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Rural and remote communities are missing out on critically important allied health services, conference will hear

The 15th National Conference for Rural and Remote Allied Health will be held in the north-west Victorian city of Mildura next week, on the lands of the Latji Latji and Barkindji peoples, with the Millewa/River Murray nearby.

It is an important gathering for Services for Australian Rural and Remote Allied Health (SARRAH), which is navigating an uncertain future at a time of escalating concerns about allied health workforce shortages in rural and remote areas.

Marie McInerney will attend and cover #SARRAH2024 for the Croakey Conference News Service, and previews some of the discussions below.


Marie McInerney writes:

Short-term, inflexible funding mechanisms and chronic workforce shortages are undermining the provision of allied health services to rural and remote Australian communities, including those serving many Aboriginal and Torres Strait Islander people who need better access to culturally safe care.

Services for Australian Rural and Remote Allied Health (SARRAH) CEO Cath Maloney told Croakey that allied health workforce shortages in regional, rural and remote Australia continue to be “severe and longstanding”, with significant consequences for health, healthcare, and the healthcare workforce.

“They directly impact the level of access people have to essential services in health, aged care, disability services, veterans’ services, child development and more, and contribute to poorer health outcomes, life trajectories and outcomes,” she said.

These concerns will be high on the agenda of SARRAH’s 15th National Conference for Rural and Remote Allied Health, to be held from 21-23 October in the north-west Victorian city of Mildura on the lands of the Latji Latji and Barkindji peoples.

More than 250 delegates will attend the sold-out event, which is titled “Going the distance: thriving in rural and remote communities”.

It will bring together occupational therapists, physiotherapists, podiatrists, speech pathologists, social workers, and other allied health professionals providing services across aged care, mental health, disability, early childhood development and chronic disease management in rural and remote regions.

Plenary speakers will include Kylie Stothers, deputy CEO of Indigenous Allied Health Australia (IAHA); Professor Faye McMillan AM, deputy National Rural Health Commissioner; Emeritus Professor Paul Worley, the inaugural Commissioner; and Chief Allied Health Officer Anita Hobson-Powell. It will feature a video message from Assistant Minister for Rural and Regional Health Emma McBride, and a keynote from the Shadow Minister Anne Webster, the local Nationals MP.

Cath Maloney

Cath Maloney said the conference will highlight and explore best and innovative practice and major reforms and issues facing the sector in what is currently a dynamic and complex policy environment that often regards allied health as a ‘poor cousin’ compared to the more influential medical and nursing sectors.

Some of the major policy developments underway include an expanding NDIS, reviews into scope of practice, GP incentives, and After-hours Primary Care Programs and Policy, the just-released Working Better for Medicare Review Final Report, and the National Allied Health Workforce Strategy being led by Australia’s Chief Allied Health Officer Anita Hobson-Powell.

The 2024 SARRAH conference will be the first such face-to-face gathering since 2018, due to disruptions from COVID-19, going online in 2022.

But of concern to many in the sector who value its focused voice and policy and program strength is that it may be SARRAH’s last conference. Maloney says there is uncertainty over the organisation’s future following discontinuation of funding for its workforce development programs in this year’s Federal Budget.

Stothers, a Jawoyn woman born, raised and now based in Katherine in the Northern Territory, said SARRAH would be a major loss to the sector.

She said it had demonstrated innovation, leadership, and authentic allyship with Aboriginal and Torres Strait Islander people and organisations, been a real driver in putting remote and rural allied health on the agenda, and its Transition to Remote and Rural Allied Health Practice Toolkit has been “a gamechanger” in providing access to ongoing professional development.

Maloney and the board are working hard to find sustainable options to ensure the intellectual property that has built up around rural allied health workforce development is preserved, including consulting widely on the prospect of establishing a college of rural and remote allied health.

“At a critical time amongst broad policy reform, it’s essential that SARRAH continues to contribute its voice on rural and remote health issues, and provide tested, evidence-based solutions to geographic workforce maldistribution,” Maloney said.

Worsening workforce shortages

Rural and remote Australian communities continue to experience a higher prevalence of chronic and other disease, potentially preventable hospitalisations and associated workforce and service shortages than their metropolitan counterparts.

Yet SARRAH says the maldistribution of allied health professionals and the associated workforce shortages in rural and remote areas are about twice as severe as for medical practitioners, “with numbers dropping sharply on a per head of population basis with increasing rurality/remoteness”.

It says the issues have worsened in recent years because of the high demand for allied health arising from the roll-out of the NDIS and increasing need in aged care service settings.

This was further exacerbated by the COVID-19 pandemic, restricting the mobility of the workforce across state borders within Australia, and adversely affecting the numbers of overseas-trained allied health professionals entering the country in recent years.

From SARRAH’s 2022 federal budget submission, showing workforce distribution by remoteness (where MMM1 is inner metropolitan and MMM7 is very remote) Source: Department of Health.

University of Wollongong researchers said this week that there are three times as many doctors per capita in metropolitan areas than in small rural towns, and twice as many nurses and allied health workers.

“This means that people in rural areas have a much harder time accessing healthcare,” said Dr Colin Cortie, lead author of the study published in the Australian Journal of Rural Health. “At the end of the day, this shortage poses significant risks to the health outcomes of Australians living in these regions.”

Unacceptable gaps

Laura Stuart, Team Leader – Chronic Conditions Allied Health at the Central Australian Aboriginal Congress, and her former colleague Andrew Jolly described to Croakey the impact of multiple barriers to providing allied healthcare to Aboriginal and Torres Strait Islander people in and around Mparntwe/Alice Springs.

“It’s been really, really challenging, and not straightforward,” said Jolly, who headed the Congress allied health team when he spoke to Croakey, but has since moved overseas.

“There isn’t a clear pathway to grow a team in an area of need,” he said.

As an example, he said Congress had not been able to feasibly sustain a position for a musculoskeletal physiotherapist, raising significant implications for healthcare and recovery.

“We know that not providing physiotherapy to people at an early stage after an acute injury means that people may live with preventable chronic pain, and it impacts their mental health, their quality of life,” he said. “That’s just not acceptable.”

Such funding gaps are an ongoing issue in rural and remote allied health that has meant services have to employ “a fair bit of creativity” to manage, including the need to engage with universities, research agencies and benevolent partners, he said.

The Fred Hollows Foundation has offered Congress funding over three years to employ an optometrist — it’s deeply valued and important support, but Jolly says the situation raises questions about having to “rely on donated funds to provide essential services”.

Stuart, a member of the SARRAH board, wants to learn more at the conference about how other services sustainably fund allied health, saying that grants-based, short-term piecemeal funding is not appropriate for Closing the Gap.

“The Productivity Commission’s review of Closing the Gap highlighted that short-term cyclical funding just really can’t make a difference in this space. We really need guaranteed longer term funding in programs in allied health,” she said.

“A lot of our work is relational, and it takes time,” she said. “We do really meaningful engagement and consultation to make sure that the work that we’re doing is fit for purpose for our community. By the time that’s done, you’re into the second half of the grant cycle.

“You don’t want to set up expectations and have people disappointed, so having the confidence to establish and grow that program is really challenging when you’re not sure if you’re going to have funding beyond June 30 next year, and that’s a reality for a number of our programs.

“It really hampers our impact and ability to grow.”

Cultural safety matters

The 2024 conference will have a strong overall focus on Aboriginal and Torres Strait Islander allied health needs and skills, and on cultural safety, including from Stothers’ opening plenary keynote address.

A dedicated First Nations session will hear about transformation in a university clinical placement program in response to the needs of a remote homeland community in Western Arnhem Land and innovation at the Orange Aboriginal Medical Service. One presentation posits: ‘collaboration is more than working together — we need to name whiteness’.

Stothers told Croakey there are still far too few Aboriginal and Torres Strait Islander people working in allied health, and particularly in remote and rural areas.

The current numbers are far from population parity and there are still no Aboriginal and Torres Strait Islander specialised health professionals in some fields, such as prosthetics, despite the high rates of diabetes and amputations experienced in Indigenous communities.

Some of the obvious barriers are around education and training pathways, including funding mechanisms and the lack of a workforce pipeline focused on people living in remote and rural Australia, she said.

“My social work career in remote and rural Australia has not been linear and I have often had to be creative in employment contracts to remain employed in allied health in remote Australia,” she said. “My career trajectory has certainly not been the same as some of my colleagues I graduated with in the late 1990s.”

“If you’re an Aboriginal or Torres Strait Islander kid from a remote community, your career trajectory, your education, your employment pathway looks very different to recruiting a clinician to come and live and work in remote Australia,” she said.

In her address, Stothers will highlight some of IAHA’s innovative programs, such as its High School to Deadly Careers Program, which has worked well to provide culturally safe and responsive remote and rural experiences for Aboriginal and Torres Strait Islander health students undertaking their tertiary degree, early career postgraduate studies, or VET qualifications.

Cultural safety in remote and rural health has always been a huge issue for communities and the Aboriginal and Torres Strait Islander workforce, impacting on access to health care and health outcomes, as well as employment and retention. High levels of staff turnover in remote Australia also leads to clinically and culturally unsafe practice, Stothers said.

That’s been heightened by last year’s Voice referendum which saw non-Indigenous people in rural, regional and remote areas vote No in high numbers.

Stothers said that through Cath Maloney’s leadership, SARRAH is doing its part to spotlight the importance of culturally safe and responsive practice in remote and rural Australia.

But she said the referendum result has caused Aboriginal and Torres Strait Islander health professionals across Australia to question “do we have genuine allies out there?” and “what does allyship look like post referendum across allied health, particularly in remote and rural Australia?”.

Solutions needed

Then National Rural Health Commissioner Worley’s 2020 report on rural and remote health documented “both a maldistribution and a shortage of workforce, resulting in thin markets, or areas of market failure” in allied health.

That was particularly so in smaller rural and remote communities, “where providers are forced to rely on temporary, short-term or part time funding arrangements, which diminish workforce attraction and retention and lead to high turnover”, his report said.

Yet despite all the reviews and reforms currently underway, Maloney said the rural and remote allied health sector is “still a long way from understanding” what will evolve “to facilitate better access to allied health services, especially for people living in the bush”.

The stumbling block will remain the availability of an allied health workforce to be part of multidisciplinary teams-based care, she said.

Maloney said the sector had been calling for 30 years for a national Allied Health Workforce Strategy. That it’s now underway is welcome, though she noted it emerged from a review of arrangements for overseas trained health professionals, “not from a workforce perspective”. In the meantime, the workforce and service need is “system-wide and immediate”, she said.

SARRAH is urging an integrated, evidence-based strategy to grow and develop the rural allied health workforce, including the implementation of a structured and supported Allied Health Rural Generalist Pathway.

It described as “devastating” the 2024 Federal Budget’s failure to provide additional funding to advance the allied health rural generalist training program, despite its demonstrated impact, saying the decision “underscores the challenges organisations like ours face in securing vital resources to drive positive change”.

The conference will devote a full day concurrent stream to showcasing the impact of allied health rural generalism. Other concurrent sessions will focus on models of care, recruitment and retention, students, children’s health, mental health, telehealth and workforce issues.

A self-care stream will look at ‘the cost of doing business in marginalised small rural communities’, discussing a physio’s changing practice in a community that “has decades of lived experience of climate awareness, social cohesion and tolerance” but a growing sense of marginalisation.

Another, on ‘Warm data in action’, will explore “current and emerging issues of clinical isolation, feelings of burnout and disconnection, prevalent in rural allied health”.

With Mildura having endured one of its worst floods in 70 years in 2022, one presentation will feature ‘a Green Social Work Study of Environmental and Social Justice in Mildura, a unique Australian river community’. Another with a local focus will report on a study to investigate and map the system of emergency care and follow-up for consumers experiencing suicidal crisis in the Mildura region.

See the full conference program. Bookmark this link to follow ongoing coverage via the Croakey Conference News Service, and also follow this list on X/Twitter for ongoing news from #SARRAH2024 presenters and participants.


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