Rebekha Sharkie (Mayo, Nick Xenophon Team) Share this | Hansard source

I wholeheartedly support the intention of this bill and the creation of a National Rural Health Commissioner. Any member of this place, and particularly the members who represent nonmetropolitan Australia, would know that access to health care for Australians who live in regional areas is significantly worse than for those who live in the cities. As the minister mentioned in his second reading speech, rural and remote Australians have a shorter life expectancy, generally have lower incomes, are older than their city counterparts, experience higher rates of chronic disease and face higher risk factors, such as smoking, alcohol abuse and obesity. We have greater challenges accessing health and mental health services based on our isolation.

In December 2015 the Regional Australia Institute released figures showing that collectively Australia's regions account for approximately one-third of our total economic output. Their report said:

… were it not for the regions, Australia's economy today would only be the size that it was in 1997 and Australia would no longer rank amongst the world's largest economies.

We are prosperous nation because of regional Australia. And yet, despite this stunning fact and the fact that one-third of our country's population lives outside of the major cities, the regions are being left behind on a wide range of issues when it comes to policy development. Nowhere is this felt more than in health. If you get sick in a regional area, you might be lucky to have a hospital in your nearest town or you might face a drive of an hour or more to a general practice clinic, where you wait for an ambulance to drive you to a major hospital. In the really remote areas, you may have to rely on the Royal Flying Doctor Service.

It is incredibly difficult to get doctors to work in rural and regional areas. Those who do so sometimes are the only doctor in town and that leads to intense pressure and responsibility. We need to implement policies to encourage doctors to work in the regions and to ensure that those doctors are supported in their endeavours to serve their communities. It is a devastating fact that regional and rural Australia have higher rates of suicide than metropolitan Australia. It is even more heartbreaking that doctors and medical professionals are suiciding at a rate more than double other professions. This is not limited to the regions; this is across the board.

I have seen firsthand how the pressures of being a doctor in regional and rural Australia can affect a community. I recently sat down with doctors from Strathalbyn, a township of 6,000 people with a small hospital. Until recently the local doctors had performed an after-hours on-call service. It was a great service for the community. In my discussions with the doctors it was apparent that the demands of being on that 24-hour roster were just far too great. I spoke to one doctor who told me that he would get called in so often that he would have no sleep and would need to work 24 hours straight, because the following day he had to see his patients in his practice. This presents a great danger to both patients and the doctors. Mistakes are made. This occurred in a town with a population of 6,000 people and a number of general practitioners. In rural towns far from major cities the effect would be magnified.

The issues in rural health extend to education and training. Australia is seeing a record number of medical students graduating from university. This is fantastic, but there is a constant battle getting new graduates to move out to regional areas. The latest data from the Medical Schools Outcomes Database survey reported that 76 per cent of domestic graduates are living in capital cities. If you expand the definition to include a major urban area, that figure increases to 84 per cent. Eighty-four per cent of Australian graduates live in a capital city or a major urban area, while a third of Australians live in a regional or remote area.

I believe that we need to put measures in place to entice medical students to look for jobs in regional and rural areas. I do not believe that we need more medical schools; rather, we need to take a strong, hard look at the schools in what they are doing to implement an outreach training into the regions. I believe that if we can encourage more young people from the country to pursue a career in medicine, it is more likely that they will want to return home to their community to practice. The current minimum intake is 25 per cent of students from a rural background. That is a good start, but I support the Australian Medical Association's stance on lifting the benchmark to at least 30 per cent of all students. It is more than offering a place to a young person; it is also about connecting them to rural health from the beginning of their degree. It is about connecting them with rural health practitioners from the beginning of their degree so that potential doctors can build relationships and create opportunities in regional Australia and can see where their career could take them. Currently just 25 per cent of medical students are required to undertake at least one year of clinical training in a rural area. I would like to see a more ambitious stance to be taken, that every Australian medical student be required to undertake a clinical placement in a regional or rural area.

I would like to take this opportunity to speak about some issues that are particular to my electorate of Mayo. In Mayo access to health care is the most common issue raised with me by constituents. For those who are unaware, Mayo stretches from the southern townships of the Barossa Valley throughout the Adelaide Hills and the Fleurieu Peninsula out to the Lower Lakes, towards the east and across and includes Kangaroo Island. The majority of Mayo is regional. The challenges in accessing health services reflect our regional status. I would also say that on a per capita basis Mayo has the oldest population in South Australia. So we have a very old population as well as a regional population.

In Mount Barker the local hospital has recently installed a service that sees a doctor overnight. This hospital has a catchment area of 70,000 people, and it is the closest hospital for people who live 20 kilometres north or east of Mount Barker. Until two weeks ago, if you were sick in the middle of the night there would be no doctor to meet you when you arrived. You would be sent down to the city. For some people that is well over an hour's drive. So I remain ever grateful to the state minister, Minister Jack Snelling, for listening to my plea on behalf of my community and months of advocacy in order for us to have an overnight doctor.

There is still no renal dialysis service in the Adelaide Hills. Again, this is an ageing population. It is the oldest electorate in South Australia and we do not have renal dialysis in one of our major centres. This means that over 1,500 trips are made to the city annually by patients so they can receive treatment. This is an area with limited public transport options, and some people are choosing to forego treatment because of the burden it is placing on their families. There are no Medicare rebatable machines in the Adelaide Hills region. This is another issue that only regional and rural Australia faces. This means that unless a patient has capacity to pay the $300, they must travel to a metropolitan area. If we had a Medicare rebatable machine it is estimated that more than 20 people a day would use it. That is how great the need is.

The Gumeracha Medical Practice is fighting for funding since the introduction of the Modified Monash Model in July 2015. In a town of just 1,000 people, the practice extends its services right across the region, with a catchment of almost 7,000 people. Under the modified Monash service the practice has lost funding, as it is deemed to be within 20 kilometres of a town of 50,000 people. This arbitrary ruling does not take into account a myriad of factors, including winding and poorly lit roads and a lack of public transport options. Gumeracha sits at the top of the escarpment of the Mount Lofty ranges and travel to the city is not an easy thing. I have written to the minister regarding this matter and I intend to continue to advocate on behalf of the Gumeracha Medical Practice. They offer services far beyond what would be expected of a small country town GP clinic, including providing training opportunities for 40 general practice registrars since 2003. They are struggling to maintain these services with reduced funding. It is one of the only medical practices in the region that offers 24-hour care. It would be another blow to our regional community if they were forced to scale back.

At the southern end of my electorate is a township called Yankalilla. The Fleurieu Family Practice is also struggling to continue its services after it was informed that its after-hours services funding was being withdrawn. The practice is the only medical facility on the west coast of the Fleurieu Peninsula, which covers an area of approximately 450 square kilometres. It services a population of 4,700 people, but that swells in the summertime to over 16,000 people. In the last two years there have been over 309 emergency presentations at that practice, such as presentations for lacerations, anaphylaxis or chest pains.

Should the clinic be forced to stop its after-hours services, some patients would have no choice but to drive south over 30 kilometres to the Victor Harbor hospital or north more than 50 kilometres to the Noarlunga Hospital. In both directions, there is no public transport. I have been talking about primary health care, but I would also like to talk about mental health services in the region. My whole electorate does not have a headspace. Mental health services in regional Australia are woeful.

These are just some of the examples I have given you of regional health centres and the challenges they face on a daily basis. I have small regional communities with somewhat concentrated population hubs, and I can only imagine how difficult it must be to deliver rural health services in areas where the population is far more remote. Honestly, I shudder to think of the challenges remote communities experience.

I am sure that these issues that I have raised are familiar to anyone who services a regional electorate. I welcome any move by the government to address the issues of health in the regions, but I question whether the introduction of the National Rural Health Commissioner should have been stronger. I note with interest that the commissioner is only being appointed for a period of two years—they will really just get their feet under the desk. And, while there is an option to extend the appointment until 2020, issues in rural health in regional Australia are not short term. They require long-term thinking and engagement with the communities in order for us to properly address the issues.

The commissioner has been appointed to develop increased access to training for doctors in regional and rural Australia, to enhance policy and to promote careers in rural health. This is excellent, but it is also limiting. As I have outlined, many Australians in regions are less financially solvent than their city counterparts, and they are older and medical services are more expensive. In my area, there is no bulk-billing. It is impossible to get in to see a doctor and be bulk-billed. Very often, people pay upwards of $50 in a gap, so I would like to see the commissioner undertake a role to reduce health costs and to closely examine health costs that people in regional Australia experience compared to our metro counterparts.

In closing, I do support this bill. Regional and rural health access is important, and it is an issue that I feel has long been overlooked by the parliament. You should not have second-class health care just because you are living in regional Australia. I believe that the powers of the commissioner could go further, but I am pleased to see that the government is recognising the challenge faced by those of us who live and work in our productive regions—our regions that are carrying the prosperity of this nation. This is a first step. I applaud the government for this step, but this is a first step with much, much more to do. Thank you.

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