Health Insurance Amendment (National Rural Health Commissioner) Bill 2017

Mr STEPHEN JONES (Whitlam) (17:35): Today we are debating a bill to establish a rural health commissioner. Government MPs will say it is a great breakthrough in health care for regional Australia. I do not say it is a bad thing, but it falls a long way short of a great breakthrough, for most of the reasons that have been set out very eloquently by the member for Grey in his thoughtful contribution right now. I say, at best, it is an admission of failure. It could be much worse than that, and that is a distraction from a whole heap of issues that really are facing health care in regional and rural Australia.

I have been saying for a long time—and most informed members in this House know—that there is a very stubborn link between health inequality and wealth inequality. When one goes up, the other goes up as well. The disease risk factors are higher in areas of lower income and lower wealth, and access to preventive health measures are lower as well. This flows through to life expectancy. In our capital cities, the median age at death is 82.2 years. In outer regional areas, that drops to 79.2 years and 73.2 years for people living in remote Australia. The relative risk of mortality between the poorest and the richest income quintiles translates to a life expectancy gap at age 20 years of six years. Diabetes, just one of the chronic diseases rampant in regional Australia, is 3.5 times more common in working-age Australians in the poorest areas as it is in the wealthiest areas. Of course, the majority of those poorest areas are in regional, rural and remote Australia.

The government cannot be held accountable for every health failure that Australia and Australians are suffering, but they can be held accountable for the breaches of their own promises. I would like to take you back to the promises that the coalition parties made in the lead-up to the 2013 election. The National Party, in particular, had this to say in their plan for regional Australia. I am quoting directly from page 45 of that document, where they said:

The Nationals will provide increased financial support for doctors who provide health services in regional and remote communities …

That was the promise—in black-and-white on page 45 of the document. But, sadly, they did exactly the opposite. Instead of providing increased payments to doctors in regional and rural Australia, they tried to force through this House and the other place a cut to the payments made available to doctors not only in regional and rural Australia but everywhere through their $6 copayment. When they could not get that through the front door, they tried to force it through the back door through the GP rebate—a tax by any other mechanism.

Again, in the lead-up to that election the shadow minister for regional health said:

Regional health deserves a higher profile in the overall health policy government. 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.

Well, the operative word in that sentence and in that commitment is 'championed'. What we found in the last four and a half sorry years was that, far from being a champion, the dedicated minister for regional and rural health was either asleep at the wheel or ignored by the people who were making the real decisions. And the honourable Senator Nash admitted as much before that community affairs Senate estimates committee when she said she was not privy to any discussion around the creation of the GP copayment. So, far from being a champion, she was left out of the room when the key decisions were being made.

You could go to any number of issues. You could go to regional hospitals, where the Nationals promised that they would not support policies that 'led to the closure of regional hospitals'. A few months later, they filed into this place and voted for a budget which slashed over $3 billion from Australia's public hospital system and supported a Prime Minister who tore up the health and hospital agreement, an agreement that was going to secure funding over the long term for regional hospitals throughout Australia. I do not hold the government and, in particular, the regional MPs accountable for every single problem that is encountered in regional and rural Australia, but I do hold them to account for the promises that they continue to make and continue to break.

Labor will support the bill, which appears to have as its principal focus making the case for a new specialisation called a rural generalist. The minister who joins us at the table, Dr Gillespie, said as much in his second reading speech in this place—that a principal priority for the new rural health commissioner will be to make the case for a new specialisation called a rural general. This is a species of GP. The proposition, although currently in existence in at least one state in this country, namely Queensland, has yet to be fully fleshed out. It does have some merit on its face, but the devil is always in the detail.

The advocates for change argue that it will increase the number of doctors in regional Australia. I do want to make the point—similar to the member for Grey in his contribution—that there has never been a point in our nation's history when we have been putting more graduate doctors through our universities in this country. We have never been graduating more qualified health practitioners in this country than we are doing today—in large part due to the expansion and the policies of the Rudd and Gillard governments. But nobody in this House can argue that we are not graduating more qualified doctors out of universities around Australia than we are today. The problem is that they are practising in the wrong places. They are overwhelmingly clustered in the cities and the large urban centres and are not available in regional and rural Australia, which is why we are today overly reliant on overseas-trained doctors in rural and regional locations.

The advocates for this proposition should note that the architecture to deal with these workforce maldistribution issues was already in place when the coalition government came into government in 2013. The solution to the problems was already in place when the coalition came into government in 2013, but they could not leave it well alone. They made it as one of their first priorities to abolish Health Workforce Australia. They abolished it with the full support of the National Party. They stood in this place and gave great speeches as to why it was in the national interest that we abolish this agency which was going to help exactly the problems—it was tasked with dealing with exactly the problems—that the new rural health commissioner is going to be charged with in a much more limited scope. The Liberal and National parties abolished it just in the same way as they cut the Medicare rebates and abolished the Prevocational General Practice Placements Program—a program specifically designed to place post-graduation future doctors into regional and rural locations so that they could get the taste and experience of practice in those areas. It was a very successful program. The coalition—the National and Liberal parties abolished it. They abolished it just as they abolished the hospital funding agreement—which is placing increasing pressure and stress on our hospital system today—and they continue to underfund our hospitals.

Surprisingly for some, neither of these initiatives featured largely in their election commitments going into the 2016 election, and for this reason we have the bill before the House today. It is also curious, I have to say, that the Rural Health Commissioner's role dissolves in 2020. If the member for Grey is right, and if the member for Lyons is right in the observations that he made, which I agree with, in the opening comments of his speech on the second reading, then the problems we are facing are not going to disappear in the next three years. But the role of the Rural Health Commissioner will disappear in three years time. Presumably, we can take from that that the creation of this new role is solely focused on establishing the new position of a rural general specialist, that this will be the first and indeed the last priority for the government in regional, rural and remote health care. There are many allied health professionals who would disagree with this proposition, and I agree with them. There are a lot of priorities that we need to focus on in rural and regional health care, and creating a new position or a new specialist called the GP rural specialist, as important as it might be, is not going to address all of those important healthcare issues.

I want to talk a little bit about the crisis that we are facing in acute care and mental health throughout regional and rural Australia. I want to take you on a very quick trip through four electorates, because it paints the story very well. These are the things that we should be focusing on, and these are the problems that are not going to be fixed by a rural health commissioner—certainly not in the next three years—by the creation of one role or one new designation. I have had a look at some of the significant problems that we are facing with mental health and acute care throughout rural and regional Australia. It is always difficult to talk about the issue of suicide, which clearly is an acute problem, a terrible problem, afflicting not only the individuals and the families directly involved but also the entire community, when somebody takes their own life. It is obviously something that happens when somebody is suffering from acute mental health issues. Right throughout rural and regional Australia, we have a significant issue, and it is not being addressed.

I have looked at the statistics for my own electorate. Thankfully, at just over nine per 100,000, that is a problem that needs to be addressed, but is below the national average of 10.8 per 100,000. As I have looked at the areas that are facing some of the most acute problems, I have found that they are all in rural and regional Australia. I have looked up the figures for Capricornia: 21 per 100,000 in the local government area of Whitsunday, 16 per 100,000 in the Mackay Region and 15 per 100,000 in Rockhampton. This is an issue in regional and rural Australia that cannot be glossed over. It is something that we need to grapple with; it is something that we need to deal with. I look closer to home, down in the Shoalhaven and Kiama areas; at 16 and 15 deaths from suicide per 100,000 respectively, this is a crisis that must be dealt with. As we cut money from our Medicare system, as we cut money from our public hospital system, as we are withdrawing money from or tightening the screws in our healthcare system, these are the public health emergencies that are not being dealt with: acute care in our hospitals and acute care in our mental health areas. Close to the minister's own area—and I know he is a man who cares deeply about this—I looked up areas in the North Coast of New South Wales: over 16 deaths per 100,000 per annum in Richmond Valley, over 11 in the Lismore area and over 10½ in Coffs Harbour and in the Clarence Valley.

These are things that we should be focusing on. These are the things that need more attention and more resources. As important as creating a new statutory role of a rural health commissioner is, it does not go nearly far enough towards addressing the real issues that we have with mental health in regional and rural Australia and with acute care in regional and rural Australia. The government's actions in withdrawing funding from this sector are not going to make things better; in fact, they are going to make it worse.

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