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Thursday, 26 November 2009
Page: 13111


Mr BALDWIN (10:13 AM) —I rise today to speak on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009. This legislation encourages overseas trained doctors and former overseas medical students to practise in rural areas of Australia, as well as in those regions suffering from a shortage of doctors. These regulations came about in the mid-1990s when society began to notice an increasing doctor shortage in rural areas. Policy thinking started to change and the Howard government introduced initiatives to address the inequitable distribution of our medical workforce between country and city, the latter being the most popular for medical professionals.

Our Constitution prevents governments from using legislation to conscript Australian doctors to work in particular regions based on geographic location, demographics or otherwise; thus, these initiatives soon focused on overseas trained practitioners, as is the case with this bill. Normally, overseas trained doctors cannot provide services which attract Medicare benefits until a decade after they become both a medical practitioner and a permanent Australian resident or citizen. However, these doctors can claim exemption from this moratorium if they work in an area of dire workforce need or in rural and remote parts of the country.

One of the main provisions in this bill would remove current restrictions on New Zealand doctors who have attained their qualifications at an accredited medical school in Australia or New Zealand. The change would reclassify these doctors so they are no longer considered overseas trained and thus would not be subject to the 10-year moratorium. The bill would also establish a time period in which doctors can appeal against the refusal to grant an exemption or a decision to impose conditions on an exemption which has already been approved. Further, this legislation would allow doctors to start this 10-year period without having both Australian permanent residency and medical registration. Instead, these doctors would be able to start work and be recognised in retrospect as long as these conditions were met any time within the decade of practice. As a result, it is expected that upon commencement of the bill a number of overseas trained doctors will have completed the moratorium. If a doctor should complete his or her decade of service without having become a permanent Australian resident or a citizen then the restrictions will remain current until they do so.

One of the main technical aspects of this bill is to replace the term ‘former overseas medical student’ with ‘foreign graduate of an accredited medical school’ to minimise confusion amongst doctors. It is hoped the new term more aptly conveys its meaning—that is, a person who gained their qualification from an Australian medical school but was not a citizen or a permanent resident of this country at the time they enrolled. Another term will explain the definition of an accredited medical school as one accredited by the Australian Medical Council and located in either Australia or New Zealand.

I am generally supportive of this bill and I hope it will encourage medical professionals to practice in my electorate of Paterson. Locally, residents battle with a chronic shortage of doctors, in particular general practitioners who bulk bill their services. Just last week the headline of our local newspaper, the Newcastle Herald, screamed ‘Doors close as Hunter GP shortage hits critical’. The articles reads:

DOCTORS in the Hunter treat twice as many people as some of their Sydney counterparts and are increasingly shutting their doors to new patients due to overwhelming demand.

                …            …            …

Figures obtained from GP Access, formerly known as the Hunter Urban Division of General Practice, show that about 40 per cent of the region’s 145 urban practices in Lake Macquarie, Maitland and Newcastle, can’t cope with the demand for services and have closed their books.

A further 27 per cent will accept new patients only if they live in the postcode of the surgery or have a relative who is an existing patient.

In some parts of the Hunter there are more than 2000 residents for every full-time GP, while there are fewer than 800 per GP in some areas in Sydney.

The Hunter urban division has an overall ratio of 1595 people for each GP, about 40 per cent higher than the state average at 1120.

GP Access chief executive Mark Foster said the area would need an additional 95 doctors to bring it in line with the industry accepted standard of one GP per 1200 people.

Dr Foster said GPs were free to choose where they wanted to work and traditionally gravitated to large urban centres.

These figures explain the critical shortage of doctors in the Hunter region. One such crisis area in my electorate is Dungog, where there are 2,189 people for every doctor. This ratio of people to doctors is almost double the industry accepted standard. Similarly, in Maitland the ratio is 1,951 to one and in Port Stephens it is 1,547 to one. Clearly, my residents struggle with a lack of doctors, forcing them to wait long periods for medical help or otherwise seek assistance from the emergency departments of nearby hospitals. Unfortunately, these facilities are also stretched to the limit.

In the first quarter of this year, for example, half of all patients at the Calvary Mater Newcastle emergency department who needed to be admitted waited more than eight hours for a bed. The NSW Health benchmarks also reveal one in five had to wait longer than eight hours to be admitted to the John Hunter Hospital, and it was the same at Maitland Hospital. Many constituents from my electorate are serviced by these hospitals and, once you include the distance they must travel to reach them, it is abhorrent that they then have to wait more than eight hours for a bed. It is also important to note that one of the main reasons suggested for this poor performance is a lack of beds because our state and federal governments simply have not provided life-saving doctors and nurses with all of the facilities they need. In terms of elective surgery performance, the numbers should also be a lot better. The average wait time for category 3 surgery at the Calvary Mater was 220 days, 240 days at the John Hunter and 150 days at Maitland. This is simply not good enough.

Two years ago, our Prime Minister, Kevin Rudd, promised he would take responsibility for fixing our health system and that the buck stopped with him. As these statistics prove, he clearly has not done so. In fact, the only part of his promise he seems to have kept is to stop the buck, which in this case means stopping the provision of vital health funding for those who need it the most. While these hospitals are not positioned within my electorate, they do service thousands of my constituents every year who are forced to travel for treatment to a major hospital. As a result, they desperately need more cash to upgrade facilities and ensure they can cater for further rises in population and demand.

The Maitland Mercury reported the shocking experience of one such patient from my electorate in last Monday’s edition. It reads:

When Wallalong’s Peter O’Brien was diagnosed with prostate cancer in January he knew it would be a long hard road to recovery.

But what he didn’t realise was that road would be literal when he was forced to drive the 72km round trip to Newcastle five days a week for two months to receive radiotherapy.

Mr O’Brien spoke to the Mercury on Friday ahead of the airing of ABC’s Roadblocks to Radiotherapy—stories behind the statistics.

He was one of more than 260 callers who flooded the Cancer Council Helpline in March to share their personal experiences with radiotherapy in NSW, leading to the report highlighting the issues that leave up to 5000 patients without treatment each year.

The 69-year-old completed his treatment in April of this year, but said he couldn’t have made it through without the support of family, friends and neighbours.

‘Being diagnosed with cancer is traumatic enough without having to worry about how you’re going to get to your treatment,’ he said.

‘I was quite surprised when I was diagnosed that there wasn’t somewhere in Maitland that could help me.

‘The commute wasn’t so bad to begin with, but after a few weeks you start get tired.

‘If it wasn’t for my neighbours and friends, who started a roster to alternate who would drive me to my treatment, I don’t know what I would have done.’

Cancer Council Hunter Region manager Christine Roach said something had to be done to unblock the State’s clogged radiotherapy services.

‘Enough is enough,’ she said.

‘Patients shouldn’t have these pressures piled on them when going through one of the most stressful periods of their lives.’

Here is a man who is battling with a traumatic and life-threatening cancer and yet he cannot access the services he needs locally. I wonder whether the Rudd Labor government really cares about, let alone understands, the needs of these people who are clearly being failed by the Rees state Labor government and need support from our nation’s leader.

Another constituent, Bill Seoullis, moved to Mallabula with his wife, Carol, three years ago from Sydney. Bill has a heart condition and needs to see a GP on a regular basis. Soon after moving to Mallabula, Bill contacted a doctor on the Tilligerry peninsula for an appointment and was told, ‘The books are closed.’ So he tried another and another and another, but the answer was the same. Bill, having moved from Sydney, did not even contemplate that a simple visit to a GP would pose a problem—and it should not. Yet sadly it has and, sadly, Bill still has to go to Sydney for treatment.

The New South Wales President of the Rural Doctors Association and Hunter-New England Area Health Advisory Council member, Dr Ian Cameron, has also raised fears. In last week’s Newcastle Herald, he questioned the effectiveness of federal and state government initiatives designed to attract doctors to areas in need. These initiatives have failed to stop the decline in qualified GPs in my electorate, with many more approaching retirement. In fact, in the greater Hunter region more than half of the doctors are more than 50 years of age and, even more concerning, one in five is over 60 years of age. Thus, in little more than a decade we look set to lose more than half the region’s current doctor workforce. This is a shocking and worrying statistic for the thousands of residents across my electorate, who are already facing long delays in appointments. It is of major concern that there is no action to attract young doctors and their families into regional and in-need electorates such as Paterson, where most of the doctors are in the latter part of their professional careers. Further, since overstressed GPs have already started to close their books, where will patients go when their family doctor closes shop to enjoy his or her own retirement?

The issue of age is also concerning when taking into account local residents and their needs as patients. Much of Port Stephens and Forster-Tuncurry is coastal land popular amongst retirees. Thus, a large portion of my constituents are elderly, and this number is only expected to grow. According to the Australian Bureau of Statistics, the number of Australian residents over 65 will double within three decades. Local councils, including Port Stephens, have identified the need to plan for our ageing population and improve pertinent services including public transport and community support networks, but what are Kevin Rudd and his Labor colleagues doing to prepare? GP Access chief executive Mark Foster has explained that the elderly need triple the care of younger people. In Paterson, where the number of elderly is already higher and growing, this means the number of patients demanding medical services is climbing at an exceptional rate. Since our health system is already struggling, I fail to see how it will cope with such a massive rise in demand.

The stories of our doctors go a long way towards putting this crisis into perspective. My local constituent and fellow of the Australia College of Remote and Rural Medicine, Dr Warwick Yonge, is among those who will establish and run a GP super clinic at Nelson Bay. He has complained during discussions with my office there is not one doctor on the Tomaree Peninsula who advertises bulk billing. He also tells me there is a severe shortage of doctors in the community, which has in turn lowered competition and led to a rise in consultation fees. These consultation fees sometimes can be $75 for a short consult and patients can only claim a small fraction—often less than half—back from Medicare. Doctors complain that these rebates are moving further and further away from reality, making it harder for GPs to cover day-to-day costs.

This is yet another price tag local families simply cannot bear. Since the Rudd Labor government started its attack on our health system, we have seen the rebate cut for pain-relieving joint injections which improve the lives of so many and we have seen the rebate cut for cataract surgery, which is truly a life-changing procedure and will now be out of reach for so many. These cuts hit hardest on the hip pockets of our most vulnerable residents—the sick, the poor and the elderly. And yet the Minister for Health and Ageing, Nicola Roxon, has pushed ahead without regard, to save a few pennies.

Where were these budget considerations when the Rudd Labor government was handing out $900 stimulus payments, many of which were lost overseas? Where were these budget considerations when the Rudd Labor government was handing out $1,600 insulation rebates, inflating the cost of roof batts and costing taxpayers millions of dollars in excessive rebates? I can only surmise that Kevin Rudd no longer cares about the sick in our community.

Last Tuesday marked two years since the Prime Minister was elected—two years since he promised to fix our hospitals, and yet nothing has been done. My constituents are sick of Kevin Rudd’s hot air, his spin, his inaction. Last Tuesday in question time, despite his promises two years ago, Kevin Rudd was forced to admit ‘there is a huge problem in the nation’s public health system’. Yes, Prime Minister, we realise that, but where is the action?

Another of my constituents, Dr Malcolm Fairleigh, has been trying to attract a second doctor to help run his practices for the past three years, without success. He stresses that while overseas trained doctors are sometimes available, his offices at Pacific Palms and Nabiac are not sought-after work destinations. According to Dr Fairleigh, this is because there are plenty of other practices in areas of need which are closer to major regional centres and therefore more attractive.

Dr Farleigh now faces the prospect of having to close both his practices if he cannot find a colleague in the next six months. He is tired after not even being able to take a holiday without having to close both offices and deal with anger from residents, who are unable to sit and just wait for a GP. This would be a massive loss to both the Pacific Palms and Nabiac communities, which rely on his services so they do not have to travel for medical help. This is not to mention the relationships and knowledge which will be lost if he is forced to give up after years of commitment to our local community—a community which might never see another doctor’s surgery, under the current lack of Rees state Labor and Rudd federal Labor government action.

These examples highlight the need for many more doctors across my electorate of Paterson. The Rudd Labor government has not done enough to ensure that incentives are in place to attract doctors to centres which need them the most. Hardly a week goes by when I do not meet or speak to a local constituent who is unhappy with the provision of GP services, and this is clearly a reflection on the state and federal governments. They owe it to those doctors who give up their holidays and weekends to facilitate a health system where the needs of both patients and doctors are met.

That is not to say, however, that the staff at hospitals in my region do not do an outstanding job with what little they are given, because they do. I would like to take this opportunity to say thank you to the doctors and nurses within the Paterson electorate at Gloucester, Bulahdelah and Dungog public hospitals, at the Tomaree polyclinic and at Forster Private, which leases 20 beds to the public system. I would also like to recognise the staff who support locals who cannot be treated in these facilities; namely, those at the Maitland Hospital, the John Hunter and Calvary Mater.

Local nursing homes also play a massive part in catering for the health needs of my elderly constituents. In my constant travels across Paterson and visits to aged-care homes I have met many amazing people whose kindness and care have allowed patients to live with dignity and largely without pain. The Regis Gardens nursing centre, at Salamander, is one such facility which does amazing health work in our local community. It was opened just five years ago by the Deputy Leader of the Opposition, Julie Bishop, and now boasts 150 beds and professional consulting rooms. Other aged-care facilities include the Gloucester, Great Lakes, Bulahdelah and Forster/Tuncurry nursing homes; Lara Aged Care at Dungog; the Raymond Terrace Gardens Nursing Centre; Stroud Lodge; Myall Lodge; Kularoo Gardens and Barclay Gardens at Forster; Beaumont Terrace and Glaica House at Tuncurry; Shoal Bay’s Harbourside Haven; Fingal Haven Village; Uniting Care at Salamander; Tanilba Bay Hostel and Largs Lodge. I would like to say thank you to all those staff in my electorate who work in collaboration with local GPs and who keep their centres running despite the shortage of doctors. These doctors usually run their own practices, fill in at the local hospital or a polyclinic and service the nursing homes. The strain placed on them is so high I can only pay tribute to them for their commitment and battle here today on their behalf to help find a solution.

All this paints a scary picture for patients in Paterson. Emergency departments are overstretched, waiting times for GPs are growing, doctors are closing their books and demand from the elderly is increasing. While this bill will go some way towards encouraging more medical practitioners to set up practices in our region, what we really need is more action from the Rudd Labor government. We need more incentives to encourage doctors to practise in areas of workforce shortage. Without them families across my electorate will continue to suffer, both from unnecessary delays in treatment and from the physical ailments which forced them to seek help in the first place. If the Rudd Labor government cannot provide adequate medical services for the nation, then it has failed the people who believed in Kevin Rudd’s promises to fix our ailing health system.