Author: gg@gordongregory.net

Rural Generalism: One of the best games in town for rural health?

This piece was first published in Croakey on 19 June 2017. My thanks to Croakey and its Chief Editor, Melissa Sweet.

Lines in the Trouser – Part Two

This is the second part of the collection of pieces from the back pockets of my trousers at June 2016. Part One (http://www.aggravations.org/#!blog) includes an introduction and explanation. As in that first part, some contextual background has been added to help explain the purpose for which each piece was written or selected.

Index 
Part One
               Introduction
 LiT 1         A country childhood
 LiT 2         11th Conference recommendations
 LiT 3         Duke Tritton, Gary Shearston
 LiT 4         A doggerel of a life
 LiT 5         Do not go gentle, Dylan Thomas
 LiT 6         Each guest at our table
 
Part Two - this post
 LiT 7         For Tony Wade
 LiT 8         Funeral blues, W. H. Auden
 LiT 9         Heart of our Universe
 LiT 10        The Mad Monk and The Ranga
 LiT 11        Christmas Party 2012
 LiT 12        from Macbeth, William Shakespeare
 
Part Three
 LiT 13         None of us is innocent
 LiT 14         from Richard II, William Shakespeare
 LiT 15         Two little boys
 LiT 16         "Some chicken; some neck", Winston Churchill
 LiT 17         We've had enough of fluoro vests
 LiT 18         What's in a name?
Lines in the Trouser 7

For Tony Wade

Context: Tony Wade was a close friend from vets’ hockey. He was a warm and unflappable person with the sort of charisma, bonhomie and leadership abilities that made him a natural captain of the ACT cohort of which I was a part for the inter-state carnivals. He was a strong player in mid-field and given his robustness it seemed unlikely that he would be the first of our group to be struck down. He contracted acute myeloid leukaemia. Tony’s wife, Helen, asked me to write a piece for his funeral service, held on 2 June 2015.

Most of the regular members of our group are mentioned, including Dougie Dawson, long-time administrator. With Gerin Hingee in our group we were expected to play our matches using a ‘system’ that few bar Gerin himself could get to grips with; and Judy Baillie was for several years our very supportive and forgiving Team Manager. Boydie (John Boyd) was the ACT teams’ strapper who pre-deceased Tony. In the ACT competitions Tony was always a United player; Checks and Central are two of the other local clubs.

For Tony Wade

Right-Oh!
Gather round and quieten down and listen up you lot.
Dougie’s called this meeting to see who we have got
For the over 95s this year in Hobart – or is it Perth?
Though we can’t run – or bend – or see – we’ll play for all we’re worth.

Paul from Coffs will be in goal, with Des and Ken at the back
That’s a lot of defensive experience – though a little pace they lack.
Paul from Scone is in the halves, with Garth and all his hair,
And Brucie R, and Finn and Scruff – there’s lots of choice right there.

We’ll have two Morries up the front, with Kingo, China, Don –
And in case we win a short corner will discuss that later on.
We’ve flexibility enough which I know you really love
For Gerin can play all over the place – and very often does.

And Bruce will be among us too – he has no truck with fools –
He reckons he alone among us understands the rules.
There’s Johnny F and let’s be clear: our numbers are quite handy,
With Peter M., and Bobby, Alan (‘Chappie’) and young Andy.

Our womenfolk will be with us to help us night and daily
With Margie, Julie, Lynne and Miff – and Mrs Judy Baillie.

But who will be our centre half, our captain, heart and soul?
Who will bind us all together, make the parts one whole?
Tony Wade’s the man we need, our cheerful, loyal friend
The sort of man one works for – on whom one can depend.

He’ll puff around, just slightly pink; he’ll put them to the test
He’ll never stop until it’s done; our fairest and our best.
He’ll mingle then and chuckle, grin – one of his most endearing tricks
And make a speech, and drink a drink – yes even with the Vics!

A disembodied voice appeared – we all looked right around
But still no mortal source was seen and neither could be found.
We listened then in disbelief, no-one even stirred
As from a far-off distance, this is what we heard:

“I’m making up a team, to play for the ACT
Not just over 95 but for all Eternity.
I’ve got the strapper, he’s the best: he’s Boydie as you know,
He’s worked on me – so Heav’nly bumps will never make me slow.

I had to have a leader, with heart and soul in the game
Tony was your common choice so first to him I came.
He didn’t volunteer to lead – so modest till the end
So I had to call on AML* – a trusted s’lector friend.
He did his work on Tony in less than half a year
So now he’s here to lead my team, though others shed a tear.

I’d like if I could to have Don on the wing – either right or left –
Been calling him for ages but perhaps he’s slightly deaf?
And as soon as Gerin gets up here we’ll switch to play his style
So if you want the standard game, let-him stay with you a while.

So now I’ll build with confidence a team to make you proud
I’ll build it on the One I have – the stand-out from your crowd.
Of course I’m hurt for Helen’s grief – they always were United –
I’ve Checked the Central registry and know their troth was plighted.

Forgive me then, if that you can, for the choice that I have made
And remember him so fondly, your best and fairest, Tony Wade.”

*acute myeloid leukaemia.

Tony is seated, second from Left

Lines in the Trouser 8

Funeral blues – W. H. Auden

Context: An early version of Funeral Blues, with five stanzas, was published in 1936, and in its final form in The Year’s Poetry (London, 1938). The 1936 version was a satiric poem of mourning for a political leader, written for the verse play The Ascent of F6 by Auden and Christopher Isherwood. The 1938 version was written to be sung by the soprano Hedli Anderson in a setting by Benjamin Britten. It is now the English contribution to the statue commemorating the Heysel Stadium disaster, where a retaining wall collapsed, resulting in 39 deaths on 29 May 1985, when Liverpool played Juventus in the European Cup Final. The poem featured in Four Wedddings and a Funeral (1994)

         – and in the musical February House, produced Off-Broadway in 2012, a large portion of the poem is sung by Auden himself. I find it very moving.

Funeral blues

Stop all the clocks, cut off the telephone,
Prevent the dog from barking with a juicy bone,
Silence the pianos and with muffled drum
Bring out the coffin, let the mourners come.

Let aeroplanes circle moaning overhead
Scribbling on the sky the message He Is Dead,
Put crepe bows round the white necks of the public doves,
Let the traffic policemen wear black cotton gloves.

He was my North, my South, my East and West,
My working week and my Sunday rest,
My noon, my midnight, my talk, my song;
I thought that love would last for ever: I was wrong.

The stars are not wanted now: put out every one;
Pack up the moon and dismantle the sun;
Pour away the ocean and sweep up the wood.
For nothing now can ever come to any good.

Lines in the Trouser 9

Heart of our Universe

Context: I can’t remember the occasion for which this piece was written but its general purpose is clear: to act as an antidote to the popular habit among people in all other parts of Australia of putting down our capital city. The strongest objection is taken by Canberra residents to the personalisation of the city as the place that brings increased taxes and bodgie government, as in: ‘Canberra hikes fuel prices’ or ‘Canberra fails on education reform’. Like so many others, my family would rather describe Canberra as a well-kept secret, given its many civic, creative and human assets, its lovely climate, autumn leaves and bike paths.

Heart of our Universe

Settled for a hundred years, where pastures used to grow,
With windy days in springtime: just see the blossoms blow!
Cold nights through the winter, with clear blue skies by day
And nights well-made for sleeping: why would we go away?

Settled on Monaro between Snowy Range and coast
It’s names like Adaminaby that locals love the most
And coloured trees in Autumn cast each year their rusty spell
In places like Dalgety – just west Nimmitabel.


The Snowy River National Park smiles next to ACT
The Murrumbidgee river flows from here to distant sea
Bombala is the sweetest home for many friends of mine
Like Queanbeyan and Berridale and lake-strewn Jindabyne.

We’re chided by our cousins, for Parliament sits here
Not every Hill is Capital, and ours we hold close dear
While others then will put us down, for taxes are a curse
We’ll sing three cheers for Canberra: Heart of our Universe!

Lines in the Trouser 10

The Mad Monk and The Ranga

Context: The Federal Election held on Saturday 21 August 2010 resulted in both Labor and the Coalition winning 72 seats in the 150-seat House of Representatives. Three Independents – Tony Windsor, Rob Oakeshott and Bob Katter – had to decide which of the major parties they would throw their weight behind. The Leader of the ALP was Julia Gillard – a redhead – and the Leader of the Liberal/National Coalition was Tony Abbott. The piece was written for CouncilFest 2010 (3 August).

The Mad Monk and the Ranga

The voters have decided, they’re going to vent their anger
They don’t trust either side: the Mad Monk or the Ranga.

Someone leaked from Cabinet – that really was a clanger
For a week or two advantage went to-the-Mad-Monk not the Ranga.

People felt quite wilted – like some lettuce in a sanga
They wanted other choices, not just a Mad Monk or a Ranga.

They’ll try to move me forward, but not in my old banger
There’s no real action, just all talk from the Mad Monk and the Ranga

While we get slim in country towns, the city folk get fatter:
Hurrah for the House of Windsor and that lovely Mr Katter.

Lines in the Trouser 11

Christmas Party 2012

Context: I liked to have a specially-written piece for the staff Christmas Party to sum up the year’s teamwork and to help invest the occasion with a sense of fun. (One can’t expect colleagues to perform one of their own party pieces if you aren’t willing to do your own!) When it came to 2012 either the muse had left me or the time had passed and I had nothing prepared right up until the last minute. Creation of the piece took the time between when everyone else had left the office and I arrived at the party late. As the piece explains, my contribution was filled out by the singing of The Rare Ould Times (one of my favourites) in honour of Audrey’s mum and dad who were out from Ireland for Christmas, and by an unrehearsed spoons duet with Millie.

Christmas Party 2012

I feel quite bare without a rhyme, especially at this season
The muse was gone this several week – I’m not sure what the reason.
So here I am at 2.15 still far from Ginninderra
It seems not right, can’t get in flight; feet still on firma terra.

The year has flown, you all must own, and what a one it was
We found ourselves so busy: why? well mainly just because.
My special thanks to all of you, I say with utmost ardour
For working with more accuracy, and faster too – and harder.

I’m not quite empty-handed – that would really be quite wrong
Without a poem’s bad enough but never without song.
If short of words a wordsmith is, you’ll think how sad that is
But though I have no poetry, instead I have a quiz.

“If music be the food of love: Play on” (so it was said)
If I can’t rhyme I’ll do my best with singing then instead.
One song I’ll try for Audrey’s folks: I hope they like the choice
It’s Rare Ould Times: please wish me luck: for I have little voice.

Make way for music! With no rhyme, let dancers take the floor
And I hope that later doggerel days return to me once more.
Now when I say it’s music time – not mainly is it tunes
But me and Mrs Clery both, full-on with duelling spoons.

Lines in the Trouser 12

from Macbeth – William Shakespeare

Act 2, SCENE IV. Outside Macbeth’s castle.

Context: I cannot recall why I apparently needed this extract on my person, but it was among the Lines in the Trouser and so must be included in this official record. The Old Man’s blessing at the end is memorable – and apt for the unlikely and troubled times on which today’s world seems to have stumbled.

from Macbeth:

Enter ROSS and an old Man

Old Man
Threescore and ten I can remember well:
Within the volume of which time I have seen
Hours dreadful and things strange; but this sore night
Hath trifled former knowings.
ROSS
Ah, good father,
Thou seest, the heavens, as troubled with man’s act,
Threaten his bloody stage: by the clock, ’tis day,
And yet dark night strangles the travelling lamp:
Is’t night’s predominance, or the day’s shame,
That darkness does the face of earth entomb,
When living light should kiss it
Old Man
‘Tis unnatural,
Even like the deed that’s done. On Tuesday last,
A falcon, towering in her pride of place,
Was by a mousing owl hawk’d at and kill’d.
ROSS
And Duncan’s horses–a thing most strange and certain–
Beauteous and swift, the minions of their race,
Turn’d wild in nature, broke their stalls, flung out,
Contending ‘gainst obedience, as they would make
War with mankind.
Old Man
‘Tis said they eat each other.
ROSS
They did so, to the amazement of mine eyes
That look’d upon’t. Here comes the good Macduff.
Enter MACDUFF
How goes the world, sir, now?
MACDUFF
Why, see you not?
ROSS
Is’t known who did this more than bloody deed?
MACDUFF
Those that Macbeth hath slain.
ROSS
Alas, the day!
What good could they pretend?
MACDUFF
They were subborn’d:
Malcolm and Donalbain, the king’s two sons,
Are stol’n away and fled; which puts upon them
Suspicion of the deed.
ROSS
‘Gainst nature still!
Thriftless ambition, that wilt ravin up
Thine own life’s means! Then ’tis most like
The sovereignty will fall upon Macbeth.
MACDUFF
He is already named, and gone to Scone
To be invested.
ROSS
Where is Duncan’s body?
MACDUFF
Carried to Colmekill,
The sacred storehouse of his predecessors,
And guardian of their bones.
ROSS
Will you to Scone?
MACDUFF
No, cousin, I’ll to Fife.
ROSS
Well, I will thither.
MACDUFF
Well, may you see things well done there: adieu!
Lest our old robes sit easier than our new!
ROSS
Farewell, father.
Old Man
God’s benison go with you; and with those
That would make good of bad, and friends of foes!
Exeunt

Lines in the Trouser – Introduction and Part One

Introduction

Words have long been of interest to me. Their use and mis-use have given me much pleasure.

I used to have a smattering of French but, for the most part, where words and language are concerned I have been limited to English.

Throughout my life certain collections of words – speeches, poems, sayings – have for some reason appealed to me and left me wanting to remember them accurately: not just the right words, but the right words in the right order.

However I have a poor memory for such things and not been good at rote learning. Therefore, to have the true form of such pieces available to me at all times, I developed the habit of carrying, in the back pocket of my trousers, folded pieces of A4 paper on which were written some of these favourite pieces. (The habit was developed before cordless phones and Dr Google provided digital means of supporting perfect recall.)

At any given time the Lines in the Trouser might have included a little Dylan Thomas (I know the text of Under Milk Wood better than any other work, thanks to regular listening over many years to the version featuring Anthony Hopkins and Jonathan Pryce as the Narrators), some Henry Lawson and some Shakespeare. To these would be added selected quotations, thoughts or references I would jot down at meetings attended.

The folds of paper would be transferred to whichever trouser was worn on a particular day, week in week out, until so thumbed and yellowed as to be in danger of falling apart.

In my working life it sometimes fell to me to say something on a rural health policy matter, or on the occasion of a colleague’s birthday or at the staff Christmas party. My trousers therefore became the receptacle not just for fine quotations and the words of others, but also for bits of my own doggerel written for specific purposes. Every now and then there would be a complete clear-out of the pockets and the process of collection would begin again.

I must have got some comfort from knowing that I had ready access to some favourite pieces in their precise form. It is organised form which distinguishes a rabble of words from a poem or a memorable phrase in a speech.

With Lines in the Trouser I reveal what was in my back pockets in the middle of 2016 when I retired from work. There is an arbitrariness about what is included, for the pieces are those that happened to have been selected in the previous few months. I hope you will forgive the juxtaposition of some favourite bits of real poetry with my own doggerel. The juxtaposition was only spatial!

There are 18 pieces, divided randomly into three separate posts for this blogg. Part One includes pieces 1 to 6. In most cases some contextual background has been added to help you know why a particular piece was selected and, in the case of my own verses, the purpose for which each was written. Those among you who find the doggerel excruciating should be alert but not alarmed – for there is plenty more where this came from.

Lines in the Trouser – Index

 Part One (this post)
               Introduction
 LiT 1         A country childhood
 LiT 2         11th Conference recommendations
 LiT 3         Duke Tritton, Gary Shearston
 LiT 4         A doggerel of a life
 LiT 5         Do not go gentle, Dylan Thomas
 LiT 6         Each guest at our table
 
 Part Two
 LiT 7         For Tony Wade
 LiT 8         Funeral blues, W. H. Auden
 LiT 9         Heart of our Universe
 LiT 10        The Mad Monk and The Ranga
 LiT 11        Christmas Party 2012
 LiT 12        from Macbeth, William Shakespeare
 
 Part Three
 LiT 13        None of us is innocent
 LiT 14        from Richard II, William Shakespeare 
 LiT 15        Two little boys
 LiT 16        "Some chicken; some neck", Winston Churchill
 LiT 17        We've had enough of fluoro vests
 LiT 18        What's in a name?
Lines in the Trouser 1

A country childhood

Context: ‘In the old days’ the NRHA produced a calendar. It was popular and of high quality, and usually contained both images and words. The 2011 calendar had Country kids as its theme and some words were needed for the back page. A country childhood was written in November or December 2010.

A country childhood

Here’s hoping that our children find the outback has delights:
Like the Southern Cross above their head on clear and dark blue nights
Or the view of unbound distances from top a craggy peak
A torrent racing dangerous that last week was a creek.

The sight and sounds of heavy gear hard grabbing at the ground
Or the sweeter voice of magpie that a city’s sounds can drown.
The seething splash of surf-whipped sea, the silver spew’s retreat
Or inland sand that’s miles from shore but close beneath their feet.

The silent sound of distance on a perfect windless day
Or the gale that strips the blossoms – blasts the tender Spring away.
The happy sound of foot on ball – and when it comes to that
The thunk of well-struck tennis ball on home-made cricket bat.

And we trust that local voices also gird these kids around
With the love not just in Nature but in family is found.
And never mind that many choose to cut the strings, depart –
For we know a country childhood always stays within the heart.

 

 

Lines in the Trouser 2

11th Conference recommendations

Context: The 11th National Rural Health Conference was held in Perth in March 2011. Nicola Roxon was Australia’s Health Minister at the time and was able to attend Conference on the last day (Wednesday 16 March) to hear the recommendations only because she had injured her foot and was therefore unable to travel to the World Health Organisation. Jan McLucas, a close friend of the NRHA’s, who was Parliamentary Secretary for Disabilities and Carers, went to WHO in Minister Roxon’s place.

This was not the only occasion on which I resorted to the use of doggerel to comment on rural and remote health policy. Note about the fourth verse: The Government had allocated money for regional cancer centres; health service managers were concerned about specialised staffing for them.

11th Conference recommendations

The Minister’s foot (if you please)
Is sore, quite unlike her knees.
She chose not to go
To the WHO
And it’s Jan who has gone overseas.

The Budget expected was tough
Announced some good rural stuff
You’re welcome today
Though this Conference must say
It still isn’t nearly enough.

The maternity services deal
Gives all of us quite a good feel
It’s not a Rolls-Royce
But should give further choice
And will lessen a problem so real.

We know the mortality graph
Shows cancer in rural’s no laugh
New capital’s great
But is it too late
To ask what we’ll use to get staff?

Though the AMA’s going to be mad
About NPs and PAs (so sad!)
We’ll continue the push
To get staff for the Bush
So our outcomes are not quite as bad.

Though the governance options are three
It’s clear what we all want to see
We are blue in the face
For a regional base
With communities consulted our plea.

These Budget provisions I’m sure
For us have a lot of allure
We trust you won’t mind
If we rurals you find
Are like Oliver: “Can we have more?”

Our people should share in the wealth
Whether at one fell swoop or by stealth
We can work hand-in-hand
Throughout this wide land
To deliver the Bush better health.

Lines in the Trouser 3

Duke Tritton – Gary Shearston

Context: The poem Duke Tritton is from the pen and the singing of Gary Shearston (1939-2013). I heard the author sing it somewhere in the 1970s. He had a lovely style both about himself and with his singing and I admired him very much. As a singer and songwriter Gary Shearston played a significant role in the folk revival of the 1960s. He spent some of his working life overseas, returned to Australia in 1989 and later became a priest in the Anglican Church. People not closely connected with Australia’s folk scene might remember Gary Shearston as the man who had a hit single with ‘I get a kick out of you’.

The story of Duke Tritton, and Gary’s admiration for him, are clear from the words of the poem. The last verse refers to Shearing in a bar, one of Tritton’s best know pieces. It describes how a shearer’s tallies become bigger after knock-off time with each beer: “And though I am a truthful man, I find when in a bar, My tallies seem to double but I never call for tar”. The song became a favourite of mine – perhaps the closest I have had to a party piece. One of my friends liked my rendition well enough to request that it be sung at his funeral. We have lost touch.

Duke Tritton

Come gather around you people and listen to my song
I want to tell you of a man, of a time that’s past and gone
Just in case you never knew him he was one of the good old kind
And I’m proud to say as I sing his song he was a friend of mine.

[Refrain] So long old-timer I’m glad that I knew you so well

Duke Tritton was a bushman, a writer and singer too
As a shearer and a drover he often humped his blue
And at timber cutting or building roads he often turned his hand
And high in the Warrumbungle Range the fences he made still stand.

When first he took to the Bush with Dutchy Fisher his mate
They did some busking in country towns a coin or two to make
On Sundays outside an Anglican church they would sing Abide with me
Then race around to the Catholic mob and hit ’em with Ave Marie.

He shore in most of the famous sheds and saw long tallies done
They called him the Duke in a boxing troupe ‘cos most of the time he won
And back in those hungry Thirties when yer tucker meant yer time
He worked as a powder monkey on the Sandy Hollow Line.

There are songs he wrote and songs he sang and stories that he told
Of every trade a man could take up in the days of old
With his blue eyes fairly blazing and gripping his ghostly blades
He taught me more than any man of how this land was made.

But now his time is over and his miles of years gone by**
If there isn’t a union where he’s gone he’s the one who’ll organise
And I’ll bet if those angels are out of tunes or their songs aren’t up to par
It won’t be long before he’ll have them Shearing in a Bar!

**alternatively: And now his time is over and he’s tramped beyond the skies

 Lines in the Trouser 4

A doggerel of a life: (If I only knew now what I didn’t know then)

Context: Presumably I wrote this for my 70th birthday party. There is a piece elsewhere in this blogg about the Beardy Street house.

A doggerel of a life

For my first ten years I was small and naive –
Feel much the same now though it’s hard to believe.
If-I-only-knew-now what I didn’t know then!
I’d be wise as I should be at threescore and ten.

At school I took Latin and science and such
Left a little bit wiser but not very much
From 10 through to 20 I took on some knowledge
And travelled to Durham to go to the college
Where the sanctuary knocker I touched
I’ll say this just twice then I’ll say it again:
‘Why-ay man I gang noo to threescore and ten’.

Between 20 and 30 I married my wife
We moved to Australia to live a new life.
We went to New England, were never alone
And the Beardy Street house was to be our dream home
While time without kids meant that pleasures were rife.
I’ll tell youse three times – so hear wot I say:
“It’s bonzer to make it to seventy eh!”

From 30 to 40 was the Babies Decade
The results of the plans when Alpha was laid that Alpha had laid
But the trouble it took has long since been repaid
By Tauri and Pella and Parri and Tad
In the care that they’ve given their mum and their dad
And the beautiful memories they’ve made.
I’ll say this more times than just threescore and ten:
‘Good luck to our children again and again’.

From 40 to 50 (we’re in Canberra somehow)
I worked for John Kerin; it was shoulder to plough
The farmers revolted, poured their wheat on the floor
Already with plenty they wanted still more
“What do we want?” the farmers all cried
“Stuffed if we know!” to themselves they replied
And “When do we want it?” was answered with “Now!”

From 50 to 60: my life’s major work:
A new Health Alliance – no effort we’ll shirk.
Our members support us to find better health
Especially for those who have less of the wealth
“What do we want?” – a reasonable ask
Equivalent health the modest first task
It’s a right or entitlement – no way a perk.
We’ll stay on our message – without getting riled
To make them more healthy: man, woman and child.

From 60 to 70: the shaky decade
(What a difference the right medication has made!)
I can’t see the ball and in hockey I’m slow
But it gives me a great deal of pleasure to know
That there still are a mixture of sports to be played.
I’ll finish off now just by saying again:
‘Good heavens I made it to threescore and ten’.
Though I mustn’t be greedy, of this I am sure:
There’s a perfect prognosis for many years more.

 Lines in the Trouser 5

Do not go gentle – Dylan Thomas

Context: This seems to me to be a poem of great emotional effect and with important meaning even though I am not certain that I comprehend what all of the meaning is. In its form it is a Villanelle: “a pastoral or lyrical poem of nineteen lines, with only two rhymes throughout, and some lines repeated”. Note: there were two copies of this (and of one other piece) in the trousers – one on each side. It must have been particularly important!

Do not go gentle 

Do not go gentle into that good night,
 Old age should burn and rave at close of day;
 Rage, rage against the dying of the light.

Though wise men at their end know dark is right,
 Because their words had forked no lightning they
 Do not go gentle into that good night.

Good men, the last wave by, crying how bright
 Their frail deeds might have danced in a green bay,
 Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,
 And learn, too late, they grieved it on its way,
 Do not go gentle into that good night.

Grave men, near death, who see with blinding sight
 Blind eyes could blaze like meteors and be gay,
 Rage, rage against the dying of the light.

And you, my father, there on that sad height,
 Curse, bless, me now with your fierce tears, I pray.
 Do not go gentle into that good night.
 Rage, rage against the dying of the light.
Lines in the Trouser 6

Each guest at our table

Context: The National Rural Health Alliance’s CouncilFest is the annual face-to-face meeting of its Council, comprised of one person from each Member Body. In 2015 it was held in Canberra in September, and included parliamentary delegations on 15 September. I sometimes wrote a piece to sum up rural and remote health issues as they stood at the time, and as a contribution to the team building, the sense of fun and the general purpose of the meeting. This was one such piece. Note: EPPIC is the Early Psychosis Prevention and Intervention Centre. The reference to a ten year difference in life expectancy for males born in Mosman compared with Bourke was from a policy document from the Royal Australian College of Physicians (RACP). Given the NRHA’s purpose, there was always the temptation to pair “equal health” with “Commonwealth”, as in the last verse here.

Each guest at our table

So here we are again, dear guest, right at the nation’s hear
And since you’ve come to join us, we know you’ll play your part.
For you, like us, must see the hurt of health that’s second best
And you, like us, think country folk deserving as the rest.

This call’s not made for exports’ sake by economic dries
No rural fundamentalist comes here to advertise;
But in the name of fairness do we say the farmer’s plight
If wanting health is wanting too a basic human right.

So why in such a country that in general has long life
Should rural folk live four years less – the husband and the wife?
What sense is there in balanced books if rural people fail
To have as many years as those who live inside the pale?

We’re not a high tax country, outgoings could increase
We live here in a wealthy place, not Ireland, Spain or Greece.
Why hitch our star so certainly to balancing the books
When all you get’s some ‘fiscal cred’ – political good looks.

Our wide brown land has served us well and saved us from the Bust
And it seems it’s more in China now and not in God we trust.
But why should the prognosis for a healthy rural home
Be poorer than for city streets where the sun has rarely shone?

In mental health please tell us why it often is the case
That services we choose to fund are from a central place?
The government’s responded and there’s now a new Commission
But Eppic challenges remain for patient and clinician.

Good health and sound wellbeing are what we crave the most
But inland folks have less of both than those who hug the coast
One’s postcode shouldn’t be a sign of waiting (what a curse)
For service from a doctor or a dentist or a nurse.

In New South Wales a rural home you maybe never chose
But having had a cancer that was lately diagnosed
Compared with those in Sydney – in most respects your peers –
You’re 35 per cent more likely to die within five years.

A white man born in Mosman, no matter what his work,
Expects a life that’s ten years more than one who’s born in Bourke.
Too many folks in most respects have health that’s frankly rude
But want for healthy teeth and gums to bite down on their food.

So welcome to our table: we will value all you bring
And from a common songbook let us all together sing;
Thanks for your understanding, right around the Commonwealth
And think upon our vision: By 2020, equal health.

The challenge for the National Rural Health Commissioner

This piece was first published in Croakey on 5 June 2017. It was edited for Croakey by Jennifer Doggett.

In a political climate where rural health issues are struggling to be heard, the creation of a new role of a National Rural Health Commissioner is a promising move. But will this new position deliver the improvements in access to health care that rural and remote Australians deserve?

In the second of his series of articles for Croakey (read the first one here), former National Rural Health Alliance CEO, Gordon Gregory, discusses the new role and provides two relevant examples of previous attempts to change the focus of government departments.

In this article he argues that, to be effective, this new position needs to be a standalone role, outside of the Department of Health, and with its own independent support staff and resources– a model more like the Mental Health Commission than the current Chief Allied Health Officer.  He also highlights the importance of ongoing political support to ensure the position achieves maximum influence.

Gordon Gregory writes:

The Bill to provide for the appointment and functions of a National Rural Health Commissioner (NRHC) is expected to be debated in the Senate between 13-22 June.

All political groupings support it.

Some of the more significant comments from the debate on the Bill in the House of Representatives can be seen in this piece from my blog. And in a piece published on 10 August 2016 (it’s been eleven months since the Election in which the Commissioner was promised) I wrote that, for it to be effective, the NRHC should be modelled on the National Mental Health Commission and not on the Health Department’s Chief Allied Health Officer (CAHO).

Having worked for a long time to help to improve the wellbeing of people in rural and remote areas I am loathe to do anything that might set back an initiative that could help. However, I am concerned about the likely ineffectiveness of the NRHC as it is currently defined.

The Chief Allied Health Officer model

I may be accused of looking a gift horse in the mouth.

My view about what might come to pass is based not only on the known plans for the establishment and role of the NRHC but also from the situation relating to the Chief Allied Health Officer and the (by now) forgotten phenomenon of the Rural and Provincial Affairs work of the Department of Primary Industries and Energy (DPIE).

When the position of Chief Allied Health Officer was announced by then Health Minister Tanya Plibersek in March 2013 it was widely welcomed, in the belief that it would strengthen the role of allied health professionals in health, aged and disability care, lead allied health workforce initiatives, and facilitate better integration with medical and nursing services.

There is little evidence of such developments. Allied health is still the forgotten professional grouping in health policy matters, particularly at the national level.

The limited effectiveness of the CAHO is a structural or systemic issue, certainly not one attributable to the personnel involved. The position as Chief Allied Health Officer was allocated to an already-busy Deputy Secretary in the Department. The Department has reported that, in the role, the Deputy Secretary/CAHO has engaged closely with allied health stakeholders through a number of speaking engagements at allied health meetings.

There is no reference to the sort of work expected of the NRHC, including providing advice to the Minister, being involved in policy development and workforce distribution, and pro-actively strengthening relationships across the professions.

Lessons from DPIE

Turning now to earlier evidence. Thirty years ago DPIE was an industry Department, concerned with the critical issues relating to productive inputs, natural resources, terms of trade, and export and domestic markets for the products of its industries. Today’s equivalent Department still is:

“The Department of Agriculture and Water Resources develops and implements policies and programmes to ensure Australia’s agriculture, fisheries, food and forestry industries remain competitive, profitable and sustainable.” (from the DAWR website)

But for a brief period from 1985 DPIE had some formal carriage of policies and programs relating to the people in rural areas – not just as human resources necessary for production but as individuals and communities whose welfare was affected by the policies and regulation affecting primary industries.

DPIE’s work on what was then called Rural and Provincial Affairs was concerned with the human and community consequences of what was happening with agricultural, forestry, fishing and resource extraction (mining) sectors of the economy. What might normally have been thought of as ‘unintended human consequences’ of industry policy became, albeit in modest form, one of the arbiters of what industry policy should be.

The special Unit established in the Department managed information programs for rural people, including farm families, on welfare, transport and educational programs. Its staff were involved as leaders in inter-Departmental work on such things as rural education, health, transport, women’s affairs, local government and environmental protection.

To the extent that they succeeded at all these endeavours were dependent on leadership and support from the Prime Minister of the day and his Primary Industries and Energy Minister. Following personnel changes in those key positions, within five years the Department was able to return – like droplets of gallium recombining into one perfectly-shaped drop – to its natural state as a hard-nosed, economic industry agency

I mean no disrespect to the politicians and public servants who oversaw or permitted that return to a normal state of affairs. Australian Government Departments have plenty to do. The Administrative Arrangements Orders mandate the areas they are required to cover. Their staff are busy. Inter-departmental collaboration takes time, energy and strong political commitment.

Impressive leadership

The leadership currently being provided for the National Rural Health Commissioner is impressive. In fact it sometimes seems as if the Assistant Minister for Health, David Gillespie, and peak bodies in the rural and remote health sector think about little else.

But if it is modelled on the Chief Allied Health Officer it will fail. Giving the additional responsibility as Rural Health Commissioner to a Deputy Secretary of the Department of Health would mean that little would change: he or she has little capacity for extra work.

So at the very least it must be a new, stand-alone position. If it is a position within the Department of Health two issues of concern will arise. The first is the resources at the disposal of the Commissioner. Second is the question of their independence. The Member for Indi Cathy McGowan was surely right when, in the debate in the Reps., she said she could not accept that a person working in the Health Department would be ‘independent’.

The all-Party all-sector enthusiasm for the NRHC initiative is based on an assumption that it will mean valuable, sustained and effective change in rural and remote health.

The need for change

And things do need to change. The special needs of rural and remote health are not high on the Government’s or the Health Department’s agenda. There is no longer a Rural Health Branch in the Department. The Rural Sub-Committee of the Australian Health Ministers’ Advisory Council no longer meets. There has been no contemporary, updated National Rural Health Strategy and Plan since 2011. The Minister, David Gillespie, no longer has the word ‘rural’ in his portfolio title.

All of this can and should be put right with the establishment of a Rural Health Commission, not a Commissioner.

To be effective it needs staff and other resources. It could be modelled on the Mental Health Commission, with a requirement to report to Parliament and the public. The amendment moved by Cathy McGowan for an annual report to Parliament was accepted in the Reps and is a critical improvement.

Numerous expectations

The numerous and extensive expectations of the NRHC have already been listed by the Government (these are all from speeches and/or Releases from Dr Gillespie):

  • the first and most pressing duty of the RHC will be to address the issue of the medical workforce and coordinate with all the various stakeholders, which are numerous, in the development of a Rural Generalist Pathway;
  • the Commissioner will provide advice in relation to rural health beyond the Pathway;
  • the RHC will have to be involved in policy development and championing causes;
  • the needs of nursing, dental health, pharmacy, Indigenous health, mental health, midwifery, occupational therapy, physical therapy and other allied health stakeholders will also be considered;
  • the Commissioner will be a member of the Workforce Distribution Working Group and could use the group to take advice on other of the Commissioner’s functions;
  • the Commissioner will be a member of, and can draw on the advice of, the Rural Stakeholder Roundtable;
  • the Commissioner will provide advice in relation to rural health to the Minister responsible for rural health on matters relating to rural health reform;
  • in order to help address the economic and social determinants of health the Commissioner will form and strengthen relationships across the professions and for all the communities; and.
  • the Commissioner will be an independent advocate, giving the Government frank advice on regional and rural health reform and representing the needs and rights of regional, rural and remote Australia

It could be exciting times for rural and remote health, with a real prospect of having equivalent health for people in those areas very soon.

But the right structure, appointee and continued political support are essential for the National Rural Health Commissioner to play a leading role in the improvements that need to be made.

This is the second in Gordon Gregory’s ongoing series of articles for Croakey (read the first one here)

Drones: workers of the future?

From the look-out at the top of Red Hill one can see Canberra airport. As I walk along, my attention is drawn to a light plane, headlights clearly visible in the growing dusk, high in the sky above the ridge ahead of me.

Suddenly, a sense of alarm and panic: the light plane appears to be stationary, like a gull in a sea breeze, and I know enough about aeronautics to be sure that stationary is not a sustainable condition for a light plane when in the air.

My gaze is fixed. What I can see soon merges with what I can hear. The light plane appears to be making a buzzing noise.

As I progress further up towards the crest of the hill, my senses join in interpreting the phenomenon more accurately. It is not a light plane high in the sky several kilometres away. It is a drone, zipping back and forth – and some time still – just 44 metres above the ground.

I know it’s 44 metres because that is one of the pieces of information I get from my discussion with Andrew, who is operating the drone. I find out that it is a DJI Phantom 4 Pro (DJI is the brand). The Phantom 4 Pro features an automatic obstacle-avoidance system. Andrew demonstrates it. The aerial beast rushes towards the nearby trees but then pulls up in the air and hovers. It charges through the air towards us but then, suddenly shy and diffident, keeps its distance about 2 yards in front of us.

This wondrous machine is about the size of an iPad with a rotor blade on each of the four corners. It has a small amount of superstructure underneath the flat surface, which includes a camera which is broadcasting sharp images back to Andrew’s handpiece.

I am absolutely entranced. People could talk to me or write about drones until they are purple in the face and I would show scarcely any interest. But to see one zipping about so rapidly and with great dexterity above our heads is absolutely intriguing.

The battery operating the rotors gives about 25 minutes’ flying time. The specifications for this model suggest that it has a reach which extends 6 km upwards and 7 km out. But Andrew will not be able to test that capacity at this site given the regulations for the operation of drones, which rest with the Civil Aviation Safety Authority (CASA).

“Australia’s safety laws for drones, or more technically correct, remotely piloted aircraft (RPA), as defined in the Civil Aviation Safety Regulations Part 101, vary whether you are flying commercially or recreationally/for fun.

When flying for money, or any form of economic gain, you need to have an RPA operator’s certificate (ReOC), or if you’re flying an RPA weighing less than two kilograms, simply notify us.

When flying for fun and not commercially, or for any form of economic gain, then the regulations are less restrictive and allow you to fly an RPA without needing to be certified, providing you follow some simple safety rules.

Check out our information sheet on the basic rules for flying RPAs.”

The model I am watching in the sky above me is made in China. It’s less than 2 kgs.  Cost: around $2500. Larger ones can cost up to $40,000. Judging from the dexterity with which he appears to be handling the drone I surmise that Andrew has many hours’ flying experience. In fact it’s about three.

Currently there are two sets of rules, one for sub-2kg drones and another for larger ones. Andrew tells me that much in the basic rules and guidelines is common sense.

The rules for commercial sub-2kg operation dictate that they may not be flown within 5.5km of a controlled aerodrome, no closer than 30m to other persons not involved in the drone’s operation, not over populous areas, and not over emergency situations (police operations, fires etc). They may only be flown during the day, and only one drone may be flown at a time by the one operator. ‘Populous areas’ include public parks and Raiders’ games – in case there is a fault and they fall on someone’s head.

Andrew has notified CASA of his intention to operate a sub-2kg drone commercially and is considering the further certification required to obtain a a remote pilot licence (RePL) and an RPA operator’s certificate to enable him to fly larger ones. (These further steps are quite expensive and time-consuming.) The certification he already has means that some of the stricter requirements that apply to non-certified sub-2kg operators do not apply.

One final question. And the answer is no: security clearance is not required.

I couldn’t wait to get home to tell of my direct contact with new technology. For someone who still doesn’t have a cordless phone, my degree of excitement was perhaps surprising.

It’s my personal introduction to one element of the ‘automation’ that is already proving to be such a boon and such a worry to communities and economies everywhere.

Note: thanks very much to ‘Andrew’.

Surfing the ‘waves of health reform’ in Australia

Waves of health reform: not so impressive after all?

Credit: Tony Hisgett via Flickr

This piece was originally published in Croakey on 30 May 2017. It was edited for Croakey by Melissa Sweet.

In the first of a series of articles unpacking current health policy concerns, a long-term rural health advocate, Gordon Gregory, argues that ‘health reform’ is a term that is much over-used and inappropriately applied.

In particular, he queries the usefulness of Health Minister Greg Hunt’s characterisation of three ‘waves of health reform’.

However, Gregory, former CEO of the National Rural Health Alliance (NRHA), does offer the Minister a way out of the froth and boil of crashing waves – with a list of 16 areas where “real and desirable” reforms could be made.

Surfing the ‘waves of health reform’ in Australia

Gordon Gregory writes:

Health Minister Greg Hunt has made no secret of the personal and Ministerial motivations he brings to his work, nor of the portfolio priorities as he sees them.

picgnfgOn his appointment (18 January 2017) he paid tribute to his mother and his wife, both nurses. And his grandmother was a pharmacist – one of the first women to take up pharmacy in Victoria. Despite this, as Minister his focus seems narrow. On his homepage one reads:

As Minister for Health and Sport, Greg is committed to ensuring all Australians are able to see a doctor when they need to and can receive medicine when they are unwell.”

And he has made a virtue of his very close attention to the views of the medical profession:

The very first call that I made, I think about 10 minutes after the Prime Minister’s announcement, was to Michael Gannon, the very capable leader of the AMA, and shortly after that to Bastian Seidel, who is the head of the Royal Australian College of GPs.”

Some people fear that this is code for ‘looking after the doctors’, and for what the Australian Health Care Reform Alliance (AHCRA) has called a ‘drugs and doctors’ policy environment.

Since his appointment the Minister has developed and consistently promoted “four pillars” of what he calls “a long-term national health plan” (the quotes in this piece are all taken from the Minister’s published speeches or interviews):

First, a rock solid commitment to Medicare and universal access to doctors and to medicines.” (“We listen to the Australian public. When you boil it down, can they go to the doctor, can they get their medicines, and when they need to, can they go to the hospital?

The second pillar is the hospitals, and the funding for hospitals is increasing every year by a billion dollars.

The third is mental health, which is a deep personal passion, and above all else perhaps on my watch I want to deliver more frontline services and work on preventive health.

The fourth is medical research.”

Some might argue that these four constitute less of a ‘plan’ and more the underpinnings and fixed financial arrangements in health care set constitutionally for the Australian Government.

Greg Hunt subscribes to the view taken by too many Health Ministers of the day that the Government’s plan for health care, and evidence of a successful commitment to that plan, is provided by the fact that rates of bulk billing are rising and expenditure on Medicare and hospitals is going up:

– bulk billing rates under the Turnbull Government are 3.5 per cent higher than they were under Bill Shorten’s Government. – – in the last half-yearly figures that are just out, we’ve gone from 84.7 per cent, to 85.4 per cent. So in other words, Medicare funding is up and bulk billing rates are at their highest ever on a half-yearly basis. What does it mean? More funding, more investment in Medicare and more people being able to go to the doctor without having to put their hand in their pocket.” (Greg Hunt, Sky News Agenda interview, 19 March 2017.)

The Government of the day doesn’t need to ‘plan’ to increase expenditure on Medicare. It merely needs to let time pass and the eligible population and number of doctors increase, while hoping that the Department of Finance doesn’t get its way in somehow capping the program.

And as for what Greg Hunt – like so many Health Ministers before him – has described as “our absolute commitment – core, fundamental, unbreakable commitment, to universal access and to Medicare”, we still don’t know for sure how many people have no access to Medicare because they have no GP within effective logistical reach or because they can’t afford the out-of-pocket costs they fear may be involved with a visit.

The number is certainly substantial, and is increasing. (On 4 May 2017, Chief Medical Officer Brendan Murphy said that out-of-pocket costs were actually the highest they have ever been. Non-government payments on health, largely private individual expenditures, are now one-third of all health expenditure.)

Three ‘waves’ of reform

In his presentation to the Health Budget lockup (9 May), Minister Hunt described three “waves of reform”.

First wave

  • Five major compacts (with AMA, RACGP, Pharmacy Guild, Medicines Australia and Generic and Biosimilar Medicines Australia.)
  • Guaranteeing Medicare through: Investing in our health professionals through Medicare and the re-indexation. “The Government will establish a Medicare Guarantee Fund from 1 July 2017 to secure the ongoing funding of the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme – – . Proceeds from the Medicare Levy (less the contribution for the NDIS) will be paid into the fund and topped up with a portion of personal income tax receipts to ensure it covers the combined costs of the MBS and PBS.” And throughl owering the cost of medicines and reinvesting in new medicines.
  • Agreement by COAG on opt-out model for My Health Record
  • Agreement with the Tasmanian government on the transfer of the Mersey hospital
  • Mental health psychosocial support (“$80 million for community psychosocial services for people who do not qualify for the NDIS. Contingent on matched commitments from the states and territories.”)

Second wave

  • Ensuring the sustainability and affordability of private health insurance
  • Strengthening mental health – particularly in rural areas
  • Workforce strategy (“which would look at issues of distribution”)
  • Aged care reform
  • National Sports Plan

Third wave

  • Reform of public hospitals and post-2020 agreement with states
  • Strengthening Primary Care (“through building on the transformative nature of Primary Health Networks”)
  • Strengthening Preventive Care (“with particular focus on Indigenous health”)

Not actually reform

There is very little ‘reformist’ about these three lists.

Most of the elements are, as I described in an earlier piece in Croakey (6 March 2017), Grand Principles: general statements of principle or intent with which no-one could disagree: ‘guaranteeing Medicare’, ‘ensuring the sustainability of private health insurance’, ‘strengthening primary care’ etc.

Others are means to an end, such as ‘five major compacts’, ‘workforce strategy’ and a National Sports Plan.

Real reform in the nation’s health sector would mean action to improve existing arrangements by alteration, correction of error or the removal of defects.

Elements of current health policy that do have a sense of genuine reform are the shift to opt-out for My Health Record and the trial of Health Care Homes (a large part of which has been postponed until 1 December).

Work on some of the Grand Principles may include reformist action, such as a new approach to mental health care – assuming it to be substantially different from the status quo. And genuine reform could be involved in “workforce strategy”, “aged care reform” and “a national sports plan”.

But to this point in time these are merely generic labels on areas of intended activity.

Presumably the Minister’s reference to ‘waves of reform’ is intended to demonstrate organisation and a sense of priority. But one of the clear implications of the ‘waves’ terminology relates to timing: one thing happens before another.

This is a problem in the lists provided: there can be no justification for putting off work on “Strengthening preventive care with particular focus on Indigenous health” until after “Ensuring the sustainability and affordability of private health insurance” or “Aged care reform”.

A 16-point plan for real reform

It’s not as if there is any shortage of true reform ideas for the health sector and its leaders. Real and desirable reform would include the following.

  1. Building a whole-of-government approach to health in certain policy and program areas. Ministers can provide leadership on this through demonstrating their personal cross-portfolio commitment. This would legitimise and strengthen inter-departmental action on such things as targeted improvements in access to high speed broadband and telecommunications; action on food security; the taxation of alcohol and selected foodstuffs; work to support vocational education and continuing professional development; and the development of recreational infrastructure.
  1. Reform of the structure and work practices of the health workforce, doing away with restrictive practices that are protected by special (mainly professional) interests. This would entail more job sharing, flexible allocation of tasks and functions, and lighter demarcation of clinical roles.
  1. Work to develop and act on a national Healthy Start in Life Manifesto, including a commitment to resourcing high impact cross-portfolio actions relating to pre-conception, infant, child and adolescent health. The required initiatives include a focus on child and adolescent mental health within the National Mental Health Plan, and a platform to bring together data collected by different agencies on child and youth health and wellbeing, including issues relating to family violence, self-harm and suicide.
  1. Cross-portfolio and inter-governmental action on a National Strategy on Climate, Health and Wellbeing for Australia to prepare the health sector and protect all Australians from the health impacts of global warming.
  1. Using the principles of ‘Consumer Directed Care’ to bring about greater collaboration (especially in rural and remote areas) between the health, aged and disability care sectors. There are opportunities in the workforce, information and infrastructure areas to see these three functions more closely integrated.
  1. Further action to bring together and make full use of research, (big) data and information systems, including for capability development and research translation in health and health-related services.
  1. A government-wide and industry-wide review of telehealth services, opportunities and barriers.
  1. Inter-departmental action to maximise the commercial and employment opportunities (especially in rural, regional and remote areas) provided by the production and utilisation of newer energy sources.

  1. Ministerial leadership to ensure that all health practitioners achieve and maintain competency to deliver and manage culturally safe services.
  1. Further action on an Arts in Health Strategy to harness and grow the wisdom, resources and impact of the sector.
  1. Coordinated inter-governmental action to improve food security. This could include the development of a National Food Security Strategy to consider food production, distribution, pricing, storage and preparation.
  1. Extension of the Health Department’s monitoring and management of health workforce policies to incorporate closer attention to matters concerning allied health, nursing, dental and health service manager staff. This work should include implementation of National Standards for Remote Health Worker Safety and Security.
  1. Alternative consideration of the primary care needs of people who, either because of geography or financial means, cannot access a doctor.
  1. Reform measures that result in a significant increase in the proportion of total health expenditure going to illness prevention and health promotion. This should be achieved through an expansion of programs relating to obesity, alcohol and tobacco.
  1. Commitment to a new National Rural Health Strategy and long term funding for an associated National Implementation Plan.
  1. An expanded health care role for pharmacists, as is currently being explored through the Pharmacy Trial Program.

Australian Government leadership on all or any of these would constitute some real health reform.

Reflections on retirement

It is now a year since I retired from the National Rural Health Alliance. (I was going to say “since I left the Alliance” but it will be longer yet before I ‘leave’ the organisation and it ‘leaves’ me.)

Some of my friends have asked what it’s like to be retired. The short answer is that it’s wonderful. Every day is a long weekend. There are few deadlines to be met, no meetings to attend, no representative duties to acquit. Getting out of bed occasionally at six o’clock in the morning is now to go for a walk or cycle while the air is still and the trees breathless – not to trail to Sydney or Melbourne with a tie on.

I will never forget how lucky I am. To be contentedly retired one needs the fundamental assets providing quality of life. A safe home – with all that the simple word ‘home’ connotes. Adequate income. Social interaction of the kind and quantity that suits you. Continued good health. Stimulation or brain food. And the means (technology; access) needed to pursue your interests or hobbies.

I was happy at work so there are many things I miss. The repetitive rhythm of a workplace can instil a sense of security and confidence. Working in a small organisation with colleagues who share one’s commitment is personally and socially satisfying, as well as professionally valuable. A happy workplace can provide some of the benefits of ‘community’: mutual support, shared purpose, recognition and self-actualisation.

Rather to my surprise, it has become apparent to me that some of this sense of community can be provided by social media. Facebook has been a revelation. It can be built in one’s own image – crafted to meet some of the needs of different individuals for ‘community’.

Two of the things one often hears about retirement before testing it for oneself are that you’ll be busier than you used to be, and that no one at work will miss you. This last might be suggested as a rationale for not working too hard: to ensure there is an appropriate work/life balance.

The first of these is palpable nonsense. You can fill the time with a wider range of smaller matters than in your working life – but you select the smorgasbord and there are gaps between each mouthful.

As for the second, it’s impossible to know because one is no longer ‘at work’ to observe the consequences of one’s absence. If you were fortunate enough to have work which gave purpose and value, all you can ask is that it continues and that the person who filled your position feels as lucky as you did.

It is so luxurious to be free of appointments, teleconferences, deadlines and protocols to which one had to be faithful at work. You can be true to yourself. If you write a blog you can wander at will over any range of topics you like.

Being retired makes it possible to look after yourself more easily. I try to walk or cycle every day which is something many people in the workforce do, but was something for which I had insufficient discipline at that time.

I am avoiding taking on regularised weekly happenings which would give the week a schedule or structure in the way that staff meetings, monthly teleconferences and other events did at work. Having a list of future appointments in a diary has always sat heavily on my mind – been a source of tension – as if the need to prepare or be prepared for each and every one crowded out the pleasure of the current moment. One of the consequences while at work was that the great majority of my own meetings with colleagues were called and held immediately – and I was always grateful for the fact that they almost always put up cheerfully with such a regime.

I’m reading a book.[1] The potted garden is being tended; next Spring’s display should be even better than last year’s. Alpha and I have time to catch up more slowly with friends and family. We haven’t fully made the switch from watching live TV to watching everything on demand, but it’s coming.

And of course if you have a partner, retirement means there is the opportunity to spend more time together. Or you can have separate work places in the home and separate interests and networks, and meet just now and then – as before.

We’re rather in the latter camp.

[1] Neal Stephenson, The Confusion.

“Julia Gillard is not a liar” – written in April 2012

This piece was initially published in Croakey on 10 April 2017 under the title: 'It’s time the truth was told – Gordon Gregory on lies, politics and missed opportunities'.

My thanks to Croakey and Melissa Sweet, who wrote the following introduction for the Croakey piece.

“Peak bodies have many advantages – they help to unite the diversity of competing interests in the health sector, and thus can be helpful in providing consensus advice and policies to inform decision-making.

But there can also be drawbacks. If the diversity of interests cannot unite to provide honest and unambiguous advice in the public interest, then our health can suffer.

See Exhibit One below, in which Gordon Gregory, former CEO of the National Rural Health Alliance (NRHA), shares an article he wrote in 2012 in an effort to correct the public record about the nature of Julia Gillard’s statements on a carbon tax.

If public debate about climate policy had been more informed at the time, would we now find ourselves in a healthier policy space in relation to climate and health?”

Gordon Gregory writes:

When I was Executive Director and then CEO of the National Rural Health Alliance (NRHA), I took very seriously the challenge of representing only the shared views of the member bodies. This imposed limits on the subjects on which I spoke or wrote, and in effect provided prescriptive guidelines for the positions taken on the subjects that were ‘within scope’.

GordonPic
Gordon Gregory: speaking out

Protocols were developed for involving all member bodies, usually through their delegate to the NRHA Council, in work to agree what was on the organisation’s agenda and what the organisation’s position was on each item.

Given the scope of the NRHA’s interests and the large number of public statements of one sort or another, I was occasionally taken to task by one or more of the member bodies for views I had expressed. However, in general, mutual trust was developed so that a large volume of public activity was maintained.

The areas in which the greatest care needed to be taken to avoid the risk of saying something that could not be supported by a member body were matters relating to the practice of particular health professionals and the relationship between them (scopes of practice, for example), and anything which could be construed as being politically partisan.

It was this latter constraint that led me to conclude that I should not publish a piece that I wrote in April 2012 in defence of Julia Gillard.

Every time I heard a reference to what became known as Julia Gillard’s ‘lie’ about a carbon tax, I felt outrage. No one – not even her own office – was able to see that statement the way I did: as something that would apply if the ALP won the election and there was a Gillard Government.

Once she failed in that endeavour, a new circumstance existed. Bets were off. A different arrangement for government had to be made.

Not only was I outraged, but also I could sense the political capital that would be made for her opponents. (What I didn’t pick, of course, was the fact that the negative capital was the reason why her stocks fell so far that it was Kevin Rudd who defeated her, not Tony Abbott.)

So here is that article, exactly as I wrote it in April 2012. It is not the clearest or simplest piece I have ever written, but it is very important to me and I am grateful to be relieved of the constraints there used to be on its public release.

Successful prosecution of the view that Gillard had lied – in which success her Party seemed curiously complicit – and the impact this had on Federal politics, set back the debate in Australia on climate policy by perhaps a decade. Because those political effects are still with us today.

Julia Gillard is not a liar

(Written in April 2012)

It’s time the truth was told. Julia Gillard is neither a liar nor the sort of person predisposed to lying.

Someone has to make this point or else the lead-up to the election due 18 months from now, and the election itself, will be dominated by just one thing: the assertion that Julia Gillard lied and cannot be trusted.

On 16 August 2010 Julia Gillard said: “There will be no carbon tax under the government I lead.”

During the same election campaign it was clear that the Labor Party wanted to legislate for an emissions trading scheme – meaning that, if in government, it would fix the quantity and allow the market to determine the price. And this was certainly not a small part of their agenda for, in calling the August 2010 election, Julia Gillard nominated economic strength, education and climate change as the three priorities for a re-elected government.

However, it was not a Labor Government that was elected but a combined Labor/Greens/rural independent Government. And that Government has been effective in passing legislation, including through the Senate where the Greens hold the balance of power, and in giving much-needed and well-deserved emphasis to the wellbeing of people in rural and remote Australia.

In 1987, the number of Australian children living in poverty was estimated at 580,000. Opening Labor’s election campaign on June 23, 1987, Bob Hawke said: “We set ourselves this first goal: by 1990 no Australian child will be living in poverty”.

Twenty years later he described the comment as one of the biggest regrets of his career – that it was “a silly shorthand thing”. “I should have just said what was in the distributed speech,” he later said. But it was not suggested as a result that Bob Hawke was a liar. After all, he could drink a yard of ale in no time at all and wished us all a day off after we won the America’s Cup.

On 2 May 1995 John Howard (the first to enunciate the difference between ‘core’ and ‘non-core’ promises) said: “There’s no way that a GST will ever be part of our policy”. By “our policy”, he meant the Coalition’s: assuming that the Coalition was elected, there would be no GST in the new term. And, true to his word, the Coalition Government did not introduce a GST during that term.

In August 1997, John Howard announced that the Coalition would contest the next election, in 1998, with a plan to introduce a GST. The voters elected a Coalition Government again and the GST was introduced on 1 July 2000. With the support of the Democrats in the Senate. Who never recovered.

After the election of 21 August 2010, neither side of politics had a clear mandate. The voters were not persuaded by the campaign promises of either. Julia Gillard had campaigned on action on climate change – but no carbon tax. That proposal was in effect rejected. But it is drawing a very long bow to suggest that action on climate change was rejected.

If ‘a Gillard Government’ had been elected in 2010 – meaning one with untrammelled authority in both houses – an emissions trading scheme would no doubt have been introduced.

But the people, in their wisdom, elected neither a Gillard nor an Abbott Government: they elected a hung Parliament with the balance of power held by one Green and five independents.

Flashback to the NRHA's Dr Jenny May and the independent MPs, Tony Windsor, Rob Oakeshott & Bob Katter
NRHA Chair Jenny May and independent MPs, Tony Windsor, Rob Oakeshott & Bob Katter

As far as Gillard and Abbott governments were concerned, all bets were off. Yet a government had to be formed. And it had to be soon, without the luxury of years to allow people to accommodate to new policy positions.

Deals were done – and good ones, too, because – thanks to the deals done by two rural independents – the Government is providing the opportunity for the people of rural and remote areas to catch up in health, infrastructure and regional development.

Julia Gillard might have tried the George Washington defence and hoped for the same boost in admiration:

“I cannot tell a lie, father, you know I cannot tell a lie! I did cut it with my little hatchet.”

“My son, that you should not be afraid to tell the truth is more to me than a thousand trees!”

But she had not told a lie in the sense of seeking to mislead people. What happened was a new political necessity: the nation must have a government, and whether it took a billion dollars for the Hobart hospital, the dumping of a Citizens Assembly on climate change or a carbon tax was for the moment in the hands of those elected who were not affiliated with the major parties.

She might have varied (‘broken’) that particular ALP commitment by fiddling with the fine print, as many had done before her, for instance by narrowing eligibility for a program or delaying its introduction to a later financial year. Perhaps due to the negotiating skill of the Greens and independents, or to her own determination, Gillard chose to go for a carbon tax after all.

And ever since, the complex realities surrounding her statement have been corrupted by even the most reliable sources.

For reasons I can’t understand, no one is challenging the view that Julia Gillard is a person who lied and who is a habitual liar.

The term ‘broken promise’ has become a key element of the current affairs lexicon. It is claimed without challenge that this is a government that lies, even though at the time of that statement there was no government in office.

The accusations reach a pitch in March 2011 with the demonstration at Parliament House featuring the infamous placards in front of which Tony Abbott was pictured.

One of those reliable sources, Radio National’s Fran Kelly, is speaking with Morris Iemma and Geoff Gallop in late March 2012 about the implications of the Queensland election results, particularly as they relate to “how much the trust thing is an issue” for Julia Gillard:

“– the promise just days before the 2010 election, “No carbon tax under a government I lead”, and then minority government;… has to negotiate with the Greens to form a government and that negotiation means bringing in a carbon tax.”

This is as full and accurate a summary of the circumstances as has been suggested by anyone. But Fran’s next question is as follows:

“Can she [Julia Gillard] win back the trust of voters – has she in fact lost it because of that broken promise?” (Radio National’s Breakfast, Tuesday 27 March 2012)

The demands the public seems to make of its media to simplify and abbreviate complex issues often support the political imperative of the Opposition – any Opposition – to destroy the credibility of the Prime Minister of the day.

This would be less critical if it were not for the extent to which Australia now has a so-called presidential style of government, particularly when it comes to elections. The personae of the leaders are all-embracing. This is for both good reasons and bad.

The bad reasons are related to the demand for simplicity and to common acceptance of the cult of personality. It’s far easier to sum up a complex choice between parties by reference to two individuals who are seen and heard nightly on television, than to undertake a detailed analysis and comparison of those policies.

The good reason for distinguishing in Australia between the major parties mainly on the basis of their leaders is that we are very fortunate country when it comes to politics and public governance. There are differences of emphasis and degree, but both sides of politics support the notion of a safety net for those who are on low income, have a disability, have chronic illness or are out of work.

Both of them will support continued investment in better roads, schools and tertiary educational institutions, public utilities and the arts. Both of them no doubt would like to solve the problems of the Murray Darling basin, save the Barrier Reef, close the gap between Indigenous and non-Indigenous life expectancy, support peace in our region and provide some overseas aid.

Many of the good things we expect of our governments are agreed – which is why, to succeed electorally, both sides of politics must win the middle ground.

The greater the challenge for voters to distinguish between the major parties on the basis of their nuanced approach to broadly agreed policies, the more will the political system become ‘Presidential’. It’s easier; for Gillard we know, Abbott we know.

On the morning of Saturday 17 July 2010, with the Prime Minister widely tipped to call an election, the media was staking out Government House in anticipation of her passing through the gates to ask the Queen’s representative to prorogue Parliament.1

The matter was being covered by ABC News 24 and, just as I left home for the NRHA office, it was reported that Julia Gillard was on her way from Parliament House. My workplace is close to where Kent Street passes over Adelaide Avenue and she would have to come this way en route to Government House.

So on a whim I stood on the bridge over Adelaide Avenue, half expecting it to be cluttered with people wanting to view this historic occasion. But I was there alone as a single black car appeared from the direction of Parliament House – no police escort, no cavalcade, just a single vehicle.

Looking down, I see in the front and on the left is the driver and on the right is the Prime Minister. In the front. Clearly visible. I lean forward and give a cheerful wave. The Prime Minister looks up at the bridge and gives a cheerful wave in return.

I have never met the Prime Minister; but she waved at me from her car.

What a wonderful open, trusting country. What a wonderful freedom to speculate on political personalities and motives and decisions made and never made. What an important and decent thing is politics, that must make daily decisions that will affect the lives of all of us. And how poorly understood.

So this is me waving back.

———————————————————

 

  1. The scene at Government House is described in the article that appeared next day in the Sun Herald, written by Dan Harrison and Steve Lillebuen: http://bit.ly/2orFawZ

Adelaide Crows Women: next year can we police have the chorus too?

If Bec Goddard wants to do the Adelaide Crows AFL Club - and the world - another big favour, she might consider insisting that the Crows' team song be revised upwards (in every respect!) to include the third musical motif: the one associated in the original with the chorus.

Apart from anything else, the words of the chorus in the English translation could hardly be more relevant to the game, perhaps setting a new standard in the AFL for the appropriateness of the words of team songs:

We run 'em in, we run 'em in,
We run 'em in, we run 'em in,
We show them we're the [mighty Crows]
We run 'em in, we run 'em in,
We run 'em in, we run 'em in,
We show them we're the [mighty Crows]

(The only possible reservation about the relevance of these extra words is that they might be construed as heaping too much praise on the rushed behind, rather than the goal. But my assumption is that the Club's preferred meaning of 'run 'em in' would in any case be far more combative or violent than the mere act of scoring a goal or rushing a behind!)

   Tayla Harris of the Brisbane Lions; 2017 AFLW Grand Final, March 25 2017. (Photo by Michael Willson/AFL Media/Getty Images)
 

As for the melodic improvement that adding the chorus would achieve: who could possibly disagree? Even If the men can only manage a (let's be honest: rather dreary) melodic structure that is A-A-B-A, surely the women can manage A-A-B-C-C-A?!

(Given the music's provenance one is tempted to say "surely the women can-can manage A-A-B-C-C-A".)

So Bec, others: let's add some more art and finesse to an already great game!

By the way: has anyone commented on the irony of Bec Goddard, officer of the AFP, having to obsess about a corrupted version of a song about corrupt gendarmes?

A nice enough version of the duet, in English, is here: https://youtu.be/oSP3LF2K4k4
Postscript: The music was originally from the 1859 opera Geneviève de Brabant by Jacques Offenbach, which debuted in Paris in 1859. It was an 'opéra bouffe', which is perhaps what appealed to Australian Rules in the first place.

Opera bouffe is a style featuring comedy, satire, parody and farce. The opera became so popular that Offenbach expanded it into three acts in 1867. The newly revised opera included a duet between two French gendarmes.

In 1871 Henry Brougham Farnie translated the opera to English and titled the song 'Gendarmes' Duet'. It has become well known in the US, with quite different words, as the Marines' Hymn, "the oldest official song in the U.S. Armed forces". [http://bit.ly/2oT4nxK]

Gendarmes' Duet.

Verse 1:
We're public guardians bold yet wary,
And of ourselves we take good care.
To risk our precious lives we're chary,
When danger looms we're never there,
But when we meet a helpless woman,
Or little boys that do no harm:

Chorus:
We run them in, we run them in,
We run them in, we run them in,
We show them we're the bold gendarmes.
We run them in, we run them in,
We run them in, we run them in,
We show them we're the bold gendarmes.

Verse 2:
Sometimes our duty's extramural,
Then little butterflies we chase.
We like to gambol in things rural,
Commune with nature, face to face.
Unto our beat then back returning,
Refreshed by nature's holy charm:

Chorus:

The first two verses are the only 'official' verses in the original script, but the song was such a show stopper that the producers often added multiple encore verses - a dozen per performance was not uncommon - which commented on the hot social and political topics of the day. This encore verse is the one commonly added today:

Encore Verse:
If gentlemen will make a riot,
And punch each other's heads at night,
We're quite disposed to keep it quiet,
Provided that they make it right,
But if they do not seem to see it,
Or give to us our proper terms:

Chorus:
We run them in, we run them in,
etc

Here are the French lyrics. The characters are Grabuge, a sergeant, sung by a comic baritone, and Pitou, a 'simple gunner', sung by a comic tenor. (There's a note on the music that Pitou should sing in "voix de tête" - head voice or falsetto - presumably to enhance the comic effect.)

G: Protéger le repos des villes
P: Courir sus aux mauvais garçons
G: Ne parler qu'à des imbéciles
P: En voir de toutes les façons
G: Un peu de calme après vous charme
P: C'est assez calme ici, sergent!

G: Ah, qu'il est beau...
P: Ah, qu'il est beau...
G: D'être homme d'arme...
P: D'être homme d'arme
Mais que c'est un sort exigeant!

G: Ne pas jamais ôter ses cottes
P: C'est bien penible, en vérité
G: Dormir apres de longues trottes
P: Rêver, c'est la félicité
G: Sentir la violette de Parme
P: Vous me comblez, ô mon sergent!

The music chart is here:
http://looselywoven.org/concerts/caves/music/Gendarmes%20Duet%20Cello.pdf
C'Mon you AFC Women! C'mon Bec Goddard, Jenna McCormick, Chelsea Randall and Beccy Cole! Do it for art: incorporate the C part into the song!

(Thinks: "Oh I do love to be beside the C side.")

gg
31 March 2017

Extracts from debate in House of Representatives on Bill to establish a National Rural Health Commissioner (NRHC)

Debate was 20 March 2017

The full transcript is at: http://bit.ly/2nNcnk9 (go to ‘Bills’ at two places down the right-hand side)Extracts begin:

Tony Zappia, Member for Makin, Shadow Minister for Medicare:

“It is seen by Labor as a step in the right direction in bridging the health divide between urban and outback Australia. So Labor will be supporting this legislation. However, we believe that the legislation falls well short of what was hoped for. I particularly note that the Commissioner’s appointment is for a two-year period. The Commissioner’s position will be abolished in just three years’ time, in July 2020. The Commissioner will have to rely on negotiations with the Health Department for any staff requirements. It could also be a part-time position. Furthermore, there is a very strong emphasis on the position being primarily to establish a national rural generalist pathway, as important as that is.”

– – “This government is failing rural health students, having cut $72.5 million from health workforce scholarships.” – – “The Health Workforce Scholarship Program, which amalgamates six scholarships into one program, was to be ready for the 2017 academic year but has now been again delayed. Those delays are already causing problems for students. For example, the interim funding arrangements for the Nursing and Allied Health Scholarship and Support Scheme have left a cohort of students beginning their studies in 2017 with funding uncertainty for future years.”

– – “It would seem to me that by the time the Commissioner is appointed and proceeds with the establishment of the national rural generalist pathway there may not be a great deal of time or scope for the Commissioner to do much else beyond that.”

Ted O’Brien, Member for Fairfax:

– -“The government has committed $4.4 million to create and support the Commissioner, who will provide frank and fearless advice and have the ability to influence the future of our country’s rural healthcare policy.”

– -“I am delighted, therefore, that the National Rural Health Commissioner will be taking responsibility for rural workforce issues. Innovative and sustainable medical practice solutions are exactly what is needed for smaller, harder to reach regional towns. Critical to this is the development of a national rural generalist pathway—a core step towards strengthening the rural medical workforce. A rural generalist pathway is not a new concept. There are varying degrees of support and infrastructure available at a state level, but what is not currently available is a coordinated national approach, and this is the gap that will be filled by this legislation.”

– -“Not only is the Sunshine Coast the healthiest place on Earth and the lifestyle capital of Australia but also, like all regional and rural areas, we benefit enormously from a supportive community, high rates of volunteerism and more social capital than our city cousins.”

Steve Georganas, Hindmarsh:

– -“I suppose it is the nature of Australia, with its scattered rural and remote populations, that providing essential services to these communities is costly. But it is also absolutely necessary, regardless of the cost. It highlights the dangers of privatising certain aspects of these essential services. This is why we must be vigilant.”

– -“The government had the opportunity to establish a Commissioner’s office with real political support and clout, which could put rural and remote health on the agenda, bringing those levels back up to the level of what we have in the cities, or close to it.”

Damian Drum, Murray:

“It was great that we had a situation where someone with an extensive knowledge of the health industry—a gastroenterologist—was able to talk on issues surrounding rural health, and that someone who has spent an enormous amount of time in the rural health sector as a professional is able to then adjudicate over the introduction of this Commissioner.”

Warren Snowdon, Lingiari:

– -“Aboriginal people in my electorate have the worst health outcomes of any people in Australia, yet they are very concerned about the nature of health services that get delivered to them. I would have thought that the job of this new person, this position, should be expanded well beyond the scope of what is currently being envisaged and should talk about the panoply of issues that confront the health workforce, for example—not only in employing more doctors, but we know that we have an emerging health crisis in this country around the shortage of nurses. That will impact upon the bush. We know that in all areas of allied health care there are shortages of workers, particularly in the bush. We know there are shortages of Aboriginal health workers in the bush, and we know that government—any government—is yet to really embrace the idea of physician assistants and giving them a role in the bush.”

David Littleproud, Maranoa

“I think it is also important to recognise that this Bill is about actually getting back to having the grassroots drive the outcomes, and not having Canberra go out there and tell the people of rural and regional Australia exactly what they should have. This is about letting the community drive the outcomes and putting in place an environment where a Commissioner can connect with the local community to be able to drive the outcomes that they are looking for—not what Canberra is looking for.”

Brian Mitchell, Lyons

“There are 1,560 allied health professionals across Tasmania. Our training sector to boost and strengthen this cohort has been negatively impacted by the stripping back of TAFE training services and the deregulating of university courses. All the loops in the chain of health care in Tasmania are cracking and breaking. We welcome this initiative today, but it is not enough.”

George Christensen, Dawson

“Unfortunately, most of the Australian population is based in capital cities and most people are very insulated from what might happen outside those capital city limits. Again, unfortunately, most of the representatives in this place also live in, and represent people from, those capital cities. That is why it takes a strong voice from those rural and regional communities to ensure their needs are not forgotten or swept under the carpet.”

– – “Rural, regional and remote Australia is the heart and soul of this country, providing so much in productivity and economic benefit, of which few people in the city are aware. Regional and rural communities put food on the table; they put clothes on our back. And yet a national survey in 2012 found that three-quarters of year 6 students thought cotton socks came from animals and a quarter of students thought yoghurt grew on trees.

Remote communities provide the nation’s wealth through mining and exports, and yet activists in the cities want to shut down the very industries that provide jobs and the taxes they want the government to spend. There is a disconnect between cities and the real world. It is almost as if out of sight is out of mind. We cannot allow the health of our rural Australians to be left out of sight and out of mind. When the regions are so important to the health of the nation and the health of our economy, the very least we can do is to ensure the health of those living in the rural, regional and remote communities is good enough for them to continue to live there and continue to do the hard work for this country.

Rebekha Sharkie, Mayo

– – “In December 2015 the Regional Australia Institute released figures showing that collectively Australia’s regions account for approximately one-third of our total economic output. Their report said: “were it not for the regions, Australia’s economy today would only be the size that it was in 1997 and Australia would no longer rank amongst the world’s largest economies”.  We are prosperous nation because of regional Australia. And yet, despite this stunning fact and the fact that one third of our country’s population lives outside of the major cities, the regions are being left behind on a wide range of issues when it comes to policy development. Nowhere is this felt more than in health.”

– – “there is a constant battle getting new (medical) graduates to move out to regional areas. The latest data from the Medical Schools Outcomes Database survey reported that 76 per cent of domestic graduates are living in capital cities. If you expand the definition to include a major urban area, that figure increases to 84 per cent. Eighty-four per cent of Australian graduates live in a capital city or a major urban area, while a third of Australians live in a regional or remote area. I believe that we need to put measures in place to entice medical students to look for jobs in regional and rural areas. I do not believe that we need more medical schools; rather, we need to take a strong, hard look at the schools in what they are doing to implement an outreach training into the regions. I believe that if we can encourage more young people from the country to pursue a career in medicine, it is more likely that they will want to return home to their community to practice. The current minimum intake is 25 per cent of students from a rural background. That is a good start, but I support the Australian Medical Association’s stance on lifting the benchmark to at least 30 per cent of all students.

It is more than offering a place to a young person; it is also about connecting them to rural health from the beginning of their degree. It is about connecting them with rural health practitioners from the beginning of their degree so that potential doctors can build relationships and create opportunities in regional Australia and can see where their career could take them. Currently just 25 per cent of medical students are required to undertake at least one year of clinical training in a rural area. I would like to see a more ambitious stance to be taken, that every Australian medical student be required to undertake a clinical placement in a regional or rural area.”

Cathy McGowan, Indi:

– – “while doctors are really important, they are only one part of what is a system. For many, many people, their place of health and health care is not the doctor; it might be their home—it is the parents, it is the mother looking after the kids, teaching the children about hygiene and how to have exercise and how to be safe. For me, the home—along with the parents—is a fundamental place for health care. And once we have the home looked after and we have educated our families and our parents well, the next circle of influence around health is our schools. I am really pleased that the Victorian government is doing some fantastic work on trialling doctors in schools and working in that context—a great approach.

And the next circle out from our schools is our communities. In country areas, it is not only community health that is important; the other community workers play a really important part. Aged-care workers, childcare workers, local government workers and health inspectors—what an important role they play in our health.”

– – “So while I welcome the support for GPs it makes me really sad that we have missed the opportunity to do so much more. I acknowledge that this was an election commitment—and it is important that we fulfil election commitments—but I really do feel that it lacks ambition.”

– – “But this system approach that I have been talking about works well because we have a dedicated internet service. Ideally, we would have access to quality internet services everywhere in Australia, particularly in rural Australia. Sadly, that is not the case—and I am not even hopeful that the NBN service will deliver the expertise we need. But if we do get it, it will absolutely revolutionise the ability of our hospitals, our GPs and our medical professionals to provide services to people back into the other parts of the system—the homes, schools, workplaces and other areas where health and healing are practised.”

– – “Multipurpose services are no longer popular. It is such a pity. In our rural communities they provide health and aged care, and they employ doctors. In Corryong, they employ doctors to come and do the health and community work that we need doing. The model of funding has not changed in years, and we absolutely need to review that multipurpose service funding and reintroduce a 21st century approach, because hospitals like Corryong provide such a service in my community and, if we cannot get the funding right and they close, we will have no doctors there, because the only doctors in Corryong are the multipurpose employed ones. So, if we do not have the MPS providing the service, that whole community will be bereft.

In a similar way, I would like to acknowledge Alpine Health. Alpine Health is another MPS, and it works in Mount Beauty, Bright and Myrtleford. That MPS is particularly noteworthy, because of the health promotion work that it does. It provides that extension to the community, families, workplaces and community health and does such a good job in actually keeping people out of hospitals and out of our GP services through its health promotion.”

“One of the things that I am really disappointed about in this legislation is that we do not talk about health promotion. We have not talked about how stopping people getting ill is a really important part of the whole role.”

– -“One of the things the Minister said in his second reading speech was that this was going to be an independent position. Sadly, I do not accept that, if you put a person working in a Health Department, they will be independent. I do not see how that is going to happen.”

– -“At the moment, as the legislation stands, this position does not report to Parliament – – The legislation says that the Commissioner has to report every year on what they are doing, but the final report goes to the Minister. It is my belief that the final report should come to Parliament.

Editor’s note: Cathy McGowan’s amendment to require the Minister of the day to table the final report within five sitting days was agreed.

Rowan Ramsey, Grey

[He suspects that the establishment of the NRHC will make little difference.] “We should be seriously looking at postcode-specific Medicare provider numbers. – – I am not suggesting for one minute that we should tell doctors that they can or cannot set up practice anywhere in Australia; what I am saying is that we should tell them, ‘You can only deliver a service here if you want to access the public subsidy,’ which is the Medicare provider number. ‘If you want to charge full tote odds for your services, go ahead.’

– -“By and large, I find that rural doctors are very supportive of the proposals that I have put forward. Of course, there would be all kinds of give and take around the edges and, in particular, I think we would have to grandfather all the current doctors and say, ‘These rules will not apply to you,’ so that it will be a slow change to the system. But they actually understand the real challenges in getting doctors to come and work and practise in the country”

– – “over 50 per cent of the doctors in rural South Australia are overseas born and trained. We will stop importing those doctors almost imminently, because the pipeline coming out of the universities now is strong. In fact, we are probably training too many doctors for our future. There is a double-edged sword here. I believe we are heading for greater shortages in the country and we are heading back into over-servicing in the cities. It is not that hard for a doctor to over-service; you ask the patient to come back more often for a refill of a prescription or order a few more tests. We need to be aware of these looming issues before we get to them.  If we neglect reform in this area now, in five or six years’ time, when we have chronic over-servicing in the cities, we do not have enough doctors in the country and we stop importing doctors from overseas, we will be in an almighty mess.”

Stephen Jones, Whitlam:

– – “I do not say it is a bad thing, but it falls a long way short of a great breakthrough.”

– – “there is a very stubborn link between health inequality and wealth inequality. When one goes up, the other goes up as well. The disease risk factors are higher in areas of lower income and lower wealth, and access to preventive health measures are lower as well. This flows through to life expectancy. In our capital cities, the median age at death is 82.2 years. In outer regional areas, that drops to 79.2 years and 73.2 years for people living in remote Australia. The relative risk of mortality between the poorest and the richest income quintiles translates to a life expectancy gap at age 20 years of six years. Diabetes, just one of the chronic diseases rampant in regional Australia, is 3.5 times more common in working-age Australians in the poorest areas as it is in the wealthiest areas. Of course, the majority of those poorest areas are in regional, rural and remote Australia”

– – “There are a lot of priorities that we need to focus on in rural and regional health care, and creating a new position or a new specialist called the GP rural specialist, as important as it might be, is not going to address all of those important healthcare issues.”

Dr David Gillespie, Lyne – Assistant Minister for Health

– -“I anticipate that the role will indeed achieve its broader objectives in helping to deliver all the critical outcomes about which many of us are in furious agreement as to the need for reform and better outcomes. I am hopeful that, in the future, further support can be obtained in both a budgetary and a legislative context.

– -“Several people have spoken up about the scope of work the Rural Health Commissioner will be asked to perform, and I would just reinforce – – that it will be the first and most pressing duty of the Rural Health Commissioner to address the issue of the medical workforce and coordinate with all the various stakeholders, which are numerous, in the development of a rural generalist pathway.

The Commissioner will provide advice in relation to rural health beyond that. There are very many other matters in which the Rural Health Commissioner will have to be involved, in policy development and championing causes: While the development of the pathways will be the Commissioner’s first priority, the needs of nursing, dental health, pharmacy, Indigenous health, mental health, midwifery, occupational therapy, physical therapy and other allied health stakeholders will also be considered.”

– -“we have already set up a rural stakeholder round table, which last met on 16 November 2016, and the idea that they would work with the Rural Health Commissioner has been established. There were 18 attendees at the last meeting, across all the stakeholder groups in the rural health space.”

– – “workforce distribution has been raised as a big issue, and within the Department I am establishing a distribution working group that will also work with the Health Commissioner, and there will be representatives from rural health stakeholders as well. The Commissioner would be a member of that distribution working group and could use the group to take advice on other of the Commissioner’s functions.”

end