George Christensen (Dawson, National Party) Share this | Hansard source

I rise to speak on the Health Insurance Amendment (National Rural Health Commissioner) Bill 2017. The bill is fulfilling a commitment that we made prior to the 2016 election. The Liberal-National government committed to establishing Australia's first National Rural Health Commissioner to provide an independent, statutory champion for rural Australians and their health. The role of the commissioner will be to work with communities across regional, rural and remote areas around this country as well as the health sector, universities and specialist training colleges. The commissioner will be required to work across all three levels of government to improve policies for rural health and to create better access to health services for all Australians, regardless of where they live.

Life in regional, rural and remote communities is very different from life in capital cities. Unfortunately, most of the Australian population is based in capital cities and most people are very insulated from what might happen outside those capital city limits. Again, unfortunately, most of the representatives in this place also live in, and represent people from, those capital cities. That is why it takes a strong voice from those rural and regional communities to ensure their needs are not forgotten or swept under the carpet.

That is why it is very good to have a representative at the dispatch box in this place like the member for Lyne, who is the federal Assistant Minister for Health. The member for Lyne visited my electorate earlier this month, and we went to the James Cook University rural clinical school in Mackay. That visit gave the assistant minister an opportunity to see firsthand the experiences on offer for medical students under the Rural Health Multidisciplinary Training Program. This Liberal-National government, the Turnbull-Joyce government, has continued to invest in this training program because it helps to address some of the disadvantage experienced by people living outside of capital cities.

We know that Australians who live in the bush generally experience poorer health outcomes compared to Australians who live in capital cities. If we are to address that very, very big issue of disparity in health outcomes between city Australians and country Australians then we need to ensure we have the right number of health professionals in the right areas but, first and foremost, we need to invest in our future workforce. That is exactly what James Cook University are doing with the Rural Health Multidisciplinary Training Program. They are encouraging students to undertake their training in areas where their skills are needed the most, enabling students to see the unique health challenges faced by Australians living in those rural, regional and remote areas. It is fantastic to see that more and more of our young people are choosing to pursue their careers in health and train in regional locations.

When young students are studying at university and training, as the member for Lyne knows very well, being a gastroenterologist, it takes a very long time. It is a time in the life of a health professional in training when, as a young student, just out of university, they are meeting future partners, they are settling down, perhaps they are buying a first house—all of those things that are planting roots in a community. They might even be starting a family. Having young health professionals set down those roots in a regional community or a rural community can be the start of a lifelong relationship with the community which can be rewarding for both the health professional and especially for the health of that regional or rural community.

When James Cook University started the medical undergraduate program that they have now back in 2000, there were 64 first-year students. Prior to that course being available, North Queensland students were forced to travel more than 1,000 kilometres, in some cases more than 1,500 kilometres, from their home to Brisbane or even further south if they wanted to undertake medical studies. Unfortunately, what ended up happening was that those students who came from places like Mackay, Proserpine, the Burdekin, Bowen, Townsville, Innisfail, Ingham, Cairns and all around were going to the capital cities and that is where they were staying—they were doing their training there, they were setting down all of those roots. Last year the number of students enrolled across the six-year course at James Cook University had grown to 1,170, and last year 38 students undertook a long-term placement in Mackay, my home town, with a further 115 undertaking short-term placements in our region under the Rural Health Multidisciplinary Training Program.

This program is effectively keeping young health professionals in regional communities where their future skills will be most needed. The dramatic improvement to health outcomes that such a program can provide are examples of why a special focus must be placed on health policy for regional, rural and remote communities. The National Rural Health Commissioner that this bill seeks to establish will develop a national rural generalist pathway as their first priority. An initial part of the role will be to work with the health sector and training providers to define exactly what it means to be a rural generalist. It is very different from what we have in the cities. Rural generalists are supposed to be not just a jack-of-all-trades but a master of them all. It is going to be the responsibility of the commissioner to ensure that adequate incentives are applied to encourage young health professionals along the training pathway to become a rural generalist and also to ensure that potential obstacles are identified and that we remove them, get them out of the way so that these people can get in these positions as soon as possible. Rural generalists will require additional skill sets, and it is appropriate that their remuneration reflects those skills and the cost and effort that is required to obtain them.

The health of people living in regional, rural and remote communities is dependent upon the expertise and the commitment of our rural health workforce. Addressing the distribution of that workforce is a key priority. We need to ensure opportunities exist for rural medical students to train and live locally and for capital city students to experience the benefits of living and working beyond the major capital cities. The commissioner will work across all sectors to champion the cause of rural practice. More broadly speaking, the commissioner will be required to undertake extensive consultation with various stakeholders. Through that consultation, the commissioner will be able to identify where gaps in the system may appear and where a more focused policy might provide the greatest improvement in health outcomes.

In regional, rural and remote communities, there are particular difficulties faced in nursing, dental health, Indigenous health, mental health, midwifery and allied health needs. During the assistant minister's visit to Mackay, he also met with a group of women who established what is known as the Nude Lunch in Mackay. I am going this year but, fear not, the name is not indicative of a dress standard requirement. The event is called the Nude Lunch because it is intended to 'expose' ovarian cancer. They raised $40,000 in their first year, as a fledgling event, and it is set to become an even bigger and better event in the years to come. One of the main drivers of the Nude Lunch is Trudy Crowley, an inspiring woman who has been diagnosed with ovarian cancer and is committed to providing better support for women in North Queensland, and all over Australia, who are diagnosed with that terrible affliction, ovarian cancer. Currently, there is limited support throughout North Queensland, including my home town, and I believe services are ineffective due to a lack of coordination and communication. It is easy for women in regional communities to feel alone and isolated under these difficult circumstances. They are often far removed from specialist care and have a limited support network—or are not aware of it—of people who have been through the same experience and who are able to provide advice and support. Having to travel more than 1,000 kilometres, often leaving family and loved ones behind, to see a specialist in the capital city is just one more stress placed on women in regional, rural and remote communities that does not apply in the capital cities.

There are also health issues that are more prevalent in regional communities, such as mental health. Ten years ago, Mackay, sadly, had a suicide cluster where a number of young people committed suicide in a short space of time and a report on suicide listed Mackay as having the second highest suicide rate in the nation. On that list, a clear trend emerged: the further a community was from a capital city, the higher the suicide rate appeared. As devastating as suicide can be on family and friends, it has a rippling impact on small communities, where most people know who the victim is or are friends with someone who knows or friends with the family.

In 2010 I made a commitment to address the particular issue of mental health and youth suicide—I did so in my maiden speech, actually. I said I was going to fight for a headspace youth mental health centre in Mackay and I have to say that centre, now delivered, is providing an amazing service across the Mackay region. I believe these centres are indispensable in our regional areas.

It is critical that the government accepts the differences between regional communities and capital cities and addresses those differences and the issues that arise because of those differences. This bill ensures a process will exist to address the inequalities in health outcomes across that city/country divide. The then Minister for Rural Health, Senator Nash, announced the Liberal-National government's decision to establish the commissioner during the 2016 election campaign. That commitment is being met with $4.4 million made available to establish the commissioner through to the end of June 2020. By the end of that term, the functions of the commissioner will have been completed. The commissioner will be an independent statutory officer with some duties directed by the minister responsible for rural health, and I assume that will be the member for Lyne.

In addition to creating and funding the role of commissioner, this bill will also repeal redundant legislation. Sections 3GC and 19AD of the Health Insurance Act 1973 will be repealed. These repeals were approved by the Prime Minister in 2015, and they were measures included in the Omnibus Repeal Day (Spring 2015) Bill 2015. While that particular bill was passed by the House, it was not debated in the Senate, due to the calling of the 2016 election. Specifically, the repeal of Section 3GC will abolish the Medical Training Review Panel. There is no net loss resulting from this repeal, because the service overlaps with the function of the National Medical Training Advisory Network; and the network has agreed to assume the functions of the panel and included them in the agreed terms of reference. An added bonus of this bill is getting rid of bureaucratic double up. The legislative instrument, by which the panel was created, expired at the end of June last year, and so this particular repeal is simply removing redundant legislation.

Section 19AD, which this bill also seeks to repeal, was designed to produce a report every five years on the operation of various sections of the Act, including 3GA, 3GC and 19AA. The report was to identify any unintended consequences arising from those sections and the regulatory burden of Medicare provider number legislation. The three reports produced so far have not identified any areas of concern, and the view expressed in the last report was that the legislation was well settled. Importantly, the repeal of Section 19AD will not affect any medical practitioner who is subject to the legislation and will not affect the operation of any current workforce or training programs. However, the repeal will remove the burden of continually reviewing the operation of legislation that is already well settled, saving taxpayers money and making a lot less work for bureaucrats—work that could be put into other areas for the effective delivery of health.

Rural, regional and remote Australia is the heart and soul of this country, providing so much in productivity and economic benefit, of which few people in the city are aware. Regional and rural communities put food on the table; they put clothes on our back. And yet a national survey in 2012 found that three-quarters of year 6 students thought cotton socks came from animals and a quarter of students thought yoghurt grew on trees. Remote communities provide the nation's wealth through mining and exports, and yet activists in the cities want to shut down the very industries that provide jobs and the taxes they want the government to spend.

There is a disconnect between cities and the real world. It is almost as if out of sight is out of mind. We cannot allow the health of our rural Australians to be left out of sight and out of mind. When the regions are so important to the health of the nation and the health of our economy, the very least we can do is to ensure the health of those living in the rural, regional and remote communities is good enough for them to continue to live there and continue to do the hard work for this country. This bill establishes a means by which rural health is put in plain sight and firmly placed into the minds of government. This bill creates a role with that purpose, and the result of this role will be better health outcomes for all Australian, regardless of which side of the city-country divide they find themselves.

See this speech in context