House debates

Wednesday, 17 June 2020


Health Insurance Amendment (Continuing the Office of the National Rural Health Commissioner) Bill 2020; Second Reading

5:39 pm

Photo of Chris BowenChris Bowen (McMahon, Australian Labor Party, Shadow Minister for Health) Share this | | Hansard source

The Labor Party will be supporting this bill, the Health Insurance Amendment (Continuing the Office of the National Rural Health Commissioner) Bill 2020. We will support it because it implements Labor policy. This bill amends the Health Insurance Act 1973 to continue the Office of National Rural Health Commissioner and expand its functions—in fact, this bill makes the office permanent. Under the existing legislation, the office will expire at the end of this month. As the House will recall, the Labor Party has long suggested that the role should be made permanent. The honourable member for Ballarat is in the chamber, and she made that view clear when she was Labor's health spokesperson. It has been our consistent position. In the debate on the bill which established this commission, through our spokesperson the member for Makin, Labor argued strongly that the many challenges in rural, regional and remote health could not be addressed in just three years, and that the commissioner's role should be a permanent one. The government has consistently rejected that argument, although we have moved amendments at various points to implement it. We are very glad that the government now shares our view.

In addition to continuing the office, the current bill expands the commissioner's functions. Until now, the commissioner has been focused on the establishment of the National Rural Generalist Pathway, a very important new program to train GPs and one that has our support. But the commissioner's role should really be more expansive than that. I particularly welcome the fact that the commissioner will now consider the entire health workforce, including, very importantly, allied healthcare professions like nursing. Allied healthcare professionals across the board will now be within the remit of the commissioner. I also very much welcome the fact that non-statutory deputy commissioners will be appointed to ensure a focus on nursing, allied health and, most importantly, Indigenous health. These are all welcome developments, so we will be supporting the bill. We note that this has come very late. The government has left it to the last minute to continue the role of the commissioner—it expires in just a fortnight. But I'm sure the Labor Party will be constructive in facilitating the passage of the bill through both houses of parliament to ensure that the role can continue as it should.

This also gives us the opportunity to focus on rural health in more general terms. While I am sure every honourable member would like to see health outcomes improve in rural and regional Australia, the Labor Party do have very real concerns about the way the government is going about this. This was a matter of some interest in question time today, when again the minister for regional health denied that there had been any bulk-billing cuts. He said there are changes to the maps—yes, but some areas have been taken out of the rural bulk-billing incentive scheme, and that is, for them, a cut. On Monday, I visited Queanbeyan with Labor's particularly outstanding candidate for Eden-Monaro, Kristy McBain. People in Eden-Monaro face the same challenges accessing health care as other people in rural Australia. They travel too far, they wait too long and they pay too much for health care. Queanbeyan is not a hamlet, it's not a small village, but nor is it a big metropolis; it's not Mosman, it's not St Kilda—it's not inner-city. It has real regional challenges.

The government's own figures show that people in Eden-Monaro paid an average out-of-pocket cost of $39 to see a general practitioner—that's up 30 per cent under this government. To see a specialist the average out-of-pocket cost is $96—up a staggering 50 per cent under this government. So one in eight people in the Eden-Monaro area are forced to skip Medicare services because they can't afford them. I asked the minister about this today, and he said there are no cuts. You'd think the government would actually want to make the position better, but they're making it worse.

The 2018 budget announced a number of changes and, again, everybody, I think, would have the intent of improving access to medical services in rural and regional Australia. It's a very important priority for me; I've made it a priority in my time in the portfolio. I've spent a lot of time going to rural and regional areas. That's one of the reasons why I'm so concerned about some of the government's impacts: because I've seen the impacts firsthand.

My last interstate trip before the restrictions came into place was to Maryborough in Queensland, where I visited a doctor's surgery impacted by the ROMPs changes of the government—the abolition of ROMPs. I asked at that doctor's surgery in Maryborough: how long would it take to see a doctor if I rang today for an appointment? If I was feeling unwell and I needed to see a GP, when could I see a GP? The answer was two weeks—two weeks before the people of Maryborough could see a GP. Some people will get better in those two weeks. Some will get a lot sicker in those two weeks. A lot of people will experience a lot of pain and discomfort in those two weeks. It's really not good enough, and yet the ROMPs changes have impacted on Maryborough and up and down regional Queensland and regional Australia.

On the bulk-billing incentives, which have impacted on Queanbeyan, the government initially claimed that just 14 areas were affected, but at Senate estimates we found out that there are actually 433 areas that have seen cuts. These areas have seen a 34 per cent reduction in incentive payments, down from $9.65 to $6.40—these are the cuts that the minister tries to gloss over in the parliament that are recurring.

In places like Queanbeyan, GPs have built their practices and their business models around these incentives. They've been told that they were there, and now they've been taken away. Many GPs say that this threatens their ability to bulk-bill and some say it threatens their viability altogether. Again, although it's a slightly different program, I have seen GPs' clinics closed in Maryborough. I went to one with a sign on the door—shut, closed down, gone due to changes in government policy. These things have real impacts on both availability and costs.

Kristy McBain and I visited the Queanbeyan GP Super Clinic on Monday. It opened in 2012, following a $5 million grant by the then Labor government—it's a very good clinic; I was very impressed with the set-up. But earlier this year the clinic announced it would have to increase its fees. It said there were two main factors: the government's long-running Medicare rebate freeze; and 'the removal of Queanbeyan from the rural and regional classification for bulk-billing incentives by the Commonwealth government'—their words, not mine. These are doctors with no political axe to grind—I've no idea how they vote; don't care. They're just calling it as they see it, and they see the impact of government policy. This is an area where already one in eight people skip Medicare services like GP visits due to cost, and the government is making it more expensive. Kristy McBain's called on the government to reconsider these changes, and I'd agree with her: the minister should be doing that.

The second change is the longstanding district of workforce shortage—it's a different program but very relevant. Doctors who trained overseas are in a bonded position in Australia and can only claim Medicare benefits in defined rural areas. The government's changed the system for defining those areas, and there can be a case for changing these things from time to time. I don't argue in this House that the DWS system was perfect. The intent of the new system indeed is one I agree with. I welcome the fact that the new system takes into account socioeconomic circumstances. That's sensible; that's compelling. But, again, they're having huge impacts and in many instances I can only assume that the impacts are unintended.

The areas that were district of workforce shortage are no longer in many instances the new distribution priority areas, and that's having an impact. For example, Yass—we heard a bit about Yass in the parliament today, Mr Deputy Speaker, you will recall, on a different matter—has struggled to attract and retain doctors even when it was a district of workforce shortage. That'll be tougher now that it's no longer a DPA. So the government is really letting down the people of Yass, and they're particularly letting down the mothers of Yass.

We asked the Prime Minister today whether it's acceptable for women to be giving birth on the side of the road on the way to Goulburn and/or Canberra hospitals, their nearest birthing hospitals, which is happening. The Prime Minister's answer was, 'That's why we're upgrading the Barton Highway.' I almost fell off my chair, I've got to say! I think honourable members on both sides probably did. I've been here 16 years. I've heard some weird stuff. That's right up there. That's right up there in the weird stuff I've heard from the mouth of a Prime Minister—to say that's the reason they're improving the Barton Highway. The member for Ballarat will point out that, actually, our policy is better for the Barton Highway than theirs. But, even giving them some credit for doing something on the Barton Highway, to suggest that that will help the women who are giving birth on the side of the road is weird. Are there going to be birthing lanes? Are there going to be little signs? What's the upgrade which is so relevant to giving birth on the way to Canberra and Goulburn hospitals?

The government should fund a new maternity ward at Yass hospital. I suggest that would be a better policy solution than upgrading the Barton Highway, which should be done but for different reasons. Two hundred mothers a year from the Yass Valley are currently forced to travel to Canberra or Goulburn to give birth. Too many of them don't make it in time and give birth on the side of the road.

In conclusion, again, I understand the intent of the government's rural health strategy. The intent is one that I am very focused on, and it will be a very strong element of Labor's policy at the next election. But we will hold the government to account for the impact of their changes on regional Australia, wherever they be. Up and down the coast, in different areas, they're having a negative impact. They need to be accountable for that, and we will hold them to account. That's why I move:

That all words after "That" be omitted with a view to substituting the following words:

"whilst not declining to give the bill a second reading, the House:

(1) expresses its concern at the Government's cuts and changes to regional health; and

(2) calls on the Government to reconsider those measures".

I commend this second reading amendment, and the bill, to the House.

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

Is the amendment seconded?

Photo of Warren SnowdonWarren Snowdon (Lingiari, Australian Labor Party, Shadow Assistant Minister for External Territories) Share this | | Hansard source


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

Thank you, Member for Lingiari. The original question was that this bill be now read a second time. To this, the honourable member for McMahon has moved as an amendment that all words after that be 'That' be omitted with a view to substituting other words. If it suits the House, I will state the question in the form that the words proposed to be omitted stand part of the question.

5:52 pm

Photo of Warren SnowdonWarren Snowdon (Lingiari, Australian Labor Party, Shadow Assistant Minister for External Territories) Share this | | Hansard source

I want to thank the government for allowing me to speak now, because I'm supposed to be at the Privileges Committee—not as a subject! So I give my apologies. I won't be long. It gives me great pleasure to support this legislation, the Health Insurance Amendment (Continuing the Office of the National Rural Health Commissioner) Bill 2020. As the shadow minister pointed out, we're pleased to do so despite the fact that it's a belated arrival at this point by the government. I think that the position of this Rural Health Commissioner is extremely important and note the changes that have been made in the context of the functions of the commissioner under this legislation.

It's worth actually reflecting upon them. I won't go through all of them, but some are as follows: to provide advice to the rural health minister; to develop, align and implement Commonwealth strategies—as you'd expect; to develop and promote innovative and integrated approaches to the delivery of health services; to identify opportunities to strengthen and align health workforce training; to strengthen and promote regionally based, patient-centred approaches to the delivery of health services to those areas that take into account the needs of communities, families and individuals in those areas; to undertake research and collect, analyse, interpret and share information about a process for improving the quality and sustainability of access to health services; and to consult with the following persons and groups: health professionals, state and territory government bodies, industry, non-profit and other community groups and other health stakeholders.

I want to make some observations about that because, in the context of my own electorate, and given my own knowledge and understanding of Aboriginal health and the role of Aboriginal community based health organisations in the delivery of primary healthcare services across this country, most particularly to regional and remote communities, it is important that we see the priority that should be given to ensuring that the consultation, which is referred to here, includes working with Aboriginal community controlled health organisations and their communities. I say that for a range of reasons, the most important being that they're the fundamental drivers of change in the delivery of primary health care in the bush. In my own communities, we're talking not about one or two health services; we're talking about a range of health services that work across the Northern Territory.

I was actually driven to write a few of these organisations down today just to check how many of them there are, but it is quite a large number if you include Nganampa Health Council, which is the community based health organisation that works in the APY Lands of South Australia, and if you then go to the primary healthcare delivery organisations in the Northern Territory working not only in Alice Springs but also in Darwin, Katherine and Tennant Creek. There are organisations such as Danila Dilba in Darwin, Central Australian Aboriginal Congress in Alice Springs, Anyinginyi Health Aboriginal Corporation in Tennant Creek and Wurli Wurlinjang in Katherine. There are organisations such as Miwatj Health, which provides primary healthcare services to all the major communities of large areas of north-east Arnhem Land. Then, if you look at the work that is being done by other health services, there is Ampilatwatja Health Service, the Utopia health service, the Pintupi Homelands Health Service, Katherine West Health Board and Sunrise Health Service, and the list goes on.

If you had any understanding of these organisations, what you would note about them is that they are fundamental to changing lives and to making sure that the life outcomes for Aboriginal and Torres Strait Islander people are a lot better than they have been. But it requires dedicated purpose. It requires ensuring that investments are being made in rural and remote health. In the context of this legislation, it requires looking at the role of the Rural Health Commissioner to reinforce the value of the role and make sure the commissioner has the resources that are required.

I say that in the context of the COVID pandemic and the issues that have confronted people right across this country. And I point out that, given the role of these Aboriginal health services, working in conjunction with the public health officials of the Northern Territory government, and the work of the Northern Territory government's own health clinics in remote parts of this country and the work that is being done in a policy sense by closing the Northern Territory borders and working with the federal government, using the Biosecurity Act to prevent travel into remote communities, it has been 72 days since there has been a COVID case in the Northern Territory and 28 days since the last patient recovered in the Northern Territory. That's phenomenal when you think about the potential impact of this virus on remote communities. The member for Durack would understand what I'm talking about. I know, Madam Deputy Speaker Claydon, you'd be fully aware of what I'm talking about. Given the poverty that strikes at the heart of many of these communities—the overcrowding in housing et cetera—it was anticipated that there would be, and there was contingency planning done around, a very, very dramatic impact of this virus on the bush. In fact, in the Northern Territory, I'm not sure that we've had any case of an Aboriginal person getting COVID.

I know of the enormous amount of work that is being done by the health services—not only the Northern Territory government's own health services but also, most importantly, the Aboriginal primary healthcare providers, the ACCHOs—to ensure that there are proper pandemic plans for every community. I've seen some of these pandemic plans, and they involve the communities integrally. When we look at those, and we know how much we rely upon these Aboriginal community controlled organisations and indeed public health generally in the bush, we are taken to the question of ensuring we've got the health workforce able to deliver the services.

One of the issues that has bedevilled remote communities in rural health in this country for many years has been the capacity to attract and retain public health professionals. I want to point out that the dedication and longevity of the Aboriginal community controlled health organisations and some of the public health offices in the Northern Territory that I am aware of have been really important in achieving the outcomes across the public health domain. But when we acknowledge the importance of the work which is being done in the COVID space, we've got to appreciate that this is effectively a partnership between the Commonwealth government, in this case, and the Aboriginal community controlled health organisations to achieve this outcome, and it's to their great credit.

The work which is being done by the Northern Territory government—by the Chief Minister, Michael Gunner, in his leadership and by the minister, Natasha Fyles, and her public health officials—with the NT Commissioner of Police in getting these plans put in place and protecting the Northern Territory community is monumental. To think that we haven't had a case in 72 days is monumental and really important. I understand there are people in this place who are bemoaning the fact that the Northern Territory government still has its borders closed. I can tell you that it's very strongly supported by a large section of the Northern Territory population. They can see the merit in ensuring there are not a lot of people coming into the Territory, and it's one of the reasons that we've been so successful. Of course that will change, I'm anticipating, over the next month or so. But lessons have been learned here.

We need to be understanding that, even though we haven't had a case in 72 days, there is contingency planning in the case that there may be an outbreak in the future. It's important, again, to understand that the people who have ventilated the views about this and developed the contingency planning are those very same organisations in partnership with the Northern Territory government public health officials, and this contingency planning is really important.

I've been regularly briefed by Northern Territory government officials, Aboriginal health services and public health around what's been happening. It's taken them quite a while, but it's very clear that they've developed very comprehensive contingency planning for the possible sad eventuality—and we hope it will never happen—of an outbreak of cases in one or two Aboriginal communities or a number of Aboriginal communities and how they might deal with that. Their response relies upon, as I say again, the professionalism and the expertise of the public health officers who have done all this work. We need to say thank you to them for continuing that work.

I'd say that the health commissioner, as he goes about his work over the next little while, appreciates and understands that we can learn a great deal from what's happened and what's worked. But his role, as I see it, is in part to advise the government of the need to make sure that we have a comprehensive plan for rural and regional health—something we don't yet have. But, if we did have such a plan, and if we were developing such a plan, it would need to understand, comprehend and accommodate the issues around Aboriginal primary health care and the Aboriginal community controlled health service organisations, who provide, in my view, the best examples of comprehensive primary health care in the country. We need to make sure they have the resources they require to be able to undertake their work effectively. So I say to the government: 'Here's an opportunity for you. You've done the right thing about this health commissioner. What we want you to do now is sit down with the health commissioner and with the community generally—the health professionals, the doctors, the nurses, the Aboriginal health workers and the allied health professionals across the country, all of whom are in great demand in the bush—and work with them and the community to develop a comprehensive rural and regional healthcare plan.' Of course, that should also include the Royal Flying Doctor Service.

It's been a privilege to be able to speak in this debate and, more importantly, to be able to highlight the importance of the Aboriginal health services. Most importantly, we need to understand the priority we should be giving to making sure we've got appropriately skilled and appropriately trained health officials in the bush, whether they're doctors, nurses, allied health professionals or, most particularly, Aboriginal primary healthcare workers, including Aboriginal health practitioners, who are fundamental to the operation of the Aboriginal Community Controlled Health Organisation. And we need to reinforce the value of training people in the bush. I know it's something which has had the attention of this place in the past, but, if we can make sure that we train people in the bush, I can guarantee you we'll get more people who are trained as professionals staying in the bush. I want to commend the work that's being done in that space at Alice Springs Hospital, for example, and at Charles Darwin University, in training medical practitioners.

It's been a privilege to offer a contribution here, and I apologise again to my colleague the member for Mallee for jumping in her place.

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

I thank the member for Lingiari for his contribution and give the call to the very patient member for Mallee.

6:05 pm

Photo of Anne WebsterAnne Webster (Mallee, National Party) Share this | | Hansard source

Thank you. I rise today to support the Health Insurance Amendment (Continuing the Office of the National Rural Health Commissioner) Bill 2020, which amends the Health Insurance Act 1973 to continue the Office of the National Rural Health Commissioner. I want to commend the hard work of the minister for regional health, Mark Coulton; and the Minister for Health, Greg Hunt, for this great outcome.

Health care impacts every person, regardless of where they live; however, we know that Australians living in the regions have less access to quality health care. In short, there is a lack of equity in healthcare provision. Valuable regional healthcare reform must address the unique problems and challenges that arise in these settings.

My electorate of Mallee is home to over 150,000 people and covers an area just shy of 82,000 square kilometres. The size of the electorate represents 36 per cent of Victoria, making it the largest in the state. Despite its size, population and economic significance to the state and nation, the Mallee is plagued by issues related to the provision of health services. Issues like those faced in Mallee are becoming exceedingly common across regional and rural Australia.

There is a significant maldistribution of health professionals between metropolitan and regional areas, especially with regard to general practitioners. The GP-to-population ratio in the Mallee is appallingly low compared to cities. The doctor-to-patient ratio in Melbourne is one GP to approximately 900 people, compared to the Mildura region where that ratio is one doctor to 3,700 people. In the Swan Hill region, it is over 6,200 people per doctor. In the Horsham region, it is over 3,400 people per doctor. This disparity highlights the inequity between regional and metropolitan areas and represents the significant workforce shortages plaguing the Mallee. Workforce shortages are exacerbated by an ageing cohort of GPs, of which one is my husband, and the difficulties in attracting new GPs to regional areas.

Honourable Member:

An honourable member interjecting

Photo of Anne WebsterAnne Webster (Mallee, National Party) Share this | | Hansard source

Absolutely. We have reached a crisis point. In September 2019, I convened a health forum with senior representatives of a number of local health organisations from across the Mallee. It came as no surprise that the most immediate concern from all involved was the lack of workforce. That is why it's so important to me that we implement the changes and the strategies to address the inequity that exists in the healthcare system. It's simply not okay that a person's location determines their access to health services and therefore their quality of life. But at the moment it does. That is why I am pleased to see the continuation of the Office of the National Rural Health Commissioner that will support the government to address the challenges of regional healthcare delivery.

Since its establishment in 2017, the office has delivered valuable outcomes for regional and remote Australia The office brokered the landmark Collingrove Agreement to develop a framework for the rural general subspecialty and delivered advice to the government leading to the $62.2 million investment in the National Rural Generalist Pathway. The office has since progressed the pathway by working with GP colleges to apply for subspecialty recognition for rural generalism within the field of general practice. More recently, the office has been investigating options to improve access to allied health professionals in rural communities and has worked closely with local doctors and health professionals in communities to prepare and respond to the COVID-19 pandemic, particularly through the rollout of the GP led respiratory clinics.

The rapid establishment of these respiratory clinics has been welcomed in Mallee, with three clinics opening: in Mildura, Horsham and Swan Hill. In Mildura, a clinic led by Sunraysia Community Health Services was the first in Victoria to be funded as part of the government's plan to establish 100 respiratory clinics across Australia. By taking pressure off the hospital and local GPs, this clinic has delivered enormous benefits to the community. In just over one month, the clinic triaged 528 telephone consultations which led to 345 GP appointments and 326 tests for coronavirus.

Lister House Medical Clinic in Horsham was chosen to operate the respiratory clinic due to its exceptional standing in the community. Lister House has been operating in Horsham since 1946 and is one of the original GP Super Clinics in Victoria. Its status as the biggest clinic in the Wimmera-Grampians area positioned it to be the best candidate to operate a respiratory clinic next door to its current building. Swan Hill District Health Service is operating the Swan Hill clinic, and I was pleased to meet with the CEO, Peter Abraham, and visit the clinic recently. It has been widely welcomed in the community.

The requirement for social distancing has created many challenges for accessing healthcare services, and the government responded with a significant shift to telehealth. I also acknowledge that GPs in Mallee have applauded the $669 million expansion of Medicare-subsidised health services. What needs to be understood is that a 10-year reform of telehealth occurred in 10 days. From March to May, over 11 million telehealth services were delivered by 70,000 providers to almost six million patients. By significantly reducing the level of physical interaction between patients and health practitioners, we have been able to slow the spread of the virus to our most valuable frontline workers and to vulnerable members in our communities.

With the surge in telehealth, we have seen a proportionate reduction in transport costs, accommodation costs and time out of work and away from family. Sentiment among family members is absolutely positive. It is also vital that telehealth subsidies remain in place after COVID-19. Telehealth has the potential to transform regional healthcare delivery, to be part of the answer, and I am working to keep it a national priority going forward.

The new, and now permanent, Office of the National Rural Health Commissioner will take a broader perspective on rural health reform, with deputy commissioners enabling the office to have expertise across a range of vital rural health disciplines, such as nursing, allied health and Indigenous health. The office will support the government's work to deliver major reforms, including providing a rural focus for primary healthcare reform, the National Medical Workforce Strategy and considering the review of the Rural Health Multidisciplinary Training Program. The office will also continue to play a key role to progress the National Rural Generalist Pathway.

Continuing the Office of the National Rural Health Commissioner demonstrates the government's dedication to supporting better outcomes for healthcare service delivery in regional Australia. The government needs to work on getting the settings right so it can address the maldistribution of our nation's healthcare workforce. A number of government initiatives are delivering positive results, and this work needs to be continued and expanded. Take, for example, the Workforce Incentive Program, which provides targeted financial incentives to encourage medical practitioners to deliver eligible primary care services to rural and remote Australia. In Mallee, we are fortunate to have many overseas trained doctors filling positions. I am pleased that the Visas for GPs Program commenced in March last year. The program directs overseas trained doctors to areas in need of primary health services—in particular, rural and remote communities. Under this program, the percentage of overseas trained doctors directed to fill primary healthcare positions in rural, regional and remote communities has increased from 35 per cent in 2018-19 to 52 per cent as of 30 April 2020.

The Murray-Darling Medical Schools Network evolved from the hard work of the National Party and was announced in the 2018 budget. It aims to provide end-to-end training for rural students in rural locations across New South Wales and Victoria. The Murray-Darling Medical Schools Network is one part of the $95 million investment set up to work towards the train in the regions, stay in the regions program. The guiding logic behind this program is train local, stay local. We know that people from a regional city or town who can learn in a regional place have the best possible chance of graduating and staying in the regions to work. The network consists of university campuses in Wagga, Dubbo, Orange, Bendigo, Shepparton and Mildura.

I know that La Trobe University is doing fantastic work with their rural medical pathway program in partnership with the University of Melbourne. This is the first course to commence as part of the Murray-Darling Medical Schools Network. Under this course, 15 students from regional and rural areas will begin their studies at either La Trobe's Bendigo or Albury-Wodonga campuses and undertake a three-year Bachelor of Biomedical Science before going on to study a four-year Doctor of Medicine at the University of Melbourne's Shepparton campus. There are seven Mallee students undertaking this program in 2020. They are: Alfred, Isabella, Abdo, Abigail, Kunind, Maddie and Oscar. These bright young students already understand the unique challenges of healthcare delivery in regional Australia. Many of them have firsthand experience. It's clear that these students are passionate about making a difference to regional and remote communities.

Alfred, who was born in India, says he wants to travel Australia, working in remote communities and ultimately return to his hometown in Mildura to work locally. Kunind, from Mildura, wants to pursue a career in craniofacial surgery and hopes to bring this area of medicine to areas in rural Victoria. I wish him all success, as it will mean patients won't have to travel to a major city to receive treatment or wait for a specialist to visit. Maddie, from Milawa, wants to address doctor shortages by working with close-knit communities in rural and remote Australia. She ultimately aims to become a rural generalist or to work with the Royal Flying Doctor Service.

Abdo aspires to becoming a general practitioner to give back to his local community of Mildura by addressing the chronic doctor shortage in the area. Abdo is committed and passionate about addressing the inaccessibility of the doctors in Mildura. Oscar is from Cohuna and he wants to develop a dependable reputation and close sense of connectedness to a small rural community. He also wants to be a rural generalist and become experienced in as many specialisations as possible in an attempt to increase the breadth and efficiency of medical care delivered in regional areas.

I truly believe in the efficacy of local, regional training as a solution to the workforce challenges we face. My husband completed his internship and registrar year at the Mildura Base Hospital in the late 1970s. The hospital was a thriving teaching hospital at that time. It took just two years to complete and gave us, as a young couple, the opportunity to experience a regional town and become connected to a wonderful community. And here we are, 43 years later, having raised our family, who have remained local and are now raising their families in Mallee.

I also know that Monash University has developed a postgraduate course under the Murray-Darling Medical Schools Network. Starting in 2021, 30 students will begin the rural end-to-end program studying at Monash in Churchill. Students will then complete clinical training in rural and regional hospitals and community based practices, including Mildura. I look forward to welcoming these future students to the region. It is wonderful to know that La Trobe University, Melbourne University and Monash University students from Mallee are taking up these opportunities and I wish each one of them the very best in their career aspirations. I hope they're the first of many to achieve success through regional training programs.

These are the types of programs that will deliver real differences to the provision of healthcare services in regional areas like Mallee. I welcome the continuation of the Office of the National Rural Health Commissioner and will continue to address the shortcomings in regional and rural health care.

6:19 pm

Photo of Katie AllenKatie Allen (Higgins, Liberal Party) Share this | | Hansard source

I commend the Health Insurance Amendment (Continuing the Office of the National Rural Health Commissioner) Bill 2020, which is to ensure the Office of the National Rural Health Commissioner continues beyond 1 July 2020.

I come from a long line of doctors. My father, Dr Bill Stevens, was the first specialist in Albury many years ago now, in the 1960s. As a child, I grew up with my father being the only specialist for a very large region of the north-east of Victoria. Dad was the adult physician. He was the paediatrician. He was the endocrinologist. He was the gastroenterologist. He was the cardiovascular expert. In fact, he manned the intensive and coronary care unit on his own without any resident staff.

You can probably imagine that, as a child growing up, we were told to answer the phone very formally, because we never knew when it was going to be an emergency or someone inquiring for Dad's services. We said: '212894 Dr Stevens' residence. Can I help you?' That was the typical line that we were taught to answer the phone, because dad was constantly being called out to heart attacks or to strokes or to someone on their deathbed and dying. It was a very informative part of my life: to deal with a community that was having to cope with having one specialist for a very large population.

I've grown up to be a doctor and, in fact, my daughter is also a medical student. And I have a lot of doctors in my family. They're scattered all over in Victoria, including my brother-in-law, Dr Simon Horne, in Point Lonsdale and my sister in law, Dr Rosamund Stobie, in Castlemaine. And I have dear friends who are still in the north-east, including Dr Rebecca McGowan, the sister of Cathy McGowan, the former member for Indi. They constantly tell me updates on how the rural health workforce is dealing with the massive changes that are occurring in the healthcare sector and that affect the regional, rural and remote communities here in Australia.

I would like to say that I'm proud the Morrison government has a longstanding commitment to rural and regional health, and there is always more we can do. This bill builds on that commitment, and it's in an area that I'm extremely passionate about. To be a local doctor in a rural or regional area is a great privilege, serving that community. The GPs in these areas have to deal with so many different diseases. They have to be able to cover them in a very generalist way. Most importantly, going forward, it's important that we understand the difference in health outcomes that occur in rural and remote areas, compared to their metropolitan cousins. On average, Australians living in rural and remote areas have shorter lives. They have higher levels of disease and injury, compared with their metropolitan counterparts. In 2015, the life expectancy for both males and females decreased as remoteness increased. In 2017, potentially preventable hospitalisation rates in very remote areas were 2½ times higher than major cities. Challenge in accessing health care or health professionals is regarded as one of the key factors behind health inequalities. As a metropolitan based physician, this was something that I saw.

I dealt with patients in the field of paediatric gastroenterology and allergy. I was very delighted when we were able to start using telemedicine, because that enabled patients to more easily access review appointments without having to travel for many hours across the state of Victoria to come to see a specialists at The Royal Children's Hospital. Families would have to take a day off work—usually two days off work—to travel from different parts of Victoria, or to fly down if they had to come down from Mildura. Not only was that a costly exercise but also a big time constraint and time impost on that family. Telemedicine has been a great boon to rural and regional medicine. The Morrison government is very proud to support telemedicine. In fact, it was the strengths in telemedicine that enabled the Morrison government's swift response to the COVID pandemic, which we are currently in the midst of.

We saw very early in the COVID pandemic a requirement to ensure that our healthcare professionals were protected and that patients who needed to see a healthcare professional were protected from coronavirus. The ability to access telemedicine—not just in rural, regional and remote areas but also in metropolitan areas—has been one of the great transformative aspects of our healthcare system in response to the COVID pandemic. So, in all this darkness there is some light, and telemedicine and telehealth are among those aspects. The Minister for Health, Greg Hunt, should be congratulated for his swiftness in activating telemedicine MBS rebate items and activating those sorts of services across Australia. Not only did it protect our healthcare professionals and enable our patients to remain safe from COVID but it also protected our PPE, or personal protective equipment, stockpile in a time when we were having some difficulties with our supply chain, early in the COVID crisis, when the world was seeking every mask and every gown around the world.

So, the government has done a lot for rural and remote care. There is a lot more to do, but we are committed to rural and regional health, and this bill is speaking to that very point. We've increased funding every year and will continue to deliver funding to regional hospitals. The Morrison government has launched the $1.3 billion Community Health and Hospitals Program. This has seen $63.4 million for regional radiation oncology centres for cancer treatments. My own uncle—'Lazy Harry', as he's known; he's a country singer who lives in Beechworth, Mark Stevens—was lucky enough to be able to access regional health care for bowel cancer, which he's recently suffered from.

Also, there's a very big intent to make sure that clinical trials are undertaken regionally so that patients in regional areas can access the best and newest novel treatments. In the past, a lot of regional patients have missed out because they haven't been able to travel to the city for the cutting-edge trials that are available to metropolitan based patients. So, it's wonderful that $100 million is invested in regional clinical trials. This is a very welcome development. The Morrison government has also established the Murray-Darling Medical Schools Network as part of a $550 million rural workforce strategy. This will deliver 3,000 additional specialist GPs for rural Australia, over 3,000 additional nurses in rural general practice and hundreds of additional allied health professionals in rural Australia over 10 years.

There have been a number of recent reforms that are very important, which I'd like to make note of today. One of those includes, in January 2020, the rollout of the workforce incentive program Doctor Stream. This has provided targeted financial incentives to encourage medical practitioners to deliver eligible primary care services to rural and remote Australia. These doctors really are quite highly specialised in their ability to do more than just general practice; they are also able to deliver some of the specialty care that they need to do. So, an incentive program is so important, because we know that many doctors travel to metropolitan areas to get their university training and don't return to their home town, and I'm an example of that.

Furthermore, from 1 January 2020 the geographic eligibility for rural bulk-billing incentives was aligned to the Modified Monash Model 2019, or MMM, which ensures that the higher incentives are correctly targeted to practitioners who are working in regional, remote and rural areas rather than in metropolitan areas or larger towns. This is a better targeting of that supplement to ensure that the incentives are correctly aligned with those who are truly distant from where they can access metropolitan services. And, as I mentioned before, we have also rapidly expanded telehealth services, which has improved continuity of care and advice during this difficult time.

The proposed legislation will ensure that rural communities and rural health workers continue to have an independent advocate. This legislation will transform the Office of the National Rural Health Commissioner from being a temporary one to becoming a permanent feature of our approach to rural health reform. I'd like to congratulate the Minister for Health, Greg Hunt, and the minister for rural health, Mark Coulton, for this extremely important initiative to make this into a more permanent office rather than a temporary one. The office will be ongoing in function, and a review of the office's effectiveness and achievements will occur after five years of operation.

It is important to constantly review and assess what we do so that we can continue to tailor and target the effects of what we are committing to. Future commissioners will be appointed on a two-year tenure with options to extend for a second tenure. The office will also take a broader focus, with the National Rural Health Commissioner supported by an expanded office. This will include deputy commissioners, and these deputy commissioners will provide specific advice on vital rural health disciplines, such as nursing, allied health and of course Indigenous health. This approach will ensure the office is well placed to provide advice on an integrated multidisciplinary model of care.

One aspect of regional health that we do hear about from our general practitioners and allied health workers is that working in a team is something that they do miss out on when they're not in large metropolitan centres. Ensuring we have a networked, multidisciplinary and integrated approach to health care in regional areas is not only important for the patients themselves; it's important for the specialist GPs and allied health workers who are working in this environment. It does already occur to a large degree, but we need to do better in this area to ensure, for instance, that a patient who is undergoing palliative care in a regional or remote town has an integrated approach, supported by a GP, a psychologist, a nurse and allied health workers who are helping solve problems together so that the patient can get the best support and advice.

The commissioner position has been a wonderful initiative and is being made into a more permanent position. The inaugural commissioner was Professor Paul Worley. The National Rural Health Commissioner was established on 1 July 2017 and has been at the centre of our response with regard to rural and regional health. Professor Worley has worked tirelessly to consult with and advocate for the rural health sector, and he's brokered the Collingrove agreement, which defines rural generalist practice. His final report will soon be submitted with regard to medical and allied health services.

The office has also provided advice leading to a $62 million investment in the National Rural Generalist Pathway and prepared draft advice on rural allied health reform, including a published literature review. It's very important to look at the role of nurses, speech therapists, occupational therapists, psychologists and the like in care in a generalist setting in these rural areas because often there are not enough healthcare providers and so we need to diversify the advice provided.

During the COVID pandemic, as we've just heard from the member for Mallee, the commissioner worked closely to develop and establish GP-led respiratory clinics, which is important not just for rural and remote areas but particularly for Indigenous communities. I have recently been on the national health and research coronavirus rapid response advisory committee, and a lot of work has been done in protecting our Indigenous communities during the COVID pandemic, including ensuring that they have been quarantined but also that they're getting enough testing to control and contain any possible outbreaks in Indigenous communities.

Most importantly, the office has worked with communities and professionals to help meet the unique needs of rural and remote patients. You really need to have a rural and remote lens to be able to solve the problems, not to have a centralised model where metropolitan services are being provided in an outreach way. It's more important that we have commissioners who actually know what they are talking about from the perspective of the locals.

An initial focus will be to assist with the government's rural response to COVID-19 and its understanding of any longer term impacts of COVID-19 from the drought and bushfires that have occurred in the last few months. Rural and regional Australia has suffered in the last year. It isn't just COVID-19; it's been off the back of the droughts and bushfires. The office will otherwise continue to build on the body of work already delivered while focusing on practical outcomes, including through supporting government delivery of key reforms and programs.

The office will have the capacity, importantly, to conduct an evidence based research approach into issues in rural health. Importantly, it will also focus on the chronic workforce shortages. We all know that we need to ensure that younger doctors train in rural and remote areas because, firstly, they get the opportunity to experience the diversity of work opportunities they have and, secondly, they're also more likely to establish roots, enjoy living in a rural and regional town and develop relationships. There are opportunities for their partners to develop working opportunities. There is a lot more work that can be done, and we do know many universities are starting to provide these sorts of programs—such as the bonded programs at Monash University—to ensure that students can actually get a foothold in a community environment and potentially stay there for the long term.

Promoting rural and regional health is fundamental to helping regional Australia to be a better place to work, live and raise a family. I'd like to commend to the House the Office of the National Rural Health Commissioner and its vital role in achieving parity in health outcomes between rural and regional patients and their metropolitan counterparts.

Photo of Ross VastaRoss Vasta (Bonner, Liberal Party) Share this | | Hansard source

The question is that the words proposed to be omitted stand part of the question. I call the honourable member for Gilmore.

6:35 pm

Photo of Fiona PhillipsFiona Phillips (Gilmore, Australian Labor Party) Share this | | Hansard source

I am always pleased to talk about rural and regional health so I am happy to rise tonight to support this bill, the Health Insurance Amendment (Continuing the Office of the National Rural Health Commissioner) Bill 2020. Health is very important to country communities like mine. Our health system can't be a cut-and-paste of those in the city. We can't use a cookie-cutter approach and think everything will be fine. Country areas need to have country-specific health policy, rural-specific health policy. That is why I support this bill today—because it is recognition by the government that a rural health commissioner is necessary into the future and that more changes are needed to improve rural and regional health. When the Office of the National Rural Health Commissioner was first established in 2017, Labor raised concerns about the fact that the office would cease in June 2020. It took a while—three years, in fact—but the government have now decided that we were right, and I am glad they did. One thing I notice about the government is that they fight and fight Labor, and then they realise that we were right and they do what we suggested. It's lovely, but I simply wish they would get there a little quicker, because, while they dither, people in country areas suffer. That is the reality.

Take the new Eurobodalla regional hospital, for example. This is another one where I hope to one day be able to say that the government realised we were right, but it sure is taking a while. I have been standing with the community in their calls for a new Eurobodalla hospital for years. The current Moruya and Batemans Bay hospitals are only level 2 facilities. They are small regional hospitals. This means that two-thirds of local patients are forced to travel outside of the area to get the treatment they need—to Canberra, Shoalhaven or Sydney. This means time away from families and friends, those essential support services. It means more expense and more stress when needing to seek vital medical assistance. In an area with a growing retirement-age population, we need to make sure that our hospitals have services up to the necessary standards to meet the needs of local people.

My electorate of Gilmore on the New South Wales South Coast has one of the highest numbers of aged pensioners in Australia so, naturally, good-quality hospital systems are crucial. Late last year, when the New South Wales Labor leader and I met with local residents in Tuross Head at a kitchen table discussion, they said the poor hospital services were turning older people away. They can stay for a time, but not as they get older. It is too risky. Those residents could see how absolutely vital this new hospital is. I thank them all for their contributions.

The New South Wales and federal governments have been dragging their heels on this critical infrastructure for years. It was only last week that the New South Wales government even confirmed that the new hospital would be in Moruya—very welcome news, absolutely, but we have waited a long time for it. At the same time, the New South Wales government has also committed an additional $50 million, which is excellent. I welcome any additional funding towards the new Eurobodalla hospital. I have been calling on the Morrison government to do the same.

But it isn't enough to just replace what we have. We need to make sure that there is real improvement for local people and local health workers. We need to ensure the hospital is a level 4 facility. This is critical. We need to ensure there is an acute mental health inpatient facility included. We need those assurances from the government urgently. I have long been calling for the New South Wales and federal governments to include funding for mental health inpatient beds as part of this new hospital, and I want to see the government take this issue seriously. This hospital has taken too long to get off the ground. The community, rightly, wants to make sure that we have a facility that is fit for purpose and will provide the ongoing health support we will need into the future. As Dr Michael Holland has said:

The Eurobodalla Health Services Clinical Services Plan was submitted to NSW Health in July, 2019.

Improvement of services needs to be provided immediately within the existing infrastructure as requested by the Petition to the NSW Legislative Assembly and as recommended by the NSW Health Agency for Clinical Innovation.

He went on:

The commencement of work on the single new Eurobodalla hospital needs to occur as soon as possible.

The community on the far South Coast deserves no less. Dr Holland has campaigned tirelessly, along with a number of people in the community, for improved health services in the Eurobodalla. I thank him for his ongoing dedication to this. We are still waiting for the clinical services plan, the next important step. I look forward to seeing those details.

It isn't just Eurobodalla hospital that is in desperate need of additional investment by this government, the Shoalhaven Hospital redevelopment has also been promised for too long without enough action to get it off the ground. It is yet another example of coalition governments at the state and federal levels dragging their heels on rural and regional health. Shoalhaven Hospital is a major regional hospital. In March this year it was revealed that 43.1 per cent of people wait longer at Shoalhaven Hospital's emergency department than the state benchmark, ranking it seventh out of the list of longest emergency wait times in New South Wales. That is absolutely outrageous and not good enough. We know that complete bed block and code blacks at this hospital are chronic, but the Morrison government is doing nothing to support the state in addressing these issues.

The hospital's lack of acute mental health beds is exacerbating this problem. Mental health beds are hugely important in taking pressure off emergency departments. They mean that people suffering from acute mental health episodes can get the appropriate treatment they need when they needed. But, in another show of rural and regional health being put last, the subacute mental health unit at the hospital was closed for three weeks during the bushfires over Christmas. This is cost saving with people's lives at one of the toughest times of the year—incomprehensible. At the time, I called on the Morrison government to intervene and provide funding to keep the unit open. The Morrison government has continually said it is committed to providing the best mental health care and support for all Australians. But all they did was divert responsibility for this closure to the New South Wales government. They abandoned our community. Sadly, that is the government's record on rural and regional health.

We need to make sure that all our regional hospitals have adequate services. For some time the community in the Milton and Ulladulla area have been campaigning for a CT scanner at the hospital. According to an article in the Milton Ulladulla Times, local paramedics have said they have become a taxi service taking people to Nowra to access the scanner there. Why do the people of Ulladulla have to settle for fewer services, more travel, more stress and difficulty? We deserve better than this. The government's changes to rural health policies are hurting our communities.

In 2018 the government announced a number of health workforce changes under a so-called Stronger Rural Health Strategy. The strategy sounds great, improving access to health services in the bush, but the reality is different. The strategy changed the rural classifications for restricted doctors, that is doctors who trained overseas or in a bonded position in Australia. These doctors can only claim Medicare benefits in defined rural areas. In 2018 the government changed this from the longstanding district of workforce shortage to a new distribution priority area system.

I want to use the example of the Shoalhaven Family Medical Centres to show the negative impacts these changes have had on practices on the New South Wales South Coast. The Shoalhaven Family Medical Centres run general practices in Vincentia, Worrigee, Basin View and Culburra Beach. I have had the pleasure of meeting with the practice owners Dr Hao Pham and Mrs Annette Pham on number of occasions now. Under the old system Shoalhaven Family Medical Centres were provided with replacement provision exemptions under section 19AB of the Health Insurance Act 1973. This meant that when an overseas trained doctor left the practice, they were able to replace them with another overseas trained doctor. Dr Pham and Mrs Pham advised me that at the time the changes were introduced the practice was in the process of recruiting two new doctors under these provisions.

In a letter I received from the minister after the changes came into effect on 1 July 2019, the minister advised that the Department of Health would still consider applications from practices in a 'workforce shortage area' that began before the changes came into place. It is certainly the Shoalhaven Family Medical Centres' view that they should meet this requirement. However, the two doctors had been denied Medicare provider numbers because the practices are not located in a 'distribution priority area'. The practice has sought reviews of this decision by the minister. However, I am yet to receive a response from the minister on this issue. As Mrs Pham said, the department continues to cite complex legislation which changed without their knowledge and has left them worse off than they were before. We need to be encouraging doctors into country areas. We need to be making it easier for practices to recruit and keep doctors in our community. Mrs Pham has said, 'It is just too hard to try and wade through this,' and she has given up.

The government's changes and cuts to rural and regional health are hurting our providers and, by extension, hurting our communities. In January, official data confirmed that out-of-pocket costs for people in my electorate to see a doctor had increased by 34 per cent. Local people are now paying $8.27 more per visit than they were under Labor. Why are people in rural and regional areas having to pay more to see the doctor? This government has been waging a war against Medicare for years. Health costs have never been higher than under the Morrison government, and it is rural and regional Australia that is suffering.

I have spoken on a number of occasions in this place about the Shoalhaven Women's Health Centre. This centre is based in Nowra, but it has been providing mental health outreach services to the Ulladulla region thanks to funding from the federal government. But this funding is due to cease in 13 days. The centre has been trying to obtain a further commitment of $70,000 from the government so that they can continue this outreach. As most people would know by now, the Ulladulla region was severely impacted by the recent bushfires. We know that this has had a huge impact on the mental health of local people. Throw COVID-19 on top of that, and it is not difficult to see that we need to be increasing mental health support in these areas. But the government has been reluctant to provide this funding—as I said, a total of $70,000.

I wrote to the minister in February this year on behalf of the centre. In March, the centre was told to try the Primary Health Network. The Primary Health Network had been given funding for additional mental health services in bushfire impacted areas, and maybe the centre could benefit from that. Fantastic news, we thought. But this contract had already been awarded. So, back to the minister I went, again, asking him to ensure we don't lose this vital mental health service in the Ulladulla region. I'm really pleased that the Shoalhaven's Women's Health Centre has received some additional funding from the federal government. However, the money is for financial counselling services. It's very welcome indeed, and hard-fought, but the money cannot be used for mental health services, so the Ulladulla outreach services remain severely at risk. So, again, I ask the minister to provide the Shoalhaven Women's Health Centre with the $70,000 they need to keep this vital local service going. Time is ticking. There are 13 days to go. It isn't much, but it makes a huge difference to local organisations and the people they serve.

We need to make sure that rural and regional areas receive targeted and appropriate services for their needs. We can't use a cookie-cutter approach. What works in the city doesn't necessarily work in the country. What works in one regional area doesn't necessarily work in another. The fact of the matter is that many of the government's changes have been hurting rural and regional areas like ours on the New South Wales South Coast. Not enough focus and attention has been paid by the federal government to improving our local hospitals.

We simply aren't doing enough to recruit and keep doctors in rural and regional areas, and healthcare costs continue to rise. The government need to take urgent action on this. They need to address it now. So I support this bill today, and I hope to see more changes by the government that will improve outcomes for people in rural and regional areas. I commend the bill to the House.

6:50 pm

Photo of Helen HainesHelen Haines (Indi, Independent) Share this | | Hansard source

I'm delighted to support the Health Insurance Amendment (Continuing the Office of the National Rural Health Commissioner) Bill 2020. As a former rural health professional and a former rural health researcher, speaking about rural health is right up my alley. I'm really pleased to do so. But, more than that, this piece of legislation heralds a really good day for rural health. Both the Minister for Regional Health, Regional Communications and Local Government and I live have worked almost all our lives in rural and regional Australia. I know that he'll agree with me when I say it's an incredible place to live. It's filled with opportunities, but they're not always fulfilled.

We both share a passion for vibrant and healthy rural communities but, as members of these communities, we know this doesn't happen by accident. Rural communities rely on good-quality health services that last the distance. Crucial to rural and regional development is having strong, vibrant, high-quality rural and regional health facilities. That's how we attract people to rural and regional Australia—by guaranteeing that we have those services. Throughout the COVID-19 pandemic that we've been experiencing this year, we have seen the strength of rural communities and the strength of our rural and regional health practitioners as they've risen to the challenge, often in very, very challenging circumstances. I have seen them across my electorate. I have seen them do what rural health people do, and that is often make do with less than optimum facilities. So I take my hat off to them. I thank them. I know they're working tonight in difficult circumstances in order to make sure that they are ready for whatever happens.

Last year, the minister visited Beechworth, in my electorate, to meet with four of our vital but very small rural health services: Beechworth Health Service, Alpine Health, Tallangatta Health Service and Corryong Health. It was clear from our discussion that the minister understood the issues that were facing these small health services and came from a place of experience. I would say that that's not always common in this House.

This bill consolidates the place of a dedicated advocate for rural health within government decision-making and policymaking. It builds on the reforms led by the outgoing commissioner, Professor Paul Worley, and recognises that the job is not yet done. It is far from done. I want to recognise Professor Worley for the reforms that he's been undertaking—in particular, the rural generalist training program. I would also like to point to the recent GP respiratory clinics. I recently attended one in Wodonga, and I was really pleased to see the work that they're undertaking there, particularly in the area of paediatric respiratory health.

Health care is a lifelong passion for me. It's both personal and professional. As a midwife, I've delivered many hundreds of babies, many of whom are now of voting age—and I think a few of them might have even voted for me! That's a heck of a way to get a vote, I've got to say—it's a long wait! Some of them have gone on to have children of their own. My own daughter is a junior doctor and she undertook her training as a medical student in the rural medical program. I worked for many years with an extraordinary obstetrician, Dr Leo Fogarty. For every baby I delivered, I think he probably delivered 20 or 30 more. I've worked extensively with another exceptional rural doctor, Dr Ian Wilson, an emergency department physician and excellent educator of rural medical students.

As a former rural health researcher and director of the Rural Health Academic Network with the University of Melbourne, I oversaw and led research into various aspects of rural health. That's the thing about rural health: it is so diverse and the amount of skill that people have to have crosses so many disciplines. Our research program included telehealth assistance for stroke and cardiovascular disease. We undertook research into palliative care, diabetes and a multitude of other chronic diseases. We did exceptionally large amounts of work in men's health, particularly on depression and anxiety. And we looked at work in dementia and aged care, and the barriers faced by older rural Australians.

I know all too well the frightening statistics around rural health for regional Australians. I can recite them in my sleep, and many of the speakers who have come before me have told us about them. Rural Australians do experience poorer health outcomes, lower life expectancy and poorer access to health than those living in metropolitan areas. The prevalence of chronic disease is higher, including asthma, diabetes, cardiovascular disease and cancer. And we have higher death rates—between 1.2 and 1.5 times higher for cardiovascular disease and between 2½ and four times higher for diabetes.

And we know that we are so far from closing the gap when it comes to Aboriginal and Torres Strait Islander health. We know that one of the things that could really work in closing the gap for Aboriginal and Torres Strait Islander people in this country is culturally appropriate care. We have to do so much more to go beyond training rural health workers in Aboriginal health; we need more Aboriginal and Torres Strait Islander doctors, nurses and midwives, and we need more culturally appropriate training into our medical schools, allied health and nursing courses.

We know that it's the social determinants of health that have the biggest impact on why health outcomes in rural and regional Australia are poorer than those in metropolitan areas. We know that we are without good regional infrastructure. We have fewer bicycle paths and we are more reliant on cars. We don't have footpaths that are good for walking and we have conditions that create chronic disease—conditions that mean more rural Australians smoke, more of them are overweight and more of them do less physical activity and have higher than optimal alcohol consumption and blood pressure than in the cities. It's little wonder when you see that some towns are just so poorly equipped for people to exercise in. Indeed, food security in some rural and regional towns—in the very remote areas—is extremely poor. So it's not that rural and regional Australians are any worse at looking after their health from a deliberate choice, it's the circumstances in which they find themselves. That's why it's so important that we invest in rural and regional infrastructure if we want to improve rural health.

The link between poor health outcomes and the lack of access to health services is well known. Often we have to travel considerable distances just to see a doctor for a basic consultation, or wait weeks to see a specialist. Of course, one of the silver linings of the COVID-19 pandemic has been the freeing up, the unlocking, of telehealth. Those of us who have worked in the area for decades have been crying out for this, so I am really pleased that this is now a permanent fixture.

Unfortunately, rural health has been viewed as the fringe of an overarching system that is set up for metropolitan Australia. It's really a metrocentric healthcare system. What we know, as I've heard other speakers say today, is that metropolitan systems of care simply cannot be translated directly into regional Australia. That's why a commissioner for rural health is so important.

I think it's really important to talk about—and the AMA only recently gave statistics about this—the healthcare deficit in spending. We can't get away from this. There is a healthcare spending deficit of $2.1 billion in rural and regional health. It's a chronic underspend of Medicare, PBS and publicly provided allied health services. I can't emphasise enough the impact on access to allied health services, and that's why I'm very pleased that there are going to be co-commissioners looking at this.

There is still so much to do in rural health. It's common sense to extend the office beyond 30 June and to establish the office as an ongoing entity. We still experience perennial issues of health workforce shortages and have a higher disease burden, as I just said, with the health consequences that arise from those. That's not to mention the health consequences that have arisen from the fires. The data is coming out now; there is very, very robust evidence emerging about the impact on people who live in rural and regional Australia of the 'black summer' bushfires and smoke inhalation—and of course on people who live in the cities too. That summer exposed the brittle systems in telecommunications, welfare and health that are the reality of service delivery in the country.

It's a comfort to me, it truly is, to know that the National Rural Health Commissioner is here to stay, and I'm confident that this commissioner will examine the multiple social and environmental impacts of health. I'm confident that they will. The functions of the office have been expanded to include the appointment of deputy commissioners, and this will support the commissioner and provide expertise across health disciplines, including Indigenous health, nursing and allied health. This is excellent news. Health care is a team sport. Interdisciplinary care is the gold standard. We need to achieve greater enrolment of rural students into allied health professions. We need greater access to allied health positions in our universities, and just this week in the House I asked a question directly to the Minister for Education about this. We need to free up places.

Deputy health officers have immeasurably enhanced and enriched our national health response. One example that comes to mind is Professor Paul Kelly, the deputy chief medical officer. He visited me in Wodonga earlier this year, in the midst of our terrible bushfires. He came with me and Minister Hunt to Corryong and saw firsthand what was going on up there. He visited the very tiny Corryong Health, which was evacuated during the bushfires. Another recent appointment is that of eminent psychiatrist Dr Ruth Vine as the deputy chief medical officer for mental health, and I really commend that appointment, too. If there's one area of health care that we are so far behind in it's mental health.

When the Office of the National Rural Health Commissioner was first established the former member for Indi, Cathy McGowan, advanced an amendment to ensure that the commissioner consulted with communities in regional, rural and remote areas, including consumer support and advocacy groups. I'm pleased to see that this bill goes into detail about who the commissioner consults with and lists health professionals, state and territory government bodies and industry, non-profit and other community groups and stakeholders. On a commonsense reading, this bill includes the groups identified by the former member for Indi, and I hope this commitment to broad-based consultation is echoed not just in legislation but in reality.

Importantly, building on the success of the office since 2017, the office is now legislatively mandated to undertake research and to collect, analyse, interpret and share information about approaches to improving the quality of and sustainability and access to health services. This strong research capacity is absolutely essential to providing comprehensive insight. Rural health research has historically been underfunded. In a study from 2018 by a good friend of mine, Professor Lesley Barclay, it was reported that, between 2000 and 2014, of the 16,651 projects funded by the National Health and Medical Research Council, just 185 focused on rural health research. That's just one per cent of NHMRC funding at that time.

I'm glad to see that the office's responsibilities will translate into practical activities, such as working with communities that are experiencing workforce shortages to co-design primary care models that respond to the community's circumstances. Again, from my own experience as a rural health researcher embedded in a regional health service, along with my colleagues Kaye Ervin, Anna Moran and Carol Reid, I have seen firsthand how important it was to connect a university to a clinician, by the bedside, so that we could assist them in undertaking key research and translating that research into practice. To get traction with health services research at the bedside is extremely difficult. Again, I would say to the government, in terms of research funding, that health services research is not very glamorous, but it's crucial to rural health.

The commissioner is scheduled to present the final report into improvement of access, quality and distribution of allied health services in regional, rural and remote Australia to the minister later this month. I am really looking forward to reading that, because, as I said earlier, allied health professionals play a major role in the prevention and treatment of so many chronic diseases. The commissioner himself notes in his interim report:

Allied health services underpin the health and wellbeing of our nation. They are the quiet achievers of our health, disability, education, aged-care, and social service sectors. Without them, our schools, workplaces, homes and aged-care facilities all struggle to realise their potential, communities suffer and economic development stalls.

The interim report identified four strategic themes for reform. One is Aboriginal and Torres Strait Islander health practitioners and culturally safe and responsive services, and I can't emphasise enough how important that is.

Finally, I'd like to speak on the university model of university departments of rural health. I particularly mention today the Going Rural Health initiative, which has worked tirelessly to undertake allied health training across the regions, particularly in my region of Indi, where almost 2,000 nursing and allied health students have been placed across the region, and I particularly mention the leader of that program, Keryn Bolte. I would also like to particularly mention Dr Seb Kirby, who is an outstanding graduate of the University Department of Rural Health medical program in Wangaratta. He has continued to practise as a junior doctor and is contributing on the ground in a way that we want to see in rural health across the nation.

7:05 pm

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

I support the Health Insurance Amendment (Continuing the Office of the National Rural Health Commissioner) Bill 2020 that we are debating tonight, which provides for continuing the Office of the National Rural Health Commissioner. I'd like to personally commend and congratulate Emeritus Professor Paul Worley, who is about to complete his term. His was the inaugural appointment, and I was very pleased to make that appointment when I was the Assistant Minister for Rural Health. I'm pleased to see that the Office of the National Rural Health Commissioner is being continued and will become a permanent fixture, rather than being temporary. It will continue for another five years before it's reviewed again. I'd like to congratulate Minister Greg Hunt and the Minister for Regional Health, Regional Communications and Local Government, the member for Parkes, on the decision to continue this wonderful initiative.

I would also like to congratulate Professor Worley on his achievements in getting the two general practice specialist colleges to agree, in the Collingrove Agreement, on the national framework for developing a national rural generalist pathway, which is no mean feat. I'm pleased to say that over $62 million has been appropriated to deliver that. He's also worked with the two colleges to get a pathway for subspecialty recognition for rural generalist practitioners. He's also advised on rural allied health reform and helped the set-up of GP-led respiratory clinics during the COVID crisis, and he's been instrumental in implementing the $550 million Stronger Rural Health Strategy. The Workforce Incentive Program has been reformed during Professor Worley's time into support for Doctor Stream and for medical practices themselves.

A lot has been said about rural bulk-billing. The rural bulk-billing incentive program is continued, but they have focused it by aligning it with areas that are rural, because there were some areas which were actually metropolitan centres which, by a freak of old classification systems, were still getting a rural bulk-billing incentive that is meant for rural, regional and remote Australia.

I'm really pleased that, at the last election, we as a coalition government made other announcements to strengthen rural health. One of the big issues facing rural Australia is the disproportionate shortage of professionals, and it's no more acute than in the health field with medical specialists and specialist rural generalist GPs, and that's what Professor Worley and the Office of the National Rural Health Commissioner have been particularly focused on. I'm pleased to say there is a growing realisation of how valuable a highly trained rural generalist practitioner can be. One of the markers of good health outcomes is timely access to medical care. That is so important. So we are really committed to getting improved access for the people of rural Australia. They have more diabetes, more heart disease and more cancer, and they get worse outcomes. We can fix it, but it takes a long time.

I'd like to run through the focus on rural health reform and the incentives. In my area of Lyne, we successfully argued for and got a commitment to a headspace centre in the town of Taree. We have got an MRI license to re-expand Manning Base Hospital, and we've got a commitment to rolling out radiotherapy in the Taree-Manning region. These are no small achievements. Over the last 10 or 15 years, a lot of the services at the Manning Base Hospital have wound back, but we're in the middle of winding them back up again. The Manning Base Hospital look after about 90,000 people, and it's important they get the support that we from the federal government can give them. The state government is committed to the already-announced expansion of that facility, and I'm really pleased to be supporting the state member in getting a hospital for Forster-Tuncurry as well.

There are many other rural incentives that we have put out to increase rural workforce retention, and I'll just elucidate some of them. It's not just about doctors in rural health; we need more pharmacists in rural health. We've just concluded a very successful seventh Community Pharmacy Agreement. Because the rural and remote pharmacists do so much more, that is a really sensible outcome, and I know a lot of my pharmacy colleagues are really pleased with the outcome.

I might mention that I actually don't just talk about it, like many of the people who've spoken tonight; I actually practised medicine for 33 years, and 22 years of that was in a regional town called Port Macquarie. When I went there, there were five medical specialists, but there are probably now almost 20. There's been an expansion of surgeons, anaesthetists—all sorts of subspecialties. And one of the biggest drivers has been the rural clinical school of the University of New South Wales at Port Macquarie Base Hospital.

One of the big initiatives driving workforce development not just for medical specialists but for GPs and rural generalists is the expanded Murray-Darling Medical Schools Network. Around the country, 12 centres in these rural clinical schools and schools of rural health are being expanded so that they have end-to-end med school teaching. That's also part of the Rural Health Multidisciplinary Training Program, where we expanded the amount of training for physiotherapists, occupational therapists and all the multidisciplinary care that you need for proper healthcare delivery.

We've developed the regional training hubs to grow that secondary degree training program. What most people don't realise is you have to do several degrees. The first one is awarded by a university and the next one by a college, and with the second medical degree you get your vocational training and recognition and your speciality status as a specialist GP, a rural generalist, a surgeon or a psychiatrist. That is going ahead full steam, with many regional training hubs now in existence.

We've got the junior doctor training initiative, allowing young doctors to work in general practice so that they get exposed to general practice before they get buried into a hospital pathway. We've also supported an increase in the Specialist Training Program, which co-funds the employment of trainee specialist registrars, and we've weighted that towards regional areas. If you get a registrar in a regional area when they're settling down and doing their second, college, degree, that's the time when they're starting families and getting their networks. It's probably one of the best initiatives that we've got.

I'm really pleased to see also that the More Doctors for Rural Australia Program is delivering dividends already. We have 291 participants. I'm really pleased the office of the Rural Health Commissioner is going to get deputy rural health commissioners to focus on allied health, nursing and Indigenous health. We also expanded funding to the Royal Flying Doctor Service. They not only fly people around but actually deliver clinics as well. We funded a project which is dear to my heart and that is the Heart of Australia bus in rural and remote Queensland. So there are many things that we have done, but I'm really pleased that the Minister for Health and the minister for rural health have supported making this office permanent. I wholeheartedly support this bill in the House.

7:14 pm

Photo of Emma McBrideEmma McBride (Dobell, Australian Labor Party, Shadow Assistant Minister for Mental Health) Share this | | Hansard source

I rise to speak on the Health Insurance Amendment (Continuing the Office of the National Rural Health Commissioner) Bill and support the amendment moved by the member for McMahon. Labor supports this bill which amends the Health Insurance Act 1973 to continue the Office of the National Rural Health Commissioner and expands its function.

During debate when the legislation and the office were first established in 2017, Labor were quite concerned that it was due to cease by June this year. The government now shares this concern, and this is why we're debating the bill before us, which extends the office indefinitely and expands its power. Until now, the commissioner has been focused on the establishment of the National Rural Generalist Pathway, which the previous speaker has spoken about, an advanced training program for GPs.

The bill expands the commissioner's remit, including providing advice to the rural health minister about matters relating to health in rural, regional and remote areas; undertaking specified projects about matters; and inquiring into and reporting on specified aspects of those matters. As part of the broader remit the office will now consider the entire health workforce. As a pharmacist and allied health worker myself, this is something that I think is really critical—including nursing, allied health and other health workers.

I want to focus a little on the divide between health and wellbeing that people experience between those living in major cities and those living in the bush. In its 2019 report on rural and regional health, the Australian Institute of Health and Welfare found that on average Australians living in rural and remote areas have shorter lives, higher levels of disease and injury, and poorer access to and use of health services compared with people living in metropolitan areas. The report found that people in remote areas were more likely to report barriers to accessing GPs and specialists than people in big cities. Life expectancy for both men and women decreases as remoteness increases. This is a really stark divide between Australians living in major cities and Australians living elsewhere. And, given the very real disparities in morbidity and mortality between the city and the bush, I welcome the continuation of the office and expansion of its role.

One thing that I want to focus on was, although we strongly support the intent of the strategy, which was to improve access to health services in the bush, that some of these measures as they've been rolled out in recent months have had some unintended consequences. It's become clear that the government's changes are hurting regional and outer metropolitan areas. The first change is to Medicare bulk-billing incentives. GPs are paid additional incentives when they bulk-bill children and concession card holders. The incentives are higher in rural areas than cities to encourage GPs to practise in the bush. But, under the government's changes to classifications of rural areas, many regions have lost access to the higher rural incentives and been dropped to the lower metro rates.

The government initially claimed just 14 areas were affected, but it was revealed at Senate estimates that 433 areas have seen cuts. GPs in these areas have seen about a 34 per cent reduction in their incentive payments. GPs have built their practices and business models around these incentives, and now they've been stripped away. Many GPs say this threatens bulk-billing and some say it threatens the viability of their practices altogether.

The second change is the longstanding district of workforce shortage system. Doctors trained overseas or in bonded positions in Australia—and I've worked with many of them—can only claim Medicare benefits for a time in defined rural areas. The government has changed the system from the previous DWS to the distribution priority area. The DWS wasn't perfect, and while we welcome a change that takes into account socioeconomic considerations, it appears the DPA model is also flawed. The change is having unintended consequences in areas that were classified DWS but are now not distribution priority areas.

The third change is the abolition of the Rural Other Medical Practitioners Program. Under the former program, GPs were paid a higher rebate if they practised in rural and regional areas. The government's stated intent was to improve the quality of rural and regional GPs and has abolished this program. At the same time, this has removed the incentive for GPs to practise in this area. In some regional towns, the abolition of ROMPs has forced the closure of the towns' few remaining general practices and, along with other changes, has made it harder for surviving practices to recruit and retain doctors.

While Labor support the intent of the government's rural health strategy, we were alarmed by continuing acute health worker shortages experienced in rural and remote Australia. But any efforts to boost rural health shouldn't come at the expense of regional areas that are also struggling to attract and retain doctors, nurses and allied health workers, and that's what these changes have done.

I'd like to turn now to the critical issue of mental health in rural and remote Australia. Before the COVID-19 pandemic, Lifeline reported that more than 40 per cent of online crisis chat contacts were from rural and remote locations. Beyond Blue says:

Remoteness is a major risk factor contributing to suicide and the likelihood that someone will die by suicide appears to increase the further away they live from a city.

They went on to say:

… people in outer regional, remote or very remote areas of Australia face more barriers to accessing healthcare than people living in major cities, making it harder … to maintain good mental health.

The COVID-19 pandemic is having a particular impact on young people's mental health and wellbeing. New data from ReachOut, which was released this May, showed a 50 per cent spike in the number of young people seeking help from their digital youth mental health service compared with the same time last year. According to ReachOut, from 16 March to 17 May this year their online information and support for isolation and loneliness was accessed more than 17,000 times. That's one young person every five minutes accessing ReachOut. Yet this bill fails to mention mental health. This appears to be an oversight when rural, regional and remote communities face the challenges of access to services and distance. Without a coordinated effort, rural, regional and remote communities will continue to struggle to receive the mental health services that they need when they need them.

The National Rural Health Commissioner released its interim report to the Minister for Regional Health, Regional Communications and Local Government in March 2020. The report observed the workforce challenges of allied health services. It said:

The undersupply and maldistribution of the allied health workforce has a significant negative impact on the accessibility of allied health services for rural Australians and the severity of impact increases with remoteness.

The report went on to say:

… there is strong unmet need for more allied health services in rural and remote Australia.


Policies need to accommodate growth of rural public, not for profit and private service capacity.

The National Rural Health Commissioner will release its final report later this month, and I urge the minister and the government to adopt any recommendations calling for improved access to allied health services.

As a pharmacist who started out my pharmacy career in 1997 in Forbes, I believe appointing a deputy commissioner to focus on allied health is a big step forward. Allied health professionals include pharmacists, social workers, OTs, physiotherapists, dietitians and psychologists who serve our rural communities as best they can, often across vast distances. Allied health professionals provide care in settings from outpatient clinics to in-home to hospital and are often the first point of contact with the healthcare system for somebody living in remote Australia and sometimes the only point of contact with the healthcare system for that person. However, I urge the government to also consider a deputy commissioner with responsibility for professionals involved in mental health care. The stated No. 1 social priority of this government is suicide prevention towards zero. Having worked in adult acute mental health inpatient units in a regional centre at Wyong Hospital in my electorate for almost a decade, I urge the government to see this as crucial and something that the government must consider.

Experience tells you that mental health in rural, regional and remote communities deserves priority, focus and an urgent funding boost. Too many people in these communities don't have access to services that people in big cities just take for granted, often leading to tragic consequences. This is even more important as we face the long and bumpy road to recovery from the economic impacts of COVID-19.

The minister would be aware of the link between unemployment and financial distress and mental health crises. It's well established. As Suicide Prevention Australia highlighted in its report released this March, an unemployed person is nine times more likely to take their life than someone who is working. The Productivity Commission report estimated the cost of mental ill health to the Australian economy to be between $43 billion and $51 billion each year, and that was before COVID. Mental health professionals and services in the bush need to be given priority and focus, and there's an opportunity to do that. The National Rural Health Alliance, made up of 44 organisations, said in its response to the draft PC report:

… it is preferable to have a focus on wellbeing—wellness not illness—and this approach needs to be implemented as part of a holistic approach to mental health wellbeing …

The service providers that make up the NRHA understand best practice for mental health in their communities and they should be heard, Minister. I urge the government to clarify what role the commissioner and the deputy commissioners will have concerning mental health. This is a chance here to be able to give mental health the priority, focus and resources that it needs. I urge you to consider this, Minister.

7:25 pm

Photo of Mark CoultonMark Coulton (Parkes, Deputy-Speaker, Minister for Regional Health, Regional Communications and Local Government) Share this | | Hansard source

It is indeed a pleasure for me to making these summing-up remarks. With regard to comments from the member for Dobell, I appreciate her interest in mental health. I was speaking to the Mental Health Commissioner yesterday. I'm sure that as the role of the rural commissioner becomes known some of your fears will be allayed, because the points you make are genuine and real. Thank you.

I'd like to take this opportunity to thank all the members on both sides of the House for their contributions. It's nice to know that, although at times we have different points of view, when good policy and a program that's actually doing what it's designed to do come through, we have that support.

Continuing the office of the Rural Health Commissioner is a very important part of tackling the challenges around rural health. I know we are very short of time, but in the minute I've got left I would like to thank Emeritus Professor Paul Worley for his outstanding commitment and the body of work that he's done in that role as the first National Rural Health Commissioner. The work that he has done around the generalist pathway and the body of work that he's done on allied health in regional Australia is a valuable resource. Certainly we'll be looking at that.

On behalf of the government, I'd like to thank the many rural health stakeholders and organisations around the nation who have welcomed our decision to continue the office of the Rural Health Commissioner. We are looking forward to working closing with the commissioner and the rural health stakeholders and organisations over coming years to achieve our shared aim of delivering a quality standard of health care for our regional, rural and remote communities, and I commend the bill to the House.

Photo of Ross VastaRoss Vasta (Bonner, Liberal Party) Share this | | Hansard source

The original question was that this bill be now read a second time. To this, the honourable member for McMahon has moved as an amendment that the words after 'That' be omitted with a view to substituting other words. The immediate question now is that the words proposed to be omitted stand part of the question.

Question agreed to.

Original question agreed to.

Bill read a second time.

Message from the Governor-General recommending appropriation announced.