Thank you for the opportunity to address you.

I pay respect to the traditional and original owners of this land the Muwinina people, to those that have passed before us and I acknowledge today’s Tasmanian Aboriginal community who are the custodians of this land.

Firstly, I thank you all for the extraordinary work you do and for your commitment and dedication to your profession.

Most Australians, live in urban areas, and would not be familiar with your work but conversely, I have no doubt that the communities within which you work, very much value every one of you.

This conference is aptly titled “Going to Extremes” and the health providers who do such important and often unrecognised work in the most remote areas know how extreme health issues can become in these regions.

Working under more difficult conditions than your city counterparts also says much about your own values.
With 87% of your members being women and 89% working in remote areas, personal safety is understandably a priority issue for CRANAplus.

The number of serious cases of violence against rural and remote health workers further confirms the high level of risks faced by CRANAplus members.

In a story for the Adelaide Advertiser on April 7, journalist Peter Jean stated that:

“A survey of 800 regional nurses …. found 60% had been assaulted while on a single nurse post and 70% said that threats to their safety had increased in the last year.”

The murder of nurse Gayle Woodford on the APY Lands earlier this year may have been an extreme case but it never the less highlights the daily risks and unacceptable conditions to which so many outback health workers are exposed.

My sincere condolences to Gayle’s family and friends, and my thanks to her, for her work in the APY Lands in South Australia.

I note that you will be devoting sometime this afternoon to addressing workplace safety.

I also note CRANA’s five key workforce priorities, as outlined in your President’s message in the Winter edition of the CRANAplus magazine.

1. Zero tolerance to violence and aggression
2. After hours call outs to be accompanied
3. All single nurse/clinician posts to be avoided
4. The establishment of a national safety implementation group to develop, implement and monitor a set of minimum standards/training for the remote health industry
5. All employers to immediately work with communities to review their structures, policies and systems to ensure a safe workplace for their remote health workforce

These priorities cannot be understated and are vital to the continued work of health professionals in remote areas.

We will not lift rural and remote health workforce numbers, if personal safety is not addressed.

And if we can’t get more health workers into rural and remote Australia, we will have great difficulty in lifting health standards.

The disadvantages faced by both health professionals and communities in regional, rural and remote Australia are well documented. The CRANAplus Remote Health Snapshot presents a very clear contrast between health outcomes in urban and non-urban Australia.

As an advanced country, it is not acceptable…

· That in remote Australia, average life spans of women and men are, respectively, 2 years and 3.4 years lower than city dwellers;
· That suicide rates are twice as high;
· That chronic disease levels, including diabetes, coronary heart disease, lung cancer, eye disease and chronic obstructive pulmonary disease, are considerably higher in remote areas;
· And the ratio of health professionals in remote areas particularly in specialised sectors is much lower than in city areas.

I have little doubt that were it not for the work of CRANAplus and other professional health organisations, the health disparity between city and country Australia would be much greater.

The differences are attributable to several factors – which together can multiply the effects.

Those factors which you are very familiar with include, but are not limited, to:

· A shortage of specialist medical professionals and allied health workers
· Travel distances which costs both time and money
· Climatic factors which have direct health effects
· Access to pharmacists and vital medicines
· The blurring of responsibility between State and Federal Departments of Health
· The low socio-economic status of many regional, rural and remote communities
· Access to fresh, health and affordable food
· Unique Indigenous health challenges

I am conscious that, in recent years, there had been considerable focus on addressing workforce issues.

Yet one of the first health cuts made by the Coalition Government, regrettably, was abolishing Health Workforce Australia.

Getting rural health graduates to return and practice in regional and remote areas – particularly when placement opportunities in remote and regional areas are limited – must be addressed.

I note the Assistant Minister’s comments about Regional Training Hubs and we will look at their roll-out with interest.

Time does not allow me to address all of the contributing factors to the health outcomes in remote areas but I will make some brief comments on two matters – social inequality and new technology.

Social inequality is indisputably linked to worse health outcomes.
Tackling social inequality although complex, lies at the heart of improving people’s health.

Numerous studies demonstrate that remote communities have amongst the lowest incomes in Australia, with many households struggling financially and facing costly health problems.

Remote communities will therefore be disproportionately affected by:
· the Medicare rebate freeze
· a GP co-payment
· increased pathology and diagnostic imaging costs
· increased costs of medicines; and
· by abolishing the Child Dental Benefits Schedule.

In the recent election campaign Labor committed to reverse:
· The Medicare rebate freeze
· Cuts to the Medicare bulk billing incentives for pathology and diagnostic imaging
· Price hikes to PBS medicines
· Cuts to the Medicare Safety Nets; and
· Cuts to public hospitals over the next four years

Child Dental Benefits Schedule
The Government’s intention to wind up the Child Dental Benefits Schedule and replace it with a Child and Adult Public Dental Scheme is code for cost cutting.

Worst of all it will disadvantage remote communities most, as for them access to public dental services is extremely difficult if not impossible.

I turn to the use of technology.

Access to a modern NBN can be a massive advantage for the health of Australians in remote areas. It can expand Telehealth services that are currently not available to so many rural and remote Australians.

It can connect people with the rest of the country and the world – including health services, education providers, business and even contact with Government departments.

The CSIRO 12-month trial of home-based Telehealth services for managing chronic disease in elderly patients reported a 24% reduction in MBS expenditure and, importantly, a substantial decrease in the rate of hospitalisation.

The cost reductions were directly linked to better health management and Telehealth was the reason why.

I note that 27% of people living in remote Australia are Aboriginal and Torres Strait Islanders. They are amongst the most disadvantaged Australians. Their burden of ill-health is 2½ times that of other Australians.

Many of your members are in the front-line of health service delivery for Aboriginal and Torres Strait Islanders and would be acutely aware of both the health and social hurdles faced.

In his “Close the Gap” speech in Parliament in February this year, Labor Leader Bill Shorten talked about the issues faced by Aboriginal or Torres Strait Islanders and Labor’s absolute commitment to addressing them.

My colleague Warren Snowdon, who has represented most of the Northern Territory for over 20 years in the national Parliament, has Shadow responsibilities for Indigenous Health. I cannot think of any person in the current Parliament with a better understanding of Indigenous matters than Warren.

Clearly, we need to do more to support our health professionals in regional Australia. Your own CRANAplus survey found that around ¾ of its members indicated a lack of professional support and inadequate management impacted the way they did their job. If management is not being given enough support, we need to address that issue as well.

The survey also reflected that 69% of all members were aged over 50 – and that 49% of all members anticipated they wouldn’t be working in remote health in 5 years’ time.

We need to find out the answers to the questions that this survey raises. For example, what is discouraging younger health care professionals from working in remote areas and why do members not expect to remain in remote health long term?

Whatever the answers – we should be recognising the efforts of all those now working in regional, rural and remote areas and doing what is possible to support them.

In the lead up to the next Federal Election, I will be working with Catherine King, Warren Snowdon, Julie Collins and others in Labor’s health team on developing the rural and remote health policies that we put forward.

Your input into the development of those policies will be invaluable.

My best wishes for the remainder of your conference.