Alan Tudge (Aston, Liberal Party, Shadow Minister for Education) Share this | Link to this | Hansard source

The purpose of the Higher Education Support Amendment (2022 Measures No. 1) Bill 2022 is to give effect to two changes which were previously introduced by the Morrison government. The first is a substantial initiative for rural, regional and remote Australia, which is to give effect to the coalition's HELP for Rural Doctors and Nurse Practitioners measure announced in the 2021-22 MYEFO. This measure provides a partial or full higher education loan program, known as HELP, debt deduction for rural doctors and nurse practitioners who reside and practise in regional, rural or remote Australia once they complete their studies.

The coalition introduced this measure to encourage doctors and nurse practitioners to relocate to rural and regional Australia by reducing their outstanding HECS-HELP debt. This is a substantial incentive, given that the HECS debt for doctors can be up to $100,000. The need for health professionals across regional and rural Australia is particularly important, though, with around one-third of our population—around eight million people—living in rural, regional and remote areas. It's of great concern that this group of Australians experience poorer health outcomes than those in metropolitan areas.

According to the OECD Health at a glance report in 2017, Australians have one of the highest life expectancies in the world. But when we dig deeper into the data the life expectancy rates between people in metro areas and those in regional and remote areas differ by about five years, with even greater differentials for Indigenous Australians. Much of this is attributed to less access to preventative health services, such as GPs and nurse practitioners. Around 20 per cent of people in regional Australia report not having access to a general practitioner nearby. In fact, around 65,000 Australians have no access to GP services within an hour's drive of their home. Consequentially, they access less care and are at greater risk of death from preventable and treatable conditions, such as diabetes and heart disease. Overall, there's a 20 per cent increase in disease compared to those living in metropolitan areas.

This measure will go a long way to addressing this by providing access to essential health services. We hope that around 850 GPs and nurse practitioners will take up this initiative. The value of debt reduction applied will be guided by where eligible doctors and nurses locate to, using the Modified Monash Model. This model depicts the remoteness of a location on a scale, with category MM 1 representing a major city and category MM 7 representing a very remote location. The locations for this measure will be in the areas of MM 3 to MM 7.

For example, doctors and nurse practitioners who choose to work in a rural or regional area will need to provide a minimum of 24 hours a week of Medicare billed services for a period equivalent to the duration of their whole degree. For doctors, this is usually around eight years. For nurse practitioners, this is around three years. These areas include locations like Dubbo and Lismore in regional New South Wales or Busselton in Western Australia.

Doctors and nurse practitioners who choose a remote area to work in will need to provide a minimum of 24 hours a week of MBS billed services, for a period equivalent to half the duration of their degree, to have their full HECS-HELP debt waived. This would equate to around four years for doctors and 1½ years for nurse practitioners, so these are very substantial incentives. I'll repeat that: a doctor who's graduated goes and works in a remote area for half the duration of their degree—let's say it's an eight-year degree—they do it for four years and they have their entire HECS debt waived. Gone. It's the same for a nurse who does that.

These areas include Alice Springs in the Northern Territory, Mallacoota in my home state of Victoria or Bruny Island in Tasmania. They are real, great incentives for new doctor and nurse graduates to go to these regional and remote areas, and we think they'll have a sizeable impact. That's exactly why we introduced this measure into the parliament at the end of last year. Unfortunately, the parliament was prorogued before the measure could pass.

The measure itself will be backdated as per the coalition announcement in the 2021-22 MYEFO, and eligibility and retrospectivity commence from 1 January 2022. This measure builds on the coalition's significant investment in health, be it through Medicare and high bulkbilling rates, more listings on the Pharmaceutical Benefits Scheme, record hospital funding or more mental health services. We will be moving an amendment, and I'm happy to table that amendment.

Our amendment seeks a review of the policy, which we would have done in government as a normal part of reviewing new policies. The review seeks to assess the policy's implementation, take-up and effectiveness in filling those particular workforce shortages across regional, rural and remote Australia. But a critical part of the review, which we have in this amendment and which we hope will get the support of this parliament, is to specifically assess other skills shortage areas in those regional and remote areas to see if a similar style of policy could equally be applicable for those skills shortage areas. It might be, for example, in mental health services. It could be engineers, which we often lack in regional or remote areas. Possibly, we can investigate having those HECS waivers for new graduates going into those areas, as well. That's what we're arguing this review should do in our tabled amendment. I urge the government to support this amendment to ensure that we can continue to provide Australians who live in regional, rural and remote areas with the services they need and should have access to.

The bill also changes the definition of a grandfathered student to clarify the grandfathering arrangements under the Job-ready Graduates Package of reforms to higher education, known as the HELP grandfathering measures. These measures meant that, when the job-ready graduates program came into place, most of the fees for students went down or stayed the same. But there were some courses where the fees went up, and these grandfathered arrangements were put in place to ensure that, if you'd already started a degree at a certain price point, that price point would be maintained for the duration of the degree.

This particular amendment ensures that an honours year of study at the end of your degree is also considered to be part of the overall degree, as far as the grandfathering arrangements are concerned, rather than being a new degree which consequently attracts a higher fee rate. It's a very straightforward, clarifying amendment. That was always the intent of the job-ready graduates program, but this will absolutely make sure that those students who started their degree under the lower rates will continue all the way through to the completion of their honours year under that rate, as well.

I commend the government and Minister Clare for re-introducing this bill. I particularly commend the government for adopting the coalition's policy—a very good policy which we introduced towards the end of last year—of providing those HECS and HELP waivers for the doctors and nurse practitioners who go and work in the regional and the rural areas. We think it will make a difference. We're confident it'll make a difference. It will make a difference in getting more doctors and nurse practitioners out to more regional and remote areas. In doing so, it will make a difference to the health outcomes of all of those Australians who live in those locations.

I thank the government for reintroducing the coalition's bill. I commend the amendment which we have put down, which will reassess how this is all going after a couple of years and take a look at whether or not any other skills shortage areas should additionally have the benefit of these types of HECS and HELP waivers, applicable through this bill for doctors and nurses. I commend this bill and the amendment.

Carina Garland (Chisholm, Australian Labor Party) Share this | Link to this | Hansard source

This House has heard me on a number of occasions talk passionately about my love of strong health systems, universal health care and a robust higher education sector that provides opportunities to all. I'm really delighted to speak today on a piece of legislation that will deliver great health outcomes and encourage the education of health practitioners in our regions, because that sector matters to Labor and it's clear we have a problem there.

This legislation, the Higher Education Support Amendment (2022 Measures No. 1) Bill 2022, protects students from experiencing unfair financial hits due to the changes to higher education fee structures introduced by the previous government in the Job-ready Graduates Package, in cases where students have already commenced a course or are forced to change courses for a range of reasons out of their control. The legislation also provides a real incentive to doctors and nurse practitioners to work in regional and rural areas, by providing a reduction of 50 or 100 per cent in their HELP debt, the figure depending on the time they spend in an eligible rural, remote or very remote location and on whether the location is rural, remote or very remote.

This legislation ensures that there are grandfathering measures for HECS-HELP arrangements, to ensure that students are not disadvantaged by the Job-ready Graduates Package introduced by the previous government. It's important that, when students are undertaking honours courses, they are not unfairly hit with higher costs due to a change in higher education policy that was introduced after they had begun their course of study. Given I have both Monash and Deakin universities in my electorate, this has the potential to impact many students in Chisholm. It is really important that we protect those students from the financial hit they would suddenly experience if we did not grandfather the HECS-HELP provisions.

This measure also protects students who, through absolutely no fault of their own, have had their courses discontinued or restructured or have been forced to change courses by their education provider. It would be unfair to deny these students grandfathering protection, so that is one of the very good reasons we are introducing this legislation. I'm really pleased that the government have recognised this problem in the system and that we are taking this very important step of grandfathering HECS-HELP obligations for students who otherwise would perhaps be unfairly hit with a financial penalty.

Mr Deputy Speaker, we know we are in the midst of a jobs and skills crisis. Indeed, that's why our government made it a priority to host the Jobs and Skills Summit here in Canberra just after we were elected, just over six months ago. I ran a local forum in my beautiful community in Chisholm too. We've heard, through these various fora, about the acute shortage of professionals in the healthcare system and the grim impacts that that is having across communities right around the country. At the recent jobs and skills round table that I hosted in Chisholm, I heard about the importance of general practitioners as the load-bearing scaffolding of the health system. I know this really well. I was raised in a family with a father who was a general practitioner running his own business and doing so much work to support our community.

I've met with Deacon and Monash universities about this issue, and I'm really grateful for their insights and expertise in this area. Both Professor Christina Mitchell, from the Faculty of Medicine, Nursing and Health Sciences at Monash University, and Professor Iain Martin, Vice-Chancellor of Deakin University, have generously shared with me their valuable thoughts on what we can do to meet our current and future workforce needs. I look forward to continuing to meet with them and listen to their expertise in advocating for evidence based solutions to problems we face as a community and as a country.

I don't know if the House is aware of this, but I was born in Traralgon, and we were living there because my dad, a doctor, and my mum, who was a nurse, had relocated from Melbourne to complete their training and assist with a workforce shortage in the region at the time, working at the local hospital. So there unfortunately have been shortages in our region for some time. It's critical that governments invest to attract to the regions health practitioners, especially GPs and nurse practitioners, who can help relieve some of the pressure experienced in hospitals and emergency departments, which happens when we don't intervene in health issues early. We know that, more often than not, early intervention leads to better outcomes for patients and is better for the economy too.

I'm really proud to be part of an Australian government that understands the problems facing communities in the regions and wants to provide real solutions—real outcomes for Australians and our communities. I'm really pleased that we're getting on with delivering the policies and solutions we need to build a better future. That's why ensuring that we establish a HELP debt reduction program for rural doctors and nurse practitioners is really important—that is, extending this incentive beyond what was introduced previously and came into effect on 1 January this year. This will ensure updates to outstanding HELP debts processed annually through the taxation system.

We are investing a significant amount in incentives for eligible doctors and nurse practitioners, and it is really important. This legislation will pay off doctors' and nurse practitioners' loans if they work in these communities, and I think that's a fantastic thing. This will make a difference both to communities and to those who would otherwise be carrying a significant HELP debt, often when they are at the beginning of their working life. The aim here is to attract students to fill the critical shortage of health workers in regional areas, and we've heard the Rural Doctors Association of Australia say that that numbers in the thousands. Eligible doctors and nurse practitioners will be encouraged to live in these areas. This will reduce their HELP debt significantly.

There are so many benefits to this for the individuals who are able to utilise this scheme and for our wonderful regional communities. We know that rural GPs are more likely to be able to provide in-hospital care as well as private consulting room care. We know that more GPs in rural areas provide after-hours services. We know that they engage in the public health roles expected of them by their communities where there often may be few doctors to choose from. They can engage in clinical procedures and emergency care. They are able to provide real holistic support to the communities that they serve, and I've seen this firsthand in my own family.

Although my electorate is not a rural area, the Monash medical school students who study in my electorate will more easily be able to choose to practise in remote areas of Victoria and Australia. I've met with some outstanding medical and nursing students at Monash University in Clayton. It is clear they are passionate about the work they do and love learning on the job. This program will give them the chance to practise in remote and regional areas and develop expertise in new communities or will allow them the opportunity to serve communities that they already had ties to before they moved to Melbourne to study.

This means people can start their careers and not have what is sometimes a real financial worry—HELP debt. I know that my parents as young health practitioners benefited from building a community as they were building their careers in Gippsland. When we moved to Melbourne a few years later to be closer to my grandparents I know the experience that they had in regional Victoria was really important for our family. They really got a lot out of being able to develop their skills and contribute their skills to the people who needed them.

This legislation does a number of things. I'm really pleased that we've introduced it to the parliament. It importantly protects students from the changes made to higher education fee structures that would have unfairly impacted those who commenced courses prior to its introduction or who were forced to change courses due to the external factors described in the legislation. It provides a real boost to our medical workforce, particularly in regional Australia, which is very dearly needed.

Anne Webster (Mallee, National Party, Shadow Assistant Minister for Regional Development) Share this | Link to this | Hansard source

I rise to support the Higher Education Support Amendment (2022 Measures No. 1) Bill 2022. It builds on what we on this side of the House know was a good piece of legislation. The original bill introduced by the coalition in the 2021-22 Mid-Year Economic and Fiscal Outlook has been reintroduced and encourages the relocation and retention of eligible doctors and nurse practitioners by reducing their outstanding HECS-HELP debts. This measure also allows for the waiver of indexation on outstanding HELP debts for eligible doctors and nurse practitioners while they are residing in and competing eligible work in rural, remote and very remote areas. HECS-HELP debts for doctors can be up to $100,000. Any reduction in that would certainly be an incentive and enticement for a graduate to move to the country—at least that's my hope in my electorate of Mallee.

Any incentives that boost our regional and rural health workforce are certainly worth pursuing and are supported by this side of the House. In Mallee, as in many regional centres across Australia, access to health care is at crisis point—and I don't say that lightly. This amendment bill will expand this policy beyond the health workforce to other sectors in the future, which would mitigate the dire workforce issues that we face in our regions. We need to ensure that everything possible is done to bolster skilled, unskilled and semiskilled workforces in rural Australia. This is for every industry—be it agriculture, education or manufacturing.

Access to health services is a key issue for people who are considering a tree change. Whether young teachers or older retirees moving to the region, knowing that there is quality health care matters. For parents of a young family who are teachers considering taking jobs at a local school, they're less likely to do so if there are no GPs available to support their family. If we don't ensure country workforces have a sustainable supply of essential services, such as health, these communities will be unsustainable in the long run.

Mildura, in the north-west of Mallee, is an example of a town with a struggling health workforce. Most GPs in town have closed their books to new patients. Some, like my husband, who is a GP, work 60-plus hours a week. In the recent General Practice: health of the nation 2022 report, I note he is one of a small number who work those hours. And he is one of the 40 per cent of Australian GPs, or nearly 50 per cent of Victorian GPs, who will retire in the next few years.

This dilemma has had terrible outcomes. People leave this pristine area because they cannot find a doctor. This is true not just for Mallee but for towns across Australia. It means hospital emergency departments are overflowing, struggling to manage the number of people who are unable to see their GP. Even worse, people simply stop trying to deal with their health issues and, sadly, that increases the morbidity statistics in the regions. How long can this situation go on?

It highlights the disparity between city and country. Nearly nine million people live in rural areas across Australia, yet these people often experience poorer health outcomes than their city counterparts. This is something that needs to change. It must change. We can change it by ensuring health workforces can meet their communities' needs. Providing incentives to bolster the uptake of not only general practitioners and nurse practitioners in the regions but other essential medical professionals, such as psychologists, psychiatrists or physiotherapists, assists in ensuring that no matter where you live you have access to adequate medical care. Beyond that, through this amendment we can bolster the workforce in other industries.

This amendment calls for a review of this bill in two years time in consultation with the National Rural Health Commissioner and the Regional Education Commissioner. It will provide sufficient time to monitor the implementation of the existing measure for doctors and nurse practitioners. With this knowledge, we can determine other priority areas relevant to rural and remote Australia.

As I said, initially, this bill was a piece of sound legislation introduced by the coalition, and it is pleasing to see it being recognised by this government—that we can do more for the regions. As a proud representative of a regional electorate and a strong advocate for regional and rural Australia as a whole, amending this bill to support other industries is the right way to provide support for all Australians, no matter their postcode.

Fiona Phillips (Gilmore, Australian Labor Party) Share this | Link to this | Hansard source

I'm incredibly excited today to speak in support of the Higher Education Support Amendment (2022 Measures No. 1) Bill 2022. I am pleased that this bill is helping to support students with fairer grandfathering provisions for job-ready graduates. As a former TAFE teacher, I know how important education is. We need to make sure that our rules are fair and clear. Students shouldn't be lumped with fees that they weren't expecting because our laws aren't clear enough or because their university made decisions to change or cancel their courses. So that is an important change.

But what I'm really excited about with this bill is the new provision to encourage the employment and retention of doctors and nurse practitioners in rural, regional and very remote areas of Australia. This fantastic bill is taking real, innovative action to address the GP shortage we are facing across regional and rural Australia but in particular in my electorate of Gilmore on the New South Wales south coast. What it means is that doctors and nurse practitioners will be incentivised to live and work in regional and rural Australia by having their university debt waived if they stay long enough. It's not just if they come for a short while but if they come for a long while. Medical degrees certainly don't come cheap, but the Albanese government is working to reduce that cost. The only catch—not that I would call it a catch—is that you have to work in regional Australia. As someone who has spent their whole life in regional Australia, I can tell you that is not a bad deal at all. The south coast is the most magnificent place on earth—why wouldn't you want to live and work there?

This is truly something to be celebrated, but to really understand why this change is so important, I think it's important to understand the scale of the problem we are facing. I want to talk a little bit about the difficulties local people have had in accessing a doctor. The shortage of doctors in regional and rural Australia has been escalating for years. Local GPs are overworked and struggling to cope in a system that isn't supporting them, with a hospital system that is broken, and with an ageing population that increasingly needs more care and support. The major hospitals in my electorate are in desperate need of upgrades. The Eurobodalla has been waiting for a new hospital for years. We have been fighting to make it a level 4 hospital against a state government that has continually played down the health needs of this community. The Shoalhaven hospital is chronically at the top 10 of a number of lists, but nothing to celebrate—it's top 10 in the state for the longest emergency department wait times and the worst hospital for rostering. Only 46 per cent of its patients have their treatment start on time, and only 47 per cent leave within four hours. The list goes on.

There has been chronic underfunding from Liberal state and federal governments for years and years. The trouble is, it's a negative feedback loop. The fewer GPs, the more pressure on hospitals, and the more pressure on hospitals means more pressure on GPs—a system that can't cope. Local people have to either travel great distances or, in many cases, go without, leading to more serious health complications. We need more GPs. Local doctors in our community have been demanding change for a long time, pointing out, quite rightly, that the incentives for getting GPs in regional areas have just not been fit for purpose.

When I was first elected to parliament in 2019, I joined with many members of the Tuross Head community to raise concerns about the closure of the Queen Street Medical Centre in Tuross Head. The wonderful Tuross Head Progress Association presented me with a five-page submission on the negative impacts this decision would have on the local community, and on the domino effect the closure would have on retail businesses, patients and the broader community. Queen Street Medical Centre has its main centre in Moruya, at the time had satellites in Broulee and Tuross Head. When the local doctor left, they struggled to recruit a new one. There weren't enough incentives or reasons to attract doctors to small places like Tuross Head—hard to imagine, given how beautiful the area is—not to mention the pressures the former government's Medicare cuts were placing on GP practices. We're working on that, too, another big but important task. So, sadly, the Tuross Head practice closed.

This is an ageing population, with more people over 65 than under, but all too often they have to travel great distances for medical care. Now they have to travel just to see their GP. The flow-on also means local people don't use the local pharmacy, stop by the local bakery or grab a coffee from the local cafe. Instead, they do all of this in a larger town, putting even more pressure on the small local Tuross Head shops. These are the flow-on impacts, all from the loss of a doctor. As an ageing population, many also don't drive. This means many people might avoid or delay seeing their doctor, which we know leads to more health complications. It's just simply not good enough.

I along with many others was relieved when in 2020 a doctor from Sydney finally came to the rescue, opening a practice once more in Tuross Head. This doctor could see the huge need in regional communities and was spurred into action after the COVID pandemic. At his own cost, he took a decision that actually didn't make business sense but acted for the good of others. I can tell you that is an attitude we know well on the south coast—a truly selfless community. We welcomed this new doctor with open arms.

Sadly, Tuross Head is not an isolated example. Last year Sanctuary Point lost its last GP because the amazing Dr Kate Manderson, who runs a few centres around Shoalhaven, could not find a doctor to replace the retiring GP there. As many of her GPs retired, she had just been unable to find and recruit new ones. I have met with Dr Kate on many occasions to hear her views on how we can address the issues facing local GPs. She has lots of great ideas, and we are connecting those through to the minister for health, who is very receptive to how we can improve regional and rural access to GPs. I always appreciate the time Dr Kate takes to share her thoughts with me on important local issues. Annette Pham, who runs another set of local practices, also had the same issue at her practice. They have struggled to recruit and keep local doctors. They could see the problems and have so many ideas to fix the issues.

Both Annette and Dr Kate advocated strongly to improve incentives for recruiting and retaining GPs in regional areas like ours. They advocated for years to have the Distribution Priority Area updated for our community, and I joined them in that fight. The former government removed the DPA status of Nowra-Bomaderry and Sussex Inlet three years ago, and the case for undoing that was clear from the start. I advocated strongly to the former minister about this, raising that concern here in the parliament, writing to the minister and begging him to change our status. We were absolutely thrilled to see that change finally happen in February this year—a huge win for our community, a hard-fought win. But it was a long fight, and that one change is not enough to make up for the loss of doctors in our community. A lot of damage was done in that time.

Dr Kate and Annette continue to be fierce advocates for how we can address this issue. Together we also managed to advocate for a reintroduction of Medicare item 288, video/telehealth psychiatry consultations, in regional and rural Australia. The former government removed this important bulk-billed service. It was a heartless decision that many local doctors and patients raised concerns with me about. People told me how they had been put into a dark place because they couldn't afford to see their psychiatrist anymore. They could no longer afford to get their prescriptions renewed. They were abandoned by a government who did not understand the healthcare needs of regional Australia. Together with local doctors and patients, our advocacy saw that reinstated by the Albanese government. I was so delighted about that, and many people contacted me to say how relieved they were.

So the voices of local doctors really do make a difference to the policies that we deliver. I was pleased to welcome Annette, her husband, Dr Hao Pham, and other advocates from their service to Parliament House this week to meet with the health minister and continue their advocacy. They want to see more doctors becoming GPs. They want to see bulk-billing increased again after years of cuts. They are fighting for vulnerable people, and our government is listening. I will be welcoming Dr Kate very soon as well so she can share her thoughts on GPs and aged care, because I know their voices are crucial to getting this right. I sincerely thank them and every local doctor, nurse and medical practitioner for their advocacy on these crucial issues.

In my time as member for Gilmore, literally hundreds of people have contacted me to say they can't find a GP. People are travelling hours in the wrong direction just to see a doctor or ending up in our already overloaded hospital system. GP access has been spiralling out of control for far too long, made worse by cuts to Medicare and a decade of mismanagement by a Liberal government who wouldn't prioritise access to health care. Fundamentally, they did not believe in Medicare, so I am absolutely delighted that today we are taking one more serious step in the right direction to recruit and keep doctors in our regional communities. Once again I like to think that it is the ideas of our community on the South Coast that have contributed towards this important reform. In my recent Jobs and Skills Summit Survey, conducted in the lead up to the summit in September, many people suggested that removing or reducing education debts for people who work and stay in regional and rural areas was the way to go. Juanita said:

Provide subsidies for relocation and providing HECS relief to those who commit to staying and working in rural communities.

Gina said:

… reduce the HECS debt of bonded medical students who come to the regions.

These were two amongst many similar suggestions. Well, Juanita and Gina, that is exactly what this bill will do. If this bill passes, from 1 January next year, eligible doctors and nurse practitioners will have their HELP debts reduced or wiped if they live and work in areas like the South Coast for the equivalent length of their degree. Doctors and nurse practitioners who meet half of the time requirements will be able to access half of the HELP debt removal. This is fantastic news.

Moving to regional and rural Australia is no easy task for someone who has never lived here before, so we need to encourage them, not just for a short time but for a long time. We need to encourage them to put down some roots, build a network of family and friends and live their lives here. Zero HECS debt is a strong incentive for a young doctor or nurse practitioner to try regional Australia, particularly in this economic climate, and I know that in a beautiful area like the South Coast there are more than a few reasons to stay. This is one step in the right direction, one part of a suite of changes we are working on to address our GP crisis across regional Australia.

I'm delighted that the recent budget is also delivering a Medicare urgent care clinic for the Batemans Bay region. Providing bulk billed medical care in this community will make a huge difference to local people. We hope to see more of these clinics rolled out over time, but I am really pleased that Batemans Bay will be one of the first. The Albanese government is going to continue to work hard to improve health services and health outcomes for regional and rural communities like ours on the New South Wales South Coast. This bill today is so incredibly important. We need to incentivise more doctors into our communities, and I say to any studying doctor or nurse practitioner, if you want a free degree, why not come and live on the sunny South Coast? We have beaches, mountains, valleys, even a rainforest, and we have the best community in Australia. We will welcome you with open arms, so give us a shot. I commend this bill to the House.

Sophie Scamps (Mackellar, Independent) Share this | Link to this | Hansard source

I rise to move a second reading amendment to the Higher Education Support Amendment (2022 Measures No. 1) Bill 2022, as circulated in my name:

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 calls on the Government to:

(1)recognise that the financial benefit delivered under this bill, will, in many cases, not be sufficient to overcome other perceived barriers for entering the regional, rural and remote workforce;

(2)acknowledge that Australia is facing a nationwide GP crisis with a workforce shortage of 11,000 GP's forecast by 2032;

(3)acknowledge that not enough medical students are choosing general practice and commit to long term planning to increase the number of GP's including improving GP training programs; and

(4)substantially increase the Medicare rebate for GP services, as per recommendation 6 of the Senate Community Affairs References Committee Provision of general practitioner and related primary health services to outer metropolitan, rural, and regional AustraliansInterim Report".

Australia is in the midst of a GP crisis, both because the rising cost to see a GP is a barrier to many Australians accessing health care and because of a widespread shortage of GPs across the country. With an ageing GP workforce and not enough new medical students choosing to specialise in general practice, the problem is set to only get worse as GPs retire over the next 10 to 15 years. Only 14 months ago I was working as a GP myself during the COVID pandemic. During this time, we faced not only the COVID-19 pandemic but the increased incidence of eating disorders, mental health issues, addictions and chronic disease management. Our practices also faced the challenges of being used as COVID call centres.

I know first-hand the pressures GPs across the country, including in my electorate, are under. I've spoken to many practices on the brink of financial collapse, a position supported by research conducted by the Royal Australian College of General Practitioners which shows 48 per cent of GP practices are in the same position. Very few GP practices in my electorate offer comprehensive bulk billing to all their patients. Many have had job ads up for months and can't fill GP positions. This parliament is on notice that we are facing a breakdown of Australia's primary healthcare a system. It is now an emergency and in need of intensive care. Currently, the situation is worse in our rural areas where people are waiting months to see a doctor. The doctor they eventually see is working up to 80 hours a week, day in, day out, to cope with the demand. We desperately need more doctors and nurse practitioners in rural and remote areas.

I welcome this bill which seeks, amongst other measures, to incentivise doctors and nurse practitioners to move to and service rural and remote areas in exchange for eliminating or reducing the higher education loan repayment debt. I also note that this measure was recommended by the Royal Australian College of GPs, the Australian Medical Association and the Australian College of Rural and Remote Medicine. However, there is no definitive evidence that reducing or eliminating the HELP debt will drive an increase in the numbers of GPs working in these areas of need. Firstly, the financial benefit conferred by this bill may be substantially offset by the lower wages received in those areas compared to metropolitan and urban areas. Secondly, there is a concern that the incentive may become an ineffective bonus if it is given to people who intended to move back to rural regions anyway. The government's modelling suggests that this measure will help 850 doctors and nurse practitioners move to regional and rural areas per year. If that number is correct and it does consist of medical practitioners who would not otherwise have moved to rural and remote areas, then it is good policy.

Despite welcoming this measure, I must acknowledge that this is the equivalent to placing a bandaid on a gaping arterial wound. The GP crisis is not a rural and remote one only; it is a crisis that impacts every electorate across Australia. In order to assess the success of this policy, we need to track and review it; however, in this legislation there's no planned review, and this is concerning. Good policy and governance depends upon evidence of effectiveness and success, particularly when the benefits are conferred upon individuals. We have had schemes like this before, but, due to a lack of evaluation and evidence, we are unsure of their benefit. We need to evaluate this initiative to determine its effect.

This measure shouldn't stand alone. We know that changes to general practice need to be comprehensive. The Australian Medical Association has an 18-point plan for supporting equal access to health care for rural communities. It includes measures to drive the rural medical training pipeline, such as by delivering a strong rural training pathway, and measures for retaining existing medical practitioners. The Royal Australian College of General Practitioners has a targeted investment plan to support patient access to general practice care.

In 2021, the Senate Community Affairs References Committee commenced an inquiry into the provision of general practitioner and related primary health services to outer metropolitan, rural and regional Australians. They released an interim report but never a final report, noting that there was merit in having the matter re-referred to the committee under the 47th Parliament. The interim report that was issued under that inquiry was extensive; it made recommendations that mirror the calls from professional bodies such as the AMA and the RACGP.

In early October of this year, the RACGP also convened a GP crisis summit here in Canberra with GP groups from around the country. Again, recommendations from that summit called for greater investment in and planning and reform of general practice. Those recommendations are not piecemeal, stand-alone measures, nor are the ones called for by professional bodies. They call for structural reform and a multifaceted approach to address the GP crisis and reverse the falling trajectory of new GPs entering the workforce. Today, only 13.8 per cent of medical students are choosing general practice as their specialty. We need to get that back to 50 per cent. Today, we face a year-on-year decline of GPs, with a 15 per cent decline in urban areas and a 27 per cent decline in rural areas. This is coupled with almost doubled demand. We are on track for a GP deficit of over 11,000 GPs by 2032. These figures are incredibly concerning, and GPs in my electorate are already feeling the impacts of doctor shortages, as are all GPs around the country.

The outcomes of the recent GP summit are clear. The pool of GPs must be increased. Reinstating GP rotations for junior doctors will help increase the number of junior doctors who choose to specialise in general practice. It is also necessary to reduce the red tape for international medical graduates to be able to participate in general practice. We need to ensure that general practice is a sustainable career path by introducing measures to, for example, increase the Medicare rebate and bulk-billing incentives, and to support GPs to spend more time with patients, which will, of course, also deliver better patient health outcomes. We also need to strengthen the role of GP team members, including nurse practitioners, practice nurses and allied health.

Australians have endured the COVID-19 pandemic and experienced the impact of a healthcare system in crisis. They have seen what happens when we fail to take the risks to the system seriously enough to plan and mitigate. We can't make the same mistakes again.

Last week many MPs were visited by passionate and dedicated GPs who shared their experience of the GP crisis and called for it to be urgently addressed. I thank the Parliamentary Friends of General Practice, of which I am a co-chair, and the Royal Australian College of General Practitioners for organising this initiative. I also appreciate the minister for health's acknowledgement that general practice is indeed in crisis, describing the low number of medical graduates applying to specialise in general practice as the most terrifying statistic in health care.

I now call on the government to prioritise this reform, plan for it in the May budget and, at minimum, deliver recommendation 6 of the Community Affairs References Committee's general practice interim report to substantially increase the Medicare rebates for all levels of general practice. I commend this bill to the House.

Kylea Tink (North Sydney, Independent) Share this | Link to this | Hansard source

I want to thank the member for Mackellar for moving this very important amendment that we have in front of us at the moment. The reality is that our healthcare system is in crisis. Whether it's in the hospital system or through to the community system, what we know without a doubt is that there are plenty of people who are looking for healthcare services and, sadly, are unable to access them. I was fortunate to be one of the members of parliament who was visited last week by people who were representing the GP workforce across this country, and I was horrified to learn that of the students who finish medicine these days at university just under 14 per cent of them are choosing to go into general practice.

As somebody who grew up in regional and rural Australia, where the general practitioners in our community were considered to be amongst the highest of the citizens that we had, it's heartbreaking to see that medical students are not choosing to lean into this pathway as a career going forward. There is no doubt that as our population ages we are going to need general practitioners who have an ability to look at a person and see them as an entire health puzzle. There is no doubt in many medical situations that having a good relationship with a general practitioner actually enables your health to be managed more effectively. As someone who has advocated very loudly in the area of mental health, I think this is particularly important.

To this end, I commend the member for Mackellar and agree with her that we do need to recognise that the financial benefits currently being offered under this bill in many cases will not be sufficient to drive what we need to see—a significant influx of talent into this professional area. I also want to reiterate the member for Mackellar's call that we are going to be 11,000 GPs short by 2032. Knowing that there are so many other industries across our nation who are also seeking talent, it's imperative that we move as quickly as we can to find these resources and close this gap. I understand from both the member from Mackellar and those who visited me last week that GP training is something that needs to be included in the fundamental training program of healthcare professionals, and I would encourage the federal government to step into that to exert pressure where they can.

I also ultimately recognise that there's been minimal movement on Medicare rebate, which makes it very difficult for general practitioners to provide the level of support that their patients are ultimately expecting from them. You cannot take care of the health of a whole human being when your business model forces you to try and get through as many people as you can by focusing on a five-minute consultation.

We need to fundamentally embrace the knowledge of members such as the member for Mackellar and the others who make representations in this chamber to ensure that we are building a healthcare system that is not just fit for purpose now but fit for purpose well into the future. I commend the member for Mackellar's amendment to the House.

Bob Katter (Kennedy, Katter's Australian Party) Share this | Link to this | Hansard source

The previous speaker referred to Cloncurry, which, of course, is my home town. It was my father's home town and my grandfather's home town. My father and his two brothers were the three Katter boys; there were three boys in the family. My uncle Norman died from an injury in rugby league. This was before the Second World War. The Qantas plane was in Longreach. If it had been in Cloncurry, they could have flown him out of Cloncurry and straight to Brisbane. But, by the time it came back from Longreach to Cloncurry and then went to Brisbane, he had died. He died as a result of the tyranny of distance.

In a terrible piece of irony, my father, who had cancer, was supposed to go down for an operation, and the airline strike hit. Even though the government supplied Air Force planes to ferry people—after three or four months, I think it was—he stood in the queue. He didn't feel it was his right to jump the queue. So it ended up that he got down for the operation some seven or eight months after he should have, and the cancer had gotten away and he died. So two of the three Katter boys died as a result of the tyranny of distance.

There's a shortage of doctors in the country areas. The previous speaker made mention of the fact that they don't realise the opportunities in country centres. If you drive into Charleville, there's a huge statue to Dr Louis Ariotti, whom people in Charleville and the area considered next to a sainthood. If you drive into Cloncurry, you drive in on Harvey Sutton highway, which is a tribute to the great doctor that lived in our community and saved so many of our lives. I'm sure that they'll have one to Dr Murphy in Longreach in the not-too-distant future! These men were not only leaders who set a wonderful example for their communities; they were great and committed doctors. They didn't just treat you when you came in to be treated; they alleviated your misery and pain and did everything humanly possible to ward off death in these areas.

In the early days of Qantas, there were many lives lost. Whilst they say Qantas has never had an accident—and that's true of the modern Qantas—the original Queensland and Northern Territory Aerial Services, as it then was, had many deaths. But the effort to overcome the tyranny of distance was so great that people took those risks. You can reflect upon the fact that Ernest Henry, the founder of my home town of Cloncurry, found some heavy rocks there when he was prospecting on horseback, and he rode off to Rockhampton to get them assayed because he thought they were very valuable copper. It turned out they were worthless iron ore, and it had taken him seven months to ride to Rockhampton, get the assays done and go back to Cloncurry. That's the tyranny of distance.

My father mentioned on many, many occasions the great Reverend Flynn, who's on one of our banknotes. He brought the mantle of safety to bush with the Royal Flying Doctor Service.

To turn to the present day, for the first time in my life there was no doctor in Julia Creek, there was no doctor in Cardwell and there was no doctor at Mission Beach. Heavens, how could you not find a doctor at Mission Beach! For two years in a row it was voted one of the four most beautiful places on earth. If you go into my offices, as you have on many occasions, Acting Deputy Speaker Vasta—I call them the Mission Beach mafia because most of them come from Mission Beach. You can't get a doctor to go to Mission Beach? There is something seriously wrong out there.

I want to pay very great tribute to my own doctor, Dr Rod Catton, at Innisfail. I want to pay great tribute to Dr Grant Manypenny, who has worked 70- and 80-hour weeks, continuously, in the latter years of his life to provide us with a vital private medical service in Mareeba. You could say, 'You can go to the hospital,' but you can only go to the hospital for emergencies now. Outpatients at hospitals in Queensland have ceased to exist.

The great 'Red Ted' Theodore, the most important person in Australian history—not my words; they're the words of Paul Keating and Malcolm Fraser—introduced the free hospital system in Queensland. For my entire lifetime, until the ALP got elected in 1990, you could walk in off the street, any time of the day or night, even Christmas Day, 24 hours a day and get service in an outpatients department. Outpatients does not formally exist in Queensland. If you want a graphic illustration of that, my now home town of Charters Towers has a huge sign at the outpatients department saying 'Closed'. On the other side of the aisle is the inpatients department, and that is open. Outpatients is closed permanently.

Lisa Fraser is a very young doctor filled with the enthusiasm of youth and gifted with an excellent intellect. Grant Manypenny has been desperately trying to retire. Rod Catton has worked well after the time he should have stopped working, and we pay great tribute to Rod's self-sacrifice. The three of them came to Canberra. They asked for four things and got all four things. I'm still in a state of shock over it. I've never seen anything like it in my life.

The first thing they asked for that day was the writing off of the HECS debt. The second thing they asked for was more money for GPs in private medical centres. The third thing was foreign doctors coming into Queensland. The restrictions were just a little bit too strict in Queensland and they asked for a liberalisation. The federal government put a second body in that could authorise doctors to become GPs in Queensland. So they're three of the four items. I'm having enormous difficulty remembering the fourth item, and I feel very embarrassed that I can't remember it. I'm at a loss to remember what it was.

It was an extraordinary achievement by those three practitioners. They came down at their own expense and lost a lot of money that they would have earned if they'd been up in their own home towns during that period. The time and research they put into those representations was extraordinary.

Quite frankly, there is no answer to this problem. You can give them all the money in the world, every concession in the world that you want to get them, but unless, to become a doctor practising in Queensland, you have to do rural service, nothing short of that is going to overcome this problem. It is a matter of forcing them to do it. You want to become a doctor in Queensland? You have to spend some time in a maybe not so salubrious centre. That was the law in Queensland for as long as we were in government in the state of Queensland—up until 1990, when the ALP took over. They changed that arrangement and now we haven't got doctors. They got rid of the outpatients.

You can spend hundreds of millions of dollars in the state of Queensland or tens of billions of dollars solving the world's planetary problems with respect to the atmosphere and what they call climate change, but people don't realise that there's not enough money to go round. That is something that has never occurred to what we used to call socialist governments. You could hardly call the Queensland government a socialist government—it's anything but.

People don't understand this. They think that the ALP is representing the have-nots. The complete opposite is true. They slither out of a university into a trade union office, where they are given their proper job of answering the telephone—they're not worth anything more than answering the telephone. But in answering the telephone they get to know all the delegates in Queensland and, when positions come up, they get elected to those positions. They are very articulate and slither in their slippery suits from Sydney universities. Of course they become the owners of Australia. The superannuation funds invest $170 billion every year in the Australian economy, so they are the haves; they are the ruling class; they are the ownership class. They are not very nice people.

What has this got to do with doctors? I'm trying to explain that in Queensland you thought that by electing an ALP government you were going to get looked after. Now your outpatients are closed and towns all over Queensland are without any doctors. The whole system is collapsing underneath you, because there's no money being put there. We're too busy saving the planet. I don't know that it's a very significant contribution there either, with the only proposal coming forward in this House and the state parliament in Queensland is putting windmills in the ocean. I don't think any of you would be game to walk into a hotel and say, 'We're going to solve the world's climate problems because we're going to put windmills in the ocean.' Yet you're game to say it in here; you're game to impose that upon us.

It's a choice: you can spend money on your fantasies and things that you think will get you re-elected or you can look after the people. I'm proud to say that, for my entire time in the state parliament in Queensland, you could go to the hospital—24 hours a day every day of the year, including Christmas Day—and be attended to by a doctor and a qualified person and every single town in the Kennedy electorate—and there are 120, but you could argue there are 142, depending on your definition—had a resident doctor. That is not now the case. I don't know how many towns are not being serviced now because the doctors are simply not there.

I had the great honour and privilege of calling the first meeting to try to secure a medical school in Townsville. Seven years later, the committee that was formed that day broke through and got the first medical school. I take some considerable pride and congratulate myself on that wonderful achievement. Kudos was given to my daughter Mary Jane Streeton, as she is now, who had been the secretary to the organisation; to Professor Wronski, who was the driving force at all times; and to Lady Pearl Logan, who was an incredible woman—I think the greatest woman of the last century in Australia. She was a lady, a knight of the realm, and had an honorary doctorate from the university. Every day of her life she used to take out her Gospels and read to us. She was a very deeply committed Christian. She was a very devout Presbyterian. Those three people enabled us to get the first medical school built in 44 years in Australia. I am told that some 18 universities have now walked through the door that those three great heroes opened for us.

The irony of this—and it gives me no joy to say this—is that in spite of 200 doctors a year coming out of the Townsville University, and in spite of incredible efforts by Professor Ronski and the dean of the faculty, who are doing everything humanly possible to get those doctors to service the regional centres, we still can't supply the doctors to these places. You can offer half a million dollars a year on top of what they're getting, and I still don't think you're going to get them to go there until you make it compulsory that they go there before they can practice as a GP.

James Stevens (Sturt, Liberal Party) Share this | Link to this | Hansard source

I rise to support the second reading of the Higher Education Support Amendment (2022 Measures No. 1) Bill 2022, which has two elements—both former measures from the previous government—the second one of which has been the focus of people's contributions for ways in which we can better support young students to take up opportunities in regional and remote settings. This bill provides a significant incentive through dramatic relief to student loans—in fact, the complete extinguishment of them up to a certain amount, depending on where you go and how long you go for.

This is a good example of a debate on a topic that we don't discuss that regularly in this chamber. I absolutely love Sydney, Melbourne and Brisbane, our three great metropolises. The three of them combined are home to the vast majority of people that sit in this chamber. If you take the greater urban areas of those three centres, they house the vast, vast majority of the population of this country. When we're discussing national policy, sometimes it is important to think about whether or not there are different opportunities and different forces at play in our economy and our society depending on whether you're in those three mega urban areas or somewhere else.

I am from the City of Adelaide—not a remote or regional area but a city of about 1.3 million people and second biggest urban area, after Perth, following those three mega areas. The state of South Australia is really a city state, so we have only about another 300,000 people in the state that don't live in urban Adelaide. If you got a compass on a map, set it to 100 kilometres and drew a circle around Adelaide from the GPO, you'd capture almost the entirety of the population of South Australia. Even though France and Germany could very easily fit within the boundaries of the state of South Australia, outside of that 100-kilometre radius from the City of Adelaide, we are a very sparsely populated state. Even though the challenges that this part of the bill is targeted to don't necessarily relate to the delivery of services my electorate, it's a bill that's extremely important to my state and to any Australian that cares about all Australians getting proper equity of access to services not just in health but across all services.

In this case, we're talking about health. The issue with the way in which our population is distributed is that in areas like health—and other areas like migration—we have a situation where those three major urban areas tend to be the magnets that attract people from a wide variety of points of view. The economies of scale in the big cities, particularly the cultural ones, lead many people to decide that, if they have the choice, they'd prefer to choose the life in the big cities than the other options available to them. I know that people who sit in this chamber who represent communities that aren't in the big cities very proudly dispute the enjoyment of life in smaller communities being less than in bigger ones, and I think they've got a lot of credibility in what they say. But that is invariably the reality of the challenge that we seek to address.

Previous speakers who represent electorates with regional and remote communities have talked about the personal impact of struggling to attract general practitioners and other medical practitioners to their communities. The member for Kennedy obviously talked about some direct impacts on his family. It's obviously quite tragic and very regrettable that, in his view, which I'm sure is accurate, the tyranny of distance for medical services led to the premature death of two of his family members.

I lived for a couple of years as a child on Norfolk Island. That is an extremely remote place to live. It wasn't very difficult to get a GP to do a couple of years posting on Norfolk Island for reasons that I believe I shouldn't need to outline. Nonetheless, we had that one GP on the island for a population of about 2,000 people in the South Pacific. In the 1980s there was not an aircraft sitting there on the airstrip waiting to medevac people to any other care facilities at the drop of a hat. So the GP there was obviously very much the guardian of life-or-death medical emergency issues. At least back then, we had a small hospital capability but obviously not one much beyond emergency issues. The general practitioner was really just working absolutely full time. If something happened in the middle of the night and you needed medical assistance then she got the call. So it's difficult. I know we have some medical professionals in the room. Being on call permanently means you don't get to enjoy a glass of red wine on Saturday night at a dinner party because at any point you could be called and asked to provide some assistance. For me, as a young boy of five, six and seven, my very first memories of a country GP were of what dedicated service they give to the community.

It is regrettable that we find ourselves in the challenging circumstance in the 2020s where it is becoming more and more difficult to attract people across a variety of allied health professions but particularly GPs in a permanent way to regional towns. My colleague the member for Grey very regularly raises this issue in this chamber. I absolutely defer to his experiences in his electorate. He represents the vast majority of the state of South Australia, where I am from. I know they have ongoing significant challenges all the time with attracting GPs to certain towns in his electorate, including his home town of Kimba. That has been quite a challenge in recent times.

This bill is one measure that we can pursue to make it more appealing, through the forgiveness of student loans, for more younger people to take up the opportunity of working in regional areas. Apart from the service that they might give in that community, it might take three to six years to qualify for the complete eradication of their student loan. We also hope that in that three or six years they fall in love with the community that they have gone to work in. I think that's a very reasonable expectation. That will probably happen in many circumstances. Certainly, that's the ultimate outcome—that someone goes to a regional community to be their GP for a few years, supported through this scheme. It might make the difference between taking that opportunity and not. Hopefully, it's not three years. Hopefully, it's 20 or 30 years because they find that they have fallen in love with the community and the lifestyle and they see that community as somewhere for them to make a future with their family. That's the hope of the main measure in schedule 2 of this bill, and certainly it's something that we intend to put in place in government. It's not a silver bullet. It's not by any means going to exclusively solve the challenges—far from it. But I think solving the challenge of these workforce shortages is going to mean multiple measures, of which this can be one of many, that come together to make sure that we are doing all that we can to provide the very best of health services to every Australian. Every Australian deserves equity of access to all services that government provides, but none are more important than access to the highest standard of health care. With those comments, I certainly commend the bill to the chamber and look forward to the passage of this legislation so the benefits of it can start to be felt in regional and remote communities in this country as soon as possible.

Terry Young (Longman, Liberal National Party) Share this | Link to this | Hansard source

I'm pleased to rise to speak on the Higher Education Support Amendment (2022 Measures No. 1) Bill 2022. The reason I am so pleased to speak on this bill is that it finalises the bill which was first introduced by the coalition in the last term. Unfortunately, due to the election, the previous bill lapsed. I'm pleased the current government has acknowledged its value, and it will hopefully be passed in the near future. It will achieve great outcomes.

One of the greatest challenges facing rural and remote regions in our country is an inability to attract and recruit professional people such as GPs, nurse practitioners and teachers to those communities. This means our people in the country, including many of our Indigenous citizens, are not receiving the care that they need. The coalition identified this issue, and a policy was formulated to address this via means of financial incentives. This bill will mean that doctors and nurse practitioners that make the decision to relocate to regional or rural areas with a Modified Monash, or MM, rating of MM 3 or higher will have their university HECS-HELP debt either reduced or completely waived depending on the Modified Monash rating of the community where they provide the service.

We know that when people are exposed to these remote and regional locations a percentage of them will make the decision to permanently settle there. Some will fall in love with the town, the community. They may find their future spouse and start a family there. Whatever the reason, this would not happen unless they first moved there. This bill encourages them to do just that.

For those GPs and nurse practitioners who choose to return to their original places of residence, their communities will also benefit as just about every community across our nation is screaming out for more GPs. So everyone's a winner. The community then benefits by having a resident health practitioner looking after their health needs, which is very important, as the data tells us that individuals living in regional Australia experience poorer health outcomes than their city counterparts. This is attributed to the fact that they have less access to healthcare professionals. The added bonus is that these communities will have new residents that will contribute to the local economy. Another benefit is that students contemplating which degree to pursue may choose to select medicine or nursing, knowing that their university tuition will be heavily or fully funded.

This bill also rectifies the anomaly around grandfathering arrangements under the job-ready program to ensure that honours students remain eligible for the grandfathering arrangements where their course started pre 2021. This was another coalition initiative in the last term of government and, again, I'm pleased that this government has continued to run with it.

To be eligible for this program, doctors and nurse practitioners will need to work in a community with a Modified Monash rating between MM 3 and MM 7. They will need to provide a minimum of 24 hours a week of MBS billed services for a period equivalent to the duration of a full degree. The other great news is the measure will be backdated as per the coalition's announcement in the 2021-22 MYEFO, and eligibility will retrospectively commence from 1 January 2022.

The HECS-HELP debt for doctors can be up to $100,000. According to the AIHW report Australia’s health 2022, GPs living in regional Australia experience greater job satisfaction than those living in urban areas—another great reason to make the move. This bill will hopefully help address the issue of only one in seven graduates in medicine choosing the path of general practitioner. If this issue is not addressed and rectified, then we will continue to see greater load put on our already struggling and overloaded emergency departments or, even worse, people simply won't bother to seek medical treatment at all, which will lead to poorer health outcomes.

In speaking to people in my electorate of Longman, there is a great appetite to see the return of the family GP, where your local doctor looked after you and your family's health needs, sometimes for generations. Many people are tired of using the public system and the larger corporates, where they often don't see the same doctor twice. This bill will hopefully go some way in returning to this method of health care. I look forward to seeing the outcomes of this bill, and, if successful, I would like to see it implemented in other demand vocations, such as teaching, for regional communities. This is a good practical bill—first developed by the coalition—that delivers numerous benefits. I commend the bill to the House.

Helen Haines (Indi, Independent) Share this | Link to this | Hansard source

I'm very pleased to rise in support of the Higher Education Support Amendment (2022 Measures No. 1) Bill 2022. This bill aims to encourage the employment and retention of doctors and nurse practitioners in rural, remote or very remote areas of Australia by reducing all or part of their outstanding university HELP debt. I'd like to pay tribute to the member for Lyne, who was very much an architect of this work in the previous government, and likewise the member for Mallee, who's been a very strong supporter of nurse practitioners.

It's well known that across Australia we have a shortage of health professionals, but rural areas are disproportionately suffering from this shortage, and we know this has been a longstanding challenge. Our higher prevalence of chronic disease, including asthma, diabetes, cardiovascular disease and cancer, is higher than that of metropolitan centres. This is a chicken-and-egg situation, where we have less early intervention for chronic diseases driving greater and greater demand for health professionals. Doctor-patient ratios are twice as high in remote regions as they are in our cities. Patients simply can't get in the door, and our doctors, nurses and allied health professionals are under enormous pressure.

This isn't a recent phenomenon, and, over the years, successive governments have introduced programs such as the departments of rural health and the Rural Health Multidisciplinary Training program to train doctors, nurses and allied health professionals in rural areas. I spent over a decade working at the University of Melbourne department of rural health and experienced the great satisfaction of seeing our students graduate and take up roles as rural doctors in local communities, where they're leading incredibly fulfilling careers and making such a difference to those local people.

There's plenty of evidence to show the success of these programs. However, we know that the strongest evidence for attracting and retaining doctors in rural areas is in recruiting young people with a rural origin to enter the medical field. There are some structural barriers for rural students choosing a career in health care, one of which is the cost of education, which goes to the object of this legislation. Additionally, there's the cost associated with leaving home, both from a financial perspective and also from a social perspective.

Programs established under the previous government, such as the Murray-Darling medical program, go to this issue. This program—set up by the previous government, and for which I congratulate them—provides medical training in the regions for students who are from the regions. The network includes La Trobe University in Wodonga—part of my electorate of Indi—where they undertake undergraduate studies in biomedicine before students go on to the Doctor of Medicine program run by the University of Melbourne's department of rural health, based in Shepparton.

When I met with participants in the program earlier this year, I was struck by their stories of why they wanted to be doctors and why they specifically wanted to be doctors in regional and rural communities. Growing up rurally, they told me, they had experienced health struggles in their own families and long hours in the car to go to and from medical appointments in major cities. They spoke of the difficulties and hardships that this created, and it galvanised their resolve to become rural doctors. The students told me how much better it was to be able to attend university and stay living on their home farm, indeed, in their local town. The students I spoke to came from small towns like Milawa and medium sized towns like Wangaratta, Benalla and Wodonga. They were all studying locally at La Trobe University's Wodonga campus.

The program at Latrobe is led by Dr Cathryn Hogarth, who told me there'd been hundreds upon hundreds of applications from students who could have been accepted into the program. They had the marks, they had the aptitude, but the university simply isn't funded for the places. It has the teachers, it has the facilities, including wet labs, and, as I've just indicated, it truly has the demand from young people wishing to study rural medicine. But there are just 15 places in that program at La Trobe each year. The university told me they could take three times as many students, so I would say here is a real opportunity for the Albanese government to expand programs like this with proven models to further increase the number of doctors studying and working in regional Australia.

I support this bill as a measure to get more much needed doctors and nurse practitioners into rural and remote Australia, and importantly encourage them to stay. We need them at the disease prevention end, and we need them at the treatment end—basically, we need them. Health professionals, though, are team players. They must be, and that's why I'm encouraged that this program includes nurse practitioners as well as doctors because, compared to other countries, we have completely underutilised nurse practitioners in Australia, so this bill is a very important endorsement of their skills and their contribution and, more importantly, their potential to do much, much more.

Nurse practitioners are highly trained. They bring years of clinical experience and expertise. They have masters-level specialist education. They can diagnose, prescribe and undertake early intervention and they often work in very hard areas of concern—areas which are hard to reach and very poorly resourced such as aged care, palliative care, wound care, drug and alcohol treatment. But their practice has been hamstrung for years by very poor and inadequate Medicare rebates. This desperately needs reform to unleash their skill in what are really very, very stretched areas of primary care. Again, I call on the Albanese government to address this issue as well, Medicare rebates for nurse practitioners. This is truly an opportunity that we could grasp if we had the will to do so.

This legislation is as yet untested in the field, so crucially, as this program rolls out, we must monitor its progress. Therefore, I support the member for Mackellar's amendment to review the scheme in 2026 and again in 2029. A review of this bill will help us see how well the scheme is working to attract and retain doctors and nurse practitioners in rural Australia and, really importantly, how it can be improved. I'm pleased to hear that the government will support this amendment, and I hope they consider any recommendations made by the reviews.

We need to pay attention, importantly, to what's missing in this bill, and what's missing is a kindred program for mental health professionals. One of the biggest challenges facing rural and regional Australia and my constituents in Indi is accessing appropriate, timely mental health support. We had a problem before the pandemic, but now that need is truly and greatly exacerbated not just in the high-prevalence issues of anxiety and depression but also in the very traumatic area of eating disorders where access to evidence based care and help is under enormous strain in the cities but nigh on impossible to access in most rural areas. Local psychologists in Wodonga tell me they simply cannot cope with the demand for their services for eating disorders. They tell me that they need to clone themselves.

While I support the government's measures to increase the rural health workforce through this bill, this is incomplete unless and until we do the same for our rural mental health workforce. I speak in support of this bill, but I believe we need to do more, and that's because of what I see every day in my community, what I hear from my constituents and what I know from my many years of experience as a clinician and researcher in rural health.

I support the government's budget initiatives to address mental health, including the commitment in the budget to restore the 50 per cent loading for telehealth psychiatry services in regional and rural areas. Telehealth psychiatric services were an especially important service to people in regional and rural areas before, and during, the pandemic, and concerned constituents contacted me after they were cut. So it's right and proper to see that the government is restoring the loading for these critical services.

I was also glad to see in the budget the government's expansion of the headspace centre network. The communities of Indi worked so hard to get a headspace in Wodonga and Wangaratta. It's such an important support for young people in regional and rural areas, but we need to increase the capacity of these services, and that means encouraging young people to study mental health sciences and to work rurally. That's why, while this bill is good, it could be better, by offering mental health professionals who come to work in the regions the same level of debt forgiveness as doctors and nurse practitioners.

Around 22 per cent of rural and remote residents are living with a mental health or behavioural condition. Benalla, in my electorate of Indi, has double the state average of people experiencing mental ill health. Despite people in the regions being more likely to experience this mental ill health than people in the cities, we are 26 per cent less likely to see a psychologist. That's because the services simply are not there. Indeed, it would take 5,000 mental health workers in the regions to give us the same level of access to care that our city cousins have right now. There are no full-time mental health workers for young people in Myrtleford, and, where there are mental health services, like headspace in Wangaratta, there are lengthy waitlists. It is the same in towns like Alexandra, where local people often must travel miles away to Melbourne or Shepparton, disrupting school, work and family.

In 2019, 90 per cent of headspace centres reported major challenges in meeting demand for their services, with the main reason being workforce availability for mental health clinicians, GPs and private practitioners. This massive shortage of mental health services was compounded again after the devastating 2019 Black Summer fires and followed by COVID-19 lockdowns. Many communities struggled to come together to heal, and the mental health impacts can have, and have had, serious long-term impacts.

In my first term of parliament, I fought hard to secure more funding for mental health services in Indi. After the 2019 bushfires, I lobbied the former government to secure $800,000 in funding for mental health programs, including for mental health nurses in Corryong and drug and alcohol responses, but, again, the issue was trying to get the workforce to carry out that work. I'll continue to advocate for improved services for those in the community suffering from eating disorders, which, sadly, increased in prevalence again during COVID-19.

Constituents are constantly contacting me about mental health. They are constantly contacting me about the challenges they face in getting the right help for themselves and their loved ones, about the impact it has on them, their community, their work and their relationships, about the high cost of mental health care and about the long distances they need to travel to access that care. Mental health workers have told me about the alarming increase in demand for their services, and they're struggling to meet it.

I want to acknowledge their hard work, and I also want to applaud the community members who are working in community connection and prevention, including the Grit and Resilience Program in Wangaratta, led by Bek Nash-Webster. This program is a community led suicide prevention program that focuses on social and environmental determinants of health. It does this by creating opportunities for people to connect through social groups, like the women's tables and the separated dads group, and events such as street parties. It promotes inclusion in the community. The Grit and Resilience Program is so successful that it hopes to continue with future federal government grants and possibly expand to other communities, such as Mansfield.

As an Independent, I can recognise good work wherever it's done, but I can also recognise where more work is needed. I will always be an unflinching voice for rural Australians. This bill will help address the need for doctors and nurse practitioners in rural Australia, but the government can do more to recognise and address the dire state of mental health. That's why I'm calling on the government today to include, in their next budget, provisions for mental health workers to be included under this scheme. This would allow psychologists, mental health nurses, psychiatrists and social workers to have all or part of their outstanding university HELP debt reduced when they reside and work in rural and regional Australia.

I recently met with the Minister for Education and was glad to receive his interest for including mental health workers in future budgets, and I look forward to working closely with him on this policy. Including these mental health workers in future budgets is smart, it's targeted and it would give a clear signal to students that the need is great and the opportunities wonderful if you choose a career in rural mental health. At a time like this, when our regions have suffered almost three years of bushfires, a pandemic, border closures and, now, floods, the time is right for this investment, on top of the investment the government is making for nurse practitioners and doctors.

So I'm very pleased to receive the Minister for Education's interest in my proposal. I hope to continue to work together with him and his team. I really want to see this government invest not only in doctors and nurse practitioners but also in mental health professionals in rural and regional Australia, in the next budget and right out into the future.

David Gillespie (Lyne, National Party) Share this | Link to this | Hansard source

I rise in support of this bill, the Higher Education Support Amendment (2002 Measures No. 1) Bill 2022, and the amendment foreshadowed by the shadow minister for education.

The biggest compliment one can get is that of imitation. This bill comes from legislation I introduced when I was the Minister for Regional Health. I'm so pleased that the current Labor government has decided to back the initiative, because we do have a problem. We have a major shortage of multiskilled general practitioners and nurse practitioners in regional and remote Australia. We have a shortage of general practitioners even in suburbia, but the situation is worst in regional Australia.

The initiative at the heart of this bill is to give graduates in medicine and nurse practitioner studies relief from repayment of their HECS-HELP debt. If you work in very remote Australia, an area defined by the Modified Monash Model classification system as MMM 6 or MMM 7, for the length of your postgraduate degree—either a nurse practitioner degree or a medical degree—you get two years credit for one year worked. If you do a six-year medical degree and you work for three years in rural and remote Australia, your HECS debt will be wiped—it will be relieved. For nurse practitioners it's a two-year postgraduate doctorate, which means that if you do one year in an area that's between regional and very remote it's one for one. If you've done a six-year medical degree and you've done six years of service, the HECS debt, which can amount to $100,000, is waived. The minimum amount you've got to do is half your medical degree. You can't just turn up for six months and get the benefit; you've got to do the hard yards. That involves working 24 hours a week in that area as a doctor or as a nurse practitioner.

There were a few bumps in the classification system, so this bill includes amendments to cover people who, up until 1 January 2021, had been enrolled in a postgraduate master's degree in medical practice. They are now effectively grandfathered and covered.

This initiative will shift people. A lot of people really like their experience as a med student when they are doing their rotations through regional Australia. We've organised for half of the training at med school and for medical registrars to be done in regional Australia, acknowledging the shortage of workforce. But having this financial carrot makes a lot of sense to younger graduates at a stage in their life when they are putting down roots. If I could have offered this during the period of government back to 2013, I wonder how many more doctors and nurse practitioners would have stayed.

The shadow minister for education has foreshadowed an amendment that calls for a review of these changes to take place two years after they're put in place. We want the review to consider, with the help of the National Rural Health Commissioner and the Regional Education Commissioner, other health graduates that are in equally short supply in regional Australia. Pharmacists, clinical psychologists, physiotherapists—all of those professions are really lacking. There's this huge magnet that drags people into metro Australia, and we really want to shift the dial on that. That's why we'll be moving this amendment.

Overall, this is a great bill. I'm not trying to blow my own trumpet, but it really is a good idea. People in the industry recommended it, and I support this bill to the hilt.

Debate interrupted.