Jonathon Duniam (Tasmania, Liberal Party, Shadow Minister for Environment, Fisheries and Forestry) Share this | Link to this | Hansard source

It is a pleasure as always to rise to make a contribution to the debate, on this occasion, on the Higher Education Support Amendment (2022 Measures No. 1) Bill 2022. At the outset I want to commend the work that my colleague the Hon. Alan Tudge put in, in the other place, to the coalition's response to this bill. To begin with, the purpose of this bill is to give effect, broadly speaking, to two legislative changes which were introduced before the last election by the coalition government and lapsed at the dissolution of the parliament. They were the Education Legislation Amendment (2022 Measures No. 1) Bill 2022 and Higher Education Support Amendment (2021 Measures No. 1) Bill 2021.

The bill before us today gives effect to the HELP for Rural Doctors and Nurse Practitioners measure announced, as I've already said, by the coalition in the 2021-22 MYEFO. The measures contained herein provide a partial or full higher education loan program, or HELP, debt reduction for rural doctors and nurse practitioners who reside and practise in regional, rural or remote Australia. This measure was previously included in the Education Legislation Amendment (2022 Measures No. 1) Bill 2022. The bill also changes the definition of a grandfathered student to clarify grandfathering arrangements under the Job-ready Graduate package of reforms to higher education, and we've referred to them as the HELP grandfathering measures. These changes correct an unintended consequence of grandfathering provisions to ensure that honours students remain eligible for grandfathering where their course commenced before the year 2021, and the changes were previously included in the other bill I referenced earlier, the Higher Education Support Amendment (2021 Measures No. 1) Bill 2021.

With regard to some of the specific elements, I'd like to turn first to the HELP for Rural Doctors and Nurse Practitioners measure. The measure was announced by the coalition, as I've already said, in the MYEFO 2021-22. This measure was aimed to encourage the relocation or retention of eligible doctors and nurse practitioners by reducing their outstanding HELP HECS debt. The measure allowed for the waiver of indexation on outstanding HELP debts for eligible doctors and nurse practitioners while they were residing in and completing eligible work in a rural, remote or very remote area. HELP HECS debts for doctors can be up to the value of $100,000, which is no small sum. The value of the debt reduction will be guided by the location eligible doctors and nurses locate to, using the Modified Monash Model.

The Modified Monash Model depicts the remoteness of the location, with the MM1 representing a major city through to MM7 representing a very remote location. The eligible locations for this measure will be in areas for MM3 to MM7. For example, doctors and nurse practitioners who choose to work in a remote area will need to provide a minimum of 24 hours a week of MBS billed services for a period equivalent to half the duration of their degree to have their full HELP HECS debt waived. For doctors and nurse practitioners who choose to work in rural or regional areas, they'll need to provide a minimum of 24 hours a week of MBS billed services for a period equivalent to the duration of their whole degree. The measures will be backdated as per the coalition's announcement in MYEFO, and eligibility will be retrospectively applied with commencement from 1 January 2022.

The program is expected to encourage up to 850 eligible doctors or nurses to relocate to a rural, regional or remote area each year, and this bill establishes the program eligibility requirements for the target health practitioners and the nature of the work to be undertaken to achieve the benefits of the program. It also provides for secondary legislation, which is the HELP debtor guidelines for health practitioners, to articulate the specifics of eligible participants, eligible locations and eligible work, and to support the administration of the program. The legislation to enact this measure was previously included in the Education Legislation Amendment (2022 Measures No. 1) Bill 2022. It was introduced by the coalition in February of last year and lapsed at the dissolution of the parliament.

Why is there a focus on doctors and nurse practitioners? It's because individuals living in regional Australia, as we know, experience poorer health outcomes than their city counterparts, and this is attributed to less access to preventative health services, such as the services of a GP. According to the General PracticeHealth of the nation2022 report, GPs living and working in regional Australia experience greater job satisfaction than those living in urban areas. Yet there's still a chronic shortage of GPs, particularly those in country communities. With only one in seven graduates in medicine choosing the path of general practice, securing doctors in rural and remote Australia is becoming increasingly difficult.

According to Richard Colbran, the CEO of the New South Wales Rural Doctors Network, there isn't a town in rural New South Wales that isn't at risk when it comes to being able to sustain primary care in their communities. Without general practice, patients will turn to the already overstretched emergency departments and won't seek medical treatment at all, leading to poorer health outcomes.

As I've already said, this is coalition legislation, in essence. It was introduced before the last election; we, therefore, support the bill. There will be an amendment during the committee stage and I look forward to speaking to it at that point.

Mehreen Faruqi (NSW, Australian Greens) Share this | Link to this | Hansard source

I wish to speak to the Higher Education Support Amendment (2022 Measures No. 1) Bill 2022. I will come to the Greens' position on this bill in a few minutes. I want to start by saying that this bill is a massive, missed opportunity, both with respect to student debt and changes and with changes to the terrible, punitive and cruel Job-ready Graduates bill that was pushed through by the Liberals and that hiked fees and cut university funding.

The entire Job-ready Graduates package was a complete disaster. It's not sufficient to just fix the grandfathering error; nor is it sufficient to pretend that nothing can be done to fix that disaster until after the university accord process, which is only due to deliver its final report at the end of this year—with recommendations years away from being implemented. When current policy is causing problems for so many people and is deeply flawed, like this Job-ready Graduates, urgent action is warranted.

Job-ready Graduates raised student fees and cut billions from Commonwealth contributions to teaching and learning. It failed in its attempt to encourage more enrolments in priority courses—such as science, engineering and mathematics—and burdened hundreds of thousands of students with billions in additional collective debt, shifting the overall cost of university education away from the Commonwealth and on to the students. Job-ready Graduates, as designed, had an unfair and disproportionate impact on students who may already be marginalised, subject to structural discrimination or at greater risk of dropping out, including women, Aboriginal and Torres Strait Islander students, low-SES students, first-in-family students and students who live in regional areas. It entrenched pre-existing inequalities.

As the CEO of the Grattan Institute, Danielle Wood, stated in relation to the Job-ready Graduates bill, back in 2020:

I honestly think it's one of the worst-designed policies that I have ever seen … Even if you accept its stated rationale, it doesn't go anywhere near achieving it.

The current bill that we are debating is a missed opportunity with regard to this particular grandfathering requirement and also with regard to the student debt.

Education is a right, not a privilege reserved for those who can afford to pay for it. It should be universal and it should be free at all levels. It is a travesty that student debt exists in the first place. It should be completely wiped. Tinkering around the edges and reducing student debt for certain cohorts is totally insufficient. The need to address ballooning student debt in this country has never been greater. Again, it's not a problem that should be palmed off until after the Accord process has wrapped up. If inflation continues to rise, as is expected, student debt is likely to be indexed by around seven per cent on 1 June this year. This means that a person with an average HELP debt of around $24,770 will face an increase of over $1,700 to that debt. This is pretty staggering, particularly in the midst of a cost-of-living crisis, which is hitting young people the hardest.

The increase in debt will be much higher for those who are shackled with a bigger study debt burden. For the close to 600,000 people who have a HELP debt of $40,000, debts could rise by almost $3,000. These debts are holding people back from being able to get a car loan or a loan to purchase their first home and are severely limiting the amount that people are able to borrow.

Ballooning student debt is already causing harm. Last year, I heard from so many people about how rising student debt was holding them back. I want to put on the record what some of them said. One said: 'I'm literally 20 and I already owe more than $20,000. That's more than $1,000 for every year of my life.' Another one said: 'My HECS and student loan comes to $80,000. Indexation will mean all I have paid in the last 12 months comes to nothing.' Then there's this: 'I've just finished my degree—mum of two who staggered through it during lockdowns—and about to enter the full-time working world, feeling I'm behind before I even begin.' Another person told me: 'I'm going to pay about $3,500 in HECS this year, and at the end of the year my HECS debt will increase by $4,760—absolute nightmare.' This is the last one I'm going to read out today, although there are plenty more: 'This year, my debt went up by more than the compulsory payments reduced it by. Paying thousands to still have my HECS debt growing is so disheartening.'

That is why I say that this bill is just tinkering around the edges and not sufficient. At the very least, we need to freeze indexation now to stop pouring fuel on the student debt crisis. We also need to raise the minimum repayment threshold to the median wage so we can ease the cost-of-living pressures for millions. That's why I have introduced a bill to do just that.

The bill we are debating amends the grandfathering provisions in the Higher Education Support Act to make them fairer and introduces a scheme for eligible doctors and nurses to have their HELP debts reduced or wiped if they live and work in rural and remote areas for a period based on the length of their degree. The bill also allows for the waiver of indexation in relation to eligible health practitioners' HELP debts while they're working in rural or remote areas. The Greens will support this bill because it does fix at least one broken element of the Liberals' Job-ready Graduates Package: the current unfair grandfathering of fee increases, which saw students who enrolled in honours courses hit by such high fees. It does also at least introduce measures to lower and wipe student debt for one cohort of students, so that's a step forward. But what we really need to work towards is the complete wiping of all student debt in this country and making education free for all.

I'm proud to be a member of the first and only party in Australia to commit to this vision. That's why I will be moving a second reading amendment to this effect—to make sure that student debt is wiped and to recognise that tertiary education, like all education, is an essential service, and it should be universal and free.

Marielle Smith (SA, Australian Labor Party) Share this | Link to this | Hansard source

I'm also rising today to make a few brief remarks on measures within the Higher Education Support Amendment (2022 Measures No. 1) Bill 2022. Particularly, I want to acknowledge the measures within this bill that work to encourage doctors and nurse practitioners to live and work in rural, remote and very remote areas in Australia. This bill will allow for eligible doctors and nurse practitioners to have their HELP debts reduced or wiped if they live and work in those areas for a period based on the length of their degree.

I rise today to welcome these initiatives as part of the bill because we know that bringing healthcare professionals to our regions is urgent business. As a senator for South Australia, as I travel around our state, I have heard countless times about the difficulties South Australians living in our regions and our remote and rural areas have in accessing adequate healthcare services, quality healthcare services and, importantly, continuity of care in the services that they do access.

We know that the provision of healthcare services in our regions is simply not up to scratch. Over the past few years, since I've been elected, we've seen things like the repeated cancellation of obstetric services in Ceduna. It's happening over and over again, leaving women and their families with huge distances to travel to give birth. They are travelling far away from their families and their support networks at an already stressful period in their lives. We see it in the provision of completely substandard health facilities in rural and regional South Australia in towns like Ceduna, where, thankfully, this government, the Labor government, in partnership with our state Labor government, is finally rebuilding the local health clinic, Yadu Health, something I have been campaigning on for years in this place. The situation that we had in Ceduna was completely substandard, and the previous government refused to act.

We know that in communities there are people who are travelling incredibly long distances to see their GPs and who have suffered from a lack of timely access to quality health care and, of course, from a lack of continuity of care from their healthcare providers. We know that, especially when it comes to managing chronic disease and complex conditions, a trusted relationship matters. Continuity of care matters. In towns like Murray Bridge, a town that can be disadvantaged at times by its proximity to Adelaide—you can be close enough to miss out on some good services because it's assumed that it's easy enough to get to Adelaide—these types of measures will really matter.

Our healthcare systems have been under strain. They need help, and I'm proud to be a part of a government that is not afraid of doing the hard work to tackle these challenges. Whilst I appreciate that this bill is primarily relating to higher education, I wanted to note and draw out the measures within this bill which go to having an impact on the workforce of doctors and nurses in our regions. This is a critical issue in which I think we have, over many, many years, seen repeated failures which have left people in my state very disadvantaged. Any measure that we can take as a government and as a parliament which will mean we have access to better services and continuity of care—with more professionals out in our regions and our rural and remote areas, making a difference to their local communities and providing that continuity of care and those services locally in a way which is accessible and which allows people to stay closer to their families, closer to their support networks and, of course, closer to their employment—is a really positive thing.

So I commend those measures in the bill and look forward to continuing to work amidst this government's broader work and efforts on strengthening Medicare and strengthening our healthcare system, because we know that, after nine years of the previous government, it has never been in worse shape. So there is a lot of work to do, and I commend the measures in this bill which will, hopefully, make a difference in regional South Australia.

Paul Scarr (Queensland, Liberal Party) Share this | Link to this | Hansard source

At the outset, we should note that the purpose of the Higher Education Support Amendment (2022 Measures No. 1) Bill 2022 is to give effect to two legislative changes that were introduced by the previous coalition government, which Senator Smith heavily criticised in her contribution in this place. The first change to which the bill gives effect is the Higher Education Loan Program debt reduction scheme for rural doctors and nurse practitioners who reside and practise in regional, rural or remote Australia. The second change is to fix an anomaly so that students who are undertaking honours programs also qualify for the assistance. The basic proposition is that, if those people who are studying medicine or nursing choose to work and live in a regional or remote community, the quid pro quo is that they're given relief on their university fees. That is entirely appropriate and, hopefully—and I share this ambition with Senator Smith—will go some way towards alleviating the crisis that is currently occurring, especially in remote and regional communities, in relation to health care.

Research from the Australian Healthcare & Hospitals Association provides some really startling facts about the health of people living in rural and remote communities as opposed to the health of those who have the benefit of living in larger major cities. I quote from an information statement which they released, which lists a number of the differences. Firstly:

People in rural and remote areas on average have shorter lives, higher levels of illness and more disease risk factors than those in major cities.

The next point is quite startling:

Mortality rates for males in very remote areas are 1.4 times higher than those living in major cities and 1.8 times higher for females.

Mortality rates are that much higher for our fellow Australians who are living in remote communities.

Age standardised suicide rates increase with remoteness and the total burden of disease rate in remote and very remote areas is 1.4 times higher than in major cities.

People living in rural and remote areas are more likely to have long-term health conditions including arthritis, asthma … diabetes, heart disease, stroke and mental health conditions.

A higher proportion of Aboriginal and Torres Strait Islander people, with worse health outcomes than other Australians, live in rural and remote areas.

The need is there but the supply of health professionals is wanting, and that's one of the things which this bill seeks to address.

In the limited time available before the time for senators' two-minute statements, I want to make some reflections on the current state of the health system in my home state of Queensland. What is happening in Queensland, especially in regional Queensland, is an absolute disgrace. This is from an ABC article dated 15 January 2023:

Gladstone Hospital in Central Queensland—

this is a city of 60,000 people—

has been on maternity bypass for more than six months.

This is a city where, typically, 600 babies are born each year—it has a population of 60,000—but the Queensland public health system, under the Palaszczuk Labor government, is incapable of providing obstetric services.

Don't just believe me in relation to this. Let me quote from the President of the National Association of Specialist Obstetricians and Gynaecologists, Dr Gino Pecoraro. He said:

Gladstone had the specialist staff, but their ill treatment by the health department led to them fleeing.

We had the obstetricians in Gladstone but they were treated so appallingly by the Queensland health department, under the Annastacia Palaszczuk Labor government, that they actually left the system. They couldn't bear working in the system. The article quoting Dr Pecoraro continues:

"This cannot be stressed enough," Dr Pecoraro said.

"Doctors—myself included—have been warning the health department of the imminent collapse of maternity services for two years.

"The root cause of this collapse was the closure of the private maternity unit in Gladstone. This led to the private specialists previously living and working in Gladstone moving out.

Dr Pecoraro said following the closure specialists were prevented from delivering private patients in the public hospital …

So that's the issue. It's an ideological issue that the Labor Party state government in Queensland won't permit private patients of obstetricians to be delivered in a public hospital.

Why? Why have this ideological blind spot in terms of the cooperation between the public health system and the private health system? When we look around the world—when we look at the health system of the United States—surely we all observe, or we should all observe, that one of the strengths of Australia is a strong public health system and a strong private health system. The two should be working together to provide the best health services to all people, including Queenslanders living and working in our remote and regional communities, who do so much for this country and produce so much in terms of revenue to pay for health services and education services, which, under the Queensland Labor government, they simply aren't getting. It's a travesty. There's a city of 60,000 people without an obstetrician to deliver babies. It's extraordinary, absolutely extraordinary, and I think the people of Queensland should carefully reflect on the situation of our health department and our health system in the lead-up to the next election.

Helen Polley (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

It is now 1.30, so we shall proceed to two-minute statements.