Tuesday, 26 August 2014
Health Workforce Australia (Abolition) Bill 2014; Second Reading
I rise today to speak in opposition to the Health Workforce Australia (Abolition) Bill 2014. Before we go into the substance of the bill, it is important to try and unpack the problem we are trying to solve. The problem is of a scale that requires urgent action. We have enormous maldistribution of the health workforce in this country. If you live in a regional area, there is a good chance you will have difficulty accessing a GP, a nurse or an allied health professional. When you look at the number of health professionals per patient, you will see that there is an enormous disparity between people who live in regional and rural areas and those who live in an urban environment.
We have a situation where it is not just about maldistribution; we also have an ageing workforce, particularly when you look at the aged-care workforce and the mental health workforce. The average age of a mental health nurse is the late 40s and for general nursing it is the mid-40s, and we just do not have the number of graduates available to replace them. If you go to many rural areas, you will find that health professionals, GPs, nurses and others work outside of their scope of practice and are being put in situations that they feel very uncomfortable dealing with because they are simply not trained to be able to deal with some of these complex issues. It is just not fair that somebody living in a regional community should not get access to a decent level of health care in the same way that people who live in cities get access to health care.
The Productivity Commission looked at this problem in 2005. They recognised that we had a huge issue on our hands. We have an enormous problem with the workforce being unevenly distributed. In some settings that workforce is ageing and we simply do not have the number of new graduates on hand to replace them. They did not just look at that problem; they looked at what the Australian government's response was in order to try and deal with it. What they found was extremely worrying. We had a huge degree of fragmentation, a lack of coordination and duplication of medical bodies in a whole range of different jurisdictions, all trying to deal with the problem.
It was in that context that Health Workforce Australia was established. It was established on the back of the act in 2009. It has a very clear mandate to deal with research and data collection to ensure we have information at hand—and one of the problems is that we often do not have that—to do long-term planning to ensure that we provide communities that are struggling with decent access to health care. Part of that is ensuring that there are training opportunities for healthcare professionals in those areas.
I heard Senator Smith talk earlier about the problem being duplication. He is right. The problem is duplication and the response to that was the establishment of Health Workforce Australia, to get a central body to coordinate what is going on. If you think that the department, with all of its competing priorities, will provide the dedicated focus that Health Workforce Australia provided and will carry on that role, you are wrong. It does not have the capacity, the expertise or, in fact, the focus that is necessary to deal with this challenge. That is why we saw the establishment of Health Workforce Australia. It is important that we have a dedicated agency that gets rid of duplication and ensures that we are able to get a much more coordinated approach to the training of our healthcare professionals and ensures that people right across the country get access to decent health care.
One of the responses has been, 'We'd rather invest our money in front-line services.' Senator Smith said that the priority for this government is to invest its money not in organisations like this but in front-line services. The logic of that statement is baffling. You see, the problem is that there are not any front-line services in many of these communities. That is the whole point of Health Workforce Australia. These front-line services just do not exist, they are not there. If you want to get access to specialised medical care, in many communities you cannot get it. The idea of simply taking money away from Health Workforce Australia and investing it in front-line services is a nice line: of course we all want money invested in people who are delivering services on the ground, but when they are not there you have got to do something to address that problem. So it is a policy position that simply does not have any basis in logic. In order to be able to provide front-line services you have got to have the healthcare professionals on the ground in those communities before we can do it—and what we have here is a proposal to make that problem worse rather than better.
This sort of reflects everything that is wrong with this government's priorities. There is a substantial body of work from the Productivity Commission and there are a number of health bodies and organisations that have said to governments repeatedly: 'You've got to do something to fix this. You can't leave it to the department. You've got to have a dedicated focus. You've got to have a workforce agency established to start collecting the data, to do the planning and to do the clinical training that is necessary to fix this over the long term.' But governments say: 'No, we're not going to listen to the experts. We won't listen to the authorities. We'll ignore the Productivity Commission report—because what we have got is a bureaucracy and, if it is a bureaucracy, it must be bad.' But I never hear people complain about the bureaucracy in this place when their cheques are getting paid; I never hear people complaining about the bureaucracy then. There is a narrow ideological view that says: 'We've got an agency over here. It is government funded. It mustn't be doing anything.' There is just this very narrow, blinkered view.
And it gets worse. In health care, there is a view that says: 'If the government is providing insurance for healthcare services through an instrumentality called Medicare, if it is government funded, it must be bad. So what we've got to do is hand it over to the private insurers.' Again, there is a complete absence of evidence to support that proposition. It is a belief system. It is an ideological view that says: 'If governments do it, it's got to be a bad thing. We're going to hand it over to the private sector.' That is why we have now got a recipe for a user-pays system in health care that will take us down the US road to a two-tiered system where there is one level of health care if you can afford private health insurance and another level if you cannot. But it is not just a question of fairness, it is a question of having an efficient health system. We know from all the international evidence that the most efficient way of funding healthcare services is through a universal insurer like Medicare—we have already got one. It means you keep healthcare costs down.
There is often a debate, and tension, between the notion of fairness and the notion of efficiency. In health care we have got a wonderful sweet spot. We can have a fair health system, which we by and large have, and a very efficient one, which we by and large have. But no. 'Ignore the evidence! Let's go down the road of ideology! Let's follow a user-pays model which is a recipe for a less fair and less efficient system!' Of course, the role of planning and coordination comes into that. 'But you can't plan and coordinate. That's a job for the market! Why would we have government bureaucrats planning and coordinating our healthcare workforce when we could use the market to sort it out!' Well, it just does not work in health care because health does not conform with the same principles we see in other areas of the economy where there is an exchange between two people with the same sorts of information from both parties.
The good news in all of this is that the Australian people do not buy it. They do not buy the notion that, simply because a government is providing a service, it must be bad. They do not buy into the notion that having a government agency, Health Workforce Australia, doing some long-term planning around workforce issues for people, particularly in rural and regional communities, is a bad thing. No, they think that is a good thing. They do not buy the idea that we should have a user-pays system in which private health insurers replace the role of Medicare. They do not like it and they do not buy it. That is the good news.
And that is the reason we have ended up in this ridiculous debate about the state of our budget, that we are facing 'a budget emergency'. The rhetoric has now softened. I do not know whether it is an emergency, a graze or what we are talking about at the moment. We end up getting tied up in knots over this stuff. We have heard language around the sustainability of the healthcare system. Well, we have got one of the most sustainable health care systems anywhere in the world. It delivers first rate health care to people right across the country. There are some problems, we could do better, but compared to similar countries we spend lower than the average on health care. Compared to the OECD countries we are trending very, very well.
Health care expenditure over the last 10 years has gone up by only a small proportion. In fact, Medicare spending has been stable. Over the next 10 years we are going to see a little increase in healthcare spending. But that does not have to be a bad thing. If that healthcare spending is giving people access to new drugs, new treatments and new technologies that they did not have access to previously, that is a good thing. That is the whole point of having an economy that grows: it gives us the opportunities to access those sorts of things. That is a good thing. It is something we should be proud of and cherish.
Instead we see this government perpetuating the myth that we cannot afford what we have already got and we certainly cannot afford what is coming down the line. It is nonsense. We can afford it. It is a question of priorities. In fact, only this week the Parliamentary Budget Office indicated that healthcare spending is under control: 'We can do it. It's not a major drama. If you're looking to cut spending, there are a whole range of other areas you should be looking at.'
So it all comes down to this. You can look for savings when it comes to co-payments; you can look at making the system less fair by letting your mates from the private health insurance industry take over the role of Medicare, you can do that in an effort to pinch a few pennies, but it will cost us more in the long run, or you can start tackling some of the fundamental problems we have in our health system, one of which is ensuring that everybody gets access to decent health care. The way you do that is not by dismantling an agency which has the responsibility to get rid of the duplication, to ensure we are much better coordinated across all of the jurisdictions that work in this space, to ensure that we have the data collection, the long-term planning and the clinical training pathways for people who want to work in regional environments. Getting rid of that agency is returning us to the bad old days, which took us to the Productivity Commission review, which said that we have a problem and we have to fix it. This is taking us backwards. It is a retrograde step. It is a sign of a government that will always put ideology ahead of evidence, ahead of common sense and ahead of the interests of a few rather than the interests of the many.