On Friday, the National Rural Health Alliance’s Gordon Gregory wrote a curiously prescient piece for Croakey arguing that the needs of rural Australia had gone missing during the election, and wondering what it might be like to have Tony Windsor as PM.
“Certainly it will do the independents in the lower house no harm at all if the major parties continue to ignore rural and remote Australia, its industries and communities,” he said.
Today Croakey asked Gordon Gregory how he would advise the independents to proceed in government-making negotiations if they wish to make rural health a priority.
Gordon Gregory writes:
In the 40 hours since the polls closed, there have been more references to policies in support of rural, regional and remote communities than in the previous 40 weeks. More appreciation of the importance of those areas to Australia as a whole. More references to rural health services. More care.
This morning the magic word ‘decentralisation’ even appeared. The last time it was given serious consideration in the Australian polity was when the nation was working on the Albury-Wodonga growth centre and decentralising the New South Wales Department of Agriculture to Orange!
But a reinterpretation of decentralisation is not a bad place to be starting. If the capacity of the public sector to provide housing and transport infrastructure is anything to go by, some of the capital cities are already ‘full’. Dissatisfaction with the public transport system in Sydney seems to have been a constant sore and led to all sorts of shenanigans in the recent campaign.
A decentralisation policy can underpin a greater focus on infrastructure development in regional areas – and not just in those areas where mineral wealth is sourced, but spread around all parts of the nation which have the ecological capacity to support a greater number of businesses, communities and families than currently exist there.
And decentralisation is not only about where physical infrastructure is built but also about the way policy decisions are made. Decentralisation in the health sector can be seen as the localisation of management and control: recognising the local communities of interest on which health services are best based.
The small hospitals and health services of the far southwest of New South Wales receive their pre-ordered frozen food from Albury (delivered through an 8-hour round trip), and management of their health staff is based in Queanbeyan (5 hours) and North Sydney (8 hours). To get a cupboard fixed in the small local hospital, permission (and the tradesperson!) come from the larger centre an hour away.
On the ground in Deniliquin and Finley the local health service managers know what needs to be done but are powerless to do very much about it. Their patients with more serious conditions travel across the Murray to northern Victorian hospitals – and some of the inter-State remuneration for such treatments flows more slowly than the river itself.
These are the reasons why, regardless of which party assumes government, the push for greater local control of both hospitals and primary care envisaged in the previous government’s health reform agenda must continue. The incoming Federal government must understand the importance of this and not leave the creation and management of Local Hospital Networks and Medicare Locals to the States, who might be tempted merely to return to the situation in which there are large area organisations run from the capital cities. The new health entities must cross State borders.
Perhaps it will turn out to be significant that the three Independents are all experienced in State as well as Federal politics, because there is no area of public policy in which the relationship between the Commonwealth and the States is more complex and more critical than in health.
In negotiating with the two major parties, the Independents will no doubt consider what is on offer as well as what is not.
Both Labor and the Coalition seem to have quarantined further tax reform for three years – which mitigates against some of the positive proposals for regional areas in the Henry Review. And speaking of taxation, will there be a price on carbon?
Unlike the Greens, neither of the major parties has committed to national action on dental health services.
The choice on broadband should be made on the basis of both technical understanding and the view as to whether a gold standard, publicly-owned system can be a ‘nation building’ centrepiece, including for investment in jobs, and can deliver equivalent broadband at an equivalent cost to consumers in all parts.
The Coalition has a more generous proposal on paid maternity leave but ruling out the mining industry resource rent tax will reduce tax expenditures for that purpose as well as for infrastructure and superannuation.
Given the critical role of the social and economic determinants of health, the election campaign included one modest pointer to an explicit regional development policy that had the support of both major parties. They have both committed to financial incentives for jobseekers willing to relocate to a new region in which they can find a job. It might be seen as drawing a long bow but such a policy may well indicate their broad support for the legitimacy of government intervening in the free market.
Given the longstanding reluctance of both sides of politics to ‘pick winners’, this is hopefully a small but significant sign that whoever is next in government will recognise that the two speed economy can be adjusted for greater equity across regions.
That would lead to a greater number of sustainable communities – healthier places in which to live and easier places to which to attract health professionals.