Monday, 29 July 2019
Health Insurance Amendment (Bonded Medical Programs Reform) Bill 2019; Second Reading
I rise to make a contribution on this bill, the Health Insurance Amendment (Bonded Medical Programs Reform) Bill 2019, and to address the contribution from Senator Roberts briefly. Talking about disadvantage in the bush, you almost had me, Senator Roberts. I agree with you fully on that issue. But then you talked about a farming family moving from Western Australia to Queensland and loving it. Now, that's where it just went completely off the rails.
On this bill though, seriously, there is a problem in rural and regional Western Australia. And all those who come from Western Australia are aware of the problem. All those who come from rural and regional Australia know there is an issue that needs to be addressed. I note there are three senators from Western Australia in the chamber at the moment on this side. All of them would know very, very well indeed some of the problems and challenges we face in rural and regional Western Australia, and I note the contribution of Senator Pratt as well in regard to some of the problems that we have in rural and regional Western Australia with attracting and retaining skilled medical professionals, in particular doctors but also nurses and allied health professionals.
This has a far-reaching effect. It obviously impacts on people requiring health care in their local communities, but it also impacts on those communities themselves. When the community loses or cannot attract a doctor or a nurse, or an allied health professional in the larger centres, that reduces the size of the community. It makes it less likely to be able to attract a doctor or nurse or medical professional in the future, as the community contracts over time, as communities have done across parts of rural and regional Australia. With the effectiveness of farmers in farming the land with fewer people and with the decline of some industries, the numbers of people in certain parts of rural and regional Australia have declined, the centres of those communities have been affected and their ability to attract and retain medical professionals and therefore access adequate medical services has declined over time.
In Western Australia alone there are just over 300 medical vacancies, 115 of them being GP positions, in regional areas. I come from a regional part of Western Australia. In fact I was born in the Manjemup hospital in the deep south of Western Australia—a hospital, incidentally, that Liza Harvey, the Leader of the Opposition in Western Australia, was also born in, and I'm sure a lot of the relatives of Senator O'Sullivan were probably born in that hospital as well. It's a fine, small, regional hospital.
GPs in those country towns are of absolutely vital importance. They're such a central part of a small town's life and existence. In the city it is easy to ignore or forget or not realise what a central component to life in the bush those GPs are. And, sadly, as I've started to outline, there are towns across Western Australia where, unfortunately, attracting a GP is proving to be difficult if not impossible.
Wongan Hills in Western Australia is a town—as Senator O'Sullivan and Senator Smith would know—not very far from Perth. In fact, it's very much within driving distance: only 2½ hours away. Wongan Hills does not have a doctor to run their $1.5 million surgery. They've been trying to attract a GP since March of this year. Hopefully, that situation has been solved in the last few days and what I have in front of me here is out of date. I sincerely hope that is the case; sadly, I suspect it's probably not, because these small regional communities have a very difficult time of finding people who want to move to the bush. This is despite an extremely attractive financial package that includes a cash component, free use of a house and, of course, access to that very well-equipped $1.5 million doctor's surgery. There are around 1,400 residents living in that shire. The next closest medical centre is around an hour's drive away. This is not something that we have to deal with when we live in a major urban centre, even a major regional urban centre. But it is something that those who live in—I don't even think you could call this a remote community—a regional community have to deal with; let alone those who live in even more remote circumstances.
There are, sadly, many other areas in Western Australia struggling to find medical professionals to meet their needs. In the north, in Derby around half a million dollars a year is on offer to attract a GP. In Kalgoorlie, they cannot get enough medical professional services, and, incidentally, there's a great availability of jobs as a whole in Kalgoorlie at the moment, and a wonderful opportunity for younger Australians who want to enter what is a wonderful and dynamic community in Kalgoorlie to take a step, perhaps, out of their comfort zone, and experience a part of Australia that many wouldn't even consider in that light, because of their lack of knowledge of what it means to live and work in a regional centre. Dalwallinu is another small country town that's seeking to attract a GP, is offering a very attractive financial package, and cannot get someone.
The Bonded Medical Program, as set out in this bill and in the changes that this government is introducing, is designed to try and address some of these very real problems that are faced by Australian communities in the regions. In short, the bill amends the Health Insurance Act 1973 to introduce a statutory scheme to streamline existing bonded medical places—so this isn't reinventing the wheel—and the Medical Rural Bonded Scholarship schemes. It will require participants to complete a return-of-service program in return for a Commonwealth-supported place to study medicine. The proposed amendment promotes access and equity to health services in rural, regional and remote Australia, where there are currently less-than-adequate services. It is, in fact, part of a much larger, $500 million Stronger Rural Health Strategy announced by this government. The bill has support of key stakeholders, such as the AMA and the Australian Medical Students' Association. This is about streamlining and modernising an existing framework, and it brings existing schemes together under a single framework to move towards a single bonded medical scheme in future years. It replaces the need for individual contracts or agreements with each participant in a bonded medical program. It reduces the administrative burden by reducing and standardising the number of conditions and sanctions. It better targets the bonded medical workforce by changing workforce distribution requirements. It will also introduce and mandate the use of a web portal to improve the administrative management of the program.
It also introduces the ability for participants to seek review of certain decisions by the Administrative Appeals Tribunal. Obviously, this is something where people take these roles on, and perhaps they don't fully understand what they may be getting in for. I hope they do. From my discussions with a number of medical professional who have been through these kinds of programs, they certainly find it a very valuable and rewarding experience. But we understand that things can sometimes not go 100 per cent according to plan, and therefore a review of certain decisions by the Administrative Appeals Tribunal is an important part of these changes.
As I have stated, these changes come to schemes that have been in place for some time. The Medical Rural Bonded Scholarship Scheme commenced in 2001. It provided 100 Commonwealth-supported places each year in a medical course at an Australian university with an attached scholarship. It began its iteration as a six-year contract requiring participants to work in rural or remote areas once their fellowship was achieved. This has been closed to new entrants, but the 100 places have been added to the bonded medical places from 2016. Bonded medical places commenced in 2004. This provides a Commonwealth-supported place in a medical course in exchange for agreement to work in an underserviced area for a length of time equivalent to the length of the medical degree. For those who joined between 2016 and 2019, the return of service is only 12 months. It is currently delivered through a complex series of contracts—in my understanding, there are around 20 contracts and deeds of agreement—which makes the system complex and makes the system outdated.
As the program has changed over time, significant differences in contractual arrangements have been developed within and across various streams. This affects the majority of participants who commence their return of service obligation. The new statutory scheme modernises and consolidates to ensure that the program is responsive to current and future workforce needs, as well as offering a modern and flexible arrangement to support the future rural medical workforce. It will not affect existing participants unless they choose for it to, so it's a voluntary, opt-in system. Participants will be required to work as medical practitioners in eligible locations for a total of three years, which must be completed within 18 years from when the participate completes their course of study.
I will note here that I think one of the key things that's been shown over the years—as various governments have quite genuinely tried to address this problem, with mixed success—is that what has proved to be successful is either training people who originated in the bush and then getting them to return to the bush or perhaps giving people who have never spent time in the bush a taste of bush life and then they find they do actually like it. That's why those three years are very important. It's important for people who commit to this program to be able to get out there into the regions and spend some time in the bush. A lot of them will fall in love with rural and regional Australia, as many of us in this place have as well.
On withdrawal costs from the scheme, if a withdrawal occurs after the second year of study or they do not complete a return of service within 18 years—if either of those conditions are met—then the participant must pay the Commonwealth costs of the person's cost of study, less the pro rata proportion of service completed, as well as the interest or cost of scholarship. Obviously, there will be those who, for whatever reason, choose not to or cannot fulfil their obligations. Medical benefits will not be payable for six years from the day a breach occurs if return of service is not completed within 18 years. There is also the potential for an administrative penalty to be imposed.
Wrapping up: a second reading amendment has been circulated. Those opposite, who have abandoned the bush for a very long time, should think very carefully about criticising this government for its level of support for those in rural and regional drought affected communities. This government over a period of time has been extraordinarily responsive to the needs of those in the bush, including through the farm household allowance, which this second reading amendment mentions. We have ensured its ongoing availability for those in drought affected areas, ensured that the length of time people are able to stay on it was increased where appropriate and ensured that those drought affected communities and drought affected shires had some direct financial assistance, assistance for fodder and the like. This government has been extraordinarily focused on and responsive to the needs of drought affected communities across Australia. I think it is slightly churlish of those opposite to propose this second reading amendment on this bill—a bill unrelated to drought relief; a bill about getting more doctors into the bush. On that, I thank you.