Anne Ruston (SA, Liberal Party, Shadow Minister for Health and Aged Care) Share this | Hansard source

I, too, today stand to talk to the motion that's been moved by Senator Waters. I thank her for moving the motion about health care in rural and regional Australia, and the health care that rural and regional Australian women in particular deserve. I'm sure that you will agree, Senator Waters, that access to health care and other services should not be determined by the postcode in which you were born in or in which you choose to live.

In Australia we pride ourselves on equity. But we know that, unfortunately, there are challenges in rural and regional Australia that make healthcare service delivery much more challenging. We know there are fewer resources that are applied out there as a result of the sparser populations. We know that that results in limited availability of the healthcare professionals that are so needed, and they include our obstetricians and our gynaecologists, our paediatricians and our midwives, and all the other amazing healthcare workers that support those health professionals, in assisting Australian women who live outside metropolitan areas through their pregnancy and the birth of their children.

Sadly, we do also know that there is a poorer health status and there are poorer outcomes for those living in rural and regional Australia. And, of course, when they need to get additional levels of care, they have to travel great distances. So we know that it is extraordinarily important that we apply innovation to any of the decisions that we make, to meet the needs of rural, regional and remote Australians, and of rural, remote and regional women, because the application of a one-size-fits-all model, whether it be in health care or aged care, is not going to work in rural and regional Australia. So we must stop focusing on city-centric models of care, and we must make sure that we understand the nuances that exist in rural, regional and remote Australia, not the least of which are the challenges facing many of our Indigenous communities, because we know they, too, are struggling with access to the kinds of maternity and health services that people in the city probably take for granted.

Before moving on to the specifics of the motion that's before us, I'd also like to acknowledge Senator O'Neill's contribution and thank her for, probably unwittingly, acknowledging the good government that was previously the government of this nation, the coalition government. It was actually the coalition government who put forward the waiving of HECS debts for those rural and regional doctors and nurses, a part of our policy which the Labor government copycat adopted. I think Senator O'Neill should probably look back a little bit further than the last five minutes, to realise that many of the initiatives that are currently being enacted by this government are actually just copycat initiatives of those that were put forward by the previous government.

Nonetheless, I'm sure the most important thing is that doctors and nurses in rural and regional Australia are being provided additional incentives to go to rural and regional Australia, because we absolutely know that so far there has been very little, if anything, in terms of assistance for rural and regional Australia in the healthcare sector. In fact, most of the initiatives that have been put in place by this government have had a detrimental impact on rural and regional Australia. For context, I'll provide some examples of that.

The very first decision of the new health minister that I became aware of was the decision to expand the distribution priority areas, that previously had been focused on rural and regional Australia, to allow doctors to move to what was referred to as MM2 areas. This means that overseas trained doctors—or international medical graduates, as they're currently called—are no longer required to do a stint in rural, regional or remote Australia before they move back into metropolitan areas. They can now move immediately, straight to our metropolitan areas, and start practising.

This has meant not only that any new IMGs, international medical graduates, who come into the country no longer have to go to rural and regional Australia but that those already in rural and regional Australia can move to the city. Sadly, we have found, time and time again, that doctors who were previously operating and practising in rural and regional areas have taken the easy option and moved into the outer metropolitan areas, often leaving their communities with no doctor at all. Next week, in estimates, we'll prosecute a number of these areas where we have seen that happen.

The reality is that rural, regional and remote Australia is the canary in the coalmine when it comes to challenges, in many areas, not the least of which is health care. Right now, we know that workforce shortages is the most significant issue impacting our care sector—whether it be health care, aged care or disability care—right the way across the country. It is hitting hardest in rural, regional and remote Australia. What we are saying to this government is it is absolutely essential that you address the cause of the problem. We need some urgency put into addressing the workforce shortages that we're seeing. We know that unless we deal with the issue of workforce shortages, we are not going to be able to deal with many of the other issues that are currently before our health system.

To that end, it was extraordinarily distressing to find out that—whether it was by design or by incompetence—the minister for immigration failed to list the 887 skilled regional migration visas on the priority list. We welcomed the government's decision to prioritise—as we had—healthcare workers, whether they be doctors, nurses or care workers, and education workers, most predominantly teachers, by fast-tracking the visa applications of these people coming into the country. We knew that we had challenges as a result of COVID. Of course, we didn't have migration for many, many months—in fact, for a couple of years—and so we welcomed the fast-tracking of these visa applications. But we then found, by accident or design, that 887 skilled regional visas were excluded from the priority list, basically relegating doctors, nurses, teachers and care workers—who would otherwise have chosen to go to rural, regional and remote Australia to undertake their caring responsibilities—to the bottom of the visa pile.

In my own home town, I've had many representations from people in my community who are frustrated by the fact that its's taking, on average, 27 months to get access to an approval process for an 887 visa. It's absolutely unacceptable that this government should have relegated rural, regional and remote Australia to the bottom of the pile when we know that it's rural, regional and remote Australia that is, often, hardest hit when it comes to these sorts of services.

It hasn't just been in my home area of the Riverland. I've spoken, right the way across the country, to doctors, nurses and health institutions only to hear the same story over and over again. Rural, regional and remote Australia are ignored. They're treated as poor cousins. We need to make sure we have the appropriate incentives so that equity of health care is something that all Australians can rely on—instead of just talking about it.

That's why we're saying the government needs to come up with real solutions, real and tangible measures that will deal with workforce crises so that we can see the whole of our care sector adequately supported. Right now, all we're seeing is healthcare workers in rural, regional and remote Australia being sucked into the city because of the greater ability of those institutions to afford it. And measures that have been put in place by this government are encouraging those people that are currently in rural and regional Australia to move into these city areas.

It is not just rural, regional or remote when we talk about small towns and communities that are very far from capital cities. They are, of course, the hardest hit, but it even applies to places like Geelong. In the last few weeks, we saw an announcement by the Epworth Geelong private hospital that it is intending to close its maternity services in March. The reason they stated was 'workforce shortages'. We have a massive hospital—that was delivering 500 to 600 babies a year—making the decision that it can no longer safely deliver its services because it cannot get access to workforce.

It's a very sad reflection that, despite the Labor Party coming into government on the promise that it was going to support the workforce—they were going to deal with the issues that we all knew COVID had delivered to our healthcare sector; they were going to assist—we have seen nothing, when it comes to addressing the workforce challenges. We have a massive, glaring example of that in Victoria with the Epworth hospital's recent decision.

We need to also understand that there are other measures that can assist rural and regional Australia in dealing with the challenges before us. One of those is telehealth. We saw this government rip 70 telehealth services out of the Medicare support network, and we're fearful that there are moves afoot for more telehealth services to be removed from the Medicare rebate or MBS system.

We know that it's people who live in rural, regional and remote Australia who are more likely to be accessing telehealth. This is simply because they either can't get in to see a doctor, because of the massive workforce shortages, or they live so far away from where a doctor is that sometimes the only opportunity for them to get access to healthcare is over the phone.

We need to change the way we look at addressing some of these challenges and stop admiring the problems. Stop talking them down. Stop talking about the negatives of the situation. Eight and a half months into government, we'd like to see the government put some real measures on the table. Deliver on your urgent care clinics. Don't keep coming in here and talking about them, actually deliver them. We know that some three months out from the date this government promised we would have urgent care clinics up and running—by the middle of May—not one urgent care clinic is up and running. All we have is seven clinics with expressions of interest. We don't know where they're going to be.

Equally, we've seen measure after measure, promise after promise, not delivered. They went to the election and said they'd strengthen Medicare. Medicare has weakened. They went to the election promising to put care back to aged care. The aged-care sector is in crisis, at the moment, because of the undeliverable mandated requirements of those opposite. Of course we want to see our aged-care facilities provide the best possible care for our older Australians, but you can't mandate the impossible. That's exactly what you've done, and you will see rural, regional and remote nursing homes close because they just won't be able to meet these requirements. So what are you going to say to those older Australians who will have to move hundreds of miles away from their loved ones because you have mandated a requirement that is impossible to deliver?

As I said, the greatest challenges before us are workforce and putting the confidence of Australians back into general practice, neither of which have been done by this government. In fact, the exact opposite has occurred. There have been issues in addressing workforce, issues that have actually had a detrimental effect on the rural and regional Australian health workforce, through the changes to DPA and the refusal to accept 887 visas as being a priority class.

At the same time, we have a minister who constantly talks about all of the negatives in the health system, who is always saying that there's a crisis and that there's a problem—he's admiring the problem day in, day out—and who is doing nothing to support our GPs. We have not seen him say a word about the fact that the states and territories have been threatening to add a greater payroll burden on our general practice clinics right at a time when there is a crisis. We are seeing bulk billing rates falling like flies—a massive drop—and yet what this minister has done is actually nothing, apart from reducing the level of confidence that GPs have that this government is actually going to do anything about it.

We'd certainly say to the state and territory governments: have a serious think about the decisions that you may be making in relation to enforcing a payroll tax, an additional financial burden on general practice, right at a time when they need our help and they need our understanding to make sure that we are able to build confidence back up in our healthcare system and particularly in general practice.

We've heard so much about the negativity of general practice, but I want to give a shout-out to our general practitioners, who, on the whole, are the most amazing, hardworking frontline people. They are the people who are absolutely at the centre of our care in Australia. If we don't have a strong general practice sector in this country, our health sector is in big trouble. So we need to address the issues that are the most burning at the moment. We need to address the issues that are fundamental and the cause of the problems that are facing our healthcare sector, and they are workforce and confidence in general practice.

As we stand here today, we know that rural, regional and remote Australia is the place where these issues are felt the most. We know, from the motion moved by Senator Waters, that women who live in rural, regional and remote Australia often have some of the poorer health outcomes and some of the lowest quality care because of an inability to access maternity, paediatric and obstetric services. It is very sad that we should be here today debating this particular motion, but I commend Senator Waters for raising the issue of rural, regional and remote access to health care and certainly want to put on the record my— (Time expired)