Milton Dick (Speaker) Share this | Link to this | Hansard source

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

The urgent need to respond to severe health workforce shortages across Australia.

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

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

Helen Haines (Indi, Independent) Share this | Link to this | Hansard source

Before becoming an MP, I was a clinical nurse and midwife and an academic researcher in rural health. I've seen up close the problems in developing a strong health workforce and the ramifications when we fall short. Nowhere is this more critical or fatal than in rural, remote and regional Australia. Last week, I spoke at the 150th anniversary of Northeast Health Wangaratta, a health service with a catchment area of 90,000 people. I was proud to be part of this workforce for close to 30 of those 150 years, starting in 1986, when I walked in the door as a midwifery graduate. I walked in for an interview and was hired almost on sight, with only one question: what size uniform do you take? I reckon a similar nurse or midwife could walk in off the street today and be working an afternoon shift that evening—sure, with more regulatory oversight, but our health services need everyone they can get.

Regional Australians have fewer doctors, nurses, dentists, pharmacists, psychologists and other health workers per capita than our city cousins. Our bulk-billing rates are among the lowest in the country. Long waiting lists mean less disease prevention, more chronic disease, longer times to diagnosis and more avoidable complications. It's expensive to see a specialist in Melbourne or Sydney—out of reach for many people who are struggling to pay their rent or their electricity bill.

Hospitals must rely on locums, meaning they're spending millions of dollars on commercial accommodation instead of clinical care. Workforce shortages lead to poor health outcomes. Taking the Albury Wodonga Health catchment area for an example, our life expectancy is one year lower than the average. We have higher rates of asthma, arthritis, obesity and cancer, and the mental health statistics are truly devastating. Our mental health rates are 38 per cent higher than the national average, and, tragically, we have a higher suicide prevalence, with 16.7 suicides per 100,000 people. Cardiac arrest rates in the Hume region are the second highest in the state.

When we don't have enough health workers, it's a local doctors, nurses and allied health professionals who suffer too, and we can't afford to lose any more of them to burnout simply because they're shouldering a load that should be shared, but there's no-one there. We need urgent change. We need a long-term and sustainable solution. We've got to focus on nurturing the talent we have locally. Our young people have enormous potential, but we often lose them to universities and hospitals in the cities because we don't have enough opportunities here in our region for their education and training in health careers.

My electorate is famous for its innovation, and we have some solutions to grow our own homegrown health workforce. The Murray-Darling Medical School is one success story, and it could accommodate double the students it's currently funded for. The Collaborative Centre for Contemporary Education and Research proposal evolved during consultations on the Albury-Wodonga Regional Deal, which is another one. This centre proposes a purpose-built facility which will co-locate multidisciplinary clinical practice education and training. It will provide health undergraduate and postgraduate student facilities for three major entities that train health workers on the border: the Australian Defence Force and the tertiary sector, which includes La Trobe University, Charles Sturt University, the University of New South Wales, Wodonga and Albury TAFEs and Albury-Wodonga Heath. The centre's research will drive data-driven informed service planning and provision, which is difficult to do in regional Australia, and it will coordinate placements, deepen the workforce pool through increased student exposure to our region and encourage education and training organisations to invest in our region

Before becoming an MP, I spent a decade researching the best ways to grow and retain a strong regional health workforce. I was deeply involved in the University of Melbourne School of Rural Health, which also pioneered this integrated form of becoming a centre of multidisciplinary education and research. I know that this proposal for the border will work, and this is where the Commonwealth government can step in. I've already taken this to the Treasurer. The Minister of Health and Aged Care and the Assistant Minister for Regional and Rural Health are on notice—glad to see you here—that I'll be coming to you too. This is what I'll be saying: 'We don't just need you to help us build a hospital. Help us build a rural health workforce by funding this centre. If you care about addressing the health workforce shortage and you believe the best way to grow our rural health workforce is to invest in locals then the only conclusion you can come to is to give us the tools to educate, train and retain our own at home.'

Emma McBride (Dobell, Australian Labor Party, Assistant Minister for Mental Health and Suicide Prevention) Share this | Link to this | Hansard source

I want to acknowledge the member for Indi for raising this critical issue of health workforce shortages. It's one of huge importance to Australians across the country, particularly those living in rural and remote Australia. I know from your experience not only as a nurse and midwife but as researcher that you've seen first-hand the importance of having the right healthcare teams in the right places and you've researched innovative solutions. I want to take this opportunity to recognise on behalf of the Prime Minister, the health minister and me, our healthcare workers around Australia for their tireless dedication, not just over the past three years but in particular then. I recognise the staff at Wyong Hospital and Long Jetty Community Health Centre in my electorate. I acknowledge the member for Robertson who continues to volunteer as an ED doctor in our community. The COVID-19 pandemic has had a huge impact on all of us. Our healthcare workers were there each and every day, keeping us safe.

Over the past few months, I've been fortunate, in my role, to travel to dozens of communities around Australia. While each of them face different and unique challenges when it comes to our healthcare system, they all have a singular voice on workforce. What I have heard loud and clear and what has reinforced my own personal experience as a regional healthcare worker is that there just aren't enough healthcare practitioners where we need them. And that's not just doctors, nurses, pharmacists and psychologists; that's all healthcare practitioners and those who work to support them. From Launceston in Tasmania to Cairns in Far North Queensland, there are not enough healthcare practitioners where people need them and when they need them—and affordably. This isn't a problem that only impacts rural and regional communities. This is an issue that starts in the outer suburbs and stretches all the way across Australia.

Since the formation of Medibank by the Whitlam government in the mid-1970s, equitable access to healthcare has been the cornerstone of our nation, grounded firmly in the belief that no matter who you are or where you come from you deserve the best health care Australia has to offer. That's not just for people who live in big cities; it's for all Australians, wherever you're born, wherever you live and whatever your age. The promise of universal health care is one that we on this side of the House take very seriously, but it's a promise that was broken.

There is no excuse, in a country like Australia, with its strong social and economic safety net backed by programs such as Medicare and the NDIS, to stand by while people miss out on care. Yet for the past 10 years the former government did just that. The coalition spruik their support for everyday Australians, but they turned their backs on them, leaving thousands of Australians with little or no access to care right across Australia. That drain on our healthcare system—not just by Mr Morrison, Mr Turnbull or Mr Abbott—has eroded universal health care in Australia, and it is the responsibility of our government and of this parliament to change that. It is a responsibility that we take seriously.

The Albanese government is committed to investing in general practice and strengthening Medicare with almost $1 billion of investment. Our Strengthening Medicare Taskforce, stood up by Minister Butler, has identified the best ways to boost affordability, improve access and deliver better support for Australians with ongoing, complex and chronic illnesses, backed by the $750 million Strengthening Medicare Fund. After our doctors worked tirelessly throughout the pandemic, we will better support them with the resources to invest in their general practices with our $220 million Strengthening Medicare GP Grants Program. We're also investing $146 million to attract and retain more healthcare workers to rural and regional Australia through improving training and incentive programs and supporting the development of innovative models of multidisciplinary care. After a lost decade which has impacted the health and wellbeing of tens of thousands of Australians, our government, the Albanese government, has made health and care and the workforce that underpins it our top priority.

We are finding new ways to better support Australians. We are investing in multidisciplinary team based care. Multidisciplinary team based care supports health professionals from a range of disciplines working in strong collaboration to deliver comprehensive and integrated care that addresses the patient's needs, supported by each member of the team working to their full or top scope of practice. It recognises that everyone's health needs are unique and the rise in complex and chronic illness needs to be supported by skills and expertise from a team of healthcare professionals from a range of disciplines working closely together. This might be delivered by a team of professionals working under one roof or by a group of professionals from a range of organisations, including private practice, brought together as a team. As a person's healthcare needs change over time, the composition of that team may change to meet their needs.

Earlier this year I was able to meet with the full inaugural class of year 1 to year 6 medical students at James Cook University at their Cairns campus. For the first time, students commencing their degree at the university and attending the campus in Cairns will be able to start and finish their studies in Cairns. We know that when kids from rural and remote communities study and do their placements in rural and remote communities they stay and practice in rural and remote communities. That strengthens that community. That builds capacity in those communities. Importantly, it provides better and more affordable care. It's about care for the regions by the regions.

When I visited James Cook University I had the pleasure of meeting Vice Chancellor Professor Simon Briggs. He could not be prouder of the work the university is doing to improve the educational outcomes of his students. Many of them are first in family. Many of them are from low-SES backgrounds. Most of them expressed to me a desire to continue to learn and study and work in regional and remote communities. They want to give back to the communities they're from, they have a strong desire to contribute to the health and wellbeing of their communities, and as a government we're providing the scaffolding to allow them to do that.

In Queensland, nine per cent of health professionals graduate from JCU. But in the outer regions, in remote Queensland, that number jumps to 41 per cent, with roughly one in five health graduates working in outer regional and remote locations graduating from JCU. This is just one of the universities that are part of our rural clinical schools.

In remote communities in Queensland, JCU graduates account for 62 per cent of the health workforce in remote areas. Work like this, working with medical students in rural and remote communities to build a rural and remote workforce, is what our government is supporting. That's why JCU graduates account for 62 per cent of the health workforce in regional and remote Australia, and we're seeing results like this mirrored by other rural clinical schools around Australia.

But more must be done. That's why the government has provided $13.2 million through the 2022-23 budget to JCU to fund 20 commencing medical students through their Commonwealth supported places. We're also funding a further 80 positions for commencing medical students and $81 million in funding through an open competitive grants process, formed as part of the government's strategy to bolster our medical force.

I see this when I visit communities across Australia, and I know the member for Indi knows this through her experience as a healthcare practitioner and researcher, and I know so many people in this House have had the same experience. But it has never been harder to see a doctor. It's never been more expensive. Bulk-billing rates have dropped across Australia. This is after a decade of neglect by the former government.

Private care is in the worst shape I have seen it, since I first registered as a pharmacist in the late 1990s. GPs in my community who have seen Medicare over time have also never seen it in worse shape. That includes my colleague and friend Dr Mike Freelander. Dr Mike said to me that he's in this House because he doesn't want to see health care end up where it was before he started, without Medicare.

That is what I am committed to do, with Minister Butler, as a healthcare worker, as a local MP and in my role assisting the health minister. We are determined to turn this around, to work with local communities to find local solutions, to build capacity, to strengthen their workforce, so every Australian, wherever they live, wherever they're born, wherever they age, can get access to quality care. That's what we're committed to. That's what universal care in a country like Australia should be.

Stephen Bates (Brisbane, Australian Greens) Share this | Link to this | Hansard source

Health care is one of the biggest employers in my electorate of Brisbane, with almost 12,500 people working as healthcare professionals. Many work in the Royal Brisbane and Women's Hospital, which provides more than one-tenth of patient services in the entire state of Queensland. Since my election I have had the privilege of speaking to many of these workers firsthand. I have healthcare workers in my family, my sister being a nurse and midwife, and I have friends who work in the industry. I have spoken with unions, peak bodies, primary health networks and not-for-profit groups in the healthcare sector. In all these conversations there is one consistent theme: hospitals and health services are understaffed and healthcare workers are burned out.

The public health system was already struggling from the former Liberal-National government ripping billions from our public hospitals and which has never been returned. Then, during the onset of the COVID-19 pandemic, we praised healthcare workers for their heroic efforts. They put their own safety on the line as they worked overtime, providing the most essential work our society needed. The praise eventually dried up. But the health workforce shortages and chronic public health underfunding has continued.

I regularly speak with nurses forced to work double shifts because there are not enough staff to adequately care for the patients. These working conditions result in exhaustion and limit their ability to provide the best standard of care. But they have no choice. There is nobody else to fill these gaps. With healthcare workers being forced to work in wards that they're not experienced enough to feel confident in for longer hours and with more patients than they can reasonably care for, they are left with little option but to move on from their jobs. This has a severe impact on the quality of health care which patients receive.

When we lose workers we lose years of irreplaceable on-the-job experience. Meanwhile our hospital wait lists are growing and people are waiting years for essential care. This is simply unsustainable. Without rapid investment in public hospitals we cannot address the workforce shortages to provide high-quality health care to everyone who needs it. We will continue to lose our essential healthcare workers to burnout. Our healthcare sector is in desperate need of government support.

Instead of investing in our public healthcare system, Labor's first budget since its election decreased public hospital funding to the states and territories by $2.4 billion over the next four years. The Greens have been listening to the needs of our healthcare sector. We took a comprehensive platform to last year's federal election, to fully fund the public healthcare system, including equal hospital funding from the Commonwealth and states that would undo years of underfunding by the coalition: invest in our workforce, clear hospital waitlists and get dental and mental health into Medicare so that healthcare workers can provide the best standard of care to their patients.

By contrast, the Labor government is gutting public hospital funding to pay for submarines and the stage 3 tax cuts. They are also propping up big private health insurance corporations with billions of dollars every year in rebates for cooperations, subsidising their corporate profits. We want to stop those handouts and reinvest $59.4 billion back into the public health sector. Instead of funnelling private health rebates into the pockets of shareholders and providing tax cuts for politicians and billionaires, we could hire the healthcare staff we need to address workforce shortages and deliver a public health system that works for people, not profits. We owe it to healthcare workers around the country to make sure that they aren't bearing the burden of government underfunding in their own working lives. It is time that we once again start treating our healthcare workers as the heroes they are. The health care of our friends and families depends on it.

Michelle Ananda-Rajah (Higgins, Australian Labor Party) Share this | Link to this | Hansard source

The other day I bumped into a medical colleague of mine. He disclosed that he had met a nurse. That in itself is not remarkable. However, this nurse was actually driving a tram. This nurse was no ordinary nurse—she was an ex-intensive care nurse. It speaks volumes that we now have a situation where the health system is haemorrhaging human capital, human capital that is not going to be able to be replaced overnight. This problem obviously has been going on for some time now, and it was made worse during the pandemic. The pressures of the pandemic undoubtedly exacerbated the problems for the workforce.

It's no coincidence that it has exacerbated the problems of a workforce that is feminised. The health workforce is feminised, as is the aged care workforce, as are teachers and child care. These workforces are haemorrhaging because they are also feminised workforces. Women are that sandwich generation. We're caught between the pressures of home duties as well as dealing with ageing parents. In addition to that we belong to these caring professions. There's no doubt that all of this has led to a situation of mental and physical exhaustion, to be honest. Here in this House we are well aware of that. I think it speaks volumes that in this parliament we have got probably the highest number of healthcare professionals, people with lived experience, like my colleague Emma McBride, and the member for Indi. I thank her excellent representation of her community. She is a former midwife and researcher who has lived experience and understands the pressures on the health system.

Coming from that position now, we have to craft policy. We have to craft policy to course-correct and invest in human capital. I have this list of amazing initiatives that the Albanese government is delivering, and I can't see a single hospital being built on this. I am actually kind of happy about that. There's no point building hospitals if you can't staff them. Actually, the bulk of our initiatives are focused on training and workforce. There was one particular initiative I spoke on not long ago, which I particularly like, which speaks to the maldistribution of the healthcare workforce currently, with oversupply in the cities and metropolitan areas and an absolute scarcity in our rural and regional areas.

There is an amendment to the Higher Education Support Act which will look to waive HELP fees for those rural doctors and nurse practitioners who choose to work in either regional or remote communities. Essentially, the further out you go, the more debt is waived and forgiven. That's not trivial because it can amount to something like $8,000 for a nurse practitioner and up to $10,000 for a doctor. That is not a trivial amount of money, particularly during the cost-of-living crunch that we have now. I sincerely hope that that encourages more of our trainees to go into the regions. As you know I worked at the Alfred, and, for the13 years I was there, I could count on one hand how many medical students planned on becoming general practitioners. There were probably two in 13 years.

The problem is that they enter the public hospital system, which is generally in big metropolitan cities—these are the doctor and nurse factories—and they get seduced. They are seduced ,and they decide that they want to become a trauma surgeon instead of working as a general practitioner in the regions. The irony of all that is, from my own lived experience, the most fulfilling rotations I had were actually in the regions, in places like Lismore, Orange, Bunbury, Rockingham and Gladstone. I've worked all over this country, and I've got to say working in the regions is just the most fulfilling experience because the communities are so grateful that you are there. So I would strongly urge our prospective trainees to consider the regions and to be deliberate about their choices. I urge them to understand that, as a government, we are doing everything we can on this side of the House to invest in our regions. In addition to training programs, mentorship programs are obviously just as important. We need those health practitioners with the grey hairs—I have quite a few, actually!—to mentor the next generation coming through.

Bob Katter (Kennedy, Katter's Australian Party) Share this | Link to this | Hansard source

It took us eight or nine years to get the Townsville medical school. It was the first medical school built in Australia in 44 years. We live 2½ thousand kilometres from Brisbane, so our young people went to Brisbane to become doctors, and they were never going to return the 2½ thousand kilometres to North Queensland. In spite of turning out 200 doctors a year, our crisis may be at its worst ever. Mission Beach, for two years in a row voted one of the four most beautiful places on earth, is without a doctor. I never wanted to be a state member of parliament at a time when we didn't have a doctor for Julia Creek, so I carried around the names of 12 doctors with me for years. They were the names of doctors in England, South Africa and America who I could ring up and get them to come to Julia Creek. But Julia Creek is now without a doctor. Now there are towns all over without a doctor. If you've got 1,000 people in a town with no doctor and if it's an hour or over to reach the nearest doctor, the official figure is that one person will die every year. We now have the situation in North Queensland where there are probably three or four people dying every year that don't have to die.

I'll tell you what is infinitely worse. When you walk into my office you will see a picture of Red Ted Theodore, the founder and creator of the Labor movement in Australia and the greatest man in Australian history. I didn't say that; Paul Keating said that. I didn't say that; Malcolm Fraser said that. Ted Theodore introduced the free hospital system in Queensland, and I could proudly say that, in the year of our Lord 1990, the only place on earth that you could walk in 24 hours a day every day of the year and get free treatment was in Queensland. Now the free hospital system has gone. Outpatient services have closed. You can see it graphically in my home town of Charters Towers, where the outpatient service has a big wooden sign across it: 'Closed'. Fifteen metres away is the entrance to the hospital, and it says 'inpatients'. So it can't be more graphically illustrated than that. We had the great Labor governments of Red Ted Theodore that created so much good for this nation, and now we have the pygmies that claim to be Labor but are about as much Labor as I am a communist or a Martian or something, and they have removed the free hospital system in Queensland.

There's no money. Why is there no money? Because the Premier has committed $62,000 million to her fairy floss fantasies of lowering CO2 emissions. Well, she's been there for nearly 10 years, and I haven't seen a single act that she's committed that has lowered any emissions anywhere. We got 4½ per cent ethanol through, and she refuses to enforce the 4½ per cent, so the one single thing she could have done to reduce CO2 emissions she has failed to do. But she's managed to find another $1,000 million for pleasure domes for herself and her government on the Brisbane River—another huge Taj Mahal going up beside the existing Taj Mahal. She's found $62,000 million for her fairy floss fantasies that she's going to save the planet with, and she's found hundreds of millions for her national parks that are being burned out everywhere and are nourishing every single invasive species known to man, because there's no-one left to man them. If you create hundreds of thousands of acres of national parks every year and don't include a single extra person to look after them, the cost of national parks, even without the increases, is colossal. If you want to spend money on all of your fantasies, well, I'm sorry: there's no money left to pay the doctors to man your hospitals. That is the reality in the state of Queensland. If you bear the name 'Labor' then you bear the imprimatur of the people who abolished the free hospital system in Queensland, and for that you will be eternally condemned.

Louise Miller-Frost (Boothby, Australian Labor Party) Share this | Link to this | Hansard source

I'd like to thank the member for Indi for this opportunity and acknowledge her sincere interest, her advocacy and her prior work in the health sector, particularly rural health. I certainly agree this is a matter of public importance. There are few things that so directly affect the quality of Australians' lives, no matter where they live, as the access to timely quality local health care, and Labor's always been the party of health care since Whitlam's introduction of Medibank and then the Hawke era, with Medicare. Labor built Medicare, and we will always protect it. Medicare is in Labor's DNA. The Albanese government is committed to strengthening Medicare for the future, and we know that to do this it will require considered and gradual reform. When we look around the world, it's clear that Australians are so lucky to have access to a world-class health system, despite its challenges. Key to provision of health services is sufficient quality staffing—doctors, nurses, allied health, paramedics and support staff—in primary care and in hospitals, and in metropolitan areas and regional, rural and remote areas.

My background is in the primary healthcare sector, non-clinical, and after nine years of cuts and neglect from the former government primary care is in the worst shape since Medicare began. Bulk-billing rates have plummeted. It's never been harder or more expensive for Australians to see a GP. Then, in the tertiary sector, we've all seen the ambulance ramping across the country, and of course what sits behind that is bed block in the emergency department and further bed block within the hospital. It doesn't matter where you are in Australia or what kind of medical assistance you need; getting the correct care when and where you need it has never been harder.

I'll say this isn't a new problem. It's a problem that's been a long time coming. We know that only 14 per cent of medical graduates now choose to work in general practice, dropping from the previous 50 per cent. General practice used to be a specialty of choice: being the primary care lead for your community, seeing a wide variety of issues and helping people literally from cradle to grave. Filling general practice and all manner of health positions in rural and remote areas has been a challenge for several decades, and there are a number of reasons for this. We haven't been training enough doctors, nurses and allied health practitioners in this country. The former government froze the Medicare rebate for six years, ripping billions of dollars out of primary care and causing gap fees to skyrocket. Why would you choose to work in an underfunded, understaffed sector?

Part of my 15 years in the health sector included a role recruiting doctors from overseas for rural and remote placements across Australia. In many of our regional and rural areas, general practice and hospitals are staffed by some excellent medical staff, trained from overseas, who've chosen to make Australia their home and bring their families to our wonderful country. But there are some real ethical concerns about this. While we in Australia are not putting enough money into training our own doctors, nurses and other medical staff, we should not be relying on overseas countries, often those in poor economic situations, to fund training for our medical staff in our country when they need them in their country. We need to be training Australians to take these jobs.

We've inherited a real mess: shortages of staff in all sectors of the health system, a Medicare system not fit for purpose and financial disincentives that drive students and graduates out of the areas where we most need them. What are we doing? We are funding an additional 20,000 university placements which includes nursing places. We have funded fee-free TAFE, and my local TAFE at Tonsley informs me that they've had an 140 per cent increase in enrolments, including students seeking to qualify as enrolled nurses. We've established the Higher Education Loan Program debt reduction program, which will eliminate HELP debt for doctors and nurses who choose to live and work in rural and remote areas. The minister for health has established the Strengthening Medicare Taskforce to look at how we can make Medicare fit for purpose in a country with our ageing population. It will identify the best ways to boost affordability, improve access and deliver better support for patients with ongoing chronic illness, backed by a $750 million Strengthening Medicare Fund. Labor will make it easier to see doctors by building 50 urgent care clinics across Australia, including one in Boothby to support the Flinders Medical Centre Emergency Department so that people in Boothby, Kingston and Mayo will have access to fast, bulk-billed care.

There's no doubt that health care in this country is critical to our quality of life. Once again, we've inherited a mess, but we have strategies to build back better.

Dai Le (Fowler, Independent) Share this | Link to this | Hansard source

I thank the member for Indi for bringing this significant matter to the attention of the House. The healthcare sector in Australia is in dire need of intensive care, and in south-west Sydney and in my electorate of Fowler, it needs resuscitation. Since last October, the primary health network in south-west Sydney has seen eight GP practices shut down in the Liverpool and Fairfield LGA. For a community like Fowler, this means many of our residents will miss out on accessing the optimum health care they deserve. A constituent, Tom Lieng, a local director of WorkRecover, which provides occupational health services in south-west Sydney, reached out to me recently regarding this very issue. He told me, 'Practising in south-west Sydney means that we are financially penalised because our patients are poorer.' He recently had to start charging a $20 gap fee, excluding aged pensioners, healthcare card holders and children. He said: 'We are surprised that 95 per cent of our patients fall in the excluded group. It reflects the low socioeconomic background of our local community.' Many GPs are struggling to stay alive and are introducing mixed billing because bulk-billing just can't pay the bills. The few GPs who are still bulk-billing can't keep up with demand, with their patients waiting for weeks for appointments.

This system is sick, and people's lives are at stake, particularly the lives of people with low incomes, who simply cannot afford to pay out of their own pockets to go to the doctor. The South Western Sydney Primary Healthcare Network, or SWSPHN, told me that Australia is producing more med graduates than ever before. That's supposed to be good news. But the fact is that less than 15 per cent of them are going down the GP route, compared to 40 per cent just 20 years ago. The drastic decline is due to the specialist and hospital sector, where jobs hold more prestige and have higher salaries. Another factor is the decline in the limited options for junior medical officers to do a GP rotation post university, meaning they're out of the GP network from the start. The SWSPHN has recommended that practical courses mandating that junior doctors do rotations at a GP clinic would inspire, and create pathways for, GP careers instead of specialised medicine. We need practical solutions to encourage medical graduates to come to the south-west as well, including professionals who can engage with a diverse community.

But we're not only having a GP crisis; we're also having a mental health one. When I first took office, I held consultations with GPs, pharmacists and allied health professionals of Assyrian and Vietnamese heritage in my electorate to get an insight into the plight of the local healthcare sector for their respective communities.

Local pharmacist Quinn On, from Cabramatta, told our office that while people from CALD backgrounds face mental health struggles, they do not speak up about it, meaning it could be hard giving appropriate care to these patients. However, he has seen a 30 per cent uptake in antidepressant prescriptions since the pandemic in 2020. And while it's good to see these communities are starting to take their mental health seriously, he said, the lack of psychologists, mental health specialists and counsellors in the area means their treatment options are compromised. There's only one Vietnamese-speaking psychologist in the Cabramatta area, but he had to stop taking patients because of the months-long waiting list. It's hard enough to find a psychologist at a moment, let alone one who can speak your language and understand your cultural needs.

The Assyrian Australian Medical Association shared similar insights with me and added that the shortages in south-west Sydney were due to psychologists being incentivised to work out of the area. They asked: why would they work in south-west Sydney when they can charge more per hour in Bondi?

My constituent Tom Ling said that Medicare indexation was not keeping up with inflation, flagging that this must be remedied in the Medicare reforms the government is planning. He raised that the state government recently announced that those working in group practices are now considered employees rather than contractors and are now subject to a five per cent payroll tax. This will be another unfair cost to our medical practitioners. I call on state and federal governments to collaborate for a fairer tax system as part of the Medicare reforms. This will alleviate the costs being passed on to patients, especially those from a low socioeconomic background. I do not blame the doctors, nurses and allied health professionals who need to charge more for their services. After all, we're all getting hit by the cost-of-living crisis. We need Medicare reform now. Overall, we need a healthcare sector that guarantees the health and wellbeing of all Australians, regardless of their socioeconomic background, cultural heritage, age or postcode. We all know that health is the real wealth of any country.

Gordon Reid (Robertson, Australian Labor Party) Share this | Link to this | Hansard source

I want to thank the member for Indi for raising this matter of public importance. The more we talk about health in this place and the more we talk about health in our communities, on the doors, on the phones and with our constituents, the more health care is kept in the national conversation, and that can only be a good thing. It can only be a good thing for the people that we here in this chamber serve. Many of us who are health professionals or who have worked in health administration or research know it's vital that we are there for our patients and there for our communities.

I want to thank the ministers and assistant ministers for their hard work with our recent policy announcements over the course of the election and also in the first 10 months of the Albanese Labor government, in particular Minister for Health and Aged Care Mark Butler and Assistant Ministers Emma McBride and Ged Kearney for the fantastic work they do in the health space and for their previous service in the nursing and pharmacy spaces as well. Also, to the health professionals that I still work alongside at the Wyong hospital emergency department and also those who work in the Gosford Hospital health setting, it's important that we recognise you for the work that you do, and I say thank you.

Primary care and healthcare access is absolutely vital not just in my home on the Central Coast but right across the country. It doesn't matter what political colour your seat is—blue, green, teal or otherwise—and it doesn't matter who you are, where you are or where you've been; access to health care is absolutely vital, in particular primary care. Primary care centres around preventative medicine. It's preventative care. I've given examples in the chamber before of where preventative health is important—seeing that GP or getting in to see that pharmacist, making sure you're nipping issues in the bud quite quickly. Take for example hypertension, which is high blood pressure: it's making sure that you have access to the appropriate medications and getting your blood pressure checked so that we can prevent hypertensive or blood-pressure-induced strokes. I look at high cholesterol, also known as hypercholesterolemia: it's making sure that's getting checked with your pathology, getting your blood tests done, and then making sure you're on an appropriate medication or controlling your diet to prevent an acute myocardial infarction, which is a heart attack.

If you find there is a patient that has something called insulin resistance, where they're not dealing with the sugar too well in their body, if you can intervene and intercept that in the short term you can potentially prevent someone from going on to develop type 2 diabetes, which we all know has a drastic and severe consequences for not just the patient but the health system and the broader health economy as well. That's why, over on this side of the House, we are investing quite heavily and significantly in that primary care space, with the Strengthening Medicare Fund. Three-quarters of a billion dollars is going into strengthening Medicare. We created Medicare and now we're here to strengthen it so that access can be improved for patients right across the country.

Moving onto urgent care as well. This is really exciting. Allow me to nerd out for a moment, as a doctor. We're creating a new model of care in Australia. Other countries have this. The UK, New Zealand, the Scandinavian countries have this middle tier, where if you're too sick for the GP but not sick enough for emergency you've got somewhere to go. We have sporadic examples of that in Australia, but for the first time we are creating a new model of care that patients can go to if they need it. If you have a cut in your hand from washing up the knife in the sink, if it doesn't need surgery but only needs sutures—urgent care. If you've got a wound that requires through-the-drip antibiotics—urgent care. If you've got a fracture that doesn't require it to be reset in the operating theatre, and you just need a plaster and an x-ray—urgent care. These are things that are coming into our emergency departments that don't necessarily need to be there. They're a triage category four or five, and now we're providing them with a new level of care. I am proud that in my electorate of Robertson and in Assistant Minister McBride's electorate there will be two urgent care clinics that will be established, which was recently announced by Minister Butler as well. That's fantastic. Not only that; it's also going to be a bulked billed service, and it is going to be for adults and children, which is really, really important in terms of healthcare access.

Monique Ryan (Kooyong, Independent) Share this | Link to this | Hansard source

Our healthcare workers are the key to the quality, accessibility, effectiveness and sustainability of our healthcare system. A major challenge to our health system is workforce shortages affecting every level of our health system: ambulance and hospital services, GP and community health care, and residential aged care. These shortages are affecting the quality of care provided by Australia's healthcare professionals, as well as their working lives.

Factors fuelling healthcare skill shortages in Australia include the effects of COVID-19, burnout of healthcare workers, an ageing health workforce and the complexity of healthcare training. These issues preceded but have been significantly exacerbated by the continuing COVID-19 pandemic.

Firstly, doctors. Our medical workforce has actually increased in recent years but it has significant sectoral challenges. There are more female doctors and more professionals seeking part-time work. There is a critical shortage of GPs, especially in rural areas. Last year the AMA predicted we would be 10,600 GPs short by 2031. We have geographic maldistribution, an imbalance between specialist disciplines, issues with junior doctors' workloads and wellbeing, a need to move away from international graduates and locums, and a need for more Aboriginal and Torres Strait Islander graduates.

Secondly, nurses. Health Workforce Australia has foreshadowed a shortage of more than 100,000 nurses in Australia by 2025. We're short of thousands of paramedics across the country, while in some areas emergency calls have almost doubled. In Victoria we have had many tragic incidents of ambulance delays resulting in deaths. We have seen the same with patients left on ramps in overcrowded emergency departments. We have a shortage of hospital and retail pharmacists. We have massive backlogs of patients waiting for delayed care, including elective surgery. It goes on. The healthcare skills shortage is even worse in rural and regional centres of Australia, which struggle to attract and retain staff and which rely more heavily on nurses than do metropolitan areas. We know these issues have been exacerbated by significant housing shortages in regional centres.

The pandemic has also affected the physical health of medical professionals. Healthcare workers were always more likely than the rest of the community to be infected with COVID in the workplace, even if they took appropriate precautions. They've had to cope with that risk. During the pandemic 22 per cent of healthcare workers increased their unpaid work hours, 20 per cent increased their paid work hours, while another 27 per cent had to change work roles. The pandemic has increased the risk of post-traumatic stress disorder, anxiety and depression in all forms of healthcare workers. In 2021 the RACP found that 87 per cent of doctors reported feeling burnt out. As many as 75 per cent of nurses in acute care are considering leaving the profession.

If nursing ratios are inadequate, patient care is at risk. When international borders closed during the pandemic, many healthcare staff working in Australia returned to their home countries. Many have not returned. The deficiencies in our training systems were exposed when we realised that reliance on overseas-trained health professionals. Locally, training of medical professionals has been negatively impacted by COVID. Clinical placements have had to be cancelled due to activity restrictions. We've had reallocation of roles. We've had persistent staffing and equipment shortages.

We need vision from the Albanese government. We have to address the state/federal divide of our healthcare system. It impedes coordination of all areas and sectors of our health care. We have to improve how we provide care, who provides it, how those individuals are trained and how they're supported. We need to critically rethink all of our medical services. We need investment in training of all parts of our workforce, and we need to ensure that we can continue to deliver world-class health care in all metropolitan and regional centres throughout this country.

I thank the member for Indi for moving this private member's motion today. I urge the government to commit to the once-in-a-generation reform of these issues that we all so urgently need.

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

I, too, would like to thank the member for Indi for moving this matter of public importance. It's refreshing to get a matter of public importance that indeed lives up to the name. There are few things more important than the urgent need to respond to severe health workforce shortages across Australia, particularly regional and rural Australia. By my count, we've had six speakers on this motion who are former health professionals, serving health professionals or health administrators. In the parliament we've got at least eight to 10 former health professionals. I'd make the suggestion to all those people on this side, the other side, the crossbench and in the Senate: get yourselves together, form a little caucus and come up with some real solutions. From what we're hearing today, the issues have been really well articulated and we know what the issues are; it's about finding the solutions. We can all say, 'Let's just chuck money at it,' but we know that the bucket is finite, so let's find solutions that don't require billions and billions of extra dollars.

The Albanese government, since coming into office, recognises—in fact the health minister has said that the GP shortage is one of the single most pressing issues facing the health sector today. We've announced a range of issues which go, as the member for Higgins mentioned, directly to workforce. We're not focusing on capital infrastructure; we're focusing on human infrastructure to try and get people out into the regions, whether it's the Northern Territory, across the vast inland plains or elsewhere.

We've committed $15 million towards upgrading the Royal Flying Doctor Service headquarters at Launceston Airport in the north of my electorate. They do amazing work. They should look at rebranding themselves as the 'royal driving doctor service', because they are doing a lot more driving than flying at the moment in my electorate. They've got mobile vans—in fact they're fully equipped clinics—which go out to aged-care homes and to more remote areas of my electorate and deliver amazing health services. I think that's a model that we should be looking at.

We're looking at a number of models in my electorate. There are few things more pressing for me as the local member for Lyons than the workforce issue with primary health care. I don't want to just say there's a GP shortage. That minimises it. The member for Kooyong alluded to this quite well. It goes across the health spectrum—nurses, psychiatrists, all sorts of allied health professionals. We face a workforce shortage in health in the regions.

We're looking at a number of things. I've set up, in my electorate, a primary healthcare committee that draws on the expertise of people in the primary health network, consumers and other stakeholders, including local and state government representatives. We get together to develop a plan of action to tackle the shortage of primary health care across regional Tasmania. Little bushfires of crises pop up from time to time, and we try and deal with those. I must say, there's a lot of goodwill. I'd like to thank the Tasmanian Liberal government, on that note. We are a federal Labor government. We're working hand in hand with the Tasmanian Liberal government to find solutions, and there's been a lot of goodwill across the aisle.

We're dealing with a lot of issues, in my electorate, in terms of GPs leaving clinics. The member for Fowler has mentioned a similar situation in her electorate. I think every member, particularly every regional member, in this House would have similar stories about the difficulty of retaining GPs let alone recruiting them.

I come at this, maybe, from left field. To me, health care is about three things. It's about staying well and healthy. If you're not well or healthy, then you need to be treated. If you can't be treated, then you should be made comfortable. We've got away from those foundations. We've made it incredibly complex over generations. The bureaucracy has grown and we've put on bandaid after bandaid after bandaid. We need to rip it away and make some really deep structural reforms. But it's difficult to make structural reform when you're in a constant state of triage, just trying to keep the system going.

That's where we need to get to, and I applaud the efforts of the health minister and his supportive team in making sure that we get to this. Strengthening Medicare is part of it. We believe in Medicare. We want to protect Medicare. We want to make sure that it's there for all Australians.

Sophie Scamps (Mackellar, Independent) Share this | Link to this | Hansard source

I also thank the member for Indi for this matter of public importance and the opportunity to speak about it. As a former GP, just 18 months ago, I will be focusing on the GP crisis at the centre of primary health care.

Imagine your child is in acute pain with an earache and you need to have them checked by a GP. Your local GP, the one that you usually see, however, can't fit her in for a few days. This is a common scenario, which all too often ends up as an hour's long wait in the emergency department. Emergency and hospital staff are already stretched to the limit, often facing bed-block issues in their hospitals, caring for inpatients in corridors and ramping of ambulances. The shortage of GPs exacerbates this situation.

An effective health system depends on a well-functioning primary healthcare system. If the GP sector collapses, if the primary healthcare sector collapses, the entire system will go down with it. The role of a GP is to manage both acute and chronic medical conditions of their patients and to prevent disease, both through education and screening. We do it in every single consult, even if somebody comes in for a sneeze or a script. The role of a healthy primary care sector is what keeps people out of hospitals and prevents chronic disease. People who have continuity of care with a GP who knows them well are far less likely to be admitted to hospital. You can imagine the cost effectiveness of this is enormous.

I know, firsthand, the pressures and stress that GPs are under. I've spoken to practices that are on the brink of financial collapse. Very few GP practices in my electorate have been able to continue bulk-billing the vast majority of their patients, simply because after a several-year freeze on Medicare rebates it's financially unviable. Many have had job ads up for months and can't fill the GP positions.

But anecdote is not data. A survey conducted by the Royal Australian College of General Practitioners last year showed that 48 per cent of GPs consider it financially unsustainable to continue working as a GP. According to a May 2022 report by Deloitte Access Economics, Australia can expect a widening shortfall in the availability of GPs. By 2032 the shortfall is expected to be over 11,000 full-time equivalent GPs, or 28 per cent of the workforce. If you think it's bad now, imagine what it's going to be like in just 10 years time.

The number of young doctors choosing to specialise in general practice continues to fall. One of the major reasons for this is that, quite simply, the critical work that general practitioners do day in and day out is not valued as it should be; the seven-year Medicare rebate freeze was emblematic of that. Why would you work in a profession where you are overworked and not valued? Burnout among GPs is a major problem, and the RACGP survey showed that unsustainable workload and burnout are contributing to GPs taking early retirement from the profession—including young GPs.

I fully support the government's concept of fully utilising allied health workers, so that there is a team based approach to looking after patients, with GPs as generalists providing oversight and that holistic care and direction. It makes good sense and is good practice for patients. It's also important that Medicare rebates for prolonged GP consultations are introduced so that GPs can be remunerated for the management of difficult and complex issues. It's this type of care which keeps people out of hospitals and will relieve that pressure on the hospital system.

However, I also have great issue with the concept that pharmacists will take on prescribing, as this will fracture care and, I feel, deliver lower-quality care. I can't tell you how many times a patient came to me saying, 'Doc, this'll just be a quick one; I just need a repeat prescription.' Thirty minutes later, you've diagnosed a couple of critical issues and you're worried what would've happened if they hadn't come and seen you that day. GPs must be valued rather than replaced by others who are not trained for this very specialist role.

I also acknowledge there are widespread workforce problems across the— (Time expired)

Maria Vamvakinou (Calwell, Australian Labor Party) Share this | Link to this | Hansard source

The discussion has concluded.