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

The reason I have brought this issue to the attention of the House is that it has been causing great distress for a number of doctors in my electorate of Maranoa and I know across many parts of Australia, particularly in Queensland. My LNP colleague the member for Leichhardt, Warren Entsch, who is seconder of this motion will talk further about the particular case in Cairns in his electorate. But, for now, I will talk generally about the need to ensure that we provide our international medical graduates with the support they need to serve our rural communities. There is much concern that the current process to assess the competency of overseas trained doctors is discriminatory and that the process to approve registration for these doctors lacks transparency. Five years ago, the Australian Competition and Consumer Commission published a report into its review of Australia’s specialist medical colleges. The purpose of this review was to investigate whether Australia’s colleges were upholding the principles of transparency, accountability and stakeholder participation, and whether there was evidence of restrictive trade practices. The report of the ACCC mentions that the authority had received complaints about medical colleges and the perceived lack of transparency in their assessment processes. The report made recommendations to improve transparency and the provision of more information on how competency assessment decisions are made. Many of Australia’s colleges have moved to improve their practices. It has now been five years since that report was published and I think it is timely to conduct a parliamentary inquiry into the assessment practices of Australia’s medical colleges so that we can see what has been improved and what needs further improvement, particularly in relation to transparency.

Another complaint that has been brought to my attention is the inappropriate use of the pre-employment structured clinical interview, the PESCI, in assessing the competency of overseas trained doctors. Recent decisions made by COAG mean that the goalposts have changed and doctors who want to practice in Australia are asked to undertake the PESCI. However, there are complaints that the PESCI was never intended to be a pass or fail test of competency per se but, instead, was simply meant to be used to identify weaknesses and lack of knowledge in some areas and to identify areas needing improvement. However, there have been reports that some doctors are finding that they are passing their college clinical exams but failing the PESCI, which is administered by the Medical Board of Australia and a relatively new organisation, the Australian Health Practitioner Regulation Agency—AHPRA, which came into effect in July of this year.

For many doctors the goalposts have suddenly and dramatically changed. A recent example was the Queensland doctor from Lowood in the Lockyer Valley who was deregistered after failing his PESCI. He had been practising for six years and from the email I received over the weekend from one of his patients he is well-liked and well-respected. The decision is going to court so let us hope some common sense prevails. I also read in the Courier Mail last month of the New Zealand born nurse who has been refused her nursing registration because she must prove that she can speak English competently, despite being born in New Zealand and undertaking her diploma in nursing at a Gold Coast college. In this case, it seems that the bureaucracy has just gone mad and unfortunately it is impacting the supply of much-needed doctors and nurses, particularly in rural and regional communities.

I acknowledge that there is a lot of fear in some areas, particularly in Queensland, that has arisen from the tragic situation in relation to the Dr Jayant Patel bungle. We must find the balance between ensuring our registration processes and competency assessments are rigorous and ensuring our medical fraternity can provide the necessary support for competent overseas trained doctors to stay in Australia, and in particular work in our rural and regional areas. It should not be a case of one rotten apple ruining the whole barrel of apples. Another issue with the current problem of assessing overseas trained doctors is that the current visa process is not flexible enough to allow doctors to stay in the country while they appeal decisions that they believe are wrong. One such example includes an ophthalmologist on the Gold Coast who was originally given just 28 days after his registration was revoked to leave the country. Thankfully, he was granted a reprieve and his visa has been temporarily extended. But his future treating his patients on the Gold Coast is still very much in limbo.

I acknowledge that there has been a significant increase in the number of medical students currently being trained so that in the future we can meet the demand of Australia’s health needs, but it will be another decade at least before the supply will match demand. Until then, international medical graduates are vital in filling gaps. Even when we are turning out more doctors from our own universities, how many of these new graduates will want to move out of the cities and live and work in rural and remote Australia? Many constituents in my electorate of Maranoa rely on overseas trained doctors to provide medical treatment. Many of them are fully embraced by the community and they have become important members of the community. Like many Australian trained doctors in regional and rural areas, they work long hours and go above and beyond to help their patients. They are certainly treasured and we need more of them.

Sadly, however, in some communities in my electorate they cannot even get a doctor. Recently the Aramac community learned the sad news that their hospital would be downgraded to a primary healthcare centre after the community was unable, through Queensland Health, to secure a permanent doctor. When the people of Aramac learned the news, they were getting ready to celebrate the hospital’s centenary. The health minister for Queensland expects that the people of Aramac will now travel to Barcaldine, which is some 70 kilometres away, for their health needs. Yet, just three days after the minister announced the downgrading of the hospital to a primary healthcare unit—without consultation with the community, might I add—the road from Aramac to Barcaldine was cut off by flooding, which is the third time it has happened this year.

Unfortunately, issues like this are endemic in rural Australia. We do need more doctors in rural and regional communities. We need more support for our rural and regional hospitals. That is why I am calling for this inquiry. There needs to be a fairer go for doctors trained overseas so that we can get them to come out into rural and regional areas of Australia and practise where we know we have a massive and critical shortage. I know many Australian doctors. I understand why they train at university and obtain their degree. They are not encouraged to go out into rural areas of Australia. I understand that. I do not know why they do not like our rural communities but I understand that for so many reasons it is becoming difficult to attract Australian trained doctors to our rural communities.

I invite the Minister for Health and Ageing to give us the opportunity to conduct a parliamentary inquiry, as this motion calls for. The health needs of our communities right across Australia are an important issue. I have mentioned the Gold Coast, I have mentioned the Lockyer Valley and I have mentioned Cairns. I have also mentioned the lack of a hospital in the very remote community of Aramac in my electorate. Can I just say to the Prime Minister that if she is really serious about regional issues, as she said she was when she was sworn in and spoke about the need to focus this government on regional issues: here is an issue of regional and rural health. I call on the minister to give us this inquiry. I also say to the health minister that if she came to Aramac she would be made most welcome. I will make sure that I am there to welcome her. I think we can do a lot with this hospital. I think that if we are able to get a multipurpose health service that would fit Aramac it will be a model that we can use in other parts of Australia. Currently the multipurpose health service criteria mean you have to have a full-time doctor. Let us try to find a way to get a model to fit this community, because one size does not fit all.

I look forward to the minister’s response and I look forward to other contributions. This is an important issue. It is about the health of rural and regional Australia. It is about overseas trained doctors, who are a vital part of our health needs in Australia. I look forward to the support of this parliament.

Shayne Neumann (Blair, Australian Labor Party) Share this | Link to this | Hansard source

Overseas trained doctors are often popular and respected in regional and rural areas, particularly in Queensland. The registration and accreditation of overseas trained doctors is the responsibility of the Australian Health Practitioner Regulation Agency. This came about following the COAG agreement of 2006. Overseas trained doctors are assessed to demonstrate they have the capacity to practise medicine at a level equivalent to that of Australian graduates. There are a couple of pathways. There is a generic pathway that they can undertake and there is a specialist pathway. Whilst overseas trained doctors are working towards full registration on their pathways they receive conditional registration. They are also required to work in an area of need during this time, and to achieve these positions they must satisfy a pre-employment interview by their employer and an assessment by the relevant specialist college.

Many overseas trained doctors, as I said, work in areas where there is a workforce shortage. In fact, the Gillard government is taking big steps with respect to this. The government has implemented a multipronged approach, providing $134.4 million in the 2009-10 budget for the Rural Health Workforce Strategy, which targets communities most in need by ensuring greater incentives for doctors to work in those isolated communities. We also announced a $632 million package in March 2010 to deliver an extra 5,500 new general practitioners, 680 specialist places and 5,400 junior doctor training places in general practice over the next 10 years. Fifty per cent of new GP training places will be in regional and rural areas.

I have been critical of the practice undertaken by the Medical Board with respect to a particular incident in my electorate, which is the Brisbane Valley, not the Lockyer Valley. There is a very popular GP practising in Lowood, Dr Rajendra Moodley. I have met with him on numerous occasions and I have also met with people in the Brisbane Valley, around Lowood and other areas, who support him. He is well respected. He trained in South Africa and worked there for about 12 years before coming to Australia and he has worked in the Lowood area for about six years. The situation in his case is that he is not on a 457 visa; he is on a 442 visa, a temporary residence visa. His moratorium completion date is 9 September 2014. I have been very critical of the way in which the Medical Board undertook the pre-employment structured clinical interview. I wish Dr Moodley well in his appeal to the Queensland Civil and Administrative Tribunal. I think it will go a long way to assuaging people’s concern, should he be successful in that appeal.

The pre-employment structured clinical interview, in his case, was undertaken by three GPs from the Australian College of Rural and Remote Medicine. There is no audio tape, no video tape and no transcript. There are deficiencies in accountability and transparency. He was told that he had failed the interview, but there were no further particulars upon which his lawyers could undertake an appeal. As I understand it, he attacked the decision making during the tribunal proceedings and has had a stay of the decision. He is in a position where he can continue to practise and will not be deported unless, at the conclusion of this process, his registration is cancelled.

I have to say this: on this issue I have to be critical of the LNP, who have politicised this issue in my area. This is a legal process. They undertook a campaign in this regard and politicised this issue to campaign against me and the Labor member for Ipswich West on this issue. They undertook a meeting and they were critical of us. The state shadow health spokesperson, Mark McArdle, came there. More questions were asked of him, and I have to say that the LNP should be ashamed of themselves for the way they have politicised this issue. Dr Moodley should be supported and given affection, love and physical support, and people should stand with him in this regard, but to politicise a legal proceeding is the wrong way to go about it.

We can do better, and I believe the process should be done better and the medical boards should have a look at themselves, but I do not think that inquiry is necessary. I think that what we need to do is have some discussions with the Medical Board of Australia. There are a number of other allied health professional organisations as well. It is not just medicine. There are a number of other allied health professions: physiotherapy and others. The National Registration and Accreditation Scheme is predicated on a profession basis. It is based on the principle of protection of public health and safety. It is not a Commonwealth scheme; it is a national scheme led by the professions, who are responsible for determining the appropriate standard for health practitioners.

I do not want a situation where the federal minister for health or the state minister for health determines whether a physiotherapist or a doctor should remain in a place and have registration and accreditation. We have to have a rigorous peer-driven assessment mechanism. I think it is appropriate to have transparency and accountability, to use the words of the member for Maranoa. I am with him on that. They need to do better in that regard, and Dr Moodley—and anyone else—deserves, frankly, to have those interviews recorded or taped, to have a transcript available and to have detailed reasons for their failure or success provided. It is not happening. That is not good enough. There should be natural justice given. I would have thought it is very difficult in the circumstances for anyone who finds themselves in that position to then successfully appeal. That is where it comes about. There is a perception of a lack of justice in the methodology.

We are not going to change the fact that doctors need to be engaged in that peer-driven assessment. What we need to make sure of is that these bodies do it better. That is what I think we need to put pressure on them to do. I do not want a situation where the medical board is not responsible for determining whether or not an application for registration takes place; I think that is the appropriate place to do it. But the Australian Health Workforce Ministerial Council consists of the health ministers from all the jurisdictions, including the Commonwealth, and has the capacity under the national law to give directions to the national agency or national board in regard to relevant policies, processes or procedures, and I think that is where a remedy lies. I think we need to have some advice and consultation and speak to these boards about the way they are conducting it. It is now important that we get fairness.

Directions may be provided by the Australian Health Workforce Ministerial Council only if ministers believe that:

… the accreditation standard will have a substantive and negative impact on the recruitment or supply of health practitioners.

It is a bit rich for the LNP, who have failed with respect to regional and rural health, to protest. The coalition are the ones who capped GP training places, and they are not the ones who are providing the incentives. We are the ones who are training more doctors, nurses and other health professionals. We are the ones who have increased it, because the coalition simply failed. They often pose, preen and posture about their support for regional and rural Australia, but the fact is that they do not support it, whether in roads, health, infrastructure or primary health care. We are the ones who are providing the funding for primary health care in those regional and rural areas, and you can see it. I have written heaps of letters of support for doctors who are providing services in the Brisbane Valley and even in the Lockyer Valley, in the seat of Wright, because I think it is important.

Dr Moodley, as I said, is a temporary resident doctor who is subject to section 19AB of the Health Insurance Act. As I said—and I want constituents in my electorate to know this—under section 19AB of the act, overseas trained doctors wanting to access Medicare benefit arrangements are required to work in a district of workforce shortage, and that is where he is working. I thank Dr Paul Crowley of Lowood Medical Centre for his support for Dr Moodley. No-one could have been a better mentor, supporter or friend to Dr Moodley than Dr Crowley. I wish Dr Moodley well. I hope for his sake and for the sake of the Brisbane Valley that we see his registration renewed and that doctors of his calibre and ilk continue to practise in the Somerset region. (Time expired)

Geoff Lyons (Bass, Australian Labor Party) Share this | Link to this | Hansard source

In response to the motion put forward by the Hon. Bruce Scott, member for Maranoa, I would like to talk about the National Registration and Accreditation Scheme. On 1 July 2010, the National Registration and Accreditation Scheme for health professionals was implemented. Ten national boards are now operating with full functions under the Health Practitioner Regulation National Law Act 2009. The National Registration and Accreditation Scheme is a national scheme led by health professionals who are responsible for determining the appropriate standards for health practitioners. We need to support this national scheme, a scheme that provides standard assessment processes across Australia. The important part of this registration scheme is that appropriate standards are determined and assessed by health professionals, who are members of colleges rather than bureaucrats.

The National Registration and Accreditation Scheme is based on the principle of protection of the Australian public. Nobody wants another Patel incident anywhere in Australia. Importantly, the National Registration and Accreditation Scheme, with appropriate collegiate and professional assessments, will maintain the standards required not only by the profession but also by the Australian people. It is in the interests of both the health professions and the public that there are appropriate and clearly defined standards in place to govern the registration of all health professionals. We need to let this scheme bed itself in, in the best interests of all Australians. It is obvious that governments and full-time bureaucrats are not the appropriate people to assess professional standards. A surgeon working in a theatre with an applicant for registration over a period of time is an appropriate person, and this would assist in maintaining the necessary standards. The National Registration and Accreditation Scheme must take evidence from people on the job so that standards are maintained.

Under the scheme, there is one professional national board setting the standards and policies for the regulation of each of the professions covered, including the medical profession. This will allow the movement of appropriately qualified people across state borders, thereby creating opportunities for trained professionals to move to a far better and more desirable lifestyle in Tasmania, particularly in the electorate of Bass, whilst maintaining their registration. The national boards are assisted by the Australian Health Practitioner Regulation Agency. The Medical Board of Australia is responsible for determining whether or not an application for registration as a medical practitioner in Australia is successful. Where an applicant’s registration is rejected, there is a process for appealing the decision.

In the second part of the member for Maranoa’s motion, he indicates that there has been a revocation of visas and requests a delay. Provided that the appropriate opportunity for assessment by the Medical Board was available, the question should be: why has the board chosen not to renew the conditional registration? It should not be about delaying visa revocations.

The Australian Health Workforce Ministerial Council, which consists of health ministers from all jurisdictions including the Commonwealth, has the capacity under national law to give directions to the national agency or board in regard to relevant policies, processes or procedures. The skills of a surgeon should be assessed by other surgeons, not by bureaucrats. The Australian Health Practitioner Regulation Agency considers every medical registration to ensure that all practitioners granted registration have the qualifications, the skills and the experience to provide safe care to the Australian public, with the application passing through a minimum of four stages before a recommendation is made to the national board. This recommendation may be to register, to register with conditions or to reject the applicant. If rejected, the applicant can make a submission to the national board for reconsideration. If that is unsuccessful, it may then go to a tribunal.

The member for Maranoa would be far better off putting his energies into supporting the National Accreditation and Registration Scheme, which will regulate assessments across the country and provide opportunities for people to move around the country to support the needs of patients without having to go through several state registration processes. In my job at the Launceston General Hospital, I saw doctors who were rejected in Tasmania move to other states and be registered. I think this is not fair and not right for patients.

Warren Entsch (Leichhardt, Liberal Party) Share this | Link to this | Hansard source

I welcome the opportunity for governance of this area to come under the jurisdiction of the federal parliament as of 1 July, because I think what we need to do here is send a strong message out to the Australian medical colleges that, with the gift of monopoly—which is what they have—come serious obligations in relation to the way in which they treat foreign trained doctors. Regional Australia could not function without the services of these foreign doctors. Let me tell you, Madam Deputy Speaker, that these colleges are nothing but old boys clubs. They have been established by those who get major benefits from the current situation. They do not like any competition whatsoever. If another doctor comes in and does not play the game, they will attack them relentlessly and they will remove their opportunity or their licence to practise.

I have such a situation in Cairns. Dr Roger Chatoor was recruited from the United Kingdom. He was recognised as one of the best cardiologists in the United Kingdom. He came over here, recruited to an area where there has never been an intervention cardiologist. He came over with glowing reports from those that recruited him of over 9,000 successful procedures. In Cairns, over a period of 12 months, he did 1,600 procedures. In those 1,600 procedures, he had operated in 500, and of those 500 there were 230 that could not be done in our region before he came. The mistake he made was that he was successful and he was not prepared to play the game.

There are four senior cardiologists in Cairns who have been involved in, first of all, collusion and, secondly, dishonest conduct. They are not interested in the wellbeing of Cairns or the far northern region. They are acting only in their own self-interest in relation to their income. Because Dr Chatoor was not prepared to play the game, they have been ringing around nursing staff and other cohorts in other hospitals. They have been involved in influencing the chair of the assessment committee at the royal college to make sure that this fine cardiologist is kicked out of the country. It is absolutely appalling.

I have over 5½ thousand signatures from people in support of Dr Chatoor. But what has happened now is that, because those cardiologists have influenced this decision, through deception and collusion, Dr Chatoor’s 457 visa is now under threat of being rescinded. He is a man of impeccable qualifications. For the last four or five months, he has been fighting this, and the community has been fighting to keep him. What they have argued all the way through is that this is a peer review issue. But understand that his supervisor, who had given him above-average assessments all the way through, subsequently relocated 500 metres down the road and, because Roger did not go with him, he had a whinge and suggested that there was a supervision issue.

For months now, we have been trying to deal with that. They changed the rules that allowed him to practise. They came back and said, ‘Well, if you get into the public health system, we’ll allow you to stay.’ He was happy to do that. Unfortunately, Queensland Health said: ‘No, we don’t have any space for somebody like Dr Chatoor. We don’t need another cardiologist in Far North Queensland.’ In the meantime, the hospital cardiologist has been filling in at the private practice where Roger was working—and they are asking him for an opinion.

It is absolutely appalling, and I call on the Australian Medical Council to start setting accreditation standards and to give 12 months for these colleges to start to sort out their nonsense, to sort out this mafia that they are involved in and to improve conditions, transparency and accountability. I also believe it is about time that we had a full Senate inquiry to investigate this. I have absolutely no doubt that we need competent people here, but we have foreign doctors training in this country who have no voice and no opportunity to defend themselves or their reputations. When they are being destroyed by greedy individuals like these four in my region, I think that those four people need to be held accountable. I have all of the evidence showing what these people have been doing and I will certainly be looking to have a full inquiry. We need to have them under oath and they need to be held accountable for what they are doing to this wonderful man and his family.

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

In strongly endorsing the words of the member for Leichhardt, I note that we had a situation in Townsville where there were only three surgeons who were able to do heart surgery. I can speak from personal experience on this because I have been rushed to Townsville for emergency surgery. The previous member for the electorate of Herbert also had to have emergency surgery in Townsville, and the state minister and Speaker of the Assembly, also from Townsville, had to have emergency surgery there too. So it is very common. Due to exactly the same sorts of things that the member for Leichhardt was referring to—petty, vicious, personal vendettas; that is the only word that I can use to describe them—we were left with one single doctor practising. He happened to be the doctor that operated on me, and we checked him out. I am related to a family with a hundred doctors in it, and we checked this bloke out. His name is Mo Diqer, and he is one of the better, arguably one of the best, heart surgeons in the country. His figures in each of the categories are exceptionally high. His survival rates are very, very high indeed, arguably higher than those of anyone except four others in the entire country. But he was under venomous and vicious attack—exactly the same type as Chatoor was under in Cairns—just through the petty prejudices of people who do not have to live there and whose lives are not at risk from us being bereft of specialist care.

The last set of figures I looked at was for the Edmonton area. In the cities of Australia we have one doctor per 300 people. In the country as a whole we have one doctor per 600 people. We have one doctor per 2,000 people in the southern end of Cairns.

Honourable Member:

Honourable member interjecting—

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

I accept the interjection: I am not Robinson Crusoe. But it is infinitely worse for us in North Queensland. All right, the cavalry is on the way a bit for North Queensland, with the JCU medical school, but we are looking at another 12 years before we have specialists coming out from that school.

I must comment upon the fact that the minister has no representatives here. It is an insult to every single person on both sides of the House.

Honourable Members:

Honourable members interjecting—

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

Do not be holier than thou, you blokes; I am very bipartisan in my comments here. But when there is a matter of such importance, when the member for Leichhardt speaks with such passion—as well he should—and the member for Maranoa and the member for Kennedy are up here and extremely angry, what is the use, when there is not a single representative of the minister here? That is absolutely disgraceful. In the state parliament we always had the head of the department and the minister. If it was a matter that concerned them, the minister had to be there and so did the head of the department. They had to face the music. But they are hiding out in ivory towers and in cowards’ castles. They are not game to face the music that is being played down here today. It is our people from North Queensland who are going to be in serious trouble and who are going to die, and for the people from Western Queensland I would assume it will be the same.

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

Mr Bruce Scott interjecting

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

I do not have to tell the honourable member for Maranoa these things. There comes a time when we really have to stand these people up, and the time has come for them to be stood up. The minister must take responsibility for what is taking place here. The Chatoor example is an absolute disgrace and a reflection not only upon the state government but also upon the federal government. It remains a reflection upon them, and if they want people in the streets in anger and with venom and spite then they should just allow the Chatoor thing to continue on—and all of the other issues that we have had over the years. Mr Deputy Speaker, we have put our point to the House, and we would appreciate it if you would put it to the Speaker that ministers should be represented.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

I must start my contribution to this debate by saying that I am exceptionally disappointed in the contribution that the member for Kennedy made. He, better than anyone up here, knows that the minister does not come to and cannot participate in private members’ business. Whilst he made some very good points, the member for Kennedy knows the rules of debate on private members’ business, and outlined in them is something that he and the other Independents all signed up to—that is, ministers cannot participate in private members’ business. The member for Kennedy stands condemned for his dishonesty in this debate.

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

Mr Deputy Speaker, I rise on a point of order. Not only have I been misrepresented; I have also been vilified. I would ask the member to withdraw and apologise.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

I will not withdraw.

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

Order! I did not hear the remarks the honourable member made. I was in conversation with the clerk. If the honourable member feels badly done by I would ask the member for Shortland to withdraw.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

I am very reluctant to withdraw because it was pure debate and the facts were correct.

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

You used unparliamentary language.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

Order!

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

I did not use unparliamentary language.

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

You certainly did.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

Order! I ask the honourable member to withdraw without qualification.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

I withdraw.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

The honourable member has withdrawn. She has now has the call.

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

Why doesn’t she stick to the subject instead of attacking me?

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

I listened quietly while the member for Kennedy made his contribution to this debate. If he is honest about the situation in relation to doctors and the doctor shortage he will first get to the reason we have a chronic doctor shortage. That shortage is because the coalition government cut the numbers of doctors and put a cap on the training of doctors. Coming from that a chronic doctor shortage developed.

The member for Kennedy has a doctor shortage in his electorate. I have a very significant shortage of doctors in the Shortland electorate; there is one doctor for 1,600 people. I will say that it is much easier for people living in Shortland to access the services of a specialist than it is for people living in the electorate of Kennedy. I think that the member for Kennedy needs to acknowledge the contributions that the minister has made in creating more training places for doctors—an enormous number of additional training places for doctors, nurses and allied health professionals. When these training places come on line that will go towards addressing the doctor shortage that exists.

The motion before us talks about the training of specialists and the role that medical and surgical colleges play in the registration process of medical graduates. I agree with comments that have been made about the need for this system to be reviewed. I think that the specialist colleges do have an exceptional amount of power in determining who should train in those specialties. I believe that there is a better and fairer system that could be put in place than the one that exists now. The system that we have came from the UK, as did many of the practices that we undertake, but now I think it is time for us to revisit it. I do not think that an inquiry that is about scapegoating certain people is the way to go; I think we need to approach this matter in a serious, mature way, where we look at the best way to train medical specialists within this country and not look at using a motion like this to attack particular scenarios or cases.

Andrew Laming (Bowman, Liberal Party, Shadow Parliamentary Secretary for Regional Health Services and Indigenous Health) Share this | Link to this | Hansard source

This very important debate, brought to this chamber by the efforts of the members for Maranoa and Leichhardt, is an issue that the government has turned a blind eye to over the last three years. Obviously, we have a maldistribution of doctors and the health workforce in this country, and we need a solution rather than internal bickering on the government benches on whether there should be a point of order or not. Let us focus on the patients and the 1,800 doctors that we need in rural areas who are not there at the moment. I should declare a conflict of interest in that I am a member of one of the aforementioned colleges. But there is no doubt that those colleges have to put their hands up, as has been pointed out, and take responsibility for distribution of the health workforce.

You cannot be the nation’s only specialist college and not take an individual, responsible position on equitable provision throughout Australia. Patients with differing clinical severity can walk into a health establishment and be triaged on need and yet when we triage this nation on geographical need there is no-one doing anything more than applying the standard Rudd-Gillard government model of trickle-down economics where we turn the taps on and train a few more GPs then hopefully one day they will find their way out to rural areas.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

Mr Deputy Speaker, I rise on a point of order. My point of order relates to the relevance of the contribution of the member on the other side. He is not addressing the substance of this motion. As such, I would like to ask you to bring him back to the issue at hand.

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

Order! The member will resume her seat. The honourable member will address the motion before the chair.

Andrew Laming (Bowman, Liberal Party, Shadow Parliamentary Secretary for Regional Health Services and Indigenous Health) Share this | Link to this | Hansard source

I hope that 20-second interruptions was worth the effort because patients in rural Australia will pay the price for that silly stunt. The key issue here is getting a workforce out to central, remote and rural Australia. We need state Labor health bureaucracies to work with the colleges, not against them. That is what we saw in Cairns. I do not want to comment on individual cases when I do not know all of the facts, but I do know one thing: PESCIs, the pre-employment structured clinical interviews, were not introduced to pass or fail doctors; or to guillotine their health careers in this country after they gave up lives, work and careers overseas to come and serve Australia in some of the toughest and most high need areas. They were introduced to assess whether doctors could move from areas of certain risk to areas of high risk—from where they might be working in a hospital to where they might be working more independently as a GP. That should be the issue.

I think it is only fair that members on this side of the chamber ask the question about these PESCIs: have they been adequately evaluated? Are they targeting the doctors that genuinely are clinical threats to rural and remote Australia or are they being used for some other purpose? What we do not want to see is a situation where state bureaucracies can say, ‘Sorry, no job here,’ and then a clinical college says, ‘Well, if there’s no job we can’t help you, sir.’ We want their heads butted together so they find solutions and are not being antagonistic.

I want to say something quite simple, and that is: ‘If you want to be the only specialist college in the country, you have a service obligation to make sure this nation is adequately provided with those doctor specialists or allied health practitioners.’ That is not a big request. We want to know that if people do come from around the world to serve in Australia that it is done fairly. We do not need a mountain of bureaucracy for the sake of bureaucracy. It is one thing to create a single registration board for the nation but quite another to use PESCIs as a way of further interfering with clinical provision. Without saying that in any individual case that is occurring, I would like to know that these PESCIs are being fairly and adequately evaluated.

In this great battle of assessing overseas qualifications, we have always found it very difficult to evaluate medical schools according to the level of quality of their graduates. Yet I note Australian universities do that all the time. They will only accept Indian graduates from tier 1 and tier 2 Indian universities to study at selected universities. We do not do the same thing with doctors. We pay an enormous price because we put English trained GPs, from high-quality institutions, through a complete rigmarole that is utterly unnecessary and serves only to damage health provision in remote areas. I believe if graduates are trained in an English-speaking university there is no need to tie up those graduates who arrive here to test them in their levels of English. If we are going to do IELTS tests, put them to clinical supervised work if they have an IELTS of six and let them show that they have adequate English, because they are working with a supervisor. Why not get them to work? Don’t use the PESCI as a way of interfering with that. I would like to see stalemates like we have seen in Cairns resolved rapidly. I would like to see PESCIs adequately evaluated. They were never meant to be pass/fail; they were meant to be indicative and be drawing attention to areas where clinical skills were inadequate. That is what we need to move towards—an area where the administration is no longer used as a way of putting brakes on clinicians but it is used as a way of identifying those who can practise safely in the bush.

Tony Zappia (Makin, Australian Labor Party) Share this | Link to this | Hansard source

I welcome the opportunity to speak, albeit very briefly, on this matter relating to overseas trained doctors. Can I say from the outset I very much understand and accept the very genuine concerns being put to this House by members opposite. There is no question at all that when one needs the service of a doctor or a medical practitioner of some kind it is of the utmost priority. The last thing that any of us would want is for a medical person not to be available when one is needed. But can I say that their concerns are not confined purely and simply to country Australia.

As a member representing metropolitan Adelaide, I can assure members opposite that there are also concerns about the lack of doctors within metropolitan areas. In recent months I have been caught in the midst of a political bunfight as to whether some local doctors should be allowed to recruit from overseas. I understand that, whether you are in the country or in metropolitan parts of Australia, in urban areas, the need for access to a doctor is of the highest priority. Having said that, I am not going to engage in a vilification exercise of doctors and the system that we currently have in place, albeit that I have my own concerns about it. I do not only have concerns about the registration process for doctors. In fact, on Friday this week I will be going back to my electorate to meet with nurses who are going through similar problems and who would also like to see the process changed. Perhaps that process needs to be changed. In saying that, however, I believe the member for Blair quite properly articulated the process that this government has followed and is following at the moment in order to ensure that ultimately we do have the best processes in place.

I also say to members opposite that the problems that they are referring to did not arise in the last year or two. They have been evident since I was elected to parliament three years ago. I say to them: if these concerns are real—and I accept they are—rather than blaming the current minister and this government, why were steps not put in place to make the necessary changes that they are now calling on this government to do and why did they not, as the member for Shortland quite properly pointed out, allocate and fund more places in our universities to ensure that we would have more graduates from within Australia in the system to fill the shortages that were emerging? One of the genuine concerns I have about recruiting from overseas is that we recruit from countries that have a greater number of patients to the number of doctors than we have in Australia. What we are really doing is taking medical people from countries in much greater need than us. I believe our first priority ought to be to ensure that we provide places within our universities and ensure that we encourage our own students to go through the process of becoming medical professionals.

I refer briefly to the motion. It talks about ‘an inquiry into the role of Australia’s medical and surgical colleges in the registration process’. It does not state who is going to conduct the inquiry, how it is going to be comprised or the particular guidelines or criteria for the inquiry. Whilst it is generally something that this House might have some sympathy for, I would suggest to the member for Maranoa that he needs to be a little bit more specific if he wants this House to support his motion in respect of establishing an inquiry. An inquiry is something that I would take very seriously because the inquiry would result in recommendations and there would be nothing short of criticism by the community if those recommendations were not implemented. I also refer to part (2) of the motion which talks about the 457 visa. I reiterate something that the member for Blair said earlier: a working visa is only granted after registration is given to a doctor. It is not the case that a 457 visa will be revoked if a doctor fails his or her pre-employment interview. Again, the motion is not correct in terms of what it is asking this House to do. I suggest to the member for Maranoa that he ought to rethink the way he wants this House to deal with the motion and resubmit it if he wants us to take it seriously.

Luke Simpkins (Cowan, Liberal Party) Share this | Link to this | Hansard source

In supporting this motion today I would like speak about matters to do with doctors in Australia. We all know that health is one of the two big default issues in this country. If you ask people what their issues are, if they cannot think of anything else they will mention health and education. We can be sure of that. But specifically what they mean when they mention health is where the difference lies.

For some Australians it might mean elective surgery waiting lists; for others it might mean getting to see their GP when they want to or need to. It could be that they mention health because of a personal perspective or because they saw a media report suggesting a problem exists and they are concerned in a detached way. In any case, health remains one of those issues that is never far from the minds of Australians. It is also in the nature of Australians that we are critical and that we see fault within our health system. I believe that in overall terms it is better than any other nation’s health system; however, despite that, it is right that we always seek to make it better.

In the last two weeks I accepted the invitation of one of my local GPs, Dr Wood, to visit her surgery and speak with her and her staff—including her registrar and two student doctors. Dr Wood and her team are adding great value in the Alexander Heights community. I want to take this opportunity to thank her for the opportunity she gave me. I have become more aware of the situation for general practices, and matters relevant to this motion came up during our discussion. The positive impact of overseas trained doctors was one point of discussion. The ability to assess these doctors is critical, and many of our suburban practices would not be able to serve their communities without these doctors coming in under 457 visas. Dr Wood will soon have a new doctor, who is moving from Northern Ireland to Perth with her husband and, I believe, four children. This is very good news for the patients of Dr Wood’s practice. I hope that it all works out well and that this doctor and her family make Australia their home permanently.

As I have alluded to already, Dr Wood is not the sort of person who just recruits overseas; she also helps in the training of student doctors and newer doctors. One of the issues I want to raise today is directly relevant to this motion. It relates to how doctors are trained and how they move through our system. Many members would be aware that upon graduation medical students must take up an internship for a year in order to finally qualify as medical practitioners before taking a registrar position. But in 2012 there will be a problem with the number of intern positions available due to the increasing number of graduates. I have been told that there will not be a guaranteed intern position for graduates of Australian universities who are overseas students. Surely this problem can be addressed; the last thing we want is for graduates of our medical schools to go back overseas immediately. These are the sorts of people who we definitely want to stay here—we want to make sure our health system is the beneficiary.

Residents in our local communities deserve the right to access doctors and medical treatment reasonably close to where they live. In the rapidly growing northern suburbs of Perth—including in my electorate of Cowan—it is a challenge to keep pace with the heavy demand for services. As I have already mentioned, without the services offered by doctors coming into Australia on 457 visas many GPs and specialists in many parts of Australia would not be able to keep up with the demands of local communities. I particularly endorse the views expressed tonight regarding specialists. Whilst we do not have a significant specialist population within Cowan—we are just across the road from the Joondalup Health Campus, and that is where a lot of the northern suburbs specialists are—these matters are extremely relevant. I certainly think the government should think through the ramifications of any revocation of 457 visas for doctors who have been deregistered because of problems, particularly the question of all problems with the pre-employment structured clinical interview.

Government should allow sufficient time for a proper thorough review of these cases and ensure there is a clear process in place that affords the opportunity for a reassessment. In overall terms, what is needed to meet the needs of primary health care in the outer metropolitan suburbs, as in my case, is to examine what can be done to remove the hurdles for existing practices to attract doctors. Neighbourhood general practice surgeries like Dr Woods’ are at the heart of successful primary health care. We should be very careful in being too hasty and we certainly should make sure that all potential doctors are given the opportunity to provide services within our suburbs.

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

I would like to commend the member for Maranoa for his interest in and promotion of good health care and a sound health workforce throughout Australia, particularly in regional and rural Australia. Parts of Australia continue to cry out for additional professionals. Doctors and other health professionals are one such group. This group is naturally central to the ongoing health and function of every community. It is well and good that this Labor government has moved to integrate state based labour markets, each with its own registration processes and lists of professionals eligible to practice, into a seamless national labour market.

Instead of a health professional working in Perth, for instance, being able to freely move interstate and take up a position in regional New South Wales, rural Queensland or rural South Australia, medical professionals have long suffered the inconvenience of having to register in each and every state in which they want to practice their profession. It would be ridiculous in this day and age to continue down that track. When people reminisce about the great economic structural and social reforms of the past—for example, the floating of the dollar in the eighties, enterprise bargaining and productivity increases of the early nineties—it is really quite odd to think that until only a couple of years ago we had seven quite distinct economies and workforces. They were partitioned by state regulation, constitutional limitation and, at least to a certain extent, by professional confinement or restriction.

It is only in the last couple of years that the obvious has been undertaken—that is, to make Australia one country, one seamless national economy. Nothing could be more obvious than the removal of marginally significant parochial borders to facilitate smooth economic activity. A mobile workforce is essential to the smooth allocation of resources to where they are most in demand, where they are most needed. Before I finish on a seamless national economy, I would like to congratulate Dr Craig Emerson and the Hon. Chris Bowen for their work in this area in the last parliament. It might not be a sexy area of public policy for most people but I rank it up there with the best. They are the most sound and most obvious examples of national leadership that we may have seen in this place for many a year.

Going back to the motion before us, let me say that it was a Labor government that brought the nation together, developed and nurtured the requisite goodwill amongst interested parties and forged the agreement to nationalise the professional accreditation boards of the various health professions. The responsible minister, Nicola Roxon, should also be congratulated for this milestone in Australia’s economic and social development.

Dick Adams (Lyons, Australian Labor Party) 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.

A division having been called in the House of Representatives—