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Wednesday, 15 February 2012
Page: 1546


Dr STONE (Murray) (17:45): I rise today in this debate on Appropriation Bill (No. 3) 2011-2012 and Appropriation Bill (No. 4) 2011-20012 to talk about a very significant part of the work of any government—the funding of medical and health services. We must succeed, in a way that is different from the past, in providing enough rural health services.

We know that there is an incredible shortage of health practitioners who are prepared to go to and stay in rural and regional Australia. My electorate is in Murray in rural Victoria. There we have a significant shortage of health service professionals compared to Melbourne or any other metropolitan area in Australia. For example, the number of GPs per 100,000 people in rural areas is 50 per cent to 66 per cent of the metropolitan provision. Mortality rates are 15 per cent higher for rural men and nine per cent higher for rural women compared to urban residents. And we need to close the 17-year gap in Indigenous life expectancy in Australia.

One of the greatest initiatives of the Howard government was designed to tackle rural doctor shortages through the establishment of departments of rural health and clinical schools. They were established in a number of key locations around rural Australia. Some of these centres have now changed the face of medical services and training for all time. They have certainly changed the culture of medical services provision in my part of the world.

Then minister for health, Michael Wooldridge, championed these initiatives and I will always be grateful that he listened to my argument that the first of these new departments of rural health should be established in north-central Victoria in Shepparton. The first sod was subsequently turned on a pouring wet day in a tent by Prime Minister John Howard. He was standing there at an excellent site over the road from Goulburn Valley Health. The site had enough space for what was soon to be built—excellent student residences and teaching places.

Shepparton is, of course, within the Goulburn Valley. It is a unique part of Australia with a rich mix of Indigenous, refugee, migrant and very long-established families. They have long suffered from a lack of specialist and general practitioner services. We were in despair. It is only a two- to three-hour drive up the highway to the capital city but it seemed impossible for us to lure new health service professionals to replace the ageing and very excellent medical workforce we had had for decades in our part of the world.

The University of Melbourne Department of Rural Health was therefore established in 1999. In 2002 it evolved into the Rural Clinical School and the School of Rural Health in that same year. I can very well remember when the first students from the University of Melbourne Parkville campus had to be cajoled—they had to be metaphorically dragged, kicking and screaming—to even think about leaving the city to come to this rural environment at Shepparton. It gives me enormous satisfaction to say now, 11 years on, that the places at the rural clinic schools are oversubscribed and that was also the case in 2009, 2010 and 2011. It is now the case that the academic results of the medical students there are better than the results achieved by their metropolitan peers. In fact, the valedictorian medical student for the 2009 graduating class in the whole of the University of Melbourne came from the Rural Clinical School—Dr James Hillis. More than 30 per cent of those who graduate are choosing rural internships. There are increasing numbers of senior registrars at our hospitals in the Goulburn Valley and elsewhere in northern Victoria who are in their final year of GP training.

We are also very proud that our longstanding professor, Professor Dawn DeWitt—who has recently taken up a new position in North America—in 2009 was part of the team from the Rural Clinical School who were awarded the Melbourne Medical School Excellence in Teaching Award and in 2010 led the team that won the Melbourne Medical School and University of Melbourne Program Innovation in Education Award.

In 2003 there were fewer than 20 students and only a few staff; now, there are 500 to 750 rural health profession students, supported each year with an annual budget of about $10 million. We also have the Centre for Excellence in Rural Sexual Health, which is extremely important in ensuring wellbeing in our part of the world. We have higher rates of teenage pregnancy than in many other areas and we certainly need to tackle a lot of sexually transmitted diseases and reduce the incidence of foetal alcohol syndrome. Two Indigenous full-time staff and, in all, five Indigenous staff work on these campuses. This is an initiative that can only continue to grow and to change expectations in relation to rural placements for medical students.

Another important initiative was providing special places at the University of Melbourne for students who had finished their secondary schooling in northern Victoria. Some of them are now looking at practising medicine in the places where they grew up.

Over $40 million has been spent in infrastructure since 1998. This has not only been at the campus itself in Graham Street but also at Goulburn Valley Health. This infrastructure has included specialist consulting suites, a simulation centre and a library. Then there is the joy of the new $1 million medical teaching facility. We have as part of this initiative a special GP teaching clinic. In Australia there is still an expectation that general practitioners, as part of their everyday work, take on senior medical students and, almost like an apprenticeship, guide them and provide some clinical experience. This is difficult when your GPs are very hard-pressed, with large numbers of patients in their waiting rooms. Also, they often do not have sufficient space to give to their student. So this GP teaching clinic has been a highly successful innovation in Shepparton.

In this clinic, patients are diagnosed initially by a student, before moving on to a specialist academic GP, who again talks with the patient and looks at the diagnosis and conclusions made in the earlier consultation. This service has grown to a point where the books are full. I have had so many comments from my constituents. They are coming to my office in Shepparton saying, 'We have been to that clinic. We can't believe how caring our treatment was; we were able to spend time discussing our health problems. We're going back.' I think that is an excellent outcome.

We also have placements for dental, pharmacy students, social work and psychology students. There is also a very important nursing collaboration with La Trobe University. I cannot imagine that in the very early days anyone would have believed the extent to which the Department of Rural Health Rural Clinical School based in Shepparton has leavened the health service professional environment throughout northern Victoria.

We now have towns like Numurkah with special funding for extra teaching space and accommodation. At Echuca we have funding that has converted what was a nursing home into excellent student accommodation, just a short walk to the Echuca District Hospital. That city too is now able to participate in convincing medical students born and bred in the capital cities that a regional city can be an excellent place to live and work. There is the Murray to Mountains internship and beyond project, which is a set of collaborative postgraduate basic trainee positions. There is the Bogong and Victoria Felix collaboration for supervisor teacher training for Melbourne university students. There has been mushroom-like development from the home base at Shepparton, and we have seen that some of our most expert GPs—our most long-serving GPs—have also been able to add academic teaching to their professional experience. They would never have expected to have had that opportunity without shifting from a rural location.

The purpose-built facilities we now have, which include things like procedure rooms, general practice and specialist consulting rooms, student consulting rooms and the student learning hub, encourage multiple interactions between our longstanding practitioners and students. At the new University of Melbourne Shepparton Medical Centre we are seeing patient care which at the same time provides a true learning environment. It is win-win all round. We are also proud to have in our part of the world a large Indigenous community that is very much integrated but there is an understanding that their needs must be met in a culturally sensitive way. That is being provided as well at the University of Melbourne Shepparton Medical Centre. It is our hope that it will not be long before one of our Indigenous school leavers chooses medicine as a career and will be able to spend some of their important learning time based in their home community at Shepparton.

There are of course a number of other cities and towns that also cooperate or integrate with the University of Melbourne's special centre of learning, what was once called the Department of Rural Health. They include Wangaratta, Benalla, Bendigo and Ballarat. I am proud that Georgia von Guttner, the manager of much of that activity, has been able to grow that collaboration and cooperation. We have been particularly blessed with the excellence of the staff in this project. I mention Professor Dawn DeWitt, who gave nearly eight years to the pioneering work of developing this institution. While she was and is a diabetes specialist, she is also a specialist academic teacher, so students who have gone through this place of learning in Shepparton have been given an extraordinary level of personal tuition and have, I am sure, had an experience that will last them a lifetime.

At the graduation ceremony at the end of last year I was so impressed with the enthusiasm of these doctors to be and of their understanding and empathy with the particular issues facing rural and regional Australia. Numbers of them said that if they were not intending to return immediately to a rural practice they certainly saw themselves basing much of their career in a place beyond the capital cities, because they appreciated that life can be very satisfying beyond the tram tracks.

I commend these types of initiatives to this government. Unfortunately, there has been neglect and there has been a failure to innovate in a way that the John Howard government did. Dr Michael Wooldridge was exceptional in his understanding as health minister, because he himself was a medical practitioner. This innovation was bold. It was not cheap. It took teaching away from institutions that had never imagined they could set up green fields sites and still offer excellence in learning. But the Shepparton campus has proved that all can be achieved with dedication and commitment. I congratulate all who have been associated with this project from the beginning. I know that in the future it will be a place of continuing excellence and will provide many dedicated and committed rural and regional health service professionals.