Katie Allen (Higgins, Liberal Party) Share this | Hansard source

I commend the Health Insurance Amendment (Continuing the Office of the National Rural Health Commissioner) Bill 2020, which is to ensure the Office of the National Rural Health Commissioner continues beyond 1 July 2020.

I come from a long line of doctors. My father, Dr Bill Stevens, was the first specialist in Albury many years ago now, in the 1960s. As a child, I grew up with my father being the only specialist for a very large region of the north-east of Victoria. Dad was the adult physician. He was the paediatrician. He was the endocrinologist. He was the gastroenterologist. He was the cardiovascular expert. In fact, he manned the intensive and coronary care unit on his own without any resident staff.

You can probably imagine that, as a child growing up, we were told to answer the phone very formally, because we never knew when it was going to be an emergency or someone inquiring for Dad's services. We said: '212894 Dr Stevens' residence. Can I help you?' That was the typical line that we were taught to answer the phone, because dad was constantly being called out to heart attacks or to strokes or to someone on their deathbed and dying. It was a very informative part of my life: to deal with a community that was having to cope with having one specialist for a very large population.

I've grown up to be a doctor and, in fact, my daughter is also a medical student. And I have a lot of doctors in my family. They're scattered all over in Victoria, including my brother-in-law, Dr Simon Horne, in Point Lonsdale and my sister in law, Dr Rosamund Stobie, in Castlemaine. And I have dear friends who are still in the north-east, including Dr Rebecca McGowan, the sister of Cathy McGowan, the former member for Indi. They constantly tell me updates on how the rural health workforce is dealing with the massive changes that are occurring in the healthcare sector and that affect the regional, rural and remote communities here in Australia.

I would like to say that I'm proud the Morrison government has a longstanding commitment to rural and regional health, and there is always more we can do. This bill builds on that commitment, and it's in an area that I'm extremely passionate about. To be a local doctor in a rural or regional area is a great privilege, serving that community. The GPs in these areas have to deal with so many different diseases. They have to be able to cover them in a very generalist way. Most importantly, going forward, it's important that we understand the difference in health outcomes that occur in rural and remote areas, compared to their metropolitan cousins. On average, Australians living in rural and remote areas have shorter lives. They have higher levels of disease and injury, compared with their metropolitan counterparts. In 2015, the life expectancy for both males and females decreased as remoteness increased. In 2017, potentially preventable hospitalisation rates in very remote areas were 2½ times higher than major cities. Challenge in accessing health care or health professionals is regarded as one of the key factors behind health inequalities. As a metropolitan based physician, this was something that I saw.

I dealt with patients in the field of paediatric gastroenterology and allergy. I was very delighted when we were able to start using telemedicine, because that enabled patients to more easily access review appointments without having to travel for many hours across the state of Victoria to come to see a specialists at The Royal Children's Hospital. Families would have to take a day off work—usually two days off work—to travel from different parts of Victoria, or to fly down if they had to come down from Mildura. Not only was that a costly exercise but also a big time constraint and time impost on that family. Telemedicine has been a great boon to rural and regional medicine. The Morrison government is very proud to support telemedicine. In fact, it was the strengths in telemedicine that enabled the Morrison government's swift response to the COVID pandemic, which we are currently in the midst of.

We saw very early in the COVID pandemic a requirement to ensure that our healthcare professionals were protected and that patients who needed to see a healthcare professional were protected from coronavirus. The ability to access telemedicine—not just in rural, regional and remote areas but also in metropolitan areas—has been one of the great transformative aspects of our healthcare system in response to the COVID pandemic. So, in all this darkness there is some light, and telemedicine and telehealth are among those aspects. The Minister for Health, Greg Hunt, should be congratulated for his swiftness in activating telemedicine MBS rebate items and activating those sorts of services across Australia. Not only did it protect our healthcare professionals and enable our patients to remain safe from COVID but it also protected our PPE, or personal protective equipment, stockpile in a time when we were having some difficulties with our supply chain, early in the COVID crisis, when the world was seeking every mask and every gown around the world.

So, the government has done a lot for rural and remote care. There is a lot more to do, but we are committed to rural and regional health, and this bill is speaking to that very point. We've increased funding every year and will continue to deliver funding to regional hospitals. The Morrison government has launched the $1.3 billion Community Health and Hospitals Program. This has seen $63.4 million for regional radiation oncology centres for cancer treatments. My own uncle—'Lazy Harry', as he's known; he's a country singer who lives in Beechworth, Mark Stevens—was lucky enough to be able to access regional health care for bowel cancer, which he's recently suffered from.

Also, there's a very big intent to make sure that clinical trials are undertaken regionally so that patients in regional areas can access the best and newest novel treatments. In the past, a lot of regional patients have missed out because they haven't been able to travel to the city for the cutting-edge trials that are available to metropolitan based patients. So, it's wonderful that $100 million is invested in regional clinical trials. This is a very welcome development. The Morrison government has also established the Murray-Darling Medical Schools Network as part of a $550 million rural workforce strategy. This will deliver 3,000 additional specialist GPs for rural Australia, over 3,000 additional nurses in rural general practice and hundreds of additional allied health professionals in rural Australia over 10 years.

There have been a number of recent reforms that are very important, which I'd like to make note of today. One of those includes, in January 2020, the rollout of the workforce incentive program Doctor Stream. This has provided targeted financial incentives to encourage medical practitioners to deliver eligible primary care services to rural and remote Australia. These doctors really are quite highly specialised in their ability to do more than just general practice; they are also able to deliver some of the specialty care that they need to do. So, an incentive program is so important, because we know that many doctors travel to metropolitan areas to get their university training and don't return to their home town, and I'm an example of that.

Furthermore, from 1 January 2020 the geographic eligibility for rural bulk-billing incentives was aligned to the Modified Monash Model 2019, or MMM, which ensures that the higher incentives are correctly targeted to practitioners who are working in regional, remote and rural areas rather than in metropolitan areas or larger towns. This is a better targeting of that supplement to ensure that the incentives are correctly aligned with those who are truly distant from where they can access metropolitan services. And, as I mentioned before, we have also rapidly expanded telehealth services, which has improved continuity of care and advice during this difficult time.

The proposed legislation will ensure that rural communities and rural health workers continue to have an independent advocate. This legislation will transform the Office of the National Rural Health Commissioner from being a temporary one to becoming a permanent feature of our approach to rural health reform. I'd like to congratulate the Minister for Health, Greg Hunt, and the minister for rural health, Mark Coulton, for this extremely important initiative to make this into a more permanent office rather than a temporary one. The office will be ongoing in function, and a review of the office's effectiveness and achievements will occur after five years of operation.

It is important to constantly review and assess what we do so that we can continue to tailor and target the effects of what we are committing to. Future commissioners will be appointed on a two-year tenure with options to extend for a second tenure. The office will also take a broader focus, with the National Rural Health Commissioner supported by an expanded office. This will include deputy commissioners, and these deputy commissioners will provide specific advice on vital rural health disciplines, such as nursing, allied health and of course Indigenous health. This approach will ensure the office is well placed to provide advice on an integrated multidisciplinary model of care.

One aspect of regional health that we do hear about from our general practitioners and allied health workers is that working in a team is something that they do miss out on when they're not in large metropolitan centres. Ensuring we have a networked, multidisciplinary and integrated approach to health care in regional areas is not only important for the patients themselves; it's important for the specialist GPs and allied health workers who are working in this environment. It does already occur to a large degree, but we need to do better in this area to ensure, for instance, that a patient who is undergoing palliative care in a regional or remote town has an integrated approach, supported by a GP, a psychologist, a nurse and allied health workers who are helping solve problems together so that the patient can get the best support and advice.

The commissioner position has been a wonderful initiative and is being made into a more permanent position. The inaugural commissioner was Professor Paul Worley. The National Rural Health Commissioner was established on 1 July 2017 and has been at the centre of our response with regard to rural and regional health. Professor Worley has worked tirelessly to consult with and advocate for the rural health sector, and he's brokered the Collingrove agreement, which defines rural generalist practice. His final report will soon be submitted with regard to medical and allied health services.

The office has also provided advice leading to a $62 million investment in the National Rural Generalist Pathway and prepared draft advice on rural allied health reform, including a published literature review. It's very important to look at the role of nurses, speech therapists, occupational therapists, psychologists and the like in care in a generalist setting in these rural areas because often there are not enough healthcare providers and so we need to diversify the advice provided.

During the COVID pandemic, as we've just heard from the member for Mallee, the commissioner worked closely to develop and establish GP-led respiratory clinics, which is important not just for rural and remote areas but particularly for Indigenous communities. I have recently been on the national health and research coronavirus rapid response advisory committee, and a lot of work has been done in protecting our Indigenous communities during the COVID pandemic, including ensuring that they have been quarantined but also that they're getting enough testing to control and contain any possible outbreaks in Indigenous communities.

Most importantly, the office has worked with communities and professionals to help meet the unique needs of rural and remote patients. You really need to have a rural and remote lens to be able to solve the problems, not to have a centralised model where metropolitan services are being provided in an outreach way. It's more important that we have commissioners who actually know what they are talking about from the perspective of the locals.

An initial focus will be to assist with the government's rural response to COVID-19 and its understanding of any longer term impacts of COVID-19 from the drought and bushfires that have occurred in the last few months. Rural and regional Australia has suffered in the last year. It isn't just COVID-19; it's been off the back of the droughts and bushfires. The office will otherwise continue to build on the body of work already delivered while focusing on practical outcomes, including through supporting government delivery of key reforms and programs.

The office will have the capacity, importantly, to conduct an evidence based research approach into issues in rural health. Importantly, it will also focus on the chronic workforce shortages. We all know that we need to ensure that younger doctors train in rural and remote areas because, firstly, they get the opportunity to experience the diversity of work opportunities they have and, secondly, they're also more likely to establish roots, enjoy living in a rural and regional town and develop relationships. There are opportunities for their partners to develop working opportunities. There is a lot more work that can be done, and we do know many universities are starting to provide these sorts of programs—such as the bonded programs at Monash University—to ensure that students can actually get a foothold in a community environment and potentially stay there for the long term.

Promoting rural and regional health is fundamental to helping regional Australia to be a better place to work, live and raise a family. I'd like to commend to the House the Office of the National Rural Health Commissioner and its vital role in achieving parity in health outcomes between rural and regional patients and their metropolitan counterparts.

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