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

I am pleased to be able to make a contribution to this debate on the Health Insurance Amendment (National Rural Health Commissioner) Bill 2017. The purpose of this bill is to amend the Health Insurance Act to establish a National Rural Health Commissioner, who is to provide advice to the relevant minister on the role of the rural generalist, to develop a national rural generalist pathway, and to provide advice on rural health reform, as requested. The proposed commissioner's position will cease operation on 1 July 2020.

We will not be opposing this legislation, but we do believe that the commissioner has been given a very narrow purview and we believe this falls short of what the expectations properly are. I know the announcement made by the coalition in the 2016 election campaign about the appointment of a National Rural Health Commissioner and the development of a rural generalist pathway was supported by the sector. I note in particular that there was good support after the announcement of the position by the government. There was support from the National Rural Health Alliance. The CEO, David Butt, said:

Australia's first Rural Health Commissioner has the potential to be the catalyst for transformational change for the 7 million people who live in rural and remote areas.

He then made the observation:

Currently, poorer access to health services results in poorer health outcomes. That covers the whole spectrum of health – promotion of good health and wellbeing, prevention of illness, early intervention, particularly in general practice and primary health care, and more specialised treatment when needed.

The Rural Doctors Association of Australia welcomed the pledge, and that is important. Dr Ewen McPhee

We're welcoming this with open arms, this is a fantastic opportunity for rural Australians and all the groups that represent and address the health needs of rural Australians to come together at the highest levels of government, and make sure that our voices are being heard.

That is important.

Significantly, the Australian College of Rural and Remote Medicine, an organisation for which I have the greatest of respect, welcomed the announcement by the Hon. Dr David Gillespie, who is at present at the table in the chamber, to establish the role of the National Rural Health Commissioner. Professor Ruth Stewart, the ACRRM president, said:

The National Rural Health Commissioner will be an independent advocate, advising government on regional and rural health reform and representing the needs and rights of regional, rural and remote Australians and will lead the establishment of a National Rural Generalist Pathway.

She went on to say:

The College has been working towards the implementation of a National Rural Generalist Pathway for a number of years, and we are pleased that this important initiative has been given a high priority.

Hear, hear I say to that. I will come back to that a little later.

I want to point out how important it is to address properly the health needs of people who live in the bush. To date, sadly, we have failed the bush. I say this having been the Minister for Indigenous Health, Rural and Regional Health and Regional Services in a previous government. But we do believe that while the development of a national rural generalist pathway is, in my view, more than welcome and is long overdue, it is unclear what role the commissioner will have in terms of how the implementation will be and what his or her role might be beyond that. This could have been a real opportunity to create a commissioner with real political support who could put rural and remote health on the agenda. I am hoping that this is the case—that it will happen—but I am concerned about the narrowness of that person's brief.

These concerns are further underlined by the fact that the office will cease to exist in 2020. I wonder why. Why would you want to terminate this position in 2020? The concerns of people in the bush about their health and health care will go well beyond 2020, and I can tell you that we will not have the solutions by them. It is very important, I think, that we support the amendments Labor will move aimed at improving the legislation by broadening the scope of the commissioner's role and reviewing the terms of reference. I note that there is no provision in the bill to extend the position. There is no review of the provisions of the commissioner's position within the legislation. That is a problem that needs to be addressed by an amendment. The scope of the commissioner's role is primarily focused on the establishment of a national rural generalist pathway and the bill appears to ignore other issues in rural health. That is a real problem. Also, there is no advisory body proposed to assist the National Rural Health Commissioner with his or her work. That is also a significant problem.

Those of us who have lived in the bush for any length of time—and I know you have Deputy Speaker Coulton—understand the vagaries of health services and what it means. We note from the work of the Parliamentary Library, through the Bills Digests, that they quote a number of medical practitioners who are currently working in the bush. I note that in their report, which includes data from tables in an Australian Institute of Health and Welfare report, it is very clear that in 2015 the supply of employed medical practitioners, not general practitioners, in major cities was 441.6. In rural and very remote areas, which is where I live, it was 262.8—probably 80 per cent more medical practitioners operating in the cities. And of course what that leads to is different levels of service.

That explains why, in part, we have very significant and different health outcomes for people who live in the bush. And we know—I know you know from your experience, Mr Deputy Speaker Coulton, as I do from mine, and the minister at the table surely knows—that we need to do a great deal more if we are to assist in improving the health needs of people who live in the bush. Australians who live in rural and remote communities have mortality rates—and here I am quoting from the AIHW, itself quoted by the Parliamentary Library—that are 1.4 times higher than for those living in major cities; mortality rates for coronary heart disease were between 1.2 and 1.5 times higher in rural and remote areas compared with major cities, and death rates due to diabetes were between 2.5 and four times as high.

You know, Mr Deputy Speaker, and I am sure many others in this place know, that if you live in a remote part of this country—what I call 'bush', as opposed to regional New South Wales, or coastal New South Wales, which some people regard as regions—and if you live where I live and look after the community that I look after that they are desperately in need of health care. Aboriginal people in my electorate have the worst health outcomes of any people in Australia, yet they are very concerned about the nature of health services that get delivered to them. I would have thought that the job of this new person, this position, should be expanded well beyond the scope of what is currently being envisaged and should talk about the panoply of issues that confront the health workforce, for example—not only in employing more doctors, but we know that we have an emerging health crisis in this country around the shortage of nurses. That will impact upon the bush. We know that in all areas of allied health care there are shortages of workers, particularly in the bush. We know there are shortages of Aboriginal health workers in the bush, and we know that government—any government—is yet to really embrace the idea of physician assistants and giving them a role in the bush.

I know it is something that has been explored in Queensland, and the previous, Labor, government in Queensland actually had explored this option and built in training packages at the University of Queensland. I now think there are only two other institutions in the country that provide training opportunities for physician assistants. But I do want to commend the Queenslanders for picking up the idea of rural general practice. It is very clear, in my view, that if you provide a rural generalist pathway and you expand the training opportunities for doctors working in the bush then you will get a far better health outcome for those people who are being served. I want to commend the Queenslanders, and ACRRM in particular, for advancing the cause of rural generalists. They deserve praise. I know there have been naysayers in other parts of the profession. What I say to them is: 'Get your head out of the sand. If you don't understand the need to provide additional specialist training for GPs who are working remotely so that they can do other procedures that might be required, then you're failing to understand the nature of the health workforce issues in this country or the health needs in this country, and that is really very important.'

Last week I was in a very remote part of the Northern Territory, Alpurrurulam. Alpurrurulam is a community of about 500 people. It is closer to Mount Isa than it is to Tennant Creek or Alice Springs, which is where I live, but a 1½-hour flight by light aircraft. For much of the year it is inaccessible because of road issues. But real issues exist in communities like this around fundamental questions about the health workforce: how do they attract not only doctors but qualified nurses, allied health professionals who are able to move in and out? How do they provide the housing and resources that are needed to make sure that those communities are being properly served? And they have endemic chronic disease. We know this, and I know the minister at the table would understand this all too well. We know from evidence given by the AIHW that the levels of service that are being given to Aboriginal people who live in the bush and other people who live in remote parts of Australia are far less than those being provided for people who live in the cities. Part of it is about the accessibility and availability of the workforce. And if this new position does anything, it has to look far beyond the idea of just rural generalists and look at the whole panoply of health workforce issues so that we know that we have someone in the structures of government whose job it is to examine the detail of what is required to improve health outcomes and the opportunities for the health workforce in the bush.

We know there have been, over many years, all sorts of proposals to expand opportunities. There have been incentive payments that are clear and obvious for remote doctors, and they are very good. They do not exist in the same way for other health professionals, and they perhaps should, because we need to make sure that we are incentivising people to relocate from major metropolitan centres, where it could be argued that there is a bit of overservicing, to people in the bush, where we know there is dramatic underservicing. And we have to comprehend the rationality of looking at people as individual workers and understanding the dilemmas they face in relocating their families from, say, Sydney or Melbourne to somewhere like—even your own electorate of Parkes, Mr Deputy Speaker Coulton, or, in my own electorate, perhaps to Katherine, and working remotely from Katherine into remote communities.

We are now seeing some GPs who are job sharing in the bush. They are quite happy to do a fortnight or three weeks at a remote community like Alpurrurulam and then go away, come back in another month and do another three weeks. If we can get those sorts of things happening on an ongoing basis then we know we are getting continuity of care, and that is what is ultimately very important if we are going to improve the health outcomes for Aboriginal and Torres Strait Islander people who live in the bush as well as people more generally who live in the bush. Men in particular have a problem in the bush, partly because they are men and also because they just fail to get the service they need because they are just too damned stupid sometimes to actually stand up and take notice of what people are saying to them and go out and get help. Clearly, this is an issue which this position ought to be contemplating.

I would also argue that an issue which we know now is top of the agenda for many people around this country is the issue of mental health. We need to make sure that people who live and work in these remote parts of Australia are being supported in that regard, and that requires mental health practitioners. We have insufficient numbers of mental health practitioners working in the bush.

No magic wand is going to change that. But what we can do is to work cooperatively and in a bipartisan way, I hope, to try to improve these health outcomes by getting workforces which are properly trained and focusing their attention on the needs of people who live in the bush—well, what I call the bush but many might call pretty remote. It is remote, but it is therefore necessary that we appreciate that these people have the worst health outcomes in the country and therefore need the most attention.

I would say to the minister at the table, Minister Gillespie: whilst we commend you for initiating this proposal, I think you do need to look beyond 2020. I think you need to look at the amendments which have been proposed by the Labor Party. That would be, I think, a good thing to do—to accept in good faith that those amendments are being moved to try to improve the outcomes for people living in rural and remote areas of Australia or what others might call the bush but I might call something different.

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