Fiona Phillips (Gilmore, Australian Labor Party) Share this | Hansard source

I am always pleased to talk about rural and regional health so I am happy to rise tonight to support this bill, the Health Insurance Amendment (Continuing the Office of the National Rural Health Commissioner) Bill 2020. Health is very important to country communities like mine. Our health system can't be a cut-and-paste of those in the city. We can't use a cookie-cutter approach and think everything will be fine. Country areas need to have country-specific health policy, rural-specific health policy. That is why I support this bill today—because it is recognition by the government that a rural health commissioner is necessary into the future and that more changes are needed to improve rural and regional health. When the Office of the National Rural Health Commissioner was first established in 2017, Labor raised concerns about the fact that the office would cease in June 2020. It took a while—three years, in fact—but the government have now decided that we were right, and I am glad they did. One thing I notice about the government is that they fight and fight Labor, and then they realise that we were right and they do what we suggested. It's lovely, but I simply wish they would get there a little quicker, because, while they dither, people in country areas suffer. That is the reality.

Take the new Eurobodalla regional hospital, for example. This is another one where I hope to one day be able to say that the government realised we were right, but it sure is taking a while. I have been standing with the community in their calls for a new Eurobodalla hospital for years. The current Moruya and Batemans Bay hospitals are only level 2 facilities. They are small regional hospitals. This means that two-thirds of local patients are forced to travel outside of the area to get the treatment they need—to Canberra, Shoalhaven or Sydney. This means time away from families and friends, those essential support services. It means more expense and more stress when needing to seek vital medical assistance. In an area with a growing retirement-age population, we need to make sure that our hospitals have services up to the necessary standards to meet the needs of local people.

My electorate of Gilmore on the New South Wales South Coast has one of the highest numbers of aged pensioners in Australia so, naturally, good-quality hospital systems are crucial. Late last year, when the New South Wales Labor leader and I met with local residents in Tuross Head at a kitchen table discussion, they said the poor hospital services were turning older people away. They can stay for a time, but not as they get older. It is too risky. Those residents could see how absolutely vital this new hospital is. I thank them all for their contributions.

The New South Wales and federal governments have been dragging their heels on this critical infrastructure for years. It was only last week that the New South Wales government even confirmed that the new hospital would be in Moruya—very welcome news, absolutely, but we have waited a long time for it. At the same time, the New South Wales government has also committed an additional $50 million, which is excellent. I welcome any additional funding towards the new Eurobodalla hospital. I have been calling on the Morrison government to do the same.

But it isn't enough to just replace what we have. We need to make sure that there is real improvement for local people and local health workers. We need to ensure the hospital is a level 4 facility. This is critical. We need to ensure there is an acute mental health inpatient facility included. We need those assurances from the government urgently. I have long been calling for the New South Wales and federal governments to include funding for mental health inpatient beds as part of this new hospital, and I want to see the government take this issue seriously. This hospital has taken too long to get off the ground. The community, rightly, wants to make sure that we have a facility that is fit for purpose and will provide the ongoing health support we will need into the future. As Dr Michael Holland has said:

The Eurobodalla Health Services Clinical Services Plan was submitted to NSW Health in July, 2019.

Improvement of services needs to be provided immediately within the existing infrastructure as requested by the Petition to the NSW Legislative Assembly and as recommended by the NSW Health Agency for Clinical Innovation.

He went on:

The commencement of work on the single new Eurobodalla hospital needs to occur as soon as possible.

The community on the far South Coast deserves no less. Dr Holland has campaigned tirelessly, along with a number of people in the community, for improved health services in the Eurobodalla. I thank him for his ongoing dedication to this. We are still waiting for the clinical services plan, the next important step. I look forward to seeing those details.

It isn't just Eurobodalla hospital that is in desperate need of additional investment by this government, the Shoalhaven Hospital redevelopment has also been promised for too long without enough action to get it off the ground. It is yet another example of coalition governments at the state and federal levels dragging their heels on rural and regional health. Shoalhaven Hospital is a major regional hospital. In March this year it was revealed that 43.1 per cent of people wait longer at Shoalhaven Hospital's emergency department than the state benchmark, ranking it seventh out of the list of longest emergency wait times in New South Wales. That is absolutely outrageous and not good enough. We know that complete bed block and code blacks at this hospital are chronic, but the Morrison government is doing nothing to support the state in addressing these issues.

The hospital's lack of acute mental health beds is exacerbating this problem. Mental health beds are hugely important in taking pressure off emergency departments. They mean that people suffering from acute mental health episodes can get the appropriate treatment they need when they needed. But, in another show of rural and regional health being put last, the subacute mental health unit at the hospital was closed for three weeks during the bushfires over Christmas. This is cost saving with people's lives at one of the toughest times of the year—incomprehensible. At the time, I called on the Morrison government to intervene and provide funding to keep the unit open. The Morrison government has continually said it is committed to providing the best mental health care and support for all Australians. But all they did was divert responsibility for this closure to the New South Wales government. They abandoned our community. Sadly, that is the government's record on rural and regional health.

We need to make sure that all our regional hospitals have adequate services. For some time the community in the Milton and Ulladulla area have been campaigning for a CT scanner at the hospital. According to an article in the Milton Ulladulla Times, local paramedics have said they have become a taxi service taking people to Nowra to access the scanner there. Why do the people of Ulladulla have to settle for fewer services, more travel, more stress and difficulty? We deserve better than this. The government's changes to rural health policies are hurting our communities.

In 2018 the government announced a number of health workforce changes under a so-called Stronger Rural Health Strategy. The strategy sounds great, improving access to health services in the bush, but the reality is different. The strategy changed the rural classifications for restricted doctors, that is doctors who trained overseas or in a bonded position in Australia. These doctors can only claim Medicare benefits in defined rural areas. In 2018 the government changed this from the longstanding district of workforce shortage to a new distribution priority area system.

I want to use the example of the Shoalhaven Family Medical Centres to show the negative impacts these changes have had on practices on the New South Wales South Coast. The Shoalhaven Family Medical Centres run general practices in Vincentia, Worrigee, Basin View and Culburra Beach. I have had the pleasure of meeting with the practice owners Dr Hao Pham and Mrs Annette Pham on number of occasions now. Under the old system Shoalhaven Family Medical Centres were provided with replacement provision exemptions under section 19AB of the Health Insurance Act 1973. This meant that when an overseas trained doctor left the practice, they were able to replace them with another overseas trained doctor. Dr Pham and Mrs Pham advised me that at the time the changes were introduced the practice was in the process of recruiting two new doctors under these provisions.

In a letter I received from the minister after the changes came into effect on 1 July 2019, the minister advised that the Department of Health would still consider applications from practices in a 'workforce shortage area' that began before the changes came into place. It is certainly the Shoalhaven Family Medical Centres' view that they should meet this requirement. However, the two doctors had been denied Medicare provider numbers because the practices are not located in a 'distribution priority area'. The practice has sought reviews of this decision by the minister. However, I am yet to receive a response from the minister on this issue. As Mrs Pham said, the department continues to cite complex legislation which changed without their knowledge and has left them worse off than they were before. We need to be encouraging doctors into country areas. We need to be making it easier for practices to recruit and keep doctors in our community. Mrs Pham has said, 'It is just too hard to try and wade through this,' and she has given up.

The government's changes and cuts to rural and regional health are hurting our providers and, by extension, hurting our communities. In January, official data confirmed that out-of-pocket costs for people in my electorate to see a doctor had increased by 34 per cent. Local people are now paying $8.27 more per visit than they were under Labor. Why are people in rural and regional areas having to pay more to see the doctor? This government has been waging a war against Medicare for years. Health costs have never been higher than under the Morrison government, and it is rural and regional Australia that is suffering.

I have spoken on a number of occasions in this place about the Shoalhaven Women's Health Centre. This centre is based in Nowra, but it has been providing mental health outreach services to the Ulladulla region thanks to funding from the federal government. But this funding is due to cease in 13 days. The centre has been trying to obtain a further commitment of $70,000 from the government so that they can continue this outreach. As most people would know by now, the Ulladulla region was severely impacted by the recent bushfires. We know that this has had a huge impact on the mental health of local people. Throw COVID-19 on top of that, and it is not difficult to see that we need to be increasing mental health support in these areas. But the government has been reluctant to provide this funding—as I said, a total of $70,000.

I wrote to the minister in February this year on behalf of the centre. In March, the centre was told to try the Primary Health Network. The Primary Health Network had been given funding for additional mental health services in bushfire impacted areas, and maybe the centre could benefit from that. Fantastic news, we thought. But this contract had already been awarded. So, back to the minister I went, again, asking him to ensure we don't lose this vital mental health service in the Ulladulla region. I'm really pleased that the Shoalhaven's Women's Health Centre has received some additional funding from the federal government. However, the money is for financial counselling services. It's very welcome indeed, and hard-fought, but the money cannot be used for mental health services, so the Ulladulla outreach services remain severely at risk. So, again, I ask the minister to provide the Shoalhaven Women's Health Centre with the $70,000 they need to keep this vital local service going. Time is ticking. There are 13 days to go. It isn't much, but it makes a huge difference to local organisations and the people they serve.

We need to make sure that rural and regional areas receive targeted and appropriate services for their needs. We can't use a cookie-cutter approach. What works in the city doesn't necessarily work in the country. What works in one regional area doesn't necessarily work in another. The fact of the matter is that many of the government's changes have been hurting rural and regional areas like ours on the New South Wales South Coast. Not enough focus and attention has been paid by the federal government to improving our local hospitals.

We simply aren't doing enough to recruit and keep doctors in rural and regional areas, and healthcare costs continue to rise. The government need to take urgent action on this. They need to address it now. So I support this bill today, and I hope to see more changes by the government that will improve outcomes for people in rural and regional areas. I commend the bill to the House.

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