Julie Owens (Parramatta, Australian Labor Party, Shadow Parliamentary Secretary for Small Business) Share this | Hansard source

I applaud the member for Shortland for making such a definitive and accurate statement at the end of her speech—that this is incredibly bad legislation. The background to the Health Workforce Australia (Abolition) Bill 2014 is quite interesting and in many ways it mirrors the history of a bill we discussed yesterday, which was the Energy Efficiency Opportunities (Repeal) Bill 2014. The Health Workforce Australia (Abolition) Bill 2014 and the Energy Efficiency Opportunities (Repeal) Bill 2014, which we discussed yesterday, both have their beginnings in the last years of the Howard government.

COAG commissioned a report from the Productivity Commission on Australia's health workforce back in 2005—again in the last years of the Howard government. It was quite forward-thinking: looking ahead to the ageing of the population; looking at the uncoordinated and complex arrangements across the states and the federal government; and looking at the lack of management of Australia's workforce, education and training as we move into the future. That report came down and a few years later, in 2008, the Council of Australian Governments, which had commissioned the Productivity Commission's research, agreed with the then federal government to provide a combined funding of over $3 billion to a national partnership agreement on hospital and health workforce reform—an incredibly important and quite difficult agreement to reach, but reached by all state governments and the federal government because they recognised and understood that there was a serious lack of forward planning and a lot of waste and inefficiency in the way that this nation managed the development of its health workforce.

As a result of that partnership agreement, Health Workforce Australia was formed in 2009. This organisation had a complex task in front of it, including the funding, planning and coordinating of clinical training across all health disciplines, the funding of simulation training, supporting health workforce research and planning and progressing new workforce models and reforms. All reports of the work done by Health Workforce Australia are positive. It has done remarkable work. It released in 2012 a report looking at the needs of the health workforce through to 2025.

I note the comments of previous speakers that Health Workforce Australia has in fact been so successful that it has now done its job. They said the same thing yesterday about the Energy Efficiency Opportunities Program—that, in a short period of time, it had done a remarkable job and had already succeeded. That, of course, is clearly untrue. We all understand that we still have chronic shortages of GPs and specialists in regional and rural areas. We understand the ageing of the workforce and the changing needs of the health workforce and what that will lead to. We understand the rise of preventable illnesses, such as diabetes type 2, obesity and liver and kidney failure. We recognise the changing demographics of this country and how that will impact on our health needs. Having an organisation like Health Workforce Australia to plan how we respond to those changing needs is incredibly important, because, if you discover that there is a shortage in one area, it takes a country 10 years to actually train from scratch the expertise that it needs to respond to that shortage.

I note that in parallel to this abolition of Health Workforce Australia—which would address those training needs in the long run—the current government have also made it easier for people to come in on 457s. So perhaps their intention is to return to the Howard years, when the training needs of the health workforce were not being met and the solution was to bring health professionals in from elsewhere. While we probably as a nation of our size will always need to do that, if it is possible to look far enough ahead for Australians to actually be trained in the fields that we require, that is a far better option for our people and for the nation.

I also want to talk about this notion that abolishing Health Workforce Australia is about efficiency and cost reduction. The current government has a very strange concept of cost, in that for them it seems that the only cost that matters is the bottom line of the federal government. But in the system of federalism that we have, where we have six states and a Commonwealth government, in order to reduce costs across the nation, in order to make the nation more efficient, in order to reduce the nation's costs, you actually have to do it in a way which does not just transfer the cost from one government jurisdiction to another. When Health Workforce Australia was first formed it pulled the roles from those states into a central place.

So it reduced duplication and inefficiency in the planning mechanism for our health workforce and created a more efficient system for the nation. True, it was an additional cost for the federal government but it was a reduction in costs for many of the departments around the states, and I would say also a reduction in costs for people who had invested considerable time in their health workforce training through university who were finding it very difficult to get clinical placements.

Again, you cannot look at reducing costs and efficiency without looking at how your policy impacts on the costs of families and the budgets of students. We knew back in 2008 and we still know that there are areas of the workforce where people are graduating from the university component of their training and finding it incredibly difficult to get the clinical placements they need. If we as a nation are supporting the training of health professionals through an extremely complex and expensive university course only to leave them sitting idle out of the health workforce because they cannot get that all-important clinical placement, the waste and inefficiency is quite extraordinary. It is not on the bottom line of the government—this government seems to care about its own bottom line—but it is on one of the bottom lines that forms the wealth of this nation.

In one of my earlier lives I worked at the Australia Council. One of the jobs I had quite early on was to reduce the paperwork burden for our many clients. I managed to do that quite considerably. I introduced a number of mechanisms which substantially reduced the reporting requirements—and through the application process as well. One of the things you learn early on when you set about doing that is that the easiest path you can take is to move the cost to someone else and the most difficult path you can take, which is the most effective, is to make the costs disappear completely by making an element of the work unnecessary.

This bill, strangely enough for a government which talks about efficiency and cost cutting, takes that easy approach. It improves the federal government's bottom line by transferring the inefficiency and the cost through to state governments and to people who engage in study, who may not be able to find the clinical placement that will allow them to give back that investment by the taxpayer and their families in their education.

It is always worth looking at the views of stakeholders when a government puts up a proposal such as this because it is quite common when governments suggest abolishing something that looks like regulation that the field will say, 'Yes, good idea, let's go there.' If we listen to the government, they seem to believe that everybody wants the removal of all regulation, regardless of whether it has a benefit. But, if you look at the comments made by the major interest groups, there is almost universal support for the work that Health Workforce Australia has done. There are the usual small concerns about clarify of purpose where there might be duplication with a federal department, all things which the stakeholders say can be easily fixed, but overwhelmingly the support is there. In the Bills Digest prepared by the Parliamentary Library there is quite a lengthy report on the positions of major interest groups, which states:

A Medical Observer article following the Budget quoted medical experts who condemned the proposal to merge General Practice Education and Training with Health Workforce Australia (HWA) and consolidate them into the health department. In the view of the President of the Royal Australian College of General Practitioners, Liz Marles, ‘the move would risk destabilising general practice training’.

The second expert:

Public Health Association chair, Michael Moore, labelled the plan short-sighted. Moore argued that the merged organisations would not have the same independence nor influence if they were combined with the health department.

The third expert:

Professor Simon Willcock, who has sat on the boards of both organisations, also pointed to the good work HWA had done in developing databases and around workforce projections and lamented that it would be a shame to see all that work not continue.

… Croakey blogger Jennifer Doggett’s opinion was that it was difficult to assess what effect mergers, abolition of agencies and rationalisation would have on the health sector as insufficient information had been given about what function … of the organisation would continue—

and where again an incredible lack of certainty about what this change means for the work that Health Workforce Australia is doing. She also said:

… there are also risks that some valuable and cost-effective activities being undertaken by these agencies will cease.

Prior to the 2013 election, the Australian Medical Association made comment on a whole range of coalition policies. The AMA is traditionally supportive of conservative policies but it said clearly prior to the 2013 election that it would 'oppose any cuts to the planning and analysis done by Health Workforce Australia'. After the election, in October 2013, Australian Medical Association President, Steve Hambleton, emphasised the value of Health Workforce Australia during a meeting with health minister, Peter Dutton. It is worth noting that the AMA continues to support the work done by and the existence of Health Workforce Australia. As I said earlier, there are some small criticisms occasionally of agency’s recommendations and some questioning of duplication, but they are things that a good government would set about fixing, things that a good government would set about making stronger. A good government would look at the efficiencies that have been gained since this organisation was formed back in 2009 and build on them. A good government would work to improve the efficiency of our training spend in the areas of the health workforce.

In spite of comments from government members that the whole thing has been fixed now and we can abolish this organisation because it did such an extraordinary job in four years that it is no longer necessary, we know that that is not the case. Australia is one of the least self-sufficient nations among comparable OECD countries in terms of meeting our health workforce needs through domestic training efforts. Part of that is because of the decisions the Howard government made to cap training places for doctors and we in government dramatically increased the number of places for both doctors and nurses and the number of clinical places as those people moved through the university to try to address that, yet we remain even now, some 10 years later, a country that is not as self-sufficient as many other comparable nations in the domestic training efforts for our health workforce. Immigrant health workers in OECD countries, in the broader context of highly skilled migration, are incredibly important, as they are in Australia. But we can lift our game in the training of Australians, for these incredibly important jobs in an area that is only going to grow as our population increases.

There is a second issue which we need to address as well, which is the decline in GP proceduralists as a proportion of the total GP work force, particularly in regional, rural and remote areas—from 24 per cent in 2002 to 12 per cent in 2000. That is an extraordinary halving of the proportion of GP proceduralists in regional, rural and remote areas. We also know that there is a growing gap, for example, between the fees that GPs are paid and the fees that specialists are paid, which means that fewer and fewer people remain in the GP area and more and more move into specialist areas. That is an issue which will affect our capacity to serve our population in primary health care and in many ways to keep our population healthy.

It is a mistake to abolish Health Workforce Australia. It was formed in 2009 after a Productivity Commission report back in 2005, at the request of all of the state governments and the federal government at the time. It is serving an incredibly valuable purpose in ensuring that our health work force is appropriate to the needs of the country. It is doing it incredibly well. Its work is not done, and it should be left alone to do its incredibly important work.

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