Even their fiercest critics would likely concede that John Barilaro and Barnaby Joyce have been vocal and energetic advocates for regional Australia.
As the former deputy premier of New South Wales, Barilaro wore his ability to secure funds for regional parts of the state as a badge of honour, even when done in ways that have exposed him to criticism.
Under his leadership the government established a department for regional NSW, and splashed hundreds of millions of dollars around the state in grant funding.
And he was never shy about butting up against his Liberal colleagues if he thought it was in the best interests of regional NSW. Barilaro threatened to tear up the Coalition agreement and move his party to the crossbench over a policy to protect koala habitat. He made similar threats over a candidate dispute ahead of the Wagga Wagga byelection in 2018, and over planned regional job cuts at Essential Energy.
In Canberra, the deputy prime minister, Barnaby Joyce, managed to extract something to the tune of $34bn in funding for road and rail projects, water infrastructure, and the vaguely titled “regional accelerator program” in this year’s budget in exchange for the Nationals’ less-than-enthusiastic support for the Coalition’s net zero emissions reduction commitment.
In terms of both media coverage and political leverage, it’s been a period of high power for the party of the bush, especially in NSW.
Meanwhile, however, their constituents have been suffering horrendous health outcomes, laid bare by the findings of an inquiry into regional health in NSW announced this week.
Following 15 months of public hearings and hundreds of submissions, the inquiry’s findings were stark. People who live outside the state’s three main metropolitan areas – Sydney, Newcastle and Wollongong – face “significantly poorer health outcomes, greater incidence of chronic disease and greater premature deaths” as a result of chronic underfunding, critical staff shortages and “significant financial challenges” to accessing diagnosis and treatment.
The report will be of no surprise to those who have followed the inquiry’s progress, or read the work of Sydney Morning Herald investigative journalist Carrie Fellner. Public hearings have revealed cases in which cooks cared for patients at Condobolin hospital because of a lack of staff.
Lack of resources meant patients were increasingly being flown to larger regional hospitals in places such as Dubbo, placing additional strain on an already stretched system.
What’s galling is that so many of the stories heard by the inquiry seemed to mirror the findings of the 2008 inquiry by Peter Garling SC. That inquiry led to the establishment of 15 local health districts which were meant to tailor services for the communities they served.
But key findings from the latest inquiry relate to the operation of those districts. There is a “lack of communication and genuine consultation” between local health boards and the communities they serve, the inquiry found, and a “culture of fear” within NSW Health in relation to speaking out about patient safety.
At its core the inquiry found both a need for a substantial increase in funding for regional health and systematic reform of the way both state and federal governments attract and keep doctors and nurses in rural areas.
After much criticism, the Coalition has committed some $900m to capital works in regional health this financial year. The government has also funded millions of dollars in hospital redevelopments in places such as Wagga Wagga, Tumut and Albury in recent years.
But the extent of the problems revealed by the inquiry into regional health show mere capital expenditure is not sufficient.
The inquiry has recommended a review of current funding models for all of the state’s rural and regional local health districts, as well as ministerial engagement with the federal government to address confusion over governance arrangements and doctor workforce shortages.
The Nationals have proved they can use their influence to generate headlines and pressure the Coalition to invest in regional areas, particularly around easy “announceables” such as new infrastructure.
Whether they can extend that to force the government to make the sorts of complex changes this report recommends shapes as a key test for the party going into next year’s state election. One imagines it will certainly be a focus of the party’s growing rival, the Shooters, Fishers and Farmers party.
