Mark Coulton (Parkes, Deputy-Speaker) Share this | Link to this | Hansard source

The original question was that the bill be now read a second time. To this the honourable member for Makin has moved as an amendment that all words after 'That' be omitted with a view to substituting other words. If it suits the House, I will state the question in the form that the amendment be agreed to. The question now is that the amendment be agreed to.

Lucy Wicks (Robertson, Liberal Party) Share this | Link to this | Hansard source

I am pleased to rise in support of the Health Insurance Amendment (National Rural Health Commissioner) Bill 2017. It is important legislation to get Australia's first national rural health commissioner off the ground, as a valuable advocate for regional and rural health. This bill delivers on our commitment from the 2016 election and, yet again, demonstrates how the Turnbull government is committed to addressing access to health services in rural and remote Australia. The rural health commissioner will work with communities, training colleges, universities, the health sector and all levels of government to improve rural health policies. A well-trained local health expert located in rural and remote towns in many cases forms the heartbeat of local health care for small communities around Australia. A national rural health commissioner will be their champion.

The coalition government is providing $4.4 million to establish the new commissioner, who will act as an independent statutory office holder with duties directed by the minister responsible for rural health. I am pleased to see that addressing the issue of workforce distribution in regional and rural areas is a key priority for the commissioner. It is this particular issue that I would like to focus on in my remaining time, as it is absolutely critical in my electorate of Robertson.

As I raised in the House just recently, this has been an issue that I have been fighting for on behalf of our local community since well before I became the member for Robertson in 2013. After years of inaction from Labor, who simply failed over six years of representing Robertson, to understand or address this emerging problem, the coalition made it part of our growth plan for the Central Coast in the lead-up to the 2013 election. By pledging to look into the unique circumstances facing our region in attracting and retaining GPs, we took the first step in acknowledging that more needed to be done. When we looked into it, it emerged that part of the problem was that the District of Workforce Shortage system, known as DWS, was actually using old data from 2004. Thanks to the coalition government, we made long-awaited changes to the DWS calculations so that now the most up-to-date data is used to more accurately identify areas where there is a doctor shortage. For those areas with DWS status, it then becomes easier to attract and recruit GPs to help meet that need.

Twenty-six suburbs in my electorate of Robertson were given DWS status, including Avoca Beach, Copacabana, Davistown, Empire Bay, Erina, Green Point, Killcare, Kincumber, Saratoga, Terrigal and Wagstaffe. This has helped people living in these suburbs enormously. Yet, as I said in my last speech on this issue, these changes did not include Umina Beach, Patonga, Ettalong Beach, Woy Woy or other suburbs in the peninsula region.

The DWS may not turn out to be the silver bullet that tackles this issue in the most appropriate way for residents on the peninsula, but one thing is clear: something needs to be done, and something needs to be done quickly. Local residents like Nicole from Umina Beach told me it took her two years to be able to access a local doctor on the Peninsula, and she has said it can now take her two weeks just to get an appointment. A local GP, Dr Ray Martin, told me the issue was 'past crisis point'.

Armed with these alarming stories, I approached the Minister for Health and the Assistant Minister for Health, who is the minister responsible for the health workforce. I invited the assistant minister to hear firsthand from the people in our electorate who were being hit the hardest. I am pleased to report that the visit happened last week and that we received an overwhelming response, and I note the presence of the assistant minister in the House this afternoon. With less than a week's notice, around a hundred residents and local doctors attended a community forum at Jasmine Greens Park Kiosk cafe in Umina. It was standing room only, as locals packed in to hear this issue addressed. Bob and Judy from Woy Woy were right when they said to me afterwards, 'Wow, what a turnout.' It really was standing room only. Another attendee, Sue, said she, 'thoroughly enjoyed this morning's discussion about the health crisis on the Peninsula', and yet she said, 'I'm really distressed for the doctors and how hard they are working to meet the needs for us locals.' We heard from people like Kim, who shared her story about how frustrating it was for her to try to find a doctor for her elderly mother, who suffers from dementia. Kim said she approached 36 doctors located on the Peninsula, all without success. Thankfully, she eventually found a GP who was able to see her mother, but they are based at Green Point, more than 20 minutes away, and Green Point is actually one of the suburbs whose DWS listing, which the coalition government obtained, enabled more GPs to be recruited to the area. We also heard from local health professionals like Dr Paul Duff, a respected local GP, who helped many of us understand some of the background to the doctor shortage problem and why it needs to be addressed.

The local primary health network—Hunter, New England and Central Coast Primary Health Network—has done some significant work in helping us understand this state of play, with up-to-date data on Peninsula general practices to assess and evaluate the workforce. Their findings confirm that a high proportion of GPs in the region are at or nearing retirement age, both in the community and in aged-care facilities. This lack of a younger GP workforce, and very few GP registrars, means there could be a risk of a large, vulnerable and ageing patient population on the Peninsula having limited access to a GP in the near future. These GPs, as we heard at our forum on Friday, are dedicated, committed and passionate about helping families and local residents right across the Central Coast. But it is simply unacceptable that, at a time when bulk-billing rates are at record highs of around 90 per cent in my electorate of Robertson, many GP practice books are closed. In the case of Dr Martin, when his practice closes down later this month, there will be around 1,200 patients looking for a new GP. The PHN data revealed that there is an active patient population of more than 35,000 in the Peninsula area, with around 34 GPs across 10 general practices, including a skin cancer clinic. Sixteen of these 34 GPs are over 61 years of age, and along with one of these doctors retiring, another is reducing their hours. Furthermore, the minister's office advised that 20 per cent of people in the Robertson electorate are 65 years of age or older, compared to the national average of almost 15 per cent.

The government does not and cannot hire, move or direct doctors, but we are listening closely to the heartbeat of my community, and this conversation is the start of genuine and much-needed action to tackle this urgent problem. After the forum that we hosted at Umina, we then hosted a roundtable with experts from International Medical Recruitment and key community advocates. We heard from representatives from the Central Coast Local Health District, PHN CEO Richard Nankervis and the University of Newcastle. The University of Newcastle is a key player in this conversation through its lead in developing the Central Coast Medical School and Medical Research Institute. This institute and medical school will operate as a branch faculty of the University of Newcastle and will provide additional medical students and young doctors when it becomes operational. The federal government has committed $32.5 million to the medical school, which will be co-located with Gosford Hospital, delivering hundreds of new jobs, along with education, health innovation and excellence.

This is a game changer that will form part of our long-term solution, but I would like to quickly return to the immediate issue of getting more doctors into the Peninsula as soon as possible. Importantly, we are committed to working together to find a solution to this critical shortage. One of the central resolutions that emerged from the discussion on Friday was to leverage the work already being done by the PHN. Following the roundtable with stakeholders in West Gosford and with the assistant minister, we were able to announce a fresh collaboration with GP Synergy, the regional training organisation responsible for the placement of registrars in the area. This will equip and enable the development of strategies to increase GP registrar numbers on the Peninsula and to assess the number of GPs able to provide supervision and mentorship to medical students. There will also be a renewed focus on evaluating and supporting GP succession planning, to make sure that we are not in this situation in the long term. Finally, a commitment has been made to do everything we can to keep the community up to date. This includes circulating information to the broader Central Coast PHN regions to raise awareness and to encourage the potential relocation of doctors from GP regions that are more densely populated. These commitments will only be the start, and there is more to be done.

But can I say, this is much, much more than was ever achieved during the six years of Labor that we endured on the Central Coast. Labor senator Deborah O'Neill, a former one-term member for Robertson, and her predecessor, Belinda Neal, simply failed to address this issue. Yet all we have heard from Senator O'Neill locally are complaints, with no sign of wanting to support the people on the Peninsula in this important fight. The Labor senator was quoted in the Central Coast Express Advocate as saying the coalition had 'done nothing' on its 2013 election commitment, yet the fact of the matter is that the senator's office is based in Erina, one of the 26 suburbs added to the DWS maps that I alluded to earlier. In 2014 a group of doctors from Erina approached me asking for someone to do something about the doctor shortage in that area. They spoke, we listened and we acted. We had to, because Labor had failed. Senator O'Neill also claims that I have 'suddenly decided this issue is an emergency'. This, to be honest, is an insult to the hundreds of local residents who have written to me and an insult to the 100 people who turned up at Jasmine Greens Park Kiosk in the pouring rain last week.

Our public commitment to fight to address the GP shortage has come after months and months of sustained hard work in listening to the needs of the people Woy Woy, Ettalong, Umina and surrounding suburbs, and partnering with them to come up with real solutions. It comes after several meetings with ministers in Canberra. It comes after door-knocking and speaking with local doctors, local GPs and local residents across the region.

We still have a lot more to do to ensure that we address this issue. But I am pleased to be able to stand in this House today not just to commend this legislation but also to endorse the focus of this government in tackling important health issues in rural areas. The forum at Jasmine Greens Park Kiosk was an outstanding example of the steps that we are taking to demonstrate effective community action and we will not rest until more is done to help the people of the Peninsula to see a local GP when they need to. I commend the bill to the House.

Warren Snowdon (Lingiari, Australian Labor Party, Shadow Parliamentary Secretary for External Territories) Share this | Link to this | Hansard source

I am pleased to be able to make a contribution to this debate on the Health Insurance Amendment (National Rural Health Commissioner) Bill 2017. The purpose of this bill is to amend the Health Insurance Act to establish a National Rural Health Commissioner, who is to provide advice to the relevant minister on the role of the rural generalist, to develop a national rural generalist pathway, and to provide advice on rural health reform, as requested. The proposed commissioner's position will cease operation on 1 July 2020.

We will not be opposing this legislation, but we do believe that the commissioner has been given a very narrow purview and we believe this falls short of what the expectations properly are. I know the announcement made by the coalition in the 2016 election campaign about the appointment of a National Rural Health Commissioner and the development of a rural generalist pathway was supported by the sector. I note in particular that there was good support after the announcement of the position by the government. There was support from the National Rural Health Alliance. The CEO, David Butt, said:

Australia's first Rural Health Commissioner has the potential to be the catalyst for transformational change for the 7 million people who live in rural and remote areas.

He then made the observation:

Currently, poorer access to health services results in poorer health outcomes. That covers the whole spectrum of health – promotion of good health and wellbeing, prevention of illness, early intervention, particularly in general practice and primary health care, and more specialised treatment when needed.

The Rural Doctors Association of Australia welcomed the pledge, and that is important. Dr Ewen McPhee

We're welcoming this with open arms, this is a fantastic opportunity for rural Australians and all the groups that represent and address the health needs of rural Australians to come together at the highest levels of government, and make sure that our voices are being heard.

That is important.

Significantly, the Australian College of Rural and Remote Medicine, an organisation for which I have the greatest of respect, welcomed the announcement by the Hon. Dr David Gillespie, who is at present at the table in the chamber, to establish the role of the National Rural Health Commissioner. Professor Ruth Stewart, the ACRRM president, said:

The National Rural Health Commissioner will be an independent advocate, advising government on regional and rural health reform and representing the needs and rights of regional, rural and remote Australians and will lead the establishment of a National Rural Generalist Pathway.

She went on to say:

The College has been working towards the implementation of a National Rural Generalist Pathway for a number of years, and we are pleased that this important initiative has been given a high priority.

Hear, hear I say to that. I will come back to that a little later.

I want to point out how important it is to address properly the health needs of people who live in the bush. To date, sadly, we have failed the bush. I say this having been the Minister for Indigenous Health, Rural and Regional Health and Regional Services in a previous government. But we do believe that while the development of a national rural generalist pathway is, in my view, more than welcome and is long overdue, it is unclear what role the commissioner will have in terms of how the implementation will be and what his or her role might be beyond that. This could have been a real opportunity to create a commissioner with real political support who could put rural and remote health on the agenda. I am hoping that this is the case—that it will happen—but I am concerned about the narrowness of that person's brief.

These concerns are further underlined by the fact that the office will cease to exist in 2020. I wonder why. Why would you want to terminate this position in 2020? The concerns of people in the bush about their health and health care will go well beyond 2020, and I can tell you that we will not have the solutions by them. It is very important, I think, that we support the amendments Labor will move aimed at improving the legislation by broadening the scope of the commissioner's role and reviewing the terms of reference. I note that there is no provision in the bill to extend the position. There is no review of the provisions of the commissioner's position within the legislation. That is a problem that needs to be addressed by an amendment. The scope of the commissioner's role is primarily focused on the establishment of a national rural generalist pathway and the bill appears to ignore other issues in rural health. That is a real problem. Also, there is no advisory body proposed to assist the National Rural Health Commissioner with his or her work. That is also a significant problem.

Those of us who have lived in the bush for any length of time—and I know you have Deputy Speaker Coulton—understand the vagaries of health services and what it means. We note from the work of the Parliamentary Library, through the Bills Digests, that they quote a number of medical practitioners who are currently working in the bush. I note that in their report, which includes data from tables in an Australian Institute of Health and Welfare report, it is very clear that in 2015 the supply of employed medical practitioners, not general practitioners, in major cities was 441.6. In rural and very remote areas, which is where I live, it was 262.8—probably 80 per cent more medical practitioners operating in the cities. And of course what that leads to is different levels of service.

That explains why, in part, we have very significant and different health outcomes for people who live in the bush. And we know—I know you know from your experience, Mr Deputy Speaker Coulton, as I do from mine, and the minister at the table surely knows—that we need to do a great deal more if we are to assist in improving the health needs of people who live in the bush. Australians who live in rural and remote communities have mortality rates—and here I am quoting from the AIHW, itself quoted by the Parliamentary Library—that are 1.4 times higher than for those living in major cities; mortality rates for coronary heart disease were between 1.2 and 1.5 times higher in rural and remote areas compared with major cities, and death rates due to diabetes were between 2.5 and four times as high.

You know, Mr Deputy Speaker, and I am sure many others in this place know, that if you live in a remote part of this country—what I call 'bush', as opposed to regional New South Wales, or coastal New South Wales, which some people regard as regions—and if you live where I live and look after the community that I look after that they are desperately in need of health care. Aboriginal people in my electorate have the worst health outcomes of any people in Australia, yet they are very concerned about the nature of health services that get delivered to them. I would have thought that the job of this new person, this position, should be expanded well beyond the scope of what is currently being envisaged and should talk about the panoply of issues that confront the health workforce, for example—not only in employing more doctors, but we know that we have an emerging health crisis in this country around the shortage of nurses. That will impact upon the bush. We know that in all areas of allied health care there are shortages of workers, particularly in the bush. We know there are shortages of Aboriginal health workers in the bush, and we know that government—any government—is yet to really embrace the idea of physician assistants and giving them a role in the bush.

I know it is something that has been explored in Queensland, and the previous, Labor, government in Queensland actually had explored this option and built in training packages at the University of Queensland. I now think there are only two other institutions in the country that provide training opportunities for physician assistants. But I do want to commend the Queenslanders for picking up the idea of rural general practice. It is very clear, in my view, that if you provide a rural generalist pathway and you expand the training opportunities for doctors working in the bush then you will get a far better health outcome for those people who are being served. I want to commend the Queenslanders, and ACRRM in particular, for advancing the cause of rural generalists. They deserve praise. I know there have been naysayers in other parts of the profession. What I say to them is: 'Get your head out of the sand. If you don't understand the need to provide additional specialist training for GPs who are working remotely so that they can do other procedures that might be required, then you're failing to understand the nature of the health workforce issues in this country or the health needs in this country, and that is really very important.'

Last week I was in a very remote part of the Northern Territory, Alpurrurulam. Alpurrurulam is a community of about 500 people. It is closer to Mount Isa than it is to Tennant Creek or Alice Springs, which is where I live, but a 1½-hour flight by light aircraft. For much of the year it is inaccessible because of road issues. But real issues exist in communities like this around fundamental questions about the health workforce: how do they attract not only doctors but qualified nurses, allied health professionals who are able to move in and out? How do they provide the housing and resources that are needed to make sure that those communities are being properly served? And they have endemic chronic disease. We know this, and I know the minister at the table would understand this all too well. We know from evidence given by the AIHW that the levels of service that are being given to Aboriginal people who live in the bush and other people who live in remote parts of Australia are far less than those being provided for people who live in the cities. Part of it is about the accessibility and availability of the workforce. And if this new position does anything, it has to look far beyond the idea of just rural generalists and look at the whole panoply of health workforce issues so that we know that we have someone in the structures of government whose job it is to examine the detail of what is required to improve health outcomes and the opportunities for the health workforce in the bush.

We know there have been, over many years, all sorts of proposals to expand opportunities. There have been incentive payments that are clear and obvious for remote doctors, and they are very good. They do not exist in the same way for other health professionals, and they perhaps should, because we need to make sure that we are incentivising people to relocate from major metropolitan centres, where it could be argued that there is a bit of overservicing, to people in the bush, where we know there is dramatic underservicing. And we have to comprehend the rationality of looking at people as individual workers and understanding the dilemmas they face in relocating their families from, say, Sydney or Melbourne to somewhere like—even your own electorate of Parkes, Mr Deputy Speaker Coulton, or, in my own electorate, perhaps to Katherine, and working remotely from Katherine into remote communities.

We are now seeing some GPs who are job sharing in the bush. They are quite happy to do a fortnight or three weeks at a remote community like Alpurrurulam and then go away, come back in another month and do another three weeks. If we can get those sorts of things happening on an ongoing basis then we know we are getting continuity of care, and that is what is ultimately very important if we are going to improve the health outcomes for Aboriginal and Torres Strait Islander people who live in the bush as well as people more generally who live in the bush. Men in particular have a problem in the bush, partly because they are men and also because they just fail to get the service they need because they are just too damned stupid sometimes to actually stand up and take notice of what people are saying to them and go out and get help. Clearly, this is an issue which this position ought to be contemplating.

I would also argue that an issue which we know now is top of the agenda for many people around this country is the issue of mental health. We need to make sure that people who live and work in these remote parts of Australia are being supported in that regard, and that requires mental health practitioners. We have insufficient numbers of mental health practitioners working in the bush.

No magic wand is going to change that. But what we can do is to work cooperatively and in a bipartisan way, I hope, to try to improve these health outcomes by getting workforces which are properly trained and focusing their attention on the needs of people who live in the bush—well, what I call the bush but many might call pretty remote. It is remote, but it is therefore necessary that we appreciate that these people have the worst health outcomes in the country and therefore need the most attention.

I would say to the minister at the table, Minister Gillespie: whilst we commend you for initiating this proposal, I think you do need to look beyond 2020. I think you need to look at the amendments which have been proposed by the Labor Party. That would be, I think, a good thing to do—to accept in good faith that those amendments are being moved to try to improve the outcomes for people living in rural and remote areas of Australia or what others might call the bush but I might call something different.

David Littleproud (Maranoa, National Party) Share this | Link to this | Hansard source

Today I am quite proud to stand in this parliament and support this great bill, the Health Insurance Amendment (National Rural Health Commissioner) Bill 2017. But I should also commend those opposite for their bipartisan support in ensuring that this bill is passed. It is an important issue, particularly for my electorate of Maranoa, a rural and remote electorate that takes up 43 per cent of Queensland. I do commend those opposite for coming on this journey with us.

But I have to express most of my gratitude to our Assistant Minister for Health, Dr David Gillespie, my National Party colleague, for what he has put in place—building on the work done by Senator Fiona Nash, as his predecessor, many years ago, to make rural health an issue and bring it to the forefront in Australia—and for making sure that today we bring forward legislation that will actually improve the lives and wellbeing of people living in regional and remote Australia. That is something we should be quite proud of as a parliament. I am, as a National Party member, very proud to be part of a party that understands the importance of rural and regional Australia. It is about making those communities out there communities of choice to live in, and that does not come without having a proper health service. Dr David Gillespie has done an outstanding job in this, and he should be commended for what he has done. So congratulations, Dr Gillespie.

I think it is also important to recognise that this bill is about actually getting back to having the grassroots drive the outcomes, and not having Canberra go out there and tell the people of rural and regional Australia exactly what they should have. This is about letting the community drive the outcomes and putting in place an environment where a commissioner can connect with the local community to be able to drive the outcomes that they are looking for—not what Canberra is looking for. We are not the holders of all knowledge and wisdom. We actually need to embrace our communities out there to get a proper understanding—not to come in here and give lectures about what should be happening, but to actually encounter those professionals who are out in regional and rural Australia who will actually be able to give us the insight required to make the proper policy settings to take regional and rural health to a new level.

The bill also builds on the work of my state colleague Lawrence Springborg, who is the former state minister who actually instituted local health boards in Queensland to drive health outcomes from the grassroots up. That is a really important piece that has had significant outcomes for people in my electorate by ensuring that there is a community board that drives the outcomes and tells Brisbane exactly what they require with respect to the outcomes that they need, whether that be an X-ray machine in Barcaldine or a CT scanner in Warwick. So this is building on what our National Party and LNP colleagues have done in Queensland, and I think it comes down to two words: common sense. That is what our electorate wants from us. They want commonsense outcomes to come out of this place that will actually drive better lives for each and every one of them.

Under this bill, the health commissioner will also be specifically charged with the responsibility for developing and promoting training and career opportunities for health practitioners across regional and remote Australia. This is an important piece to me in particular. I have an electorate that is 43 per cent of Queensland. It is important to be able to lure young doctors coming out of university at the start of their careers, or even those at the end, to come out and impart their wisdom and be part of our community, to ensure that we actually get the right outcomes. That is very important to me.

In fact, in Queensland, we are probably a little further ahead—as we normally are—with respect to the national rural generalist pathway in Queensland. In fact, a good friend of mine, Dr Tom Gleeson, who I saw on Saturday at the Roma airport, was one of the first ever to be appointed. He will be in Canberra in a couple of weeks to impart his experience of what this has done for him but also for the community of St George that he lives in. Dr Gleeson is a young man who was educated in Charleville, went away to university and now has come back to his community. He is prepared to give his expertise and skills to make the community of St George a better one for each and every one of those who live there.

These are the sorts of things that we need. We need to have pathways to entice and incentivise people to come back, and to give them a pathway into not just being a GP but into general surgery, obstetrics, anaesthetics and even mental health, which is a significant issue right across regional and rural Australia. So creating this pathway will enable the commissioner to work with the government to validate these practitioners as an absolute necessity in the rural and regional and remote areas of this country. It builds on the great work that the health professionals, not only in Maranoa but right across rural and regional Australia, are undertaking on a daily basis.

I am quite fortunate to live in an electorate where I feel very safe that, if something untoward were to happen to me and I were to need medical services, I would be looked after by some of the best practitioners in this country, if not the world. In fact, I have had the need to use the Warwick base hospital, and I can assure you that my family and I were nothing less than impressed by the professionalism and hard work that those people are putting in to a regional community such as Warwick. So this builds on that.

This initiative will also ensure that we get more timely and acute diagnosis of the issues of people in regional and rural Australia and their health concerns and sicknesses. In many ways, it will also lead to taking the pressure off metropolitan services by providing people who are able to identify those issues. Having them being able to extend further than being a GP is very important to ensuring that we get better outcomes. This pathway program is an exceptional outcome for the people of rural and regional Australia, and I can assure you that Dr Tom Gleeson will epitomise what is the very best of that. He is very proud to be somebody who is a product of Maranoa. He has been given the opportunity to come back and expand his career and to go past being a GP. Getting the professional acknowledgement and satisfaction of being able to extend past the basic services of a GP is important, and enticing him and his young family back to St George to contribute to that community in such a way I think speaks volumes of that program and of what the commissioner will continue to do.

The commissioner will also be tasked with providing the health minister with crucially important advice on rural health reform. As I said earlier, it is important that outcomes are driven from the community up and not from Canberra to the community. We need to encourage the community to become part of the solution on this, and what this step will do is open that up to ensure that there is a conduit for this commissioner from the community back to Canberra so that the outcomes that we give are ones that will actually make a difference. I have no doubt that this will lead to far better outcomes for communities in my electorate like Charleville, Chinchilla, Longreach or Kingaroy, or for any other regional or rural community right across Australia. This is an exceptionally proud moment for me to stand as part of this parliament and be able to say that we are actually going to improve the lives and wellbeing of so many rural and regional Australians.

I think it is also important to acknowledge that what this has the potential to do, as I said earlier, is not only to give more acute and timely diagnosis of sickness for people in regional and rural Australia; it also has the potential to cut the cost of patient travel times and funding for people in regional and rural Australia. We have to pay a significant amount to get people from regional and remote Maranoa into Brisbane or Toowoomba, into a larger centre, so this has potential around cost savings for the people of regional and rural Australia and ensuring that our health costs do not continue to blow out.

It is also important because it acknowledges that electorates like Maranoa are the engine room of this economy. Agriculture is booming and these communities are booming. The reality is that we have to make them communities of choice, and we will not be able to decentralise people away from major cities unless we can provide good health services, good education and a job. The National Party has again been at the forefront of ensuring that we put in place policies that decentralise, that incentivise people to move out and take the opportunities that are out there in rural and regional Australia. This measure is another cog in that wheel to ensure that our communities can become communities of choice for those who want to live out there.

It is also important to acknowledge that our outcomes in rural and regional Australia are not as good as those in metropolitan areas. The Australian Institute of Health and Welfare found that rural Australians have higher rates of death, particularly as a result of coronary heart disease, motor vehicle accidents and emphysema. The institute hypothesized—and I think we all know—that access to services is likely to be the core contributor. There are currently 409 medical practitioners for every 100,000 people in the cities, compared to only 253 per 100,000 people in remote areas. Yet the rate of emergency admissions for surgery is highest for the very remote areas, at 22 per 100,000, which is almost twice the amount of admissions to city hospitals at 12 per 100,000.

Sadly, that reality does not surprise me. On my travels around my vast electorate of Maranoa, one of the prevailing concerns for people living in that area is the provision of health services. Over the last 30 years, the incidence of cancer has climbed from 383 per 100,000 to 504 per 100,000 in 2008, before decreasing slightly to 407 in 2017. In terms of mortality, over the same period the rate has decreased from 209 per 100,000 to 161 per 100,000. That is to be expected with the research and innovation occurring in the health space in terms of cancer diagnosis and treatment. Let us not forget the importance of the provision of the right advice from our health experts, first and foremost, in terms of preventative screening and assessments and, obviously, treatment. That is where people with the dedication of Tom Gleeson come into effect.

It is important to acknowledge that, despite the decrease in mortality rates across Queensland, the Western Queensland PHN mortality rates for cancer patients over the five-year period from 2009 to 2013 was 206.6 per 100,000. This rate of mortality is far higher than that of the Brisbane North PHN, at 167.8, and the Brisbane South PHN, at 183.2. The Gold Coast PHN has a mortality rate of 169.1. In fact, the only PHN across the country that has a result worse than the Western Queensland PHN is the Northern Territory, which records a rate of 210.7 per 100,000. To allow these statistics to continue to grow and the gap to continue to widen would be a travesty, and it is something that we as a government—and even the opposition, as they have, quite rightly, supported this bill—cannot allow to happen. We have to stand strong and firm on this and make sure that we walk hand in hand with our regional and rural communities to ensure that we are able to provide an environment in regional and rural Australia where their health outcomes are not disadvantaged because of their postcode. What this initiative says to the people of my electorate and to all people living and working in regional and rural Australia is that, with access to quality health care, it does not matter where you live.

It is also important to acknowledge that it is about preserving that precious human capital that we need in regional and rural Australia and developing it. It is about them not leaving regional and rural Australia, knowing that we have a good health system, that we have a good education system, that the job opportunities are there and that they understand that the opportunities that are provided in regional and rural Australia will give them the opportunity to have a career, to start a business and to raise a family, and that they can get that with the same equity as those in metropolitan Australia.

This is an important day for the people of rural and regional Australia. It is important that we took this step. We will continue to evolve this measure as rural and regional Australia evolves. It is important that we as a government, no matter the persuasion, continue to acknowledge that and to be fluid as those circumstances change. I am proud to be part of a National Party, a coalition government, that has brought this to the fore.

Brian Mitchell (Lyons, Australian Labor Party) Share this | Link to this | Hansard source

The Health Insurance Amendment (National Rural Health Commissioner) Bill 2017 is of particular interest to my electorate of Lyons, as we identify as regional and rural, and certainly as relatively forgotten by this government in everything from telecommunications to health, education and the provision of medical services.

The appointment of a national rural health commissioner, strategically placed to drive rural health services, is music to many people's ears. Certainly, Labor will not oppose this legislation and appointment. However, Labor are seeking to improve it. Labor will seek to move amendments in the Senate that will broaden the scope of the commissioner's role, that will review rather than cease the commissioner's role on 1 July 2020 and that will establish an unpaid advisory board to support the commissioner. Labor's concerns are not around prioritising a focus on rural health but rather around the government's very narrow focus for this role. A national generalist pathway is a welcome addition to the complex world of healthcare service delivery. However, there are many other issues that need strategic management and long-term vision to support effective service capacity in rural and regional areas. This is no easy task, Mr Deputy Speaker Coulton, and Labor appreciate that. In fact, we did suggest and support the creation of a similar position long before the government initiated this measure.

The incomplete package before the parliament today represents a missed opportunity for rural healthcare service providers. The proposal is for a commissioner to be appointed by the minister on a full- or part-time basis for a period of up to two years. It lacks substance. Labor's preference was to create a health reform commission with more people and more reach to make more of a difference. Rural health care is a complicated chain of services that work with people through all stages of their lives.

If you were to take a snapshot of the lives of rural Tasmanians, including many in my electorate, the picture would look significantly different to the lives of those in central Queensland, in outback Western Australia or South Australia, or in any of the other regional and rural areas in this country. It is no surprise that a one-size-fits-all approach will never work in a country as diverse as ours. Australians living in rural and remote areas have much poorer health outcomes than those living in our major cities. The contrast is most stark for those in remote areas where average life spans of women and men are, respectively, two years and 3.4 years lower than city dwellers. Suicide rates are twice as high. Levels of chronic disease, including diabetes, coronary heart disease, lung cancer, eye disease and chronic obstructive pulmonary disease, are considerably higher. The ratio of health professionals, particularly in specialised sectors, is much lower than in city areas.

Alarmingly, despite much poorer health and much lower incomes, the average yearly Medicare Benefits Schedule spend per individual in remote areas is $536 a year compared with $910 in major cities. That gap really tells us something. Let us drill down into this a little more. Tasmania has a population of 513,000 people, with only 625 GPs across 152 practices. That means each doctor needs to have, on average, 820 patients. Tasmanians do not do very well with average weekly earnings; they are $1,344 per week. They are the lowest in Australia. Why does this matter?

The Abbott-Turnbull government has frozen the Medicare rebate for doctors, which means bulk-billing rates have fallen faster in Tasmania than anywhere else—from 76.4 per cent to 74 per cent in the last three months of 2016. This freefall is escalating, which is alarming. We have low income, low numbers of GPs and high doctor fees which are going up ever more. The GP rebate freeze looks to be a long one—kicking right through to 2020 as an election promise that was delivered by the Turnbull government. More cost equals less access for Tasmanian families. It means more pressure on late-diagnosis services. It means more use of the ER and ambulances for low-level issues. It means cost shifting from the federal government to the state. With a Liberal government in Tasmania as well, I am not hopeful that it gets the importance of health care as a universal, accessible necessity.

There are 1,560 allied health professionals across Tasmania. Our training sector to boost and strengthen this cohort has been negatively impacted by the stripping back of TAFE training services and the deregulating of university courses. All the loops in the chain of health care in Tasmania are cracking and breaking. We welcome this initiative today, but it is not enough.

Facebook chatrooms are full of people chasing appointments with doctors' surgeries who have their books open. They are one of the key ways that people in my electorate make contact with each other, and they are full of people seeking openings in GP appointment books. The emergency rooms at Royal Hobart and Launceston General are full of patients seeking basic treatments that a GP could otherwise manage. For higher needs patients or those needing diagnosis and treatment, there are 286 medical specialists. No wonder chronic care is the new focus. The system has lost the ability to manage early intervention and preventative treatments under the heavy weight of high-needs and complex healthcare complaints.

In the midst of all this, pharmacies are offering more services. They are stepping into the gaps left by GP clinics. Tasmania is a small state, with big, complex healthcare needs and a decentralised population across small towns and hamlets. Recently we have seen a very disjointed rollout of primary healthcare services that has seen the entire focus move from holistic health care to a narrow focus on just chronic health care, in its wake taking whole suites of very loved community healthcare programs with it. The Assistant Minister for Health is in the chamber today; he knows full well the impact this has had in Tasmania. I know he has been lobbied quite heavily not just by myself but by members of his own government. The senators in Tasmania are aghast at what has happened to rural and regional health service programs in Tasmania on his watch, with the gutting of services in Meander Valley and Kentish and other areas throughout Tasmania—preventative health services that kept people, certainly older people, out of hospital, kept them well in their the homes and well in their communities, and that has all ended. So that has not been good.

Communities have been outraged by the loss of these services with no real warning, no real replacement and no real understanding by the government of what people in rural Tasmania really want and of the need to keep them happy and living independently in their communities. People have come out in droves to public meetings across Tasmania, lobbying their state and federal members and senators, demanding a return of funding to services that they dearly want—and that anecdotal evidence suggests really worked. But we have not seen any movement or any funding returned to these vital services—just a cold shoulder from this government. This government seems determined to rule from its short sighted platform in the inner city rather than listening to voices in regional areas. I certainly hope this appointment of a rural health commissioner turns that around.

What is enlightening around this new role is the plan to define what it means to practice rural generalist medicine. In 2014 at the World Summit on Rural Generalist Medicine in Cairns a definition was decided upon:

We define Rural Generalist Medicine as the provision of a broad scope of medical care by a doctor in the rural context that encompasses the following:

•Comprehensive primary care for individuals, families and communities

•Hospital in-patient care and/or related secondary medical care in the institutional, home or ambulatory setting

•Emergency care

•Extended and evolving service in one or more areas of focused cognitive and/or procedural practice as required to sustain needed health services locally among a network of colleagues

•A population health approach that is relevant to the community—

and the minister should listen to that, because that is what we used to have, and—

•Working as part of a multi-professional and multi-disciplinary team of colleagues, both local and distant, to provide services within a 'system of care' that is aligned and responsive to community needs.

Unfortunately, some of those were covered under the previous system and have now been cut by this government. All those points will be an excellent starting point for the new commissioner to really double down on rural healthcare provision across the broad range of service areas, and I certainly hope we can see the commissioner recommend measures that will replace what Tasmania has lost in recent months under this government.

I cannot wait to see the yearly reporting from the new commissioner. Medicare Local, or Primary Health Tasmania as it is now, has our healthcare position in Tasmania at a place where we see Tasmania's mortality rates sitting higher than anywhere else in Australia: cancer, heart disease, organic mental disorders, injury and poisoning, cerebrovascular disease, chronic lower respiratory diseases, diabetes, other forms of heart disease, and arterial, arterioles and capillary disease all take far more of my fellow Tasmanian's lives each year than anywhere else in this country. This is devastating for my state, especially when there is a chance that earlier interventions, education, supports and preventative programs could have made a dramatic difference to these outcomes.

Today, Labor is backing this legislation in the hope that it is a first step to working on a long-term plan to really get back to basics for rural health care. It is a starting point; it is not perfect, but it is a starting point with an end point of 2020. We would prefer to see it reviewed rather than ended, so that when we take government one day—after the next election, hopefully—we will have a plan that is substantial and robust and ready to tackle the issues that rural Tasmanians and regional Australians need to be tackled.

George Christensen (Dawson, National Party) Share this | Link to this | Hansard source

I rise to speak on the Health Insurance Amendment (National Rural Health Commissioner) Bill 2017. The bill is fulfilling a commitment that we made prior to the 2016 election. The Liberal-National government committed to establishing Australia's first National Rural Health Commissioner to provide an independent, statutory champion for rural Australians and their health. The role of the commissioner will be to work with communities across regional, rural and remote areas around this country as well as the health sector, universities and specialist training colleges. The commissioner will be required to work across all three levels of government to improve policies for rural health and to create better access to health services for all Australians, regardless of where they live.

Life in regional, rural and remote communities is very different from life in capital cities. Unfortunately, most of the Australian population is based in capital cities and most people are very insulated from what might happen outside those capital city limits. Again, unfortunately, most of the representatives in this place also live in, and represent people from, those capital cities. That is why it takes a strong voice from those rural and regional communities to ensure their needs are not forgotten or swept under the carpet.

That is why it is very good to have a representative at the dispatch box in this place like the member for Lyne, who is the federal Assistant Minister for Health. The member for Lyne visited my electorate earlier this month, and we went to the James Cook University rural clinical school in Mackay. That visit gave the assistant minister an opportunity to see firsthand the experiences on offer for medical students under the Rural Health Multidisciplinary Training Program. This Liberal-National government, the Turnbull-Joyce government, has continued to invest in this training program because it helps to address some of the disadvantage experienced by people living outside of capital cities.

We know that Australians who live in the bush generally experience poorer health outcomes compared to Australians who live in capital cities. If we are to address that very, very big issue of disparity in health outcomes between city Australians and country Australians then we need to ensure we have the right number of health professionals in the right areas but, first and foremost, we need to invest in our future workforce. That is exactly what James Cook University are doing with the Rural Health Multidisciplinary Training Program. They are encouraging students to undertake their training in areas where their skills are needed the most, enabling students to see the unique health challenges faced by Australians living in those rural, regional and remote areas. It is fantastic to see that more and more of our young people are choosing to pursue their careers in health and train in regional locations.

When young students are studying at university and training, as the member for Lyne knows very well, being a gastroenterologist, it takes a very long time. It is a time in the life of a health professional in training when, as a young student, just out of university, they are meeting future partners, they are settling down, perhaps they are buying a first house—all of those things that are planting roots in a community. They might even be starting a family. Having young health professionals set down those roots in a regional community or a rural community can be the start of a lifelong relationship with the community which can be rewarding for both the health professional and especially for the health of that regional or rural community.

When James Cook University started the medical undergraduate program that they have now back in 2000, there were 64 first-year students. Prior to that course being available, North Queensland students were forced to travel more than 1,000 kilometres, in some cases more than 1,500 kilometres, from their home to Brisbane or even further south if they wanted to undertake medical studies. Unfortunately, what ended up happening was that those students who came from places like Mackay, Proserpine, the Burdekin, Bowen, Townsville, Innisfail, Ingham, Cairns and all around were going to the capital cities and that is where they were staying—they were doing their training there, they were setting down all of those roots. Last year the number of students enrolled across the six-year course at James Cook University had grown to 1,170, and last year 38 students undertook a long-term placement in Mackay, my home town, with a further 115 undertaking short-term placements in our region under the Rural Health Multidisciplinary Training Program.

This program is effectively keeping young health professionals in regional communities where their future skills will be most needed. The dramatic improvement to health outcomes that such a program can provide are examples of why a special focus must be placed on health policy for regional, rural and remote communities. The National Rural Health Commissioner that this bill seeks to establish will develop a national rural generalist pathway as their first priority. An initial part of the role will be to work with the health sector and training providers to define exactly what it means to be a rural generalist. It is very different from what we have in the cities. Rural generalists are supposed to be not just a jack-of-all-trades but a master of them all. It is going to be the responsibility of the commissioner to ensure that adequate incentives are applied to encourage young health professionals along the training pathway to become a rural generalist and also to ensure that potential obstacles are identified and that we remove them, get them out of the way so that these people can get in these positions as soon as possible. Rural generalists will require additional skill sets, and it is appropriate that their remuneration reflects those skills and the cost and effort that is required to obtain them.

The health of people living in regional, rural and remote communities is dependent upon the expertise and the commitment of our rural health workforce. Addressing the distribution of that workforce is a key priority. We need to ensure opportunities exist for rural medical students to train and live locally and for capital city students to experience the benefits of living and working beyond the major capital cities. The commissioner will work across all sectors to champion the cause of rural practice. More broadly speaking, the commissioner will be required to undertake extensive consultation with various stakeholders. Through that consultation, the commissioner will be able to identify where gaps in the system may appear and where a more focused policy might provide the greatest improvement in health outcomes.

In regional, rural and remote communities, there are particular difficulties faced in nursing, dental health, Indigenous health, mental health, midwifery and allied health needs. During the assistant minister's visit to Mackay, he also met with a group of women who established what is known as the Nude Lunch in Mackay. I am going this year but, fear not, the name is not indicative of a dress standard requirement. The event is called the Nude Lunch because it is intended to 'expose' ovarian cancer. They raised $40,000 in their first year, as a fledgling event, and it is set to become an even bigger and better event in the years to come. One of the main drivers of the Nude Lunch is Trudy Crowley, an inspiring woman who has been diagnosed with ovarian cancer and is committed to providing better support for women in North Queensland, and all over Australia, who are diagnosed with that terrible affliction, ovarian cancer. Currently, there is limited support throughout North Queensland, including my home town, and I believe services are ineffective due to a lack of coordination and communication. It is easy for women in regional communities to feel alone and isolated under these difficult circumstances. They are often far removed from specialist care and have a limited support network—or are not aware of it—of people who have been through the same experience and who are able to provide advice and support. Having to travel more than 1,000 kilometres, often leaving family and loved ones behind, to see a specialist in the capital city is just one more stress placed on women in regional, rural and remote communities that does not apply in the capital cities.

There are also health issues that are more prevalent in regional communities, such as mental health. Ten years ago, Mackay, sadly, had a suicide cluster where a number of young people committed suicide in a short space of time and a report on suicide listed Mackay as having the second highest suicide rate in the nation. On that list, a clear trend emerged: the further a community was from a capital city, the higher the suicide rate appeared. As devastating as suicide can be on family and friends, it has a rippling impact on small communities, where most people know who the victim is or are friends with someone who knows or friends with the family.

In 2010 I made a commitment to address the particular issue of mental health and youth suicide—I did so in my maiden speech, actually. I said I was going to fight for a headspace youth mental health centre in Mackay and I have to say that centre, now delivered, is providing an amazing service across the Mackay region. I believe these centres are indispensable in our regional areas.

It is critical that the government accepts the differences between regional communities and capital cities and addresses those differences and the issues that arise because of those differences. This bill ensures a process will exist to address the inequalities in health outcomes across that city/country divide. The then Minister for Rural Health, Senator Nash, announced the Liberal-National government's decision to establish the commissioner during the 2016 election campaign. That commitment is being met with $4.4 million made available to establish the commissioner through to the end of June 2020. By the end of that term, the functions of the commissioner will have been completed. The commissioner will be an independent statutory officer with some duties directed by the minister responsible for rural health, and I assume that will be the member for Lyne.

In addition to creating and funding the role of commissioner, this bill will also repeal redundant legislation. Sections 3GC and 19AD of the Health Insurance Act 1973 will be repealed. These repeals were approved by the Prime Minister in 2015, and they were measures included in the Omnibus Repeal Day (Spring 2015) Bill 2015. While that particular bill was passed by the House, it was not debated in the Senate, due to the calling of the 2016 election. Specifically, the repeal of Section 3GC will abolish the Medical Training Review Panel. There is no net loss resulting from this repeal, because the service overlaps with the function of the National Medical Training Advisory Network; and the network has agreed to assume the functions of the panel and included them in the agreed terms of reference. An added bonus of this bill is getting rid of bureaucratic double up. The legislative instrument, by which the panel was created, expired at the end of June last year, and so this particular repeal is simply removing redundant legislation.

Section 19AD, which this bill also seeks to repeal, was designed to produce a report every five years on the operation of various sections of the Act, including 3GA, 3GC and 19AA. The report was to identify any unintended consequences arising from those sections and the regulatory burden of Medicare provider number legislation. The three reports produced so far have not identified any areas of concern, and the view expressed in the last report was that the legislation was well settled. Importantly, the repeal of Section 19AD will not affect any medical practitioner who is subject to the legislation and will not affect the operation of any current workforce or training programs. However, the repeal will remove the burden of continually reviewing the operation of legislation that is already well settled, saving taxpayers money and making a lot less work for bureaucrats—work that could be put into other areas for the effective delivery of health.

Rural, regional and remote Australia is the heart and soul of this country, providing so much in productivity and economic benefit, of which few people in the city are aware. Regional and rural communities put food on the table; they put clothes on our back. And yet a national survey in 2012 found that three-quarters of year 6 students thought cotton socks came from animals and a quarter of students thought yoghurt grew on trees. Remote communities provide the nation's wealth through mining and exports, and yet activists in the cities want to shut down the very industries that provide jobs and the taxes they want the government to spend.

There is a disconnect between cities and the real world. It is almost as if out of sight is out of mind. We cannot allow the health of our rural Australians to be left out of sight and out of mind. When the regions are so important to the health of the nation and the health of our economy, the very least we can do is to ensure the health of those living in the rural, regional and remote communities is good enough for them to continue to live there and continue to do the hard work for this country. This bill establishes a means by which rural health is put in plain sight and firmly placed into the minds of government. This bill creates a role with that purpose, and the result of this role will be better health outcomes for all Australian, regardless of which side of the city-country divide they find themselves.

Rebekha Sharkie (Mayo, Nick Xenophon Team) Share this | Link to this | Hansard source

I wholeheartedly support the intention of this bill and the creation of a National Rural Health Commissioner. Any member of this place, and particularly the members who represent nonmetropolitan Australia, would know that access to health care for Australians who live in regional areas is significantly worse than for those who live in the cities. As the minister mentioned in his second reading speech, rural and remote Australians have a shorter life expectancy, generally have lower incomes, are older than their city counterparts, experience higher rates of chronic disease and face higher risk factors, such as smoking, alcohol abuse and obesity. We have greater challenges accessing health and mental health services based on our isolation.

In December 2015 the Regional Australia Institute released figures showing that collectively Australia's regions account for approximately one-third of our total economic output. Their report said:

… were it not for the regions, Australia's economy today would only be the size that it was in 1997 and Australia would no longer rank amongst the world's largest economies.

We are prosperous nation because of regional Australia. And yet, despite this stunning fact and the fact that one-third of our country's population lives outside of the major cities, the regions are being left behind on a wide range of issues when it comes to policy development. Nowhere is this felt more than in health. If you get sick in a regional area, you might be lucky to have a hospital in your nearest town or you might face a drive of an hour or more to a general practice clinic, where you wait for an ambulance to drive you to a major hospital. In the really remote areas, you may have to rely on the Royal Flying Doctor Service.

It is incredibly difficult to get doctors to work in rural and regional areas. Those who do so sometimes are the only doctor in town and that leads to intense pressure and responsibility. We need to implement policies to encourage doctors to work in the regions and to ensure that those doctors are supported in their endeavours to serve their communities. It is a devastating fact that regional and rural Australia have higher rates of suicide than metropolitan Australia. It is even more heartbreaking that doctors and medical professionals are suiciding at a rate more than double other professions. This is not limited to the regions; this is across the board.

I have seen firsthand how the pressures of being a doctor in regional and rural Australia can affect a community. I recently sat down with doctors from Strathalbyn, a township of 6,000 people with a small hospital. Until recently the local doctors had performed an after-hours on-call service. It was a great service for the community. In my discussions with the doctors it was apparent that the demands of being on that 24-hour roster were just far too great. I spoke to one doctor who told me that he would get called in so often that he would have no sleep and would need to work 24 hours straight, because the following day he had to see his patients in his practice. This presents a great danger to both patients and the doctors. Mistakes are made. This occurred in a town with a population of 6,000 people and a number of general practitioners. In rural towns far from major cities the effect would be magnified.

The issues in rural health extend to education and training. Australia is seeing a record number of medical students graduating from university. This is fantastic, but there is a constant battle getting new graduates to move out to regional areas. The latest data from the Medical Schools Outcomes Database survey reported that 76 per cent of domestic graduates are living in capital cities. If you expand the definition to include a major urban area, that figure increases to 84 per cent. Eighty-four per cent of Australian graduates live in a capital city or a major urban area, while a third of Australians live in a regional or remote area.

I believe that we need to put measures in place to entice medical students to look for jobs in regional and rural areas. I do not believe that we need more medical schools; rather, we need to take a strong, hard look at the schools in what they are doing to implement an outreach training into the regions. I believe that if we can encourage more young people from the country to pursue a career in medicine, it is more likely that they will want to return home to their community to practice. The current minimum intake is 25 per cent of students from a rural background. That is a good start, but I support the Australian Medical Association's stance on lifting the benchmark to at least 30 per cent of all students. It is more than offering a place to a young person; it is also about connecting them to rural health from the beginning of their degree. It is about connecting them with rural health practitioners from the beginning of their degree so that potential doctors can build relationships and create opportunities in regional Australia and can see where their career could take them. Currently just 25 per cent of medical students are required to undertake at least one year of clinical training in a rural area. I would like to see a more ambitious stance to be taken, that every Australian medical student be required to undertake a clinical placement in a regional or rural area.

I would like to take this opportunity to speak about some issues that are particular to my electorate of Mayo. In Mayo access to health care is the most common issue raised with me by constituents. For those who are unaware, Mayo stretches from the southern townships of the Barossa Valley throughout the Adelaide Hills and the Fleurieu Peninsula out to the Lower Lakes, towards the east and across and includes Kangaroo Island. The majority of Mayo is regional. The challenges in accessing health services reflect our regional status. I would also say that on a per capita basis Mayo has the oldest population in South Australia. So we have a very old population as well as a regional population.

In Mount Barker the local hospital has recently installed a service that sees a doctor overnight. This hospital has a catchment area of 70,000 people, and it is the closest hospital for people who live 20 kilometres north or east of Mount Barker. Until two weeks ago, if you were sick in the middle of the night there would be no doctor to meet you when you arrived. You would be sent down to the city. For some people that is well over an hour's drive. So I remain ever grateful to the state minister, Minister Jack Snelling, for listening to my plea on behalf of my community and months of advocacy in order for us to have an overnight doctor.

There is still no renal dialysis service in the Adelaide Hills. Again, this is an ageing population. It is the oldest electorate in South Australia and we do not have renal dialysis in one of our major centres. This means that over 1,500 trips are made to the city annually by patients so they can receive treatment. This is an area with limited public transport options, and some people are choosing to forego treatment because of the burden it is placing on their families. There are no Medicare rebatable machines in the Adelaide Hills region. This is another issue that only regional and rural Australia faces. This means that unless a patient has capacity to pay the $300, they must travel to a metropolitan area. If we had a Medicare rebatable machine it is estimated that more than 20 people a day would use it. That is how great the need is.

The Gumeracha Medical Practice is fighting for funding since the introduction of the Modified Monash Model in July 2015. In a town of just 1,000 people, the practice extends its services right across the region, with a catchment of almost 7,000 people. Under the modified Monash service the practice has lost funding, as it is deemed to be within 20 kilometres of a town of 50,000 people. This arbitrary ruling does not take into account a myriad of factors, including winding and poorly lit roads and a lack of public transport options. Gumeracha sits at the top of the escarpment of the Mount Lofty ranges and travel to the city is not an easy thing. I have written to the minister regarding this matter and I intend to continue to advocate on behalf of the Gumeracha Medical Practice. They offer services far beyond what would be expected of a small country town GP clinic, including providing training opportunities for 40 general practice registrars since 2003. They are struggling to maintain these services with reduced funding. It is one of the only medical practices in the region that offers 24-hour care. It would be another blow to our regional community if they were forced to scale back.

At the southern end of my electorate is a township called Yankalilla. The Fleurieu Family Practice is also struggling to continue its services after it was informed that its after-hours services funding was being withdrawn. The practice is the only medical facility on the west coast of the Fleurieu Peninsula, which covers an area of approximately 450 square kilometres. It services a population of 4,700 people, but that swells in the summertime to over 16,000 people. In the last two years there have been over 309 emergency presentations at that practice, such as presentations for lacerations, anaphylaxis or chest pains.

Should the clinic be forced to stop its after-hours services, some patients would have no choice but to drive south over 30 kilometres to the Victor Harbor hospital or north more than 50 kilometres to the Noarlunga Hospital. In both directions, there is no public transport. I have been talking about primary health care, but I would also like to talk about mental health services in the region. My whole electorate does not have a headspace. Mental health services in regional Australia are woeful.

These are just some of the examples I have given you of regional health centres and the challenges they face on a daily basis. I have small regional communities with somewhat concentrated population hubs, and I can only imagine how difficult it must be to deliver rural health services in areas where the population is far more remote. Honestly, I shudder to think of the challenges remote communities experience.

I am sure that these issues that I have raised are familiar to anyone who services a regional electorate. I welcome any move by the government to address the issues of health in the regions, but I question whether the introduction of the National Rural Health Commissioner should have been stronger. I note with interest that the commissioner is only being appointed for a period of two years—they will really just get their feet under the desk. And, while there is an option to extend the appointment until 2020, issues in rural health in regional Australia are not short term. They require long-term thinking and engagement with the communities in order for us to properly address the issues.

The commissioner has been appointed to develop increased access to training for doctors in regional and rural Australia, to enhance policy and to promote careers in rural health. This is excellent, but it is also limiting. As I have outlined, many Australians in regions are less financially solvent than their city counterparts, and they are older and medical services are more expensive. In my area, there is no bulk-billing. It is impossible to get in to see a doctor and be bulk-billed. Very often, people pay upwards of $50 in a gap, so I would like to see the commissioner undertake a role to reduce health costs and to closely examine health costs that people in regional Australia experience compared to our metro counterparts.

In closing, I do support this bill. Regional and rural health access is important, and it is an issue that I feel has long been overlooked by the parliament. You should not have second-class health care just because you are living in regional Australia. I believe that the powers of the commissioner could go further, but I am pleased to see that the government is recognising the challenge faced by those of us who live and work in our productive regions—our regions that are carrying the prosperity of this nation. This is a first step. I applaud the government for this step, but this is a first step with much, much more to do. Thank you.

John McVeigh (Groom, Liberal Party) Share this | Link to this | Hansard source

I rise to support very strongly the Health Insurance Amendment (National Rural Health Commissioner) Bill 2017. The city of Toowoomba in my electorate of Groom is a significant health services centre for the regional areas of southern Queensland and northern New South Wales. We have excellent health and allied health services and facilities, including the Toowoomba base hospital, St Vincent's hospital, St Andrew's hospital, other professional medical centres, numerous specialists and, most particularly, a wide range of general practitioners who are dedicated to servicing their patients and our community.

The health outcomes of regional and rural Australians, as we have heard during this debate, are quite often diminished due to their remoteness and reduced access to health services. But our health sector in Toowoomba not only supports local residents but also steps up to its responsibility in servicing these far-flung communities throughout Queensland and New South Wales of which I speak. Toowoomba based health professionals cannot, however, do that on their own. Our region recognises that addressing the distribution of a professional and dedicated health workforce in regional, rural and remote areas—in our case, southern Queensland and northern New South Wales; our larger catchment area, if you like—is a very high key priority.

As the Assistant Minister for Health said in introducing this bill, its aims include: opportunities for regional and rural medical students to train and live locally and for other students from elsewhere to experience the benefits of living and working beyond the major cities; the new commissioner working with communities, the health sector, universities, specialist training colleges and across all levels of government to improve rural health policies and to champion the cause of rural practice; the development of a national rural generalist pathway that recognises the extra skills needed, the longer working hours and the required courage for general practitioners in these rural areas to meet all kinds of challenges; and also giving consideration to the nursing, dental health, Indigenous health, mental health, midwifery and allied health needs in these rural and remote areas.

The bill is therefore a very important step forward for regional, rural and remote health throughout Australia, particularly in my electorate of Groom and, might I say, the wider electorate of Maranoa—represented by my good friend and colleague David Littleproud—which forms part of the catchment area of the health services provided in our region, especially in Toowoomba.

The coalition government recognises the value of our rural communities, the special place they hold in this country, the enormous national wealth that they generate for all Australians and the special place that they have in our history and culture as well. People living in these communities, such as in my electorate and regional Queensland, make an enormous contribution to our national economy and to our character, as I said. Access to a high-quality standard of health care is therefore what they deserve and are entitled to expect. As I said, often, though, we know that that is not the case—that they often receive services that are not quite up to par with those received in a metropolitan area. The key is to recruit and retain more doctors and health professionals outside of those major cities, and that certainly, I am pleased to note, will be the focus of the National Rural Health Commissioner in this move led by our government.

In Toowoomba I am so very proud of: Griffith University's Queensland rural medical education stream, which is based in our city and led by a good friend of mine, Professor Scott Kitchener; the University of Queensland's Toowoomba Rural Clinical School; the University of Southern Queensland's Bachelor of Nursing program, based in Toowoomba; and the focus of the Darling Downs Hospital and Health Service on rural medical needs throughout our region.

I note in relation to Griffith University, the University of Queensland and the University of Southern Queensland that I have had the good fortune to meet and work with senior academic leaders, including Professor Janet Verbyla, a senior deputy vice-chancellor at the university of Southern Queensland and at present the interim vice-chancellor of USQ, which is based in Toowoomba. She and her colleagues get this. She and her colleagues understand that academia needs to join with those in practice to ensure the provision and planning of medical and health services throughout these regions in the years to come.

I also note the Darling Downs and West Moreton Primary Health Network led again by a good friend of mine, Chairman John Minz, and CEO Simone Finch. It was the PHN which stood with me to make an announcement on behalf of Greg Hunt, the health minister, at Sunrise Way in Toowoomba just last Friday. Sunrise Way is a drug and alcohol rehabilitation service. From an allied health perspective, it was tremendous to stand with the leaders of the PHN to announce $5.5 million of funding for Sunrise Way and a couple of other local agencies to implement initiatives under the coalition government's ice strategy, announced at the last election just last year. That is the sort of focus we have in our community and we simply want to maintain in our community. I am very much looking forward to the role of the National Rural Health Commissioner supporting that move going forward.

I commit myself to continuing to work with all of them to champion the incredible and rewarding opportunities of a career in rural medicine. I have had the great fortune and honour to be a guest lecturer in some of these programs, particularly at Griffith University's Queensland rural medical education service in Toowoomba, to talk to students about life in regional communities and the risks in agricultural industries they should be aware of. I have been able to share my experience as that is the sector from which I come and emphasise to them that, should they take up opportunities in rural and remote areas, not only will they be able to ply their trade to become medical and healthcare professionals but they will take up a position in those communities as a respected community leader alongside other regional community leaders. I say to those students and to those we need to attract and train in the future: we need to hear from you, we need to listen to you and we need to take the necessary steps in our health system to ensure that it works better for you, regional communities and patients throughout our region now and those you will hopefully encounter in your professional lives in the years to come.

That is what this bill ensures significant progress towards. That is why I very much welcome and look forward to working with the National Rural Health Commissioner in relation to the needs of patients now and in the future throughout the electorate of Groom.

Michelle Landry (Capricornia, National Party) Share this | Link to this | Hansard source

I rise today in support of the Health Insurance Amendment (National Rural Health Commissioner) Bill. I applaud Dr David Gillespie for having the courage to put this bill forward with insight, common sense and practicality. We promised the people of regional, rural and remote Australia that we would deliver and champion better health services. Through this bill we will be taking the first steps to deliver on this promise. The rural health groups of my electorate of Capricornia have welcomed the announcement and look forward to working with the commissioner to deliver better services. In particular, I support this bill because: firstly, it aims to bridge the gap in regional health services; secondly, it is practical in approach by being collaborative with local experts who live and breathe regional health daily; and, finally, it aims to take real measures to attract rural generalists to the regions that most need them through an incentive program.

The tyranny of distance will always be a challenge for regional Australia. The people of regional Australia already endure fewer services, reduced communication facilities, lower incomes and fewer job opportunities. When it comes to health, the facts speak for themselves. The per-capita ratio of doctors working in Australia's major cities compared to regional and remote areas varies considerably. In 2011, the per-capita ratio of GPs to population in major cities was double that of remote areas and considerably higher than the ratio of GPs in regional areas.

Health outcomes for people of regional Australia mean higher rates of death than the cities. That is mothers, fathers and children dying because they do not have the same access to health care. They are dying at higher rates from coronary heart disease, other circulatory diseases, motor vehicle accidents and chronic obstructive pulmonary disease. Eighty-five percent of Australia's specialists work in major cities. In regional areas, the ratio of specialists per capita is half that of major cities. In remote areas, the number of specialists is comparable to Third World countries. It is high time that we seek to address this divide by taking real and practical measures to review health services. Through the commissioner, the Turnbull-Joyce government is bridging this gap.

This bill and the National Rural Health Commissioner mandate must be passed. We must work to bring doctors to the regions instead of regional patients to the doctors. This is not just in the pursuit of equity for all Australians. The cost of seeing a doctor for many rural, regional and remote people has a number of financial implications for the individual and for the government. On a recent trip to the north of my electorate, I had the good fortune to be shown firsthand the impractical realities of having to travel just to see the doctor. Most people living in major cities would baulk and cry foul at the idea of having to travel hundreds of kilometres just to see a GP, let alone a specialist. This is the daily reality for people in the country. Many farms are multigenerational. When someone gets sick, it is not just the patient who suffers. Family members often need to take time off work to get the patient to a medical practitioner. When it is a sick child, that is additional time away from school, putting them further behind in educational advancement. This is time and money away from their dependants and their work. Getting doctors to where they are needed not only ensures that regional Australians get the healthcare most take for granted, it means less time away for supporting staff members, which improves the productivity of the communities they live in. Living remotely is tough enough—we know the rate of suicide is higher than in cities, we know that remote and rural families are more financially susceptible to weather incidents, and we know that people in rural areas travel further on country roads. These factors combine to create additional health concerns for people in rural, remote and regional communities.

Most importantly, the bill will provide unbiased expertise, working with the professionals who deal with remote, regional and rural health on a daily basis. This is exactly the type of collaboration that will deliver real outcomes for the people living in these communities. This is not about party politics and pointscoring; this is about giving people in regional Australia a fair go when it comes to health. The bill proposes an independent body that will operate independently, working with all sectors of the government and with rural health providers. In my discussions with local medical experts, I have been informed that we need to prepare regions for the medical needs of a future population. We need better mental health services, better aged-care services and easier access to generalist health care. By addressing these issues with the community, the commissioner will be working directly at the coalface of regional health and finding real solutions that benefit the families of regional Australia. This collaboration will be the key to success.

In my electorate of Capricornia, we have the capacity to deliver the training and programs required. Universities, local and state governments all have a role to play in addressing the issue of regional health. Rockhampton is perfectly positioned to become a leader in training doctors to prepare them for the challenges of working in the bush while providing a support network in a regional area for those working in the field.

Finally, there is an absolute need to incentivise rural generalists. Doctors working in regional, remote and rural areas work longer, have less access to peer support and, due to living regionally, have less access to services enjoyed by their city counterparts. The development of the national rural generalist pathway will improve access to training for doctors in rural, regional and remote Australia and will recognise the unique combination of skills required for the role of a rural generalist. It is not an easy task for a young graduate doctor heading for regional Australia. They will be isolated from their peers and isolated from their families. They will deal with matters that they did not expect, and they will be doing so without the support of a large medical team. If we realistically expect these doctors to head out into the country, then we need to expect them to receive some form of compensation. A by-product of this bill may be improved attention to health in regional areas. Decent health care will make it easier to attract other professionals to the regions, in turn driving demand for additional services.

Australia faces considerable challenges in meeting the health needs of all Australians. We have a wonderful, diverse and widespread land, but this comes at a cost to those building our economy from outside the city centres. The commissioner will work with rural, regional and remote communities, the health sector, universities, specialist training colleges and across all levels of government to improve rural health policies. I support better health outcomes for rural, regional and remote Australia. I commend the work that has gone into the role of the National Rural Health Commissioner and the national rural health pathway. It is time that we bridge the gap in health care.

Cathy McGowan (Indi, Independent) Share this | Link to this | Hansard source

I am absolutely delighted to support this bill, the Health Insurance Amendment (National Rural Health Commissioner) Bill 2017, and to second the comments from the various speakers. However, in doing so I would like to say that, while it is a good first step, it does not go nearly far enough. In addressing my comments to that, I would like to add to the context that I acknowledge the minister and his staff for the open way they have worked with this bill. I am going to be moving some amendments a little bit later, but I acknowledge the great communication that we have had together, so thank you for that.

I would like to stress that health is one of the fundamentally important aspects of our community. In my electorate, together with transport, telecommunications and education, health is one of the most commonly addressed issues that I hear when I go around my community. So when we get a bill like this in front of us, I am really optimistic that the government have actually understood the complexity of health and how it is an integrated issue that we need to address. Sadly, it is not only about GPs. I would like to talk about my electorate and about how important an integrated approach to regional health is. And, while doctors are really important, they are only one part of what is a system. For many, many people, their place of health and health care is not the doctor; it might be their home—it is the parents, it is the mother looking after the kids, teaching the children about hygiene and how to have exercise and how to be safe. For me, the home—along with the parents—is a fundamental place for health care.

And once we have the home looked after and we have educated our families and our parents well, the next circle of influence around health is our schools. I am really pleased that the Victorian government is doing some fantastic work on trialling doctors in schools and working in that context—a great approach.

And the next circle out from our schools is our communities. In country areas, it is not only community health that is important; the other community workers play a really important part. Aged-care workers, childcare workers, local government workers and health inspectors—what an important role they play in our health.

And then we have our workforce. Again, our OHS people play a really important role in keeping us safe at work.

We also have the hospitals. The emergency service at the hospital is the most obvious place we go to when we think about health. And then, of course, we have our GPs and specialists.

If you can imagine that as a system, everything needs to be in balance if we are going to do what needs to be done to improve the overall health of our community. We have heard all the speakers today, including the minister, say how poorly our rural communities are doing with health. So while I welcome the support for GPs it makes me really sad that we have missed the opportunity to do so much more. I acknowledge that this was an election commitment—and it is important that we fulfil election commitments—but I really do feel that it lacks ambition. So I am looking forward to now working with the minister and his advisers and saying: 'A tick for this. Now let's see if we can get the whole system to work and do a much better job of improving health for rural people.'

I will now take the opportunity to talk a little bit about what happens in my electorate with health. I want to take a few minutes to call out to the many providers. I have talked about the home and the family, and I have talked about community health. But what I really want to do in this speech today is acknowledge the work of the institutions. They are the focal point that really needs a lot of attention and a lot of help. We constantly talk about government, but it is the institutions that we are looking to for funding to allow them to do their job. I want to acknowledge Albury Wodonga Health, a fantastic cross-border initiative. I do not know if you can possibly imagine the impact it has had on our community to have Albury and Wodonga work together, the cross-border approach that we have now got, and the connectivity that is happening because we have one board and everything working together—the cancer centre, the babies and the emergency health. So I want to give a bit of a shout-out to Albury Wodonga Health for the fabulous work you do there.

And I want to link it to this legislation. Albury Wodonga Health does not only exist as a hospital; it also does training. Albury Wodonga Health has a relationship with the University of New South Wales. The student doctors do their rural work year in Albury-Wodonga. That is such an important aspect of the training because it gives all those student doctors who are city based or who have gone to the city for training a chance to work in a rural community and get a sense of how wonderful it is to work there. I really want to thank all those people who have done the work to make that training centre there work so well. I know that all the staff there go so far beyond the call of duty to make it such a rich experience for doctors doing their training. And to all the doctors who come from other places to do that year of training in Albury-Wodonga: we love having you. We want to see more of you. We really do hope that the experience is so rich and rewarding that you will put your roots down and come and live in our community.

Similarly, we have Northeast Health Wangaratta. The Wangaratta Hospital does a fantastic job of providing hospital and related services, and it also does doctor training. Through their relationship with the Department of Rural Health at the University of Melbourne they do fantastic work. They get the people from the University of Melbourne to come up and do their training in Wangaratta and get some amazing exposure to top-quality medical specialists and ways of working. So I give a shout-out to Albury Wodonga Health and Northeast Health Wangaratta for the training you do for our doctors.

I will be looking forward to working with the commissioner and saying: 'Here are some models that are working really well. How can we replicate them in other areas and finesse them a little bit where appropriate?' I just want to take a moment to talk about what happens in Wangaratta. It is an amazing example of the creativity and innovation that is coming out of our rural hospitals and related training. In Wangaratta we have telehealth. Through the internet, with high quality video services, some of the smaller hospitals can link into Wangaratta. You might be in Corryong or Mansfield; over the weekend, you can link into specialist services in Wangaratta via the internet and have an immediate diagnosis done—and if you need extra services it is all there. That has made such a difference to our smaller hospitals. I am so pleased, and I really want to congratulate Wangaratta for taking that initiative. What a fantastic job it has done, and what a service it provides to our communities.

But this system approach that I have been talking about works well because we have a dedicated internet service. Ideally, we would have access to quality internet services everywhere in Australia, particularly in rural Australia. Sadly, that is not the case—and I am not even hopeful that the NBN service will deliver the expertise we need. But if we do get it, it will absolutely revolutionise the ability of our hospitals, our GPs and our medical professionals to provide services to people back into the other parts of the system—the homes, schools, workplaces and other areas where health and healing are practised.

In acknowledging those two major providers in my electorate I also want to do a call-out for two other specialist health providers. The Upper Murray Health and Community Service, which works in Corryong and Walwa, is a multipurpose service. Multipurpose services are no longer popular. It is such a pity. In our rural communities they provide health and aged care, and they employ doctors. In Corryong, they employ doctors to come and do the health and community work that we need doing. The model of funding has not changed in years, and we absolutely need to review that multipurpose service funding and reintroduce a 21st century approach, because hospitals like Corryong provide such a service in my community and, if we cannot get the funding right and they close, we will have no doctors there, because the only doctors in Corryong are the multipurpose employed ones. So, if we do not have the MPS providing the service, that whole community will be bereft.

In a similar way, I would like to acknowledge Alpine Health. Alpine Health is another MPS, and it works in Mount Beauty, Bright and Myrtleford. That MPS is particularly noteworthy, because of the health promotion work that it does. It provides that extension to the community, families, workplaces and community health and does such a good job in actually keeping people out of hospitals and out of our GP services through its health promotion.

One of the things that I am really disappointed about in this legislation is that we do not talk about health promotion. We have not talked about how stopping people getting ill is a really important part of the whole role. I am just putting it out there that it is an area of work that I think the government could do a huge amount of work in and would save us so much money further down the line. I want to say that health is a complicated system and this bit of legislation only addresses a small part of it—a very important part, which is our doctors and GPs, but we have a lot more work to do to make sure that the system actually works better in rural and regional areas.

I will turn my thoughts for a moment to some of the problems that I see with this legislation and what I would like to see happen. One of the things the minister said in his second reading speech was that this was going to be an independent position. Sadly, I do not accept that, if you put a person working in a health department, they will be independent. I do not see how that is going to happen. I cannot see the arm's length there that is going to be engaged. I cannot see how this position is going to actually have the ability to consult widely. You could spend your whole two years just doing consultation. So that idea of an expert panel that this position can work to would be really important.

At the moment, as the legislation stands, this position does not report to parliament—in fact, it does in a way. The legislation says that the commissioner has to report every year on what they are doing, but the final report goes to the minister. It is my belief that the final report should come to parliament. I have great respect for this current minister who is bringing this legislation to the parliament, but, sadly, he might not be the minister in two years time, so we have to make sure that the report actually comes to parliament and the parliament gets a chance to know what the commissioner is doing and that they are in fact, doing what they have been set out to do.

My amendments set out to make the position more transparent by requiring the minister to table the final report within five sitting days. It is to ensure that rural and regional communities are consulted by including them in the bill rather than assuming that they will be in the other stakeholder group. I cannot quite see how the family, the home and the schools are going to be consulted in this process, and it is really important that they are.

I also include in one of my amendments a role for the commissioner to consider the affordability of health services, particularly addressing the problem of no-gap bulk-billing. Just to talk about bulk-billing, it is such a problem in my community that we do not have doctors who bulk-bill in many of my smaller rural communities. The doctors say, 'We can't afford it,' on one hand, but they also say, 'We do it,' and they do it as an act of grace if they see the need. To me, you should not be relying on the goodwill of a doctor to be bulk-billed. It should be part and parcel of the function, and we need to do a lot of work on bulk-billing to make sure it is more evenly addressed in rural and regional areas.

In bringing my notes to a close—and, as I said, I will be further addressing this in consideration in detail—I would like to acknowledge what the bill does. It is great that the election commitment is being addressed. I would like to acknowledge the work of the minister and his staffers and thank them for their cooperation. I would like to ask for much greater ambition. I think, as everybody said, we have not got anywhere near resolving the problem. All we have done is picked up on one very small aspect of the problem in the system, and we still need to do a significant amount of more work. I would be very happy to work with the minister to do that and I am very keen that we come back to the House with other pieces of legislation that actually bring a systems approach to this particular issue.

Rowan Ramsey (Grey, Liberal Party) Share this | Link to this | Hansard source

I rise to speak on the Health Insurance Amendment (National Rural Health Commissioner) Bill 2017. I must say I am very pleased with this legislation, because with an electorate like Grey, which is an area a bit bigger than New South Wales, health delivery is certainly one of the core services and it is something that is a challenge at any time. I spent 10 years of my life before I entered this parliament serving on local hospital boards and higher authorities within those organisations, and so I understand many of the issues that confront governments as they try to roll out decent, appropriate health services.

It is vital, I think, that this national parliament recognise that there is a vast difference between rural, regional and remote communities and the places where most Australians live, in the city. In fact, differences in opportunity sometimes are of benefit to the rural dwellers but are often to our disadvantage in areas such as education, aged care, communication needs and particularly health needs. Those differences need to be recognised, and this bill is part of that process. The budget allocation of $4.4 million to the National Rural Health Commissioner has the potential to make a real difference to rural, regional and remote Australia, because the success of Australia will ultimately be determined by how successful regional Australia is.

Last week, though, quite disturbingly—it is not all good news—I attended a public meeting in Quorn, a township of about 1,100 people almost 45 kilometres from Port Augusta. Four hundred of them, or one in three, rolled up to the meeting. Why? Because they are scared that some parts of their medical services are about to cease. Very little has been spent on the Quorn hospital and they are fearful that the South Australian government will use the lack of building currency as an excuse to say it is no longer safe to deliver services.

I can tell you that Quorn is representative of concerns held all over the electorate and all over regional South Australia. Not so long ago, for instance, the Jamestown hospital, which is about 125 kilometres to the south of Quorn, lost its ability to sterilise surgical instruments. The reason was that the steriliser had reached its use-by date and the state government refused to find the $60,000 or so to buy a new one. Jamestown is a can-do community and it does not mind digging in. In not a very long period of time it had raised enough money locally to pay for the unit. But was this enough? No. Country Health, the government's health management team, declared that the room that the steriliser was positioned in is no longer adequate. How hard can we make this process? The room is no longer adequate for the steriliser and SA Country Health refuse to do up the room, so at this stage Jamestown soldiers on without a steriliser and brings in sterilised instruments from Port Pirie, which is about a 45-minute drive away.

At the Quorn meeting local doctor Tony Lian-Lloyd ran through a long list of similar rough funding instruments, if you like, where local ability and facilities had been strangled by the lack of investment. On one spectacular occasion a hospital had a very leaky roof that the government chose not to repair or replace, so the local community rallied to put a new roof on the hospital. This is really quite a serious lack of investment.

The latest offence is in Yorketown on Yorke Peninsula, in the southernmost part of the electorate of Grey. The community have been told that that their surgical facilities are no longer up to scratch and will be terminated. The Yorketown hospital has been operating safely and competently for generations. Despite having qualified doctors and staff capable of continuing the service, people are being asked to attend the Wallaroo hospital, which is 130 kilometres to the north. This is not the Far North; this is some of the most productive agricultural land in South Australia and is quite closely settled. That kind of demand on people is ridiculous. This lack of attention is appalling if real care cannot be offered closer to the residents than that.

It seems apparent that, while the federal government's spending on hospitals is increasing at three per cent above the rate of inflation, country hospitals in South Australia at least are being neglected and starved of resources. We are told the new Royal Adelaide Hospital is the third most expensive building in the world. There are headlines that it is finally ready to use and it will be handed over to taxpayers, who will be paying $1 million a day for the next 30 years for the lease on it. It takes a little bit to get your head around the figures. It seems quite obvious that rural health facilities are being asked to provide the funding shortfall. This is a dereliction of duty by the government. I certainly will be looking to the new Rural Health Commissioner to at least make a case for the protection and improvement of country services.

I look forward to the establishment of the rural generalist pathway. This was an issue that was raised at the Quorn meeting by a number of young doctors. They said we have an uneven situation across Australia and it would be far better if we had one pathway. I hope that will all help make a real difference, but I have been around this game long enough to suspect that it will not make a difference. In fact, I have come to the conclusion that we should be seriously looking at postcode-specific Medicare provider numbers.

I look back to my time on hospital boards in the 1980s and 1990s. It was a time when we had chronic overservicing of GP services in Australia in the cities. It was a time when we were short of doctors in the country but had chronic overservicing in the cities. The government of the day decided to address this by cutting training numbers at universities, so we took in fewer medical students. This eventually drew back the numbers and the overservicing but the foot was kept on the neck of the intake for too long, if you like, and consequently we ended up with a shortage of doctors in Australia, and there are still not enough in the country.

To fill the shortfall we began importing overseas-born and -trained doctors. Nobody should think that this is an exercise in bashing overseas doctors. I tell you that without them our medical system would be on its knees. But we treat them in a different way to the way we treat our own medical students insomuch as, through the powers of our immigration system, we tell them where to go: 'If you want to immigrate to South Australia, you will serve the hospital at Coober Pedy'—or at Kimba, where I live, Ceduna or Quorn—'You will deliver services there for five years. After that we hope you elect to stay.' We do not tell our graduates that. Largely when they come out of university with their qualifications—and they are not easy to obtain; they spend many years training—they can basically work wherever they like.

There are some who say that postcode-specific Medicare provider numbers would be a restraint of trade and would be prohibited by the Constitution. I am not suggesting for one minute that we should tell doctors that they can or cannot set up practice anywhere in Australia; what I am saying is that we should tell them, 'You can only deliver a service here if you want to access the public subsidy,' which is the Medicare provider number. 'If you want to charge full tote odds for your services, go ahead.' I have got no complaint about that at all, but I think the time has come when we have to address this issue.

I am brought to this point by the remarks from the previous member about rewards for doctors. When I am told by some doctors that they are earning in excess of $300,000 and $400,000 a year working in the country—and I do not begrudge them that money, let it be said—I do not think we can actually offer any more carrots, offer more money, and expect that it is going to make a substantial difference to the supply of doctors.

Since my time on hospital boards all those years ago, the provision of backup for doctors in rural areas is far better. They have much better access to locum services, they have much better access to replacements so they can go and get training, they have assistance for training and they have the ability to have a holiday. All of those things are much better now than they were 20 years ago. I do not know what else it is we can do to make it so much more attractive to live and work in the country.

Of course, once you have doctors—and any other profession—there, many times, people actually find that they have been missing out on something and that it is the best lifestyle. But getting them there in the first place is the real difficulty here. I make the comparison: if you go through university, largely funded by the taxpayer, and get a teaching degree or a nursing degree, when you leave university, you will go where the vacancy exists in the system. You do not go off and create a new school or a new hospital for yourself. You will go where you can land a job that is on offer within the system. But we do not do that with our doctors. We do not tell them that the taxpayer is insisting that we need a service at X. They have the ability to go to Y and still access the taxpayer funding through the Medicare system. There is no doubt that this would lead to a fair bit of discussion with the medical industry.

I have spoken about this proposal on a number of occasions, and certainly where there have been doctors present. By and large, I find that rural doctors are very supportive of the proposals that I have put forward. Of course, there would be all kinds of give and take around the edges and, in particular, I think we would have to grandfather all the current doctors and say, 'These rules will not apply to you,' so that it will be a slow change to the system. But they actually understand the real challenges in getting doctors to come and work and practise in the country, including all those normal issues—jobs for their partners, who may be highly trained professionals in areas where there are not jobs and, often, they bring up the case that they might have to send their children away for education. Of course, for all the rest of us who live in the country, that is a reality. I do not see that that should be such an impediment within itself.

But I understand what all those attractions of the city are. My children did three years of senior secondary education in the city to prepare themselves properly for university. If you are training to be a doctor it is a another six or so years at university and then, perhaps, another three or four years after that to get the suitable GP accreditations. You would have lived in the city for 15 to 16 years. It is quite likely that you might find the city much more comfortable and attractive than the country after that amount of time. All of these things I understand, but it does not address the central issue at the bottom of the pile—that is, that we do not have enough doctors in the country.

Currently, in South Australia, over 50 per cent of the doctors in rural South Australia are overseas born and trained. We will stop importing those doctors almost imminently, because the pipeline coming out of the universities now is strong. In fact, we are probably training too many doctors for our future. There is a double-edged sword here. I believe we are heading for greater shortages in the country and we are heading back into overservicing in the cities. It is not that hard for a doctor to overservice; you ask the patient to come back more often for a refill of a prescription or order a few more tests. We need to be aware of these looming issues before we get to them.

If we neglect reform in this area now, in five or six year's time, when we have chronic overservicing in the cities, we do not have enough doctors in the country and we stop importing doctors from overseas, we will be in an almighty mess. I have put together a paper on this. I have been speaking on it in various forums. I presented it to the health minister. I will continue to try and raise awareness of what we are heading for and what I think we should be trying to do to fix it before our head hits the concrete wall, if you like, because I think that is what we are heading for. With those remarks, I commend the bill. I think it is a step in the right direction, but I think we need to do much more.

Stephen Jones (Whitlam, Australian Labor Party, Shadow Parliamentary Secretary for Regional Development and Infrastructure) Share this | Link to this | Hansard source

Today we are debating a bill to establish a rural health commissioner. Government MPs will say it is a great breakthrough in health care for regional Australia. I do not say it is a bad thing, but it falls a long way short of a great breakthrough, for most of the reasons that have been set out very eloquently by the member for Grey in his thoughtful contribution right now. I say, at best, it is an admission of failure. It could be much worse than that, and that is a distraction from a whole heap of issues that really are facing health care in regional and rural Australia.

I have been saying for a long time—and most informed members in this House know—that there is a very stubborn link between health inequality and wealth inequality. When one goes up, the other goes up as well. The disease risk factors are higher in areas of lower income and lower wealth, and access to preventive health measures are lower as well. This flows through to life expectancy. In our capital cities, the median age at death is 82.2 years. In outer regional areas, that drops to 79.2 years and 73.2 years for people living in remote Australia. The relative risk of mortality between the poorest and the richest income quintiles translates to a life expectancy gap at age 20 years of six years. Diabetes, just one of the chronic diseases rampant in regional Australia, is 3.5 times more common in working-age Australians in the poorest areas as it is in the wealthiest areas. Of course, the majority of those poorest areas are in regional, rural and remote Australia.

The government cannot be held accountable for every health failure that Australia and Australians are suffering, but they can be held accountable for the breaches of their own promises. I would like to take you back to the promises that the coalition parties made in the lead-up to the 2013 election. The National Party, in particular, had this to say in their plan for regional Australia. I am quoting directly from page 45 of that document, where they said:

The Nationals will provide increased financial support for doctors who provide health services in regional and remote communities …

That was the promise—in black-and-white on page 45 of the document. But, sadly, they did exactly the opposite. Instead of providing increased payments to doctors in regional and rural Australia, they tried to force through this House and the other place a cut to the payments made available to doctors not only in regional and rural Australia but everywhere through their $6 copayment. When they could not get that through the front door, they tried to force it through the back door through the GP rebate—a tax by any other mechanism.

Again, in the lead-up to that election the shadow minister for regional health said:

Regional health deserves a higher profile in the overall health policy government. When health policy decisions are being made regional concerns must be championed by a dedicated Minister with regional experience and a primary focus on the welfare of regional Australians.

Well, the operative word in that sentence and in that commitment is 'championed'. What we found in the last four and a half sorry years was that, far from being a champion, the dedicated minister for regional and rural health was either asleep at the wheel or ignored by the people who were making the real decisions. And the honourable Senator Nash admitted as much before that community affairs Senate estimates committee when she said she was not privy to any discussion around the creation of the GP copayment. So, far from being a champion, she was left out of the room when the key decisions were being made.

You could go to any number of issues. You could go to regional hospitals, where the Nationals promised that they would not support policies that 'led to the closure of regional hospitals'. A few months later, they filed into this place and voted for a budget which slashed over $3 billion from Australia's public hospital system and supported a Prime Minister who tore up the health and hospital agreement, an agreement that was going to secure funding over the long term for regional hospitals throughout Australia. I do not hold the government and, in particular, the regional MPs accountable for every single problem that is encountered in regional and rural Australia, but I do hold them to account for the promises that they continue to make and continue to break.

Labor will support the bill, which appears to have as its principal focus making the case for a new specialisation called a rural generalist. The minister who joins us at the table, Dr Gillespie, said as much in his second reading speech in this place—that a principal priority for the new rural health commissioner will be to make the case for a new specialisation called a rural general. This is a species of GP. The proposition, although currently in existence in at least one state in this country, namely Queensland, has yet to be fully fleshed out. It does have some merit on its face, but the devil is always in the detail.

The advocates for change argue that it will increase the number of doctors in regional Australia. I do want to make the point—similar to the member for Grey in his contribution—that there has never been a point in our nation's history when we have been putting more graduate doctors through our universities in this country. We have never been graduating more qualified health practitioners in this country than we are doing today—in large part due to the expansion and the policies of the Rudd and Gillard governments. But nobody in this House can argue that we are not graduating more qualified doctors out of universities around Australia than we are today. The problem is that they are practising in the wrong places. They are overwhelmingly clustered in the cities and the large urban centres and are not available in regional and rural Australia, which is why we are today overly reliant on overseas-trained doctors in rural and regional locations.

The advocates for this proposition should note that the architecture to deal with these workforce maldistribution issues was already in place when the coalition government came into government in 2013. The solution to the problems was already in place when the coalition came into government in 2013, but they could not leave it well alone. They made it as one of their first priorities to abolish Health Workforce Australia. They abolished it with the full support of the National Party. They stood in this place and gave great speeches as to why it was in the national interest that we abolish this agency which was going to help exactly the problems—it was tasked with dealing with exactly the problems—that the new rural health commissioner is going to be charged with in a much more limited scope. The Liberal and National parties abolished it just in the same way as they cut the Medicare rebates and abolished the Prevocational General Practice Placements Program—a program specifically designed to place post-graduation future doctors into regional and rural locations so that they could get the taste and experience of practice in those areas. It was a very successful program. The coalition—the National and Liberal parties abolished it. They abolished it just as they abolished the hospital funding agreement—which is placing increasing pressure and stress on our hospital system today—and they continue to underfund our hospitals.

Surprisingly for some, neither of these initiatives featured largely in their election commitments going into the 2016 election, and for this reason we have the bill before the House today. It is also curious, I have to say, that the Rural Health Commissioner's role dissolves in 2020. If the member for Grey is right, and if the member for Lyons is right in the observations that he made, which I agree with, in the opening comments of his speech on the second reading, then the problems we are facing are not going to disappear in the next three years. But the role of the Rural Health Commissioner will disappear in three years time. Presumably, we can take from that that the creation of this new role is solely focused on establishing the new position of a rural general specialist, that this will be the first and indeed the last priority for the government in regional, rural and remote health care. There are many allied health professionals who would disagree with this proposition, and I agree with them. There are a lot of priorities that we need to focus on in rural and regional health care, and creating a new position or a new specialist called the GP rural specialist, as important as it might be, is not going to address all of those important healthcare issues.

I want to talk a little bit about the crisis that we are facing in acute care and mental health throughout regional and rural Australia. I want to take you on a very quick trip through four electorates, because it paints the story very well. These are the things that we should be focusing on, and these are the problems that are not going to be fixed by a rural health commissioner—certainly not in the next three years—by the creation of one role or one new designation. I have had a look at some of the significant problems that we are facing with mental health and acute care throughout rural and regional Australia. It is always difficult to talk about the issue of suicide, which clearly is an acute problem, a terrible problem, afflicting not only the individuals and the families directly involved but also the entire community, when somebody takes their own life. It is obviously something that happens when somebody is suffering from acute mental health issues. Right throughout rural and regional Australia, we have a significant issue, and it is not being addressed.

I have looked at the statistics for my own electorate. Thankfully, at just over nine per 100,000, that is a problem that needs to be addressed, but is below the national average of 10.8 per 100,000. As I have looked at the areas that are facing some of the most acute problems, I have found that they are all in rural and regional Australia. I have looked up the figures for Capricornia: 21 per 100,000 in the local government area of Whitsunday, 16 per 100,000 in the Mackay Region and 15 per 100,000 in Rockhampton. This is an issue in regional and rural Australia that cannot be glossed over. It is something that we need to grapple with; it is something that we need to deal with. I look closer to home, down in the Shoalhaven and Kiama areas; at 16 and 15 deaths from suicide per 100,000 respectively, this is a crisis that must be dealt with. As we cut money from our Medicare system, as we cut money from our public hospital system, as we are withdrawing money from or tightening the screws in our healthcare system, these are the public health emergencies that are not being dealt with: acute care in our hospitals and acute care in our mental health areas. Close to the minister's own area—and I know he is a man who cares deeply about this—I looked up areas in the North Coast of New South Wales: over 16 deaths per 100,000 per annum in Richmond Valley, over 11 in the Lismore area and over 10½ in Coffs Harbour and in the Clarence Valley.

These are things that we should be focusing on. These are the things that need more attention and more resources. As important as creating a new statutory role of a rural health commissioner is, it does not go nearly far enough towards addressing the real issues that we have with mental health in regional and rural Australia and with acute care in regional and rural Australia. The government's actions in withdrawing funding from this sector are not going to make things better; in fact, they are going to make it worse.

Nola Marino (Forrest, Liberal Party) Share this | Link to this | Hansard source

I am very pleased to support the establishment of the National Rural Health Commissioner, and I commend the ministers that have been involved in bringing this to this point. It is something that those on the other side have never even considered. Throughout the years of Labor government this was something that the Rural Doctors Association of Australia were constantly asking for. For as long as I can recall going to the Rural Doctors Association of Australia gatherings, the rural generalist pathway is exactly what they have been asking for. It is something that I have heard about for many years, and I commend the minister at the table for taking this particular action. This was something that was very important during the campaign.

We know that the National Rural Health Commissioner will be an independent statutory champion for rural Australia—great words, but greatly needed. Let's face it: rural Australia needs all the champions it can get, across all areas. The commissioner will work in a broad range of regional, rural and remote areas, and that is where I can see, through listening to the Rural Doctors Association of Australia for so many years, where this particular role for the commissioner will be so important. It will be important for the commissioner to work right across the board with the health sector, the universities and the specialist training colleges, across all levels of government, with the sole aim to improve rural health policy and access for all Australians, no matter where they live. It does not get simpler or more important than that.

Championing the cause of rural health is something the members on this side of the House do on a regular basis. I know that the national rural generalist training program that was suggested by the rural doctors came about because they understood so well the importance of a generalist—that is, the rural GP. I only have to look back into my own history. We had a couple of fantastic doctors who gave historic service in my region, serving the areas of Harvey and Brunswick, which were very small rural communities in those days. I can recall a man by the name of doctor Dr Stimson, who used to do small visits to Brunswick, where I lived. He worked out of the Harvey hospital. Dr Topham and Dr Wu came as well. In those days these gentlemen would do everything. It did not matter what happened in the local Harvey hospital, these doctors were capable of performing in that setting virtually everything that needed doing. They did everything from delivering babies to operations right across the board. It was the one-stop-shop pretty well, except for the very serious cases, which in those days went through to Perth.

We have seen since the establishment in Bunbury of the South West Health Campus, which is now supporting so many specialist services as well as the St John of God hospital, the local public hospital, and the regional hospital. There are so many services, from mental health through to cancer support, right across the board. It also supports our rural clinical school, which again was an initiative of the Howard years of encouraging more young people who were training to be doctors, to be GPs, to actually consider training in a regional area. We have these rural clinical schools operating in Bunbury and in Busselton as well and we get students from all over the state. One of the things they do while there is get for 12 months the experience of living and working in a rural community. What we hope from that is that we get more locally trained, locally sourced kids—whether they are from right around Western Australia or our locals—who go away and do their training and come back and spend some time at the rural clinical schools. We are starting to see some results, where they are making a conscious decision to come back and live and work in our communities. The one thing that does for those who become rural GPs—and I do not mean any disrespect—is that they almost become a god in a small community because they deal with the life and death and the lifetime health issues of complete families. The Dr Wu in Harvey I spoke about before not only delivered my children but has been our family GP all our lives. This is what happens in small regional communities. We rely on those doctors, especially when we are at a distance.

As most people in this House know I am a farmer. In my time as a local farmer I have had everything from a man who had been run over by a tractor rock up at my home to a young man who, after a paddock had been burnt, fell down an ant nest that was still burning and was red-hot. He had basically lost the skin from the lower part of his body. He ran through the diversion drain to get to my home and stood there shaking, completely in shock. I got a moist sheet—I had fortunately done nine years of first aid, which you need out on the farm—and got him on it and told my husband to ring the hospital and to tell the police I am coming, going pretty fast as I needed to get this young man in. My own husband had a close encounter with a tiger snake, and at one point my own son was kicked in the heart by a cow and stopped breathing.

So our reliance in rural, regional and even more remote areas is based around the capabilities of these wonderful general practitioners. Let me tell you that there are countless people in my own community who have relied all their lives on the work of these amazing GPs. They historically have been what is now termed the 'rural generalist'—they could do anaesthetics, they could deliver babies, and they were operating on people. They did almost every task except for the real specialist work that needed doing. They have done an amazing job and I want to pay tribute to the lifetime of work that so many of our GPs throughout rural and regional Australia have put into their whole communities. I want to say a huge thank you to them, because the lives of our whole community depends on them. They stay in our community and our part and parcel of it. When we walk down the street we can talk to them and if you have a real emergency you can ring them up. That is the way it has worked. And they work with the local St John Ambulance volunteers. These people also, being the first responders, do such an extraordinary job in rural and regional Australia. Often, many of the services provided by St John are in very extreme and remote areas, just as we have the Royal Flying Doctor Service, which comes in and out. So often we rely on the GP and those emergency services, our volunteer St John Ambulance people. I grew up having St John in my home, in a sense, because my mother was a St John Ambulance attendant and first aid teacher. For all my life at home our home phone was the ambulance phone, so even as children we would have to be able to take a call, get an ambulance and get it to the right place, knowing how many people needed treatment.

When I see someone like our National Rural Health Commissioner, who is going to be focusing on and championing the interests of rural Australians, all I can think of is the great need that is out there and the great team of people who work so hard in this place already. As we know, it is so important, because health outcomes tend to be poorer outside of major cities, and that is where all these different parts of this whole health provision come in.

We see that the major contributors to higher death rates in rural and regional and remote areas are coronary heart disease, other circulatory diseases, motor vehicle accidents and chronic obstructive pulmonary disease. And of course in the case of motor vehicle accidents we see so many of them, which is where St John Ambulance volunteers and even our local GPs are so important, because they are often the first people who see these patients when they are taken to a small local hospital.

We see such differences in usage of health services between the metro areas and rural and regional areas. In some instances there are lower rates of some hospital surgical procedures, lower rates of GP consultation and generally higher rates of hospital admissions in rural and regional and remote areas than in major cities. There are also inter-regional differences in risks. For instance, people from regional and remote areas tend to be more likely than their major city counterparts to smoke and drink alcohol in harmful or hazardous quantities, according to the Australian Institute of Health and Welfare. So, there are higher death rates and poorer health outcomes outside major cities.

But in talking about the rural clinical schools, I want to commend the work in my electorate. In November 2016, 60 rural students from 22 country towns, including 17 students from Bunbury, graduated from the University of Western Australia's medical school. It was the biggest number of rural-background doctors to graduate in a single year. That is a great outcome, because what we are really hoping is that some of those great young people will choose to come back to our part of the world to practise and to become an integral part of a small community. It might be somewhere like Augusta in the south, or it could be Nannup. It could be any one of my small communities where this person will become very much the centre of health provision in that community. And I do hope that more of them do so, as we are seeing throughout the electorate.

This program is now in its 16th year, and the number of UWA medical graduates from country areas has really grown since it was launched in 2000, with 325 rural WA students graduating. It is great news, and there is very good evidence that rural-origin students are three times more likely to return to the country than are their urban counterparts. So, the more young people I see from my electorate and from rural and regional electorates and remote electorates who go off and do their training in the city, where they have to do their training, the more young people I am likely to see coming back.

In the time remaining to me I want to acknowledge the wonderful work of Murray Cowper, who was the member for Murray-Wellington, who I worked with. He did an enormous amount of work to get the $13 million revitalisation of Harvey Hospital and the Harvey Health Service, and he did an absolutely amazing job. We had to be very persistent in this, but the new emergency department that is linked to the procedure room is absolutely amazing. It is going to make a massive difference to a small community—and it is already, and we are seeing a difference in my part of the world. And the money that was put into the Busselton Health Campus was really significant. There was $117.9 million of state government funding that went into the new Busselton Health Campus.

What I am demonstrating is that the rural areas are different, and remote is different again. I am really supporting this piece of legislation and the work of the Rural Health Commissioner. I commend the minister at the desk, and I commend this bill to the House.

David Gillespie (Lyne, National Party, Assistant Minister for Health) Share this | Link to this | Hansard source

I would like to take this opportunity to thank all members on all sides of the chamber for their contributions to this debate on the Health Insurance Amendment (National Rural Health Commissioner) Bill 2017. I thank them for the suggestions they put forward to me directly and during their speeches, which I have endeavoured to incorporate into this legislation. To my Nationals and Liberal colleagues, thank you for your contributions. To the members for Indi, Mayo, Lingiari, Whitlam and many others, as well as my colleague the member for Makin, the shadow minister, opposite: thank you for your contributions.

There are a few things I would like to summarise and point out again. The legislation and the funding commitment over the forward estimates does allow the coalition government to deliver on an election promise in the lead-up to 2016 made by my colleague Senator Fiona Nash. I anticipate that the role will indeed achieve its broader objectives in helping to deliver all the critical outcomes about which many of us are in furious agreement as to the need for reform and better outcomes. I am hopeful that, in the future, further support can be obtained in both a budgetary and a legislative context.

Several people have spoken up about the scope of work the Rural Health Commissioner will be asked to perform, and I would just reinforce, as I mentioned in my second reading speech, that it will be the first and most pressing duty of the Rural Health Commissioner to address the issue of the medical workforce and coordinate with all the various stakeholders, which are numerous, in the development of a rural generalist pathway. The commissioner will provide advice in relation to rural health beyond that. There are very many other matters in which the Rural Health Commissioner will have to be involved, in policy development and championing causes.

I understand the value of multidisciplinary health, and so does just about anyone that works in the health space, particularly in the rural workforce, where there is multidisciplinary care and—whether it is rural or very remote—teamwork is paramount. As I said in my earlier speech—I will quote my own words, just so there is no ambiguity in any way or form about how I think there are more roles for the Rural Health Commissioner than what was alluded to:

While the development of the pathways will be the commissioner's first priority, the needs of nursing, dental health, pharmacy, Indigenous health, mental health, midwifery, occupational therapy, physical therapy and other allied health stakeholders will also be considered.

Health-care planning, programs and service delivery models must be adapted to meet the widely differing health needs of rural communities and overcome the challenges of geographic spread, low population density, limited infrastructure and the significantly higher costs of rural and remote health-care delivery.

In rural and remote areas, partnerships across health-care sectors and between health-care providers and other sectors will help address the economic and social determinants of health that are essential to meeting the needs of these communities. The commissioner will form and strengthen these relationships, across the professions and for all the communities.

There were other comments made about an independent or a voluntary advisory group to help the Rural Health Commissioner, and in fact I have brought to the attention of some of the speakers this evening that we do indeed have, and have already set up, a rural stakeholder round table, which last met on 16 November 2016, and the idea that they would work with the Rural Health Commissioner has been established. There were 18 attendees at the last meeting, across all the stakeholder groups in the rural health space. There was the Dental Association, Indigenous health Australia—I could go through a long list, but I just mentioned that there were 18 different stakeholders. It was not an isolated group of people by any means. We had all the voices at the table and the role of the Rural Health Commissioner was spoken about at length, and that person taking advice from that stakeholder meeting and attending it as well was spoken about.

Also, separate from this legislation, workforce distribution has been raised as a big issue, and within the department I am establishing a distribution working group that will also work with the health commissioner, and there will be representatives from rural health stakeholders as well. The commissioner would be a member of that distribution working group and could use the group to take advice on other of the commissioner's functions.

So it is always good to flush out good advice and good ideas. I am open to good ideas. But I think there is genuine and universal support for the position. As I mentioned, we have established funding for it up to the defined period, but I am sure it will be a successful role, and I will lend my executive and other support on that basis going forward after that period. I commend the bill to the House.

Ross Vasta (Bonner, Liberal Party) Share this | Link to this | Hansard source

I thank the honourable minister. The question is that the amendment be agreed to.

Question negatived.

Original question agreed to.

Bill read a second time.