Rural health

Mr RAMSEY (GreyGovernment Whip) (17:20): I rise to speak on the Health Insurance Amendment (National Rural Health Commissioner) Bill 2017. I must say I am very pleased with this legislation, because with an electorate like Grey, which is an area a bit bigger than New South Wales, health delivery is certainly one of the core services and it is something that is a challenge at any time. I spent 10 years of my life before I entered this parliament serving on local hospital boards and higher authorities within those organisations, and so I understand many of the issues that confront governments as they try to roll out decent, appropriate health services.

It is vital, I think, that this national parliament recognise that there is a vast difference between rural, regional and remote communities and the places where most Australians live, in the city. In fact, differences in opportunity sometimes are of benefit to the rural dwellers but are often to our disadvantage in areas such as education, aged care, communication needs and particularly health needs. Those differences need to be recognised, and this bill is part of that process. The budget allocation of $4.4 million to the National Rural Health Commissioner has the potential to make a real difference to rural, regional and remote Australia, because the success of Australia will ultimately be determined by how successful regional Australia is.

Last week, though, quite disturbingly—it is not all good news—I attended a public meeting in Quorn, a township of about 1,100 people almost 45 kilometres from Port Augusta. Four hundred of them, or one in three, rolled up to the meeting. Why? Because they are scared that some parts of their medical services are about to cease. Very little has been spent on the Quorn hospital and they are fearful that the South Australian government will use the lack of building currency as an excuse to say it is no longer safe to deliver services.

I can tell you that Quorn is representative of concerns held all over the electorate and all over regional South Australia. Not so long ago, for instance, the Jamestown hospital, which is about 125 kilometres to the south of Quorn, lost its ability to sterilise surgical instruments. The reason was that the steriliser had reached its use-by date and the state government refused to find the $60,000 or so to buy a new one. Jamestown is a can-do community and it does not mind digging in. In not a very long period of time it had raised enough money locally to pay for the unit. But was this enough? No. Country Health, the government's health management team, declared that the room that the steriliser was positioned in is no longer adequate. How hard can we make this process? The room is no longer adequate for the steriliser and SA Country Health refuse to do up the room, so at this stage Jamestown soldiers on without a steriliser and brings in sterilised instruments from Port Pirie, which is about a 45-minute drive away.

At the Quorn meeting local doctor Tony Lian-Lloyd ran through a long list of similar rough funding instruments, if you like, where local ability and facilities had been strangled by the lack of investment. On one spectacular occasion a hospital had a very leaky roof that the government chose not to repair or replace, so the local community rallied to put a new roof on the hospital. This is really quite a serious lack of investment.

The latest offence is in Yorketown on Yorke Peninsula, in the southernmost part of the electorate of Grey. The community have been told that that their surgical facilities are no longer up to scratch and will be terminated. The Yorketown hospital has been operating safely and competently for generations. Despite having qualified doctors and staff capable of continuing the service, people are being asked to attend the Wallaroo hospital, which is 130 kilometres to the north. This is not the Far North; this is some of the most productive agricultural land in South Australia and is quite closely settled. That kind of demand on people is ridiculous. This lack of attention is appalling if real care cannot be offered closer to the residents than that.

It seems apparent that, while the federal government's spending on hospitals is increasing at three per cent above the rate of inflation, country hospitals in South Australia at least are being neglected and starved of resources. We are told the new Royal Adelaide Hospital is the third most expensive building in the world. There are headlines that it is finally ready to use and it will be handed over to taxpayers, who will be paying $1 million a day for the next 30 years for the lease on it. It takes a little bit to get your head around the figures. It seems quite obvious that rural health facilities are being asked to provide the funding shortfall. This is a dereliction of duty by the government. I certainly will be looking to the new Rural Health Commissioner to at least make a case for the protection and improvement of country services.

I look forward to the establishment of the rural generalist pathway. This was an issue that was raised at the Quorn meeting by a number of young doctors. They said we have an uneven situation across Australia and it would be far better if we had one pathway. I hope that will all help make a real difference, but I have been around this game long enough to suspect that it will not make a difference. In fact, I have come to the conclusion that we should be seriously looking at postcode-specific Medicare provider numbers.

I look back to my time on hospital boards in the 1980s and 1990s. It was a time when we had chronic overservicing of GP services in Australia in the cities. It was a time when we were short of doctors in the country but had chronic overservicing in the cities. The government of the day decided to address this by cutting training numbers at universities, so we took in fewer medical students. This eventually drew back the numbers and the overservicing but the foot was kept on the neck of the intake for too long, if you like, and consequently we ended up with a shortage of doctors in Australia, and there are still not enough in the country.

To fill the shortfall we began importing overseas-born and -trained doctors. Nobody should think that this is an exercise in bashing overseas doctors. I tell you that without them our medical system would be on its knees. But we treat them in a different way to the way we treat our own medical students insomuch as, through the powers of our immigration system, we tell them where to go: 'If you want to immigrate to South Australia, you will serve the hospital at Coober Pedy'—or at Kimba, where I live, Ceduna or Quorn—'You will deliver services there for five years. After that we hope you elect to stay.' We do not tell our graduates that. Largely when they come out of university with their qualifications—and they are not easy to obtain; they spend many years training—they can basically work wherever they like.

There are some who say that postcode-specific Medicare provider numbers would be a restraint of trade and would be prohibited by the Constitution. I am not suggesting for one minute that we should tell doctors that they can or cannot set up practice anywhere in Australia; what I am saying is that we should tell them, 'You can only deliver a service here if you want to access the public subsidy,' which is the Medicare provider number. 'If you want to charge full tote odds for your services, go ahead.' I have got no complaint about that at all, but I think the time has come when we have to address this issue.

I am brought to this point by the remarks from the previous member about rewards for doctors. When I am told by some doctors that they are earning in excess of $300,000 and $400,000 a year working in the country—and I do not begrudge them that money, let it be said—I do not think we can actually offer any more carrots, offer more money, and expect that it is going to make a substantial difference to the supply of doctors.

Since my time on hospital boards all those years ago, the provision of backup for doctors in rural areas is far better. They have much better access to locum services, they have much better access to replacements so they can go and get training, they have assistance for training and they have the ability to have a holiday. All of those things are much better now than they were 20 years ago. I do not know what else it is we can do to make it so much more attractive to live and work in the country.

Of course, once you have doctors—and any other profession—there, many times, people actually find that they have been missing out on something and that it is the best lifestyle. But getting them there in the first place is the real difficulty here. I make the comparison: if you go through university, largely funded by the taxpayer, and get a teaching degree or a nursing degree, when you leave university, you will go where the vacancy exists in the system. You do not go off and create a new school or a new hospital for yourself. You will go where you can land a job that is on offer within the system. But we do not do that with our doctors. We do not tell them that the taxpayer is insisting that we need a service at X. They have the ability to go to Y and still access the taxpayer funding through the Medicare system. There is no doubt that this would lead to a fair bit of discussion with the medical industry.

I have spoken about this proposal on a number of occasions, and certainly where there have been doctors present. By and large, I find that rural doctors are very supportive of the proposals that I have put forward. Of course, there would be all kinds of give and take around the edges and, in particular, I think we would have to grandfather all the current doctors and say, 'These rules will not apply to you,' so that it will be a slow change to the system. But they actually understand the real challenges in getting doctors to come and work and practise in the country, including all those normal issues—jobs for their partners, who may be highly trained professionals in areas where there are not jobs and, often, they bring up the case that they might have to send their children away for education. Of course, for all the rest of us who live in the country, that is a reality. I do not see that that should be such an impediment within itself.

But I understand what all those attractions of the city are. My children did three years of senior secondary education in the city to prepare themselves properly for university. If you are training to be a doctor it is a another six or so years at university and then, perhaps, another three or four years after that to get the suitable GP accreditations. You would have lived in the city for 15 to 16 years. It is quite likely that you might find the city much more comfortable and attractive than the country after that amount of time. All of these things I understand, but it does not address the central issue at the bottom of the pile—that is, that we do not have enough doctors in the country.

Currently, in South Australia, over 50 per cent of the doctors in rural South Australia are overseas born and trained. We will stop importing those doctors almost imminently, because the pipeline coming out of the universities now is strong. In fact, we are probably training too many doctors for our future. There is a double-edged sword here. I believe we are heading for greater shortages in the country and we are heading back into overservicing in the cities. It is not that hard for a doctor to overservice; you ask the patient to come back more often for a refill of a prescription or order a few more tests. We need to be aware of these looming issues before we get to them.

If we neglect reform in this area now, in five or six year's time, when we have chronic overservicing in the cities, we do not have enough doctors in the country and we stop importing doctors from overseas, we will be in an almighty mess. I have put together a paper on this. I have been speaking on it in various forums. I presented it to the health minister. I will continue to try and raise awareness of what we are heading for and what I think we should be trying to do to fix it before our head hits the concrete wall, if you like, because I think that is what we are heading for. With those remarks, I commend the bill. I think it is a step in the right direction, but I think we need to do much more.

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