

Ladies and gentlemen it's called Smyth [pronounced Smith] because my father's Irish.  And, many years ago, the English alphabet only actually had 24 letters.  It didn't have an I and it didn't have a Z.  So if you look at the old manuscripts that's why King is K Y N G.  That's why Fitzgerald is spelt F I F F, because they didn't have a Z.  And that's why I'm a Smith instead of a Smythe - which is a good introduction to this because I actually think the Irish model is where we should be going.

Ireland has three levels of government.  They actually only use two of them.  They have a national government delivering national services.  They have county governments delivering services on the ground.  And they have provinces to rightly pick football teams, because that's all provinces are good for.  And if you look at Australia, that's all the states are good for.  Except for Queensland at this stage, which can't pick a rugby league team - until probably next fortnight and I'll have to eat those words, because they always come back.

But if we do look at where we're at.  We are in this position because of history ... because of geographers and politicians drawing lines on maps that bear no relevance to the modern situation that we find ourselves in Australia.

And if you go back to the time of Geoffrey Blainey's book Tyranny of Distance - much of what's evolved in Australia is because of the tyranny of distance.  And it's probably why we've got a federal system, because there was that - the 1890s - at the time -travel was hard.  And it must have been so much easier then for politicians to meet and get on a train and head off to Canberra and be out of touch for several weeks, whereas we all now know that mobile phones - which, mine is still on - can ruin your day quite easily.

But I'm serious when I say that the Irish have actually got it right, because what they've said is there's a split between the national and, what they call, the county.  And for the sake of the chat today I'll call them counties.  We perhaps need to come up with our own word that's relevant to where we are - and whether that's shires or not I'm not sure. 

But what they've been able to do is come up with a system - it's the sort of system that I would like to see.  The federal would look after things like international trade, taxation, defence.  They actually set standards.  They're responsible for the validation that those standards are met and for auditing.  And we on the ground in county government would be responsible for delivery.  And that's about the people closest to the people, closest to their needs, actually meeting those needs, situation by situation, area by area.

And I want to congratulate Mark and Jim for what they've done here today in this ongoing series of lectures about Shed a Tier.  Because this is where we start.  The question was asked: how do you bring the community along with you?  Well it's through fora like this.  It's through actually getting it up in the media.  And it's about chat.  All things start with chat.  Somebody says to somebody: "What about?"  And if people start talking about this.  And politicians as leaders need to talk about it more often - you'd be surprised at what you can achieve.

Now I'm somewhat lucky.  I've been a federal backbencher in an Opposition.  I've been a state member in Government and now in Opposition.  And I've also been out of government - or out of politics - in the middle, and it gives you time to reflect.  And in that off period I actually worked for Senator Vanstone when the federal government came to office in '96.  And one of my jobs in her portfolio at that time was to go out and visit the regions.  It was like an expedition.  It was bigger than Burke and Wills.  At that stage DEETYA, I think, had 19 area offices, 65 regional offices, 233 local offices.  And I'm apparently - or so they told me - maybe they were just being nice - the only ministerial staffer to ever have visited all of the area offices and the majority of the regional offices.

And if you're not out on the ground and you're not listening, you're making it up.  And that's our problem.  People who aren't in touch are making it up.  And I think it then brings us to the issue that we want to discuss today. 

The gentleman asked about how you determine the regions.  Now it's really important that we get the regions right.  If we were to move away from three tiers to two tiers and we didn't set up a system of regions that was sustainable into the future, then it will fail.

So the problem with, say, let's take the existing health regions, for instance, and make them work better, would be okay in only one area, and that would be the ACT.

If you look at the document there on the desk in front of you called Commonwealth and State/Territory Health Care Regions - come on get it out, come on.  The breakdown there shows only one region, which happens to be the ACT, which is consistent across the board.

Let's look through Queensland.  There are 16 state health regions; 16 Commonwealth aged care planning regions; Commonwealth Carelink Regions - 7; and Commonwealth HACC Regions - 14.

How can you have consistency in the delivery of services when you're not even talking about the same product continually?

And I'd like you all - if you can get a copy of it - to go and read a book called "Handle with Care'.  Doug Cocks, from the CSIRO, put it out in early '92, and it's a tremendous book, because he actually quotes, on page 249, one of my heroes, the Governor General of the day Ninian Stephen.

And Ninian, in his 1988 address, was actually asked: what was it to be an Australian?  What made him proud?

And Ninian was one of the first traveling GGs who got out of Government House and actually went out and talked to people.

And Ninian, in this book it goes: "in the 1988 Australia Day address, Governor General Sir Ninian foresaw the possibility of the abolition of state governments, but, because of constitutional difficulties, the impossibility of an Australian republic."  Well maybe we can overcome that as well.

But he goes on to talk about how you would design states - or sorry, how you would design what I'll today call counties.

And can I put it to you that the founding fathers of the ACT actually got it right 100 years ago.  It's actually based on water catchment as one of the defining parameters for a region.  And if you've ever wondered why the ACT is the funny shape that it is - it's because we actually control, apart from all of the Murrumbidgee, we actually control our water catchment.  We actually have control over one of the major defining factors of the sustainability of a region - access to water.  And they got that right in 1908, and we've forgotten about it ever since.  But the things that look towards sustainability - it's got to be sustainable.  Let's set up something that will last 1000 years, because we get it right.  It needs to have catchments that control the water.

The whole Murray Darling fiasco.  It needs to be economic.  These regions actually need to be self-supportive.  It needs to have an employment base, so that you're not leading the kids to the cities, or down to the coast.  It needs to be geographically defined so that people can associate to it.  And it needs to be sustainable into the long term future.  And if we can get that right, we actually have a chance.

Now, to get back to working for Senator Vanstone.  On my tours around the country, going out to find out what it is that we should be doing, it was really interesting.

You'd talk to state funded bodies or state bodies and they would say: "oh look our problem's not with you, the federal government, you're great" - they wanted something - "our problem's with the locals - they never deliver it on the ground properly."

And if you went and talked to the locals, they'd say: "No gripe with you guys - it's the state governments - they're screwing everything up - there's something between us and you."

And I'm sure that if we weren't there, the locals and the state would say: "oh bloody federal government - it's all there fault."

And the reason is - there is too much government.  There is too much bureaucracy.

And so I would float at all of those meetings the concept of, well look, if you're really that dark on these states, why won't you talk about abolishing them?  And you initially get deathly silence.  And everyone would say: "Haven't thought about that.  Not a bad idea.  Well let's explore that."  And so obviously traveling the country side and seeing -  And except for one gentleman in Mackay - who was just a Queenslander first and I don't think he probably was Australian at that stage -he said "never happen in Queensland son" - everybody said "okay that's worth considering."  And it brings me then to what we have to talk about here today, which is the health issues, and I'm glad that the Southern Area Health Service is with us, because we're quite odd.  Canberra is a city state of 300,000 people, has a self-sustaining health system, but, the figure is absolutely right - 35% of our business comes from across the border.

Now are we Canberrans?  Are we New South Welshmen?  Or are we actually Capital Territory Region folk?  And I actually think there's a really good case that says we're Capital Territory region folk.

Canberra does very well on it's own, but we do oh so much better because we draw across the border, because we are the capital of, call it the Capital Territory county.  It's because there's two or three hundred thousand New South Welsh men and women around us from Yass and Cooma, from Goulburn, from Batemans Bay and from Queanbeyan, who use our services, that keep our services viable, and now because we've struck a deal and we're getting an extra 10 or 12 million dollars out of you over the next couple of years, we've even got more cash to put into services -we can actually deliver better services.  And I think it's appropriate that we do.  But in looking at the regions, what we have to do is recognise that the people of Tweed Heads actually think they're probably Queenslanders.  The people of Broken Hill would much rather be associated with the people of South Australia.  The people of Kununurra and Derby actually would rather go to Darwin than Perth.  And what we've done is put artificial lines that were in fact stopping communities from reaching their potential and causing them not to function as properly as they could.  And the outcome of that is that the individual person, the ratepayer, the taxpayer, the voter - the human being that lives somewhere is disadvantaged.  And that's what we need to look at.

The area of aged care and disabilities are an interesting area of discussion.  Who's responsible? You hear various governments chant not not not responsible.  Because we're constantly shifting.

Up to World War II the disability sector was probably ignored, and in aged care you kept Gran and Pop at home until they died.

We've changed as a society.  We've got a different set of values and the way we're going about things is quite different.  But what we've got is a ping pong ball that bounces between the governments.

We in the ACT have responsibility for actual planning for aged care under our planning authority, but, they won't issue you a permit to build an aged care facility until you've got beds, over which we have no care because we've got to wait for the federals to issue the beds.

Now there's 6000 packages in the budget - based on 1.6% of that - we'll get 108 beds in the ACT if we get our pro rata ratio.  Based on that we can now do a little bit of planning but we have to wait until the feds tell us when we get the beds. 

It's not the way we should be doing it.  We actually know in the ACT that aged care - the number of people over the age of 65 will double in the next 15 years.  You may look upon us with envy, because we are the youngest population in Australia.  It's about to change.  And some of the problems that the health systems have been encountering around the country are about to come home and visit us in Canberra.

And I think Meg was right, when she was talking about prevention and early intervention.  Our budget - the Liberal Government budget last year - actually had three themes in it.  And two of them - one was addressing poverty and the second was early intervention.

So we could start breaking some of these cycles.  But on issues like health and aged care and disabilities, and indeed housing, which is one of those critical determinants of health, we had no control because there were agreements - the Commonwealth-State Housing Agreement, the Commonwealth-State Disabilities Agreement - that hadn't been signed, and about we had, in the main, not a lot of control over.

So what I would say to you is that, and again, I assume you've all got the email from Mark, where he lists some numbers - maybe you don't, but what it says is that there's about 1500 hospitals in Australia - just approximate numbers.

And if you do the all but math on the duplication, the administration, the cost-shifting, and lack of coordination between state, federal and local budgets, you can actually come up with a loss of about $15 billion.  And if you divide $15 billion by 1500, there's $10 million extra per annum for every hospital in the country.

Now if you don't want to spend it all on health, that's fine.  There's 15,000 schools across this country.  That into $15 billion is a million dollars extra for every school in this country.

The question is: how do we, as a country, actually have the courage to address this duplication, and actually start caring about the taxpayer - the ordinary person on the ground who is denied services because of budgeting, because of jurisdictional envies, and because of inefficiencies of borders drawn on maps 100 years ago which, in the context of the time were quite accurate but now are quite inappropriate.

And the difficulty is - some of the things we've been trying to explore with the Southern Area Health Service - it's about letting your guard down.  And it's about developing a long term approach.  And that's why I say to you the split, that I put at the start of my speech, is the way that it should go, because, what we have to include is a formula for the future.  And it's got to be a formula that takes into account ageing, say, as an emerging issue.  And how we actually look after our aged care in the future. 

We've probably got an ageing care crisis at the moment, in that our hospital has about 28 people in it who are taking up beds that are denying people access to accident and emergency.

Accident and emergency department was rationing health care in the ACT last week when they put out a press release saying don't come to us - we can't deal with you, go to your doctor.  Now the reason was: there were 28 people in beds upstairs who were reasonably well, but they had nowhere to go.  They were aged care patients who really needed to come to a step down facility which we had money in our budget for but the current Labor government's chosen not to spend.  Or we hadn't had access yet to additional aged care packages.  So, two systems working in total isolation.  Who loses?  It's not politicians on either side I would put to you.  It's probably not the bureaucrats on either side.  It's always the people who are left in the limbo land in the middle. 

I believe the way to get rid of limbo is to actually create sustainable counties, shires, regions - whatever you want to call them.  Because then what happens is you have people from your area, who are charged with the responsibility of looking after your neighbourhood, actually taking charge of what happens in your region, and the last answer to the last question was about the explosion of the bureaucracy.  Even after New South Wales regionalised, more and more people went into the state capital, and not everybody lives in a state capital.

And the way to, I believe, get over what happens every time a new government comes to office early February when they say that they will address the issues of the bush.  The issues of the bush are about sustainability.  The issues of the regions are about sustainability.  And you think this is your Woollies and things like that can survive because everybody needs to buy food.  But, it's the extra services that people are denied.

And Meg raised the issue of the doctor who said "well I'm not going to go because there's not the critical backup that I need to be a good doctor.

But it's beyond that in - I was lucky enough to go up to Bindoon, which is about two hours, or three hours north of Perth.  And talking to the local community - as a community they decided that their number one priority was that they wanted a dance school.  Bindoon didn't have a dance school.  The older folk were concerned that young people didn't know how to do traditional dancing.  And so, as a job creation scheme, they actually set up a dance school and got an unemployed dance instructor from Perth to come up to them in Bindoon.  Might seem a bit trivial, but it's the sorts of services that you lose at the periphery that really do impact on the quality of life until it all caves in on itself.

Now, the way those services - whether it be your auto-electrician or your dance instructor -whether it be your upholsterer, or whether it be your health food shop - how they survive is on cash flow, and cash flow is relative to income.  If people are spending there's cash flow through businesses.

One of the ways that governments can assist with permanent cash flow in the regions is actually to break down the bureaucracies that exist in capital cities, through regionalisation.  And that's why the states should go.

We actually have an interesting dilemma here in Canberra.  When the federal government, in the 60s and 70s, was moving all the departments here, they set up the White Plan.  We got six discrete town centres.  And Canberra is actually a repetition of what's been done with the states.  We've got six town centres.

All the public servants went into civic.   They went into Woden.  They went into Belconnen.  And then they started building all of these huge offices in Tuggeranong.  Guess what?  No more public servants.  It was almost like that line out of the Kevin Costner film: "if you build it they will come".  They kept building but then they ran out of public servants.

In the end, Tuggeranong got one federal department - social security.  Poor old Gungahlin gets nothing.  Now we either take it out of the other areas and we shift it up north, so that there's some balance and equity, or we leave it as it is because that's of course the status quo.

So, as a microcosm, we've got exactly the same problems here in Canberra.  Because what happens now, is that your business concentrations are Belconnen, Civic and Woden.  Places like Tuggeranong struggle for 20 years, and poor old Gungahlin is yet to get the critical mass it needs to become a community in its own right.

And the way that governments can get over that is by adjusting where they station their public servants and it puts cash flow into those communities.  That allows those communities to thrive and off that base will come other businesses which of course makes the whole thing self-sustaining.

But it just brings us then back to health.  And the issue here now is:  What are we going to do?  The future for us in health as a nation is quite interesting.  The pharmaceutical benefits - there will be more and more drugs offering more and more relief and longevity in the next 10, 20 years than we could ever imagine in the last 10 or 20.  There will be more operations for replacement of hips, replacement of knees become better and better.  Transplants will become easier and more viable and more cost effective.  We will live longer and longer and longer.  And the tail of aged care is going to become this dilemma for all of us into the future.  Unless we make sure that (1) people are actually allowed to age in place - in their communities, where they grew up, in their networks, we'll actually start to create artificial communities by moving the elderly out, and I think that's a shame.

But (2), we have an issue to address in making sure adequate services are available for everyone in the region.

Again - microcosm -Canberra -we can't get a doctor in the southernmost part of Canberra called the Lanyon Valley.  There are 12,000 people there - projected to be 16,000 in a couple of years, and we've got 3 doctors.  I think the national average is - you're aiming for one doctor per 1400 people.  We've got 3 already for 12,000, so that's a ratio of 1 to 4000.  It will get worse.

So, the forward planning cannot be done in isolation.  The forward planning cannot be done by different segments in different areas.

What we need to do, I believe, is actually come down to a system that says: local communities are the most viable communities.  I think the figure is probably something like four to six hundred thousand.  I'd like to see somewhere between 30 and 40 - constitutionally the arrangement of Tasmania about 450 - Tasmania may become the benchmark for the future counties.

But we actually have to make sure - and Meg covered a lot of these - about making sure that, within a region, within a community, within a county, you actually have all the services that are available, for people there to receive the treatment that they need when they need it, where they need it, without having to move off to the six state capitals.

So, ladies and gentlemen, I can keep going on this for a long long time.  I'd be happy to take some questions.

The possibility of a Canberra region I think's quite exciting.  Kate and Michael were quite keen to see that.  That it hasn't happened nearly as well as it could have is a shame.  And perhaps it's something that I'm sure you'll take up with the new government.

But perhaps it's something that you can all keep an eye on, because the people of Canberra actually didn't want self government.  We voted in two referendums and said "no".  And the reason we said "no" was: we were actually happy with one level of government, because at that stage we had one level of government, that, conversely, gave us about $500 million worth of expenditure in the ACT above which everybody else was getting.  Were we a pampered society?  Possibly.  But because we didn't have duplication of bureaucracies, that money was actually spent on us, not on bureaucracy.  And so there's a nice thought.

I'm not advocating a one-tier system of government.  I think two tiers would be more than acceptable.  And I think a two tier system of government - looking at natural communities, in their own catchment - whatever that might be, will work better and deliver better health care outcomes for all Australians.

Thank you.