Steve Georganas (Hindmarsh, Australian Labor Party) Share this | Link to this | Hansard source

I move:

That this House condemn the Federal Government for:

(1)

failing to adequately fund healthcare in Australia;

(2)

its role in causing the current doctor and nurse shortage in Australia; and

(3)

failing to adequately address this shortage.

The health of the nation is expensive, but everyone from economists through to the public know that it is more cost effective to get your health system right and keep people living and working healthily rather than making the odd saving and letting things deteriorate. For the national economy to be healthy we need to adequately invest in our own health. This means money being put where it is strategically needed; it means managing the nation’s health system and ensuring the supply of the health workforce.

The federal government’s record in this regard, though, is not one that most Australians would applaud. The 2006-07 federal budget gave us a double whammy. While health expenditure decreases as a proportion of government spending overall, it also fails keep up with health inflation. So the federal budget is actually decreasing this government’s investment in health and leaving us with a shrunken share of health funding which is, in itself, of decreasing value. This means poorer health outcomes for Australians.

What the budget did advance was the agenda of the Council of Australian Governments. Sixty-two per cent of the total health budget concerns measures driven by COAG. This is somewhat ironic. The last time the government and the states negotiated hospital funding, the federal government ripped $1 billion off the table. But we have seen the states step in and take over the national health agenda. COAG measures of late largely stem from the report of the Productivity Commission that was released in January 2006 which identified a health system with serious and substantial shortcomings. Areas within which the federal government’s game has been found lacking are: improving preventative health care, increasing the number of training places and retaining more of those currently employed and those who will re-enter the workforce.

There has been a widespread and long-term acknowledgement of shortages in workforce supply, especially in the fields of general practice, medical specialty areas, dentistry and nursing. Naturally there are many and varied factors that have brought this to be. As in many industries, and in Australia’s population as a whole, the health industry’s workforce is ageing. It is estimated that one quarter of the existing nursing profession will retire in the next 15 years. Ageing doctors are tending to work fewer hours and I am sure many suspend their careers for family reasons. Health industry professionals are facing increasing workplace demands and, in cases, poor professional and financial rewards are resulting in more and more qualified professionals opting out to make alternative careers for themselves, which increases the pressures on those who remain within the industry.

Poor planning and insufficient investment are also playing their part. Take the nursing profession: the current estimate is a shortfall of 31,000 in nursing. That is increasing every year but over one-third of qualified applicants for university nursing places are being turned away, refused entry to the profession and refused a role in sustaining and strengthening the overall health workforce. And while these hopeful Australians are turned away by the federal government’s failure to adequately support its own health system, this same government bends over backwards to bring 2,500 nurses into Australia on temporary work visas in 2005-06 alone. The lack of planning and investment is also evident in the medical profession. With national shortages of GPs, the government’s bureaucratic bungling has caused a queue of 1,200 doctors waiting for Medicare provider numbers. And while this remains unaddressed, the government again pulls out its 457 visa card.

The number of doctors recruited from overseas last year included 980 general medical practitioners, and the overall number has risen in the last 10 years by some 30-plus per cent so that now some 25 per cent of the medical workforce comprises doctors trained overseas. Still, shortages remain and this government’s failure to adequately plan, invest in and support its own health industry remains evident. The Productivity Commission identified these shortcomings and flagged the necessity for broad health policy and health funding reforms.

As no-one else is prepared to, we have witnessed COAG drive the health agenda in this country. We have seen state governments driving the higher education sector to increase numbers in certain health professions, not the federal government which is responsible. We have a federal government which has put down its pen, lent back in its chair and effectively encouraged the states to gather around the desk and perform the federal government’s own job and advance the national health workforce agenda. If the government says, as it does, that dental health is not their thing, not their fault and someone else’s problem, then how can the minister’s own call in recent months for the federal government to take over hospitals be greeted with anything but mirth?

Dick Adams (Lyons, Australian Labor Party) Share this | Link to this | Hansard source

Is the motion seconded?

John Anderson (Gwydir, National Party) Share this | Link to this | Hansard source

I second the motion. It will hardly surprise you that my opening remarks will indicate that, whilst I do not pretend there is never a need for increased effort in the area of health—expectations continue to rise, technologies tend to expand and people’s expectations that society will be able to help them access these new technologies and capabilities, even in quite advanced years, increase—in reality we manage health care at a federal level quite well. I think the government deserves much commendation for the efforts it has made and indeed I firmly rebuke the former speaker, the member for Hindmarsh, for his implication that somehow the states are simple, pure and clean. The member behind me comes from Queensland.

Michael Johnson (Ryan, Liberal Party) Share this | Link to this | Hansard source

Absolutely!

John Anderson (Gwydir, National Party) Share this | Link to this | Hansard source

I think we have seen some pretty clear evidence of bungling in the administration of health in that state, including the registration of medical practitioners whom, it would have been revealed with something as simple as a Google search, should never have been employed to work in this country’s health systems.

In terms of funding, I am almost inclined to think that one of the things that we ought to be prepared to do in this country is display a little proportion and balance. Whilst, as I have acknowledged, you can always do better, the reality is that, so I am told, we spend more on health in this country than the GDP of 65 per cent of the nations on earth, and we ought to always recognise that we indeed have probably as good as the best, if not the best, health care available to any of the peoples on earth, notwithstanding the fact that administratively, as we have seen in places like Queensland, it sometimes goes seriously wrong. I would not excuse any mistakes made by the Commonwealth in that regard either. Nonetheless, I think we have done quite well.

We come to the thrust of this debate, and in many ways it must, by definition, centre on what is acknowledged as quite a serious shortage of doctors, specialists, nurses and allied healthcare workers in this country. The reality is that if we are short of them now, 10 years into government, given the training time involved, particularly in specialities, where must the blame lie? On those who, frankly, were in government before us. I would hear, if they were here, the collective groans of those who might be present on the other side, but it is a reality and I would like to focus briefly on what has happened in rural and regional Australia.

When we got into government it was estimated that we were somewhere between 600 and 900 short in country Australia of a reasonable number of GPs, and something like 900 to 1,100 specialists short. They are extraordinary figures. The then health minister, Dr Michael Wooldridge, and I undertook a country tour. We went to the base hospital in Tamworth, a big regional centre, and to Gunnedah, a mid-size country town chronically short of doctors at that stage—disgracefully short of doctors. Those doctors there were doing a Herculean task but working against the odds, and exhausted. We went to Mudgee, a reasonably well-provided mid-size town; Moree, a substantial town with some particular health needs with its high Indigenous population; and Ashford, a small one-doctor country town.

What emerged from that was something very interesting indeed, and that is that the chronic shortage of doctors and nurses we had in country areas was related to the fact that for decades—and this is why I say the previous speaker needs to have a look at the record of the Labor Party in office—we had not been training anything like a sufficient number of country kids in medicine and health care. We had known for a long time—the department of health had all the research it needed to formulate right policies and the ministers of the day should have been responding—the reality that if you want enough country doctors, nurses and healthcare specialists you have to train enough country kids. In fact, the intake of country kids had got down to four or five per cent. At one of our great medical schools, country intake was down to two per cent. Via a range of mechanisms we got that back up to somewhere around 25 to 30 per cent.

I meet country kids everywhere who are going to study medicine or who are well through with a RRMA scholarship. I meet others who have benefited from the Flynn scholarships. The point that I draw from this is that we have, since very early days in this government, been addressing a problem that predated us and even now it needs to be recognised that those doctors are only just beginning to graduate. The vastly increased supply of doctors that we will have for those areas of need is only now starting to emerge because we had to correct a very longstanding policy shortfall that predated this government.

Let me conclude by just referring to the amount of money being spent. Since we came to government, annual spending on health and aged care has more than doubled from $19 billion in 1995-96 to an expected $48 billion in 2006-07. I think that is clear evidence of a real financial commitment and a very strongly increasing medical expenditure on the part of the federal government in this country.

Chris Hayes (Werriwa, Australian Labor Party) Share this | Link to this | Hansard source

I congratulate the member for Hindmarsh for bringing this motion to the attention of the House. I could not agree more with his sentiments—perhaps taking a slightly different view than the member for Gwydir on this subject. Electorates like my own are currently paying the price for the cuts to doctor training that were introduced in 1996, the year that this government took office. Werriwa currently has a ratio of population to full-time equivalent GPs of 1,700 to one—that is, 1,700 people for every full-time equivalent GP. This is in contrast to the Department of Health and Ageing recommended acceptable levels: a ratio of around 1,200 to one.

Recently, the shadow minister for health, Julia Gillard, visited my electorate with me at Carnes Hill. We were presented with a petition from over 1,000 residents from that one suburb calling for more doctor training. Since that time, I have been receiving many petitions in my office dealing with the same subject. I would like to take the opportunity to thank Graham Conroy for his efforts in collecting those signatures. As a resident of that area and someone who is particularly concerned about the state of health and the provision of GPs—like the concerns of many other people in Carnes Hill—he has made it his task to go out and have this discussion within his suburb.

Constituents in my electorate are paying the price of GP training places that were reduced to 400 when this government took office—and it put that in as a first-order priority after the 1996 election. Nearly half the households in my electorate—and, I assume, in many other growing and younger electorates—contain couples and dependent children. These families are now concerned that they will not have access to medical care when they need it and when their kids need it.

What is worse, the cuts to the health programs keep coming under this government. In the last budget alone, the government decided that that it would slash the More Doctors for Outer Metropolitan Areas program by $1.5 million. This program has already assisted two doctors relocating to my electorate of Werriwa. But, instead of using it to encourage more doctors to relocate to the outer metropolitan areas of Sydney, this government has decided to cut the program. It is clear that health simply is not the priority of the Howard government.

This government will say that the problems it faces in health care are all the fault of state governments. The member for Gwydir is no different. That is precisely what he was trying to argue in his contribution to this debate. The blame game is not what the residents of my electorate want to hear. They want to know that, when they need it, they will have access to health care and that their family will have access to proper health care when it is needed. They want to know that, when they are sick or when their kids are sick, there will be someone available to help them.

I welcome the fact that the University of Western Sydney will have its medical school up and running very shortly and will be training students in the outer metropolitan areas of Sydney. I am confident that the school will produce excellent doctors, as the staff who are involved with the school—people like Professor Neville Yeomans, the head of the school, and Dr Andrew McDonald, the assistant professor, who is also head of paediatrics at Campbelltown Hospital—are highly dedicated and will work hard to produce their best efforts when producing doctors for our area, for outer metropolitan Sydney. But they know that this will not resolve our immediate problem. They will not be able to produce doctors for a number of years. Add to that the fact that a recent survey from the medical profession reports that many GPs are saying now that doctors should specialise rather than go into general practice, and that obviously paints a very grim picture for health care provided by our system.

The government boasts that it is spending record amounts on health, yet the budget document says otherwise. It is cutting the PBS. It will only fund bulk-billing initiatives for a further two years. It is wasting money on advertising to prop up private health insurers, and additional funding for medical research that is promised now appears in the budget to be conditional on the sale of Medibank Private. What is worse for people in my electorate is cutting the More Doctors for Outer Metropolitan Areas program. This is a disgrace, and it reflects the attitude that is being exhibited by this government.

Michael Johnson (Ryan, Liberal Party) Share this | Link to this | Hansard source

I am pleased to speak on this motion in the parliament today. At the outset, I want to bid a very warm welcome to the people of Queensland and of course to all the residents of the wonderful western suburbs in the Ryan electorate. I am pleased to speak in the parliament about an issue, health care and health policy, which is very important to my constituents. In general, it is a very important issue for the people of Queensland, particularly as they go to a state election. We all know in Queensland that health care, the management of health, is one of the top two or three issues in Queensland. Indeed, it might even be ranked as the top issue for the people of Queensland.

We know that managing health care is very challenging. It is very important to each and every Australian. Indeed, health care is literally a question of life and death for many Australians. We need a very significant minister to lead this area. In the case of the Howard government here in Canberra, we do have that with Tony Abbott. I am not quite sure whether the opposition spokesperson, the member for Lalor, would have the same capacities and talents as Mr Abbott. Let us see whether there is any guidance from the last election. The shadow spokesperson came up with a healthcare policy called Medicare Gold, if I recollect accurately. Thank goodness the people of Australia emphatically rejected that, because it would have taken us to the cusp of bankruptcy. It was very Whitlamesque in its nature.

In this parliament, the Howard government has the great responsibility of the health management of the nation. Since the Howard government came to office in 1996, annual spending on health care and aged care has more than doubled from $19 billion in 1995-96 to $48 billion in 2006-07. In 2006-07 the Australian government expenditure on health and aged care will be 22 per cent of total Australian government expenditure, compared with 15 per cent under the previous government in 1995-96—an enormous amount of taxpayers’ money, which reflects the significance of this area for the government.

In 2006-07, the Medicare Benefits Scheme will be $11.2 billion of the $48 billion. Supporting the states’ and territories’ hospital systems will be some $8.8 billion. Subsidising prescription medicine will be $7.1 billion. Assisting Australians with the cost of private health insurance will be some $3.3 billion. It is 2006 and I am still not quite sure whether the opposition supports the private health insurance scheme. I would be very interested to know that, because of course previously they rejected that policy.

There is $3.7 billion in veterans’ health care, and in the aged in community care sector some $7.8 billion is spent. It is a lot of taxpayers’ money, reflecting the Howard government’s priorities in the healthcare area. As the Minister for Health and Ageing says, clearly the Howard government is the best friend Medicare could ever have, and clearly the Howard government is the best friend that everyday Ryan residents using the Medicare system could ever hope to have as well.

I want to draw the House’s attention to the PBS. The PBS is the mechanism by which the Australian government ensures that as many Australians as possible can benefit from costly medicines and drugs that would be out of reach for most Australians. Some 2½ thousand different brands’ items are listed on the PBS. In 1995-96 the PBS expenditure was $2.5 billion. In 2006-07, PBS expenditure will be in excess of $7 billion. This represents almost a tripling of nominal expenditure.

We all know that the opposition clearly and without any capacity at all has a go at the government for its Medicare take-up. I want to refer to my electorate of Ryan, where the bulk-billing rate has gone up from 52 per cent to 56 per cent. I know that the opposition quite often has a go at the government in this area, but that reflects that this area of the health portfolio is no longer fertile ground for them. In Queensland it is up some 12.5 points to 74 per cent, as the minister for health referred to in question time today. I think it is very important for members of the government to continuously remind the electorate. As a Queensland based federal member I am going to continue to remind Queenslanders that it is time for them to give the Beattie government a real kick. (Time expired)

Harry Jenkins (Scullin, Australian Labor Party) Share this | Link to this | Hansard source

I support the motion moved by the member for Hindmarsh and congratulate him on bringing this important area of public policy up for discussion today in private members’ business. Those that have spoken on behalf of the government have tended to look at the figures and resources that they claim are being put into health and claim that the adequacy is just on the basis of quantum. I think the real problem is that you need to analyse where these funds are going, the misdirection of funds and the fact that, in toto, these funds do not effectively look at the long-term best interests of the Australian healthcare system. If we continue to have a system that is based on secondary and tertiary health care and do not really look at the role of primary health care, the role of general practice, the role of community health centres and at what is happening in the day-to-day lives of people, we are going to completely miss the point.

The member for Werriwa talked about the outer western suburbs of Sydney; I will talk about the outer northern suburbs of Melbourne, where the population growth is great. One municipality that I represent is having eight new residents a day moving in. That is at least two households a day. When you look at some of the new suburbs you see that there are no general practitioners or neighbourly family medicos living in those areas because the needs are being outstripped by the growth. These are the problems that we confront. The member for Werriwa indicated that the ideal ratio of population and general practice is 1,200 to one. In the electorate of Scullin the actual ratio is about 1,500 to one, and the shortage is getting even more stressful because of the population growth and the ageing of the health workforce. General practitioners are ageing and they are not being replaced.

A number of the programs that the Howard government has had in place have missed the mark. The outer northern suburbs of Melbourne have fallen through the cracks. It is all right to talk about regional Australia—meaning rural regional Australia—but in the regions of our major cities there is no direct assistance in combating the types of shortages and disproportionate ratios that are seen in electorates like Scullin.

The shortage of nurses is chronic. It is a shortfall of something like 31,000 nationally and it is growing every year. There are plenty of statistics that show that the average age of nurses is increasing. There are not enough new nurses coming on stream to replace those that are leaving the profession, so we need to look at the ways in which we can assist people to get into training and make it more attractive for trained nurses to be retained in the workforce. The government at one stage, in the run-up to an election, indicated that they would lessen the HECS burden for those who go into nursing. What have we seen? What has been the outcome? Of course it is the reverse. The HECS burden for a nursing course is nearly 40 per cent more than the minimum HECS contribution. This is despite the government indicating that they would assist and understand that this is a burden on a special skills shortage in the Australian population.

The other thing that we need to look at is the amount of work that is done in outer urban areas—areas that might be seen as being on the wrong side of the Yarra. Traditionally one of the workforce issues in Australia has been that we cannot get medicos spread across the metropolis as we would like. It has always been places like the northern and western suburbs of Melbourne and the western suburbs of Sydney that have had these shortfalls. But the general practitioners that actually operate in, say, places like the Northern Division of General Practice in Melbourne consult something like 5.7 locally per head of population; nationally that ratio is 4.7. So it is not as if they are not doing the work and putting in the effort. But why should general practitioners in electorates like Scullin have to work harder? We need to address these shortages.

These shortages exist because not enough people are going into university courses to meet the shortfalls. Members of the government say that the number of places has opened up but it is still behind the eight ball. We need to have concrete ideas that will see that these types of workforce shortages are addressed. It is in the long-term benefit of our health system that general practitioners can play their important role in primary health care throughout Australia. 

Sophie Mirabella (Indi, Liberal Party) Share this | Link to this | Hansard source

I am pleased to be speaking on this motion today about the health system in Australia because there is a very good story to tell. It is unfortunate that it is left to the member for Hindmarsh to do the heavy lifting for the Labor Party in moving this motion because it seems that the opposition spokeswoman on health has clearly lost interest in the health portfolio and rarely uses question time to raise matters on health policy. The former Leader of the Opposition claimed that the 2004 election was:

... a referendum about the future of Medicare. It’s a referendum about the future of health care in this country.

Judging by the result it is pretty clear that the Australian people feel that their health system is in very good hands with the coalition government.

The honourable member for Hindmarsh has accused the government of failing to adequately fund the health care system and failing to address workforce shortages. This claim—at a time when 22 per cent of total government expenditure is pumped into the health system—is patently absurd. A decade ago the Labor government spent $6 billion on Medicare benefits. Today the figure is $10.4 billion. It is little wonder that the oft-quoted catchcry of the Minister for Health and Ageing is gaining traction because all the evidence backs up the fact that the Howard government is the best friend that Medicare has ever had. We have overseen the single greatest health care policy to complement the existing Medicare system with the institution of the Medicare safety net. It is a scheme that the Labor Party wants to abolish even though it is greatly assisting thousands of people in my electorate with their out-of-pocket costs for out-of-hospital treatment, something the Labor Party chooses to ignore.

We have substantially increased bulk-billing rates, including in my electorate where bulk-billing rates have been traditionally low. We keep the popular and very useful 30 per cent private health insurance rebate while Labor continues to send out confusing messages about its future. We know of Labor’s deep-seated hatred of the private health insurance rebate. It stems back to 2000 when it was claimed by the former Leader of the Opposition, Mr Latham, that the current Leader of the Opposition was going to:

... make some major policy announcements. For instance, he is going to scrap Howard’s rotten private health insurance rebate.

It is also suggested that the member for Jagajaga ‘despises the rebate and wants to pole-axe it’. The private health insurance rebate was even extended and improved for older Australians at the last election.

So much for Labor’s supposed concern at improving health care in this country. All they do is whinge and complain but never offer any detailed policy alternatives. We can only look at their recent history and the albatross hanging around their collective necks in health care. 

Ian Causley (Page, Deputy-Speaker) Share this | Link to this | Hansard source

Order! The time allotted for this debate has expired. The debate is adjourned and the resumption of the debate will be made an order of the day for the next sitting.