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Speaker 1: Now we know that the spotlight has remained on Alice Springs,

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Speaker 1: this time on the health workforce crisis, and we'd heard

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Speaker 1: from congress Chief Medical Officer of Public Health, doctor John Boffer,

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Speaker 1: who had said that the primary healthcare workforce in rural

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Speaker 1: and remote Northern Territory is at breaking point and the

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Speaker 1: critical shortage of doctors, nurses, Aboriginal health practitioners, Allied health

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Speaker 1: and other staff has forced Congress to make some temporary closures.

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Speaker 1: So joining me on the line right now is doctor

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Speaker 1: John Boffer. Good morning to you, Doctor Boffer. Good morning Katie,

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Speaker 1: Thanks so much for your time this morning. Now, doctor Boffer,

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Speaker 1: I know that Central Australian Aboriginal Congress has met with

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Speaker 1: Professor Brendan Murphy AC as well as the Chief Minister

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Speaker 1: to discuss these issues. How did those talks go.

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Speaker 2: I think they've gone very well. I think everyone's aware

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Speaker 2: that we've got a big problem and we've got a

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Speaker 2: crisis and it's deeply affecting the capacity to maintain the

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Speaker 2: delivery of effective primary healthcare services in rural and remote areas,

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Speaker 2: but particularly in the remote areas, and the situation, you know,

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Speaker 2: I go back a long way. We were in this

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Speaker 2: situation in the nineties. And you know, I remember I

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Speaker 2: was the only doctor of the Winter ten and Creek

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Speaker 2: in nine eight. It was there on my own. We

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Speaker 2: couldn't get doctors, we couldn't get locans. But the Cornwath

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Speaker 2: government in that period a whole series of reforms happened.

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Speaker 2: We got the Rural Incentives Program, which gave remote area grants,

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Speaker 2: it gave local support grants, it produced a local support program.

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Speaker 2: We had retention payments, and a whole range of things

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Speaker 2: came in. We had a holy of reforms in the

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Speaker 2: university sector. We had university departments of Rural Health, we

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Speaker 2: had Rural Health Training in it set up. We had

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Speaker 2: Rural Workforce AISY set up. And then we also freed

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Speaker 2: our access to international medical graduates and health professionals. And

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Speaker 2: ninety ninety nine we got the Overseas Trained Office scheme

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Speaker 2: which Michael Woolridge left, which was really quite revolutionary in

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Speaker 2: terms of us being other access pece from overseas. Now,

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Speaker 2: all of that has made a big difference for twenty years,

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Speaker 2: and this is an unprecedented situation for Congress. Congress has

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Speaker 2: never previously closed the clinic. We've had to close one

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Speaker 2: town clinic for now. We'll look at you again in April.

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Speaker 2: But in order to maintain our remote clinics, we've done

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Speaker 2: that because in town we have multible clinics. We've got

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Speaker 2: sermon clinics in town, so one of those closes, so

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Speaker 2: people have got options, it's not like there aren't options,

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Speaker 2: but also one of our main clinics we've had to

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Speaker 2: really set up a very big part of that clinic

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Speaker 2: as an urgent care clinic, which is again non optimal.

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Speaker 2: We can meet demand on the day for urgent issues,

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Speaker 2: but then we're not going to be able to do

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Speaker 2: as much as we need to be able to do

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Speaker 2: to address the complex kindic conditions that people have got

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Speaker 2: with this workforce crisis. The impact.

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Speaker 1: Do you continue?

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Speaker 2: Yep, that will impact. We've seen big gains in premature

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Speaker 2: death and life expectancy for every people in Central Australia

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Speaker 2: since nineteen ninety eight for the last twenty years, bigger

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Speaker 2: gains than anywhere else in the territory. We've started from

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Speaker 2: the lower base and we've seen bigger improvements than other

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Speaker 2: parts of the Turkey, and particularly in premature death rates,

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Speaker 2: which in the gaps closing more quickly in that than

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Speaker 2: it is in life expectancy because there's a lag in

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Speaker 2: life expectancy data. But life expectancy improved ten years for men,

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Speaker 2: and this has been because of better primary healthcare and

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Speaker 2: better healthcare in general. The hospitals improved a lot in

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Speaker 2: that un as well. Now these gains will be lost

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Speaker 2: if we can't do what we need to do at

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Speaker 2: the primary health care level to manage complex chronic conditions. Well, well,

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Speaker 2: we're going to see preventable deaths and preventable premiature and

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Speaker 2: mortality start to return. And we just can't afford to

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Speaker 2: go backwards. And this is a solvable crisis. There are

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Speaker 2: things we can do that will make an immediate difference,

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Speaker 2: and we need where people are really screaming out for help. Now,

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Speaker 2: the situation's urgent, talk through collection.

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Speaker 1: Can you just talk us through. I mean, how many

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Speaker 1: staff are you short at the moment? What's the situation

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Speaker 1: for Congress right now? When it comes to those staffing levels?

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Speaker 2: Seven full time GP short, that's about a third. We're

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Speaker 2: twenty two nurses short, that's about a third of our

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Speaker 2: nurse workforce. We're nine average and health workers health practitioners short.

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Speaker 2: That's been over a third, getting close to fifty percent

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Speaker 2: of that workforce, and we're seventeen allied health staff short.

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Speaker 2: That's the start. It is not ass educated, so you know,

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Speaker 2: that's a very significant proportion of our workforce. And these

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Speaker 2: that's the town and remote so it's very difficult. You

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Speaker 2: can't maintain normal service delivery with those sorts of shortages,

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Speaker 2: so you know, and this has come on quite for us.

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Speaker 2: We were holding out and doing reasonably well till towards

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Speaker 2: September October last year and then it's really hit us hard.

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Speaker 2: So this is the covid era was hard. But coming

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Speaker 2: out of the covid era, health presents are exhausted, they're

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Speaker 2: taking lay, they're resigning leading the profession. There's a shortage everywhere.

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Speaker 2: We get that, but there's some policy leaders that have

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Speaker 2: to be pushed now to make a difference. And one

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Speaker 2: of the most important we've started. Australia has relaxed and

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Speaker 2: it's working to relax further the way international graduates can

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Speaker 2: come into the country doctors, nurses and others. But unfortunately

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Speaker 2: they're allowed to go and work in the outer suburbs

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Speaker 2: of Melbourne and Sydney. Now now that's a new thing.

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Speaker 2: They used to only be allowed to come and work

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Speaker 2: in Roland remote areas, but now you know the out

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Speaker 2: of subs and Melbourne, the out of Suthers of Sydney,

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Speaker 2: the big regional centers can all get these international health professionals.

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Speaker 2: That's unfair, it is and needs to be stopped. We've

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Speaker 2: got to stop these people going to work where they're

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Speaker 2: not needed and we have to make sure they come

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Speaker 2: in and work where they're needed.

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Speaker 1: It seems like a no brainer, like it honestly seems

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Speaker 1: like a no brainer.

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Speaker 2: Well it should be an no brainer. Look if there

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Speaker 2: are pockets of disadvantage and the out of suthers, and

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Speaker 2: then look at those pockets. But don't make a blanket rule,

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Speaker 2: because there's not a severe workforce shortage in those parts

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Speaker 2: of the country compared to what we're dealing with. So

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Speaker 2: that's that's something. And we've got a further relax and

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Speaker 2: work on streamline the way in which international graduates are

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Speaker 2: assessed in Australia because there's too much, too much time

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Speaker 2: put into over scrutinizing. We've got to make sure we

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Speaker 2: get people that are at the right standard, but we

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Speaker 2: don't want to take too long, so that's that's one

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Speaker 2: aspect of what could make an immediate difference. But look

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Speaker 2: a country like this, we can't just rely on overseas

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Speaker 2: trained health professions. We've got to train more of our own.

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Speaker 2: There's forty medical undergraduate places up for grabs right now

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Speaker 2: that are already funded by the Cornwell the Cornwall Department

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Speaker 2: of Education determine where they go. We think they must

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Speaker 2: go to Charlesdowne University. The Northern Churchy needs its own

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Speaker 2: medical undergrad its own medical school and to compliment and

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Speaker 2: nursing the Deity Allied Health. You know a range of

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Speaker 2: things that we are gett We're getting phantasy back, we're

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Speaker 2: treating training our own occupation of therapose through Charlestown University.

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Speaker 2: But what we don't have is a medical school. We've

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Speaker 2: got sixty five intern positions a year that we have

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Speaker 2: to fill and if we fill them with doctors who

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Speaker 2: are more from the Northern Churchy, they're more likely to

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Speaker 2: stay and then that's the pipeline into general practice. Some

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Speaker 2: of those doctors then come and work in primary health

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Speaker 2: care do GP training. So that's a long term thing.

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Speaker 2: But we've got to look at short term, medium term

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Speaker 2: and long term virtues. Money is part of the issue

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Speaker 2: at the moment. We've got to be able to pay

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Speaker 2: significantly more money to track people into remote areas and

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Speaker 2: we're sitting on two and a half percent CPI increases

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Speaker 2: through our core funding, which is completely inadequate. Because wages

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Speaker 2: have exploded in this area, they've gone through the roof.

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Speaker 2: And there was that publicity about the Health Department having

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Speaker 2: to pay fifteen hundred dollars a day to keep a

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Speaker 2: remote clinic open. Now we under sound why they are

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Speaker 2: paying that money, and I think some of the publicity

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Speaker 2: was suggesting, you know, you've got to keep remote clinics

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Speaker 2: open to some extent. You've got to do what you've

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Speaker 2: got to do. But those sorts of if you start

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Speaker 2: paying fifteen hundred dollars a day for eMTA and Earth,

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Speaker 2: that's five hundred thousand a year for AMATA.

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Speaker 1: And nurse, it's unbelievable.

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Speaker 2: The system's not funded at that level, nor should it be.

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Speaker 2: We've got to look at policies that distribute. See, we've

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Speaker 2: got a problem with NOLL distribution in this country, a

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Speaker 2: big problem. We haven't dealt with that. In nineteen ninety nine,

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Speaker 2: Minister Warriage at the time was about to introduce what

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Speaker 2: we call geographic provider numbers. Now the medical profession said,

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Speaker 2: don't do that. Don't do that. We'll make sure we

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Speaker 2: soort this out through incentives, mainly financial centers. We don't

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Speaker 2: need to dictate where people work. So look here we

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Speaker 2: are in twenty twenty three. We're back to where we

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Speaker 2: were in the mid nineties and we're back to having

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Speaker 2: to have a discussion about how does Australia regulate where

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Speaker 2: health professionals work. We can't just let them set up

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Speaker 2: shop where they want to and work in areas where

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Speaker 2: they're not needed.

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Speaker 1: It's pretty unbelievable. It is honestly pretty unbelievable. Dr boff Ray.

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Speaker 1: I'm going to have to wrap up, but we did

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Speaker 1: just speak to Kath Hatcher from the Nursing Union a

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Speaker 1: little bit earlier this morning as well about the shortages

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Speaker 1: that they've got when it comes to staff in Alice Springs.

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Speaker 1: I mean, you're obviously talking about the situation for Congress

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Speaker 1: for Central Australian Aboriginal Congress right now in the Red Center.

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Speaker 1: I mean, are we at a crisis point here in

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Speaker 1: Central Australia when it comes to health staff I.

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Speaker 2: Think we need to. We are at a crisis point

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Speaker 2: when it comes to remote health staff. It's not just

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Speaker 2: Central Australia. I think that the recent publicity hasn't helped us,

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Speaker 2: but the alcohol restrictions have been so effective that this

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Speaker 2: town is back to normal. It's back to where it was.

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Speaker 2: So there's no longer the property offenses, they're a third

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Speaker 2: of what they were, the domestic bond, the salts are

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Speaker 2: gone from seven a day to two a day. So

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Speaker 2: we've sent a transformation in the town and we need

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Speaker 2: to get that message out. That's not a reason not

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Speaker 2: to come here. This is a great place to come

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Speaker 2: and work. But there's a crisis in remote and rural health,

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Speaker 2: but particularly remote health more generally, and Congress is caught

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Speaker 2: up in that. So I think we need national we

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Speaker 2: need Commonwealth government to act here. This is not a

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Speaker 2: Turkey driven crisis. Is a crisis in the way that

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Speaker 2: health professionals are regulated, the way they're trained, and the

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Speaker 2: way that primal healthcare systems funded. There's no loadings on

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Speaker 2: Medicare for really remote areas, so we think we've got

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Speaker 2: to do that. We've got to make substantive more loadings

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Speaker 2: on Medicare for rural and remote areas. So there's lots

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Speaker 2: of things were like we were in the nineties, this

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Speaker 2: won't be There's no quick fix here. And we can't

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Speaker 2: just align international health professionals, and particularly we can't pull

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Speaker 2: the Man of Africa around third world countries. So our

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Speaker 2: first world countries workforce bonds. We've got to grow our own.

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Speaker 2: We've got to make sure when we train them they

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Speaker 2: work with our needed and that's going to require some

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Speaker 2: regulatory leaves, not just financial and other incentives. We've got

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Speaker 2: to look at a system that ensures we do not

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Speaker 2: continue to allow health professors to work with or not

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Speaker 2: needed for instances. Doctor, how many orthopedic surgeons do you

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Speaker 2: think there are in Sydney in the in the area

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Speaker 2: around the racecourse, you know now around Bondi. People meant

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Speaker 2: to look at the way these these health professors are

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Speaker 2: distributed is a massive issue for the parts of the

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Speaker 2: country that aren't popular.

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Speaker 1: Dr Boffer. I really appreciate your time this morning and

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Speaker 1: your passion. Thank you so very much for having a

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Speaker 1: chat with us. We are going to have to leave

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Speaker 1: it there. Thank you for your time.

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Speaker 2: Thanks Katie, Thank you