Guy Barnett (Tasmania, Liberal Party) Share this | Link to this | Hansard source

The federal budget, handed down by the Treasurer, the Hon. Peter Costello, on 8 May this year, provided $291.3 million over the next four years for the inclusion of two new attendance items in the Medicare Benefits Schedule. These are to commence from 1 November 2007. They will provide for lengthier consultations between patients with chronic and complex health conditions and the consultant physicians or paediatricians to whom they are referred than has previously been the case.

Patients with chronic and complex conditions have two or more serious medical conditions simultaneously and with combined effect—for example, they have cardiovascular disease and diabetes, they have osteoarthritis and chronic respiratory disease, or they are children who are not thriving for any number of reasons. People with chronic and complex conditions are among the sickest people in our community. The number of Australians with chronic and complex conditions is steadily increasing as our population ages, but it is also due to the growing incidence of serious diseases among young Australians.

Consultant physicians and paediatricians are the specialist medical consultants to whom patients with chronic and complex conditions are referred for specialist attention. They advise the referring general practitioner, surgeon or other specialist on the patient’s diagnosis and management. Consultant physicians and paediatricians undertake many years of postgraduate training and have specialised knowledge, understanding and skill plus broad holistic understanding. They are particularly qualified to treat the diseases which have been identified by the Council of Australian Governments as national health priorities, which often feature in chronic and complex conditions.

Compared with the needs of other patients, the needs of patients with chronic and complex health conditions typically take longer for consultant physicians and paediatricians to investigate, consider and address. Until now, this difference has not been reflected in the Medicare Benefits Schedule. The new items 132 and 133 will go a long way towards remedying this longstanding and anomalous situation. These two new attendance items will provide Australians with chronic and complex conditions unprecedented access to the highly specialised medical care they need for optimum health outcomes. The implications are positive and wide ranging for patients with chronic and complex conditions, for the patients’ families and carers, and, not least, for consultant physicians and paediatricians.

In recent years the growth of Australia’s consultant physician and paediatrician workforce has not kept pace with the demand for its services. The supply and distribution of consultant physicians practising general medicine is a matter of growing concern, while many specialist appointments and training positions for consultative subspecialties are empty. Considering the duration and intensity of training followed by the skill, responsibility and complexity required to practise as a consultant physician or paediatrician, these subspecialities—including geriatrics, general medicine, renal medicine, rheumatology, haematology, endocrinology and diabetes, respiratory medicine, rehabilitation and cancer medicine—have become financially unattractive, particularly to potential trainees. For example, in my home state of Tasmania, the Launceston General Hospital has been underfunded by the state Labor government to the tune of $22 million a year. In terms of consultant medical staff, the Launceston General Hospital, I am advised by the relevant staff, needs one interventional cardiologist, one endocrinologist, two medical oncologists, one neurologist, one haematologist and an emergency medicine consultant. It is a great relief that our local federal member, Michael Ferguson, is standing up for the local community.

Michael Ronaldson (Victoria, Liberal Party) Share this | Link to this | Hansard source

Hear, hear!

Guy Barnett (Tasmania, Liberal Party) Share this | Link to this | Hansard source

Thank you, Senator Ronaldson; I agree. He is a very fine member. Five thousand plus people rallied to support the Launceston General Hospital only 10 days or so ago. I want to thank Alderman Rosemary Armitage and the organisers for making it happen. The state Labor Minister for Health and Human Services, Lara Giddings, said at the rally that she would use all the money saved from the federal takeover of the Mersey hospital for north and north-west Tasmania. However, today, in public—on radio—Minister Lara Giddings confirmed that she had misled those 5,000 people. She said that $8 million of the total saved would be expended at the Royal Hobart Hospital in southern Tasmania. She said one thing and has done another. Why didn’t she come clean and say this at the Launceston rally? This is appalling behaviour when the Launceston General Hospital is in such dire need. She should apologise for breaking her promise to northern Tasmanians. Likewise, I want to say that, on the north-west coast, federal member Mark Baker has been listening and working for his local community to ensure ongoing health services. Well done, and thank you, Mark Baker, for what you are doing.

Minister Giddings said that the federal government has cut funding to Tasmanian hospitals. The opposite is true: federal funding has increased from $700-odd million over the five years to 2003 to $920 million over the five years to 2008—yes, a $220 million increase over five years, or a 17 per cent increase in real terms. On top of that the state of course is swimming in GST dollars, with a $117 million windfall gain this financial year.

The impact of the shortage of consultant physicians and paediatricians has been increasing progressively across the health system but particularly affects the availability of medical care for our ageing population and in outer metropolitan and rural areas. Medical graduates have been increasingly choosing to train in other specialties rather than as consultant physicians and paediatricians, with a significant potential impact on the delivery and efficiency of our healthcare system over the next decade and on the Australian government’s capacity to provide a medical workforce that can treat the diseases identified by the Council of Australian Governments as national health priorities.

I would like to acknowledge the work of the Australian Association of Consultant Physicians. It represents approximately 8,000 Australian consultant physicians and paediatricians in economic and workforce matters. In its submission to the health minister, Mr Abbott, on 28 September 2006 and at subsequent representations to senators and members of this parliament, its leadership demonstrated a profound commitment to creating a better healthcare system for the entire community by presenting a compelling case for the inclusion of these new attendance items in the Medicare Benefits Schedule as part of a holistic strategy for improving health outcomes.

I would like to pay particular tribute to the efforts of the following individuals, who took substantial time out of their busy careers to pursue the AACP’s case: AACP President Dr Leslie Bolitho, an internal medicine physician from Wangaratta in country Victoria and senior lecturer in the University of Melbourne Rural Clinical School; the AACP Vice President, Dr Lewis McGuigan, a rheumatologist in private practice in Sydney’s south; and the AACP Secretary-Treasurer, Dr John Best, AO, who has long been involved in developing and reviewing healthcare services in rural and remote Australia. I was delighted to support their case and to contribute to my government’s decision to expand the Medicare Benefits Schedule to include the two new attendance items.

I also note the support of the Tasmanian Liberal Senate team for this initiative and, indeed, the many other health and community organisations, like Diabetes Australia. I must also take this opportunity to publicly note the strong support given over many months on this issue by the health minister, Mr Tony Abbott. Tony Abbott is an outstanding minister for health. He quickly realised the need for prompt action to maintain equality of access for specialist services in rural and regional Australia and was able to bring this to the attention of his cabinet colleagues and support the measures in the budget. Thank you to the leadership in the Howard government.

The case presented by the AACP has particular personal relevance to me in several ways. Having been diagnosed with type 1 diabetes in 1997, I am acutely aware that diabetes frequently figures in chronic and complex conditions. I am a member of the Australian government’s Health and Ageing Policy Committee and have many elderly friends residing in aged-care facilities in my home state of Tasmania. Importantly, as a Launceston resident, I am aware of the pressures on the Launceston General Hospital and the very fine people who work there. Thank you for what you do and for the services offered, including those at the Diabetes Centre at the hospital. I especially commend all those at the Holman Clinic and understand the pressures that you are under. Thank you for the services that you provide.

While I am justifiably proud that this government has decided to introduce these new items, thereby achieving better health care for the Australian community, it is not a partisan issue. Each senator here represents substantial and growing numbers of Australians who have chronic and complex conditions and/or Australians who are older. This is an issue that rightly touches our hearts as well as our minds and simultaneously helps create improved access to specialist health care for all Australians, more available beds in emergency ward hospitals, incentives for our best and brightest medical graduates, and a revitalised consultant physician and paediatrician workforce. I applaud the inclusion from 1 November 2007 of the two new attendance items in the Medicare Benefits Schedule.