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Wednesday, 17 August 2005
Page: 31


Ms HALL (11:06 AM) —I find it rather surprising that the previous speaker, the member for Wakefield, failed to pick up on the excellent amendment moved by the shadow minister for health, because that touched on some of the real problems that exist within our health system—problems that, if fixed, would really help the people in the electorate of Wakefield. In speaking to the Health Insurance Amendment (Medical Specialists) Bill 2005, I would like to associate myself with the comments made by the shadow minister for health and also state how pleased I am to second the amendment moved by her. That amendment touches on issues that are very important to the communities in the electorate of Shortland that I represent in this parliament.

I have to say at the outset of my contribution to this debate that it is most unfortunate that the Howard government has failed the people in Australia when it comes to health. I do not think there is any other area where there is more evidence that the government has failed. We have a situation where we have got rising health costs, where a greater percentage of the GDP is being spent on health, where the cost to people throughout Australia of purchasing health services and paying for private health insurance, which this government is so committed to, is increasing and where the cost of pharmaceuticals is increasing. There is an increase in costs in every area of this country’s health system. I hate to say it, but I really feel that the government has failed to recognise the key drivers of this situation and to address these issues. These issues are a symptom of a health system that is under enormous pressure and teetering on the brink of disaster. We cannot allow that to happen, because so many people in Australia depend on a strong health system. The government should resolve these issues and not blame other people for their failures. They blame the states, and they refer to the fact that the problem of the increased costs in health are to do with the ageing population. You name it—the government will find some reason to abrogate their responsibility in this area.

After those few introductory comments, I turn to the legislation before us, which  implements change to the prerequisites for the recognition of certain medical practitioners and consultant physicians. The changes will remove separate process these medical practitioners must undertake to access Medicare rebates. It will not affect the registration process that these professionals must undertake to be recognised as specialists or physicians by their relevant medical boards. I am going to talk a little bit more about specialists later in my contribution to this debate.

As previous speakers have pointed out, currently there are three ways in which medical practitioners can apply to the Health Insurance Commission to provide Medicare rebatable services. Firstly, a medical practitioner who is domiciled in Australia and who is a fellow or has a relevant qualification from a specialist medical college is able to seek automatic recognition. This recognition occurs after the HIC receives confirmation from the medical colleges that these qualifications have been satisfied. Secondly, consultant physicians and other medical practitioners that do not meet that criteria must seek recognition through specialist recognition advisory committees, established in every state and territory, which meet every two months. Thirdly, medical practitioners not domiciled in Australia may seek recognition through ministerial determination.

The government sees these committees as redundant because they rely on advice of the specialist medical colleges and have the effect of delaying recognition for the purpose of Medicare, because the committees only meet two monthly. This legislation seeks to change that. This recognition will now come from the minister’s delegate in the Health Insurance Commission. I think that anything we can do to streamline the system to make recognition quicker is a good change. As the shadow minister pointed out, we will not be opposing this legislation but we have moved an amendment, which I am going to talk about at some length.

The amendment will also apply to consultant physicians so that they have an avenue for applying for recognition for the purpose of Medicare. So this legislation will make a very minor change in that area. But, unfortunately for the people I represent in this parliament, I do not believe it will make any real difference to the services they get, to the availability of those services or to the fact that there is a chronic shortage of doctors and nurses within the Shortland electorate. The Shortland electorate basically covers two areas. The first is the Central Coast, which has had a chronic shortage of general practitioners for a long time. The Central Coast urban division of GPs have been lobbying the government and I have been working with them to try to get more doctors to move to the Central Coast, but unfortunately no action that this government has taken has done anything to alleviate that situation.

The Central Coast has an ageing population and it is also an area that has many very young people living in it. It is an area that this government has failed when it comes to providing adequate medical services. It does absolutely nothing to change the situation that exists there. The fact that we have a shortage of GPs and specialists in areas like the Central Coast was recognised in a report brought down by the Productivity Commission. It identified that we have a real problem with a medical work force shortage, and it does not begin and end with GPs but it is an area that is causing a lot of difficulty both on the Central Coast and in Lake Macquarie.

The Lake Macquarie part of the electorate is an area that, for a long time, was not under the same level of pressure that the Central Coast was under. For a long time I would be talking to people on the Central Coast and hearing about how an age pensioner or a veteran had to wait for up to three weeks to get an appointment with their local doctor. I would hear about how GPs had closed their books and how people moving to the Central Coast were not able to see any GP at all. Or I would hear how there was a nursing home bed empty because we could not find a GP who would actually supervise the person who was desperately in need of moving into that nursing home or high-care residential facility. The person needed the support that they would get there but, because there was no GP who would oversight them, the bed would remain empty.

The change is that now that is happening in the Lake Macquarie part of the electorate. With the ageing work force, in a significant number of suburbs in Lake Macquarie, we have had doctors retiring because, as has been mentioned previously in this debate, we have an ageing medical work force. We have doctors with their books closed. In our office, when we have rung around all the GPs within the local area trying to access a GP who can supervise a person who is in a nursing home, it has taken us some two weeks to find someone to take on as a patient a person in one of the local nursing homes. This causes anxiety not only to the person who needs the doctor but to their family. They know how important it is for their relative or spouse to have the care of a general practitioner. Within the suburb of Belmont, quite a few doctors have retired recently. People living in that area are now unable to access doctors. Their doctor has retired and a large segment of the population no longer has a general practitioner.

They are the kinds of issues that are affecting real people every day. On the Central Coast, people are waiting long term—up to three weeks—to see a doctor. People are unable to go into nursing homes because they cannot get a doctor to supervise them. In Lake Macquarie, doctors are retiring and people are left without a doctor. Previously they had a doctor, but now the doctor has retired. It has an enormous impact on those communities. It also has an impact on the local public hospitals. People who cannot see a doctor in the community are going to the local emergency department and waiting for some hours to see a doctor. This is a health issue. If people do not get the proper medical treatment, their condition can be exacerbated. This also leads to more serious illnesses that have greater costs to our health system.

Linking into the fact that we have this problem with a shortage of doctors is the issue of overseas trained doctors. I have a few issues that revolve around that. Firstly, I believe that this government has a commitment to train young Australians to be doctors. Under this government, there has been a reduction in the number of training places for doctors and nurses. I know from my own community that there are many young people who would embrace careers as doctors or nurses. Unfortunately they are turned away from the universities every day.

The importing of skilled doctors and nurses from overseas has a downside. For me, one of the issues is an ethical issue—the fact that quite often these doctors are trained in developing countries and their skills are needed there. Many of these doctors come from countries that put a lot into training them. They get them to a level where they have a high level of expertise. Then we encourage them to move to Australia. I see that as quite an issue for doctors coming to Australia. It is important to mention also that there is a chronic worldwide shortage of doctors, nurses and others—you name the profession—within the health sector.

Rather than draining resources from other places throughout the world, we should be investing in our own work force. We should be investing in the young people that are leaving school. We should be making sure that our own young people have the ability to get the skills and training that they need. We should not be abdicating our responsibility there. It is very important to put on the record just how vital it is that, as a nation, if we want to thrive and grow, we have to develop the skills and expertise within our country to do so. We have to develop them, not bring them in—not take them from somewhere else. I have quite a problem with the government on that issue.

There is another issue relating to overseas trained doctors. We have some excellent overseas trained doctors. Within my own electorate some of the most skilled doctors are overseas trained doctors. But there have been some problems in the area of overseas trained doctors. Obviously, the most highly publicised has been the case of Dr Patel in Queensland. I put on the record that the New South Wales government has tightened the approval and checking procedures for overseas trained doctors. That is a result of the inquiry that took place in Queensland. The New South Wales system has checks and balances. It has panels of doctors interviewing GP applicants, specialist colleges interviewing specialists, supervision once the registration is approved and a move to more stringent checking of credentials.

Most of these overseas trained doctors go to areas of need. Quite often the patients that they deal with have serious and significant illnesses, and the doctors need to have a very high level of skill and a high level of support. I do not see that this legislation does anything to help in that area. The government has an obligation to all the people living in rural and regional areas, where the resources are scarce, to ensure that there are proper procedures in place and to look at the issue in the way that the New South Wales government has. The government needs to be putting in place some changes and working with the state governments so that that there is some sort of uniform system and a whole-of-government approach. That is one thing that this government fails at very badly. I think that is because it likes to have someone to blame when things go wrong.

Finally, I would like to touch on the issue that the shadow minister touched on: the failure to address the impact that the regulation of medical professionals by the colleges has on the supply and distribution of specialists. Within my electorate, and I am sure within the electorates of all members of this parliament, there are specialty areas where there is a significant shortage. These shortages are created, to a large extent, by the fact that the colleges will not allow more specialists to be trained in a specific area. I see this as anticompetitive behaviour. The restrictions that are being put in place by the colleges are affecting access to specialists by people throughout Australia. Unless the government takes some action to address this then it will escalate and there will be a further shortage of specialists, which will mean that it will be harder for people to see specialists when they need to. The government needs to get real about health. It needs to show leadership. It needs to address the real issues out there in the community—the real issues associated with a skilled work force. It needs to make sure that all Australians can access health care when they need to.