Local, Independant and Effective

National Rural Health Commissioner role needs more work

Posted March 24, 2017


Ms McGOWAN (Indi) (17:05): I am absolutely delighted to support this bill, the Health Insurance Amendment (National Rural Health Commissioner) Bill 2017, and to second the comments from the various speakers. However, in doing so I would like to say that, while it is a good first step, it does not go nearly far enough. In addressing my comments to that, I would like to add to the context that I acknowledge the minister and his staff for the open way they have worked with this bill. I am going to be moving some amendments a little bit later, but I acknowledge the great communication that we have had together, so thank you for that.

I would like to stress that health is one of the fundamentally important aspects of our community. In my electorate, together with transport, telecommunications and education, health is one of the most commonly addressed issues that I hear when I go around my community. So when we get a bill like this in front of us, I am really optimistic that the government have actually understood the complexity of health and how it is an integrated issue that we need to address. Sadly, it is not only about GPs. I would like to talk about my electorate and about how important an integrated approach to regional health is. And, while doctors are really important, they are only one part of what is a system. For many, many people, their place of health and health care is not the doctor; it might be their home—it is the parents, it is the mother looking after the kids, teaching the children about hygiene and how to have exercise and how to be safe. For me, the home—along with the parents—is a fundamental place for health care.

And once we have the home looked after and we have educated our families and our parents well, the next circle of influence around health is our schools. I am really pleased that the Victorian government is doing some fantastic work on trialling doctors in schools and working in that context—a great approach.

And the next circle out from our schools is our communities. In country areas, it is not only community health that is important; the other community workers play a really important part. Aged-care workers, childcare workers, local government workers and health inspectors—what an important role they play in our health.

And then we have our workforce. Again, our OHS people play a really important role in keeping us safe at work.

We also have the hospitals. The emergency service at the hospital is the most obvious place we go to when we think about health. And then, of course, we have our GPs and specialists.

If you can imagine that as a system, everything needs to be in balance if we are going to do what needs to be done to improve the overall health of our community. We have heard all the speakers today, including the minister, say how poorly our rural communities are doing with health. So while I welcome the support for GPs it makes me really sad that we have missed the opportunity to do so much more. I acknowledge that this was an election commitment—and it is important that we fulfil election commitments—but I really do feel that it lacks ambition. So I am looking forward to now working with the minister and his advisers and saying: 'A tick for this. Now let's see if we can get the whole system to work and do a much better job of improving health for rural people.'

I will now take the opportunity to talk a little bit about what happens in my electorate with health. I want to take a few minutes to call out to the many providers. I have talked about the home and the family, and I have talked about community health. But what I really want to do in this speech today is acknowledge the work of the institutions. They are the focal point that really needs a lot of attention and a lot of help. We constantly talk about government, but it is the institutions that we are looking to for funding to allow them to do their job. I want to acknowledge Albury Wodonga Health, a fantastic cross-border initiative. I do not know if you can possibly imagine the impact it has had on our community to have Albury and Wodonga work together, the cross-border approach that we have now got, and the connectivity that is happening because we have one board and everything working together—the cancer centre, the babies and the emergency health. So I want to give a bit of a shout-out to Albury Wodonga Health for the fabulous work you do there.

And I want to link it to this legislation. Albury Wodonga Health does not only exist as a hospital; it also does training. Albury Wodonga Health has a relationship with the University of New South Wales. The student doctors do their rural work year in Albury-Wodonga. That is such an important aspect of the training because it gives all those student doctors who are city based or who have gone to the city for training a chance to work in a rural community and get a sense of how wonderful it is to work there. I really want to thank all those people who have done the work to make that training centre there work so well. I know that all the staff there go so far beyond the call of duty to make it such a rich experience for doctors doing their training. And to all the doctors who come from other places to do that year of training in Albury-Wodonga: we love having you. We want to see more of you. We really do hope that the experience is so rich and rewarding that you will put your roots down and come and live in our community.

Similarly, we have Northeast Health Wangaratta. The Wangaratta Hospital does a fantastic job of providing hospital and related services, and it also does doctor training. Through their relationship with the Department of Rural Health at the University of Melbourne they do fantastic work. They get the people from the University of Melbourne to come up and do their training in Wangaratta and get some amazing exposure to top-quality medical specialists and ways of working. So I give a shout-out to Albury Wodonga Health and Northeast Health Wangaratta for the training you do for our doctors.

I will be looking forward to working with the commissioner and saying: 'Here are some models that are working really well. How can we replicate them in other areas and finesse them a little bit where appropriate?' I just want to take a moment to talk about what happens in Wangaratta. It is an amazing example of the creativity and innovation that is coming out of our rural hospitals and related training. In Wangaratta we have telehealth. Through the internet, with high quality video services, some of the smaller hospitals can link into Wangaratta. You might be in Corryong or Mansfield; over the weekend, you can link into specialist services in Wangaratta via the internet and have an immediate diagnosis done—and if you need extra services it is all there. That has made such a difference to our smaller hospitals. I am so pleased, and I really want to congratulate Wangaratta for taking that initiative. What a fantastic job it has done, and what a service it provides to our communities.

But this system approach that I have been talking about works well because we have a dedicated internet service. Ideally, we would have access to quality internet services everywhere in Australia, particularly in rural Australia. Sadly, that is not the case—and I am not even hopeful that the NBN service will deliver the expertise we need. But if we do get it, it will absolutely revolutionise the ability of our hospitals, our GPs and our medical professionals to provide services to people back into the other parts of the system—the homes, schools, workplaces and other areas where health and healing are practised.

In acknowledging those two major providers in my electorate I also want to do a call-out for two other specialist health providers. The Upper Murray Health and Community Service, which works in Corryong and Walwa, is a multipurpose service. Multipurpose services are no longer popular. It is such a pity. In our rural communities they provide health and aged care, and they employ doctors. In Corryong, they employ doctors to come and do the health and community work that we need doing. The model of funding has not changed in years, and we absolutely need to review that multipurpose service funding and reintroduce a 21st century approach, because hospitals like Corryong provide such a service in my community and, if we cannot get the funding right and they close, we will have no doctors there, because the only doctors in Corryong are the multipurpose employed ones. So, if we do not have the MPS providing the service, that whole community will be bereft.

In a similar way, I would like to acknowledge Alpine Health. Alpine Health is another MPS, and it works in Mount Beauty, Bright and Myrtleford. That MPS is particularly noteworthy, because of the health promotion work that it does. It provides that extension to the community, families, workplaces and community health and does such a good job in actually keeping people out of hospitals and out of our GP services through its health promotion.

One of the things that I am really disappointed about in this legislation is that we do not talk about health promotion. We have not talked about how stopping people getting ill is a really important part of the whole role. I am just putting it out there that it is an area of work that I think the government could do a huge amount of work in and would save us so much money further down the line. I want to say that health is a complicated system and this bit of legislation only addresses a small part of it—a very important part, which is our doctors and GPs, but we have a lot more work to do to make sure that the system actually works better in rural and regional areas.

I will turn my thoughts for a moment to some of the problems that I see with this legislation and what I would like to see happen. One of the things the minister said in his second reading speech was that this was going to be an independent position. Sadly, I do not accept that, if you put a person working in a health department, they will be independent. I do not see how that is going to happen. I cannot see the arm's length there that is going to be engaged. I cannot see how this position is going to actually have the ability to consult widely. You could spend your whole two years just doing consultation. So that idea of an expert panel that this position can work to would be really important.

At the moment, as the legislation stands, this position does not report to parliament—in fact, it does in a way. The legislation says that the commissioner has to report every year on what they are doing, but the final report goes to the minister. It is my belief that the final report should come to parliament. I have great respect for this current minister who is bringing this legislation to the parliament, but, sadly, he might not be the minister in two years time, so we have to make sure that the report actually comes to parliament and the parliament gets a chance to know what the commissioner is doing and that they are in fact, doing what they have been set out to do.

My amendments set out to make the position more transparent by requiring the minister to table the final report within five sitting days. It is to ensure that rural and regional communities are consulted by including them in the bill rather than assuming that they will be in the other stakeholder group. I cannot quite see how the family, the home and the schools are going to be consulted in this process, and it is really important that they are.

I also include in one of my amendments a role for the commissioner to consider the affordability of health services, particularly addressing the problem of no-gap bulk-billing. Just to talk about bulk-billing, it is such a problem in my community that we do not have doctors who bulk-bill in many of my smaller rural communities. The doctors say, 'We can't afford it,' on one hand, but they also say, 'We do it,' and they do it as an act of grace if they see the need. To me, you should not be relying on the goodwill of a doctor to be bulk-billed. It should be part and parcel of the function, and we need to do a lot of work on bulk-billing to make sure it is more evenly addressed in rural and regional areas.

In bringing my notes to a close—and, as I said, I will be further addressing this in consideration in detail—I would like to acknowledge what the bill does. It is great that the election commitment is being addressed. I would like to acknowledge the work of the minister and his staffers and thank them for their cooperation. I would like to ask for much greater ambition. I think, as everybody said, we have not got anywhere near resolving the problem. All we have done is picked up on one very small aspect of the problem in the system, and we still need to do a significant amount of more work. I would be very happy to work with the minister to do that and I am very keen that we come back to the House with other pieces of legislation that actually bring a systems approach to this particular issue.

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