Coalition cuts to health workforce hit regional Australians hard

nurses_required.jpgMr STEPHEN JONES (Throsby) (11:30): I am delighted to have the opportunity to speak on an important matter but saddened that the occasion that brings us to the chamber to discuss health workforce needs is the proposed abolition of this agency. I take the opportunity to congratulate the member for Kingston and shadow parliamentary secretary for health for the great work that she has done in bringing before the House the egregious dangers that are contained within the Health Workforce Australia (Abolition) Bill 2014, because it warrants a great deal of scrutiny—a lot more scrutiny, I have to say, than we are able to have, because members of the government's own backbench, as the member for Hunter has pointed out, do not have the courage or the wherewithal to come in here and talk about their own government's proposal.


It is important to the whole nation to get and keep doctors, nurses and allied health professionals, but nowhere is it more important than in rural and regional Australia. It is important because regional Australians experience poorer health outcomes compared to their fellow Australians in metropolitan Australia. Regional Australians have a higher rate of injury, arthritis, obesity and melanoma, a higher incidence of suicide and a higher incidence of chronic diseases such as diabetes. They have a greater tendency to smoke, to drink and to engage in riskier behaviours. They have poorer survival rates for cancer and a shorter life expectancy, anywhere between one and seven years less, the further away you get from a major urban centre.

With these stubborn facts in mind, you would think that more effort would be put into addressing the maldistribution of doctors, nurses and allied health professionals between city and country. In the major cities, Deputy Speaker, you will be surprised to know that you can find about 220 specialists per 100,000 of the population. But, if you move into regional areas like my own or even further out into the bush, you will see that ratio drop to 48 in 100,000. Just compare the two. Focus on that for a moment: 220 specialists per 100,000 people in the city; 48 per 100,000 in the bush. And, for hospital non-specialists, in the major cities there are 41 per 100,000 compared to just 18 per 100,000 in outer regional areas. So a national health workforce strategy to address the workforce pipeline, the supply of medical professionals and health professionals, particularly into regional and rural Australia, is absolutely critical.

The health workforce is under tremendous pressure, and it is only going to get worse, in part because of the very measures that are being debated before the House today. Today there are about 1.3 million Australians who work in the Australian health industry, according to the 2011 census. That is about six per cent of the total workforce. We have an ageing population on the other side of the ledger, and that is going to bring in significant health needs. By 2050, there will be 2.7 people of working age to support every Australian above the age of 65. We know we have a problem now, but if we look into the future—and it is not the too distant future—we know that we have a significant problem, because we know that there is an increased usage, particularly in the primary care space, by older people when it comes to accessing health services. If we think we have an issue now, we have not seen anything yet.

It is not a new problem. It is not as if this is the first time that this parliament has been apprised of the issue. It is not, because in 2005 the then Howard government commissioned the Productivity Commission to inquire into this issue, in part because of the pressure that was put upon them by the then Labor opposition. They commissioned a report, and the report was published on 22 December 2005. Amongst the many conclusions, it said that there would 'continue to be poor health outcomes in particular regions and for particular groups'. It said workforce strategies and 'inflexibilities and inefficiencies' in workforce arrangements are 'major contributors to these problems'. The Howard government commissioned the report. It came up with the answers, but the government sat on the report and did not listen to the answers.

Wind the clock forward. On winning government in 2007, the then Rudd government made addressing these issues one of its highest priorities. We knew that we could not do it alone. We knew that we had to work together with the state governments and the territory governments, which have principal responsibility for delivery, particularly in relation to hospital care. So we worked through the health ministers council and through COAG to ensure that we could get a coordinated response. We knew it needed to be a national, large-scale response which was cross-jurisdictional. We also knew that we had to work with the relevant professional bodies. That is why today Health Workforce Australia is partnered with state and territory governments, with higher education institutions and the professional training sector, with healthcare bodies, with employers and with all the professional and regulatory bodies to ensure that we are working together to address the health workforce needs now and into the future.

I can say there was some success. We know that any of the things you do in this space take some time to turn around because of the long time it takes to take somebody from high school through university, through professional training and then into the health workforce. We did see an improvement under Labor: 74 per cent of Australia faced a medical workforce shortage when we took office in 2007 but by the time we left office the distribution of GPs had improved across regional areas. This was a tremendous achievement, but we definitely had our challenges because of the deliberate decisions of the now Prime Minister, when he was health minister, to effectively put a cap, a lid, on the number of new GPs entering the system. We had a big hole to fill, a big job to do, but significant steps forward were made, particularly due to the work we were able to put in place through Health Workforce Australia.

We knew that we needed one strategy, not five, six, seven or eight, because Australians know that wherever they live they should have access to a decent health service and to a GP or primary health care provider. It should not matter whether you are living in Queensland or Tasmania, in the Northern Territory or the Australian Capital Territory, we need a national strategy to address these shortages. We made agreements with the states and territories and tackled the burden of resolving this monumental problem, rather than leave it to each state and territory to go their different ways trying to resolve it on their own. So Health Workforce Australia has led the way nationally and that has been paying off. We have produced the first national long-term projections for doctors, nurses and midwives, because if you do not know what the problem is you are not going to know what the solution will be. We have funded over 8½-thousand new quality clinical training places for students across different disciplines. We have supported a 115 per cent increase in simulation education hours and delivered 446 nurses and allied health workers to regional communities. In addition, we have improved the national coordination of medical training with the National Medical Training Advisory Network. None of this would have happened without the work of Health Workforce Australia.

We knew this was all under threat with the election of a coalition government, but there was cause for some hope, particularly in rural and regional Australia. When people in rural and regional Australia looked at the various candidates they were going to vote for and considered their policy options they may have had a look at the National Party health platform and gained some hope from statements such as this in the Nationals' policy:

We will enhance incentives for doctors and health professionals to take up regional practice and stay there. And we will go further with the advent of a dedicated Federal Minister for Regional Health to specifically oversee regional healthcare and the needs of regional patients.

That must have given them some hope, if that was what they were going to do. And when the platform talks about the role of the minister for regional health it says:

When health policy decisions are being made regional concerns must be championed by a dedicated Minister with regional experience and a primary focus on the welfare of regional Australians.

Those who read that and voted on that policy platform must feel devastated. If they were listening to budget estimates a few nights ago they would have heard their minister for rural and regional health confess under questioning from a Labor senator that she had not even been consulted on the rural and regional impact of the GP tax and that she was not interested enough in this issue and its impact on rural and regional Australia to ask the department to do some research or modelling on the issue. You would have thought the party that is dedicated to representing the interests of rural and regional Australia, apprised of the maldistribution of doctors and allied health professionals and apprised of the discrepancies in health outcomes for rural and regional Australians when compared to their brothers and sisters and cousins in the city, would at least be taking some interest in the impact of the GP tax and the other healthcare changes on rural and regional Australians. What we see is a complete lack of interest. What we see is National Party failure and ministerial failure.

What is the government's answer on this? We see with the bill before the House that part of their answer is to abolish the only Commonwealth agency which is focused on addressing workforce shortages in the health professional area, particularly in rural and regional Australia. But that is not where they stop. It seems they have got three bows to their answer to workforce shortages in the health industry. The first is to abolish the agency which is overseeing. The second is to make it harder to get a medical education: slash the per capita funding to universities, with a 20 per cent cut on average in funding to universities, including to regional universities that have a medical school; take the lid off student fees, which we all know is going to lead to an increase in fees; and double the rates you pay on your student debt. What is the impact of this going to be on medical students? The vice-chancellor of the University of Melbourne says that he expects significant increases. A medical degree currently costs a student about $80,000 for the life of that degree. That price will go up, to anywhere between $100,000 and $183,000.

Those who come from a regional area and those who have a great university like the University of Wollongong, which runs a postgraduate medical degree, will know that if somebody is giving up a job, perhaps already incurring a student debt and going back to university to take up postgraduate medicine, this will be a massive disincentive for new doctors, new nurses, new allied health professionals to take up a course of study which will lead them to becoming a health professional.

The government are abolishing the only agency and they are making it harder and more expensive for somebody to train to be a health professional. Their answer, effectively, is to let the market rip. We know what happens when the market rips in the area of health workforce distribution. You can see as many doctors as you like in Bondi, but try to see a doctor in Dubbo or west of there and you will see the disparities. This is bad legislation, built on a bad plan and it should be rejected.