Introduction by Croakey: In our latest article from the recent 15th National Conference for Rural and Remote Allied Health, Marie McInerney reports on the strengths of multidisciplinary allied healthcare and innovative ways of growing the rural workforce.
The conference was hosted by Services for Australian Rural and Remote Allied Health (SARRAH), in Mildura on the lands of the Latji Latji and Barkindji peoples. McInerney interviews several delegates and reports on presentations below.
Marie McInerney writes:
The recent conference for rural and remote allied health professions highlighted the strengths of allied health and multidisciplinary care as well as the ongoing impacts of chronic workforce shortages in rural and remote communities.
Below are ten key takeaways from #SARRAH2024.
1. Allied health helps emergency care
A new allied health team operating in the emergency department at Armidale Hospital in regional New South Wales has helped lead to shorter wait times and reduced length of stay, fewer admissions and less case load on emergency specialists, the conference was told.
Physiotherapist Lisa Fraser said the model of care, operating in just five hospital sites in the New England region, allows early involvement of physiotherapists, occupational therapists, pharmacists and social workers in a patient’s hospital journey.
This changes the traditional operation of emergency departments, by “enabling increased collaboration between multidisciplinary team members and a more holistic approach to patient care”, she said.
Fraser provided a detailed case study of an elderly woman, who had brought her husband in for day surgery but had a fall while onsite. A number of key interventions by the allied health team were not only significant for the woman’s health and wellbeing and that of her husband, but also for the health system.
The introduction of senior Level 4 allied health positions includes extra training and upskilling for an extended scope of practice, as well as strengthening the existing allied health workforce by having senior clinicians available to supervise and mentor junior staff, she said.
The significant outcomes include:
- shorter wait times and reduced length of stay in ED
- fewer admissions (for those who would normally wait to be cleared by inpatient allied health)
- smoother handovers to inpatient allied health teams and improved referrals and linkages of patients to community-based services
- reduced load on ED medical staff, particularly with physiotherapy operating as a primary contact service.
Watch the video interview with Lisa Fraser here.
2. Cross pollination matters
Wunan Health is an Aboriginal community controlled private practice in the East Kimberley in Western Australia that provides healthcare to Indigenous and non-Indigenous people living in Kununurra, Wyndham, Halls Creek and extended communities.
At the heart of its work and employment practice, 3,000 kilometres north of Perth, is the Aboriginal Cultural Safety Framework, which focuses on four key domains: building a strong, vibrant, and culturally safe workforce; embedding culturally strong and place-based practices; enabling continuous quality improvement; and fostering effective communication and leadership.
The Framework is “not sitting on the side, it’s sprinkled through the whole thing,” said Dr Stephanie Trust, a Gidja/Walmajarri GP and clinical director of Wunan Health. “It’s like salt and pepper, you’ve got to put it everywhere.”
Trust, who was this year announced as joint GP of the Year in the WA Rural Health Excellence Awards 2024, said Wunan Health was established a decade ago by the Wunan Foundation, a community-controlled organisation focused on the social determinants of health.
The Foundation has a strong commercial arm that owns office blocks in Canberra, hotel shares in Darwin and the local Lily Lagoon Resort in Kununurra — it’s partly about generating income and wealth, but it also seeks to grow a workforce and opportunities for local people in the East Kimberley, she said.
Trust had travelled the distance from Kununurra to Mildura for SARRAH’s allied health conference, despite being a GP, because she believes “there should be lots of cross pollination between different professions”.
“Allied health is really important in our multidisciplinary team,” she said, describing how the initially small Wunan Health service has grown strongly, including creating a purpose-built centre in the midst of the pandemic, where they “just went for broke” in its design and ambition, complete with rooms that are plumbed for dentists.
“We haven’t got [dentists] yet but that’s the dream,” she said, confessing to “dental envy” and “gym envy” from an earlier presentation to the conference from the Orange Aboriginal Medical Service (OAMS) – see posts from X at the end of the article.
However, Wunan has a strong focus on the social and cultural determinants, offering support across health, education, housing and financial, including a headspace clinic and the first Western Australian withdrawal intervention centre to be opened outside of Perth.
A couple of weeks ago, Trust saw a patient, a mum whose young child was sick.
“We talked about the immediate issue around the acute illness, but then it came to light that the little one doesn’t go to school because there’s stuff going on with development and speech and a bit of bullying,” Trust said.
Trust referred the child to Wunan’s child and parent centre, to book into health assessments, speech therapy and early learning, while the mother, who revealed she was struggling with household bills, was referred to its financial hub.
Operating as an ACCHO, Wunan’s services work under holistic understandings of health that go beyond standard Western medicine, to look at “how do we support the family as a whole?”, she said.
And that’s not only for Indigenous people in the region. “One of the things we firmly believe is that we’re not just an expert in Aboriginal health in rural and remote (regions), we’re an expert in rural and remote health,” she said.
Watch our interview with Dr Steph Trust here.
3. Geography is a construct in health funding
Karen Hayes, an occupational therapy academic at Charles Sturt University, wants to flip the narrative that “the reason our rural health outcomes are so much worse is our geography”.
“In fact, we shape our geography,” said Hayes who lives and works in Port Macquarie on the mid-north coast of NSW.
“We decide where we’re going to build things. We decide where services are going to be placed. We decide where we’re going to put infrastructure.
“And so the outcomes that we get are a direct result of social decisions about how we’ve shaped our geography to limit opportunities for people in rural areas to access health,” she said.
Hayes addressed the SARRAH conference on the case for spatial justice in rural and remote allied healthcare, driven by the evidence that, “almost universally, people living in rural and remote places die younger, poorer, and sicker than urban dwelling citizens of the same country”.
She explained how spatial justice applies geographical concepts to suggest how rural and remote geography may have been shaped by ideologies of capitalism and neoliberalism to result in spatial injustice.
“Our analysis suggests that rather than rural geography being a neutral issue, society shaped geographies to limit health opportunities for people that live in rural and remote places.”
Hayes later told Croakey she had dug into spatial justice amid frustration with the widely accepted argument that health services are commonly less available and more costly and challenging to access for rural and remote people because they live in places that too distant, too under-populated, and too difficult to access.
That is, that it’s their choice against an urban norm.
She’s calling instead for reciprocity, in return for all the benefits that urban Australians extract from rural and remote areas – “we get mined, we get toured, we get harvested”.
“We need people to send back the resources that we don’t have,” she said.
With women in very remote areas in 2022 facing a median length of life a shocking 19 years shorter than metropolitan women, “we need to decide whether our lives are worth more than the money that’s been saved and not spent on us,” she said.
Watch the video interview with Karen Hayes here.
4. A lot of families are going without for a long time
Physiotherapists Zoe Tyack and Matiese Byrnes from Rise Physiotherapy in Forbes, New South Wales, tell Croakey about the financial, health and wellbeing, and educational costs of allied health workforce shortages for their local community, particularly for families.
Many of their clients have to travel regularly to other regional centres or up to five and a half hours to Sydney to access services, missing work and school. Others can’t make the trips. “We just need [allied health professionals] to come to the rural areas and want to be there.”
Watch this brief interview here.
5. Recruitment in Broken Hill is very challenging
Senior occupational therapist Phoebe Anderson tells Croakey about the difficulty in recruiting and retaining allied health staff in the remote New South Wales town of Broken Hill, which means waiting times remain long at real cost to the local community.
“It’s hard to see those waitlists just not come down,” she said.
She hopes the growing employment of allied health assistants and the rural allied health generalist pathway may provide some solutions in the near future. “We can only hope.”
Anderson also talks about the impact of the recent power blackouts in Broken Hill, as a result of extreme weather, saying it’s affected schools, daycare, work, with food in fridges and freezers going to waste, and no firm end date as rising temperatures loom.
Watch the video interview here.
6. Power failures have wide-ranging health impacts
Cory Paulson also talked about the impact of the recent Broken Hill power failures for the local community, saying it has been “massive” with implications for costs of living, food security, health and wellbeing, and access to life-saving devices.
A Worimi and Minjinbul man, Poulson is Manager of First Nations Health and Wellbeing Services for the Royal Flying Doctor Service (RFDS) in Broken Hill on Wilyakali Country, and a member of SARRAH’s Allied Health Rural Generalist Accreditation Council.
He leads a busy life, including travelling in September to the International Conference of Community Psychology in Montevideo, Uruguay to showcase an RFDS partnership with Broken Hill knowledge holders for medicinal and edible native plant uses. A couple of years ago he played didgeridoo on stage alongside Midnight Oil at the Mundi Mundi Bash in Broken Hill.
Paulson told Croakey that friends and family initially were “irritated” by the Broken Hill power failure, but the concern deepened as it stretched beyond the first 12 hours. Food had to be thrown out, concerns grew about how to stay cool as temperatures began to rise, while risks emerged for people who rely on CPAP machines, breathing devices and other critical health equipment in their homes.
“So those social and emotional wellbeing issues that we experience as a community actually grow with no power,” he said.
Paulson said he can’t speak highly enough of the emergency services in the local area who have stepped up their responses since the COVID-19 pandemic, honing them through all sorts of extreme weather events — flash floods, hail storms, and “that craziness of electrical storms that we experience out there”.
He tries not to allow fear to consume him about the unfolding climate crisis “because I have responsibilities as dad, as a son, as a community member and also part of the larger network of service delivery”.
But his worry is at the global level, “because it’s not just Australia that’s experiencing these issues, and it needs to be a global approach…supporting the life of Earth.”
7. “We’re trying to solve very similar problems”
Dr Jane George, a senior rural health workforce consultant from Aotearoa/New Zealand, talked to Croakey about being at the SARRAH conference, her interest in the allied health rural generalist pathway, and a changing political landscape at home.
George has undertaken her PhD on ‘Understanding the complexities of recruitment and retention of allied health professionals in rural health settings’.
Like in Australia, she said targeted investment in academic, political, and financial strategies have aimed to increase the numbers of doctors and nurses entering the workforce in rural New Zealand, and to support them to stay but “comparatively little” has been done for the allied health professions.
Her research identified four significant concepts which are critical to the experiences of allied health professionals:
- Sense of connection and belonging – which captures the ways they feel connected to their rural work and community setting.
- Safe and supported practice – those components which enable them to do their best work.
- Creating roles people want to come for – the various elements that make roles attractive.
- Fit – a sense of being in the right space, place, and time.
George says in rural healthcare, every learning opportunity is precious. But her research also warns against “one-size-fits-all training” – where mandatory sessions designed without allied health input can mean using valuable professional development time on content that doesn’t match participants’ scope of practice or skill level.
George has posted on her LinkedIn page about the conference, including highlighting her meeting there with physiotherapist and lecturer Michael Pang, whose doctoral research, like hers, is looking at how access to continuous professional development influences the retention of rural allied health workforces.
“I’m watching with interest as Michael’s research adds to the growing knowledge base addressing the recruitment and retention challenges in the rural health workforces, and improving the sustainability of health services in rural and remote settings,” she said.
Read Pang’s scoping review about building knowledge translation capacity and capability in health services in regional and rural Victoria.
Watch this video interview with Dr Jane George.
8. Access to resources is always a barrier
See this quick chat with three delegates who travelled from remote Queensland to deliver presentations on their allied health work, and learn more about delivering equitable health outcomes for patients in rural and remote communities.
9. Allied health assistants help reduce waitlists
The growing value of allied health assistants to address workforce shortages and add to care was a recurring topic at SARRAH, with a number of presentations focused on how they have shortened waitlists and freed up time for allied health professionals.
In a presentation that won a conference award, Mildura speech pathologist Emma Livingstone gave an example of a model of care developed in the Sunraysia region, “that maximised our resources, while continuing to provide high quality client-centred care”.
10. “Growing our own” workforce is key
An innovative cadet program in the regional Victorian area of Gippsland is allowing a local health organisation to “grow our own” workforce.
Ainsleigh Whelan, executive manager and occupational therapist (OT) at Gippsland Lakes Complete Health in Lakes Entrance, said the organisation partnered with Federation University to create opportunities for OT cadetships.
The cadet is paired with a mentor in their discipline throughout their degree, and supported with onsite experience, access to office space and learning opportunities. Students are offered paid employment as an Allied Health Assistant while they complete their degree, as well as an annual stipend for university costs. In return they work for GLCH once they complete their degree.
Whelan said strong partnerships with the Local Learning and Employment Network and secondary schools helped Gippsland Lakes Complete Health recruit three OT Cadets in the first year and the program has now expanded to include physiotherapy and speech pathology.
The program is proving successful with a focus on developing an immersive opportunity for students to study and work alongside practitioners.
More posts ‘n pix from #SARRAH2024
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