Bob Baldwin (Paterson, Liberal Party, Shadow Minister for Defence Science and Personnel) Share this | Link to this | Hansard source

I rise today to speak on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. This legislation encourages overseas trained doctors and former overseas medical students to practise in rural areas of Australia, as well as in those regions suffering from a shortage of doctors. These regulations came about in the mid-1990s when society began to notice an increasing doctor shortage in rural areas. Policy thinking started to change and the Howard government introduced initiatives to address the inequitable distribution of our medical workforce between country and city, the latter being the most popular for medical professionals.

Our Constitution prevents governments from using legislation to conscript Australian doctors to work in particular regions based on geographic location, demographics or otherwise; thus, these initiatives soon focused on overseas trained practitioners, as is the case with this bill. Normally, overseas trained doctors cannot provide services which attract Medicare benefits until a decade after they become both a medical practitioner and a permanent Australian resident or citizen. However, these doctors can claim exemption from this moratorium if they work in an area of dire workforce need or in rural and remote parts of the country.

One of the main provisions in this bill would remove current restrictions on New Zealand doctors who have attained their qualifications at an accredited medical school in Australia or New Zealand. The change would reclassify these doctors so they are no longer considered overseas trained and thus would not be subject to the 10-year moratorium. The bill would also establish a time period in which doctors can appeal against the refusal to grant an exemption or a decision to impose conditions on an exemption which has already been approved. Further, this legislation would allow doctors to start this 10-year period without having both Australian permanent residency and medical registration. Instead, these doctors would be able to start work and be recognised in retrospect as long as these conditions were met any time within the decade of practice. As a result, it is expected that upon commencement of the bill a number of overseas trained doctors will have completed the moratorium. If a doctor should complete his or her decade of service without having become a permanent Australian resident or a citizen then the restrictions will remain current until they do so.

One of the main technical aspects of this bill is to replace the term ‘former overseas medical student’ with ‘foreign graduate of an accredited medical school’ to minimise confusion amongst doctors. It is hoped the new term more aptly conveys its meaning—that is, a person who gained their qualification from an Australian medical school but was not a citizen or a permanent resident of this country at the time they enrolled. Another term will explain the definition of an accredited medical school as one accredited by the Australian Medical Council and located in either Australia or New Zealand.

I am generally supportive of this bill and I hope it will encourage medical professionals to practice in my electorate of Paterson. Locally, residents battle with a chronic shortage of doctors, in particular general practitioners who bulk bill their services. Just last week the headline of our local newspaper, the Newcastle Herald, screamed ‘Doors close as Hunter GP shortage hits critical’. The articles reads:

DOCTORS in the Hunter treat twice as many people as some of their Sydney counterparts and are increasingly shutting their doors to new patients due to overwhelming demand.

               …            …            …

Figures obtained from GP Access, formerly known as the Hunter Urban Division of General Practice, show that about 40 per cent of the region’s 145 urban practices in Lake Macquarie, Maitland and Newcastle, can’t cope with the demand for services and have closed their books.

A further 27 per cent will accept new patients only if they live in the postcode of the surgery or have a relative who is an existing patient.

In some parts of the Hunter there are more than 2000 residents for every full-time GP, while there are fewer than 800 per GP in some areas in Sydney.

The Hunter urban division has an overall ratio of 1595 people for each GP, about 40 per cent higher than the state average at 1120.

GP Access chief executive Mark Foster said the area would need an additional 95 doctors to bring it in line with the industry accepted standard of one GP per 1200 people.

Dr Foster said GPs were free to choose where they wanted to work and traditionally gravitated to large urban centres.

These figures explain the critical shortage of doctors in the Hunter region. One such crisis area in my electorate is Dungog, where there are 2,189 people for every doctor. This ratio of people to doctors is almost double the industry accepted standard. Similarly, in Maitland the ratio is 1,951 to one and in Port Stephens it is 1,547 to one. Clearly, my residents struggle with a lack of doctors, forcing them to wait long periods for medical help or otherwise seek assistance from the emergency departments of nearby hospitals. Unfortunately, these facilities are also stretched to the limit.

In the first quarter of this year, for example, half of all patients at the Calvary Mater Newcastle emergency department who needed to be admitted waited more than eight hours for a bed. The NSW Health benchmarks also reveal one in five had to wait longer than eight hours to be admitted to the John Hunter Hospital, and it was the same at Maitland Hospital. Many constituents from my electorate are serviced by these hospitals and, once you include the distance they must travel to reach them, it is abhorrent that they then have to wait more than eight hours for a bed. It is also important to note that one of the main reasons suggested for this poor performance is a lack of beds because our state and federal governments simply have not provided life-saving doctors and nurses with all of the facilities they need. In terms of elective surgery performance, the numbers should also be a lot better. The average wait time for category 3 surgery at the Calvary Mater was 220 days, 240 days at the John Hunter and 150 days at Maitland. This is simply not good enough.

Two years ago, our Prime Minister, Kevin Rudd, promised he would take responsibility for fixing our health system and that the buck stopped with him. As these statistics prove, he clearly has not done so. In fact, the only part of his promise he seems to have kept is to stop the buck, which in this case means stopping the provision of vital health funding for those who need it the most. While these hospitals are not positioned within my electorate, they do service thousands of my constituents every year who are forced to travel for treatment to a major hospital. As a result, they desperately need more cash to upgrade facilities and ensure they can cater for further rises in population and demand.

The Maitland Mercury reported the shocking experience of one such patient from my electorate in last Monday’s edition. It reads:

When Wallalong’s Peter O’Brien was diagnosed with prostate cancer in January he knew it would be a long hard road to recovery.

But what he didn’t realise was that road would be literal when he was forced to drive the 72km round trip to Newcastle five days a week for two months to receive radiotherapy.

Mr O’Brien spoke to the Mercury on Friday ahead of the airing of ABC’s Roadblocks to Radiotherapy—stories behind the statistics.

He was one of more than 260 callers who flooded the Cancer Council Helpline in March to share their personal experiences with radiotherapy in NSW, leading to the report highlighting the issues that leave up to 5000 patients without treatment each year.

The 69-year-old completed his treatment in April of this year, but said he couldn’t have made it through without the support of family, friends and neighbours.

‘Being diagnosed with cancer is traumatic enough without having to worry about how you’re going to get to your treatment,’ he said.

‘I was quite surprised when I was diagnosed that there wasn’t somewhere in Maitland that could help me.

‘The commute wasn’t so bad to begin with, but after a few weeks you start get tired.

‘If it wasn’t for my neighbours and friends, who started a roster to alternate who would drive me to my treatment, I don’t know what I would have done.’

Cancer Council Hunter Region manager Christine Roach said something had to be done to unblock the State’s clogged radiotherapy services.

‘Enough is enough,’ she said.

‘Patients shouldn’t have these pressures piled on them when going through one of the most stressful periods of their lives.’

Here is a man who is battling with a traumatic and life-threatening cancer and yet he cannot access the services he needs locally. I wonder whether the Rudd Labor government really cares about, let alone understands, the needs of these people who are clearly being failed by the Rees state Labor government and need support from our nation’s leader.

Another constituent, Bill Seoullis, moved to Mallabula with his wife, Carol, three years ago from Sydney. Bill has a heart condition and needs to see a GP on a regular basis. Soon after moving to Mallabula, Bill contacted a doctor on the Tilligerry peninsula for an appointment and was told, ‘The books are closed.’ So he tried another and another and another, but the answer was the same. Bill, having moved from Sydney, did not even contemplate that a simple visit to a GP would pose a problem—and it should not. Yet sadly it has and, sadly, Bill still has to go to Sydney for treatment.

The New South Wales President of the Rural Doctors Association and Hunter-New England Area Health Advisory Council member, Dr Ian Cameron, has also raised fears. In last week’s Newcastle Herald, he questioned the effectiveness of federal and state government initiatives designed to attract doctors to areas in need. These initiatives have failed to stop the decline in qualified GPs in my electorate, with many more approaching retirement. In fact, in the greater Hunter region more than half of the doctors are more than 50 years of age and, even more concerning, one in five is over 60 years of age. Thus, in little more than a decade we look set to lose more than half the region’s current doctor workforce. This is a shocking and worrying statistic for the thousands of residents across my electorate, who are already facing long delays in appointments. It is of major concern that there is no action to attract young doctors and their families into regional and in-need electorates such as Paterson, where most of the doctors are in the latter part of their professional careers. Further, since overstressed GPs have already started to close their books, where will patients go when their family doctor closes shop to enjoy his or her own retirement?

The issue of age is also concerning when taking into account local residents and their needs as patients. Much of Port Stephens and Forster-Tuncurry is coastal land popular amongst retirees. Thus, a large portion of my constituents are elderly, and this number is only expected to grow. According to the Australian Bureau of Statistics, the number of Australian residents over 65 will double within three decades. Local councils, including Port Stephens, have identified the need to plan for our ageing population and improve pertinent services including public transport and community support networks, but what are Kevin Rudd and his Labor colleagues doing to prepare? GP Access chief executive Mark Foster has explained that the elderly need triple the care of younger people. In Paterson, where the number of elderly is already higher and growing, this means the number of patients demanding medical services is climbing at an exceptional rate. Since our health system is already struggling, I fail to see how it will cope with such a massive rise in demand.

The stories of our doctors go a long way towards putting this crisis into perspective. My local constituent and fellow of the Australia College of Remote and Rural Medicine, Dr Warwick Yonge, is among those who will establish and run a GP super clinic at Nelson Bay. He has complained during discussions with my office there is not one doctor on the Tomaree Peninsula who advertises bulk billing. He also tells me there is a severe shortage of doctors in the community, which has in turn lowered competition and led to a rise in consultation fees. These consultation fees sometimes can be $75 for a short consult and patients can only claim a small fraction—often less than half—back from Medicare. Doctors complain that these rebates are moving further and further away from reality, making it harder for GPs to cover day-to-day costs.

This is yet another price tag local families simply cannot bear. Since the Rudd Labor government started its attack on our health system, we have seen the rebate cut for pain-relieving joint injections which improve the lives of so many and we have seen the rebate cut for cataract surgery, which is truly a life-changing procedure and will now be out of reach for so many. These cuts hit hardest on the hip pockets of our most vulnerable residents—the sick, the poor and the elderly. And yet the Minister for Health and Ageing, Nicola Roxon, has pushed ahead without regard, to save a few pennies.

Where were these budget considerations when the Rudd Labor government was handing out $900 stimulus payments, many of which were lost overseas? Where were these budget considerations when the Rudd Labor government was handing out $1,600 insulation rebates, inflating the cost of roof batts and costing taxpayers millions of dollars in excessive rebates? I can only surmise that Kevin Rudd no longer cares about the sick in our community.

Last Tuesday marked two years since the Prime Minister was elected—two years since he promised to fix our hospitals, and yet nothing has been done. My constituents are sick of Kevin Rudd’s hot air, his spin, his inaction. Last Tuesday in question time, despite his promises two years ago, Kevin Rudd was forced to admit ‘there is a huge problem in the nation’s public health system’. Yes, Prime Minister, we realise that, but where is the action?

Another of my constituents, Dr Malcolm Fairleigh, has been trying to attract a second doctor to help run his practices for the past three years, without success. He stresses that while overseas trained doctors are sometimes available, his offices at Pacific Palms and Nabiac are not sought-after work destinations. According to Dr Fairleigh, this is because there are plenty of other practices in areas of need which are closer to major regional centres and therefore more attractive.

Dr Farleigh now faces the prospect of having to close both his practices if he cannot find a colleague in the next six months. He is tired after not even being able to take a holiday without having to close both offices and deal with anger from residents, who are unable to sit and just wait for a GP. This would be a massive loss to both the Pacific Palms and Nabiac communities, which rely on his services so they do not have to travel for medical help. This is not to mention the relationships and knowledge which will be lost if he is forced to give up after years of commitment to our local community—a community which might never see another doctor’s surgery, under the current lack of Rees state Labor and Rudd federal Labor government action.

These examples highlight the need for many more doctors across my electorate of Paterson. The Rudd Labor government has not done enough to ensure that incentives are in place to attract doctors to centres which need them the most. Hardly a week goes by when I do not meet or speak to a local constituent who is unhappy with the provision of GP services, and this is clearly a reflection on the state and federal governments. They owe it to those doctors who give up their holidays and weekends to facilitate a health system where the needs of both patients and doctors are met.

That is not to say, however, that the staff at hospitals in my region do not do an outstanding job with what little they are given, because they do. I would like to take this opportunity to say thank you to the doctors and nurses within the Paterson electorate at Gloucester, Bulahdelah and Dungog public hospitals, at the Tomaree polyclinic and at Forster Private, which leases 20 beds to the public system. I would also like to recognise the staff who support locals who cannot be treated in these facilities; namely, those at the Maitland Hospital, the John Hunter and Calvary Mater.

Local nursing homes also play a massive part in catering for the health needs of my elderly constituents. In my constant travels across Paterson and visits to aged-care homes I have met many amazing people whose kindness and care have allowed patients to live with dignity and largely without pain. The Regis Gardens nursing centre, at Salamander, is one such facility which does amazing health work in our local community. It was opened just five years ago by the Deputy Leader of the Opposition, Julie Bishop, and now boasts 150 beds and professional consulting rooms. Other aged-care facilities include the Gloucester, Great Lakes, Bulahdelah and Forster/Tuncurry nursing homes; Lara Aged Care at Dungog; the Raymond Terrace Gardens Nursing Centre; Stroud Lodge; Myall Lodge; Kularoo Gardens and Barclay Gardens at Forster; Beaumont Terrace and Glaica House at Tuncurry; Shoal Bay’s Harbourside Haven; Fingal Haven Village; Uniting Care at Salamander; Tanilba Bay Hostel and Largs Lodge. I would like to say thank you to all those staff in my electorate who work in collaboration with local GPs and who keep their centres running despite the shortage of doctors. These doctors usually run their own practices, fill in at the local hospital or a polyclinic and service the nursing homes. The strain placed on them is so high I can only pay tribute to them for their commitment and battle here today on their behalf to help find a solution.

All this paints a scary picture for patients in Paterson. Emergency departments are overstretched, waiting times for GPs are growing, doctors are closing their books and demand from the elderly is increasing. While this bill will go some way towards encouraging more medical practitioners to set up practices in our region, what we really need is more action from the Rudd Labor government. We need more incentives to encourage doctors to practise in areas of workforce shortage. Without them families across my electorate will continue to suffer, both from unnecessary delays in treatment and from the physical ailments which forced them to seek help in the first place. If the Rudd Labor government cannot provide adequate medical services for the nation, then it has failed the people who believed in Kevin Rudd’s promises to fix our ailing health system.

James Bidgood (Dawson, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak in favour of the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. Before I launch into my prepared speech, I would like to address some of the issues that the member for Paterson has raised. I would like to ask him, through you, Mr Speaker, this: what did the Howard government do for the last 11 years? We do not just suddenly have this situation after two years. We have a situation where for 11 years the previous government failed to invest in extra doctor and GP training, extra nurses and extra provisions for the healthcare service. That is why the Rudd Labor government has had to come on board and do a complete review of the whole national health service across this nation. We have come up with 123 recommendations which are now before the government for consideration. So to the member for Paterson I say let us not have any more of this blame game, which you have continued with for 11 years, between the federal government and the state governments. You ripped $1 billion out of the states’ healthcare systems. Let us have no more of this deceit. Let us have the truth on the table. Why didn’t you have the political will to train more GPs in rural areas? Why didn’t you double the number of GPs being trained? You did not have the political will and you did not have the courage to take on the real hard issues and the hard causes of the nation. That is why it has been left to this Rudd Labor government to truly deliver for the nation of Australia, and I know we will deliver for the people of Dawson.

I now want to go to the substance of the bill. Its substance is to streamline the operation of section 19AB of the Health Insurance Act 2009 and to remove a number of anomalies. Section 19AB of the act provides that overseas trained doctors and former overseas medical students are not able to provide professional services that attract Medicare benefits for a period of 10 years, otherwise known as the 10-year moratorium. The bill amends the class of persons subject to the restrictions of section 19AB and amends the start date of the moratorium period. This bill is about providing for New Zealanders who study in Australia to be treated in no different way from Australians studying in Australian universities.

This bill benefits the many Australian citizens who elect to study at New Zealand medical schools. These are medical schools which are accredited by the Australian Medical Council, the AMC, to the same standards as Australian medical schools. However, as these Australians did not gain their primary medical degree in Australia, they are also subject to section 19AB of the act—being trained overseas.

In the medium to long term it is likely that changes in the bill will see an increase in the number of doctors working in non-metropolitan areas. A larger number of properly trained doctors is a win for our system and something which the previous government should have addressed in its 11 years in power but obviously failed to do.

As stated before, the main provision in the bill relates to the removal of current restrictions applicable to doctors who are New Zealand permanent residents and citizens who have obtained their primary medical education at an accredited medical school in Australia or New Zealand. The change effectively removes these doctors from the classification of ‘overseas trained doctor’ and the ‘former overseas medical student’, now to be termed ‘foreign graduate of an accredited medical school’ in section 19AB of the act.

Another important provision in the bill is the removal of the requirement for overseas trained doctors and foreign graduates of an accredited medical school to have both Australian permanent residency or citizenship and medical registration in order for the 10-year moratorium to commence. Specifically, the bill will amend the Health Insurance Act 1973, known as ‘the act’, to make four major changes: (1) removal of persons who are permanent residents or citizens of New Zealand and who obtained their primary medical education at an accredited Australian or New Zealand medical school from the classification of ‘overseas trained doctor’; (2) amendment of the classification ‘former overseas medical student’ to ‘foreign graduate of an accredited medical school’; (3) removal of the requirement for overseas trained doctors and foreign graduates of an accredited medical school to have both permanent residency and medical registration in order for the 10-year moratorium period to commence; and (4) introduction of a maximum period of 90 days in which medical practitioners can appeal against a decision to refuse to grant an exemption or a decision to impose conditions on an exemption pursuant to subsections 19AB(3) and (4) of the act.

The amendment takes into account the awareness of the Department of Health and Ageing that overseas trained doctors enter Australia via New Zealand, with the majority of these doctors obtaining New Zealand passports as a result of New Zealand’s different entry and citizenship laws. It is not intended that this proposed amendment be extended to medical practitioners whose primary medical education was obtained outside New Zealand or Australia. A significant number of temporary resident doctors, including New Zealand trained doctors, work in a district of workforce shortage for two to five years before gaining permanent residency or Australian citizenship. When the 10-year moratorium is applied to their tenure, these doctors may be obliged to work in a district of workforce shortage for up to 15 years.

This amendment proposes that the 10-year moratorium will commence from the time the medical practitioner is first registered as a medical practitioner in Australia and will cease after 10 years, provided the medical practitioner has gained Australian permanent residency or citizenship during that period. It is anticipated that a number of overseas trained doctors and foreign graduates of an accredited medical school will be taken to have completed the 10-year moratorium at the commencement of the amendment. Documentation will not be required to transfer the status of persons following commencement of the bill—that is, the department will not require the lodgement of any documentation; for example, visas or citizenship documentation in support of the change in status at the commencement date of the bill. Should the medical practitioner not have obtained Australian permanent residency or citizenship by the conclusion of 10 years from first gaining registration, the restrictions will remain in force until the medical practitioner gains permanent residency or citizenship.

I speak with some authority on this, having been the owner and financial director of two medical centres in Mackay, looking after the healthcare records of 40,000 people and managing 10 GPs and 30 staff. I know the difficulty there is in obtaining medical care for urban rural areas such as Mackay, and also areas such as Proserpine, the Whitsundays, Bowen, Ayr and South Townsville. I know these dilemmas of registration. I know that attracting Australian-trained doctors is difficult, even to somewhere as beautiful as the seat of Dawson, with over 74 tropical islands—possibly the best in the world; yet we still have trouble attracting Australian-trained doctors.

As I mentioned earlier to the member for Paterson, the reason for this difficulty is the failure of the last 11 years of the previous Howard government to have the political will to invest in more GP training. And I do take on board that there need to be incentives to move to rural and regional Australia. I know from my own personal experience that if we were to say to all the people who are not trained in Australia as doctors to leave, I can tell you now that Mackay Base Hospital would close down and a lot of the surgeries across Mackay and the seat of Dawson would also close. That is quite a damning indictment of the previous government because, as most people know, it takes at least 10 years to train a medical student and then take them on to GP training as well.

I am glad to say that JCU in Townsville is training up doctors, and I will give credit where credit is due—that was done by the previous government. But the criticism that we had at the time, as a medical centre owner and also politically, was that it was not enough. It was a good start—we recognise that—but it could have been so much more. If the capacity had been built when those original decisions were made the supply would be a lot stronger right now and we would not be having the problems that we are having in trying to meet the healthcare needs of our good citizens in rural and regional Australia.

I can say from my own personal experience that that was a good move, but the best move is what the Rudd Labor government is doing. We are taking on a full and comprehensive analysis of the whole healthcare system across Australia. The final report on the national healthcare system of Australia has been presented to the government with 123 recommendations. Those recommendations have been taken far and wide by the members of this House, by the Prime Minister and by the Minister for Health and Ageing. Over 70 consultations directly with peak bodies in the health profession have taken place. I organised one at the Mater Hospital in Mackay. Through the Mackay Division of General Practice I invited GPs and peak leaders of the health profession from hospitals and all of the specialities to come along and give their views. Many have also given their views by emails as well and those emails have all been submitted to the Minister for Health and Ageing and the Prime Minister.

This is exhaustive consultation and it should have happened in the last 11 years. The previous Howard government has left us with a healthcare system that was not efficient, that was riddled with problems and that was underfunded to the tune of $1 billion—it was ripped away from the states by the previous federal government. We are addressing workforce issues; we are investing in more elective health surgery—we have done that; and we are investing profusely across the nation in training up more GPs and nurses. This is the way to go. This is what should have been done previously.

My experience with overseas-trained doctors is that they are really diligent when they come to this country—as my former wife did—and work hard to make a difference in the communities in which they serve. Obviously there is due process and due accreditation, which are the right and correct things to go through.

I can truly say thankyou to all the overseas trained doctors who come and serve due to the lack of our own Australian trained doctors. Again, I put that squarely on the former government of the last 11 years. It was squarely their responsibility to foresee the population increases. They knew that the population was going to grow and yet they failed to meet the capacity demands that were coming. Any government with vision can see these things coming. Any government with an eye on the long term and not the short term can see these issues coming down the track. We, the Rudd Labor government, are a government of vision. As I have said before in this place, and I will say it time and time again, the Bible is true when it says that a nation without a vision is perishing, a leader without a vision is perishing and, where there is no vision, the nation does perish. We need to have vision in health, in education, in housing and in industry. We need to look after the citizens of Australia. We need to give them the best health care, the best education, the best housing and the best opportunities in life as our nation grows.

We also need to have the best education to understand the complexities of climate change—which, as we know, is very topical at this moment in time, particularly with the opposition party completely and utterly divided. The old adage is true that division is death. If you cannot govern yourselves, you cannot govern the nation. You failed to govern the health system proficiently to provide for the future. This bill goes towards that. This bill helps make the capacity designs that we need in our health service by allowing New Zealand and overseas trained doctors to come on board and to be recognised equally alongside Australian trained doctors. I wholeheartedly back what this government is doing in its complete analysis and review of the whole healthcare system in meeting the true healthcare needs of this nation. I commend this bill to the House.

Nola Marino (Forrest, Liberal Party) Share this | Link to this | Hansard source

I rise to speak on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009, which aims to streamline the operation of section 19AB of the Health Insurance Act 1973 and to remove several anomalies. The bill will remove the restrictions imposed by the act on New Zealand citizen and permanent resident doctors in relation to their access to the Medicare benefit arrangements. It will also remove current restrictions on New Zealand doctors educated at accredited medical schools within Australia and New Zealand. Under this legislation they will no longer be subject to the 10-year moratorium on access to Medicare benefit arrangements and will be removed from the classifications of overseas trained doctor and former overseas medical student.

The bill will also change the start time of the moratorium for other overseas trained doctors, who are currently required to have both residency or citizenship and medical registration before the moratorium begins. Under this legislation the moratorium will start from the time doctors receive medical registration with consideration given to doctors’ working visas before obtaining residency or citizenship. Another change is the introduction of the time period in which medical practitioners can appeal against the refusal to grant a section 19AB exemption or a decision to impose conditions in connection with an exemption that has been granted. Currently, the act does not have a time limit to apply for the review of a rejected exemption application. This amendment will create a provision in the act that will allow applicants to apply for a review of a decision within 90 days of that refusal. The legislation would also include a 90-day period for a review of a decision to impose one or more conditions on that section 19AB exemption.

This bill could be considered uncontroversial—and it is—with major stakeholders including the AMA, rural doctors and the RACGP supporting the bill and considering it a positive change. Furthermore, the Senate Standing Committee on Community Affairs had no comment to make on this bill and it has not been referred to a senate committee for inquiry or report. Overseas trained doctors and former overseas medical students have generally been restricted from providing professional services which attract Medicare benefits for a period of 10 years commencing on the date that the person becomes a medical practitioner and a permanent Australian. However, overseas trained doctors and former overseas medical students may be granted an exemption from these restrictions.

Plans to increase the number of medical student places is extremely important, as we have heard in this House today. Attempts to increase the supply of Australian trained doctors in the future is also very important, but, as we know, given the amount of time it takes to train a doctor the effect will not be felt for many years. It should be noted that increasing the number of graduates will not necessarily result in increasing rural, regional and remote practising doctors; the two are not a mutual arrangement. It does not necessarily happen that those trained doctors will actually go out to rural and regional areas like my own.

As the Bills Digest states, in the mid-1990s doctor shortages in rural and regional and remote areas, such as my electorate of Forrest, became increasingly obvious. An article in the Sunday Times on 15 March this year stated:

… new figures show that WA has fewer doctors, as a percentage of population, than any other state or territory in Australia.

That is certainly the case in my electorate in the south-west of Western Australia. According to a West Australian newspaper article from July this year, there were at least 54 vacancies for GPs in country WA and regional areas. When you consider the distances involved in accessing medical attention in the regions, this is a really significant number. And despite an increase in medical students in Australia, rural, regional and remote communities in Western Australia continue to rely on overseas trained doctors, like those from New Zealand. This is largely due to the two requirements that must be met before an overseas trained doctor is considered eligible for employment in WA: the location must have been classified as an ‘unmet area of need’ by the WA government and a ‘district of workforce shortage’ by the federal government.

One of the well-known and experienced doctors in my electorate recently reinforced the importance of overseas trained doctors in our particular area. He is a person with a great interest in the medical profession and sees it right across the state. He said, ‘Overseas trained doctors are the backbone of general practitioner services in country areas.’ For those of us who live there, there is no doubt that this is the case. The general practitioner shortage is so severe in my electorate of Forrest that a medical attraction task force was developed as a result of the work of Dr Ron Jewell, who saw a particular model operating elsewhere in Australia and believed that this was what we needed to attract and retain GPs in Forrest.

The medical task force got together to address the challenge of sustaining the services of medical practitioners in communities right across the south-west. The greater Bunbury area, which is the largest population centre in my electorate, is currently classified as an area of unmet need for GPs. The doctors have also stressed the terrible situation that faces many smaller country towns. Even Bunbury itself, which was voted the Best Tourism Town in WA in 2009, still cannot attract general practitioners. I noted the comments of the previous speaker, and Bunbury is also a part of the world that one would expect could attract and retain professionals of all types, particularly doctors. I understand that the shortage of doctors in the Bunbury region is largely contributed to by the fact that GPs service not only the Bunbury area but also the smaller surrounding towns. So many people from around the area actually make appointments to see the doctors in Bunbury itself, so their workload is quite significant. Also, disturbingly, in September 2006 it was estimated that Bunbury was short of at least 10 medical practitioners and that the average age of general practitioners in the area was mid- to late-fifties.

Let us look at what has actually happened from the task force that I referred to. I will quote from an article from my local newspaper by Lee-Maree Gallo. I am really pleased that the South West Medical Attraction Task Force has reached stage 3 of its objectives. It has been working hard at implementing a plan to get GP and specialist practitioners into the region and to retain them there. According to the article:

Twelve local government councils in the region are involved including Bunbury, Capel, Harvey and Dardanup.

Consultant Alison Comparti was quoted in the article as saying that at the moment in the south-west there was one GP per 1,700 patients when it should be one GP per 1,200 patients. ‘Some areas have enough doctors but then others don’t,’ Ms Comparti said, and Bunbury is one of those areas. She also said:

… the taskforce had several ideas to entice practitioners to the region such as using the Bunbury Regional Hospital as a training hospital for medical students, professional linkages for spouses and partners of practitioners and linkages with educational facilities for spouses and children.

“Medical graduates are more likely to return to the region if they have had experience down here,” Ms Comparti said.

“We also want to set up a network with local schools to ensure the children of doctors can gain a place at their preferred school.”

I note that the task force will release its report next month.

It was interesting that one of the reasons for the shortage given at the forum that I and the member for Bunbury, John Castrilli, who is also the Minister for Local Government; Heritage; Citizenship and Multicultural Interests, were part of was that, even when doctors were attracted to the area, they looked around at the facilities and opportunities not only for themselves but for their families—and that could also include the professional opportunities for their partners—and made judgments on that basis. So these are all part of the assessments that a doctor might make when considering where he will locate and choose to practise.

A doctor in my electorate also stressed, as I said, the terrible situation for many small regional towns. Often these are overlooked. Our major centres often attract more doctors than small regional centres, where you will find perhaps a GP or even two working so hard and such long hours to service the needs of their patients. And they do take it very personally. I know the Western Australian government has tried various methods, including funding grants for general medical practices to extend their opening hours. However, it often comes down to the simple fact that rural, regional and remote areas cannot even attract enough doctors for adequate services during normal working hours, let alone those outside normal working hours.

I am still concerned that some of the proposed youth allowance changes could work against increasing the number of medical students. I was contacted during this time by a sole income earner with eight children. She provided her financial details to show the impact that the youth allowance changes will cause to her. She said that the total cost for her to send one child to university is nearly a whole year’s income. She is ineligible for any assistance under the youth allowance changes and will have to find an alternative way of financing her children’s attendance at university. But they are intending to become doctors.

We really need to encourage and foster young people from our regional areas who want to become professionals to go away and train but come back to our regional areas. Their knowledge and experience of, their empathy for and their commitment to their own regional area could not be questioned. We need to get these bright young people to train to become GPs but come back to our rural and regional communities. The government’s expectation of a student who wants to study medicine that they will take two years off to become eligible for independent youth allowance and then complete at least a six-year medical degree really does compromise this outcome.

Retaining and attracting doctors is really vital and it is of immediate need. An article that appeared in the Sunday Times in Western Australia during March of this year quoted that more than 60 per cent of doctors working in rural and remote WA have been recruited from overseas. The article went on to say that the doctors are being used as a last resort to relieve pressure created by the severe shortage in the region. They include eight New Zealand doctors working on a part-time basis.

The main provision of this legislation is in relation to the removal of current restrictions applicable to New Zealand permanent resident and citizen doctors who obtain their primary medical education at an accredited medical school in Australia or New Zealand. Effectively this will mean that these doctors will be excluded from the classification of overseas trained doctors and former overseas medical students under, as I said earlier, section 19AB of the Health Insurance Act. It should be noted, however, that, like all Australian trained doctors, New Zealand graduates of Australian medical schools will be required to gain postgraduate specialist medical qualifications or be in approved placements before they are eligible to access Medicare.

In conclusion, I support this legislation in its aim to streamline the operation of section 19AB and remove the anomalies. Given the impact that additional numbers of overseas trained doctors from New Zealand could have on my regional and rural electorate, let alone other similar electorates throughout Australia, I certainly support this legislation.

Chris Trevor (Flynn, Australian Labor Party) Share this | Link to this | Hansard source

The government’s Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009 is integral to maintaining a viable health system in our country. The health system of our country, and indeed any country, relies heavily on government support and the continual updating of legislation to match the requirements of the time. We live in a time when many laws of previous governments either have grown outdated or have failed to fulfil their intended purpose, resulting in complications for the people or issues they sought to assist or regulate. The act we are proposing to amend is a prime example of laws that hinder people unnecessarily because they never fulfilled their intended purpose.

We live in a country where our health system is largely supported by overseas trained doctors. Without their work and commitment to Australian health, our medical system would collapse. The bill today will make life easier for many of these doctors working here in Australia. By changing the ways our laws dictate the ability of overseas trained doctors to access the full benefits of Medicare, we can open up our health system to more government supported medical professionals and remove many of the complications associated with achieving this support.

The Australian population is growing at a faster rate than the medical workforce. Over the decade 1996-97 to 2006-07 the population grew by 13 per cent but the full-time workload equivalent of GPs only rose by 10.9 per cent, enhancing the shortfall in an area that was already struggling to keep up with demand. The changes in this amendment bill are absolutely necessary if we are to ensure that the capacity of our medical system does not continue to be outgrown by the ever-increasing population of our country. The amendments proposed by this bill have the potential to increase the number of government supported medical professionals working in Australia by increasing their capacity to be eligible for Medicare benefits, a change that will effectively benefit all Australians.

The major problem with the current legislation is the implications it has for New Zealanders. As many New Zealanders elect to study in Australian universities and are treated equally to Australians in terms of their eligibility to study, a large number of them enrol in a medical course before they discover that they are not considered a permanent Australian resident under the act. The problem with this, of course, is that eligibility is measured from the time of commencement of their primary medical degree and once they have commenced the degree any changes to their status, such as citizenship or permanent residency, will have absolutely no impact on their eligibility.

Another major problem with the legislation as it currently stands is the effect that it has on the Australian students who elect to study at New Zealand medical schools. As these medical schools are accredited by the Australian medical council to the same standard as Australian medical schools, many Australian students elect to study in New Zealand without understanding the dire impacts that this will have on their future ability to attract Medicare benefits. Due to the fact that the schools are overseas and not Australian, these students become subject to section 19AB of the act and, effectively, the 10-year moratorium if they choose to register as professional medical practitioners in Australia after they have completed their studies in New Zealand.

The amendments proposed in this bill aim at bringing the legislation in line with the Australian Medical Council’s recognition of New Zealand medical schools and will change the laws so that permanent residents of New Zealand are treated similarly to citizens and permanent residents of Australia under section 19AB of the act. One issue that could arise from this is the exploitation of this change by the large number of overseas trained doctors that use New Zealand as a back door into Australia because of the different entry and citizenship laws there. As this is not the intended purpose of this amendment bill, the term ‘former overseas medical student’ to be renamed ‘foreign graduate of an accredited medical school’ will continue to include any persons who were not an Australian or New Zealand permanent resident or citizen at the time they were enrolled in an accredited Australian or New Zealand medical school. This is just one of the many far-reaching, positive impacts that the amendments in this bill will have on both Australian and New Zealand medical students.

It is indeed quite clear that the significant amendments in this bill will have major positive impacts on New Zealanders who wish to work as professional medical practitioners in Australia. It will remove persons who are permanent residents or citizens of New Zealand and who obtain their primary medical education at an accredited Australian or New Zealand medical school from the classification of ‘overseas trained doctor’. Under the act, overseas trained doctors are considered to be any professional medical practitioners who obtain their primary medical degree from a medical school outside Australia. This amendment is proposing that New Zealand citizens or permanent residents who obtain their medical degree from either an Australian or New Zealand medical school are completely exempt from the 10-year moratorium. This effectively allows them to practise as registered medical practitioners with Medicare benefits from the date they register, which will not only increase their accessibility, but also increase the viability of New Zealand doctors working in Australia.

The second amendment will also assist New Zealand citizens to avoid the 10-year moratorium by renaming the term ‘former overseas medical student’ to ‘foreign graduate of an accredited medical school’. This simple yet irrefutable crucial amendment clarifies the meaning of the term and completely revolutionises its impact on New Zealand citizens who have obtained their medical degree from an Australian medical school. Under the current legislation, New Zealand citizens can stay permanently in Australia on a special category visa. Because they are not permanent residents or citizens, they are restricted by the 10-year moratorium after they obtain their medical qualifications and register as a professional medical practitioner. It is undeniable that these students, who study at medical schools that are accredited by the Australian Medical Council, should not be hindered by the legislation based on a technicality of citizenship and residency when they are already treated equally to Australians for the purpose of attaining their qualifications to be professional medical practitioners. This clearly highlights the complications of the current laws and makes it openly obvious that these amendments must come to pass.

Another of the significant amendments introduced by this bill will rectify an anomaly in section 19AB of the act to change requirements for the commencement of the 10-year moratorium for medical benefits. Currently, the 10-year moratorium will not commence until the person is both registered as a medical practitioner in Australia and a permanent resident or citizen of Australia. As many overseas trained health professionals enter Australia through the temporary skilled visa categories for periods of up to four years, the current legislation prevents the 10-year moratorium commencing until they become permanent residents or Australian citizens, meaning that it could take in excess of 10 years for these professionals to be eligible for Medicare benefits for these services.

The intent of the original act was for the 10-year moratorium to commence when the medical practitioner was first registered in Australia, but because of technicalities in the legislation this was not the case. The amendments eliminate this significantly detrimental delay by commencing the 10-year moratorium from the date they first register as a medical practitioner in Australia. With the amendments, the moratorium will cease once the 10 years have transpired, provided that they have become a permanent resident or Australian citizen during that period. If the 10 years have transpired but they have not attained permanent residence or Australian citizenship in that time then they will be ineligible until such time as they achieve it. This will effectively reduce the length of time that overseas trained doctors must work without Medicare benefits, increasing their capacity to service people of the public and making it more viable for them to do so.

It is also important for me to note here that the 10-year moratorium will continue to be used, along with reforms that are to be implemented under the Rural Health Workforce Strategy, to recruit and retain GPs in rural and remote Australia. These measures make sure that the system is fairer and recognises service to districts of workforce shortage. And, as part of our $134 million rural package in the 2009 budget, the 10-year moratorium will also be scaled so that the more remote the places doctors go, the shorter the moratorium. This year’s federal budget also delivers more than $200 million to help tackle the shortage of doctors and health workers in regional and remote areas of Australia. For the people of my home electorate of Flynn, this is great news, as all of these actions will culminate in an increased quality of services to regional and rural communities and therefore result in an improvement to rural health. I am proud, as the member for Flynn, to say that we as the people’s government are working to improve the quality of health of the people of rural and regional communities.

The final amendment in the bill that I will talk about today pertains to section 19AC of the act. It proposes that a time limit of 90 days be allowed for an applicant to seek a review of a decision to refuse an application for a section 19AB exemption or a decision to impose one or more conditions on a section 19AB exemption. This is a vital amendment that allows applicants nearly triple the time allowed in the current act, enhancing their ability to pursue what they perceive to be a viable reason for the exemption.

The amendments in this bill will ensure that the original act fulfils its intended purpose and does not cause any further unnecessary detriment to overseas trained workers. Our health system is heavily supported by overseas trained doctors and without them, as I have previously said, it would collapse. As a government we have been granted the opportunity through this bill to streamline the processes for overseas trained doctors to provide professional medical services that attract Medicare benefits, which will increase the amount of medical services available to the public and therefore increase the quality of the health of all Australians. I am a firm supporter of the amendments and believe that the changes that they will make are imperative to ensure that our health system has a bright and healthy future. It is for these reasons that I commend the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009 to this House.

Bruce Scott (Maranoa, National Party) Share this | Link to this | Hansard source

The question is that this bill be now read a second time. I call the member for Herbert.

Peter Lindsay (Herbert, Liberal Party, Shadow Parliamentary Secretary for Defence) Share this | Link to this | Hansard source

Mr Deputy Speaker, I was just asking if there were any applications to join the Australian Labor Party on that side of the parliament. It was not for me, I might add!

Bruce Scott (Maranoa, National Party) Share this | Link to this | Hansard source

I do not think that is the bill before the House; the bill is the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. I draw the member’s attention to the bill before the House.

Peter Lindsay (Herbert, Liberal Party, Shadow Parliamentary Secretary for Defence) Share this | Link to this | Hansard source

Mr Deputy Speaker, perhaps I do need some health advice at this stage. Mr Deputy Speaker, thank you for calling me. I want to speak on this particular bill because it talks particularly about policy in relation to overseas trained doctors. I want to draw the parliament’s attention to the inadequacies of the current policy on overseas trained doctors. You will know, Mr Deputy Speaker, the Townsville Hospital, which is a level-6 hospital, in the fair city in the north. And you will know the Mater hospital, which provides a private service for the citizens of the north. Both hospitals are extraordinarily good in the services that they provide. But they cannot provide them without doctors. They cannot provide those services, those high-quality, high-level specialist services, without having the doctors to deliver those services. And while this bill addresses that issue, it does not address the current situation that we face in Townsville. It is a disgrace.

Currently there is a shortage of anaesthetists, and Dr Charmaine Barrett, who is a specialist anaesthetist, alerted me a day or so ago to the current problem at the Mater hospital and at the Townsville Hospital in relation to overseas trained doctors and an inability to recruit them. Dr Barrett tells me that her practice has been advertising on her college’s website for an anaesthetist for the past three years. There have been no Australian replies; in three years there has not been one Australian apply for a specialist anaesthetist job at the Mater hospital. And on top of the Mater hospital advertising, the Townsville Hospital is currently advertising for a specialist.

This situation has become critical with the loss of the current anaesthetist, Dr Christoph Frahm, on 9 October. He went to the Royal Brisbane hospital; he went to fill in a temporary position. With the loss of him from our local community, in fact the North Queensland community because both hospitals provide services across the north, an area larger than the size of Victoria, if we do not get an overseas trained doctor appointed immediately because there are no Australian doctors then surgical lists will be cancelled. How do we run a health system in this country when overseas trained doctors are available but they are not allowed to be employed and so we cancel surgery lists? How can we run a health system like that? I saw this morning in the Townsville Bulletin that the Townsville Hospital’s emergency department was named as the emergency department that has the most number of walkouts in the state. That means people present at the emergency department and give up waiting so they just leave. It is very significant that that should be happening in Townsville.

But back to what this bill is about and what I am on about. Dr Barrett says:

We have a UK anaesthetist who is immediately available to work, as a deemed specialist, at the Mater.

Having filled in innumerable forms—

and we can all understand that—

over months to the AMC, ANZCA, Medical Board, Area of Need Section of Medical Board, I now discover that the [Department of Health and Ageing] have decided that we are not an area of workforce shortage for anaesthetists.

Therefore we cannot employ this UK doctor who is available immediately for appointment and to start work.

Dr Barrett has also discussed this with Dr Isaac Seidl. Dr Seidl is the Deputy Executive Director of Medical Services at the Townsville Hospital. He agrees with this situation. Both the Townsville Hospital and the Mater hospital will continue to cancel lists until this particular situation is resolved. The British anaesthetist is without a job and he has a family to feed. He is ready to come to Townsville and he is ready to provide these much needed specialist services, but the department says we are not an area of workforce need, despite the previous anaesthetist being employed on the basis that we were an area of workforce need. So what has changed? Why is this happening? Why is the department not allowing the appointment of an overseas trained doctor when, clearly, three years of advertising did not produce an Australian for the job? Why is it that we have to cancel surgical lists when a specialist is available to supervise those operations? Why is that? All of us in this parliament must surely be very concerned that this is happening. It is probably happening across the whole of Australia if it is happening in Townsville.

This is not satisfactory. This is not the way we should be running our health system. I appeal to the Minister for Health and Ageing to intervene on this. I appeal to the department: for heaven’s sake, have a modicum of common sense and see that you cannot leave our community in a situation where we are cancelling people’s surgery. You cannot leave us like that when we have doctors available to take over and manage that surgery, particularly when it is a doctor replacing a similar overseas trained doctor who was deemed to be working in an area of workforce need. I support the medical fraternity in Townsville in relation to this issue. I support my community and demand that the department immediately clear the way and give the green light to the Mater hospital to employ the UK specialist. Let us get our lists back on track and have our people looked after.

Janelle Saffin (Page, Australian Labor Party) Share this | Link to this | Hansard source

I welcome the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. It has been a long time coming; it is a long time overdue. It is welcomed universally by the community and the medical profession. I would like to thank the Minister for Health and Ageing for her responsiveness on this matter. The matter has sat inert for some years. It was in the too-hard basket, there was lack of interest or it was overlooked, but the fact is it is before us today and deserves support across the board in this place. This bill corrects the problem that excludes New Zealand citizens and New Zealand permanent residents who are doctors from accessing Medicare benefits for a period of 10 years after first being recognised to practise as a medical doctor after 1 January 1997, which was the operative date. It is known colloquially as the 10-year moratorium. It is to do with provider number restrictions. The current system is that overseas trained doctors and former overseas medical students may be granted an exemption from the provider number restrictions et cetera. It is said that the primary consideration—and, from my perspective, it is the primary consideration—in granting this exemption is that an applicant must work in a district of workforce shortage, or area of need, as we call it.

The operative part of the Health Insurance Act is section 19AB. Section 19AB provides that Medicare benefits are not payable to an overseas trained doctor or a former overseas medical student except in certain circumstances—and generally, as I referred to, in a district of workforce shortage. I noted the comments by the member for Herbert in relation to the particular problems he has with workforce shortage in his area. In 2007, when Labor came into government, I had a look at the figures that were used to assess the areas of need. They were still using data from the 1991 census, which is a bit outdated to determine an area of need. There were some other factors implying that that needed to be changed, and that whole system has been reviewed. Also, in general, the mechanism I am referring to has been used to assist rural and remote communities where Australian doctors do not practise so that the public can get access to well-trained doctors—because that is what we need. It follows then that there are more overseas trained doctors in some rural and remote areas. For a whole range of reasons, some doctors do not want to go to rural and remote areas. Sometimes it is because of the changing nature of medical practice. Sometimes it is about wanting to get a balance between family and work. Sometimes it is about wanting to work with other doctors so that you can actually do that.

In her second reading speech the minister said that 41 per cent of all doctors in communities of greatest need are in rural and remote areas. The government has also created more places for medical students. Part of the policy approach is that they will be in rural and remote areas, but this will take some time to kick in because of the time it takes to train our doctors. It seems to take a long time, but I know it is essential that they have that long training.

I welcome the extra student placements in country areas. There are some in my area, where we have the university’s department of rural health, and quite an influx of rural medical students and allied health students as well. It is great, because they work under a collaborative model but they are effectively under the university’s department of rural health. Dr Sue Page, a very active health advocate in our area, has said that what is also encouraging about getting them into these areas is that the longer they are there the longer they stay. They sometimes form relationships and get married, so they are more likely to stay in the area. That is one of the factors.

The main change that this bill will effect is the removal of the current restrictions on New Zealand permanent resident and citizen doctors who obtained their medical qualifications at an accredited medical school in Australia or New Zealand. Section 19AB of the Health Insurance Act, which classifies them as ‘overseas trained doctors’ and ‘former overseas medical student’, will no longer apply to them. There has also been confusion about the classification of ‘former overseas medical student’. It actually means a foreign person who graduates from an Australian medical school, but hardly anyone got that upon the first, second or even third reading. It does cause confusion. A ‘former overseas medical student’ will now be known as a ‘foreign graduate of an accredited medical school’. This is a better classification than ‘former overseas medical student’, but in my view it could have been made a little bit better. But it is certainly better and removes the confusion of the other title.

The current requirement for the operative date of the 10-year moratorium made it mandatory for the doctor to have Australian citizenship or permanent residency. If they were here for, say, two to five years practising and then acquired either status, the 10-year rule would then start to kick in. Therefore it could be up to 15 years in all before they could access a Medicare provider number in general. That seemed an inordinately long time. It seemed to be an unintended consequence of the way that that section of the act worked. This bill, sensibly and fairly, changes this so that the 10 years start when the medical practitioner is first registered as a medical practitioner in Australia and becomes a permanent Australian, as it will be known, at least in that 10-year period. The definition of ‘permanent resident’ will be repealed and the ‘permanent Australian’ definition will be amended to replace ‘permanent resident’ with ‘a holder of a permanent visa’, thus making ‘permanent resident’ redundant.

The new definition accords with definitional consistency with the Migration Act 1958. New Zealand citizens are entitled to take up what is called a special category visa that enables them to stay permanently in Australia, but this category of visa is not a permanent visa in the sense that I have just been talking about—so that it falls within the definitions of the Migration Act 1958. So that anomaly will be overcome. The good part of this bill is that from 1 April 2010 or on royal assent, whichever is the later date, the New Zealanders who obtained their primary medical degree from an Australian or New Zealand medical school and were previously subjected to the 10-year moratorium or a section 19AB(3) Health Insurance Act exemption will attract the Medicare benefits—that is, a provider number. The moratorium periods of section 19AB and any section 19AB(3) exemptions will no longer have any effect—so, finito.

Another key development is that, when medical practitioners appeal against a decision to refuse to grant them an exemption or a decision to impose conditions on an exemption made pursuant to sections 19AB(3) and 19AB(4) respectively of the Health Insurance Act, there will be a 90-day maximum period within which the medical practitioner must appeal. It is section 19AB(3) that covers exemptions in general and it is section 19AB(4) that covers the conditions on such exemptions. The upshot is that, if a medical practitioner applies for a review of a deemed refusal, such an application has to be made within the 90-day period. That 90-day period begins, so I am advised, on the day after the end of the 28-day period referred to in section 19AC(2). Medical practitioners who have received a decision refusing an exemption or a decision to impose conditions prior to the commencement of the bill will have 90 days from the commencement to make a review application.

It is a welcome change, particularly for my Northern Rivers area, where it did have a dire consequence for a very able and very well regarded general practitioner. I would also like to say thank you to the people who advocated in my area, such as Dr Sue Page and Dr Chris Mitchell, President of the Royal Australasian College of General Practitioners, who also lives in the Northern Rivers area. In something that is sent out to all the GPs he thanked me for my advocacy. The result of that was that I got some feedback from general practitioners around Australia, including from some who are not New Zealand citizens but who have had some ideas about ways of moving forward, particularly on how we can continue to attract doctors to rural and remote areas and other areas in need. It was most welcome. It is something I am reading through now and am in discussions with doctors about.

The member for Herbert prompted my memory on one other thing I wanted to say. Some years back when I was a member of the New South Wales Legislative Council we did not have this system, but there were a lot of doctors who were overseas trained, were trying to practise in Australia and lived in Australia as either permanent residents or Australian citizens. Understandably, there were restrictions on their right to practise, but some of them were without foundation. Those doctors belonged to an association, and some of them went on a hunger strike outside the parliament building. That was quite distressing to some people. The doctors were on that hunger strike for quite some time. I profess to not quite understanding hunger strikes, but I know that when people are desperate they undertake such missions.

I had quite an engagement with those doctors and with the health minister at the time, Dr Andrew Refshauge, and we had some negotiations. Then Stepan Kerkyasharian was commissioned to do a review. He did a review and came up with 28 good recommendations, a lot of which were taken up nationally at the state level—at the intersection of state and national governments, working together to cover these areas. I remember very well what some of those recommendations were. They were taken on board by the AMA and by other associations. When we are dealing with these issues, there is a point at which any government has to make a decision and provide leadership, but there have to be negotiations and consideration, and it is necessary to work hand in glove with the profession. I am sure that in the future we will see some other changes, but this is one that was ridiculous in its application and made a ridiculous differentiation, and that will be corrected. I am very pleased to be able to support this bill.

Mike Symon (Deakin, Australian Labor Party) Share this | Link to this | Hansard source

It is a pleasure to follow on from Ms Saffin, the member for Page. I, too, speak in support of the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. This bill amends the Health Insurance Act 1973, with the purpose of streamlining the operation of section 19AB of that act and removing some of the anomalies in its operation. Section 19AB of the Health Insurance Act was introduced in 1996 and dictates that Medicare benefits are not payable in respect of professional services provided by or on behalf of an overseas trained doctor, except in certain circumstances. The change was made as part of a package of reforms designed to help address shortages in the medical workforce in rural and remote areas.

Under the legislation there is a 10-year moratorium on overseas trained doctors accessing Medicare benefits, unless they are working in an area where there is a workforce shortage. The main provision in this bill removes the current restrictions applicable to New Zealand permanent residents and citizens who are doctors and who have obtained their primary medical education at an accredited medical school in Australia or New Zealand. This change will effectively remove New Zealand permanent residents and citizens from the classification of overseas trained doctor and former overseas medical student under the Health Insurance Act. Under these proposals, the term ‘former overseas medical student’ will be changed to ‘foreign graduate of an accredited medical school’ to more accurately reflect its meaning. A time limit will also be introduced for seeking review of a decision to refuse an application for a section 19AB exemption or a decision to impose conditions on an exemption.

Finally, there will be a change to the way in which the 10-year moratorium is counted. Currently, the moratorium starts from the time an overseas trained doctor achieves Australian permanent residency or citizenship. Most overseas trained doctors, however, come to Australia through the temporary skilled visa category; hence, the 10-year moratorium could, in effect, last for up to 14 years. Under this amendment the period will commence from the time that a medical practitioner is first registered as a medical practitioner in Australia. It will continue to operate for 10 years and then cease, provided that the medical practitioner has gained Australian permanent residency or citizenship during that period.

The moratorium has been effective in helping meet demand in rural and remote areas for medical services, but of course there is still much more to be done. It will continue to be used in order to bring GPs into rural and remote areas, in addition to the measures announced in this year’s budget as part of the government’s $134 million Rural Health Workforce Strategy. The focus of the strategy is to improve access to health services for people in rural, regional and remote areas of the country. To encourage more medical professionals to practise in remote areas, the government is targeting incentives under the banner ‘The more remote you go, the greater the reward’. The 10-year moratorium will be scaled so that, the more remote the area where a doctor practises, the shorter the moratorium.

Financial incentives are also in place, such as a $120,000 grant for a doctor relocating to a very remote area. Under these reforms almost 500 communities around Australia will, for the first time, become eligible for rural incentive payments. As the Minister for Health and Ageing stated, ‘Australia’s increasing reliance on overseas trained doctors is not unique, with other OECD countries experiencing similar trends.’ I believe that, in the longer term, we actually have to address our own shortages and train more local doctors. It is something that we cannot escape. We as a developed nation cannot continue to go on taking doctors from other overseas countries where they have greater shortages than we do.

There is also an impact of not having enough doctors locally. My electorate is most certainly neither rural nor remote—it is very urban—but we have shortages of doctors in that urban setting. We have general practices that are closed down and not replaced. We have waiting lists to see a GP. It is not a simple thing. In many cases, people may have to wait one, two and sometimes even three days for an appointment with their local GP. We do have bulk-billing clinics. There are a few of those around but, even then, there can be long waits and I represent a very populated part of Melbourne. It being hard to find an available doctor is certainly not an isolated incident.

One of the references I always like to use when I talk about health issues is produced by the Australian Institute of Health and Welfare. Their publication Australia’s health 2008 is particularly good when it comes to facts and figures on anything to do with the health system. In the 2008 report they referred to a report put out by the Australian Medical Workforce Advisory Committee in 2005 which looked at the supply and requirements of the general practice workforce in Australia through to 2013. That report, even at that time, estimated that there was a shortage of between 800 and 1,300 general practitioners. Obviously, as our population grows, that figure will become even greater.

The changes in this bill to the classification of doctors trained in New Zealand are a reflection of the close relationship that our two countries enjoy. Australia’s relationship with New Zealand is probably better developed and more extensive than our relationship with any other country. This relationship brings enormous benefits to both countries. I think we see those every day. Dr Ashton Calvert, former Secretary of the Department of Foreign Affairs and Trade, stated:

… the partnership with New Zealand is of first-order importance.

The historical, economic, social, cultural and political foundations of Australia-New Zealand relations run deep, and will always inform what we do together.

The common background of our two countries, the long history of cooperation both bilaterally and on the wider international plane, and the values we share are all part of the strong base on which the contemporary relationship is built.

Of course, New Zealand citizens enjoy many benefits in Australia. The Australian Citizenship Act 1948 provides New Zealand citizens living in Australia with many benefits and citizenship rights through its provisions, such as permanent residency rights without the requirement of obtaining a permanent residency visa.

Contrary to this, the Health Insurance Act requires the department to use the Migration Act 1958 to determine residency status. This act considers New Zealand citizens to be temporary residents of Australia. Thus, New Zealand citizen doctors are considered to be overseas trained doctors if they registered as a medical practitioner after 1 January 1997.

Many New Zealanders—or Kiwis, as most of us would call them—choose to study at Australian universities. When they do so, they are treated the same as Australian students. They may not be aware that, under the Health Insurance Act, they will not be considered to be a permanent resident. Eligibility is measured from the time a student commences their primary medical degree, so obtaining permanent residency or citizenship after this offers no relief.

Similarly, many Australians elect to study in New Zealand. I know they have many fine universities over there; I have visited them on many occasions. Although these New Zealand medical schools are accredited to the same standards as Australian medical schools, Australian citizens who obtain their degrees at them will fall within section 19AB of the act as they did not gain their primary medical degree in Australia.

The effect of this bill is to remedy these anomalies. Professional services provided by New Zealand residents or citizens who obtained their primary medical degree from an Australian or New Zealand medical school and who had previously been subject to the 10-year moratorium will now attract Medicare benefits from the commencement date—that is, such people will no longer be subject to the moratorium.

This bill does not intend to extend these benefits to medical practitioners whose primary medical education was obtained outside New Zealand or Australia. Former overseas medical students are to be renamed ‘foreign graduates of an accredited medical school’, as I mentioned earlier. This will continue to include people who were not Australian or New Zealand permanent residents or citizens at the time they enrolled in an accredited Australian or New Zealand medical school.

The proposals in this bill clear up a few outstanding anomalies and recognise the standard of primary medical degrees from New Zealand. New Zealand permanent residents and citizens will be treated similarly to Australian citizens and permanent residents for the purpose of section 19AB of the act. This bill also makes some other changes to tighten up the operation of the Health Insurance Act, as I touched upon earlier. I commend this bill to the House.

Brett Raguse (Forde, Australian Labor Party) Share this | Link to this | Hansard source

I acknowledge the comments of the member for Deakin and his firm understanding of some of the issues that face our health system in this country. I rise today to speak on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. This is a bill that will make working in Australia easier for medical practitioners from New Zealand and improve administrative processes surrounding overseas sourced medical practitioners in general.

The bill has three main components. The first component is to resolve problems New Zealand doctors can face working in Australia. Current arrangements do not reflect the close relationship between Australia and New Zealand. Under the Trans-Tasman Travel Arrangement, people who are citizens of Australia or New Zealand can travel to the other country to visit, live or work without needing to apply for a visa. However, doctors currently fall under the significant restrictions placed on all overseas doctors.

Within the Health Insurance Act 1973, section 19AB is used in effect to place individual overseas doctors in a district of workplace shortage. By restricting eligibility for Medicare benefits, this system makes overseas doctors spend their first 10 years practising in areas of need. This system has been used since 1997 to manage doctor shortages, particularly in rural and regional areas. While effective, it is not reasonable for doctors from New Zealand to face these restrictions.

Importantly, these conditions are faced not just by doctors moving from New Zealand to Australia but also by people from New Zealand who train to become a doctor in Australia. This is because the term ‘former overseas medical student’ in the existing legislation is ambiguous and problematic to implement.

The bill proposes to replace the term ‘former overseas medical student’ with ‘foreign graduate of an accredited medical school’. The bill text reads:

foreign graduate of an accredited medical school means a person:

(a)

whose primary medical qualification was obtained from an accredited medical school; and

(b)

who was not …

(i)

a permanent Australian;

(ii)

a New Zealand citizen;

(iii)

a permanent resident of New Zealand.

When he or she is first enrolled in an accredited medical school. In turn the bill describes an accredited medical school as:

… a medical school that is:

(a)

accredited by the Australian Medical Council; and

(b)

located in Australia or New Zealand.

The consequence of these relatively small amendments is that doctors from New Zealand, educated in an accredited medical school either in Australia or in New Zealand, can be exempt from section 19AB restrictions.

The Health Insurance Act 1973 currently has no application time limits for review of section 19AB exemption decisions. These review requests are made to the minister or to the minister’s delegate and can apply to a decision or conditions of a decision. The second amendment plans to limit the time frame within which a review of a section 19AB decision can be requested. This will be set in a time frame of 90 days, which provides a reasonable amount of time while achieving process efficiency.

As previously noted, section 19AB of the Health Insurance Act 1973 is used to restrict where an overseas doctor can work during their first 10 years in Australia. However, the current condition is that these 10 years start when an overseas doctor becomes a permanent resident. Often, an overseas doctor may not become a permanent resident until some years after they begin practising in Australia, so individuals may, therefore, work under restrictions for far longer than the planned 10 years. The third main change proposed in this bill aims to fix that anomaly.

It is proposed to change the term ‘permanent resident’, within section 19AB, to that of ‘a holder of a permanent visa’ within the meaning of the Migration Act 1958. It is proposed that the time spent as a permanent resident working as a medical practitioner in Australia contribute towards the 10-year restriction. Doctors from overseas will be able to start their 10 years on restrictions from when they are first registered as a medical practitioner in Australia, as long as they gain permanent residency or citizenship during those 10 years. In the long term, we must move away from our reliance on overseas doctors. Not only do we have people with sufficient training who are capable of doing these jobs, but other countries need their own doctors. We cannot, therefore, take doctors from other countries where they are also needed.

In the second reading speech by the Minister for Health and Ageing, the bill was placed within the context of a broader health workplace reform. The Rudd government is working through a $1.6 billion COAG partnership to boost Australian trained graduates from 12,700 this year to 14,700 by 2013. We will help to fund undergraduate clinical training for 13,800 medical students, 38,500 nursing students and 18,000 allied health students in 2010. Part of this boost is an increase in the total number of general practitioner places from 600 under the former government to more than 800 from 2011 onwards. These are critical increases needed to manage an ageing population and ageing healthcare workforce.

Many times in this chamber I have spoken about issues within my electorate of Forde. It is an electorate diverse in nature in South-East Queensland with a mixture of rural and urban populations. Many times we have faced issues about the Beaudesert Hospital, which was built over a number of years and which has maintained a certain level of service. But some years ago the obstetrics unit was removed from the hospital. At the time, as a community that often will see certain services change, the hospital’s being downgraded was seen very much as a threat to the community. Essentially, the problem related directly to trained professionals. Even in South-East Queensland, in a region that is much better serviced than other areas—and certainly areas that you represent, Mr Deputy Speaker Scott—the fact is that the number of trained doctors available is rather weak.

I have for many years, and certainly prior to becoming the federal member for Forde, advocated the need to continually improve and increase the number of trained health professionals. I must say that the people of the township of Beaudesert in particular have certainly felt the effects of the shortage of trained staff. In fact, there have been a number of schemes over the years to attract other people and trained professionals to the region. When we talk about districts with workplace shortages, quite often if they are less than 100 kilometres from a major city they are probably worse affected by shortages. The importance of providing more trained people for our system and being able to train more people in our own system is very important. In the relationship and the treaties that we have with New Zealand it is very important that we recognise under our own system, and certainly in this bill, the importance of New Zealand training and the doctors or trainees that come from that system.

It is a very good time for this government and for our nation to consider how we deal with training issues in our medical professions. The government has put forward a view in the Bennett report, which is now in circulation, about the major reforms that we need to consider for the future of our hospital system and the entire health system in this country. It is always a problem when you have cyclical issues concerning services, appropriate assets, appropriate training and being able to attract the appropriate people to a system. The health system, by its nature, needs highly professional people. The reality is that we need not only bricks and mortar to provide good services to the communities of Australia but also appropriately trained people. While we recognise that many people from other countries who have trained in their systems are very appropriate for our system, the reality is that we cannot continue to take people and source people from countries that may have a whole range of issues around the availability and supply of their own medically trained people.

I mentioned the Beaudesert Hospital as an example of a hospital that most people in the region always complain about. They argue that it is only a case of putting one or two extra doctors into a hospital to make something work—in this case, obstetrics. The reality is that any service we provide within our medical system is part of an overall model that includes many other professionals that support and supplement any medical procedures that take place. For instance, to deliver obstetrics services within a hospital you have to have all of those other levels of professionals available.

This bill recognises the training of New Zealand doctors and encourages those doctors to move into the system. It will certainly make it much easier for us as a government to provide those 800 training places and have sufficient people taking up those opportunities. It is important that, through this bill and through the health reforms that the Rudd government intends to make, we work together collectively to ensure that we take care of all of these problems that have resulted from legislation that has almost penalised those people who have come to our country in good faith to train and work.

The Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009 puts forward a number of improvements to arrangements for overseas doctors in Australia. Our close relationship with New Zealand is reflected by our no longer applying section 19AB to doctors originally from New Zealand. The fair new arrangements in this bill better reflect the enduring friendship and good will between our countries. Improvements have also been made to the review processes and residency requirements within section 19AB. The improvements provide valuable administrative clarity and fairness for all overseas doctors. I therefore commend this bill to the House.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. The purpose of the bill is to streamline the operation of section 19AB of the Health Insurance Act 1973 and remove a number of anomalies. The act provides that overseas trained doctors and former overseas medical students are not able to provide professional services that attract Medicare benefits for a period of 10 years, and that is called the 10-year moratorium. The bill amends the class of persons subject to the restriction in section 19AB, and amends the start date of the moratorium period.

The bill relates to the removal of current restrictions applicable to doctors who are New Zealand permanent residents and citizens who have obtained their primary medical education at an accredited medical school in Australia or New Zealand. The change effectively removes these doctors from the classification of ‘overseas trained doctor’ and ‘former overseas medical student’. The removal of the requirement for overseas trained doctors and foreign graduates of an accredited medical school to have either Australian permanent residency or citizenship and medical registration in order for the 10-year moratorium period to commence is an important provision of this bill. The bill also makes an amendment to section 19AC of the act, which provides a period in which medical practitioners can apply for a review of the decision to refuse to grant an exemption or to impose one.

The issue is that many New Zealanders elect to study in Australian universities and are treated no differently to Australians. A New Zealand student may enrol in a medical course before they discover that they are not an ‘Australian permanent resident’ under the meaning of the act. Eligibility is measured from the time a student commences their primary medical degree, so obtaining Australian citizenship or permanent residency once they have commenced their studies offers no relief.

Many Australian citizens elect to study at New Zealand medical schools. These medical schools are accredited by the Australian Medical Council to the same standards as Australian medical schools. However, as these Australians did not obtain their primary medical degree in Australia, they are also subject to section 19AB of the Health Insurance Act. The proposed amendment means that Australian and New Zealand students who attended schools accredited by the Australian Medical Council in New Zealand and Australia will be treated the same as students who studied in Australia. The amendment recognises the standards of primary medical degrees from New Zealand universities and will ensure that New Zealand citizens and permanent residents are treated similarly to Australian citizens and permanent residents.

This amendment also addresses the fact that, although New Zealand citizens are generally entitled to stay permanently in Australia on a special category visa, these visas are not permanent visas pursuant to the Migration Act 1958. Currently, New Zealand citizens who complete their medical qualifications at an Australian medical school come within the definition of ‘former overseas medical student’. The effect of this amendment will be that New Zealand residents or citizens who obtained their primary medical degree from an Australian or New Zealand medical school and who had previously been subject to the 10-year moratorium will attract Medicare benefits from the commencement date of the bill, and they will no longer be subject to that moratorium. That will be really good for our health system and good for those New Zealand doctors and former overseas medical students, including Australian citizens who trained and qualified in New Zealand.

This is a very important issue. I represent an electorate where there is a chronic shortage of GPs. This shortage has existed for a very long time and it is an issue that I have been raising in this parliament since 2000. The current minister for health has embraced the issue and acknowledged the fact that there is a shortage of doctors within the Shortland electorate and, for that matter, Australia wide. She has taken steps to address this shortage, and I would like to put on the record my thanks to her for the actions that she has taken.

As I have already mentioned, this is an issue that has existed for some time in Australia. In the mid-1990s it was proposed that there were sufficient medical practitioners in Australia to meet the health needs of Australians. The thinking behind the policy was that there was an oversupply of general practitioners in the city, metropolitan and large population areas, while the rural and remote areas could not attract doctors. It was thought that there was a maldistribution of general practitioners throughout Australia. Of course, because of our Constitution, it is impossible to force doctors to practise in certain areas. So the Howard government, following their election in 1996, introduced legislation and initiatives to address medical workforce maldistribution. Unfortunately they did not think it through properly because, instead of addressing the maldistribution, they created a chronic medical workforce shortage. The Howard government at all levels constantly ignored the fact that this was an issue that needed to be addressed, unlike the current Rudd government and unlike the current health minister.

In 2006 the Standing Committee on Health and Ageing of the parliament conducted an inquiry into health funding. Its report, called  The blame game: report on the inquiry into health funding, made some very critical findings about workforce shortage. It did identify the fact that, the further you are away from the heart of Sydney in New South Wales or the heart of Melbourne in Victoria, the harder it is for you to obtain a doctor or treatment from nurses and allied health professionals. It identified the fact that the workforce shortages were worse in outlying areas. It also identified that there was a skilled health workforce shortage throughout Australia in particular in relation to GPs. Some areas raised were that there was a constant, continuing, ongoing problem with a shortage of general practitioners and a failure of the government to address this. Part of the shortage of the health workforce was due to—and the report makes this point—the underinvestment in the number of training places. The maldistribution of health professionals across Australia with the shortage of GPs and most other health professionals in suburban, regional and rural areas was also identified as a big problem. Underlying everything was the underinvestment in the training of doctors that we needed.

I was checking the table on health professionals and there is a comparison in the The blame game report between general practitioner numbers per 100,000 head of population in Australia. In 2000 there were 191.5 GPs to 100,000 head of population. In 2005, under the hand of the Howard government, that had dropped to 178.6 GPs per 100,000 head of population. I think that in itself is a comment on the way the Howard government under the leadership of the health minister, Tony Abbott, managed to ensure that people throughout Australia actually could go and see a GP when they needed to.

Shortland electorate is an older electorate. It is the 11th oldest electorate in Australia. We do have a chronic shortage of GPs as I mentioned earlier in my contribution to this debate. As at August 2009, there were 310 GPs working on the Central Coast. At the Wyong end of the Central Coast there were 131 doctors. Shortland electorate fits into the Wyong end of the Central Coast and the northern part of the Wyong Shire Council falls within Shortland electorate. That is the area where there is an incredible shortage of GPs and has been for a very long time.

The average age of GPs in the area is 54.5 years. As that workforce continues to age, that is going to have a further impact on the shortage of GPs in the area. I believe that it is vitally important that this issue is addressed. I see the legislation that we are debating here in the parliament today as providing some relief to the people not only of the Central Coast part of my electorate but the Lake Macquarie part of my electorate as well.

It is interesting to note that the socioeconomic status of the Central Coast population is lower than the average for New South Wales and Australia. People there experience poorer health, have higher mortality rates and have higher rates of behavioural health risks such as smoking and obesity. Poor access to GPs and primary health care further exacerbate the issue. The majority of the area’s Aboriginal and Torres Strait Islander populations in the northern Sydney and Central Coast area health catchment reside on the Central Coast, and a significant number reside within the Shortland electorate.

I mentioned that Shortland electorate is an older electorate. In the Central Coast part of the electorate, the population is proportionally older and younger and those people have a greater need to access medical services because of the need for support at both the older and younger ends of the health spectrum. Smoking levels among Central Coast residents are approximately one in four males and one in five females, which is well above the average. Risky drinking behaviour is above the average and mental health, drug and alcohol related conditions are increasingly prevalent on the Central Coast. The burden of chronic disease and avoidable acute conditions is increasing across the region.

With figures like that attached to the area, rather than having fewer GPs we need to have an increase in GPs. At this particular point, I thank the minister for the initiatives that she has already introduced to increase the number of GPs that are available. In the Hunter part of the electorate, we will receive an additional four GP allocated places this year, with this continuing to increase over the coming years.

We should not be in the position we are in now. If the former Minister for Health and Ageing, Mr Abbott, the member for Warringah, had acknowledged early in the piece that there was a problem with doctor shortage and if the 12 years of poor workforce planning by the former Howard government had not happened, we would not be in a position where we have this chronic shortage of GPs across the country. As I mentioned, there has been an increase in the number of training places for GPs this year. The number will increase further in 2010-11 as part of the government’s $86 million commitment to providing 212 additional ongoing GP training places from 2011. As I have already mentioned, our region—the Hunter part of the electorate—has four new GP allocated places for this year.

I have talked about the Central Coast part of the Shortland electorate. I would now like to turn to the Lake Macquarie area of the Shortland electorate. It has been an area that, over time, has fared a lot better in relation to GPs, but in the dying days of the Howard government the shortage became much more apparent. One of the GPs in an area of the electorate where there are a lot of elderly residents decided that he just could no longer practise. He was about 78 years of age and had a medical practice where he worked full-time. He tried to attract doctors to work in the area, and one person that was very keen to come and work in the area was a person that was trained in New Zealand. He had lived in Australia for about three or four years but, unfortunately, this person was affected by the moratorium that is referred to in this legislation and was unable to take up that position. The result was that the practice closed. The result was that all those elderly people that relied on that GP for treatment and support were without a GP.

I raised the issue with the former Minister for Health and Ageing and got no satisfaction whatsoever. Mr Abbott was not receptive to doing anything to address this chronic doctor shortage within the Shortland electorate. That is why a situation has now arisen where people have to wait not three to four weeks, as I have mentioned in speeches over the last few years, but up to a month or six weeks for an appointment with their doctor. Action has been taken but, unfortunately, the action has been taken when there is a crisis, not at the time it should have taken place. The Howard government and Mr Abbott should have looked at taking some decisions in planning for the future and addressing the chronic workforce shortage that existed—but no, they ignored it. We had to wait until the current Minister for Health and Ageing and the Rudd government came to power to address these issues.

We have legislation before us today that is going to amend the classification of overseas medical students. It will remove the requirement for overseas trained doctors and foreign graduates of an accredited school to have both permanent residency and medical registration, for a moratorium of ten years, and will remove the requirement for persons who are permanent residents of New Zealand to obtain primary medical education at an accredited school in Australia. I commend the legislation to the House. (Time expired)

Amanda Rishworth (Kingston, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. I would like to thank the member for Shortland for her contribution. I know that she was always a very passionate advocate when we were on the House Standing Committee on Health and Ageing together and she is always raising this as a very important issue—and it is an important issue. This bill is yet another example of the government’s commitment to reforming Australia’s health system and delivering better health outcomes for Australians, wherever they live. It demonstrates that the government is in tune with the needs of both healthcare providers and patients and that this government is proactive about ensuring Australia has a strong healthcare system, staffed by world class doctors, nurses and allied health professionals.

I want to speak from the perspective of my electors in Kingston who, over the last two years, have seen many positive developments when it comes to improving health services. They are beginning to benefit from the substantial federal government investment and assistance—in particular, the availability of general practitioners. When I was running as a candidate in the seat of Kingston, getting access to see a general practitioner was a huge issue. In fact, many residents found it difficult not only to get in to one during the day but also to find after-hours access to GPs. This brought a huge influx of people presenting for accident and emergency treatment out of hours which could have been better dealt with by a general practitioner.

I know that the South Australian government has been doing a lot of work in primary health care. The opening hours of a GP-plus clinic at Aldinga has shown that if you provide primary health services out of hours then you can reduce the burden on accident and emergency facilities. In fact, the state Minister for Health has said many times that from the postcodes of Aldinga and Aldinga Beach there has been a 13 per cent decrease in presentations to the Noarlunga Hospital. We have seen that if you can improve the provision of primary healthcare services outside of those normal operating hours then you can actually reduce the burden on our hospitals.

I have to commend this government greatly for the General Practice After Hours program. The program has been widely taken up by GP surgeries in my electorate. The improvement has been felt by the residents of Christies Beach who now under this program have better access to after hours GP services provided by the Dyson family practice. Likewise, the $95,000 grant provided to the Trinity Medical Centre under the same program has improved GP services for the residents of Seaford. Similar grants have been received by GP centres in Huntfield Heights, Aldinga, Morphett Vale and Sheidow Park. These grants are being used to cover the cost of things such as on-call allowances, training and the running costs associated with longer opening hours. They have made it easier for local residents to find a doctor after hours and receive the primary care that they need to stay healthy, manage chronic disease and, most importantly, as I mentioned before, to stay out of hospital. I know from constituents in the local area that there has been a lot of interest in this and they are very pleased with and greatly appreciate these extended opening hours.

This government went to the election with a platform of providing GP superclinics. This was a very innovative and exciting election commitment and one that this government is now delivering. In particular, there is a lot of work being done at the moment with the creation of the Noarlunga GP superclinic. The development is under way for a new purpose-built facility and also the redevelopment of existing buildings within the Noarlunga Hospital and health village precinct. This is a combined investment between the Rudd Labor government and the South Australian government and it will go a huge way towards providing a whole range of different services to local people who have not been able to access these before. It will include things such as privately practising GPs, practice nurses, specialists, dentists and allied health providers. It will have a particular focus on chronic disease management, which is becoming more and more an important area that we must focus on if we are going to improve this country’s long-term health.

The work on the GP superclinic is well underway. It is my understanding that interim services will be provided to patients from late 2010 before the project is completed in 2011. With an eye on the future, it is pleasing to note that the clinic will incorporate design functions to support teaching, training and education. I have been regularly reminded that if we can make sure that we are putting the best into training our new health professionals, especially in the area of general practice, we actually can get GPs who are very well suited to the local area.

The best way to get and retain doctors and nurses in our regions and outer metropolitan areas is to have local residents trained locally to fill these positions. The training which will be undertaken will complement the $10 million of funding that was provided to Flinders University which will be used and has already been used by the university to equip state-of-the-art teaching and training facilities, which will help Adelaide attract and retain medical, nursing and allied health professionals. This was another commitment that the shadow health minister at the time, Nicola Roxon, made and it has now been delivered. There were huge commitments and investments from this government. We are now delivering. The reason that we had to make these commitments was that the previous government fell far short of delivering decent training facilities and healthcare services to the people in my electorate.

A final development in Kingston that is deserving of mention has been the $295,000 injected for training of local aged care staff. This particular grant is being used to train and develop the skills of 73 local aged care and community staff. Carers for the aged have been historically underpaid and undervalued in this country and I hope that this assistance will not only provide better care for older residents in Kingston but also will go some way towards providing long-term carer opportunities for those in our community who are providing that care.

These and the many other positive developments in the provision of health care in Kingston are part of this government’s larger commitment to delivering better health care to all Australians. At the heart of this project is the $1.6 billion COAG partnership that will help deliver better training for Australian graduates. This funding will help support undergraduate clinical training for over 13,000 medical students, 38,000 nursing students and 18,000 allied health professionals in 2010. The government will also provide $28 million to help train around 18,000 nurse supervisors, 5,000 allied health and VET supervisors and 7,000 medical supervisors. The total number of GP training places will also be boosted to more than 800 from 2011 onwards, representing a 33 per cent increase from the cap of 600 places set by the previous government.

This year’s federal budget also provides for an additional $200 million to help tackle the shortage of doctors and health workers in regional and remote Australia. I think this has outlined just how seriously this government is taking the issue of workforce shortage in the area of health services. From talking to people, I know this was clearly an area that was neglected by the previous government. In fact, it is well known within my electorate that at some point in the previous government the previous health minister decided to cut the number of places for doctors, and the result of that is now hugely strained medical services because of workforce shortage.

Speaking to people in my electorate about getting to see a GP, I know that, while the measures we have introduced have helped ease some of that pressure, there continues to be a great amount of pressure on GPs, who have huge workloads, who often have to close their books and often do want to see more patients with a range of different issues but are unable to service people in their local area. A lot of GPs have said to me that they feel a lot of strain and stress about having so many people they have to service. They are worried that they are not able to service all these people and be able to see all the people who may need to see a doctor. They do feel an obligation. This government has decided that we will take seriously the issue of workforce shortage and ensure that in seats like mine, in outer metropolitan areas, those people too can access a doctor.

The bill before the House will introduce four changes to the Health Insurance Act 2009 and is designed to streamline the operation of section 19AB of the act. This section of the act is important for rural, regional and outer metropolitan areas as it provides that overseas trained doctors and foreign graduates of our medical schools are not able to provide professional services that attract Medicare benefits for a period of 10 years. Exceptions to this 10-year moratorium are granted, and one of the primary considerations is that the applicant must work in a district of workforce shortage. It is through these exceptions that the government influences the distribution of the medical workforce throughout Australia.

The importance of the scheme is reflected in the higher proportions of foreign trained doctors in rural and remote areas. The first change introduced by this bill is the removal of restrictions imposed by the act on New Zealanders and permanent resident doctors who obtain their primary medical degree from an Australian medical school. Under the existing arrangements, such graduate doctors are unable to access Medicare benefits for a 10-year period. This change recognises the fact that New Zealand medical schools are accredited by the Australian Medical Council under the same standards as those in Australia. It also addresses the inconsistencies between the Citizenship Act 1948, which provides New Zealanders with permanent residency rights without obtaining a permanent resident visa, and the Migration Act 1958, which considers New Zealanders to be temporary residents in Australia.

Secondly, the bill will address an anomaly in the act which means that the 10-year moratorium begins from the time an overseas trained doctor receives Australian permanent residency or citizenship. Under the amendment, this period will begin from when the doctor is first registered as a medical practitioner in Australia. This means that, under the new system, years of tenure as a temporary resident will count towards the 10-year period.

Thirdly, the bill introduces a 90-day time limit for seeking a review of a decision to refuse an application for a section 19AB exemption. Under the act an individual who has been refused exemption may apply for a review of that decision by the minister or delegate, but no time limit in which to seek that review is currently stipulated. Introducing a time limit will minimise the chance that the conditions relating to the consideration of the initial application will vary. It is intended that this change will improve the management of the review process.

Finally, under the changes introduced in the bill, students of an Australian medical school who were not an Australian citizen or permanent resident when they enrolled in their primary medical degree at an Australian medical school will no longer be described as a ‘former overseas medical student’ and will now be referred to as a ‘foreign graduate of an accredited medical school’. The previous wording was misleading and caused confusion in the medical profession.

The overall impact of this bill will be a medium- to long-term increase in the number of doctors working in rural, regional and outer metropolitan areas. That said, section 19AB of the Health Insurance Act will continue to allow government to influence the distribution of doctors in areas where they are most needed. Importantly, as the projects in Kingston and the government’s wider national health policies indicate, Australia is in the process of investing heavily in training medical professionals close to where they are needed. In the future it will be these graduates who will be meeting the demand of the healthcare profession in metropolitan, regional and remote areas of Australia. I commend the bill to the House.

Chris Hayes (Werriwa, Australian Labor Party) Share this | Link to this | Hansard source

Through the amendments that are contained in the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009 it is proposed to streamline the Health Insurance Act 1973 by removing a number of anomalies. As previous speakers have alluded, there has been a chronic shortage of doctors in this country. One of the things that this bill is attempting to do is to address, amongst other things, some of those anomalies that may artificially restrict the health professionals, the doctors, from being able to work within our system.

The Health Insurance Act 1973, amongst other things, currently restricts doctors who are New Zealand permanent residents and citizens who have obtained their primary medical education at an accredited medical school outside Australia. It restricts them from providing professional assistance that attracts Medicare benefits for a period of 10 years. This is commonly referred to as the 10-year moratorium. So you can see from that, Madam Deputy Speaker, as the act currently applies it artificially restricts graduates of New Zealand based medical academic institutions or New Zealand permanent residents, if they seek to practise in Australia, from being able to bill for Medicare benefits over that period.

Overseas trained doctors and former overseas medical students may be granted an exemption from these restrictions if they work in a district with a workforce shortage, particularly if it is in a rural, remote or outer metropolitan area. Indeed, we have in the south-west of Sydney sought to have various overseas trained doctors apply under those exemptions in order for them to be able to practise in the south-west of Sydney.

The first amendment in the bill removes from the classification ‘overseas trained doctor’ any New Zealand permanent resident or citizen who obtained their primary medical education at an accredited Australian or New Zealand medical school. Previously a person was considered to be an overseas trained doctor if they obtained their primary medical degree from a medical institute outside this country. Given the amount of activity that has occurred in the last decade between Australia and New Zealand, it does seem to be significantly restrictive, particularly where we have cross-recognition regimes in place in just about all professional areas, and I think only recently even in accounting, that we provide an artificial restriction restricting doctors trained in a New Zealand medical institute.

The second amendment in the bill will rename the ‘former overseas medical student’ to a ‘foreign graduate of an accredited medical school’. That will more accurately reflect the meaning of the term. This will address issues arising from New Zealand citizens who are able to stay permanently in this country on a special category visa but who are not considered to be Australian permanent residents being restricted under the 10-year moratorium after they obtain their medical qualifications from an Australian medical school.

The third amendment will rectify an anomaly in section 19AB of the act, which currently says that the 10-year moratorium will start from when a medical practitioner achieves Australian permanent residency or citizenship. The amendment proposes that the 10-year moratorium commences from the time the medical practitioner is first registered as a medical practitioner in Australia and will cease after 10 years, provided that the medical practitioner has, by that stage, gained permanent residency status in this country. Should a medical practitioner not obtain Australian permanent residency or Australian citizenship by the conclusion of that 10-year period, from when they first gain their medical qualification, the restriction will then remain in force until such time as permanent residency or citizenship is obtained.

Finally, section 19AC of the act will be amended to insert a new time limit of 90 days during which an applicant can seek to a review of a decision to refuse their application for a section 19AB exemption or a decision to impose one or more conditions on a section 10AB exemption.

This is a bill which is seeking to streamline the application of those parts of the act but it will also remove some of the artificial barriers for overseas trained doctors, particularly for our colleagues from New Zealand. I will talk later about the number of overseas trained doctors that we have currently working in our system, which as everybody knows has been strained for some time. It is a system that this government is determined to do something about.

The bill will allow more doctors to provide medical services which attract Medicare benefits to patients throughout this country. I am happy to report that I have a facility in my electorate doing almost the same thing. The University of Western Sydney School of Medicine was opened by the Acting Prime Minister, Julia Gillard, in November 2008. The School of Medicine is an 8,000-square metre facility based at the Campbelltown campus of the University of Western Sydney. It boasts an impressive lecture theatre as well as an anatomy laboratory, a computer laboratory, a clinical skills area and eight research laboratories.

The University of Western Sydney School of Medicine is helping to solve the south-west of Sydney’s critical doctor shortage. This shortage is one which I spoke about many times during the term of the previous government and one which we said was, quite frankly, an embarrassment for the people of south-west Sydney to have to endure. The School of Medicine is an institute which is working very well to try to encourage local students—students who have lived and grown up in this area—to stay on, take their medical education in the area and, hopefully, stay as GPs and specialists in the south-west of Sydney.

Approximately two-thirds of the university’s medical students are very much proud local kids from greater western Sydney. It is a very big catchment area, but until the university’s program was established the opportunities for those young people was either to go to one of the sandstone universities of Sydney or to go to Newcastle. Young people can now decide to study medicine locally. We believe this will produce a greater number of local doctors. We are very proud of the fact that two-thirds of the current medical students registered at the university are local to greater western Sydney. It is expected that most of these students will choose to live and work as doctors in the area. This has been borne out by a series of research projects which gave rise to the decision of the former government to place a campus of the university in the south-west of Sydney.

Last year, UWS received 3,000 applications from students to study a medical degree. There are certainly plenty of young people in western Sydney willing to start and commit to a career in medicine. I think that is very important. As I said earlier, for the years and years that I have been in this place I have complained that the number of doctors available, particularly general practitioners, in the south-west of Sydney was a blight on our area.

Under the leadership of the School of Medicine’s new dean, Professor Alison Jones, these medical students will learn and obtain the clinical skills and knowledge necessary to be the medical leaders of the future. Professor Jones joined UWS in October this year. She is an internationally recognised leader and educator in clinical toxicology and a very active clinician in her own right. Professor Jones has been Professor of Medicine and Clinical Toxicology at the University of Newcastle, as well as the director of the National Poisons Information Service in London and Head of Medicine at London’s Guy’s and St Thomas’ hospitals. To say that the medical students at the University of Western Sydney are in good hands would be an understatement.

When the School of Medicine was opened in 2008, the foundation dean of medicine was Professor Neville Yeomans. He said at the opening that the school would provide:

… a state-of-the-art learning environment that seeks to stimulate, challenge and inspire a new kind of doctor—one who understands the importance of doctor-patient communication, primary health, and collaborating with nursing and other allied health professionals to provide a continuum of care for every patient.

The education our students receive in this facility, together with the training they receive in our local hospitals and community settings with specialist doctors, GPs and community health partners, gives them a special perspective on chronic health problems, particularly in Greater Western Sydney, which has high rates of cardiovascular disease, mental illness, obesity and diabetes …

Professor Yeomans went on to say:

Now, for the first time, hundreds of aspiring doctors and medical specialists from across Sydney’s west have the opportunity to stay, train and work in the region they have grown up in and understand so well.

UWS doctors and researchers will be at the frontline of health care, working to significantly improve the health and wellbeing of future generations of Australians.

The University of Western Sydney School of Medicine’s approach to clinical education is one that should be mirrored throughout this country. For the 4½ years for which I have been the member for Werriwa, I have had an association with the practitioners from this institution. I have seen firsthand how they work with various local community groups—not necessarily medically based groups but groups looking after single parents and children with disabilities. These doctors have the opportunity to work with the real people, if you like, outside the lecture rooms of a university, people who reflect the nature of the area in which we live in south-western Sydney. This is something which is quite foreign, as I understand it, to contemporary medical education—actually exposing doctors not simply to the academic aspects of their profession or what they are likely to be coming into contact with in the future but actually showing them the real dynamics of what occurs within a modern society, the one they grew up and choose to live in and which they will hopefully continue to serve as medical practitioners. It is not just textbook diagnosis. It is looking for doctors who actually understand, empathise and will work with their society as it develops and meets the challenges of the future.

I would like to take this opportunity to congratulate Professor Yeomans for all that he achieved at the School of Medicine before his retirement a few months ago. His hard work and dedication over the five years during which he acted as dean of the college have not gone unnoticed by either the university or the School of Medicine. His persistence, dedication and professional approach have certainly meant that his standing in my local community is extremely high. Although Professor Yeomans has retired, I know that he will be a continuing source of advice and encouragement long into the future.

Speaking for the future of the first hundred doctors, who are due to graduate from the School of Medicine in 2011, these young people are about to experience in a very unrestricted way practising medicine in a very different environment from what would have been the case had they selected a different medical school in which to do their undergraduate studies. Bear in mind that the south-west of Sydney is going through an extraordinary growth rate. It is predicted that over the next 20 years there will be an additional 450,000 people based in the south-west of Sydney. As these students graduate in 2011, undoubtedly, through the education they have received at the University of Western Sydney, they will certainly have a very bright but nevertheless very busy future ahead of them.

To help prepare them for that future, students undertaking a Bachelor of Medicine and Bachelor of Surgery at the School of Medicine receive an education which, quite frankly, in my opinion is second to none. They are working closely with the clinical staff at the Liverpool, Campbelltown and Camden hospitals, where they are getting very much a hands-on experience of what it means to be a doctor. From week 1, students are placed in a hospital based environment, learning skills that will equip them for the future. But one of the main things they learn—and this is what Professor Yeomans had always stressed ever since I first met him some 4½ years ago—is to do no harm. This is not experimenting on patients; this is understanding the patients. The approach that has been established at this School of Medicine is unique.

One of the people helping to guide these students is the state Labor member for Macquarie Fields, Dr Andrew McDonald. I happen to know Andrew very well. As a matter of fact, I was heavily involved in recruiting him to stand for the seat of Macquarie Fields not all that long ago. Both Andrew and his wife, Jenny, are paediatricians. Jenny is still a paediatrician practising at Campbelltown Hospital, and Dr Andrew McDonald, who now is a state member of parliament, still attends hospital one day a week. He works pro bono either at the Campbelltown Hospital for people in need or, alternatively, at Tharawal medical centre, servicing our local Aboriginal population, which is the second largest in the state. This is pro bono.

I suppose politicians cop a lot of brickbats in their time, and sometimes it is more deserved than others. But here is a man who has sought to advance the aims and interests of his area in entering state parliament, and I think he makes a very good contribution to the state parliament in doing that. But, in addition to that, one day a week he practises without charge, pro bono, for people in need. That is an outstanding contribution.

Apart from other things, Andrew is an associate professor at the University of Western Sydney, and therefore, I think, having him involved in the teaching of young people coming up in the medical profession is quite invaluable. He takes his commitment to advancing the needs of the area very seriously. Apart from being a paediatrician, he has become—and I hate to use the word ‘politician’—a parliamentarian and takes that role very seriously also. But, in addition to that, he still maintains an active medical role. It is not just a matter of keeping his hand in—that is not what he does, because he is a specialist in his own right. He goes out there with a view to working pro bono for people in need. That is the sort of person we do want to develop in a modern society, a person who actually cares. I am very proud to have Andrew as a friend, and he and his wife have made an extraordinary contribution to our society. (Time expired)

Darren Cheeseman (Corangamite, Australian Labor Party) Share this | Link to this | Hansard source

I commend the member for Werriwa for his very wide-ranging contribution on this matter. He certainly has a very deep interest in the people of Western Sydney and is a very fine advocate for their needs.

Today I rise to speak on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. The relationship that has been maintained between Australia and New Zealand is a very special one. The two countries have had various arrangements in place since the 1920s and this has led to a free flow of people between Australia and New Zealand—and that, of course, includes me. We share common ideals and a bond that extends from the history of the Anzac legend to our cross-Tasman rivalry in all forms of sport. It is fair to say that barely a week goes by without a major story arising about a clash between the Silver Ferns and the Diamonds or the Wallabies and the All Blacks.

Since 1973 the trans-Tasman travel arrangement that has allowed Australian and New Zealand citizens to flow freely between one another’s countries has very much assisted both our economies. The number of New Zealanders in Australia has increased, particularly in times of economic strength, and when our economic conditions lessen or slow there is a free flow back. On 30 June 2009, an estimated half a million New Zealanders were residing in Australia. Currently, New Zealand residents are allowed to stay in Australia permanently under the conditions of a special category visa. Under the current terms of the Health Insurance Act 2009, New Zealand doctors who seek to practise in Australia are lumped with the same restrictions as those that apply to other international doctors. This, of course, does not reflect the nature of the special relationship between our two countries.

The Australian Citizenship Act 1948 provides New Zealand citizens living in Australia with many benefits. Under the provisions of the act, New Zealand citizens maintain permanent residency rights without the requirement to obtain a permanent residency visa. On the other hand, the Health Insurance Act 2009 requires the Department of Health and Ageing to refer to and use the Migration Act 1958 as the authority in determining residency status. The Migration Act 1958 considers New Zealand citizens to be temporary residents of Australia. The effect, under the current provision, is that New Zealand citizen doctors are considered to be overseas trained doctors if they were first recognised as a medical practitioner after 1 January 1997.

The framework of section 19AB of the Health Insurance Act 2009 does not currently accommodate the close nature of the relationship that Australia and New Zealand maintain. Under the current arrangements, many New Zealanders who elect to study at an Australian university are treated no differently from Australian students. Also, a New Zealand student can enrol in a medical course in Australia in much the same way as an Australian can. However, they are not considered to be an Australian permanent resident under the meaning of the act. This has the ongoing effect of bundling them under the same arrangements as doctors who have trained overseas.

Once these doctors enter the skilled workforce they are subject to the same constraints as international doctors. This means they are restricted from providing professional services which attract Medicare benefits for a period of 10 years from the date on which they become both a medical practitioner and an Australian permanent resident or citizen. A significant number of temporary resident doctors, including New Zealand trained doctors, work in districts of workforce shortage for two to five years before gaining permanent residency or Australian citizenship. When the 10-year moratorium is applied to their tenure, these doctors may be obliged to work in a district of workforce shortage for up to 15 years.

The experience of temporary resident doctors is not in keeping with the original intent of the act, which was for a 10-year moratorium to commence from the time the medical practitioner is first registered as a medical practitioner in Australia. Whilst New Zealand and Australian citizens have benefited from changes to the Migration Act 1994, this has not been reflected in the Health Insurance Act, as it refers to the Australian Citizenship Act 1948 for its definitions. Due to the nature of these requirements, from the time a student commences their primary medical degree to the time they obtain citizenship or permanent residency they are restrained by an act that should no longer be there.

Due to this situation, a number of anomalies arise. There is no point in beating about the bush when we talk about the shortage of doctors in Australia. By aligning the anomalies that currently exist between departments, this government is delivering positive reform to health services in Australia. Whilst the previous government spent 11 years savaging the health system and trying to dismantle Medicare and privatise the health system, they failed to address the reality that we need more doctors practising medicine in Australia. This reform will have the effect of encouraging health professionals from New Zealand to go through the processes and help us bring quality services to our health sector. Currently our migration laws reflect our close relationship with our neighbours across the Tasman, yet our Health Insurance Act does not reflect that close arrangement.

I would briefly like to highlight some of the things the Rudd government has been working on within my electorate of Corangamite. I want to talk in particular about our GP superclinic, which was an election commitment that I secured in the lead-up to the 2007 federal election. That commitment was for a $7 million facility that we worked on with Deakin University and the local GP association. This GP superclinic will not only provide a huge amount of services to Geelong’s growth corridor of Belmont, Waurn Ponds, Highton and Grovedale; it will also play a very significant role in training Deakin University medical graduates coming out of the Waurn Ponds campus, which will of course help bolster the number of GPs in regional and rural Victoria. It will also play a significant role in bringing together many allied health professionals so that we have team based medical services being delivered, enabling our communities to access world’s best practice in the delivery of medication and medical services.

We have worked very closely in partnership with Barwon Health who have provided the land for the clinic to be built on. That highlights the strong and continuing work that we have been able to do with the state government in Victoria to ensure that our growth corridor in Geelong has adequate medical services. The first of the medical students coming out of Deakin University will be in 2011-12. I certainly look forward to having the super clinic up and running by then, enabling those medical students to be able to practise whilst they learn under the appropriate supervision of doctors.

In conclusion, I would like to commend the work of the minister. She is prepared to work very hard to reform our health care system. She is prepared to make the hard decisions, often against the interests of sectional minorities, and I commend her for the zeal that she takes to the debate in reforming the sector. I commend the bill to the House.

Steve Georganas (Hindmarsh, Australian Labor Party) Share this | Link to this | Hansard source

I rise to give my wholehearted support to the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. We have been encouraging labour to flow into the Australian market at times of heightened demand, in all sectors. The longstanding skill set of visas, be they temporary or permanent residency visas, has assisted diverse industries such as construction, engineering, accounting, business and even health and nursing. This has been a long-held practice by this and previous governments. It gives our economy and our essential services the skilled labour that we desperately need. From time to time, the skilled labour needs change, but these are things that we have to look at continuously in contributing towards the targets in periods of increased demand. The last thing we want is unnecessary artificial barriers that discourage the flow of targeted labour across our borders that is required by our economy and service sectors, which from time to time will continue to supply our nation and our economy with the people it may need desperately. The medical professionals who make up our medical teams in Australia do tremendous and important work.

It has been an honour to chair the House of Representatives Standing Committee on Health and Ageing. It has given me a great opportunity to meet many people within the medical industry with specialisations as diverse as every profession you can think of. Each profession has unique and captivating stories to tell us and lessons to teach us in their contribution to our Commonwealth. They are truly remarkable people whose work I, as chair of the committee, am usually more than happy to support and serve.

The longstanding position of pretty well everyone who looks at this is that we as a Commonwealth have neglected to provide the training opportunities that we have needed to sustain our medical workforce. In the case of nurses, for example, I believe there is plenty of training available, but there is an unacceptably high attrition rate. Far too many nurses leave the industry because of the poor conditions they are expected to endure, but with doctors the situation is somewhat different. In the past we have failed to provide sufficient numbers of prospective doctors or the training that they need to meet the expectations of our population in the public services provided, or paid for, by the Commonwealth. The retirement of individual medical doctors—in high numbers as a proportion of their workforce—foreshadows very real shortages in this area. I believe that one can conclude that the training of sufficient numbers of doctors here in Australia has been a problem and a mistake for a generation. It is the generational turnover that is causing an extremely alarming drop in the supply of medical labour.

So it is right and it is good that we look further afield for supplementary and replacement labour. There is no more obvious place to look than the country which, many years ago, could have become one of the states of our Commonwealth. There probably is not any one country that is more similar to Australia. There probably is not any one people that has more in common with us here in Australia. And there is not any set of teaching institutions that turns out doctors with levels of skill and knowledge so similar to those here in Australia. Also, there is not any foreign country to which we have made our national border so permeable and open.

The bill before us amends the strict embargo placed on doctors trained in New Zealand. Currently, there is a 10-year moratorium on such doctors performing services that attract Medicare benefits, whether they be New Zealanders or Australians who are trained across the Tasman. As it currently stands, the 10-year moratorium can extend well beyond that, depending on the residency status of the individual concerned. This was not the original intention of the moratorium.

The training that such professionals receive is very much akin to that which professionals receive here at our own institutions, both being accredited by the Australian Medical Council. Similarly, New Zealanders can and do elect to train here in Australia, at Australian institutions accredited by the Australian Medical Council. The quality of training is not an issue in each of these categories of professionals being welcomed into our workforce. Let us be clear about the professionals we are talking about here. We are talking about Australians who train in New Zealand and New Zealanders who train either in New Zealand or here in Australia. We are not talking about professionals who train in other countries who make their way to New Zealand, whence they enter Australia. We are talking exclusively about the people of these two countries, Australia and New Zealand, who undergo training within these two countries at an institution that will, as a matter of course, be accredited by the Australian Medical Board.

The original intent was for such professionals to wait 10 years from the date they obtain Australian medical registration—no more, no less. Within the moratorium, such doctors were to be able, and are able, to take up salaried medical positions for which billing against Medicare is not required, such as within a hospital. Nothing makes more sense than the objects of this bill. Nothing makes more sense as we seek to expand the pool of readily available labour that provides Medicare services. Nothing makes more sense as we seek to provide medical services to our ageing Australian population, medical services that increase the quality of life of our population. This is the ultimate objective, and this bill is a good and proper means of furthering the realisation of this objective, together with many other things that this government is doing.

We know that the government is investing $64 billion in the hospital and health system across the country over the next five years. That is a 50 per cent increase on the previous agreement by the former Liberal government. We have invested $600 million in our elective surgery program. Stage 1 committed to a target of 25,000 extra elective surgeries in 2008 but delivered in excess of a whopping 41,000 procedures. We have invested $750 million in taking pressure off the emergency departments of more than 30 hospitals around the country. We have see the government rolling out 2,000 new transition care beds for senior Australians. That is a $293.2 million program to help our mums and dads who have no reason to be in hospital—taking the bed of someone who really does need it—transition back into the community and thereby reduce the capacity pressures on our hospitals.

The government is also investing $1.1 billion in training more doctors, nurses and other health professionals, and $1.1 billion is the single biggest investment in the health workforce ever made by an Australian government. We will see 812 additional GP training places from 2011 onwards and a 35 per cent increase on the cap of 600 places imposed, since 2004, by the Liberals. This bill is a continuation of the good things this government is doing to ensure that we meet the needs of an ageing population by having the doctors and medical staff to look after the ageing population and to look after all Australians. I therefore commend this bill to the House.

Kerry Rea (Bonner, Australian Labor Party) Share this | Link to this | Hansard source

I too rise in support of the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. Whilst many in this House today may be primarily focused on or concerned with their political health, if there is one thing that is of major concern to all Australians, including those in remote and regional communities, it is their reliance on good quality, personal health care. This bill is yet another very practical, reasonable and appropriate step in the Rudd Labor government’s commitment to improving the quality of our healthcare system and to improving the provision of medical services to all Australians regardless of where they live or their current circumstances.

The bill is designed to remove a number of anomalies that currently exist in the Health Insurance Act. It focuses on amendments to address the restrictions that apply to overseas trained doctors and former overseas medical students. It specifically amends the Health Insurance Act to make changes to the so-called 10-year moratorium, which prevents an overseas trained doctor from attracting Medicare benefits until that moratorium has been served. The bill recognises the need to change in order to provide more general practitioner services throughout the suburbs and in communities across the whole nation. Overseas trained doctors and former medical students who were first recognised after 1 January 1997 have generally been restricted from providing professional services that attract Medicare benefits for a period of 10 years, and this is what has become known as the 10-year moratorium. Approval of this legislation will enable New Zealand doctors who have trained either in Australia or in New Zealand to be exempt, effectively, from the moratorium. It means that New Zealand medical students, once they are registered as doctors either here or in New Zealand, will be able to attract Medicare benefits as soon as they start practising.

There are a range of reasons why this legislation is good, but I think it is important to acknowledge that the amendment reflects the very close relationship that exists between our two countries. As the previous speaker has already said, the similarities between us and our cousins or friends across the Tasman are very clear. We might fight it out on the sporting field and, at times, we may well be bitter rivals in the field of sport. We might both fiercely protect our national and cultural differences—and, of course, this is a good thing because communities are shaped by their circumstances and their unique history and there is much between New Zealand and Australia that because of historical circumstances has highlighted the differences. We might make fun of each other’s accents quite regularly and we might often jibe each other with what are well-known nicknames—and of course the word ‘Kiwis’ comes to mind.

Ultimately it is the similarities that we share, not the differences, that have made us very long-term, historical friends and good neighbours and allies. It is our commitment to our democratic institutions, our commitment to the political system that we both work under, our commitment to providing good-quality education and professional services and the goals that we both want to seek for improving the welfare of our communities that we share. It is the commitment that both countries have to providing essential services to the citizens of both our nations, particularly a good-quality healthcare system, that means we often speak and act as one. Our differences may be the subject of good humour, but they do not outweigh the common bonds that we hold. For that reason alone I support this amendment, because I believe that it is important that we acknowledge our similarities and that we work with our New Zealand neighbours to share the skills, the resources and the intellectual capacity of the citizens of both countries to provide good-quality health care.

Another important amendment also acknowledges the professional services from some overseas trained doctors who are currently providing medical services here as temporary residents by including those years of service within the calculation of the 10 years of their moratorium and therefore reducing, in effect, the amount of time that these doctors serve as medical practitioners before they attract Medicare benefits. The 10-year moratorium is currently calculated from the time an overseas doctor receives permanent residency or citizenship here in Australia, but some overseas doctors are currently working and providing very important medical services in the areas that we call ‘districts of workforce shortage’. They are providing a very important service that sometimes would not be provided if we were simply relying upon either an Australian trained doctor or an overseas trained doctor who had served their 10 years and had their moratorium lifted.

This bill enables the 10 years of moratorium to be calculated from the time of registration if overseas doctors have been working in these areas, albeit with a temporary residency visa. This is important, because it means that some very well trained, good-quality overseas doctors—particularly those filling very important vacancies in some of our more remote and regional communities—could have to wait for up to 15 years before the moratorium ends and they are able to attract Medicare benefits. This bill is a very important step in reducing that time frame and enabling these doctors to attract those benefits—which, of course, flow on directly to the cost of health care to their patients. In acknowledgement of the difficulties that often occur in very remote communities, the scale of reduction in time can be affected by the remoteness of the community that the doctor is working in. In more remote communities, it may well be that the time frame required for the moratorium to end is shortened.

Both of these amendments are very important, and not just because they provide very important health services in areas of remote Australia where vacancies may not otherwise be filled. Even an electorate like my own—the electorate of Bonner, which covers the south-eastern suburbs of Brisbane—whilst contained within a metropolitan city, has very real shortages of trained doctors working as GPs. There are shortages in suburbs right across our country, from the largest inner-city suburbs to the very remote areas of the country. What this means is that we as a community will have access to more doctors who will be able to provide that very important localised personal health care that we all depend on. In particular, those New Zealand doctors who, as I said, have trained here or in New Zealand will be able to step in and provide very important services in all of our local communities. It addresses the chronic shortage of GPs, and it should be commended.

It is very much a part of the approach to improving both preventative healthcare services and primary healthcare services in all of our communities. We hear much and we read much about the pressure on our public hospital system. We hear and read much about the crisis in the public health system. We all know that perhaps one of the most significant ways in which we can reduce pressure on our public hospital system is to reduce pressure on casualty departments, to reduce the number of people who are presenting at a public hospital either because they cannot afford to go to a local GP or because they simply cannot find a local GP who is open. We all know that illnesses, particularly in children, do not confine themselves to nine to five business hours. My own experience is that, invariably, they will happen at any time of the day other than during business hours. It is then that you are desperately looking for a doctor to assist you. Putting more doctors into our communities to provide primary health care will definitely contribute to easing the pressure on the casualty departments of our public health system, which in turn will take pressure off elective waiting lists. There is a range of ways in which putting more doctors in the field will assist across the whole spectrum of public and private healthcare services.

It is also important to acknowledge that this bill works very much in partnership with the significant number of dollars which the Commonwealth government are currently putting into improving our healthcare system, including the $1.6 billion that is the COAG partnership working towards providing better health services. More importantly, there are significant dollars working in partnership with our state governments. We are ending the blame game. We are stopping the rivalry and we are stopping the buck passing; we are actually putting money towards a partnership which, if we work together, will give us greater value for our health dollars than if we were simply rivalling with each other or blaming each other. The $1.6 billion will go towards the training of 13,800 medical students, 38,500 nursing students and 18,000 allied health students. On top of that there are another $28 million to help train 18,000 nurse supervisors, 5,000 allied health and VET supervisors and 7,000 medical supervisors. This year’s budget also delivers more than $200 million to help tackle the shortage of doctors and health workers in rural and remote Australia.

As I said in the beginning, while we are dealing with very important matters of national interest here today, particularly in the Senate—and we hope that the health of our planet will prevail as a result of their debates—it is also important that we do not take our eyes off the ball in relation to the other very important responsibilities which we as a government and as a parliament have towards the Australian community. Indeed, there can be no greater importance than supporting our healthcare system and protecting the personal health and welfare of all our citizens, regardless of where they live and regardless of their economic circumstances. The only way we can do that is to look at ways and means to get better quality health care with more health professionals, particularly more doctors, out in our suburbs and in our local communities, those who can work with individual patients to prevent many of the preventable diseases which currently cause people to rely much more than should be the case upon our public hospital system. This is about a healthier society and a healthier community. I commend the bill to the House.

Mark Dreyfus (Isaacs, Australian Labor Party) Share this | Link to this | Hansard source

Since coming to office in November 2007, the Rudd government has paid close attention to reform of the health system and that close attention has taken the form of innovations in relation to primary health care and preventative health care, and a great deal of consultation and listening to the community. Since the release of the national health report by the Minister for Health and Ageing in the middle of the year, we have seen the Prime Minister at very many hospitals throughout the country, sometimes in the company of the health minister and sometimes with other ministers. It is an indication that the Rudd government, from the Prime Minister down, is listening hard to what Australians have to say about the need for reform of the health system.

The emphasis that has been placed on preventative health care and primary health care is very important. Certainly what I hear constantly from people in my electorate is the need to attend to and to make sure that the system works in favour of the interaction that most people have with the health system, which of course is not in large hospitals or in relation to very acute conditions but rather in day-to-day medical care and, in particular, the care that is provided to the community by general practitioners. Certainly I have heard in the course of a men’s health forum that I conducted earlier this year at the Central Bayside Community Health Services centre in my electorate, which was attended by the health minister, about the importance of ensuring that the primary healthcare system is delivering services in the way that it should. And at a women’s health forum that I conducted in my electorate later in the year we very much got the same message—that is, it is important that the primary healthcare system deliver services.

The particular legislation that is before the House, which is the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009 has, as its focus, changes to the way in which New Zealand doctors are able to work in Australia. It proceeds by treating New Zealand doctors—and it is entirely appropriate that this occur—differently to the way in which the system treats doctors who have obtained their qualifications in places other than New Zealand or Australia. It is perhaps not well understood by the wider community, but it is a fact and has been for many years, that the Australian Medical Council, which is the body that accredits training institutions and, in particular, accredits undergraduate training for doctors, administers a system that looks, together, at Australian medical schools and New Zealand medical schools. Although it is called the Australian Medical Council, it is one which delivers accreditation to New Zealand undergraduate medical training in exactly the same way as it delivers accreditation to Australian undergraduate medical training. It has produced the outcome over many years that New Zealand undergraduate medical training is undertaken to exactly the same high standard as is reached in undergraduate medical training at Australian institutions.

It has also been the case for many years not only that New Zealand citizens and New Zealand permanent residents undertake their undergraduate medical training at Australian medical schools but that numbers of Australian students—that is, Australia’s citizens or Australian permanent residents—go to New Zealand to undertake their medical training. It is quite appropriate that there be an adjustment to the system which recognises that closeness of association between Australia and New Zealand and recognises the high standard that is achieved in New Zealand undergraduate medical training.

Since 1997 the Health Insurance Act has adopted a mechanism which creates a 10-year moratorium for overseas trained doctors and former overseas medical students. The 10-year moratorium is a bar on those medical practitioners providing professional medical services that attract Medicare benefits for a period of 10 years. That is why it is called the 10-year moratorium. It is used as a tool of workforce management. It is possible for an overseas trained doctor or a former overseas medical student to be granted an exemption from that 10-year moratorium, and a primary consideration—and the legislation sets this up—in granting an exemption from section 19AB of the Health Insurance Act is that an applicant is working in an officially designated district of workforce shortage.

What that produces is that section 19AB, which sets up this 10-year moratorium, is able to be used as a key mechanism in directing doctors to areas of our country which are experiencing a shortage of doctors. Generally speaking, those communities tend to be rural and remote. It has produced the result over time that a very significant proportion of doctors in rural and remote areas are overseas trained doctors. I think it is probably obvious to all that, were it not for the adoption of this mechanism sometime back, there would be very many areas of our country, particularly rural and remote areas, where there would be no doctors at all. It is the case that there are very many communities in Australia that are reliant on overseas trained doctors.

As the Minister for Health and Ageing commented in her second reading speech, Australia is certainly not alone in facing that phenomenon. Other OECD countries, notably Canada, the United Kingdom, New Zealand and the United States, have experienced a very significant increase in the number of foreign trained doctors working in their countries. Recognising, however, the closeness of training and the high standards that are reached in undergraduate medical training in New Zealand as well as in Australia, this legislation seeks to remove the restrictions which are imposed by effectively a combination of the Australian Citizenship Act and the Migration Act on New Zealand citizens who have trained and obtained their medical qualifications either in New Zealand or in Australia.

The way in which the provisions currently interact is that the Australian Citizenship Act 1948 provides New Zealand citizens living in Australia with many benefits and citizenship rights. One of those provisions accords to New Zealand citizens permanent residency rights without the requirement of obtaining a permanent residency visa. A number of other speakers in this debate have commented on the hundreds of thousands of New Zealanders who are living in our country and making a tremendous contribution to Australia. They are very often very well educated and very enterprising people and fit very closely in the Australian community, not just for the reason that English is their native language but for many reasons of cultural similarity. I have noted that many of the other speakers in this debate have commented on the closeness of association in relation to various sporting events. Indeed, we have shared competitions with New Zealand in a range of sports.

While that is the situation created by the Australian Citizenship Act, the Migration Act, by various provisions in the Health Insurance Act which interact with it, is the authority for determining residency status. Under the Migration Act, New Zealand citizens who are living in Australia, even though they are able to come to Australia without obtaining a permanent residency visa, are considered for the purposes of the Migration Act to be temporary residents of Australia. The consequence of the interaction of these provisions is that New Zealand citizens who are doctors are considered for the purposes of the current regulatory regime to be overseas trained doctors if they were first recognised as medical practitioners after 1 January 1997.

As I indicated earlier, it is the case that many New Zealanders elect to receive their undergraduate medical training at Australian universities and some Australian citizens or permanent residents elect to receive their training at New Zealand universities. It is wholly appropriate that the health insurance regime recognises the high standards of undergraduate medical training that are provided in both Australia and New Zealand and recognises that, where we have someone who happens to be a New Zealand citizen but who has received undergraduate medical training that is for all intents and purposes identical to that of an Australian citizen, and sometimes there will be Australian citizens obviously educated at exactly the same medical school at exactly the same time, it is appropriate that there be a recognition of the standard of undergraduate medical training that New Zealand citizens or New Zealand permanent residents wishing to work in Australia have and to treat them differently to medical practitioners who have obtained their undergraduate medical training and their medical qualification in a place other than New Zealand or Australia.

The technical result of the amendments that are contained in this bill will be that New Zealand residents or citizens who have obtained their primary medical degree from an Australian or New Zealand medical school who would under the current provision of section 19AB have been subject to the 10-year moratorium will no longer be subject to that moratorium. Any person who has already commenced working in Australia and being subject to the moratorium will also no longer be subject to that moratorium. Equally and obviously, in relation to a New Zealand citizen with training from an Australian or New Zealand university who has obtained a section 19AB(3) exemption, for a person in that category the exemption will cease to have effect.

It is to be noted that the Department of Health and Ageing is very well aware that there will be some New Zealand citizens and some New Zealand residents who have come to Australia wishing to work as medical practitioners whose undergraduate medical training was not at an Australian or New Zealand medical school. The legislation draws that distinction and it will be the case that any New Zealand citizen or New Zealand permanent resident whose undergraduate medical training was not from a New Zealand or Australian university will continue to be subject to the regime that presently applies to them.

Although the moratorium provision and the exemption which goes with it are directed at ensuring that the workforce shortages that are experienced in rural and remote parts of Australia are able to be managed, it is also the case, and I hear it constantly in my electorate, that there are in fact shortages of doctors in the outer suburbs of our large capital cities. My electorate takes in a range of middle and outer suburbs, including in particular growth areas like Carrum Downs, Keysborough, Springvale and Dandenong South, which are in part established but also are experiencing great expansions in new housing. It is also the case that suburbs like that which are at a distance of 20 to 40 kilometres from the centre of Melbourne—and there is a similar phenomenon in Sydney and Brisbane—are finding that the traditional model of provision of general practitioner services, which was a solo practitioner operating a family practice in possibly a fairly residential setting in the suburbs, is disappearing. Practices that have been conducted for decades are not able to be sold, not able to be transferred to a younger practitioner because younger doctors, it seems, wish to work more in group settings. What is being found is that the spread of provision of general practitioner services is in decline. Certainly that is something that is constantly mentioned to me by the GP networks in my electorate—that is, the Dandenong-Casey GP network and the Bayside GP network.

The Dandenong-Casey network covers the eastern part of my electorate, across into Casey and into the federal electorate of Holt. The Bayside GP network covers, as the name suggests, the suburbs along Port Phillip Bay. The phenomenon of shutting down solo general practices is one that has now been going on for several years and is continuing. I contacted the hardworking CEOs of those two GP networks: Kath Ferry, who is the CEO of the Bayside GP network; and Anne Peek, who is the CEO of the Dandenong-Casey GP network. I meet with them as often as I am able. They are able to keep me informed about issues of concern in the health system. They had some very favourable observations to make about this amending legislation, both of them saying, in effect, that it was desirable for the simple and obvious reason that it will make it easier for New Zealand doctors to come and work in Australia. It is likely that that will benefit electorates like mine and communities such as those I represent because it is likely to increase the availability of doctors and will deal with workforce shortages that are occurring in the middle and outer suburbs of our cities, even though those areas are not designated areas of workforce shortage. Kath Ferry, the CEO of the Bayside GP network, said, ‘The measures are desirable to make it easier for New Zealand doctors to work in Australia and will help to address workforce issues in areas like ours which are other than officially designated districts with workforce shortages.’

Anne Peek, whom I mentioned earlier, the CEO of the Dandenong-Casey GP network, said, ‘Not only are New Zealand doctors excellent but the proposed measure in this legislation will help our area enormously in addressing the supply of doctors.’ It is to be sincerely hoped that her expectation of the worth of this legislation is in fact realised.

The legislation has some other, minor changes in it, but the major measure that is contained in it is of course the appropriate recognition of the different status of New Zealand doctors who have received their training in Australian or New Zealand medical institutions. The second change is to amend the classification, which is presently used in the legislation, that places restrictions on a category of individuals known as—and this is the defined term—‘former overseas medical students’. That is to be amended to ‘foreign graduate of an accredited medical school’. It is an appropriate amendment to make because the term ‘former overseas medical student’ has been commonly misunderstood and has resulted in significant confusion among doctors. The term is very much intended to refer to foreign persons who graduate from an Australian medical school, and renaming the term as ‘foreign graduate of an accredited medical school’ aims to remove this confusion.

The third matter that is dealt with by this legislation is the removal of the requirement for overseas trained doctors and foreign graduates of an accredited medical school to have both permanent residency and medical registration in order for the 10-year moratorium period to commence. (Time expired)

Kirsten Livermore (Capricornia, Australian Labor Party) Share this | Link to this | Hansard source

I too rise to support the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. As we have just heard from my colleague, the member for Isaacs, this bill contains some straightforward and very common-sense changes to the Health Insurance Act 1973. Specifically, these amendments will streamline the operation of sections 19AB and 19AC of the act and in so doing will remove some anomalies and confusing terms that have created particular problems for doctors from New Zealand who are practising in Australia.

Those of us in parts of Australia characterised as districts of workforce shortage—or where we think we should be recognised as a district of workforce shortage—are familiar with section 19AB of the Health Insurance Act. I am sure that you, Deputy Speaker Saffin, have been in that situation yourself, coming from a regional part of Australia. Under normal circumstances overseas trained doctors and former overseas medical students are subject to a moratorium of 10 years in terms of their access to a Medicare provider number. Those doctors cannot provide medical services that attract Medicare benefits for a period of 10 years from the date on which the person is both a medical practitioner and an Australian permanent resident or citizen.

That is where section 19AB of the Health Insurance Act comes in. That is the section that provides for an exemption to the restriction on overseas trained doctors providing services that attract Medicare benefits. Many of us have made representations on behalf of doctors or medical practices wishing to employ overseas trained doctors, and that always involves trying to make the case for an exemption under section 19AB on the basis that the practice is indeed serving a district of workforce shortage. These restrictions on the access of overseas trained doctors to Medicare provider numbers were introduced as a way of giving the government a direct means to encourage doctors to work in rural and remote areas. The 10-year moratorium, by restricting an overseas doctor’s right to practise, in one sense also creates an incentive for those doctors to provide services in rural and remote communities that would otherwise struggle to attract doctors. If you go bush you can avoid the moratorium and start providing Medicare rebateable services immediately.

Up until now New Zealand citizens and permanent resident doctors have also been caught up in these restrictions, with the 10-year moratorium being imposed on them. This is clearly not logical when New Zealand medical courses are accredited by the Australian Medical Council in exactly the same way that Australian courses are accredited. This bill, therefore, amends the Health Insurance Act to remove the anomaly relating to New Zealand doctors. People who are permanent residents or citizens of New Zealand and who obtained their primary medical education at an accredited Australian or New Zealand medical school will be removed from the classification of ‘overseas trained doctor’. This makes sense and will not change the strict standards that will apply to those New Zealand doctors practising in Australia. Because of the requirement that they must be a graduate of an Australian Medical Council accredited medical course, their qualifications, even when received from a New Zealand university, will be the equivalent of an Australian graduate.

The second amendment in this bill relates to the use of the term ‘former overseas medical student’ in the Health Insurance Act. Currently section 19AB of the act imposes the Medicare restrictions on those ‘former overseas medical students’, meaning someone who attended an Australian medical school for their primary medical degree but who was not an Australian citizen or permanent resident at the time they were enrolled. This has proved to be misunderstood and has caused confusion among the medical profession. Instead, the term to be used in the act will now be ‘foreign graduate of an accredited medical school’. This better reflects the situation of doctors whose nationality is foreign but whose education is Australian. The use of terms has been tidied up but the effect of the section in the original act is the same—the moratorium will apply to foreign graduates of accredited medical schools because of the requirement for the 10 years to run from the time you are both a permanent resident or citizen and a medical practitioner.

The third amendment in this bill will be welcomed by those doctors who are currently subject to the moratorium, because for some of those doctors the starting point of the 10-year period has been delayed by ignoring any period the doctor might have been working in the country as a temporary resident. The amendment removes the requirement for overseas trained doctors and foreign graduates of an accredited medical school to have both permanent residency and medical registration in order for the 10-year moratorium period to commence. This overlooks the reality that most overseas trained doctors enter Australia as temporary skilled migrants, usually for a four-year stay. Many then apply during those four years to become permanent residents.

As is currently drafted, the Health Insurance Act provides for the 10-year moratorium period to start from the time a person is both a permanent resident and a medical practitioner. Under the current arrangements, those doctors who move from temporary residency to permanent residency, and who have been working in a district of workforce shortage in order to obtain the exemption under section 19AB effectively have the 10-year moratorium extended by a matter of some years. This bill will mean that the 10-year moratorium period starts from the time the medical practitioner is first registered as a medical practitioner in Australia and will cease after 10 years, provided that the practitioner has gained permanent residency or citizenship during that period. This is much more in line with the original intent of the moratorium and is fairer to overseas trained doctors and foreign graduates.

Finally, the bill contains an amendment that will place a time limit on appeals against a decision made pursuant to section 19AB. Those practitioners or medical practices that wish to appeal against a decision by the minister to refuse an exemption sought under 19AB will now have to appeal within 90 days of that decision. This is a commonsense amendment to ensure that there have not been substantial changes in circumstances between the time of the original determination and the subsequent reconsideration by the minister.

The debate on this bill gives us the chance as well to talk about medical workforce issues more generally, and I am sure that most people in the debate have taken that opportunity. It particularly allows me to recognise the role of overseas trained doctors and other health professionals in keeping services going in many parts of my electorate. We should acknowledge their contribution while at the same time recognise that we need to address the underlying factors that have caused us to rely so heavily on the skills of overseas trained health professionals. For the time I have been in parliament, there have been significant problems with workforce shortages across the health system. Whether it is nurses, doctors, specialists or those working in aged care, a lot of the issues we have faced in Central Queensland have come back to the difficulty in recruiting and retaining staff. As a fairly new government, we are still dealing with the legacy of the previous government’s failure to properly plan for our health workforce needs. That was exemplified by one of the Howard government’s earliest decisions to cut the number of GP training places. In contrast, I am pleased to say that one of the first things this government did was to increase the number of GP training places. Those places will jump from 600 in 2004 to more than 800 in 2011. That represents something like a 35 per cent increase in GP training places.

We know that for most people it is the wait to see a GP, or being told that GPs in their town are not taking new places, that is the clearest sign that our workforce is not keeping up with demand and also that our health workforce is not effectively distributed—and that hits us hardest in rural and regional Australia. That is why the federal government has moved to prioritise rural health and rural health workforce needs. The 2009-10 federal budget included a significant measure, the Rural Health Workforce Strategy, which encompasses a number of initiatives that aim to better target workforce incentives to communities in greatest need. One of the components of that package is the introduction of the Australian Standard Geographic Classification Remoteness Area system as a measure of eligibility for a number of workforce programs. This new system will replace the previous Rural, Remote and Metropolitan Areas system. One of the things that the Australian Standard Geographic Classification Remoteness Area system looks at is how to scale or allocate incentives when it comes to trying to attract and retain health professionals in rural and regional areas. It means that the use of this new classification system will result in an estimated 2,400 doctors in rural communities across Australia being able to access incentives for the first time. Almost 500 communities around Australia will become eligible for rural incentive payments.

I am pleased to say that Rockhampton, which is the major town in my electorate, is one of those communities eligible for rural incentive payments under this new classification system. I would hope to see those incentive payments being taken up by health professionals, and a subsequent increase in the number of health professionals choosing to set up practice and join practices in Rockhampton.

The other thing that the government is doing is continuing the National Rural and Remote Health Infrastructure Program that was available under the previous government, and I am happy to see that it has been continued by this Labor government. There was recently an announcement, which was very welcome in my electorate, of about $43,000 being paid to the Central Queensland Physio Group to provide additional services in the community of Yeppoon. Yeppoon is a beautiful seaside town, about 30 kilometres east of Rockhampton. It is a very fast-growing community and one of those places where demand for medical services and allied health services is very quickly outstripping supply. It used to be the case, when I first started in this House, that it was quite acceptable and the people in Yeppoon thought it was reasonable to travel into Rockhampton for services. But Yeppoon has really come of age. It is one of the fastest growing places in Queensland and it is really not the case any more that people in Yeppoon should have to travel outside of their community to access basic health and allied health services.

Central Queensland Physio Group have recognised this and have set up practice in Yeppoon, but this additional money will allow them to expand the services they can provide out of their new building. It will mean they can have room for more physiotherapists than they originally anticipated and will also be able to provide equipment and room for services like podiatry. That is going to be great for those people living on the Capricorn Coast. It is a recognition that the Capricorn Coast, and Yeppoon in particular, is really coming of age and that these basic health services should be provided right there in that community and not require people to travel into Rockhampton, which has traditionally been the major centre for these kinds of medical services.

I want to congratulate the principals of CQ Physio Group, Jim Griggs and Ben McGuire. They provide a terrific service to Central Queensland, not just Rockhampton but also the Capricorn Coast, and also out to the mining towns. They really play a strong role in training up-and-coming physios and training physio students and those who are just starting out in the profession. They also play a very active role in the community, encouraging people to stay fit and active and to take responsibility for their own health. Congratulations to Ben and Jim and to the team at CQ Physio Group. It was a great pleasure to be able to tell them a few weeks ago that they were successful in their bid for funding under the National Rural and Remote Health Infrastructure Program.

The support for health services in Central Queensland from this government goes well beyond $43,000 for the CQ Physio Group. Earlier this year it was announced in the budget that the Rockhampton Base Hospital would be the recipient of $76 million for a major upgrade of facilities there. That is on top of the $75 million that the state government has already contributed towards the upgrade of the hospital. We are seeing some really exciting things happening at the base hospital, which will create the facilities and capacity to boost the services available. I think there have been cranes and work crews up at the Rockhampton Base Hospital for as long as anyone in Rockhampton can remember, but it is all going towards building us a health service that will see us well into the new century by recognising the growth and development that is going on in Central Queensland and by making sure that those essential services keep up with the demands of a growing population that is being attracted by the booming economy.

While that building program is still going on, one thing that is already up and running as part of those new facilities is the long awaited, full-time MRI machine in Rockhampton. This is something that goes back quite a few years. I think I was lobbying and campaigning for this in the lead-up to the 2004 election. It was still an issue in the 2007 election and I secured a commitment from Nicola Roxon, who is now the Minister for Health and Ageing, that the Rockhampton Base Hospital would be given an MRI licence. The state government has purchased the MRI machine and is providing for its operation, but the federal government, through granting that licence, is effectively picking up the tab for the services provided by that MRI machine. Up until now, we have had a part-time machine in Rockhampton. We had a situation where the MRI machine was operated by a private company. It was located in a very large truck and was driven up and down the coast between Rockhampton, Gladstone and Bundaberg. But it has been recognised for some time that a hospital the size of the Rockhampton Base Hospital that provides the level of services it does needs a permanent MRI machine. That was something that I campaigned very hard on in the lead-up to the 2007 election because I saw it as a facility that was really essential in providing world-class health care in my electorate.

The next thing to work on is the Rockhampton Base Hospital’s bid to be considered as one of the regional cancer centres. The health minister announced that applications for the regional cancer centres program opened up a couple of weeks ago and I think, with the development that is already happening at the Rockhampton Base Hospital, there would be great scope to really increase the bang for the buck if it were successful in a bid to be a region cancer centre. The building that is going on right now is creating additional capacity at the hospital and it would dovetail very nicely if we were to secure additional funding for a regional cancer centre and fully integrate that into the development that is already going on. I am right behind that application by Queensland Health and I hope the case can be successfully made to secure funding to again increase the level of service available in Rockhampton.

If we ever get out of this place, I am looking forward to having a consultation with representatives from the health sector on Wednesday and looking at the recommendations from the National Health and Hospitals Reform Commission. Hopefully I can get out of here on Wednesday but, until then, I stand here and commend the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009 to the House.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

I thank the member for Capricornia, and I am sure we all share her sentiments about getting out of this place at some stage.

Tony Zappia (Makin, Australian Labor Party) Share this | Link to this | Hansard source

I take this opportunity to speak on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. As others have already said, the purpose of this bill is to amend the Health Insurance Act 1973 to, firstly, remove restrictions which apply to New Zealand permanent resident and citizen medical practitioners who have obtained their primary medical education at an accredited medical school in Australia or New Zealand and, secondly, remove the specification in the act that the period of 10 years during which overseas trained doctors are restricted from accessing Medicare benefits must commence from the time doctors become permanent Australians, even if they become medical practitioners prior to gaining that residency status. The bill also introduces a time period in which medical practitioners can appeal against the refusal to grant a section 19AB exemption or a decision to impose conditions in connection with an exemption which has been granted.

In essence, this bill not only removes unnecessary barriers to New Zealand medical practitioners but also eliminates the discrimination that currently applies between New Zealand medical practitioners and other New Zealand professionals who work in Australia. For years this country has had a special immigration arrangement with New Zealand whereby New Zealanders and Australians can travel and work much more freely between the two countries than can people of other nationalities. But, because of the specific requirements relating to doctors working in this country, that same freedom relating to New Zealanders does not apply to medical practitioners. This bill seeks to remove that aspect of the medical requirements to ensure that New Zealanders, regardless of whether they are medical practitioners or related professionals, have the same ability to work freely in this country as their other professional counterparts.

The government is also responding to the health needs of the nation and the inadequate level of services available in many parts of the country. These services have deteriorated over the last decade because of the neglect and buck-passing by the previous Howard government, which cut a billion dollars from the states under the last health agreement. Specifically, in relation to this bill, the Howard government failed to invest in sufficient university medical training places. Not surprisingly, we are now faced with a shortage of medical practitioners around the country and particularly in regional and remote communities. It was not just in the number of medical practitioners that fell. Using the latest international comparisons, in 2006-07 Australia spent 8.7 per cent of its gross domestic product on health. That was less than the OECD median expenditure of nine per cent of GDP and considerably less than the weighted average of 11.2 per cent of GDP across the 29 OECD countries that we were compared with. It might only be a couple of per cent but as we all know a couple of per cent in terms of real budgets equates to billions of dollars.

The Rudd government takes seriously its health obligations and the commitments it has made to the Australian people. Since coming to office, the Rudd government has invested $64 billion in the nation’s hospital and health system over the next five years. That is a 50 per cent increase on the previous agreement between the former government and the states. The Rudd government has invested $600 million in the elective surgery program and $750 million in taking pressure off more than 30 hospital emergency departments. The Rudd government is also now undertaking historic investment in nation-building health infrastructure by investing $3.2 billion in 36 major projects across our hospital and medical research initiatives, including $1.2 billion in world-class cancer centres.

The Rudd government has also committed $275 million for some 36 GP super clinics across the country, and $500 million has been approved for sub-acute care to help older people leave hospital and free up hospital beds. The Rudd government will also invest $1.1 billion in training more doctors, nurses and other health professionals. This is the single biggest investment in the health workforce ever made by an Australian government. The commitment will see an additional 812 ongoing GP training places from 2011 onwards, which represents a 35 per cent increase on the cap of 600 places imposed since 2004 by the previous coalition government.

One area of particular concern to the people I represent in Makin, and I expect of concern to people across Australia, is dental health care. I understand some 650,000 Australians are currently on public dental waiting lists. The Rudd government when it came to office committed a total of $650 million for two dental programs. One is the teen dental program, which provides a $150 annual payment to eligible families. It commenced last year and, to the end of December, 258,203 teenagers had received a dental check-up under the program, with 7,598 dentists providing services. Regrettably and unfortunately, due to the Liberals standing in our way in the Senate, the Commonwealth Dental Health Program, which would provide up to a million consultations, has not been able to commence.

The Rudd government also commissioned and is now considering the recommendations of the comprehensive report of the National Health and Hospitals Reform Commission, led by Dr Christine Bennett. That report is the product of 16 months of consultations, research and deliberations by the commission. It provided the government with 123 recommendations, which the government, through its consultations across the country right now, is in the process of considering. I want to quote from page 3 of the executive summary of that report, because it effectively summarises the state of our health system in Australia. It says:

The case for health reform is compelling.

The health of our people is critical to our national economy, our national security and, arguably, our national identity. Our own health and the health of our families are key determinants of our wellbeing. Health is one of the most important issues for the Australian people, and it is an issue upon which they rightly expect strong leadership from governments.

While the Australian health system has many strengths, it is a system under growing pressure, particularly as the health needs of our population change. We face significant challenges, including large increases in demand for and expenditure on health care, unacceptable inequities in health outcomes and access to services, growing concerns about safety and quality, workforce shortages, and inefficiency.

Further, we have a fragmented health system with a complex division of funding responsibilities and performance accountabilities between different levels of government. It is ill-equipped to respond to these challenges.

That is part of the executive summary of the Bennett inquiry. I suspect that very few of us in this place would disagree with those comments.

I mentioned earlier that, amongst the Rudd government’s commitments, $275 million had been allocated towards the provision of GP superclinics across the country. I particularly note and welcome that one of those GP superclinics will be established in the Makin electorate, which I represent. This particular clinic has a special status in that it will be established in partnership with the Rann state Labor government, which has also committed a matching amount of $12.5 million towards the clinic, so that it will be a $25 million GP superclinic. That collaboration has enabled us not only to carefully plan for and identify the location of the GP superclinic but, more importantly, to very carefully and methodically work through the range of services that will be made available from the clinic.

I understand that work on all of that is progressing and that the first services are expected to be provided from the clinic in the second part of 2010. The concept being supported is one whereby there will be a new facility established on Smart Road in Modbury, close to the Modbury hospital, and a range of medical and allied services will be provided from that facility. I also understand that a support facility is intended to be established on North East Road at Hillcrest, a few kilometres away, that will be linked to the Modbury GP superclinic and will form, in essence, an outreach centre of that superclinic.

I know from my discussions with people, including many of the medical people, out in the community that there are shortages and we could do much better in the delivery of health services to the people in Makin. I also know that there has been an incredible amount of pressure on the Modbury hospital outpatients department over recent years as a result of insufficient medical services being available. I look forward to the establishment of the GP superclinic in Modbury because I know that it will not only deliver much-needed services to the people I represent but also take pressure off the Modbury hospital and allow it to get on with providing the hospital services that it was established to provide.

I am grateful to Minister Nicola Roxon and to the South Australian state government Minister for Health, John Hill, for the cooperation and support I have seen from them in working through this complex problem. The funds have been committed. We want to see those funds being used in the most cost-effective way. And that is exactly what has been happening. To those who might say that it has taken us two years to deliver on this election commitment, I say: it is a process that we committed to, but we also committed to the necessary consultation that has taken place over recent months and the necessary planning to ensure that we deliver the best possible service when the doors to the new superclinic open.

I mentioned earlier the concern about the lack of funding for sufficient training places for medical practitioners in our universities over recent years and how that has resulted in a shortage of medical practitioners right across the country. I note that regional and remote parts of Australia in particular have been hit by those shortages because, not surprisingly, any medical graduate or medical professional who comes into this country would much prefer, in most cases, to work in one of the urban or city areas. It is not surprising that they do not particularly want to go out and work in remote and regional areas of Australia, and the government recognises that and has tried to provide additional incentives for them to do so.

But the shortages do not only apply in regional and remote areas; they also occur in metropolitan areas of our major capital cities. Certainly I am aware that we have had and still have shortages in parts of the Adelaide metropolitan area. I do not recall the exact figures but I do recall very clearly that the ratio of doctors to the community out in the northern suburbs of Adelaide was much lower than in other parts of Adelaide. Not surprisingly, when I was elected to this place I was made aware of the difficulty that people were having in securing appointments with their local GPs within a reasonable time. I can well recall one person ringing me up, quite frustrated and concerned that she was unable to get her daughter in to see her local GP for some three weeks; her daughter needed medical attention much earlier than that for an urgent issue. Having rung a number of GP service providers in the area, she had been unable to secure an appointment. That is the sort of thing that we need to overcome. It should not occur in Australia. Yet it did occur, because we were not training enough doctors in this country.

It would take some years for us to correct that shortage if we were to rely simply on medical students graduating from our universities. Clearly, therefore, the answer lies in attracting medical professionals to this country from overseas. That is what has been happening in recent years and it will continue to happen until we do have more medical graduates coming out of our own universities. In the interim, we need to change the regulations relating to those medical graduates who come from overseas—whether from New Zealand or any other country—to make it much easier for them to get on with providing the medical services that they are quite properly qualified and trained to do, because the sooner we can do that the sooner the Australian community will be the beneficiaries of the services they are calling out for.

I believe this bill is a critical step towards doing that. Yes, it addresses very specifically the case of medical practitioners who come from New Zealand, but it also deals with other matters that relate to some of the barriers in place against overseas-trained medical professionals. The sooner we can break down those barriers the better off the Australian community will be. For those reasons, I commend the bill to the House.

Julie Owens (Parramatta, Australian Labor Party) Share this | Link to this | Hansard source

It is good to see so many members on the government side of the House taking the opportunity to speak on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009, which recognises two areas that are very important to us all. The first is, of course, ensuring that we have a medical workforce that is able to meet the needs of all our communities. The second is acknowledging the very strong and extraordinary relationship that exists between Australia and New Zealand. We do bag the Kiwis at just about every opportunity, and I am desperately trying not to do so in this speech, so if it slips in, Madam Deputy Speaker, perhaps you can call me to order.

Our two countries are well and truly tied together by our proximity, our way of life, our business relationships and our family ties. In fact, as I stand on my feet now, my older sister, who has been living in New Zealand with her family for 30 years, is flying to Brisbane to get together for Christmas. I do hope we get out of here in time for me to see her. I think we might; I hope we do.

We do have a special status between our peoples and between our businesses, and we also have a special status that is recognised in law. Under the 1973 trans-Tasman travel arrangements, citizens of Australia and New Zealand can move freely between the two countries. We can live, visit and work in each other’s country without the need for a specific authority. But, under the changes to the Migration Act in September 1994, Australia required all noncitizens lawfully in Australia to hold a visa. This led to the introduction of a special visa to accommodate that Australia-New Zealand relationship. A new visa called an Australian special category visa was created. This means that, when a New Zealand citizen presents their passport to immigration at the airport, they are considered to have applied for a visa and, subject to health or character considerations, automatically receives that special category visa, which is then recorded.

While in Australia, New Zealand citizens can live here and work here as if they are permanent residents or citizens, even though they are not. People from both countries travel to the other country to study. As long as a New Zealand citizen or permanent resident who is staying in Australia is studying accountancy or engineering, that is fine. But, when they choose to study medicine, the Migration Act bumps up against the Health Insurance Act 1973 and creates consequences for graduates of New Zealand citizenship which are at odds with the special relationship between our two countries. New Zealand medical students studying in Australia have, in effect, permanent resident status without the need to attain permanent residency, but under the Health Insurance Act they are treated very much as if they are temporary residents because they are captured under the definition of ‘former overseas medical students’ in section 19AB of the act. That definition includes a person whose primary medical qualification was attained from a medical school located in Australia but who was not a permanent resident or an Australian citizen when he or she first enrolled at a medical school in Australia.

This amendment proposes to remove New Zealand citizens and permanent residents from the category of former overseas medical students, and there is a very good reason to do that—it is more than just a technical matter. Currently, former overseas medical students are subject to what is known as the 10-year moratorium. Doctors who are former overseas students who were trained in Australia are ineligible to claim Medicare benefits for 10 years unless they meet some specific criteria, usually involving practising in rural areas where there are shortages of health specialists.

It was known by the mid-nineties that Australia was not producing sufficient medical practitioners to meet the health needs of its population. In 1997 the 10-year moratorium was introduced. Overseas trained doctors and former overseas medical students can be granted an exemption from that restriction under section 19AB if they work in a district of workforce shortage. Section 19AB is one of the key mechanisms which the government uses to influence where doctors work and ensure that we have an appropriate workforce in rural and remote areas of Australia. The 10-year moratorium has proved to be a particularly effective mechanism. It is well known that some 41 per cent of doctors in those shortage areas have trained overseas.

We continue to be largely reliant upon overseas doctors in rural and remote areas, and in that respect we are not that much different from many other OECD countries: Canada, the UK and the United States, all of which have relatively large percentages of foreign trained doctors working in areas of shortages. These changes, of course, will exempt New Zealand doctors who trained in Australia or in accredited universities in New Zealand from that moratorium. It will allow them to work freely in Australia on the same basis as Australian doctors, in keeping with the special relationship we have between the peoples of our two countries.

I am particularly proud of the medical training that takes place in my electorate of Parramatta. The University of Western Sydney is the key trainer of nurses in the state of New South Wales. It has an exceptionally good-quality nursing training facility at both the undergraduate and the postgraduate level. We also have a recently opened medical school in Western Sydney which fulfils an extremely important role in training people for our region and beyond. It is good to know that some two-thirds of the people studying in that facility come from the local area of Western Sydney, because unless we have those training facilities in our own region it is very difficult to attract the number of medical practitioners that we need.

We are also making some changes to the 10-year moratorium process. In this year’s budget there was some $134 million for a rural package to encourage more doctors into rural areas. We have also adjusted the 10-year moratorium so that it is scaled so that the more remote you are the shorter the moratorium. From 1 July next year, some 3,600 overseas trained doctors who have restrictions on where they can practise will be able to discharge their obligations sooner, depending on where they choose to work—again, an important adjustment that ensures we have appropriate medical services in all of our communities.

We have also introduced an extensive workforce reform program that will deliver the biggest ever investment in workforce through a COAG partnership that delivers training for the huge increase in Australian trained graduates, which will increase from 12,700 positions this year to some 14,700 in 2013. That is being delivered through a $1.6 billion COAG partnership. As part of that, there will be support for undergraduate clinical training for 13,800 medical students, many of whom will be in the region of Western Sydney, and some 38,500 nursing students and allied health students in 2010. We are also providing a significant boost to help train some 18,000 nurse supervisors through a $28 million allocation of funds and an additional 7,000 medical supervisors. These are important additions to the support for medical services training, and I was very proud to see them put forward in this year’s budget.

This is an important bill, Madam Deputy Speaker, as you can see by the number of people who have spoken on it, particularly on this side of the House. It will deliver some significant benefits to the relatively small number of New Zealanders who study in Australia or choose to practise in Australia having studied in Australia. It is a relatively small number but they are an incredibly important group for this country, given our special relationship. I commend the bill to House.

Graham Perrett (Moreton, Australian Labor Party) Share this | Link to this | Hansard source

I too rise to speak on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. Like many people in the House, I have been waiting all year to speak on this piece of legislation. The purpose of the bill is to amend the Health Insurance Act 1973 to remove the restrictions which apply to New Zealand permanent resident and citizen medical practitioners who obtained their primary medical education at an accredited medical school in Australia or New Zealand and the specification in the act that the period of 10 years during which overseas trained doctors are restricted from accessing Medicare benefits must commence from the time the doctors become permanent resident Australians, even if they became medical practitioners prior to gaining that residency status. The bill also introduces a time period in which medical practitioners can appeal against a refusal to grant a section 19AB exemption or a decision to impose conditions in connection with an exemption which has been granted.

For New Zealand overseas trained doctors, this will be a welcome administrative clean-up, but, taken in the context of the Rudd government’s commitment to making changes in health generally, this will lay down one more plank in a nice solid platform for the Australian public. There are some scary facts out there, such as the reality that the very first baby boomers will be retiring next year—or will be eligible for the pension next year; I guess some will have retired beforehand. The people from the late World War II and post World War II baby boom in Australia—and around the world, but I am talking about Australians in particular—will be confronting our health system in great waves starting from next year. So it is important that we get our health system prepared and ready for the realities of an ageing Australia and, unfortunately, a slightly unhealthier Australia.

The member for Griffith, the now Prime Minister, Kevin Rudd, made a commitment in the lead-up to election night in 2007 to end the blame game when it came to health, to end the playing of politics in health and to instead deliver something which is in the nation’s interests and which saves and changes lives. We are not the sort of government to make political decisions like the decision to take control of one single hospital down in a marginal seat in Tasmania. We are not a government that believe in that sort of thing. We believe in preparing the nation for some challenges that are ahead.

To that end, we have had 80-odd health forums around Australia conducted by the Prime Minister; the Minister for Health and Ageing; the Minister for Ageing, Justine Elliot; and many other ministers. Below that, we have had another 80- or 90-odd other health forums conducted by backbenchers. I was fortunate enough to be with Minister Justine Elliott at the PA Hospital on the south side of Brisbane at one of these health forums, and the mood that was in the air and the way people responded to this government that goes out and talks to the professionals, the people at the coalface, about what their concerns are—their challenges, what they are doing well, what the opportunities are and what the threats are—were incredible. That was a great forum with Minister Justine Elliot. I had another at the Mater Hospital, also on the south side of Brisbane, with Prime Minister Kevin Rudd—it is his local hospital, but it services all of Queensland and particularly the south side of Brisbane—and Health Minister Nicola Roxon. I did my own health summit as well in my electorate office. I would particularly like to acknowledge the great work done by the Southside Division of General Practice, who provided me with great insights into some of the challenges on the south side but also some of the things that we are doing well and should continue to do and maybe pour some more money into.

It is one thing to talk to the people; it is another thing to actually do some real good. Obviously, money talks, and that is why the Rudd government poured money right from the word go into addressing some of the waiting lists that have grown over the last few years as the Howard government ripped over $1 billion—it is quite criminal really—out of the hospital system. They were happy to play politics with health, to say that it was a state issue and it was all the states’ fault. But, at the same time as they were pointing at the states with one finger, they were then reaching around and taking money out of their back pocket with the other hand. That is what they were doing, playing politics with the health system, and, unfortunately, that means playing politics with people’s lives. It does not take long to wander around a hospital to find people whose lives were changed significantly by the fact that their health system had been underfunded certainly in this century, in this decade, under the Howard government.

If we kept increasing the money going into health at the current rates, we would end up with a health budget and no other budget—no defence, no education, no support, no arts, no culture; it would all be health—so we obviously cannot continue to do that. As I said, we have got an ageing population and people are having fewer children. Disturbingly, people are also becoming quite unhealthy. I saw some data the other day saying that prepubescent girls are actually some of the fattest people in the world. Australia has got a gold medal in something like that, a gold medal that we should be ashamed of. It is scary to think that in 2009 we are creating a generation that will have a shorter life expectancy than ours. It is not something that we as a nation can be proud of. It makes us unworthy of the title of a civilisation if we are not able to produce a healthier lifestyle and children with a brighter future. We are getting something horribly wrong. Throw into that something like the Carbon Pollution Reduction Scheme, which is hovering around over in the red chamber, and we can see that we really need to get things right for the next couple of generations.

So what do you do? In terms of remedying that dreadful health diagnosis, you train more doctors and dentists. Both of those courses have been underfunded. But obviously that takes time. I would like to commend one of the universities in my electorate, the Griffith University, for what they have done in taking on medicine. But it takes time to turn a student into a doctor, a GP out there and able to save lives and change lives. It takes many, many years of study and then many years of training on the job.

So what else can you do? You can do something about prevention. A dollar spent on prevention is not the same as ‘a stitch in time saves nine’, but a dollar in time can save five or six dollars; that’s for sure. So we need to put more money into prevention. At the moment, if we look at our health budget, only about two per cent actually goes into prevention. When you look at the increase in chronic diseases, things like heart disease, diabetes, and chronic obstructive pulmonary disease—that is basically to do with the lungs and is connected to smoking or some workplace exposure or maybe even pollution—they are all on the rise. But, thankfully, we are able to combat those increases by a little bit of education and a bit of targeted activity.

I think we are guilty of having some poor workplace practices in this building. Perhaps we do not make the option of exercise something to be embraced by parliamentarians, as it should be. It is good to see that there are people who do set the right example. The reality is that we need to change our community’s approach to these chronic diseases. Too many people are dying too young because of preventable diseases.

I turn to the legislation before the chamber. We are particularly focusing on New Zealand overseas trained doctors. However, I would like to digress and mention the fact that overseas trained doctors from places other than New Zealand have made a significant change to Australian culture. Why? For a start, most of them are in rural and remote areas. If you look at the recent survey, you will see that 3,028 overseas trained doctors are working in general practice—1,068 of them being in capital cities and 1,437 in rural and remote areas due to district workforce shortages. That is a nice little figure that presents itself from the legislation. I know, coming from a country town myself, that doctors are seen as very significant people in communities. They are some of the better paid people, especially in rural communities, and what they say has sway on how the community treats people. It has been quite a cultural shift for the bush to have these 1,437 overseas trained doctors working in rural communities. It has meant a great stirring of Australian culture because so many of our bush traditions and rural traditions have now been melded and stirred and mixed in with these other traditions from all over the world.

A Zimbabwean doctor of Pakistani descent, say, can be working in rural Queensland and suddenly they have to find a mosque or some sort of way to pray and mix in with the local community. It has been a great insight into how open Australians are to change. Most Australians—97 per cent—come from overseas. So to have these rural communities suddenly having these influences from all around the world inside their community with these significant people—and they are doctors; as I said, they are very important people—augers well for the definition of what Australia is. Whatever that definition is, it is a much more lively and entertaining definition now because of the influence of these overseas trained doctors.

Obviously the legislation before us is about remedying a wrong and making sure that New Zealand overseas trained doctors are looked after as well as possible so that they can continue to do the great work in their communities. About three per cent of my electorate comprise people of New Zealand birth, which is about the norm for most electorates—except perhaps in Bondi or some places such as that where it might be higher. We have such a close connection with New Zealand. I am sure one day they will forgive us for the underarm bowling incident.

Jon Sullivan (Longman, Australian Labor Party) Share this | Link to this | Hansard source

Never!

Graham Perrett (Moreton, Australian Labor Party) Share this | Link to this | Hansard source

They certainly will not forget, but one day they might forgive. We have such a close friendship with them and we compete with them in so many sports. They play such an important part in our community. But the legislation before the House is about remedying the wrong that occurred there so that they can continue to do great work. I commend the legislation to the chamber.

Jim Turnour (Leichhardt, Australian Labor Party) Share this | Link to this | Hansard source

I rise today to support the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009 and support the member for Moreton and others on this side who have made a contribution to this debate. The Rudd government are committed to improving the health system in this country. We have shown that through our ongoing investments in GP superclinics, in cutting elective surgery waiting lists and in improving cancer services. This bill is another measure and another step along the road to improving the healthcare system in this country.

The member for Moreton and others have touched on the Health and Hospitals Reform Commission report, which is an important part of an overall look at the healthcare system. It was great to have the Prime Minister in my electorate in the middle of this year to undertake a commissioned consultation at the Cairns Base Hospital following the recommendations coming down. I know local GPs, hospital staff, nurses and allied health professionals enjoyed the opportunity to make direct contributions to that report. The report is important in terms of looking at the overall health system. We need to make sure that, going forward, we address issues such as the ageing population as well as the real challenges we face with preventable disease—such as diabetes, heart disease, obesity, or other diseases that we can prevent—becoming a real burden on society to a point where they gobble up the entire federal and state budgets.

We need to ensure that we put in place a sustainable healthcare system. That is why the Rudd government has put a focus on health; it is a priority. This bill is just one of the things that we are doing along the way to create a fairer and better system not only for New Zealand trained doctors but also for overseas trained doctors. It is part of our overall commitment to address and improve the health system in this country. This bill goes to the shortage of doctors in Australia and the need to ensure that overseas trained doctors, as I have said, are treated fairly and appropriately if we are to continue to attract them to Australia. It allows Australia to recognise the close relationship between New Zealand and Australia and the valuable contribution that New Zealand doctors make to Australia.

The purpose of the bill is to streamline the operation of section 19AB of the Health Insurance Act and remove a number of anomalies. Section 19AB of the act provides that overseas trained doctors and former overseas medical students are not able to provide professional services that attract Medicare benefits for a period of 10 years—the 10-year moratorium. The bill amends the class of persons subject to the restrictions in section 19AB of the act and amends the moratorium period. The bill removes current restrictions applicable to doctors who are New Zealand permanent residents and citizens and who obtained their primary medical education at an accredited medical school in Australia or New Zealand. The change effectively removes these doctors from the classification of ‘overseas trained doctor’ and ‘former overseas medical student’ in section 19AB of the act, which is fantastic for New Zealand trained doctors.

Another important provision goes to the issue of overseas trained doctors generally. It removes the requirement for overseas trained doctors and foreign graduates of an accredited medical school to have both Australian permanent residency or citizenship and medical registration in order for the 10-year moratorium to commence. What we are basically talking about here is that, under the current system, you need to be registered and an Australian citizen or a permanent resident before the 10-year moratorium commences. We want to change that so that registration in Australia becomes the starting point. Many overseas trained doctors have been forced to work well in excess of 10 years before their services have become eligible for Medicare benefits. If you take five years to get permanent residency or Australian citizenship, it is only fair that, after a 10-year contribution to the community as a citizen or a permanent resident, this be recognised.

It is fair and I think it is going to help Australia attract good quality overseas trained doctors because they are going to get recognised within what is a 10-year period. They will not have to wait until they get their residency or their citizenship before they start the 10-year moratorium period. When the legislation was introduced it was about ensuring that, when you became registered in Australia, you had practised for 10 years as an overseas trained doctor and you needed to become a permanent resident or an Australian citizen. After 10 years the intent was that your services would be eligible for benefits under the Medicare schedule. Under the current laws that is not possible.

It is a good day for the number of overseas trained doctors who would have been here for longer than 10 years and are now residents or citizens and will now be able to access Medicare benefits. I think that is good, particularly for many doctors in rural and regional Australia.

I represent the great electorate of Leichhardt, the region including Cairns, the Cape York Peninsula, the Torres Strait and, who can forget, in the wonderful former Douglas shire, Port Douglas and Palm Cove. They are wonderful tourist icons, there is an international airport and it is a great place to live. We do love good-quality people coming to live in the far north—in Cairns, Cape York and the Torres Strait—and we do need more doctors up there. Cairns has been an area of district workforce shortage in the past and it is an area that we are looking to attract doctors to, which means ensuring that they will be treated fairly.

Under this legislation, doctors from New Zealand will be able to get registered and recognised appropriately here, and overseas trained doctors from other parts of the world will, after the moratorium period, be recognised appropriately within that 10-year period. As I said in the beginning, this is part of one of our overall steps to improve the healthcare system. It is maybe only a little step in terms of the bigger picture but it is a very important step for those overseas trained doctors and for New Zealand doctors who may be living here now or thinking about coming here to work in places like Cairns or in other parts of the country. So it is part of our overall plan to improve the health system—unlike the former government, which ripped a billion dollars out of the public hospital system and had no workforce strategy to ensure that we did not get to the situation we have in many communities across the country, where there is a crisis in the availability of doctors and nurses.

Through the National Health and Hospitals Reform Commission and our workforce planning we have started the work of developing up health strategies and workforce planning strategies for this nation. This year we are spending more than $700 million, which we will invest in better targeted workforce initiatives in rural communities. That is a 45 per cent funding increase for rural programs compared to the $483 million provided by the previous government in its last full year, 2006-07.

The government is making the necessary reforms to rural health policy in order to ensure that incentives respond to current population trends and provide the most support to communities in greatest need, because we not only need good quality overseas trained doctors; we need to make sure that we have incentives in place so that doctors want to work in rural, remote and regional areas like the ones I represent—Cairns, Cape York and the Torres Strait. I know that my electorate is benefiting from these reforms.

There was a $134.4 million package in this year’s budget to respond directly to medical workforce shortages in rural and remote communities. Part of this package is the introduction of Australian standard geographic classification remoteness areas as a measure of eligibility for a number of workplace programs. It will replace the outdated rural, remote and metropolitan areas classification, the old RRMA system. The new package will encompass a number of initiatives that aim to better target workforce incentives to communities in the greatest need. These reforms are based on scaling or gearing of incentives in return of service obligations to provide greatest benefit to the most remote communities, where there is the greatest need, and transition of program eligibility in a new geographic remoteness classification system. It is estimated that the transition to the new system will see 2,400 doctors in rural communities being able to access incentives for the first time. Almost 500 communities around Australia will become eligible for rural incentive payments.

The rural incentive package announced by the Rudd government in the 2009 budget, as I said, will directly benefit my electorate of Leichhardt. A doctor relocating to Cairns and surrounding suburbs from a capital city will be eligible for a $30,000 relocation incentive for the first time, and around $18,000 per year after working in Cairns for five years. If doctors move from Brisbane or another capital city to Cooktown, north of Cairns, for example, they will be eligible for a $60,000 relocation payment and will be paid $13,500 after their first year working in Cooktown. This yearly retention rate grows to $27,000 every year after they have been in Cooktown for five years. These are great initiatives to attract doctors to regional centres and to rural and remote areas. But this legislation is not just about making it fairer for overseas trained doctors, New Zealand trained doctors; it is also about ensuring that we have in place a system that encourages Australian doctors to work in rural and regional areas, because many overseas trained doctors effectively end up working in rural and remote areas.

This is part of an overall package to improve the health system in this country. As I said, there are plenty of things happening in my electorate. We had 10 or 12 years of not a lot happening but we have seen quite a bit happen since the Rudd government was elected, across the spectrum of health. I want to touch on a few of those initiatives and those commitments that we have achieved in my electorate of Leichhardt. We know that dental care is a particularly important challenge that we face. We are talking today about the availability of overseas trained doctors, including New Zealand trained doctors. I have already spoken about some of the strategies we have put in place to attract doctors to rural and regional areas. We have also got a shortage of dentists in this country—another area where we need to do more in terms of the workforce shortages. I am very pleased that the Rudd government has committed almost $50 million to support James Cook University in developing a dental school. I see the member for Herbert here; they have got a great medical school in Townsville, and they are building a dental school in Cairns, the other hub of James Cook University. I know that the member for Herbert will welcome the ongoing growth of the university that we have in the north and the far north. It is certainly a wonderful university. I was out there earlier in the year and had an opportunity to meet with a number of students and to open some of the training facilities. I congratulate Professor Ian Wronski and his team for the work they are doing in bringing the dental school on.

We have also committed $8 million to the Cairns Base Hospital, and the state government has provided $450 million for the redevelopment of the hospital, which is a fantastic commitment from them. We are working in partnership with them to improve health services in the far north. The $8 million we have committed to the Cairns Base Hospital is for a new MRI machine and a Medicare licence to provide recurrent funding for the operation of the machine. In 2004 I ran for office and unfortunately was not elected, but I made a commitment that we would get an MRI machine at Cairns Base Hospital. Unfortunately, the Howard government was returned in 2004 and there was no MRI machine for the Cairns Base Hospital, but I ran again in 2007 and got elected, and it is wonderful news that we have continued that commitment to see an MRI machine in the Cairns Base Hospital. The Rudd government has delivered on it already.

It shows the difference between this side of the chamber and the other side. We can talk about providing more doctors in a city like Cairns and we can talk about providing better facilities. An MRI is a classic example. Many times people came to the Cairns Base Hospital for an MRI, but there was no access to an MRI machine so they were airlifted to Townsville. Now we have an MRI machine at Cairns Base Hospital, people will get the assessment, the treatment and the care they need at Cairns and they do not have to go on to Townsville for that. That is good news, and that is the sort of improvement in health care that we have managed to achieve under the Rudd government.

We also made an $8.3 million commitment towards a radiation oncology facility in Cairns Base Hospital. This is being built in partnership with the state government and is well progressed. It is going to be known as the Liz Plummer Memorial Centre. Liz was a great campaigner for oncology services in Cairns, and tragically we lost Liz this year. I know Max and her family would still be hurting, as the community is hurting, over the loss of Liz. She was a great Australian and a great member of the Cairns community.

Jon Sullivan (Longman, Australian Labor Party) Share this | Link to this | Hansard source

I can confirm that.

Jim Turnour (Leichhardt, Australian Labor Party) Share this | Link to this | Hansard source

The member for Longman, who obviously knew her, can confirm that as well. She will be sadly missed. But her efforts will be remembered through the better oncology and cancer services in Cairns. COUCH are doing a wonderful job, and it is great to be able to work in partnership with the Queensland government to deliver the Liz Plummer Memorial Centre, which will be a great addition and improvement to Cairns cancer treatment facilities.

I am also looking forward to working with the hospital foundation under the leadership of Ken Chapman, and also Bob McGill and the COUCH team, on the work that they are doing with the Queensland government, putting in a submission to the new federal government cancer centres funding that was announced in the budget earlier this year. I have spoken with the minister, Nicola Roxon, about that and I look forward to continuing to work with the local community, the private sector and the base hospital to see what we can do to continue to improve cancer services in Cairns, building on the work that COUCH has done and the work that people like Liz Plummer have done and the contribution they have made to the community of Cairns. Improved services in Cairns benefit Cape York, the tablelands and the Torres Strait. They benefit a lot of people in rural and regional Queensland. I am looking forward to continuing to work with those groups and the Queensland government to develop better services and a submission for a cancer centre for Cairns as part of the package that was announced by the health minister following the budget.

So, as I said, we have made considerable contributions to cancer services through the MRI and radiation oncology commitment. We had $500,000 for expanded chemotherapy services at Cairns Base Hospital that were opened this year. We have also put additional funding into Indigenous health. There was $307,000 this year for the Apunipima Cape York Health Council to employ an additional community GP who will provide primary health care services in Mapoon and Napranum communities on a shared basis. We have also delivered $291,000 a year to assist the council to implement a family centre primary health care model in Mossman Gorge with the Queensland government in order to establish a similar model to the one operating in Mapoon. These are examples of what we are doing in Indigenous healthcare support.

Earlier this year we announced $5 million for Mookai Rosie to build a new 24-bed facility. That is about closing the gap and improving the quality of facilities available to Indigenous mothers from the Cape, the Torres Strait and the Gulf who have to come to Cairns to have their babies. Mookai Rosie does a wonderful job. It is a wonderful Indigenous organisation that was set up by Aunty Rose many years ago to provide support for mums who came down to the Cairns Base Hospital and did not have anywhere to stay. Rose took them home, and subsequently a group worked together to establish Mookai Rosie. I am very pleased and proud that the Rudd government is investing $5 million to build a new facility for this organisation, because they have done a wonderful job. This will effectively expand their facility from, I think, 12 beds to a facility that will have 24 beds.

We have a new breast cancer nurse for Cairns as part of the McGrath Foundation. It was great to be with Glenn and the health minister when we announced that. They are doing a good job. That is another example of the work that we are doing on improving cancer services and support in Cairns.

We are spending $10 million as part of our Economic Security Strategy to improve and redevelop the health precinct at the Tropical North Queensland Institute of TAFE. We have $12.8 million in the budget this year to improve health care in the Torres Strait, including $9.2 million over four years for the expansion of the Saibai Island clinic and the provision of staff housing to facilitate delivery of an HIV-AIDS and STI support and education program, plus $2.9 million over four years to continue support for a joint Australian government and Queensland government mosquito control program. There are significant health risks and issues across the border between the Torres Strait and Papua New Guinea.

These are just some of the health initiatives that we are implementing and working on as the Rudd government. The government take health care very seriously. We are very serious about making a difference to working Australians and the types of services that they receive. We came to power ripping up Work Choices, improving education through the education revolution and making very strong commitments around improving health services. Today’s bill is a technical bill that goes to the issues around overseas trained doctors and New Zealand trained doctors, but it is part of an overall commitment that we have to improve health services in this country. I am very proud to be part of a government that makes commitments and delivers on them. It is a government that is making a difference not only in Brisbane, Sydney and Melbourne but also in places like Cairns, Cape York and the Torres Strait. It is a good government, it is a strong government and I look forward to being part of it in the future.

Jon Sullivan (Longman, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. Let me say at the outset that, whilst it is not my intention to revisit all of the issues that have been raised in terms of what we on this side of the parliament see as very definite shortcomings in the Health portfolio under the former Howard government, I concur with my colleagues who raised those in detail earlier. The main provision of this bill relates to the current restrictions applicable to doctors who are New Zealand permanent residents and citizens—I will come back to that in a moment—who have obtained primary medical accreditation at an accredited medical school in Australia or New Zealand.

The health professions in Australia and New Zealand are fairly heavily intertwined. All but one of the colleges of surgeons—I think there are 11 or so—are termed ‘Australasian’ or ‘Australia and New Zealand’. Joint Australia-New Zealand organisations provide the same training for higher roles in the medical professions. It makes sense that training for general practitioners should be provided in the same way, but the College of General Practitioners is the one college that is not a joint Australia-New Zealand college—there are separate colleges in Australia and New Zealand.

We have heard a lot about section 19AB of the Health Insurance Act and the 10-year moratorium that restricts foreign trained overseas doctors from providing medical services that attract a Medicare rebate—for example, pathology tests—or referring patients to a specialist. We have heard quite a deal about how doctors in that category are able to go and work in an area of workforce shortage in order to overcome the moratorium and get a Medicare number for rebatable services. Provided that they stay there for 10 years, when they emerge from the bush after their 10-year hiatus—if they ever do emerge; the bush lifestyle really grows on the people who go out there and I imagine medical professionals would get used to living in some of those small towns—they will have full capacity to charge for Medicare rebatable services.

But what we have not heard spoken about much today is the fact that there is a shorter course that can be taken, particularly for harder to fill positions. This bill provides for a gradual diminishing of the 10-year provision for those who remain on it—not the New Zealanders, of course—depending on the remoteness of the area or the difficulty in filling the position that they take up. But already in place is a five-year moratorium—or what I like to think of as a short course—for particularly hard to fill positions, where overseas trained doctors in certain categories are able to get full Medicare accreditation in a shorter time. This process is handled by the Royal Australian College of General Practitioners rather than by the Australian Medical Council.

It is very interesting to look at who is able to access this five-year provision. This scheme has four real requirements. The first requirement is that doctors complete five years in a practice in an agreed rural location—and that can even be reduced to three years if they go to a significantly remote area. The second requirement is that they obtain fellowship of the Royal Australian College of General Practitioners. The third requirement is that they obtain permanent residency in Australia. The fourth requirement is that they meet all the requirements of the state or territory administering the scheme.

Which doctors can access this scheme? Interestingly enough, the Royal Australian College of General Practitioners divides doctors into a number of categories. In category 1, there are GPs who hold a fellowship with the Royal New Zealand College of General Practitioners, along with certain doctors from Canada and the United Kingdom. This group of doctors is immediately eligible for admission into the fellowship of the Royal Australian College of General Practitioners. Doctors in the next group, category 2, are able to get onto this short course, if you like, provided that, within two years, they successfully complete the exam to become fellows of the Royal Australian College of General Practitioners. This group includes certain doctors from the UK, Ireland, South Africa, the USA and Singapore.

The health architecture in this country is, I must say, particularly convoluted. On the one hand, we are creating a group of doctors who are from certain areas and who have a special relationship with us and, on the other hand, we are, through this legislation, bypassing some of those relationships and giving doctors from New Zealand an extra special relationship with Australia. As has been said a number of times, Australians and New Zealanders have an interesting relationship. The suggestion has been made on a number of occasions, but particularly back in the 1890s, that New Zealand should form part of the federation or Commonwealth that has become Australia. That was not to happen. And I suspect that it will not happen until enough New Zealanders have taken out Australian citizenship so that we can regularly beat the All Blacks at rugby!

It is a friendly rivalry that we have between our countries. Nowhere else would you think of getting away with wearing a T-shirt that said ‘I barrack for two teams—New Zealand and anybody who is playing Australia’. But here we are today proposing to make not just New Zealand doctors but doctors who are resident in New Zealand a little more equal than Australian resident doctors. For example, the removal of the 19AB requirements applies to New Zealand trained doctors, whether they are trained at one of the two AMC accredited universities in New Zealand or whether they are trained in Australia, and also to New Zealand resident doctors. Hence, a doctor who is a resident in New Zealand but is a citizen of a third country can come to Australia and not have to work through the 19AB or 10-year moratorium restriction, whereas a doctor who is a resident of Australia but a citizen of another country other than New Zealand and who is working in Australia does not have that restriction lifted from them, despite the fact that they have done their medical training in an Australian university. I think it is an anomaly, and I suspect it is an anomaly that we are going to want to correct in the future.

The bill makes a couple of other minor changes. It puts in place some time limits on applications or appeals against a rejection of the 19AB exemption and puts forward sensible measures in relation to when the clock stops clicking for those people who are subject to the 10-year moratorium.

Having made those few comments, I want to talk about some of the issues that I am discovering in my seat of Longman—and I will be brief. Members who followed the 2007 election campaign and people who live in my area will know that, during that campaign, I gave a very strong indication that, while hospitals were and for the moment will remain the province of the state governments, I believe that in our area of South-East Queensland, which is fast becoming the northern outskirts of Brisbane, we need to make provision for another hospital. There is a lot of talk about expanding the Caboolture Hospital. The nearest estimate of what that would cost is $600 million. It may be much more economical to look for another site than to put a fourth hospital in that part of Brisbane.

I have heard plenty of talk today about doctor shortages. Doctor shortages happen everywhere. They are a consequence of decisions that were made in this country earlier on, in the last 10 years or so—but not just in this country; I have spent a fair bit of time in New Zealand, a fair bit of time in England and a little bit of time in America and let me tell you that the headlines in each of those countries relating to health issues are just the same as the headlines that run in the papers here in Australia. Doctor shortages is a worldwide phenomenon and it is something that is going to be very difficult to overcome even in the longer term, I suggest, as the population rapidly ages and as medical technology enables people to live longer—and I think we all want to do that. I think all of us look at the health profession as what keeps us alive and keeps us from finding out what there is after death.

So those shortages are going to occur, but what I am also noticing is not a rush but a move from small practices to major medical centres in towns, and I have noticed that is part of what is happening in my electorate. In one case doctors from one practice were offered a sign-on fee to close that practice and move to another practice some 18 or 20 kilometres away, which caused great distress for the patients. Those doctors, as I understand it, were given a financial enticement to do so and left. The other clinic closure that happened in my area was a consequence of the global financial crisis where the practice, as I understand it, had overextended itself through borrowings from the American market and was not able to keep running.

Doctor shortages and hospital overcrowding, particularly in emergency centres, are pretty much features of every community. I am not aware of anybody who thinks that they have enough medical services in their electorate. I would like to suggest one thing that might help overcrowding at hospital emergency centres. It is a change to the Medicare act to allow the state governments, who are running hospitals, to employ general practitioners to meet patients at public clinics at a hospital and bulk-bill Medicare for it, because these are indeed the patients who are clogging up the emergency centres and who are making complaints about state hospitals on the basis that they are often waiting enormous lengths of time while people with serious injuries are prioritised above them as they come in.

In talking in favour of this bill, I do want to point out that there is an unintended anomaly that we are going to have to look at in the future. I think that we can extend the scope of overseas doctors to whom this kind of treatment can be given, particularly the Canadian and UK doctors who join with the New Zealand doctors in the short course as to the five-year moratorium for hard to fill positions that I mentioned. I think this bill will go a long way to assisting people in the remote locations, in the bush, to acquire doctors. I know that the Rural Doctors Association has said that the system has not been particularly successful. However, the fact that somewhere in the area of 40 to 45 per cent of doctors practising in rural Australia are overseas trained doctors shows that it has been of some help. Obviously, the rural medical schools, such as the one at James Cook University, will help people who have a fondness for their community and want to help their community and who will train through these schools and will do well.

I want to finish by saying that I did not know until I heard the previous speaker say it that the oncology unit at the Cairns Base Hospital is going to be named for Liz Plummer. Liz and Max were friends of mine in excess of 25 years ago. I remember both Liz and Max as wonderful people and I was very saddened to hear that Liz had passed away. I send to Max and family my and Carryn’s best wishes and look forward to catching up with him sometime later on when I get to Cairns again. With those few words, I commend the bill to the House.

Yvette D'Ath (Petrie, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak in support of the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. This bill will make four amendments to the Health Insurance Act 1973. Before I go to the detail of the amendments, I wish to comment on the context in which this bill arises. Many speakers, if not every speaker, during the debate on this bill have spoken about the shortage of general practitioners in their local communities. The electorate of Petrie is no different in that respect. I have been given anecdotal evidence over the past two years by local doctors about our ageing GPs and the concerns about the future of medical services in the local area. In an area with a significantly large elderly population, it is of great concern that people throughout my community will continue to experience difficulties in getting access to timely medical assistance. Of course, we know the risk if people are unable to visit their local GP: these people end up in our emergency wards.

The Rudd government has recognised that shortage of doctors in Australia is one of the more significant problems in our health system along with the shortage of other health and allied health professionals. On 22 September 2008, the Minister for Health and Ageing, the Hon. Nicola Roxon, announced that the federal government would boost training for junior doctors in general practice. This commitment is taken in an effort to increase the number of GPs across Australia. Throughout 2009 $20 million was announced to fund approximately 80 additional places in a program which enables junior doctors to undertake short-term supervised training placements in general practices, bringing the total to 360. This program increases training capacity in the early years of a doctor’s postgraduate training by providing opportunities for junior doctors to gain clinical training experience in primary care. Of course, the range of initiatives announced by the Rudd government and the minister for health to lift the number of trained doctors in Australia will not result in additional doctors in our communities and in our hospitals overnight. Training as a doctor in Australia takes many years and Australia is proud of its training to produce high-quality doctors that will service our communities well into the future.

It is fair to say that Australia still needs to rely on a number of doctors from overseas. I understand that overseas trained doctors have caused concern in recent years. People want to make sure that our system of registration of doctors from overseas is vigorous and robust to ensure that foreign doctors are, at the least, equally qualified to those who train within Australia. This is extremely important. I support the need for a thorough process to ensure that the proper checks on qualifications are made and the history of the doctor is considered by the relevant medical authorities in Australia prior to registration being granted.

That brings me to the proposed amendments in the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. This bill provides more access to certain trained doctors to provide professional services that attract Medicare benefits. It does not make it easier for foreign doctors to practise in Australia. It is important that those doctors who are given registration to practise in Australia are given fair access to Medicare benefits for the professional services that they provide, where they meet the relevant requirements.

The Health Insurance Act 1973 does not, it can be argued, provide fair access for doctors who have in fact been providing a professional service in Australia for some time or for persons who are not Australian residents but have attended a medical school in Australia. Equally unfair exclusion applies to Australian citizens who have attained their medical qualifications in New Zealand. The proposed amendments in the bill before the House address this inequity. Section 19AB of the Health Insurance Act 1973 provides that overseas trained doctors and former overseas medical students are not able to provide professional services that attract Medicare benefits for a period of 10 years, known as the 10-year moratorium. This bill amends the class of person subject to the restrictions in section 19AB and amends the start date of the moratorium period.

The first amendment removes from the classification of overseas trained doctor persons who are permanent residents or citizens of New Zealand and who obtain their primary medical education at an accredited Australian or New Zealand medical school. As New Zealand citizens are categorised under the Migration Act 1958 as temporary residents of Australia, they currently fall outside the definition of overseas trained doctor. Despite this status under the Migration Act, New Zealand citizens, as we know, have been afforded many rights in Australia, including being afforded permanent residency rights under the Australian Citizenship Act.

In addition to the general status of New Zealand citizens who choose to reside in Australia, New Zealand doctors who have trained in New Zealand are in fact undertaking studies that are accredited by the Australian Medical Council. These students are accredited to the same standards as students of Australian medical schools. The proposed amendment will provide some equity in the way New Zealand trained doctors are able to provide professional services within Australia. Of course, it is only reasonable to then apply the same equity to New Zealand citizens who have studied at an Australian medical school and who seek to practise here. This amendment provides equity with Australian doctors by ensuring that New Zealand doctors are not defined as overseas trained doctors and as such are not required to comply with the 10-year moratorium. This amendment will also rectify another anomaly wherein an Australian citizen could elect to study at a New Zealand medical school. As these Australians did not gain their primary medical degree in Australia, they are also subject to section 19AB of the Health Insurance Act.

The second amendment changes the category ‘former overseas medical student’ to ‘foreign graduate of an accredited medical school’. This amendment seeks to remove the confusion that caused among some doctors by the term former overseas medical student. This category, which attracts restrictions under section 19AB, is meant to refer to foreign persons who graduate from an Australian medical school. Altering the name of the category is aimed at removing this confusion.

The third amendment removes the requirement for overseas trained doctors and foreign graduates of an accredited medical school to have both permanent residency and medical registration in order for the 10-year moratorium period to commence. Currently, doctors who are trained overseas or who are non-citizens of Australia who completed their medical studies in Australia can find themselves being excluded from providing professional services that attract Medicare benefits for a period much longer than the 10-year moratorium. The reason this can occur is that the current framing of the Health Insurance Act requires that the 10-year moratorium does not commence until the person becomes both an Australian permanent resident or citizen and a medical practitioner.

Australia has a migration policy that requires individuals who seek to obtain permanent residency to go through an application process. This process has a number of steps and can take some time. In the meantime, if granted by the Department of Immigration and Citizenship a person is able to reside in Australia on a visa while their application is being considered. This individual may actually be a doctor who has received registration and is providing services within Australia. If, for any reason, the immigration process takes, for example, five years then it is only at the point of the application for permanent residency being granted that the 10-year moratorium period commences.

In setting time frames, it is not the intention of the legislators to establish a process that enables the time frame to be much greater than that prescribed. That is, however, what the current act does. The amendment in this bill will ensure that the act will better reflect what the intent of the section is. The bill will break the mandatory nexus between registration and residency or citizenship so that the 10 years can commence immediately upon registration. The bill, however, continues to ensure that the doctor’s professional services do not attract medical benefits unless the person is an Australian resident or Australian citizen by ensuring that the moratorium will cease after 10 years if the medical practitioner has gained residency or citizenship during that 10-year period. This requirement is much more reflective of the realities of gaining such migration status while ensuring that these benefits are only extended to doctors who have become Australian residents or citizens.

The last amendment is to introduce a maximum period of 90 days in which medical practitioners can appeal against a decision to refuse to grant an exemption or a decision to impose conditions on an exemption pursuant to sections 19AB(3) and 19AB(4) of the act. It is important that those doctors who are refused an exemption, or where a decision to impose conditions on an exemption has been made, have the right of appeal and that right of appeal is considered within a timely manner. It is also important that certainty exist to ensure that appeal processes do not continue indefinitely.

To ensure that proper consideration is given to decisions under appeal, it is important that the review of such decisions occur within a time frame that ensures that the materials are relevant and current at the time of such consideration. Under the Health Insurance Act 2009, there is no time limit for seeking a review under section 19AC. It is a common aspect of legal systems, tribunals and other bodies of review throughout Australia to set time limitations on the filing of claims. This right of appeal or review under section 19AC of the Health Insurance Act 2009 should not be exempt in this regard. The 90-day time limit proposed in this bill before the House is reasonable, considering the circumstances and the nature of the appeal or review sought. This will ensure that any decision to overturn the original decision can be made in a timely manner on the basis of current information.

Overall the amendments put forward in this bill address a number of anomalies that exist in the current act and will provide reasonable access to New Zealand doctors and Australian doctors trained in New Zealand to provide professional services that attract Medicare benefits. This bill will also ensure that overseas trained doctors and foreign graduates of an accredited medical school are not required to wait beyond the 10-year moratorium, where residency or citizenship is obtained. Lastly, this bill provides an improved process for the effective management of appeals and reviews.

This bill is a positive piece of legislation for Australia’s health system. It will not result in an influx of overseas trained doctors, but it will provide more fairness in the system and may encourage overseas trained doctors or foreign persons trained within Australia to remain in Australia long-term and assist in addressing the shortage of doctors throughout Australia.

It is pleasing to hear those on the opposition side supporting this bill. It is certainly a bill worthy of support. However, it would be remiss of me not to take the opportunity to highlight some of the less than beneficial actions by those on the other side of this chamber in relation to addressing the genuine health issues in this country. While the Rudd government has been undertaking the most significant review of the health and hospital system in Australia, the opposition has been belligerent in its conduct. The Rudd government is tackling national issues such as: the lack of health expenditure on preventative health; one-third of Australians presenting to public hospital emergency departments are not being seen within a clinically recommended time; one out of every six Australians on a waiting list for elective surgery are not being seen within the clinically recommended time; it is estimated that there are some 650,000 Australians on public dental waiting lists, with an average wait of two years for essential dental treatment; and about two-thirds of people who need mental health care go untreated. In addition, health costs are rising rapidly: from $84 billion in 2003 to $246 billion in 2033, or about nine per cent of GDP now to 12.4 per cent of GDP in 2033. These are the challenges identified in the National Health and Hospitals Reform Commission report released on 27 July 2009.

The opposition has been blocking important legislation which aims to assist in the reform of health and hospitals in Australia. An example is the National Health Amendment (Pharmaceutical and Other Benefits—Cost Recovery) Bill 2008, which sought to provide authority for the cost recovery of services provided by the Commonwealth in relation to the exercise of powers for listing medicines, vaccines and other products or services on the Pharmaceutical Benefits Scheme and designation of vaccines for the National Immunisation Program. The Liberal Party delayed this bill for 12 months, costing the government at least $9.4 million expected in 2008-09. That is revenue that could have been redirected to support improvements in the health sector.

We all know of the delays and confusion from the opposition on the excise and customs bills, better known as the alcopops bills. Then there was the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009, the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-Off Cover Support Payment) Bill 2009. The Liberal backbenchers supported these bills in their submissions to this chamber. However, the shadow health minister could not bring himself to say anything positive about the new initiatives. More recently we have had the Australian National Preventive Health Agency Bill 2009, which is now sitting in limbo in the Senate. The Rudd government is not standing still on our health reforms, with the health minister reintroducing the Fairer Private Health Insurance Incentives Bill 2009 after the Liberal Party in the Senate rejected this bill earlier this year.

Whether it is child health, hospitals, aged care, Indigenous health, rural and remote health, mental health or dental health this government is committed to tackling the needs of Australians now and into the future. The Rudd government has already committed to investing $64 billion in the hospital and health system across the country over the next five years—a 50 per cent increase on the previous agreement by the Liberals. We have invested $600 million in our elective surgery program. Stage 1 committed to a target of 25,000 extra elective surgeries in 2008 but delivered more than 41,000 procedures. In stage 2 more than 150 hospitals will receive funding across Australia and we have invested $750 million in taking pressure off emergency departments.

The Rudd government has also invested in new health infrastructure, in investing in our health workforce and in preventive health measures. The government has committed to a total of $650 million for two dental programs and will invest $1.6 billion to improve Indigenous health. Additional funding has also gone into aged cared. For the future, the government has embarked upon a path to build the health and hospital system that Australia needs for the 21st century. The government has committed to an overhaul of the health system to ensure that it can cope with future challenges, including an ageing population and rising healthcare costs.

The government has already undertaken many more measures to deal with the critical issue of health services. In an electorate such as Petrie, we do not take the health system for granted. We know more needs to be done; we know that the federal government through the national health and hospitals reform process is serious about finding solutions for the future—solutions that plan for the long term. Already my area has seen the commitment of the federal government in announcing a GP super clinic. This clinic will be known as the Moreton Bay Integrated Care Centre and will have a strong focus on preventive health. These centres around the country will complement any future initiatives that the government implements to improve the health services for our communities. I support this bill before the House today and look forward to supporting many more health reform initiatives by the Rudd government.

Sharryn Jackson (Hasluck, Australian Labor Party) Share this | Link to this | Hansard source

Can I at the outset commend the member for Petrie for her fine contribution in respect of this legislation and on health generally—

Luke Hartsuyker (Cowper, National Party, Deputy Manager of Opposition Business in the House) Share this | Link to this | Hansard source

Mr Hartsuyker interjecting

Sharryn Jackson (Hasluck, Australian Labor Party) Share this | Link to this | Hansard source

and perhaps commiserate with the member for Cowper as the only member of the opposition who seems to have been able to find his way into the chamber at this point in time in the debate. I say to members of the public gallery that the activities in the corridors, I suspect, rather than in the chamber, are taking precedence.

I, like many others, rather than debating the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009, would prefer to be debating bills regarding the health of our environment and giving effect to the Carbon Pollution Reduction Scheme and genuinely taking action on climate change. Nevertheless, the matter before the House is the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill.

As we have heard from many previous speakers, this bill seeks to amend the Health Insurance Act 1973. That act currently provides that Medicare benefits are not payable in respect of professional services provided by an overseas trained doctor or a former overseas medical student except in certain circumstances. This bill seeks to streamline the operations of the act and this provision, consistent with government policy and complementing workforce reforms the government has implemented, especially in relation to the rural medical workforce. In particular, this bill amends the class of persons subject to the restrictions in section 19AB of the act and amends the start date for the 10-year moratorium period. The bill proposes to remove New Zealand permanent residents and citizens who have obtained their medical qualifications from an accredited medical school in Australia or New Zealand from the classification of ‘overseas trained doctor’. Consequently, such doctors will no longer be restricted by the 10-year moratorium imposed by the act. They will still be subject to the requirement that they have obtained appropriate recognition of their medical qualifications in order to access the Medicare Benefits Scheme.

The bill also redefines the classification of ‘former overseas medical student’ to ‘foreign graduate of an accredited medical school’. This is a better reflection of the actual definition of this class of person, meaning ‘students of Australian medical schools who were not an Australian citizen or permanent resident when they enrolled in their primary medical degree at an Australian medical school’. Another important provision is the removal of the requirement for overseas trained doctors and foreign graduates of an accredited medical school to have both Australian permanent residency or citizenship and medical registration in order for the 10-year moratorium to commence. The 10-year moratorium has been an effective mechanism in ensuring that overseas trained doctors provide services to those communities with the greatest need for medical practitioners. These communities are most often in rural and remote areas. As the Minister for Health and Ageing identified in her second reading speech, some 41 per cent of all doctors in Australia in rural and remote areas have trained overseas. However, in my own outer metropolitan electorate of Hasluck we have areas of significant unmet need. We are fortunate to have two very effective Divisions of General Practice in the Canning and Swan regions, and I am especially appreciative of the work of the Perth Primary Care Network. The division promotes a primary healthcare model that encourages partnered and collaborative approaches to health care. This has been the basis of the current after hours GP clinic at the Swan Health Campus that fills a vital need in our local community—the Swan and Midland regions, in particular—having been identified as an area that has a shortage of general practitioners. I am very fortunate to enjoy a good working relationship with the Perth Primary Care Network and I am very aware of the good work they do in providing quality and affordable health care to the Hasluck community.

The final reform that I want to address in the bill is the amendment to rectify the situation where the 10-year moratorium starts when the overseas trained doctor achieves permanent residency or citizenship in Australia. Many overseas trained doctors have entered Australia through temporary skilled visa categories or the business long stay visa class for initial periods of up to four years. The way the 10-year moratorium currently works excludes this service, as the doctors are temporary residents. This is not fair and this anomaly is corrected by the bill. The moratorium will also be scaled to give greater weight to periods of service in more remote communities so, to quote the minister, the more remote you go the shorter the moratorium. As I said at the outset, these amendments complement the medical workforce reforms being driven by the minister. I congratulate her on her work and for the changes she is bringing to the Australian healthcare system. Indeed, we had a very good exposition of those from the member for Petrie.

There are a range of Australian government initiatives aimed at recruiting and retaining GPs in rural and remote Australia. The Rudd government is investing more than $700 million to better target workforce incentives in rural communities. The government is making the necessary reforms to rural health policy in order to ensure that incentives respond to current population trends and provide the most support to the communities in the greatest need. The 2009-10 federal budget measure known as the rural health workforce strategy encompasses a number of initiatives that aim to better target workforce incentives to the communities in greatest need. This is a significant package of $134.4 million to respond to medical workforce shortages in rural and remote communities.

I cannot speak on a government health bill without referring to this year’s budget boost in my own electorate for the proposed Midland Health Campus. I welcome the Rudd government’s funding commitment of $180.1 million for the construction of the Midland Health Campus, an important hospital that services not only the outer metropolitan region of Perth but also the nearby rural and wheat belt towns and regions of Western Australia. This funding ensures that there is no need to delay the construction of the new hospital. I had been very concerned at recent media comments from the state government minister implying that the project would be put on the backburner and preference given to hospitals in the inner city and the western suburbs.

The redevelopment of the Midland Health Campus is vital to the people in the Swan region and surrounding country areas. Swan Districts Hospital Campus is no longer able to effectively meet the needs of the communities it serves and requires a replacement facility to be built in Midland. State health minister Kim Hames has said that the hospital would be delayed due to a lack of funding—a shortfall of $100 million. The substantial funding injection from the Rudd government ensures there is no reason why the hospital cannot be completed by 2013, as was first envisaged. Indeed, this funding should enable the state government to also overcome the rail and traffic issues surrounding Lloyd Street rail crossing that are concerning many local residents.

The Reid report, which is a very detailed study of our health and hospital needs in Western Australia, emphasised the importance of building hospitals and health infrastructure within the communities they serve. This new 300-bed hospital will offer state-of-the-art health care and services to the people of the east metropolitan corridor. This project is supported under the Rudd government’s nation building Health and Hospitals Fund, which is building health infrastructure for the 21st century while also creating and supporting employment opportunities in our local community.

However, moving back to the original piece of legislation before the House, this bill is a small but important part of the overall health reform agenda of the Rudd government. It makes some sensible and practical amendments to the Health Insurance Act 1973 which should ensure a smoother and more beneficial operation, especially for overseas trained doctors. I commend the bill to the House.

Craig Thomson (Dobell, Australian Labor Party) Share this | Link to this | Hansard source

I rise to support the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. The purpose of the bill is to streamline the operation of a section of the Health Insurance Act 1973 and remove a number of anomalies. Section 19AB of the Health Insurance Act restricts overseas trained doctors and former overseas medical students from providing professional services which attract Medicare benefits for a period of 10 years from the date on which the person is both a medical practitioner and an Australian permanent resident or citizen. This is commonly referred to as the 10-year moratorium. Overseas trained doctors and former overseas medical students may be granted an exemption from these restrictions if they work in a district of workforce shortage located in a rural, remote or outer metropolitan area.

This bill will amend sections 19AB and 19AC of the act. There are five amendments proposed in this bill. The first amendment will remove persons who are permanent residents or citizens of New Zealand and who obtained their primary medical education at an accredited Australian or New Zealand medical school from the classification of ‘overseas trained doctor’. Previously, a person was considered to be an overseas trained doctor if they obtained their primary medical degree from a medical school outside Australia.

The second amendment will rename the term ‘former overseas medical students’ to ‘foreign graduate of an accredited medical school’ to more accurately reflect the meaning of the term. This will address issues arising from New Zealand citizens who are able to stay permanently in Australia on a special category visa but who are not considered to be Australian permanent residents being restricted by the 10-year moratorium after they obtain their medical qualifications from an Australian medical school.

The third amendment will rectify an anomaly in section 19AB of the act which currently operates, in relation to a person who becomes a medical practitioner prior to becoming an Australian permanent resident or citizen, to count the 10-year moratorium from when the person achieves Australian permanent residency or citizenship. The amendment proposes that the 10-year restriction will commence from the time the medical practitioner is first registered as a medical practitioner in Australia and will cease after 10 years, provided the medical practitioner has gained permanent residency during that period.

Finally, section 19AC of the act will be amended to insert a time limit of 90 days during which an applicant can seek a review of a decision to refuse an application for a section 19AB exemption or a decision to impose one or more conditions on a section 19AB exemption. These provisions will take effect from 1 April 2010 or when the legislation has received royal assent, whichever is the later date.

The Rudd government are strengthening our health system after years of neglect and buck-passing by the former Howard government. Let us have a look at some of the programs that the government have put in place in terms of hospitals. The government, through the COAG program, will invest $64 billion in hospitals and the health system across the country over the next five years. That is a 50 per cent increase on the previous agreement of the former government. We have invested $600 million in our elective surgery program. Stage 1 committed to a target of 25,000 extra elective surgeries in 2008 and delivered more than 41,000 procedures. Under stage 2, more than 150 hospitals will receive funding right across Australia. We have invested $750 million in taking pressure off emergency departments. More than 30 hospitals will benefit from this particular program.

Labor are now undertaking historic investment in nation-building health infrastructure. We are investing $3.2 million in 36 major projects across our hospital and medical research institutes, including $1.2 billion in world-class cancer centres, and we are providing $275 million to construct 34 GP superclinics across the country. One of those, at Warnervale, is a temporary one. A couple of months ago I had the pleasure of opening the temporary facility. Warnervale is in a fast-growing area of the Central Coast. Many of the other speakers on this bill have identified doctor shortages as being an issue. The areas of Warnervale and Hamlyn Terrace are new suburbs with new people moving in, but we do not have the doctors. By the end of 2010 this temporary GP superclinic will be permanent and will go a long way to assisting the doctor shortage in that area. This has happened with the absolute cooperation of the Central Coast Division of General Practice, which is a very enlightened division of general practice. It has worked with the government on almost all of the initiatives that the government have put forward on improving health.

I would like to commend Dr Phil Godden, who is the Chairperson of the Central Coast Division of General Practice, and Mr Bill Parker, the CEO, for the very cooperative and constructive approach that they have taken to both this GP superclinic and primary healthcare issues right across the Central Coast. In fact, they started from a position of having some scepticism about a GP superclinic and have moved to a position of absolute support. They are proposing to me ways in which the type of model that is set up for the GP superclinic can be expanded to many more GP practices on the Central Coast. This is a terrific initiative—$275 million has been provided to construct these GP superclinics across the country. As I said, we in Dobell are lucky enough to have one that not only provides those services but is inspiring other GP clinics in the area to look at adopting a similar model of delivery of service, and that is a terrific thing.

The Rudd government has also made available $500 million for subacute care to help older people leave hospital earlier and free up beds. As we know, one of the real problems with our hospital system is what is called bed blockage, whereby we do not have the type of transitional care that is required to get people out of public hospitals—they do not want to be stuck there, but they are not well enough to go home. This $500 million for subacute care provides the sort of assistance that gives people some dignity, gets them out of the hospitals and frees up those beds so that the hospitals can deal with the acute care issues that they are designed to deal with.

In terms of workforce, the Rudd government will invest $1.1 billion in training more doctors, nurses and other health professionals. This is the single biggest investment in the health workforce ever made by the Australian government. It will see 812 additional ongoing GP places from 2011 onwards—a 35 per cent increase on the cap of 600 places imposed in 2004 by the former Liberal government. Little wonder that our health system is experiencing these workforce shortages, given the previous government’s chronic lack of investment in training for doctors, nurses and allied health professionals in general right across the board. It is because the former government did not put the money into making sure that the health workforce was being properly trained that we are seeing these shortages right across our health system today. This government is determined to make sure we train enough doctors, enough nurses and enough allied health professionals so that when people need health care they can get the sort of health care they deserve and people will be available to provide that care.

This government will also deliver $134.4 million to better target existing incentives and provide additional non-financial support to rural doctors. The reform introduces incentives based on the principle that the more remote you go the greater the reward. Under this initiative, 2,400 more doctors in 500 communities around Australia will become newly eligible for rural incentive payments. We will deliver $122.7 million in a package of measures to improve choice and access to maternity services for pregnant women and new mothers by providing MBS and PBS benefits for services provided by midwives. This is a very important initiative and one that I know many people on this side of the House have spoken about before, but it is particularly important to the people of the Central Coast. Because of a lack of obstetricians, it was proposed that Wyong Hospital’s maternity ward would have to close. With initiatives like this the maternity ward has changed to being midwifery led. There are midwives there who are delivering two or three babies a day in this area because of the freedom that has been provided to them under this sort of package, which enables midwives to step in and provide that sort of service.

This government is providing access to the MBS and the PBS for nurse practitioners at a cost of $59.7 million. The government will also provide 20 nurse practitioner scholarships, 1,134 new annual Commonwealth-supported higher education places in national priority areas of nursing and a new incentive of $6,000 for eligible nurses who return to a hospital or aged care setting. These are practical steps for addressing the workforce shortages that this government inherited after the inaction of the previous government. They are very important measures to make sure that people are able to receive the sorts of health care that they should be able to get access to in a country like Australia.

Prevention is better than cure. This government is also recognising that fact and has invested a record $872 million—the largest, single investment ever in preventative health—to keep people fit, healthy and out of hospitals. We are providing child health checks for four-year-olds to promote early detection of chronic disease risk factors and funding of $12.8 million to 190 schools around the country to construct either a kitchen or a garden under the Stephanie Alexander kitchen garden program. In dental care, we have committed a total of $650 million to two new dental programs. The Teen Dental Plan commenced last year and provided a $150 million annual payment to eligible families. To the end of December, 258,203 teenagers will have received a dental check-up under this program with 7,598 dentists providing these services.

Unfortunately, due to the position that the opposition have taken in the Senate—not just on this issue but on many issues affecting families—the Commonwealth Dental Health Program that will provide up to one million consultations has been unable to commence. I take this opportunity to urge those opposite to get on with it, to make sure that those who have the greatest difficulty in paying for their dental care are able to access the Commonwealth dental health scheme which we have proposed. This scheme should not be held up in the other place. This is a measure for people who have chronic dental problems and it is being blocked by those opposite for the sake of some ideological position. This should be passed to ensure that there is better dental health care for older Australians and for those who cannot afford dental health care.

The government, along with the states and territories, will invest $1.6 billion through a number of partnerships to target chronic disease among Indigenous Australians. Chronic disease is the single largest contributor to the life expectancy gap. This government is determined to have a better approach to reducing the gap in life expectancy of Indigenous Australians. The enormous gap is shameful for all of us. This government is out there ensuring that we make those types of investments which go some way to reducing the life expectancy gap.

We have committed funding of over $44 billion over the next four years on age and community care. No government in the history of the Commonwealth has committed more. This is a record amount of money being spent on age and community care with more allocation of community places, as well as residential places. We are rolling out an additional 2,000 transitional care beds at a cost of $293.20 million. As I said earlier, this will help reduce pressure on hospitals.

Construction work is already underway on the government’s commitment of $300 million zero real interest loans to create more than 1,300 new beds in aged care. This year will provide $192 million for the National Respite for Carers Program, which funds a national network of more than 600 community based respite care services. Since being elected, we have improved and strengthened quality measures by increasing announced and unannounced visits to homes by 3,000 a year and by investing more than $127 million in the aged-care workforce.

For the future, the government has embarked on a path to build the health and hospital system that Australia needs for the 21st century. Last week the Minister for Health and Ageing hosted a consultation here at Parliament House with private health insurers and private hospitals to discuss the National Health and Hospitals Reform Commission’s final report. It was the 76th consultation around the country to road-test the commission’s proposed reforms. Promoting personal wellness and combating chronic disease are priorities for the Rudd government.

The social and economic burden of chronic disease is unacceptably high. The government encourages private health insurance providers to continue to extend their products by including positive preventative health treatments such as those to quit smoking, to lose weight or to manage stress. Figures released just two weeks ago show that private health insurance membership continues to rise as Australians increasingly seek to improve their health, to stay well and to adopt preventive measures in their lifestyle.

At the most recent consultation the minister outlined the commission’s recommendations and discussed with the private health sector their priorities to improve the nation’s health system, including proposed modifications to Medicare that the commission called Denticare and Medicare Select. Denticare proposes that all Australians have universal access to preventative and restorative dental care and dentures, regardless of their ability to pay. People would have their choice of either a public or private insurer and in both cases Denticare would meet the costs incurred. Dental services are a large and growing part of private health insurance. This is an issue that is very close to my heart, and I spent many years in my former job campaigning to try to get governments to properly address dental care. We have had Medicare now for well over 26 years but, for some bizarre reason, when it comes to discussing dental care the mouth seems not to be part of the rest of the body. The proposal for Denticare firmly puts this issue right at the front and centre of some of the reforms that this government will look at and consider for the future of Australians’ health. It is one that I would urge us to look at very carefully and closely because of the health and lifestyle issues that people suffer from when they cannot afford to go to the dentist and illness occurs because their teeth are in such a chronic state. This is a very good recommendation that we should spend a considerable amount of time looking at with a view to adopting.

Consultations have been held in my electorate of Dobell, where the Minister for Health and Ageing visited Wyong Hospital. We consulted with front-line health professionals there about the ways in which the Rudd government can address the challenges in the health system. Wyong Hospital has benefited from the recent injection of $792,000 to improve elective surgery performance. The funding is part of stage 2 of the Australian government’s elective surgery waiting list reduction program. It has allowed the hospital to purchase additional surgical equipment to reduce the waiting times for elective surgery. Under stage 2 of the elective surgery plan the Rudd government provides funds to support the construction of new operating theatres, to upgrade existing elective surgery facilities and to purchase new surgical equipment to reduce waiting lists.

The visit was also part of the government’s national consultation program following the release of the National Health and Hospitals Reform Commission report that I have been talking about. This is part of the Rudd government’s conversation with the nation to road-test the commission’s proposed reforms. It involves hearing first-hand what doctors, nurses and other health professionals think of the recommendations that will help shape the future of health and aged care in this country. We have already taken concrete steps to improve Australia’s health and hospital system, after 12 years of neglect by the previous government, under the first stage of the plan, which provided $150 million to Australian hospitals to increase the number of elective surgeries being carried out, and the other programs I have gone through in my contribution in this debate. This legislation in relation to New Zealand doctors is a small part of that, but an important part of the narrative of improving our health system, something that this government is very committed to. I commend the bill to the House.

Dick Adams (Lyons, Australian Labor Party) Share this | Link to this | Hansard source

The Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009 has been developed to find a solution to a problem that has been caused through certain health legislation and to accommodate our New Zealand friends’ rights to immigration. The purpose of the bill is to amend the Health Insurance Act 1973 to remove restrictions which apply to New Zealand permanent residents and citizens who are medical practitioners who obtained their primary medical education at an accredited medical school in Australia or New Zealand. The act specifies that the period of 10 years during which overseas trained doctors are restricted from accessing Medicare benefits must commence from the time the doctor becomes a permanent Australian resident, even if they became medical practitioners prior to gaining that residency status. The bill also introduces a time period in which medical examiners can appeal against the refusal to grant a section 19AB exemption or a decision to impose conditions in connection with an exemption which has been granted.

In the mid-1990s the view that Australia produced sufficient medical practitioners to meet the health needs of the population, which had dominated policy thinking for some years, began to be questioned as doctor shortages became increasingly obvious in rural and remote areas. Initially, because general practitioners and specialists were concentrated in major urban areas, it was considered that, rather than there being actual shortages in the medical workforce, there was a maldistribution between the bush and metropolitan areas. This thinking prompted the then government, following its election in 1996, to introduce legislation and initiatives intended to address medical workforce maldistribution.

As there is a constitutional restraint on governments which prevents them from introducing legislation to conscript the services of Australian medical practitioners to work in certain areas, doctors who obtained their primary medical qualifications overseas became the focus of government strategy. Amendments to the act were introduced which obliged those doctors to agree to practise in rural and remote areas where medical workforce shortages had been identified if they wished to access Medicare benefits for the services they provided. In addition to the restrictions on overseas trained doctors, the government of the day limited the granting of new Medicare provider numbers to people who had achieved minimum proficiency qualifications—that is, specialist medical qualifications including general practitioner qualifications.

The minimum proficiency requirements for new medical practitioners are imposed under section 19AA of the act. Under this section, medical doctors who were first recognised as medical practitioners on or after 1 November 1996 are unable to claim Medicare benefits unless they satisfy certain conditions. These are that they are recognised general practitioners, specialist or consultant physicians, or they are undertaking approved authorised placements.

Section 19AB of the act imposes restrictions on medical practitioners who did not obtain their primary medical qualifications in Australia. These medical practitioners are known as overseas trained doctors or international medical graduates. Under the 1996 legislation, permanent-resident overseas-trained doctors were not subject to restrictions if, before 1 January 1997, they were registered with an Australian medical board or eligible to have their qualifications assessed by a board. However, those who did not meet this requirement were not eligible to claim Medicare for a certain period. Those restrictions were commonly referred to as the 10-year moratorium. Temporary-resident overseas-trained doctors are subject to restrictions under section 19AB of the act for an indefinite period.

Exemptions to the requirements under section 19AB can be granted to overseas trained doctors if they agree to work in areas where medical workforce shortages have been identified. These areas are known as districts of workforce shortage—DWS. These are areas in which the community is considered to have less access to medical services than experienced by the population in general. This can be because of the remote nature of certain communities or because of the lack of services available to those communities, or a combination of the two factors.

Added to these details is the unique situation that New Zealand citizens have found themselves in as far as accessing Australian work and benefits is concerned. New Zealanders were allocated a special visa to accommodate the Australia-New Zealand relationship which was developed in 1973. That entitled the citizens the right to visit, live and work in each other’s countries. So when New Zealanders present their passports at immigration they are considered to have applied for a visa and, subject to health and character considerations, they automatically receive an Australian special category visa.

New Zealanders do not need to be granted permanent residency in Australia. They are allowed to remain and work in Australia lawfully as long as they remain New Zealand citizens. However, New Zealand citizens who arrived in Australia on or after 27 February 2001 must apply for and be granted Australian permanent residency if they wish to access certain social security payments, obtain Australian citizenship or sponsor their family members for permanent residency.

New Zealand medical students do not enjoy the status generally afforded to their fellow citizens. In fact, that applies to all New Zealand students, as I have found a number of New Zealanders living in Tasmania who have been trying to study there and have been asked to pay full fees as they are not Australian citizens. They are treated as temporary residents.

This bill is to try and rectify this. It proposes to remove New Zealand citizens and permanent residents from the category of ‘former overseas medical students’ and allow those who are here to train or retrain into this profession. However, it should be noted that the proposed changes to the legislation will not exempt New Zealanders from the requirements that apply to Australians, in that graduates of Australian medical schools will be required to gain postgraduate specialist medical qualifications or be in approved placements before they are able to access Medicare.

Hopefully this legislation will allow a few more locally trained but New Zealand born doctors to be available to practise in Australia. However, I do not believe that this alone can assist with the serious shortage of doctors and specialists in this country. I am aware that our waiting lists are not growing any shorter. In Tasmania we are faced with ongoing shortages wherever we look. Some of our few specialists have lately retired, been killed in accidents or, in a couple of cases, murdered—not for the work they did but maybe because of some of the pressures they come under.

We have to make the system work better. It is not right for people in their 70s to wait 18 months to four years to have elective surgery because insufficient operations can be carried out under Medicare because there are not the doctors or theatres to perform them. The state hospital systems are not coping with the demand. Surely it should be only a few months after diagnosis of the need for it that an operation takes place. Those in their late 60s or 70s do not have that sort of time left and cannot live a fulfilled life if they are in constant pain and anxiety from having to wait for an operation.

The Lyons electorate is a very country electorate that covers a wide-ranging area of Tasmania, and the problems seem even more obvious there. Many people who are on waiting lists even have to move away from their friends and relatives to get services to help them while they are waiting. When you have led a very active life, it is quite soul destroying to suddenly have your independence taken away from you. Private health insurance is not the answer, because, even if some of the older people can afford it, there are still huge gap fees which throw many of them back onto the public waiting lists because they simply cannot afford the ancillary costs.

Doctors are still leaving the state in droves or retiring because of the lack of attraction of being in the country areas. Tasmania as a whole is seen as regional and is not attractive to young doctors, who do not want to be bothered with the paperwork of a small practice and would prefer to work as a specialist from a set of professional rooms set up to look after the needs and the administration of a busy city practice that would allow reasonable hours of work and extremely good pay. Some young doctors spend some time in Tasmania as locums, around the coast, which I suppose is a good thing to do if you can get into it.

I think the profession needs to take some responsibility for the present model, which is now failing. Asking young doctors to work in broken-down cottages in country towns, without proper disability access, is unreasonable. A better concept would be to have all the health professionals working out of a regional centre accessible to all patients and where the practice can reach the high standards required by government without putting too much of a financial burden on one doctor. This would allow us to look at regional health and see which areas are falling behind and which have good health standards so that governments can put extra resources into regions that are showing poor health outcomes.

There is an article in the Launceston Examiner today which describes GPs wanting subsidised rent and cars if they are to practise in Launceston. Local government is not in the business of providing properties at reduced rental, even if they had any that were suitable, which they do not. In an attempt to attract more doctors some councils in my electorate have bought houses and cars for corporate medical companies that recruit doctors. The state government is reported to have been offering ‘European cars, overseas travel, mobile phones and entertainment credit cards as incentives’ to keep doctors and specialists in Tasmania. On top of that, they get their private patient fees. I am not sure where this will all lead. Simply, if we cannot afford doctors, other medical providers such as nurse practitioners and alternative medicine practitioners will be called upon to fill some of the gaps starting to emerge. Maybe we should look at the preventative healthcare angle more seriously and stop the need for a lot of people to take up elective procedures by keeping them healthier for longer. Of course that will not stop the accidents or the chronic ailments, but if we are able to live a more healthy lifestyle certainly it would help stop the desperate need for doctors being required to prop us all up as much as they do at present.

I am moving away from the bill a little, Madam Deputy Speaker. I must put in a plug for the those who know and understand the principles behind ‘be well’—a means of dealing with a recently diagnosed ailment, people to whom you can turn so that you can turn your life around and just ‘be well’. At the moment, you come out of a doctor’s appointment with a handful of pills but no instructions or understanding of what your body is doing and why you need all the things you have been prescribed nor any real direction on how you can improve your health, other than some vague suggestions about losing weight, giving up smoking or drinking or exercising more. Then you go to the supermarket and look at food labels which bear no relationship to what the doctor has told you. There is a need for major reform in labelling laws in Australia.

We need proper, long-term health assessments for individuals, which might be available under benefits. We do not even have medical check-ups for our electorate staff these days as we used to. This means that, if someone has a chronic condition, they cannot be assisted in the workplace, which often means time off without any means of helping that person to become healthier. Governments and large corporations, and even small ones, can do more here for their employees and save themselves money. This idea needs more research and for some models to be developed. We are also helping our New Zealand friends become a further part of our system in that, under this bill, they can train here now under Australian guidelines and receive payment. I believe that we have to have a complete look at health as it is delivered in Australia today and I believe that our minister, Minister Roxon, who is in the chamber, has started that process. But we have to deal with the relationship between doctors and governments, because I do not believe that is working very well.

In conclusion, restrictions on provider numbers for overseas trained medical practitioners were introduced in 1996 in an attempt to address doctor shortages, which at first it was thought were confined to rural and remote areas. The restrictions were criticised for a number of reasons, and there continues to be some argument that they have not achieved their objectives. However, given the significant number of overseas trained medical practitioners currently working in rural and remote areas, the claim that the restrictions have had no discernible impact on the medical workforce in the bush is less than convincing.

There are strategies in place to improve the number of Australian trained doctors, which it is hoped will further improve the rural medical workforce. These are long-term solutions to medical workforce shortages. However, there can be no guarantee that Australian trained doctors will opt to practise in areas of workforce shortages. It is likely, therefore, that provider number restrictions on overseas trained doctors will remain in place for some time. Given that this is the case, the decision to reconsider aspects of the restrictions that have been described as particularly onerous and incongruous appears to be a justifiable one. Indeed, it appears particularly unfair that some practitioners have been subject to restrictions for a period of more than 10 years, when it was not the intention of the original legislation for this to occur. Similarly, it appears contradictory to the special relationship afforded New Zealanders in Australia that those who choose to study medicine in Australian medical schools should be disadvantaged upon graduation. The legislation intends to remedy these anomalies.

The other proposed changes in this bill will set a time limit on the period in which medical practitioners can seek review of exemption decisions under section 19AB. Setting such a limit also appears sensible and is more likely to ensure that the circumstances under which a review process is conducted reflect the circumstances which prompted the original decision.

In effect, changes to the act for New Zealand citizens and permanent residents will not have a major negative impact on the number of doctors who are required to complete a 10-year period of service in rural and remote areas and areas of workforce shortage. There may be more impact on doctors’ numbers from the second change proposed in this bill, although it is not clear how many practitioners have been subject to an extended moratorium. However, in keeping with the original intent of the provider number legislation and from the perspective of fairness to doctors who have already made a notable contribution to health in rural and remote areas, it appears justifiable that any effects of the proposed changes should be absorbed. Finally, the third change in the legislation is likely to have a positive effect for administrative review processes that may be as beneficial to those seeking a review of decisions as to those undertaking those reviews. I certainly commend this bill to the House.

Debate interrupted.