HEALTH — REGIONAL SERVICES

HON MARTIN ALDRIDGE (Agricultural) [1.04 pm]: I move —

That the Legislative Council acknowledges the disparity that exists between metropolitan and regional Western Australia with respect to health care and calls on the state government to —

(a)  implement strategies to improve health care in regional Western Australia;

(b)  appoint a rural health commissioner to deliver better information and transparency and most importantly to drive innovation and reform in health care and population health generally;

(c)  immediately increase and modernise the patient assisted travel scheme to better support those required to access specialist and allied health services; and

(d)  ensure palliative care is accessible across regional Western Australia.

Comments and speeches from various members

Amendment to Motion

Hon ALANNA CLOHESY: I move —

(1)  In paragraph (b) — To delete “appoint” and substitute —

consider the appointment of

(2)  In paragraph (b) — To insert after “generally” —

within a Western Australian context

HON MARTIN ALDRIDGE (Agricultural) [1.44 pm]: I rise to indicate I had a conversation with the government through the parliamentary secretary behind the Chair. I am supportive of the amendments moved by the government in this regard, noting that the concept of a rural health commissioner at state level would be a national first and something that was not mooted beyond two weeks ago. It will require some further consideration by other parties, including the government, to fully consider its merits. I say this in the interests of indicating general support and interest and ensuring that the motion gets the support of, hopefully, all parties in this place, with them agreeable to the amendment.

HON NICK GOIRAN (South Metropolitan) [1.45 pm]: On behalf of the opposition, I briefly indicate our support to the amendment moved by the parliamentary secretary.

Amendment put and passed.

Motion, as Amended

Comments and speeches from various members

HON ALISON XAMON (North Metropolitan) [2.05 pm]: I rise to indicate that the Greens will also be supporting the amended motion. I thank the member for once again bringing the issue of regional health care to the attention of this house for discussion. It remains an important area, which is useful for us to be debating. Obviously, we know that the disparity broadly between health care in metropolitan WA and rural and regional WA is real. I note particularly that only this week the Australian Institute of Health and Welfare released its latest report on rural and remote health. The key findings are not particularly surprising: from 2015 to 2017, life expectancy for both men and women decreased as remoteness increased; in 2017–18, potentially preventable hospitalisation rates in very remote areas were two and a half times those in major cities; in 2015, the total disease burden rate in remote and very remote areas was 1.4 times as high as it was in major cities; and in 2016, people in remote areas were more likely to report barriers to accessing GPs and specialists than those in major cities, which is obviously a self-evident point.

We know that the further out they get, people do not have the same level of services and facilities and access to professionals. I want to make the point, however, that the disparity between regional and metropolitan health outcomes is not simply limited to location. It is not the case that there is some sort of magical barrier around the metropolitan area whereby if it is crossed, one’s health care suddenly goes from excellent to being not so. It is the case that a number of population groups within the metropolitan area experience systemic disadvantage. I think, for example, of the systemic disadvantage faced by Aboriginal Australians. I would suggest that an Aboriginal family living in Girrawheen is likely to have poorer health outcomes, for example, than a millionaire living in Eagle Bay. It is not as simple as saying that this is about where people reside, although that is significant. We must also make sure that we are interrogating the population groups that are living in particular areas. It is partly about access to services but it is also about the disadvantage experienced by particular population groups. It is a multifaceted concern.

I have spoken in this place, through previous motions on the issue of regional health care, about the need for better access to palliative care services as well as mental health services. Today, I want to specifically pick up on one of the points that the motion touched on and go into it in a bit more detail—that is, the issue of the significant disparity in ear health between not only children in metropolitan and regional areas, but also, as I have already indicated, Aboriginal and non-Aboriginal children. We know that the importance of good ear health is not to be taken lightly, particularly in young children. It is well documented that if we miss the opportunity to intervene in the very early years, that does and can have some devastating consequences. We know that hearing loss in those critical years can lead to speech and language delay. My son was caught up with that. Children with undetected hearing loss are more likely to be subject to adverse disciplinary processes by the parents or perhaps their schools, because misunderstanding can arise whereby hearing loss is interpreted as rudeness or defiance. Repeated ear infections and hearing loss can also lead to mental health problems and higher levels of psychological distress. It is well established that people with hearing impairments are over-represented in our justice system. That is why we need to take this issue extraordinarily seriously.

Otitis media, as it is referred to, is an infection of the middle ear and is very common in children. Most children will develop otitis media at least once in the first three years of their life. Frequent or severe episodes can lead to permanent ear damage and hearing loss. The key will always be ensuring that we can get access to early treatment to prevent the problems that are associated with the ongoing chronic condition, which is where the reduced access to healthcare services in the regions in particular becomes very problematic. In June this year, the Auditor General, continuing to be worth every taxpayer dollar that office receives, released the findings of an audit that her office conducted into whether state government entities are reducing the burden of ear disease for Aboriginal people. Although the Auditor General’s report looked at services for all children across the state, it is safe to assume that these findings are amplified in regional settings where access to services is much more limited than it is in the metropolitan area. The data backs this up. We know that 28.3 per cent of children in the Kimberley are classified as developmentally vulnerable on two or more domains in the Australian Early Development Census by the time that they enter primary school—I want this noted—except for the Augusta–Margaret River region and southern parts of the wheatbelt and Esperance. This comes back to my point about looking at population groups. In all of regional WA, more than 10 per cent of children are classified as developmentally vulnerable, with the general trend being that the further away from Perth they live, the greater the number of children who will be developmentally vulnerable. That is an issue for us as a state, and an issue that we need to address.

The Australian Early Development Census has identified five areas of development: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills, and communication skills. Those domains were selected on the basis that they have been shown to predict later health and wellbeing and academic success. All these areas stand to be negatively impacted by poor ear health, which is why ensuring access to early intervention health services, no matter where we live, needs to be an absolute priority. It can have lifelong impacts. Where someone lives in regional WA has an impact on ear health. As I said, the situation is generally worse for Aboriginal children. The World Health Organization has found that the rate of chronic middle ear infections in Aboriginal Australian children is amongst the highest in the world and for non-Aboriginal children the rate is one of the lowest. It is in this context that the Auditor General’s damning findings on the lack of progress in improving Aboriginal ear health is very disheartening, to say the least.

The Auditor General found that WA Health, including WACHS, does not track or analyse the rate of otitis media in Aboriginal children nor does it know whether efforts to reduce the burden or severity of the disease is working. Even the piecemeal data that happens to be available does not build a clear picture. The report noted that any of that data is rarely being shared and, obviously, this is a missed opportunity to improve services. The research that was undertaken by the Telethon Kids Institute in the goldfields found that Aboriginal children had otitis media at more than double the rate of non-Aboriginal children. It found that infections tended to occur at a younger age and were more likely to result in hearing loss in Aboriginal children. The Auditor General also found that programs to identify otitis media do not reach most Aboriginal children early enough. I have already said why that is a problem and why time is so critical. The main government-run program specifically targeted at Aboriginal children was found to have a very limited reach. The enhanced Aboriginal child health schedule, which is an extension of the universal checks, includes ear checks. Although that program appears to be working for those kids who are tested, these checks are estimated to reach only 29 per cent of families, even in the metropolitan regions, and there is no reliable data for the non-metropolitan areas at all.

Further, the Auditor General found that despite the benefits of co-designing Aboriginal services being espoused in the Department of Health’s “WA Aboriginal Health and Wellbeing Framework 2015–2030”, services continue not to be co-designed. This means that once again we have services that continue to be hard for Aboriginal families to use, which will obviously have ramifications for how effective they will ultimately be. Despite these rather disheartening findings, the Auditor General found some examples of good practice and has urged all agencies to learn from them. For example, there is a pilot project in Kalgoorlie whereby opportunities for immunisation are also being used to check children’s ears. When a problem is identified, a nurse works with families to help navigate services, which is a critically important part of that process.

While we are talking about success stories, it would be remiss of me not to acknowledge the fantastic work undertaken by the Earbus Foundation, which I have been talking about in this place for quite a while. The Earbus Foundation’s aim is to eradicate the impacts of hearing loss in every community in Australia so that every young person can reach their full potential through listening and learning. Earbus is now delivering outreach services in the goldfields, the Pilbara, the south west and the Kimberley, and its reach has been expanding despite some very tight funding constraints. As a result of those funding constraints, the foundation has been unable to service significant parts of the state. I know that the government committed funds in the last budget to further expand the service in the Kimberley, and clearly this is welcome, but I also note that the Earbus Foundation right now is running a fundraising campaign so that it can expand its outreach programs to more places in the Pilbara. Frankly, I think this is outrageous. We are talking about what I think needs to be viewed by all governments as a foundational element of a child’s development, and here an award-winning organisation wants to expand, but it is being hampered simply because of insufficient funds—and it is out fundraising. That is such a problem. This is clearly a worthwhile and proven service and something that the government should be funding. As I have pointed out, there are lifelong implications when we do not fund these types of services, including the ultimate waste of taxpayers’ dollars—people ending up in prison simply because they did not get the services they needed early in their lives. It is a false economy not to put the money primarily into these services.

This takes me back to the Auditor General’s report and perhaps the most disheartening of all her findings, which is that despite the “WA Child Ear Health Strategy” being released in 2017, in her words, many of the conditions for a successful implementation are not yet in place. She also said that although the planning work has been undertaken on identifying the issue and what needs to be done, the strategy is not funded and there is no line of accountability for who should be responsible for its implementation, meaning that it has gone absolutely nowhere. Indeed, the themes that have arisen in the Auditor General’s report mirror the findings in the audit of the mental health system, which I have already spoken about and which we will undoubtedly be referencing for some time, as well as reviews of other health services, particularly relating to unclear lines of accountability and a lack of data.

This is simply astounding, and it begs the question: if the government is unable to deliver improved outcomes for a clearly defined, discrete and treatable health condition such as otitis media, what chance does it possibly have in tackling the really complex issues, such as suicide prevention in our regions? Given the poor state of health care that is evident in much of regional Western Australia, the Greens will support this motion, but today I particularly wanted to focus on this one element, because there are so many areas we could cover.

Comments and speeches from various members

Question put and passed.

 

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