Wednesday, 14 June 2017
Health Insurance Amendment (National Rural Health Commissioner) Bill 2017; Second Reading
I would like to continue following the brief start that I had for about 30 seconds on this legislation when I first spoke. This is a really good plan put forward by the member for Lyne, David Gillespie—a national rural health commissioner to actually look at the health issues in rural and regional areas and give frank assessments and opinions to the ministers.
There are many things that we could do within regional areas. One that I am promoting at the moment is neurological nurses throughout not only New South Wales, but Australia, for people with Parkinson's disease—such as I have; so far, so good—but also that terrible disease of motor neurone disease and multiple sclerosis. We have just three of those such nurses in New South Wales. I believe there is one at Nowra, one at Wagga Wagga and one at Coffs Harbour. A motion passed at the New South Wales Nationals conference at Broken Hill a couple of weeks ago, and my good colleague Senator Nash was there, to see that the federal government along with the state governments provide 50-50 funding for these neurological nurses. That is one thing we need to discuss with this health commissioner when this commissioner is appointed. I would hope that this legislation would be supported right around the chamber.
Another thing that we are short of, especially in many remote areas, are dentists. Early in this job—eight years or so ago—we received an increase in our electoral allowance payments of some $4,800 a year. Since that very day, I have donated the $4,800 a year to a rural dental scholarship, actually managed by the National Rural Health Alliance, where a first-year dentistry student going to university receives my $4,800—$400 a month—for the 12 months. It is a big assistance to anyone, but especially a university student who has to travel and get accommodation. On a verbal commitment, they come from a rural or regional background and they will return to those areas to practise when they become a fully qualified and professional dentist. I have actually put a bit of money into that and I am very proud to say that we have now paid out some $40,000 in sponsoring my dental scholarship.
There are many things we need in regional Australia as far as health goes. So what will be the role of this health commissioner? How will it work? The commissioner will work across all levels of government to improve rural health policies and champion the cause of rural practice. The first task of the commissioner will be to develop a national rural generalist pathway. Working with the sector and training providers to define what is to be a rural generalist, the commissioner will develop options for increased access to training and appropriate remuneration for rural generalists, recognising their extra skills. While the commissioner's first priority is the development of the pathway, their role will be much broader and will include consultation with stakeholders to give consideration to the nursing, dental health, Indigenous health, mental health, midwifery and allied health needs in rural and remote Australia. Dentistry has been mentioned again.
For the benefit of the whips, I will not be speaking my full term of 20 minutes. That might put you on notice as to who your next speaker is.
Senator Urquhart interjecting—
Thank you for the thumbs up, Senator Urquhart. What we are being told—and I have no reason to doubt this—is that the National Rural Health Commissioner will be very frank in his or her assessment. That is the point of the job. It is for them to look at the details, assess the details, assess the problems, come up with solutions and give frank opinions and directions to our health ministers, regardless of who is in government. I would hope this is supported right around the chamber. The National Rural Health Commissioner will be there for decades to come.
We talked earlier in the debate about housing prices and foreign investors. There is plenty of room in regional Australia for people to move to. There are plenty of jobs. Mr Acting Deputy President Marshall, you would be familiar with the huge argument we had about the backpackers tax and what to charge them, because we need them to work in our abattoirs and to pick our fruit—the seasonal work. We have more than 700,000 Australians unemployed. Why aren't they going out to pick the fruit or to work in abattoirs? That always amazes me. Perhaps we are a bit soft when we actually pay people not to work. When I was a young fella, we did not have enough land to support my father, my brother and me, so I learnt to drive a truck and to sheer sheep. I was never unemployed as a result. Shearing sheep is not the easiest job going, but I was young and fit in those days—a bit different from now. Age does weary us.
This is a situation where we want people in regional Australia. We have already seen the government working actively in that direction with APVMA and many other government institutions being moved out to the regions, freeing up the housing in the cities. We have the land. We have the housing. The population actually grows jobs. The more population in a town, the more teachers, the more nurses, the more doctors, the more police are needed—the more everything is needed. Population in and of itself builds jobs. If you do not believe me then ask what Canberra had 100 years ago. It probably had some cattle—beef cattle, dairy cattle—some sheep and a few farmers. There was probably a little village somewhere, with a general store. Look at it now. This is a classic example of regional development.
The National Rural Health Commissioner will play a major role as the regional areas grow—and I am sure they will in time. People will be forced out of the cities because of the simple fact that they will not be able to afford to buy a house. Where I live in Inverell, a lovely town, there is ample water supply—no water restrictions. There are never water restrictions. Even in the biggest drought we do not have water restrictions, thankfully, because of the Copeton Dam water supply. You can buy a good home in Inverell for $300,000. When I say a 'good home' I mean a three-bedroom, brick veneer home on an 800-square metre block in a nice area, a quiet area, of town. That is not a lot of the money; $300,000 would not buy you a dog kennel in Sydney.
As we grow the regions, it will be vital that the National Rural Health Commissioner provide frank assessments of the things that we need in regional areas as far as health goes. Sure, we are lucky in this country. If you are in a spot of bother or in a serious spot of bother, we have the helicopters, the air ambulances. Those things are there for an emergency. But more than that is needed. There are the aged care facilities. There is the general hospital for people who are just recovering from a minor or, in some cases, even major surgery. Of course, there is a shortage of dentists. As I said, I will be keen to see the neurological nurses established right throughout Australia to take a bit of the load off the GPs. Also, it takes a long time to get in to see a neurologist. It can often take six months, so you have to book ahead to get in to see one. Most of them seem to be based in the cities. The nurses could do a lot of good work out in the regional areas.
I look forward to the support of senators from right around the chamber. I hope no-one will oppose this legislation. I look forward to the appointment of the National Rural Health Commissioner. Also, I look forward to meeting that commissioner and having a frank discussion with them and saying: 'Look, here are a few things I can bring to your attention straightaway.'
I do hope there is support around the chamber. It is all right to have everything in the cities—the specialists, the big hospitals and the good care we see in so many cases—and sometimes in the regional areas we are behind simply for lack of population. You are not going to book into the Inverell hospital for a heart transplant, you are going to go to Saint Vincent's. It is as simple as that: we simply do not have big enough casualties, customers, clients, patients—whatever you want to call them. I do think it is going to be very good thing and I hope it is supported all around. I look forward to meeting the commissioner as soon as possible after the commissioner is appointed.
Of course, not all of them, Senator Williams. I will take that interjection. Living in a rural community I am not surprised that you wanted to stand up and support the arrival of this commissioner, but again it is from this government in the area of health too little and too late, After breaking so many things, there is a great need for repair. This government's appointment of a National Rural Health Commissioner to oversee health care for the people of remote and rural Australia really needed to happen an awful lot sooner. It would have been a much easier job if so much money had not been ripped out of the health system and if the problems of access to health services had not been so exacerbated during this government's time in power.
I would not envy the commissioner's job because this coalition government, despite the rhetoric and despite the very nice visual appeal of this appointment, continues to run the health system into the ground. It is particularly hurting Australians in the bush. About one-third of our Australian population lives in regional, rural and remote areas and that comes in at around seven million people whose access to services is significantly impaired. That is at the heart of what this commissioner will be told he or she has the responsibility to clean up.
Sadly, on average, rural, regional and remote Australians do not enjoy the same high standards of health and wellbeing as people living in cities, nor do they experience the same access to health services and health-related infrastructure. The truth is that health-care models that work in urban settings do not necessarily translate to rural or remote settings, where services are necessarily more fragmented and often more difficult to reach. We heard a great deal of evidence in the select committee of the last parliament about the simple cost of transport in getting to vital health services.
One might have hoped that the NBN might have delivered a line of modern access to services away from where you live but, sadly, the NBN committee in this parliament is only hearing about the disastrous rollout of the NBN. People on Sky Muster and people on the border of Victoria describing very clearly their failure in accessing service in a reliable way. Many of them were asking for their ADSL back because the NBN is so bad. I do not mean the real NBN, but the dodgy, lemon version that we have had inflicted on us by the Abbott and Turnbull governments through their poor decision making.
Distances are clearly greater in the bush, and so attracting and retaining staff in the health sector is a major challenge. With the tearing apart of Medicare Locals, we heard story after story all around regional Australia of the incredible waste in human capital—how people had been recruited to the bush but were held up by this government's mismanagement week after week and month after month to the point where they had no certainty of paying their mortgages in regional or remote Australia and so they simply packed up and headed back to the cities. That is how badly this government, in both its Turnbull and Abbott iterations, has dealt with the challenges of getting great Australian health workers to the bush. They killed off the workforce in their mismanagement of the sector.
Some of the challenges that the rural health commissioner has before him or her include the larger proportions of social disadvantage, higher unemployment rates and reduced access to support services such as allied health, pathology, radiology and investigative disciplines. Those are a lived reality which has only become worse in recent years. Where I live on the Central Coast and in communities further away from our capital city communities have higher morbidity and mortality, and their health care costs are usually higher. That is why the Labor government, instead of putting in a commissioner for rural health, had a policy of putting in place 26 regional cancer centres.
I am very pleased to say that it was a federal Labor government that put in $29 million for Gosford regional cancer centre, with $10 million from the Keneally government in New South Wales, to make sure that people on the Central Coast could finally get public access to cancer treatment, to radiotherapy. That was a practical response to the needs of regional and rural Australia. It is very different from what we are seeing here—wreck it first then bring in a commissioner to clean up the mess that you have made or at least look like they are going to clean up the mess that has been made. Why is this so desperately needed?
If we look at children from Aboriginal and Torres Strait Islander backgrounds, the reality is right now they continue to be more at risk of death, with their mortality rate 2.3 times higher than non-Indigenous children. Clearly there is a great need for a changed response to access to services and management of that whole process. I sincerely hope that the commissioner can work the miracle of resurrecting access to services for Australians in the terrible context that they will find themselves in, given this government's former health decisions.
The National Rural Health Alliance points out that, despite the high health needs of our remote population, there is around 20 per cent less Medicare funded GP activity in remote Australia compared to the same population in the city. It is not because people are sicker; it is because the system is so sick, so broken. It is because access to people who can provide the health care that you need is so difficult to get that you just cannot get the treatment that you need. You just cannot get to see the people that you need. You cannot afford to travel. You cannot find the person to do the job because the speech pathologist that got recruited out to your area by Medicare Local got stuffed around so much they went back to the city, and now you cannot get that service anymore. That is everywhere across the country, and this government has to take responsibility for the brokenness that it has inflicted on workforce around the country.
That situation is not only bad because of the real life outcomes and impacts it has on ordinary Australians but it is terrible because it is leading to a very aberrant set of behaviours about cost-shifting, with the states having to pour more money into acute hospital care for people from rural and remote areas. Sadly, people with mental health issues from remote communities who are unable to access early intervention services are more frequently hospitalised than their fellow Australians in the city. These are the facts of how terrible things have become under the watch of this government through its series of ministers that it has pushed through the portfolio. Why is it like this?
The government deny many of the decisions they have made. I want to talk about one decision on perinatal depression. The federal government wrote to the nation's health ministers saying that they had just pulled up stumps and were not going to fund it anymore. The original $85 million agreement expired and then there was supposed to be a continuation of it. But that terrible budget in 2014 just saw the money disappear. The letter arrived from the federal health minister, according to the Minister for Health in Queensland. He said, 'I received a letter from the federal health minister, Sussan Ley, telling me they are abandoning this initiative.' That is the kind of public action that this government have taken around health that has led to the decay of services and the increasing need for people to have acute hospital care.
Why would this government bother about it? They do not care because it has shifted the cost onto the states so they can play games with their numbers. Playing games with their numbers is actually costing people their health. In its worst manifestations, it is costing lives, and people in the bush know this. They know that access has become harder to achieve and they know the quality of the services and their capacity to be able to get health care when they need it has decreased under this government.
I want to make some remarks about mental health, particularly. According the Australian Bureau of Statistics, 3,027 Australians died by suicide in 2015, and that is a 5.4 per cent increase on the previous year. By all reports, that continues to rise. Sadly, death by suicide continues to disproportionately affect remote and rural Australia, especially Indigenous communities and young men.
I want to acknowledge in my remarks this evening that this week marks Men's Health Week, and I also made some remarks in the adjournment last night about infant mental health. This year's theme for men's health week—Healthy Body Healthy Mind: Keeping the Balance—explores the way men and boys can keep healthy, physically and emotionally, in a busy and challenging world.
The challenges facing men and boys in rural and regional communities are very significant. There is considerable difficulty, as I said, in accessing services because of isolation, but also financial difficulties means that support services that are needed cannot be accessed in real times of need but are often delayed—delayed to the point where the need increases to the acute level and, in the worst instances, where, sadly, people feel that they simply cannot go on. Sadly, also, in the context of rural and regional Australia, people have more access to suicide means that are likely to result in immediate death. The commissioner and all levels of government need to focus on a holistic approach to suicide prevention. It is only through working together that we can hope to reduce the impact of suicide in our society.
We have heard this government prattle on about how they really care about mental health. It is one of Mr Turnbull's signature phrases, but the reality is: he has not put it front and centre as he said he would, and there is a massive mess out there—a mess of his own making—that he has now decided this commissioner should come in and sort out.
The health department revealed to Senate estimates back in October last year that at that time it was yet to provide any detailed evidence and advice to the government on the Turnbull government's commitment of $20 million to 10 new headspace centres. During the course of the election, Mr Turnbull says: 'Look. I'm going to be your man for mental health. I'm definitely going to be doing something good on mental health. Okay, what'll we do? Let's just come up with—10 headspace centres. How much? $20 million. Any advice from the department? Sorry? No, don't worry about that.' That is not evidence based policymaking but prejudiced policymaking; policymaking that is interested in votes, not people; policymaking that is on the run, not consultative; and policymaking that is made by members of this government in isolation without fair and proper consultation with the states with whom they are in deep partnership with regard to health and without proper consultation with the people in Australia in an open and honest way.
The smoke and mirrors that this government has managed to manufacture—there is an unbelievable construction of myth around medical support. While I support the need for a commissioner to try and come and rectify some of the worst excesses of this government's decision-making in health, the job that they have created for him or her is enormous—absolutely enormous.
It has been almost 12 months since the federal election. We have had a change of health minister. We have only got half the promises, half of the commitments, that were promised last year. Four of the five new headspace centres that have been announced have been—wait for it—in Liberal-held seats. In one of those cases, the member for Canning, Andrew Hastie, said that it was his collection of 3,000 signatures that tipped the scales—so much for evidence based decision-making.
Communities are an important part of decision-making in the country, but that is not what this government said it was about. Yet we have got a member out there saying, 'It's thanks to the groundswell of community support that our efforts have been successful. Today's announcement shows that the federal government is listening and responding to the difficulties faced in the Peel region. I thank Minister Greg Hunt for being so receptive to our call for help.'
We have got a member out there campaigning for headspace, getting signatures from people who have experienced incredible grief and loss through the suicide of their children and their friends and their family playing some political game with this—eking out how long they can drip-feed into the Australian population these headspace centres, which are desperately, desperately needed—instead of a transparent announcement of: 'This is the needs analysis. This is the population data. This is what the health professionals are telling us, and we will get it out as quickly as we can.' No, we have got: 'Let's campaign on it. Let's drip feed it, and we won't tell anybody about our decision-making around this with any clarity.' It is wrong. It is exploitative, it is wrong and it is contemptuous.
According to the member for Hastie, Mr Hunt seems to operate using policy by petition. Until estimates questions are answered, this still remains a murky proposition. We are yet to get information from estimates about the criteria for these centres. The government is quick to maximise political capital, but it is very slow in responding to the urgent needs of vulnerable Australians, which it has exacerbated by bad policy-making in the area of health.
In the interests of the work of the Senate, I will restrict my remarks to those key areas this evening. I know that Senator Griff is going to make a contribution shortly. I simply close with the reality of this. In preparing my remarks this evening, I had a look at the explanatory memorandum. I thought, 'We've had a reprint of the explanatory memorandum', but it was not a reprint. There is one explanatory memorandum. Then there is another one entitled 'Revised explanatory memorandum'. And the final one, an additional page—it talks about the need for the commissioner to actually do something about the workforce—is entitled 'Supplementary explanatory memorandum'.
We do have a very big problem with workforce in rural and regional Australia. I have given some of the reasons why the practical decisions of this government have made that worse. But let us not forget that there was an organisation established under Labor, called Health Workforce Australia, and its job was to plan, to audit and to see that Australians got the support that they needed where they lived. Doctors certainly. The rural specialist program, which has come out of Queensland and is now being replicated around the country, is a great part of giving health care to Australians in the bush.
But this government, with three explanatory memoranda on the appointment of this commission, show that they are making it up as they go. That is because they are not governing with care. They are not governing in a way that explores and really uses the expertise of great Australians working in the health sector. They are using health as a political football and creating a mythology over the top of it to pretend that they actually care about Australians. And while the commissioner is a step in the right direction, I hope I have made clear to those listening this evening that they cannot trust this government on health. A commissioner charged with the scale of repair that is required after the coalition's wrecking of the health system is a piece of window dressing at worst. Please God, let an amazingly talented Australian come in who can do some genuine work to clean up the dog's breakfast of policy making that has been inflicted on the Australian population, particularly those most vulnerable in regional and rural Australia.
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.
It is a pleasure to deliver these summing-up remarks in relation to the Health Insurance Amendment (National Rural Health Commissioner) Bill 2017—indeed, particularly as I was the minister at the time who announced this. I place on record my congratulations to the member for Lyne, Dr Gillespie—the good Dr Dave—for the work he has done in making this a reality. He has done a tremendous job.
This bill will amend the Health Insurance Act 1973 for the purpose of establishing Australia's first National Rural Health Commissioner. This government recognises the many challenges of delivery, access and provision of health services in rural, regional and remote Australia. The most pressing concern is a lack of access to training for doctors and health professionals who practice outside of our major cities. Establishing the National Rural Health Commissioner will ensure this issue is front and centre of the government's rural health agenda. The National Rural Health Commissioner will be an independent statutory office holder who will champion the cause of rural health, provide expert advice to government and report directly to the responsible minister for rural health. The first priority of the National Rural Health Commissioner will be to develop a national rural generalist pathway which will improve access to training for doctors in rural, regional and remote Australia and consider options for appropriate remuneration for rural generalists.
In recognition of the importance of the commissioner's role, the government has introduced its own amendments that will clarify the scope of the commissioner's role and review the role 12 months before cessation and, finally, an amendment that will direct the commissioner to consider the advice of the Rural Health Stakeholder Roundtable and the Distribution Working Group. The two other amendments of this bill are the repeal of sections 3GC and 19AD of the Health Insurance Act 1973. Repealing section 3GC of the act will remove the duplication of functions between the Medical Training Review Panel and the National Medical Training Advisory Network. It will also simplify legislation in the Health portfolio. Under section 19AD, a review was required every five years into the operation of the Medicare provider legislation in the Health Insurance Act 1973. These previous reviews have been costly, time consuming and resource intensive and have not provided any operational improvements to the application of the legislation.
I would like to take this opportunity to thank all senators for their contributions to this bill. Appointing the National Rural Health Commissioner is an important step forward in the government's aim to improve the access and provision of health services for all Australians who live outside of our major cities. On behalf of the government, I would like to thank the many rural health stakeholders and organisations around the nation, many of whom I have worked with, who have welcomed our decision to establish a National Rural Health Commissioner. We are looking forward to working closely with the commissioner, rural health stakeholders and organisations over the coming years to achieve our shared aim of delivering a quality standard of health care for our rural, regional and remote communities. I commend the bill to the Senate.