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Monday, 21 May 2012
Page: 4925


Ms O'NEILL (Robertson) (17:29): It gives me great pleasure to speak and address this report and the recommendations that we have put forward after what was for me one of the most interesting periods of learning about our health system that I have undergone. Happily, I have been blessed with good health most of the time and my experience, like most Australians my age, is of a fairly seamless system. But the reality is that we have not, particularly given the $1 billion that was pulled out of health under the former health minister, had a very careful planning of our workforce; neither have we had a very careful education of our doctors to a point that they were able to come into our system in a way that responds to the needs that are evident in the seats that we represent.

So I have to acknowledge from the outset the incredible contribution to the public health of this country of international medical graduates who have been coming to us for so many years and contributed to our local communities in incredibly significant and positive ways. That being said, some high-profile cases recently indicate that perhaps the system was not all in good health and that people who should have been picked up as unsuitable for working in our system were overlooked.

I think I can say that it was definitely a bipartisan, unanimous report in the end. Working with my colleagues we all had a sense of great understanding and acceptance of the good work that had been done but also the fact that currently people who were seeking to coming to Australia to work as international medical graduates to support the service delivery that is so vital to our people were actually, literally caught and lost in a labyrinth.

Considering that in regional, remote and rural communities 40 per cent of the medical workforce comes from the supply of international medical graduates, it will give people listening to this debate some idea of how critical this issue is for us. It was a long inquiry and it was held right across the country. There was incredibly moving testimony by people who had managed their way through the system, got out the other side and were now participating. Similarly, there was incredibly moving in a very unhappy way testimony from people who could not negotiate the system. In that sense I think that the words 'lost in the labyrinth' are something that I want to explore.

Firstly, lost in the sense that there was a very uncertain pathway forward for many of these people, who had in quite a number of cases very lengthy periods of successful service as health professionals, as doctors, in their own countries and who came and met a wall of resistance. It is fair to say that the committee was very mindful that excellence in practice was always at the heart of our concern. But with some of the processes that these formerly highly proficient and recently practising medical professionals had been engaged in, they were suddenly completely lost to our service because they were unable to negotiate the kind of paper warfare that they had to undertake to get through the requirements.

We had the testimony of people who are recruiters themselves, investing a huge amount of time in attracting great people with great recommendations and finding that when those people came to approach the system here there were complete disconnects between information received on application and then information that had to be handled and managed here. It was embarrassing to hear that people had provided accurate registrations of their success and completion of studies and that they had done that over and over and were requested on so many occasions to completely resubmit material.

It spoke somewhat to me of the imbalance of power in this structure. The people who are the gatekeepers of the profession are, with best intentions, determined to maintain excellent standards, but, sadly, in a duty-bound, process-bound system of applying and looking at applications, they ended up creating a structure where people who really should have been able to get in, get their paperwork processed, get through and get practising were actually impeded from doing so. So the sense of being lost in the labyrinth was a loss of capability to our system by people who were messed around through Immigration and through different agencies; a loss of the capacity for their talents and skills to be actually used very, very well here. A couple of the recommendations that relate to the problems that arose related to testing, particularly recommendations 22 and 23 in our report. They spoke about problems that we identified with the way in which people were tested. We had quite a degree of testimony from people who were very experienced, who had been operating for 20 years in their profession in some cases, who had to do the equivalent test of a student who was just completing their undergraduate studies. The mismatch between the testing of current practical capacities and old, known, abstract knowledge was something that we were really concerned about, and we have a number of recommendations regarding that.

I think the member for Hasluck has highlighted one of the other very significant concerns that we came across, which was a failure to have proper workforce planning. That was very evident and had resulted in the situation where we have a period where we have been incredibly overdependent on overseas trained doctors. In the testimony that we took, a number of people pointed out that we are, indeed, a very rich country, an economically developed nation, and it is vital that we have the capacity to meet our own medical practitioner workforce needs. It was indicated that the World Health Organisation global code of practice states that member states should meet their own health human resources needs as much as possible.

Sadly, we have had a period of inadequate supply complicated further by a very uneven geographical distribution of our workforce. Our commitment, as a federal Labor government, to increasing the number of training places for doctors to 'grow our own' is actually beginning to have an impact, but even that was pointed out as having some horns on it in terms of how we get the proper training in place for this large number of graduates who are coming through who are home grown.

I was pleased that in our hearings we went right around the country. I know that the member for Bass indicated that it was the first hearing of that kind held in his electorate. We did glean some extremely helpful evidence when we were in Launceston. We also had the opportunity to visit my electorate on the Central Coast.

As the member for Bowman was just pointing out, the definitions of terms such as 'district of workforce shortage' and 'area of need' became problematic. It was evident to us that these were problematic terms. When faced with the cost of recruitment and then the challenge of how that met with current regulations about where a district workforce shortage occurred and where an area of need was determined according to criteria, we found there was incredible misfit in an area such as mine, which is only 1½ hours north of Sydney. We have had a number of local ageing practitioners, some of them overseas trained, who have now retired. With three or four of them retiring, there was, all of a sudden, a drop in the capacity of local practitioners to respond to growing need, which was not being assisted by current definitions of 'district of workforce shortage' and 'area of need'. That was very, very apparent not just in the remote areas, which we could see when we went to the electorate of the member for Parkes. We saw incredible difficulty there, but it was surprising to me how there were difficulties also in areas such as mine that were quite close to cities. It tells us how fine the line is between the number of people that we are training and the capacity that we have to respond to our local communities. I think that the recommendations we have made in this report—all 45 of them—address some of the systemic problems that became increasingly apparent to us as what was described as 'the spaghetti-like nature' of how one might proceed through this system became more and more apparent.

In closing I thank the members of the committee, the members for Swan, Parkes, Shortland, Bass and Hasluck. It has been very much an experience that I will remember as a very positive one in my first major hearing in this place. I also acknowledge the leadership of the member for Hindmarsh, and in particular the work of the secretariat, who were so determined in making sure that we got excellent evidence on which to draw in making these recommendations. I particularly single out Dr Alison Clegg, Mrs Sharon Bryant and Mr Muzammil Ali, who did incredible work for us.