SPEECH - Health Insurance Amendment Bill

26 October 2021

I am very pleased to rise in support of the amendments moved by Labor to improve the bill currently before the House, the Health Insurance Amendment (Enhancing the Bonded Medical Program and Other Measures) Bill 2021.

I will come to some of the comments made by the previous speaker, the member for Robertson, with regard to the University of Newcastle shortly. I want to take this opportunity to, at least in the beginning, try to map out the intention of this bill. It is an effort to amend the Health Insurance Act that would try to provide some flexibility into the Bonded Medical Program and the administration of those related scholarships and contracts there. The government says the bill is designed to address the doctor shortage across the regions, including in rural and remote areas. I take issue with that claim. I seriously think that is overstating the work of this bill. Whilst this might provide some relief to one small component of the reasons why we continue to have doctor shortages in rural, regional and remote parts of Australia. But it is not only those parts, as you would have heard many members on this side of the House say, including now me, as the member for Newcastle. We are suffering doctor shortages in metropolitan and outer metropolitan regions. Don't for one minute think this is a problem only for remote or rural parts of Australia. Why is that? It is because of deliberate policy decisions made by this government over the last eight long years.

There are aspects of the bill that Labor is absolutely supportive of. We do welcome these small changes to the way in which the Bonded Medical Program is going to be administered. It is welcome that there will be increased flexibility around the administration of the program. We don't have any beef, we don't have any problem with the proposed changes being made there. What is at issue is the notion that this will somehow address doctor shortage issues in this country, because it's not going to, and I don't think we should be pretending otherwise. That is really the reason why Labor pushed so hard to establish the Senate Community Affairs References Committee inquiry into the provision of GP and other health care services in outer metropolitan, rural and regional areas. We needed to be able to consider the performance of programs like the one that is the subject of this legislation, the Bonded Medical Program.

The Bonded Medical Program has been in operation for some time. It needs a thorough review, I would suggest. It has not met expectations by any means, but let's not for one moment think this is the sole reason for doctor shortages in our nation. Indeed, it is worth reminding the House that it is the Morrison government's decision to remove areas like Newcastle and the Hunter region from the new distribution priority area classification that means that doctors in thee Bonded Medical Program cannot meet their return of service obligations in areas like Newcastle and the Hunter. That just makes our GP shortage even worse.

I said at the beginning that I wanted to come back to some of the comments made in relation to the University of Newcastle by the member for Robertson. I'm not disputing the fabulous work that the university is doing and the big efforts being made to establish yet another medical school, this time on the Central Coast, but I warn this government that just creating new medical schools is not going to be the panacea either. Do you know why? I went through this argument when the government, and the National Party in particular, led the charge to create the new Murray-Darling Medical Schools Network. The government dedicated nearly $75 million to establish this network of medical schools. I believe there was a bit of celebration this year with new students starting in some of those medical schools, but let's not kid ourselves that this government, in setting up new schools, provided a single extra medical place to go into those schools. What they did was to rob universities like Newcastle, which already had the oldest and most successful regional medical training program in Australia, of medical places. We have since 1978 had a partnership with the University of New England in Armidale, training doctors for regional and remote regions of Australia, way above the national average for universities. You—not you, Mr Speaker, but this government—took medical places from successful universities like Newcastle in order to stump up on a promise from the National Party to deliver a new set of medical schools around the Murray-Darling region. It is terrific that people from Orange, Wagga and parts of Victoria get access to medical schools closer to home, but they weren't new places; you robbed existing programs in the country of those places.

If you were serious about addressing medical workforce shortages in Australia, you wouldn't just build new medical schools; you would be properly resourcing them, and you would be backing in programs such as those that the University of Newcastle wishes to implement now. We already run a really fantastic nurses training course: the Bachelor of Nursing program at the University of Newcastle. But we know that there are low numbers of First Nations nurses in Australia. For example, people from the Aboriginal medical services in Walgett and Brewarrina have come to Newcastle to say, 'We want you to run a Bachelor of Nursing program on country.' What a terrific idea! The University of Newcastle is flexible and innovative enough to be able to deliver a Bachelor of Nursing program on country, but it needs some support from this federal government to do so. So, if you were really serious about trying to address GP shortages and medical workforce shortages more broadly in rural, regional and remote Australia, you would be backing in, 100 per cent, universities such as Newcastle, which are seeking to deliver bachelor programs on country for First Nations people.

The university is not resting on its laurels. We know that the University of Newcastle is already training more than 50 per cent of First Nations doctors; they will be trained and coming out of the University of Newcastle. It is a phenomenal course that's taken 30 years to build. But, not content to just sit back, pat ourselves on the back and say, 'Good job,' we now realise the challenges of delivering bachelor programs on country, where we can increase the numbers of nurses coming through tenfold or more. So I really hope that the government is listening today and is prepared to back in a great program like the nursing-on-country program.

As I said, you can't just take from existing programs, plop them over the country and expect that all of a sudden you will have more doctors and they are going to stay in rural and regional areas. You should be turning to places like Newcastle, which has been running that regional medical training, as I said, since 1978. So it's not as if we're newbies in this field. Thirty-six per cent of the students coming through those programs come from rural and regional communities in the first place, and that compares to the 20 per cent currently coming through other medical programs. We know that graduates of that joint medical program between Newcastle and the University of New England at Armidale are twice as likely to seek work in the rural and regional areas as the national average.

So, as a program with the highest proportion of graduates working in rural and regional areas, I think there is a lot to be learned from programs that have a lot of runs on the board already.

I want to highlight a couple of case studies that show how detrimental the continuous freezing of the Medicare levy over the last eight years has been. There is this change now, where you carve out the Newcastle and the Hunter region and take out the incentives for bulk billing payments, carving us out of the Distribution Priority Area classification list—all of this means that you are making it less and less possible for people to be able to see a GP in a timely and affordable manner in my community of Newcastle.

I want to raise the case of the Fletcher medical centre in my electorate. It's one of many GP clinics across Newcastle affected by this government's callous disregard, really, for what is happening to the health and wellbeing of Australian families in nonmetro, non-capital-city communities. Madison, who is the practice manager at the Fletcher clinic, recently reached out to me, because they are desperately trying to fill GP vacancies in their clinic. The clinic is working overtime in order to try to meet demand. It is not sustainable. It has been made worse by the COVID-19 pandemic, of course, yet they know that the Newcastle catchment area is only one per cent over this mythical catchment benchmark that means they now have to apply for an exemption in order to be able to recruit an additional GP. As I said, they're only one per cent over this benchmark, but the government hasn't been able to see its way to providing them any kind of break: no exemption for you to go out and find the GP that you so desperately need, for what is a vast and fast-growing area in the western part of my electorate.

I also want to highlight the recent closure of a practice at West Wallsend. This was a practice that existed for over 30 years. Again, in an area of growing families, six years of Medicare freezes followed by this decision to reclassify our area out of the DPA list was the final straw for this GP clinic; they had to shut their doors. They serviced a low-socio-economic part of my electorate, with more than 50 per cent of patients being concession card holders. That practice no longer exists because of the inaction of this government over the last eight years. You cannot just say that you want to see more doctors out in regional areas if all you do suggests otherwise.