Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Mental Health) Share this | Link to this | Hansard source

I rise to speak on the Health Workforce Australia (Abolition) Bill and I want to indicate that the Labor Party will be opposing this bill.

In the explanatory memorandum of this bill, it describes the purpose of the bill:

It will enable more efficient and effective delivery of policy and programme activities related to the health workforce, to ensure Australia continues to have a high quality, capable and well distributed health workforce, delivering frontline health services for all Australians.

That is simply not true. The word that I am offended by is the word 'continues'. We do not have a 'high-quality, capable and well-distributed health workforce' in this country. We do have a high-quality and capable health workforce, but frankly it has never been well distributed; that was why Labor in government established Health Workforce Australia.

We received no substantial evidence at the Senate Community Affairs Legislation Committee inquiry that would support the contention that was included in the explanatory memorandum. In fact, the overwhelming evidence points to the success of Health Workforce Australia and its success into the future. Many witnesses who came before our committee said that the work had not yet been completed. So Labor will oppose this bill here in the Senate. In saying that, can I say that the motivation from the government is purely political and frankly spiteful.

Labor established Health Workforce Australia through legislation in May 2009. This was partly in response to a Productivity Commission inquiry that was established in 2006. That was before Labor came to government, so the current government knows well and truly that our country has a problem in the distribution of our workforce. The Productivity Commission concluded that a more sustainable and responsive health workforce was needed. The report went further and highlighted the complexity of Australia's health workforce arrangements—the numerous organisations and agencies involved in health workforce education and training.

What we had at the time were many smaller agencies. There were inconsistencies between the states and territories. There were many different committees. Frankly it was a mess when it came to health workforce planning for the future. It was getting better, in terms of GPs. It was still not so great with specialists. In terms of nursing and allied health it was literally a mess.

So in 2008 it was an agenda item for COAG. The states and territories agreed that there was a need for a national independent health workforce agency to work across the Commonwealth, and states and territories. It was agreed that we needed an agency designed to deliver more effective, streamlined and integrated clinical training arrangements. But it was also agreed that this was not simply the province of state and territory governments or Commonwealth governments. We needed to include higher education providers, the training sector and the health sector. We needed to include employers, professional bodies and regulatory bodies, with the goal of building a sustainable health workforce for our country.

The key responsibilities of Health Workforce Australia were to include: funding, planning and coordinating clinical training across all health disciplines—funding simulation training, supporting health workforce research and planning, and progressing new workforce models and reforms. That was what health workforce was tasked with.

It began in 2010. It has been well supported by all the partners, and it has achieved results in its short lifetime. One example is the document 'Health Workforce 2025—Doctors, nurses and midwives'. It delivered evidence-based planning and avoided the peaks and troughs of workforce availability into the future. It was intentionally established as an agency independent from the Commonwealth but partnered by the Commonwealth, states and territories, and by a number of partners which I mentioned earlier.

There were a number of reasons it was agreed by everyone that an independent agency was required. Independence underlines and confirms that health workforce planning is not the province of the Commonwealth Department of Health alone. It has to include the states and territories, universities, health professionals et cetera. Recommendations could be made outside the culture, operations and political directions of the Commonwealth government of the day. It was agreed that we needed to have an independent agency to improve the evidence collection capability to best inform recommendations that were to be made to all stakeholders.

So it begs the question: why is this government so intent on bringing Health Workforce Australia functions into the Department of Health? In fact, the Mason review—quoted from so often during the inquiry established in 2013—recommended refinements rather than wholesale abolition and absorption or Health Workforce Australia into the department.

Outside of the real long-term benefits, we are seeing benefits happening right now. We are seeing improved clinical training. We have seen 8,500 new quality clinical training places across 22 disciplines. We have seen simulation training improve by 115 per cent. Health workforce research and planning has delivered a number of pieces of work—particularly Health Workforce 2025but there are many other pieces of research that are informing decisions that states and territories, universities and training organisations are making, so that we will achieve a better distributed health workforce and improved clinical training.

Let me go to the distribution of the workforce. The misdistribution of the health workforce in our country has been an ongoing problem for many years. It is a problem that has had a number of policy responses over those years, mostly around financial incentives and scholarships programs. Success has been patchy. I have said that there has been improvement in the distribution of our doctors, particularly our general practitioners, but there is much more to be done.

Health Workforce Australia has undertaken some great work to provide the policy basis for health ministers to respond to. The Geographic Distribution: Medical Workforce project has had real potential to truly address some of the misdistribution issues. Further, the Rural Health Professionals Program aims to attract, recruit and retain nursing and allied health professionals from metropolitan Australia and approved overseas locations into rural and remote areas including into Aboriginal medical services and Aboriginal and Torres Strait Islander community controlled health services.

The expanded scope of practice program, while primarily intended as a strategy to boost productivity has also got potential to provide more services for people in regional, rural and remote areas. It is recognised that these are early days in the delivery of programs to address the health workforce distribution challenges that we have. There is so much more to be done. To that end, I do encourage senators with an interest in regional, rural and remote health to read the Hansard of the Community Affairs Legislation Committee inquiry into the health workforce bills and, particularly, the evidence from the National Rural health Alliance. Mr Gordon Gregory, when he was talking about his opposition to the abolition HWA, said:

The main reason for being concerned about the integration of the two agencies into the Department of Health is the impact this will have on the political importance and resources that will be attached to the work they have been undertaking to good effect.

He went on to say, 'Health workforce shortages are worse in rural and remote areas.' And he said, 'Data are harder to find.'

So I say to the minister and to the department, the flippant statement in the explanatory memorandum is simply not a good start. And the evidence from the department to our committee can only be described as dismissive and defensive. This is not a good start to incorporating an agency which relied on its independence to provide evidence based advice to all the relevant governments and also to industry and education.

Health Workforce Australia's reliance on evidence based policy and its preparedness to consult are to be commended. I commend those principles to the department given they are going to take on this work.

In conclusion, Labor does not support the abolition of Health Workforce Australia. In its short period of operation, significant gains have been made, gains that Labor is concerned will be eroded by its absorption into the Department of Health.

Finally, I do thank the staff of Health Workforce Australia. They have done some marvellous work. Labor certainly values the work that they have done. We thank them for it and wish them all the best in the future.

Jacqui Lambie (Tasmania, Palmer United Party) Share this | Link to this | Hansard source

On behalf of the people of Tasmania, I rise to contribute to this debate on the Health Workforce Australia (Abolition) Bill 2014. The purpose of the Health Workforce Australia (Abolition) Bill 2014 is to abolish the health Workforce Agency. This agency was established in 2010 with a view to fixing a problem this country has experienced for decades—namely, shortages across all of our medical workforce. Put simply, we do not have enough doctors, nurses, psychologists, dentists and specialists. This medical professional shortfall affects every Australian on a daily basis in every state including in my own state of Tasmania.

The crisis in the supply of medical professionals in Australia, particularly in the last decade, has become so severe our governments have chosen to steal and poach medical professionals from Third World nations. The crisis in our health workforce leads us to poach health professionals from their own countries. On the whole, the level of healthcare provided by overseas medical professionals has been as good as the level of healthcare provided by Australian trained doctors and specialists. However, there have been a number of spectacular failures, which have cost the lives and wellbeing of many Australians. While those failures reflect poorly on those doctors and medical professionals who became and who are a serious threat to the public health system, those failures have reflected even more poorly on the government authorities and medical professional oversight bodies who had responsibility to protect the public from dodgy doctors.

Bodies such as AHPRA, the Australian Health Practitioners Registration authority and the AMA have a long history of turning a blind eye to doctors accused of serious crime and misconduct. AHPRA in particular is in need of major reform. Most Australians would be shocked to learn that the authority that has the responsibility of registering and of disciplining doctors is funded by doctors, run by doctors and is essentially doctors disciplining doctors—Caesar judging Caesar; judge and jury all in one. There needs to be a better, more open, transparent and independent way of registering and disciplining doctors. The current system is open to corruption and dysfunction—indeed, I have evidence of both—and fails to properly protect the public from criminal or incompetent medical professionals.

This system was deliberately designed to cut out all levels of accountability and transparency while doing completely the opposite. Most would also be shocked and alarmed to learn that no state or federal health minister, apart from in Queensland, has the power to deregister a doctor. This is a power and privilege only available to the doctors who control AHPRA. With such a flawed national doctor registration system, it is even more important that as a nation we properly plan for the health workforce.

Proceedings suspended from 18:30 to 19:30

I rise to continue my speech on the Health Workforce Australia (Abolition) Bill 2014. With such a flawed national doctor registration system, it is even more important that as a nation we properly plan for the health workforce. So it is deeply disappointing that this government has taken a course of action which essentially strips an independent medical workforce planning agency of resources and staff.

We have systemically failed for decades at a national level to properly plan a workforce this country needs, not just today but into the future. This has this led to a slip in the standards of care, where there are shortages of medical professionals. Those that are most acutely affected are our rural areas—areas like Tasmania, my own state. A report by respected Tasmania health policy academic Martyn Goddard was recently made public and cased important public debate. The following are key points made by Mr Goddard in his report:

Our Tasmanian public healthcare system is in crisis. Elective surgery waiting lists have blown out. That has been caused by a number of reasons. Poor management by the Labor-Greens coalition is one of the main factors. A number of serious matters regarding our public health crisis were raised in May in the Tasmanian Commission of Health report; however, one of the first questions that must be addressed is: Do we have enough public hospital beds and associated clinical staff to deliver a safe and high-quality public health system to Tasmania?

The AMA reports that the Australian average is 2.6 public hospital beds for every 1,000 head of population. That means that, with approximately 507,000 people, Tasmania should have 1,318 public beds. Appendix D of the latest Commission of Health report shows that there are a total of 1,188 public beds available for sick Tasmanians requiring medical treatment in a hospital. These figures prove that just to reach the Australian average, Tasmania needs an immediate increase of 130 properly funded and clinically staffed public-hospital beds.

I acknowledge that, in the short to medium term, Tasmania's private health system, which has extra bed capacity, must play an important role in delivering lifesaving and enhancing operations to Tasmanians stuck on public waiting lists. However, in the long term a greater investment must be made by our state and federal governments into our public healthcare system. This means that, if we want our children appropriately cared for, we should at the very least aim to have a Tasmanian public hospital bed per thousand-population ratio, currently at 2.35, raised to our national average of 2.6. I call on the federal government to ensure Tasmania receives sufficient funds to address and solve our public health care crisis. It is a life and death issue which has been caused by a lack of planning for well over a decade and beyond.

I understand it is not unique to Tasmania. In Queensland and Western Australia, the constituents my Palmer United Party colleagues, Senator Lazarus and Senator Wang, represent sometimes have to drive for hours and hours just to see a doctor, a specialist or a dentist. In some country towns in these states, pregnant woman are forced to travel to city areas to deliver their babies. I have constituents in Tasmania who need critical psychological care and have to get on a boat or a plane and travel to the mainland just to see a psychiatrist.

As early as 2005 the Productivity Commission told the federal government of the day, the then Howard government, about this problem. What happened? Nothing happened. After being advised they had a very serious and critical problem in meeting the health needs of the nation, they did nothing about it. The coalition government did nothing in 2005, nothing in 2006 and nothing in 2007. The Labor government were aware of this problem when they took office in 2007. Despite that, it still took them three years to act.

Finally, after years of health workforce debacles, years of public debates, years of media reports of understaffing, and the employment of under trained and in some cases unsafe medical professionals, Labor did something about this critical issue affecting all Australians, including people across my state of Tasmania. They established Health Work Force Australia in 2010 to properly plan our medical workforce for today and for the future of this country. Given time, Health Workforce Australia could have fixed some of the health problems faced by Tasmanians forced to travel by boat or hundreds of kilometres to receive basic medical care, and today this government bill seeks to abolish that agency. In fact, the government critically wounded the agency to the point where it has been on life support. The question that remains for the Senate is whether we switch off the life support system for Health Workforce Australia. That is not an ethical way to run a government, but that is how this government has chosen to deal with these agencies: shut them down and then seek Senate support to repeal the bills that established them.

The problem is that, until the bills are repealed, certain costs with regard to these agencies cannot be avoided. Costs include paying a CEO more than $300,000 a year to do nothing. Ongoing costs include rent that cannot be avoided—a total waste of taxpayer money. On that basis, the Palmer United Party has no choice but to support both bills to repeal these agencies and prevent further taxpayer money being wasted. The government clearly has a set agenda. They had, and have, no intention at all of negotiating this health matter in good faith. That worries me because one of the bigger issues in health is the matter of a $7 co-payment or, to be more correct, a $7 tax on sick and dying people.

I thank the health minister and his staff for the briefing we recently received. However, during that briefing it became obvious that the real spike in rising costs to the Medicare system began in 2004-05 when the then Howard government began to pay incentives for GPs to bulk-bill patients. The incentive was around $9 per patient in Australian rural areas and Tasmania and around $6 in the cities. The graph the minister supplied in his briefing clearly showed the bulk-billing Medicare expenditure steeply climb from 2004-05 when compared to non-bulk-billed Medicare expenditure. In other words, a significant incentive was given to GPs to bulk-bill patients. This policy saw some unscrupulous GPs beginning to run patients through on six-minutes consultations, all bulk billed and all with an incentive payment from the government. Not long after that, super clinics began to pop up. Some could argue that these clinics focused on the budget bottom line rather than on delivering good medicine to the patients they were seeing.

When they sat down to look at their budget, the government did not ask themselves what was causing our Medicare costs to blow out. They did not consider it may have been their own policies when they were in government all those years ago that began to change the culture of doctors and increase costs on the system. They never said, 'Let's re-educate doctors about the appropriate use of this incentive payment with a view to reducing the bottom line.' They never said, 'Let's crack down on Medicare fraud.' Instead, they said, 'Let's punish the public. Let's charge the public more money.' Their intention is to punish the public with a $7 co-payment, and that is just not fair. The public should not pay for your past mistakes, and that is exactly what you are making them do.

Zed Seselja (ACT, Liberal Party) Share this | Link to this | Hansard source

I am pleased to speak in support of the Health Workforce Australia (Abolition) Bill 2014 this evening. It is worth saying at the outset that the debate over the abolition of Health Workforce Australia is not a debate about whether you want to engage in health workforce planning; it is a question of how you do it and working out what is the best vehicle for that. The coalition has very clearly formed the view, correctly, that Health Workforce Australia, whilst it may have been well intentioned some years ago, has not worked out. I will go to a couple of the ways it has not worked out as may have been intended when it was put together a few years ago.

The bill will streamline the delivery of health workforce policy and programs through removing an unnecessary level of administration and bureaucracy. Over the last six years the health bureaucracy has continued to increase in size and, more importantly, in complexity with 21 standalone agencies operating outside the portfolio department. That is something that we have seen in other portfolio areas as well. It is one of the areas that the coalition wanted to address. Having something like 1,000 agencies in the Commonwealth does not make good sense. There is cause to consolidate many of those agencies in order to make sure that they are delivering in the most efficient and most effective manner for the Australian people.

The coalition government is determined to get every possible dollar onto the front line in order to make every dollar spent on behalf of our community as effective as possible, so that we do health workforce planning in the most effective way—not in a way that, as I said, may have been well intentioned but has not worked out.

Health Workforce Australia was established under the now expired four-year National Partnership Agreement on Hospital and Health Workforce Reform, agreed by the Council of Australian Governments in November 2008. Health Workforce Australia became operational on 1 January 2010. Fundamentally—and I think this is one of the strongest arguments in favour of this bill—all Australian governments were to provide funding to Health Workforce Australia. However, the states and territories have not contributed any funding as agreed. The Commonwealth government, in partnership with the states and territories, agreed to fund it to the tune of over $1 billion and the states and territories promised to do their bit to the tune of around half a billion dollars, but they have not come to the party. So we have a model where the Commonwealth becomes the sole funder, yet the states and territories, as part of that agreement, effectively get to be there as part of the government's arrangements. For me, that is at the heart of why this legislation is important.

Programs and functions of Health Workforce Australia have transferred to the Department of Health. This government is not withdrawing support for the health workforce; it is delivering on its commitment to reduce red tape and streamline programs. Savings will support frontline health services and programs.

The coalition has a strong record of making sensible investments in Australia's health and medical workforce. The previous coalition government invested in nine new medical schools, which has resulted in an increase in medical students graduating now. The number of domestic school graduates per year has more than doubled since 1996.

The government has committed to doubling from $100 to $200 the Practice Incentives Program teaching payment for each three-hour teaching session provided to a medical student. It will better compensate general practices for the consultation time dedicated to teaching, it will encourage more general practices to provide much needed teaching opportunities and it will work to strengthen the future workforce. The measure will benefit approximately 3,000 general practices that are expected to provide PIP teaching sessions. It is expected that approximately 20,000 students per annum will be provided with PIP teaching sessions. A rural loading of up to 50 per cent will also be applied to payments to practices in rural and remote locations.

The government is also investing $40 million in up to 100 additional medical internships each year in non-traditional settings, including private hospitals in regional areas. This will provide more certainty for students and alleviate pressure on public hospitals for training. Priority will be given to positions and rotations outside major metropolitan centres to bolster the medical workforce in rural and regional areas.

The coalition will provide infrastructure grants to general practices on the basis of an equal commitment from the practice. This will leverage private investment and help ensure efficient and productive use of resources. The government has committed to provide up to 175 grants for rural and remote general practices to expand facilities 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. The measure will benefit GPs, registrars, medical students and communities situated in inner regional, outer regional, remote and very remote Australia where the grants will be targeted. These practices face unique challenges in the provision of health care.

The government will also significantly expand the number of GP training places. GP training places will increase by 300—from 1,200 to 1,500—new places in 2015. The significant increase in GP training places will create more vocational training opportunities for this 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.

I commend the bill to the Senate.

Claire Moore (Queensland, Australian Labor Party, Shadow Minister for Women) Share this | Link to this | Hansard source

It is a real pleasure to be able to speak tonight about my admiration for Health Workforce Australia. Even though we stand here tonight speaking with great passion about the worth of this group and the work that they have done, we know that the government has already disbanded them. Most of the work has already happened. I am sure the property is being sold. People have already moved. People know who has got their job and who has not. But regardless of that process it is still important to talk about the concerns that were shared with us in our committee about why the government has decided to make savings—and 'budget savings' is the only reason they are able to put forward as to why Health Workforce Australia is no longer with us. There were no questions about why Health Workforce Australia was set up. There were no questions about the efficacy of what they did. There were no questions about the importance of the work they did or indeed the fact that they had a forward plan already in place, already approved by their board, to look at work into the future. There were no questions about that.

We had a considerable discussion about the fact that this particular organisation was originally set up after a Productivity Commission report that talked about the need for a coordinated response to the health workforce in our nation. Again, this is an issue about which there is no debate. There is agreement that there must be a form of coordinating workforce in our nation so that we can effectively respond to the differing needs of our nation and so that we can work with people across state boundaries and professional boundaries and have a shared commitment to meeting those needs.

When Health Workforce Australia was put in place the terms of reference were very clear. It was set up to ensure that there was a coordinated response, it was there to plan into the future and it was there to ensure that there was an effective program that looked at innovative ways to look at training to make sure that we had the best trained workforce in our country.

In evidence to the inquiry that we held, a range of professional groups, consumer groups and people from the community all talked about how much they valued the services that were provided by this organisation. It is on the Hansard record. A number of submissions came through and we had very detailed Hansard processes. I would like to quote from a few of them because I think it is important to hear from the people who work in the industry about their concerns about this government decision and about losing this valuable process that we had. The Royal Australasian College of Physicians, in its submission to the inquiry, said:

The core functions currently performed by HWA are becoming more rather than less important. Driven by Australia’s aging population, increasing levels of chronic disease and the emergence of new healthcare technologies, there will be a need for changing models of healthcare which in turn dictates changing workforce needs. Hence, there is a significant imperative for the timely collection and analysis of detailed and accurate health workforce data. This data needs to be able to be considered at a national, State and local level. HWA’s health workforce data collection and analysis functions also need to be seen in the broader context of its role in facilitating and developing new models of care … The continuation of these related functions needs to be assured following the abolition of HWA.

So the people who are involved in the area were also aware that the government was not going to be diverted from its publicly stated position that was announced rather than debated in this place. The government announced that Health Workforce Australia was going to close. My understanding and also the understanding that was presented at our Senate committee was that there had not been extensive consultation with the industry. There had not been engagement with the range of people who were all too willing to come and talk to us at our Senate inquiry. We had no problems, with the very short time frame we had, in having a range of people wanting to come and tell us about how much they had considered the roles which had been carved out by Health Workforce Australia, that they had worked with their board and had engaged with, as I have said, all states and territories and all professions and had come up with an analysis of what we needed in terms of an effective workforce to respond to the needs of our nation.

The best we could get from the department when they came to give evidence at our inquiry was that the roles would continue, only this time in the department. We thus heard from Senator Seselja about some of the key programs which will be maintained. We still do not have a full list and a commitment into the future. What would be very useful to see and what I asked for was some commitment around the forward plan that Health Workforce Australia had developed—to see a graph, to see all the work that was on that plan, which had been endorsed by the board and industry, and to see which of those were going to be fully funded and implemented by the government into the future. There are some and I think that needs to be acknowledged. Some of my personal favourites are the training aspects and the incredible work that Health Workforce Australia has done using simulated training. This is an area that is becoming particularly relevant across a whole range of professions in this nation where they can have training that can be done not necessarily in the actual workplace but whereby people can actually get their training in a simulated way, which is fully accredited and acknowledged and which uses the best possible development. That came up consistently as an important area that needed to be continued and my understanding is that the government will continue to do that. I sincerely hope so because of the considerable investment that has been placed in setting up that program, in having it there and ensuring the knowledge base. There is no reason why that workforce training should not continue into the future.

What I think is most distressing about the process is that the need was identified through the Productivity Commission and through the engagement of people in the community that the most effective and indeed engaging way to get the work, the analysis and the independence was to have a statutory body which was separate to the department but naturally cooperating with the department, because that is the way it operates. There would be work and tasks being undertaken by the department consistently but working with Health Workforce Australia, which was specially tasked and funded to do a range of jobs. They would be able to complement each other, work effectively together and fulfil the needs that had, jointly, been agreed to be undertaken.

Naturally, at times, there would be communication issues. I asked the department about communication issues, because the department in their submission quoted that a lot of the bases upon which they brought forward issues were on issues that were brought out in the Mason review of the structures which were done, completed and actually tabled in 2013—not that long ago—which had a range of recommendations about the best way that workforce planning could continue into the future in the medical area.

At no time did the Mason review, although quoted by the department to look at the way things had to improve—which I have read and it was an in-depth and extensive review of this area—recommend the abolition of Health Workforce Australia. In fact, when you read the department's submission, which I know is public, you might be excused for thinking that perhaps there was some recommendation of that kind. It was clear that there were issues about communication and no-one doubts that. When I asked the department at the inquiry about the communication processes around how it worked, they said that a mechanism was in place for interaction between, firstly, the department, the unit of the department which looked after workforce, Health Work Force Australia, and then the minister and the government. I would have thought that would have been an expected process out of an organisation which has only been around for a short time, working with the department from whence it came. However, it seems that, rather than working on ensuring that that communication process was better entrenched, rather than working on how you could best use the expertise and the resources that were in place with Health Workforce Australia working with the department, the government's decision for economic reasons—and I am willing to be told if there is any other reason to close down this organisation; clearly, it was a savings measure and it was a difficult decision that the government had to make—was not to look at streamlining or working in a way that would fit a model better but to wipe out Health Workforce Australia.

That process has been successful; it has already gone. That is what I find most frustrating about this process: it has already gone. Nonetheless, it is important to talk about what will happen in this area without this resource. Other senators have talked about the extraordinary work that Health Workforce Australia has been able to do in pulling together issues around the best use of the areas of nursing and midwifery. As you know, our community affairs committee has had a long relationship working with these professions to see how we can best look at the need and at the practice. The debate about the best way that we can use the professional skills of people who are well trained and skilled in our health workforce will continue and must continue.

The health workforce process could do an efficient analysis of where the jobs are at this point across the board in our nation and project forward what the needs would be into the future, looking at all those dynamics which we know about, with our changing population, our regional needs and also the way that Australians are seeking to use their health system, which I think has differed in a great way. The skills of Health Workforce Australia could look at that and produce what I think is a well-acknowledged series of documents which now has provided a benchmark for future planning in this area. That was a huge task and was one that took a great deal of time and needed to be there. It also needed to be maintained, because out of that work came planning for the future about how we would best meet the needs of our community.

We cannot have a body of work of that type completed and then shelved. This has got to be a dynamic process. Again, this is looking at the issues of having a work plan, meeting the milestones of that work plan and then planning into the future, using the same people who have the dedication and engagement in the process. The difference with Health Workforce Australia was this came out of the COAG process, it has engagement from the states and territories, and this was seen as an independent organisation. So rather than having individual organisations in states and state governments and state departments working with the Commonwealth department, they were able to meet and work—and I keep using the word but it is such an important word, it is a value-added word—'engaging' with the process. With an independent statutory body, they are going to be back to the process of working with the Commonwealth department.

Consistently, Acting Deputy President Smith, as you would know from our experience in Western Australia, there is tension in terms of the relationship between state bodies and Commonwealth departments. That is not laying blame in terms of process; it is a reality. It was an issue identified in the Productivity Commission report out of which Health Workforce Australia was created. It continues to be an issue because of the whole feeling of ownership and effective respect.

I have no doubt that there will be absolute commitment and professionalism by the officers in the Commonwealth department who will take back the full responsibility of workforce planning in the process. I have no doubt about that. What I do actually acknowledge, though, is that there will be competing demands, there will be competing tensions and also in terms of the people with whom they can meet and interact there will be limitations in having a Commonwealth department dealing with agencies across states and also with professional organisations across a whole range of areas.

Out of this debate we need to salvage the good work of Health Workforce Australia. When you go into the last annual report of Health Workforce Australia—and I am determined not to use the abbreviation in this contribution; I will continue to spell it out in full—you actually see the pride with which the organisation had mentioned what had happened; their highlights of 2012-13. They actually put on record the third and final volume in Health workforce 2025. That is the one to which I was referring to earlier. It was the doctors, midwives and nurses series, which was completed and released in November 2012—again, to be a dynamic document to be worked on into the future.

I mentioned earlier the simulated learning environment. I know we have had contributions about the Clinical Training Funding Program. Again, our committee has been involved over many years with issues about the clinical training programs and access to clinical training by a range of medical professions not just medicine but in terms of other groups which desperately need an effective clinical training program. It absolutely must be coordinated effectively nationally. At the moment so much of it is reliant on states, and we have seen at the end of academic years the loss—I think the absolute waste—of people who trained effectively in their professions and could not then get an effective clinical placements. This was another area that Health Workforce Australia had identified and looked at working cooperatively into the future to ensure that we did not waste the very valuable resources that we have in the workforce.

I know that I am getting close to running out of time, but I just want to mention two of the things that I think have not been picked up as much as they could have been in this contribution. I do ask people who are interested in this area to have a look at the annual report of Health Workforce Australia, to have a look at the contributions that came through to our Senate Community Affairs Committee about what people in the profession, consumer groups and organisations valued about the work. One of the areas that we worked a lot in over the last few years has been in the area of Indigenous workforce across the board but in particular in the health workforce. This organisation had done work about planning into the future about how we respond to the need to have more well-trained Indigenous operatives across-the-board across professions. This is something that governments of all kinds have been struggling with over a large number of years, not just providing people in place but ensuring that they have the skills necessary, again, to look after their communities in the best possible way and to ensure that there is that effective placement particularly in remote regions but not only there. It is looking to ensure that we have people who are best trained and best placed to serve their local communities. This will continue to be a challenge for all of us. This was a program that Health Workforce Australia had put in place which needs to be picked up by the department, and I am sure it will. It must not be lost.

The other area was the National Cancer Workforce Strategic Framework, which was published in June 2013. This is another area where there has been considerable interest and engagement. This was an area that was particularly mentioned by consumers in Australia. There are so many opportunities now in the cancer workforce. We have seen great discussion about pharmaceuticals in this area but also different training and access to services. Rural and regional people still, to our shame in this country, are not being able to access their best care in cancer services, and there have been numerous papers put out, including one by Health Workforce Australia, about the issues around that. That is another program that I would hope that would be able to be brought forward into the future.

I do not believe, even though we will be strongly arguing the case in this place, that we will be able to turn the government's decision around, particularly as they have moved most of the staff and that has already concluded. However, I think that we cannot lose the investment and the commitment that we had, and shared, in setting up the organisation in the first place. We cannot lose the investment and the interest that determined why it was needed. We know the work continues to be needed. We know it must not be lost. So, in the rush to make the difficult decisions, in terms of the process, keep in mind what was achieved by Health Workforce Australia, value what was done and, please, do not forget this period in our history, because what we have done we can learn from and it will be a better place.

Fiona Nash (NSW, National Party, Assistant Minister for Health) Share this | Link to this | Hansard source

The Australian government is meeting its commitments to cut red tape, repeal unnecessary regulation and stop waste caused by duplication in government services. The Health Workforce Australia (Abolition) Bill 2014 will repeal the Health Workforce Australia Act 2009 and legally abolish Health Workforce Australia or HWA. The government has committed to streamline and better coordinate the health workforce planning efforts that were spread across two Commonwealth government agencies and remove duplication and unnecessary costs. Accordingly, HWA's health workforce activities have been transferred to the Department of Health. This legislation recognises this change made by the government.

This bill will not reduce or weaken national efforts to improve health workforce planning and development. On the contrary, the coalition government is committed to supporting our highly skilled health workforce and to ensuring that all Australians have access to high quality health services. This government is committed to improving the capacity, quality and mix of the health workforce to provide front-line health services. This bill frees resources spent on bureaucracy and duplication to support health workers to deliver vital services to the community.

The coalition government has a long history of supporting and developing the Australian health workforce. It was the coalition government that supported innovative approaches to train more health workers in rural and regional areas, and we are justifiably proud of our network of rural clinical schools and university departments of rural health right around Australia. The rural training network is supporting thousands of health students—future doctors, nurses, dentists, psychologists, physiotherapists, and many others—to complete practical training in rural areas of Australia. Evidence is now showing that these students are choosing to stay and work in rural areas at much higher rates than their counterparts training in metropolitan areas. This approach has been an enormous success. It was a coalition government that acted in 2006 to increase the number of Australian-trained doctors by increasing medical student numbers at Australia's universities. In fact, the previous coalition government established nine new medical schools, including in rural and regional Australia. We are now seeing those newly qualified doctors entering practice and delivering essential services around the country. Many of these will be undertaking work and training in rural areas.

The coalition will continue its efforts to train and support the health workforce through better, more efficient programs delivered across both the health and education systems. We will work with the private sector and state and territory governments to provide opportunities for health professionals to train and work in all sectors and settings where front-line health services are delivered.

A strong approach to health workforce development has several components, including: critical analysis of data and effective planning, and consultation with employers and the community to ensure that we are developing and implementing policies that will produce the right numbers of health professionals with the right skills for the future; supporting educational and training opportunities for health professional students to meet the standards required for registration to practice; providing opportunities for ongoing clinical education, not only for those seeking to specialise in a particular field of practice but for all health professionals, to ensure that they keep abreast of the latest developments in their fields; and supporting our experienced clinicians to remain in productive practice and to pass on their skills and experience by supervising students and mentoring the next generation of the health workforce.

The government is committed to ensuring that this important work continues. Forecasts of Australia's health workforce needs will be updated regularly as new data becomes available for analysis. This work will be undertaken within the Department of Health in collaboration with key stakeholders and other data experts, including relevant government agencies and the Australian Health Practitioner Regulation Agency.

The department continues to support the important work of the National Medical Training Advisory Network to produce national medical training plans. It will be given a very high priority by the department.

Through the Department of Health and the education portfolio, the government invests hundreds of millions of dollars every year in training doctors on behalf of the community, and we must ensure that this investment is targeted to the types of medical services and the areas of medical practice that the community most needs, now and into the future.

But the department will not just focus on the medical workforce, and the government will maintain a multidisciplinary approach to supporting the health workforce. The single largest annual expenditure under the department's Health Workforce Fund is over $300 million a year, supporting practice nurses to deliver primary care services to patients in general practice. The department also operates programs supporting nursing and allied health scholarships, which have been expanded through this government's election commitments. The government is also making improvements to our support for experienced supervisors. We want more GPs to be training our new doctors in general practice. The government is doubling the practice incentive payment for teaching from $100 to $200 a session. This will encourage more GPs to train medical students, and there is an extra loading for training in rural areas.

The government is strongly committed to continuing to deliver health workforce data, analysis, policies and programs. What this bill will do is to ensure that this work is delivered more efficiently with less bureaucracy and waste. We will achieve efficiencies by having Commonwealth health workforce policies and programs delivered together in a division of the department rather than through a separate agency with its own executives, accommodation leases, IT systems, and legal and human resource departments.

Taxpayers want more health workers and health services, not more Public Service overheads. The Commonwealth and states and territories continue to work collaboratively through established fora such as the COAG health council. However, the national partnership agreement under which HWA was established expired on 30 June 2013. It clearly indicates that it was intended that HWA would be a joint agency managing Commonwealth, state and territory investment in developing the Australian health workforce. As it turned out, the states and territories did not contribute any funding to HWA.

Since its inception, no state or territory has directly provided funding to Health Workforce Australia for its clinical education and training activities or in fact any of its work program. Instead, Health Workforce Australia has been solely funded by the Commonwealth, essentially creating an additional separate Commonwealth agency as well as the Department of Health which continue to have overlapping responsibilities. Additional staffing and administrative costs have been required to run HWA for functions that can be effectively performed by the Health portfolio's lead department. The HWA joint agency model never eventuated, but we ended up with a high-cost agency with board meetings, directors' fees, a CEO and a large CEO support office and high travel costs, all entirely funded by the Commonwealth. The Commonwealth has now taken action to ensure that taxpayers resources are spent more efficiently.

Some of the duplication between HWA and the Department of Health that we have seen over the last four years include staff from both agencies being represented on the same project steering committees for health workforce planning, education and training projects; both agencies running slightly different programs supporting the recruitment and retention of internationally trained health professionals; and both agencies funding overlapping workforce distribution projects and programs. This has led to a fragmented approach and waste through duplication of administrative policy and program functions.

The passage of this bill will produce a more coherent and streamlined approach to health workforce funding programs, provide a central point of liaison for health workforce stakeholders, produce a joint approach with state and territory governments on health workforce activities through the COAG Health Council and formalise the responsibility of the Department of Health to manage health workforce activities. The Australian government through the Department of Health has long played a national leadership and advisory role in supporting the development of the health workforce in both the public and private sectors, and in implementing a range of innovative programs to support clinical training for health workers.

The Labor government created an unnecessary and costly increase in the number of portfolio agencies, increasing the bureaucracy at great cost but with no change of outcome and no real benefits. The passage of this bill will reduce administration so more resources are available for programs which support Australia's health workforce. Shifting responsibility for these activities back to the department will ensure a clear policy focus into the future with no loss of commitment in this space.

This bill will support the efficient delivery of functions. It does not change the government's support for nationally coordinated, effective and efficient health workforce planning. The government continue to provide support for the education and training of a highly skilled and mobile health workforce for Australia. The government inherited a legacy of $123 billion of projected deficits and debt that was projected to rise to $667 billion. It is imperative that we find ways to deliver programs as efficiently as possible so resources can continue to be available for important front-line initiatives.

The bill enables the official wind-up of HWA as an entity separate from the Commonwealth. Essential ongoing functions have been integrated with the department's existing work program to plan for and deliver our future health workforce. The department's existing work program includes more than $5 billion in health workforce investment over five years, invested in strategies to train, support and develop the health workforce. A longstanding component of the department's work program are strategies to improve distribution of the health workforce so all Australians, including those in rural and regional Australia, can access appropriate health services in their local communities.

All existing funding agreements and commitments entered into by HWA will be honoured. The government has already announced its commitment to continue funding clinical training under the clinical training funding agreements with universities for the 2015 academic year. The coalition government remains committed to improving the capacity, quality and mix of the health workforce to meet the requirements of health services now and into the future.

The Australian government can continue its focus on priority health workforce activities without the unnecessary costs of an additional Commonwealth funded agency. I reiterate: the new streamlined arrangements will improve not diminish the government's focus on workforce planning and policy development and implementation to ensure we have the right mix of health professionals on the ground delivering services to the Australian community now and into the future. The bill will enable essential actions to continue under more appropriate arrangements without the inefficiencies, confusion and costs associated with maintaining a separate Commonwealth agency.

Stephen Parry (President) Share this | Link to this | Hansard source

The question is that the bill be now read a second time.