Healthcare Matters

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26 October 2021

I rise to speak on the Health Insurance Amendment (Enhancing the Bonded Medical Program and Other Measures) Bill 2021.

In the middle of a global pandemic, health care saves lives. People should be able to book an appointment with their GP and receive care straightaway—whether it's COVID related or for a regular health check-up. Unfortunately, this isn't the case for many people in my community on the Central Coast of New South Wales. Like many regions of Australia, the Coast is battling an acute GP shortage. Locals are waiting weeks for routine appointments, practices have been forced to close their books and doctors are struggling to keep up with demand. People often say that Australia has a universal health-care system, but we don't. A two-tiered system has developed, where access is increasingly determined by where you live and how much you earn, and communities outside big cities are finding it harder and harder to see a GP.

People living with chronic health conditions, such as heart disease or diabetes, find they're made worse by longer waiting times and are facing the barriers to care of high out-of-pocket costs exacerbated by a shortage of health-care workers. As a pharmacist and local MP, I know that if people delay care their condition will only get worse, which is worse for them, worse for our health-care system and worse for the economy. They'll end up in emergency departments, clogging up an already-overwhelmed hospital system, when a trip to the GP could have helped them sooner. This is the case for too many people on the Central Coast. The lack of doctors on the Coast is largely because of the government's refusal to recognise most of the northern end of the Coast as a priority; it's not a distribution priority area. I have been calling on the government to give our region DPA status for a long time now. Changing our classification would allow practices to recruit and retain more GPs, and would help people in my community get access to quality health care close to home when they need it.

Fortunately, Wyoming-Ourimbah, which is part of my community, was granted DPA status on 1 July. This has meant that after a chronic shortage on the Central Coast, the Central Coast Community Women's Health Centre has finally been able to recruit a GP, who is now working two days a week. I spoke to Theresa Mason, the manager of the Central Coast Community Women's Health Centre today after their AGM. They, like many others in my community, made a submission to the Senate inquiry that Labor pushed for. As she said in the submission: 'Recruiting and retaining GPs to our health service has been a long-term challenge, a challenge which hasn't been improved by the government's stubborn refusal to act on the DPA status, which has meant a chronic shortage on the Central Coast of New South Wales. It's just not good enough: health care should be a priority, especially in regional communities.'

When a young mum notices that her son is sick, she should be able to take him to a GP straightaway. She shouldn't have to wait days to make an appointment while her son's condition only gets worse. Sadly, this was the case for Kristy. Kristy's son ended up in ICU at Westmead Hospital in Sydney for a month with a collapsed lung when he was just 16 months old. Thankfully, he has fully recovered but this should never have happened and it could have been avoided. It might not have happened if Kristy had been able to get her son into a GP sooner.

Then there are people like David. David lives in Wyong, my hometown on the Central Coast, but he used to live in the Hawkesbury. He told me that he needs to make an appointment at least a week in advance if he wants to see a doctor on the coast, but that it isn't the case further south. He says he's better off making the trip to the Hawkesbury because he can see a GP within an hour there, where he used to live. No one should have to drive that far to get quick access to health care, especially, he told me, during the middle of lockdown. Locals should have timely access to care close to home, in their own community.

I heard a similar story from Leonie. Her husband tried to get in to see a GP in their local area of Toukley after he became unwell. Every single practice told him they couldn't take on new patients, and then they were forced to send him away. He had to make a half-hour trip to his old neighbourhood where he could get into a GP, only to be told that he was in the middle of a cardiac event. In Australia today this is unacceptable. If Leonie's husband had been able to see a GP close to home he would have known what was happening sooner and could have got the essential health care at the hospital straightaway, and the emergency treatment he needed. Any delay in treatment can mean lives. This is all happening because there aren't enough GPs in our community and the government refuses to help. The critical lack of doctors on the north end of the Coast has gone on for too long.

That's why, on this side of the House, we had to take things further. Together with Labor MPs and senators, we pushed for a Senate inquiry to be established to investigate GP shortages in outer metropolitan and regional areas across Australia, including on the Central Coast. The inquiry is now up and running, and there are already 110 published submissions. I have one here that I referred to earlier, from the Central Coast Community Women's Health Centre. From speaking with the secretariat, I understand they are struggling to keep up with the sheer volume of submissions. Over the next few months, this inquiry will investigate the lack of doctors in our area and reforms to the DPA classification system and GP training, as well as the impact of COVID-19 on GPs. This is good news for people on the Coast. It's a step forward in our fight to secure more GPs and an opportunity for locals to be heard, and I will be pushing for a hearing in our region, because the voices of local people on the Central Coast deserve to be heard, not to be overlooked, ignored or pushed aside by this government.

In the meantime, the minister has announced a new exceptional circumstances review—and I have a copy of his media release on it here—for the Department of Health DPA classification, where anyone in a non-DPA area, such as a clinic, can apply for an assessment. It goes on to say:

'the following factors would be considered alongside an area's non-DPA status:

Changes to health services, workforce, or health system

Patient demographics or changes

Absence of services ...'

After eight years, the best the government can do on is to put out, on 2 September, a media release which says there will be a new exceptional circumstance review for the department of health's distribution priority area classification. That is the best they can do. I think the minister is genuine, and I know he's acting in good faith. I have provided letters of support for practices who are trying to access this review. But a case-by-case review will not fix a systemic, systemwide problem. Everybody knows that. After eight years in government, it's just too little, too late, and, as I said, it will not address the underlying systemic problems that are afflicting people, particularly anybody living outside big cities.

As a footnote to the minister's announcement on 2 September, the minister said:

We are aiming to ensure the process is a speedy one, to quickly help address any GP service shortfall arising from those additional factors—

the ones I mentioned before: changes to health services, workforce, or health system; patient demographic changes; and absence of services. Well, I hope so too, Minister. A belated Zoom meeting on the Central Coast will not fix years of neglect.

I'm pleased the minister has come into the House, because I've called him about this myself. I've spoken to him about this urgent problem in our community. More action needs to happen, and it needs to happen now for people like Kristy, who couldn't get her son in to see a GP, with the result that he ended up in the ICU at Westmead Hospital when he was 16 months old; David, who had to drive to Sydney to get access to health care when he couldn't get any access close to home; or Leonie's husband, who, in the middle of a cardiac event, couldn't get health care on the Central Coast.

Minister, you said yourself that, as a health practitioner, you understand the urgency. I urge you to push the government to advocate strongly for regional communities like the one that I represent and the ones that you represent. It must be better. It has to change. It's risky. It's risking people's lives. We need practical solutions to fix this shortage so we can improve health care for all Australians. It's gone on for too long. Anyone who lives outside a big city—anyone living in regional, remote or rural Australia—is feeling this.

We support the intention of the DPA changes, which were meant to get doctors to the bush. But do you know what doctors have told me across Australia? It hasn't fixed the problem in the bush; it's just spread the problem further, so that everyone living outside a big city is now impacted by this, whether it's the outer suburbs, the regions or the bush.

Minister, you said in your media release on 2 September:

The Australian Government is also preparing a formal review of the DPA indicator. Further details of the review will be announced soon.

Well, I really hope so, because I understand that, in my community on the Central Coast of New South Wales, close to 150 local practices have lost DPA status over the last three years. Some of them have closed. Others have been forced to close their books. Do you know what that represents, Minister? Forty per cent of practices in our region, on the northern end of the Central Coast, have lost their DPA status.

At the same time, as you would know, we're seeing an increase in low-urgency presentations at Wyong and Gosford hospitals' emergency departments. I worked at Wyong hospital; I worked there for almost 10 years. The staff there are dedicated, they're capable, but they are under enormous strain, and the emergency department doesn't need to be clogged up with low-urgency presentations which would be more quickly, and safely, seen in a GP surgery. Minister, it is not good enough. It has to change, and a belated case-by-case review process and a yet-to-be-announced wider review of the DPA indicator are not good enough.

I know, Minister, you are genuine in your intentions, but our community, the community on the northern end of the Central Coast, has been left behind, overlooked by this government for eight years. People in my community are feeling the impact of that. It is risky. It's impacting people's health, mental health and wellbeing. It's not good enough that people on the Central Coast are being overlooked and left behind. As I said earlier, I've spoken to you about this personally, Minister, and I've raised these issues with you countless times. I believe you are genuine in your desire to do something—but there is no urgency, and it needs to happen now. People are missing urgent health checks. Somebody I heard from today has missed a breast-screening check. People are missing checks for melanoma. People are missing urgent health-screening checks at the same time as being unable to get care, and it's clogging up our emergency departments.

Minister, this is not good enough. The people of the Central Coast deserve better. You've said you're aiming to ensure that this process is a speedy one, to quickly help. I hope so. You've also said that you'll announce a wider review of the DPA indicator soon. I hope so. But, Minister, a review is not good enough. What's needed is action, what's needed is action now, for people in my community who have been overlooked and forgotten and whose health is at risk because of this government.