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Thursday, 3 June 2010
Page: 5266


Mr OAKESHOTT (10:34 AM) —I rise to talk about the Appropriation Bill (No. 1) 2010-2011 and associated bills, and to do a round-the-world trip of some issues within the Lyne electorate on the mid-North Coast of New South Wales. I will start with the central issue for a high-growth area that has traditionally been underserviced by state governments in regard to its own resource distribution formulas in the area of health. In the 2007 Garling report, the whole North Coast window was identified as being underserviced by up to $70 million per year. Our area has been underfunded for too long now due to our high growth rate and our large ageing population cohort. State structures have continually failed to deal with that growth. Therefore, the move by the Prime Minister and others to tackle the issue of health and hospital reform was strongly welcomed by me and others on the North Coast. It was described as a slam dunk for high-growth areas such as ours because it would bypass the perennial problems of state based funding, and the abuse of resource distribution formulas, through direct Commonwealth funding of local health networks. A bit of command and control at a clinical level and at a local level would be very welcome.

That was pre-COAG language. In post-COAG language it is probably less of a slam dunk. We are now at the detailed stage where boundaries are being defined and governance structures in regard to who is going to be involved and how they are going to be involved at a local level are being determined. I flag this as an issue of concern: we have the same foxes in the henhouse of reform—that is, the same state authorities that have been the traditional problem in high-growth areas are now, post COAG, back in a position of command and control over some of the critical issues around boundary definitions and governance of local health networks. Also post COAG, we have the concerning issue of once again putting state funding authorities and state based human discretion into resource distribution. We are potentially repeating the same problems of the past. I hope I am wrong. I hope that this detailed stage fleshes out this new state funding authority, which has been included in the Commonwealth funding direct to local health networks, and that it actually does not mean anything, does not get in the way and does not affect resource distribution formulas. I hope that there is no human discretion element and no ulterior state motives involved in it, which raises the question of why it is there at all. I sincerely hope that it plays a minimal role in deciding where money ends up and that we can be as pure as possible about Commonwealth funding direct to local health networks.

I also raise the concern that it is a state cabinet decision that is essentially being made now in regard to boundary definitions and local health network governance structures. I would hope those decisions are as pure as possible and that the Commonwealth is not walking away from the critical framework decisions that are being made right now. It is in this detailed stage that we will hopefully see a health reform system that is pure and does meet the rhetoric and the language of the Prime Minister when this whole process started. I sincerely hope it does, but I do flag that there are creeping concerns at the community, clinical and political levels. Some of those command and control issues are now creeping back to the area that was the problem in the first place—the state bureaucracy in New South Wales not coping with questions of equity and population movement to high-growth areas like the North Coast of New South Wales.

I sincerely hope that the federal health minister, the Prime Minister and the federal cabinet have not walked away from the detail stage and that they are still very much engaged with what is happening in this detail phase of the proposals. If necessary we do not just use carrot; we also use stick in regard to tied grants and in relation to any mechanisms that keep the rhetoric pure. We see in practice what has been promised in this reform program, which is critical for communities, particularly for high-growth communities such as the mid-North Coast of New South Wales.

Pre COAG I was thrilled that for the first time in the history of the seat of Lyne we had a Prime Minister, regardless of political persuasion, walk through the door of a local hospital in the Lyne electorate. That reflects on the history of the Commonwealth and on the history of political representation nationally and in the seat of Lyne. I will also give credit where credit is due and say I think it reflects well on the Prime Minister that he was willing to get his hands dirty on the topic of health and was willing to get into the regions and meet with clinicians and communities. I know the Prime Minister cops criticism for being overexposed in hospitals but, for regional areas such as mine, when this was a first to have a Prime Minister walk through our hospital’s doors, it was well received, I can assure this place. Again, regardless of political persuasion or who holds office, I would hope that in the future we all encourage prime ministers to get into the regions, to get into regional hospitals and to be willing to get their hands dirty on some of these critical community issues around health services.

I was pleased he came through our doors. By logical extension, when he came back a second time, he was also the first Prime Minister ever to come back. I think that was welcomed as well. I know our clinicians, of all political persuasions, pitched a very strong case to the Prime Minister and did leave an impression, which could be seen in the language when he announced the health and hospital reforms. At the National Press Club it was hospitals in the Lyne electorate, Port Macquarie Base Hospital in particular, that were front and centre in those debates and in those policy releases.

From a community perspective that is very, very welcome because we have a history on the mid-North Coast of division over health. Port Macquarie Base Hospital was the Australian experiment in regard to privatised public services, which caused enormous divisions at a local, state and national level in regard to the ideologies in and around how health services are delivered at a community level. The Prime Minister’s visit was therefore a good moment for us to be a leading example in a positive way rather than one that is dragged down and used to clobber one political party or another over the head as a negative example.

I appeal to this place to keep health and hospital reform on the agenda and ask that no-one walks away now that we are in the detail stage—that we do not leave it to the same decision makers at a state level to make the same decisions for the same poor reasons. The regions matter, and equity in resource dollars also matters. I would hope the Commonwealth stays very engaged on that front.

We have a submission for a fourth wing at Port Macquarie Base Hospital. It is a large project of $70 million but it is to meet the growing needs in our area. None of this reform will fly in areas such as mine unless we deal with the capacity questions that are confronting us on a daily basis right now—that is, the issues of more beds, more bricks and mortar and more capacity for hospitals such as Port Macquarie Base Hospital. That submission sits and waits to be dealt with by, preferably, the state government—because capital is traditionally theirs—but, in this environment where reform is on and capital is in the game, I also have put that submission before the government. I urge them to deal with it sooner rather than later.

As well, we have put a submission in for what will hopefully be the next round of GP superclinics. That program has been broadly welcomed by both the community and the primary healthcare network locally. I am surprised at the politics around it and disappointed that some have chosen to oppose the concept of GP superclinics. It is a model that works. Aligning allied health and primary healthcare organisations generally into the one-stop shop concept is eminently sensible, particularly, I might add—from my old state parliament days—locating them as close to hospital emergency departments as possible to relieve pressures on emergency departments. I would certainly recommend that the minister for health once again look at our submission. It is exactly along those lines and includes a component on GP training. If government is going to make a contribution then there should be a contribution from the GP network to build a long-term GP structure for the future, as part of those who might receive some government support giving a bit of love back.

I flag the issue of mental health. I am not sure whether others have flagged it in this debate. There were a range of concerns expressed—including by the Chair of the National Advisory Council on Mental Health, John Mendoza—around the lack of support within this budget for mental health services. It does matter in regions such as mine. We have been traditionally underserviced. I was pleased we saw a change of budget position with regard to the ability of social workers and occupational therapists to participate in the delivery of mental health services. That was a sensible change after the budget. If it had not been changed, it would have had a huge impact in communities like mine. I make the pitch again, and I am sure there are others who have done so in this debate: mental health services are needed and they need much greater attention from government to get it right, because we have not got it right at the moment.

I noticed that John Mendoza also made some comments about Indigenous health services. The medical centre within my community that deals with 2,000 Indigenous residents made a very strong point to me—that is, there is largely no difference between Indigenous health issues and mental health issues. Of their clients, 70 per cent have mental health issues. We need to get our heads around—pardon the pun—a lot of these issues in a much better way from a policy perspective, because many people in the community are suffering and the services are not on the ground to meet the need.

I also want to mention education, while I have the chance. It is probably a nice segue from comments about silo thinking in public policy on issues such as Indigenous health and mental health. We have submissions before government within the education space around place based thinking. Our region has a pretty good track record of people making it through to year 12, but the figure is still frighteningly low at just over 50 per cent. For that to be the national average, I think, reflects on all of us and is something for us all to think about. Secondary school participation rates, in my view, are low; so why are they generally seen to be accepted?

We as a region have pretty good comparative levels of vocational education and training uptake, but traditionally we have had very poor tertiary education uptake. The Bradley review wants 40 per cent or higher of 25- to 34-year-olds to hold bachelor degrees by 2025, but our current levels on the mid-North Coast are 11 per cent. As a local community we need to get our skates on, but so does the federal government. There is a lot of very exciting work being done within the education space on low SES engagement and within the space of employment-education, and I welcome that, but we still face some challenges. I want to put on the record a comment in the DEEWR report—the government’s own report—that was released this week in the lead-up to the regional loading questions. The report focused specifically on engagement, access and participation rates in regional and remote areas. A comment in this report said that, based on administrative data—the government’s own data:

Regional and remote access and participation rates … have deteriorated over the last five years.

The report did not say ‘slowed’, it did not say ‘declined’; it said ‘deteriorated’. All of us who have read hundreds of government reports know that the language used in such reports is normally incredibly cautious and incredibly conservative. For a report to say ‘regional students’ access and participation has deteriorated’ is, I think, national emergency stuff.

If we treat as a national emergency a dispute with some mining executives then I would ask the Treasurer and the Prime Minister to have a conversation with the Deputy Prime Minister about the crisis of confidence with regional students’ access and participation rates and to get their skates on in turning this deterioration around. If we are serious about the national interest, if we are serious about meeting these Bradley targets—these ambitious and welcome Bradley targets—we need to deal with this issue now and turn around the trend which is saying that regional and remote students are not participating and not accessing education pathways. ‘Why not?’ is the question. And what is the government doing about it when it is a national emergency?

I also very quickly want to put on the record some issues about roads and bridges and the community regional infrastructure program. I am disappointed that this program has been cut. It has been treated as a stimulus only program. For regions such as mine, it was an absolute breath of fresh air to see Commonwealth funding going directly to local councils. It made a huge difference in their capital works programs. I would urge some reconsideration on that front and that it be an ongoing program. You do not have to be too much of a visionary to argue the case that such a program finishes the story around regionalism and the very point of the Commonwealth. You could argue that that job is only half done. Direct funding from the Commonwealth to local councils for community infrastructure was very welcome, and it is disappointing that it has been cut.

I have asked the government before, and I will ask it again, about a national timber bridge fund. It might sound small scale to some in this place but it is not for people who live on the North Coast of New South Wales. This issue affects not only my electorate but also that of the member for Page, who spoke before me. The town of Kyogle has the highest number of failing timber bridges in Australia. In the land of valleys and hills, these timber bridges are the lifeblood of many people. We cannot leave it to local councils to deal with this issue when the bridges are all failing around the same time, en masse. Councils are rate pegged in New South Wales and simply do not have the budgets to deal with this situation. It is a shame that, in 2010, we see one level of government struggling for money while the other two levels of government are splashing it around. I once again ask the government to consider this matter.