Helen Polley (Tasmania, Australian Labor Party, Shadow Parliamentary Secretary for Aged Care) Share this | Hansard source

The Health Insurance Amendment (National Rural Health Commissioner) Bill 2017 amends the Health Insurance Act 1973 to provide for the appointment of the National Rural Health Commissioner as a statutory office holder. The bill sets out the functions of the commissioner, which will be to provide advice in relation to rural health to the minister responsible for rural health, including by (a) defining what it means to be a rural generalist; (b)    developing a national rural generalist pathway; and (c) as requested by the minister, providing advice to the minister on matters relating to rural health reform.

The need for a rural health commissioner has been established but the Health Insurance Amendment (National Rural Health Commissioner) Bill 2017 only goes part of the way to delivering an effective one. Labor supports this legislation but would like to see the government take it further. There are several issues which are obvious from the outset. The commissioner's position will cease on 1 July 2020—in just three years; the appointment itself is only for two years; the position may be a part-time position; the commissioner will be limited in his or her ability to act with full autonomy because they will have to go through the health department for even the most basic of staff requirements; and the role appears to be very narrow in scope.

Why the bill only provides for a commissioner for three years is a mystery. Are all of rural Australia's health needs going to be fixed in that time? Is there some guarantee that no future issues or needs will arise? The Assistant Minister for Health has said that this is 'an incredible and historic occasion'. We believe that the role of the commissioner should be a little more substantial to live up to that description. Stakeholders have advocated and probably expected that the commissioner's position would be a more long-term arrangement that would allow the commissioner to achieve longer term outcomes. The National Rural Health Alliance has welcomed the appointment of a rural health commissioner, in the hope and expectation of a lot of positive changes. The NRHA wants the commissioner to engage with, support and promote policies addressing chronic disease in rural Australia, and to develop key indicators of rural health and report annually on their progress. They sound like long-term objectives. If abolished in 2020, the commissioner will only be able to report three times and will then be gone.

The commissioner's role, as set out in this bill, appears to be very narrow and mainly focused on a national rural generalist pathway. Labor is in full support of the establishment of a national rural generalist pathway; however, the commissioner's role can and should be about more than that. The sobering facts about the health of Australians living in rural areas confirms that they need and deserve quality, consistent health care from doctors and health professionals who are well trained and prepared stay. Many chronic diseases are significantly higher in the country. Suicide rates are double. Dementia rates in rural and remote areas are higher than the national average. With those statistics, it is not surprising that the life span of people in rural Australia is disturbingly shorter than people who live in the cities.

Many of the challenges in rural health directly relate to the health workforce. There is a geographic maldistribution of healthcare professionals in Australia. It is already difficult to get healthcare workers to go to remote areas. Reported cases of sexual assault and physical violence against healthcare providers, both during work hours and even in their own homes, is a major concern for remote health professionals. If we want to attract more people to work in rural and remote areas, we need to improve their safety. The remote workforce, particularly the registered nurses who work in outlying areas is also an ageing workforce. This will mean that, in order just to maintain current levels, recruitment will need to replace those workers when they retire. We need to rebuild confidence in rural and remote healthcare workplaces. A more stable workforce will go some way towards achieving that, but so far the government has done little to promote it.

This is a government which has cut millions from the Health Workforce Scholarship Program and abolished Health Workforce Australia.    Cuts to health workforce scholarships have reduced the number of scholarships being offered. Delays with the Health Workforce Scholarship Program have seen many students commence their studies this year with uncertain funding for future years, and many of these are rural Australia's future healthcare providers.

For all rural people, there has long been an issue with the provision of and access to adequate health services. The remoteness of many locations presents inherent problems that have a direct impact on health outcomes. Greater distances to travel to access or provide services means greater costs to providers and to patients in both time and money compared to people living in cities. Telecommunications, especially a lack of affordable, reliable and fast internet, is a critical issue for most people who might think about moving to a rural or remote area. But a lot more needs to be done to address rural health issues, including ensuring that those rural Australians who cannot afford private health cover do not fall through the cracks. As it is, less than 48 per cent of people in rural and remote regions have private health insurance. This compares with 61 per cent for people living in major cities.

Significantly, people in rural areas are more likely to need the services more readily accessed through private health cover. In the less than four years the coalition has been in office, insurance premiums have risen 23 per cent. I could not believe that: a 23 per cent increase in premiums in less than four years of this government. That gives us some idea of why rural people on low wages cannot afford to maintain their cover. At the same time, the government has frozen the Medicare rebate, increased co-payments, cut $1.4 billion from preventative health and cut bulk-billing incentive payments to pathologists and radiologists. This, of course, affects all Australians, but its impact on rural and remote Australia is where they feel it the most. The national rural generalist pathway will help address some of these issues by providing a greater level of health care in the long run.

I will briefly mention two other aspects of the bill. The bill abolishes the Medical Training Review Panel. Its functions will be absorbed by the National Medical Training Advisory Network, which was established in response to the Health Workforce 2025 report. NMTAN was part of Health Workforce Australia but was moved to the Department of Health when, as I mentioned earlier, the coalition abolished Health Workforce Australia. Each year, a national report on medical education and training will continue to be produced and published on the Department of Health website. This will ensure that stakeholders and state and territory governments continue to have access to this data. The requirement to conduct reviews of the Medicare provider number legislation, section 19AD of the Health Insurance Act, is being removed to reduce the regulatory burden for external stakeholders, such as rural workforce agencies. Since their inception, these sections of the act, section 19AA, 3GA and 3GC, have not changed, despite reviews under sections 19AD in 2002, 2005 and 2010. We consider those last two matters to be fairly uncontroversial and will not oppose them.

The appointment of a national rural health commissioner and the creation of the national rural generalist pathway are positive steps in addressing rural health needs. However, the commissioner could be a much more substantive position; a longer-term position with broader focus has the potential to deliver more for rural Australia. As I have said from the outset, Labor supports this bill. We had foreshadowed our own amendments to address several of the issues with this bill; however, the government has come to the table with their own amendments. Labor appreciates the government's willingness to consider the concerns we have highlighted which were the commissioner's position being abolished without review after only three years; the apparent narrow focus of the role; and, finally, that there was no advisory body to support the commissioner. Broadly, the amendments proposed by the government achieved much of what we were proposing. They are acceptable to us and they do address our main concerns. We, therefore, do not need to move our own amendments. I commend the bill to the Senate.