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Estimates: Richard asks the Health Department rural placements

Estimates & Committees
Richard Di Natale 26 Feb 2014

During the February session of Senate Estimates, Dr Richard Di Natale asked the Department of Health about rural placements.

Senator DI NATALE: I get that the rural placements are a little more expensive.
Ms Flanagan: Yes—and all of these are rural placements. That is one of the aims of this. The intention is that they be placed in rural and regional areas.
Senator DI NATALE: I need to check what the commitment was, but my understanding of the commitment was that there would be 100 places offered.
Ms Flanagan: No, up to.
Prof. Halton: It was very clear: the wording was 'up to'.
Senator DI NATALE: That is a big range: from zero to 100.
Prof. Halton: Depending on the price—
Senator DI NATALE: Particularly when you consider that 185 people applied. I suppose the first question I have is: how many people were ineligible of the 185 applications?
Ms Shakespeare: Of the 185 applications we received, twelve were considered ineligible based on the applications. That was people, for instance, from the Monash Malaysian campus who trained primarily in Malaysia and possibly from people who applied where they had graduated in earlier years. The program was designed for 2013 medical graduates.
Senator DI NATALE: So over 170 applicants were eligible?
Ms Shakespeare: There were 173 applicants who were eligible. Of those, 44 subsequently withdrew and advised us that they had withdrawn.
Senator DI NATALE: Do we know why?
Ms Shakespeare: There would have been a range of reasons. Most often, I would expect, it was because they were offered a place in a public hospital through the state and territory offices.
Ms Flanagan: And we have a return-of-service requirement on the Commonwealth positions. The state ones do not. Therefore—
Senator DI NATALE: So what is that—129 left?
Ms Shakespeare: Yes. Seventy-six of the 129 were placed with hospitals that we have negotiated funding agreements with.
Senator DI NATALE: So we had 76 placed.
Ms Shakespeare: That is 53 applicants that were on our list originally. Some of those would have accepted places with the states and territories and not advised us. Others may have returned to their home countries and not withdrawn and advised us.
CHAIR: Are there any issues around the rural hospitals themselves having the resources to take them?
Ms Shakespeare: We did have negotiations with a large number of hospitals. In the end we had three main groups of hospitals that agreed to take interns.
CHAIR: You cannot just plonk an intern into a hospitals.
Senator DI NATALE: But the whole point of this is that there was not enough funding to provide more than 76 places. You could easily have provided enough positions, given that the funding was there. It is not a capacity issue; it is a resourcing issue.
Ms Shakespeare: I think it is both. We had a happy outcome in that the 76 places we funded have come out at about $10 million for this year. But there was also a lack of additional places that were accredited, and we need to have accredited training places in hospitals, otherwise the interns will go through training and—
CHAIR: That is what I was trying to get to.
Senator DI NATALE: That is a fair point, but are you suggesting that you do not have the capacity to train more than the additional 76 interns? If the funding was there, I am a bit confused.
Ms Shakespeare: At the moment there are not a lot of additional accredited positions—
Senator DI NATALE: There are not a lot? What is the constraint here? Is it funding, or is it capacity?
Ms Shakespeare: We identified 81 accredited places in private hospitals that we could have used; however, there were subsequent changes in the number of interns that some of the private hospitals were willing to take, and that might be because there have been changes in their circumstances that affected their capacity to take the interns. So while they may have had an accredited position when they spoke to us, if there were changes in employment for the people that would have been involved in supervising them, it may have meant that they could not accept the number of trainees that they had previously thought they could.
Senator DI NATALE: What are the plans for next year?
Ms Shakespeare: We need to talk to other private hospitals that have not been involved to this point. We need to talk with states and territories, so that we can better integrate these Commonwealth-funded intern positions with the intern programs that are run through the states and territories. We need to make sure that we are operating a program that is consistent with our requirements for competitive applications for hospitals that are interested in hosting interns. We have already started talking to private hospital groups and now that that there is ongoing funding available over the next four years, we will properly have more interest from some of the hospitals we have already spoken to or those which we may not have spoken to that decided that they were not quite ready to train interns at that point.
CHAIR: Have you got questions on other programs, Senator Di Natale? We have spent a lot of time on this and we have very little time.
Senator DI NATALE: Last question. Do you expect that there will be more than the current 76 placements, next year?
Ms Shakespeare: We hope that over time, as more private hospitals are involved in training interns, the capacity in those hospitals will improve and there will be less of the start-up costs involved with getting a hospital that has not been involved in training interns before do all that accreditation work, and making sure that their systems are in place to train interns. They will probably become more efficient and the costs will drop over time.
Prof. Halton: It is worth reminding ourselves that we have been through a big increase. All of the demographic information we have says that the kick-up in public students, and therefore the absorption of the capacity, has happened. We are now talking about a modest escalation in numbers of both full fee-paying and public places. The significant hump that we had to get over the last couple of years, we have already gotten over. Yes, there is a need to look at this in the ongoing years, but we are not facing the same issues that we have in the past.
Senator DI NATALE: We have to train them after the intern year now, which is a big challenge. It just shifts the focus elsewhere.
Senator DI NATALE: I get that the rural placements are a little more expensive.
Ms Flanagan: Yes—and all of these are rural placements. That is one of the aims of this. The intention is that they be placed in rural and regional areas.
Senator DI NATALE: I need to check what the commitment was, but my understanding of the commitment was that there would be 100 places offered.from the ACCC. They are familiar with that process from another experience that they have had in this regard. But it is to enable the code to have appropriate public scrutiny of both the code provisions and the processes used in relation to complaints. They will do that and seek to also have in that regard some sanctions, which are not simply the removal of an advertisement, which is the only sanction they currently have. In order to have those sanctions, they would need authorisation in the public interest essentially for breach of the competition provisions of the act. The other major recommendation to the industry self-regulatory advertising scheme is that they review their interpretation in particular of the code provision around children and advertisements appealing to children, which has been quite narrowly interpreted.
Senator DI NATALE: And the process from here for the draft paper?
Ms Sylvan: We have comments open for four weeks or so or a bit longer than that. Then we will proceed to the final report. The final report, as you know, goes to the minister for health.
Senator DI NATALE: And then the minister would have the same conditions—a year to respond?
Ms Sylvan: That is correct, Senator.

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