Andrew Laming (Bowman, Liberal Party, Shadow Parliamentary Secretary for Regional Health Services and Indigenous Health) Share this | Link to this | Hansard source

Flanked by the member for Riverina and, I am sure, supported on both sides of the chamber, I want to acknowledge the important work done by rural and remote healthcare providers right around this great nation. Whether they are working in rural towns or in remote communities, whether they are doctors, nurses or allied health workers, they are working to close the rural-urban gap in health, which at the moment, in life expectancy, is between five and seven years.

Something is certain about living in remote Australia: you should not have to take second-class health care. That is a commitment, I know, from this whole chamber. I know also that, if many of these regional towns and communities were patients, they would be category 1 and wheeled straight in for emergency care of the highest quality. But too often we hand them a bag of cash and say: 'Do your best to recruit a health worker,' without ever ensuring that those health workers are actually deployed.

Right now the issue is obstetrics, surgery and anaesthetics—procedures done by our rural general practitioners, who actually hold the communities together, preventing people who live in remote and rural Australia from having to suffer delayed diagnosis, travel long distances for care and suffer the emotional and financial expense of what ensues. What we need—and, again, I know it is supported in this chamber—is more focus on rural training, more focus on incentives and a way of seeing our overseas trained doctors, who in many cases are the backbone of our medical workforce, being assisted and supported to not only deliver the services that we need but to feel like they are part of those rural communities.

I tonight want to recognise the important work of the two jurisdictions that are the most dispersed and decentralised of all, and they are New South Wales and Queensland. I want to acknowledge the work of the Queensland government in having a rural training pathway for GPs that has become the model for the rest of Australia. They give significant payments for professional development and provide recreational leave for their nurses twice a year as well as bonuses, which are extended to the allied health sector as well. And there is Queensland's well-known system of seven-tiered payments, of between $6,900 and $48,300 per year—non-pro rata-ed—to doctors to work in the most remote of locations. That is a very, very strong attractor for getting our doctors, predominantly trained in the cities, to work in rural and remote Queensland.

In New South Wales they do it differently, and that is the benefit of a federal system. Through their Rural and Remote Incentive Scheme, they offer payments of up to $10,000, not just to health workers but for human services, education and training, police, firefighters and the SES. They also offer significant study incentives, for a semester every three years and four hours a week to do additional study. That maintains the intellectual and training connection to urban centres. In New South Wales there are payments to VMOs of up to $10,000 and to dentists of up to $20,000, which, innovatively, can be used not only to pay for a vehicle or for travel expenses but even to pay for school tuition fees.

Here are two states doing things differently but effectively, but it is still not enough. There are three big frontiers ahead of us. The first one is incorporating the overseas trained doctors, who still remain the backbone of service in some communities. They need to have an opportunity, in some cases, for the families to be able to access public education and health facilities. In some cases they cannot do that now, even though they are supporting the communities in those areas.

Second, we need an advanced rural training pathway so we can say to young doctors: 'We will take you from the point at which you are deciding whether or not to be a specialist and offer you a procedural based general practice in the bush which is inspiring and satisfying, and in a way that can allow you to do procedures,' because that skill is dying in the bush. A procedural training pathway that offers young doctors a college qualification at the end of it is vitally important.

Last—and I hate to lament this—there has been fiddling of the geographic classification standard by the current Labor federal government that has led to pooling of communities of completely different geography into five simplified categories. I can understand that there is a need for an academically developed system for remoteness. On behalf of rural doctors around this country and those who are training to be rural doctors, I say: remember it is not geography alone. I know they may well be an equal distance from a major centre, but you cannot class Gundagai as the same as Wagga, with a specialist hospital; if you do, the doctors in Gundagai will move to Wagga. It is utterly counterproductive that the payments are now the same. Huge numbers of coastal Queensland doctors are now receiving incentives that are not much less than they would get for working in places like Cloncurry. So why would doctors remain in Cloncurry?

I ask the obvious question: why should Ingham be like Townsville; why should Busselton, Bendigo, Wagga and Gundagai all be in the same category as Hobart? Hobart is a major metropolitan centre with a completely different challenge of remoteness. If we can fix up the issues for overseas doctors and their families and support them, look after the geographic classification scheme and take some action on incentives, we can ensure rural and remote health service delivery occurs for Australia.