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

This motion is most appropriate. One of the issues that constantly comes to my three offices in western New South Wales is vacancies and the need for more health professionals. As of yesterday, it's been 17 years since I was elected. The Member for Blair and I turned up on the same day. There have always been attempts to look for a silver bullet—the quick answer to fixing these problems.

With regard to health, we've actually made it considerably worse. The idea of paying health professionals, whether they're doctors, nurses or in allied health, considerably more to go and work as locums has actually meant that it is now a pathway for people to choose as a career. I asked why someone would choose to go and hang up their shingle and work for 40 or 50 years as a local GP when they can fly in and fly out and earn considerably more money? The problem with that is that the standard of health is much lower. It doesn't matter how qualified that person is; health is all about relationships. It's all about having a person you know and can trust and having those critical discussions—end-of-life care, aged care and all of those things.

I could point to the time when I was a regional health minister and working with the then Rural Health Commissioner, Professor Ruth Stewart. We worked with ACRRM and considerably increased the numbers of training places for the generalist pathway. Part of the problem was that general practitioners were getting trained in specific areas but they didn't have the qualifications to go into a rural region where they may have needed more skills in emergency medicine but also other skills such as in anaesthetics or obstetrics—something that could benefit a broader range of patients.

There was a reluctance to go out, but changing the John Flynn program from being a student experience to putting that money into more actual training places in regional areas has significantly given more people that opportunity to train in a regional area. We've also had a generalist training program for allied health so they can actually have a broader range. It makes a difference. When this government came in and changed the rules around distribution priority areas, just so people know, those that live in the peri-urban areas, that week my electorate lost six doctors from the most underprivileged needy communities in western New South Wales. It was done for a reason. That was put in place so doctors who had obligations to meet as part of their qualification to work in Australia would go to certain areas. Six doctors went to less underprivileged areas, peri-urban areas, areas on the coast. That issue itself has been overhanging regional areas. I just want to leave the message to this place that decisions here matter. Everyone thinks they live in the most disadvantaged part of Australia. Even people in the capital cities talk about their need for more doctors. That's fine, but don't take them from western New South Wales, where the need is the greatest. I commend Dr Webster on her motion and understand that regional health is very important.

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

I rise to speak on this motion from the member for Mallee and acknowledge the importance of this issue in my electorate. The Albanese Labor government has put forward a range of measures to address health workforce shortages and improve health outcomes for people living in rural, remote and regional Australia, including my regional electorate of Blair, which takes in rural parts of Ipswich and the Somerset region. At the outset, the government funds more than $1.9 billion a year for programs to develop the workforce and support a more equitable distribution of health professionals to areas of need, especially regional and rural areas. Our first budget put in place a range of increased incentives for doctors to practice in rural and remote communities like that of the member who's bringing this motion. It is very significant and rewards doctors moving to regional Australia with the skills they need. We've already seen the benefits of this investment, with a significant increase in the number of junior doctors commencing as GP trainees in 2024. In fact the last two years have seen the biggest increase in doctor numbers in a decade. We've also seen extra training places from an oversubscribed rural generalist training scheme, building our rural workforce. That's not fixing every problem in every single community, but more doctors, bulk-billing, Medicare urgent care clinics and Medicare mental health centres, like in my community, are starting to turn around the challenges we inherited from the coalition, who saw bulk-billing go into freefall.

I know there are a range of levers we need to pull, and we're doing so. For example, in the education portfolio we put in place some very significant HECS or HELP debt relief for medical and nursing graduates who move to regional Australia. We put in place a number of single-employer model trials to try and deal with the industrialised disadvantage that GP registrars face in regional communities compared to their hospital based counterparts as well. The $3.5 billion investment put in place 12 months ago to triple the bulk-billing incentive is benefiting regional Australia more than our cities. We know about 40 per cent of more than five million additional free visits to a doctor that took place over the last 12 months happened in regional Australia. Australians living in regional, rural and remote areas will benefit from the $213.6 million package in the 2024-25 budget, delivering cheaper medicines, more access to scans and other tests and more free mental health services and investments in the health workforce.

But I acknowledge that this is an ongoing challenge in my community. In August last year, I held a roundtable on regional health, in Fernvale in the Somerset region in my electorate, with the Assistant Minister for Rural and Regional Health. It was attended by a number of participants from a range of professional bodies, service providers and local community groups, including Services for Australian Rural and Remote Allied Health, SARRAH, which the member referred to in her motion.

A key focus of the forum was allied health workforce shortages and service access issues, which have a real impact on people living in the Somerset region. One of the things we discussed was that the government had just announced a health workforce review to address these issues and to ensure we optimise our health professionals, including allied health professionals, in regional, rural and remote areas. That review recently concluded, and the government is now carefully considering its recommendations along with other primary health care and workforce reviews. We look forward to seeing the outcome of that.

Certainly, as a regional MP, I have been advocating for better healthcare services in my electorate. I am pleased to say that we delivered a Medicare urgent care clinic and a Head to Health, or Medicare mental health centre, in Ipswich. These proved to be very popular and made a real difference for patients in Blair, including people from rural areas who come in to Ipswich to access these services. Recently, the Minister for Health and Aged Care and I visited both facilities. We heard that the Ipswich urgent care clinic has had 11,000 presentations since it opened in August last year, while the Medicare mental health centre has had 1,660 appointments since it opened in May. I want to thank Dr Ajit Bhalla and the ForHealth team at the urgent care clinic and the Open Minds team at the mental health centre for their outstanding work in boosting bulk-billing health services in Ipswich.

The minister also met Dr Tony Bayliss and his partner and wife, Dr Cath Hester, of the Colleges Crossing Family Practice. Tony is the chair of the Darling Downs West Moreton PHN, and Cath is the Queensland chair of the RACGP Queensland. They talked about the issues in regional and rural areas. I'm pleased that we've got great practitioners across my electorate who contribute in this way.

Andrew Wallace (Fisher, Liberal National Party) Share this | Link to this | Hansard source

Regional communities like mine are in a healthcare crisis, and Australians have had a gutful of this Labor government's cuts and clumsy mismanagement of the healthcare sector. More than a quarter of the Australian population lives in regional, rural or remote Australia. Nearly a quarter of those Australians are over 65 years of age, when we all know people require more health care. They are more likely to need access to acute critical and/or long-term health care as well as aged care, disability and practical support.

Despite this demand on their services, communities like mine have a dire shortage of general practitioners and primary healthcare workers. High turnover, skyrocketing costs and poor infrastructure and connectivity mean that GPs can't afford to practise and can't afford to set up a clinic or keep their doors open. We know this all too well in Fisher. I cannot tell you the number of emails and phone calls that I've received from GPs screaming out for help—screaming out for more doctors—because they are overworked, and, quite frankly, they are at the end of their tether.

Since my election in 2016, I've stood shoulder to shoulder with the Fisher community in the fight for better healthcare infrastructure. I fought for mental healthcare services, and I remain committed to establishing the Sunshine Coast as a mental healthcare hub. To that end, I delivered $4 million to set up a headspace in Caloundra, which is now 18 months—long—overdue. Despite the continued hassling and pressuring of this government, they're only just now starting to talk about opening next month, which is going to be 18 months late.

I secured $8.3 million to establish the national PTSD centre in Birtinya, Australia's first PTSD research centre. I secured $11.4 million to set up and fund youth mental health and suicide prevention work through the University of the Sunshine Coast Thompson Institute alongside Roy and Nola Thompson. I secured $7.3 million to set up and operate Australia's first residential eating disorder facility at Wandi Nerida. I also secured funding for eating disorder recovery coaches, youth mental health events, men's sheds, veterans' wellbeing and psychosocial care.

Now in opposition I am fighting for Fisher families to access the healthcare services we need. I spoke up for the community of Montville, who desperately needed a doctor. Hundreds of hinterland locals signed my 'Montville needs a doctor' petition, calling for the government to reconsider the funding model they apply to GP funding. Our petition and requests fell on the deaf ears of this Labor government.

We stood up to Labor's reckless attack on community pharmacies. Labor's botched changes to dispensing, discounting arrangements and reckless red tape pushed community pharmacies to the brink. In Fisher, the uncertainty and skyrocketing costs drove some doors to close. As the shadow assistant minister and member for Mallee said so well, 'Labor's scorched earth approach to regional Australia has left some regional towns with their pharmacist as their sole primary healthcare provider—that is, if they still have a pharmacy.' Thankfully, alongside community pharmacies, the coalition fought to negotiate a new eighth community pharmacy agreement with the government.

But as always, the coalition has a plan to remedy Labor's regional health crisis. We will invest $400 million to incentivise and equip the next generation of GPs for regional communities. We'll slash the red tape and cut the taxes that are crippling healthcare providers. We'll restore the telehealth system that Labor has sought to dismantle, and we will once again double the number of psychologist visits available under Medicare. One of the first things this health minister did was to dismantle the number of visits a person could make to a psychologist. This Labor government cut the funding for people who are at their most vulnerable, people who need to go and see a psychologist. The health minister cut that funding, shamefully and disgracefully. It meant that tens if not hundreds of thousands of Australians could not access appropriate psychologist visits. We will fix that when we win government, God willing, and if the Australian community supports us next year.

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

I thank the member for Mallee for moving this important motion. Health, as you know, is a topic close to my heart, and I am interested in pathways for more generalist doctors, because I, too, was a generalist doctor. I worked as a medical doctor specialising in general medicine. I was essentially what is called a specialist generalist, which means, like GPs throughout this country, I saw everything that came through the door—and I mean everything. I, too, have had the privilege during my training and my career to work in many regional towns throughout this country, from Rocky to Armidale, Warrnambool, Orange, Coffs Harbour, Lismore, Rockingham, Bunbury, Burnie—I could go on and on. But every major hospital where I have worked in a metropolitan area has always had deep connections into rural and regional communities, because these were our referral pathways, and we were there also to take on calls and support our GPs in those regions as well as the few specialist doctors out there. It is an enduring regret of mine that I didn't end up in rural or regional medicine, because I really loved it when I was a trainee doctor and medical student. I just ended up getting seduced by metropolitan big-hospital frenetic medicine, and I really wasn't deliberative enough when I was making the decision about where to train and what to specialise in. And I didn't have any mentors at the time who could point me in the right direction.

The time I spent in regional communities was incredibly rewarding. It was like nothing I have ever experienced in the city, and I do mean that. You were stopped at supermarkets and at the church. People were caring, they were grateful to have a medical student or doctor working in their town, and they were interested in your wellbeing. I still remember a GP I worked with who provided a bike to help me get from my accommodation to the practice. Everyone in the clinic knew I had this bicycle and would wonder whether it was okay and whether I needed anything more. The medicine was rewarding, as was the gratitude, which came in bucketloads, and it was genuine.

So what we are doing to support our rural and regional communities? By and large, patients want to see a doctor, and they would like to have a bulk-billing doctor.

To that end we are opening urgent care clinics right around the country. We have already opened 78, with more to come, and some of these are in regional towns such as Albury, Shepparton, Bendigo, Ballarat, Rocky, Broome, Mount Gambier, Tamworth, Toowoomba, Ali Curung in the Northern Territory, Bunbury and Dapto in New South Wales. We have invested $1.9 billion in programs to boost the workforce, and this is already yielding benefits. Last year we saw an uplift in the number of people registering to practice as new doctors. In 2022-23 there were 8,356. In 2023-24 that number has gone up to 9,490. Moreover, we're seeing an increase, a 25 per cent uplift, in the number of doctors who want to become GPs. That is news to shout from the rooftops. We had 1,504 juniors doctors train as GPs, and in 2024-25 we're seeing an increase of nearly 250 on top of that, which is fantastic. In addition we're seeing more of those doctors spend more time in regional areas. Half of those junior doctors who are going through the GP training program will spend at least 12 months in the regions so they can get a taste of what I had back in the day.

In addition we have reduced HELP or waived it entirely for GP registrars, meaning trainees, who go into general practice and work in the regions as well as for nurse practitioners, and the further out you go—the more remote, in other words—the more debt we will waive. In some circumstances the Commonwealth will actually pay 100 per cent of your HELP debt, which could be up to $70,000 for a doctor and $20,000 for a nurse practitioner. That is really good news. We've also seen an uplift in the amount of bulk-billing throughout the country but particularly in the regions. As you know, in our second budget we tripled the bulk-billing incentive, and that has translated to an additional 2.2 million visits to the GP that are bulk-billed. That is happening right across the country, with people in the regions actually the highest beneficiaries. We know there's more to do, but we are focused on strengthening Medicare, which is the backbone of the healthcare system.

Pat Conaghan (Cowper, National Party, Shadow Assistant Minister for Social Services) Share this | Link to this | Hansard source

I thank the member for Mallee for bringing on this motion about the crisis in rural, remote and regional health. My father was a GP in Kempsey for 30-odd years, and one of the biggest kicks I get out of this job is when people, for example, at the markets on Saturday at Port Macquarie, come up and say to me, 'Your dad delivered my three kids' or—this actually happened last weekend—'I had a motorbike accident when I was 19, and I was in a coma for six weeks. Your dad saved my life, and he looked after me for many months after that.' I'm very proud of that fact. But it really is reflective of the fact that, long ago, doctors went to the regions and they stayed in the regions. Right now there are fewer doctors than there were in the seventies and eighties in my home town of Kempsey. That's the problem we face not just with specialist generalist GPs but with health care across the board—occupational therapy, speech therapy.

You can't make a GP go to the country. You can't push them out there; you can't force them and say, 'If you're going to be a GP and graduate from university after six, eight, 10 years, you've got to go to the country.' That's not fair on them. People need to make that decision as to what their future looks like. But we can certainly put things in place to incentivise our young people who are basically putting their life on hold to get through their medical degree. My nephew is doing one at Wagga Wagga right now. We know if people study in the regions, they settle in the regions. Generally they might meet a boyfriend or girlfriend, spend time there and decide to settle. We need to build up that relationship with our universities to get our young people into regional and rural programs or degrees so they go to the country, go to regional and rural areas, study and stay. The other thing we can do is incentivise to get those people out into the country, whether that's through tax concessions or helping them with housing, which is a huge problem at the moment. It's all well and good to have somebody come to the region—

A division having been called in the House of Representatives—

Sitting suspended from 13:15 to 13:24

I was in the throes of talking about incentivising general specialists as well as allied health professionals into the region. I note the coalition's work with the National Rural Generalist Pathway back in 2017. The coalition have committed to $400 million to incentivise rural and regional practitioners. We also need to restore telehealth. In the absence of those practitioners, the second-best practice is telehealth, and to see cuts in this area is disappointing. But we do need that backup system in the absence of having people on the ground.

In finishing up, I want to highlight two of the government's policies that have seriously affected regional Australia. The first one was the change to the distribution priority area. For those of you who don't know, this allowed overseas doctors to practise in the regions to ensure that we filled that void where it was needed. Unfortunately, Labor changed that to include peri-urban areas. In my electorate alone, I've heard that we've lost four doctors. The member for Parkes said he'd lost six doctors. That is across Australia. Those doctors moved from regional and remote areas because they could, because of the changes that Labor made. It made it more difficult to access services in the regions. The second one was reducing visits covered by Medicare for mental health issues from 20 to 10. We have committed that we will restore those visits back to 20 when we get back into government next term.

Marion Scrymgour (Lingiari, Australian Labor Party) Share this | Link to this | Hansard source

Aboriginal and Torres Strait Islander people are more likely to live in urban and regional areas. The proportion of First Nations people living outside these centres increases with remoteness. Aboriginal and Torres Strait Islander people make up just 1.9 per cent of people living in major cities but 32 per cent in remote and very remote areas of Australia.

Access to quality health care shouldn't be dependent on where you live. My electorate of Lingiari includes all of the Northern Territory's regional and remote Aboriginal communities, making up around 61,000 people and representing 26.3 per cent of the Northern Territory's population. A priority for me is increasing access to culturally safe and appropriate health care for all constituents in my electorate that is delivered in true partnership with local people and communities. These partnerships not only build a stronger health system for rural, remote and regional Australia; importantly, they ensure the system is equipped to better meet the complex and multilayered health challenges facing people living in these locations.

A good example of effective partnership at work was the rollout of the Medicare urgent care clinics across Australia. The Albanese Labor government is increasing the number of Medicare urgent care clinics, including six new clinics announced for remote regions in my electorate. The six new clinics will be at Ali-Curung, Galiwinku, Alyangula, Wurrumiyanga, Lajamanu and Maningrida—very remote communities but with big populations. These are in addition to the two new clinics that have already been established in Palmerston and the regional town of Alice Springs, or Mparntwe, which has been ranked No. 1 in terms of visitation and usage by any urgent care clinic.

The locations of these remote clinics were chosen in partnership with the Northern Territory Department of Health and the Aboriginal Medical Services Alliance Northern Territory. Their involvement ensured that these clinics are best placed to meet the priority needs of remote Aboriginal communities.

The new clinics are also being adapted to local circumstances and will operate differently from other Medicare urgent care clinics in Australia. Innovative workforce models have been designed and new service delivery approaches are being developed to help reduce the number of aeromedical retrievals from these communities. The cost of air evacuations out of these communities can be in excess of $50,000 for just one emergency medevac. This will ease the burden on existing primary healthcare services.

There are also a number of dialysis units in remote and very remote communities, which will allow a lot of Aboriginal people to stay closer to home and be treated on country. Four communities in my electorate have also been invited to apply for grants under Labor's $73.2 million investment in better renal services for First Nations people. These communities were chosen based on the number of people requiring dialysis and their distance from existing services. I have to applaud our federal Minister for the Environment and Water for putting substantial investment toward stable and reliable water supply services in these communities so that these renal dialysis machines can operate effectively.

If we can keep people on country, it means that their families can stay and be part of their broader healthcare and treatment. Labor's investment in better water security under the National Water Grid Fund will ensure good-quality water, which most of us take for granted, can be available in remote First Nations communities, which is vital for dialysis treatment. Better renal services are about increasing access to life-saving dialysis treatment for First Nations people in remote communities. It shows true partnership between two federal government programs and is a very practical example of working in tandem to close the gap for Aboriginal and Torres Strait Islander people by improving the livability of remote and very remote communities through safe, secure and reliable water. That supports better health and well-being outcomes.

Bridget Archer (Bass, Liberal Party) Share this | Link to this | Hansard source

The time allotted for this debate has expired. The debate is adjourned, and the resumption of debate will be made an order of the day for the next sitting.

Sitting suspended from 13:31 to 16:00