Harry Jenkins (Speaker) Share this | Link to this | Hansard source

I have received a letter from the honourable member for Lyne proposing that a definite matter of public importance be submitted to the House for discussion, namely:

The importance of Commonwealth involvement in regional health and aged care delivery.

I call upon those members who approve of the proposed discussion to rise in their places.

More than the number of members required by the standing orders having risen in their places—

Robert Oakeshott (Lyne, Independent) Share this | Link to this | Hansard source

I thank members for staying behind to support this matter of public importance. It is time for the greater Commonwealth involvement that has been talked about for so many years not only in this place but right throughout the pubs and clubs of Australia for many years. There is now an urgent need for the Prime Minister and the government to deliver on their health and hospital reform package. The term ‘takeover’ is one that seems to have taken over this debate. I do not think it really matters whether it is a takeover not. What we all certainly want to see is greater Commonwealth involvement—in whatever form, but hopefully one showing greater care and responsibility for the taxes that Australians are paying and for the desire of the Australian community to see the money that washes through the Commonwealth deliver real and practical outcomes on the ground for residents and recipients of health care.

I start by noting aged-care concerns. On the mid-North Coast of New South Wales we are the litmus test for this country. We are Australia in 20 years time. We are the demographics that everyone is saying Australia will be in 20 years time. It is critically important that we get aged-care funding right on the mid-North Coast and that we get it right over the coming 20 years for this country. The Intergenerational report released in the last fortnight by government once again affirmed the importance of this issue.

I want to highlight the way aged-care packages are distributed to local communities such as mine. Whilst we all in this place would take more residential packages for our electorates, the way of the future is the Community Aged Care Packages and the EACH packages, both of which provide for low-level or high-level care within the community to allow people to live as independently as possible for as long as possible. We have received on the mid-North Coast a good round of CACP and EACH packages, but if we are going to tackle this issue seriously there need to be greater resources provided through the Expenditure Review Committee and the budget process, particularly on the low- and high-care CACP and EACH packages. Please, Government, take that on board and find money wherever possible for regional aged-care living and for better independent lifestyle outcomes. Those two types of packages at a community level are critically important.

The other aged-care issue I want to raise in this health and hospital reform context is the enormous frustration in my community—and I imagine it is shared throughout the country—about aged-care type patients taking up beds in the public health system, which shows a complete breakdown of Commonwealth-state relations. There is this bed block because of a lack of aged-care places, therefore placing enormous pressure on the public hospital system and leading to less than optimum clinical outcomes for communities such as mine. If there is one change that the Commonwealth could make with regard to health and hospital reform, it is resolving the issue of aged-care type patients being in beds in the public hospital system of this country. It is a lower level of appropriate care for the aged-care patients involved, who do not need to be in hospital. It is also placing enormous strain and pressure on an already strained and pressured public hospital system. Please make sure that is part of this upcoming package.

The third issue I want to mention with regard to aged care is the national insurance scheme Bill Shorten has been talking about. Whilst it is targeted specifically at people with disabilities, if taken up it will be a complementary program with regard to many aged-care services. I endorse the scheme and I congratulate the member for Maribyrnong for the work he has done. It will expand the amount of resources available within communities such as mine and it will help deal with the full range of issues and challenges faced by people who are ageing. Please, Government, make sure the upcoming health and hospital reforms include improvements in all three: the community packages, the aged-care type patients in the public hospital system and the national insurance scheme for people with disabilities.

With regard to hospitals in particular, I want to get on record the importance of the Commonwealth starting to take a bit of care with and control over the way Commonwealth taxes hit the ground in communities, particularly growth communities such as, again, the mid-North Coast of New South Wales. Every state, in every department, has a resource distribution formula. It is their own formula. It is based on a whole range of demographics in the field and, before you come to a place like this and start to look at the detail of what government does, you would just assume that state governments followed their own funding formula. Sadly, in growth areas such as the North Coast—and the member for Page will endorse this as well I hope—the state government does not follow its own funding formula.

Janelle Saffin (Page, Australian Labor Party) Share this | Link to this | Hansard source

The RDF.

Robert Oakeshott (Lyne, Independent) Share this | Link to this | Hansard source

The RDF—the resource distribution formula. In the growth areas in New South Wales—south-west of Sydney and the North Coast of New South Wales, I am sure it is the same in other states in other growth areas—we are under equity by about two to four per cent which does not sound like much in percentage terms, but in dollar terms that is about $50 million per annum.

Janelle Saffin (Page, Australian Labor Party) Share this | Link to this | Hansard source

Fifty to 60.

Robert Oakeshott (Lyne, Independent) Share this | Link to this | Hansard source

Fifty to 60, thank you, Member for Page. That is in dollar terms a substantial amount of money that an area that is growing and is already under pressure is not accessing based on the government’s own funding formula and based on the principle of fairness and equity. I do not think it is too much for members like me to come to this place and ask for nothing more or nothing less than fairness and equity.

At the moment in the delivery of health care in a region such as the North Coast of New South Wales we do not get fairness and we do not get equity. We do not have a state government that is following its own funding formula. Therefore, the role of the Commonwealth in this new environment of health and hospital reform—hopefully the greatest change that we have seen since the introduction of Medicare—is to place a value on the money trail through the system and to make sure equity and fairness is delivered on the ground. It involves hard decisions; populations move, governments have to move with them. It means taking away at times from areas where those populations move from, but that is the work of government. We may as well not be here unless we are willing to make those decisions. Sadly, in New South Wales today those decisions are not being made and, as a consequence, high-growth regions such as the North Coast suffer. That is unfair, that is unjust and I would hope, over the coming months when we see the health mandate of the Commonwealth revealed, that there is a strong element that says equity, justice and equal funding per head of population wherever they may live is a critical part of health reform for the future.

I also mentioned the upcoming cancer funding. We are sweating on the Minister for Health and Ageing, the government and the minister at the table to be serious about that regional cancer funding. For example, in a community such as ours a second linear accelerator would be of enormous value to people’s lives where there are still, despite one linear accelerator being in operation, way too many people going outside of the community for radiotherapy services and way too many demands on families and social networks as a consequence. This would be one of those situations where you save money in the long term by spending a bit of sensible money upfront and trying to get clinical services delivered as close to home as possible. In this regional cancer package that we are hopefully going to see sometime soon, again, I would urge the government to look at the high-growth regions, the ones with the high elderly populations, the lower socioeconomic communities—I have just summed up my region—and to make sure that we are part of the mix of the future because it will provide savings to the health service by doing so.

Another point I want to make is about efficiencies in the system. We have not had much to start with and have therefore learnt to do things in our region pretty efficiently. In Port Macquarie in particular, we have a legacy of going through a period of being a privately run public hospital where there was a buck to be made at the end of the process if you were efficient in the delivery of clinical excellence. The consequence of that was that the cost per bed, now that the hospital has been returned back to the public system, stands out as being significantly less than the seven peer review hospitals around New South Wales. The question is: why? Where are the inefficiencies in the other peer review hospitals and does that reflect inefficiencies in the system more generally?

We have an excellent standard of clinical care at Port Macquarie Base Hospital. It can be done; therefore to some degree it exposes the inefficiencies in the system at other locations that were supposed to be there to peer review the privately run public hospital. It is worth government looking at that because if we are going to have a sustainable health system into the future, efficiency needs to be an important part of it. At the moment, at the end of the financial year—there was something in the paper today about it—there is no rewarding those who are efficient in their clinical delivery. At the moment there is an attempt to either spend it or run over budget so that you do not get money taken back to consolidated revenue in the future. There has to be a better way of building in the efficient delivery of clinical excellence.

A final point is again directed to the duplication in the system where on the North Coast of New South Wales we have an infrastructure list and again Port Macquarie Base Hospital is the No. 1 priority capital works project on that list—despite the hospital at Grafton getting some Commonwealth money and getting some work at the moment. The frustration is that there is also a state infrastructure list that is at complete odds to what the list, which has been put together by local administrators and local clinicians, is saying is their priority. When I was elected I was on the back end of a government promise about the $10 billion Health and Hospital Fund and it was enormously frustrating trying to get the area health services capital works list, the regional list, treated as a priority in that process. Unfortunately, the fix was in or the deal was done between the Commonwealth and the state and the state infrastructure list was treated as a priority; therefore, what the region wanted and what the region was asking for was totally ignored.

This builds into the general theme from our region that we are pitching to government—that is, the idea of place based thinking. There is not a lot of care, compassion or ears for the views of people on the ground who are delivering—whether they be in health or in education. I ask for a better process for bottom-up views to get through to the bureaucracies in the big cities like Sydney, Brisbane or Melbourne, and for place based thinking to have a place in the healthcare mix of the future. On the North Coast we have a priority on the ground and it is the Port Macquarie Base Hospital, but it is not a priority for New South Wales Health. I would have thought that the clinicians and administrators on the ground are worth listening to on the subject of future funding models. At the moment they are not being heard. It is a critical step if we are going to see the proper and consistent delivery of health care into the future.

Warren Snowdon (Lingiari, Australian Labor Party, Minister for Indigenous Health, Rural and Regional Health and Regional Service Delivery) Share this | Link to this | Hansard source

I thank the member for Lyne, firstly, for taking the initiative to put this matter of public importance on the agenda and, secondly, for his thoughtful contribution. I and my colleagues—the Parliamentary Secretary for Health, Mr Butler; the Minister for Health and Ageing, Ms Roxon; Minister for Ageing, Ms Elliot; and, most importantly, the Prime Minister—have been involved in consultations around the country concerning the Health and Hospitals Reform Commission proposals of Dr Christian Bennett’s team. There were 123 recommendations and 103 consultations with around 36 to 40 of those in regional parts of Australia. I went to the member for Kennedy’s electorate, but unfortunately was unable to be at the meeting.

Bob Katter (Kennedy, Independent) Share this | Link to this | Hansard source

We appreciate your visit.

Warren Snowdon (Lingiari, Australian Labor Party, Minister for Indigenous Health, Rural and Regional Health and Regional Service Delivery) Share this | Link to this | Hansard source

And I appreciate the fact that I was there; I learned quite a bit. We have been visiting places as diverse as Cloncurry, Mount Isa, Ceduna, Whyalla, Murray Bridge, Ballarat and regional parts of Gippsland—all over Australia. I think the member for Lyne has shown an insight into what has been reflected in the discussions—that is, that people in the regions have a particular view about their communities and the way their health system operates and they want to be heard. It is very clear that they want to be heard. I think I can safely say we have been doing a lot of listening. We visited parts of the member for Eden-Monaro’s electorate like Bega and Batemans Bay and we had a lovely time.

Janelle Saffin (Page, Australian Labor Party) Share this | Link to this | Hansard source

We want you to come to Lismore.

Warren Snowdon (Lingiari, Australian Labor Party, Minister for Indigenous Health, Rural and Regional Health and Regional Service Delivery) Share this | Link to this | Hansard source

And I will come to Lismore. The important thing is to note that we have gone across this country and talked to people. I am the first Minister for Indigenous Health, Rural and Regional Health and Regional Service Delivery in this nation’s history and I think that shows the commitment of the government to putting in place a process of going to talk, listen, learn and try and come up with policy options which meet those concerns. My most important observation is that everybody is different and everywhere is different.

I will use an example to explain the difference, one that I have used across the country. I go to particular equivalent sized communities in different states which will remain anonymous, both with public and private hospitals servicing around 60,000 people. In one of those places there is no GP superclinic or really effective after-hours primary care by any GPs. There is a corporate medical practice that knocks off at seven o’clock. That means all of the after-hours care is effectively done in the hospitals. Seventy-five per cent of the after-hours emergency patients, categories 3 and 4, could be seen by a general practitioner but are not. The other community is of an equivalent size in a different part of Australia. It has a similar structure—a public and a private hospital working in close association—and it has an effective team of private medical practices delivering primary health care with 24-hour on-call seven days a week and surgery sessions on Saturdays and Sundays. The demands on the hospital are totally different.

That is replicated across the country. In some cases, like Cloncurry in the member for Kennedy’s electorate, we have seen a very dynamic relationship between a private practice and the local council. The local council are working with the private practice. The local council have provided them with not only capital equipment, which remains on the council’s books, but also motor vehicles and three homes. This says the community take their primary care seriously. They see themselves as having a role in making a contribution. This is equally the case in Ceduna in South Australia where there is a similar approach. There is a different model because Queensland is different from South Australia, but clearly there was an effective relationship between the private medical practices in the town and local government where local government are providing accommodation.

That does not happen across Australia, but it is important to note that—and I make this observation despite the member for Lyne’s reservations about the way in which hospitals are run et cetera—the workforce is absolutely committed to getting an outcome. I want to take this opportunity to commend the whole of the health workforce who live in rural, regional and remote parts of Australia. There is no doubt about their dedication. Often they are working in isolation without a great deal of peer or professional support and they do so while making great personal sacrifices in committing themselves. This raises a significant issue for us, and perhaps one of the most significant questions which we have confronted in this whole process of consultations is workforce issues: our ability to recruit and attract workers into the health system, to attract doctors to work in the bush—GPs in particular—and to attract nurses and allied health professionals to work in the bush.

We were not helped by the capping of GP training places by the previous administration under the guidance of the then health minister, Mr Abbott. Thankfully, this government has addressed that by upping the number of GP training places to 800 by the end of this year, a significant increase—a 35 per cent increase in the number of GP training places. And we have not stood still on the issue of what we should do in regional and remote parts of Australia, because we understand that, if we are going to actually address the needs of regional communities, we have to do something about investment.

We have done this in a number of forms, and one which I am sure the member is aware of is our concern for regional infrastructure programs. We have a National Rural and Remote Health Infrastructure Program, NRRHIP, which has visited a local practice in Batemans Bay, which has got money from this NRRHIP—up to $500,000 in this particular case. It is a private practice which has used the resources which were made available out of this program to build a wing onto the practice which provides additional surgery and, at the same time, a place for teaching and training doctors and providing accommodation on site for those doctors. That is a program which is worth $45 million over four years. We have undertaken four rounds of funding thus far. They have been broadly distributed across the country, and that will continue.

It is important, I think, also to understand that that is not the only way we do our business. We are concerned about making sure that we actually work effectively with these local communities. I make this observation because it will be clear to the member for Kennedy, because of the nature of his electorate, that when we are talking about regional and remote Australia it is vastly different when we are talking about the Cape to what it is for the Central Coast of New South Wales, and the nature of the population we are serving is vastly different. With my electorate, if I talk about regional parts of the Northern Territory, I am talking about Indigenous health, largely. I know this is true for the member for Kennedy’s electorate and many parts of the north. So we are committed to making effective changes to the way in which we deliver these services across Australia, and we have made significant inputs into the developing of additional expenditures into Aboriginal and Torres Strait Islander health.

But, in the context of rural health, the government is investing more than $700 million in targeted rural health programs. It is investing through the Medicare Benefits Schedule—MBS—in the Pharmaceutical Benefits Scheme and the national healthcare agreements. It is providing a 45 per cent funding increase for rural programs compared to the $483 million in the last Howard government budget, when health responsibility rested with the then Minister for Health and Ageing, now Leader of the Opposition. This $483 million includes also $200 million to help tackle the shortage of doctors and health workers. Under programs which we will introduce as of 1 July of this year, 2,400 rural doctors will for the first time become eligible for grant payments to remain in rural and remote areas, a very important initiative. At the same time, that will affect the medical workforce in 500 communities across the country. That is a dramatic change from the way we have done our business in the past. It will not solve all the problems, but it is an initiative which I think will provide significant change to the way in which we do our business and provide real opportunities for us to attract people into the bush and retain them there.

Another element of the workforce, of course—which I know the member for Lyne would be aware of—is that of overseas trained doctors. While I talked before about the workforce, what I do not think the Australian community properly comprehends is the importance of overseas trained doctors. In 2008 and 2009, there were 5,027 GPs working in rural and remote Australia. Forty-five per cent or thereabouts were overseas trained doctors—almost half. Frankly, we could not deliver primary care in the bush without overseas trained doctors. When I met these overseas trained doctors in South Australia—I met with them in Wilpena Pound—we had a very long discussion about the importance of these doctors and the respect they have within their own communities where they are working and the respect they have from their peers. I think that we need to get the message across to people that these doctors are very highly qualified and very well trained and sustain medicine in the bush. They do, and we have to recognise it.

I think that what we need to do is comprehend the total workforce picture. We need to talk about recruiting and training more doctors and having more GP training places. We need to think about how we deal with overseas trained doctors. We need to think about how we attract and retain allied health workers. We need to think about how we attract and retain nurses. We have made significant strides in that direction.

Whilst I know that the member for Lyne was not at all political in his contribution, it would be remiss of me if I did not make some observations about the Leader of the Opposition when he was the minister. We have lifted the Abbott cap and increased the GP training places by 35 per cent to over 800. We have increased by 10 per cent this year the number of training places for junior doctors to experience working in a general practice setting. We have provided additional opportunities for GP training in the bush—really important initiatives. I think they go unremarked by the opposition, I might say, simply because they are embarrassed by their own poor performance. We have invested in an extra 1,000 nurse university places. We have established Health Workforce Australia.

We know already that the Leader of the Opposition has over recent days been making fairly callous and mindless accusations on the question of ministerial responsibility. Yet we had a picture today of Abbott’s balls. He was responsible for a process of having golf balls as an initiative to attract doctors to work, and unfortunately he had forgotten about it. I just say to him: be very, very careful when making these accusations across the chamber if you neglect to think about your own opportunities when you were in government. I would say to him also that, when he is thinking about what we might do on health reform—going back to the health reform space—what he might do is look at his own poor performance, the impact of withdrawing the billion dollars, the impact of capping the number of GP training places and the impact of not addressing the issue of shortage of nurses and say what impact that total effect had on the health system.

You and I know that in rural Australia we have really felt those changes; as you rightly point out, the further away you are from the major metropolitan centres, the less you are in front of mind and the less access you historically have to the dollars. But we need to think about those things. I applaud the member for Lyne for raising them in the chamber.

The Health and Hospitals Reform Commission process has been enlightening and enlivening. I am sure you will see over coming weeks and months new changes and initiatives to the health system which will go a long way to addressing the concerns which have been raised by the member for Lyne. We will look very seriously at the 123 recommendations of the report from Dr Christine Bennett. I am absolutely, 100 per cent confident that the changes which we will bring about to the nation’s health system will be seen far and wide as bringing about the significant change that you require.

Tony Windsor (New England, Independent) Share this | Link to this | Hansard source

When I first went into the New South Wales parliament in 1991, the proportion of the state budget that went to health was about 20 per cent. About one-fifth of the state’s budget was allocated to health. I am told that in New South Wales at this particular time, even though the budget is much larger, over 40 per cent is allocated to health. There would be a number of political debates as to how and why that occurs—whether the doctors or pharmaceutical companies are getting too much, whether it is management—but I think it is becoming very plain to most people that a portfolio area that is absorbing something like 40 per cent of the state’s budget cannot go much beyond that proportion. There are a number of things that have to happen there; probably the simplest one is that there has to be more money going into that system. Once you get to 50 per cent of the total in a budgetary sense, other things have to drop out: the vital necessities of the provision of services by the states, from police to education—the whole range of other activities that are demanded of the state’s budget.

So there has been this massive explosion in spending. From time to time the debate in this place is about who took what, who cut the budget and who did not do what they should have done, but there is no doubt that across Australia in the last decade or so there has been an explosion in health costs and expenditure. At some stage, I think, we as a population really have to look at what is actually going on here. There are a number of things that I think we possibly should look at, but one of them is that the Australian population may well have to pay more for their health care. It is the No. 1 issue; it always is the No. 1 issue; it will be the No. 1 issue at the next election. There will be a debate that goes on about who is going to do what in terms of health policy. At some stage the people have to recognise that, for the population that we have with the remote area issues that the minister spoke of and many other issues that we are all aware of in country areas, we are going to have to address this by injecting more money into it. Management can do only so much.

We will always debate whether we need local hospital boards or other boards, whether the Commonwealth takes it over or the states stay in charge. Those things may achieve something at the margin, but none of them are likely to achieve the outcomes that many people, particularly those who live in the country seats of the Independents who have put forward this motion today, deserve. I suggest that we either look at increasing the amount of money that we put in—and I mean that from the people rather than from the existing budget areas—or we look at other measures like the Medicare provider number that has been explored before. I know the AMA has a very large union in terms of health policy, but we have limited funds from the taxpayer and we have this, in my view, rather absurd system where the doctors can access a Medicare provider number and, hence, the public purse in any location they prefer rather than the location where the patient needs them. I think that is something we have to have a serious look at. I know it is very easy to get into an argument with the doctors over that. I have nothing against private practice—doctors can practise privately wherever they are—but accessing a depleting public purse is something where I think the policy arrangements should come into play.

The minister would be well aware of the importance of the Tamworth Base Hospital redevelopment in terms of the training of medical students. The Leader of the Opposition copped a bit of flack a moment ago. I would like to pay him a compliment, because when he was Minister for Health and Ageing he came to Tamworth, looked at what was happening with the University Department of Rural Health, the relationship between the University of New England, the University of Newcastle, and the Tamworth Base Hospital and other hospitals as well, and recognised the importance of training for the future. There were many others involved, but I think the current opposition leader played no small role in the development of a medical school at the University of New England and the subsequent relationship with training facilities in Tamworth, Armidale and Taree.

I think we also have to recognise—and I am sure the minister does—the importance of the National Broadband Network to remote health, regional health, country health and health generally. This could be one of the significant ways in which costs can be saved. The delivery of some of the services that the member for Lyne mentioned could be changed in an enormous way. The National Broadband Network or access to high-speed broadband is to me the one thing that negates distance as a disadvantage of being in the country. It turns the tables. It will allow access to global specialist and teaching services in a medical sense. I see at the University of New England’s University Department of Rural Health some of the extraordinary communication services that are based there at the moment and linked into the Tamworth Base Hospital. There are some extraordinary initiatives occurring there, so I hope that at some stage we get some unity of purpose in a rollout of a national broadband network, particularly with how it relates not just to the individual but also to our health and education systems.

Another issue I want to raise briefly, if I could, is the way in which Aboriginal medical services are being treated. There have been issues, particularly in my electorate in Armidale. There is a real issue, Minister, and I am sure you would be aware of this. Given your background you would have a close look at it anyway—it is in the original documentation about the development—

Sharon Bird (Cunningham, Australian Labor Party) Share this | Link to this | Hansard source

Can the member refer his remarks through the Chair to the minister. I just do not want to encourage a discussion to go across the table.

Tony Windsor (New England, Independent) Share this | Link to this | Hansard source

Okay. Thank you, Madam Acting Deputy Speaker. Through you, I ask the minister to have a close look at the terminology that was used in the original setting up of the Aboriginal medical services and the term ‘culturally significant application of health’. I think that has really dropped off in recent years. I have not seen an improvement since the change of government, but there are some very real issues there, in terms of the cultural appropriateness of the delivery of some services to Aboriginal people. Through you again, Madam Acting Deputy Speaker, I ask the minister would he have a look at that issue and particularly how it has impacted on the Armidale Indigenous community.

Small-town doctors are another issue that has been raised today. It is a very important issue, a critical issue. In my home town of Werris Creek, which has only 1,700 people, we are having difficulties with doctors again. We have had some tremendous people in that particular area—and in Quirindi and other smaller communities around the region. I think it applies right across the board. We really are having difficulties with the ageing workforce. I understand the minister has said that we are very dependent on overseas doctors. We are, and we are very grateful for them. This is something we really need to concentrate on.

In conclusion I would just like to—through you again, Madam Acting Deputy Speaker—ask the minister if would he look at the arrangements in terms of the Council of Australian Governments’ 2006 through to 2011 program on suicide prevention and mental health and follow-up on where the suicide prevention arrangements are at, particularly some of the 24-hour hotline arrangements, because I have been told that in various states we are not achieving the outcomes that COAG set out.

In conclusion, I endorse what others have said, in terms of those who are in the health workforce. It is all very well from time to time for people to play politics with the health system, but I think we all have to remember that there are very hardworking individuals within all those systems, and the very great majority of them work extraordinarily hard for the benefit of our people. I think it is quite appropriate that a forum such as this recognises their work and thanks them for their efforts for our people.

Mark Butler (Port Adelaide, Australian Labor Party, Parliamentary Secretary for Health) Share this | Link to this | Hansard source

We welcome the debate that has been initiated by the member for Lyne. That was the second speech that he has given in the chamber this afternoon; the first was in the guise of a question—

Robert Oakeshott (Lyne, Independent) Share this | Link to this | Hansard source

I learnt from the master, the member for Kennedy.

Mark Butler (Port Adelaide, Australian Labor Party, Parliamentary Secretary for Health) Share this | Link to this | Hansard source

That’s right, and the member for Kennedy’s name was mentioned in vain during the very long but very important question the member for Lyne asked.

As the only city slicker, as I understand it, speaking in this debate, I hope I can do it some justice. The first ever Minister for Rural and Regional Health—and, if I can also say, the best ever, Minister for Rural and Regional Health—has indicated the importance with which the government regards these issues in a general sense. I have been asked by my minister to indicate to the member for New England, through you, Madam Acting Deputy Speaker, that a range of the matters that the member for New England raised by way of request to the government to consider will be considered by the minister, and there will be a response in due course.

It is a pity that the only way we can have a debate in this chamber around health policy is through an MPI initiated by the Independents, because, beyond this chamber and in this chamber, other than on the opposition benches, health policy is seen as one of the most significant public policy challenges confronting the country at this time. It goes without saying that this government has indicated very clearly that it is committed to reform. There are very obvious reasons for that: the ageing of the population, the growing burden of chronic disease and, as the member for New England indicated, an explosion in costs over the last decade or so which is only going to increase exponentially over the 10, 20 and more years.

We initiated the Bennett report through the Health and Hospitals Reform Commission—and a number of others as well—to talk about the ways we might deal with those trends. The Bennett report also confirmed what all of us knew, but particularly what those members who represent rural and regional Australia knew—that is, that there are glaring inequities of access to health services in Australia. You can slice and dice those inequities a number of ways—for example, you can do it by ethnicity or by income—many of which apply in metropolitan Australia. But perhaps the most glaring inequity of access is geography. The most glaring graph I remember from the Bennett report is the one that indicated that the further away you get from a central GPO, the less MBS services you access as an Australian citizen every year. I would like to think that that is because the further away you get from a GPO the healthier you are, but we know that that is not the case. In fact we know that there are, if anything, greater health challenges for Australians living in inner-regional, outer-regional, remote and very remote Australia. There is a range of very clear recommendations that the government is currently considering from the Bennett report that go specifically to that inequity of access.

The Bennett report tells us that it is all well and good to have a universal entitlement through the Medicare system, and that universal entitlement is something that Australians cherish very deeply. But, if there is no equity of access—particularly for rural and remote Australians—as well as an equity of entitlement, then the universality of entitlement is a bit of a chimera. In addition to considering the far-reaching recommendations from the Bennett report, we are already acting on some of these inequities.

There are already a range of Commonwealth-led initiatives in rural and regional Australia. The minister has talked about a number of them, as have the member for New England and the member for Lyne. The workforce challenges in rural and remote Australia are perhaps the most significant legacy from the last 10 years or so. The minister talked about them as well. GPs are so important in rural and remote Australia. We know that in addition to the primary-care services they provide throughout Australia, they are often the front-line doctors in emergency departments and they are often the front-line doctors who do shifts in the broader hospital settings.

There is a particular challenge to get GPs to rural and remote Australia and to get them to stay. We know that the previous government’s program of rural incentives was a broken program. It was operating on the basis of 16-year-old data and it simply failed. We have overhauled that program and introduced a new GP rural incentives program based on up-to-date census data. We have introduced real incentives for GPs to shift from metropolitan Australia to rural Australia. If a GP shifts from a major city like Sydney or Melbourne to very remote Australia, that GP will now receive a relocation grant of up to $120,000—a very significant increase on the previous program. If a GP moves from a smaller city like Launceston or Hobart to very remote Australia, that GP will now receive a relocation grant of up to $60,000.

As well, we have introduced a range of supports for rural GPs to help them get through the very difficult burdens that they bear—burdens that metropolitan GPs just do not experience. Metropolitan GPs work incredibly hard. They have a range of support mechanisms that rural GPs just do not have—the capacity to take leave for professional development, the capacity to take leave to have a holiday and the capacity to take time off if a family emergency arises. These are challenges day in, day out for rural GPs. We have introduced the Rural GP Locum Program to allow locums to work with GPs in rural areas, including an urban GP incentive program, which will provide professional development opportunities for urban GPs if they undertake to spend four weeks of paid time working as a locum in rural and regional Australia.

We also confronted very stark infrastructure deficits in the rural and regional health system in Australia. Notwithstanding that we have not yet made a formal response to the Bennett report, a range of programs are already underway trying to deal with that infrastructure deficit. Of the GP superclinics that are underway—and 28 of the 36 are under contract—half of the rural GP superclinics will be in rural and regional Australia.

I also want to talk about an experience I had with the member for Franklin last week when I was in Tasmania in relation to the National Rural and Remote Health Infrastructure Program, NRRHIP—a program from the 2008 budget involving $46 million over four years to build infrastructure, hard infrastructure or equipment, for communities in rural and regional Australia with fewer than 20,000 people. The member for Franklin and I visited a health service in Geeveston, which is within the Huon Valley in south-east Tasmania. Geeveston had struggled for a considerable amount of time to get a GP. With the cooperation of the Huon Valley council, they managed to upgrade the old GP office and get a range of cutting-edge equipment. Two new GPs—importantly, not just a male GP but also a female GP—were attracted to work in that area with the up-to-date equipment. They will service not only people who live in the area but also the 500,000 or so people who visit the airwalk—a major tourist attraction in Tasmania. Some occasionally fall off the airwalk and cut their heads open, as some poor tourist did when we visited the centre. These things are making real differences already in rural and regional Australia.

The regional cancer centres were mentioned by the minister—$560 million out of the health and hospitals infrastructure fund to try and close the shameful gap that Australia has in cancer outcomes between metropolitan cancer sufferers and rural and regional cancer sufferers. As members in this House know, the invitation to apply for those cancer centres closed in January this year and is now under consideration by the government, and in due course by the Health and Hospitals Fund assessment processes. These are very important things that will try and close the gap and do what I said earlier about improving the equity of access to health services.

A range of other training infrastructures are in place, and I would like to mention Charles Sturt University dental school, which has five new locations—and I have opened three of them. These schools will train rural doctors to work there, but while being trained they will also deliver up to 30,000 low-fee consultations in those areas which have gross shortages of dental procedures. There is a range of work we are already doing to try and close this gap. The gap is so significant and the challenges so immense in a country as big and diverse as Australia that we are not going to do it overnight. But we welcome the opportunity to debate these points in a constructive way through an MPI such as the one initiated by the member for Lyne and which was supported by the other Independents. This process takes resolve and the government have the resolve to do it. (Time expired)

Bob Katter (Kennedy, Independent) Share this | Link to this | Hansard source

We have a situation where the culture of the health department in Queensland has got particularly bad. They are simply closing hospitals. They closed the Gordonvale hospital—they call it a hospital, but it provided none of the facilities of an ordinary hospital. We are very afraid that Babinda will also close. Moves have been initiated to close Atherton and Mareeba. An area with nearly 100,000 people will be left with no doctors. They will have to drive an hour down the road to Cairns to see a doctor, but that road is often closed during the wet season. It will be interesting to see what happens if the health department gets their way.

Minister, to a very large degree, I think your ministry will be decided on whether you overcome a problem that was created by, I think, the previous government—though maybe it was the Keating government. We always got first- or second-year doctors. They came to country centres where they got a wide range of experience and they fitted into the system very swiftly. They got very big incomes in these centres. Those doctors provided hospital treatment outside of the big capital cities. When the provider number was introduced it was not provided to a doctor unless he had spent two years in a major hospital, and that meant that our doctors who were going to the country areas were then not able to. They all had to go into the major hospitals, leaving us in a parlous situation. If you need any indicator of the failure of the former Deputy Prime Minister and the former Leader of the Nationals, Mr Vaile, you need only look to the big rally they had in his area and still nothing was done to overcome this problem. There has been a little bit done but very little.

The net result of that is that almost all of the doctors in the mid-west, gulf and Mount Isa are foreign doctors. We deeply appreciate them coming here and the work that they do. In fact, my own doctor in Charters Towers fits into this category and is a very excellent person in every way. But, by the same token, there is something terribly wrong with a country that cannot provide its own doctors—and the provider number is at the heart of this problem. We had the doctors there; now we do not. The problem that arose was the provider number. If you go to one of these country centres you will have a provider number whilst you are there but when you want to move out of those country centres you will not have a provider number—so you are two years behind the people who went to the city hospitals.

I represent the greatest number of aged-care facilities of any member in this place because, unfortunately, rural Australia is an ageing population. There are large demands put upon these aged-care facilities. There are places with only 20 or 30 employees who have had to employ another two or three people to meet audit requirements. They are not servicing the people who are in the aged-care facility; they are protecting the backsides of the public servants down here in Canberra. That is what is happening and that is the only purpose they are serving. It is simply a protective mechanism for people down here. When I have spoken to them, every one of my facilities has raised the issue of these huge administrative demands. In one facility there have been 10 audits—they call them support services—in a year. All of the senior people in the aged-care facility had to do nothing for a week whilst these people were sitting around doing nothing except protecting their own backsides.

The other phenomenon which I must bring to the attention of the House is that there are empty beds available in Brisbane but there are no beds in our areas. We have got a very great shortage. There is a great necessity to rebuild centres such as Mount Isa’s aged-care facility. It is 35 years old and was built in a most inappropriate manner in those days. These places need to be replaced—(Time expired)

Janelle Saffin (Page, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak in strong support of the motion moved by the honourable member for Lyne. The Commonwealth government is involved in regional health and in aged care, and under the Rudd government it is involved in a bigger way than ever before. I will give a few examples and then I will turn to some of the comments from the honourable member for Lyne. I will also associate myself with the comments of the minister and the parliamentary secretary, and those from my colleagues from New England and Kennedy—I was going to say, ‘Katter’.

Bob Katter (Kennedy, Independent) Share this | Link to this | Hansard source

Kennedy died with a dozen spears in his back. I am likely to go the same way.

Janelle Saffin (Page, Australian Labor Party) Share this | Link to this | Hansard source

Okay. We have a federal Minister for Indigenous Health, Rural and Regional Health and Regional Services Delivery. We did not have that before and that in itself speaks volumes. It is not just the name; he is a minister who is actually out and about in rural and regional Australia, and is coming to my electorate of Page—not that I am verballing. I cannot complain; I have had many visits. We have an Office of Rural Health. We did not have an Office of Rural Health before, and it is in Canberra. Normally I would say that is not a good thing but it is a good thing because health at an Australian government level needs to be here. It has brought together a whole range of programs—in fact, about 60—that were dispersed all over the place without any cogent plan around them.

We are putting more money into the Australian Health Care Agreement. I know the honourable member for Lyne in moving this motion was not attacking and was doing it as a supportive motion, but I do have to say that under the Australian Health Care Agreement the previous government—and the minister at the time was the honourable member for Warringah—ripped out a billion dollars plus some more. It would take me more than my five minutes to go through them all. The previous government froze GP training places. I know there are issues to do with provider numbers, as the honourable member for Kennedy said, but it is the freezing of GP training places that created this backlog. It is a problem that has started to unfreeze but it will take years for that to kick in.

We are delivering more training to regional centres and through various universities, particularly the university department of rural health in my area. The honourable member for Lyne and I share the North Coast Area Health Service and other health services. This is the same with the honourable member for New England. We have a border and we share Urbenville. We got money for the Urbenville medical clinic in the budget—nearly $300,000—so that we could keep the two GPs there. That was in the last budget. There is reform, such as the $560 million available for regional cancer care centres. From our area there are two submissions that have gone up. The honourable member for Lyne and I know about both of those and we hope that they get up.

The member for Lyne also talked in his contribution about the community packages and the aged people in hospitals who do not need to be there. I stand to be corrected, but I think that nearly 2,000 people nationally may be in hospitals who do not need to be there. It is a long-term problem and it has not been addressed before, but I do know that 12,000 new aged-care places have been allocated and that will go some way to start dealing with that problem. First, those people should not be in the hospital; second, it is not the appropriate care; and, third, it uses the wrong resources.

The member for Lyne talked about RDF. I made a submission to the Garling inquiry on that very issue, so I am in agreement with him there. Whatever happens, and we are going to see reform in health, we need RDF to kick in according to the formula as it is. So I am in complete agreement on that point.

The other issue is the Bennett report and the 123 recommendations which are being worked through now for the major health reform. That work actually shows that one’s postcode makes a difference to one’s health outcome. That is a critical issue for rural and regional Australia and it is one that we have all turned our minds to in order to correct.

Bruce Scott (Maranoa, National Party) Share this | Link to this | Hansard source

Order! The time for the discussion has expired.