Deborah O'Neill (NSW, Australian Labor Party) Share this | Hansard source

Of course, not all of them, Senator Williams. I will take that interjection. Living in a rural community I am not surprised that you wanted to stand up and support the arrival of this commissioner, but again it is from this government in the area of health too little and too late, After breaking so many things, there is a great need for repair. This government's appointment of a National Rural Health Commissioner to oversee health care for the people of remote and rural Australia really needed to happen an awful lot sooner. It would have been a much easier job if so much money had not been ripped out of the health system and if the problems of access to health services had not been so exacerbated during this government's time in power.

I would not envy the commissioner's job because this coalition government, despite the rhetoric and despite the very nice visual appeal of this appointment, continues to run the health system into the ground. It is particularly hurting Australians in the bush. About one-third of our Australian population lives in regional, rural and remote areas and that comes in at around seven million people whose access to services is significantly impaired. That is at the heart of what this commissioner will be told he or she has the responsibility to clean up.

Sadly, on average, rural, regional and remote Australians do not enjoy the same high standards of health and wellbeing as people living in cities, nor do they experience the same access to health services and health-related infrastructure. The truth is that health-care models that work in urban settings do not necessarily translate to rural or remote settings, where services are necessarily more fragmented and often more difficult to reach. We heard a great deal of evidence in the select committee of the last parliament about the simple cost of transport in getting to vital health services.

One might have hoped that the NBN might have delivered a line of modern access to services away from where you live but, sadly, the NBN committee in this parliament is only hearing about the disastrous rollout of the NBN. People on Sky Muster and people on the border of Victoria describing very clearly their failure in accessing service in a reliable way. Many of them were asking for their ADSL back because the NBN is so bad. I do not mean the real NBN, but the dodgy, lemon version that we have had inflicted on us by the Abbott and Turnbull governments through their poor decision making.

Distances are clearly greater in the bush, and so attracting and retaining staff in the health sector is a major challenge. With the tearing apart of Medicare Locals, we heard story after story all around regional Australia of the incredible waste in human capital—how people had been recruited to the bush but were held up by this government's mismanagement week after week and month after month to the point where they had no certainty of paying their mortgages in regional or remote Australia and so they simply packed up and headed back to the cities. That is how badly this government, in both its Turnbull and Abbott iterations, has dealt with the challenges of getting great Australian health workers to the bush. They killed off the workforce in their mismanagement of the sector.

Some of the challenges that the rural health commissioner has before him or her include the larger proportions of social disadvantage, higher unemployment rates and reduced access to support services such as allied health, pathology, radiology and investigative disciplines. Those are a lived reality which has only become worse in recent years. Where I live on the Central Coast and in communities further away from our capital city communities have higher morbidity and mortality, and their health care costs are usually higher. That is why the Labor government, instead of putting in a commissioner for rural health, had a policy of putting in place 26 regional cancer centres.

I am very pleased to say that it was a federal Labor government that put in $29 million for Gosford regional cancer centre, with $10 million from the Keneally government in New South Wales, to make sure that people on the Central Coast could finally get public access to cancer treatment, to radiotherapy. That was a practical response to the needs of regional and rural Australia. It is very different from what we are seeing here—wreck it first then bring in a commissioner to clean up the mess that you have made or at least look like they are going to clean up the mess that has been made. Why is this so desperately needed?

If we look at children from Aboriginal and Torres Strait Islander backgrounds, the reality is right now they continue to be more at risk of death, with their mortality rate 2.3 times higher than non-Indigenous children. Clearly there is a great need for a changed response to access to services and management of that whole process. I sincerely hope that the commissioner can work the miracle of resurrecting access to services for Australians in the terrible context that they will find themselves in, given this government's former health decisions.

The National Rural Health Alliance points out that, despite the high health needs of our remote population, there is around 20 per cent less Medicare funded GP activity in remote Australia compared to the same population in the city. It is not because people are sicker; it is because the system is so sick, so broken. It is because access to people who can provide the health care that you need is so difficult to get that you just cannot get the treatment that you need. You just cannot get to see the people that you need. You cannot afford to travel. You cannot find the person to do the job because the speech pathologist that got recruited out to your area by Medicare Local got stuffed around so much they went back to the city, and now you cannot get that service anymore. That is everywhere across the country, and this government has to take responsibility for the brokenness that it has inflicted on workforce around the country.

That situation is not only bad because of the real life outcomes and impacts it has on ordinary Australians but it is terrible because it is leading to a very aberrant set of behaviours about cost-shifting, with the states having to pour more money into acute hospital care for people from rural and remote areas. Sadly, people with mental health issues from remote communities who are unable to access early intervention services are more frequently hospitalised than their fellow Australians in the city. These are the facts of how terrible things have become under the watch of this government through its series of ministers that it has pushed through the portfolio. Why is it like this?

The government deny many of the decisions they have made. I want to talk about one decision on perinatal depression. The federal government wrote to the nation's health ministers saying that they had just pulled up stumps and were not going to fund it anymore. The original $85 million agreement expired and then there was supposed to be a continuation of it. But that terrible budget in 2014 just saw the money disappear. The letter arrived from the federal health minister, according to the Minister for Health in Queensland. He said, 'I received a letter from the federal health minister, Sussan Ley, telling me they are abandoning this initiative.' That is the kind of public action that this government have taken around health that has led to the decay of services and the increasing need for people to have acute hospital care.

Why would this government bother about it? They do not care because it has shifted the cost onto the states so they can play games with their numbers. Playing games with their numbers is actually costing people their health. In its worst manifestations, it is costing lives, and people in the bush know this. They know that access has become harder to achieve and they know the quality of the services and their capacity to be able to get health care when they need it has decreased under this government.

I want to make some remarks about mental health, particularly. According the Australian Bureau of Statistics, 3,027 Australians died by suicide in 2015, and that is a 5.4 per cent increase on the previous year. By all reports, that continues to rise. Sadly, death by suicide continues to disproportionately affect remote and rural Australia, especially Indigenous communities and young men.

I want to acknowledge in my remarks this evening that this week marks Men's Health Week, and I also made some remarks in the adjournment last night about infant mental health. This year's theme for men's health week—Healthy Body Healthy Mind: Keeping the Balance—explores the way men and boys can keep healthy, physically and emotionally, in a busy and challenging world.

The challenges facing men and boys in rural and regional communities are very significant. There is considerable difficulty, as I said, in accessing services because of isolation, but also financial difficulties means that support services that are needed cannot be accessed in real times of need but are often delayed—delayed to the point where the need increases to the acute level and, in the worst instances, where, sadly, people feel that they simply cannot go on. Sadly, also, in the context of rural and regional Australia, people have more access to suicide means that are likely to result in immediate death. The commissioner and all levels of government need to focus on a holistic approach to suicide prevention. It is only through working together that we can hope to reduce the impact of suicide in our society.

We have heard this government prattle on about how they really care about mental health. It is one of Mr Turnbull's signature phrases, but the reality is: he has not put it front and centre as he said he would, and there is a massive mess out there—a mess of his own making—that he has now decided this commissioner should come in and sort out.

The health department revealed to Senate estimates back in October last year that at that time it was yet to provide any detailed evidence and advice to the government on the Turnbull government's commitment of $20 million to 10 new headspace centres. During the course of the election, Mr Turnbull says: 'Look. I'm going to be your man for mental health. I'm definitely going to be doing something good on mental health. Okay, what'll we do? Let's just come up with—10 headspace centres. How much? $20 million. Any advice from the department? Sorry? No, don't worry about that.' That is not evidence based policymaking but prejudiced policymaking; policymaking that is interested in votes, not people; policymaking that is on the run, not consultative; and policymaking that is made by members of this government in isolation without fair and proper consultation with the states with whom they are in deep partnership with regard to health and without proper consultation with the people in Australia in an open and honest way.

The smoke and mirrors that this government has managed to manufacture—there is an unbelievable construction of myth around medical support. While I support the need for a commissioner to try and come and rectify some of the worst excesses of this government's decision-making in health, the job that they have created for him or her is enormous—absolutely enormous.

It has been almost 12 months since the federal election. We have had a change of health minister. We have only got half the promises, half of the commitments, that were promised last year. Four of the five new headspace centres that have been announced have been—wait for it—in Liberal-held seats. In one of those cases, the member for Canning, Andrew Hastie, said that it was his collection of 3,000 signatures that tipped the scales—so much for evidence based decision-making.

Communities are an important part of decision-making in the country, but that is not what this government said it was about. Yet we have got a member out there saying, 'It's thanks to the groundswell of community support that our efforts have been successful. Today's announcement shows that the federal government is listening and responding to the difficulties faced in the Peel region. I thank Minister Greg Hunt for being so receptive to our call for help.'

We have got a member out there campaigning for headspace, getting signatures from people who have experienced incredible grief and loss through the suicide of their children and their friends and their family playing some political game with this—eking out how long they can drip-feed into the Australian population these headspace centres, which are desperately, desperately needed—instead of a transparent announcement of: 'This is the needs analysis. This is the population data. This is what the health professionals are telling us, and we will get it out as quickly as we can.' No, we have got: 'Let's campaign on it. Let's drip feed it, and we won't tell anybody about our decision-making around this with any clarity.' It is wrong. It is exploitative, it is wrong and it is contemptuous.

According to the member for Hastie, Mr Hunt seems to operate using policy by petition. Until estimates questions are answered, this still remains a murky proposition. We are yet to get information from estimates about the criteria for these centres. The government is quick to maximise political capital, but it is very slow in responding to the urgent needs of vulnerable Australians, which it has exacerbated by bad policy-making in the area of health.

In the interests of the work of the Senate, I will restrict my remarks to those key areas this evening. I know that Senator Griff is going to make a contribution shortly. I simply close with the reality of this. In preparing my remarks this evening, I had a look at the explanatory memorandum. I thought, 'We've had a reprint of the explanatory memorandum', but it was not a reprint. There is one explanatory memorandum. Then there is another one entitled 'Revised explanatory memorandum'. And the final one, an additional page—it talks about the need for the commissioner to actually do something about the workforce—is entitled 'Supplementary explanatory memorandum'.

We do have a very big problem with workforce in rural and regional Australia. I have given some of the reasons why the practical decisions of this government have made that worse. But let us not forget that there was an organisation established under Labor, called Health Workforce Australia, and its job was to plan, to audit and to see that Australians got the support that they needed where they lived. Doctors certainly. The rural specialist program, which has come out of Queensland and is now being replicated around the country, is a great part of giving health care to Australians in the bush.

But this government, with three explanatory memoranda on the appointment of this commission, show that they are making it up as they go. That is because they are not governing with care. They are not governing in a way that explores and really uses the expertise of great Australians working in the health sector. They are using health as a political football and creating a mythology over the top of it to pretend that they actually care about Australians. And while the commissioner is a step in the right direction, I hope I have made clear to those listening this evening that they cannot trust this government on health. A commissioner charged with the scale of repair that is required after the coalition's wrecking of the health system is a piece of window dressing at worst. Please God, let an amazingly talented Australian come in who can do some genuine work to clean up the dog's breakfast of policy making that has been inflicted on the Australian population, particularly those most vulnerable in regional and rural Australia.