House of Representatives

I’m delighted to support the Health Insurance Amendment (Continuing the Office of the National Rural Health Commissioner) Bill 2020.

As a former rural health professional and a former rural health researcher, speaking about rural health is right up my alley. I’m really pleased to do so. But, more than that, this piece of legislation heralds a really good day for rural health. Both the Minister for Regional Health, Regional Communications and Local Government and I live have worked almost all our lives in rural and regional Australia. I know that he’ll agree with me when I say it’s an incredible place to live. It’s filled with opportunities, but they’re not always fulfilled.

We both share a passion for vibrant and healthy rural communities but, as members of these communities, we know this doesn’t happen by accident. Rural communities rely on good-quality health services that last the distance. Crucial to rural and regional development is having strong, vibrant, high-quality rural and regional health facilities. That’s how we attract people to rural and regional Australia—by guaranteeing that we have those services. Throughout the COVID-19 pandemic that we’ve been experiencing this year, we have seen the strength of rural communities and the strength of our rural and regional health practitioners as they’ve risen to the challenge, often in very, very challenging circumstances. I have seen them across my electorate. I have seen them do what rural health people do, and that is often make do with less than optimum facilities. So I take my hat off to them. I thank them. I know they’re working tonight in difficult circumstances in order to make sure that they are ready for whatever happens.

Last year, the minister visited Beechworth, in my electorate, to meet with four of our vital but very small rural health services: Beechworth Health Service, Alpine Health, Tallangatta Health Service and Corryong Health. It was clear from our discussion that the minister understood the issues that were facing these small health services and came from a place of experience. I would say that that’s not always common in this House.

This bill consolidates the place of a dedicated advocate for rural health within government decision-making and policymaking. It builds on the reforms led by the outgoing commissioner, Professor Paul Worley, and recognises that the job is not yet done. It is far from done. I want to recognise Professor Worley for the reforms that he’s been undertaking—in particular, the rural generalist training program. I would also like to point to the recent GP respiratory clinics. I recently attended one in Wodonga, and I was really pleased to see the work that they’re undertaking there, particularly in the area of paediatric respiratory health.

Health care is a lifelong passion for me. It’s both personal and professional. As a midwife, I’ve delivered many hundreds of babies, many of whom are now of voting age—and I think a few of them might have even voted for me! That’s a heck of a way to get a vote, I’ve got to say—it’s a long wait! Some of them have gone on to have children of their own. My own daughter is a junior doctor and she undertook her training as a medical student in the rural medical program. I worked for many years with an extraordinary obstetrician, Dr Leo Fogarty. For every baby I delivered, I think he probably delivered 20 or 30 more. I’ve worked extensively with another exceptional rural doctor, Dr Ian Wilson, an emergency department physician and excellent educator of rural medical students.

As a former rural health researcher and director of the Rural Health Academic Network with the University of Melbourne, I oversaw and led research into various aspects of rural health. That’s the thing about rural health: it is so diverse and the amount of skill that people have to have crosses so many disciplines. Our research program included telehealth assistance for stroke and cardiovascular disease. We undertook research into palliative care, diabetes and a multitude of other chronic diseases. We did exceptionally large amounts of work in men’s health, particularly on depression and anxiety. And we looked at work in dementia and aged care, and the barriers faced by older rural Australians.

I know all too well the frightening statistics around rural health for regional Australians. I can recite them in my sleep, and many of the speakers who have come before me have told us about them. Rural Australians do experience poorer health outcomes, lower life expectancy and poorer access to health than those living in metropolitan areas. The prevalence of chronic disease is higher, including asthma, diabetes, cardiovascular disease and cancer. And we have higher death rates—between 1.2 and 1.5 times higher for cardiovascular disease and between 21⁄2 and four times higher for diabetes.

And we know that we are so far from closing the gap when it comes to Aboriginal and Torres Strait Islander health. We know that one of the things that could really work in closing the gap for Aboriginal and Torres Strait Islander people in this country is culturally appropriate care. We have to do so much more to go beyond training rural health workers in Aboriginal health; we need more Aboriginal and Torres Strait Islander doctors, nurses and midwives, and we need more culturally appropriate training into our medical schools, allied health and nursing courses.

We know that it’s the social determinants of health that have the biggest impact on why health outcomes in rural and regional Australia are poorer than those in metropolitan areas. We know that we are without good regional infrastructure. We have fewer bicycle paths and we are more reliant on cars. We don’t have footpaths that are good for walking and we have conditions that create chronic disease—conditions that mean more rural Australians smoke, more of them are overweight and more of them do less physical activity and have higher than optimal alcohol consumption and blood pressure than in the cities. It’s little wonder when you see that some towns are just so poorly equipped for people to exercise in. Indeed, food security in some rural and regional towns—in the very remote areas—is extremely poor. So it’s not that rural and regional Australians are any worse at looking after their health from a deliberate choice, it’s the circumstances in which they find themselves. That’s why it’s so important that we invest in rural and regional infrastructure if we want to improve rural health.

The link between poor health outcomes and the lack of access to health services is well known. Often we have to travel considerable distances just to see a doctor for a basic consultation, or wait weeks to see a specialist. Of course, one of the silver linings of the COVID-19 pandemic has been the freeing up, the unlocking, of telehealth. Those of us who have worked in the area for decades have been crying out for this, so I am really pleased that this is now a permanent fixture.

Unfortunately, rural health has been viewed as the fringe of an overarching system that is set up for metropolitan Australia. It’s really a metrocentric healthcare system. What we know, as I’ve heard other speakers say today, is that metropolitan systems of care simply cannot be translated directly into regional Australia. That’s why a commissioner for rural health is so important.

I think it’s really important to talk about—and the AMA only recently gave statistics about this—the healthcare deficit in spending. We can’t get away from this. There is a healthcare spending deficit of $2.1 billion in rural and regional health. It’s a chronic underspend of Medicare, PBS and publicly provided allied health services. I can’t emphasise enough the impact on access to allied health services, and that’s why I’m very pleased that there are going to be co-commissioners looking at this.

There is still so much to do in rural health. It’s common sense to extend the office beyond 30 June and to establish the office as an ongoing entity. We still experience perennial issues of health workforce shortages and have a higher disease burden, as I just said, with the health consequences that arise from those. That’s not to mention the health consequences that have arisen from the fires. The data is coming out now; there is very, very robust evidence emerging about the impact on people who live in rural and regional Australia of the ‘black summer’ bushfires and smoke inhalation—and of course on people who live in the cities too. That summer exposed the brittle systems in telecommunications, welfare and health that are the reality of service delivery in the country.

It’s a comfort to me, it truly is, to know that the National Rural Health Commissioner is here to stay, and I’m confident that this commissioner will examine the multiple social and environmental impacts of health. I’m confident that they will. The functions of the office have been expanded to include the appointment of deputy commissioners, and this will support the commissioner and provide expertise across health disciplines, including Indigenous health, nursing and allied health. This is excellent news. Health care is a team sport. Interdisciplinary care is the gold standard. We need to achieve greater enrolment of rural students into allied health professions. We need greater access to allied health positions in our universities, and just this week in the House I asked a question directly to the Minister for Education about this. We need to free up places.

Deputy health officers have immeasurably enhanced and enriched our national health response. One example that comes to mind is Professor Paul Kelly, the deputy chief medical officer. He visited me in Wodonga earlier this year, in the midst of our terrible bushfires. He came with me and Minister Hunt to Corryong and saw firsthand what was going on up there. He visited the very tiny Corryong Health, which was evacuated during the bushfires. Another recent appointment is that of eminent psychiatrist Dr Ruth Vine as the deputy chief medical officer for mental health, and I really commend that appointment, too. If there’s one area of health care that we are so far behind in it’s mental health.

When the Office of the National Rural Health Commissioner was first established the former member for Indi, Cathy McGowan, advanced an amendment to ensure that the commissioner consulted with communities in regional, rural and remote areas, including consumer support and advocacy groups. I’m pleased to see that this bill goes into detail about who the commissioner consults with and lists health professionals, state and territory government bodies and industry, non-profit and other community groups and stakeholders. On a commonsense reading, this bill includes the groups identified by the former member for Indi, and I hope this commitment to broad-based consultation is echoed not just in legislation but in reality.

Importantly, building on the success of the office since 2017, the office is now legislatively mandated to undertake research and to collect, analyse, interpret and share information about approaches to improving the quality of and sustainability and access to health services. This strong research capacity is absolutely essential to providing comprehensive insight. Rural health research has historically been underfunded. In a study from 2018 by a good friend of mine, Professor Lesley Barclay, it was reported that, between 2000 and 2014, of the 16,651 projects funded by the National Health and Medical Research Council, just 185 focused on rural health research. That’s just one per cent of NHMRC funding at that time.

I’m glad to see that the office’s responsibilities will translate into practical activities, such as working with communities that are experiencing workforce shortages to co-design primary care models that respond to the community’s circumstances. Again, from my own experience as a rural health researcher embedded in a regional health service, along with my colleagues Kaye Ervin, Anna Moran and Carol Reid, I have seen firsthand how important it was to connect a university to a clinician, by the bedside, so that we could assist them in undertaking key research and translating that research into practice. To get traction with health services research at the bedside is extremely difficult. Again, I would say to the government, in terms of research funding, that health services research is not very glamorous, but it’s crucial to rural health.

The commissioner is scheduled to present the final report into improvement of access, quality and distribution of allied health services in regional, rural and remote Australia to the minister later this month. I am really looking forward to reading that, because, as I said earlier, allied health professionals play a major role in the prevention and treatment of so many chronic diseases. The commissioner himself notes in his interim report:

Allied health services underpin the health and wellbeing of our nation. They are the quiet achievers of our health, disability, education, aged-care, and social service sectors. Without them, our schools, workplaces, homes and aged-care facilities all struggle to realise their potential, communities suffer and economic development stalls.

The interim report identified four strategic themes for reform. One is Aboriginal and Torres Strait Islander health practitioners and culturally safe and responsive services, and I can’t emphasise enough how important that is.

Finally, I’d like to speak on the university model of university departments of rural health. I particularly mention today the Going Rural Health initiative, which has worked tirelessly to undertake allied health training across the regions, particularly in my region of Indi, where almost 2,000 nursing and allied health students have been placed across the region, and I particularly mention the leader of that program, Keryn Bolte. I would also like to particularly mention Dr Seb Kirby, who is an outstanding graduate of the University Department of Rural Health medical program in Wangaratta. He has continued to practise as a junior doctor and is contributing on the ground in a way that we want to see in rural health across the nation.

[June 17, 2020]

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