MEDICARE 2023: three perspectives

"Australians enjoy access to a world class health system with primary care at its centre. Our vital and valued primary care workforce includes Australia’s hard working general practitioners, allied health professionals, primary care nurses, nurse practitioners and midwives, pharmacists, Aboriginal health workers, practice managers and other practice staff. Primary care provides the foundation for universal health care, working hard to keep all Australians healthy and well in the community, and to deliver care that meets the needs of people and communities at all stages of life, no matter where they live.....

Modernising primary care

Recommendations

• Modernise My Health Record to significantly increase the health information available to individuals and their health care professionals, including by requiring ‘sharing by default’ for private and public practitioners and services, and make it easier for people and their health care teams to use at the point of care.

• Better connect health data across all parts of the health system, underpinned by robust national governance and legislative frameworks, regulation of clinical software and improved technology.

• Invest in better health data for research and evaluation of models of care and to support health system planning. This includes ensuring patients can give informed consent and withdraw it, and ensuring sensitive health information is protected from breach or misuse.

• Provide an uplift in primary care IT infrastructure, and education and support to primary care practices including comparative feedback on their practice, so that they can maximise the benefits of data and digital reforms, mitigate risks and undertake continuous quality improvement.

• Make it easier for all Australians to access, manage, understand and share their own health information and find the right care to keep them healthy for longer through strengthened digital health literacy and navigation." 

[Strengthening Medicare Taskforce Report December 2022, Introduction opening sentences, p.2 & Modernising primary care, one of four recommendation clusters, p.9]

Last week I 'phoned the GP practice I normally attend when I am unwell seeking an appointment.

Rather than the expected two to three week wait for an appointment I was given a choice of appointment dates that week.

When I entered the four-doctor practice it only had two patients sitting in the waiting room and I made a third.

The situation was almost self-explanatory when I read the signs at reception. The practice was now charging fees payable at time of visit.

A Standard Consultation is $84 (which includes a $10 medical centre facility fee). There is a federal government rebate of $39.75 for patients with a Medicare Card – payable electronically after the $84 is handed over.

The Facility Tax For Professional Services also includes as or when required – a medical centre treatment room fee of $20 and a medical centre consumables fee of $20. There may also possibly be a surcharge applied for public holidays.

There is no bulkbilling of DVA Gold Card Holders and Pension Card Holders until they are over 75 years of age.

As the The Australian Government Actuary is currently not expecting the average 67 year-old to live more than somewhere in the vicinity of another 20.1 years, it would appear that a number of GPs are now willing to lock a significant number older patients out of bulk billing for all but the last 12 years of their remaining lifespans.

So is it any wonder that everyone from the prime minister & state premiers to patients are wondering just how far this corporatisation of primary health care will go and, what workable solutions might be found to correct a dysfunctional primary care system.

An excerpt from The Sydney Morning Herald Economics Editor Ross Gittens’ perspective on the recently updated final report of the Strengthening Medicare Taskforce, 8 February 2023:

According to the doctors’ union, the AMA, the reason GPs have become so hard to find is that the federal government isn’t paying them enough. Whereas in the old days half of all medical graduates became GPs, now it’s down to about 15 per cent.

So, pay them more. Problem solved.

What the report’s saying is: sorry, not that simple. It’s true the Coalition government inherited a temporary freeze in Medicare rebates – the amount of a doctor’s bill that’s paid by the feds – in 2013, and continued it until 2018. And although the schedule of rebate payments has been increased annually since then, the increases have been much smaller than inflation.

Why? Partly because the Liberals were trying to prove they could cut taxes without damaging “essential services” such as Medicare.

But also because they knew something was wrong with the way general practice works. They needed to pay GPs differently to do different things. Rather than pay more and more the old way, they’d hold back until they – or some future government – worked up the courage to make changes.

Over the almost 40 years of Medicare, there’s been a big change in the problems people bring to their GPs. Because we’re living longer, healthier lives, much more of our problems are chronic – someone with heart trouble or diabetes has to wrestle with it for the rest of their lives – rather than acute: something that’s easily and quickly fixed.

But the present (subsidised) fee-for-service way of remunerating doctors is designed to suit acute problems, not chronic conditions. It involves waiting for problems to arise, not early diagnosis or stopping chronic conditions getting worse.

It encourages GPs to keep consultations short, avoiding long discussions of multiple problems.

A change no one wants to talk about is the way sole practitioners or partnerships of doctors are giving way to companies owning chains of practices staffed by doctors they employ.

When you separate the person delivering the care from the person watching the bottom line, you increase the likelihood doctors are pressured to keep consultations short and order many tests – a further reason to be cautious about reinforcing GPs’ dependence on fee-for-service.

The report wants to move to “blended” funding, with acute consultations continuing to be fee-for-service, but GPs paid lump sums for developing and managing “care plans” for particular patients with chronic conditions.

While it’s true fewer medical graduates are becoming GPs, it’s not the whole truth. As the Grattan Institute reveals, “Australia has more GPs per person than ever before, more GPs than most wealthy countries, and record numbers of GPs in training”.

How do other countries with good healthcare get by with fewer GPs? By making sure their GPs can’t insist on doing things that could be done by other health workers – nurses, nurse practitioners (nurses trained to do some of the more routine things doctors do), pharmacists and physios.

This is what “co-ordinated, multidisciplinary team-based care” means. Changing GPs’ surgeries into more wide-ranging “primary care clinics” is also about making it easier for patients to move between different kinds of care, with GPs taking more responsibility for the total package, and all the various doctors and paraprofessionals having access to a patient’s medical history.

There’s nothing new about this. Federal governments have been trying to improve the performance of primary care for decades – with little success. Why? Because they’ve had so little co-operation from the premiers and the GPs themselves.

The true message of the latest report is: Medicare reform must not just be about more money to do the same things the same way.

The full 10-page plus cover sheets Strengthening Medicare Taskforce Report can be found at:

https://www.health.gov.au/sites/default/files/2023-02/strengthening-medicare-taskforce-report_0.pdf

The taskforce was formed by the Albanese Labor Government and has 17 members. Its first meeting was held on 29 July 2022 and the taskforce has issued 6 communiques containing meeting minutes.

Show Us The Money, Perrottet!

 

Fool us once, shame on you; fool us twice, shame on us. Try to fool us a third time, then your vote count drops on Saturday 25 March 2023.

Clarence Valley Independent, 1 February 2023, excerpt:

The unveiling of the master plan for the $264 million redevelopment of Grafton Base Hospital (GBH) has been described by Des Harvey of the Grafton Base Hospital Community Committee (GBHCC) as a miniscule step forward.

“The Minister and others might think it’s a major step, but in our opinion, there is still no funding other than just a mention of funding,” he said.

“There is a promise of $263.8 million, but that has been around for too many years.

“We’ve also had a promise that construction will commence before March 2023, and we know that’s not going to happen.

“We’re still talking about planning.

“In my opinion, and that of many people I speak to in the community, the planning really was completed back in 2015, and that’s the reason that the government was able to come up with a figure of $263.8 million, so they knew specifically how many nails, screws and alike were involved in the job…..

 “But as far as I can see, there is no money in the budget for it, and until there is money in the budget, nothing happens,” he recalled.

And the expansion of inappropriate urban development on a Northern NSW high risk coastal flood plain continues apace in 2023.....

Northern Regional Planning Panel (NRPP) now has Development Application SUB2023/0001 before it as PPSNTH-195.

A 284 lot subdivision on Lot 47 DP 751395 at 52-54 Miles Street, Yamba NSW, with a capital investment value of $48,458,741.

Composed of 277 low density residential lots, 1 medium density residential development lot, 1 commercial development lot, 1 low density development lot, 3 drainage reserve lots and 1 open space reserve lot on the est. 21.25ha lot.

This DA was lodged with Clarence Valley Council on 18 January and referred to NRPP on 30 January 2023.

It appears to be the second stage of the urban development of Lots 46 & 47 by Kahuna No 1 Pty Ltd, a property development corporation. Stage 1 is already in the process of landfilling.

Stage 1 and proposed Stage 2 now before the NRPP stretch from Carrs Drive in the west to Golding Street in the east, with Miles Street forming the northern boundary and a common property line forming the southern boundary.

These two lots are 42.5ha of the remaining natural flood storage area in Yamba which has a potential to flood to a height range of 1.6-2.0m in years when the Lower Clarence River floods and, the filling of the lots to a height above 1 in 100 flood levels will inevitably force storm & river waters onto adjoining and adjacent residential land causing it to flow into residential streets further afield.

There is one certainty with this development application - with the exception of the two local government representatives on the Northern Regional Planning Panel - the issues of climate change, changing flood behaviours and an inadequate, badly thought though emergency evacuation plan for Yamba township, will receive only lipservice consideration. Because the Perrottet Coalition Government in Sydney still insists on urban development across high risk floodplains and the Clarence Valley's retiring Nationals state member and his replacement candidate will inevitably continue playing the game of mates rather than genuinely representing the town's population.

In 2023 some developers refuse to take no for an answer - one example is the multiple occupancy application by Kempcove Pty Ltd, NCV Enterprises Pty Ltd, Peter Van Lieshout, Dolph Cooke, Darko Kovac & Zimmer Land Pty Ltd.

 

On 19 June 2020 NCV Enterprises Pty Ltd at public auction purchased land at 3222 Kyogle Road, Mount Burrell, NSW, for $2 million.

This land formerly owned by Wollumbin Horizons Pty Ltd (in liquidation) had been intended as a commune, the Bhula Bhula Community.

On 14 January 2021 Tweed Shire Council received Development Application 21/0010 Integrated Development – lodged by NCV Enterprises Pty Ltd for multiple occupancy at 2924, 2956, 2984 & 3222 Kyogle Road. A collection of land parcels comprising 1,584.3ha of forested land stretching from Kunghur to Mount Bullah. With a section of the Tweed River within its boundaries.

Described for promotional purposes as Nightcap on Minjungbul at: https://www.youtube.com/c/NightcaponMinjungbul/videos.

Tweed Shire Council rejected the concept plan at its 1 July 2021 ordinary monthly meeting.

Noting that The Development Application was referred externally to: Natural Resources Access Regulator, Heritage, Community Engagement – Department of Premier and Cabinet, NSW Rural Fire Service, Department of Planning Industry & Environment – Biodiversity and Conservation Division. All of the agencies either required further information or did not support the proposal. The Biodiversity and Conservation Division advised that they estimate the proposed development would require extensive land clearing of approximately 106ha of native vegetation with a further 220ha of impact in native populations and areas described as “cleared/grassed paddocks with scattered trees, regrowth and weed thickets”. The cost of Biodiversity Offsets required to offset the loss of biodiversity values to enable the proposed development is estimated in excess of $27 million.

On 10 February 2021 Council passed the matter to the Northern Regional Planning Panel (NRPP) as designated consent authority, recommending refusal.

On 18 August 2021 the NRPP refused DA21/200 a multiple occupancy concept plan for this land. Applicants were listed as Kempcove Pty Ltd, NCV Enterprises Pty Ltd, Peter Van Lieshout, Dolph Cooke, Darko Kovac and Zimmer Land Pty Ltd.

Echo online reported on 2 February 2023:

The contentious Tweed Valley, Nightcap Village multiple occupancy (MO) $39M development application (DA) near Uki, promoted by Pete Evans, was refused by the Northern Regional Planning Panel (NRPP) in August 2021. They had one year to appeal the decision, and with one day to spare the MO solicitors lodged an appeal to the Land & Environment Court (L&EC) against the NRPP’s decision not to give approval for the project.

An ‘on site Mediation Conference’ was originally set for ‘9 and 10 February 2023’, however, this has now been moved to an online meeting starting 9 February…..

Nightcap Village area to be developed

The full article can be read here.

The Royal Commission into the Robodebt Scheme peels back layers of a six year old onion

 

A SINGLE MOTHER HITS OUT AT THE ROBODEBT SCHEME IN EARLY 2017

The Sydney Morning Herald, 6 February 2017:

It all started when I began receiving calls from a debt collector, which I initially ignored. I knew I had no debt and that any request for personal details from a stranger was cause for suspicion. But after some time I gave in to the harassment – my curiosity got the better of me, and by then the calls were interrupting everything from work meetings to putting the children to bed.

And that was how I discovered I had a Centrelink debt…..

Terrorised by Centrelink, I began to behave as the bureaucracy saw me: angry, emotional, confused, dependent and idiotic. It does not matter that I am a full-time employed economist with several degrees, published books and articles, and security clearance for giving economic policy advice on secret government documents. Now, I was a welfare cheat….

The debt recovery operation currently being run by Centrelink using data matching has the extraordinarily high error rate of one in five. I doubt any private enterprise would be allowed to get away with these error rates for debt collection.

You would like to think that my story means at least the one in five errors are all being identified and eventually resolved, but it doesn't. Many of my fellow Centrelink "clients" will lack the assertiveness, confidence, energy and literacy I used to fight for my case. The errors in their debt will not be found. Money will be taken, wrongfully, from some of the very poorest people in this country. I guarantee you they are terrified.

And anyway, my case isn't over.

Days before publication of this piece I was contacted by Centrelink with a new notification of debt. I have been instructed to pay back the Family Tax Benefit we received in the year my ex didn't file his tax return. And so, it begins again.

PUBLIC PUSH BACK BY THE THEN MORRISON COALITION GOVERNMENT BEGINS

Excerpt from The Canberra Times columnist Paul Malone’s article in The Sydney Morning Herald on 24 February 2017:

“But Centrelink has a different story.

The agency says Ms Fox's debt is a Family Tax Benefit (FTB) debt for the 2011-12 financial year which arose after she received more FTB than she was entitled to because she under-estimated her family income for that year.

The original debt was raised because she and her ex-partner did not lodge a tax return or confirm their income information for 2011-12.

Centrelink says that after Ms Fox notified the department that she had separated from her partner, the debt due to her partner's non-lodgement was cancelled.

In a later article on 5 March 2017 Malone admitted his 24 February article was based on information supplied by both Centrelink and the office of the Minister for Human Services “To my surprise I got answers to my questions in a series of emails from Centrelink and the office of the Minister for Human Services, Alan Tudge.

They said Ms Fox's case was not a robo-debt matter.

Her current debt was a Family Tax Benefit debt for the 2011-12 financial year which arose after she received more FTB than she was entitled to because she under-estimated her family income for that year”.

POLITICAL EXCUSES APPEAR IN MAINSTREAM MEDIA

The Guardian, 2 March 2017:

The office of human services minister, Alan Tudge, mistakenly sent a journalist internal departmental briefings about a welfare recipient’s personal circumstances, which included additional detail on her relationship and tax history.

Senior departmental figures were grilled at Senate estimates on Thursday about the release of welfare recipient Andie Fox’s personal information last month.

Fox had written an opinion piece critical of Centrelink and its handling of her debt, which ran in Fairfax Media in February. The government released her personal details to Fairfax journalist Paul Malone, who subsequently published a piece attacking Fox and questioning the veracity of her claims.

Two responses were given to the journalist, one from the department of human services and the other from Tudge.

The department said its response – three dot points containing only minimal detail on Fox’s personal history – was cleared by lawyers and was lawful. The minister’s office then added two quotes from Tudge and sent its own response to Malone.

Guardian Australia can now reveal that the minister’s office also accidentally sent the journalist two internal briefing documents, marked “for official use only”, which had been prepared by the department…..

SIX YEARS LATER THOSE POLITICALLY MOTIVATED LIES ARE REVEALED 

Excerpts from Twitter threads by journalist Rick Morton @SquigglyRick as he live tweeted from the Royal Commission into the Robodebt Scheme public hearing on 31 January 2023:

Greggery: "You said the media demand was very high while the Minister was on leave, the media was generally adverse, heavily critical. Would you say that by January 2017... the media situation was in crisis mode?"

Miller "Yes, but I didn't think it was not able to be shut down."

1:22 PM · Jan 31, 2023

Miller: "He [the Minister, Tudge] was very firm with me that I needed to shut this story down. The Minister became very quickly aware that the Prime Minister was unhappy. At the time, we were trying to decline as many media opportunities as we could."

1:23 PM · Jan 31, 2023

Miller: "That media strategy that I developed was very comprehensive and that involved placing stories in more friendly media about how the Coalition was actually catching people who were cheating the welfare system."

1:24 PM · Jan 31, 2023

Miller: "We were getting feedback from the Prime Minister's office that this was playing quite well in the marginal seats, Western Sydney, that sort of thing."

1:25 PM · Jan 31, 2023

This "counter-narrative" in the crisis strategy that Miller developed included pushing the message that they were "tracking down debts from the period when Labor was in Government that were not detected because they did not take the integrity of the welfare system seriously."

1:27 PM · Jan 31, 2023

Greggery asks about using "real life examples."

Miller: "The Minister was very adamant with me that I needed to hunt down as many case studies as I could, he was really very forceful about obtaining these."

He wanted to dismiss the stories that he thought were gussied up.

1:30 PM · Jan 31, 2023

Miller: "He wanted to put the attention back on the Labor Party and say 'what, you would let these guys go, you would happily give them taxpayer money that they were not entitled to'."

Miller spoke to Bevan Hannan, head of media at DHS etc

1:31 PM · Jan 31, 2023

Greggery: "What do you recall of the topic of releasing personal information from persons with whom Centrelink dealt to media?"

Miller: "So we didn't think of doing that at all ever."

This is early on. But then the author of an SMH/Age piece gets in touch.

1:38 PM · Jan 31, 2023

This journo sees this case in the media and says the case is "disgraceful" and "how is it the Minister can let this happen on your watch and he said I am going to write another piece about this." But he asks: can you assure me that what the author has written is correct?

1:41 PM · Jan 31, 2023

Miller talks to the DHS, they say well actually you CAN release very limited details about a person to "correct the record."

"The Minister requested the file of every single person who had appeared in the media."

The file was already in the MO

1:42 PM · Jan 31, 2023

Miller recalls Tudge being adamant they wanted people to think twice about going to the media with "false" information because if it's not true "we will correct the record."

"I wasn't too worried about [the criticism from the leftwing media]. That didn't surprise me at all."

1:44 PM · Jan 31, 2023

But she was worried, she says, that what they were doing was legal.

Miller says of the one case, where they released details "and the publicity that it got" sent the message that the Govt would push back.

1:45 PM · Jan 31, 2023

In the case of the person whose name they released, but in other cases too, Miller says there was "formal, signed legal advice." The Minister "requested that specifically."

1:46 PM · Jan 31, 2023

Miller: "It wasn't usual practice at that stage for Ministers in that portfolio to do that. It was a risk. There weren't, to my knowledge, previous cases of people using that particular loophole."

In retrospect, Miller says it is "not something I would do again."

1:48 PM · Jan 31, 2023

Miller says it was unethical that some leftwing journalists were not even going to them for comment.

"The usual relationships I would have with journalists were not working, and this particular group were being quite vindictive, being very biased and unbalanced."

1:49 PM · Jan 31, 2023

Of the name they did release, Miller says: "I did trust the reporter who was going to write that up, that rebuttal of ours, he was reputable, very reputable."

1:51 PM · Jan 31, 2023

Miller: "I did try to seek assurances from the policy issue but he was very firm that 'hey, this isn't your job'."

Policy adviser was Mark Wood.

1:56 PM · Jan 31, 2023

Miller: "Kathryn Campbell was there on a regular basis [in January 2017 at the Minister's office]. She was set up in the boardroom, almost permanently, I think. Malisa Golightly, I can't recall other specific people... Craig Storen."

1:57 PM · Jan 31, 2023

Prime Minister (Turnbull) asked Tudge to return from leave immediately to deal with the Robodebt "crisis."

Miller is asked about what she recalls about people committing suicide after receiving debt letters.

1:59 PM · Jan 31, 2023

The Saturday Paper, 4 February 2023, excerpts:

Alan Tudge, Rachelle Miller and Christian Porter appear at the robo-debt royal commission this week.  CREDIT: ROYAL COMMISSION INTO THE ROBODEBT SCHEME

An ugly “strategy” of demonising welfare recipients extended to almost all elements of the official response to the developing media storm. 

In the Rhys Cauzzo matter, in the week following publication of The Saturday Paper story in February 2017, the minister’s office debated the merits of releasing a dead man’s personal information in order to strike back at what they perceived to be unfair coverage. 

Tudge’s chief-of-staff, Andrew Asten, appeared to draw a line in the sand. 

“I would advise against going through these details in public because I think it is a bad look to be discussing the wrongdoing of a person who committed suicide.” 

He was overruled, presumably by Tudge himself, who micromanaged every aspect of his office’s media strategy, down to dictating the formatting of documents. Journalists were duly briefed about the “facts” as the government saw them. 

What is particularly telling about this specific episode – one in a catalogue of grotesque and deliberate acts designed to save robo-debt from “unethical” journalists, as Miller described them, and their good-for-nothing welfare complainants – is that Tudge ordered an investigation into the department’s handling of Cauzzo’s matter, but only to make them look good. 

A month after briefing journalists with Cauzzo’s protected Centrelink record, a departmental liaison officer working in Tudge’s office emailed her colleagues in the DHS with a “specific request” from the minister. The department and minister’s office had been drafting a letter to send to Rhys Cauzzo’s mother, Jennifer Miller. 

“The Minister has a specific request to open an investigation into Rhys’ circumstances,” the officer wrote on March 31, 2017. “He would like a brief on the investigation. The intent is to be able to update the letter to include a line similar to [redacted] letter, stating that he has investigated the matter and is confident the Department has done everything correctly (etc).” 

Within days, Tudge got the pre-determined outcome he was looking for: a ministerial brief from his department that noted “all interactions were appropriate and undertaken within the parameters of departmental processes”. 

What Tudge didn’t do, however, was investigate the use of income averaging in the creation of debts attributed to Rhys Cauzzo. Part of the fury about The Saturday Paper story at the time was that it was “not a robo-debt case” – even though this newspaper did not suggest that it was. The royal commission heard on Wednesday that Cauzzo’s matter was part of the manual PAYG intervention, which still included the use of income averaging and is now considered to be the very first iteration of the illegal robo-debt scheme. 

Greggery said that this matter was “the first point in time when the potential adverse consequences have gone beyond a matter of mere finance”. 

Addressing Tudge, he said: “Did you ask for an investigation into whether the role of averaging led to the death of Mr Cauzzo, a factor relevant to the suicide?” 

Tudge said what had been written in the piece “concerned him” and he “did want to … directly understand what had occurred”. Tudge’s inquiry deliberately avoided the two key criticisms of the debt recovery system, aired at length by this time in early 2017 and now accepted by Tudge. They were that debts being raised under the system were inaccurate and that Centrelink recipients were being swamped by the sudden reversal of the onus of proof. 

Now, people were killing themselves. 

The conflagration had ruined Tudge’s summer. There were many of these negative stories, beginning in December 2016, before Tudge went to Britain on a family holiday. Over Christmas, however, the situation was so obviously bad that then prime minister Malcolm Turnbull demanded Tudge cut short his holiday and return to deal with the crisis. 

In the royal commission this week, the former minister made a point of mentioning this holiday over and over again. It was a significant moment in a significant career because it was a media disaster and Tudge was a media performer. 

Miller had described her then boss as a “media tart” so obsessed with making a name for himself that he, a junior minister, sometimes did even more media appearances than his senior minister, Christian Porter, who held the Social Services portfolio at the time. 

Turnbull had forwarded to Tudge an article by the Fairfax economics editor Peter Martin, a former Treasury official and economist, in which Martin confidently – and presciently – declared the raising of Centrelink debts by use of income averaging could not be legal. 

Tudge flew back to Melbourne on January 9, 2017. From there he went immediately to Canberra, where “every second or third day” he held meetings in his parliamentary office, in committee meeting rooms or in the Department of Human Services, with the most senior leaders. 

“When I came back I very quickly had confirmed for me that this was a program that had been through the cabinet process,” he told the commission. “They are a rigorous process that always have a legal overlay through it so Social Services lawyers would have to have formed a view that it was lawful.” 

Later, Tudge claimed it was “unfathomable” to him that a secretary of his department would ever continue with a scheme that he or she knew to be illegal. That said, he didn’t expect them to bring their concerns to him, if there were any, without first “resolving” them within the department. 

 And so his self-described “laser-like” focus on fixing the scheme never went to the issue of lawfulness in this period. It apparently never went there at all during his time as minister. 

“I did not know the full context about the legalities,” he said. “It just had not crossed my mind until the [2019 federal] court case.” 

One of the “hurdles”, as Justin Greggery described it, was that Tudge knew how important these welfare compliance schemes were for the Coalition government because he had unwittingly, or otherwise, helped further them in the July 2016 election. 

Tudge was sworn into the ministry in February that year and told the royal commission that the then Finance minister, Mathias Cormann, had asked him if there was anything more they could get out of welfare compliance – that is, he was asked by one of the most senior members of the government if there were budget savings that could be made from welfare recipients. 

After this conversation, Tudge spoke with his department’s secretary, Kathryn Campbell, to pass on this request. Her department dutifully sent a raft of so-called “new policy proposals”, or NPPs, with attendant savings figures that could be pursued. 

The April 28 brief noted there were “five NPPs that will increase compliance and debt activity and deliver significant savings commencing July 2016”. 

That year was an election year. Tudge agreed that, once announced, there would be added political pressure making it more difficult to walk-back any money-saving measures if they were later deemed too hard to implement. He noted Cormann would “have absolutely been aware” of the figures. 

Tudge’s office had sent an email to then treasurer Scott Morrison or Cormann, or both, with the new policy proposals attached “for the purpose of announcing during the election campaign, literally a few days before the election”. 

According to estimates shared with the commission, robo-debt was expected to add $1.2 billion to the 2016-17 bottom line. If the debts were raised under the older, manual, lawful system, that number dropped to $150 million. 

One post-election measure was to extend the robo-debt scheme by two years. By early December 2016, Tudge had been given a brief from his department responding to questions about the fiscal savings robo-debt programs were expected to produce for the budget over the forward estimates. 

That figure was $4 billion. Tudge was quick in instructing his staff to drop this story with the “friendly” newspaper The Australian, where it ran on page one on December 5, 2016, with the headline: “Welfare debt squad hunts for $4bn.” 

The interview with A Current Affair followed on December 6, but, according to the national media manager for the Department of Human Services, Bevan Hannan, Tudge was so “bullish” in his approach that it put a big target on their backs. “It conflated welfare fraud with compliance activities,” Hannan told the inquiry on Tuesday. “The rest of the story had nothing to do with putting people in jail, but that – that grab seemed to galvanise everyone. “And so suddenly instead of being a story which would explain what we are doing, it put a big target on things, and the program and the minister became the hunted.”....

When problems began being reported in the press, Tudge fought back with the only weapon he had bothered to sharpen in his political career: a dependent and obsequious relationship with the right-wing media. 

In January, on his instruction, the Department of Human Services put together a dossier of all of the people with debts who had complained in the media. This information contained their protected Centrelink information, albeit anonymised, and special legal sign-off from DHS chief counsel Annette Musolino. It was sent to The Australian’s political editor, Simon Benson. He ran the story as the front-page splash in the next day’s edition: “Debt scare backfires on Labor.” 

This tactic of tying a neat bow around a story and handing it to a favoured journalist, Greggery said to Rachelle Miller, was to ensure the story was written “or at least presented in a way that the minister liked”. 

She agreed. “And Simon Benson,” she said, “was very good at doing that.” 

This preoccupation with establishing a “counternarrative”, as Miller described it, may have clouded the minister’s judgement. But there were at least three concurrent and damning threads running as Tudge faced the royal commission this week. Many of them involved the at times clandestine behaviour of his own department. 

One prominent figure in this is DHS chief counsel Annette Musolino, who herself spent nearly one-and-a-half days in the royal commission witness box this week. During Musolino’s own leave over the new year break in 2017, lawyers within her team at the Department of Human Services drew up draft instructions to seek advice from the Australian government solicitor that could have settled once and for all whether robo-debt was legal. The instructions were never sent.....

It is worth noting that these instructions were drawn up within a day of Alan Tudge arriving back in the country from his aborted overseas holiday to deal with the unfolding catastrophe. 

Did he know anything about them? 

“I’m asking you,” Greggery said on Thursday, “whether you can explain why, if you didn’t turn your mind to legality in the first couple of days when you came back, your legal department would be preparing instructions to the Australian government solicitor about the lawfulness of averaging?” 

Tudge said he couldn’t explain it. 

“It’s the first I’m even aware that that was occurring,” he said. 

Musolino was not in the dark about potential legal issues with the scheme. From at least late 2016 and then into 2017, her team was closely monitoring and providing reports on the outcomes of Administrative Appeals Tribunal decisions that were either rejecting the use of income averaging to raise debts or waving them through. 

In one particular matter, in a March 2017 decision by then AAT member Terry Carney, Musolino’s own lawyers agreed Carney had made no error of law in his reasoning. Despite this, and model litigant obligations placed on Commonwealth agencies, Musolino said DHS didn’t have to agree with the decision. It only had to implement it. If there was no appeal against the decision, it was very unlikely it would receive attention – and so the scheme could continue. 

“So how does the position get resolved where the AAT is making decisions that a significant program is being conducted on a basis which isn’t lawful?” Commissioner Holmes asked. 

“It just ticks along, and as long as nobody ever recommends an appeal, which they never need to because you can always implement the decision without regard to the program, it just goes on forever, does it?” 

Musolino said the AAT decisions “were cutting both ways”. Commissioner Holmes was unimpressed. “Okay,” she said. “I think you’re either missing my point wilfully or inadvertently.” 

The March 8, 2017, decision from Professor Carney did involve a general point of law that Musolino eventually accepted, after much circular argument. Essentially, it found a fundamental aspect of the scheme was unlawful. “That’s … yes,” Musolino finally said. 

This was a significant moment in the hearings, although it was dealt with carefully by Commissioner Holmes.

Musolino was shown a ministerial brief, prepared well over two years later, on November 6, 2019, for then minister for Government Services Stuart Robert, following the unequivocal receipt of legal advice from the solicitor-general, which declared robo-debt had no basis in law. 

Even though the solicitor-general’s opinion was “not a declaration of law” it was sufficiently alarming to DHS officials that they recommended robo-debt be terminated. 

“There is considerable legal and reputational risk should the Department continue to administer the program in its current form,” the document says. 

“[Then] Secretary of the Department, Ms [Renée] Leon, also carries personal risk associated with the continued administration of the program in its current form by reference to various obligations that she had as a public servant.” 

Crucially, the brief also put in writing a case that is being built brick by brick by the royal commission. “The continued administration of the program in its current form may amount to misfeasance in public office,” the Robert brief says. “This is because continued administration of the program after receipt of the opinion would contribute to an argument that the Department had been raising and recovering debts in bad faith.” 

Commissioner Holmes thought that the Carney decision might have put a concrete time line on when officials ought to have acted. A key element of the offence is acting with “reckless indifference” to the use of an official power that was reasonably expected to cause harm. 

“The fact is that the AAT was finding that averaging was not a legitimate procedure in cases – not all of them, but in some – and that proved to be perfectly correct as the solicitor-general’s opinion demonstrated,” Holmes said on Tuesday. 

“So that went on through 2017, 2018, to some time in 2019, when, around about March 2017, somebody could have been having a look at this. Is that a fair summary? You were getting decisions from the AAT pointing to a problem?” 

When then senior minister in the Social Services portfolio Christian Porter took the witness stand on Thursday afternoon he was asked about whether, while acting for the holidaying Tudge in late December and early January 2017, he formed the view that there was a “reticence” from DHS to publicise detail about how the online compliance system worked. 

“I recall … a sort of acceptance of the position and the talking points,” he said. 

“That then turned, at some point, into circumspection. Then I became sceptical and in the end I was extraordinarily frustrated with the level of information being provided.” 

There was another suicide after Rhys Cauzzo’s. It involved a woman who killed herself just five days after receiving a debt “discrepancy” reminder letter. The woman had previously sought social work support through the department but had no “vulnerability indicator” on her file. 

Despite the fact an employment separation certificate was already on the woman’s Centrelink file, which contained more detailed employment information, compliance officers were not permitted to consider this because, under the design of the scheme, it could never have allowed the government to recoup billions of dollars. 

This was an element of the scheme Tudge had promised to fix five months earlier, in January. He never did. 

Unlike with Cauzzo, whose case had been the subject of reporting, Tudge never ordered an investigation into this case. 

Greggery noted this difference and the reason for it. “I am suggesting,” he said, “the reason you didn’t order an investigation into this case, and you did for Mr Cauzzo, is because you were confident this wouldn’t reach the media.” 

 Tudge denied this.