Senate debates

Tuesday, 2 August 2022

Matters of Public Importance

Rural and Regional Health Services

3:43 pm

Photo of Sue LinesSue Lines (President) Share this | | Hansard source

IDENT (): I inform the Senate that, at 8.30 am today, 36 proposals were received in accordance with standing order 75. The question of which proposal would be submitted to the Senate was determined by lot. As a result, I inform the Senate that the letter from Senator Chandler proposing a matter of public importance was chosen, namely:

The failure of the Albanese Government to outline any meaningful plans to address rural and regional workforce shortages, particularly General Practitioners, that are impacting the health of Australians who live outside our capital cities

Is the proposal supported?

More than the number of senators required by the standing orders having risen in their places—

I understand that informal arrangements have been made to allocate specific times to each of the speakers in today's discussion. With the concurrence of the Senate, I shall ask the clerks to set the clock accordingly.

3:44 pm

Photo of Claire ChandlerClaire Chandler (Tasmania, Liberal Party, Shadow Assistant Minister for Foreign Affairs) Share this | | Hansard source

I'm pleased to speak on this matter of public importance on the topic of health, which is consistently the top priority for Australians, including Tasmanians, when it comes to the delivery of government services. In a rural and regional areas around Australia, particularly in my state of Tasmania, one of the constant challenges for small communities is their ability to attract and retain general practitioners. We see this problem regularly affecting communities, particularly in the electorate of Lyons—communities like Ouse, which has been desperately trying to find GP providers to deliver primary care to that community. Indeed, we see the same problem occur regularly around Lyons when a GP in a local practice retires or moves on. When you speak residents, medical practices and councils in any part of Lyons, whether it's Deloraine, New Norfolk, Brighton, Oatlands or the Tasman Peninsula, this is raised as a concern more often than any other topic. Communities right across Tasmania have experienced the difficulty in finding GPs to live and work in their communities. Of course, in regional areas there is often an older and less mobile population who can't simply get in a car and drive to Hobart or drive to Launceston every time they need to see a doctor. They want to be able to have that service closer to home.

This is a longstanding challenge, and there are no simple solutions. We all understand that in this place. But, in the context of that challenge for regional Tasmania, it was disappointing that the government's main election tactic in Lyons was to spread misinformation about pensioners being forced onto the cashless debit card—misinformation that they continued to spread even after independent fact checks declared it false during the election campaign. When it came to specific health policies, they flew down to Tasmania, re-announced the failed Kevin Rudd GP Super Clinics policy for major cities only, jumped on a plane and left again.

The Australian Medical Association had a particularly interesting reaction to this GP Super Clinics policy at the time, and I do want to quote the AMA president:

These centres will do little to relieve the hospital logjam, will further fragment care and will unfairly compete with nearby general practices which, without this government funding, will not be able to keep their doors open after hours.

The president went further:

… the plan acknowledges the costs faced by general practices in opening after hours but instead of enabling thousands of practices across the country to improve their offering to patients, it focusses on only 50 practices, using a model reminiscent of the failed Rudd era GP Super Clinics.

This government policy will unfairly compete with the very general practices that are already having difficulties recruiting and retaining doctors in our region or rural areas. Instead of recognising the great need in those areas of Tasmania—those areas in our regions—the super clinics are to be located only in Hobart, Launceston and Burnie.

The recent decision of the Albanese government to include urban areas in the distribution priority model further exacerbates the difficulty in attracting doctors to rural parts of Tasmania. We now have a situation where incentives designed to attract GPs to move to rural and regional areas can now be used for GPs in urban areas like Sydney. Medical practices and organisations in Tasmania have made it clear that, if GPs have a choice between living in a state capital or moving to regional Tasmania, where they are desperately needed by those communities, the likely outcome is doctors will choose the capital city and it will be regional residents that miss out. If GPs who previously had an incentive to work in rural and regional parts of Australia can now get the same incentive for working in an urban area like Sydney or Brisbane then that doesn't help. It doesn't fix the rural workforce issues; it just makes them worse. There is clearly no plan from the Labor government for rural and regional health workforces.

During the campaign, they made plenty of noise about the party being more focused on health, but, just like the commitments that they'd reduce the cost of living and power prices for Australians as soon as they got into government, we're all starting to find out that those promises were completely hollow and meaningless.

3:49 pm

Photo of Nita GreenNita Green (Queensland, Australian Labor Party) Share this | | Hansard source

I'm very pleased to speak on this incredibly important issue. I don't know if Senator Chandler is a fan of RuPaul's Drag Raceit doesn't really seem like her kind of show—but there's a saying on that show that I want to repeat right now: the cheek, the nerve, the gall, the audacity and the gumption! How dare those opposite come in here and talk about the GP crisis. How dare they come in here and talk about primary health care. How dare they come in here and lecture this government about how hard it is to see a GP in rural and regional areas. We know, after nine years of neglect, that they created this problem, they made it worse, they refused to acknowledge it and they refused to do anything about it. It is absolutely disgraceful that they are now standing here and demanding plans and talking about action, when they did absolutely nothing for nine years.

The government care about people in rural and regional areas, and we care deeply about fixing the GP crisis. I can tell you from my conversations with people in regional Queensland that it is very well known that under the former government people in Emerald had to wait 12 weeks to see a GP. That means there are people right now who made an appointment when the last government was in power and are still waiting to get that appointment. The Labor government has been in power for 10 weeks; people in Emerald have to wait 12 weeks to see a GP. When those opposite were in government they refused to do anything about this. They cut Medicare, froze the Medicare rebate and drove primary health care into the ground. They refused to acknowledge that there was even an issue. When we moved a motion in the Senate to establish an inquiry to look into this issue, they voted against it. This is an issue that was created by the former government and it is an issue that the Labor government will fix. It is an issue that the Labor government cares deeply about and has a plan to fix. But it is absolutely appalling for those opposite to come in here and talk about this issue. I thank Senator Chandler for raising it. I can't think of another matter of public importance ever debated on the floor of this chamber that was more like a dorothy dixer.

We've been meeting with doctors and practice managers all across the country and with admin staff who are answering phones, and they tell us they are working incredibly hard and are just overwhelmed. That is the situation that was left behind. In the conversations I have with people working in the industry I can tell that they are desperate, and I know the community is absolutely desperate. When you can't see a GP, where do you go? You end up in the emergency department at your local hospital. We saw this time and time again through the COVID crisis—complete denial by those opposite that the lack of GP access had anything to do with emergency departments being full. They refused even to acknowledge that it was an issue.

The former government failed to improve the dire situation facing rural and regional areas; in fact, they contributed to making it worse. The lack of doctors and other medical professionals in these communities across Australia is not a new problem. It has been around for a very long time. A series of decisions by the former government during the pandemic meant that we had a spotlight put on this issue—finally, thank goodness!—but people were left with no healthcare options in their community. We want to see practical, positive solutions on the table to make sure people have access to quality health care regardless of where they live. We were noisy during the campaign and we were noisy in opposition because we knew that the government refused to acknowledge they had a crisis on their hands. We on this side of the chamber believe that if you have a Medicare card you should be able to use it, but that is not the present situation for people living in rural and regional areas.

I want to acknowledge the many people—individual residents, GPs, peak bodies, academics and others—who took time to engage with the Senate committee process, whether it was through a written submission or providing evidence at a public hearing. We heard your call. We listened. The Labor senators on that committee listened to the evidence that was being given. And here is what our government will do. I can assure the Senate that the Albanese government is committed to investing in general practice and strengthening Medicare with an almost $1 billion investment. Our Strengthening Medicare Taskforce will identify the best ways to boost affordability, improve access and deliver better support for patients with ongoing and chronic illness, backed by the $750 million in the Strengthening Medicare Fund. We made this commitment before the election and we've moved quickly. The Minister for Health and Aged Care has already appointed members to the task force and they are getting straight to work. We are working with the experts. We are making sure the experts are around the table and we are taking their advice. We are listening—something those opposite failed to do. The task force brings together Australia's health policy leaders, health professionals, and includes consumer, rural and regional, and, importantly, Aboriginal and Torres Strait Islander representatives.

On top of that we're working tirelessly to ensure doctors have the resources to invest in their GP practices. We're making sure the $220 million in the Strengthening Medicare GP Grants program is available to GPs to invest in their businesses. We're also investing $146 million to attract and retain more healthcare workers to rural and regional Australia, for improving training and incentive programs and supporting developing innovative models of multidisciplinary care. And our 50 Medicare urgent clinics across the country will be bulk-billed and will take pressure off the hospital system.

Those opposite can trot out whatever quotes they want from anybody, but you know what really matters: this is a policy that people in rural and regional Australia voted for. They care about these clinics. They want these clinics in their community. When you have a sick child, when you have a sick baby, and the only place you can take that child is to an emergency department, that is an indication the primary healthcare system is not working—and it wasn't working under the previous government. This is an incredibly serious issue, and it's why we are taking it so seriously. It's why we are investing in our healthcare system. It's also why we have made sure there is a distribution priority area classification system to recognise 700 areas for which either full or partial DPA classification is required.

We have not wasted any time. Our government has moved quickly and decisively when it comes to improving this crisis. We have been listening to Australians—something those opposite stopped doing years ago. We know it is hard to see a GP. We know the cost of medicines has been high, which is why health care is high on our agenda. We will reduce the cost of medicines to improve the cost of living and make it easier for people to access medicines under our government.

Finally, can I say, on a local level, that in my hometown of Cairns we are investing in rural GP places at the James Cook University. We know this is a problem that cannot be fixed overnight but if we train local doctors in rural and regional areas—something the former government refused to do—we can make sure we have a generation of doctors who stay in the regions because they've been trained in the regions. This is a commitment we made on a local level but it shows this government is planning on doing the hard, long-term work to fix this issue.

I have to say, coming back to the mover of this MPI: never in my life have I seen more hypocrisy than in this MPI, moved by a former government that refused to do anything when it came to rural and regional GP access, that voted against a Senate inquiry, that cut Medicare telehealth appointments so that people in rural and regional areas could not access telehealth, that froze the Medicare rebate, that drove primary health care into the ground and that even refused to acknowledge that this was a crisis because they voted against a Senate inquiry seeking to look into this issue. The evidence of what the former government did is on the table. And the plans from the Albanese Labor government are clear. It is what people in Australia voted for. It was the thing that got people to change their mind. It was the thing that made them change the government.

Opposition Senator:

An opposition senator interjecting

Photo of Nita GreenNita Green (Queensland, Australian Labor Party) Share this | | Hansard source

I'll take that interjection. If you'd been sitting here during my contribution—look it up in the Hansard if you like. I can tell you we're doing more than your government ever did. We're acknowledging there's an issue. We're investing in strengthening Medicare. We're making sure GPs have access to funding, and we are making sure that if you have a Medicare card you can actually use it under an Anthony Albanese Labor government. For nine years people in rural and regional areas have not been able to do that. (Time expired)

3:59 pm

Photo of Janet RiceJanet Rice (Victoria, Australian Greens) Share this | | Hansard source

There is no doubt the shortage of healthcare workers, including GPs, in rural and regional Australia is at absolute crisis point. We have got a massive problem, which is absolutely a sign of failure of the previous government. The previous government led us to a situation where now the crisis point is so obvious that anybody in rural and regional Australia that talks to you about access to GPs and healthcare practitioners will tell you that it is a huge problem.

The question that I find really juicy, that we need to talk about today, is what we do about it. What measures are going to be put in place by this new government to actually seriously address that problem?

I chaired the inquiry by the Senate Community Affairs References Committee into the provision of general practitioners in outer metropolitan, rural and regional Australia, and we travelled quite widely across regional Australia. I'm hoping that that inquiry will be re-referred to the community affairs committee so that we can continue our investigations.

It was eye-opening, during those hearings, to hear countless health practitioners share their concerns about the lack of access to timely and affordable health care—particularly to GPs in the bush—and to hear of the consequences for people's health. One doctor from coastal New South Wales told us: 'We're at breaking point, trying to service the needs of our community with a depleting number of very tired and very stressed doctors.' We've got doctors in rural areas working 80 or more hours a week. We've got people waiting for weeks to see their GPs. And then there's just zero accessibility to allied health practitioners. We've got a massive problem.

Our committee recommended that the government investigates substantially increasing the Medicare rebates for all levels of general practice consultations, as well as other general-practice funding options, and that we review the primary-care components of the medical education curriculum with a view to ensuring that general practice is a core component of the curriculum. These were consensus recommendations of that committee.

But, fundamentally, what we need to do is to properly fund and support health care across the board. That means actually putting the money into health care, and it means doing things like putting dental care and mental care into Medicare. It means actually spending the money and it means raising the money—it means actually saying: 'Yes, we should have a corporate superprofits tax. We should have a tax on billionaires. We should scrap the stage 3 tax cuts, which are going to cost the budget bottom line over $200 billion over the next 10 years'—and putting that money into services such as health care, education and income support, the services that the people of Australia really need. (Time expired)

4:02 pm

Photo of Anne RustonAnne Ruston (SA, Liberal Party, Shadow Minister for Health and Aged Care) Share this | | Hansard source

I rise today first of all to acknowledge the extraordinary effort of our medical workforce—particularly over the last 2½ years, as they have single-handedly battled in the frontline response to the COVID pandemic, and there is nowhere where these health workers have worked harder, longer or more diligently than in rural, regional and, particularly, remote Australia. I think all Australians owe a huge debt of gratitude to all of our healthcare workers across the whole country, and I would like to add the weight of our parties, the parties of the coalition, to that, as to their amazing efforts, and to thank them very much for what they have done on behalf of all Australians.

The opposition absolutely acknowledges that there are huge challenges out there at the moment in our health workforce, exacerbated significantly by the challenges that have been put forward by COVID but also because of the changing nature and landscape of rural and regional Australia. That's why, in government, we invested very heavily in making sure that we had started to put in place the things that needed to be done to make sure that we could continue the rebuild on a strong rural, regional and remote workforce. We acknowledge that there is still a long way to go, and we hope that those opposite who are now in government will continue to make sure that they prioritise rural, regional and remote health as one of the priorities of the new government, because it was something that we prioritised as the previous government.

We still find ourselves with great challenges—not the least of which is the fact that we no longer have access to an external workforce from overseas because of our borders having not been open for such a long period of time, and the lack of a response, as to seeing our borders reopen, and the lack of encouragement for people to come to Australia. We are still waiting for the jobs summit before that, apparently, is going to happen.

In government we invested a billion dollars specifically into our rural and regional health sector—including into making sure, through our Stronger Rural Health Strategy, that we were encouraging more health professionals to move into rural and regional Australia. Since we put this in place, in the space of five years over 5,000 GPs, nurses and other allied health workers were recruited to work in rural, regional and remote Australia in support of those people who choose to live outside our capital cities—making sure that they have access to appropriate health services.

Just in this last budget we added another $300 million to the previous investments; things like making sure that we were getting access to MRIs in rural and regional Australia so that people who live there did not have to travel to capital cities in order to get this really important treatment that's able to be accessed through this particular technology. We also made sure that we were continuing to invest heavily in making sure that there were Commonwealth funded places for medical students training to be GPs in rural and regional locations, because we know that people who train in rural and regional locations are much more likely to stay in those locations and support their communities once they have finished their studies.

We established two new university departments of rural health, at Edith Cowan University and in the Goldfields for Curtin University in Western Australia. We also invested through the Charles Sturt University's Rural Clinical School, and we also committed additional funding to the Rural Health Medical Training Program. Another thing that we committed to, understanding that the health outcomes in rural and regional Australia are often challenged by the tyranny of distance, was to continue to invest in Australia's favourite, I think, when it comes to rural and regional health services, the Royal Flying Doctor Service. This means that we have, over 10 years, invested nearly $1 billion in the RFDS, as well as in other flight services that have supported so many sick Australians through CareFlight and Little Wings.

So we stand by our track record of supporting rural and regional Australia, but we also understand that rural and regional Australia continues to suffer under some very significant pressures for workforce. Some of those have been exacerbated by some of the actions of the incoming government—which did not need to happen. Just as an example: one of the first things that the Labor government chose to do was to cut almost 70 telehealth services that had been put in place to enable access by telephone to your GP, recognising that at the time they were put in people often either could not get to a GP or there were health reasons why they did not want to interact in the broader community. So a telephone was one of the ways in which they could interact. In removing the telephone consultations without proper reason, rationale or advice—well, if there is, we haven't seen it—we have now excluded, disproportionately, people who live in rural and regional areas.

For example: many people who live in rural and regional areas do not have videoconferencing opportunities, so they can't video into their doctor. Their telephone line was the lifeline that they had to their health services during COVID. Seventy of these services have been cut, particularly for people with the most chronic need of health support. We condemn the decision to do that without proper advice. As I said, if there is advice it's not something that has been provided for transparency as to why that decision was made at the time that it was made—particularly when we were entering into a new wave of the COVID pandemic when, once again, Australians were needing the support, protections and measures that the COVID measures had put in place. We would also say that one of the great revolutions of the COVID pandemic was telehealth. During the first two years of the pandemic over 100 million consultations took place over telehealth, absolutely transforming Australia's healthcare system. It's something that has been of disproportionate benefit to people who live in rural and regional Australia, because often they are a very long way away from the services that they have to access if they have to do so in person.

Another issue that has been raised, significantly, around rural and regional health has been around the Distribution Priority Area classifications. Previously, this was put in place because we knew of the difficulty in attracting overseas doctors to go to rural and regional areas. By putting in place a mechanism that prioritised rural and regional areas for access to this particular workforce, we sought to try to encourage more people to go to the regions and, in doing so, alleviate some of the pressure that was our health system because of a lack of doctors. The decision by this government to expand those DPA areas means that a possibly unintended consequence is going to be that those outer metropolitan areas and larger regional centres that have now got access to the DPA classification are likely to be sucking the doctors out of those regional and rural communities which are further out and which can least afford to have those health services or those GPs removed from them. These kinds of decisions impact immensely on rural and regional Australia.

Another issue I would put on the record that indicates that this government before us has got no regard for what happens in rural and regional Australia is around their urgent care clinics. They were supposed to be prioritised into areas that had very low numbers of GPs to improve access to GPs for the people that live in those communities. During the election campaign, one of the areas that was nominated as a location for an urgent care clinic was Macnamara. Macnamara is an inner-city Melbourne electorate. Not only is it an inner-city Melbourne electorate but it actually has a ratio of doctors to patients three times higher than the average in rural and regional Australia, so you would have to question the logic behind the rationale of those opposite when, instead of supporting with incentives getting more GPs into areas where there are low numbers, they're actually prioritising protecting their own marginal electorates from an onslaught from the Greens by putting urgent care clinics into an electorate that already has three times the average number of GPs of many of our rural and regional settings.

In relation to the motion before us today concerning the failure of the government to outline any meaningful plans, I would say that the only plans that they've outlined so far have had a detrimental effect on the rural and regional workforce, particularly our GPs, and the only things that we have before us are for strengthening Medicare. What does that mean? We've got $1 billion put against it and we have no idea where that $1 billion is going to go. If our urgent care clinics are any indication of the kinds of activities that that $1 billion is going to be spent on, I wouldn't be holding my breath that it's going to go to rural and regional Australia. I'd be suggesting we'll be seeing it spent in metropolitan areas. I hope that's not the case, and I plead with those opposite: rural, regional and remote Australia needs your help. (Time expired)

4:12 pm

Tammy Tyrrell (Tasmania, Jacqui Lambie Network) Share this | | Hansard source

This is not my first speech. It's my first opportunity to put on record how frustrating I find this. Maybe I'm the only one who is sick to the gills of it, but we're spending an hour making speeches about how big a problem the rural GP shortage is. Couldn't we spend an hour actually doing something about it? It's hard to put into words how disconnected this all feels. The Liberals are getting up and saying that this problem is all Labor's fault. Labor is getting up and saying it's the Liberals' fault. Does it matter? This isn't about you. The big parties see every problem as the fault of the other side. Nobody ever stands up and says: 'This is our mess. This is our problem to fix.' Everybody here thinks they're cleaners sent in to tidy up after somebody else. It's painful to watch.

When regional communities lose doctors, they don't survive for long. If you're sick and you need a doctor and there isn't one where you are, you leave. You go where you need to go. And, if you need to see the doctor again, you leave again. Sooner or later, you move closer to where you need to be. That's when you leave for good. That's what we're seeing in Tasmania. It's happening in Rosebery, it's happening in Ouse and it's even happening in Dover. The song is the same across Tasmania: doctors are leaving and nobody is replacing them. Communities are crying out for help. People are flying to the mainland because that's the only way they're going to see someone quickly. What are you supposed to do if you can't afford a return airfare? What if you're too sick to get on a plane in the first place? And all we hear from the major parties is arguments over whose fault it is. The Titanic is sinking around you, and you're arguing about who's supposed to be on the lookout for icebergs.

We've got a well-intentioned policy to attract GPs to rural and regional areas, but it's obviously not working because it doesn't push GPs to work in areas where they're needed the most, and the slack is falling on local councils to pick up. Local councils are paying doctors to work in their area. They're paying to upgrade medical centres. They're offering free houses to GPs. They're paying for their office equipment, their cars, their fuel and even their phone bills. Not every council can afford to do this, and if you can't afford to compete with the larger councils, if you can't afford to offer the same benefits to GPs, you just don't get a doctor. You go without, and that's not good enough. This is not good enough. How are we supposed to pat ourselves on the back and say, 'Job done, move on,' when only wealthy communities can afford a GP? There's a word for that, and it's failure. It's a failure of everyone here, on every side of the debate—major party, minor party and independent. Until it's fixed for everyone, it's at the feet of everyone to fix it.

I want to start fixing it. I'm open to how we do it. Maybe we can offer full scholarships to young people in areas that need GPs the most, so long as they commit to returning home when they graduate with a medical degree. Maybe we can let pharmacists do more in high-need areas to take some of the burden off existing GPs. Maybe the way we classify the needs of communities has to change. In rural Tassie, about four in five doctors have been trained overseas. When we try to attract new doctors, we're competing with the rest of the world. Maybe the federal government needs to get into our corner and help us win the race for the talent.

If you've got ideas, if you want to work with me, my door is open. We can do it quietly—you can even take the credit. I don't care. Senator Lambie doesn't care. Just work with us. My office might be on the other side of the building, but it's not impossible to find. Knock on my door; I'll open it. I want to have a chat.

4:16 pm

Photo of Matt O'SullivanMatt O'Sullivan (WA, Liberal Party) Share this | | Hansard source

I rise to speak on this very important MPI brought before the chamber by Senator Chandler. From day one, the Albanese Labor government proved that they do not care about regional Australia. They have proven this time and again, and we're only two months into this government.

Let me give you the clearest example of this. Last week the Albanese Labor government decided to axe the Joint Standing Committee on Northern Australia and the Office of Northern Australia. They abandoned Northern Australia on day one of parliament. One of our key regional areas across Australia is in the north. They made their view on the importance of rural and regional Australia very clear; that is, that they do not care about rural and regional Australia. Now, by their failure to act or to outline any meaningful plan to address rural and regional workforce shortages in the health sector, they continue to fail our rural and regional communities.

Our rural and regional communities face significant challenges and inequalities. There is still a great divide between the city and the country. As my colleague in the other place the member for Calare, Mr Gee, said only yesterday, there is a divide in income opportunities and outcomes, and if you live in a country area, your income will not be as high as if you lived in the city. There is a divide in educational opportunities between the city and the country, and there is a divide in health outcomes. What do we know? The cold hard truth is that the further you live away from the city, the younger you will die. The average life expectancy in the country is lower than in the city. It has been noted by the Australian Institute of Health and Welfare that life expectancy decreases with remoteness. They've also noted that potentially avoidable hospitalisations can be 2.5 times higher in remote areas than in cities. Australians living in remote communities face higher levels of difficulty in accessing medical services, including GPs. And while some of the reasons for this are outside of the control of the healthcare sector, access to health services plays an important part.

This is about to get much, much more difficult for our rural and regional Australians. We know that the availability of medical practitioners—particularly GPs—has a direct impact on the health outcomes in regional, rural and remote Australia. This is why we have Distribution Priority Areas—to help identify areas in regional, rural and remote communities with unmet needs, and which are lacking important access to services by GPs. There are benefits to having DPA status. It ensures that these areas, which are lacking access to GP services, are looked after, by bringing in trained medical practitioners from overseas and participants in the Bonded Medical Program and requiring them to set up in these areas to help reduce that division between the city and the country. The DPA is crucial to the rural healthcare system, and it's the backbone of these communities.

Now, despite strong opposition from rural doctors, the Albanese Labor government is pushing ahead with their 'ill-informed' plan—as it was described by the Rural Doctors Association of Australia—to expand distribution priority areas to include peri-urban and outer metro areas. Labor have now expanded DPAs to include large regional centres and outer metro areas. They are taking away from our rural and regional communities, abandoning patients in rural and regional communities, who will be left with no access to services that are close to their homes—no access at all. They're 'robbing Peter to pay Paul'—that's how the Royal Australian College of General Practitioners described it, because the RACGP know that there is an extreme risk that rural and regional communities will lose doctors as they take up positions that are closer to the cities.

I mean, you can't blame them, really, if you're not providing those incentives and that direct support that is available to ensure that we are attracting good doctors into these remote and regional settings. This is an unintended and unwanted consequence of this ill-informed decision made by an Albanese Labor government. Despite what they've been told by those working in our rural and regional healthcare sector, they're persisting with this policy. What they should be doing is looking to encourage more of our medical students and our future doctors to choose general practice as their career, whether this is through cutting red tape or making easier and more attractive career pathways for our students. Whatever it is, they will not solve the GP shortage in rural and regional Australia by taking away from our rural and regional communities.

In the brief time that I have remaining in this MPI discussion, I want to give a shout-out to the More Than Mining campaign. This is a particular initiative that's been driven primarily by the mining industry communities, or communities that have resources-sector jobs that are close by. They're advocating for a change to how we treat the fringe benefits tax. One of the big issues in attracting staff in these areas is housing and access to affordable housing, particularly in a market that's cyclical because of the boom and bust cycle. In this moment here, in the remaining time for this MPI—the 30 seconds that I've got left—I just want to give a shout-out to those that have been advocating for this program. I remain committed to this. I think they've got some innovative ideas. Whether it's precisely the solution that they've come up with or, quite possibly, a variation of that, I think it's something that we should look closely at in enabling people that are choosing to put their roots down in regional communities to get a tax benefit in choosing to purchase homes and rent homes in these places. To increase the pool of homes that are available, to increase the stock that's available, could be a good way of actually attracting staff into these areas. I want to commend the More Than Mining campaign and the communities that have been supporting it.

4:23 pm

Photo of Pauline HansonPauline Hanson (Queensland, Pauline Hanson's One Nation Party) Share this | | Hansard source

I thank Senator Chandler for bringing this matter to the attention of the Senate, although I am compelled to point out that the shortage of general practitioners in rural and regional Australia is a problem the coalition failed to address during the nine years it was in power. This crisis is not only risking the health and wellbeing of Australians who live in rural and regional areas; it is costing taxpayers and the economy a great deal of money.

In June this year, the Courier Mail newspaper revealed Queensland taxpayers were funding pay packages of up to $1 million a year—for each doctor—to fly in locum doctors to plug gaps in health services delivery across the state. They have been recruited in desperation, with regional hospitals in Queensland sometimes being forced to turn patients away for the lack of a doctor. Rural generalists have been offered $2,700 per day to work in Wide Bay. Radiologists have been offered up to $4,000 per day to work as locums on the Sunshine Coast. The total outlay for these fly-in locums was $118 million last year, and this cost is rising. The Queensland government spent $34 million on locums in the first quarter of this year, and it's not working. When you're sick you have the right to see a doctor there and then, not after you've recovered. But waiting times for GP appointments in regional Queensland have blown out to months. People are travelling long distances in order to see a doctor more quickly. The town of Moura in Central Queensland hasn't had a permanent GP since December and went without a doctor for more than a week back in March. Local residents were forced to resort to telehealth appointments or else drive 65 kilometres to Biloela to see a doctor.

It's no wonder doctors are leaving regional areas: the workload is horrendous and many are burnt out or exhausted. And it's not just doctors: there are shortages of a wide range of health practitioners—nurses, midwives, pharmacists, dentists, optometrists, psychologists and occupational therapists are all in short supply. Then there's aged and palliative care; the lack of these services in regional Queensland is appalling. There is not a single hospice in Queensland located north of the Sunshine Coast. This is why I fought tooth and nail for $8 million to build the Fitzroy Community Hospice in Rockhampton, and I hope the Albanese government doesn't cut out that funding.

We must do more to encourage and incentivise Australians to study medicine and to practice in the country. Importing doctors is not the solution. Up to 12,000 foreign doctors are in Australia and have applied to work here but cannot pass the standards required and many cannot even speak English, which risks misdiagnosis and adverse medical outcomes if they are ever to be allowed to work here. It is also worth noting here the impact of COVID-19 vaccine mandates: many are not allowed to treat patients because they have not taken the wonder jab. Isn't it amazing that bureaucrats think they know more than doctors about the safety and efficiency of the wonder jab?

Photo of Lidia ThorpeLidia Thorpe (Victoria, Australian Greens) Share this | | Hansard source

Here we go!

Photo of Pauline HansonPauline Hanson (Queensland, Pauline Hanson's One Nation Party) Share this | | Hansard source

This all adds up to a potential disaster in the making. On average, Australians living in rural and regional areas have lower life expectancy and experience higher levels of disease and injury compared to people living in our cities.

Photo of Lidia ThorpeLidia Thorpe (Victoria, Australian Greens) Share this | | Hansard source

You don't care!

Photo of Pauline HansonPauline Hanson (Queensland, Pauline Hanson's One Nation Party) Share this | | Hansard source

Rural and regional Australia should be prioritised, not neglected. One Nation has been calling for practical solutions to be implemented, such as tightening the obligations on medical graduates under the Bonded Medical Program.

Photo of Lidia ThorpeLidia Thorpe (Victoria, Australian Greens) Share this | | Hansard source

You don't care!

Photo of Pauline HansonPauline Hanson (Queensland, Pauline Hanson's One Nation Party) Share this | | Hansard source

At the moment, graduates have 18 years to complete an obligatory three years of practice in a regional area in exchange for a Commonwealth supported place in a medical course. It should be reduced to seven years, and the government needs to consider ways to recover the taxpayer contribution to graduate studies if they don't meet their regional obligation.

All Australians should be able to afford and access quality medical care, regardless of where they live. The taxpayers have funded this, there's a scheme put out and these students have taken it up. They suggest they will go and work in regional and regional areas, they're given 18 years to do that and they haven't taken it up. Only 500 have actually done it out of thousands. Why are we funding these students? Why hasn't the government chased it up and said, 'You made an obligation, the taxpayers have funded you now; why haven't you done your duty?' I am calling on this government now to look at that obligation, reduce it to seven years and make sure that doctors are actually given the jobs in rural and regional areas to look after all Australians as well.

Photo of Lidia ThorpeLidia Thorpe (Victoria, Australian Greens) Share this | | Hansard source

Look at yourself!

Photo of Catryna BilykCatryna Bilyk (Tasmania, Australian Labor Party) Share this | | Hansard source

Before I call Senator Pratt, Senator Thorpe, I will ask you to stop yelling across the chamber.

Senator Thorpe! I have asked you to—

Senator Thorpe, please respect the request of the chair. Senator Pratt.

4:29 pm

Photo of Louise PrattLouise Pratt (WA, Australian Labor Party) Share this | | Hansard source

When I read the MPI this morning and its topic, I was completely astonished. For a representative of a party that, while in power, dismantled and starved our rural and regional health workforce of funding and employment opportunities to bring on an MPI on this topic, to my mind, was extraordinary. I will go into the detail and unpack that—perhaps they were taking more credit in looking at their own policies in a blinkered way without seeing what was going on?

We saw years of neglect of our Medicare system by the coalition. In my own home state, if you look at rural and regional Western Australia, the spending on Medicare per head of population is proportionately so much lower than anyone in a metropolitan area. People do not have access in rural and regional Western Australia to the health professionals, such as doctors and specialists, that they should be able to go and see. The lack of access to health professions is very much reflected in the per head spending on Medicare around regional WA when compared to the Perth metropolitan area. So I wonder, really, what's going on in the heads of those opposite. While, in your time in government, you ripped billions of dollars out of primary care and caused gap fees to rocket, so we will clean up that mess left by the Liberal Party—but this is not going to be easy.

The last government arbitrarily axed the ability of a long list of communities to recruit overseas trained doctors to fill gaps in general practice as well as those in outer suburbs and the regions. There's a dire need not only in regional WA but also in Perth communities. In Western Australia last year a well-known paediatrician died, a paediatrician who had a high case load. As a result of that, the waiting list to get in to see a paediatrician blew out for everyone by more than a year. It wouldn't matter if you were a high-needs family or child or not; you could not get in to see a paediatrician for more than a year. This is the legacy of the historical underfunding of our medical—

Photo of Catryna BilykCatryna Bilyk (Tasmania, Australian Labor Party) Share this | | Hansard source

Senator Pratt, can you assume your seat for a moment. Senator O'Sullivan, I've asked you once already to stop interjecting. Interjections are disorderly. Please stop interjecting. Senator Pratt.

Photo of Louise PrattLouise Pratt (WA, Australian Labor Party) Share this | | Hansard source

So the Labor Party initiated the Senate inquiry into GP shortages in the last parliament. We heard mountains and mountains of evidence from people not being able to see a GP at all, about having to wait many months for an appointment, having to travel hours when they finally do get to see one. This is why Labor has deliberately not changed the regional incentive payments that doctors receive for working in remote Australia. It's why we recognise the importance of providing additional incentives for doctors to work in those remote and regional communities. So I find this extraordinary that Senator Chandler, now that she's lost the power of being in government on these issues, suddenly appears interested in these issues.

The government funds a range of program incentives to encourage GPs to relocate and work there, in addition to the distribution priority area program. So, while we have this architecture, we know that we have to prioritise improving it. We have our Strengthening Medicare Taskforce now. This task force met last Friday. It's tasked with finding the best ways to boost affordability, improve access and deliver better support for patients, especially for payments with ongoing and chronic illnesses. This work, their work and their findings, will be backed by the $750 million Strengthening Medicare Fund.

We know that our health professionals have worked tirelessly throughout the pandemic. They are working tirelessly now. I have two aged parents—one of whom has significant health conditions—who are at home in quarantine, as they recently tested positive with COVID. But they have a good GP that's checking in on them, and they also have the resourcing of the state government. We know it's critically important that we resource our doctors to look after Australians, to provide them the care they need. This is, in particular, why we are investing some $220 million in GP practices around Australia. This will be incredibly important to rural and regional Australia.

We also have a plan to invest $146 million to attract health workers to, and retain them in, rural and regional Australia. This includes improving training and incentive programs and supporting the development of innovative models of multidisciplinary care. We are going to boost workforce incentives for rural and regional GPs to support the engagements of nurses, allied health and other health professionals and provide multidisciplinary team based care—also critically important. We are also going to expand the innovative models of the collaborative care program across rural and regional Australia, because we know support to retain our rural health professionals is absolutely critical.

There are so many practical steps that governments can and should take to support the rural and regional workforce here in Australia. This includes, for example, a constituent case that recently came through my office, where the only psychiatrist in the Pilbara in Western Australia that is there to service and is qualified to meet the needs of children can't stay in Australia because she has a child with autism. Clearly the state government is now making appeals to the Commonwealth government, saying, 'These are the kinds of issues that we need to fix.' And I know, sitting on the government benches, that these are indeed the kinds of issues that we need to fix and that your government, on a day-to-day basis, was absolutely missing in action on.

We are also here to expand the John Flynn Prevocational Doctor Program to more than 1,000 placements in rural and regional Australia per year and strengthen rural generalist and GP registrar training as well as provide Australians access to universal, prompt, world-class medical care—something that has been ignored by those opposite for too long. We want to see our rural and regional communities right around Australia get the access they deserve—access, like I said, to universal, prompt, world-class medical care. No-one in our nation deserves to face a multiyear wait for vital treatments simply due to where they live.

Whilst I can see that those opposite recognise these issues now that they're in opposition, I am very pleased to stand up here and debate them on it. You were silent for eight years on all these issues. Not once did I come in here and see you prioritise these needs. Instead, we got the glib 'all announcement and no delivery'. The proof will be in the pudding. We are early in our term and we know we have to get on and implement these measures, whereas those opposite were all announcement and no delivery year after year. We are here with a commitment in the Labor Party to building our public healthcare system right across remote and regional Australia. (Time expired)

4:39 pm

Photo of Perin DaveyPerin Davey (NSW, National Party, Shadow Minister for Water) Share this | | Hansard source

I just want to acknowledge I actually heard some very good news from Senator Pratt in her contribution. I was very relieved to hear that the new government will be continuing the former coalition government's model of multidisciplinary team based care, which I had the pleasure of announcing the pilot for under the former regional health minister, Mark Coulton. So I'm very pleased that our coalition government policy will be continued.

I'm also pleased to hear that the regional training programs will be continued, such as the Murray-Darling Basin medical school—which recognises that, if you train in the regions, you're more likely to stay in the regions—and our rural generalist pathways. I hope that includes the rural generalist pathways for registered nurses and allied health professionals as well. I didn't hear whether the new government will continue, as we termed in the pilot, the Murrumbidgee single employer model, which improves the working conditions and the contractual arrangements for GPs who move to regional areas. That was something that our government implemented.

What I didn't hear from Senator Pratt is how the new government's changes to the distribution priority areas are going to help us achieve an increase in the rural and regional health workforce. How can the new government look people in the eye and say that an overseas trained doctor should get the same incentives and benefits to work in Newcastle as they would if they were going to work in a GP clinic in Cessnock or Scone? How can they say that they're putting these hard-fought for, overseas trained doctors in bonded Australian medical places in Western Sydney compared to Broken Hill or Burke? It doesn't stack up. There are already significant inequalities—yes, our government was in place for nine years and, yes, we put in the hard yards, because there is no silver bullet on this issue. We acknowledge there is no silver bullet. But we worked very hard talking to the Rural Doctors Association, the Royal Australian College of General Practitioners and the allied health professionals on how to address this issue, on how to train more in the regions and retain more in the regions.

This one policy announcement by the new government has the Rural Doctors Association of Australia now warning that they are 'fearful' for rural communities right across Australia that are now at extreme risk of losing their doctors as they take up positions closer to the cities, abandoning their rural and remote patients who will be left with no access to care close to home. They went further and made a harrowing call that Labor's policies will cost the lives of rural and remote patients who already suffer poorer health outcomes than their city counterparts.

Just this afternoon I had a meeting with council representatives from Far North Queensland. They told the story of how, in their small community, they have a doctor, they have a district nurse, and they have a policeman, but how, if there is a road trauma or an accident overnight due to workplace fatigue management—which is a very serious issue in regional areas—there is a snowball effect. They would love to have the extra workforce. But how can they compete if we're saying that the distribution priority areas can have someone in Townsville rather than in remote Far North Queensland?

The Australian Institute of Health and Welfare has noted that these hospitalisations in rural areas can be avoided by getting more GPs out there. The Labor Party's policy will not do that. (Time expired)