Mr LAURIE FERGUSON (3:16 PM) —by leave—In October 1996 the Minister for Veterans' Affairs (Mr Bruce Scott) made a ministerial statement detailing the government's policy entitled `Health policy for the veteran community in rural and remote areas'. This afternoon's statement is essentially a progress report on the 1996 report, covering the period November 1996 to March 1998.

Whilst Australia's repatriation system has many strengths, historically it has suffered from an excessive degree of centralisation, with its public presence restricted to massive offices in capital city central business districts and a small number of designated repatriation hospitals. The location of these facilities was often as problematic for veterans and their families living in outer suburban areas and regional cities as it was for veterans living in what could properly be described as rural and remote areas.

Over the last decade or so, we have seen praiseworthy efforts to reverse this trend. Specialist services such as Vietnam Veterans Counselling Service offices have long been established in suburban and regional sites that broadly reflect the distribution of the Vietnam veteran community. Veterans' Affairs Network—VAN—offices have been established in a considerable number of centres. And of course entitled veterans can now, with some variation from state to state, access private patient hospital treatment through a considerable number of public and contracted private hospitals.

Many of these service delivery models still, however, required a critical mass of veterans in order to be economical and effective. They were therefore most suited to significant regional centres like Townsville, Wollongong or Launceston. There is thus the problem of devising ways of providing adequate support to veterans in rural and remote areas. The DVA's definition of these is `non-metropolitan areas which have populations of less than 100,000'. It is appropriate to acknowledge that some 30 per cent of the veterans treatment population—that is, veterans, war widows and dependants entitled to health care through DVA—live in such areas. It is also clear that this definition covers centres that are themselves diverse. Not all are inland and some would generally be considered small cities rather than rural towns.

The opposition acknowledges that more could and should be done for veterans in rural and remote areas. All veterans are entitled to enjoy ready access to both information and services. As shadow minister I am happy to acknowledge the enthusiasm of the Minister for Veterans' Affairs and his commitment to progressing this particular policy agenda.

A particularly notable statistic in the 1996 policy statement was that 40 per cent of the veterans living in rural and remote areas were aged 75 years or over—42,000 of 106,000. This at least partly reflects the fact that rural Australia was an important source of enlistment during the Second World War. It was therefore appropriate that a key component of the strategy was on preventive health care measures focusing on an increasingly frail generation of veterans.

Many of the detailed measures outlined in the 1996 statement were also small scale and focused on named locations. In saying this I am not implying criticism of the government. It is sensible to identify what is achievable and realistic and not to raise excessive expectations that cannot be feasibly met in the immediate future.

You can best review progress on reform measures in the light of the announced goals for them. In this regard, the 1996 policy statement said that the goals were:

to maintain and improve the health and well being of the veteran community in rural and remote areas; and increase the awareness of DVA entitlements and services among the veteran community and health care providers in rural and remote areas.

To address these goals, 10 priority areas for action were identified: improved access to, and availability of, health care and support services in the local community; more flexible transport arrangements for entitled veterans who require health care outside their local community; increased focus on health education and preventive care; improved planning and delivery of DVA services, particularly in remote areas; better information for the veteran community and health care providers about DVA entitlements and the range of health care services; greater support for groups who have special needs within the veteran community; greater support for health care providers; greater support for ex-service organisations; better information and support on housing assistance; and better information about income support and disability compensation.

At this juncture it is not possible for me to make an immediate and definitive assessment on progress, as the actual report arrived shortly before question time. I can acknowledge that some worthwhile things are happening, in particular with the enhancements to the repatriation transport guidelines and the trialling of various models of providing outreach information services to veterans in rural areas.

I would like to canvass some of the other issues that have been raised with me by veterans in rural and remote areas. Amongst Vietnam veterans, in particular, there are still clear difficulties in accessing specialist services, particularly for psychiatric conditions such as post-traumatic stress disorder. Even in large regional cities such as Townsville, veterans have reported to me—and the minister has not disputed this—that local specialists have not been keen to perform such work and those that do cannot cope with the level of demand. The alternatives facing veterans are either to visit capital city specialists, which is disruptive and costly to the taxpayer, or to decide that it is not worth the bother, which could have long-term adverse consequences for veterans, their families and the wider community.

I turn next to domiciliary nursing services for veterans. These are an important support to veterans who have been discharged from hospital or are terminally ill. The minister's statement makes no reference to the reform of DVA's funding arrangements for private nursing agencies, reforms that came into effect last year. Without debating the details of this somewhat complex issue, I note that the agencies that have approached me with concerns about these reforms have overwhelming been those based in rural areas, particularly in New South Wales. This is an issue that requires continuing scrutiny to ensure that there is no reduction in the level and nature of nursing care that veterans receive, as guaranteed by the minister. I am afraid to say that this guarantee has not always been reflected in the feedback I have received from individual veterans and service groups.

I also note that veterans in rural and remote areas are not immune from the coalition's broader cuts. These broader cuts mean that veterans, while finding it easier to make contact with DVA, then find it harder to gain legal aid to the required degree because of Commonwealth cuts or to obtain adequate public hospital care. If and when they need access to a nursing home, they now face paying the hefty annual entry fee for five years, totalling $20,000 in many cases.

In conclusion, the 1996 policy statement contained worthwhile initiatives. Indications of some progress cannot be disputed. They must, however, be viewed in the context of the impact of changes in nursing home care, pharmaceutical benefits and legal aid which daily affect rural veterans. The minister must ensure that the hyperbole is matched by actual budget dollars, given the scant reference to expenditure in the report, lest it be thought that these aspects are actually just a shuffling of the cards rather than the introduction of new initiatives.