Andrew Laming (Bowman, Liberal Party) Share this | Hansard source

As we inherited a health system that ran out of money, as we pore over the performance of a Labor government that never saw a cause they could not fund, we come here today to look at Health Workforce Australia. I think it is only appropriate that we recognise that the many good employees in that agency did great work over four years and that some very important reports were prepared, written and disseminated. But the work of Health Workforce Australia in doing that good work is now done. We now have to reinvest in the front line of health and that has been a clear message from the coalition government.

Australia is one of the most sparsely populated countries in the world, with one of the highest performing health systems. Keeping up that quality care in every corner of this nation, wherever citizens choose to live, is a daunting task. I say to the 35,000 GPs out there, the 290,000 nurses and the 100,000 allied health workers all over this great nation: thank you for what you do every day, and the interference from government—certainly if I have anything to do with it—will be as minimal as possible. Thank you for caring for Australians from dawn to dusk; for the after-hours work you do; for your coordination of complex care in tiny towns. To all of you: thank you. Be you from Cape York to Kalumburu, from Byron Bay to Busselton, we have an incredible health workforce.

With that workforce come some pretty big challenges in health distribution, capacity and training, but it is not one where we need to count our successes by the number of floors in the high-rise building where we have bureaucrats offering support. This is not to be measured by how many pot plants are watered, how many water bubblers we have and how many people we can employ in major cities worrying about country areas. No, this is about supporting the front line, and that is what this government is determined to do. When you have a health system in a nation like Australia endeavouring to deliver world-class care in remote, rural and regional areas as well as in our cities where there is high need, the one thing we must be sure of is that we never take a dollar away from that old man who needs a new hip, that we never take a dollar away from that woman who needs cancer treatment, all in the guise of needing better organisation.

I can appreciate that no matter what country to go to, no matter great their health system is, if you talk to people they will find problems. The natural Labor inclination for every challenge is to set up another agency. That government set up so many agencies they ran out of acronyms—they could not come up with any more acronyms. We have over 20 health agencies now, all with their own individual backends, their own administrative systems, their own support systems, and all operating in a space where it gets so complex they need yet another agency to tell agencies how to talk to each other. There are a dozen health agencies collecting health data using different criteria so that we cannot even perform basic comparisons with that information that is so expensively collected.

I say to Australian practitioners out there in the health system that we as a government want you to go and serve the people and we know a third of Australians do not live in capital cities. You have seen governments from both sides of the fence—let me give some credit—working on that really important proposition. But when the Abbott government came to power we said we just did not need more floors in a high-rise building in a capital city to fix a problem. We know that if we are going to fix a workforce problem we do so with a workforce solution—and you start with your students. You make it more possible for them to get scholarships. You make it more attractive for them to be supervised by our great clinicians. You create more general practice training places. You free up some funding for infrastructure, not in a GP Superclinic handout. That is not how we do it on this side. We provide matching funds so that regional practices will invest their own money and truly utilise that investment efficiently in infrastructure to help GPs train others and train their successes.

I have lived in a country town that had a retiring general practitioner. The fear in that town at the thought of losing a general practitioner was palpable on the street, outside the Foodland, outside Australia Post. Attracting practitioners out there is a complex balance of supporting Medicare and supporting access, supporting those good country people who take out private health cover and often do not use it greatly because there is not even a private hospital in town.

We have got to support access to the PBS by looking after that pharmacist and making sure that he or she can afford to run that business. Then we have to make sure that support for ancillary and allied health care is such that allied health workers will leave the cities where they train and set up their shingle in those small towns. That is the essence of a workforce solution and that is the coalition's approach to doing just that.

I do not want to take the remaining five minutes to pull apart the achievements of Health Workforce Australia. I have already said that some of their reports were valuable and welcomed. The Health Workforce 2025 report gave us some pretty sobering statistics, about being over 100,000 nurses short within 15 years and, depending on productivity and 'business as usual' modelling, we could well be short by up to 1,500 to 1,800 general practitioners. In the end, those figures told us what we already knew. They told us we had workforce challenges ahead. The 'do nothing' scenario, business as usual, was never going to happen, because sensible governments were going to make changes between now and then to ensure Australians had the support and the services that they need.

Let us make no mistake: we are getting close to the appropriate numbers of many of our health professions. There is still room for more nursing training. We have a maldistribution issue, an issue of redirecting the health effort to areas where it is most needed. That was to be the focus of Health Workforce Australia but, like most entities established by the previous Labor government, they were hopelessly and overly broadly commissioned. They were expected to do everything and, in the end, they did a few things well. However, we are replete with examples of poorly-spent money.

I understand the Growing our future report and the emphasis upon respecting, encouraging and cultivating our Aboriginal health worker population is really important. We need those Aboriginal health workers. But I am not sure that we needed to develop the community's understanding by funding a television documentary to do so. I have got no problem with really great but modest causes being done pro bono. I have no problem with engaging the university sector—PhDs and those who are aspiring to earn one—getting involved in solving some of our great problems. But I do not think that, as long as our health system will always need more money on the front line, we should be doing things like funding large and complex online hubs in the hope that they will be used by practitioners. There are way more modest ways to get to the same solution.

When I heard about the National Inventory of Innovation I thought to myself, 'How many hardworking GPs actually have time to look at online innovation hubs?' In reality, if you are going to refocus and refashion general practice in regional Australia, start by talking to the local GP. Do not start by setting up an empire in Adelaide and then wondering what you can create from the fifth floor that will reinvent health workforce in Australia.

Health Workforce Australia embarked on a very important piece of work, looking at cancer workforce in Australia. We have significantly refashioned cancer service delivery in this country, but we are still vexed with major publicly funded cancer services in large cities and smaller cancer services in regional cities and the way in which these interact. Health Workforce Australia were right to turn their attention to that topic. But, in the end, have they significantly changed the business model of cancer in this country? The answer is no—a fascinating expose of the challenges of getting cancer workforce out into our regional cities and towns but, in the end, very little change.

The National Health Workforce Innovation and Reform Strategic Framework was published in the middle of last year. It was a comprehensive course of action for a range of reforms that would have been appropriate to help regional workforce. But I put to you: that is the job of the department. The previous speaker, who claims to be a bureaucrat in a past life, acknowledged the tension between policy creation and service delivery. But that is not an excuse sufficient to create new agencies; it is an excuse to fix the problem in the department. The department is big enough, well-resourced enough, to attack some of these major workforce challenges without the need for these extra agencies.

We also know that Health Workforce Australia worked on a prescribing pathway for those who are not general practitioners, nondoctors. Controversial as that is, that was never going to address a workforce problem in this country. But resources were devoted there.

Workforce agencies, states and territories would have been grateful that there was yet another kid on the block working on getting people out into the bush. Aspen Medical were relocating thousands of health workers to Central Australia, only to have yet another provider, Health Workforce Australia, lay claim over four years of effort in relocating 400 workers. That is a drop in the ocean and that is not what we expected to have another provider doing when, in fact, we have these rural health workforce agencies already fully commissioned and fully funded in every state in this country. Recruitment is a challenge and it is complex. But that is not an excuse for another agency. Fixing up the recruitment process, simplifying the immigration process for incoming health practitioners from overseas who apply to be registered here, is not an excuse to get more, independent double-dipping and silo-structured agencies operating out of, in this case, Adelaide, trying to fix a problem that really should have been sorted out, without the need for the agency in the first place.

Health Workforce Australia put together a Reconciliation Action Plan, released, I think, in April 2013. One of how many? I do not know. I ask: how many reconciliation action plans were read by health practitioners? How many of them were downloaded? With the greatest of respect, I am very keen to see as many reconciliation action plans put together as possible. But I do not see the need for massive transfers of government resources to develop them. Plans focusing on fostering these relationships are utterly welcome, but not large transfers of taxpayers' money to achieve them.

We have had 500 health leaders come together for a conference, the first national conference in, I think, 2012, Reshaping Australia's Health Workforce. There is no problem if it is cost recovery 100 per cent. I have no problem with a health leaders' group. There is no problem with a group of 500 young health leaders getting together online, at no cost to the taxpayer, because that is how it should work. There is no problem with cultivating those great policymakers, but there is no need for taxpayers' money to be diverted or consumed in the process.

Then we had the launch of the HWA Connect, an online interactive consultation hub. Just in case you are confused, it is different to the online resource. That was developed because there were so many of these outputs coming from Health Workforce Australia that you needed one place where you could find them all. So the next thing we knew was that we had the Integrated Regional Clinical Training Networks; the nursing workforce retention and productivity group; the National Medical Training Advisory Network; the mental health peer workforce; the Rural Medical Generalist Framework; the International Medical Graduates' Orientation and Supervision project; and Health LEADS Australia all on this resource, again, created from taxpayers' money.

You can only go so far, Deputy Speaker. You have to appreciate that. In the end there is only so much money that you can convince yourself is well spent from a fifth floor in Adelaide. Ultimately we have to go and confront the coalface that is working in small and regional communities and high-need urban communities where there is significant urban poor. That is where we need to make sure workforce is available, to make a real difference to Australians' health.

In conclusion, I have emphasised that we have a changing environment, an ageing workforce as well as an ageing population, a new raft of diseases, social and economic determinants of health that are changing and ever more complex and the imposition of highly expensive technology, and health is one of the few areas where you cannot really replace labour with capital. No matter how much capital you invest in this system, you need labour to run it. It is one of the most complex areas of public policy and one of the most complex areas of public service. There are probably more groups and more politically active groups engaged in delivering services here than in any other part of the economy. So I thank the people that do that work. I commend those that try and improve the system and lift their head away from caring for patients to dream of a better system, but most of them, no matter how much you look at, will argue that more investment in something like Health Workforce Australia was really only adding undue complexity and bringing a risk of waste of taxpayers' money to the table.

I am glad to see the back of Health Workforce Australia. I acknowledge that in their time they did good work. I think in retrospect history will record that they pulled together some useful reports. With those completed, it is now time to move on and reinvest in the frontline by building capacity, by investing in more students, by freeing up general practice places, and by having rural infrastructure funding that can be partnered with GP investment we can do just that. We can transform the situation in regional general practice and we can make sure that those in outer met and inner urban poor get all of the care that they need, complex arrangements provided by teams of health practitioners. But in the end the one thing that Australians will welcome will be the passing of an entity that for four years produced useful reports but was at risk of having an overly broad commission and letting down those who need health care most.

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