Brian Mitchell (Lyons, Australian Labor Party) Share this | Hansard source

The Health Insurance Amendment (National Rural Health Commissioner) Bill 2017 is of particular interest to my electorate of Lyons, as we identify as regional and rural, and certainly as relatively forgotten by this government in everything from telecommunications to health, education and the provision of medical services.

The appointment of a national rural health commissioner, strategically placed to drive rural health services, is music to many people's ears. Certainly, Labor will not oppose this legislation and appointment. However, Labor are seeking to improve it. Labor will seek to move amendments in the Senate that will broaden the scope of the commissioner's role, that will review rather than cease the commissioner's role on 1 July 2020 and that will establish an unpaid advisory board to support the commissioner. Labor's concerns are not around prioritising a focus on rural health but rather around the government's very narrow focus for this role. A national generalist pathway is a welcome addition to the complex world of healthcare service delivery. However, there are many other issues that need strategic management and long-term vision to support effective service capacity in rural and regional areas. This is no easy task, Mr Deputy Speaker Coulton, and Labor appreciate that. In fact, we did suggest and support the creation of a similar position long before the government initiated this measure.

The incomplete package before the parliament today represents a missed opportunity for rural healthcare service providers. The proposal is for a commissioner to be appointed by the minister on a full- or part-time basis for a period of up to two years. It lacks substance. Labor's preference was to create a health reform commission with more people and more reach to make more of a difference. Rural health care is a complicated chain of services that work with people through all stages of their lives.

If you were to take a snapshot of the lives of rural Tasmanians, including many in my electorate, the picture would look significantly different to the lives of those in central Queensland, in outback Western Australia or South Australia, or in any of the other regional and rural areas in this country. It is no surprise that a one-size-fits-all approach will never work in a country as diverse as ours. Australians living in rural and remote areas have much poorer health outcomes than those living in our major cities. The contrast is most stark for those in remote areas where average life spans of women and men are, respectively, two years and 3.4 years lower than city dwellers. Suicide rates are twice as high. Levels of chronic disease, including diabetes, coronary heart disease, lung cancer, eye disease and chronic obstructive pulmonary disease, are considerably higher. The ratio of health professionals, particularly in specialised sectors, is much lower than in city areas.

Alarmingly, despite much poorer health and much lower incomes, the average yearly Medicare Benefits Schedule spend per individual in remote areas is $536 a year compared with $910 in major cities. That gap really tells us something. Let us drill down into this a little more. Tasmania has a population of 513,000 people, with only 625 GPs across 152 practices. That means each doctor needs to have, on average, 820 patients. Tasmanians do not do very well with average weekly earnings; they are $1,344 per week. They are the lowest in Australia. Why does this matter?

The Abbott-Turnbull government has frozen the Medicare rebate for doctors, which means bulk-billing rates have fallen faster in Tasmania than anywhere else—from 76.4 per cent to 74 per cent in the last three months of 2016. This freefall is escalating, which is alarming. We have low income, low numbers of GPs and high doctor fees which are going up ever more. The GP rebate freeze looks to be a long one—kicking right through to 2020 as an election promise that was delivered by the Turnbull government. More cost equals less access for Tasmanian families. It means more pressure on late-diagnosis services. It means more use of the ER and ambulances for low-level issues. It means cost shifting from the federal government to the state. With a Liberal government in Tasmania as well, I am not hopeful that it gets the importance of health care as a universal, accessible necessity.

There are 1,560 allied health professionals across Tasmania. Our training sector to boost and strengthen this cohort has been negatively impacted by the stripping back of TAFE training services and the deregulating of university courses. All the loops in the chain of health care in Tasmania are cracking and breaking. We welcome this initiative today, but it is not enough.

Facebook chatrooms are full of people chasing appointments with doctors' surgeries who have their books open. They are one of the key ways that people in my electorate make contact with each other, and they are full of people seeking openings in GP appointment books. The emergency rooms at Royal Hobart and Launceston General are full of patients seeking basic treatments that a GP could otherwise manage. For higher needs patients or those needing diagnosis and treatment, there are 286 medical specialists. No wonder chronic care is the new focus. The system has lost the ability to manage early intervention and preventative treatments under the heavy weight of high-needs and complex healthcare complaints.

In the midst of all this, pharmacies are offering more services. They are stepping into the gaps left by GP clinics. Tasmania is a small state, with big, complex healthcare needs and a decentralised population across small towns and hamlets. Recently we have seen a very disjointed rollout of primary healthcare services that has seen the entire focus move from holistic health care to a narrow focus on just chronic health care, in its wake taking whole suites of very loved community healthcare programs with it. The Assistant Minister for Health is in the chamber today; he knows full well the impact this has had in Tasmania. I know he has been lobbied quite heavily not just by myself but by members of his own government. The senators in Tasmania are aghast at what has happened to rural and regional health service programs in Tasmania on his watch, with the gutting of services in Meander Valley and Kentish and other areas throughout Tasmania—preventative health services that kept people, certainly older people, out of hospital, kept them well in their the homes and well in their communities, and that has all ended. So that has not been good.

Communities have been outraged by the loss of these services with no real warning, no real replacement and no real understanding by the government of what people in rural Tasmania really want and of the need to keep them happy and living independently in their communities. People have come out in droves to public meetings across Tasmania, lobbying their state and federal members and senators, demanding a return of funding to services that they dearly want—and that anecdotal evidence suggests really worked. But we have not seen any movement or any funding returned to these vital services—just a cold shoulder from this government. This government seems determined to rule from its short sighted platform in the inner city rather than listening to voices in regional areas. I certainly hope this appointment of a rural health commissioner turns that around.

What is enlightening around this new role is the plan to define what it means to practice rural generalist medicine. In 2014 at the World Summit on Rural Generalist Medicine in Cairns a definition was decided upon:

We define Rural Generalist Medicine as the provision of a broad scope of medical care by a doctor in the rural context that encompasses the following:

•Comprehensive primary care for individuals, families and communities

•Hospital in-patient care and/or related secondary medical care in the institutional, home or ambulatory setting

•Emergency care

•Extended and evolving service in one or more areas of focused cognitive and/or procedural practice as required to sustain needed health services locally among a network of colleagues

•A population health approach that is relevant to the community—

and the minister should listen to that, because that is what we used to have, and—

•Working as part of a multi-professional and multi-disciplinary team of colleagues, both local and distant, to provide services within a 'system of care' that is aligned and responsive to community needs.

Unfortunately, some of those were covered under the previous system and have now been cut by this government. All those points will be an excellent starting point for the new commissioner to really double down on rural healthcare provision across the broad range of service areas, and I certainly hope we can see the commissioner recommend measures that will replace what Tasmania has lost in recent months under this government.

I cannot wait to see the yearly reporting from the new commissioner. Medicare Local, or Primary Health Tasmania as it is now, has our healthcare position in Tasmania at a place where we see Tasmania's mortality rates sitting higher than anywhere else in Australia: cancer, heart disease, organic mental disorders, injury and poisoning, cerebrovascular disease, chronic lower respiratory diseases, diabetes, other forms of heart disease, and arterial, arterioles and capillary disease all take far more of my fellow Tasmanian's lives each year than anywhere else in this country. This is devastating for my state, especially when there is a chance that earlier interventions, education, supports and preventative programs could have made a dramatic difference to these outcomes.

Today, Labor is backing this legislation in the hope that it is a first step to working on a long-term plan to really get back to basics for rural health care. It is a starting point; it is not perfect, but it is a starting point with an end point of 2020. We would prefer to see it reviewed rather than ended, so that when we take government one day—after the next election, hopefully—we will have a plan that is substantial and robust and ready to tackle the issues that rural Tasmanians and regional Australians need to be tackled.

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