Parliament

Regional and rural health funding

June 06, 2018

Grievances

I have been listening to the debate for the last hour and I must say, when I came into this place I thought the grievance debate was to raise an important issue in relation to your electorate, rather than worry about the party on the other side.

I rise today to grieve for the people in rural communities who are disproportionately disadvantaged when it comes to health outcomes and access to health services.

Deputy Speaker, coming from a regional community yourself, you too would understand that it is often a challenge to get the resources you need in your community to deal with the issues that arise in them. It is a very different story when you live in a metropolitan area where you have access to so many services and so much opportunity to access them with virtually no travel of significance associated with it.

Just over two years ago I had my first grievance debate and this is my second. I will only get two during the course of this Parliament. At that point I spoke on education and the disparity between educational outcomes in regional areas as, again, compared to metropolitan areas, and they were very significant. I am very pleased to say that as a result of that I got some traction, and after not too long we have got a Shepparton education plan well underway and, in this budget, $20.5 million committed to the design work on a new Shepparton secondary college, which will merge the four existing colleges together with an integrated children's centre on the Doveton College model over in Mooroopna. So I certainly see the grievance debate as an opportunity to raise some serious issues and hope that the government is listening and will respond as best it can.

In 2015 the Garvan Institute of Medical Research released its inaugural medical research and rural health report. It is a disturbing indictment of the systemic neglect of rural and regional communities when it comes to health. It reports that people living outside the major capital cities, when compared with those living in capital cities, experience higher mortality rates and lower life expectancy; higher reported rates of high blood pressure, diabetes and obesity; higher death rates from chronic disease; higher rates of dementia; and higher rates of alcohol abuse and smoking. It is then not surprising to learn that while people living in rural areas make up 30 per cent of the population they do not receive anything like a third of health funding or services in relation to mental health.

The Garvan institute also notes that rural and remote communities are more reliant on general practitioners than their city counterparts. Their healthcare facilities are generally smaller, have less infrastructure and fewer specialists servicing them, and that makes life very difficult for people in remote areas to access the sorts of professional services that at times they want to. Of course the interplay between health outcomes for people in regional and rural areas, their access to services and so forth is tied up with a whole lot of social and economic issues that impact on them. The challenges faced by these communities are compounded by often higher rates of socioeconomic disadvantage and, as outlined earlier, generally poorer educational outcomes.

Distance from key services is also obviously a major contributing factor. I do not know how many of you might have watched Landline on Sunday, 20 May this year. It was a really heartbreaking program that told stories about people living in remote areas of regional Australia. There was the story of a young mother who, because of her risk of developing breast cancer — it was a high risk — decided that she would have a double mastectomy instead of facing up to the sorts of time away from home that she would need to have the treatments that others faced with the same risk might definitely choose to have. There was another story of a mother who had to spend months away in Adelaide while seeking cancer treatment. She had three young daughters aged six, eight and 11, and she had to put them in a boarding school and be hundreds of kilometres away from her home, leaving her husband on the farm on his own for all those months. That description in itself really paints a very different picture than that of someone who might be living in the suburbs of Melbourne and what their access to treatment would be if they had cancer.

In the Shepparton district we have much better access to diagnostic and treatment services than a lot of those cases that were portrayed on Landline, but my electorate is crying out for a cancer centre. We are the fifth largest regional city in Victoria and we are a hub for many things across the north and north-east, yet patients in my electorate are forced to travel to Bendigo, Albury or Melbourne to seek radiation therapy. This is really an emotional and physical burden that should not be placed on people when they are sick. It requires them to take time off work, it comes at considerable financial expense to them and their choices are quite limited. Bendigo is actually the closest place for treatment, yet the bus timetable between Shepparton and Bendigo does not allow you to travel home on the same day. People have often talked to me about feeling so ill after having treatment that they lie on the back seat of the car and then have to travel for hours to make their way home. They deserve to be treated in their own communities. When they are feeling ill and having treatment they deserve to be able to just go home, just like people in metropolitan areas can.

Landline also reported that for every 100 kilometres a person with colorectal cancer lives from a radiotherapy provider, they are 8 per cent more likely to die. Bendigo is 120 kilometres, Albury is 176 kilometres and Melbourne's CBD is 190 kilometres from Shepparton. Travelling these distances, whether for cancer treatment or for any other medical reason, also comes at a financial cost, as I have said. The Garvan institute estimated the travel costs attributed to people with osteoarthritis and rheumatoid arthritis alone as being $78.6 million in 2012 for regional people. I think that is a really sobering figure.

Last year I went to Sydney, and I visited, along with the safe injecting room there, the Kinghorn Cancer Centre. I did that because we are looking at the redevelopment of Goulburn Valley Health. Indeed the first stage is now underway — the cranes are there, things are happening on the ground, which is really pleasing to see. But because of the need for a cancer centre and the fact that we are advocating strongly for it as a second part of the redevelopment of Goulburn Valley Health, I was keen to see the sorts of services they had in that cancer centre. Let me tell you, they are unbelievably state-of-the-art services. I am realistic enough to know that we will not be seeing that replicated in Shepparton.

In Shepparton we have access to chemotherapy services but not radiotherapy, so we simply want that addition and to be able to bring all the cancer services for our region into one centre — chemo, radiation therapy and all the support services that go around them in a single centre for our region. Of course we do not just service the Goulburn Valley and up to the Murray River. Residents from southern New South Wales also often come down to our region. I grew up in Jerilderie in southern New South Wales, and Shepparton was our go-to town. It is a large regional town — the fifth biggest in Victoria — and it services a much broader community. Often when we talk about the population of a place we do not take into account the fact that its catchment is quite a large one.

Primary Care Connect is a community health service in Shepparton that targets vulnerable and hard-to-reach communities. Last year it brought men of all walks of life together to take part in an event during Men's Health Week and to launch what they have called an agrisafe clinic. It is a clinic that is set up to do a comprehensive check-up of men working in agriculture. It is only once a month and it is only for 4 hours, but they book in four farmers. Starting at 6.00 a.m., they take blood tests, give them breakfast and then undertake a full health assessment, so that during that 4-hour period a really good assessment is done on four people. It is limited. It could easily be expanded, but they report that it has been incredibly popular, and it takes into account the capacity of farmers to get to these sorts of things. Often their work life does not lend itself to dashing off in the middle of the day. They have to come to town to do the assessment, and that early start seems to have had some appeal and to have really increased the patronage of it.

Farmers are the backbone of our food-producing community. All the factories in our towns are dependent on the produce of farmers, but the challenges they have faced have been great. We had the dairy crisis not long ago; I suppose it was nearly two years ago. We have had drought and we have had floods. We are facing the uncertainty of the Murray-Darling Basin plan with the water that is coming out of our region and what that might mean for the future of irrigation in our district. We already know about the damage that has occurred — up to $500 million a year has been lost at the farm gate, as have many jobs, with a further 1000 jobs predicted to be lost if this additional 450 gigalitres of water is taken out of our region. So supporting farmers and farm workers in regional areas, who often are faced with really difficult challenges, particularly from a mental health point of view, is something that is important, and I would encourage the government to keep that in mind when rolling out health services.

I had occasion to visit our local stroke group in Shepparton recently and found that they are in desperate need of support and are really just a fairly loose group of people who are meeting together post stroke — community members and their carers. They talked about the Geelong stroke centre, which is fairly new, I think, and provides targeted services. The services have names such as Drysdale Blokes with Strokes, Geelong Blokes with Strokes, the Stroke a Note Choir and the Women's Cafe Group. These sorts of programs have arisen out of a group of people getting together in Geelong with the Stroke Association of Victoria and looking at what their community needs and how they might support those people. I certainly found out that there was a need for something like this in our area, and we know that appropriate support for stroke survivors can lead to continuing improved outcomes and even to people who have had significant strokes resuming many of the previously very productive aspects of their lives.

I have spoken about the challenges faced by rural communities in terms of access to health. There are many discrepancies. Although research indicates that the prevalence of mental health issues is relatively consistent between metropolitan and regional areas at a rate of 20 per cent of the population, the Garvan Institute of Medical Research puts the rate of suicide in the country at 66 per cent higher than in major cities. I think this is a really shocking statistic, particularly when it is often thought that people in regional areas have a higher life satisfaction and a stronger sense of community. There seems to be a lot of nice things about living in the country, but the reality is that there is an underside that is leading people to take their own lives and to suffer from very significant mental health issues. The plight of those suffering from mental health problems in regional Australia has had a global reach recently, with an article in the New York Times highlighting the fact that all is not going well among our farmers and regional communities.

According to the National Rural Health Alliance, for every $1 spent per capita on Medicare-funded mental health services in major cities, only 77 cents is spent in inner-regional areas, and that is what Shepparton is — an inner-regional area. The alliance reports that inner-regional areas have only 37 per cent of the psychiatrists, 61 per cent of the psychologists and 93 per cent of mental health nurses of major cities. So there is a significant underservicing of the needs of those regional communities. I would add also that the turnover of professional staff in country areas is often much higher and this leads to disjointed and unsatisfactory therapeutic outcomes for people. At the heart of that problem is the broader challenge of recruitment that we face in many regional areas for a whole range of professional people. In my electorate I believe this can only be addressed by a really fundamental whole-of-community change.

We are seeing significant change through massive government investment in the first stage of our health system with the redevelopment of Goulburn Valley Health, with our new Shepparton education plan and new schools coming on board, and with the physical connectivity that the promised rail service will deliver to us — $313 million, now in the budget, now real, which is eventually going to deliver us nine return Vlocity train services from Shepparton each day. These are the sort of things that are game changing for rural communities, and when you bring those things together you are creating an investment that is needed. I could go on at length about the sorts the things we need. We definitely need a mother-baby unit and we need it to be of a standard that places like Tweddle in Melbourne have because we know about the damage that occurs without it. But Shepparton district is in need, and it is receiving attention.

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  • Suzanna Sheed
    published this page in Parliament 2018-08-30 14:21:54 +1000