Education Legislation Amendment (Integrity and Other Measures) Bill 2025

Dr RYAN (Kooyong) (13:20): I rise today to speak to the amendments to the Higher Education Support Act 2003 in the Education Legislation Amendment (Integrity and Other Measures) Bill 2025, which provide for demand-driven funding of places in medical schools for First Nations students. This amendment is about equity—equity of education, and equity of access to the best possible medical care in this country.

It's about removing barriers and it's about planning for Australia's future healthcare needs. Access to best practice medical care should always be available. It should always be culturally appropriate.

But, too often, patients in First Nations and culturally diverse communities in Australia have experienced language barriers, cultural misunderstanding and, more often than we would like to acknowledge, outright prejudice when it comes to accessing health care. Those services are not safe, and unsafe services are a deterrent to seeking medical assistance, which can lead to negative health outcomes.

A diverse medical workforce and the inclusion of First Nations people on the very front line of our medical care will help to build culturally safe services and will improve the standard of care across all of our health professions. I reflect on my own experiences as a paediatric registrar at the Royal Darwin Hospital more than 20 years ago, when I was trying to find common ground with children who had never been in a building with a lift before, who had never experienced air-conditioning, and who primarily spoke a First Nations language with which I could not correspond.

I remember how complicated, difficult, challenging and sad it was to find it really difficult to provide best-quality, culturally safe health care. I contrast that with the experiences of hearing from and witnessing the amazing work of Dr Jason King, Director of Clinical Services at Gurriny Yealamucka Health Services Aboriginal Corporation in Yarrabah last year, when the parliamentary Standing Committee on Health, of which I'm very proud to be a member, visited his community as part of our inquiry into diabetes in this country.

In a generation, we have come such a long way, and we are now able to see the extraordinary value and impact of Indigenous Australians leading multidisciplinary best-practice healthcare facilities within their own communities. Aboriginal Community Controlled Health Organisations are possibly the most successful community health organisations in this country. They were founded in response to Indigenous Australians experiences of racism—let's call it what it is—in primary health care, and their unmet need for culturally safe and accessible services.

The model has now been so successful that we have more than 145 ACCHOs delivering holistic, comprehensive, culturally safe primary health care for Aboriginal and Torres Strait Islanders peoples nationally. Those services have been shown to improve health outcomes. They have been shown to decrease the cost of care, especially for remote communities.

First Nations doctors are still underrepresented in our medical profession. In 2023, roughly 0.6 per cent of all doctors in Australia identified as Aboriginal or Torres Strait Islander peoples, despite them representing three per cent of the Australian population overall. In uncapping places in medical courses for First Nations students, so that all First Nations students who meet the entry requirements to enrol in courses in medicine can be enrolled in a Commonwealth supported place, this amendment responds to recommendation 3(b) of the Australian Universities Accord final report, which recommended that the Australian government provide places for all First Nations students who apply and who meet the entry requirements for a position in a medical school.

It is worth noting that our medical schools are already trying hard to recruit Indigenous medical students through special entry schemes and quotas, and they have already had some success. Three per cent of domestic medical students are Indigenous compared to 2.3 per cent of the overall domestic student population. In fact, the main obstacle to further enrolment increases might actually be in finding the right students, not in the availability or otherwise of training places.

I note that the government has budgeted only $560,000 for places under this scheme in 2026-27. That equates to only about 17 medical-equivalent, full-time student loads, suggesting that the government does not anticipate that this legislation is going to result in a major increase in the number of Indigenous medical students. There's a complication here.

Medical degrees are designated courses in our universities. That means that they have a specified number of allocated student places. University funding agreements limit them to specified numbers of domestic medical degree completions, and over-enrolment can actually result in a breach of the universities' funding agreements.

That means that introducing demand-driven funding for Indigenous medical students will not, in itself, change the completions cap, which operates independently of designation. If a university has designated medical places transferred to the estimated Indigenous demand-driven places, but then ends up having fewer commencing Indigenous medical students than anticipated, its actual number of total medical students will decline.

Given the likely low numbers involved, and the low numbers estimated by the government in budgeting for this scheme, I ask the government to ensure that any additional Indigenous medical students will be put into a model of future completions, in which case the cap could be adjusted up. It's a win-win for everybody. It's going to take years to address the inequality in our medical systems, but creating opportunities for them to study medicine is the first step in building an expanded workforce of Indigenous graduates, GPs and specialist doctors to work in the great teaching hospitals of our metropolitan centres, in small private hospitals like those in my electorate of Kooyong, and also in the ACCHOs and the outreach services of rural and regional Australia.

We know that rural and regional Australia has significant shortages of medical practitioners. Despite the outstanding work of rural nurses and allied health professionals, those shortages result in inequity, which is apparent in the health outcomes experienced by people living in those communities. According to the Australian Institute of Health and Welfare, rural and regional students are more likely to have chronic health conditions and less likely to access health care than patients in major cities.

While most First Nations people live in urban centres, they do represent a third of the population in remote locations, which are areas that suffer the double disadvantage of increased health risks and lesser health services. Most medical graduates don't want to practise outside a capital city, but more than 72 per cent of graduates from rural backgrounds prefer to go home and to practice outside the cities.

First Nations doctors are also more likely to choose to practice in ACCHOs and in rural, regional and remote communities. The solution is clear: barriers to rural and First Nations students must be removed to attract and support the rural doctors of the future. I urge the Minister for Education to continue this important work to remove barriers to training and to support First Nations and rural medical graduates.

The support should include an increase in designated places for Indigenous students, additional to but not replacing the places that we have for non-Indigenous students. I commend this bill to the House.