National Health Amendment (Decisions under the Continence Aids Payment Scheme) Bill 2021

01 Sep 2021 speech

Ms FLINT (Boothby—Government Whip) (16:59): I would just acknowledge the contributions and expertise of the members for Cooper and Macarthur on this very important issue. They have both had very successful careers within medical services in Australia. I know that they have just provided a lot of information that will be of great use to people watching today or listening at home.


The National Health Amendment (Decisions under the Continence Aids Payment Scheme) Bill 2021 will reform the review of decisions made under the Continence Aids Payment Scheme Instrument, conferring review functions of decisions to the Administrative Appeals Tribunal. This will allow for Australians who are using the CAPS program, or their nominated representative, to apply for an independent merits review by the AAT for decisions made under the program. This is a commonsense reform to the scheme's operation and brings it into line with many other programs and benefits offered by the federal government to Australians in need. I think it's important to reiterate what the members for Cooper and Macarthur have said and explain a little bit about why this program is needed, who this program assists and how the program helps people before again reiterating why the changes to this legislation are needed. The CAPS program assists people suffering from incontinence. This, like many other health issues that involve bodily functions, is not something that many people are comfortable talking about or letting others know that they suffer from. So I hope that by discussing this bill today, and the broader issues, we might help someone watching or listening to get the help they need or to discuss their problems with somebody—to assist in understanding and to gain support. Again, I thank the members for Cooper and Macarthur for lending their medical expertise. The member for Cooper was a nurse and the member for Macarthur was a specialist paediatrician, and they have both had personal experience in supporting people and families with incontinence issues.

Incontinence is described as follows by the Continence Foundation of Australia:

Continence is the ability to control your bladder and bowel. Incontinence is the involuntary loss of bladder and bowel control.

This affects approximately 15 per cent of the Australian population. If you would like more information about continence and incontinence, please visit the Continence Foundation of Australia website, which is continence.org.au. You can find a lot of very clear and easy-to-understand information, and you can find out more about where to get help and support. The Department of Health also provides the National Continence Helpline, which is staffed by a team of continence nurse advisers and is available to anyone in Australia. It operates from 8 am to 8 pm, eastern standard time, Monday to Friday. You can contact the hotline on 1800330066, and that's a free call.


It's really important to understand that incontinence can affect anybody: men, women, young adults, teenagers and children. For sufferers, it can be deeply embarrassing and affect and impact every part of their daily life. But, as the Continence Foundation of Australia explains, there's a lot of help available to people, so, again, please visit their website at continence.org.au or call the Department of Health's national hotline from 8 am to 8 pm, eastern standard time, Monday to Friday, on 1800330066.


There are many specific health issues that can cause incontinence. In men it may be because of prostate issues, or perhaps after prostate cancer surgery or perhaps because of pelvic floor issues. In women it may be because of menopause, pelvic floor issues or as a direct result of childbirth or prolapse. It can also affect children and teenagers for a variety of reasons. A range of other serious diseases and medical conditions can also cause incontinence, from stroke and diabetes to dementia and Parkinson's disease, and arthritis and mental health conditions may be linked with incontinence, even if they don't directly cause it.


People with incontinence often need careful planning in their days; they need to make detailed plans for travel and ensure that they have the continence products they need, which is what this bill is all about. Those who care for people with incontinence also take on an involved and taxing task. It can complicate even the simplest of tasks that most of us take for granted. It can often be one of the most difficult aspects of caring, as the member for Macarthur has just powerfully described. It can be unpredictable and add a lot to a carer's workload. For this reason, there's a huge psychological toll and impact on carers but also, of course, on the person who is suffering from incontinence. If the condition is not managed well, people may experience feelings of rejection, social isolation, dependency, loss of control, and may also develop problems with their body image. These immense pressures can, of course, also impact carers, overwhelming them with stress and straining their relationships.

While the CAPS program could be considered small within the context of the broader health budget, the subsidy and provision of incontinence products can have a huge impact on a person's life. In addition to the social cost, this has an impact on Australia's overall health system. A Deloitte Access Economics report commissioned by the Continence Foundation of Australia estimated that incontinence cost Australia's health system around $450 million last year alone. The report estimates that further costs born by the economy generally include productivity losses numbering into the tens of billions, the costs of formal care and aids that this program assists with directly, and the burden of the problems themselves. This is why the effective delivery of this scheme to all who are entitled to it is so important.

Every year, the CAPS program helps around 130,000 Australians by providing financial support of more than $620 to each person to assist them with the cost of incontinence products. This benefit is non-taxable, it's offered on an annual or six-monthly basis and it is provided to those who are over four years of age and have permanent and severe incontinence. Earlier this year, the CAPS instrument was amended to provide for an internal merits review of decisions by the secretary of the Department of Health and, following internal review, an independent merits review of the internal review by the Administrative Appeals Tribunal. This bill amends the National Health Act to make it clear the results of merits reviews conducted by the AAT are valid. This amendment will take effect immediately after the royal assent, and it is an important administrative improvement to the program's operation and to the previous reform. The program is administered by Services Australia, who work with CAPS applications, and applicants, to resolve issues relating to their eligibility, ensuring there are very limited numbers of applicants who wish to have decisions reviewed. In instances where an applicant wants to have a review, they should be entitled to one, and this is what this bill achieves.


Resources such as continence products provided through the CAPS program work hand in hand with such things as the federal government's National Continence Helpline, which I have previously mentioned, and also the National Public Toilet Map app, which shows the location of 19,000 public toilets Australia-wide and is a resource also provided by the Department of Health. If you have a google, you'll be able to track down both of these very important information resources. These initiatives also, importantly, work alongside the NDIS funding, which the member for Macarthur mentioned, and have had such a huge impact for people suffering from incontinence. There are also state and territory run resourcing and funding schemes so that everybody receives the support they need to manage their incontinence.


We know that independent merits reviews are key to accountability and transparency in decision-making that affect Australians in many ways, and, as such, this is a sensible reform. The bill is designed to provide more support to those that need it most, and it builds upon the Morrison government's strong record of investment in health and health care. We could not afford to provide this sort of support without the Morrison government's strong economic management that allows a range of health investments such as this. Broadly speaking, the Morrison government is investing a record $121.4 billion in the year 2021-22, and $503 billion over the next four years, to provide more support to Australians as we face some of our greatest health challenges in a generation, including the COVID-19 pandemic.


I've already referred to the mental health impact that incontinence has on sufferers and also on carers, as did the members for Cooper and Macarthur. I do just want to note that we have made a record Commonwealth government mental health investment through our $2.3 billion investment in the National Mental Health and Suicide Prevention Plan. This includes creating a landmark national network of up to 57 additional mental health treatment centres and satellites for adults around Australia, as well as more centres for youth and children through the Head to Health and the headspace programs. I'm incredibly proud the Morrison government is delivering this record mental health support at a time when the nation most desperately needs it. Improving the mental health of Australians is one of the Morrison government's key priorities and, of course, it has never been more important following the impacts of the coronavirus pandemic. I know in my electorate, for example, we are already seeing the benefits that further mental health investment has, through the recently opened headspace centre in Marion, in the heart of my electorate of Boothby. We know that early intervention is essential to minimise longer-term impacts on mental health, and headspace was created to serve precisely this purpose.


The Morrison government is also guaranteeing the future of Medicare through an investment of $125.7 billion over four years, which is an increase of over $6 billion since last year's budget. It is extending a series of primary care measures in response to the COVID-19 pandemic through to 31 December 2021, including telehealth. It is continuing to implement reforms to the MBS from the Medicare Benefits Schedule Review Task Force recommendations and Medical Services Advisory Committee recommendations. The Morrison government also has a health reform agreement which will deliver more doctors, more nurses and more services across public hospitals in every state and territory. These are all completely related to making sure that people, whatever their health issue may be—but particularly on the issue we're discussing, which is incontinence—can access their GP, can call their GP if they're not able to travel at the moment or leave their house because of all the COVID restrictions that we're seeing. Our national mental health investments mean that people can access the support that they need when they need it.


I note that we are also listing a record number of medications on the Pharmaceutical Benefits Scheme. As part of our funding measures, we're also investing $43 billion over four years in the Pharmaceutical Benefits Scheme. This has an absolutely critical role in making sure people can access the medications they need at an affordable price, especially where those medications are for rare diseases and people would never be able to afford them if they had to pay the retail price on the market without the support of the Pharmaceutical Benefits Scheme. The listings that we've made recently represent an average of around 30 listings or amendments per month, or one each day, for an overall investment by the government of $13.6 billion. This reaffirms our commitment to making sure all Australians can afford the medicines they need.


We're also doing a lot of work with the medicines and technology sector to continue streamlining and deregulating processes to apply for reimbursements for new products and services. We have invested $36 million in the Health Products Portal, where we are creating a new one-stop shop for applying electronically to the Pharmaceutical Benefits Advisory Committee, the Medical Services Advisory Committee, and other mechanisms for listing new medicines and medical devices.


In conclusion, the health care of Australians is absolutely paramount. This bill is just one small part of a raft of achievements and record funding amounts that support the health of everyone in the community. The National Health Amendment (Decisions under the Continence Aids Payment Scheme) Bill 2021 will reform the review of decisions made under the Continence Aids Payment Scheme instrument, conferring review functions of decisions to the Administrative Appeals Tribunal. It will allow for Australians who are using the CAPS, or allow their nominated representative, to apply for an independent merits review by the AAT of decisions made under the program. So it's a commonsense reform, and I commend the bill to the House.