Ms Catherine King (Ballarat, Australian Labor Party, Shadow Minister for Health) Share this | Hansard source

I too rise to speak on the Health Workforce Australia (Abolition) Bill 2014, which seeks to repeal the Health Workforce Australia Act 2009 and absorb Health Workforce Australia's functions and programs back into the Department of Health. As we have heard from a number of contributors to this debate, Health Workforce Australia was established by Labor to provide a national, long-term, coordinated approach to health workforce planning and reform to ensure that Australia's health workforce can meet Australia's health needs into the future.

One of the points that the new Minister for Health likes to trot out is the glib line that these are all just bureaucracies and that they have no value at all. This measure is counter to the government's own claim that they are seeking to put health on a more sustainable footing. Leaving aside that this has now been revealed to be a mere fig leaf for breaking their own election promise of 'no cuts to health', they are cutting health and they are heading down a path of substantially changing the Medicare system we have in this country. I note also that not a dollar, as noted in the previous speaker's contribution, is in fact being reinvested in the health system, in medical services, in public hospitals or in doctors, where there is apparently such a crisis of sustainability, which blows the government's own arguments out of the water.

Clinicians are saying that where huge efficiencies are to be had in health—and you can look at academic paper after academic paper—is in the areas where we try to achieve consistent clinical practice across the country, tackling issues that lead to adverse events in hospitals. We know from the data that, in terms of readmissions to hospitals because of clinical failures, they are occurring and they are occurring on a more regular basis than they should be, and we actually have to deal with issues of quality and safety. We have to tackle issues that lead to those adverse incidents in hospitals and readmissions. We need to look at other clinical settings—for example, infection control, improving the quality and safety of clinical practice. Who oversights all of that work? Who actually brings stakeholders together? Who teaches people about the important clinical guidelines and how you actually work? They are organisations like Health Workforce Australia, like the Australian Commission on Safety and Quality in Health Care. They are the organisations that are actually driving efficiency and productivity in health. The government, in this bill in particular, is in fact going counter to its own false arguments.

In 2006, the Productivity Commission was asked to look at the whole issue around the health workforce, and it concluded that a more sustainable and responsive health workforce was needed. The report went further by highlighting the complexity of Australia's health workforce arrangements and the numerous organisations and agencies involved in health workforce education and training. In other words, what we had at the time was lots of smaller agencies, inconsistencies between the states and territories, lots of different committees and a bit of a hodgepodge when it came to health workforce planning. It was getting better in terms of GPs—not so great in specialists but in terms of nursing and allied health it was literally a mess.

In response to that Productivity Commission report, in 2008, Labor took a proposal to COAG, which then agreed to the formation of a national health workforce agency to work across jurisdictions to build more effective, streamlined and integrated clinical training arrangements and to support workforce reform initiatives. The legislation establishing Health Workforce Australia was introduced in 2009 and, in 2010, Health Workforce Australia commenced their work, partnering with higher education providers, the training sector, the health sector, employers, professions and regulatory bodies to deliver a sustainable health workforce for Australia.

The key responsibilities outlined for Health Workforce Australia were national funding, planning and coordination of clinical training across all health disciplines and across jurisdictions, supporting health workforce research and planning, funding simulation training, and progressing new workforce models and reforms.

Health Workforce Australia in that short time has established itself and developed a track record in national health workforce planning. It has broad support from across the health workforce peak bodies in this country, and it has broad support from states and territories in its role. In 2012, Health Workforce Australia produced the first national long-term projections for doctors, nurses and midwives, titled Health workforce 2025doctors, nurses and midwives. It set out the workforce needs of Australia in critical workforce groups over the future. The report highlighted that, under the arrangements and policy settings at that time, Australia would face a significant shortage of nurses and doctors by 2025.

Labor deliberately set this agency up as separate from the department. Any of the people who have worked either in the department, as I have, or in agencies outside know the extraordinary tension that exists between policy development and the implementation that occurs. What we have seen constantly in this particular space is a really important debate, one I want to highlight here. The department has been very keen for a long time to get Health Workforce Australia and the funding associated with it back in the department. It has been very keen. I know that the department is not that keen—I am not going to refer to personalities within the department—to have too many separate agencies outside. With a new government coming in, I am very concerned that basically this has just been one of the agencies that has been put up to be brought back into the empire without any real thought being given by the government to what that actually means. I just caution the government about always taking on absolute face value every single piece of advice it might get. It needs to come up with its own ideas, and this one, I think, is concerning.

Since being established, Health Workforce Australia has funded close to 8½ thousand new quality clinical training places for students across 22 disciplines. Through the Simulated Learning Environments Program, Health Workforce Australia has increased simulated education hours by 115 per cent. I visited the John Hunter Hospital recently, where they were having an emergency theatre operation performed. They had their specialists, their nursing staff and their anaesthetists there going through the important practices that they needed to do. They talked about just how critical it had been to get the extra funding from Health Workforce Australia and the huge change they had had in the way they were doing clinical training within their hospital and bringing clinicians from other hospitals into that facility to make sure that they improved clinical training.

Mr Ewen Jones interjecting—

Mr Laming interjecting—

I note the interjectors, and I note particularly that one of the interjectors is a former clinician, who I would think would actually be concerned that his own profession does not support the government on this measure. His own profession does not support this bill, so I am interested that he happens to have somehow forgotten where he has come from as he has come into this place.

Taking on the challenges of workforce distribution and responding to the identified needs of rural and remote communities across Australia, Health Workforce Australia's efforts have delivered an additional 446 nurses and allied health professionals in those areas. Health Workforce Australia has also commenced work on an innovative reform strategy for the rural and remote health workforce and also for the Aboriginal and Torres Strait Islander health workforce, an area where there are critical shortages.

In direct response to the House of Representatives report Lost in the labyrinth, the agency, in conjunction with the Australian Medical Council, has jointly funded the construction of Australia's first National Test Centre, which will serve to expedite testing of international medical graduates seeking to practise in Australia.

All of this planning and program activity is critical if Australia is to have the health workforce able to meet the health needs throughout Australia into the future, and it is critical if communities all over Australia are to be well served with good access to healthcare providers. As I have said many times in this place before, Australia's population is ageing, and we have increasing rates of chronic disease. If Australia is not planning and positioning itself in relation to the workforce needed to care for our future population, then we are going to be in strife.

This government is determined to undermine and rip apart universal health care for all Australians and revert to the old way, its way, of a haphazard and unplanned approach to workforce planning. Labor knows that that did not work, which is why Health Workforce Australia was established as a separate entity from the department and why funding was appropriated to support the unified, national approach to the health workforce for all Australia. A key issue arising out of the Health workforce 2025 report was the importance of and need to improve the national coordination of medical training by working with trainees, employers, educators and governments through a National Medical Training Advisory Network. If the government is to do away with the agency established to lead and drive this work in a coordinated way, it is not clear who or what entity it expects to carry on with it.

I have already outlined that Health Workforce Australia's programs were addressing the issue of the distribution of the health workforce, in addition to increasing workforce numbers. The government can run their line on delivering front-line services—and I heard that from the side here—as much as they want to, but, unless you invest in, plan, coordinate and train the health workforce of the future, there will be no-one to deliver those front-line services, no-one to deliver them in rural and regional communities, no-one to deliver them in Indigenous communities and no-one to deliver them in the outer metro areas, where there is extraordinary pressure on those services. So you can just see that there is an absolute myth in the way they are constructing these arguments.

Another really well-progressed initiative of Health Workforce Australia was the Expanded Scopes of Practice Program. I note particularly their extended-care paramedics project as well, ensuring that extended-care paramedics are able to assess patients in their own homes, reducing the number of presentations to emergency departments and reducing the number of patient transfers—an area of health efficiency, I would have thought. These advance paramedics are being trialled in South Australia, Tasmania, the Northern Territory and the Australian Capital Territory.

I note that even the government's own Commission of Audit has acknowledged the Expanded Scopes of Practice Program and suggested that this type of reform go further. Who do you think is going to do that work? Health Workforce Australia is at arm's length from government, at arm's length from the department, in an incredibly contested space. Who do you think is now going to lead and develop that work? The abolition of Health Workforce Australia is anticipated to 'save' the government $142 million. The minister would have us believe that no support is being taken away from the health workforce, but how can you take $142 million out of clinical training, placements and planning and still be maintaining support for the health workforce?

When Labor came to office we inherited the now Prime Minister's caps on GP training places. We in fact doubled the number of places to 1,200 and increased this number each year so that Australia has top-quality, well-trained GPs moving through the ranks to provide Australians with the primary care they need. Under Labor the number of nurses in training grew by 11,000 and the number of specialists in training by 5,000. And we invested through Medicare Locals, providing funding to plan and fund extra health services that were supporting around 3,000 front-line health workers like GPs, nurses and psychologists. The investments that Labor made to supporting and growing Australia's high-quality health workforce were having an impact on all regions and enabling services to be delivered by a well-trained health workforce.

As at February 2013, Australia's health workforce totalled 1.3 million, made up of 25,000 GPs; 24,000 specialists; 290,000 nurses; 14,000 midwives; 12,700 dentists and 4,000 more people employed as dental therapists, hygienists and prosthetists; 1,254 Aboriginal health workers; and almost 94,000 registered allied health professionals—all doing critical work in this country. Abolishing Health Workforce Australia is not the way to continue to support planning in this area.

Labor will not and cannot support this bill because it is counter to the government's own arguments about how you get efficiencies in health. If you want to improve clinical training and education and get efficiencies in health, if you actually want that to occur, then you have to have an agency that is driving it. These are not bureaucracies. These are important organisations that are seeing important work done in the area of health efficiency. (Time expired)

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