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    NRHA MEDIA RELEASE: 13 May 2013
    Rural health expectations of the Budget

    National purse strings may be tight but people in rural and remote areas are holding out for things they have been promised that they trust they will not lose, and for some modest new spending to improve access and equity for rural people.

    Non-negotiable promises include funding according to need for rural schools as part of the Gonski reforms; funding for DisabilityCare Australia; ongoing funding for enhanced public dental health services for children and people with special need; and a ‘fix’ to the current system used for the classification of rurality.

    In addition, new and better directed expenditure is expected as a result of the Mason Report into health workforce programs. Augmentation and rationalisation of successful health workforce programs is expected along the ‘life course’ of recruitment, education, training and support for health professionals in rural and remote areas.

    For many years governments have invested in training greater numbers of health professionals, and now the emphasis needs to turn to their spatial distribution.

    Despite these initiatives relating to supply, Health Workforce Australia has predicted shortages of 80,000 registered nurses and 30,000 enrolled nurses by 2025. The Mason Report should therefore propose specific new initiatives for the nursing workforce, in particular in rural and remote areas.

    In general, rural health workforce programs must build the integrated health care team, and so encompass health service managers, medicine (GPs and specialists), nursing and midwifery, all allied health (including optometry and exercise science), oral health (including dentists), pharmacy, chiropractic and paramedicine.

    Other important rural expectations of the Budget include high speed broadband, reduced smoking rates, telehealth, and crush protection devices on quad bikes.

    Further details of these expectations are in the Alliance’s media release.

    Attachment: Rural health expectations of the Budget

    DisabilityCare Australia
    Ongoing bipartisan commitment and secure funding are critical to ensure that DisabilityCare Australia unfolds in ways that can deliver fully on the entitlements of people living with disability in rural and remote areas, as well as their carers and clinicians.

    Public dental health services
    The Budget must continue to underwrite joint Federal-State improvements in public dental services, particularly for those in special need. These include people in rural and remote areas, Indigenous Australians, the aged and those who are socio-economically disadvantaged.

    The legislated Grow Up Smiling (GUS) program for eligible young Australians is a good start in moving oral health care into the mainstream and should be seen as the first step towards ensuring regular, appropriate oral health care is available to all Australians on the basis of need.

    Health workforce programs
    The increased numbers of health professionals in training come from a new generation with different values and expectations. So now is a good time to refurbish and re-focus health workforce programs. The Budget should indicate where new and existing investments will be made and how the targeting of rural incentives will be improved.

    The system should begin in local High Schools in order to enable local communities to ‘grow their own’ doctor, allied health professional, nurse, midwife or dentist. Universities should be required to have a minimum of 30 per cent of their intake from rural, regional and remote areas – with better inter-university and inter-agency means of collaboration and information exchange on issues relating to rural placements.

    Additional investments must ensure that all health students have access to rural placements that are well-supported with appropriate educational infrastructure and clinical teachers. Students must also have access to affordable accommodation and appropriate financial support while on placements. Additionally, HECS reimbursement options should be extended to nurses, midwives, allied health professionals and dentists who are willing and able to practise in rural and remote areas.

    It is anticipated that the current restrictions on access to the Mental Health Nurse Incentive Program through MBS will be removed to allow all nurses with the appropriate postgraduate mental health qualifications access to the MBS-funded MHNIP.

    There should be funding for newly-graduated nurses, midwives, nurse practitioners and allied health professionals to undertake transition to practice programs in rural and remote areas. These programs should be inter-professional, thus modelling and preparing for the integrated multi-disciplinary teams that have to be the reality in rural and remote areas.

    Later on down the life course support system, with the goodwill and support of the range of regulatory bodies and organisations engaged, vocational training settings will be expanded to permit a greater proportion of vocational training to be undertaken in rural areas. The home base for vocational training will then more frequently be in regional centres, with rotations in the cities being necessary mainly for more specialised content.

    In all of this activity there should be positive discrimination for Aboriginal and Torres Strait Islander people to help to build up and sustain their numbers in the health professions.

    Maximum value should be obtained from older health professionals who may want to retire from full-time practice but still have much to offer by way of teaching, mentoring and supporting others.

    The Federal Government should more actively promote the elements of its refurbished rural health workforce program from schools through to retirement to make sure there is widespread knowledge of what is available.

    High speed broadband
    The Budget (and the Budget Reply speech from the Leader of the Opposition) should confirm the Government’s commitment to the delivery of high speed broadband to all families, services, businesses and communities in rural and remote areas.

    The broadband infrastructure provided must be robust and adaptable enough to accommodate future information technology developments, and to provide high speed connectivity and the coalescing of various media. The costs to the consumer must not discriminate against people in rural and remote areas but facilitate availability to all who need it, and both the rollout schedule and costs that apply must be widely publicised.

    High broadband speeds are crucial for ensuring that the people who live and work in rural and remote communities are connected to the world as well as the rest of Australia. New and emerging best practice models of health care rely more and more on high speed broadband, and include those which incorporate high definition videoconferences, data exchange and high resolution image transfer,

    People most in need of broadband, including those who are isolated, on low incomes, or with disabilities, should have special assistance to enable their access as soon as possible.

    Smoking reduction and health promotion
    Health promotion activity has not been as effective in rural and remote areas and health risk factors remain worse, on top of there being poorer access to health services.

    Rates of smoking provide an important and well-evidenced example. In 2008-09, whereas 17.6 per cent of people in the Major cities were smokers, the figures were 27 per cent for Outer Regional areas and up to 35 per cent for Remote and Very remote areas.

    Funding must continue for successful work to reduce rates of smoking, particularly among Aboriginal and Torres Strait Islander people. Given the particular challenge of health promotion in rural and remote areas, and the relative extent of health need, health promotion allocations (including to the Australian National Preventive Health Agency) should be increased and appropriate amounts spent in rural areas.

    The Government should also foreshadow new investments in health promotion activities targeted at other key determinants such as obesity, physical activity and alcohol consumption.

    Some of these additional investments should be targeted through Medicare Locals so they can be genuine primary health care agencies with the capacity to improve the social determinants of health in rural areas.

    The Budget should provide support for a coordinated national approach to Indigenous eye health, in which eye health checks are integrated with routine screening such as for hearing and diabetes, as well as for general health and wellbeing. Funding must be available for an increased number of Aboriginal Health Workers and Regional Eye Health Coordinators based in Aboriginal Community Controlled Health Services. The feasibility of a national spectacle scheme for Aboriginal and Torres Strait Islander Australians should be considered.

    Telehealth
    The Budget should maintain the current momentum and map out increased support for the development of telehealth, including for store-and-forward services as well as real-time consultations. To ensure that telehealth serves the front line health professionals and their patients in more remote communities, this support should be provided through new or expanded MBS items and with appropriate training and support for those involved, including doctors, nurses, midwives, allied health professionals and Aboriginal Health Workers.

    There needs to be block funding for telehealth for rural and remote area nurses, midwives and allied health professionals working where there are no GPs. This would allow for the expansion of telehealth consultations between a broader range of health professionals involved in care and help reduce the need for busy GPs to be the gatekeepers for access.

    Legitimate and potentially valuable telehealth transactions can involve a range of pairings, such as allied health to nurse; allied health to allied health; or nurse to nurse, as well as the pairings that are currently more familiar, such as GP to specialist. And the applications of telehealth are numerous: health monitoring, video consults, interim reviews between consultations, aged care services and professional supervision sessions.

    Quad bikes
    Consideration should be given to legislation relating to the manufacture and sale of quad bikes, to require both the mandated inclusion of crush protection devices, and the education of those who sell and purchase such machines.

    NRHA
    12 May 2013

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