Dean Smith (WA, Liberal Party) Share this | Hansard source

We have just had a very colourful display from Senator Cameron. I congratulate him on his colour but not his substance. Senator Cameron shared with us views about arrogance, incompetence, policy recklessness. Of course, Senator Cameron was speaking from firsthand experience of the former Labor government. It is very high order to talk about farce and rabble. We know that that is really the pot calling the kettle black from Senator Cameron. I would like to contrast my contribution with Senator Cameron's by filling it out with a bit more substance, if I might, Mr Acting Deputy President. I am pleased to have this opportunity to make a contribution to this debate on the Health Workforce Australia (Abolition Bill) 2014 because it gives me an opportunity to highlight some important issues in regional health—issues which are important to the whole nation but particularly to me as a Western Australian senator.

As its name suggests, the bill does seek to abolish Health Workforce Australia, and there is one overarching reason why this government seeks to do that: it is to eliminate some of the duplication within our health system. It may well come as a surprise to some of those opposite but our country does not have limitless financial resources and nor does our health system. This coalition government's first priority is to invest in front-line services and to improve the country's capacity for medical research. Those are the two most significant challenges that our health system is facing today.

What our health system is not in a position to do is sustain an ever-growing number of bureaucratic bodies that are duplicating or replicating the work already being done at a state level or, indeed, within the Commonwealth Department of Health itself. To put it bluntly, we are not operating in the sort of fiscal environment that permits optional extras. This is not as a result of this government's actions, however. This is the doing of our predecessors, who, having created a budget mess, now sit here and attack any and every effort to fix that problem. Governing is about making choices—and, I might add too, it is about ideology; it is about ideas; and, of course, it is about the allocation of finite economic resources. To be frank, if I have choice between investing a dollar in front-line health services or investing money in office space for health bureaucrats then I will choose, and I am sure many Australians would choose, front-line services every single time. I hope to have confidence that over time the Labor Party and the opposition in this place will recognise the error of their ways. I am not saying this to belittle any of the work done by Health Workforce Australia; the opposite is true.

We remember that Health Workforce Australia was set up and funded for four years by the previous government, but those four years have ended. The budget situation and challenge this government faces is vastly different from that faced by Labor when they were in office in 2007. Labor talked and dreamed big things in health but they were not so good on the delivery. When Health Workforce Australia was established under Labor, it was intended to operate over four years, with financial support coming from both the Commonwealth and the state governments. Here again we see the consequences of Labor's flawed planning and policy processes. The states have not put in any money. The more than $1 billion that has gone into Health Workforce Australia since its establishment has all been federal money. The $550 million that was supposed to come from the states and the territories over those four years never materialised. Why? Because it was another example in a litany of examples of the Rudd government imposing its will in the absence of any cooperation or proper policy discussion and formulation with the states. Health Workforce Australia was established under Kevin Rudd's National Partnership Agreement on Hospital and Health Workforce Reform. It was a four-year agreement that expired in June 2013. Under the national partnership agreement Health Workforce Australia was supposed to act as a national body, working to health ministers to streamline clinical training arrangements and support workforce reform initiatives. In its time Health Workforce Australia did do some important work in research, most particularly through the publication of national health workforce modelling that gave long-term projections of supply and demand for the Australian health workforce. But that work is done now.

The government is now charged with dealing with the challenges that this sort of work identified. In order to do that, we have to invest more in the front line. We do not have the luxury of continuing to support an organisation like Health Workforce Australia to identify problems and fix those problems it identifies. We have a Commonwealth Department of Health that already has the expertise and capacity to undertake many of the activities that Health Workforce Australia was undertaking. We do not need another layer of bureaucracy sitting between the department and those delivering front-line services. This government, like our predecessors, understands that every additional layer of bureaucracy has the effect of skimming resources from the already limited pool of money. Also in contrast with our political predecessors, this government recognises and respects the roles that the states and territories play in the development and improvement of Australia's health workforce.

We believe that the states—who are closer to the medical professionals and the patients to whom services are being provided—are in a better position to understand the needs of their communities than a federally directed bureaucracy. This is especially true in relation to services provided to regional communities. To my mind, it is doubtful that sustaining offices for a government agency in our capital cities is going to help those living in regional communities experience better and improved health services. It is not going to make it easier for medical students from regional areas to get scholarships so that they can get the high-quality training they need. You provide incentives for regional GP practices to provide matching funds alongside government investment so that regional practices will invest their own money and truly utilise that investment efficiently in infrastructure to help local GPs train the next generation of regional medical practitioners.

I think it is also worth making the point, which is self-evident to me and to coalition senators on this side but apparently not to others, that we do not need a separate federally funded agency to deal with the challenges facing Australia's medical workforce. I would remind the Senate that the federal government does not actually employ doctors and nurses; instead, they are employed through state and territory governments. They are employed through these governments because, as we on this side of the chamber believe, those governments have a better idea of the health needs of the communities they serve than a remote government in a faraway place in Canberra. This is especially true for regional communities across my home state of Western Australia. One size most certainly does not fit all in the delivery of health services across Australia's various jurisdictions.

We heard from the Labor Party, during their contributions to the debate on this bill in the other place—as we will do this afternoon—that the measures contained in this bill will mean the burden is being placed on the states. With the greatest of respect, this signifies a pretty fundamental misreading of how our Federation was designed to work. While the federal government has long been a significant funder of health services in Australia and will continue to be into the future, it is the states' responsibility to make decisions about service delivery. The only 'burden' the states will be shouldering as a result of these changes are the responsibilities they are supposed to already shoulder.

The Commonwealth Department of Health has always worked closely with its state and territory counterparts to find ways of boosting employee productivity, improving retention rates and ensuring the effective allocation of health workforce resources. Nothing contained in this bill will change that arrangement. The Commonwealth Department of Health will continue to work closely with its state and territory counterparts in this area. But what it will not be doing under this government is duplicating that work.

To put it simply: we do not need a separate agency to do that. Continuing to fund that separate agency will simply siphon off money from where it is most needed, and that is in front-line health services and, most particularly, in front-line regional health services. We need to respect the fact that the various state and territory governments understand their own constituents better than a distant federal government ever will. As the Prime Minister said in relation to the reform of our Federation, we should be doing more to make sure that states and territories are sovereign in their own sphere. Of course, this is especially true in Western Australia, Queensland and the Northern Territory.

So, contrary to some of the claims we have heard from those opposite, the abolition of Health Workforce Australia does not indicate any lack of commitment of Australia's health workforce; instead, the reverse is true. Indeed, the Department of Health advised the Community Affairs Legislation Committee inquiry into another bill, the Australian Preventive Health Agency (Abolition) Bill 2014, that:

There will continue to be work undertaken by the Department, and in state governments, to develop innovations and reforms to address health workforce challenges, and to support the implementation of those policies.

Key words there: 'There will continue to be work undertaken'. They continue:

The Government remains committed to effective health workforce training, productivity and innovation and will ensure that this work is delivered more efficiently through reducing corporate overheads, and eliminating duplication between HWA and the Department.

The closure of Health Workforce Australia is not a withdrawal of support or resources for our health workforce. By creating efficiencies, by streamlining programs, by reducing bureaucracy, we are ensuring that we get better value from the investment in programs to build the health workforce of Australia for tomorrow.

I think in many ways this bill neatly encapsulates a core philosophical difference between the coalition and our political opponents. This government is interested in practical, pragmatic solutions. Labor, when in office, was more interested in press releases. Thus, Labor's automatic response to every challenge is to set up a taxpayer funded agency to look into a problem, without ever stopping to ask itself if the work is already being done—or if it can be done more effectively elsewhere, such as through the states and territories. After all, there is no photo opportunity in making sure that government departments are doing the work they are supposed to be doing. In Labor's view, it is much better to set up a new agency and try to generate some excitement and some publicity to convince the public that you are dealing with an issue. Whether or not that is the most effective use of limited financial resources seems to be a secondary consideration for those opposite.

It was that sort of thinking that lead to the protracted debacle of Labor's GP superclinics—which were first announced in the 2007 election, re-announced in the 2010 election and, by the time of the 2013 election when Labor left office, more than half of them had still not been built. That is what I mean by 'government by press release'. The botched GP superclinics rollout was $650 million into a big, showy program that was designed to shore up Labor's support in marginal electorates around Australia—while, at the same time, Labor reduced funding for subacute hospital beds. The Australian National Audit Office found that less than 10 per cent of the GP superclinics that Labor promised in the first round—that is, in the lead up to the 2007 election which Kevin Rudd won—were delivered on time.

As a result of the measures contained in this bill, programs and functions of Health Workforce Australia will be transferred to the Department of Health. That is part and parcel of this government delivering on its commitment to reduce red tape and streamline programs and get better outcomes. The savings that flow from this bill will support front-line health services and programs.

This leads me to another important point that I would like to make. As a result of the decisions of this government, annual federal assistance to the states for public hospitals will—contrary to what Labor is saying—increase by more than nine per cent every year for the next three years and by more than six per cent in the fourth year. In total, that represents a 40 per cent increase over the next four years. We are increasing funding for states to run public hospitals—remember they, and not the federal government, run the hospitals—by more than $5 million from $13.8 billion in 2013-14 to $18.9 billion in 2017-18. The overall annual health spending will increase by more than $10 billion or 16 per cent from $64.5 billion in 2013-14 to $74.8 billion in 2017-18. Consistent with our commitment to get the budget back into the black, the coalition government is also putting the growth in health spending on a more sustainable trajectory from 2017-18. In spite of the very difficult budget challenge this government inherited from Labor, every year Commonwealth spending on our health system will continue to grow.

Of course, this government has also committed to provide up to 175 grants for rural and remote general practices to expand facilities and to support teaching and training of medical students and registrars. The grants, of up to $300,000, will be provided to successful applicants and require a matched contribution from the practice. This will encourage local practices in regional areas to think about the needs of their communities and plan their future expansions accordingly. This is the sort of initiative I spoke of earlier, when I noted the importance of involving people who are on the ground delivering services rather than having money sucked into a another level of bureaucracy and directed away from service delivery. In addition to this, the coalition government has committed to significantly expanding the number of GP training places. GP training places will increase by 300, from 1,200 to 1,500 new places in 2015.

These initiatives and programs have been well received across regional Western Australia. They will create more vocational training opportunities for the workforce, freeing up more junior doctor training positions for new graduates coming through. The Australian General Practice Training program, which the government's commitment will expand, has a distribution target that requires 50 per cent of training to occur in rural and remote locations. This is a health workforce plan that listens to and takes note of the health workforce needs of regional Australia. This is the type of practical assistance that regional communities need.

Furthermore, the government will also invest around $40 million in up to 100 additional medical internships each year in non-traditional settings, including private hospitals in regional areas. This will help to provide additional opportunities for medical students and will also help to reduce some of the pressures on public hospitals for training. Priority will be given to positions and rotations outside major metropolitan centres to expand the capacity of our medical workforce in rural and regional areas.

Then we come to the historic announcement in the budget two months ago that this coalition government will establish a Medical Research Future Fund. The fund will grow to become a $20 billion fund that will boost illness prevention and promote early intervention in a way that will reduce healthcare costs, making our health system more sustainable. The fund is being established because the government recognises that research is every bit as important as treatment in the creation of a healthier population and in contributing to the long-term sustainability of our health system.

In spite of all this, Labor and the Greens have the audacity to come into this chamber and accuse this coalition government of not caring about health. It is a charge that I and my colleagues reject. It is precisely because we care about health that we are making the difficult decisions with regard to building a sustainable health system for Australia into the future, and the budget is a necessary part of that.

It is important to recognise that we cannot keep doing things as we have been doing them. The business-as-usual approach does not work anymore. It was rejected at the last election, and this government should be given a clear path to try its ideas, to try its reforms and to improve the health outcomes of Australians and, more particularly, of regional Australians. We cannot continue wildly spending public money without asking the tough questions about whether we are getting the maximum value for that spending or whether it would be better directed elsewhere or, indeed, whether it would be better done by someone else. Australia does have a debt and deficit problem. It is a problem that has been recognised by this government, by the Secretary of the Treasury, by the independent Parliamentary Budget Office, by the OECD, by former Labor Prime Ministers Bob Hawke and Paul Keating and by numerous respected independent economic commentators.

Of course, some would prefer to keep their head in the sand. The fact that those opposite are unwilling to face up to the challenge is unfortunate—not surprising, but it is unfortunate—but that is their decision and they will ultimately have to live with its consequences. Meanwhile this government will not be cowered by their cheap, populist politics. We will not shirk our responsibility to get the budget back on an even keel, because that is what we told the people of Australia we would do. More than that, it is the right thing to do, and it is right and proper to act soon and to act quickly. The measures contained in this bill are entirely consistent with this government's overarching commitment to reduce red tape, to reduce inefficiencies, waste and duplication within government and to make sure that valuable taxpayer dollars are actually targeted effectively. (Time expired)