Wednesday, 7 September 2022
Questions without Notice: Take Note of Answers
That the Senate take note of the answer given by the Minister for Finance (Senator Gallagher) to a question without notice asked by Senator Ruston on distribution priority areas and health.
The Albanese government's recent decision to expand the classification of a distribution priority area to include suburbs of state capital cities is more bad news for regional Australia. Regional communities from my home state of Western Australia, who were already struggling to get doctors, will now have to compete with large metropolitan areas.
The whole idea of the DPA was to identify areas experiencing lower numbers of GP services and provide unique channels and incentives for them to be able to attract GPs and be able to retain them in these areas. Three areas in Western Australia where the Labor government have now granted full or partial DPA status include Kwinana, Kalamunda and Brigadoon. For those not familiar with Perth, these suburbs are hardly even considered outer metropolitan suburbs. In fact, I live just north of one of these places, and it is hardly a regional area, and certainly not a remote area.
What is the government doing? It's just going to draw in people to work in these areas. I'm not at all disputing the fact that there would be a need for GPs and GP services in these localities across Perth and, indeed, across Australia, where the other locations are. We know that Fyshwick is listed, which is just down the road from here. Tuggeranong is another one which is just down the road—not too far at all. There might be need for GPs in these areas, but you need to come for a drive around Western Australia to some of the regional communities that are in desperate need of adequate services provided by GPs. You don't even have to go that far.
If you go out to somewhere up in the Kimberley, across to Halls Creek and Fitzroy Crossing and Kununurra. How do these places attract staff, GPs and GP services if you're providing in the capital cities the same incentives and initiatives that are designed to support those communities and regional areas? I've got no doubt that these locations may be struggling to attract and retain GPs, but it should not be at the expense of GPs leaving regional and remote areas of Western Australia, which are already battling to ensure that they're able to access sufficient health services. It's not too difficult to work out that, in general, the health status of people declines the more remote they are, the further they are from capital cities. Therefore, it's hard to imagine that the changes the government has made will strengthen the ability of Western Australians in regional and remote areas to access GP services, and how they will be improved.
What we know is—and I'm wondering if we're going to start to see a pattern here—that when the Labor Party was last in government, they started to really tinker with health services. One of the things they tinkered with a lot was the Pharmaceutical Benefits Scheme, where we saw the delisting of medicines on the Pharmaceutical Benefits Scheme. Yet while we were in government—the whole time that I was in this place sitting on the other side—we listed an equivalent of one new medicine for every day of the last term. I don't know about you, Senator Rennick, but it is one of the great things that, as a new senator in this place, I am proud that we were able to achieve—to see that happen, to see that track record.
We know that this mob on the other side don't have the ability to manage the books. They don't have the ability to manage the affairs of this government appropriately. Australians need a government that is sensible about their needs and about the services required and are prepared to stand up and do what is necessary and not just rob Peter to pay Paul to provide the services that are required—and that's exactly what we're seeing here. We need services in the bush, and all this is doing is taking it away from them. (Time expired)
Sometimes it's difficult to understand whether the opposition understands what a 'Dixer' is, because this question is an opportunity for those on this side to talk about the appalling history under the Morrison government and its treatment of Medicare and GPs, particularly in rural and regional areas, and what our government is doing to fix the mess you left.
Let me break this down for you. You so utterly broke the Medicare system and the reliance on GPs that it was so incredibly difficult for people to see a GP in rural and regional areas. But now we have a situation where we have had to step in and make sure people can see a GP. But it's very interesting to see that those opposite are opposed to the use of distribution priority areas. I am wondering whether senators on that side have consulted with members of their own party, because I know that, in Queensland, Cairns is a distribution priority area. The member for Leichhardt hasn't opposed that listing. Townsville has DPA status. The member for Herbert hasn't opposed that listing. Mackay has DPA status, and the Whitsundays. And we certainly haven't seen that happen from the member for Dawson. And Hervey Bay has DPA status, under the Labor government. We know that means that the member for Hinkler must be very supportive of our policy.
But it is clear that under the Liberal-Nationals government—the former Morrison government—at every opportunity they had, they ripped out funding from Medicare and made it harder to see a GP. We know they froze the Medicare rebate for six years. If you speak to a GP, whether in the city or the bush, they will tell you that the former government ripped the heart out of Medicare when they froze the rebate. They went as far as to cut access to telehealth appointments for regional Australians. They also made sure that people living in places like Emerald were waiting 12 weeks to see a GP.
We had a Senate inquiry and we put that motion to this place, and those opposite—who are going to get up today and talk about access to GPs—voted against that inquiry. You said there was no problem, that there was no issue, nothing to see here, no problem to be fixed. But when we held that inquiry, initiated by Labor, we heard horrible stories from people around the country about the treatment that you lot put them through so that they couldn't see a GP. That is why a Labor government is strengthening Medicare, and we were very clear at the election and were supported at the election to form a government with a core value of strengthening Medicare and protecting it. We will be delivering urgent care clinics in regional areas and across the country. We have developed the Strengthening Medicare Taskforce, an important opportunity to bring so many people around the table to fix this workforce issue caused by your former government. And we have delivered DPA access to areas that are desperately in need of GPs.
We will not stand here and be lectured by a political party that sacked nurses in Queensland. Queenslanders will never forget that. We know that Queenslanders are so pleased to finally have a government that values Medicare. I won't stand here, as someone who lives in a regional area, and be lectured to by those opposite about who cares about access to GPs and Medicare.
I note that the previous speaker raised the issue of medicines. Well, I have fantastic news for you. Today, we have announced that we will be making medicines cheaper for millions of Australians. This is a fantastic step forward—the first time in 75 years—
Are you opposed? There is a choice here. You can support that policy or you can be opposed to it, but we on this side of the chamber know that our government is making medicines cheaper. We'll be introducing legislation. You'll have the opportunity to support that legislation to make sure that people have access to the medicines that they need. Labor built Medicare, and we will always protect it. You tried to rip the heart out of Medicare. You made it harder to see a GP. That is why our Labor government is fixing it. We will always stand here on our record, and it is complete rubbish from your side of politics to lecture us about access to GPs in rural and regional areas.
I suggest that Senator Green go back and do some study on the history of health care in this country. I stand here as the son of a midwife who also had a general ticket. She worked in many hospitals—in four states, as a matter of fact. She did her training at Saint Vincent's in 1953 in Sydney—
I've actually got something important to say because I actually know the history of health care in this country. Let me tell you, the state governments have taken advantage of the good nature that Medicare was set up for and have cost shifted from the states onto the federal government. I know that because when I grew up and had to see a doctor I would sit in a thing called 'Outpatients' in a public hospital. That has been renamed Emergency. The reason they renamed it Emergency is so that people don't go to Emergency. The state governments want it that way because then they don't have to pick up the cost. By sending it to a doctor in the primary healthcare system they get the federal government to pick up the cost. The problem with that is that it has overloaded the system on the doctors. What we need in this country is more doctors on fixed salaries, and we need the public health system in the states—to be honest, we need to go further than this. We need to get one level of government trying to run health care in this country, because we're getting this cost shifting all the time in this blame game between the federal and state governments, and these ambiguous responsibilities result in nothing but name-calling, rather than problem-solving.
I will touch on something that Senator Green was talking about, this so-called discount for the Pharmaceutical Benefits Scheme. That may sound very well at first intentions, but the point is that you need to ask the question. I notice there was a cholesteryl drug called Lipitor, which was a prescription drug patented by Pfizer. This goes back a decade or so. The Australian government was paying about 50 bucks for this particular drug, and Pfizer was collecting about $40 of the $50. The fact was that there was a similar generic drug that came off patent that you could have bought for $2. So it's all very well saying that you're spending billions of dollars on the PBS, but the question needs to be asked whether or not there are suitable drugs out there that you can use and that aren't going to line the pockets of rich pharmaceutical companies. I would like to see greater detail of the PBS.
Getting back onto doctors and having priority schemes for doctors, the fact of the matter is that we've got an undersupply of doctors in this country. We need to also point the finger at the professional bodies of the medical industry who, quite frankly, aren't training enough doctors here in this country. I touched on this in my maiden speech. It is an absolute insult that Australia, a first-world country, is importing doctors from underdeveloped countries because our AMA and our doctors are running a cartel in this country and are restricting the supply of specialist services in order to make sure that they can maximise their fees. We've got to have a serious look at this.
I don't want to get bipartisan on this, because I am sick to death of the health issues that we've got in this country. If we're meant to solve this problem, we really need to get one level of government taking responsibility for health. I'm happy to work with Labor on this, and I mean that, because regional health is very, very important to me. In the last 30 years, I've seen under the Queensland state Labor government the closure of over 30 maternity wards in regional Queensland. I know that it happens in other states, as well.
That's because of a combination of factors, but one of those factors is that we just will not get doctors to go to the regions. They don't want to take on the insurance because they work in the private sector. We've got a problem with training nurses. Many nurses now do either general practice or midwifery but they don't do both. If you want nurses out in the regions you need them to get their general ticket—mum would always call it a 'general ticket'—and be a midwife as well. Out there, there aren't enough babies being born every day to have a full-time midwife; they need to also be general nurses as well.
At the end of the day, what we really need are better front-end services. I would actually like to get rid of the states altogether, but it is absurd that we have nine health bureaucracies in this country while our front-end services are suffering. We've really got to get serious about having a big overview. If you want a job summit, you should have a health summit—and I will turn up to that one, I guarantee you that.
I think you can see in that flow-of-consciousness contribution from Senator Rennick, as generous as it was in its intention, a bit of a map of the former government's way of planning the health sector—chaotic and destructive, not doing anything valuable that is going to stand up to Australia's real needs. Let me remind you of a bit of history. Before Medicare was—
Senator Rennick, you were heard in silence. I remonstrated with Senator Green.
Senator Rennick, that's not a point of order. I appreciate it. I appreciate that you're very passionate about it, but Senator O'Neill is entitled to be heard in silence.
Let's get to the reality of what Medicare does and why we're talking about GPs today. The government of the last nine years, and their various iterations over the last few decades, have attacked Medicare at every turn. The main cause of a bankruptcy before Medicare was medical debt—Australians died or they sold their house. Finally, the Labor Party moved to make sure that was no longer the case, and Medicare was established. In establishing that, we change the course of the health of this nation in a very positive way. It was attacked relentlessly by every iteration of the federal Liberal-National government that came after. That's what we've seen over the last nine years, so let's get a little bit of fact on the record.
The reality that we confronted when the Rudd-Gillard government was established was that there was a declining number of GPs being trained. We completely changed that and ramped up training of our own. Mr Abbott's solution as health minister was to stop training Australians and bring in overseas-trained doctors. It was a short-term decision and a bad long-term decision. The reality is that those wonderful GPs that we trained happened to come out into a medical profession that was being ripped asunder by the Abbott government. When they froze Medicare, they basically kicked out from underneath the business model of our GPs their sustainability as a practice. What happened with those smart cookies who were training to be GPs? They had a look at these businesses in collapse, destroyed by the Australian government, and they said, 'Hold on, I don't really want to be a GP anymore.' We don't have a training problem in terms of the numbers. We have a problem of a broken business model that has destroyed GP practices across this country. Right across this country, it's the Liberal and National parties, who always pump themselves up as being great understanders of businesses, who broke the back of the GP business model for Australia.
The reality that we confront right now is because of that failure. Because they broke access to GPs, they decided to tinker with this thing that they called the DPA or Distribution Priority Area. On the record, in the other chamber today, the Minister for Health and Aged Care very clearly indicated that the changes we were being asked about here today—changes to the DPA that Labor has instituted—were to reverse a cut made by the former government in 2019. It was a reverse to what that government had done in terms of denying Australians in this country access to a GP. They did that as a response to the failure of their own policies of ruining Australian's access to GPs. And then they thought they could just shrink the places in which it was distributed.
On the Central Coast, there was evidence given to our committee—it was a Labor instituted GP shortage inquiry. It was our committee that determined to tell the reality of what's going on in Australia. Whether we were taking evidence in Victoria, Queensland, New South Wales or out in Whyalla, it was the same story everywhere: a completely ruined system and communities in desperate need of doctors. And it's the responsibility of the former government that we do not have that workforce today.
Now Labor have come in. We've been here, what, 108 days. We can't undo everything that they did wrong, but this really egregious move of cutting the DPA in 2019 was a con job by the former government. It didn't fix the problem. It bought them time, but what it didn't do was give Australians access to the health care that they paid for and the health care that they deserve. Labor is on the job of fixing the mess in the health sector that we have been left by the former government, and Australians can trust that the Labor Party who built Medicare will restore the integrity that the system deserves.
Perhaps I can strike a somewhat more conciliatory note as we discuss what I consider to be a very important issue, and that is the access of Australians to general practitioners across this country.
For those in the gallery—through you, Mr Deputy President—I might just explain what we're talking about here. It is what's referred to as distribution priority areas. For those areas which are classified as distribution priority areas, there are various incentives in place to attract medical professionals into those areas to be general practitioners. Benefits to attract medical professionals into those areas include, for international medical graduates and foreign graduates of accredited medical schools, having access to Medicare in those distribution priority areas only. If overseas medical practitioners come to this country, they can access Medicare as long as they're practising in those areas.
The whole intention of this policy is to try to provide an incentive for that pool of professionals to provide general practice services to Australians living in those rural and regional areas. That's the issue we're talking about. In my view, the system is broken and we shouldn't be focusing so much on history; we should be focusing on the way forward. How do we fix the system? We know the system is broken. There is such a lack of general practitioners that we now have the absurd situation of the incentives which are meant to be given to a medical practitioner to go to a place like Emerald, in my home state of Queensland, which is three hours from Rockhampton, being the same as the incentives which are provided to medical practitioners to practice at Fyshwick, 13 or 15 minutes down the road from Parliament House. It doesn't make sense.
Of course they get sick, Senator O'Neill. Of course they do. As I said, I'm trying to strike a more conciliatory tone and look forward. The issue is that, if you're providing the same incentives to someone to work 15 minutes down the road from Parliament House as you're providing to someone in Mildura, over five hours from Melbourne, or Emerald, three hours from Rockhampton, the incentive obviously isn't going to work. The problem is so widespread around this country that there's a fundamental issue with the incentive system, and that's what we're talking about here.
There's also a fundamental system issue, in my view, with what's referred to as the Modified Monash Model, which is the way in which different areas are categorised, and I've spoken to different communities across Queensland with respect to the application of that system. To give you one example, the town of Rosewood in my home state is put in the same classification as Ipswich. Again, me being a senator, this is one of my patron seats, and the demographics, the geographical challenges and the ability to attract medical staff are completely different in those two areas, but they are considered to be in the same category. This system, this modified Monash system, does not reflect what happens on the ground, the realities of local communities, and it is a system which we really should look at—it really is.
I'd like to finally, with indulgence, thank someone who brought this to my attention, and that is Mr Lyall McEwin. Lyall has served for many years as chair of an aged-care facility in a little town called Rosewood. He talked to me about his frustration as the chair of a community organisation providing aged-care services. He talked about the issue in terms of attracting health professionals to that aged-care facility, when he's in the same category as Ipswich, which is more of a major metropolitan centre. There are major, major issues with this system—major, major issues in relation to this system and in relation to every Australian's legitimate expectation to be able to access health services, GP services in particular, whether or not they live in Mildura, whether or not they live in Fyshwick, down the road from Parliament House, or whether or not they live in Emerald, in country Queensland, And that is something which all of us should be united in attempting to fix.
Question agreed to.