Warren Snowdon (Lingiari, Australian Labor Party, Minister for Indigenous Health, Rural and Regional Health and Regional Service Delivery) Share this | Hansard source

And I will come to Lismore. The important thing is to note that we have gone across this country and talked to people. I am the first Minister for Indigenous Health, Rural and Regional Health and Regional Service Delivery in this nation’s history and I think that shows the commitment of the government to putting in place a process of going to talk, listen, learn and try and come up with policy options which meet those concerns. My most important observation is that everybody is different and everywhere is different.

I will use an example to explain the difference, one that I have used across the country. I go to particular equivalent sized communities in different states which will remain anonymous, both with public and private hospitals servicing around 60,000 people. In one of those places there is no GP superclinic or really effective after-hours primary care by any GPs. There is a corporate medical practice that knocks off at seven o’clock. That means all of the after-hours care is effectively done in the hospitals. Seventy-five per cent of the after-hours emergency patients, categories 3 and 4, could be seen by a general practitioner but are not. The other community is of an equivalent size in a different part of Australia. It has a similar structure—a public and a private hospital working in close association—and it has an effective team of private medical practices delivering primary health care with 24-hour on-call seven days a week and surgery sessions on Saturdays and Sundays. The demands on the hospital are totally different.

That is replicated across the country. In some cases, like Cloncurry in the member for Kennedy’s electorate, we have seen a very dynamic relationship between a private practice and the local council. The local council are working with the private practice. The local council have provided them with not only capital equipment, which remains on the council’s books, but also motor vehicles and three homes. This says the community take their primary care seriously. They see themselves as having a role in making a contribution. This is equally the case in Ceduna in South Australia where there is a similar approach. There is a different model because Queensland is different from South Australia, but clearly there was an effective relationship between the private medical practices in the town and local government where local government are providing accommodation.

That does not happen across Australia, but it is important to note that—and I make this observation despite the member for Lyne’s reservations about the way in which hospitals are run et cetera—the workforce is absolutely committed to getting an outcome. I want to take this opportunity to commend the whole of the health workforce who live in rural, regional and remote parts of Australia. There is no doubt about their dedication. Often they are working in isolation without a great deal of peer or professional support and they do so while making great personal sacrifices in committing themselves. This raises a significant issue for us, and perhaps one of the most significant questions which we have confronted in this whole process of consultations is workforce issues: our ability to recruit and attract workers into the health system, to attract doctors to work in the bush—GPs in particular—and to attract nurses and allied health professionals to work in the bush.

We were not helped by the capping of GP training places by the previous administration under the guidance of the then health minister, Mr Abbott. Thankfully, this government has addressed that by upping the number of GP training places to 800 by the end of this year, a significant increase—a 35 per cent increase in the number of GP training places. And we have not stood still on the issue of what we should do in regional and remote parts of Australia, because we understand that, if we are going to actually address the needs of regional communities, we have to do something about investment.

We have done this in a number of forms, and one which I am sure the member is aware of is our concern for regional infrastructure programs. We have a National Rural and Remote Health Infrastructure Program, NRRHIP, which has visited a local practice in Batemans Bay, which has got money from this NRRHIP—up to $500,000 in this particular case. It is a private practice which has used the resources which were made available out of this program to build a wing onto the practice which provides additional surgery and, at the same time, a place for teaching and training doctors and providing accommodation on site for those doctors. That is a program which is worth $45 million over four years. We have undertaken four rounds of funding thus far. They have been broadly distributed across the country, and that will continue.

It is important, I think, also to understand that that is not the only way we do our business. We are concerned about making sure that we actually work effectively with these local communities. I make this observation because it will be clear to the member for Kennedy, because of the nature of his electorate, that when we are talking about regional and remote Australia it is vastly different when we are talking about the Cape to what it is for the Central Coast of New South Wales, and the nature of the population we are serving is vastly different. With my electorate, if I talk about regional parts of the Northern Territory, I am talking about Indigenous health, largely. I know this is true for the member for Kennedy’s electorate and many parts of the north. So we are committed to making effective changes to the way in which we deliver these services across Australia, and we have made significant inputs into the developing of additional expenditures into Aboriginal and Torres Strait Islander health.

But, in the context of rural health, the government is investing more than $700 million in targeted rural health programs. It is investing through the Medicare Benefits Schedule—MBS—in the Pharmaceutical Benefits Scheme and the national healthcare agreements. It is providing a 45 per cent funding increase for rural programs compared to the $483 million in the last Howard government budget, when health responsibility rested with the then Minister for Health and Ageing, now Leader of the Opposition. This $483 million includes also $200 million to help tackle the shortage of doctors and health workers. Under programs which we will introduce as of 1 July of this year, 2,400 rural doctors will for the first time become eligible for grant payments to remain in rural and remote areas, a very important initiative. At the same time, that will affect the medical workforce in 500 communities across the country. That is a dramatic change from the way we have done our business in the past. It will not solve all the problems, but it is an initiative which I think will provide significant change to the way in which we do our business and provide real opportunities for us to attract people into the bush and retain them there.

Another element of the workforce, of course—which I know the member for Lyne would be aware of—is that of overseas trained doctors. While I talked before about the workforce, what I do not think the Australian community properly comprehends is the importance of overseas trained doctors. In 2008 and 2009, there were 5,027 GPs working in rural and remote Australia. Forty-five per cent or thereabouts were overseas trained doctors—almost half. Frankly, we could not deliver primary care in the bush without overseas trained doctors. When I met these overseas trained doctors in South Australia—I met with them in Wilpena Pound—we had a very long discussion about the importance of these doctors and the respect they have within their own communities where they are working and the respect they have from their peers. I think that we need to get the message across to people that these doctors are very highly qualified and very well trained and sustain medicine in the bush. They do, and we have to recognise it.

I think that what we need to do is comprehend the total workforce picture. We need to talk about recruiting and training more doctors and having more GP training places. We need to think about how we deal with overseas trained doctors. We need to think about how we attract and retain allied health workers. We need to think about how we attract and retain nurses. We have made significant strides in that direction.

Whilst I know that the member for Lyne was not at all political in his contribution, it would be remiss of me if I did not make some observations about the Leader of the Opposition when he was the minister. We have lifted the Abbott cap and increased the GP training places by 35 per cent to over 800. We have increased by 10 per cent this year the number of training places for junior doctors to experience working in a general practice setting. We have provided additional opportunities for GP training in the bush—really important initiatives. I think they go unremarked by the opposition, I might say, simply because they are embarrassed by their own poor performance. We have invested in an extra 1,000 nurse university places. We have established Health Workforce Australia.

We know already that the Leader of the Opposition has over recent days been making fairly callous and mindless accusations on the question of ministerial responsibility. Yet we had a picture today of Abbott’s balls. He was responsible for a process of having golf balls as an initiative to attract doctors to work, and unfortunately he had forgotten about it. I just say to him: be very, very careful when making these accusations across the chamber if you neglect to think about your own opportunities when you were in government. I would say to him also that, when he is thinking about what we might do on health reform—going back to the health reform space—what he might do is look at his own poor performance, the impact of withdrawing the billion dollars, the impact of capping the number of GP training places and the impact of not addressing the issue of shortage of nurses and say what impact that total effect had on the health system.

You and I know that in rural Australia we have really felt those changes; as you rightly point out, the further away you are from the major metropolitan centres, the less you are in front of mind and the less access you historically have to the dollars. But we need to think about those things. I applaud the member for Lyne for raising them in the chamber.

The Health and Hospitals Reform Commission process has been enlightening and enlivening. I am sure you will see over coming weeks and months new changes and initiatives to the health system which will go a long way to addressing the concerns which have been raised by the member for Lyne. We will look very seriously at the 123 recommendations of the report from Dr Christine Bennett. I am absolutely, 100 per cent confident that the changes which we will bring about to the nation’s health system will be seen far and wide as bringing about the significant change that you require.

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