Shayne Neumann (Blair, Australian Labor Party, Shadow Minister for Indigenous Affairs) Share this | Link to this | Hansard source

I rise today to speak on the Health Workforce Australia (Abolition) Bill 2014. I do so as a member of parliament but also as shadow minister for ageing. We know that this is a particular challenge in the aged-care sector. We have about 350,000 workers in the aged-care sector—doctors, nurses, allied health professionals—and by 2050 we will need a million or more people working across that sector, so it is crucial that we get the health workforce right. At Federation about four per cent of Australians were over 65 years of age; currently 14 per cent are over 65. By 2050, at the latest, it will be 25 per cent. Dementia is a major problem facing this country. We currently have about 300,000 people suffering from dementia and we will have nearly a million by 2050. More doctors, more nurses, more allied health professionals and more carers will be required to meet those challenges.

We have many ups and downs with respect to workforce development but, when the former Labor government was first elected in November 2007, about 74 per cent of Australians were suffering as a result of a workforce shortage with respect to general practitioners. So we set about trying to address this issue. Sadly, the legislation before this House, which abolishes Health Workforce Australia, is a retrograde step with respect to getting rid of that cycle of boom and bust in the development of the workforce.

Health workforce planning is absolutely crucial. It is essential for the demographic challenges we face in the future across the health sector and across the aged-care sector. The crucial need for more funding for health and aged care was recognised by the Queensland Treasurer yesterday in his budget speech in the House in George Street in Brisbane. He actually mentioned the fact that the current federal government is 'turning its back on the challenges of health funding.' He said, 'The federal government thinks that the states can survive with less' and we see in this legislation before the House that the government thinks that workforce development can survive with less as well. This is a tragedy and a shame.

After the federal election last year, we saw the first hint of the Abbott government having a closer look at HWA and other health agencies when the now health minister said ominously on Sky's Sunday Agenda:

… we want to be complemented by the Commission of Audit, but I’ve already started to look at the composition of some of those agencies.

At Senate estimates on 20 November 2013 the Assistant Minister for Health, Senator Nash, confirmed that HWA was under a funding freeze which affected its support for clinical placement funding. But it was not until the Abbott government finally released National Commission of Audit report—delayed surreptitiously and obviously until after the Griffith by-election and the WA Senate re-run were over—that it became clear that HWA's days were numbered. The Commission of Audit argued that there were too many government bodies in Australia and that this leads to duplication and overlap, unnecessary complexity, a lack of accountability, the potential for uncoordinated advice and avoidable costs.

The commission recommended that five of the 22 agencies within the health portfolio be consolidated into the Department of Health. Shamefully and tragically, Health Workforce Australia was one of those agencies. Apparently the commission believed it was appropriate that HWA be amalgamated and considered a clinical training unit. So it was no surprise that in the budget we saw this vital agency abolished by the Abbott government.

The government claims that getting rid of HWA is a simple streamlining of officialdom. It is simply untrue. It is instructive to recall.as I said, the state of the Australian health system we inherited in 2007 after 11 years of neglect from the Howard government. The Australian Institute of Health and Welfare made it crystal clear on the eve of that federal election that the Howard government had abdicated its responsibilities by cutting funding consistently compared to the states and territories across the board, particularly in health and hospital funding, and in primary health care.

At the time that Labor came to power in 2007, Australia was experiencing a grave shortage of doctors, nurses and other health professionals. This was keenly felt in my community where the then Ipswich and West Moreton division of general practice had reported a shortage of doctors and nurses after a study on the health issues in my community.

The report indicated that in the Ipswich region there was one GP for every 1,609 people. Worryingly, the report suggested this problem was likely to worsen as this workforce aged, and many local doctors were reaching retirement age. Within five years we would have a critical shortage of GPs at the front line of health services in the Ipswich and West Moreton region. The report highlighted some of the major health challenges in the areas as preventable and chronic diseases such as obesity, diabetes and heart disease—the challenge of smoking rates and alcohol abuse.

This budget cuts funding for preventative health strategies, cuts and abolishes so many agencies dealing with those problems, including the one that is before the chamber today—the workforce agency that deals with the development and planning for our future workforce challenges—is a backward step. It will leave that obligation to the states and territories. It is an abdication of national responsibility and is a federalist model gone made.

The Howard government left us with that cycle of boom and bust. The problems were identified by the Productivity Commission in its 2005 report, Australia's Health Workforce. The commission recognised that there were health workforce shortages across the country and that some shortages may be potentially short-term—for example, shortfalls in nursing and allied health professionals could be rectified relatively quickly, but others were long term such as retention and re-entry.

These shortages remain persistent, and the commission confirmed what Australians in rural and regional areas, such as my area, knew already: that they were being affected badly by the shortfall. As the report neatly put it:

In particular, apart from nurses, the relative number of health professionals diminishes for communities located further away from major centres.

referring to places like Brisbane, Sydney and Melbourne.

In the area of education and training, the commission referred to 'rigidities, fragmentation and disconnects in the system.' The report highlighted:

… a lack of coordination between health planners and those responsible for allocating the number of university places across the various health professional areas, resulting in gaps between health service needs and the numbers of appropriately trained professionals.

So the commission was scathing about what had happened under the Howard government, and we saw that in practice in my community. The commission was quite clear about one of the major reasons for the health workforce shortage. They said:

The health workforce is planned, educated, deployed, funded and regulated by a myriad of different public and private entities. This can be advantageous in a number of respects. For example, it provides for the development and application of specialised knowledge in specific areas.

But the number of entities involved, and especially the division of responsibility for the various parts of the health workforce system between and within governments, results in conflicting objectives, inefficiencies and cost and blame shifting

That is what we are going to experience and see in the future with this legislation.

At this time health workforce planning was the domain of two committees: the Australian Medical Workforce Advisory Committee which was responsible for medical workforce planning; and the Australian Health Ministers' Advisory Council responsible for non-medical workforce planning, including nursing and allied health. So it was a hodgepodge—an alphabet soup. The Productivity Commission recommended the Labor government's commitment, strategy and funding, and the creation of Health Workforce Australia.

Faced with these challenges, we set about doing it. In a national partnership agreement we directly committed $1.38 billion to a package and the states and territories put aside $540 million. We introduced the Health Workforce Australia Bill in 2009, fairly soon after we are elected, to establish this new agency. It was agreed across COAG—Labor and Liberal states and territories agreed to this. The stakeholders expressed some concerns at the time, and we responded by accepting amendments to the bill so that the functions of the agency would not include responsibility for the accreditation of clinical education and training. We made amendments; we listened to the stakeholders. We put people such as medical academics, nurses and experts in rural recruitment and rural workforce in the agency. We did that in consultation with the states and territories. They were precisely the kinds of experts you would want and expect to have in an agency that deals with health workforce planning. We acted in response to the need of the Australian population. We did it on the recommendation of the Productivity Commission and we did it with the concurrence, consent, approval and approbation of the states and territories. Through this legislation this government is doing exactly the opposite. The work that has been done by Health Workforce Australia is crystal clear—evidence based health workforce planning, capacity building, targeted reforms, innovation and reform of the health workforce in this country, international recruitment and retention programs—the list goes on and on. We received an interim program report from them for approval by AHMC. We announced further funding of $425 million for clinical training and we provided it for 83 agencies across 470 projects on workforce planning, for everything from simulated learning environments to integrated regional clinical training networks to clinical supervision projects—all with the concurrence of the states and territories. Health Workforce Australia produced a groundbreaking report, Health Workforce 2025, analysing trends, providing recommendations, setting forth strategies. We listened to what they had to say.

It takes no imagination to understand why those opposite want to get rid of this. They say they are in favour of good evidence based policy but with this legislation they are showing exactly the opposite. They are going back to the pre-Rudd government period. They going back to the mid-2000s, when there were ups and downs in workforce development. What the government are doing has been criticised by the Royal Australian College of General Practitioners. Its president, Dr Liz Marles, has been very critical. She said:

Investment in a well-trained general practice workforce is the key to delivering a high quality, cost efficient and accessible healthcare system.

The chair of the Public Health Association labelled the plan to get rid of the agency's 'short-sighted'. Former president of the AMA Dr Steve Hambleton reported that at a meeting with the minister on 9 October 2013 he had:

… emphasised the important contribution the HWA had made to improved workforce planning, and the need for such work to continue.

But the Abbott government are continuing regardless. They are not listening to the stakeholders. They are not listening to the Productivity Commission. They are not listening to the states and territories. The minister obviously has not read the Productivity Commission's 2006 report Australia's Health Workforce, which recommended the creation of HWA. He may not have read the report Health Workforce 2025. He is certainly not listening to the states and territories in relation to this. This is a short-sighted, ideological decision made because they do not like anything that involves the word 'planning'. As if the market works in this area! It does not work and has been shown not to work. Even Liberal states and territories agreed that what we did was the way to go.

This legislation is not the way to go for the future development of our workforce. We face enough challenges in health and ageing in the future, in getting doctors, nurses and allied health professionals in our public and private hospital systems, in our nursing homes and in community care. You do not meet those challenges by abolishing the agency that is doing the planning, running the projects and doing the investment across this area. The government are not listening to the experts on climate change. They are not listening to the experts on education. They are not listening to the experts on health. They are certainly not listening to the experts across this field. They are not even listening to the states and territories owned and run by their own side of politics. (Time expired)

Peter Hendy (Eden-Monaro, Liberal Party) Share this | Link to this | Hansard source

I rise to support the bill and to condemn the Labor Party for leaving a debt and deficit disaster requiring the necessary budget repair that we are now implementing. The measures in this bill form a part of a budget that is absolutely necessary to secure Australia's economic future. We need to put health funding on a sustainable footing. The budget outlines a clear plan—in fact, the only plan—that will address Labor's debt and deficit disaster. When the coalition last left office Australia had a $20 billion surplus and $50 billion in the bank. But over six years Labor squandered this and ran up five record deficits, with a further $123 billion in projected deficits and gross debt headed towards $667 billion.

The antics of the Labor Party remind me of a quote heard now and again which is attributed to all manner of important people. It has been said that 'the American republic will endure until the day Congress discovers that it can bribe the public with the public's money'. I have seen this statement variously attributed to Benjamin Franklin, to US President John Adams and even to the famous French political commentator Alexis de Tocqueville. It turns out that the original statement was made by none of these notables but, rather, by a more obscure person named Alexander Fraser Tytler. Tytler is believed to have written that democracy 'can only exist until the majority discovers it can vote itself largess out of the public treasury. After that, the majority always votes for the candidate promising the most benefits, with the result that democracy collapses because of the loose fiscal policy ensuing'.

I do not subscribe to such sentiments and I think the last election result proves that I am correct. The Australian public are much smarter than that. However, the Leader of the Opposition and his crew seem to work on the political theory that they just have to promise more spending and they will get away with it. What a remarkably craven bunch they are! As I have said, we are stopping the rot and putting health expenditure back on a sustainable footing—but, of course, no surprise, Labor is opposing this bill. In his budget in reply speech the Leader of the Opposition talked about meeting with a Queanbeyan family. Queanbeyan is a town in my electorate. The Leader of the Opposition scored an own-goal when referring to that family. He noted that 'like many Australians they aren't wealthy, they work hard to make ends meet'. But he went on to say 'they balance their budget'. Well, if it is good enough for that Queanbeyan family to balance their budget, maybe the Labor Party should listen to them.

As the Minister for Health said, this bill will streamline the delivery of health workforce policy programs by removing an unnecessary level of administration and bureaucracy. Over the last six years, the health bureaucracy continued to increase in size, with 21 stand-alone agencies operating outside the portfolio department. A bureaucracy of this size is unsustainable. Again, as the minister says, the coalition government is determined to get every possible dollar away from administration and bureaucratic processes and back into frontline services. This bill is part of that process. The government is committed to reducing red tape and duplication, delivering a smaller and more rational government footprint.

Health Workforce Australia was established by the Rudd government under the now expired four-year National Partnership Agreement on Hospital and Health Workforce Reform, agreed by the Council of Australian Governments in November 2008. HWA became operational on 1 January 2010. Under the national partnership agreement HWA was to act as a national body working to health ministers to streamline clinical training arrangements and support workforce reform initiatives. All jurisdictions were to provide funding to HWA. However, the states and territories have not contributed any funding as agreed. That was to be $540 million over four years. The Commonwealth government has been the sole funder of HWA, committing $1.05 billion since its establishment.

Following the passage of this bill, programs and functions of HWA will be transferred to the Department of Health. I say again that the government is not withdrawing support for the health workforce; it is delivering on its commitment to reduce red tape and streamline programs. Savings will support front-line health services and programs. Indeed, the budget does not cut funding for health at all. Annual federal assistance to the states for public hospitals will increase by more than nine per cent every year for the next three years and by more than six per cent in the fourth year. That is a 40 per cent increase over the next four years. We are increasing funding for states to run public hospitals by more than $5 million from $13.8 billion in 2013-14 to $18.9 billion in 2017-18. The overall annual health spending will increase by more than $10 billion or 16 per cent from $64.5 billion in 2013-14 to $74.8 billion in 2017-18. The government is also putting the growth in health spending on a more sustainable trajectory from 2017-18, but every year it will continue to grow.

Let me also say a few words about GP co-payments. From 1 July 2015 previously bulk-billed patients will contribute $7 towards the cost of standard GP consultations. Ten years ago, we were spending $8 billion a year on Medicare; today we are spending $20 billion. So we are asking everyone to make a modest contribution to ensure that Medicare is sustainable in the long term. A strong safety net will be put in place. Concession cardholders and children under 16 will only pay the contribution for the first 10 visits each year. The government will not be wasting this money. Every dollar of savings in health expenditure in the budget will be reinvested back into the Medical Research Future Fund. There is a very important point to make here: the government is not introducing a co-payment as much as reintroducing it. Prime Minister Bob Hawke actually introduced it in the 1991 budget. He and his health minister, Brian Howe, fully supported it. Someone else who has supported it is the member for Fraser, who also happens to be the shadow Assistant Treasurer. He is supposedly the brains trust for the Labor Party economic team. When he was studying for his PhD, which he got—

Ms Catherine King (Ballarat, Australian Labor Party, Shadow Minister for Health) Share this | Link to this | Hansard source

Mr Deputy Speaker, I rise on a point of order. I note that the bill is about the abolition of Health Workforce Australia; it is not about broader measurers within the budget.

Bruce Scott (Maranoa, Deputy-Speaker) Share this | Link to this | Hansard source

I am listening very carefully to the member for Eden-Monaro. It was wide ranging, which I would admit to with the former speaker; but I will remind the member for Eden-Monaro of the bill before the chamber.

Peter Hendy (Eden-Monaro, Liberal Party) Share this | Link to this | Hansard source

This is a bill about the Health Workforce Australia agency, and of course that is about expenditure of $1 billion in the health area. Obviously, how we are making health spending sustainable into the future is directly relevant to this bill, Mr Deputy Speaker. If I may continue to make my remarks, I was talking about co-payments as a central part of the health spending of the budget and I was noting that when he was studying for his PhD—that is, the shadow Assistant Treasurer—which he got in 2004, not that long ago, he argued in relation to a co-payment, and I quote him from a 14 April 2003 article in the Sydney Morning Herald:

A just doctor's fee will aid the needy but deter the frivolous ...

The shadow Assistant Treasurer says that he no longer supports this policy and that he was a naive university student when he wrote these comments. He does himself a disservice.

For my sins, I have also done a PhD. Can I tell the House that to get a PhD, it usually involves a minimum of four years research, where you grapple with the subject day after day, coming to grips with every argument, every nuance and every alternative argument. After four years, you come to a considered decision. It would appear that, in the space of four weeks, the shadow minister has dumped four years of careful consideration. Political expedience will do that to you.

The coalition has a strong record of making sensible investments in Australia's health and medical workforce. As the Minister for Health has said, the Howard government invested in nine medical schools, which has resulted in the increase in medical students graduating now. The number of domestic school graduates per year has more than doubled since 1996. The government has committed to doubling the Practice Incentives Program teaching payment from $100 to $200 for each hour teaching session provided to a medical student. It will better compensate general practices for the consultation time dedicated to teaching; it will encourage more general practices to provide much-needed teaching opportunities; and it will to strengthen the future workforce. The measure will benefit approximately 3000 general practices, and it is expected that approximately 20,000 students per annum will be provided with teaching sessions. A rural loading of up to 50 per cent will also be applied to payments to practices in rural and remote locations. Indeed, I want to acknowledge that this rural loading is so important for electorates like mine.

Further, the government is also investing $40 million in up to 100 additional medical internships each year in non-traditional settings, including private hospitals regional areas. This will provide more certainty for students and, to alleviate pressure on public hospitals for training, priority will be given to positions and rotations outside of major metropolitan centres to bolster the medical workforce in rural and regional areas. As a member for a regional seat, I strongly endorse this measure; it will inject talented medical students into areas of great need. I commend the minister for such a press practical measure.

The coalition will also provide infrastructure grants to general practices on the basis of an equal commitment from the practice. This will leverage private investment and help ensure efficient and productive use of resources. The government has committed to provide up to 175 grants for rural and remote general practices to expand facilities to support teaching and training of medical students and registrars. The grants of up to $300,000 will be provided to successful applicants and require a matched contribution from the practice. The measure will benefit the GPs, registrars, medical students and the community in inner-regional, outer-regional, remote and very remote Australia, where the grants will be targeted. These practices face unique challenges in the provision of health care. Providing more opportunities for medical students to experience rural and remote practice will encourage students to pursue careers outside of metropolitan areas once they graduate and help address the maldistribution of the medical workforce in Australia.

While talking about infrastructure, I am happy to confirm that the coalition government will continue with its $160 million commitment to the Bega Valley community to build the new South East Regional Hospital in the town of Bega. This is a major project in collaboration with the New South Wales government; we hope it will be completed in 2016. The New South Wales government is contributing $10 million and will be responsible for the ongoing operation of the hospital. Only in February this year was it announced that the tenders for the main works were awarded the Brookfield Multiplex. Do not let people think that this is the Labor government project, just because they announced it before the 2013 election. It is taking form and substance under a coalition government. We are actually getting the work done.

Finally, the government will also significantly expand the number of GP training places. GP training places will increase by 300 from 1200 to 1500 new places in 2015. This significant increase in training places will create more vocational training opportunities for this workforce, freeing up more junior doctor training positions for new graduates coming through. I also note that the Australian General Practice Training program has a distribution target that requires 50 per cent of training to occur in rural and remote locations. This is another step in the right direction—more GP training places will mean better medical delivery, and for a regional electorates such as mine that 50 per cent requirement that training occur in rural and remote locations recognises our needs. In conclusion, this government is making sensible changes to reduce waste on duplication and bureaucracy so that sustainable investments can continue to be made to services and programs that benefit our health system and our future workforce. I commend the bill to the House.

Ms Catherine King (Ballarat, Australian Labor Party, Shadow Minister for Health) Share this | Link to this | Hansard source

I too rise to speak on the Health Workforce Australia (Abolition) Bill 2014, which seeks to repeal the Health Workforce Australia Act 2009 and absorb Health Workforce Australia's functions and programs back into the Department of Health. As we have heard from a number of contributors to this debate, Health Workforce Australia was established by Labor to provide a national, long-term, coordinated approach to health workforce planning and reform to ensure that Australia's health workforce can meet Australia's health needs into the future.

One of the points that the new Minister for Health likes to trot out is the glib line that these are all just bureaucracies and that they have no value at all. This measure is counter to the government's own claim that they are seeking to put health on a more sustainable footing. Leaving aside that this has now been revealed to be a mere fig leaf for breaking their own election promise of 'no cuts to health', they are cutting health and they are heading down a path of substantially changing the Medicare system we have in this country. I note also that not a dollar, as noted in the previous speaker's contribution, is in fact being reinvested in the health system, in medical services, in public hospitals or in doctors, where there is apparently such a crisis of sustainability, which blows the government's own arguments out of the water.

Clinicians are saying that where huge efficiencies are to be had in health—and you can look at academic paper after academic paper—is in the areas where we try to achieve consistent clinical practice across the country, tackling issues that lead to adverse events in hospitals. We know from the data that, in terms of readmissions to hospitals because of clinical failures, they are occurring and they are occurring on a more regular basis than they should be, and we actually have to deal with issues of quality and safety. We have to tackle issues that lead to those adverse incidents in hospitals and readmissions. We need to look at other clinical settings—for example, infection control, improving the quality and safety of clinical practice. Who oversights all of that work? Who actually brings stakeholders together? Who teaches people about the important clinical guidelines and how you actually work? They are organisations like Health Workforce Australia, like the Australian Commission on Safety and Quality in Health Care. They are the organisations that are actually driving efficiency and productivity in health. The government, in this bill in particular, is in fact going counter to its own false arguments.

In 2006, the Productivity Commission was asked to look at the whole issue around the health workforce, and it concluded that a more sustainable and responsive health workforce was needed. The report went further by highlighting the complexity of Australia's health workforce arrangements and the numerous organisations and agencies involved in health workforce education and training. In other words, what we had at the time was lots of smaller agencies, inconsistencies between the states and territories, lots of different committees and a bit of a hodgepodge when it came to health workforce planning. It was getting better in terms of GPs—not so great in specialists but in terms of nursing and allied health it was literally a mess.

In response to that Productivity Commission report, in 2008, Labor took a proposal to COAG, which then agreed to the formation of a national health workforce agency to work across jurisdictions to build more effective, streamlined and integrated clinical training arrangements and to support workforce reform initiatives. The legislation establishing Health Workforce Australia was introduced in 2009 and, in 2010, Health Workforce Australia commenced their work, partnering with higher education providers, the training sector, the health sector, employers, professions and regulatory bodies to deliver a sustainable health workforce for Australia.

The key responsibilities outlined for Health Workforce Australia were national funding, planning and coordination of clinical training across all health disciplines and across jurisdictions, supporting health workforce research and planning, funding simulation training, and progressing new workforce models and reforms.

Health Workforce Australia in that short time has established itself and developed a track record in national health workforce planning. It has broad support from across the health workforce peak bodies in this country, and it has broad support from states and territories in its role. In 2012, Health Workforce Australia produced the first national long-term projections for doctors, nurses and midwives, titled Health workforce 2025doctors, nurses and midwives. It set out the workforce needs of Australia in critical workforce groups over the future. The report highlighted that, under the arrangements and policy settings at that time, Australia would face a significant shortage of nurses and doctors by 2025.

Labor deliberately set this agency up as separate from the department. Any of the people who have worked either in the department, as I have, or in agencies outside know the extraordinary tension that exists between policy development and the implementation that occurs. What we have seen constantly in this particular space is a really important debate, one I want to highlight here. The department has been very keen for a long time to get Health Workforce Australia and the funding associated with it back in the department. It has been very keen. I know that the department is not that keen—I am not going to refer to personalities within the department—to have too many separate agencies outside. With a new government coming in, I am very concerned that basically this has just been one of the agencies that has been put up to be brought back into the empire without any real thought being given by the government to what that actually means. I just caution the government about always taking on absolute face value every single piece of advice it might get. It needs to come up with its own ideas, and this one, I think, is concerning.

Since being established, Health Workforce Australia has funded close to 8½ thousand new quality clinical training places for students across 22 disciplines. Through the Simulated Learning Environments Program, Health Workforce Australia has increased simulated education hours by 115 per cent. I visited the John Hunter Hospital recently, where they were having an emergency theatre operation performed. They had their specialists, their nursing staff and their anaesthetists there going through the important practices that they needed to do. They talked about just how critical it had been to get the extra funding from Health Workforce Australia and the huge change they had had in the way they were doing clinical training within their hospital and bringing clinicians from other hospitals into that facility to make sure that they improved clinical training.

Mr Ewen Jones interjecting—

Mr Laming interjecting—

I note the interjectors, and I note particularly that one of the interjectors is a former clinician, who I would think would actually be concerned that his own profession does not support the government on this measure. His own profession does not support this bill, so I am interested that he happens to have somehow forgotten where he has come from as he has come into this place.

Taking on the challenges of workforce distribution and responding to the identified needs of rural and remote communities across Australia, Health Workforce Australia's efforts have delivered an additional 446 nurses and allied health professionals in those areas. Health Workforce Australia has also commenced work on an innovative reform strategy for the rural and remote health workforce and also for the Aboriginal and Torres Strait Islander health workforce, an area where there are critical shortages.

In direct response to the House of Representatives report Lost in the labyrinth, the agency, in conjunction with the Australian Medical Council, has jointly funded the construction of Australia's first National Test Centre, which will serve to expedite testing of international medical graduates seeking to practise in Australia.

All of this planning and program activity is critical if Australia is to have the health workforce able to meet the health needs throughout Australia into the future, and it is critical if communities all over Australia are to be well served with good access to healthcare providers. As I have said many times in this place before, Australia's population is ageing, and we have increasing rates of chronic disease. If Australia is not planning and positioning itself in relation to the workforce needed to care for our future population, then we are going to be in strife.

This government is determined to undermine and rip apart universal health care for all Australians and revert to the old way, its way, of a haphazard and unplanned approach to workforce planning. Labor knows that that did not work, which is why Health Workforce Australia was established as a separate entity from the department and why funding was appropriated to support the unified, national approach to the health workforce for all Australia. A key issue arising out of the Health workforce 2025 report was the importance of and need to improve the national coordination of medical training by working with trainees, employers, educators and governments through a National Medical Training Advisory Network. If the government is to do away with the agency established to lead and drive this work in a coordinated way, it is not clear who or what entity it expects to carry on with it.

I have already outlined that Health Workforce Australia's programs were addressing the issue of the distribution of the health workforce, in addition to increasing workforce numbers. The government can run their line on delivering front-line services—and I heard that from the side here—as much as they want to, but, unless you invest in, plan, coordinate and train the health workforce of the future, there will be no-one to deliver those front-line services, no-one to deliver them in rural and regional communities, no-one to deliver them in Indigenous communities and no-one to deliver them in the outer metro areas, where there is extraordinary pressure on those services. So you can just see that there is an absolute myth in the way they are constructing these arguments.

Another really well-progressed initiative of Health Workforce Australia was the Expanded Scopes of Practice Program. I note particularly their extended-care paramedics project as well, ensuring that extended-care paramedics are able to assess patients in their own homes, reducing the number of presentations to emergency departments and reducing the number of patient transfers—an area of health efficiency, I would have thought. These advance paramedics are being trialled in South Australia, Tasmania, the Northern Territory and the Australian Capital Territory.

I note that even the government's own Commission of Audit has acknowledged the Expanded Scopes of Practice Program and suggested that this type of reform go further. Who do you think is going to do that work? Health Workforce Australia is at arm's length from government, at arm's length from the department, in an incredibly contested space. Who do you think is now going to lead and develop that work? The abolition of Health Workforce Australia is anticipated to 'save' the government $142 million. The minister would have us believe that no support is being taken away from the health workforce, but how can you take $142 million out of clinical training, placements and planning and still be maintaining support for the health workforce?

When Labor came to office we inherited the now Prime Minister's caps on GP training places. We in fact doubled the number of places to 1,200 and increased this number each year so that Australia has top-quality, well-trained GPs moving through the ranks to provide Australians with the primary care they need. Under Labor the number of nurses in training grew by 11,000 and the number of specialists in training by 5,000. And we invested through Medicare Locals, providing funding to plan and fund extra health services that were supporting around 3,000 front-line health workers like GPs, nurses and psychologists. The investments that Labor made to supporting and growing Australia's high-quality health workforce were having an impact on all regions and enabling services to be delivered by a well-trained health workforce.

As at February 2013, Australia's health workforce totalled 1.3 million, made up of 25,000 GPs; 24,000 specialists; 290,000 nurses; 14,000 midwives; 12,700 dentists and 4,000 more people employed as dental therapists, hygienists and prosthetists; 1,254 Aboriginal health workers; and almost 94,000 registered allied health professionals—all doing critical work in this country. Abolishing Health Workforce Australia is not the way to continue to support planning in this area.

Labor will not and cannot support this bill because it is counter to the government's own arguments about how you get efficiencies in health. If you want to improve clinical training and education and get efficiencies in health, if you actually want that to occur, then you have to have an agency that is driving it. These are not bureaucracies. These are important organisations that are seeing important work done in the area of health efficiency. (Time expired)

Andrew Laming (Bowman, Liberal Party) Share this | Link to this | Hansard source

As we inherited a health system that ran out of money, as we pore over the performance of a Labor government that never saw a cause they could not fund, we come here today to look at Health Workforce Australia. I think it is only appropriate that we recognise that the many good employees in that agency did great work over four years and that some very important reports were prepared, written and disseminated. But the work of Health Workforce Australia in doing that good work is now done. We now have to reinvest in the front line of health and that has been a clear message from the coalition government.

Australia is one of the most sparsely populated countries in the world, with one of the highest performing health systems. Keeping up that quality care in every corner of this nation, wherever citizens choose to live, is a daunting task. I say to the 35,000 GPs out there, the 290,000 nurses and the 100,000 allied health workers all over this great nation: thank you for what you do every day, and the interference from government—certainly if I have anything to do with it—will be as minimal as possible. Thank you for caring for Australians from dawn to dusk; for the after-hours work you do; for your coordination of complex care in tiny towns. To all of you: thank you. Be you from Cape York to Kalumburu, from Byron Bay to Busselton, we have an incredible health workforce.

With that workforce come some pretty big challenges in health distribution, capacity and training, but it is not one where we need to count our successes by the number of floors in the high-rise building where we have bureaucrats offering support. This is not to be measured by how many pot plants are watered, how many water bubblers we have and how many people we can employ in major cities worrying about country areas. No, this is about supporting the front line, and that is what this government is determined to do. When you have a health system in a nation like Australia endeavouring to deliver world-class care in remote, rural and regional areas as well as in our cities where there is high need, the one thing we must be sure of is that we never take a dollar away from that old man who needs a new hip, that we never take a dollar away from that woman who needs cancer treatment, all in the guise of needing better organisation.

I can appreciate that no matter what country to go to, no matter great their health system is, if you talk to people they will find problems. The natural Labor inclination for every challenge is to set up another agency. That government set up so many agencies they ran out of acronyms—they could not come up with any more acronyms. We have over 20 health agencies now, all with their own individual backends, their own administrative systems, their own support systems, and all operating in a space where it gets so complex they need yet another agency to tell agencies how to talk to each other. There are a dozen health agencies collecting health data using different criteria so that we cannot even perform basic comparisons with that information that is so expensively collected.

I say to Australian practitioners out there in the health system that we as a government want you to go and serve the people and we know a third of Australians do not live in capital cities. You have seen governments from both sides of the fence—let me give some credit—working on that really important proposition. But when the Abbott government came to power we said we just did not need more floors in a high-rise building in a capital city to fix a problem. We know that if we are going to fix a workforce problem we do so with a workforce solution—and you start with your students. You make it more possible for them to get scholarships. You make it more attractive for them to be supervised by our great clinicians. You create more general practice training places. You free up some funding for infrastructure, not in a GP Superclinic handout. That is not how we do it on this side. We provide matching funds so that regional practices will invest their own money and truly utilise that investment efficiently in infrastructure to help GPs train others and train their successes.

I have lived in a country town that had a retiring general practitioner. The fear in that town at the thought of losing a general practitioner was palpable on the street, outside the Foodland, outside Australia Post. Attracting practitioners out there is a complex balance of supporting Medicare and supporting access, supporting those good country people who take out private health cover and often do not use it greatly because there is not even a private hospital in town.

We have got to support access to the PBS by looking after that pharmacist and making sure that he or she can afford to run that business. Then we have to make sure that support for ancillary and allied health care is such that allied health workers will leave the cities where they train and set up their shingle in those small towns. That is the essence of a workforce solution and that is the coalition's approach to doing just that.

I do not want to take the remaining five minutes to pull apart the achievements of Health Workforce Australia. I have already said that some of their reports were valuable and welcomed. The Health Workforce 2025 report gave us some pretty sobering statistics, about being over 100,000 nurses short within 15 years and, depending on productivity and 'business as usual' modelling, we could well be short by up to 1,500 to 1,800 general practitioners. In the end, those figures told us what we already knew. They told us we had workforce challenges ahead. The 'do nothing' scenario, business as usual, was never going to happen, because sensible governments were going to make changes between now and then to ensure Australians had the support and the services that they need.

Let us make no mistake: we are getting close to the appropriate numbers of many of our health professions. There is still room for more nursing training. We have a maldistribution issue, an issue of redirecting the health effort to areas where it is most needed. That was to be the focus of Health Workforce Australia but, like most entities established by the previous Labor government, they were hopelessly and overly broadly commissioned. They were expected to do everything and, in the end, they did a few things well. However, we are replete with examples of poorly-spent money.

I understand the Growing our future report and the emphasis upon respecting, encouraging and cultivating our Aboriginal health worker population is really important. We need those Aboriginal health workers. But I am not sure that we needed to develop the community's understanding by funding a television documentary to do so. I have got no problem with really great but modest causes being done pro bono. I have no problem with engaging the university sector—PhDs and those who are aspiring to earn one—getting involved in solving some of our great problems. But I do not think that, as long as our health system will always need more money on the front line, we should be doing things like funding large and complex online hubs in the hope that they will be used by practitioners. There are way more modest ways to get to the same solution.

When I heard about the National Inventory of Innovation I thought to myself, 'How many hardworking GPs actually have time to look at online innovation hubs?' In reality, if you are going to refocus and refashion general practice in regional Australia, start by talking to the local GP. Do not start by setting up an empire in Adelaide and then wondering what you can create from the fifth floor that will reinvent health workforce in Australia.

Health Workforce Australia embarked on a very important piece of work, looking at cancer workforce in Australia. We have significantly refashioned cancer service delivery in this country, but we are still vexed with major publicly funded cancer services in large cities and smaller cancer services in regional cities and the way in which these interact. Health Workforce Australia were right to turn their attention to that topic. But, in the end, have they significantly changed the business model of cancer in this country? The answer is no—a fascinating expose of the challenges of getting cancer workforce out into our regional cities and towns but, in the end, very little change.

The National Health Workforce Innovation and Reform Strategic Framework was published in the middle of last year. It was a comprehensive course of action for a range of reforms that would have been appropriate to help regional workforce. But I put to you: that is the job of the department. The previous speaker, who claims to be a bureaucrat in a past life, acknowledged the tension between policy creation and service delivery. But that is not an excuse sufficient to create new agencies; it is an excuse to fix the problem in the department. The department is big enough, well-resourced enough, to attack some of these major workforce challenges without the need for these extra agencies.

We also know that Health Workforce Australia worked on a prescribing pathway for those who are not general practitioners, nondoctors. Controversial as that is, that was never going to address a workforce problem in this country. But resources were devoted there.

Workforce agencies, states and territories would have been grateful that there was yet another kid on the block working on getting people out into the bush. Aspen Medical were relocating thousands of health workers to Central Australia, only to have yet another provider, Health Workforce Australia, lay claim over four years of effort in relocating 400 workers. That is a drop in the ocean and that is not what we expected to have another provider doing when, in fact, we have these rural health workforce agencies already fully commissioned and fully funded in every state in this country. Recruitment is a challenge and it is complex. But that is not an excuse for another agency. Fixing up the recruitment process, simplifying the immigration process for incoming health practitioners from overseas who apply to be registered here, is not an excuse to get more, independent double-dipping and silo-structured agencies operating out of, in this case, Adelaide, trying to fix a problem that really should have been sorted out, without the need for the agency in the first place.

Health Workforce Australia put together a Reconciliation Action Plan, released, I think, in April 2013. One of how many? I do not know. I ask: how many reconciliation action plans were read by health practitioners? How many of them were downloaded? With the greatest of respect, I am very keen to see as many reconciliation action plans put together as possible. But I do not see the need for massive transfers of government resources to develop them. Plans focusing on fostering these relationships are utterly welcome, but not large transfers of taxpayers' money to achieve them.

We have had 500 health leaders come together for a conference, the first national conference in, I think, 2012, Reshaping Australia's Health Workforce. There is no problem if it is cost recovery 100 per cent. I have no problem with a health leaders' group. There is no problem with a group of 500 young health leaders getting together online, at no cost to the taxpayer, because that is how it should work. There is no problem with cultivating those great policymakers, but there is no need for taxpayers' money to be diverted or consumed in the process.

Then we had the launch of the HWA Connect, an online interactive consultation hub. Just in case you are confused, it is different to the online resource. That was developed because there were so many of these outputs coming from Health Workforce Australia that you needed one place where you could find them all. So the next thing we knew was that we had the Integrated Regional Clinical Training Networks; the nursing workforce retention and productivity group; the National Medical Training Advisory Network; the mental health peer workforce; the Rural Medical Generalist Framework; the International Medical Graduates' Orientation and Supervision project; and Health LEADS Australia all on this resource, again, created from taxpayers' money.

You can only go so far, Deputy Speaker. You have to appreciate that. In the end there is only so much money that you can convince yourself is well spent from a fifth floor in Adelaide. Ultimately we have to go and confront the coalface that is working in small and regional communities and high-need urban communities where there is significant urban poor. That is where we need to make sure workforce is available, to make a real difference to Australians' health.

In conclusion, I have emphasised that we have a changing environment, an ageing workforce as well as an ageing population, a new raft of diseases, social and economic determinants of health that are changing and ever more complex and the imposition of highly expensive technology, and health is one of the few areas where you cannot really replace labour with capital. No matter how much capital you invest in this system, you need labour to run it. It is one of the most complex areas of public policy and one of the most complex areas of public service. There are probably more groups and more politically active groups engaged in delivering services here than in any other part of the economy. So I thank the people that do that work. I commend those that try and improve the system and lift their head away from caring for patients to dream of a better system, but most of them, no matter how much you look at, will argue that more investment in something like Health Workforce Australia was really only adding undue complexity and bringing a risk of waste of taxpayers' money to the table.

I am glad to see the back of Health Workforce Australia. I acknowledge that in their time they did good work. I think in retrospect history will record that they pulled together some useful reports. With those completed, it is now time to move on and reinvest in the frontline by building capacity, by investing in more students, by freeing up general practice places, and by having rural infrastructure funding that can be partnered with GP investment we can do just that. We can transform the situation in regional general practice and we can make sure that those in outer met and inner urban poor get all of the care that they need, complex arrangements provided by teams of health practitioners. But in the end the one thing that Australians will welcome will be the passing of an entity that for four years produced useful reports but was at risk of having an overly broad commission and letting down those who need health care most.

Kelvin Thomson (Wills, Australian Labor Party) Share this | Link to this | Hansard source

In my 2014 budget reply speech I said I was going to devote more time to health policy issues and become more expert in these matters. In delivering on that, yesterday I had the opportunity to speak at some length about preventive health and today I want to make some observations about our health workforce. The Health Workforce Australia Abolition Bill seeks to repeal the Health Workforce Australia Bill 2009 and absorb Health Workforce Australia's functions and programs into the Department of Health.

In 2006 the Productivity Commission report Australia's Health Workforce concluded that a more sustainable and responsive health workforce was needed. The report also highlighted the complexity of Australia's health workforce arrangements and the involvement of numerous bodies at all levels in health workforce education and training. In 2008 COAG agreed to the creation of a national health workforce agency that works across jurisdictions to establish more effective, streamlined and integrated clinical training arrangements and to support workforce reform initiatives. The Health Workforce Australia Bill back in 2009 established a national health workforce agency, Health Workforce Australia. Since its establishment Health Workforce Australia produced Australia's first ever national long-term projections for doctors, nurses and midwives with the publication in 2012 of Health Workforce 2025—Doctors, Nurses and Midwives. This report highlighted that under current policy settings Australia will face a significant shortage of nurses and a shortage of doctors by 2025.

Australia has become highly dependent on migration of international health professionals, particularly in rural and remote communities, as a consequence of a lack of sufficient attention to training young Australians to take up health workforce roles. In the 2013-14 budget the previous Labor government invested more than $344 million in Health Workforce Australia to support Australia's healthcare system and its workforce, especially in rural and remote areas. Health Workforce Australia has delivered an additional 446 nurses and allied health professionals to rural and remote communities. It is very surprising to me and quite unacceptable that Australia is one of the least self-sufficient nations amongst comparable OECD countries in terms of meeting our health workforce needs through domestic training efforts. It is even more remarkable that, despite this, what we are seeing today is skilled nurses finding it difficult to find work. The proportion of international nurses who we bring into Australia each year on 457 visas is comparable to the proportion of nurse graduates who find themselves unable to find work. Seriously, how are Australian nurses meant to transition from graduate into experienced nurses if the opportunities to work, experience and refine their skills are not available to them? It is wrong and foolish and short-sighted that Australian nurses are not given employment priority. Instead, hospitals and managers are getting bonuses for bringing in foreign nurses and getting them to sign up with universities to do masters and PhDs in nursing at great expense to the migrants themselves and at great cost to the wider Australian society. While this is going on, many excellent local nurses with years of experience are now unable to find work.

In a submission to the 457 Visa Integrity Review the Australian Nurses and Midwifery Federation pointed out 'the sorry state of the employment prospects for new nurse graduates, with an increasing number struggling to find work, with many rejected for work by employers that use international recruited nurses under the 457 program'. They urged the panel to resist calls for any deregulation that will remove or dilute current protections or safeguards, particularly to labour market testing, English language requirements and current obligations regarding wages and employment conditions. I believe the nurses federation is quite right to urge the government not to water down the 457 visa program. The underemployment of nursing graduates, despite the employment of large numbers of offshore nurses, is inconsistent with the key policy objective of the temporary migrant worker programs. There is a clear policy disconnect here that needs to be addressed.

The nurses federation estimates that, in 2013, 60 per cent of Tasmanian nursing graduates were unable to find work; in Queensland only around 28 per cent of new nursing graduates secured positions with Queensland Health; in 2014, only 600 of 2½ thousand graduates were employed; and, in 2013, 800 graduates in Victoria, 400 in Western Australia and 280 in South Australia could not secure positions. An online questionnaire of new graduates undertaken by the nurses federation revealed further troubling anecdotal evidence of large numbers of new graduates failing to find employment in their field; many graduates receiving numerous employment rejections—and in one case over 70; most graduates fortunate enough to obtain employment being engaged on a precarious basis through agency, part-time or casual arrangements; many graduates going to great lengths to obtain work—for example, by moving interstate and separating themselves from their families; most employers who were named in the questionnaire as rejecting new graduates using 457 labour; and, finally, and I think most seriously, most new graduates are saddled with a HECS debt and many are disillusioned that they studied at all.

Indeed, if this government gets its way in deregulating student fees and increasing the interest on student debts, young student nurses will be at risk of being in the demoralising position of having no jobs and going deeper and deeper into debt. I agree 100 per cent with the nurses federation that the current labour market testing requirements need to be strengthened to include employer obligations such as the need to advertise locally and nationally at market rates; offering relocation, housing and utility assistance where required; reporting on specific measures taken to employ disadvantaged groups, local job seekers and recently retrenched workers; and, where possible, making sure that new graduates have a reasonable chance of filling vacancies.

Graduate nurses are our future. Initiatives need to be in place to ensure that they are placed in employment upon completion of their degrees, otherwise the future of Australian nursing will be one of shortages of nurses and dependence on overseas recruiting. Given the proposed changes to the federal budget, it is a bleak outlook for thousands of nursing graduates each year who are desperate to be employed but are often losing out on job opportunities to nurses recruited by hospitals and other facilities on 457 visas. The nurses federation is right when saying in their submission that, putting aside the demoralising and devastating effect that this has on new graduates who are unable to find work after undertaking a three-year tertiary course, it also represents a loss in investment in the education of professional health workers and a loss in the contribution of these potential workers to the health-care systems—absolutely.

In the light of these facts, one has to seriously question how well temporary migrant worker programs like the 457 visa program are serving this country. I think it would be crazy to further liberalise the program. The only reason for doing this would be to undermine the pay and conditions of local workers. Yet, this is what the government with its 457 visa review seems to want to do. The situation is so grim that there is an online petition circulating calling for a review of the issuing of subclass 457 visas for nurses in Australia which has over 27,000 signatures. Anyone interested can find the petition on the website candobetter.net. Online comments by supporters of this petition include: 'We must give priority to Australian nurses over 457 visa holders; our future depends on it' and 'Destroying the reasonable expectations of employment of nurses born here is cruel, unnecessary and shameful'.

The 457 visa program, in my view, needs tightening to ensure that Australian workers and young people are given priority over temporary visa workers. Immigration department figures released in May show that there were over 110,000 457 visa workers in Australia on 31 March this year, up by over 6,000 or 5.9 per cent compared to 12 months ago. The 457 visa workforce is growing much faster than Australian employment generally. This is completely unjustifiable in the present jobs climate. It is a recipe for increasing unemployment with all the misery and hardship that accompanies that. It is all very well for ministers opposite to say that everyone has to earn or learn, but how are you supposed to earn even after you have learned when we have over a million people in Australia on temporary visas, which give them no work rights—a docile workforce who employers prefer because they can be sent packing from the country if they speak out about their rights at work?

The Liberal government is allowing too many employers to access 457 visas without any obligation to look for Australian workers first and young people especially are losing out. Under the coalition, around two-thirds of all 457 visas are not subject to any employer obligation to advertise the job and test the local labour market, and nearly half of all 457 visas are still going to younger foreign workers aged 30 or less. Prime Minister Abbott promised 'no cuts to health' but the abolition of Health Workforce Australia through this bill is another example of that promise being broken. Labor established Health Workforce Australia to provide a national, long-term, coordinated approach to health workforce planning and reform to ensure our health workforce can meet the increasing demand for health services now and into the future. Health Workforce Australia has had a proven track record in national health workforce planning, which is crucial if Australia is to have a health workforce able to meet the health needs of Australians wherever they live into the future.

Health Workforce Australia has funded 8,400 new quality clinical training places for students across 22 individual disciplines. It has supported a 115 per cent increase in simulated education hours in 2012 through the Simulated Learning Environments Program. The Health Workforce Australia report Health Workforce 2025 shows the current medical training system is inefficient and there is an uneven distribution of the medical workforce, which of course particularly affects rural and remote communities.

A key policy action from Health Workforce Australia's report was to improve the national coordination of medical training by working with trainees, employers, educators and governments through the National Medical Training Advisory Network. A Medical Observer article following the budget quoted medical experts who condemned the proposal to merge Health Workforce Australia into the health department. It said that, in the view of the President of the Royal Australian College of General Practitioners, Liz Marles:

… the move would risk destabilising general practice training …

And in the same article the CEO of the Public Health Association Australia, Michael Moore, was said to have labelled the plan short-sighted. Mr Moore argues that the merged organisations would have neither the same independence nor influence if they were combined with the health department. Professor Simon Willcock, who sat on the board, also pointed to the good work Health Workforce Australia have done in developing databases and around workforce projections, and he lamented:

It would be a shame to see all of that work not continue.

So, if this bill is passed, this complex but important planning work will not occur on a national level, and the burden will fall to the states and territories.

I regret that this government seems determined to dismantle universal health care and consign our country to a return to a piecemeal approach to health-workforce planning. I am concerned that this will result in a boom-and-bust cycle in the supply of doctors, nurses and midwives. This scenario is unsustainable and unaffordable, and it will result in a health workforce which will not be able to meet the increasing demands for health care, now and into the future.

Ewen Jones (Herbert, Liberal Party) Share this | Link to this | Hansard source

Could I just ask the member for Wills a question? He quoted at length—for about 11 minutes—in his speech stories from the nurses' federation about the role of nurses and where we were going and all that sort of stuff; what did Health Workforce Australia do about it? Isn't that what they were supposed to be doing? The member went through this whole account of what Health Workforce Australia is; he spent nearly three minutes on Health Workforce Australia in his speech. But isn't that what they were supposed to be doing? Wouldn't that be a core responsibility for Health Workforce Australia? Isn't that what we should be talking about here? Isn't that the role of the department?

I would like to back up the member for Moreton. No-one is saying that Health Workforce Australia has not done a good job. No-one is saying that they all deserve to be sacked; no-one is saying that at all. What we are saying is that their work has finished. Their plan was for four years. Their strategies were to:

I just do not see what that work has done.

I want to make a couple of real points here. There was a four-year agreement that all Australian governments were to provide funding for Health Workforce Australia; it has expired. However, the states and territories have not contributed any of the agreed funding. So, once again, you have a Labor federal government making decisions for other levels of government which are never going to be supported. Right from the get-go, this thing has fallen over—it has fallen at the very first hurdle. The Commonwealth government has been the sole funder of Health Workforce Australia, committing $1.05 billion since its establishment. Where is the money from the states? This is all supposed to be under the National Partnership Agreement on Hospital and Health Workforce Reform. This was supposed to be an agreement between the states and the federal government. When they said, 'Are we all going to put in?' it was, 'Yeah!' So they all signed up. But no money was ever put in from the states. So where does the actual agreement come from?

What we are doing with the Health Workforce Australia (Abolition) Bill 2014 is streamlining the delivery of health workforce policy and programs through removing unnecessary levels of administration and bureaucracy. We could not have been clearer about what we were trying to do when we talked about our overall strategy on health. The Minister for Health, who is sitting at the table, was very clear in all my conversations with him, and in all he said in the press. Our philosophy was about getting the goods to the customer, and about removing the number of hands through which the goods had to pass before they got there, because at every stage along the way you lose some money—the more levels of bureaucracy you put between the source and the recipient, the less money gets to the recipient. It is just like farm produce: the product goes from the farm gate, through a wholesaler to a retailer, and the more hands the product goes through, in going from the farm to the end-user, the more expensive that product will be. So it makes perfect sense to me that, if we can cut down the levels of bureaucracy and the numbers of people who are standing in the way of getting our health dollars to our people—to the people in the community, the people we are supposed to be helping—then the better off we will be.

This government has committed to doubling the Practice Incentives Program, or PIP, Teaching Payment from $100 to $200 for each three-hour training session provided to a medical student. Can I just tell you a story to show what we are trying to do in this country and what is actually happening out there? It feeds into what we are trying to do here.

I have a good friend in Townsville and he had a doctor from the Congo who was doing training with him. A 64-year-old man came in to see them and he presented with pneumonia. The doctor from the Congo, who was being supervised by my friend the Australian doctor, gave this man some Panadol and was going to send him home. My friend stopped him at the door and said to the doctor, 'Why did you do that?' And the doctor said, 'Well, he's 64 years old and he's got pneumonia; he's going to die. I'm sending him home.' My friend said, 'Not in Australia, mate; not in Australia.' So what we have to do is to make sure that we get our doctors and GPs to be able to understand exactly what is required to be a GP here. We need to be able to pick up on those things.

I think most of us here who have a good relationship with our GP will understand just what role they play in our lives. I know that when I go to my GP she can tell from the first time she looks at me how much trouble she will find I am in when I get into the room. This is what a good GP will do for you. So if we can do anything to assist GP practices, and if we can do anything to assist people who provide primary health care, that is what we should do. We do not assist primary health care by establishing another building in another city or another capital city around Australia to rake out these sorts of things.

I do not want to sound flippant, but there were 21 agencies developed by the previous government. It is sort of like that scene from Yes, Minister with the hospital with no patients: 'But the hospital has won prizes for its efficiency!' And Hacker says, 'But there are no patients!' The reply is, 'The patients would ruin it!' The patients ruin the health system. It is like 'education is wasted on the young', but they are the necessary part of it. That is why we are there! And that is why the work of Health Workforce Australia has been completed and it should be rolled up.

The previous government just had a problem with letting go. As the member for Bowen has reminded us, they did do some very good work but when you start to self-perpetuate to try to find out what you are trying to do and what you stand for, and if you give people such a wide brief that they no longer actually produce anything of significance, you have to wonder why they are still being funded. I believe that the Labor Party would say, 'We are going to employ someone to build your house. But when the house is built we still want to keep that bloke on, because we don't want him to lose his job. So we should just keep on funding him all the way through. It is that sort of thing that we just have to do.' Sooner or later the job is done.

This government is also investing $40 million in up to 100 additional medical internships each year in non-traditional settings, including private hospitals in regional areas. Townsville is the perfect example of this. We have a number of full-fee-paying doctors who have come through their training at universities throughout Australia who otherwise would have been cast to the wood heap if it were not for the health minister of Australia at the time, Peter Dutton—sitting at the table here today—saying that we cannot let this happen.

So we had all these interns taken into the Mater Hospital Pimlico in Townsville and put to work there. They are predominantly overseas students but educated in Australia. I will 'sort of' quote the Minister for Health when he said, 'Look, we understand that your parents and your country have supported you to be here and we can't really come out and say that we want you to stay in Australia. But, gees, it would be handy if you all met a partner here, settle down in Townsville and became members of our society—never went home, got citizenship and stayed here for ever.' Those are the sorts of things that we must do. But this internship is about making sure that we get value for these people in completing their degrees, and making sure that they come out as good a doctor as we can possibly handle.

This government has also committed to provide up to 175 grants for rural and remote general practices to expand facilities to support teaching and training of medical students and registrars. The grants of up to $300,000 will be provided to successful applicants and require a matched contribution from the practice. In Townsville we have a GP Super Clinic which was promised in 2007, promised in 2010 and was actually built—it has the signs up, has the car park marked out, has the beautiful frosted glass and everything—but still not opened, seven years after being promised. Not one thing—$6 million down the gurgler with nothing happening. And they built that thing less than 800 metres away from an existing GP practice.

The GP around the corner had to pay for his own facility. The physio across the road from the GP had to pay for his own facility. He carries that loan, but the GP Super Clinic that the federal government brought in, ostensibly to take the pressure off the emergency department—but this one will only be open from seven in the morning until nine at night—was never going to bulk-bill anyone, even when bulk-billing was the course de rigueur. That is not going to take the pressure off the emergency department. So this thing was an abject failure from day one and should never have progressed beyond that. But the previous government could not let itself get away with that and just kept on pouring money in, in direct competition with someone around the corner who has a mortgage and loans in trying to make a business run. What we will do is to enhance the practice that is there dollar for dollar and to enhance the medical training facilities.

The government will also, significantly, expand the number of GP training places. GP training places will increase by 300—from 1,200 to 1,500 new places in 2015. The significant increase in GP training places will create more vocational training opportunities for this workforce, freeing up more junior doctor training positions for new graduates coming through. The Australian General Practice Training program, which the government's commitment will expand, has a distribution target that requires 50 per cent of training to occur in rural and remote locations.

James Cook University in my city of Townsville had a medical school established under the prime ministership of John Howard. That was one of the greatest achievements of Peter Lindsay, the former member for my seat. And they are turning out doctors who work as registrars all around Northern and regional Australia. We are trying to work on programs where we can do the New Colombo Plan, where people can actually do some training and placements in places like Papua New Guinea, the Solomon Islands and out to Fiji. We should be able to do those things. That is why making the decisions as close as possible to the student and to the client will actually happen.

In the time I have left I would like to address a couple of things in relation to Aboriginal and Torres Strait Islander health. Obviously, this is a concern for everyone in this House and everyone in this House takes a great deal of interest in relation to our first Australians. It is of great concern to me, being from a regional area, that we do see a lot of Indigenous people in hospital. If you walk through The Townsville Hospital, the number of Aboriginal and Torres Strait Islanders is absolutely shocking. This overrepresentation is a cause for great concern.

Of course, Townsville is a regional centre so we do have people flying in for treatment. But the number of Aboriginal and Islander people in the hospital at any one time just beggars belief. There is something going seriously wrong out there, and it comes down to education; it comes down to example and education.

I have Palm Island in my electorate, where domestic violence is a massive issue. It is a massive issue all throughout the Pacific. In my electorate we have domestic violence and major health issues, but it comes down to access to the clinician and access to education and example.

We have Matthew Bowen in North Queensland—probably the greatest full-back of all time. He is currently overseas for a couple of years with Wigan. I can tell you one story about Matthew Bowen. On his first trip away he scored a try for the Cowboys. They gave him a can of beer and they said, 'Congratulations!' He took a mouthful out of it and said, 'I don't know how you can drink this stuff!' and poured it out. He is a father of two kids and he has a partner, Rudie. He is a great family member and still loves going home to Hopevale. His mum is a teachers' aide.

I would love to see Matthew Bowen go around and talk to the kids about the choices he made to get there. More than that, I would love to see someone like his mum, who still works as a teacher's aide at the Hopevale State School, sit down and talk to parents about the choices and decisions she made to make sure that Matthew Bowen was given the opportunity and given the diet that actually mattered for him to come through as the person he did. We can do those things that are so close to the ground, which will cost so little money, but which will yield actual tangible results for someone that we actually know. More than that, a parent should know that giving a child a can of Fanta at six o'clock in the morning may keep them quiet for a little while but is not good for them. We must address this issue because they are dying too quickly and too soon.

People like Michael Gleadow of Connect'n'Grow, who had nothing to do with Workforce Australia, has come up with a program of taking healthcare workers into schools such as Abergowrie College and Shalom Christian College. They have dedicated facilities there to make sure that he is able to get these people to go through training so they know how to take blood pressure, know what the vital signs are, and can do basic health care there. He has a stitch-up with Deakin University so they can become nurse clinicians and health workers. It has become a career path for a lot of people who care about the community.

If we can get those sorts of decisions made at that level by someone who has just come up with an idea and goes and gets some equipment from Catholic Education to go into these places, we get the good result. I thank Health Workforce Australia for what they have done but their time is over. It is time for people on the ground to do what we need to do.

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

It was interesting to hear the member for Herbert raise issues of alcohol abuse, obesity and domestic violence associated with alcohol abuse. I just remind him that he voted to abolish the Preventative Health Agency last night in this parliament. It was an agency that actually provided education and did exactly what he was calling for.

This Health Workforce Australia (Abolition) Bill 2014 is a very short-sighted piece of legislation. It is legislation that will have an enormous impact on health workforce planning in Australia. The member for Herbert was another member of this parliament at the time health work planning was ad hoc and led to a maldistribution of the health workforce across all health disciplines in Australia. Health Workforce Australia has addressed this maldistribution. It has planned and looked to the future of the health workforce needs of this country and the health needs of our society.

Health Workforce Australia ensures that the Australian government and the state governments work together to provide the health workforce and the services that Australians. It is a fantastic advance and it is very short-sighted for this government to seek to abolish it. Planning is an ongoing process as needs change. There is not a start and a finish date. That is particularly apparent in health. You need to have health prevention, you have got to have strategies in place and you need to look at best practice for treatments. Every Australian needs to be able to access health care.

Health Workforce Australia is an independent body that works across jurisdictions. It has responsibility for the national coordination of planning and training of Australia's health workforce. It undertakes complex planning that would otherwise fall to a state or territory. Abolishing Health Workforce Australia is a very reactive approach to health workforce planning—the kind that we saw in the past. The removal of Health Workforce Australia will lead to a return to the boom-and-bust approach to the supply of doctors, nurses and midwives because the system responds in a very ad hoc fashion.

Health Workforce Australia has provided a planned expansion of its clinical training program. It funds clinical placements of health students across Australia and allows them to complete the full clinical requirements of their training. One of my bibles on health and health workforce is The Blame Game, a report on the inquiry into health funding that was brought down in 2006. The terms of reference were given to the Standing Committee on Health and Ageing by the Prime Minister, the then health minister. That report made some interesting findings in health workforce shortages before Health Workforce Australia came into existence.

Health Workforce Australia came into existence to address the maldistribution of the health workforce across Australia, a situation where some Australians could receive health care and others could not. I have referred to this quote made by Terry Clout, the then CEO of the Hunter New England Health Service, a number of times in this place. He said:

If you are in metropolitan Sydney, or if you are in New South Wales, the further you are from the Harbour Bridge, the greater the impact of the shortage of trained doctors, nurses and allied health staff …

That was brought about by the previous policies that saw restrictions put on universities and other colleges and it impacted on the workforce. I would also like to refer to this excellent document that says, 'Health workforce shortages in Australia have developed over a long period of time.' That is what the committee found at that time. In response to a perceived oversupply, a cap was placed on the number of medical school students that could be trained. Once again it was a very ad hoc approach to the provision of GPs across Australia. It identified a number of other issues in relation to shortages, but the key message that the committee received was that it was an ad hoc process; it was a reactive process; there was no long-term planning, and every move, every decision, was made in a reactive way. That was why Health Workforce Australia came into being.

I would now like to refer to another report of the health and ageing committee; this one was brought down in March 2012. It is called Lost in the labyrinth: Report on the inquiry into registration processes and support for overseas trained doctors. This, once again excellent, document highlights that in 2008 the COAG National Partnership Agreement on Hospital and Health Workforce Reform announced that it would establish Health Workforce Australia. It states that Health Workforce Australia was established:

To facilitate more effective and integrated clinical training for health professionals, provide effective and accurate information and advice to guide health workforce policy and planning, and promote, support and evaluate health workforce reform.

That is what health workforce planning is about. I am pleased that the minister is here in the chamber now so I can say to him: this is a really short-sighted decision.

Health Workforce Australia plays a vital role in the planning of the health workforce across Australia. It ensures that we do not go back to the boom-and-bust approach that we had in previous times. It ensures that all Australians, no matter where they live, can access quality health care. Whether it is doctors, hospital nurses, community nurses, physios or other allied health professionals, you need to plan so that you can train the right number of health professionals. You need to plan to ensure that the people undertaking the training are distributed across Australia so that a situation does not exist in which the further you are from Sydney Harbour Bridge in New South Wales the poorer the service that you will receive.

Health Workforce Australia manages and oversees the workforce. It has looked at increasing supply. It has improved the capacity and the productivity of the health sector. It has worked on clinical education, because in a health workforce you need to have ongoing education. It has looked at the immigration and training of overseas doctors. It is a program that looks at the system, the funding and the payment mechanism, to support new models of care and expanded roles. It has been redesigning and creating evidence based alternatives; looking at scopes of practice and developing strategies for aligning incentives around productivity and performance. That is what health workforce planning is about. That is what we need in this country. We need a situation where we have a trained workforce and a workforce that is evenly distributed across the country.

A number of projects have been put in place under Health Workforce Australia. It has implemented actions to address health workforce shortages. It has worked very closely with the Australian Medical Council. It has worked on workforce innovation and reform programs. It has worked in five main domains: health workforce reform for more effective, efficient and accessible service delivery; health workforce capacity and skills development; leadership for the sustainability of the health system; health workforce planning; health workforce policy, funding and regulation.

It really makes me sad to think about the problems that were exacerbated by poor planning and an ad hoc approach to our health system before Labor came to power in 2007. After all our struggle, after the big input, after the effort that so many people made to address the problems that existed, it really makes me sad that we are returning to those days.

I would like to reiterate that Health Workforce Australia provides a national, long-term, coordinated approach to workforce planning and reform, to ensure that our health workforce can meet the increasing demands for health services. It has a proven track record in national health workforce planning, and that is critical for all Australians. It has provided the first national, long-term projection for doctors, nurses and midwives, with the 2012 report, Health workforce 2025: doctors, nurses and midwives. I was astounded to see that this was actually the first publication of this kind and then to learn that the body that oversaw the production of this document is now going to be abolished. It shows how short sighted those on the other side of this parliament are.

Health Workforce Australia has funded 8,400 new clinical training placements for students across 22 disciplines—once again ensuring that we have in place the health workforce that Australia needs for the future. It supported a 115 per cent increase in simulated education hours in 2012 through simulated learning environment programs. That is very, very important. It is imperative that our health workforce has ongoing training.

If this bill is passed it will lead to a situation where complex planning work will not occur at a national level, and that will place a burden on the states. It will lead to a fragmented system, a system that will not benefit Australians that rely on this parliament to ensure that we have the right type of health policy in place and the right bodies established to look at the planning and the future needs of health within Australia. This is truly bad legislation. I implore the Minister for Health to rethink this, and I encourage members on the other side of this House to cross the floor and vote with the opposition. (Time expired)

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

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

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

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

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

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

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

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

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

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

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

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

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

The second expert:

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

The third expert:

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

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

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

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

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

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

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

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

Joel Fitzgibbon (Hunter, Australian Labor Party, Shadow Minister for Agriculture) Share this | Link to this | Hansard source

Having spent three years throughout the course of the 43rd Parliament trying to wreck this joint, the Prime Minister now in government is determined to wreck the country. There is much bad news in budget—bad news for pensioners, bad news for the unemployed, bad news for families, bad news for motorists and particularly bad news for those in rural and regional Australia. But I cannot think, frankly, of anything more threatening to those in rural and regional Australia than a diminution of our health work force planning. There is no greater role for any government than the provision of affordable health care services to its people. Nothing, maybe other than the defence of the country, is more important for the broad community. The abolition of Health Workforce Australia is a backward step which undermines our capacity as a country to properly plan our health work force and therefore properly deliver health services to our people.

We have an ageing population in our health work force, like so many areas of our economy, and that is posing a bigger challenge than ever before. There was a Productivity Commission report—and I know those who sit opposite, including the Minister for the Environment at the table, are fans of the Productivity Commission, as, I am happy to say, am I. This was not a lightning bolt idea from the former government. Health Workforce Australia was a considered policy proposal first from the PC and then of course considered by COAG. In other words, it was an agreement by the then Labor government here in Canberra and each of the state governments around the country, because it was a good idea. It was a good idea to, for the first time, have some real policy based strategies for our work force issues.

In my electorate for many, many years—the first 10 years, almost, of my 18 years in this place—there was no bigger issue than the capacity of people to see a GP. People who live in the capital cities, including people in this place, would not understand this concept. In most capital cities there is a doctor, a GP, on just about every corner. It is the reason bulk-billing rates are so much healthier in the capital cities—in most areas, at least. That is, there is competition amongst GPs. We are lucky just to see a GP in rural Australia. But, thankfully, with the advent of the Rudd government in 2007 that situation dramatically improved. It improved because of initiatives of the former Labor government. It improved because we have taken health work force planning by the nose and done something about the issues. Today, I am happy to say, in places like Cessnock, Maitland and right throughout the upper Hunter—although it is not always easy, still, to see a GP and bulk-billing rates are not what I would like them to be—things are much better than they were for the first 10 years I was in this place, including throughout the period the now Prime Minister was minister for health, an appalling period in health policy in my opinion.

It is not just GPs and the capacity to see them; it is the training of GPs. I have always said the best way to ensure that bush communities, rural communities, have a GP or two, and hopefully three, is to train people from the bush—the people who are most likely to go back and live and practice in the bush. That is why we were making sure more rural students had an opportunity to do medicine. We were funding the training of more nurses and other clinicians, and I fear this is all going to be unravelled as a result of this government's approach to health planning.

I fear for our Medicare Locals. When a doctor unexpectedly leaves a rural town in my electorate, I go to the Medicare Local. They are the people who understand the structure of our health work force in the Hunter Valley. They are the people who know where to go, whose door to knock on, to find a replacement doctor, to provide the relevant incentives et cetera. If Medicare Locals go, it will be a big hit on GP services in my electorate.

This goes to another point. It is a point I made in this place yesterday. If you cut $80 billion out of the budgets of the states, it will have ramifications and knock-on effects. I am asking myself whether the state government in New South Wales is today willing to pledge, despite these cuts from the Commonwealth, that it will maintain all the public health services in my electorate that we have enjoyed up to this point.

I fear for Kurri Kurri Hospital, for example, which has been a marginal hospital because of the size of the town but is a hospital that delivers important local community services, including some specialist services. Will the New South Wales state government agree today that Kurri Kurri Hospital or any other hospital in my electorate will be protected despite these massive cuts? And it is a question that all those who sit opposite and represent rural and regional areas should be asking their Prime Minister today—the member for Braddon and the member for Eden-Monaro. I should say that the member for Eden-Monaro at least had the courage to talk on this bill—one of only four on his side. He was one of only four in here defending this, despite their huge backbench—one of only four backbenchers in here prepared to back this proposal to abolish Health Workforce Australia. I want a guarantee from both the Prime Minister and the New South Wales Premier that no public health services will be reduced in my electorate as a result of both that $80 billion worth of cuts and what they are doing in this particular bill. I am opposed to this bill absolutely. It is a backward step, and it should be rejected.

Stephen Jones (Throsby, Australian Labor Party, Shadow Parliamentary Secretary for Regional Development and Infrastructure) Share this | Link to this | Hansard source

I am delighted to have the opportunity to speak on an important matter but saddened that the occasion that brings us to the chamber to discuss health workforce needs is the proposed abolition of this agency. I take the opportunity to congratulate the member for Kingston and shadow parliamentary secretary for health for the great work that she has done in bringing before the House the egregious dangers that are contained within the Health Workforce Australia (Abolition) Bill 2014, because it warrants a great deal of scrutiny—a lot more scrutiny, I have to say, than we are able to have, because members of the government's own backbench, as the member for Hunter has pointed out, do not have the courage or the wherewithal to come in here and talk about their own government's proposal.

It is important to the whole nation to get and keep doctors, nurses and allied health professionals, but nowhere is it more important than in rural and regional Australia. It is important because regional Australians experience poorer health outcomes compared to their fellow Australians in metropolitan Australia. Regional Australians have a higher rate of injury, arthritis, obesity and melanoma, a higher incidence of suicide and a higher incidence of chronic diseases such as diabetes. They have a greater tendency to smoke, to drink and to engage in riskier behaviours. They have poorer survival rates for cancer and a shorter life expectancy, anywhere between one and seven years less, the further away you get from a major urban centre.

With these stubborn facts in mind, you would think that more effort would be put into addressing the maldistribution of doctors, nurses and allied health professionals between city and country. In the major cities, Deputy Speaker, you will be surprised to know that you can find about 220 specialists per 100,000 of the population. But, if you move into regional areas like my own or even further out into the bush, you will see that ratio drop to 48 in 100,000. Just compare the two. Focus on that for a moment: 220 specialists per 100,000 people in the city; 48 per 100,000 in the bush. And, for hospital non-specialists, in the major cities there are 41 per 100,000 compared to just 18 per 100,000 in outer regional areas. So a national health workforce strategy to address the workforce pipeline, the supply of medical professionals and health professionals, particularly into regional and rural Australia, is absolutely critical.

The health workforce is under tremendous pressure, and it is only going to get worse, in part because of the very measures that are being debated before the House today. Today there are about 1.3 million Australians who work in the Australian health industry, according to the 2011 census. That is about six per cent of the total workforce. We have an ageing population on the other side of the ledger, and that is going to bring in significant health needs. By 2050, there will be 2.7 people of working age to support every Australian above the age of 65. We know we have a problem now, but if we look into the future—and it is not the too distant future—we know that we have a significant problem, because we know that there is an increased usage, particularly in the primary care space, by older people when it comes to accessing health services. If we think we have an issue now, we have not seen anything yet.

It is not a new problem. It is not as if this is the first time that this parliament has been apprised of the issue. It is not, because in 2005 the then Howard government commissioned the Productivity Commission to inquire into this issue, in part because of the pressure that was put upon them by the then Labor opposition. They commissioned a report, and the report was published on 22 December 2005. Amongst the many conclusions, it said that there would 'continue to be poor health outcomes in particular regions and for particular groups'. It said workforce strategies and 'inflexibilities and inefficiencies' in workforce arrangements are 'major contributors to these problems'. The Howard government commissioned the report. It came up with the answers, but the government sat on the report and did not listen to the answers.

Wind the clock forward. On winning government in 2007, the then Rudd government made addressing these issues one of its highest priorities. We knew that we could not do it alone. We knew that we had to work together with the state governments and the territory governments, which have principal responsibility for delivery, particularly in relation to hospital care. So we worked through the health ministers council and through COAG to ensure that we could get a coordinated response. We knew it needed to be a national, large-scale response which was cross-jurisdictional. We also knew that we had to work with the relevant professional bodies. That is why today Health Workforce Australia is partnered with state and territory governments, with higher education institutions and the professional training sector, with healthcare bodies, with employers and with all the professional and regulatory bodies to ensure that we are working together to address the health workforce needs now and into the future.

I can say there was some success. We know that any of the things you do in this space take some time to turn around because of the long time it takes to take somebody from high school through university, through professional training and then into the health workforce. We did see an improvement under Labor: 74 per cent of Australia faced a medical workforce shortage when we took office in 2007 but by the time we left office the distribution of GPs had improved across regional areas. This was a tremendous achievement, but we definitely had our challenges because of the deliberate decisions of the now Prime Minister, when he was health minister, to effectively put a cap, a lid, on the number of new GPs entering the system. We had a big hole to fill, a big job to do, but significant steps forward were made, particularly due to the work we were able to put in place through Health Workforce Australia.

We knew that we needed one strategy, not five, six, seven or eight, because Australians know that wherever they live they should have access to a decent health service and to a GP or primary health care provider. It should not matter whether you are living in Queensland or Tasmania, in the Northern Territory or the Australian Capital Territory, we need a national strategy to address these shortages. We made agreements with the states and territories and tackled the burden of resolving this monumental problem, rather than leave it to each state and territory to go their different ways trying to resolve it on their own. So Health Workforce Australia has led the way nationally and that has been paying off. We have produced the first national long-term projections for doctors, nurses and midwives, because if you do not know what the problem is you are not going to know what the solution will be. We have funded over 8½-thousand new quality clinical training places for students across different disciplines. We have supported a 115 per cent increase in simulation education hours and delivered 446 nurses and allied health workers to regional communities. In addition, we have improved the national coordination of medical training with the National Medical Training Advisory Network. None of this would have happened without the work of Health Workforce Australia.

We knew this was all under threat with the election of a coalition government, but there was cause for some hope, particularly in rural and regional Australia. When people in rural and regional Australia looked at the various candidates they were going to vote for and considered their policy options they may have had a look at the National Party health platform and gained some hope from statements such as this in the Nationals' policy:

We will enhance incentives for doctors and health professionals to take up regional practice and stay there. And we will go further with the advent of a dedicated Federal Minister for Regional Health to specifically oversee regional healthcare and the needs of regional patients.

That must have given them some hope, if that was what they were going to do. And when the platform talks about the role of the minister for regional health it says:

When health policy decisions are being made regional concerns must be championed by a dedicated Minister with regional experience and a primary focus on the welfare of regional Australians.

Those who read that and voted on that policy platform must feel devastated. If they were listening to budget estimates a few nights ago they would have heard their minister for rural and regional health confess under questioning from a Labor senator that she had not even been consulted on the rural and regional impact of the GP tax and that she was not interested enough in this issue and its impact on rural and regional Australia to ask the department to do some research or modelling on the issue. You would have thought the party that is dedicated to representing the interests of rural and regional Australia, apprised of the maldistribution of doctors and allied health professionals and apprised of the discrepancies in health outcomes for rural and regional Australians when compared to their brothers and sisters and cousins in the city, would at least be taking some interest in the impact of the GP tax and the other healthcare changes on rural and regional Australians. What we see is a complete lack of interest. What we see is National Party failure and ministerial failure.

What is the government's answer on this? We see with the bill before the House that part of their answer is to abolish the only Commonwealth agency which is focused on addressing workforce shortages in the health professional area, particularly in rural and regional Australia. But that is not where they stop. It seems they have got three bows to their answer to workforce shortages in the health industry. The first is to abolish the agency which is overseeing. The second is to make it harder to get a medical education: slash the per capita funding to universities, with a 20 per cent cut on average in funding to universities, including to regional universities that have a medical school; take the lid off student fees, which we all know is going to lead to an increase in fees; and double the rates you pay on your student debt. What is the impact of this going to be on medical students? The vice-chancellor of the University of Melbourne says that he expects significant increases. A medical degree currently costs a student about $80,000 for the life of that degree. That price will go up, to anywhere between $100,000 and $183,000.

Those who come from a regional area and those who have a great university like the University of Wollongong, which runs a postgraduate medical degree, will know that if somebody is giving up a job, perhaps already incurring a student debt and going back to university to take up postgraduate medicine, this will be a massive disincentive for new doctors, new nurses, new allied health professionals to take up a course of study which will lead them to becoming a health professional.

The government are abolishing the only agency and they are making it harder and more expensive for somebody to train to be a health professional. Their answer, effectively, is to let the market rip. We know what happens when the market rips in the area of health workforce distribution. You can see as many doctors as you like in Bondi, but try to see a doctor in Dubbo or west of there and you will see the disparities. This is bad legislation, built on a bad plan and it should be rejected.

Lisa Chesters (Bendigo, Australian Labor Party) Share this | Link to this | Hansard source

The Health Workforce Australia (Abolition) Bill 2014 before the House seeks to repeal the Health Workforce Australia Act 2009 and to absorb this agency and its functions into the Department of Health. We will see the important work done by this agency transferred. My concern about this bill is simple: it seeks to water down the important role that the Australian government plays in national health workforce planning. This bill seeks to undo the good work that has been done by the previous government in tackling this important area.

This agency is an independent body and it works collaboratively with a number of agencies, stakeholders, and has direct links with states and territories, which is vital. We on this side of the parliament acknowledge that states, territories and the federal government are in partnership when it comes to meeting the health needs of our community. National health workforce planning is critical to addressing the looming crisis that we have not just within our cities but within our country when it comes to having the workforce we need to ensure that we are meeting the health needs of people wherever they live.

That is why it is so important that we have a national plan. We need to acknowledge that the training that is done of these health professionals is largely the responsibility of our national federal government. Yet where these people work is in the states. That is why it is so important that we have an independent body to bring those stakeholders together, to bring levels of government together and to ensure that we have the workforce in training and ready to meet the health needs of our future.

In the past, the result of the reactive approach to medical and nursing training, immigration and workforce overseas recruitment was a metro-dominated distribution of health professionals. This has affected regional areas like mine in ensuring that we have the health professionals to meet the health concerns of people in our region. We still have health workforce challenges, particularly in country areas. Workforce recruitment is tough. It is more expensive than in metropolitan cities. Retention remains one of the key issues and a major challenge and it is another reason why it is so important that we have a strong long-term plan and an agency to do that work.

Whilst it is important that we acknowledge that recruitment is an issue, it is just as important that we have a strong plan to retain health professionals in rural and remote areas. As the distance from metropolitan areas increases, the retention of rural health professionals becomes more problematic. Rural communities are currently unable to recruit and retain the health professionals that they need and, as a result, we are seeing access to health services as a problem. We are seeing poorer health standards in our regional communities. One measure that speaks to this problem so loudly and so clearly is the lower life expectancy of people living in rural and particularly remote areas. As my friend the member for Mallee quite often states in the media publicly—and on any occasion that he can—people living in regional Victoria have a life expectancy of 4.7 years less than people living in major cities. One reason is not being able to access affordable and available health care and having their health professionals in their town and communities when they need them.

If we focus specifically on medical practitioners, GPs and specialists: is there a shortage in regional areas? The answer is yes. Quite often, when I am out in the smaller towns in central Victoria I talk to people and they tell me stories about how the books of their doctor—for example, in Heathcote—are full. They cannot get into the books. They have to travel to Bendigo to visit a GP.

The difference between the number of specialists in the city and country is also a major issue. Data released by the National Rural Health Alliance speaks to this difference. In major cities there are roughly 134 specialists per 100,000 population. Yet compare that to inner regional areas where there are 63 per 100,000 and, in outer regional areas, 43 per 100,000 population. It is a huge difference. Then we compound that by the distances in our remote and regional areas and the travel that is required.

Only on the weekend was I speaking to people, talking about how they constantly travel to Melbourne and about the associated out-of-pocket costs for people living in Bendigo and further out from Bendigo by having to travel to Melbourne to see their specialist. That is because we do not have enough specialists in the regions. It is important that we tackle these issues. That is another reason why we need one agency that is independent nationally, such as Health Workforce Australia, addressing these issues.

In the cities there are ample opportunities for GPs and specialists to work in private practice, to work in corporate practices, to be salaried in hospital positions or work in bulk-billing medical services. In the bush there are not the same opportunities for doctors and this is one of the reasons why we believe we have such an issue when it comes to retaining and recruiting doctors. Our doctors just do not have the same opportunities. There is also more expected of them, which again makes it harder to recruit people to the area. Take, for example, our small hospitals in my electorate. In Castlemaine, Heathcote and Kyneton, local GPs are expected to be on the on-call roster for their local hospital. In Castlemaine and Heathcote it works quite well. However, there is currently a problem in Kyneton, a dispute which has meant that the current hospital does not have local GPs on the roster in rotation. Again, what we need is workforce planning not just at a state level but at a federal level to ensure that we have enough doctors in the places that need them. Understanding planning for the health workforce is vital if as a nation we are going to resolve and solve the ongoing GP issues across regional Australia. It sounds like a task for a health agency that is an independent body that works collaboratively with a number of key stakeholders and has direct links with states and territories, just like the agency that this bill seeks to abolish.

It is not just with GPs where we have a critical area to look at, it is also allied health professionals. Many regional and rural communities, including my own, struggle to attract the staff that they need for allied health. A study by Monash University made a number of significant findings in this particular area. Annual turnover in regional areas for allied health professionals was on average 35 per cent whilst in the city it was only 28 per cent. Retention rates were also an issue: on average in the city 12 months after starting it was 82 per cent, yet in some of our most remote areas retention rates were as low as 64 per cent. The study also finds that the cost associated with recruiting allied health professionals to the regions was much higher. In the city it was roughly $26,000 whereas in the country it was $45,000. It is a study that speaks to policy needing to address directly not only recruitment but that funding to those agencies, those hospitals, needs to be increased to recruit. It highlights again the need to have a national framework and a national agency. It is another task for a national agency focused on health workforce planning.

The other problem with this bill is that it does not say anywhere that the agency is not working. We know from our previous speakers that Health Workforce Australia is working. During the last four years there are many examples of how it is working. It has established the National Medical Training Advisory Network. It has examined the barriers and the enablers to entering the workforce. It has investigated the increasing need for self-sufficiency within the medical workforce. So if the Health Workforce Australia agency is working and there is still a need for workforce planning, as I have demonstrated, particularly in regional areas, why is the government seeking to abolish this very important organisation? It can only be described as pure Liberal ideology, an ideology and an attitude that is against universal health care and against ensuring that we have equity that takes into account where you live.

This attack on universal health care is no clearer than in the moves the government made on budget night. It was not just about the abolition of this institution but also about the cruel health cuts and funding cuts to the regional areas and the new GP tax. In my electorate the hits on budget night were huge, with nearly $29 million cut from Bendigo electorate hospitals over the next five years. Bendigo Health takes the largest whack, which is $25 million to be stripped from now up to 2018. There is almost $1 million from Kyneton District Health, which is one of our small hospitals. Today Kyneton District Health will get a visit from the state Liberal Premier, although we do not know how long he will be the Premier, and he is staging a photo op at the Kyneton hospital. He is doing the first sod turn for the Kyneton ambulatory care centre. I mention this because this centre was first funded by the federal Labor government budget in 2011, yet it has taken three years for the state Liberal government to finish the planning and to get on with the job of building. Why has it taken this government so long? If it has taken three years to do the sod turn, how long till we expect the centre to be open? This delay smacks of a deliberate political decision to give the Premier an opportunity to stand in front of a project with his candidates in an election year. We are months away from an election and its speaks volumes about the politics of the Liberals and the politics of our state government and our federal government. It is politics before the health of central Victorians, it is politics and ideology before the health workforce of central Victorians.

Having worked closely with paramedics and nurses in central Victoria, I know the commitment that they make to our region. Currently in regional Victoria we are in the midst of an ambos crisis. We do not have enough paramedics working in the area. This is another area where we need workforce planning. When you talk to nurses at the Bendigo Health or at our small hospitals, they speak of the worry that when they retire there are not enough younger nurses coming into the hospitals to replace them. This is another area where we need workforce planning. When you look at the people who are taking up the specialist nursing courses, like midwifery and so on, it is again another area where we need workforce planning. I suppose you do not want to do the planning if you know fewer people will be going into those training courses, because of the exorbitant fees they will have to pay to complete their courses.

In conclusion, what we have seen is the good work being done by Health Workforce Australia. It is improving our services. We are seeing that it is tackling the issues in our regional areas. We are seeing that it is ensuring that students have the best possible training and that models of care are being delivered in the most appropriate ways. This is an agency with purpose. It is an agency achieving its goals, yet this bill seeks to abolish it. This bill speaks as another example of Liberal ideology; it is another cruel cut from budget night that will not only put the health of all Australians at risk but also make it harder for people in regional Victoria to seek the professional help, the medical help, that they need and when they need it.

Natasha Griggs (Solomon, Country Liberal Party) Share this | Link to this | Hansard source

As many of us recall, March 26 was 'red tape repeal day'—by any measure, a red letter day for this government, business operators and workers from all across the country. This government has a very clear objective when it comes to red tape. As it is very clearly outlined in the Australian Government Guide to Regulation, this government seeks to ensure that regulation is never adopted as the default solution but rather is introduced as a means of last resort. The Health Workforce Australia (Abolition) Bill 2014 is another step on the way towards the government achieving its goal of stripping away unnecessary and wasteful red tape. The bill is intended to streamline the delivery of health workforce policy and programs by removing an unnecessary level of administration and bureaucracy that currently weighs down this very important component of health service delivery.

The Abbott government has detailed 10 principles for Australian government policymakers that should drive policy development now and into the future. Mr Deputy Speaker, I will share those with you so that they are on the record. No.1, regulation should not be the default option for policy makers. The policy option offering the greatest net benefit should always be the recommended option. No. 2, regulation should be imposed only when it can be shown to offer an overall net benefit. No. 3, the cost benefit of new regulation must be fully offset by reductions in existing regulatory burden. No. 4, every substantive regulatory policy change must be the subject of a regulation impact statement. No. 5, policymakers should consult in a genuine and timely way with affected businesses, community organisations and individuals. No. 6, policymakers must consult with each other to avoid creating cumulative or overlapping regulatory burdens. No. 7, the information upon which policymakers base their decisions must be published at the earliest opportunity. No. 8, regulators must implement regulation with common sense, empathy and respect. No. 9, all regulations must be periodically reviewed to test its continuing relevance. Finally, No. 10, policymakers must work closely with their portfolio deregulation units throughout the policymaking process.

It is a fairly safe bet that if these guidelines had been followed the Health Workforce Australia legislation would never have made it through the House. Over the past six Labor administrations, the health bureaucracy continued to increase in size, with no immediately obvious improvements in the delivery of health services. At last count, there were 21 stand-alone agencies operating outside the actual portfolio department. A bureaucracy of that size incurs significant costs to build up and maintain. This diverts much-needed resources from areas that directly benefit patients. The coalition government is determined to get every possible dollar away from administration and the bureaucratic process and back into front-line services, and the passage of this bill will assist in achieving this aim.

Health Workforce Australia, or HWA, was established under the now expired four-year National Partnership Agreement on Hospital and Health Workforce Reform, agreed by the Council of Australian Governments in November 2008. It is worth remembering that back in 2008, nationally, I think there was only one non-Labor government in power in Australia—and that is a sure-fire recipe for unnecessary regulation to bind the smooth operation of the bureaucracy. HWA was established to provide financial and other support for the delivery of clinical training and to carry out research, as well as to collect, analyse, and publish data relating to the health workforce. In addition, it was charged with developing and evaluating strategies for the development of the health workforce. It became operational in January 2010. All Australian governments were intended to provide funding to HWA; however, the states and territories have not contributed any funding, as was agreed.

The Commonwealth government has been the sole funder of HWA, committing $1.05 billion since its establishment. This is approximately $250 million a year, with no contribution from the jurisdictions. Should this bill be passed, programs and functions of the HWA will transfer to the Department of Health, which, I am advised, has the capacity to fulfil the agency's function. This government is not withdrawing support for the health workforce—far from it. It is, however, delivering on its commitment to reduce red tape and streamline programs. Savings will support front-line health services and programs—and what is really important here is front-line health services. It is what health funding should be doing—that is, putting resources into front-line health services.

The coalition has a strong record on making sensible investments in Australia's health and medical workforce. The previous Howard government invested in nine new medical schools, which have resulted in an increase in medical students graduating right now. I am further advised that the number of domestic school graduates per year has more than doubled since 1996. The Northern Territory Remote Clinical School, with sites in Alice Springs, Katherine and Nhulunbuy, was founded in 2005 and is part of the Northern Territory Medical Program. This initiative is run by Flinders University. It aims to give students the opportunity to take training in rural environments and also offers support to health professionals working in these remote teaching locations.

The coalition and, in particular, the health minister are committed to providing proper and responsible training for health practitioners. This government has committed to a doubling of the Practice Incentive Program payment, from $100 to $200, for each three-hour teaching session provided to a medical student. This provision directly benefits the teacher and will better compensate general practices for the consultation time they dedicate to teaching. It will also encourage more general practitioners to provide much needed teaching opportunities and will work to strengthen the future workforce. Approximately 3,000 practices are expected to provide PIP teaching sessions, which translates to about 20,000 students every year. A rural loading of up to 50 per cent will also be applied to payments to practices in rural and remote locations, which will be a fitting reward for the legion of GPs who service the Territory's bush centres.

The government is also investing $40 million in up to 100 additional medical internships each year in non-traditional settings, including private hospitals in regional areas. This will provide more certainty for students and alleviate pressure on public hospital training. I will certainly be working with the Darwin Private Hospital, in my electorate of Solomon, to secure some placements. I welcome the fact that priority will be given to positions and rotations outside major metropolitan centres. That is a welcome development, and I will make it my work to ensure that it works to the advantage of Territorians.

The coalition will provide infrastructure grants to general practices on a dollar-for-dollar basis. The intention is to leverage private investment and help ensure the efficient and productive use of resources. This is in stark contrast to the wasteful GP superclinic program, which saw promises and taxpayer dollars literally splashed around with precious little accountability to monitor what exactly was going on. The government has also committed to providing up to 175 grants for rural and remote general practices to expand facilities to support the teaching and training of medical students and registrars. This will be particularly beneficial when the construction of the Palmerston Hospital is completed. The grants of up to $300,000 will be provided to successful applicants and, again, will require a matched contribution from the practice. This measure will benefit the GPs, registrars, medical students and communities in regional remote and very remote Australia, where these grants will be targeted. It goes without saying that these practices face unusual challenges in the delivery of health services and health care, and it would be a great opportunity for medical students to experience life in rural or remote health practices. I hope it will also encourage students to pursue careers outside the comfort of metropolitan areas once they graduate.

Another measure which I hope will benefit families in Darwin and Palmerston is the planned expansion of GP training places. Australia wide, GP training places will increase by 300—from 1,200 to 1,500—in 2015. This will create more vocational training opportunities for this workforce and free up more junior doctor training positions for new graduates who are coming through. The Australian General Practice Training Program, which this commitment will expand, has a distribution target that requires half of training to occur in rural and remote locations. This government is making sensible changes to reduce the waste of duplication and bureaucracy so that sustainable investments can continue to be made in services or programs that benefit our health system and the future workforce. This can only work to the benefit of families, pensioners and workers in Darwin and Palmerston.

I commend the bill to the House.

Tony Zappia (Makin, Australian Labor Party, Shadow Parliamentary Secretary for Manufacturing) Share this | Link to this | Hansard source

If this was good legislation, coalition members would be tripping over themselves to come into this chamber and speak in support of it. Instead we have seen only a handful of them bother to do so—probably because they know they can defend neither this legislation nor the $50 billion of cuts in health spending that the Abbott government brought in in its first budget. This is one of only several cuts made by the Abbott government in that budget. Having gone to the 2013 election promising not to cut health spending—in addition to a range of other promises—the Abbott government has now managed through this budget to unite people from across Australia. Regardless of political leanings, regardless of whether we are talking about community groups or even political groups such as the premiers of the various states, people from across Australia are united in condemnation of this government's $50 billion of cuts to health spending across the country.

But the criticisms are not confined to politicians and other levels of government. The Rural Doctors Association has issued press statements critical of the health program cuts. The AMA has issued similar critiques. Yesterday I received the May 2014 bulletin of the Australian Dental Association. I will quote the last two sentences of the bulletin:

All in all, funding the dental care has been less impacted than other areas of health. Nonetheless, the losses outweigh the gains.

I repeat the words 'less impacted than other areas of health' and 'the losses outweigh the gains'. This is a non-political and independent analysis of spending in respect to the dental areas.

The South Australian Health Alliance—an alliance of South Australia's leading health unions, health consumer groups, community groups and service providers—have come out strongly with their concerns about the Abbott government's cuts to health programs. I can understand that; particularly coming from South Australia, I am aware that the federal government has cut funding to South Australia by $655 million over the four-year budget forecasts. This is made up of $444 million in cuts to specific purpose payments, $120 million of cuts to national partnership agreement funding for public hospitals, $42 million of cuts to national partnership agreements funding for financial assistance for longstay patients and $50 million of cuts in other health initiatives.

This legislation seeks to repeal the Health Workforce Australia Bill 2009 and transfer Health Workforce Australia's functions into the Department of Health. It has already been stated by the member the Kingston that most of those losses will occur in South Australia, and so it is not at all surprising to hear the concerns of the South Australian Health Alliance. Transferring a program to an existing department may sound like a reasonable thing to do—particularly if it really is going to save public funding; under those circumstances, it could be defended. However, a close analysis of this decision to axe Health Workforce Australia will show that it is short-sighted. It is a decision that will ultimately result in more costs being incurred and no national coordination of planning and training Australia's future health workforce. That in turn will reduce Australia's ability to deliver the very high standard of health services across the country that we would all expect.

The effect of this legislation will be that the responsibility for planning and training Australia's health professionals will fall onto the individual states, as it was prior to the legislation coming into effect. It will result in an uncoordinated, piecemeal approach, rather than a coordinated national approach. The approach we currently have and the legislation that currently covers Health Workforce Australia resulted from a Productivity Commission report of 2006—a report initiated by the Howard government, but not implemented by it. When Labor came to office, we implemented it because we needed a national approach to preparing and planning the medical and health workforce for this country. With the implementation of Health Workforce Australia we have for the first time reliable statistics and reliable projections of the numbers of doctors, nurses and midwives that we need into the future. That in turn enables us to plan for the training of the health professionals that are required to take the place of those who retire or otherwise get out of the industry.

Yesterday the Rural Doctors Association issued a media release, warning that the Abbott government's decision to shut down that general practice education and training will erode the high quality GP training that new medical graduates currently receive. According to the release:

We have very high standards in Australia for the selection and training of GPs, and this been developed over many years. In many respects, Australia's GP training system is the envy of many other countries. It is crucial that these standards are maintained and not destroyed overnight simply because the current government wants to get the budget back into surplus in the shortest possible time frame. This would be a false economy.

The Rural Doctors Association, I believe, reflects the views of people in country areas broadly and certainly reflects the views of those doctors who are working in country areas.

It has been one of the challenges of state governments in this country for a long time to try to ensure that we get enough health professionals in country areas. It has never been easy; it has been very difficult. We have tried to provide incentives for health professionals to do so, but I am aware of many country towns that are still struggling to get the health professionals they need. Just when it appears that we are making some progress through programs that are currently in place, the government comes along and says, 'We are going to cut those programs.'

It is not surprising that the Rural Doctors Association is very concerned about the cuts and is raising concerns. These are the people that you would expect to know most about health services in their communities, and yet the government clearly is not listening to what they are saying. I would have thought that any good minister and any good government would take advice from the very bodies that know most about the issues they are dealing with. But that is simply not the case here, because the government is prepared to put budget cuts ahead of the needs of communities.

This policy comes on top of a series of other cuts to health services made by the Abbott government. Only yesterday we learnt that $9.9 million has also been cut from the training of nursing and allied health students in Tasmania: nursing scholarships will cease from 1 July of this year and allied health scholarships from 1 July 2015. Yesterday in this House we also saw the abolition of the Australian National Preventive Health Agency—another short-sighted decision by the Abbott government. Health preventive programs inevitably have a substantial cost saving for our health system and for the nation. It is much more cost-effective to prevent illness than to treat it. That should be understood by all. It is a common theme and a common message from all health professionals: prevention is better than cure. We have a process and a system in place that the government, again, has chosen to disband or move to another department. It is incredibly short-sighted, and it is not surprising that so many health organisations across the country have come out in condemnation of it.

With these decisions that the government are claiming will save money now, inevitably health costs will be compounded and transferred into the future. The government are transferring those additional costs to future governments and future generations. Of course, the government, and the Minister for Health, who I see is in the chamber, will not be around to wear those future health costs; they will be someone else's problem. That is not responsible government. Responsible government is about doing the right thing for today's generation and for future generations.

There are 1.3 million Australians working in the health sector. It is a major employment sector. It needs good management to make sure that it is balanced and well supported. When Labor was elected in 2007 the health workforce was in total disarray. There was no national strategy or planning for future needs. We had a shortage of health professionals across several health professions. We had a great deal of difficulty in getting GPs and other health professionals to work in country areas. We had a frustrating process in place for international medical graduates to have their qualifications recognised in Australia and then be cleared to work as health professionals in the country. I can recall raising this matter on several occasions and I can recall meeting with several health professionals in my own office. All of them expressed their frustration at having their qualifications properly recognised so that they could take up the job they had been offered but which they were not able to do until they had been cleared. We had the Howard government even threatening to take over hospitals, starting with the Mersey hospital in Tasmania. There was also a limitation on the number of medical places that were made available to students within our universities. This highlights just how chaotic the health system was when we came to office.

The Labor Party set about reforming the process and the system. Many of the reforms we introduced have made the system better. It is only a relatively short period of time that those reforms have been in place, but they are already making a difference. After the Abbott government was elected the first thing it is doing is dismantle everything that has been put in place and cut $50 billion in health funding on top of that.

I have heard the denials from the Prime Minister and the Minister for Health about cuts to health funding by the federal government. Their problem is that nobody believes their denials. Their problem is that all of those who have studied the budget and who need to know exactly what is in it for them have come out in condemnation of the government. The government's problem is that none of the premiers believe their spin that there are no cuts to health spending in this country. None of the professionals around the country that work in the health sector believe their spin that there has not been $50 billion of cuts to the country. And none of the people that I speak to in my community as I get around believe their spin that there has not been $50 billion of cuts to health spending in this budget over the forward estimates. The government's problem is that they know that they have made cuts that are going to deeply hurt the Australian community and deeply hurt the health profession more broadly. It knows those decisions are not popular. No amount of spin, no amount of weasel words and no amount of denials by the minister when he comes into this place will change the fact that health spending in this budget has been cut by $50 billion and that that will have devastating effects for people right around the country.

Peter Dutton (Dickson, Liberal Party, Minister for Health) Share this | Link to this | Hansard source

I thank all of those members who have contributed to the debate on the Health Workforce Australia (Abolition) Bill 2014. I put on record the government's firm commitment to our health workforce across the country. That was evidenced in the budget, where health funding increases year on year and hospital funding increases by nine per cent next year, nine per cent the year after, nine per cent the following year and six per cent in year 4. I say thank you, very much, to those members in particular who have pointed out the fact that when this government came to office it inherited a health portfolio that, in addition to those people who are working hard within the department, had 23 outside agencies. I point the attention of members opposite to an article in the Australian. Ironically, its chief political correspondent and the author of the piece is Matthew Franklin, who went on to become a spin doctor for then Prime Minister Rudd. In his article Mr Franklin quotes Mr Tanner, the former Labor finance minister, as saying:

The indiscriminate creation of new bodies or the failure to adapt old bodies as their circumstances change increases the risk of having inappropriate governance structures,

Mr Tanner went on to say:

This in turn jeopardises policy outcomes and poses financial risks to the taxpayer.

The article further quotes Mr Tanner as saying:

The more agencies you have, the more embedded fixed costs that you have.

This government is staying true to the sentiment within Mr Tanner's contribution. Indeed, any good government would want to make sure that it had efficiency, because in the end governments are guardians of taxpayers' money. We have inherited an enormous amount of debt from the Labor Party. It is our responsibility to clean up their mess and clean it up we will.

The Health Workforce Australia (Abolition) Bill 2014 will close Health Workforce Australia and transfer the programs and functions of HWA to the Department of Health. The bill is not about a withdrawal of support or resources for the health workforce but about this government delivering on its commitment to remove duplication and red tape so that there can be more focus on the policies and programs that directly support our health workforce. We want to deliver a smaller and more rational government footprint. We know that without our health workforce we would have no healthcare system. We also know that there remain issues with the availability, mix and distribution of the health workforce, but another health walk force bureaucracy is not the way to address these issues.

Labor's policy of style and announcement over substance and delivery is on display in relation to this area. HWA has added an unnecessary level of administration and bureaucracy. Valuable resources have gone into the significant overhead costs that come with running an agency. By transferring the functions and programs of HWA to the Department of Health we can save money by reducing duplication and we can continue to support programs to build our health workforce. All priority activities will continue to be delivered. The organisations funded by HWA can be assured that all current funding agreements will be met. The Commonwealth government will continue to work with the states and territories, private health employers and the professions towards national health workforce planning and reform.

Ross Vasta (Bonner, Liberal Party) Share this | Link to this | Hansard source

The question is that this bill be now read a second time.