The availability of high-speed broadband in rural and remote areas will be a critical election issue if rural health advocates have their way.
The 12th National Rural Health Conference in Adelaide made 17 priority recommendations for advancing the health of rural and remote communities, with equitable access to high-speed broadband at the top of the list.
High broadband speeds are crucial for facilitating new and emerging best practice models of health care, such as those which incorporate high definition videoconferences, data exchange and high resolution image transfer, conference delegates said.
They also called for a bipartisan federal election commitment to the principles of Western Australia’s Royalties for Regions program, either through a program of the same type in each jurisdiction and/or through a sovereign wealth fund for rural development to which the Commonwealth, States and Territories would contribute.
They also want more place-based models of community empowerment and program administration in areas such as health, education, housing, employment, arts and culture, transport, infrastructure, and family and community services.
Medicare Locals and Regional Development Australia committees are examples of such place-based models in health and regional development that are already improving the quality and pertinence of decisions through a focus on local engagement and action, they said.
(The recommendations – which address infrastructure, clinical services, workforce issues and chronic conditions among Indigenous Australians, and include calls for the major supermarket chains to play a more constructive role in food security – are published in full at the bottom of this post or you can read them on the National Rural Health Alliance site).
The post below includes reports from journalist Marge Overs on presentations by the Federal Health Minister Tanya Plibersek, Professor Lesley Barclay, and Independent MP, Rob Oakeshott.
The next National Rural Health Conference will be held in Darwin in 2015.
Summarising Minister Plibersek’s presentation
Marge Overs writes:
On the National Broadband Network: It is phenomenal that the NBN is at the top of the top of your list of recommendations. We have to build it based on the needs in the future, not how we are using it now. I can’t begin to imagine how much we’ll depend on broadband 10 years’ time in bringing health care to rural and remote Australia.
On community engagement: The idea of investment coupled with autonomy right is the reason we’ve set up Medicare Locals. The reason they’re working is because we’re giving the money to the people who are working on the ground in communities.
We say to communities: have a look at the needs, we will back you with this investment and you use it flexibly and responsibly in your community for your community. That’s the way that health systems should work.
I have a lot of faith in my pubic servants in Canberra. They do an excellent job but they can’t be in every community determining need and allocating resource and nor should they be. That should be done as close to where treatment is being delivered as possible.
On the rural health training pipeline: We are working on end-to-end training from student days to practising in rural areas, and I’m waiting on the results of a review by Jenny Mason, which will soon be available.
One of the things Jenny Mason has had to wrestle with in her review are the ongoing concerns about the remoteness classification system. The system is controversial and changes will be controversial. I’m glad to report that detailed proposals for reform are undergoing technical assessment and we will then consult key stakeholders.
While I’m a city girl, some of the most rewarding experiences I’ve had as Health Minister have been seeing the marvellous work you do in your communities. We will continue to back you with dollars and policy consideration. The benefits are beginning to show but there is no room for complacency.
We have a great deal still to do to bridge the city country divide when it comes to health outcomes, but I hope we can work together to do that.
Summing up the conference themes: Professor Lesley Barclay
Leadership: The conference blends old and new in terms of leadership. I welcome the newness, freshness and inspiration from emerging leaders.
Strategy and innovation: Tom Calma’s presentation showed the importance of community engagement as a strategy. If we don’t engage the community, we fail. Tom gave us some wonderful examples in his speech.
I was also thrilled to hear Louise Sylvan talking about the innovation coming out of the Australian National Preventive Health Agency. I would also like to acknowledge Alison Fairleigh, who is using social media so creatively and had such a powerful presentation.
Evidence: Thirty per cent of the population of Australia lives in rural and remote Australia, but there is a $2 billion underfund in health. We need data to claw back some of that money.
Other key ideas and slogans that had emerged during the conference:
People possibilities: When resources are scarce, you pair up and pare down: you make sure what you do is effective and you do it together.
Seismic shift: We need place-based services and better governance. We need to do things that matter for the people who live there.
A fair go for all Australians: We need to go back to that. I’m sure the rest of Oz doesn’t realise we don’t get a fair go.
The quality of dying is as important as the quality of living.
And another value that came out of the conference, so beautifully summed up in Dougie Herd’s presentation about the NDIS: we need to move to an approach that realises people’s rights — not a 1970s patronising welfare-based approach.
Place-based models are the go: Rob Oakeshott
After the last election, the three Independent MPs told the Federal Government it had to engage better with rural and remote communities, which were screaming out for health equity, Member for Lyne Rob Oakeshott told the conference.
That is happening, he said, through an exciting chapter for community-based health strategies, but more could be done.
There was an opportunity for peak organisations such as the NRHA because placed-based models, such as Medicare Locals, were “the new black” in government thinking and were vital to building sustainability.
“Engaging communities early, empowering and encouraging and listening – that is where you get real change in social determinants of health.
“We are at a crossroads moment where central government is starting to want to reach out and wants to develop regionalised models of business and work in partnership with rural and remote Australia.”
At the same time, he said there were some exciting structural changes in government, such as the Commonwealth Financial Accountability Reforms, which would improve the accountability of government to regional Australia.
He said the “great inhibitor” of the past three years had been State-Federal relationships, but COAG had made inroads into improving these relationships. Importantly, auditors-general would have oversight over the COAG process, as the lack of oversight due to sovereign boundaries has been a problem.
“So now there is a chance of resource distribution formulas being delivered in an equitable way,” he said.
Mr Oakeshott urged the rural and remote health community to take advantage of this reform agenda.
“We are at the front end of a process where community engagement matters and government wants to get involved in that,” he said. “They may be doing it badly but don’t miss the opportunity to help them to do it better.
“Use that big reform agenda that’s happening anyway – make sure you don’t miss the opportunity. There’s a huge opportunity to get equity nailed down across the country. I hope you’re up for it.”
The 12thNational Rural Health Conference calls on political parties to make a bipartisan commitment to the delivery of high speed broadband to all families, services, businesses and communities in rural and remote areas so as not to entrench ‘the communications divide’ between rural and metropolitan Australia.
• The broadband infrastructure set in place 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 be such as ensure social inclusion, with pricing models that don’t discriminate against people in rural and remote areas but facilitate availability to all who need it.
• High broadband speeds are crucial for facilitating new and emerging best practice models of health care, such as those which incorporate high definition videoconferences, data exchange and high resolution image transfer.
2. Royalties for Regions
The conference calls on political parties to make a bipartisan commitment in the context of the 2013 Federal election to the principles embedded in Western Australia’s Royalties for Regions program, either through a program of the same type in each 2jurisdiction and/or through a sovereign wealth fund for rural development to which the Commonwealth, States and Territories would contribute.
•These funds would be used to strengthen rural and remote communities, their health infrastructure and services.
•Under such programs it would be vital for regions to retain autonomy with regard to how the resources are spent.
3. Place based programs and decisions
Conference calls on political parties to make a bipartisan commitment in the context of the 2013 Federal election to legislate more place-based models of community empowerment and program administration in areas such as health, education, housing, employment, arts and culture, transport, infrastructure, and family and community services.
• These place-based planning and delivery models should be responsive and accountable to the local community.
• Medicare Locals and Regional Development Australia committees are examples of such place-based models in health and regional development that are already improving the quality and pertinence of decisions through a focus on local engagement and action.
4. Food security
Given the critical importance of nutrition to good health and wellbeing, strategic plans for population health in rural and remote Australia should include measures to ensure food security, with specific funds available for ongoing and long-term community work on food security.
• A cross-sectoral and collaborative approach should be used to develop an effective and strategic approach to food security – driven by a new inter-governmental and interagency Food Security Council.
• In the same way that Telstra has a Community Service Obligation, the major supermarket chains should be encouraged by every means to share the responsibility of improving food security in rural and remote Australia through contributing to programs that improve the supply chain and/or the local production and distribution of food.
To measure the impact of health-related programs on the 33 per cent of Australians who live in rural and remote areas, and to assess their health status in an ongoing way, accurate and accessible data are needed that are specific to location.
This will permit analysis of health-related investment in non-metropolitan areas and the identification of effective programs that should be enhanced and of those with limited success that could be phased out.
• Conference calls for the National Strategic Framework for Rural and Remote Health to address this need for quantitative and qualitative data.
• Such data should include:
common wellness indices for all Australians, permitting comparisons between various areas (major cities, inner regional, remote);
standard frameworks for self-reporting; and
data that can provide the basis for needs assessment and regional planning.
• The data available for planning and evaluation should include medical evacuations; levels of patient assisted travel; and the use of specialist and allied health non-admitted activity provided by the States and Territories.
• Data collection practices and strategies undertaken in Aboriginal and Torres Strait Islander communities must be carried out in a sensitive and culturally appropriate way following genuine and prior consultation with Elders and/or community representatives.
6. A National Arts and Health Framework
The role of community arts in health -for healing and wellbeing, for communicating health and lifestyle messages, and for community development – needs to be recognised by governments through their adoption of the National Arts and Health Framework that is currently before Arts and Health Ministers at Federal and State/Territory levels.
B. Clinical services
7. Indigenous eye-health
Ninety four per cent of vision loss in Aboriginal and Torres Strait Islander peoples is preventable or treatable by simple solutions. A coordinated national framework should be developed to ensure a comprehensive approach to eye health.
Conference calls on the Department of Health and Ageing and State and Territory Governments to make provision in their budgets for:
• the integration of eye health into routine screening programs, for example, ear checks, diabetes checks (to avoid retinopathy) and general health and wellbeing checks; and
• the provision of eye care services within local communities by an adequate number of Aboriginal Health Workers and Regional Eye Health Coordinators based in Aboriginal Community Controlled Health Services, with funds provided for training and support for these roles. Spectacle schemes provided by the States and Territories should be nationally consistent and comply with best-practice standards. The feasibility of a national spectacle scheme specifically for Aboriginal and Torres Strait Islander Australians should be urgently considered.
8. Aged Care
Conference calls on the Living Longer, Living Better legislation, with its focus on greater support for older people to live in their own homes and communities, to be adapted to closely address the particular vulnerabilities of older people living in rural and remote communities.
These include higher costs of living, a higher proportion with low incomes, greater isolation, and greater exposure to adverse weather events (eg heat waves, fires and floods).
Measures should include
•rural seniors’ fuel vouchers to compensate for poor access to public transport; and
• ‘safe at home’ modifications that include timely access to falls prevention modifications, air-conditioning, and reflective roofing
Pooled Commonwealth and State investment in aged and disability services should be considered in order to increase the potential for viable home services in under-served rural communities.
9. Oral Health
Good oral health is essential to general health and wellbeing. Despite being mostly preventable, as socio-economic disadvantage grows so does the incidence and severity of dental disease.
Due to their lack of access to affordable preventive and acute oral health care, those in Australia who are most seriously affected are: rural and remote populations, Indigenous Australians, the aged and those who are socio-economically disadvantaged.
To ensure that regular, preventive-oriented oral health care is available to all Australians, the 12th Conference calls on bi-partisan political support for the National Partnership Agreement on public dental health services. It urges Commonwealth, State and Territory Governments to publicly and urgently progress the developments in the Agreement to provide equitable and accessible oral health services.
• 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.
10. Maternity Care
Maternity care in rural and remote Australia should be community-oriented and focus on services that meet the needs of women, families and the community. There is an urgent need to implement more innovative models of maternity care. These care models should reflect the goals and practices espoused in the national Maternity Services Plan, incorporate evidence-based care, meet population needs and include effective linkages and networks to higher-level services.
• Employment of Bachelor of Midwifery graduates should be encouraged within these models. To facilitate this, Conference recommends that the term “Named medical practitioner” in COAG’s Standing Council Health Determination be changed to “Health provider organisation” with minimal delay.
• Mentoring systems, similar to those offered in medicine and nursing, should be implemented for new midwifery graduates.
• Professional development for those delivering maternity services must be multidisciplinary, with supervision and mentoring provided across the entire team and equitably funded across professions.
11. Early Childhood
The vulnerability of children in rural and remote communities, including Aboriginal and Torres Strait Islander children, those with a disability, homeless children and those exposed to violence, is compounded by the impacts of key social determinants of health in these settings such as family income levels and access to education, health care, transport and support services.
• To ensure a bright start to life for country children, the 12th Conference looks to Megan Mitchell, the recently-appointed National Children’s Commissioner, to lead a cross-sectoral, rights-based approach to addressing the issues affecting children living in rural and remote areas. This work should include the collaboration of all involved government departments and agencies, and focus on the provision of child-centered, early intervention services.
12. Metro-rural services link
Specialist health services in rural areas should not be dependent on tenuous links with metropolitan services and the good will of visiting specialists. Such ad hoc relationships, whether in the public or private sectors, should be replaced by service agreements and clinical governance structures that ensure continuity and networking of services in rural areas.
• Formal arrangements should be instituted between metropolitan and country services that withstand the test of time and changes in personnel, and which build workforce and service capacity in country locations by providing nurses and allied health professionals with links to tertiary services, supervision and case conferencing, and support technologies (including telehealth) for timely advice and expertise.
13. Allied health, sector integration and National Disability Insurance Scheme (NDIS)
The current focus on the NDIS highlights the key role played by allied health professionals in disability and rehabilitation services. In rural areas there is an urgent need to increase sustainable allied health services, by integrating disability, aged and health care.
• To expand the availability of allied health services to meet the increased demand from sectoral integration (health, aged care, disability), funds should be allocated to enable local residents to undertake Cert IV in Allied Health Assistance.
• A supervision framework for allied health professionals, students and assistants must be provided.
• This will increase access to allied health services, enable allied health professionals to take leave and professional development entitlements, and provide local employment for local people.
Australia is ready for telehealth development that does not undermine the provision of face-to-face specialist services in rural and remote areas and is driven by clients’ needs, not by commercial gain and efficiency at the expense of quality care.
• Conference calls for additional program funds and a flexible approach to access (specialist to patient; GP and nurse to patient; Aboriginal Health Worker to specialist and patient; midwife to mother-to-be) which would include store-and-forward services as well as real-time consultations and would be unaffected by State and Territory borders. These telehealth services will be underpinned by broader MBS items and appropriate training and support.
• Telehealth developments should focus on practical, regular interactions in challenging communication environments and will include monitoring as well as video consults, interim reviews between consultations, and professional supervision sessions.
• In view of the need to systematise and integrate telehealth care into rural and remote practice, Conference calls on government to continue the work of the ACRRM Telehealth Advisory Committee and to provide resources for the evaluation of approaches to guide future development.
15. Maximising student advocacy and leadership
Conference calls on all health organisations, in their work on reforming healthcare in Australia, to engage closely and meaningfully with health students and early career health professionals. Health students and early career health professionals offer a unique perspective on the healthcare system and should be actively engaged in health reform alongside mid and late career health professionals and sector leaders.
Priority issues currently being promoted by students and other future health leaders include:
• that support for rural clinical placements currently offered to medical students should be extended to students of other health professions; and
• that guidance and mentoring of emerging clinicians and leaders from established health professionals is critical to effective support and succession within the sector.
There should be a national campaign led by Health Workforce Australia to promote the importance and rewards of generalist health practice as a specialty in its own right, and one that is essential to leading and providing health care in rural and remote Australia.
• Well-supported and easily-navigated training pathways to rural generalist careers need to be developed and articulated in medicine, nursing and allied health.
D. Managing Indigenous Chronic Conditions
17. Indigenous chronic conditions
A number of the plenary and concurrent session presentations made it clear that significant advances in rural and remote health would be made with the introduction of greater numbers of Indigenous health promotion campaigns addressing hypertension, heart disease and diabetes. These targeted programs would help address the social determinants of health and must be designed to fit local circumstances and meet the needs of various demographic groups. They would address smoking, obesity, physical activity and alcohol consumption, and should be evaluated to provide guidance on the most effective approaches.
• The importance of local community engaged leadership is powerfully demonstrated in a number of the presentations and is essential, together with innovative technologies such as mobile phone apps.
Previous Croakey articles on the 12th NRHC
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