House debates

Tuesday, 30 September 2014

Matters of Public Importance

Rural and Regional Health Services

3:19 pm

Photo of Mrs Bronwyn BishopMrs Bronwyn Bishop (Speaker) Share this | | Hansard source

I have received a letter from the honourable member for Throsby proposing that a definite matter of public importance be submitted to the House for discussion, namely:

The government's broken promises and failures on rural and regional health.

I call upon those members who approve of the proposed discussion to rise in their places.

More than the number of members required by the standing orders having risen in their places—

3:20 pm

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

Thank you, Deputy Speaker. The question that all members on this side of the House are asking themselves today is why the government insists on punishing Australians who live in rural and regional Australia. Why are they so insistent on punishing people who live in the bush? The other question we are asking is: why is the National Party so eager to support them? The truth is this: the government's budget is a war on the poor—

Photo of Mrs Bronwyn BishopMrs Bronwyn Bishop (Speaker) Share this | | Hansard source

I remind the member that the Speaker is in the chair, not the Deputy Speaker.

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

Thank you, Madam Speaker. The issue is this: the government's budget is a war on the poor; it is a war on the people who live in rural and regional Australia. The $7 GP tax will cost patients over $1.4 billion in communities outside of metropolitan centres.

The destruction of the PBS safety net is going to cost an additional $1.2 billion for people for their medicines. If you look at the top 12 electorates that will pay the greatest out-of-pocket expenses as a result of this rotten budget in the PBS, they are all in rural and regional Australia. And they are going to be wacked an additional $112 million over the next four years.

Where is the member for Gippsland? Where is the member for Hinkler? Where is the member for Murray? Where is the member for Gilmore? And where are the other members who claim to represent regional and rural Australia electorates? Why aren't they here today, standing up for their electorates?

The sad truth is this. If you live in the bush, you do not enjoy the same health outcomes as you would if you lived in the city, whether they be diabetes, the incidence of a melanoma or other cancers, injuries or, tragically, suicide. The sad fact is that, if you live in the bush, you do not enjoy the same sorts of health outcomes as you would if you lived in the city. Tragically, those on the other side are letting down their constituencies.

It is also true that, if you live in rural and regional Australia, you not only have the lowest incomes but are also paying more in out-of-pocket health expenses. The poorest people in the country are being whacked the hardest by those on the other side of the chamber.

Labor has a very proud record when it comes to health. Labor is the party that introduced Medicare 30 years ago and we are defending it here today, while those on the other side are attempting to attack it. From 2007 to 2013 we ensured that there were more doctors trained and more doctors sent to the bush to practise. We built over 29 new cancer centres and we put in place health and hospital funding which ensured that funding of hospitals around the country was more sustainable.

Unsurprisingly, perhaps out of embarrassment at the success that the Labor Party had in looking after people in the bush and looking after people in rural Australia, before the last election the National Party published this policy document. When you look at this policy document you will see it has a fair few things to say about health and health policy. For instance, they made some very big promises about having a policy to ensure that no member on that side of the chamber would support policies which were going to lead to the closure of hospitals in rural and regional Australia. The $55 billion cut to health and hospital funding is going to have a devastating impact on hospitals in the bush and those on the other side know it. We demand that the National Party live good to their promises and stand up here and defend the things that they went to the last election on.

The coalition went to the last election promising, in this document here, that they would increase financial incentives and payments for doctors practising in rural and regional Australia. As soon as they got into government, what did they do? They cut Medicare rebates for doctors. So, instead of increasing funding, they have decreased funding for doctors practising in the bush. The best promise of all—and this is the one we love—was that they would have a full-time minister for regional and rural health, to ensure that the interests of regional and rural Australia were looked after when the big decisions were made. It is no surprise, but it is a Liberal Party health minister who is going to be standing there defending their record because The Nationals will not get up and defend it.

Photo of Michael McCormackMichael McCormack (Riverina, National Party, Parliamentary Secretary to the Minister for Finance) Share this | | Hansard source

What about Fiona Nash?

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

I am asked about Fiona Nash. Let us hear what she had to say about it. She was asked whether she did some modelling on the impact of the GP co-payment and whether she had consulted rural communities on the impact. What did she have to say? When the biggest decision by this parliament was made, impacting on rural and regional health, the minister for rural and regional health was not even in the room, making it quite clear to everyone on this side of the chamber—and it should also make it quite clear to everyone in rural and regional Australia—that the Liberal Party has absolutely no regard for the promises that the National Party made to their electorates in the run-up to the last election.

Having been excluded from the big decisions, you would have to ask yourself: is there anything that the minister for rural and regional health will go into bat for when it comes to rural and regional Australia? We know that she was willing to go into bat for big food companies, to save them from the tyranny of a star-rating system. She was willing to stick up for the interests of 'big food,' but she will not stick up for her own policies. Two weeks ago in the Senate, when she was asked about these issues she had to this to say, 'You've got to understand that we have National Party policies but, when we get elected to government, they don't mean anything. They have absolutely no bearing on coalition policy, because they are only National Party policies.'

We know that the Liberal Party has no regard for National Party policies and no regard for people in the bush, but we also know that the National Party no longer has any regard for people in the bush. How quick they have been to disregard their own policies!

Some members were willing to stand up for people in rural and regional Australia. Even National Party members were willing to stick up for people in rural and regional Australia. I see that the member for Richmond is in the chamber today. She is willing to stick up for the interests of her electorate, unlike the previous member for Richmond, whom she defeated, who was not willing to stick up for the interests of people in rural and regional Australia. But his predecessor was.

In the good old days there have been National Party members who have been willing to stand up to their own side and to the tyrants in the Liberal Party. I remember when Doug Anthony was willing to bring the National Party across the floor to vote against his own side to ensure that the interests of the bush were looked after. But not today! It is a pale imitation. They will not even stand up and defend their own policies. They are sending the Liberal minister in here to stand up for their own policies. Not one National Party member has been willing to stand up and defend their own policies. It is absolutely clear that they will not defend their own policies because, as the minister for rural and regional health has also made absolutely clear, the Liberal Party has no regard for their policies. They will not be able to stand in their electorates in the lead-up to the next election and make one single promise, because the people in the bush will understand that, when it comes to health and when it comes to anything else, National Party promises have absolutely no bearing on what a coalition government will do in practice.

It is time for members of the National Party to stand up; if they will not stand up, they should stand down. They should tell the truth that they are no longer members for country Australia; they are no longer anything more than associate members of the Liberal Party. (Time expired)

3:30 pm

Photo of Peter DuttonPeter Dutton (Dickson, Liberal Party, Minister for Health) Share this | | Hansard source

I have watched some MPIs in this parliament in my time. What normally happens is: the opposition builds up during question time to the MPI because they believe in the MPI. During question time today, I was waiting for the questions on this particular topic—around funding for health services within regional communities. There were 13 questions from the opposition today. But this member opposite could not get one question up—talk about those who are effective in this place—in tactics today to ask of the government on this particular topic.

I will tell you why this shadow minister has been given this MPI: it is because he has no capacity to get questions up in question time. They have said to him: 'So ineffective are you that we will not allow you to ask a question in question time. We will give you the MPI, as some sort of sop.' That is what has happened here today. It has nothing to do with passion or interest in this particular topic. It is because we have a completely ineffective shadow minister in this area.

He represents the great seat of Throsby. It is a good area—no question about that—but is it a patch on the area that is represented by members from the Nationals or from the LNP or from the Liberal Party on this side of parliament? No, not in terms of regional services and delivering to those on the land. When you compare the shadow minister for regional health with the Assistant Minister for Health in the other place, the Assistant Minister for Health in the other place would run rings around this shadow minister, and she does so on a regular basis. He has no capacity to carry this argument. He has no capacity to get a question up in question time, so he is given this second-rate opportunity on the MPI after question time. It says more about him than it does about anything else.

I will tell you what the Labor Party is dominated by. They are dominated by union thugs on the front bench from start to finish. They do not have any impact on regional services or in regional areas because they do not come from those areas. That is the reality in this place. They might say that they represent rural interests, but they do not; they represent capital city interests and, in particular, they represent the interests of the people who control them on a daily basis—that is, the union bosses. The union bosses do not have any interest in regional and rural areas, let alone rural and regional health in this place. These people demonstrate this incapacity on a daily basis.

I will tell you what that means: it means that all of the Labor Party policies are concentrated on the bureaucracy in health, and that has been demonstrated at a state and territory level over the course of the last decade or so. Labor, to please the union bosses, pumps money into health bureaucracies and away from health services—not just in capital cities but, most importantly, in rural and regional areas. That is what happens in Labor governments. It happens at a state level, which is why we see monumental failure in NSW health under Labor governments. It is why we see huge problems in Queensland health with outrages like the Doctor Patel case; with money being diverted away from front-line services into IT systems. It is because the Labor Party has no interest outside of the union movement. That is why there is such a big divide between the modern Labor Party and people in outer metropolitan areas and people working hard in rural and regional areas.

We know it was demonstrated at a federal level over the course of the last six years, because the Labor Party built up the numbers in the health bureaucracy. Why? Not because they wanted to deliver additional services to regional areas or remote or Indigenous communities, but because they wanted to please union bosses in capital cities. That is what happened. Not only did they build up the numbers in the federal bureaucracy; they also built the number of agencies up to 21—that is, 21 outside agencies attached to the health department in addition to the additional bureaucrats. What did that do? It starved money from rural and regional areas. That is what happened under Labor's watch. So we are not going to sit here and be lectured to by some second-rate shadow minister who cannot get a question up in question time.

If you look at what we have done since we have come to government, we have increased money in this budget, in the health portfolio, each and every year. The Labor Party is running around trying to run some scare campaign—saying that we are taking money out of hospitals or we are taking it out of the MBS—but the opposite is the case. We are increasing the amount of money that we have put into public hospitals across the country. We are increasing the amount of money that we put into the MBS across services, and we are doing it in a sustainable way. That is the big difference between those opposite and those people on this side of the parliament. These people who are representing regional areas come from real backgrounds not from ivory towers in every union office across the country. They are people who have come from the land. They are people who have worked hard in small business. They are people who have employed other Australians and they have accessed those health services in regional areas. That is why they will always have more passion about rural communities than those people opposite, who pretend that they have interests in rural and regional areas.

When you look at the facts of what we are doing in relation to rural and regional health, let me say to you: this government promised, as part of the election commitment, $40 million over four years to create additional intern training capacity in private hospitals—and rural and regional focus in particular—76 interns already trained in 2014. We have provided $13.4 million to an additional 500 scholarships for nursing and allied health professionals, targeting rural professionals. We have provided $238 million over four years to double the practice incentive payment for teaching and general practice. We have provided $52½ million for infrastructure grants to build on teaching and supervision, where? In the rural and regional medical workforce. That is the focus of this government. That is what makes Minister Nash in the other place a very effective Assistant Minister for Health. That is why we have put additional money including into the Royal Flying Doctor Service. Labor was building up bureaucracies in Canberra to please its Labor bosses and its puppet masters while it was taking money away from rural services. We have put $6 million into the Royal Flying Doctor Service to enable it to increase the services it provides to rural and remote locations. We have undertaken to have a look at the classification scheme so that, wherever possible, we can get more doctors and allied health professionals out of capital cities and into regional, rural and Indigenous communities. We are committed to those outcomes. What did the Labor Party do? It built up to 21 outside agencies—it is unbelievable when you contemplate it—all with separate administration and leasing, all with cars, all with PR people, all with accountants and with all their overheads. It was taking money away from the capacity of government to be able to make the sorts of investments that we announced in the budget and in the lead up to the last election.

They can be no choice for people in rural communities at the next election, because this government has demonstrated its commitment, which failed Labor over the course of its six years in government. People not just in the cities but in the bush know that this is a government that will get on with getting money back to frontline health services. We increase money going into hospitals in New South Wales, Victoria, Queensland, WA, South Australia, Tasmania, the ACT and the Northern Territory over the course of the forward estimates and we are very proud of that. We are very proud that that includes putting money into regional areas. In this year's budget we allocate $13.8 billion to hospitals across the states and territories. By 2017-18 that figure will have grown to $18.8 billion. That is an increase from 2013-14 to 2017-18 of just over $5 billion. That is a 36 per cent increase.

Photo of Ewen JonesEwen Jones (Herbert, Liberal Party) Share this | | Hansard source

That's a lot of money.

Photo of Peter DuttonPeter Dutton (Dickson, Liberal Party, Minister for Health) Share this | | Hansard source

My friend the member for Herbert says that it is a lot of money. Yes, it is. It is a lot of taxpayer's money. People have worked hard for it. We are not putting it into bureaucratic structures here in Canberra to please union bosses. We are putting it into practical programs on the ground that will help doctors, nurses and allied health professionals see patients. We are putting money into telehealth. We are putting money into stroke care. We are making sure that people in regional communities can see specialists through outreach programs. We can make sure that where specialists will not travel to regional communities we can provide those services via telehealth programs. That is what this government has done. That is what this government will continue to do through the wise investment of taxpayers' money. We will not be lectured by union bosses absolutely dominated day and night by those who sit outside this place, who pull the strings. We will get on with helping people in regional communities. The Labor Party failed for six years. (Time expired)

3:40 pm

Photo of Joel FitzgibbonJoel Fitzgibbon (Hunter, Australian Labor Party, Shadow Minister for Agriculture) Share this | | Hansard source

I do have a degree of respect for the Minister for Health but that was one of the worst contributions to a matter of public importance that I have seen in my more than 18 years in this place. I grant him that he did not have much to work with, obviously having been so comprehensively rolled by the ERC and cabinet on so many occasions. Nothing else could explain his paltry contribution to this debate, if you can call it a debate. In a debate, no matter which side you sit on, you have to accept that others on the opposite side may have some points to make. The minister made no points whatsoever. He spent most of his time getting stuck into the trade union movement. What that has to do with this debate remains beyond me. When I think of the trade union movement within health services I think of ambos and nurses, who rely upon their unions to ensure their conditions and wages are maintained.

We do not have the speakers list from the other side. It will be interesting to see who comes to their feet. There are only two choices for people from rural and regional seats, seats like that of the member for Capricornia, who is in the chamber. I count the member for Bass in that category as well. Even the member for Macquarie I count in that category. Will they speak or will they run? They have two choices. They have to come in here and defend the indefensible or run. It will be interesting to see whether they run and it will be interesting to see whether all those other regional and rural National and Liberal party MPs—

Mr McCormack interjecting

I did not see the member for Riverina sneaking across to the other side of the chamber. Of course I include him in that category, as I do the member for Lyne, who also is in the chamber. Let me tell them this: they will wear the abandonment of their seats around them like a crown of thorns all the way to the election. To paraphrase Paul Keating, there will be no early exit for any of them; we will pursue them slowly all the way to the next election. It will not be just the member for Bass and the member for Lyne but the member for Braddon, the member for Page, the member for Eden-Monaro and all those others in relatively marginal seats, who have completely abandoned their constituents.

Those on the opposite side, particularly the minister, do not seem to understand the difference between health in the capital cities and health in the bush. In the capital cities, of course, you have plenty of hospitals. You have plenty of GPs. That is why bulk-billing rates are so high, because GPs enter into competition for patients. You have plenty of nurses, although we can always have more. There are specialists galore. In the bush we go to Sydney too often—that is, if you live in New South Wales—to visit a specialist. Just as importantly as all of that is that we travel a long way to get to them. In the bush there are fewer GPs, fewer hospitals, fewer specialists and fewer nurses and it usually takes us a long time to access them. These things have always been taken into consideration by governments of all political persuasions when developing health policy.

Sadly, this government has abandoned those conventions. Not only has it cut the health budget generally but it has imposed a number of new savings initiatives which will fall disproportionately and adversely upon rural and regional Australians. The $7 GP tax of course does not apply just to GPs; it applies to a range of health services and is a perfect example of a savings measure which will fall disproportionately on those living in rural and regional Australia. The changes to the Pharmaceutical Benefits Scheme will fall more heavily on people living in rural and regional Australia. These are issues not canvassed by the minister in his contribution this afternoon. In fact at no point did he acknowledge that the way we deliver health services in rural and regional Australia is different from the way we deliver health services in the cities. They have taken the Medicare Locals, which in my area at least, have made an enormous contribution to closing that gap, enormously addressing GP to resident ratios. But I have got a very bad feeling: we will see no rural and regional member from that side contribute to this debate. (Time expired)

3:45 pm

Photo of Andrew SouthcottAndrew Southcott (Boothby, Liberal Party) Share this | | Hansard source

In listening to this speech, we get a very clear idea of the opposition's motive here as we listened to a lot more about the National Party and nothing at all about regional health. With the indulgence of the House, I think I might speak on rural and regional health in this MPI. This looks like nothing more than a wedge. It is the sort of thing that Simon Crean used to specialise in.

But let us talk about regional health. Let us compare and contrast. The previous Howard government from the moment it was elected had a strong focus on rural and regional health. There were the John Flynn Scholarships to encourage people from regional backgrounds to go into medicine. There was looking at changing the way universities did their entry criteria so that more people from rural backgrounds would go into a course in medicine. There was the experience in my electorate, for example, of Flinders University which established in the mid-90s a parallel rural curriculum and showed with an evidence base that instead of a teaching hospital you could actually do your training in a rural general practice. This was built on by having university departments of rural health and then from 1998-1999 rural clinical schools. You just have to look at Townsville, and James Cook University where we now have a rurally based clinical school with a reputation for excellence in the area of tropical health where the students are coming, by and large, from a rural and regional background and looking towards a career in rural and regional health. That is the sort of transformation that we have seen. Look at the Prime Minister when he was Minister for Health. He realised that we did have a shortage, a workforce issue, in rural and regional areas. He doubled the numbers of medical students going through and doubled the numbers of nursing students. Then there is in the area of mental health. We expanded the access to mental health through Medicare. We also had a program, the ATAPS program, which meant that people in regional areas were able to access a fund and get access to psychologists and allied mental health services which previously had not been possible.

Compare and contrast that with the approach the Rudd government took. We had a big National Health and Hospital Reform Commission and one of the recommendations that came out of that was activity based funding in public hospitals. Kevin Rudd, Prime Minister, grabbed it—a fantastic thought bubble—saying that we were going to have activity based funding in every public hospital in Australia. Wrong. Big problem. Anyone with any knowledge of health policy understands that activity based funding, while it is a great policy in metropolitan areas and metropolitan hospitals with high workloads, does not work in those rural hospitals which have seasonal fluctuations and much smaller caseloads. Thankfully, the Labor Party did see sense on that and realised that Kevin's thought bubble was not long-lasting.

So when we look at the state of play in Australia right now, we have 18 medical schools and a number of them were opened during the period of the Howard government in regional areas. We have seen the numbers of doctors graduating increase from 1,660 in 2000 to 3,469 in 2010. We see that spending on rural health workforce programs is more than $1 billion. The Abbott government has been in for one year and already they are looking at addressing all of the areas that we need to in rural health. They are looking at increasing the funding for general practitioners who do teaching, through the PIP, and there is a loading for people in rural areas and, instead of having the dopey GP Super Clinic program, actually encouraging in regional areas to increase their infrastructure for teaching with 500 additional scholarships for nursing and allied health students. They are also looking at expanding medical internships in non-traditional areas. We have expanded the numbers of GP training places by 300 for next year—from 1,200 to 1,500.

These are the real and tangible things that are happening. There is no doubt that the health of Australians in rural and regional areas is not as good as in the rest of Australia. There is no doubt that the workforce needs to be better. There is more to be done but we have got a good track record and we are continuing with the job.

3:50 pm

Photo of Sharon ClaydonSharon Claydon (Newcastle, Australian Labor Party) Share this | | Hansard source

It is with pleasure that I join my Labor colleagues to address this issue concerning the government's broken promises and their failures on rural and regional health. I welcome the contribution from the member for Boothby just a moment ago and I would like to return to the issue of some of the health workforce issues.

It is undeniable that the Abbott Liberal-National government is failing people in rural and regional Australia, and their supposed representatives in this government—in particular, the National Party—have gone into hiding. We have watched them hide from their budget plans as those plans went from bad to worse. But when it comes to health policy, the evidence is especially damning. It is not just Labor Party people saying this. In case members opposite want to chant their usual retort about 'scaremongering' and 'whipping up a storm', I would just like to share with the House a few comments from people working in this area, some experts. The CEO of Services for Australian Rural and Remote Allied Health, Rod Wellington, said:

This budget will exacerbate the key inequities in health coverage outside urban Australia …

He could not be more right. The Vice-President of the Rural Doctors Association of Australia, Dr John Hall, had something to say too. He warned us:

The new arrangements will only make it much more difficult for rural Australians, who are among Australia's poorest people, to afford healthcare …

The real danger is that many of the poorest rural patients will choose not to see a doctor for preventative healthcare, and will then present in subsequent years with serious health issues that will cost the health system and hospitals significantly more to treat.

That is exactly what we are trying to avoid. This government has misunderstood the health needs of rural and regional Australians. Compared to people living in major cities, we know that people living in rural Australia are far more likely to be affected by chronic diseases and illnesses. We have already heard that they are more likely to have melanoma, serious injuries and obesity. And if you are a man, increased risk suicide is a really serious issue. But this government has nothing to say about the issues in this space.

To make matters worse, we know that the out-of-pocket health costs in rural Australia are significantly more. We know that people are earning less money in regional Australia and access to any form of health care is more expensive and takes more time. Any additional obstacles that this government puts in the way of regional Australians just increase the difficulties and the inequities which already exist in our health system. The actions of this government—the ongoing broken promises—are just making it that much tougher for rural Australians. When we look at the budget cuts that have come down from this government we already know that the Hunter New England Health service in my electorate is set to lose more than $156 million in funding over the next five years.

This Prime Minister will remember well the leadership debates at Rooty Hill where he stood up and said:

We are not shutting any Medicare Locals.

He could not be clearer—no ambiguity whatsoever: 'We are not shutting any Medicare Locals.' I have got news for members opposite. There are 61 Medicare Locals all around Australia—a great Labor initiative—under threat of having their doors closed. Medicare Locals—there is one my electorate—have been the pioneers of GP access after hours. It is a model that this government should roll out across the nation. You want to shut the doors on that? There is not a single family or senior person in Newcastle who does not sing the praises of the after-hours GP access service provided by Hunter Medicare Local. But no. This government is going to shut those doors. They are going to rip out all of the infrastructure currently in place in regional Australia to deliver primary health care. Shame on you!

3:55 pm

Photo of David GillespieDavid Gillespie (Lyne, National Party) Share this | | Hansard source

The opposition appear to think they have a mortgage on doing anything good in the health portfolio. I would just like to remind the House of their track record. In the Treasury portfolio, they inherited a $20 billion surplus and $45 billion in the bank. At the end of the June quarter, there was $319.473 billion in government securities for the nation to pay back. Their legacy in health, apart from what they alluded to before, is a lot of ballooning bureaucracy and broken promises—an incredible waste.

The previous speaker mentioned the wonderful Medicare Locals. They inherited a $1.8 billion budget and managed to spend 40 per cent of it on bureaucrats and buildings. The Divisions of General Practice Network were just washed away and consumed into this overwhelming bureaucracy. At the opening of the Medicare Local in my electorate, when I was a practising doctor, the CEO walked in and said, 'We've got a $20 million budget. We'd like you to tell us what we should do with it.' Talk about too much money and no idea about what to do with it! That was just a classic Labor Party thought bubble. But the thought bubble grew so big that it became a $1.8 billion thought bubble. Not only did they increase that bureaucracy, but there were 11 other bureaucracies and a 27 per cent increase in bureaucrats. About 64 GP super clinics were promised.

In my electorate, in the town of Port Macquarie, we have had a super clinic for over 20 years and there were no government grants involved in that. They made a promise and allocated $7.5 million for a super clinic in Port Macquarie in 2010. But two private ones were designed, built and have been operating for three years and that $7.5 million is still involved in turning an old hotel, which had been a nursing home, into a whole new super clinic. So four years later we have all that capital tied up. Imagine the drugs for rare diseases or for ground-breaking cancer treatments that we could have approved and paid for with $7 billion—let alone the $650 million program.

They attacked private health insurance at every opportunity—the trouble is that there are 11 million people in this country who depend on it—whether it be removing the indexation, introducing means-testing or removing the lifetime health cover rebate. They introduced the co-payment system for the Pharmaceutical Benefits Scheme. They have been supporting it for 25 years and now, when we are trying to keep it sustainable by increasing the cost by 80c for a pensioner and $5 for non concession card holders, they are opposing it. It is gross hypocrisy. The shadow minister for health walked out when this debate on a matter of public importance started. At least our Minister for Health stayed here. We have an Assistant Minister for Health, Fiona Nash, who resides in the other place—that is the only reason she could not be here: she is a senator—and she does a damn good job. She grew up in the regions. She knows what it is like.

So what are we doing? We are making the health budget sustainable. Health funding is being increased from $64 billion in 2013-$14 to $75 billion by the 2017-18 budget. In New South Wales, for instance, it will increase each year from $4.6 billion in 2014-15 to $5.9 billion in 2017-18. Look at the Medical Research Future Fund. That will be a great legacy for the country. The clever accountants in the Labor Party pulled a swiftie on the medical research community and withdrew $400 million in 2011 by funding things in arrears rather than prospectively. How sneaky can you get? You try to make out you have not cut anything, but you move things around in the budget and—bingo: you have saved yourself $400 million. They are all going quiet now, aren't they? We are trying to make Medicare sustainable. It has gone up 122 per cent and we have to make it sustainable. (Time expired)

4:01 pm

Photo of Lisa ChestersLisa Chesters (Bendigo, Australian Labor Party) Share this | | Hansard source

I would also like to highlight the appalling speech made by the Minister for Health in this debate. He attacked hardworking health professionals; he attacked our ambos; he attacked our nurses. I am not surprised that there is a Liberal in this place attacking our ambos, because they do it every day in Victoria. Their state government has failed to negotiate a decent agreement with decent working conditions for the Victorian ambos. Their Code Red campaign has been ongoing because the state Liberal government has failed. I am not surprised to hear the health minister not only attack this MPI but make a personal attack on people involved in the health sector. I am not surprised because, when he was the shadow health minister, he came to Bendigo but did not talk about health. He did not let people in Bendigo know that he would introduce a GP tax. He did not let people in Bendigo know—and here is a fact—that he would cut $25 million from Bendigo Health. He stood up in front of a Bendigo Health sign and talked about the carbon tax. He did not talk about health care of central Victorians; he spoke about the carbon tax.

When the then Leader of the Opposition, today the Prime Minister, went around talking to patients and tweeting a photo, he did not say that, when he became Prime Minister, he would oversee a budget that would rip millions of dollars out of health care in regional Victoria; he spoke about the carbon tax. That is the twisted priority of the government. They do not care about people in the bush and they continue to punish people in rural and regional Australia. That is why we have not seen many speakers opposite from country electorates, whether they be country Liberals or country Nationals, stand up and speak on this MPI about regional health.

On this side, we know that regional health is a big issue. People living in the regions are 1.3 times more likely to report with diabetes, they are 1.2 to 1.3 times more likely to get melanoma, they are 1.2 times more likely to suffer serious injury and they are 1.1 times more likely to be obese, particularly in regional Victoria and my part of the world. Funding which was going towards preventative healthcare programs has now been cut—another cut because of this government.

I know I am not alone in raising these facts because the member for Mallee himself, one National Party member who does occasionally speak up for his electorate, stood outside this place, not inside, and said that people in regional Victoria, in his part of the world, have a life expectancy 4.7 years lower than their city counterparts. Yet, rather than address that life expectancy issue, what we see from this government are more and more attacks on regional healthcare services. This government does not have a plan for regional healthcare services; all this government does is attack and cut. We have seen regional health professionals standing up and speaking out, and this government has no way to respond to them. The GPs of Castlemaine have spoken out several times and they have written to the Prime Minister asking him to reverse his plan for a GP tax. To this date they are still waiting for a response. The government not only does not have a decent plan for improving regional health care; it is also not responding to constituents and people working in the sector.

One of the main reasons these GPs are so concerned in regional Australia, particularly Victoria, is that these GPs are on call for urgency care units—not emergency care units, where the doctors are paid by the state government, but urgency care units, which are staffed by regional doctors. Some who work in private clinics, some who work in bulk-billing clinics and some who work in GP superclinics are on a roster and they staff these urgency care units. What this government is doing to those doctors is that, every time somebody presents at an urgency care unit, it is expecting these doctors to be the tax collector and collect $7. It will put these urgency care units at risk. For some of these patients, their urgency care unit is two hours away from another hospital. This government is forcing those families to make a choice: do they go to the urgency care unit, which may not be open because it has been closed due to this government's policies, or get in the car and drive for two hours? Let's remember: they do not have any ambos because of the state government's inability to train and invest in a workforce and establish fair rostering for our ambos.

This government should finally stand up for regional health. This government should have a plan for regional health. This government should stop attacking unions and attacking people standing up for regional health and do the right thing. (Time expired)

4:06 pm

Photo of Louise MarkusLouise Markus (Macquarie, Liberal Party) Share this | | Hansard source

It is with respect that I suggest that the member for Bendigo may need to have her hearing checked, because her claims with regard to what the Minister for Health said were absolutely false. I am astounded that Labor can rise to speak in this place about these apparent failures. They have short-term memories when it comes to how the coalition government left the economy in 2007 and how drastically the economy deteriorated under Labor's short tenure. The member for Throsby has been quite busy lately visiting the electorate of Macquarie, rallying the public on the issue of health again, sidetracking the public from the woes they left behind and interfering with what this government is required to do to fix them. Labor have been and will always continue to be out for the media grab or a deflection from their own broken promises and failures.

Firstly, let me remind the House of some—given I only have a few minutes—of Labor's broken promises. With superclinics Labor promised 64, but what did we get? Thirty-three. Labor promised no cutting of the private health insurance rebates. What did we get? Four billion dollars worth of cuts in that space. I would like the member for Throsby to explain that to the 56,000 people in the electorate of Macquarie who have private health insurance. What would you say to them who now struggle to pay their private health insurance? New medicines already referred to by the PBAC—what did we get under Labor? Deferred. Labor tried to take $400 million from medical research in 2011 and then reversed their stance at the last moment. One hundred and forty million dollars was taken out of medical research last year using tricky accounting, hiding it in a budget that paid the National Health and Medical Research Council funding monthly in arrears rather than quarterly in advance.

In contrast, in just one year the coalition has worked to act on what we committed to prior to the 2013 election. First, this government is committed to ensuring we spend precious health money in the most efficient way, ensuring each dollar is spent on improving patients' outcomes. This was not the case under Labor; they created more than 10 new health bureaucracies instead of putting more doctors and nurses in front of patients.

In relation to pharmaceuticals the previous government deferred already recommended PBS items. In contrast, since stepping into government the coalition has listed 221 and is listing medicines twice as fast as Labor. We are listing in excess of 20 medicines each month in contrast to Labor's average of eight. Back to medical research: instead of last-minute flips and tricky accounting, this government is taking measures that will see medical research taken seriously in Australia, with the recent announcement of a $20 billion medical research future fund.

Budget papers do not lie and, in spite of Labor's continuous scaremongering, including in the electorate of Macquarie, health and hospital funding is increasing each year over the forward estimates. In New South Wales hospital funding will increase each year, from $4.6 billion in 2014-15 to $5.9 billion in 2017-18. In rural health, where the member for Throsby says we have broken our promises, the coalition government is investing $40 million over four years to create additional intern training capacity, $52.5 million for infrastructure grants to build on the teaching and supervision of the rural and regional medical workforce, $13.4 million to provide 500 additional scholarships for nursing and allied health professionals and $238 million to double the practice incentives payment for teaching and general practice.

October is Mental Health Month I would like to finish by speaking on the coalition's investment in this area. With three-quarters of all mental illness manifested in people under the age of 25, the coalition government is supporting people experiencing mental health issues by expanding the highly successful headspace network by an additional 10 sites, taking total to 100 sites across Australia by 2015-16. We are also investing $80 million over four years to establish a national centre of excellence in youth mental health and are providing $5 million over three years in funding to the Young and Well Cooperative Research Centre. This government is focused on delivering real outcomes while ensuring sustainability for the future.

4:10 pm

Photo of Justine ElliotJustine Elliot (Richmond, Australian Labor Party) Share this | | Hansard source

I am very pleased to be speaking on this MPI on the government's broken promises and failures in rural and regional health, because there are so many broken promises. It has been interesting listening to the contributions from the other side. I do not recall any of them talking about the GP tax. All of those speakers from the Minister for Health to all the backbenches. I particularly note the member for Lyne not once in his contribution mentioned the $7 doctor tax. I wonder what the good people of Lyne—the people who are severely impacted by his support for such an unfair, cruel and unjust tax—think of that. It is fascinating. None of them were prepared to defend any of their harsh and cruel actions. We will certainly outline some of them. You have heard some of the harsh actions outlined today by the speakers on our side.

The fact is this government has a trail of broken promises across a huge range of areas, and for regional areas those cuts to health are some of the very cruellest. The fact is that the Liberal-National Party is continuing to punish people in regional and rural Australia. In fact, it is the Nationals who are responsible for these cruel cuts to health. Indeed, the cruellest cut is probably the $7 doctor tax, which makes it so much harder for people in country areas to actually access health services. It is one of their many, many broken promises.

The fact is that in rural and regional Australia out-of-pocket health costs are higher, and they will only increase with this government's unfair policies. Indeed, another broken promise was about Medicare locals. We have spoken about that today as well. This will have a huge impact on regional areas because Medicare locals have been very effective particularly at coordinating a lot of different services in rural areas that did not have that before. They have been able to provide great services where there were gaps before. Of course it is another broken promise. I refer to this wonderful book about the Abbott government's broken election promises—there are so many. This book refers specifically to health, but there are many listed. We return to 28 August 2013, when the Prime Minister—the then Leader of the Opposition—said, 'We're not shutting any Medicare locals.' What happened? They broke that promise. All 61 Medicare locals will be axed. This is devastating for regional areas. Not many from the city electorates over there would understand, and we know the regional ones do not care. Medicare locals actually do an incredibly important job in our rural areas, so we certainly need to have them in place.

As we have heard other speakers say today, people living in rural and regional areas have some of the very poorest health outcomes. Incomes are low, and we know that chronic disease rates are much higher. There is also a higher proportion of Indigenous population with poorer health conditions. Access to health is more expensive, and there are also far greater distances in regional areas. That is why other broken promises like the petrol tax are devastating; people have to travel further in regional areas. So that is another broken promise that impacts people.

As I have said, people in regional areas have poorer health outcomes. Despite all of this, the Abbott government's first budget really declared war on Medicare. It really was horrendous. Introducing the doctor tax for all patients will cost over $1.4 billion to communities living outside metropolitan centres, and those rural and regional patients will be charged over and over again when they see the doctor, when they fill their prescriptions and when they get scans, X-rays and blood tests as well. That, on top of the increases to PBS medicines, will just mean that people from these regional areas will not access healthcare services. That is what your government has done. People from these areas just will not do it. That is what they are telling us. They simply cannot afford it.

But let's compare all of that—all that devastation, all of that harm, all of those hurtful policies—to what Labor did when we were in government and the great changes we made.

We have a very proud record when it comes to health reform. Firstly, we are the party that introduced Medicare 30 years go—and we are very proud to be defending it today. We also made great advances, when we were in government, getting GPs to rural and regional areas, and increasing bulk-billing rates to the highest level in history. That is a great achievement. Labor lifted the bulk-billing rates to over 82 per cent, on average.

When the now Prime Minister was health minister they were as low as 67 per cent. That is pretty low. We also heard some great achievements—like the GP superclinic in my electorate, which is fantastic. It was funded, built and delivered by Labor, and it provides a great variety of allied health services. So we will always fight to ensure that there are great health services in our regional areas. But the biggest attack on future health and hospital services in rural and regional areas comes from the National Party. It comes from the National Party because they are out there with cruel policies like the doctor tax. They are pursuing the funding cuts in hospitals and they are devastating regional areas. (Time expired)

4:15 pm

Photo of Andrew LamingAndrew Laming (Bowman, Liberal Party) Share this | | Hansard source

This debate is about people living in the bush. It is about the practitioners and providers that deliver world-class health services to one of the most sparsely populated places on the planet. If you are in this chamber, on either side, I know that you fundamentally support the great work that they do. But I will tell you one thing about people from the bush—they know bulldust when they see it. They know talking-point ping-pong when they see it. And I will tell you what they want—they want us, down here in Canberra, fully focused and fully committed to better services in the bush.

In the six years of Labor government there was plenty of money spent but not a lot of change on the ground. We have come to government with a very different focus, and that is to listen to the people on the ground. We will listen to the rural doctors; we will listen to the rural health agencies that were here even last week—the rural health networks that tell us what people in the bush want.

As we have one of the truly sparse places on earth, with the finest health system in the world, we need to listen to the rural doctors and ask them how they do it, and we need to make their jobs easier. Nothing is achieved by screaming at each other down here in Canberra. The rural doctors have released Think rural, with 10 recommendations. I will run through them very quickly. The first of them is to sort out training for interns, registrars, house officers and medical students, and make sure that we provision for them. The coalition have put in $40 million over four years to get those internships funded, when the Labor government over the last six years simply dithered at the challenge.

We need specific ways of identifying the truly committed and impassioned health clinicians who want to be rural docs. We need to identify them early and get them started. And we need an advanced rural training pathway, acknowledging that the job of a doctor in the bush is completely different to the job of an urban doctor. They do a completely different job, as many overseas trained doctors learn to their chagrin. We need to have a specific training pathway for them.

We need to know that overseas trained doctors, who have committed to this beautiful country and have moved to one of the most remote parts here and set up practice, can have their kids going to a state school, that they still get coverage under Medicare and that we will look after these new citizens and respect them as equals, as they have been adjudged by the Medical Council. Because they are just that—they are the backbone of rural health service provision in so many areas where we cannot get an Aussie trained doctor to work.

We need to have the infrastructure. The general practitioners in the bush will tell you that they have nowhere to accommodate the medical students. That is why we need to have practice incentives—$238 million over four years—that partners do that with the $52 million of coalition money matching, dollar for dollar, the commitments by rural practices. No, we are not having pop-up superclinics around the country right next door to existing general practice. We are doing it where general practices put in 50 per cent of the amount.

Lastly, we want to see some recognition of incentives to go bush. If someone commits to working out in Camooweal they deserve a little bit more than someone who lives on the Queensland coast. We need to recognise those GPs who invest their lives in the bush.

I just want to say thank you to the docs who head out there and do that great work, and thank you to the nurses, who know their towns backwards. I want to say thank you to the allied health practitioners, who drive hundreds of kilometres every week delivering their expertise to communities that cannot support a single professional with their skills. I want to thank those who take out private health cover, who fund the system that builds the hospitals of the future. Thank you to the half of the Australian population, who, because they can pay for their private health, do just that. I want to say to CEO Gordon Gregory and Chair Tim Kelly from the National Rural Health Alliance: thank you for coming down here and giving us your views, not just on the future of Primary Health Networks, which you understand can do the job, but also on the importance of an adequate NBN so that these practices can do their job—they can work in telehealth so that the education reforms that we are proposing will release more, not fewer, highly qualified health providers to the bush.

I know that they are fully committed to dental services being delivered, and they are committed to seeing them delivered by private dentists. We know that 98 per cent of dentists work in the private sector, and no matter how much those on the other side of the chamber have an aversion to private services, if you do not have private dentists on board it ain't gonna happen.

I thank the National Rural Health Alliance for putting their views so clearly. We could do far better spending this time in the chamber listening to those expert bodies, listening to Jenny Johnson and Dr Paul Mara from the Rural Doctors Association, because they are on the ground, looking after the local people. They know that those communities will support a small copayments to keep the health system running effectively. They know that the compassion of doctors is such that those who cannot afford to pay a copayment will never be asked to do so.

Photo of Bruce ScottBruce Scott (Maranoa, Deputy-Speaker) Share this | | Hansard source

Order! The discussion has concluded.