I acknowledge the traditional owners of this land, the Wurundjeri tribe of the Kulin Nation, on which we meet here today in Melbourne.

Id also like to acknowledge CRANAplus President Dr Janie Smith and Chief Executive Officer Mr Christopher Cliffe.

Im also very pleased to be speaking in the same session as Associate Professor Paul Bennett.

A story of dealing with complex health needs in remote Australia

The Spring Edition of the CRANA Plus Magazine features a compelling story of Peter Strachan, known to his mates as Strachy, from Alice Springs.

Peter was diagnosed with acute myeloid leukaemia (AML) in April 2010. Determined to fight the disease for his wife and 8 year old daughter, Peter was forced to get on the next plane to Adelaide for radiology and oncology treatment, over 1,500 km away.

And so began his journey.

The same journey thousands of Australians and their families from remote areas have to make every year to access treatments many in the cities and regions take for granted.

Six months after treatment, Peter relapsed. The advice from his doctor in Adelaide was straight to the point chemotherapy will give you another 12 months, a transplant can give you at least 5 years.

As many of you would know, stem cell transplants are not easy to come by in Alice Springs. So it was back to the Royal Adelaide Hospital for stem cell replacement and another five months as an outpatient before Peter was able to return home to his family.

He still requires monthly blood tests and quarterly bone marrow biopsies back in Adelaide but he survived.

There are many more in his situation, living in remote areas of Australia for whom cannot say the same.

Fortunately for Peter, he could access a blood test immediately and have the Royal Flying Doctor Service airlift him to Adelaide within 36 hours.

If he lived in similar remote areas such as Amata or Kintore, it is highly unlikely he would be telling his story.

The financial hardship was another issue many remote patients face. Peter had to give up his job to fight AML and relied on his family for support.

Exhausting his own savings, his sister Alison gave up her job in Melbourne to care and provide for him.

Centrelink regulations for carer payments are particularly restrictive. Eligibility depends on being basically incapable. Many like Peter do not qualify.

We know that incomes in rural and remote areas are lower than the national average and distances to travel for treatment more vast.

Unable to work, out of sick leave and recreational leave and with medications in the thousands remote patients face a heavy burden. We need to do all we can to help ease this burden.

Stories like Peters would be familiar to you. Put simply it is the story of the enormous gap in services that are available to Australians who live in metro areas when compared to those enjoyed by people in remote Australia.

That difference can mean the difference between life and death.

More often it means the difference between a longer life or a shorter one.

If you get cancer, pray you live in a city and not in the outback. That's because where you live affects your chances of survival - and being in the city beats the country by a country mile.

People in remote areas have a 35 per cent greater chance of dying from cancer compared to those in the cities. And as we contemplate closing the gap between Indigenous and non-Indigenous contemplate the fact that the mortality rates are highest where the proportion of Indigenous Australians is highest.

Labor values demand we lift our game

One hundred and fifteen years ago, a new political party was formed to represent the needs of workers in remote Australia.

They were shearers, and stockmen, itinerant farmer workers, timber getters and miners.

They sought a fair go when they could work, and a safety net when they couldnt.

When I joined the Labor Party it was because I believed in this historical mission to deliver social justice and a fair go to all Australians.

It is because we believe in addressing inequality that we must fix our gaze upon the inequality in health and life and services between urban and remote Australia, and resolve to fix it.

In an era when we can send tourists into orbit and map the origins of the universe, we have to ask why we cant deal with the challenges of less remote parts of our own continent, where:

• Life expectancy in remote areas is lower by up to 7 years.
• Diet and nutrition is poorer.
• Chronic disease rates are higher, especially for diabetes and heart disease.
• Rates of accident, injury and substance abuse are higher.
• Access to care is more expensive and distances more vast.
• Education and disease prevention is harder and more expensive.
• Practices, clinics and programs are also more expensive to run and logistically harder to attract clinicians.

Labors Policies

If you want an indication of what Labors policies will be in government on remote health first look to our values. Then look to what we prioritised in previous governments.

Labor has a proud record on health reform.

We were the party that introduced Medicare 30 years ago and we are defending it today.

We will never vote for this absurd co-payment.

In Government we understood that, for remote Australia, access to health professionals was crucial.

We increased the number of doctors and nurses in training and made big advances in getting GPs to rural and remote Australia.

We increased bulk-billing rates to the highest level in history to over 82 per cent on average.

When Tony Abbott was Health Minster, they were as low as 67 per cent.

We introduced a more rational and equitable system of helping the states meet their increasing health and hospital obligations something the Government has now reversed, ripping $55 billion from the system.

We built 25 regional cancer care centres to cut-down on travel time and costs for rural and remote patients.

We provided MBS and PBS items to Practice Nurses for the first time.

Access to Nurses and Allied Health professionals

Good government is about addressing inequity. It is also about planning for the future.

We know that nurses and allied health professionals are the key to implementing preventative health strategies, and managing chronic health conditions.

In remote Australia, they fulfill many of the roles of a city GP.

We know that we need to support health workers to practice in remote Australia.

We also know we face a shortfall. The Health Workforce 2025 report revealed that by 2016, there needs to be an additional 10,949 nurses graduating per year just to meet demand.

At the current rate we will has an estimated shortfall of 109,000 nurses by 2025.

A responsible government would understand that if there is a shortage of nurses in the system, and those shortages are going to get worse.

These parts of the health service that are already under stress will face greater pressure.

A responsible government would understand that drastic steps are needed to encourage more nurses and allied health professionals into training and then into remote and regional practice.

The number one job would be to remove obstacles to entry.

Regrettably, this Government has taken a different route:

Unhappy with the message, it has sacked the messenger.

Health Workforce Australia, which produced the report and had the job of planning the response, has been closed.

They are also increasing the costs of getting a qualification.

A student who is currently enrolled in a Commonwealth supported place for a three year degree in nursing would graduate with a HECS debt of between $18,000.

Christopher Pynes higher education changes will see these costs go through the roof.

A 20 per cent cut to university funding sets the average minimum that universities will have to increase their fees just to stand still.

Others estimate that a nurse could pay up to $98,000 for their nursing degree.

This will discourage people from taking on a degree in nursing. It will certainly act as a barrier for a person going to university as a mature age student, or retraining to change careers.

The increase in the interest charged will mean that debts the size of mortgages will hang around many students necks well into middle age, and women and poorer students will end up paying more.

I agree with Lee Thomas, from the Australian Nurses and Midwives Federation when she says:

If we are to have a first rate health system, we should be encouraging more people to study, not putting more barriers in their way.

Industrial reforms

The Minister for Industrial Relations has promised a comprehensive review of Industrial Relations and nothing will be off the table.

I know the ANF has raised some strong concerns about penalty rates and shift arrangements. They have been very vocal, as is their responsibility.

I dont want to focus on the industrial issues so much as my concern about a dismissive attitude toward alternative voices particularly collective ones.

On several occasions I have heard the Minister seek to dismiss the objections of nurses and health workers by reference to union membership.

It is a regular retort in Parliament but last week it reached a ridiculous point when a research paper prepared by the NSW Department of Health showed that the GP Tax would see a flood of 500,000 new patients going to Hospital Emergency Departments instead of their GP.

The Federal Health Minister dismissed the findings as being the evil work of union sympathisers within the NSW Liberal Government.

The State Liberal Minister for Health, to her credit, slapped down her federal colleague, but it underscores a real problem.

The Health Minister seems to think that a person who joins a union is incapable of providing dedicated care or participating in public health debate.

This cannot be allowed to stand.

Indigenous Health

The Governments commendable words on addressing Indigenous health have not been matched by its funding commitments.

Over $125 million in cuts to health funding and the review of existing programs means uncertainty for the community based services working on the front line.

The $500 million in cuts to other Indigenous programs means less money in the system.

The gap in life expectancy between Indigenous and non-Indigenous Australians is currently estimated at 11.5 years for men and 9.7 years for women.

The gap has narrowed only slightly in comparison with increases in life expectancy for non-indigenous Australians.

They are 2.5 times more likely to be hospitalised for preventable conditions, and have higher rates of death due to injury, digestive system disease, kidney diseases, maternal, neonatal and congenital conditions and certain infectious and parasitic diseases.

Social Determinants of Health Recognition

Yesterday I attended the opening of a Partners in Recovery program in Kiama, NSW.

It is an important program under threat from funding cuts which acknowledges that when dealing with people who have mental health issues, we also need to look at all of the other issues going on in their life the social determinants of their health conditions.

Before the launch, the Doonooch Dancers performed and talked about the importance of culture to healing.

Its a simple but obvious message that has with immediate relevance to dealing with prevention, chronic health, mental health, alcohol and other drug issues.

For workers on the front line in remote communities it is also very apparent.

In the Report of the Expert Panel on the Recognition of Aboriginal and Torres Strait Islander Peoples in the Constitution, a number of participants commented on the particular benefits of recognition for Aboriginal and Torres Strait Islander peoples, including the enhanced protection of Aboriginal and Torres Strait Islander cultures, and an improved sense of identity and mental health.

It is why recognition of the first Australians in our constitution is not just symbolic it is about redressing past injustice.

It is about validating the cultures language and history of Aboriginal and Torres Straight Islander people.

A submission to the Report from the Western Australian Centre for Health Promotion Research also confirmed that, without constitutional recognition, it will be more difficult to close the gap in Indigenous health outcomes and life expectancy.

What will we do

I understand that people are keen to hear what Labor will do if returned to office in 2016.

The truth is we are at the beginning of a consultation phase for our policies but there are at least three areas that are of direct concern to you.

Our first task is immediate. To stop the damage that the Government is doing right now in regard to the GP Tax and PBS charges.

You can also be certain that the values which underpinned our approach when we were last in Government will inform us again.

We know we need to look at the system of workforce incentives to ensure health professionals can work in remote locations.

We commissioned the Mason Review and it is still a very good guide.

We also know we have to have a rational and sustainable system of funding our hospitals particularly for regional and remote locations.

The third point is that much of the policy that lies outside the health portfolio has a direct bearing on health outcomes in the bush

It is one of the reasons we championed the NBN and continue to do so.

Access to broadband means access to Telehealth.

Telehealth has the potential to transform the way health services are delivered to people living in remote Australia, and also how professional education is delivered for health workers.

Conclusion

As we work through these and other challenges, one thing is critical.

We need a big voice for nurses and a big voice for regional, rural and remote Australia.

Labor traces its roots to the concerns of rural workers.

It was about equality and fairness then its about equality and fairness now.

Thank you.