Emma McBride (Dobell, Australian Labor Party, Shadow Assistant Minister for Mental Health) Share this | Hansard source

I rise to speak on the Health Insurance Amendment (Continuing the Office of the National Rural Health Commissioner) Bill and support the amendment moved by the member for McMahon. Labor supports this bill which amends the Health Insurance Act 1973 to continue the Office of the National Rural Health Commissioner and expands its function.

During debate when the legislation and the office were first established in 2017, Labor were quite concerned that it was due to cease by June this year. The government now shares this concern, and this is why we're debating the bill before us, which extends the office indefinitely and expands its power. Until now, the commissioner has been focused on the establishment of the National Rural Generalist Pathway, which the previous speaker has spoken about, an advanced training program for GPs.

The bill expands the commissioner's remit, including providing advice to the rural health minister about matters relating to health in rural, regional and remote areas; undertaking specified projects about matters; and inquiring into and reporting on specified aspects of those matters. As part of the broader remit the office will now consider the entire health workforce. As a pharmacist and allied health worker myself, this is something that I think is really critical—including nursing, allied health and other health workers.

I want to focus a little on the divide between health and wellbeing that people experience between those living in major cities and those living in the bush. In its 2019 report on rural and regional health, the Australian Institute of Health and Welfare found that on average Australians living in rural and remote areas have shorter lives, higher levels of disease and injury, and poorer access to and use of health services compared with people living in metropolitan areas. The report found that people in remote areas were more likely to report barriers to accessing GPs and specialists than people in big cities. Life expectancy for both men and women decreases as remoteness increases. This is a really stark divide between Australians living in major cities and Australians living elsewhere. And, given the very real disparities in morbidity and mortality between the city and the bush, I welcome the continuation of the office and expansion of its role.

One thing that I want to focus on was, although we strongly support the intent of the strategy, which was to improve access to health services in the bush, that some of these measures as they've been rolled out in recent months have had some unintended consequences. It's become clear that the government's changes are hurting regional and outer metropolitan areas. The first change is to Medicare bulk-billing incentives. GPs are paid additional incentives when they bulk-bill children and concession card holders. The incentives are higher in rural areas than cities to encourage GPs to practise in the bush. But, under the government's changes to classifications of rural areas, many regions have lost access to the higher rural incentives and been dropped to the lower metro rates.

The government initially claimed just 14 areas were affected, but it was revealed at Senate estimates that 433 areas have seen cuts. GPs in these areas have seen about a 34 per cent reduction in their incentive payments. GPs have built their practices and business models around these incentives, and now they've been stripped away. Many GPs say this threatens bulk-billing and some say it threatens the viability of their practices altogether.

The second change is the longstanding district of workforce shortage system. Doctors trained overseas or in bonded positions in Australia—and I've worked with many of them—can only claim Medicare benefits for a time in defined rural areas. The government has changed the system from the previous DWS to the distribution priority area. The DWS wasn't perfect, and while we welcome a change that takes into account socioeconomic considerations, it appears the DPA model is also flawed. The change is having unintended consequences in areas that were classified DWS but are now not distribution priority areas.

The third change is the abolition of the Rural Other Medical Practitioners Program. Under the former program, GPs were paid a higher rebate if they practised in rural and regional areas. The government's stated intent was to improve the quality of rural and regional GPs and has abolished this program. At the same time, this has removed the incentive for GPs to practise in this area. In some regional towns, the abolition of ROMPs has forced the closure of the towns' few remaining general practices and, along with other changes, has made it harder for surviving practices to recruit and retain doctors.

While Labor support the intent of the government's rural health strategy, we were alarmed by continuing acute health worker shortages experienced in rural and remote Australia. But any efforts to boost rural health shouldn't come at the expense of regional areas that are also struggling to attract and retain doctors, nurses and allied health workers, and that's what these changes have done.

I'd like to turn now to the critical issue of mental health in rural and remote Australia. Before the COVID-19 pandemic, Lifeline reported that more than 40 per cent of online crisis chat contacts were from rural and remote locations. Beyond Blue says:

Remoteness is a major risk factor contributing to suicide and the likelihood that someone will die by suicide appears to increase the further away they live from a city.

They went on to say:

… people in outer regional, remote or very remote areas of Australia face more barriers to accessing healthcare than people living in major cities, making it harder … to maintain good mental health.

The COVID-19 pandemic is having a particular impact on young people's mental health and wellbeing. New data from ReachOut, which was released this May, showed a 50 per cent spike in the number of young people seeking help from their digital youth mental health service compared with the same time last year. According to ReachOut, from 16 March to 17 May this year their online information and support for isolation and loneliness was accessed more than 17,000 times. That's one young person every five minutes accessing ReachOut. Yet this bill fails to mention mental health. This appears to be an oversight when rural, regional and remote communities face the challenges of access to services and distance. Without a coordinated effort, rural, regional and remote communities will continue to struggle to receive the mental health services that they need when they need them.

The National Rural Health Commissioner released its interim report to the Minister for Regional Health, Regional Communications and Local Government in March 2020. The report observed the workforce challenges of allied health services. It said:

The undersupply and maldistribution of the allied health workforce has a significant negative impact on the accessibility of allied health services for rural Australians and the severity of impact increases with remoteness.

The report went on to say:

… there is strong unmet need for more allied health services in rural and remote Australia.

And:

Policies need to accommodate growth of rural public, not for profit and private service capacity.

The National Rural Health Commissioner will release its final report later this month, and I urge the minister and the government to adopt any recommendations calling for improved access to allied health services.

As a pharmacist who started out my pharmacy career in 1997 in Forbes, I believe appointing a deputy commissioner to focus on allied health is a big step forward. Allied health professionals include pharmacists, social workers, OTs, physiotherapists, dietitians and psychologists who serve our rural communities as best they can, often across vast distances. Allied health professionals provide care in settings from outpatient clinics to in-home to hospital and are often the first point of contact with the healthcare system for somebody living in remote Australia and sometimes the only point of contact with the healthcare system for that person. However, I urge the government to also consider a deputy commissioner with responsibility for professionals involved in mental health care. The stated No. 1 social priority of this government is suicide prevention towards zero. Having worked in adult acute mental health inpatient units in a regional centre at Wyong Hospital in my electorate for almost a decade, I urge the government to see this as crucial and something that the government must consider.

Experience tells you that mental health in rural, regional and remote communities deserves priority, focus and an urgent funding boost. Too many people in these communities don't have access to services that people in big cities just take for granted, often leading to tragic consequences. This is even more important as we face the long and bumpy road to recovery from the economic impacts of COVID-19.

The minister would be aware of the link between unemployment and financial distress and mental health crises. It's well established. As Suicide Prevention Australia highlighted in its report released this March, an unemployed person is nine times more likely to take their life than someone who is working. The Productivity Commission report estimated the cost of mental ill health to the Australian economy to be between $43 billion and $51 billion each year, and that was before COVID. Mental health professionals and services in the bush need to be given priority and focus, and there's an opportunity to do that. The National Rural Health Alliance, made up of 44 organisations, said in its response to the draft PC report:

… it is preferable to have a focus on wellbeing—wellness not illness—and this approach needs to be implemented as part of a holistic approach to mental health wellbeing …

The service providers that make up the NRHA understand best practice for mental health in their communities and they should be heard, Minister. I urge the government to clarify what role the commissioner and the deputy commissioners will have concerning mental health. This is a chance here to be able to give mental health the priority, focus and resources that it needs. I urge you to consider this, Minister.

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