Deborah O'Neill (NSW, Australian Labor Party) Share this | Link to this | Hansard source

Tonight I rise to both celebrate and lament on behalf of the primary health care of this country. Globally Australia delivers some of the best primary health care in the world. Our Medicare Local network is cost-effective, nimble and responsive. Medicare Locals are primary health care organisations that were established by the last government, the Labor government, to coordinate primary health care delivery and to tackle local health care needs and service gaps. They make prevention their first order of business every day. Their second order of business is to connect the services to provide the best possible health care for Australian citizens.

We celebrate, as the Labor Party, the diversity with Medicare Locals because this diversity, unique to each area and community, enables tailored, timely, responses in unique circumstances. At a time when the population is ageing and chronic illness is increasing, it seems inconceivable that any government would want to make the changes this Abbott government is intent on, to break up this strong, front-line network of evidence based excellence in health care delivery, to place barriers in the way of people accessing primary care.

I have the honour and privilege of chairing the Senate Select Committee on Health. The committee has had hearings to date in Townsville, Canberra, Moruya and Lismore. The same sense of urgency is being relayed to us in place after place—urgency about the cuts to health care in rural and regional areas, the dismay at the closure of Medicare Locals and the loss of best practice, evidence based health programs and the professional health workforce that are vital to these communities. The preventive health programs in Townsville, the fantastic chronic disease management plans being created in Lismore and the integration of allied health and general practice in Moruya are creating a one-stop shop for accessing quality primary care. All of this, and so much more across this nation, is now under threat because of new taxes and cuts, cuts and more cuts by this Abbott, Liberal-National Party coalition. I will quote extensively from the evidence we have received because the voices of these Australians are powerful and should be heard in this place. Professor Larkins from Townsville told us in relation the GP tax:

I think it will be devastating. I am speaking not only has a community member but as a GP. My clinical background is mostly in Aboriginal and Torres Strait Islander health. I was at the local community controlled health service for 15 years. Now I am in a private general practice but 50 or 60 per cent of the patients I see would still be Aboriginal and Torres Strait Islander. Most of the remainder are low-income earners for some reason or another.

  I do not see people with constant colds in my practice. I see people with a raft of chronic comorbidities. They are very complex. There are very often complex social issues. Seeing them regularly in a general practice with very good team based, multidisciplinary care—maybe once a month or so—I have no doubt I am keeping multiple people out of hospital and out of the expensive end of the health service. I also have no doubt that were there a co-payment introduced, and were we to charge it, my patients just would not come. They would just put other things ahead of health care, such as feeding their families and transport. They would not attend for primary care. The upshot of that would be more emergency department presentations and late-stage chronic disease admissions.

Professor Larkins knows a thing or two about primary health care and she knows her community. She articulated the great danger that is being foisted on this country right now by those opposite. Similarly, Mr Gil Wilson, a clinical nurse specialist from Lismore, went on the record and told us exactly what his days present him with:

I walk through wards every day where I see elderly people who are in hospital simply because they could not afford to fulfil their medication scripts. They say, 'I could not get them for a couple of weeks. The pension is not much.' I hear it every second day. These sorts of things happen. They sit in hospitals, chewing up our funding, simply because they cannot fulfil their scripts. If you do not take care of your health, your health will take care of you eventually.

Then there are people with chronic conditions. Nobody chooses to be a diabetic. Nobody chooses to be an asthmatic. But if you put barriers up that prevent people seeking health care, such as a $7 GP co-payment, they may not go when that cough starts. They might say, 'I'll be right. My asthma is fine.' They can end up in hospital, in an ICU, with a ventilator tube shoved down their throat and a specialist like me caring for them for 24 hours until such time as they can go out and pay their taxes again.

Gil went on to say:

Any impingement to health is a dumb-arse idea. A $7 GP co-payment will see these patients come through the ED system. If you do not charge it at ED, then that is what is going to happen. Our lower socioeconomic groups will be pushed into ED system

Lismore Base ED is currently going through a revamp to 30-odd beds, which is excellent, but we are nowhere near that. We run at a high occupancy every day. We have ambulances backed up. As an after-hours manager, I can get three or four calls from the ambulance person saying, 'Why are my ambulances still there?' I have to tell them, 'I need beds to put patients in. I don't have a bed to put them in at the moment.' That then takes ambulances off the road.

This type of evidence is not isolated. From Moruya, we have Dr Carlson's thoughts on the co-payment, which echo Professor Larkins. He said:

I just do not understand how there was no thought put into this process of educating the community. I think people contributing to the cost of their health care is a good thing, but I do not think you do it overnight and make a blanket 'Here, everybody is going to have to pay this.' I have patients who do not have $7 in their pocket. Whether they smoke or drink or eat McDonalds is irrelevant. They do not have $7 in their pocket today and they will not tomorrow. They live from day to day. They may have a mental illness. They may have a chronic illness such as diabetes, as well. They struggle with accommodation and transport. They do not have $7. At the moment they have a health care card, and, being in a rural area, if my practice is prepared to bulk bill them I also get the $9.10 incentive payment. If we have to charge them a $7 co-payment they cannot afford, and we lost the $9.10 incentive payment, what we are actually losing is approximately $16 that we would currently get if we see that patient and bulk bill them. General practice is not sustainable when you bulk bill every patient. The cost of business is enormous. My practice has a philosophical approach. We believe in providing care to patients irrespective of whether they can afford it. We bulk bill a lot of people and that $9 co-payment makes it possible. But, if we lose $16 per patient, and instead of getting in the region of $45 a consultation it will drop back to just under $30, we are going to have to make some very significant decisions about how we manage those patients and whether or not we can afford it. I am not really sure why the expectation is that general practice has to absorb those costs. All it can result in is us putting off staff. We cannot afford that cost in 10, 20 or 30 per cent of our patients. It will make our business unsustainable, which means that you do not have quality general practice in this rural area any more. So what do these people then do?

Indeed, what do these people do when this government has systematically and deliberately completely unpicked a right to health care for ordinary Australians and has taken away, from the most vulnerable, points of access to primary health care?

This week I visited Martin Carlson's practice on Queen Street in Moruya. The practice has 13 general practitioners offering generational care to families in the Moruya area and surrounds. They see from 150 to 400 patients per day. They offer nursing home visits, home visits and after-hours care. This practice is innovative, efficient and caring towards their community. While it is an exemplary practice in that area, can I say that we have seen the quality of this sort of practice replicated around the country. We met there nurse practitioners who have become a vital part of what is able to be delivered through our local GPs these days. Indeed, we heard one of the local GPs there say, 'Can you imagine what it was like before we had nurse practitioners?' So embedded is primary care and integration of all levels of doctors, nurses and allied health professionals that we are seeing a transformation of health care in communities such as Moruya.

This particular practice has a model that is replicated around the country, particularly because of the engagement of Medicare Locals in building these connections. This practice has pathology on site, physiotherapy, a psychologist, an audiologist, speech pathology and four rural clinical nurse specialists who implement the Queen Street Better Health program, offering coordinated clinical programs for chronic disease management including diabetes and kidney disease plus coordinated veterans care, health assessments and GP management plans. They are innovative, they are connected, they care, they are improving the health outcomes of their local community, but they are determined to be punishable by this government in the most shameful way.

Moruya is a low socioeconomic area and this practice bulk bills 90 per cent of its patients. In fact, the conditions there replicate the conditions in many of the electorates held by National Party members in this place, who are mute on this matter—silent in coalition with their Liberal partners. They are worried in this community about the proposed GP co-payment and the impact on their patients. And so they should be. In that electorate alone, the $7 GP co-payment is going to take $4.7 million out of the pockets of local people, out of that local economy, in its very first year. The most worrying thing, though, is that people will not be able to afford to attend to their healthcare needs. Imagine saying that out loud in the parliament of Australia, in this year, in this wealthy nation. This government is constructing a reality where we are saying to Australians, 'It's too bad if you can't afford to attend to your healthcare needs.

The audiologist in Moruya comes to the practice two days a week from Ulladulla, an hour's drive from Moruya. Prior to settling in with this GP clinic, those services were inaccessible to many people in the community. It is one of the critical partnerships that the Medicare Local facilitated and has established. The obvious improvement in access to these services is clear, and the obvious improvements for the GPs, the nurses and the patients that we saw there were manifest.

The allied health practitioners working in partnership with this general practice all have private practices in neighbouring regions; however, by working alongside the nurses and the GPs in this practice, they can provide holistic care, saving hundreds of kilometres of travel and thousands of dollars in costs to individuals—and, most importantly, providing timely access to the quality care people need and deserve. At least that is the view that I believe most Australians have—although sadly not this miserly government.

Much of the training for the nurses and practice staff in this practice has been provided by Medicare Locals, and many of the relationships with the allied health providers was facilitated by Medicare Locals. This is just one example of a model of primary care delivery working very well, and under threat by the introduction of the GP tax and the abolition of Medicare Locals.

Sixty-one Medicare Locals were established. It is proposed that they will be reduced to maybe 25 primary health networks—or maybe 31. No-one knows. There is no detail. There is no engagement of the expertise on the ground. GPs and critical people like the people whose testimony I have reported in this place this evening are not being consulted by this government, who, in their high and mighty stance on all issues, believe they are above consultation with the key players in the industry. They have excluded expertise. They have sought only to impose their ideological warfare on health seekers in this nation.

There is an absolute failure from this government to meet their own time lines on the rollout of the primary health network that they propose. The sharing of information is tardy and delayed. But they are retaining a hard date for the closure of Medicare Locals of 30 June. The breathtaking arrogance of this government beggars belief. In my view, the health budget is a sign of a set of beliefs and values of a nation about its people. Health budgets—perhaps more than any other part of the budget—reveal whether a country and community has its priorities right. Budgets are all about spending choices. A wealthy country such as ours should be choosing to invest in its greatest resource—its people, their health and their wellbeing. Ill-health, failure to prevent disease, failure to respond to rural and regional Australians, to help them back to a full life of work, rest and play costs us all.

There is a profound productivity cost. There is a hit on our national economy from the short-sighted ideological war that the Liberal-National coalition are inflicting on our health sector at this time. They are costing us in the quality of life and relationships. Their vision, or dystopian view of the world, costs us in terms of people's capacity to participate in the workforce, to run small businesses, to employ people. And it costs in that most often prized measure, our GDP. National wealth is adversely affected by ill health. That is why spending on health is an investment, not the permanent cost burden that we hear about from those opposite.

At the end of life, our decisions around life reveal our respect for our citizens—or our abandonment of them in their last hours. We need careful, informed discussions about health with the sector and the citizenry, not ideas imposed from on high by ideologues of the first order.

Let me be clear: the closure of 61 Medicare Locals is being done in spite. It is being done in spite of Professor John Horvath's review, which found that Medicare Locals were substantially doing precisely what Labor established them to do—that is, to better integrate the fragmented health services across Australia and improve health outcomes of Australians at a localised level.

Sixty-one Medicare Locals have been told to close up, and to dismiss staff and teams that are deeply knowledgeable about their particular communities. They will be closed up, in spite of the fact that they all hold comprehensive population health data that can be used to drive reform and design, and implement programs at a local level to deliver savings to the system and improve the health of every community.

I have been hearing about the great preventative health programs that are being delivered via Medicare Locals. I have been hearing of the leaps forward in chronic disease management, mental health care and Indigenous health. These improvements are achieved by integrating care, integrating teams of health professionals, integrating with local council programs and integrating with local leaders in communities.

Medicare Locals have proven that good health does not always equal good medicine and doctors alone. Good health is much broader than that. Increasingly, we are seeing and receiving evidence that shows the importance of allied health professionals working together with medical practitioners to deliver better health outcomes.

The future health outcomes of Australians relies on us in this place deciding to support a universal health insurance scheme, where everyone pays and everyone gets the care that they need.