Chris Bowen (McMahon, Australian Labor Party, Shadow Minister for Health) Share this | Hansard source

The Labor Party will be supporting this bill, the Health Insurance Amendment (Continuing the Office of the National Rural Health Commissioner) Bill 2020. We will support it because it implements Labor policy. This bill amends the Health Insurance Act 1973 to continue the Office of National Rural Health Commissioner and expand its functions—in fact, this bill makes the office permanent. Under the existing legislation, the office will expire at the end of this month. As the House will recall, the Labor Party has long suggested that the role should be made permanent. The honourable member for Ballarat is in the chamber, and she made that view clear when she was Labor's health spokesperson. It has been our consistent position. In the debate on the bill which established this commission, through our spokesperson the member for Makin, Labor argued strongly that the many challenges in rural, regional and remote health could not be addressed in just three years, and that the commissioner's role should be a permanent one. The government has consistently rejected that argument, although we have moved amendments at various points to implement it. We are very glad that the government now shares our view.

In addition to continuing the office, the current bill expands the commissioner's functions. Until now, the commissioner has been focused on the establishment of the National Rural Generalist Pathway, a very important new program to train GPs and one that has our support. But the commissioner's role should really be more expansive than that. I particularly welcome the fact that the commissioner will now consider the entire health workforce, including, very importantly, allied healthcare professions like nursing. Allied healthcare professionals across the board will now be within the remit of the commissioner. I also very much welcome the fact that non-statutory deputy commissioners will be appointed to ensure a focus on nursing, allied health and, most importantly, Indigenous health. These are all welcome developments, so we will be supporting the bill. We note that this has come very late. The government has left it to the last minute to continue the role of the commissioner—it expires in just a fortnight. But I'm sure the Labor Party will be constructive in facilitating the passage of the bill through both houses of parliament to ensure that the role can continue as it should.

This also gives us the opportunity to focus on rural health in more general terms. While I am sure every honourable member would like to see health outcomes improve in rural and regional Australia, the Labor Party do have very real concerns about the way the government is going about this. This was a matter of some interest in question time today, when again the minister for regional health denied that there had been any bulk-billing cuts. He said there are changes to the maps—yes, but some areas have been taken out of the rural bulk-billing incentive scheme, and that is, for them, a cut. On Monday, I visited Queanbeyan with Labor's particularly outstanding candidate for Eden-Monaro, Kristy McBain. People in Eden-Monaro face the same challenges accessing health care as other people in rural Australia. They travel too far, they wait too long and they pay too much for health care. Queanbeyan is not a hamlet, it's not a small village, but nor is it a big metropolis; it's not Mosman, it's not St Kilda—it's not inner-city. It has real regional challenges.

The government's own figures show that people in Eden-Monaro paid an average out-of-pocket cost of $39 to see a general practitioner—that's up 30 per cent under this government. To see a specialist the average out-of-pocket cost is $96—up a staggering 50 per cent under this government. So one in eight people in the Eden-Monaro area are forced to skip Medicare services because they can't afford them. I asked the minister about this today, and he said there are no cuts. You'd think the government would actually want to make the position better, but they're making it worse.

The 2018 budget announced a number of changes and, again, everybody, I think, would have the intent of improving access to medical services in rural and regional Australia. It's a very important priority for me; I've made it a priority in my time in the portfolio. I've spent a lot of time going to rural and regional areas. That's one of the reasons why I'm so concerned about some of the government's impacts: because I've seen the impacts firsthand.

My last interstate trip before the restrictions came into place was to Maryborough in Queensland, where I visited a doctor's surgery impacted by the ROMPs changes of the government—the abolition of ROMPs. I asked at that doctor's surgery in Maryborough: how long would it take to see a doctor if I rang today for an appointment? If I was feeling unwell and I needed to see a GP, when could I see a GP? The answer was two weeks—two weeks before the people of Maryborough could see a GP. Some people will get better in those two weeks. Some will get a lot sicker in those two weeks. A lot of people will experience a lot of pain and discomfort in those two weeks. It's really not good enough, and yet the ROMPs changes have impacted on Maryborough and up and down regional Queensland and regional Australia.

On the bulk-billing incentives, which have impacted on Queanbeyan, the government initially claimed that just 14 areas were affected, but at Senate estimates we found out that there are actually 433 areas that have seen cuts. These areas have seen a 34 per cent reduction in incentive payments, down from $9.65 to $6.40—these are the cuts that the minister tries to gloss over in the parliament that are recurring.

In places like Queanbeyan, GPs have built their practices and their business models around these incentives. They've been told that they were there, and now they've been taken away. Many GPs say that this threatens their ability to bulk-bill and some say it threatens their viability altogether. Again, although it's a slightly different program, I have seen GPs' clinics closed in Maryborough. I went to one with a sign on the door—shut, closed down, gone due to changes in government policy. These things have real impacts on both availability and costs.

Kristy McBain and I visited the Queanbeyan GP Super Clinic on Monday. It opened in 2012, following a $5 million grant by the then Labor government—it's a very good clinic; I was very impressed with the set-up. But earlier this year the clinic announced it would have to increase its fees. It said there were two main factors: the government's long-running Medicare rebate freeze; and 'the removal of Queanbeyan from the rural and regional classification for bulk-billing incentives by the Commonwealth government'—their words, not mine. These are doctors with no political axe to grind—I've no idea how they vote; don't care. They're just calling it as they see it, and they see the impact of government policy. This is an area where already one in eight people skip Medicare services like GP visits due to cost, and the government is making it more expensive. Kristy McBain's called on the government to reconsider these changes, and I'd agree with her: the minister should be doing that.

The second change is the longstanding district of workforce shortage—it's a different program but very relevant. Doctors who trained overseas are in a bonded position in Australia and can only claim Medicare benefits in defined rural areas. The government's changed the system for defining those areas, and there can be a case for changing these things from time to time. I don't argue in this House that the DWS system was perfect. The intent of the new system indeed is one I agree with. I welcome the fact that the new system takes into account socioeconomic circumstances. That's sensible; that's compelling. But, again, they're having huge impacts and in many instances I can only assume that the impacts are unintended.

The areas that were district of workforce shortage are no longer in many instances the new distribution priority areas, and that's having an impact. For example, Yass—we heard a bit about Yass in the parliament today, Mr Deputy Speaker, you will recall, on a different matter—has struggled to attract and retain doctors even when it was a district of workforce shortage. That'll be tougher now that it's no longer a DPA. So the government is really letting down the people of Yass, and they're particularly letting down the mothers of Yass.

We asked the Prime Minister today whether it's acceptable for women to be giving birth on the side of the road on the way to Goulburn and/or Canberra hospitals, their nearest birthing hospitals, which is happening. The Prime Minister's answer was, 'That's why we're upgrading the Barton Highway.' I almost fell off my chair, I've got to say! I think honourable members on both sides probably did. I've been here 16 years. I've heard some weird stuff. That's right up there. That's right up there in the weird stuff I've heard from the mouth of a Prime Minister—to say that's the reason they're improving the Barton Highway. The member for Ballarat will point out that, actually, our policy is better for the Barton Highway than theirs. But, even giving them some credit for doing something on the Barton Highway, to suggest that that will help the women who are giving birth on the side of the road is weird. Are there going to be birthing lanes? Are there going to be little signs? What's the upgrade which is so relevant to giving birth on the way to Canberra and Goulburn hospitals?

The government should fund a new maternity ward at Yass hospital. I suggest that would be a better policy solution than upgrading the Barton Highway, which should be done but for different reasons. Two hundred mothers a year from the Yass Valley are currently forced to travel to Canberra or Goulburn to give birth. Too many of them don't make it in time and give birth on the side of the road.

In conclusion, again, I understand the intent of the government's rural health strategy. The intent is one that I am very focused on, and it will be a very strong element of Labor's policy at the next election. But we will hold the government to account for the impact of their changes on regional Australia, wherever they be. Up and down the coast, in different areas, they're having a negative impact. They need to be accountable for that, and we will hold them to account. That's why I move:

That all words after "That" be omitted with a view to substituting the following words:

"whilst not declining to give the bill a second reading, the House:

(1) expresses its concern at the Government's cuts and changes to regional health; and

(2) calls on the Government to reconsider those measures".

I commend this second reading amendment, and the bill, to the House.

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