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

Last night I began my contribution on the Health Insurance Amendment (Bonded Medical Programs Reform) Bill, and in those introductory remarks I took a little bit of time to reflect on the very poor performance of the Labor Party in Queensland, most particularly across regional Queensland. But I won't bore the Senate this afternoon with a repetition of that. It's on the record for the public to see—the very, very poor performance by the Labor Party in Queensland. And it demonstrates a much bigger issue—that is, that the election results are a powerful endorsement of the coalition's program for regional Australia.

In the Senate today we've seen two important bills: the Farm Household Support Amendment Bill, which we've just agreed to, and this health amendment bill. They both deal with very important regional issues. There's lots of commentary around what the 18 May election result meant—what it meant for the future, what it might have said about the past, what it might have said about Australians' attitudes to the high-taxing policies of the Labor Party. For me, particularly in a state like Western Australia—and I see Senator Brockman in the chamber with me this afternoon, and Senator Askew, who did an important job returning to the coalition some important seats in Tasmania—above all, the 18 May election result was an endorsement of the coalition's plans and promises for regional Australia.

What we have here this afternoon is an important piece of legislation that will give effect to an important part of the coalition government's Stronger Rural Health Strategy. You might recall that, prior to the election, the coalition committed up to $500 million of taxpayers' money—not its money but taxpayers' money, much of it earned out of regional Australia, I might add—to the Stronger Rural Health Strategy. What we're debating this afternoon is an important element of that strategy which, in short, is to drive better health outcomes for people living in our rural, regional and remote areas by better supporting access to doctors, nurses and other allied health professionals. Why is that important to a senator like me from Western Australia and, indeed, Senator Brockman from Western Australia? Sometimes, Senator Askew, I think people forget that, Tasmania, while it is an original state in our Commonwealth, is predominantly a regional state. It is very regional. I was reflecting last night that it is second only, I think, to Queensland in terms of its regional diversification.

I would just like to read from an article that appeared on PerthNow, which is a Western Australia based publication, published in May of last year, which talked about the importance of access to doctors, nurses and other allied health professionals across regional Western Australia. The story started by saying:

Western Australia has a 'critical shortage' of GPs that is set to worsen, adding more strain on emergency departments and 'poorer health outcomes'.

When I share this with the Senate, it's a powerful demonstration of why the coalition's Stronger Rural Health Strategy is important for every regional community across Australia but particularly for regional communities in Western Australia. It goes on to say:

A new Department of Health report shows there was a shortfall of 534 general practitioners in 2015 and warns the ageing GP workforce is being replaced by millennials who want to work less.

This meant twice as many young doctors, who are opting for a better work-life balance, would need to replace the older ones. The median age of GPs in WA is now 55 and many are facing retirement.

About 500 metropolitan GPs and 134 rural GPs were due to retire by 2021. A shortfall of 774 GPs was expected by then, which would be 974 by 2025.

WA’s GP ratio is 81.5 per 100,000 people compared with the national average of 96.8, making WA the worst performing State. This was based on 'full service equivalents' which estimates total hours of work based on Medicare data.

The article continues:

The report identified 'maldistribution'—

and I'll come back to this point—

of GPs across the State, with most outer metro and several rural areas suffering the lowest ratios, while the wealthy western suburbs were at 'saturation'.

Those are not my words; they are the words of PerthNow. The article goes on:

A poor training system for GPs was making matters worse and was 'insufficient to replace WA’s ageing GP workforce'. WA would have to continue relying on interstate and overseas GPs to fill the gap, the report states.

In sharing that with the Senate this afternoon, the point I am making is that this particular bill—part of a broader strategy known as the Stronger Rural Health Strategy—is necessary and is addressing a very real issue in regional communities across our country and particularly in Western Australia.

By way of background, the 2018-19 federal budget provided a total of $20.2 million over five years to reform the Bonded Medical Programs Scheme and the Medical Rural Bonded Scholarship Scheme. The Bonded Medical Programs Scheme provides a Commonwealth-funded place in a medical course at an Australian university. In return, the participant agrees to work as a doctor for a period of time specifically in a regional, rural or remote location or an area of workforce shortage. This period of work is known as the participant's return of service obligation. It's something we hear a lot about as we travel around regional Western Australia.

As I've already alluded to, reforms to the bonded medical program, which are core elements of this piece of legislation, are part of the 2018-2019 federal budget's $500 million announcement of the Stronger Rural Health Strategy. The strategy aims to implement legislative reforms to increase the number of fully qualified Australian trained doctors working in regional, rural and remote locations and areas of workforce shortage. Importantly, these reforms will create a modern, flexible administrative system with greater capacity for the program to support and target vocationally recognised Australian trained doctors so they will work and stay—and this is an important point. When we're travelling across regional communities and we're listening to what regional communities have to say, they want their doctors to be members of their communities. They want their doctors to be available. They want to know their local doctor as well as they might know their local councillor or their local mayor. I think we've seen for ourselves that when doctors take their families to and have long relationships in regional communities we get much better health outcomes. In Western Australia we've seen some great examples where local shires and other areas have invested very heavily in attracting and retaining good doctors and keeping doctors or other health workforce participants in their communities.

As I was saying, the reforms will create a modern, flexible administrative system with a greater capacity for the program to support and target vocationally recognised Australian trained doctors so they will work and stay in regional, rural and regional areas. Under these reforms, the minister will have authority to make rules to ensure the bonded medical program remains up to date and responds to the government's workforce distribution requirements. The reformed bonded medical program will ensure a better supported, fully qualified Australian trained workforce is available to address workforce shortages in regional, rural and remote areas. Importantly, this is a legislative initiative by the coalition which is strongly supported by key stakeholders, including the Australian Medical Association and the Australian Medical Students' Association. I dare say that across regional Western Australia it also enjoys the very strong support of local government authorities and local councillors.

I might just continue with a brief summation of the broader challenge that we face. This was alluded to in the perthnow article that I cited at the beginning of my contribution. The key challenges are these. The first is that there is an oversupply of GPs in some urban areas of our country while at the same time there are very real shortages in rural, regional and remote areas. Importantly, the need to incentivise non-vocationally recognised doctors to obtain specialist GP qualifications is becoming more and more urgent. Importantly, the need for team based and multidisciplinary primary healthcare responses to Australia's increasingly complex and chronic health needs is as urgent in the metropolitan areas as it is across rural, regional and remote Australia.

These are very important issues. I'm sure this legislation will enjoy the support of the Senate. It gives effect, in part, to the $500 million Stronger Rural Health Strategy that is a very powerful, important initiative of the coalition government—a coalition health initiative that enjoyed strong support and great endorsement in the 18 May election outcome. I think this will help correct some of the inertia around rural workforce issues. When we think about how our health workforce, whether they be doctors, nurses or allied health services, is actually distributed across our country, it will help to address the maldistribution that is occurring and, in the end, it will go a long way towards making sure that the health outcomes of Australians living in rural and regional areas are equal to, if not better than, the health outcomes that Australians in our cities and suburbs enjoy.