Monday, 9 December 2013
Private Members' Business
Rural Clinical Schools
The issue of the training and retention of country doctors is an age-old one. This is a challenge which many regional and rural communities, including many of those in the Riverina electorate, have faced for some time. I am pleased to rise to support this motion and to inform the House of a couple of proactive moves in the Riverina to increase the training and retention of country doctors. There are many good examples of how the Riverina is playing its part in trying to solve the issue of rural access to general practice, allied health and specialist care. I commend the member for Murray for moving this motion. It is a good one. The member for Murray has an electorate like the Riverina with many towns which need more general practitioners and more country doctors, and I am pleased to speak to this motion today.
Dr Stone's motion has three central tenets. The first is that this House celebrates the success of rural clinical schools around Australia, started in 1999 by the then minister for health, the Hon. Dr Michael Wooldridge, and continued by his successor, the now Prime Minister, Tony Abbott. This is something which all country members in this place should agree on. We represent communities which rural clinical schools are helping to better service, and in celebrating and recognising such a contribution we can continue to better service those communities which still need more GPs, such as Hay in the Farrer electorate.
Point (2)(a) is a very important one. It notes that RCSs were designed to overcome the maldistribution of all doctors, including GPs, across Australia which left country regions short of GPs and other specialty doctors. In this debate today it is important to remember the main challenge here is the training and retention of doctors in rural and remote areas, not larger regional cities. On 24 May this year I attended the Charles Sturt University Regional Health Conference in Canberra, alongside my colleagues the member for Bowman and the Hon. Melinda Pavey MLC, New South Wales Parliamentary Secretary for Regional Health. The point of this symposium was clear: the challenge for regional health lies not in how to attract doctors to larger regional cities but instead to smaller towns and communities whose access to general practice is far worse than for those in bigger centres. I might note that we have in the chamber today Irene Broad from Temora, who during her time on Temora Shire Council did a great amount of work, particularly for that community, and was certainly there at the opening of the medical complex in Hoskins Street. She has with her former Filipino congressmen Alfredo Abueg and also a special Olympian, Alfred Abueg. Both are here to visit Australia and look at the many areas and aspects of Australia and what we are doing, including in health.
The member for Murray's motion highlights that students undertaking training in rural locations have academic results that are equal to or better than their metropolitan counterparts, and that published data from public universities show higher rates of RCS graduates working in, or intending to work in, rural areas. Dr Stone is right. The need to get more country doctors to go to more regional and remote locations is something Dr John Preddy, a Wagga Wagga-based paediatrician and lecturer at Wagga Wagga's University of New South Wales Rural Clinical School, understands well and is passionate about. Dr Preddy has been championing this cause in Wagga Wagga and the wider area for many years. He realises, as many country communities do, that remote GPs are much more needed in smaller communities than they are in coastal cities or larger inland regional centres.
Dr Preddy has provided some very pleasing statistics about UNSW's Rural Clinical School program and its contribution to country medicine in the Riverina. He told me today that the Wagga Wagga Rural Clinical School currently has 50 students enrolled, with 16 set to graduate this year. Almost half of those, Dr Preddy said, are students who are already from rural, regional or remote areas—they are country kids. There are currently 18 interns at the Wagga Wagga Base Hospital, 17 of whom are graduates from UNSW's Rural Clinical School in town. Further to this, Dr Preddy said the school has recently conducted a survey of the career intentions of their students. Of those students, 70 per cent have indicated they want to work in remote general practice. That is great. They do not want to work in the eastern suburbs of Sydney, they do not want to work in coastal centres; they want to be a rural and remote GP and treat patients in the areas which need it most, like Hay and like Temora, and that is something we should commend. Recently, Dr Preddy met with my National Party colleagues Senator the Hon. Fiona Nash, Assistant Minister for Health, and the member for Lyne, himself a former rural specialist, along with Dr Lesley Forster, Kate Pitney and Josh Lane, the last two of whom are students at Wagga Wagga's RCS, to tell us of their great work and to share those statistics. They are to be commended for their work in this area.
I also commend Charles Sturt University for lobbying for the next step up , a rural medical school for Wagga. I know UNSW is also actively working in this space. It is very important to note that the rural medical school implementation committee at Wagga Wagga, headed by Dr Nick Stephenson, is working towards getting a rural medical school. That is the next step, that is what we need. I support this motion put forward by the member for Murray.
It is 'Parramatta'—unless you live there it does not really matter, Mr Deputy Speaker!
I also commend the member for Murray for raising what is an incredibly important issue which should be important to all Australians, and that is the quality of medical care available to our rural Australians. In my area of Western Sydney we, too, from time to time have had trouble in attracting and keeping the kinds of qualified professionals that we needed. We also found that the opening of the clinical school in Blacktown has had an incredible effect in retaining people in the professions in our area.
But there is something about this motion that I would like to point out, and that is what appears to be an attempt to really airbrush out the fact that there ever has been a Labor government for the last six years. It refers back to what was happening before 2007. I understand that the member for Murray might prefer that the focus be on that, so I would actually like to start there and just point out to the member for Murray that, while there might have been some clinical schools open, there were some very real issues in regional Australia when we came to government in 2007.
It was the case then that for some types of cancer you were twice as likely to die of that cancer if you were diagnosed in a regional centre than if you were diagnosed in a city. For some forms of cancer it was up to four times. So there was an incredible amount of work to do for the Labor government on its election in 2007. I just want to walk through some of the things that the Labor government did in order to improve the quality of health care in regional Australia, and it was quite apparent that it was necessary to do so. In doing this, I do not want to pretend for a minute that the work is done. The deficit for regional Australia was great, and still remains quite substantial.
But there was the $134.4 billion Rural Health Workforce Strategy, designed to encourage doctors to work in some of the most isolated rural and remote communities. As a result, since 1 July 2010 around 11,000 doctors have been assessed as eligible to receive payments each year to move to and/or continue practising in regional areas. As a result of that, there was a 21 per cent increase in the number of GPs providing services in regional and remote areas of Australia between 2007 and 2011.
There was $345 million to deliver 1,300 more general practitioners practising or training by 2013, and 5,500 new GPs or GPs undergoing training in the next decade, with 50 per cent of those positions going to rural and regional Australia.
There was $370.8 million over three years for the Rural Health Multidisciplinary Training Program, which includes the Rural Clinical Training and Support program, referred to in the member's motion; the Dental Training—Expanding Rural Placements Program; the University Departments of Rural Health Program; and the John Flynn Placement Program to support rural clinical placements and training for medical, nursing and allied health students.
There was $6.5 million for 400 more clinical placement scholarships over four years for allied health students in rural and remote areas, bringing the total to 1,000 people over four years. There was $34.1 million for a Nursing and Allied Health Rural Locum Scheme that will fund 3,000 nurse locum placements and 400 allied help locum placements in rural areas over four years. There was $390.3 million to support an expanded and more flexible role for nurses in general practice, particularly in chronic disease management and prevention, with a special loading for those working in rural areas. And there was $12 million over four years for the Rural Health Continuing Education program to provide access to accredited continuing professional development support for medical specialists, allied health professionals, nurses, general practitioners and Aboriginal and Torres Strait Islander health workers in rural and remote areas. And of course there was the $77.7 million over four years for the relocation and infrastructure grants to encourage and support dentists to relocate and practice in regional, rural and remote areas.
So, again, while no-one would even begin to assume that the deficit in rural health services has been solved—it still remains; it was substantial when we came to government in 2007 and it has been substantial for many decades—there has been considerable work done in the last six years, and it is a shame that the member for Murray has tried to airbrush out the last six years of the Labor government rather than acknowledge that work was done, in quite a collaborative manner, I should say, with members opposite who now sit on the government bench.
I commend the member for Murray for moving this motion. In addressing maldistribution in the workforce that makes it harder to get health practitioners working in rural areas, there are really four elements that need to be addressed. You need to address the students who are entering the courses; you need to address the encouragement and the exposure they get to rural practice during their course; you need to address where they are doing their postgraduate training; and then you need to look at the incentives which are there to assist people who are practising in a rural setting. All of the universities and the medical schools have come a long way with the establishment of rural medical schools. The previous coalition government created nine new medical schools, including some in regional areas. We also doubled the number of medical school places, but the establishment of the clinical skills program in 2000 did provide a much longer-term and more concrete commitment to having people trained in a rural setting.
There are currently 17 rural clinical schools across Australia. In my electorate of Boothby, Flinders University runs two rural clinical schools. They have one based in Renmark, which covers Mount Gambier, the Hills and Fleurieu regions and Warrnambool—the greater green triangle—and they also cover all of the Northern Territory. Flinders University says that is a very important part of their mission. I visited their Centre for Remote Health in Alice Springs. The University of Adelaide is specifically focused on the Spencer Gulf and its main cities of Whyalla, Port Augusta, Port Pirie and Port Lincoln. The Dean of Medicine at Flinders University, Dr Paul Worley, has long been interested in this issue. He pioneered the parallel rural curriculum, which started in the Riverland and which allowed people to spend one whole year of their medical training in a rural general practice setting. The initiative has since been introduced around Australia and around the world.
I want to take this opportunity to commend the member from Murray and to say that she has correctly identified that increasing numbers of medical students are coming through and we are looking at where they are going to do their training. It will be important to have increased training places in rural settings and in private-sector settings as well. The initiative of the PGPPP has been very important, allowing people to spend part of their intern year in a rural general practice setting. We have detailed information about districts of workforce shortage at the Department of Health, which has a database on this, but it is still very clear that we need to do much more to address the maldistribution in a rural setting. The rural clinical skills program has been an important part of this.
I rise to support the motion before us today and in doing so I would like to say that prior to the Labor government being elected in 2007 there was a chronic shortage of health professionals in rural Australia. The Beyond the Blame Game report that was tabled in December 2006 identified the maldistribution of health professionals as a major issue. I remember Terry Clout, who was the head of the Hunter-New England Area Health Service at the time, commenting that the further you were from the Sydney Harbour Bridge, the greater the maldistribution was and the fewer health services you could access. Based on that 2006 blame game report, the Labor government of the day really worked to address that maldistribution of health workers and put in place a lot of programs designed to address that.
I would like to refer to Health Workforce Australia's National Rural and Remote Workforce Innovation and Reform Strategy, released in May 2013. That strategy talks about a plan for improving the health workforce and the distribution of doctors, nurses, midwives and allied health professionals. It examines the specialties in Australia. It makes some key findings, one of which is that there are not enough general practitioners and medical specialists in regional and rural Australia. For years the shortage has been taken up by overseas-trained doctors. Earlier today the member for Kingston was talking about the freezing of funds for clinical placements. This is all part of ensuring we have trained health professionals.
An item on the ABC reported on the fact that $8 million had been committed by the previous government over a four-year period for getting trained doctors for rural and remote areas, and an additional 60 intern places were to be created. Tony Wells, from Rural Health Workforce, said he welcomed students wanting to work in the rural environment being encouraged to do so. What was the response from the then opposition? The Leader of the Nationals, Warren Truss, who I would see as somebody who would be totally committed to getting more doctors and nurses and allied health professionals out in rural and regional Australia, said that he would not commit to matching Labor's pledge. I found that very disappointing because I know just how important it is to have trained health professionals in rural and remote areas. I know that the Rural Doctors Association of Australia has been concerned about this over a long period. This is a very important issue and one that needs to be addressed.
I am delighted to speak in support of this motion on rural clinical schools. We have seen real benefits from this initiative. As a medical specialist myself, and having spent the last 20 years in the regions, I have seen what rural clinical schools can deliver.
This initiative was introduced by the federal government back in 1999, and the aim was to decentralise medical training. Now we have 17 rural clinical schools, established by 16 of the 19 universities with medical faculties. In our electorate we have a campus of the University of New South Wales School of Rural Health, in Port Macquarie, and in the Manning, in Taree, we have the University of Newcastle Department of Rural Health and Rural Clinical School. They have both delivered great results. There is a lot of evidence showing the benefits of this rural clinical schools program. The likelihood of a doctor ending up in rural practice once they have finished their training doubles if they come from a rural background. Another factor that helps is having a partner who went to high school in a rural location. But there is something else that will help, and that is rural postgraduate training, as rural clinical schools and universities only turn out half-cooked doctors. They graduate with a degree but the gestation period for producing a clinician who can practise safely and competently takes at least another four years.
Since 2003 we have had a massive increase in the number of medical undergraduates. It has gone from 1,266 to 3,185 graduating in 2015. But Australian cities have 370 doctors per 100,000 people, and some of the inner city areas have even greater concentrations than that versus 200 per 100,000 people in the rural and regional areas, and even less in the remote areas. But at graduation, most of the people leaving the rural clinical schools expressed a great desire to go into rural practice. In fact, at the University of Sydney rural clinical school, 80 per cent said they wanted to go into rural practice, and at the University of New South Wales rural clinical school, that figure was 72 per cent.
How do we convert this into a doctor who decides to live and work in a rural location? The answer is to keep this system going and then support it, because we have half the recipe there; we just need the rest of it. The remaining part of the recipe is to get post-graduate training expanded in these rural locations, because it is during this extended gestation of producing a skilled doctor that people set down their roots. They partner off, they make real estate purchases, they have children, they have developed social networks and all of this is lost if they are forced back into the cities to do their post-graduate training. As the head of the Australian Medical Students Association said the other day:
Medical graduates can't fix a rural workforce shortage if there aren't rural jobs to go to. Without an expanded rural training capacity, the new doctors would be forced to return to the cities—
Just as I was outlining:
There, they would likely settle down.
My case rests, even the students have recognised that.
Evidence that rurally-based post-graduate training delivers results is striking. The statistics of the professor of General Practice and Education Training Limited indicate that if you have had GP training in a rural location for half your time, there is a 46 per cent chance that you will stay practicing in a rural location for at least five years. That is a pretty good strike rate; 46 per cent—a cricketer would be glad if he had a strike rate like that, let alone producing a doctor.
In my own little patch we turned the Port Macquarie Base Hospital from the humble Hastings District Hospital into a post-graduate teaching centre and examination centre. We have a rural clinical school and twelve or more advanced trainees—baby specialists. After converting it into a training centre, we now have two specialist cardiologists, one specialist chest physician, one specialist dermatologist, one specialist A&E physician and one infectious diseases specialist residing in Port Macquarie. That is not a bad strike rate out of the medical registrars that we trained in Port Macquarie. (Time expired)
Thank you for the opportunity to briefly add to this debate. I am very pleased to be able to support the intention of the motion that was moved by the member for Murray. To take up the point made by my colleague the member for Parramatta, I will talk about the ongoing commitment that the previous Labor government gave to the work of establishing the training opportunities for young people in rural and regional Australia so that we could aim to keep workforces in those areas.
As one example, when I was the Minister for Higher Education and Skills in May this year I was very pleased to announce $59 million for the La Trobe Rural Health School. That was designed specifically to ensure that rural Victorians would benefit from up to 1,700 extra health professionals that would be produced by that rural health school over the four years. We were also announcing new facilities that were being built at that particular facility. The school was a boost for the local community, obviously, and for regional Victoria more broadly. It will bring new students into the area and provide training and education opportunities for young people who already live in the area. It is specifically aimed at addressing regional Victoria's need for more allied health professionals.
It was a great joy to be at that particular announcement and it was very welcome. In fact, we were told that, in the range of fields that the students would be studying, they are significantly more likely to stay in a regional area having studied in a regional facility. The same was true at La Trobe. The university's Vice Chancellor Professor John Dewar said that 71 per cent of graduates from the campus choose to continue to work in regional Victoria, so it is an issue that the previous Labor government continued to give a great focus to.
One of the important parts of that particular initiative was also the provision of funding for student accommodation, and I was very pleased to be able also to attend the new housing that we had funded in areas like Shepparton and Albury-Wodonga in order to provide accommodation for students when they were doing their placements. Under the Education Investment Fund we put significant money into those sorts of facilities.
I also want to take the opportunity to recognise my own university in my hometown of Wollongong, which has a medical school as well. They have very strong links with GP services across regional and rural New South Wales, again with a view to having students from those areas recruited into the courses and to sustain their links with their regional hometowns to be able to do placements in those areas and to be supported by the university in doing that. Again, it is exactly targeted at providing a workforce. It is such an important issue for our rural and regional areas.
I particularly want to acknowledge that the Pro Vice Chancellor of Health from the University of Wollongong is a fantastic man called Professor Don Iverson. Sadly we have just been informed that he will be resigning from his position at the university. He was appointed the Dean of the Faculty of Health and Behavioural Sciences at the university in July 2001. In December 2006 he was made executive dean of the faculty, and in June 2009 he was made Pro Vice Chancellor (Health). He also functions as the executive director for a very important medical research facility at the university, the Illawarra Health and Medical Research Institute, and the money for that was announced by the previous Labor state government.
He had an extensive and illustrious career in the US and Canada before he came to Wollongong. The partnership that he leads in medical research between the university and the South Eastern Sydney and Illawarra Area Health Service has been very strongly focused on creating partnerships with community; with professionals working in our community, particular in the area of cancer research, as well as with many of the local community organisations who fundraise and work to support people in our local area.
Don Iverson is loved across the community. It is not often that you come into a huge place like the University of Wollongong and have a whole community know who you are, and that is absolutely the case with Don. He has been a huge asset to our university and to our region. I want to pay a great tribute to the work that he has done, to wish him all the best in his future endeavours and to assure him that he will always be welcome to address health issues in Wollongong at any time—to come and knock on my door, it will always be open to him. I pay tribute to his community service.
Sitting suspended from 13:33 to 16:00