Appropriation Bill (No.5) 2012 came before the Senate this week and I had hoped to make some remarks on it. The role of the Senate is to act as a house of review and to hold the government to account for the legislation it passes, particularly in the important area of appropriations, which is the spending of taxpayers’ dollars. Unfortunately the government, in partnership with their coalition partners the Greens, have chosen to guillotine debate on a large number of bills this week, including important bills such as appropriation bills.
This bill includes a provision that the government will provide the Department of Health and Ageing with an additional $44.1 million to support increased payments in 2011-12 for primary care financing, quality and access, and rural health services. I have no concerns with the government providing more money to health, but I do have a concern with the fact that rural health in particular is not adequately funded. Not only is it not adequately funded but the government is not listening to people working in rural areas about what is and what is not working. I accept the fact that no government will ever be able to fund everything that everyone wants, but with the money available surely there is an imperative for people to listen to those working on the ground and to understand what is not working and change it, and understand what is working and reinforce it with the money that is available.
The National Rural Health Alliance estimates that the actual deficit in funding rural health requirements is in the order of $2.1 billion. That group highlights a range of other inequities, but in terms of the budget that is the quantum, that is the magnitude, that we are talking about. The government has responded with a number of initiatives and plans—for example, the National Strategic Framework for Rural and Remote Health. On the surface that sounds good, except for the fact that, again, it does not actually take into account what rural health practitioners in communities are telling them. You have to question whether all the money placed into developing that framework, if it is not taking account of what is happening on the ground, is money well spent.
Take, for example, the Australian standard geographic classification of remoteness areas. This is the system this government has chosen to use to decide on the payments and benefits with which it will reward doctors for choosing to go and live in rural and remote communities. Unfortunately the system does not work. We have just recently had a Senate inquiry into rural health and the incentive payments that have been made, and witness after witness after witness—practitioners, professional associations and communities—identified the fact that the classification system does not work. The small town of Eudunda in South Australia was classified 5 under the old RAMA system, which is fairly remote. It has a population of around 640 people. Under this government’s current system, it is RA2, which is considered inner regional. Hobart, on the other hand, with a population of 212,000, with hospitals and universities and high schools and a range of other facilities, under the old system was RAMA1—quite well developed and well resourced—and under this system has exactly the same classification as Eudunda. Places like Townsville, again with universities and hospitals and high schools, are considered to be more remote than Eudunda. Is it any wonder that the system is not working as intended in terms of attracting and providing incentive for medical professionals to go and support rural communities? Dr Paul Mara from the Rural Doctors Association said during the inquiry:
Quite clearly, there is a major disconnect between what the Government and its health bureaucrats are portraying as a classification system that is working well, and what the procession of witnesses at this inquiry reported.
The government needs to listen to those working in the field if it is to spend taxpayers’ money wisely. Take, for example, the superclinics. In South Australia the GP Plus Super Clinic at Modbury cost around $25 million, and it opened in 2010 with no doctors. The provider that had contracted to run it had to withdraw. GP Solutions, the second provider, has also had to withdraw. Yet, just down the road there were quite viable existing GP practices. Overall that program has cost the government $650 million, and often existing services that were working well have been duplicated. If we are in a situation where rural health is underfunded by $2.1 billion, with what justification are we duplicating existing services in the city—services that are then failing—and not funding people in rural areas?
Take, for example, the Mental Health Nurse Incentive Program. I have done a fair bit of work over the years with communities in the mid-north of South Australia, and one of the standout providers of health care is the Clare Medical Centre, which has led the way in trying to provide sustainable health models to care not only for the people of Clare but also for those from a number of satellite towns around it. In South Australia, the demographics mean that we have a lot of people in the city and small communities in the bush, and the state based services are thin. So we rely largely on private practice providing a lot of allied health services. The Clare Medical Centre, under this incentive, had engaged some mental health nurses. That saw a 50 per cent reduction in the number of patients who had to be transferred to Adelaide for hospital admissions related to their mental health problems. This government has now frozen the funding for that, which has meant that the Clare Medical Centre has not been able to take on an additional nurse they had already found and had plans to bring on board to help the community. In fact, there is no certainty of funding beyond 30 June 2013, so they are finding difficulty in retaining the people they currently have to service the community. Here is a community program that clearly works and provides a required medical service, and yet, rather than building on its strengths, the government is actually choosing not to develop it.
The Headspace program, again for mental health, for youth, was an initiative of the Howard government, and I am pleased that the current government has continued to invest in that. But, again, investment is one thing and following through with sensible implementation is another. I was speaking to a GP in the Riverland earlier this year who is quite passionate about supporting young people in the area of mental health. She described the frustration around the funding rules. In the Riverland hub-and-spoke model, there are three or four towns that all come in to a central point. She was quite happy to travel to each of those towns because the target group for Headspace is young people, who often do not have cars, and there is no public transport linking the towns that they can easily jump on. She was happy to travel to meet them, but she was told that under the program she could not access the funding unless she did it in the one location that was approved. To my mind, that is just dreadful bureaucracy getting in the way of local providers who are happy to go out of their way and service a community. In that case, it is not even asking for more money; it is just asking for sensible, good management.
One of the things that has come out of the studies looking into how we can provide sustainable health care in regional areas is that the more that trainee doctors can do their training in rural communities for long-term periods of at least a year, the more likely they are to stay with the community. Flinders University, in particular, has done some good work with longitudinal studies to prove that that is the case. The problem is that once the trainee doctors have finished their university training, they need to do their intern training. In South Australia, the workforce agency has identified that we need around 50-odd rurally based intern places to sustain the workforce. Currently there are only about half a dozen. There is a pilot program running in South Australia looking at how we can use rural GPs who cover a wide range of procedural skills—obstetrics, surgery, accident and emergency—to provide supervision for interns. But, for them to do that and to sustain their practice, the rate of pay for those GPs needs to be high enough to be an incentive to take on the additional staff, to give them the capacity to take on those young doctors.
So I call on the government and the departments working for them to not only allocate the extra $44 million but to listen to the industry, to work with people and to reinforce things that are working so that we can build for this country and for those who live in rural and remote areas a sustainable, equitable and accessible system of health care for the future of this nation.