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Wednesday, 22 August 2012
Page: 6139


Senator McKENZIE (Victoria) (17:22): For almost 12 months now the Community Affairs References Committee has been looking into the factors affecting the supply of health services and medical professionals in rural areas. This inquiry started with the knowledge that people from regional Australia experience poorer health outcomes than their urban counterparts. It was the Nationals' very own Senator Fiona Nash who brought these terms of reference to the committee.

Research tells us that people who live outside major cities are 20 per cent more likely to have had asthma and 16 per cent more likely to report mental or behavioural problems. The Australian Institute of Health and Welfare reports that people living outside major cities are 1.2 times more likely to engage in behaviours associated with poorer health, such as smoking and binge drinking, than people living within major cities. Life expectancy in regional areas is one to two years lower and in remote areas it is much more—seven years lower. Part of that could be because of the difficulty country people have had in accessing health services. We know that to be the case—because there is not a doctor's surgery 10 minutes down the road; there are no specialist staff in the local small hospital there ready to assist.

We wanted to find out exactly what the issues are so that we can look at how the government and community can work together to solve the problem. As others have mentioned, there was no shortage of people assisting us with the task—from academics and the medical fraternity, both retired and current, to local community members. As part of that process we have heard from stakeholders right across Australia and built up a picture that shows that the problems being faced by those in country areas are quite consistent throughout the country.

For a start, the Australian Standard Geographical Classification Remoteness Areas model used by the government to determine what is classified as regional, rural or remote is flawed. It is the same model that is being used to determine a whole host of incentives and policy settings which I will not detail now for the sake of time. But it is the classic one-size-fits-all policy: it does not work, especially for the regions. It is particularly relevant in my patron seat of Bendigo, a large regional centre that serves the surrounding area with a soon-to-be-built, world-class $630 million hospital. We heard examples from Central Victoria General Practice Network and the Murray Plains Division of General Practice regarding the crude application of the RA classification, which gives communities with population bases ranging from 2,000 to 100,000 the same relocation and retention grants. There is a big scope of difference there in reality. Tiny towns in the region surrounding Bendigo, such as Elmore, do not receive any additional recognition for their particular situation.

The Centre of Research Excellence in Rural and Remote Primary Health Care, based in my patron seat, has done some excellent work in this area. It is referenced throughout the report and commended by the committee. I suggest that anyone with an interest in this area read the work of Professor Humphreys. Additionally, we found that a problem in country areas is that GPs are becoming increasingly rare as more medical students opt to specialise; yet rural GPs need a well rounded, complete set of skills. One day you have to set a leg, the next day deliver a baby, do the stitches and dispense some antibiotics for a cold—and that is just for the animals. Jokes aside—that is for the community members. We need really well rounded medical graduates in regional areas. These skills are just as important as a specialisation in other areas. Indeed, these days general practice can be a specialisation in its own right. We have mentioned Queensland Health's efforts in this area and I would particularly like to highlight those. It is quite an exciting approach to the problem.

Medical specialist numbers plummet outside the major cities to levels as low as one-sixth of those in large capitals, hence the need for better access to specialist services whether through transport assistance or even through specialists travelling to regional areas for one or two days a month to enable locals to access their services. The committee is encouraged by the steps already taken and wants to see the progress of the Rural Clinical School programs continue to ensure that students have access to support at all stages in the training and placement program. There is a great quote that I would like to be able to deliver here but for the sake of time I will not be able to. It was a key factor in supporting the training out there. The evidence suggests that we have seen the need; we are training more medical graduates but they do not have the funded places to go to, to complete their training. We would like that to happen in the regions so they can get on board with what a fantastic experience it is outside capital cities—and hopefully join us there for their long careers.

I would like to thank Senator Siewert, Senator Nash, Senator Moore, Senator Boyce and Senator Fawcett for great work done on a great report.