Senate debates

Tuesday, 26 August 2014


Health Workforce Australia (Abolition) Bill 2014; Second Reading

12:32 pm

Photo of Doug CameronDoug Cameron (NSW, Australian Labor Party, Shadow Minister for Human Services) Share this | | Hansard source

I oppose the Health Workforce Australia (Abolition) Bill. The bill is part of the unfair agenda of this government. It is unfair to the Australian public not to develop a long-term strategy to deliver health workforces that can meet the needs of the community. It is another example of the incompetence of this government—something that the public are seeing every day of the week. Day in and day out we see on display the incompetence of the coalition government. The third element to this government is their arrogance—their arrogance that they think they can do anything in the name of the market; that you should not plan for the future of health but should just let the market rip and everything will be okay.

It is interesting to note that the coalition were warned by their own think tanks and their own national secretaries that they should stop being ideological about how they deliver their message to the Australian public. If anything is ideological, it is this approach by the coalition government to dump the Health Workforce Australia organisation. It is a triumph of ideology over the national interest. It is another example of the lies that the coalition took to the Australian people prior to the election—there were to be no cuts to health, no cuts to education, no tax rises. We heard lie after lie from this incompetent, arrogant and unfair government.

It is clear that the public are well aware that they were conned by the then opposition prior to the election. The incompetence and the arrogance abound. You only have to look at the Leader of the Government in the Senate, Senator Abetz. How could you ever trust the coalition government on health issues when the Leader of the Government in the Senate links abortion to breast cancer based on running an ideological line, based on trying to get some of the most extreme groups in the world to look at his approach on these issues? It beggars belief that the Leader of the Government in the Senate could be so wrong on an issue or so deliberately political that he would run a line linking breast cancer with abortion. Nobody believes that these days, and for the leader in the Senate and for this rabble of a government to be running those sorts of agendas and those sorts of lines for purely political and ideological purposes is a nonsense.

Then we have Senator Brandis. Senator Brandis has been described as the man with a brain like a planet. Well it is a barren planet—there is nothing growing up there. For him to bring policy to public forums and then not be able to explain that policy is another example of the incompetence of this government. Then there is Treasurer Hockey saying the poor do not drive so they do not have to worry about the petrol excise. How out of touch, how arrogant, how incompetent can this government get? The Minister for Education, Mr Pyne, threatened to cut research funding because this place is opposed to the ideological attacks on higher education. Again we see this arrogance. Then we have Senator Joyce talking this morning about not being able to pay the Defence Force, about not being able to have hospitals, even about closing down hospitals, because of some manufactured budget crisis. On top of that, and clearly against this government's promise that there would be no cuts to health, we get this cut of $100-odd million to Health Workforce Australia.

I am of the view that the public want long-term planning. They want governments to actually have a look at the challenges that the country and governments will face—not just in the short term, but in the medium and long term—and to sit down and plan a way forward. What could be important than planning for the health of all Australians? This issue was looked at by the Productivity Commission. They are not an organisation that I would praise very often, but I think they got it right when they said there was an ad hoc approach to long-term planning for health and that we had to put in place a proper approach to planning. That is why Health Workforce Australia was brought into being. It came from a recommendation of the Productivity Commission, it was discussed and debated by governments of both political persuasions at COAG, and COAG came up with a recommendation in support of the establishment of Health Workforce Australia. COAG did that because they agreed with the Productivity Commission that there had to be a separate independent body sitting down and planning for the future of Australia's health management issues. The establishment of Health Workforce Australia was a very important initiative of the previous government.

There was a Senate inquiry into the abolition of this organisation. Academic after academic came to that inquiry and indicated that it would be stupidity to move away from having an independent body that examines and analyses the health needs of the country in terms of the health workforce, in terms of health research and in terms of the future needs of the ageing Australian community. They argued that we should not do this. We had the AMA, the College of Surgeons and body after body representing the professional health carers in this country saying that we should not do this. Yet this government, in its arrogance and incompetence, has set about destroying an organisation that is focused wholly and solely on ensuring the health and welfare of Australian citizens.

When does ideology just become too much? When should we be saying that the interests of the Australian community should get a look in with this coalition government? The department, as I understand it, were unhappy with having the work they had been doing moved out of the department to Health Workforce Australia. Labor resisted the department's argument that they should maintain control and oversight of this work, because we took the view that the Productivity Commission got it right, and they had identified major flaws, major problems, with this work being done by the department and had recommended that it should be handed out to an independent group. That is why we established Health Workforce Australia. We accepted the arguments from the Productivity Commission and we accept the arguments right now of the health professionals and health organisations that came to the Senate inquiry and said, 'Do not do this. It is not in the national interest to get rid of this organisation.'

The problem, as has been identified by the Liberal secretariat, is that this government is dominated by ideology. Ideology dominates this government—not common sense, not the national interest, not what is good for the nation, but whatever the ideology of 'small government' and 'let the market rip' dictates. I can imagine the debate going on in the cabinet room about the socialisation of medicine, about the planning that is taking place by government: 'We should just let the market rip. We do not really need an organisation to look at the skill needs of the health industry. We do not need to look at what the issues are for the Australian public. Just let the market rip, and, by the way, we can probably save $140 million by getting rid of this organisation'—an absolute pittance. It is another budget cut for what? Because they have manufactured this false budget crisis. They have manufactured a lie about the state of the Australian economy, and they are now caught up in their own lie. They are now caught in a position where everything they do has to be about cutting costs, regardless of the impact that it has on the health of individual Australians and regardless of whether we can ensure that we have enough surgeons, that we have enough doctors, and that we have enough nurses and allied health professionals to ensure the health of an ageing Australian community. So ideology triumphed and arrogance triumphed—because they thought they could just get away with it and ram it through. Arrogance dominated and once again we have bad policy because of the arrogant, incompetent position adopted by this government.

Anyone who looked at the record of this government on health would be absolutely appalled. Everyone who understands the health system knows well that preventative medicine is extremely important, that you have to plan for the future and prevent as much ill-health as possible. Yet what has this government done? This government has set about making it even more difficult for ordinary Australians, for poorer Australians, for battling working Australian families, to go to their doctor. They introduced a GP tax, they introduced a PBS co-payment and they set higher safety net thresholds—all designed to cut costs regardless of the implications for the health system in this country. What is more ideologically stupid than that?

I see that Senator Seselja will be speaking in this debate. He should get up and explain why his government is cutting $60.5 million out of health in the ACT. Where is the money going to come from to ensure that decent standards are maintained? How is the ACT government going to deal with that cut? Senator Smith looks as if he is gearing up for a go. Senator Smith, please explain, when you get on your feet, why you are taking $428 million out of the Western Australian health system. These are the challenges that the ideologues have to deal with—the real implications of ideology and stupidity. That is what you have to deal with and you cannot deal with it by including more ideology and more stupidity in your speech. You have to deal with the facts. In Queensland, $952 million is being cut—nearly $1 billion out of the health system in Queensland. That is the result of the actions of this government, who are incompetent, who do not care and who put their own ideological interests before the national interest. It just beggars belief what this mob are all about.

We have not even been here in parliament for the last five weeks, yet we have still had the experience of watching this government selfdestruct, watching them nark at each other, argue with each other, fight with each other. Senator Macdonald has said—I do not normally quote Senator Macdonald, let me tell you—that the health policies of this unfair government, through this unfair budget, are not just bad but dangerous. When was the last time you heard a backbencher talk about government policy being dangerous? You might criticise your own government's policy from time to time—I have been known to do that myself—but you do not actually pick out a policy and say, 'This policy is dangerous.' The Australian public now have a government that is a danger to their health. They have a government that is a danger to building a decent society in this country. They are a danger to this country's long-established principle of the fair go. Yes, Senator Macdonald, this government is a danger—and not just on one policy issue. They are dangerous, they are incompetent and they are arrogant. What a combination that is!

This government have set about destroying the long-term health workforce planning of this country on the basis of their arrogance, their ignorance and their contempt for both this parliament and the Australian public. Even before this bill has gone through, we have seen the department start to transfer obligations from Health Workforce Australia back into the department—even before this bill has been debated in this house of review. The arrogance beggars belief. Every aspect of this government's operations is riddled with incompetence. No wonder the public are looking askance at this coalition government. No government has ever descended into such a farce, such a rabble, as quickly as this government. The Abbott government is seen as incompetent, the Abbott government is seen as a government that lies and the Abbott government is seen as a government that is not acting in the national interest. This bill is but one small example of the Abbott government putting their ideology before the national interest and before the health needs of this country. Abolishing the body that is looking at the long-term plan for the health needs of this community is one of the most arrogant, ideological and stupid propositions to have come before this parliament in a long time. That is why Labor opposes it—because we stand up for the Australian public and against the coalition's ideology. (Time expired)

12:52 pm

Photo of Dean SmithDean Smith (WA, Liberal Party) Share this | | Hansard source

We have just had a very colourful display from Senator Cameron. I congratulate him on his colour but not his substance. Senator Cameron shared with us views about arrogance, incompetence, policy recklessness. Of course, Senator Cameron was speaking from firsthand experience of the former Labor government. It is very high order to talk about farce and rabble. We know that that is really the pot calling the kettle black from Senator Cameron. I would like to contrast my contribution with Senator Cameron's by filling it out with a bit more substance, if I might, Mr Acting Deputy President. I am pleased to have this opportunity to make a contribution to this debate on the Health Workforce Australia (Abolition Bill) 2014 because it gives me an opportunity to highlight some important issues in regional health—issues which are important to the whole nation but particularly to me as a Western Australian senator.

As its name suggests, the bill does seek to abolish Health Workforce Australia, and there is one overarching reason why this government seeks to do that: it is to eliminate some of the duplication within our health system. It may well come as a surprise to some of those opposite but our country does not have limitless financial resources and nor does our health system. This coalition government's first priority is to invest in front-line services and to improve the country's capacity for medical research. Those are the two most significant challenges that our health system is facing today.

What our health system is not in a position to do is sustain an ever-growing number of bureaucratic bodies that are duplicating or replicating the work already being done at a state level or, indeed, within the Commonwealth Department of Health itself. To put it bluntly, we are not operating in the sort of fiscal environment that permits optional extras. This is not as a result of this government's actions, however. This is the doing of our predecessors, who, having created a budget mess, now sit here and attack any and every effort to fix that problem. Governing is about making choices—and, I might add too, it is about ideology; it is about ideas; and, of course, it is about the allocation of finite economic resources. To be frank, if I have choice between investing a dollar in front-line health services or investing money in office space for health bureaucrats then I will choose, and I am sure many Australians would choose, front-line services every single time. I hope to have confidence that over time the Labor Party and the opposition in this place will recognise the error of their ways. I am not saying this to belittle any of the work done by Health Workforce Australia; the opposite is true.

We remember that Health Workforce Australia was set up and funded for four years by the previous government, but those four years have ended. The budget situation and challenge this government faces is vastly different from that faced by Labor when they were in office in 2007. Labor talked and dreamed big things in health but they were not so good on the delivery. When Health Workforce Australia was established under Labor, it was intended to operate over four years, with financial support coming from both the Commonwealth and the state governments. Here again we see the consequences of Labor's flawed planning and policy processes. The states have not put in any money. The more than $1 billion that has gone into Health Workforce Australia since its establishment has all been federal money. The $550 million that was supposed to come from the states and the territories over those four years never materialised. Why? Because it was another example in a litany of examples of the Rudd government imposing its will in the absence of any cooperation or proper policy discussion and formulation with the states. Health Workforce Australia was established under Kevin Rudd's National Partnership Agreement on Hospital and Health Workforce Reform. It was a four-year agreement that expired in June 2013. Under the national partnership agreement Health Workforce Australia was supposed to act as a national body, working to health ministers to streamline clinical training arrangements and support workforce reform initiatives. In its time Health Workforce Australia did do some important work in research, most particularly through the publication of national health workforce modelling that gave long-term projections of supply and demand for the Australian health workforce. But that work is done now.

The government is now charged with dealing with the challenges that this sort of work identified. In order to do that, we have to invest more in the front line. We do not have the luxury of continuing to support an organisation like Health Workforce Australia to identify problems and fix those problems it identifies. We have a Commonwealth Department of Health that already has the expertise and capacity to undertake many of the activities that Health Workforce Australia was undertaking. We do not need another layer of bureaucracy sitting between the department and those delivering front-line services. This government, like our predecessors, understands that every additional layer of bureaucracy has the effect of skimming resources from the already limited pool of money. Also in contrast with our political predecessors, this government recognises and respects the roles that the states and territories play in the development and improvement of Australia's health workforce.

We believe that the states—who are closer to the medical professionals and the patients to whom services are being provided—are in a better position to understand the needs of their communities than a federally directed bureaucracy. This is especially true in relation to services provided to regional communities. To my mind, it is doubtful that sustaining offices for a government agency in our capital cities is going to help those living in regional communities experience better and improved health services. It is not going to make it easier for medical students from regional areas to get scholarships so that they can get the high-quality training they need. You provide incentives for regional GP practices to provide matching funds alongside government investment so that regional practices will invest their own money and truly utilise that investment efficiently in infrastructure to help local GPs train the next generation of regional medical practitioners.

I think it is also worth making the point, which is self-evident to me and to coalition senators on this side but apparently not to others, that we do not need a separate federally funded agency to deal with the challenges facing Australia's medical workforce. I would remind the Senate that the federal government does not actually employ doctors and nurses; instead, they are employed through state and territory governments. They are employed through these governments because, as we on this side of the chamber believe, those governments have a better idea of the health needs of the communities they serve than a remote government in a faraway place in Canberra. This is especially true for regional communities across my home state of Western Australia. One size most certainly does not fit all in the delivery of health services across Australia's various jurisdictions.

We heard from the Labor Party, during their contributions to the debate on this bill in the other place—as we will do this afternoon—that the measures contained in this bill will mean the burden is being placed on the states. With the greatest of respect, this signifies a pretty fundamental misreading of how our Federation was designed to work. While the federal government has long been a significant funder of health services in Australia and will continue to be into the future, it is the states' responsibility to make decisions about service delivery. The only 'burden' the states will be shouldering as a result of these changes are the responsibilities they are supposed to already shoulder.

The Commonwealth Department of Health has always worked closely with its state and territory counterparts to find ways of boosting employee productivity, improving retention rates and ensuring the effective allocation of health workforce resources. Nothing contained in this bill will change that arrangement. The Commonwealth Department of Health will continue to work closely with its state and territory counterparts in this area. But what it will not be doing under this government is duplicating that work.

To put it simply: we do not need a separate agency to do that. Continuing to fund that separate agency will simply siphon off money from where it is most needed, and that is in front-line health services and, most particularly, in front-line regional health services. We need to respect the fact that the various state and territory governments understand their own constituents better than a distant federal government ever will. As the Prime Minister said in relation to the reform of our Federation, we should be doing more to make sure that states and territories are sovereign in their own sphere. Of course, this is especially true in Western Australia, Queensland and the Northern Territory.

So, contrary to some of the claims we have heard from those opposite, the abolition of Health Workforce Australia does not indicate any lack of commitment of Australia's health workforce; instead, the reverse is true. Indeed, the Department of Health advised the Community Affairs Legislation Committee inquiry into another bill, the Australian Preventive Health Agency (Abolition) Bill 2014, that:

There will continue to be work undertaken by the Department, and in state governments, to develop innovations and reforms to address health workforce challenges, and to support the implementation of those policies.

Key words there: 'There will continue to be work undertaken'. They continue:

The Government remains committed to effective health workforce training, productivity and innovation and will ensure that this work is delivered more efficiently through reducing corporate overheads, and eliminating duplication between HWA and the Department.

The closure of Health Workforce Australia is not a withdrawal of support or resources for our health workforce. By creating efficiencies, by streamlining programs, by reducing bureaucracy, we are ensuring that we get better value from the investment in programs to build the health workforce of Australia for tomorrow.

I think in many ways this bill neatly encapsulates a core philosophical difference between the coalition and our political opponents. This government is interested in practical, pragmatic solutions. Labor, when in office, was more interested in press releases. Thus, Labor's automatic response to every challenge is to set up a taxpayer funded agency to look into a problem, without ever stopping to ask itself if the work is already being done—or if it can be done more effectively elsewhere, such as through the states and territories. After all, there is no photo opportunity in making sure that government departments are doing the work they are supposed to be doing. In Labor's view, it is much better to set up a new agency and try to generate some excitement and some publicity to convince the public that you are dealing with an issue. Whether or not that is the most effective use of limited financial resources seems to be a secondary consideration for those opposite.

It was that sort of thinking that lead to the protracted debacle of Labor's GP superclinics—which were first announced in the 2007 election, re-announced in the 2010 election and, by the time of the 2013 election when Labor left office, more than half of them had still not been built. That is what I mean by 'government by press release'. The botched GP superclinics rollout was $650 million into a big, showy program that was designed to shore up Labor's support in marginal electorates around Australia—while, at the same time, Labor reduced funding for subacute hospital beds. The Australian National Audit Office found that less than 10 per cent of the GP superclinics that Labor promised in the first round—that is, in the lead up to the 2007 election which Kevin Rudd won—were delivered on time.

As a result of the measures contained in this bill, programs and functions of Health Workforce Australia will be transferred to the Department of Health. That is part and parcel of this government delivering on its commitment to reduce red tape and streamline programs and get better outcomes. The savings that flow from this bill will support front-line health services and programs.

This leads me to another important point that I would like to make. As a result of the decisions of this government, annual federal assistance to the states for public hospitals will—contrary to what Labor is saying—increase by more than nine per cent every year for the next three years and by more than six per cent in the fourth year. In total, that represents a 40 per cent increase over the next four years. We are increasing funding for states to run public hospitals—remember they, and not the federal government, run the hospitals—by more than $5 million from $13.8 billion in 2013-14 to $18.9 billion in 2017-18. The overall annual health spending will increase by more than $10 billion or 16 per cent from $64.5 billion in 2013-14 to $74.8 billion in 2017-18. Consistent with our commitment to get the budget back into the black, the coalition government is also putting the growth in health spending on a more sustainable trajectory from 2017-18. In spite of the very difficult budget challenge this government inherited from Labor, every year Commonwealth spending on our health system will continue to grow.

Of course, this government has also committed to provide up to 175 grants for rural and remote general practices to expand facilities and to support teaching and training of medical students and registrars. The grants, of up to $300,000, will be provided to successful applicants and require a matched contribution from the practice. This will encourage local practices in regional areas to think about the needs of their communities and plan their future expansions accordingly. This is the sort of initiative I spoke of earlier, when I noted the importance of involving people who are on the ground delivering services rather than having money sucked into a another level of bureaucracy and directed away from service delivery. In addition to this, the coalition government has committed to significantly expanding the number of GP training places. GP training places will increase by 300, from 1,200 to 1,500 new places in 2015.

These initiatives and programs have been well received across regional Western Australia. They will create more vocational training opportunities for the workforce, freeing up more junior doctor training positions for new graduates coming through. The Australian General Practice Training program, which the government's commitment will expand, has a distribution target that requires 50 per cent of training to occur in rural and remote locations. This is a health workforce plan that listens to and takes note of the health workforce needs of regional Australia. This is the type of practical assistance that regional communities need.

Furthermore, the government will also invest around $40 million in up to 100 additional medical internships each year in non-traditional settings, including private hospitals in regional areas. This will help to provide additional opportunities for medical students and will also help to reduce some of the pressures on public hospitals for training. Priority will be given to positions and rotations outside major metropolitan centres to expand the capacity of our medical workforce in rural and regional areas.

Then we come to the historic announcement in the budget two months ago that this coalition government will establish a Medical Research Future Fund. The fund will grow to become a $20 billion fund that will boost illness prevention and promote early intervention in a way that will reduce healthcare costs, making our health system more sustainable. The fund is being established because the government recognises that research is every bit as important as treatment in the creation of a healthier population and in contributing to the long-term sustainability of our health system.

In spite of all this, Labor and the Greens have the audacity to come into this chamber and accuse this coalition government of not caring about health. It is a charge that I and my colleagues reject. It is precisely because we care about health that we are making the difficult decisions with regard to building a sustainable health system for Australia into the future, and the budget is a necessary part of that.

It is important to recognise that we cannot keep doing things as we have been doing them. The business-as-usual approach does not work anymore. It was rejected at the last election, and this government should be given a clear path to try its ideas, to try its reforms and to improve the health outcomes of Australians and, more particularly, of regional Australians. We cannot continue wildly spending public money without asking the tough questions about whether we are getting the maximum value for that spending or whether it would be better directed elsewhere or, indeed, whether it would be better done by someone else. Australia does have a debt and deficit problem. It is a problem that has been recognised by this government, by the Secretary of the Treasury, by the independent Parliamentary Budget Office, by the OECD, by former Labor Prime Ministers Bob Hawke and Paul Keating and by numerous respected independent economic commentators.

Of course, some would prefer to keep their head in the sand. The fact that those opposite are unwilling to face up to the challenge is unfortunate—not surprising, but it is unfortunate—but that is their decision and they will ultimately have to live with its consequences. Meanwhile this government will not be cowered by their cheap, populist politics. We will not shirk our responsibility to get the budget back on an even keel, because that is what we told the people of Australia we would do. More than that, it is the right thing to do, and it is right and proper to act soon and to act quickly. The measures contained in this bill are entirely consistent with this government's overarching commitment to reduce red tape, to reduce inefficiencies, waste and duplication within government and to make sure that valuable taxpayer dollars are actually targeted effectively. (Time expired)

1:12 pm

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

I rise with some pleasure and also with some incredible sadness as an Australian to have to speak to the bill that this government has the temerity to put before this place today, the Health Workforce Australia (Abolition) Bill 2014. Australia's health workforce is vital to the wellbeing of this nation. It is not just about individuals feeling well; being well and having the people who are skilled enough to help you stay well and to return you to good health are a vital part of the work of governments.

We know that the health workforce in Australia is under tremendous pressure, partly because of our ageing population and rises in chronic diseases and also because of the reality of increasing community expectations about living a healthy life. The health workforce is rich and diverse. It totals 1.3 million people, made up of 550,000 registered health professionals and 750,000 workers from other health occupations. This is no small entity. The work that it does is no small thing for this country, because a healthy Australia is vital to our national productivity as well. At the last census 6.7 per cent of all employed people in Australia were engaged in a health occupation. This number rose by 22.5 per cent up to 2011 and continues to do so. We know that health and planning for the workforce that will support Australians' health is one of the great works of all levels of government.

One comment I want to make before going to my prepared remarks relates to what we have just heard from Senator Smith: gilding the lily, pretending that what they are delivering here is in line with their promise prior to the election that there would be no cuts to health, when what we are seeing here is a massive cut and no clear indication of where this cut is going, and at the same time an abrogation of the responsibility of the federal government to work systematically and carefully with the states to make sure that we have the doctors, the nurses, the podiatrists, the dieticians, the healthcare workers in all their form that Australia needs. But Senator Smith revealed what might be lying ahead in terms of the white paper that this government is threatening, and that really, really frightens me. We heard him say that the burden of service delivery is placed on the states, and the responsibility of federal government in that mix is something that they are trying to walk away from with this bill. Claiming a duplication of service is a very cheap and very low-level way of thinking about the importance of the workforce that we need to prepare for Australians.

States are certainly responsible for service delivery. That is correct. That is one factual, correct thing that we heard from the senator. But the reality is that something called the GST, instituted by the great hero of the Liberal Party, changed the way in which those states that make up the federation are actually able to acquire money to provide the services that people in the states need. And the reality is that that has changed forever the nature of state-federation relationships. What we see here is a government so fixated on cutting and destroying and lacking a vision for the future that this failure to actually plan for working people to be available to help Australians when they need health care. That is an indictment of this government.

I want to make some comments about this notion of duplication that we are hearing about. 'Duplication' is just a cover word that this government is attempting to use to cut down the communication that the federal government needs to have with the states. In the old days that Senator Smith might hark back to, we did not have transport of the kind we have now. People did not fly. People did not move from state to state. People did not shift around the way they do now. But, thankfully, we now have that capacity, and Australians exercise that capacity all the time. The notion that there is no national need to look at workforce is a very false argument, and it belongs to another time. It is not a forward-looking vision that this government has; it is a backward, miserly vision. It is an absolute abrogation of responsibility in the modern Australia that we live in.

But it is just another expression of this government's backward-looking reality. They are constantly looking in the rear-vision mirror: 'Let's go back to when Federation commenced.' Well, as a woman, I can tell you that I am very glad I am not going back to the days of bearing 10 children and doing the washing by myself out in the bush, completely unconnected to the rest of the world. I like Facebook. I like the future. I like the opportunities of education for my children. I like the thought that Labor was planning for a health workforce that was going to be there to meet my needs, the needs of my family and friends, the needs of people in the community who I represent, the needs of the people of the great state of New South Wales. Labor understood, in our health reform, that it was the federal government that had to step up to take financial responsibility alongside the states. Yet here, within just a few months of coming to government, this backward-looking lot decided that they could completely rewrite the impact of the GST on Australia's economic reality and simply absolve themselves of the responsibility for funding and for planning a national workforce for Australia, the nation.

I am proud to be a New South Welshwoman, but I am prouder to be an Australian. And this government is attacking all of the institutions that support us as Australians in its negative, miserly way. What we are facing with this government—and those listening should make no mistake about it—is the end of Australia's health system as we know it. For 40 years, since the inception of Medicare, Australians have really understood and appreciated the fairness of Labor's vision for health. We believe as Australians that it is not how much money you have in your pocket that should determine whether you can go to a doctor or not. We think you should be able to show up with your Medicare card and get the services you need. We believe that that creates a fair Australia. That is what Labor believes. But every single time those opposite have come into government they have attempted to tear down that very essential part of Australia's fabric. They have had a go at Medicare every single time they have come into government. And I thought it was pretty bad before, but it was nothing on what we are seeing this ideologically driven government doing now: tearing apart our universal healthcare system. They want to abolish so many parts of it, attacking it on every level. But how can you possibly stand in this place as a government for Australia and say: 'It's not my responsibility to look after the health workforce for the people of Australia. Sorry: not interested today; let's just hand it over to the states'?

Australians can stand here today while we fight this legislation and every other bit of disgraceful health legislation that those opposite are bringing into this place this week, proud that we have one of the best health systems in the world. And this ideological war is being waged by those opposite. But Australians are awake to it. They know about that essential, quintessential fairness. People know that the budget that this government brought down absolutely stinks. It is rotten to the core. It is taking away very simple rights from Australians with a lot of gobbledegook talk, but you just cannot fool all the people all the time. They got away with their lies before the election—'no cuts to education, no cuts to health, no changes to the pension'. But look at what we have. In the budget that reveals the truth—cuts to education, cuts to health and changes to the pension. It tears at the very fabric of our country.

Prior to the establishment of Health Workforce Australia, when we were coming off the back of the Howard government, we were faced with a piecemeal approach—that means this state doing a little bit and that state doing a little bit. It resulted in this boom-bust cycle of ad hoc systems—sometimes there were doctors, sometimes there were not; sometimes there were nurses, sometimes there were not; sometimes there were podiatrists, and many times there were not—because nobody was actually doing the work to figure out what was going on. You have to have a look to see what is happening across the nation, not just in one state. The distribution of workers within the health sector before Health Workforce Australia came was absolutely unequal and unfair, and it was worst in the regions and in rural Australia. I see Senator Nash sitting there with major responsibilities in the field of health and with carriage of this piece of legislation—otherwise she probably would not be sitting there. She is a woman from the bush, like the National Party members she sits with—one who should have a big, loud voice seeking equity for that community. And I see my two colleagues here from Tasmania—Senator Polley and Senator Urquhart—who fought for the establishment of Health Workforce Australia and who understand that, in Tasmania, the people are incredibly disadvantaged in terms of the access they have to health workers.

But that was significantly ameliorated by Labor's investment in delivering a health workforce. We went about improving the training of health professionals nationwide by funding a $1.1 billion national partnership agreement on hospital and health workforce reform. This led to Health Workforce Australia, which was gathered together to create a national body to counter those pressures within the health system and to provide long-term, sustainable solutions. We invested in that for the people of Australia with the money collected under the GST that comes to the federal parliament. We invested $344 million to make sure we were planning the workforce and enabling the universities to be part of that planning; enabling the community to be part of that planning and enabling all of the peak bodies to be part of that planning across the nation. Not within the states, because this is Australia. It is no longer the great state of New South Wales all around the country—this is a federation of states that sends tax to the federal government and has a responsibility for national workforce planning in this critical area.

If we are going to dismantle this national authority that this miserly, short-sighted government wants to do, we will see a dramatic decline in health care, particularly in those areas that Senator Nash and the other Nationals are representing—particularly in rural and remote communities. And the impact will be felt first amongst the elderly, amongst the disabled and amongst the chronically ill. What we are going to see if this is not managed properly is an incredible impact on our workforce of 1.3 million people and fragmentation of the system—breaking it apart so states fight with one another to bring nurses backwards and forwards. It will do nothing to enhance health outcomes for Australia, and that is at the heart of what is wrong with this government—they have forgotten that politics is about people. They have forgotten that Australia is a country about fairness. They have lost that sense of responsibility to people, and their language reveals it every day. We have had ministers here speaking about education, but you would never know because all they talk about is business, business, business. When they talk about childcare, there is not a mention of children. And what we are seeing here in the health sector is the same thing: 'health dollars'; 'state responsibilities'; the old one-two shuffle—'let's hide that pea under the thimble and see if we can find where it is, because if we bamboozle them enough, they will never notice.' But the reality is that Australians are too smart for this lot. They have figured them out. There is no capacity for Australians to be conned any more by this government that wants to take away the things that build the nation and enhance people's lives. Those opposite have forgotten about people, but I can tell you that we on this side of the chamber have not. That is why, as bad as it is to have to come in and speak about this matter, I am so proud to be here for Labor and to be fighting for fairness for Australian workers and for those Australians who use the health system. And let's face it—that is every single one of us.

The reality of this government is that they are planning to pull apart a structure. They are going to cut clinical-training funding; they are going to stop talking to the universities; they are going to stop enabling people to plan for the sorts of needs we have right across this country. In my time in the House of Representatives on the standing committee on health, and now as the chair of the Senate's Health Committee, I have been able to see firsthand what is going on with this government, and the kind of impact this government is determined to inflict on the Australian people. The last time Tony Abbott was in charge of health he took a billion dollars out of health. He was responsible for a complete shortfall of doctors and nurses, and a system of overseas-trained doctors was his solution to that workforce shortage. In the last parliament we undertook an extensive inquiry into the overseas-trained doctors scheme, which the AMA themselves said had failed. It was extremely complex: we described the way that many wonderful doctors, who have come to us from all parts around the world, in trying to negotiate that system as being 'lost in the labyrinth'. So convoluted and so ridiculous was the scheme they had set up that it simply did not serve Australians' needs.

When Labor came to power, we invested and invested and invested in massively expanding the number of training places for doctors, nurses and other health professionals. Only last week in the Riverina, in Wagga, I met graduates who are coming out of a program where they have been able to engage rural and regional students and be very successful with them. In Townsville in particular, just last week regional students were brought in to study at a regional university and they are doing their placements in regional hospitals. This increases their capacity to become general specialists. These are things that Labor did to enhance the workforce. We have a proud record to stand on. We did the hard work. We cleaned up the mess that saw Australian people compromised, that saw Australians who could have had medical service denied that service, with the likely consequence of ill-health and, potentially, death from not having a person trained to do the job that needs to be done.

Today, 25 Labor senators will make it clear to the Australian people that there is one party that stands for the health of all Australians, not just some Australians. There is one party that will invest in making sure that we have the health workforce required to attend to the needs of Australians if they get sick. You can look around here today and think about people in your family. You might say, 'I'm pretty healthy,' but, let me tell you, ill-health might only be an hour away. It could be an accident, it could be a stroke, it could be that you find out that you have a chronic illness, it could be that your grandchild is born tomorrow with a disability, or it could be that you get diabetes, you need help with your foot care and you need a podiatrist. What we are debating here is no esoteric thing about states, the Federation and 1901; we are talking about real Australians who live now and want to live into the future. We need to keep Health Workforce Australia. This government should have known better, but they have revealed their true colours. They have shown themselves as the miserly, backward-looking lot they are.

Photo of Richard Di NataleRichard Di Natale (Victoria, Australian Greens) Share this | | Hansard source

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.

1:46 pm

Photo of Sue LinesSue Lines (WA, Australian Labor Party) Share this | | Hansard source

I rise today to question and to speak against the government's decision to abolish Health Workforce Australia. This decision is a clear demonstration of the Abbott government's lack of vision for Australia, its complete failure to plan for the future, its failure to take responsibility for the health of Australians and its ideological hatred of anything that strengthens our universal health care system. Health Workforce Australia was our vision, Labor's vision to establish a national approach to the planning and training of Australia's health workforce. Labor, unlike the Abbott government, wanted to ensure that we planned today for Australia's health needs of the future. Labor inherited from the last Liberal-National government a piecemeal approach to health workforce planning, a system that responded badly, in an ad hoc way, to peaks and troughs. If the abolition of Health Workforce Australia goes through, health workforce planning will fall back on states and territories.

I would like to illustrate just how ill-equipped my state, under the Barnett Liberal government, is to deal with health workforce planning. I am sure government senators from Western Australia have seen today's headlines in The West Australian newspaper. The Barnett government, 12 months ago, lost our AAA credit rating. In a state where the money flows from mining dollars, a state rich in resources, we saw the Barnett Liberal government lose—just drop, just disappear—through its absolutely poor management, our AAA credit rating.

Today The West Australian is reporting that the Barnett government is now down to a AA1 credit rating. What a disgrace, what squandering, what mismanagement by the Western Australia Liberal government. The state of Western Australia and our prospects should lead the nation not lag behind. Remember what Prime Minister Abbott said of Mr Barnett? The Prime Minister said that he wanted to be a leader like Mr Barnett. This abolition is going down exactly the same path—no vision, just a plan to abolish Health Workforce Australia, a body set up specifically to look at our future health needs.

To continue on the Western Australian theme for the moment, their take on health in Western Australia is nothing short of a cot case. It is an absolute disgrace. The latest report on our brand new, fully costed under Labor hospital, the Fiona Stanley Hospital, which should be the showcase of the nation, was published by the Auditor-General in June criticising the Barnett Liberal government for wasting taxpayers' money, for failing to deliver top-class, world renowned information, communication and technology. You would think with a brand-new hospital, with proper planning by the state government, that we could get that right, but no; we have yet another bungle by the Barnett government over the Fiona Stanley Hospital.

The Auditor-General's June report reveals that the Barnett government, as WA taxpayers know, is making a mess of the Fiona Stanley Hospital and this time with critical information, communication and technology, something that is needed to create a modern, world-class functioning hospital. That one bungle alone—and there have been countless bungles at Fiona Stanley Hospital—has cost Western Australians $370 million, that is, $370 million just gone, down the drain, because the government clearly has no idea how to run a health system, let alone how to plan for the future needs of our health workforce. The Auditor-General went on to say that the project was poorly planned, managed and monitored. Remember the Prime Minister said he wanted to copy the Barnett government? Well he is copying by abolishing Health Workforce Australia.

The woes with Fiona Stanley do not stop there. The hospital is complete. It is ready for patients, or it would have been ready had it not been bungled by the Barnett government. When was the hospital completed? In December 2013, almost 12 months ago. It is going to be old by the time it is opened. But when will it get patients? Well, there has been delay after delay after delay and we are now told it will be sometime in 2015. What a disgrace! Imagine how much that is costing the taxpayers of Western Australia. And this is where the Abbott government thinks health workforce planning should sit: back with the states.

The Fiona Stanley Hospital is ready to go but it cannot go. Why can't it go? Because there are workforce shortages in Western Australia. We have already seen the Barnett government completely fail to plan for the workforce that is needed at the Fiona Stanley Hospital. Yet the Abbott government and the Prime Minister, who wants to model himself on the bungled Barnett government in Western Australia, believe that somehow the states and territories are better placed to manage health workforce planning. Nobody in their right mind could agree that the Barnett government could plan anything in health, except a massive cost to taxpayers. They can certainly plan that! But they cannot plan workforce issues.

And the bungling of the Barnett government does not just stop at the Fiona Stanley Hospital. It failed to deliver women's reproductive services and family planning to the new Midland Hospital. The issue of the lack of women's reproductive technology and family planning was repeatedly raised by the local community over and over again. It has been a major issue in the Midland area for at least the past three years, possibly longer. Yet earlier this year the Barnett government tried to hoodwink Western Australians, by saying, 'Actually, we weren't aware that women's reproductive technology and family planning services weren't going to be available at the new Midland Hospital.' Can you believe that? How could they not have been aware? This just shows that they are absolutely incapable of planning health services and health workforce in Western Australia. Nevertheless, at this point, no reproductive or family planning services will be undertaken at the eastern suburbs hospital, the new Midland campus, because the government simply ignored it and thought it would go away. They have no capacity to plan.

So how can Western Australians trust that the Barnett government will be able to develop long-term workforce planning? It clearly cannot even manage the services it is currently accountable for. 'Poorly managed'—and that is not the Labor opposition saying that; that is the Auditor-General saying that.

Health Workforce Australia's own record shows the current medical training system is inefficient and it is uneven in its distribution of the medical workforce. We all know this and we know that it particularly affects rural and regional communities. We also know that chronic diseases are on the rise in Australia and are the leading cause of death and disability in Australia. None of this is secret; it is obvious. We have an ageing population, we have chronic diseases occurring, we have workforce shortages and they are much more acute in rural and regional communities.

We know that chronic diseases are associated with a high use of healthcare services and that that puts pressure on our healthcare system in Australia. We also know that there are cost pressures around chronic diseases and that Australia's ageing population, together with chronic diseases, will lead to a greater use of health services. These are services which require a skilled clinical workforce and solid evidence-based workforce planning, not the sort of mismanagement we have seen in Western Australia by the Barnett government.

Work is already underway by Health Workforce Australia. It has already produced Australia's first national long-term projection for doctors, nurses and midwives, with its publication of Health Workforce 2025: doctors, nurses and midwives. Why would we want to throw that out? Why would we want to say that we do not want to focus on health workforce planning anymore; we are just going to ignore that and somehow imagine that the Department of Health, with all of its pressures, will be able to dedicate particular resources to focus on this vital issue?

This report, prepared by Health Workforce Australia, is the first ever national report and it identifies Australia's long-term health workforce needs. Health workforce planning is complex; it is not simple. It cannot be left to ill-equipped states and territories. And it certainly cannot be left to the Western Australian Barnett government, which cannot be financially responsible, with the downgrading of its credit rating today. It certainly cannot be left to that government. But it does involve coordinating state and territories. We have seen by the Western Australian example that states just cannot get this right. It should not be left to them.

Health workforce planning needs a focus and Health Workforce Australia provided that focus. That focus will be lost in the Department of Health. The abolition of a specific focus through Health Workforce Australia demonstrates, once again, that the Abbott government has no commitment to health and no plan for Australia's future health needs. It either does not care or expects the issue of workforce planning to happen elsewhere. This is another unfunded throwback to the states and territories. What a shambles!

Where are the Nationals on this issue, supporting the Liberals? They are nowhere to be seen. The Nationals are interested in power, not people. There is already a well-known, well-documented shortage of doctors and nurses in rural areas. What is the Nationals plan? They have no plan. They have deserted the bush and left future workforce need to chance—'Just roll the dice, let's see what the numbers are and maybe the states and territories will provide the much-needed long-term planning.

So what will happen? The Abbott government will continue to rely on recruiting our health workforce—

Debate interrupted.