David Gillespie (Lyne, National Party) Share this | Hansard source

I rise to give my analysis of the critical parts of this first Labor government budget. All around, there are so many programs that are cut-and-paste copies of initiatives that the former coalition government brought through in our former budget, particularly in the aged-care space and in the Health portfolio. I guess I could reiterate that well-known phrase that the best form of flattery is when people copy you. There are some pleasing things. During the campaign we announced some initiatives in the rural and regional healthcare space which were critical for the growth of the rural healthcare workforce. That is the most outstanding issue in rural healthcare. There are not enough nurses and doctors in rural areas of Australia. There is a huge vortex of activity that drags away a lot of health professionals—and other professionals, I might add; it's also engineers and lawyers, and pharmacists, physiotherapists, speech therapists and all other health professionals. It takes a village of professionals to get a good health system. But the most glaring thing is the lack of medical practitioners who are, first of all, going into general practice and, secondly, going into rural general practice. That's why we focused on the rural general practitioner initiatives.

Leading up to the last election, following our budget, we had announced a $143 million package. There are tiered financial incentive payments delivered in this budget, like the then opposition, during the campaign, said they said they would deliver. Just so people know, these were policies that we had worked up and funded in our last budget and that we advocated for in the election campaign. There is $74.1 million going into workforce incentive payments in a tiered fashion so that the doctors and the practices that are more rural and remote get more. For those of you that don't know what workforce incentive payments are, they are payments paid in arrears for services that medical practices deliver. It encourages better behaviour. We had already announced the bulk-billing incentive, which was tiered towards the more rural and remote areas. This is a way of getting better payments for doctors working in rural and remote areas. There was $29.4 million allocated to this out of the tiered incentive payments. We have three extra rounds of the innovative models of care program, which allows incentives to be paid to sign on young GPs into rural practices as well as other initiatives to network them and get hub-and-spoke models and innovative models that we had identified in other innovative models of care in rural New South Wales.

Rural generalist training is advanced general practice training. There is a particular model of rural generalist training which I know the RACGP is now copying from the august College of Rural and Remote Medicine; it has a very specific rural generalist program. Those two curricula will now mimic one another, not as a result of this budget but because they have decided that's a good system. This budget, like in our announcements, is to deliver another set of funding for extra places in the rural generalist program, which requires GPs being employed in hospitals so they can learn anaesthesia and so they can learn obstetrics. But GP trainees have to compete with the big specialist hospitals, which get a lot of those spots. So the only way we can get them a look-in is to actually fund those positions that are dedicated to rural generalist training.

In the last government we started the concept of having a single employer during general practice training, and we plan to expand that, because many people in salaried jobs in hospitals are very loath to leave the security of a salary with all the added benefits like maternity leave, holiday pay, superannuation payments—all those other conditions that you get with salaried employment in public health. When you become a general practice registrar you lose those and you take a pay cut, and they wonder why only 15 per cent of med students plan to go into general practice. That's why it was so important to increase the payments for rural GPs, and I'm glad that the assistant minister responsible honoured their commitment to bringing in these programs, but I would have liked more volume in that assistance.

You would also realise that there is a general shortage of general practitioners. We set up the distribution priority areas to favour areas outside the major metropolitan centres, because, whilst there is a shortage of doctors everywhere, the worst shortages are in rural, remote and regional towns, where it's not a question of having to wait a long time to get into a general practice; there are plenty of towns that don't have a general practice, or they're down to their last GP, which also affects the hospital. That's why we wanted this innovative model of care, where the hospital employs the GP, and they work in the hospital but they also work in a general practice. That way, they get all the certainty of a salary, but half of what they bill in the medical centre goes back to their single employer, which is the state government public hospital. That way, they don't think, 'Wow, if I go into general practice, I lose maternity leave, holiday pay, superannuation and all those things.' When you go into general practice, you've got to organise those things for yourself. So it's no wonder people are voting with their feet and choosing a specialty, because they see it as a higher-status, higher-pay part of the profession, and, if you do specialty training, you're staying in hospitals, with all those benefits. There is a lot more work to be done in that.

I was pleased to see that there were new places allocated to James Cook University for a rural clinical school and end-to-end training based in Townsville, and they're going to expand into Cairns. That was part of our policy too, so, again, the government have copied good policy, and I give them credit for it. But our policy wasn't for just 20 more places; we were going to allocate 80, across other rural portfolios. I put the Minister for Health and Aged Care and the assistant minister on notice that I expect them, in their next budget, to deliver the other 60 places—which aren't mentioned anywhere here—to the other rural clinical schools that we set up, so that they can have more end-to-end, in-the-country training. We know that, if they train in the country, they're more likely to stay there. If they're there for four or five years rather than just a three-month or a six-month rotation, that becomes the focus of their life, and you actually get better training when you're training in these big country hospitals.

One thing I wasn't happy about was the change to the distribution priority areas. They've made it open slather. Previously, doctors who were coming to work in Australia had to work in distribution priority areas in the country. Now there'll be some people who have come from overseas to work who will hightail it into the cities, and they'll just be another number in the cities. Outer metro is a very difficult area to staff as well, but I don't think cannibalising country towns of GPs is a good solution. The trick is to get more into general practice as a whole.

Other initiatives in this budget included more university places. Hello? We announced that in our last budget. They've made out that this is a big new initiative, but we were already doing that, also focused on rural places. We knew that there was a skill shortage. We had over 150,000 extra low-fee or no-fee TAFE places over three years. They've just added another year and put the same amount in and made it look like they're giving a whole lot more. So there is a bit of smoke and mirrors happening here. We all know we need more tradesmen. In fact, trade skills are a really important thing that the states need to support and we need to support, and we had all those incentive programs in place to subsidise the cost of first-year, second-year and third-year apprentices so that more employers would take them on. Anyone who has run a trade related business knows that your first-year apprentice doesn't really deliver a net positive cash flow, because you've got to supervise them, and they're slow. But, once they get into their second, third and fourth years, then they're not a burden on you, and you're growing your own replacement for your business. So we need more apprentices.

The former Minister for Health and Aged Care oversaw an amazing increase in cash going into the aged-care system. We allocated $17 billion, and we set up a new funding model called the Australian National Aged Care Classification, or AN-ACC, system, as opposed to the Aged Care Funding Instrument, which was being gamed and wasn't reflecting the extra costs of remote care, complex care and high-needs care in aged care. There are many institutions that, since 1 October this year, will have been benefiting from that. That accounts for a lot of this so-called extra funding that the new government has put in. It was decided in previous budgets; it's just that it's only now maturing. A lot of these things, as I said, are actually good because they're exact copies, plus a few changes of title and names, and they're claiming the credit for it—no more comments on that.

The other thing that is really disappointing in this budget is that we in the National Party had secured $20 billion of extra funds for regional development. We argued and won the case for huge investments in Darwin and in Central Australia, for sealing east-west roads through the brown plains of western Queensland across into the Northern Territory and over into the Kimberley because with that east-west link we want to connect all these corridors where the wealth of the nation is going to be developed. But unfortunately those opposite think that anything outside a capital city—like Paul Keating said, in Australia, if you're not within 20 kilometres of the CBD, you're camping out. And who on earth would want to build a road that hasn't been graded for 10 years? Well, it's a circular argument. Part of the reason a lot of these roads are needed is that they carry hundreds of millions of dollars of produce and wealth for the nation. They may not have hundreds of thousands of people, like you have in cities. If you're just going to put your money where there are lots of people, we will never develop and we would never have developed regional Australia, which is where most of the wealth of the nation is created. Our tourism product, apart from the Harbour Bridge and Parliament House, is basically rural Australia. Our beaches up and down the coast, Ayres Rock, the Great Barrier Reef, the Kimberley, the goldfields, all those adventure locations—most of them are in regional Australia. We had programs for tourism roads, for beef and cattle and mineral roads. They weren't just for the odd remote agricultural business.

But the huge amounts of money they earn for the nation involve transportation costs. That's why we were developing the Inland Rail—so that the cost of freight for products from the farm and the factories could get off the highways and through to ports. That's why we were supporting taking the Inland Rail not just to Brisbane but up to Gladstone. It was going to be great. But all those things seem to have just gone off the radar, as well as really useful programs such as the Building Better Regions Fund. It's really disappointing to hear that all those regional wealth-developing funds—they weren't bankrolling; they were just catching up with the huge investment that's been ploughed into our cities for the last 200 years. The reason we got to be wealthy was because we developed our nation, and that is why we in the National Party argued for it. If the Labor Party want to really make their mark and be respected, they'd put that money back in. They've got the opportunity at their next budget, and we'll wait and see and make sure that they do things that develop things outside of metro Australia just as much as they do inside metro Australia.

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