I’m very pleased to rise in support of the Higher Education Support Amendment (2022 Measures No. 1) Bill 2022. This bill aims to encourage the employment and retention of doctors and nurse practitioners in rural, remote or very remote areas of Australia by reducing all or part of their outstanding university HELP debt. I’d like to pay tribute to the member for Lyne, who was very much an architect of this work in the previous government, and likewise the member for Mallee, who’s been a very strong supporter of nurse practitioners.
It’s well known that across Australia we have a shortage of health professionals, but rural areas are disproportionately suffering from this shortage, and we know this has been a longstanding challenge. Our higher prevalence of chronic disease, including asthma, diabetes, cardiovascular disease and cancer, is higher than that of metropolitan centres. This is a chicken-and-egg situation, where we have less early intervention for chronic diseases driving greater and greater demand for health professionals. Doctor-patient ratios are twice as high in remote regions as they are in our cities. Patients simply can’t get in the door, and our doctors, nurses and allied health professionals are under enormous pressure.
This isn’t a recent phenomenon, and, over the years, successive governments have introduced programs such as the departments of rural health and the Rural Health Multidisciplinary Training program to train doctors, nurses and allied health professionals in rural areas. I spent over a decade working at the University of Melbourne department of rural health and experienced the great satisfaction of seeing our students graduate and take up roles as rural doctors in local communities, where they’re leading incredibly fulfilling careers and making such a difference to those local people.
There’s plenty of evidence to show the success of these programs. However, we know that the strongest evidence for attracting and retaining doctors in rural areas is in recruiting young people with a rural origin to enter the medical field. There are some structural barriers for rural students choosing a career in health care, one of which is the cost of education, which goes to the object of this legislation. Additionally, there’s the cost associated with leaving home, both from a financial perspective and also from a social perspective.
Programs established under the previous government, such as the Murray-Darling medical program, go to this issue. This program—set up by the previous government, and for which I congratulate them—provides medical training in the regions for students who are from the regions. The network includes La Trobe University in Wodonga—part of my electorate of Indi—where they undertake undergraduate studies in biomedicine before students go on to the Doctor of Medicine program run by the University of Melbourne’s department of rural health, based in Shepparton.
When I met with participants in the program earlier this year, I was struck by their stories of why they wanted to be doctors and why they specifically wanted to be doctors in regional and rural communities. Growing up rurally, they told me, they had experienced health struggles in their own families and long hours in the car to go to and from medical appointments in major cities. They spoke of the difficulties and hardships that this created, and it galvanised their resolve to become rural doctors. The students told me how much better it was to be able to attend university and stay living on their home farm, indeed, in their local town. The students I spoke to came from small towns like Milawa and medium sized towns like Wangaratta, Benalla and Wodonga. They were all studying locally at La Trobe University’s Wodonga campus.
The program at Latrobe is led by Dr Cathryn Hogarth, who told me there’d been hundreds upon hundreds of applications from students who could have been accepted into the program. They had the marks, they had the aptitude, but the university simply isn’t funded for the places. It has the teachers, it has the facilities, including wet labs, and, as I’ve just indicated, it truly has the demand from young people wishing to study rural medicine. But there are just 15 places in that program at La Trobe each year. The university told me they could take three times as many students, so I would say here is a real opportunity for the Albanese government to expand programs like this with proven models to further increase the number of doctors studying and working in regional Australia.
I support this bill as a measure to get more much needed doctors and nurse practitioners into rural and remote Australia, and importantly encourage them to stay. We need them at the disease prevention end, and we need them at the treatment end—basically, we need them. Health professionals, though, are team players. They must be, and that’s why I’m encouraged that this program includes nurse practitioners as well as doctors because, compared to other countries, we have completely underutilised nurse practitioners in Australia, so this bill is a very important endorsement of their skills and their contribution and, more importantly, their potential to do much, much more.
Nurse practitioners are highly trained. They bring years of clinical experience and expertise. They have masters-level specialist education. They can diagnose, prescribe and undertake early intervention and they often work in very hard areas of concern—areas which are hard to reach and very poorly resourced such as aged care, palliative care, wound care, drug and alcohol treatment. But their practice has been hamstrung for years by very poor and inadequate Medicare rebates. This desperately needs reform to unleash their skill in what are really very, very stretched areas of primary care. Again, I call on the Albanese government to address this issue as well, Medicare rebates for nurse practitioners. This is truly an opportunity that we could grasp if we had the will to do so.
This legislation is as yet untested in the field, so crucially, as this program rolls out, we must monitor its progress. Therefore, I support the member for Mackellar’s amendment to review the scheme in 2026 and again in 2029. A review of this bill will help us see how well the scheme is working to attract and retain doctors and nurse practitioners in rural Australia and, really importantly, how it can be improved. I’m pleased to hear that the government will support this amendment, and I hope they consider any recommendations made by the reviews.
We need to pay attention, importantly, to what’s missing in this bill, and what’s missing is a kindred program for mental health professionals. One of the biggest challenges facing rural and regional Australia and my constituents in Indi is accessing appropriate, timely mental health support. We had a problem before the pandemic, but now that need is truly and greatly exacerbated not just in the high-prevalence issues of anxiety and depression but also in the very traumatic area of eating disorders where access to evidence based care and help is under enormous strain in the cities but nigh on impossible to access in most rural areas. Local psychologists in Wodonga tell me they simply cannot cope with the demand for their services for eating disorders. They tell me that they need to clone themselves.
While I support the government’s measures to increase the rural health workforce through this bill, this is incomplete unless and until we do the same for our rural mental health workforce. I speak in support of this bill, but I believe we need to do more, and that’s because of what I see every day in my community, what I hear from my constituents and what I know from my many years of experience as a clinician and researcher in rural health.
I support the government’s budget initiatives to address mental health, including the commitment in the budget to restore the 50 per cent loading for telehealth psychiatry services in regional and rural areas. Telehealth psychiatric services were an especially important service to people in regional and rural areas before, and during, the pandemic, and concerned constituents contacted me after they were cut. So it’s right and proper to see that the government is restoring the loading for these critical services.
I was also glad to see in the budget the government’s expansion of the headspace centre network. The communities of Indi worked so hard to get a headspace in Wodonga and Wangaratta. It’s such an important support for young people in regional and rural areas, but we need to increase the capacity of these services, and that means encouraging young people to study mental health sciences and to work rurally. That’s why, while this bill is good, it could be better, by offering mental health professionals who come to work in the regions the same level of debt forgiveness as doctors and nurse practitioners.
Around 22 per cent of rural and remote residents are living with a mental health or behavioural condition. Benalla, in my electorate of Indi, has double the state average of people experiencing mental ill health. Despite people in the regions being more likely to experience this mental ill health than people in the cities, we are 26 per cent less likely to see a psychologist. That’s because the services simply are not there. Indeed, it would take 5,000 mental health workers in the regions to give us the same level of access to care that our city cousins have right now. There are no full-time mental health workers for young people in Myrtleford, and, where there are mental health services, like headspace in Wangaratta, there are lengthy waitlists. It is the same in towns like Alexandra, where local people often must travel miles away to Melbourne or Shepparton, disrupting school, work and family.
In 2019, 90 per cent of headspace centres reported major challenges in meeting demand for their services, with the main reason being workforce availability for mental health clinicians, GPs and private practitioners. This massive shortage of mental health services was compounded again after the devastating 2019 Black Summer fires and followed by COVID-19 lockdowns. Many communities struggled to come together to heal, and the mental health impacts can have, and have had, serious long-term impacts.
In my first term of parliament, I fought hard to secure more funding for mental health services in Indi. After the 2019 bushfires, I lobbied the former government to secure $800,000 in funding for mental health programs, including for mental health nurses in Corryong and drug and alcohol responses, but, again, the issue was trying to get the workforce to carry out that work. I’ll continue to advocate for improved services for those in the community suffering from eating disorders, which, sadly, increased in prevalence again during COVID-19.
Constituents are constantly contacting me about mental health. They are constantly contacting me about the challenges they face in getting the right help for themselves and their loved ones, about the impact it has on them, their community, their work and their relationships, about the high cost of mental health care and about the long distances they need to travel to access that care. Mental health workers have told me about the alarming increase in demand for their services, and they’re struggling to meet it.
I want to acknowledge their hard work, and I also want to applaud the community members who are working in community connection and prevention, including the Grit and Resilience Program in Wangaratta, led by Bek Nash-Webster. This program is a community led suicide prevention program that focuses on social and environmental determinants of health. It does this by creating opportunities for people to connect through social groups, like the women’s tables and the separated dads group, and events such as street parties. It promotes inclusion in the community. The Grit and Resilience Program is so successful that it hopes to continue with future federal government grants and possibly expand to other communities, such as Mansfield.
As an Independent, I can recognise good work wherever it’s done, but I can also recognise where more work is needed. I will always be an unflinching voice for rural Australians. This bill will help address the need for doctors and nurse practitioners in rural Australia, but the government can do more to recognise and address the dire state of mental health. That’s why I’m calling on the government today to include, in their next budget, provisions for mental health workers to be included under this scheme. This would allow psychologists, mental health nurses, psychiatrists and social workers to have all or part of their outstanding university HELP debt reduced when they reside and work in rural and regional Australia.
I recently met with the Minister for Education and was glad to receive his interest for including mental health workers in future budgets, and I look forward to working closely with him on this policy. Including these mental health workers in future budgets is smart, it’s targeted and it would give a clear signal to students that the need is great and the opportunities wonderful if you choose a career in rural mental health. At a time like this, when our regions have suffered almost three years of bushfires, a pandemic, border closures and, now, floods, the time is right for this investment, on top of the investment the government is making for nurse practitioners and doctors.
So I’m very pleased to receive the Minister for Education’s interest in my proposal. I hope to continue to work together with him and his team. I really want to see this government invest not only in doctors and nurse practitioners but also in mental health professionals in rural and regional Australia, in the next budget and right out into the future.