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Community Affairs References Committee
11/05/2012
Health services and medical professionals in rural areas

NAIRN, Mr Alister, Director, Geography, Australian Bureau of Statistics

VAN HALDEREN, Ms Gemma, Program Manager, Demography, Regional and Social Analysis Branch, Australian Bureau of Statistics

Evidence was taken via teleconference—

[10:07]

CHAIR: I welcome representatives of the Australia Bureau of Statistics. Can I just clarify that you have information on parliamentary privilege and the protection of witnesses and evidence.

Ms Van Halderen : Yes.

CHAIR: Thank you. I remind witnesses that the Senate has resolved that an officer of the department of the Commonwealth or of the states shall not be asked to be give opinions on matters of policy and shall be given reasonable opportunity to refer questions asked of the officer to superior officers or to a minister. This resolution prohibits only questions asking for opinions on matters of policy and does not preclude questions asking for explanations of policies or factual questions about when and how policies were adopted.

I would like to invite either or both of you to make an opening statement if you wish and then we will go to questions.

Ms Van Halderen : Because we are on the phone, could you just let us know who is in the room?

CHAIR: I beg your pardon; sorry. I am Senator Siewert. I am the chair of the committee.

Senator MOORE: Senator Moore from Queensland.

Senator NASH: Senator Nash from New South Wales.

Senator FAWCETT: Senator Fawcett from South Australia.

Senator DI NATALE: Senator Di Natale from Victoria.

CHAIR: We also have two members of our secretariat.

Ms Van Halderen : Wonderful. Thank you very much. I will just make a very brief opening statement and then hand over to my colleague. Apologies for not being able to physically attend, but we are very pleased to be able to appear before the committee today and answer any questions that you may have relating to the Australian Standard Geographical Classification remoteness structure. We sent in a submission on Wednesday, 9 May. Hopefully, it has now been received by you.

CHAIR: Yes.

Ms Van Halderen : That provides an overview of the related structure to assist you in understanding that. We are very happy to amplify any aspect of that document. I as program manager am happy to take questions. Alister here is the director of geography and he is happy to answer questions about our classifications.

CHAIR: Mr Nairn, do you want to add anything?

Mr Nairn : No. Did you say you had received the submission we sent in?

CHAIR: Yes, thank you. It is No. 24.

Senator MOORE: Thank you for your submission. I just want to clarify: clearly, the model you put forward is a model based on geography. Is that right?

Mr Nairn : Our classification is a geographically based classification.

Senator MOORE: I am unaware of how much you are aware of the other submissions we have received. No-one doubts the accuracy of the geographic model. So there is no sense that the statistical base is being questioned. The question that is being brought up consistently in this inquiry is whether it is the best basis for the provision of medical services. That question is the basis of our inquiry.

I wonder whether there is any cross-area discussion in the bureau between the geographical branch in which you work and the group that does the various statistical returns on medical and socio-economic issues?

Mr Nairn : ABS produces a number of different classifications that take into account some of those other factors such as SEIFA, but in this case we decided we needed a geographically based classification that split up the country into different areas of remoteness to produce statistics so that the government could compare different programs over those same consistent geographic areas. So the basis of our classification is purely geographic; it is part of our geographical classification. We do not have another classification that takes into account different factors like that that are based on geography and combinations of other socio-economic factors.

Senator MOORE: My last question, because I have read the submission and I think I get it in terms of the geography but I do not know whether it is the right thing for this area: is there any way you can do a process of putting the geographic division that you have undertaken and overlaying that with the various other reports that you do, so you could actually get a build up. If you took a particular city somewhere, where it fitted in your geographic base, and then cross-referenced to see where it fitted in the various other collections that you do. Is that something that the ABS could do?

Ms Van Halderen : The purpose of this one is to be geographically based. I am struggling a bit to understand what it is you are asking me, because it would be a very unusual basis to put together a whole range of factors associated with, say, a particular area. Alister referred to SEIFA—the socioeconomic indexes for areas—and that puts together a lot of factors related to a geographical location. That one is based on socio-economic factors that are collected in the population census. That may be a little bit like what you are talking about, but you would not necessarily overlay that with a geographical base structure.

Senator MOORE: What was the verb that you actually used in that last sentence?

Mr Nairn : Overlay.

Ms Van Halderen : You would not necessarily overlay the geographically based one with a socio-economic index.

Mr Nairn : I guess the point there is that it would be possible to combine our classification with lots of other factors but for what purpose and where would we draw the line?

We try and keep those things reasonably separate. We are talking about a geographic classification here whereas some of the other things we do are actually indicators of the data in the area. It would be possible to build up a formula for an area that took a lot of different factors into account, but building that into one product is not something that we have looked at doing.

CHAIR: I am going to break in for a second because we are all interested in this. I have a couple of other senators who want to ask questions specifically on this issue, and then I will go back to Senator Moore.

Senator DI NATALE: Simply using geographical location might not necessarily be the only important metric that we need to consider when we are talking about issues like workforce. So the question is: could you provide some sort of weighting to a number of factors—you mention socioeconomic factors, geography and there are other things of course—and produce a metric that potentially weights each of those things and produces essentially a map of Australia that takes all of those things into consideration and is not just based on geography? We understand of course that, when you are doing a classification based on a question like remoteness, that is one important thing, but all we are asking is: is it not possible to weight each of the things that we think are necessary when we are talking about planning a rural workforce and then come out with a final metric that reflects that?

Mr Nairn : Anything is possible, I suppose, but if the purpose of this is specifically about health policy, then that is an issue that is probably better referred to the department of health. But we can provide all of the different factors and they could be used. If the department of health wanted to come up with a different formula, it would be possible to take other factors into account.

Senator DI NATALE: Thank you.

Senator FAWCETT: I am probably asking a very similar question to Senator Di Natale but in a slightly different format. I do not criticise your model at all; it is what it is and it is probably very valid, but the current application in this context sees a great disparity, whereby the same incentives are offered to rural practitioners in very small regional towns in the mid-north of South Australia and large population centres with all kinds of facilities, hospitals and training institutions in Tasmania. Can you suggest a way, on a statistical basis, that the government get a more appropriate guide on how those incentives should be offered?

Mr Nairn : Again, that is really a policy issue about what factors should be taken into consideration to meet those requirements. It is not the role of ABS to offer that sort of advice. I think it is better to refer those questions to the department of health. We have had discussions with the department of health about the use of this classification and some of the problems that have been expressed, but we did not reach a conclusion with them about anything that would be better—not at this stage. I think you would be aware that there was a review undertaken by GISCA within the department of health about possible changes to the model, but I am not sure where that concluded. At this stage, as I have said, we have had discussions with them about possible changes that may improve things but nothing conclusive has come from that. We would have to be mindful also that there are other departments that use this classification for different purposes than just the rural health workforce. It is used by other departments in terms of education. It is also used for government reporting in terms of government expenditure into regional areas. So it is a multiuse classification. It is not our role to produce one specific for addressing medical workforce issues.

CHAIR: We now have a slightly related question from Senator Nash.

Senator NASH: Just on this geographic: as you say in your submission, it is purely a geographic measure of remoteness. Remoteness from what? What is the definition? What is it remote from?

Mr Nairn : It is our classification. We call is the remoteness structure of the ASGC. It is based on the ARIA grid produced by the University of Adelaide. That ARIA grid is an accessibility and remoteness index of Australia. It is based on access to towns of certain sizes. They make the assumption that small towns have a lesser range of services than larger towns. It is really remoteness based on access to various sized towns. In the ARIA, they use five different classifications of town sizes, ranging from very small towns that have limited services up to towns of 250,000 and above that are assumed to have all of the services that you would need. It is really a remoteness from available access to services.

Senator NASH: If it is remote from access to services and as an example—sorry for my interstate colleagues—take New South Wales, where there is—

Senator MOORE: Just as an example.

Senator NASH: the town of Gundagai, four hours from Sydney. Then you have got the town of Wagga, which is probably only another three quarters of an hour away from there. Those two towns—one has a population of 3,000 and one has a population about 60,000—are both classified exactly the same in terms of remoteness, but it could quite well be argued that Wagga provides almost exactly the same services, say, as Sydney. When you are talking about remoteness and, as you say, remoteness from services, if the services in Wagga are similar to services in Sydney and yet services in that smaller town of Gundagai are virtually non-existent, how can Gundagai and Wagga be classified the same, if it is talking about remoteness from services, when Wagga has those services?

Mr Nairn : The next biggest town that is close to Gundagai might be Canberra.

Senator NASH: No, it would be Wagga.

Mr Nairn : It is Wagga, is it? I was talking about ARIA there. ARIA has 15 different—

Senator NASH: Sorry, can I just stop you there too: also, with Canberra it is an issue of interstate; it is not actually in the same state. Senator Moore, wants to add to that.

Senator MOORE: Mr Nairn, the other thing is that I have a view—and I would like to see whether you agree or not—that the particular model is particularly pertinent in New South Wales and Queensland, because of the size of the states and the size of the regional towns. So that the issue that Senator Nash is putting out is not as relevant in Western Australia, Tasmania or even in Victoria—

CHAIR: They have big towns.

Senator MOORE: because of the size of the regional cities. The same point that Senator Nash is making has been made to us very clearly in Queensland. I am not going to name the towns. We have, because of the geography in Queensland, a large devolved nature of significantly large towns which seem to compete with each other and smaller towns under this model.

Mr Nairn : The point I was trying to make though is we are only grading the remoteness down to four or five levels: major cities—there is 68 per cent of the population living in those areas; the inner regional, which has around 20 per cent of the population; the outer regional has about nine per cent; and then remote and very remote that has a very small percentage of the population. We only divide it down—all of the accessibility—into five levels. There would be a difference between Gundagai and Wagga when you look at the ARIA scores for them, but, when we are just having to simplify that down to five levels, they might have the same score because there is a range in each of those categories. For instance, we classify all of the places that have ARIA scores of 0.2 to 2.4 as inner regional. One place might have a more remote around of 2.3 and some might be 0.3, and they are going to be group into the same area for our classification. It would be a broad classification, largely for reporting purposes. It will not answer all of those fine levels of differences between towns that happen to be close to the edges of the remoteness categories.

Senator NASH: That is the point that you make very well, because it is a broad classification. It is not necessarily appropriate for what it is being utilised for in terms of the incentive payments. The other point I would make is that, if the remoteness is remoteness from the provision of services and yet one of those towns like Wagga provides the services, isn't it illogical to say it is remote from services when that town actually provides the services?

Mr Nairn : It would not provide the same services as Sydney, though, would it?

Senator NASH: But relative to the smaller towns around it, it has 80 per cent more. That is what we are trying to draw down in the committee—the inequities and the illogical nature of the remoteness from services when a lot of services are being provided in the towns which are being said to be remote from the major cities.

Mr Nairn : When you look at the overall national nature of the index, particularly the ARIA 15 score grid, I think it does give a reasonable picture. A place with a score of 14 is going to have better access to services than a place with a score of 15. But you will always have these issues and I understand where you are coming from. Whether it is appropriate to use this for payments is really an issue for the department and we cannot comment on that. This is not just used for the provision of health services; it is largely a tool that we produce for reporting and statistical purposes that has been picked up by other departments for different purposes. Whether it is appropriate for those purposes is really an issue for discussion with those departments.

Senator NASH: True. If you were asked to relocate from Canberra, Sydney or wherever you are to either Wagga or Gundagai and they were going to give you $10,000 in incentive to go to either, would there be any incentive for you to go to Gundagai?

Mr Nairn : That is a personal question. I might like bushwalking or something.

Senator NASH: I do not expect you to answer that. That is fine.

Senator DI NATALE: Given that one of the issues is obviously that you have to have a cut-off for each of those five categories, is there capacity to drill down further and to perhaps double the number of categories and therefore reflect a bit more of that complexity in the classification?

Mr Nairn : That was one of the things that was considered when we chose to use five categories. The reason we did it was that we wanted a general break-up, still keeping enough population in each category. We would not want to break up the very remote and remote areas any more because there are only very small populations in those areas. The inner regional category has roughly 20 per cent of the population. It would be possible to split that up a little bit more, but it only spans 2.2 within the 15-point range in ARIA. So it is not a big range as it is. But, in answer to your question, it would be possible. It would have been possible to have a greater number of categories in the classification, but when we consulted most of the users came back and said at that time they felt it met their purposes.

Senator DI NATALE: To follow up on that, it is clear that that is the category that causes the most problems in this area. Technically I imagine it is very straightforward to do that.

Mr Nairn : Yes.

Senator DI NATALE: To do it, you just need a directive from the department of health. Essentially, you would just need to break it down a little further, and that might be one way of resolving the issue we have in terms of workforce.

Mr Nairn : The department of health does not actually direct the ABS on these classifications. They may have a discussion with us, and we are doing that. If it was agreed and it was stated by the department that they had a position where they felt we should split one of these into two, or something along those lines, we would then need to go through a consultation process with other users, bearing in mind that any change affects a lot of people. They do not like to see classifications changed too frequently, so we have to weigh up that issue as well and allow enough time for consultation before we continue. Having said that, those sorts of changes would be possible and are the kinds of things we usually look at when from time to time we review classifications to see whether they are meeting the needs of the people who use them.

Senator DI NATALE: Perhaps the issue of directing and so on was not the right phrase. My point is that it is possible to do it and, if there were agreement that it would be useful, it would not require a huge amount work to be able to do that.

Mr Nairn : No. Technically, it would not be difficult, it is more about making sure that other users and people who use this classification are also happy that that would be it.

Senator DI NATALE: Why couldn't you have a model that applies for workforce planning and then other users of the existing five classifications continue to use it as it is?

Ms Van Halderen : The benefit of having a standard classification in this case is that it can then be used for multiple purposes. Not only could you use this as in this case, for the health workforce, but you could compare it to, say, population numbers and get a profile on the region. You could bring in statistics from the census and you can bring in statistics from the biophysical aspects of the town, and you could start bringing in a bit of a profile by using the standard classification. If you start breaking it into a specific classification for workforce and then try to bring up a profile of other things to do with that workforce it is a bit tricky.

Senator DI NATALE: Don't you just aggregate the data when you need to analyse it?

Ms Van Halderen : You certainly could if you wanted to use it in a different instance. The classification itself, the five groups, is based on ARIA, which is a continuous index between zero and 15. You could, technically, not use the classification at all, go back to ARIA and use the scores of zero through to 15 on a continuous scale. That is another option.

Senator FAWCETT: In one of your tables you mention that, as well as population size, you look at distance. Is that distance as the crow flies or does it take into account actual accessibility?

Mr Nairn : It is the distance by road?

Senator MOORE: Usable roads?

Mr Nairn : It does not take into account whether it is a four-lane highway or a one-lane road.

Senator FAWCETT: Sure, but, for example, it does not take into account whether pensioners in a particular town have access to public transport to travel that distance.

Mr Nairn : No, it is geographically based purely on distances between places.

Senator FAWCETT: So in the case of Port Lincoln it would take into account the eight-hour drive as opposed to the 30-minute flight.

Mr Nairn : Yes.

CHAIR: On your website you say that, during the development of the ASGCRA, you did not adopt the original classes of remoteness recommended by GISCA and DoHA. Can you explain why you did not adopt them and what were the details of those particular classes of remoteness.

Mr Nairn : I am not sure that I can answer that now. I would like to take that question on notice and get back to you.

CHAIR: That is fine. If I understand your submission correctly you are saying that there are potential changes, given the recent review of ASGC.

Mr Nairn : Yes.

CHAIR: Can you articulate a little bit more what they may be?

Mr Nairn : Those changes were really about changing a whole lot of other geographical classifications. You may be familiar with census collection districts, the smallest area you can get census data from. All of those areas are going to be changed according to some new classifications. It will not affect the remoteness classification in that we were still proposing releasing it with the same five categories. The unit that we built it up from, instead of being the CD, which was the old census unit, will be the new SA1, which is a replacement unit for census output. We do not expect that those changes will cause a lot of change to the remoteness classification itself, but the remoteness classification is due for update towards the end of this year, the end of 2012, because we do take the new census data and we produce a new list of all the towns of Australia and all their sizes, and ARIA is recalculated based on that information. We then take those ARIA values again and overlay them—in this case it will be with SA1s—to produce the five categories and the new map of remoteness for Australia, which will come out towards the end of 2012.

Senator MOORE: Mr Nairn, is the new SA1 component a smaller component, a more focused component or about the same as a CD?

Mr Nairn : It is a little bit smaller; I think there are around about 65,000 SA1s, whereas there were about 38,000 CDs.

Senator MOORE: So it is a more focused definition?

Mr Nairn : Yes, the SA1s are a little bit more homogeneous in nature. If they are residential, there is not much mixed residential and industrial and that sort of thing, and they are generally a little bit higher resolution, which in a way probably could improve things. Then again, they are not much smaller perhaps in rural areas, because they have a lower population, which limits the criteria for the size of those units.

CHAIR: Did I understand correctly that this would probably be done by the end of this year?

Mr Nairn : Yes. At the end of this year we anticipate releasing the new version of remoteness. As I said, it is still the same sort of conceptual product, but the boundaries will change a little bit, based on the fact that the populations of the centres have changed and that the unit we are using to build them up is the SA1 instead of the CD.

Senator MOORE: Mr Nairn, getting back to how different organisations interrelate with each other, is there any ongoing cross-departmental group that includes Stats and Health and Ageing to continue reviewing these things? Ms Van Halderen, this could weld with a question to you.

Ms Van Halderen : Yes, that is right, and you asked that question earlier as well.

Senator MOORE: No, the question I asked earlier had to do with internally in Stats. My question is now between departments. Senator Nash has already said that, within Education, there are issues between the statistical basis and the way policy is developed. I want to know whether there is an ongoing interrelationship between Stats and Health and Ageing on the various issues of how you use the model, what the best way of doing it is and what factors are required.

Ms Van Halderen : The ABS is in constant contact with the Commonwealth and the state and territory departments around these issues. We consult quite extensively, not just with the Department of Health and Ageing but with the education sector, with FaHCSIA, the users of the classifications. It is an ongoing dialogue. In particular we consult very closely at this time when we are reviewing the process. Alister mentioned the release coming out later this year. We will be going through a consultation process as part of that development prior to release. Specifically on this one, we do have an ongoing dialogue with the department of health around the use of this between our two institutions.

Senator MOORE: Is that with the health workforce or the rural health part of Health and Ageing? We will ask the department as well. I am just wondering with whom you dialogue.

Ms Van Halderen : I would have to take that on notice and get back to you with which part of the portfolio we—

Senator MOORE: We will ask the department this afternoon as well. I am always interested in this ongoing discussion.

Mr Nairn : We have had quite a lot of ongoing discussion with Health on this. They have obviously been considering different options and have asked us for different information. We have been continually providing some information and discussing options with that department.

CHAIR: Thank you very much. We have given you some questions on notice. Could we have those back within two weeks, if possible.

Mr Nairn : Would you be able to send those questions across to us?

CHAIR: Yes, we will.

Mr Nairn : Thank you.

Proceedings suspended from 10:40 to 11:01