Warren Snowdon (Lingiari, Australian Labor Party, Shadow Parliamentary Secretary for External Territories) Share this | Hansard source

I thank the member for Murray for putting this motion on the books and I thank the seconder for doing the right thing by her and us. I will make some observations, although I will come back a little later to the substance of what the member for Murray said earlier. She mentioned the maldistribution of doctors. I will refer to that as we go through. She mentioned roadblocks, the number of training positions and the need for specialists—all of which I concur with. I just want to give some sort of picture here of why this is so vitally important.

Where I live, Alice Springs, probably is the most remote major regional town in the country and has amongst the sickest population in the country. We know—the data is there for all to see—that people in the bush, regardless of where the bush is or what your definition of 'the bush' is, are more likely to suffer from chronic disease, have a shorter life expectancy and experience higher rates of death. The main contributors to these higher rates of death include coronary heart disease, other circulatory diseases and chronic obstructive pulmonary disease. Compared to their metropolitan cousins and their brothers and sisters who live in the cities, they have a shorter life expectancy by one to two years in regional areas and up to as much as seven to eight years in really remote parts of Australia, such as in my own electorate. Of course, health outcomes for Aboriginal and Torres Strait Islander people in the bush are the worst of all. The picture here is not a good one. For example, nowhere else in the developed world are there such high rates of endemic trachoma as in Australia. We are on track to defeat it by 2020, but the fact is that we still have not.

People in remote areas are unfortunately and quite sadly more likely to smoke, more likely—and sadly, again—to engage in risky alcohol consumption and more likely to be sedentary. This places them at greater risk of developing preventable illnesses associated with smoking, alcohol and lack of exercise, and chronic and acute injuries. Rates of asthma, arthritis, bronchitis and some preventable cancers, such as melanoma and lung cancer, are higher in rural and remote areas.

Part of the rural-urban health disparity in Australia is caused by inequalities in access to health care. For example, as noted in the Australian Journal of Rural Health:

Part of the rural-urban health disparity in Australia is caused by inequalities in access to healthcare, for example, in timely access to life-saving cardiac catheterisation services and availability of medical practitioners, particularly specialists.

That concurs with the member for Murray's view. This suggests we need better service delivery of health care for people who live outside the metropolitan centres. Part of the problem is the undersupply of trained health professionals in rural areas. Whilst we are concentrating on doctors, we need to understand that we have shortages across all health disciplines in the bush.

A 2008 audit by the Department of Health and Ageing found a persistent workforce shortage in the supply of doctors, nurses and other health professionals in rural and regional Australia. Rural Australia has experienced medical workforce shortages for a considerable period across the full range of health disciplines. Numbers of GPs in proportion to the population decrease significantly with greater remoteness, with the lowest supply to very remote areas. That concurs again with the member for Murray's observation about the maldistribution of medical practitioners.

One strategy to combat this has been to restrict Medicare provider numbers for overseas trained doctors to encourage them to work in rural areas where there is a workforce shortage. Currently 41 per cent of all rural practitioners are doctors who were trained overseas—that is a staggering figure. We have a real issue here about making sure that Australian trained personnel get the opportunity to live and work in the bush and be trained in the bush.

The rural clinical schools provide a way to overcome this maldistribution, as suggested by the member for Murray, including general practitioners across Australia, by increasing the exposure of Australian medical students to training and to getting work in a rural area. It was an initiative of the Howard government that has been continued by successive governments. Ten RCSs were established in 2000-01 and a further seven in 2006-07. We now have 17 rural clinical schools across Australia, managed by 16 universities. The need for greater coordination between the university medical schools—where they are operating and how they are operating; what they are doing, in fact—is an issue that I hope to come back to.

The RCS program is part of the broader Rural Clinic Training and Support program, which is the amalgamation of the Rural Clinical School and the Rural Undergraduate Support and Coordination programs. This program, as the member for Murray mentioned, mandates that 25 per cent of medical students must be from a rural background and that they must attend an RCS for at least 12 months.

We know that people who are trained in the bush are more likely to stay in the bush. From my own discussions with people outside this place, in my electorate of Lingiari there is the Northern Territory Remote Clinical School, which was established in 2005 and has sites in Alice Springs, Katherine and Nhulunbuy. It is part of the NT Medical Program, which is a partnership between the Flinders University School of Medicine and Charles Darwin University. This program provides training and placement opportunities for Flinders University and James Cook University students and for interstate medical students from other universities, including ANU, Melbourne—you name it. They are all ending up in the Northern Territory, which is good. It allows students to spend up to six months or more in a rural location, exposing them to a different learning environment that adds to their broader clinical experience.

In my home town of Alice Springs we have had the development of the Centre for Remote Health, a joint centre of Flinders University and Charles Darwin University. It is one of a network of university departments of rural health funded by the Commonwealth Department of Health and Ageing to improve the health status of populations in rural and remote areas by appropriate preparation of the health workforce, thereby improving recruitment and retention levels. The schools have a valuable role in providing opportunities to increase intern and postgraduate training places in rural locations to enhance the future of specialty medical services delivery, with a focus on general practitioners in rural and regional Australia. I believe that the impact of the Remote Clinical School in the Northern Territory has been a very positive one. It means that more students are spending time in rural and remote communities.

It is true also that we have a large number of people seeking training, because of the number of training places that were put in place by the former Gillard and Rudd governments. We have doubled the number of training places currently available from that in 2007. That is remarkable in itself, but it means that, working together with universities and medical practitioners in the bush, we can get people into the bush and trained in the bush, ideally in places like Alice Springs and the member for Murray's city of Shepparton, which I have visited—I have visited the RCTS in Shepparton. It is very important that we undertake to reinforce our desire to see these continue.

I will make an observation: we should not be preoccupied just with medical practitioners. There are shortages across the whole range of health professions, not just in the specialties across the areas that the member for Murray spoke about but in physiotherapy, audio services, audiologists, all the health sciences you can think of—those allied health professionals who are essential to getting people to recover. What we are seeing more of is that GPs do not work on their own; they work as part of a team, which might include a physiotherapist or a speech therapist or one of the other allied health professionals. So it is important that when we think about this training we think about encouraging university departments of rural health to think about having team training, to think about making sure that when they are putting these doctors in these places for training they provide the resources where possible to train allied health professionals alongside them, because they will be working alongside them. I am sure it is the experience in Shepparton. I know it is the experience across Northern Australia. It is certainly the experience of doctors in Central Australia, and I know how highly they value these partnerships with allied health professionals, because then they can provide effective treatment for the sickest people in this country. That is what this is ultimately about: getting better health outcomes for the poorest people and the sickest people in this country—in my case, in my electorate of Lingiari. If we can continue to work with these programs, we will get the outcomes we all want over time. I say to the honourable member: whilst I understand paragraph 3(b) of her motion, I would prefer to have seen it expanded across all the health professions. (Time expired)

Debate interrupted.

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