Stirling Griff (SA, Nick Xenophon Team) Share this | Hansard source

I rise to briefly speak on the Health Insurance Amendment (National Rural Health Commissioner) Bill 2017, which provides the appointment of a National Rural Health Commissioner. At the outset, I wish to commend the government for this most worthwhile initiative. With roughly one-third of Australians living outside metropolitan areas, the need for this bill speaks for itself. We know that those living in rural areas experience higher rates of chronic disease; have shorter life expectancy; face higher health risk factors such as smoking, drinking and obesity rates; have poorer access to medical and allied health services; and are, on average, older than their city counterparts.

The health needs of these Australians are, in many ways, unique. This bill recognises this and focuses on providing an agenda dedicated solely to addressing the needs of our regional communities. The commissioner will, as we know, be responsible for the development of a new national rural generalist pathway to increase access to training for doctors in regional, rural and remote Australia; for working with the government and the health sector to enhance policy and to promote opportunities for a career in rural health; and for developing options for increased access to training and appropriate remuneration for rural generalists.

I am pleased to see that the government has listened to some of the concerns raised—particularly by those members who represent rural electorates, including Rebecca Sharkey, the member for Mayo. The government's amendments are very much a good first step, but there is no doubt that we need to do much more in this space. In today's day and age, there is absolutely no justification for treating those Australians who live in regional areas as second-class citizens. There is absolutely no reason why they should not have access to the same levels of health care as people living in the metropolitan areas.

The member for Mayo highlighted very succinctly in the other place just how much electorates like hers have to gain from the implementation of this bill. It is not acceptable, for instance, that the Adelaide Hills does not offer its ageing population a renal dialysis service, or that around 1,500 trips have to be made to the city annually by patients so that they can receive that treatment. There are no Medicare rebate machines in the Adelaide Hills region, which means that patients are forced to foot massive medical bills that often they can ill afford. Again, this is another issue that is only in rural and regional Australia.

The Gumeracha Medical Practice, for example, has been forced to fight for funding that was arbitrarily axed because the practice was deemed to be located within 20 kilometres of a town with 50,000 people. This is despite the fact that the practice itself extends its services across a region with a catchment of almost 7,000 people and that it offers services far beyond what would be expected of a small country town GP clinic, including, importantly, providing training opportunities for 40 general practice registrars since 2003.

Another example is the Southern Fleurieu Family Practice, which is struggling to continue its services after having its after-hours services funding withdrawn. That practice is the only medical facility on the west coast of the Fleurieu Peninsula, which covers an area of approximately 450 square kilometres. It services a population of 4,700 people that swells in the summertime to over 16,000 people. If its services fold, patients will be left with no choice but to travel over 30 kilometres to the Victor Harbor hospital, or north more than 50 kilometres to the Noarlunga Hospital. It is not acceptable that all of the South Australian radiation facilities for patients with cancer are within 15 kilometres of the Adelaide CBD and that rural patients always have to travel to Adelaide for treatment.

We anticipate that the National Rural Health Commissioner will put a spotlight on all of these issues, and, importantly, help rural people get the health care that they deserve. These issues are certainly not unique to South Australia's regional areas. According to an ABC report the hundreds of kilometres of roads leading to larger places like Orange, Dubbo and Canberra are well-worn for many patients, who often have to wait weeks for even the most basic health services in their local district. There are very real fears that if basic medical facilities are not built and supported that some of these communities will slowly be wiped out.

Often, what we do not think about is that it is not as simple as hopping in the car and driving to the nearest metropolitan area for treatment. In many instances, partners are required to take time off work, alternative arrangements have to be made for the kids and sometimes it will mean an overnight stay and so accommodation will also be required. Seeking basic health care can significantly impact on a patient's ability to maintain a job, as a person from a rural area may need two to three days off work for something that a person from a metropolitan area can do in a morning or an afternoon. If these trips are required on a regular basis they can also have profound effects on the family unit, never mind the family budget.

The establishment of a rural commissioner is, as I said, a good first step. But we need to do all we can to ensure that the sorts of situations I just outlined are addressed—that a person living in regional Australia can visit the doctor during business hours or after hours without worrying about whether the consultation will eat into their weekly income and that they can visit a doctor without needing to travel 20, 30 or 50 kilometres for that consultation.

A good next step would also be allowing the use of Telehealth for GP-delivered mental health services. Suicide and mental health issues in particular are made even more significant by isolation and distance.

The fact that there will be a greater emphasis on training for doctors in regional areas and career opportunities in rural health is something that has been wanting for a very long time. As it is, so few doctors are electing to go into GP training. In the past decade, only one in 11 doctors in training have decided to become GPs—and that is a staggering number. The rest choose to go into specialist training, and this has been impacting on the availability of GPs for regional and rural areas significantly. In my home state of South Australia, the shortage of generalist doctors has, in recent times, seen doctors at breaking point, with many of them complaining that they have had to do 24-hour emergency department shifts to cope with staff shortages. National health workforce figures show that, in 2012, there was double the number of doctors for city residents compared to regional and remote areas—437 medical practitioners per 100,000 people in the major cities, compared with 262 for inner regional areas, 247 for outer regional areas and 274 for remote areas. Many regional and rural communities are now at crisis point and it is imperative that decisive action be taken to address these shortages. The development of a pathway to increase access to training and promote career opportunities in rural health is key to addressing this issue.

We will be watching closely to ensure that this bill results in real outcomes for Australian families in regional and rural areas, and we will be watching to ensure that this is the first instalment in a series of measures aimed at strengthening our regional communities even further. With those few words, I support the second reading of this bill.