NCSR – it's all about the optics
It's always fun to watch senators on the government side of the benches squirm under the questioning of their opponents at the carnival that is Senate estimates, where the usual power structure is reversed and normally obscure parliamentarians can have their day in the sun. After all, this is where Bronwyn Bishop first made her mark back in the Hawke-Keating years and look how well that turned out.
This week in the Senate, we were served up an absolute treat as NSW Senator Fiona Nash fidgeted and fussed through a couple of hours of intense questioning by the Greens' Richard Di Natale and Labor's Murray Watt over the delay to the roll-out of the National Cancer Screening Register (NCSR). Not that Senator Nash had much to say for herself, with Department of Health secretary Martin Bowles and Commonwealth chief medical officer Brendan Murphy taking most of the heat.
It was Senator Nash who had a bit of a whinge though, insisting to the stunned faces of the committee in their high chairs that the NCSR shouldn't be controversial. No, it shouldn't be, but it is, Senator Di Natale said, to which he might easily have added that it was all due to the bungled handling of the whole thing from end to end by the government. And that bungling goes back to the announcement during an election campaign that the contract to build the thing had been won by what 99 per cent of Australians think of as a telephone company.
While the health IT industry knows Telstra Health as a conglomeration of medical software vendors that are more than capable of standing up the register and doing it properly, the Australian public just sees Telstra, and it's no surprise that there is widespread alarm at the thought of sensitive Pap smear or faecal occult blood test results being handled by a poorly paid Telstra call centre operator in the Philippines.
If it weren't so serious it would have been almost comical, especially coming at the same time as the drama over outsourcing Medicare payments was dominating the news. From the very start there have been a litany of errors: the government didn't bother to submit enabling legislation to establish the register before Parliament was dissolved for the election; it announced that Telstra Health had won the contract to build the register during the caretaker period but only after the news had been splashed all over the Fairfax newspapers; it chose Martin Bowles and Senator Linda Reynolds, both combative figures who cannot hide their contempt for people who ask questions they consider beneath them, to lead the defence during several inquiries; and it tried to heavy the Greens and Labor into passing the legislation before October 31 with the threat that if they didn't, the register and the introduction of the HPV test would have to be delayed, which has subsequently happened anyway.
The Department of Health also sent out an upbeat report on progress from its implementation branch which has proved to be rubbish; it turns out it knew before Christmas that the register probably wouldn't be ready in time but didn't bother to tell anyone about it until late February; and now it has had to come up with an extra $13.5 million to pay pathology providers to keep doing Pap smears despite them having gone through a long-planned downsizing of their cytology workforce.
In comparison to something as massively bungled as the PCEHR this saga is small change and we expect that Telstra Health will build a register that is functional and beneficial, but it should never have come to this. Yet again a health IT vendor has been asked to shoehorn a technology roll-out and complete workflow reconfiguration into a timeframe set not by public health needs or a rational roadmap but by political agendas and 'announceables'. The Department's handling of it has been bloody awful too.
Needless to say, our stories on the NCSR were some of the most popular this week. So while we have run polls on this topic before, let's have another go. Who is mainly to blame for the NCSR bungle? Telstra Health, the Coalition government, or the Department of Health? Leave your comments below or take the poll in our Weekend Edition.
In last week's poll we asked: Should all Australians have a My Health Record created for them automatically when they turn 65? 73 per cent of you said yes, with 21 per cent saying no.