Tony Windsor (New England, Independent) Share this | Hansard source

I support the legislation, the Health Insurance Amendment (Provider Number Review) Bill 2007,before the House. I was doing a quick run-through of some of the issues in this legislation and recalled that the first question I asked when I came into this parliament was in relation to Medicare provider numbers, in particular to the possibility of the geographical allocation of Medicare provider numbers. I note with interest that in the 2004 election, even though the government had rejected the concept of using the allocation of Medicare provider numbers on a population or geographical basis, the access of doctors to public funds through Medicare was driven by the need of the population for the doctors rather than the need for the doctors to locate in places they particularly liked to be.

I note that the government, on rejecting that concept, actually introduced it into the major western urban areas, particularly of Sydney and Melbourne but also of Brisbane, to encourage specialists and other medical people to locate in those areas. So the concept of geographical allocation of provider numbers is not alien to the government; it is just that the government has tended to use it as a political tool rather than one for delivering equity to patients across the nation. Those of us involved in politics realise that the decisive seats in a federal election, particularly the last one, are in those geographical locations—for instance, the importance of Western Sydney in maintaining government.

It is an issue that has interested me for some years. I believe that from a number of perspectives we should have a closer look at the use of Medicare provider numbers as a way of getting services to the people rather than, as I said earlier, doctors accessing a provider number in an area where there is an oversupply of doctors on a population basis. I am sure others have been through the number of patients per doctor in country areas compared to the number of patients per doctor in city areas. But most doctors have one thing in common. Most of them have access to Medicare, which is access to the public purse. Given the ballooning of health costs, whether they be state or federal, at some stage we have to have a closer look at the way we allocate medical operatives in terms of their access to public funding.

I congratulate the government on its initiative of the new medical schools that will be started up across Australia, in particular the one to be based in Armidale in my electorate. I believe the concept is a good one and it is based on the successful concept of the university departments of rural health. I particularly congratulate Associate Professor Peter Jones on the work that he has done. Peter Jones is from Newcastle, but he has been resident in Tamworth for some years. In my view, he and his team have driven the concept of the university departments of rural health. He brought this concept of medical training from Newcastle, located it in Tamworth and developed an infrastructure. Now that infrastructure is going to be converted into a full-blown medical school based in Armidale at the University of New England. There will be training of doctors and nurses—there are nurses being trained there now—and training at the major training hospital of Tamworth, which is a major base hospital for the north of the state.

I think Peter Jones has done an outstanding job and I am sure that the Minister for Health and Ageing, Tony Abbott, would concur. The minister was in Tamworth for the launch of the new facility for the Newcastle University Department of Rural Health and I hope he will revisit Tamworth when the medical school is formally opened. It is a medical school that is going to embrace the existing infrastructure of Newcastle and the courses that are being delivered there.

Newcastle university also deserves congratulations because it has been providing services particularly to country students. And, as the previous speaker pointed out, if you educate a country student in medicine, or in an associated faculty, in the country, the likelihood of them forming their relationships et cetera in the country and actually working there as a medico are heightened. I think the government has recognised that. It is going to take some time to come through, of course, because there is a lack of doctors in Australia at the moment, but at least there is movement in the right direction. I think Peter Jones, with his relationship with Newcastle university and his capacity to develop a relationship with the University of New England, has been the main driver behind the establishment of the new medical school, and it is a great credit to him.

I also congratulate the state government. The states, having custodianship over the hospitals, have a valuable role to play in this process of moving towards a medical school located in the country. Working with the Commonwealth they have been able to achieve an outcome where New South Wales has actually given a guarantee to upgrade a number of hospitals, particularly Armidale and Tamworth, to teaching status. Obviously, you cannot teach new doctors in facilities that are not set up to embrace their education. So Tamworth, Armidale and, I believe, the Manning Base Hospital—and I think there is one other that I cannot recall for the moment—will be upgraded at a state level so that that teaching can take place.

Obviously, that will have a spin-off for people within those regions in terms of the specialists who might be encouraged to move to those regions. I think that will be a very important step forward for medicine in that part of the world but also, most importantly, for educating medical students in a country environment.

The state government has recently announced that it will be allocating $48 million over four years in recurrent funding for the allowance for the teaching component at those hospitals, plus upgrade funding of, I think, about $8 million. And only in the last 10 days there has been a commitment given to fully rebuild the Tamworth Base Hospital, at a cost of about $130 million.

All these things augur well, but it is no good having facilities if you do not have doctors, and I think the most important ingredient of all, in what I have just talked about, is the fact that the government has taken the initiative to set up medical schools in country locations. I think it will have a positive effect, over time. Too often we look for short-term fixes in this place, and I think this is one instance where we are actually trying to address a long-term problem. The outcome, regrettably, is going to take some time to achieve, but at least progress is being made.

Another issue related to the lack of professional people in country communities is the dental issue. From time to time we hear being thrown around in this place the question of whose fault the state of dental care is and who is responsible for funding arrangements. It is often said dental care is essentially a state responsibility. Most people would remember—I was not in this place at the time; in fact I was in the New South Wales parliament—Prime Minister Keating introducing some arrangements where the Commonwealth put money into the provision of dental care and the Howard government removing that. Who should be paying for the provision of dental care has been a continual political football.

One thing should be very clear and that is that oral health should be included under the Medicare arrangements—and that is a Commonwealth responsibility. There should not be a distinction based on who funded dental care, whether it was state or Commonwealth; that distinction should not run over into the Medicare arrangements. And, for the life of me, I cannot understand why oral health is treated differently to bodily health. We had one particular circumstance in my own electorate in recent months where a lady removed a tooth with a pair of pliers—and I think that lady was in this parliament only in the last few days—because she could not get access to a dentist.

There are two problems. The first is that there are not enough dentists. That leads to another issue: the training of dentists and the allocation of student places for the training of dentists, and, of those who are being trained, the numbers who are either going into research or going overseas. The retention rate of new dentists who are available to go into the Australian marketplace is quite small. We have had the foresight to look at the doctor problem and come up with ways and means of trying to address that, and now we have to look very closely at what we are doing on the dental issue.

One thing that should be done immediately, to alleviate the cost to many Australians, is that oral health—not cosmetic oral health, but oral health—should be included under the Medicare arrangements. Currently, if a patient can show that if they do not attend at a dentist it will lead to other bodily health problems, they can gain access to some Medicare funding. Now that seems extraordinarily counterproductive; it is placing policy before the needs of people when you actually wait for someone to get ill before you look after their teeth. I think, in the long term, if that was our attitude to health problems generally, the saving of money would be outweighed by the long-term cost. So I would encourage the government to revisit that issue. And I think this may well be the year that that issue is revisited, partly because of the political dimension to the issue that seems to be developing in this place and partly because of the demands by many hundreds of thousands of Australians to have some form of access to dental care at an affordable price.

We keep being told by both sides of parliament—and I agree—that we are a nation enjoying a degree of prosperity not seen before. If we cannot as a society look after our elderly and those who need their teeth fixed so that they can eat their food and survive and be productive members of the community, it really raises a number of questions irrespective of who historically is responsible for the delivery of those services. We have seen a whole range of activities, some of which I agree with and some of which I do not, where the Commonwealth has moved on the states to take away some of their responsibilities. Perhaps this is one of those areas, particularly in relation to Medicare access.

The final issue that I raise, and I have raised it before—and here again I congratulate the government, as I have before on this issue—is the multipurpose service issue, the provision of what most of us still think of as hospital services, which are traditionally funded by the state, and aged-care services, which are funded by the Commonwealth. I think this is a very good example of where both levels of government have worked well together to put in place a service delivery mechanism which is reasonably cost-effective in smaller and medium sized communities and delivers a service into those communities that was formerly under threat.

There is no doubt that in smaller communities like Emmaville, Guyra, Bingara, Bundarra, Tingha and Walcha—all of which are in my electorate—and communities such as Boggabri and others, with 500 to 2,000 people, there were pressures developing for the idea of a centralised healthcare mechanism that would provide a better way of treating those people because it saved money. The development of the MBS arrangement actually went back the other way.

I pay great credit to some people in the electorate of New England. Prior to me being the member, in the community of Emmaville a lady called Ellie Seagrave and other ladies in that community made a significant difference, not only to their particular community—and they have a great MBS at the moment—but also in terms of health policy and the delivery to other smaller and medium sized communities. The government, to its credit—and the state governments, to their credit—have embraced this policy. It is a very good example where, through working together, the objectives of health care and aged care have been achieved at reasonable cost to the budget bottom line. I pay great credit to all of those people that have been involved in structuring those processes. I think that most Australians would suggest that that particular policy decision has probably done a lot to maintain the integrity of some of those smaller communities which were very much at risk under a centralised arrangement where aged and sick people would go somewhere else because there was no local facility.

I have often been quoted as saying that if you apply a centralist approach, which is, in theory at least, the most cost-effective way to deliver the greatest number of services to the highest number of people at the lowest possible cost, you put them in a feedlot—in theory. I think that is what we have tended to do in our major urban areas. But this policy initiative reversed that, and there is a whole range of other social consequences for those smaller communities that evolved from that change in policy. I think the government should have a look at that model and start applying it in a number of other service provision areas as well. There is no doubt that it has had a positive impact on the structure and integrity of those communities by allowing the maintenance of the aged in the community that they have made a contribution to and allowing the capacity for people with low-level illness to be looked after within the community from which they come.

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