The National Rural Health Alliance is one group in health that is worth listening to. Unlike many other health organisations, it is not speaking for the interests of a single professional group or a single disease lobby, but is attempting to represent the broader community’s interests (and believe me, for all the fine words spoken on this subject, this does not happen nearly often enough).
The Alliance held its 10th National Rural Health Conference in Cairns last week. Normally, Croakey doesn’t post press releases verbatim but in this case we figure it’s worth an exception. Below are two statements issued after the conference: a communiqué and a list of priority recommendations.
Croakey hopes that those in Government and other positions of power and influence take particular note of the recommendations to improve food security, to reinstate the Racial Discrimination Act for the Northern Territory, and calling for open publication of Government-commissioned studies relating to the health sector.
Communiqué
The 10th National Rural Health Conference was held in Cairns at a time of unprecedented opportunity for health reform. A range of key strategic reviews are due to report to the government within the next two months. The global financial crisis highlights the need for Australia to invest in health promoting policies which have the capacity to reduce national costs on health care in the medium term.
The 920 delegates at the event have therefore called on the Australian Government to work in collaboration with the States and Territories, and with the health sector, to seize the opportunity for system-wide improvement. Indigenous Australians in particular, and people living in rural and remote Australia, will be among the main beneficiaries of an improved health system overall.
The Conference again demonstrated the cohesion of the rural and remote health sector and the capacity for innovation and the resilience of the people in it.
Despite the enormous challenges posed by the natural and financial environments, people in the rural and remote health sector are confident of their ability to lead health innovation and the development of better ways of providing health services.
People in the rural and remote health sector have great expectations of the governance proposals to be included in the final report in June of the National Health and Hospitals Reform Commission. Delegates have a range of views on the relative benefits of options A, B and C (and of other possible models) but agree that the best way for improving health in the bush will be one that allows funds for health services to be held and managed at the regional level.
A major focus at the Conference was on the social and economic determinants of health and the social gradient which affects the health of individuals and communities. In the context of the national health change underway, the rural and remote health sector should be seen as “the best bet” for early investments in new and better ways of delivering health services. The sector has renewed its commitment to lobbying and advocacy which will bring an end to the locational disadvantage in health status from which people in rural and remote areas suffer.
The Conference again attracted a range of Aboriginal and Torres Strait Islander consumers and professionals. Members of the rural and remote health sector recommitted to direct advocacy, as appropriate, and strong support for Indigenous bodies for improvements to Australia’s national Indigenous health shame.
Given the global shortage of health professionals and the serious maldistribution within Australia, significant emphasis at the Conference was on ways to improve access to health professionals and the services they provide. Conference delegates believe that with the right incentives in place and available across all professions, it will be possible to meet the need for services even in more remote areas. The Budget announcement relating to the scaling of incentive programs was supported in this context. However, to ensure that workforce shortages are not a constraint on service development, a more rapid adoption of new health professional roles and expansion of existing health professional roles will be necessary. This will require governmental and professional support and cultural change.
Conference called for early investment in an individual electronic health record, with due provisions relating to confidentiality and the nature of the sort of system required to cover all spatial and demographic realities.
There was strong support for the development of a national rural health plan, and for advocacy to have governments and others in a position to act implement the actions proposed in the range of existing national strategies that relate to health.
For the first time at the biennial National Rural Health Conference, there was a significant emphasis on climate change and its impacts on the health of rural and remote communities and individuals, as well as the demographic and economic changes likely to occur. It was agreed that there is much to be done to moderate climate change and to mitigate its impacts, and to take advantage of the potential economic opportunities that climate change will bring to rural and remote areas.
People at the Conference noted and welcomed the announcements in the recent Federal Budget, including those relating to incentives for rural general practice, regional cancer centres, MBS and PBS payments for nurse practitioners and selected midwives, and maternity services.
The reservations felt about these Budget announcements relate to the continued lack of equivalence in incentives for recruitment and retention across the various health professions, and some questions about the devil that may be in the detail of the programs as they are rolled out.
Inspirational addresses were heard from a range of Keynote and Concurrent Session speakers, with a small number of special guests from Canada and the US. The whole Conference was infused with the sense that if there is genuine engagement with communities at the regional level, health consumers and professionals can overcome both short and longer-term challenges and meet their shared aspiration of equal health for people in rural areas.
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Priority Recommendations
1. This Conference believes that the time is right for major changes to the structure of the Australian health system. The range of issues covered in the interim report of the National Health and Hospitals Reform Commission, and their complexity, should not distract from the overriding urgency of improving health governance. Whichever of the options the Commission favours, the new system should be based on the following principles:
• a national health system, with a regional focus for fund holding and service delivery;
• genuine community engagement at the regional level in the design, implementation and evaluation of regional and local health services;
• governance based on appropriate regional areas, which in more remote areas will be relatively small populations determined by natural communities of interest;
• funding equivalence between all regions, moderated by health need; and
• delivery of health and related services in an integrated manner.
2. To help meet rural and remote health workforce shortages and to improve care, the Conference emphasises the need to speed the rate of development of new health professional roles (eg physician assistant, nurse practitioner and advanced allied health practitioner) and the expansion of existing roles (such as ambulance officers, paramedics and Aboriginal and Torres Strait Islander Health Workers) as appropriate. This will require the establishment and funding of additional positions as well as structural change in the professions and further consideration of revised models for funding health services. These changes will enable the implementation of the innovative service models needed in rural and remote areas and must be driven by patients and their needs.
3. Conference called for the early investment in the adoption of individual electronic health records so that people in rural and remote Australia have their health information where and when they need it. It is critical that people and health services in rural and remote Australia begin to build their capacity using the technologies currently available so they can participate in the improvements in broadband connectivity and adoption of NEHTA standards as health applications improve. The experience of e-Health-NT provides a working example.
4. The Conference recognises the great improvements to health which would be made through implementation of existing national strategies related to health. For example, the National Indigenous Education Strategy includes a number of evidence-based and potentially effective initiatives for this urgent and critical issue. The priority must be on implementing these policies at the local level.
5. The Commonwealth, State and Territory governments, in conjunction with the NRHA, should develop a national rural health plan to succeed Healthy Horizons, the strategic framework which lapsed in 2007. The new plan will incorporate benchmarks, targets and programmatic elements along the lines of those already included in State and Territory rural health plans. This national plan should:
• have strengthened emphasis on the social and economic determinants of health;
• reflect genuine national partnerships relating to Aboriginal and Torres Strait Islander health;
• for the first time, consider the impacts of climate change on health and prepare the rural and remote health sector for these impacts; and
• draw on the demonstrated capacity of rural Australia to develop innovative and effective services that are underpinned by community ownership and resources that are focused on local needs.
6. The 10th National Rural Health Conference calls for greater equivalence of incentives for education, training, recruitment and retention of rural and remote health professionals across all disciplines.
7. Those at the Conference welcome the commitment to a new national health workforce agency and the substantial resources allocated to it including for rural placements. Conference delegates call for ongoing tracking of undergraduate, post-graduate, training and practice trends in rural areas for all disciplines .
8. The Conference recommends that climate change be recognised as a core issue for health, and that its impact on health policy, planning and service delivery be considered in all health priorities and initiatives. This should encompass:
• proactive mitigation strategies;
• enhanced environmental literacy;
• incentives for renewable energy generation and energy conservation (an economic opportunity for rural and remote Australia);
• health infrastructure (eg hospitals) using best practice renewable energy and energy-efficient design; and
• a national conference on climate change and health.
9. The Conference welcomes the Budget commitment to establish ten regional cancer care centres in rural areas. This initiative needs to be supported by funding for adequate staffing and by effective relationships with smaller communities.
10. The new National Men’s Health Strategy must include specific measures for rural and remote areas.
11. As part of a comprehensive primary health care system, the Conference delegates call on the Commonwealth to take responsibility for ensuring that adequate oral health care is available for people in rural and remote areas. This care should include screening, education and preventative care within routine health checks, acute care where necessary and regular preventative oral health care. Aboriginal and Torres Strait Islander Health Workers should have a key role in the development, management and delivery of services in their communities
12. Given the particular challenges that mental illness poses in rural areas, one area in which increased resources and attention would be effective is in prevention and early intervention in the school systems. This would include additional effort through school counsellors, school nurses, mental health professionals, other allied health professionals and general practitioners.
13. Conference delegates call for targeted funding for Aboriginal and Torres Strait Islander community controlled health services for initiatives such as smoking cessation and oral and dental health programs.
14. That the Australian Health Ministers’ Council agree on the means by which patient assisted transport schemes (PATS) will be better funded, more available and more uniform.
15. Conference calls on the NRHA to develop a position paper on the important role played by arts-in-health in health promotion and community engagement. This paper will help make the case to funding agencies for support of arts-in-health activities.
16. Natural Disaster policy should include ongoing elements for community capacity building.
17. Improving food security in remote areas offers a positive focus for investment in community infrastructure, transport, personal health, nutrition, child education, community education, social cohesion and physical and commercial activity.
18. The Conference calls on the Australian Government to permanently reinstate the Racial Discrimination Act for the Northern Territory.
19. Governments should publish the results of analytical and evaluative studies it undertakes or commissions relating to the health sector.
