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Wednesday, 24 November 2010
Page: 3592


Dr STONE (12:15 PM) —Unfortunately, the member for Greenway is misguided in her hopes for the Federal Financial Relations Amendment (National Health and Hospitals Network) Bill 2010. She is quite wrong in proposing that this bill would lead to major changes in health service provisions in her electorate or anywhere else in Australia. This bill is not about any proposed health reforms. The bill is simply about federal-state financial relations. It is specifically about the federal-state Labor deal to take $50 billion of GST revenue away from the states and territories and hand it to the Gillard government from 1 July 2011.

If this was a great government that had a track record of spending dollars very efficiently and producing great value for money we would feel less alarmed, but we all know what this government does with funds. We have the BER as an example of getting extraordinarily poor value for money. We have the pink batts debacle where not only dollars were wasted but also lives were lost. In my electorate and right across Australia there are still thousands of householders who live in fear and dread of what dangers lurk in their ceilings as a result of such a badly mismanaged government policy. In fact, I defy anyone to find anything more badly mismanaged in our history since Federation.

The problem is that after more than $40 billion in new or increased taxes in the past three budgets and $94 billion in new net debt, the Gillard government now wants to get another $50 billion of GST revenue at the expense of states and territories. Not unsurprisingly, some states, particularly New South Wales, Victoria and Western Australia, are saying that they are not going to support health reform.

This bill does very little for the problems which face rural and regional populations in particular. Let me quote a few statistics. According to the Australian Institute of Health and Welfare, people in rural and remote communities experience poorer health, have higher rates of most chronic diseases and have higher mortality rates than those who reside in metropolitan areas. People in rural and remote communities experience higher death rates than their counterparts in metropolitan areas, with death rates increasing for more remote communities. Compared with major cities, the life expectancy in regional areas is one to two years lower and in remote areas it is up to seven years lower, reflecting a higher proportion of Indigenous population in those remote areas. Death rates in inner and outer regional areas are about 10 per cent higher than in major cities, and the death rates in remote and very remote areas are 20 to 70 times higher than in major cities.

This bill does nothing to address the fact that if you are born in the bush and you live in rural and regional areas your health is on average substantially poorer than if you live in a metropolitan area, and the allied health and other key health services that are provided to you—such as oncology and so on—are substantially poorer, even though the Medicare take for tax purposes is the same whether you live in Burke, Echuca or Burwood. That is not fair in a country that claims to do a fair deal for all Australians.

The AIHW reported that people living in regional and remote areas were more likely to report chronic diseases such as asthma, arthritis and bronchitis, but less likely to report osteoporosis, than those living in major cities; however, rates of diabetes, cerebrovascular disease and coronary heart disease were generally similar across all areas. So there is good news and bad news there, but, unfortunately, in 2001-03 the incidence of cancer for people in regional areas was about four per cent higher than in major cities—particularly for preventable cancers, such as those associated with sun exposure. The statistics go on and they are not a happy read, let me assure you.

So what has this government done about all this, other than state that it is going to try to get more GST funding out of the states? The federal government will try but we know it is going to have a real battle there. Why is the government not focusing on real issues such as access to health services? For example, a Senate report found that the provision of hospitals and hospital beds is concentrated in major cities. Some 22 per cent of public hospitals but only 4.8 per cent of available beds are located in rural and very remote areas that comprise about six per cent of the population.

Most small rural hospitals are not equipped to provide the full range of specialised services, and people must be transferred to larger regional or metropolitan centres. The report found that the supply of health workers declines with remoteness. The number of medical practitioners per 100,000 people was 326 in major cities compared to only 179 in inner regional areas, 155 in outer regional areas, 154 in remote areas and just 130 in very remote areas. So there is an enormous difference in access to health services, including dental services.

What has this government done? It has just very recently decided to change the classification system for how it offers incentives to get medical doctors to live and work beyond metropolitan Melbourne, Adelaide, Sydney and the other major cities of Australia. The Department of Health and Ageing has recently completed an internal review of its funding models for medical services. As part of this process, DoHA has decided to replace its current measure of geographic dispersion, the Rural, Remote and Metropolitan Areas—or RRMA—Classification, with the Australian Standard Geographical Classification—Remoteness Areas system. This is the ASGC-RA system. This change was due to be implemented on July 2010. The coalition was very concerned about this when we were in government, but the idea is to make sure there is a whole range of incentives put into various parts of Australia that reflect the need to attract and retain medical practitioners in those areas.

But what have we got with this new system that has been introduced by this government? We have a system which has places like Deniliquin competing with outer suburban areas like Sunshine because they will be offering the same incentives to attract and retain medical practitioners. That is an absurdity. Of course a very different range of incentives is required to work in outer suburban Melbourne compared to relocating your family to Deniliquin or Echuca. Subsequently, small and relatively isolated inland towns will be left to compete with much larger outer metropolitan and regional centres for GP recruits. These are the places that are now to be zoned inner regional RA2. With the significant differences and relocation and retention incentives proposed between these different levels, it is going to make it almost impossible to recruit general practitioners to small rural towns that do not have a more remote classification—in other words, outer regional RA3+.

Given the shift to the ASGC-RA system is intended ultimately as a whole-of-government initiative—and we know it has already been used in the criteria for access to youth allowance—there will also be implications for the rurality loadings in practice and service incentive payments as well as the bulk-billing incentives. This is a very serious problem. With capitation and pay for performance likely to become a far more significant component of practice income, pending the National Health and Hospitals Reform Commission recommendations on blended payments, the viability of practices in these towns must now be seriously questioned.

This new system of reclassification has seriously compromised the capacity of those, for example, in the new so-called inner region to survive with medical health services. I am referring to a report prepared by the Murrumbidgee General Practice Network, the Murray-Plains Division of General Practice and the Albury-Wodonga Division of General Practice. They have done an enormous amount of work in this area. They are very concerned and I join with them in their concern. We have to change the system. It is nonsense putting Sunbury and Sunshine in the same category as Echuca and Deniliquin. The rural health recruitment and retention incentives include the general practice component, the Rural Relocation Incentive Grant, overseas trained doctors and foreign graduates of an accredited medical school program, the bonded medical places and the Medical Rural Bonded Scholarship Scheme, and of course the HECS reimbursement scheme. All of those different incentives hang off this new system of classification which has outer suburbia competing with the same level of incentives as places like Echuca, Kyabram, Deniliquin, Moama, Nathalia, Numurkah and the list goes on. All of those places struggle to have doctor replacements, but they are not going to be able to offer any better incentives than places that are on a tram track or a short suburban train ride from downtown CBD Melbourne. That is a nonsense.

This bill before the House is only about state-federal relationships; it is about stripping away more funds from the states and putting them in the pocket of the federal government—a federal government that has a horrendous track record of poor value for money and very serious misadventure when it comes to spending taxpayers’ dollars on essential services. I commend the amendment moved by the shadow Treasurer, Mr Hockey, the member for North Sydney, which states:

That all the words after “that” be omitted with a view to substituting the following words:

   “the House declines to give the bill a second reading until:

(a)   there has been laid on the table of the House a copy of an agreement reached between the Commonwealth and each of the states and territories about GST handback in relation to the measures in this bill;

(b)   each of the states and territories has signed that agreement; and

(c)   given that the state opposition parties in New South Wales and Victoria have signalled that they do not support the current agreement, the people of those states have voted in their upcoming state elections”.

The bill’s premise is basically hypothetical. We are not talking about a bill which is going to advance the cause of delivering better health services and more health service professionals to rural and regional Australia. I find that extraordinarily disappointing in a government that claims to know about social inclusion and giving everybody a fair go.

The best thing that ever happened in my part of the world was the coalition’s introduction of departments of rural health and clinical schools and the funding provided to universities so that students in their final years of medical training could live and work in rural communities, and experience the life and the culture with the hopeful view that they might fall in love with life beyond the cities and stay there. The department of rural health and clinical school in Shepparton together with the University of Melbourne has been extraordinarily successful. Medical students at the Shepparton campus who are about to graduate experience higher outcomes in their academic results than those who remain in Parkville, and the students who go to the Wangaratta, Ballarat and Bendigo campuses are not far behind them. Therefore, we hope this government will look at those sorts of initiatives rather than the nonsense of simply playing games with the states over their GST funding. The issues are too important. I have already provided the data to the chamber about the differences in the mortality and morbidity rates between metropolitan and rural Australia. Those are real statistics. If you are born beyond the tram tracks and beyond where the government focuses its attention, it is not fair to expect a shorter life and a life with higher rates of chronic disease and disability.

My electorate has two large hospitals—Echuca and Shepparton. The one in Shepparton is called Goulburn Valley Health and Echuca is called Echuca Regional Health. Both of those hospitals urgently need an injection of capital. We have had no commitment from the Brumby government to put any additional funding into either of those hospitals. However, we have had a commitment from the state coalition in regard to the Echuca hospital. This government should be looking into issues like that. The Echuca hospital, for example, has not had any major upgrades since 1962. People going into the wards at that hospital in winter have to take their own heaters. It is an absurd almost Third World situation to ask patients to take heaters to hospital so they can be warm in their ward. Women in labour have to compete for bathrooms with those attending the accident and emergency department. Goulburn Valley Health’s accident and emergency department has the second longest waiting period in Victoria. It has the highest number of people who turn away in despair because they cannot get access to a doctor when they have presented with an emergency. This bill is not a bill which any government should be proud of and the coalition will certainly attempt to amend it.

Debate (on motion by Dr Mike Kelly) adjourned.