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Tuesday, 26 May 2009
Page: 4380

Mr CRAIG THOMSON (5:40 PM) —I rise to support the Health Workforce Australia Bill 2009. This is a very important bill because it allows for the first time proper workforce planning throughout Australia. We have heard from pretty much every contributor so far about their own local situations and the difficulties that are there. I, too, want to start with my local situation, because I think it gives a good reason as to why the HWA is so important and why we do need to actually plan our health workforce better than we have in the past. Wyong Hospital, which falls in the beautiful electorate of Dobell, happens to have the fifth busiest emergency department in New South Wales. Yet we struggle to have emergency doctors at the emergency department and rely regularly on locums. While the popular press is quick to blame the state government in terms of these issues, it is not nearly as simple as that. It is really about planning to make sure that our health workforce is there and available. Wyong Hospital has been substantially rebuilt under the state Labor government. But there is no point having a brand spanking new hospital if you cannot get fixed when you go there and there is no-one there to see you. That is the importance of making sure that we have proper planning for the health workforce.

We recently at Wyong Hospital had the maternity ward close down for some months because there were no obstetricians that could be attracted to the area. This was not a fault of the local area health service. It was not a fault of the state government. There were widespread advertisements trying to attract them. There just were not enough doctors because there had not been enough planning to make sure that our hospitals are properly staffed. This is one of the key motivating forces as to why Health Workforce Australia is being established. In the end, with the maternity ward, they had to look at alternate ways of delivering maternity. In Wyong we adopted a midwifery model, which is working tremendously well. My partner and I are soon to avail ourselves of the services of Wyong Hospital, in July of this year. So we are pleased, from a personal point of view, that that is going well, too. What it illustrated was that because of a lack of planning over many years the model needed to change and we needed to plan better for the future, and that is precisely what this bill does.

There is also a very different approach to the way in which the Rudd government will be working with the states compared with the approach of the previous government to these things. Unlike the previous government, we actually intend to work with the states. There cannot be a better and more important example of this than Health Workforce Australia being established. This came out of COAG, where we were able to reach agreement with the other states to make sure that we do plan properly in terms of our health workforce. There is no point setting up different regions of Australia or different states in Australia to compete for the limited pie in terms of the workforce that exists there at the moment. We need to increase the pie, and we need to do that by properly planning where they go. For too long we have seen different health professionals being lured away from one state, and there has been a temporary situation where that state or that particular region may be better off. But it is only temporary if you are not actually increasing the numbers overall and you are not taking a position that looks at the workforce needs across the country. That is precisely what this package intends to do.

The Commonwealth will provide $125 million over four years for the establishment and the operation of Health Workforce Australia. A further $1.2 billion in combined Commonwealth, state and territory funding will be administered through the HWA for the majority of the initiatives under the COAG health workforce package. Given the tight time frames to implement the COAG health workforce package, the HWA needs to be established by July 2009 so it can start managing clinical placements from the start of the 2010 academic year.

Let us have a look at the background of Health Workforce Australia. In November 2008, COAG agreed to a $1.6 billion health workforce package. The Commonwealth is contributing $1.1 billion to the COAG package, with the states and territories providing $539.2 million. The COAG package forms part of the national partnership agreement on hospital and health workforce reform signed by all states and territories in March 2009. This package gives the Commonwealth greater involvement in the health workforce, traditionally an area managed by the states and territories. It means that we take a national position in terms of health workforce rather than setting states and territories to compete against each other in relation to where the workforce should be best utilised.

The package includes establishing a national health workforce authority to produce more effective, streamlined and integrated clinical training arrangements and to support workforce planning and policy development. The authority will implement the majority of the initiatives under the COAG package, including funding, planning and coordinating pre-professional entry clinical training across all health disciplines; supporting clinical training supervision, health workforce research and planning, including through a national workforce planning statistical database; funding simulation training; providing a national approach to workforce planning; and providing a secretariat and research support to an independent advisory council for the National Registration and Accreditation Scheme. The authority will also ensure best value for money for the workforce initiatives, more rapid and substantive planning for future workforce needs and will provide advice to health ministers on relevant workforce issues.

I can recall in the late 1990s in New South Wales when linear accelerators were first coming into hospitals to provide vital cancer treatment. We had the terrible situation of these very expensive machines in some parts of Sydney not working to capacity not because the state government had not provided the machines and the capital but because they could not get the staff to operate these machines. That clearly adversely affected the treatment and ongoing rehabilitation of cancer sufferers. That is something that we should be able to avoid through proper planning of the workforce.

The Commonwealth will also fund the establishment and operation of the authority at $125 million over four years, and the authority will administer around $1.2 billion of Commonwealth and state and territory funding for workforce initiatives. Health ministers have agreed to the authority being called Health Workforce Australia. Health ministers also agreed to Health Workforce Australia being established under the Commonwealth Authorities and Companies Act, therefore providing governance arrangements that reflect the shared funding and policy interests of all jurisdictions.

The bill is required to establish the HWA as a statutory authority under the act and to specify the functions, governance and structure of the HWA. Given the functions and level of funding for which HWA will be responsible, it is essential that there is a legislative basis for its operations. The bill will also enable mechanisms for health ministers to provide directions to the HWA and for the HWA to report to health ministers. The HWA will be governed by a board comprising a nominee from each jurisdiction represented on the Australian Health Ministers Advisory Council and a chair, and may include up to three independent members selected by health ministers. The board’s responsibilities will include advising and reporting to health ministers and developing policies and operational plans as required. A chief executive officer will be responsible for the day-to-day administration of Health Workforce Australia and will report to the board. Expert committees and consultants will be engaged to assist with the HWA functions as required. HWA is to commence management of pre-professional entry clinical training from January 2010. This bill is required to establish HWA by July 2009 to ensure it is operational within the time frames agreed to in the COAG health workforce reform package.

The Rudd government are committed to dramatically improving Australia’s health system, and setting up Health Workforce Australia as a statutory authority is just one small part of that. In the 2009-10 budget we are delivering a vital boost to our hardworking doctors, nurses and midwives with a series of major investments to expand and modernise our health workforce. The Rudd government are delivering more training places for GPs, providing Medicare Benefits Scheme and Pharmaceutical Benefits Scheme access for nurse practitioners and midwives, and reforming support scholarships and training programs. The budget initiatives build on the government’s unprecedented $1.1 billion package of COAG reforms to expand Australia’s health workforce.

The COAG package increases funding for undergraduate clinical training and postgraduate training places and establishes a national health workforce agency to drive a more strategic long-term plan for the health workforce. The budget workforce initiatives will invest $148 million over five years for additional GP training places in 2009 and 2010. It will provide training for remote vocational training scheme GP places in 2011. In addition, there will be a further 212 GP training places provided through the COAG package by 2011. This will permanently increase the number of GP training places to more than 800 per annum from 2011 onwards—a 35 per cent increase on the cap of 600 places imposed since 2004.

The budget initiatives will encourage more junior doctors to become GPs by investing an additional $41.2 million over four years in high-quality supervised general practice training under the Prevocational General Practice Placement Program and will establish the first medical school in the Northern Territory with a strong focus on increasing the number of Indigenous doctors. The government will invest $27.8 million in capital funding to establish the medical school plus $4.4 million over three years from July 2010 in ongoing funding. The government will recognise the valuable role and skills that nurses bring to the health system and to the broader community through providing access to the MBS and PBS for nurse practitioners, at a cost of $59.7 million over four years. This will improve the flexibility and the capacity of Australia’s health workforce, improve patient access to services and provide eligibility for midwives to access MBS and PBS for the first time, expanding choice for women at a cost of $66.6 million over four years. These measures will improve the flexibility of the health workforce and facilitate better access to services for patients.

There are currently significant workforce shortages affecting both pathology and diagnostic imaging. To address this, the government will fund an increase of $10.8 million over four years for pathology places. There will be an additional $5.7 million over four years for radiologists. The government will also introduce a mentoring and academic support initiative for rural pathologists at a cost of $6.2 million over four years. You can see that there is a significant range of additional dollars that are going from the budget to supplement and improve the delivery of health care across Australia. This piece of legislation that helps to plan our workforce is an integral part of that whole package.

I recently had the pleasure of breaking the news in my electorate of Dobell on the Central Coast that a very capable and experienced partnership of doctors had successfully tendered to establish a super GP clinic in the key growth area of Warnervale. This current doctors’ partnership runs a Toukley medical practice, where there are 17 doctors working along with a range of other health professionals, and another practice at Tuggerah where there are an additional seven doctors. A shortage of GPs is a real issue in my electorate, as it is in many electorates around Australia. In fact, the most common problem in the electorate of Dobell is not about how much you pay when you get to a doctor, it is actually being able to get in to see one because many of them have closed their books. The Rudd government in relation to its program of opening up super GP clinics across the country has again contributed in a major way in my electorate to making primary health care more accessible to the people of Dobell. This, along with providing these additional training places for GPs in the coming three years means that we are going to have more doctors available on the ground to be able to see to the people of Australia and to make sure their health is better looked after.

This is an important piece of legislation, because it means that for the first time across the country we are able to plan and look at the way we deliver our health care, matching up the demand for health care with the training that is required for health professionals and making sure that they are not only trained but sent to the places where they are needed in the numbers that are needed. It is long overdue in this country. We have had many commentators on the health system speaking for many years about the silos of health care that operate in this country. This is a significant step towards making sure that these silos are broken down, that we can go across state borders and that we can plan properly so that the health care of all of our citizens is better planned for and better looked after. I commend this bill to the House.