Amanda Rishworth (Kingston, Australian Labor Party, Shadow Parliamentary Secretary for Health) Share this | Link to this | Hansard source

It is very important that I am able to speak on the Health Workforce Australia (Abolition) Bill 2014 tonight, because if we do not plan for our future health work force on a national scale we will not have the right number and type of health professionals to meet the health care needs of Australia in the future. The Australian population is growing older, and we are living longer. We will have more complex health care needs with the rise of chronic conditions such as diabetes. And they will need access to services more often. This means the cost of providing these services will increase. Our current health work force is already under tremendous pressure to meet the health care needs of the nation. This pressure is only going to increase in the coming years. Our health work force is also ageing. There are more health professionals retiring, and this rate will be increasing over the coming years. There are also fewer young workers coming through to replace them.

National health work force planning is a critical part of addressing this looming crisis and ensuring that we have a sustainable and affordable health work force that is able to meet the needs of the people wherever they live. We need to take a national approach to health workforce planning to ensure that we have the right numbers and types of doctors, nurses and allied health professionals in the places—importantly—where we need them. We need to plan on a national level now because of the length of time it takes to complete medical or health service training.

We cannot go back to the mistakes of the past, where for 20 years health workforce planning did not exist. In the past there was a piecemeal and reactive approach to medical and nursing training, immigration and workforce deployment. This led to a boom-bust cycle in the supply of doctors, nurses and allied health professionals because the system reacted in an ad hoc fashion. This has also resulted in a maldistribution of health professionals which particularly affects regional and rural areas.

This scenario is unsustainable and unaffordable and will result in a health workforce that will not be able to meet the increasing demands for health care now and into the future. This was recognised in 2006 with the Productivity Commission report Australia's health workforce. This report concluded that a more sustainable and responsive health workforce was needed. The report also highlighted the complexity of Australia's health workforce arrangements and the involvement of numerous bodies at all levels in health workforce education and training.

These are the mistakes of the previous coalition government and the mess that we inherited when we came back to office in 2007. Indeed, 74 per cent of Australia faced a medical workforce shortage when Labor took office in 2007. This affected 60 per cent of the population, including many constituents in my electorate of Kingston who struggled to find a local GP. Of course, it was not limited to my local electorate; it was right across the country. There was no vision and no policy from the Howard era, in which the now Prime Minister was the Minister for Health and Ageing. It seems that this pattern will now continue under this new Prime Minister.

Indeed, when Labor came to office, we had to start fixing up the mess that the previous health minister, now the Prime Minister, had left. In 2008, Labor funded a $1.1 billion National Partnership Agreement on Hospital and Health Workforce Reform, which included more funding for undergraduate clinical training, an increase in postgraduate training places and a huge capital investment into teaching and training infrastructure to expand teaching and training, especially in major regional hospitals to improve clinical training in rural Australia.

As part of this agreement, we established a national health workforce agency, Health Workforce Australia. Importantly, its job was to drive a long-term vision and plan for our health workforce. It commenced operation in January 2010 following the enactment of the Health Workforce Australia Act 2009. Health Workforce Australia's national responsibilities include funding, planning and coordinating clinical training across all health disciplines and jurisdictions; supporting health workforce research and planning; funding simulation training; and progressing new workforce models and reforms. In establishing Health Workforce Australia, we recognised that a national coordinated approach was needed to create a health workforce able to meet the current and future healthcare needs of all communities. We recognised that, without strategic and coordinated reform, the demand could not be met and the challenges could not be overcome. We recognised that reform must be national and large scale and that it must cut across jurisdictional, sectoral and professional boundaries.

During the last four years, Health Workforce Australia has achieved far more than any previous coalition government has achieved in health workforce planning. Health Workforce Australia produced the first-ever national long-term projections for doctors, nurses and midwives in the 2012 publication Health workforce 2025—doctors, nurses and midwives. This document cannot be underplayed. Health workforce 2025 represents the first time that health workforce planning has been conducted on a national level. The three volumes of this landmark report highlight a range of major issues facing our health workforce. Under current policy settings, Australia will face a significant shortage of nurses and a less significant shortage of doctors by 2025. It also found that Australia will continue to remain highly dependent on migration of international health professionals, particularly in rural and remote communities.

As a result of Health workforce 2025, Health Workforce Australia provided a set of policy proposals to address these serious challenges, which were subsequently approved by health ministers. These actions include improving productivity through workforce innovation and reform; improving mechanisms for the provision of efficient training through the establishment of a National Medical Training Advisory Network; examining the barriers to and enablers for workforce reform; streamlining clinical training through the development of nationally consistent approaches to funding clinical training opportunities in public, non-government and private sectors; and investigating the implications of increasing self-sufficiency in the medical workforce.

Health Workforce Australia has been leading the implementation of this reform effort in partnership with government, the higher education and training sector, the health sectors, employers, professions and regulatory bodies. But its achievements do not stop there. Health Workforce Australia's Clinical Training Funding program has successfully expanded the clinical training capacity of our health workforce. This investment in infrastructure saw clinical training facilities being built or refurbished in urban, regional and rural Australia.

There are many great examples of this investment in clinical training infrastructure, but I will just highlight a few. The projects include the Adelaide Women's Health Centre, a project that was a collaboration between the Women's and Children's Hospital and the University of Adelaide. Thanks to the investment of Health Workforce Australia, the health clinic was refurbished and student and consulting rooms were developed. This refurbished facility allowed medical students to gain real-life clinical training experience and develop their expertise in women's health.

Another great Health Workforce Australia investment was at the Graylands Hospital in partnership with the WA Department of Health to improve teaching for nurses in mental health. Through the Clinical Training Funding program, the funding allowed the department to remodel and the hospital to become a centre of excellence in education and research for nursing. New areas for group work student nurses were established, and there was an increase in capacity in clinical areas. This investment allowed students to gain the maximum exposure to training in nursing and mental health, as well as increasing the facility's capacity for students by 94 per cent. In addition, they were able to learn from vastly experienced clinicians and address the shortage of mental health nurses.

Student accommodation to support clinical placements was also funded by Health Workforce Australia. This program has already achieved 8,400 new quality clinical training places for students over 22 individual disciplines. This has included new and refurbished accommodation for medical and nursing students. This has supported students to undertake clinical placements, particularly in rural and remote areas. One of these examples includes mobile accommodation and learning areas for students on clinical practice from Southern Cross University in New South Wales. This has allowed the university to support students to undertake placements in rural and remote communities in areas where the infrastructure was previously not in place. This meant that clinical training opportunities in those communities would not occur. These mobile accommodation units have been able to quickly respond to support students to complete these placements in otherwise out-of-reach communities. The refurbished student accommodation next to the local health service in Geraldton, Western Australia, allows students to stay in rural areas for a longer period of time. The results of this Health Workforce Australia funded initiative have been the ability to get students to undertake clinical placements in rural areas, to ensure that they are rural workforce ready and to entice them to come back and work in these areas when they are qualified.

In addition to these achievements, Health Workforce Australia has supported a 115 per cent increase in simulation education hours in 2012, through its Simulated Learning Environments program. Simulated learning provides a realistic, cost-effective and flexible alternative to clinical training. An example of this is in the purpose-built simulation centre which was a collaboration between Mater Health Services, Brisbane, and the University of Queensland. The addition of the purpose-built simulation centre has ensured that nurses and midwives are clinically confident when they graduate. It has ensured they understand how to manage a whole case, including emergencies that may arise, and learn different skills, which before this purpose-built centre, they would have never had the opportunity to rehearse.

Another investment in simulated learning education can be seen with the SA Ambulance Service's vehicle crash simulator, which allows paramedics and ambulance officers across the state to undertake realistic simulated emergency training exercises. The vehicle crash simulator is the first of its type to be developed by an Australian ambulance service. The simulator is a modified Holden Commodore that can be dismantled section by section to simulate an extrication. All four doors, their windows, the B-pillar and the roof can be removed to help provide a realistic environment for car crash scenarios. The vehicle crash simulator is part of SA Ambulance Service's mobile simulation training unit, which also includes a decommissioned ambulance and car carrier trailer to transport the unit across the state. This is another great example of how Health Workforce Australia's investment was building the capacity of those in our health workforce, and paramedics in particular.

In the 2013-14 budget, the Labor government invested more than $344 million through Health Workforce Australia to support Australia's healthcare system and its workforce, especially in rural and remote areas where support programs are vital in addressing workforce shortages. It is disappointing that, when this government came to office, it put a freeze on all unallocated funds, ensuring that no money left the door.

Health Workforce Australia jointly funded the construction of Australia's first national test centre with the Australian Medical Council. The facility in Melbourne, which opened in July 2013, enables international medical graduates to take their clinical examinations. The centre was a direct response to the House of Representatives Lost in the labyrinth report, which highlighted the need to clear the backlog of IMGs waiting to sit their examinations.

Health Workforce Australia has delivered an additional 446 nurses and allied health professionals to rural and remote communities. Health Workforce Australia also responded to new and innovative ways of getting the best out of our workforce, through its Expanded Scopes of Practice program, which aimed to increase workforce productivity, recruitment and retention by expanding the scope and uptake of established health professional roles. Since July 2012, Health Workforce Australia has supported 27 project sites across 25 organisations from around Australia to develop and implement expanded scope of practice initiatives. These include expanding the scope of nurses in eight emergency departments and physiotherapists in nine sites to help manage the increasing number of patients presenting to emergency departments; five projects where advanced practice in endoscopy nursing has led to increased capacity and productivity in gastrointestinal endoscopy to help meet an increasing demand; and extending the role of paramedics in five sites, a project which aims to provide care to patients in their usual place of residence, thereby reducing the number of emergency department admissions and transfers to other health facilities.

There have already been tangible results from this program. Between January 2013 and January 2014, the nurse endoscopist trainees completed 1,259 colonoscopies. A nurse endoscopy program implemented at Victoria's Monash Health has reduced its seven-year waiting list for routine endoscopic procedures to a maximum of 40 days, from its initial waiting list of 400 people. This is a significant achievement. This initiative has certainly changed people's lives and helped patients get the treatment they need and given them peace of mind.

An initiative to expand the scope of practice for physiotherapists in emergency departments has also been a resounding success. This initiative involved experienced musculoskeletal physiotherapists undertaking a primary contact role for suitable patients with musculoskeletal injuries. These highly trained physiotherapists have increased competency and autonomy in areas such as simple fracture management, interpretation of imaging and referral to specialist services. Indeed, at Ballarat Health Services, their expanded scope of practice physiotherapists have received rave reviews from patients.

In conjunction with the ED team, the expanded scope of practice physiotherapists have treated patients with musculoskeletal injuries at the weekend, caused mainly by sporting activities. Patients ranging from junior netball players to self-employed businessmen would have faced significant waiting times in ED prior to the expanded scope of practice physiotherapists initiative. But these patients now receive treatment when they need it quickly and they are back at work or school on Monday. The treatment from the expanded scope of practice has enabled doctors to treat patients with more serious injuries.

Another major success of this program was extending the role of paramedics. These are experienced paramedics with advanced training and skills in patient assessment, the delivery of quality care and the coordination of appropriate referral pathways. Extended care paramedics treat identified patients in collaboration with other health professionals in their usual place of residence, thus reducing emergency department presentation and interfacility transfer. This model of care was customised in South Australia, Tasmania, the Northern Territory and the ACT.

Preliminary findings show that patients are being treated in situ and are avoiding transport to an emergency department in around 70 per cent of cases. This is another real example of the model working well and a model benefiting from the funding.

Another example of this extended scope of practice working is at residential aged-care facilities in Tasmania where there has been a break-out of gastroenteritis. Extended care paramedics were able to provide in-home treatment and support to residents and staff, resulting in several residents avoiding having to go to hospital. It also saw minimal disruption to both residents and staff. It is hard to believe—and I have only provided some of the evidence—that Health Workforce Australia has been in existence for only four years because it has achieved a lot.

However, the coalition government are proposing to abolish Health Workforce Australia as part of their cruel budget. They want to turn their back on the health workforce and health workforce planning. It does not seem to matter that Health Workforce Australia has achieved more than any other coalition administration. It does not seem to matter that they are delivering on clinical training hours, more efficient and effective workplaces, and health workforce strategies. This has caused alarm bells to ring not just for us on this side of the House but also for many other third parties around this country. For instance, Dr John Hall, of the Rural Doctors Association of Australia has expressed his fears about the closure of Health Workforce Australia. He said, 'It is critical that the good work the agency has already achieved is not lost.'

The Health Workforce Australia (Abolition) Bill 2014 seeks to repeal the Health Workforce Australia Bill 2009 and to absorb Health Workforce Australia's functions and programs into the Department of Health. The Health Workforce Australia (Abolition) Bill 2014 will transfer Health Workforce Australia's functions and programs to the Department of Health.

Our concerns about this bill are very simple. If this bill is passed the complex planning work will not occur on a national level and the burden will fall on the states and territories. This government seems to be determined to dismantle universal health care and consign our country to a return to a piecemeal approach to health workforce planning, which will result in a boom-bust cycle in the supply of doctors, nurses and allied health professionals. Without Health Workforce Australia there will be no investment in clinical training. This government is neglecting tomorrow's health professionals and ripping away training opportunities that they need.

The agency was an independent body that worked collaboratively with a number of key stakeholders and had direct links with states and territories. I think this is an incredibly important point: that on the board of Health Workforce Australia there were representatives from the states and territories, the Commonwealth, and training facilities, universities. So everyone who had a stake in training our future health workforce was represented. Unfortunately, as soon as they came to government, those on the other side turned their backs. They refused to appoint a permanent CEO, making it clear before they had received any advice, that they had no intention whatsoever of ensuring that Health Workforce Australia was a success. Indeed, they refused to re-appoint board members when there was a vacancy. Up until their announcement, there were only four board members left, out of a possible 13. So, once again, that shows huge neglect of this important independent body.

Importantly, this board had links with universities. These are so important because it is universities that train our medical workforce. They are focused on providing leadership, advice, research and funding to address the challenges of building a sustainable health workforce for our future. These relationships will be now be lost if this bill is passed.

As a member of parliament from South Australia, there are deep concerns about the future of the 130 staff, based mainly in Adelaide. A number are also based in Melbourne and other cities and these jobs are now in jeopardy. It remains to be seen how many Health Workforce staff, who have a great deal of expertise in all facets of the health workforce, will go to Canberra and work for the department. In fact, many have less than a week to decide their fate. Indeed, many will decide not to come to Canberra. Therefore, they may not have the opportunity in Adelaide to work in the area that they love.

In addition, we know that while the coalition is saying that this department will be able to just as effectively and efficiently be run as the Department of Health, we know that that was not the case under the previous government and that it did not happen. It did not work and that is why so many people supported the creation of Health Workforce Australia and why there have been so many people willing to work in a collaborative way to see that these projects are a success.

We also know that, in addition to perhaps not having the expertise and ability to engage with stakeholders in the way that the board of Health Workforce Australia was able to do, approximately $142 million is being ripped out of Health Workforce Australia. We know from Senate estimates hearings today that there will be no more money going out of the door, funding clinical placements on the ground. We know from Senate estimates that there is no certainty about the simulated learning environments that I spoke about previously and the success they had. Indeed, the department has revealed today that they probably will not exist after December 2014. So not only is the coalition trying to pull the wool over people's eyes with 'Nothing to see here, health workforce planning will still go ahead,' what we really know from Senate estimates today is that there is no money there anymore. There is no money going out to universities, going out to health services, going out to rural and regional areas to help with clinical placements and clinical funding. This is a real travesty, especially when we are dealing with this challenge for the future.

There are a number of questions that need to be posed and have not been answered. How will the Department of Health continue the momentum of the programs, or will they just fizzle into the history books? How can this government assure the House that this good work will continue when money is being ripped out? How can this government assure the House that national health workforce planning will continue if only a handful of Health Workforce Australia staff are relocated and work in Canberra? Health Workforce Australia has a proven track record in national health workforce planning. Why break something that doesn't need breaking? Surely this is ideology gone astray. This scenario is unsustainable and unaffordable and will result in a health workforce that will not be able to meet the increasing demands. Of course, the government have argued that this is all about getting rid of health bureaucracy and cutting red tape. However, by abolishing Health Workforce Australia, and indeed other organisations such as Medicare Locals, they are indeed cutting the very quality of our future health care.

Those on the other side have said they want to direct money into frontline services, but where are those frontline services going to happen if there are not the doctors, the nurses and the allied health care professionals to deliver them? We know that they are cutting billions of dollars from hospitals, preventive health and indeed primary health. In addition, we are now seeing cuts to health workforce training. Labor opposes this bill. We will not stand by and let this government throw a wrecking ball at Health Workforce Australia and smash all of its good work.

The Prime Minister promised not to cut health. We now know he is putting a $7 tax every time you go to the doctor and is cutting billions from our hospitals. He is also abolishing Medicare Locals. This seems to be an ideological assault on the health care of this country, an ideological assault that is about ensuring that if people can afford health care they get it and if they cannot afford health care then bad luck. But when it comes to health workforce planning, I had hoped that the Prime Minister would have learnt from his mistakes while he was health minister. At that time there was a significant problem when it came to health workforce planning in this country, and surely after the mistakes of the past he would have had a bit of a flare go up when this proposal came to cabinet. He would say, 'Look, I don't think it's right that we don't plan properly for our health workforce. I remember the trouble I got into when I didn't plan for the health workforce needs.' Unfortunately, it has not been the case and ideology has won out.

All the good work that has been done by Health Workforce Australia to improve the workings of our services, to ensure that rural and regional areas actually get the services that they deserve, to ensure that students have the best possible training and that models of care are done in the most efficient way—you would think that would be a priority of the government when they are talking about an efficient health system. You would think that having the most efficient model of health care would be something to strive for, but no—the body that worked towards ensuring lower emergency department presentations by extending scope of practice for medical practitioners abolished, not just the agency that delivered it but the program abolished by December 2014. It is of great concern to Labor. We will oppose this bill. We believe in putting practicalities of planning for our future health workforce before ideology and therefore we will not be supporting this bill.

Alan Tudge (Aston, Liberal Party, Parliamentary Secretary to the Prime Minister) Share this | Link to this | Hansard source

I rise to speak on this bill with a few minutes remaining before we adjourn for the evening. The first point I wanted to make is that the Commonwealth does not employ any doctors, does not employ any nurses, does not employ any physiotherapists, does not employ any occupational therapists—indeed, does not employ any health workers. The Commonwealth government does not do that because that is the role of the state governments and of private entities. The state governments have responsibilities for hospitals, the state governments have responsibility for most of the primary health care, and that is where the doctors and the nurses are employed. So one of the reasons why we are abolishing this entity—not the programs, just the entity—is because we do not actually employ any of the doctors and nurses. It is a classic Labor agency, isn't it, a Health Workforce Australia agency supposedly to do all this terrific planning of the health workforce when we do not actually have any health workers employed by the Commonwealth. There are 21 health agencies in the Commonwealth despite not employing any doctors and nurses. This is a sensible measure. Yes, it is to save some money but it also is to make the overall system work more effectively and more efficiently. We have previously debated the abolition of the Australian National Preventive Health Agency and now we are debating the abolition of the Health Workforce Australia agency. We are doing this in order to make the overall system of governance more effective.

The second point I would make is that many of the programs that were being run by Health Workforce Australia are not being abolished overall but are being incorporated into the health department. Why are we doing this? Firstly, so that they can be more effectively executed and in line with other policy which is being implemented by the health department. But, yes, we are doing it in order to make some cost savings. I know that the opposition does not quite realise this, but they left the budgetary finances in a complete and utter mess, so we do need to make some tough decisions in order to bring the budget back into surplus in the medium term. We are prepared to accept that responsibility to do so.

Debate adjourned.