| March 22, 2017

Why Australia needs a Rural Health Commissioner

Delivered: Monday 20th March 2017, House of Representatives, Parliament House, Canberra.

It is a great opportunity to be able to stand in this place and talk on the Health Insurance Amendment (National Rural Health Commissioner) Bill 2017.

I was in the House last sitting when the Assistant Minister for Health, Dr David Gillespie, got up and read the second reading speech to the House.

It was great that we had a situation where someone with an extensive knowledge of the health industry—a gastroenterologist—was able to talk on issues surrounding rural health, and that someone who has spent an enormous amount of time in the rural health sector as a professional is able to then adjudicate over the introduction of this commissioner.

The introduction of the National Rural Health Commissioner was a major platform of the National Party in the last election.

It was one that the then minister, Fiona Nash, was able to put front and centre as, more or less, a line in the sand, saying: 'We cannot accept this inequality that exists in rural health and regional health any further. We need to understand that, yes, we might have enough doctors, when you look at the Australian population and divide it by the number of GPs and the number of specialists that we have; however, you would be a fool to suggest that we have all those doctors in the right places.

Therefore, what we need to do is have a continual referencing and a continual filtering to make sure that, as we expect, the third of our population who live outside of the major regional cities have a very efficient and very world-class health service.'

We also understand that that is just not the case at the moment. We also understand very clearly that, if you do live in rural and regional—but predominantly rural—Australia, you are going to be in that bracket of people who experience a higher rate of chronic disease than would our metropolitan cousins.

We have a shorter life expectancy in rural Victoria and rural Australia. We have higher risk factors of smoking, excessive drinking and obesity. This is often put in place primarily because, in many of the areas we are talking about, we have lower wages and lower incomes. It is becoming more and more apparent now that education has a direct correlation to wealth and that when you map our wealthier and our poorer suburbs you get another direct correlation between wealth and health.

Of those health areas, the first to shine through from having low wealth in the economy, or in the community, is that you find things such as certain types of cancers. You are going to find that areas such as oral health and dental health are some of the first areas that are going to show very, very poor outcomes.

And, quite simply, people do not have the money to go and get skin cancers checked. They do not have the money to go and get some ailments that may be threatening and worrying checked. They simply do not have the time or do not have the money to invest in some of the high-priced services that might be available. Certainly the opportunity to get this work done cheaply sometimes does not exist in the regions. Plus, the distance to the services becomes cost prohibitive and becomes time prohibitive. And, quite simply, we know that there are higher rates of preventable cancers, such as melanomas and lung cancers, in regional Australia and rural Australia than there are in metropolitan Australia.

I know that the Deputy Prime Minister and Leader of the National Party has continually said that it is our job in here to make sure that, for those who are doing it tough, we do not make their lives tougher.

I think that is something that we just need to understand. This bill is going to, hopefully, create a system where the commissioner will be able to highlight and pinpoint significant gaps in our health system and our health services and will be able to then report those gaps back to the minister to be able to bridge those gaps in our health system.

The former minister, Fiona Nash, who was able to argue for and deliver this policy through the previous election campaign, has labelled this as a bold and historic commitment. I want to commend her for pushing this initiative through. We are going to make sure our rural and remote communities will be able to acknowledge that there is someone who is going to champion and advocate on their behalf to make sure that they get the health services delivered to the locals in their area that they may otherwise be lacking.

Going back to where I started, this is because we have that deep line principle that every Australian should have access to a high-quality standard of health care no matter where they live. This first ever National Rural Health Commissioner will be an integral part of the agenda to deliver those more equitable health services.

To establish this role, we are going to have to amend the Health Insurance Act of 1973. This will be a statutory provision enabling the commissioner to carry out their duties independently and transparently. We expect that this position will be totally independent and completely impartial, and the person who fills this position will need to be a fearless champion to carry out the roles within this area.

The commissioner will have to do work with the health sector, the universities and the specialist training colleges across all levels of government and will have to champion the cause of rural practice. It would be expected that the commissioner would be someone with extensive experience in the health sector, someone who can consult with a whole range of different players within the health sector and someone who has a real passion for creating some improved outcomes in the future as opposed to what we are putting up with at the moment. This position will roll for two years.

Once appointed, we expect the commissioner to develop a national rural generalist pathway. Again, in sitting down and talking to some GPs last week in my electorate office in Shepparton it became very clear that once someone has completed their medical degree they are about halfway through their training if they wish to become a GP. It is quite shocking when you look at the degree of training and the areas of specialty that we expect our doctors to continue to train in and work towards.

One of the troubles we have in rural Australia is the lack of ability to not just attract but keep many of these health specialist professionals. If we are able to look at ways we could retain the health professionals we are able to attract I think we will be in a much better position. It is also worth acknowledging that in rural Australia our rural generalists tend to have more advanced training than those from a metropolitan centre. We understand that they have a wider set of skills.

They obviously have more demand. They work longer hours across a whole range of different incidents and accidents that force them to do work that may be slightly outside their comfort zones. But the sheer nature of life in rural and remote Australia is that if an accident has happened and an injury has occurred then sometimes doctors have no option but to act to the best of their ability.

We also expect that healthcare planning and programs of service delivery must be adapted to meet the widely differing health needs of different communities. Again, one of the areas that I think we can do more work in is strategy and planning. Most regions would have a major regional hospital and, from there—maybe within a drive of 20, 30 or 40 minutes—you would find five or six other smaller hospitals. We need each of those health centres and hospitals to work together in a strategic manner so we do not have duplication of service.

The quid pro quo of having duplicated services is that you have total gaps in other services. We need the ability for many of these regions to have healthcare plans put in place to make sure that each of these both larger and smaller hospitals are working hand in glove to ensure that, wherever possible, they are complementing each other and working with each other and not against each other.

There will also be a couple of other amendments to the act in relation to the repealing of section 3GC to abolish the medical training review panel. We understand that in 2014 it was revealed that the Medical Training Review Panel identified a strong overlap between their function and that of the National Medical Training Advisory Network. So repealing the review panel is going to enable this duplication to be cleared up.

Also, it will remove the burdensome and ineffective process of the five-year review. It has been more or less acknowledged that these reviews have been ineffective. So, therefore, taking this aspect out of the act will also be a promising and positive initiative.

As I said, we are really looking forward to this commissioner position coming into play. This is going to be an investment of over $4.4 million in rural health to have that real champion who will have the capacity to acknowledge where the gaps are and to acknowledge what is working well. I know some of the PHNs are looking at doing this type of work as well.

The health situation we find ourselves in is very, very complex. In many instances it is very frustrating, because so much of the health budget is determined by our states, and so much of the health funding is delivered to the states by the Commonwealth government.

And generally what you see when you have more than one body responsible for an outcome, and what you would normally find, is that nobody takes responsibility when things go wrong.

This is one of the issues: if we were wanting to start now and get ourselves a well-thought-out process for delivering health services to all Australians, we would not start where we are at the moment. But the fact is, we have got what we have got, and we have to look at the best way forward.

This initiative, driven by Fiona Nash and carried on now by Minister Gillespie, is going to see a real champion with the sole objective of making sure that the health needs of rural and remote Australians are well serviced—making sure that, if there are gaps, that those gaps are identified, and that the information about those gaps is then delivered and passed directly through to the Minister for Health, to ensure that appropriate action is taken and that those services can then be best delivered to those people in Australia who most need them.

The whole conversation will then revolve around asking questions like whether we have an equitable health system, whether the health needs of people that live in rural and remote Australia are well serviced, and whether we can start closing the gap between the health outcomes of our people in metropolitan Melbourne versus those in regional cities versus those in remote and smaller rural communities.


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