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What will it take to improve rural health? Internet, internet, internet…

Jennifer Doggett reports:

One of the most important outcomes from the National Rural Health Conference in Darwin will be a set of recommendations for action to improve health services in rural and remote areas and to overcome some of the barriers to good health.

These recommendations will be developed via a collaborative and structured process open to all delegates.  This process centres around the ‘Sharing Shed’, an online portal through which Conference delegates can propose recommendations to the full body of delegates, with every individual delegate being able to express a view on all ideas proposed by providing comments and by ranking or weighting separate recommendations.

The process will be moderated by a Conference Recommendations Group, whose members have already scrutinised the recommendations in the concurrent papers and are also reviewing those submitted during the Conference by delegates in attendance.

The Sharing Shed is accessible via laptops, tablets and smart phones and on-site computers are available for those without access to their own devices.

After reviewing all the recommendations made, along with the votes and comments they attract, the Conference Recommendations Group will present a set of priority recommendations to a Conference plenary session tomorrow to enable delegates to indicate their broad support.

Non-delegates are unable to vote but can view all the recommendations and comments on the conference website.

Recommendations cover a broad range of issues, from public health, to clinical services, workforce issues and prevention.  Infrastructure support for rural and remote health is a key theme and currently, the recommendation attracting the most votes is the following, which picks up on a recurring message arising from the plenary and concurrent sessions:

Don’t assume rural and remote citizens have good quality, reliable internet. For Telehealth and other connecting technologies to increase access for rural and remote communities, we need to lobby for infrastructure that for some regions is just not there. The opportunity is to work with other sectors of the economy who also need adequate internet services to take advantage of the innovation online technologies can bring.

The next most popular recommendation comes from the Royal Australian College of General Practitioners and focuses on workforce reform:

More support for multidisciplinary team practice in addressing health disparities: a supportive policy focus is required which recognises that in overcoming significant disadvantage, including in rural areas, it is the capacity of the primary healthcare workforce that remains key to realising improved health outcomes in the community. Responsive policy needs to be broad and flexible enough to support community need, it must tackle the main drivers of poor health and ensure a fairer share relative to need if it is to provide for an enduring health benefit for all. Supporting multidisciplinary team practice through flexible and targeted funding will help to shift disparities but this requires sustained funding and commitment from Government.

The need to recognise the role of Indigenous people in the development of health programs and services is the subject of another recommendation which states that we should:

Ensure that policies and program guidelines require local Aboriginal people to be involved in co-designing and delivering research and other projects. Ensure that programs recognise the investment in time and funds required for local Aboriginal people to co-design and participate in delivering projects.

Another recommendation focusses on the role of women in disaster response efforts:

The inclusion of women in local disaster preparation and response planning is essential. We need to identify and harmonise best gender and disaster practice across levels of government. This can include individual women, representatives of women’s services and or of women’s organisations, particularly women who have been trained in this area.

Reflecting the diversity of delegates at this Conference, the following two recommendations express conflicting views on non-medical prescribing:

Expand Nurse Practitioner access to MBS Item numbers to reflect the work they do, particularly in rural and remote settings. Some NPs do the work of GPs where no GP will go and therefore should have similar Item numbers available. Also allow Nurse Practitioner access to Provider Numbers for facilities that are not 19(2) Exempt OR expand the exemption criteria to include facilities in towns with populations <50,000 people.

VS

Role and task substitution is not the answer to improving health outcomes or workforce shortages in rural communities. Patient safety and quality of care must underpin any development in delivering patient services. Non-medical prescribing in the case of pharmacists, in particular, is cause for concern: competency to prescribe and fragmentation of care being key issues. The known benefits of having a continuous and coordinated patient care framework cannot be ignored. The solution lies in more investment in GP-led primary care teams and team based care models in rural and remote areas to improve health outcomes.

Less controversially, another delegate has focused on supporting access to allied health services in rural areas proposing that:

Access to Allied Health Services under Medicare should not be limited per calendar year to enable all people with Chronic Disease access to services to manage their chronic and complex care needs.

Picking up on the comments this morning from Professor Alan Cass on the cost of food in remote communities, a number of recommendations address the need to improve the supply of fresh food in these areas. The following two recommendations propose some innovative solutions:

Given food security in many communities is a major problem, we need to look at sustainable funding models to address access, affordability and skills/knowledge. I propose an investigation of the feasibility and impact of taxing sugary drinks across Australia to fund programs which address these issues, with a particular emphasis upon targeting communities where healthy food is unaffordable for many families. Furthermore the money raised could be used to fund preventive nutrition programs which are currently funded in piece-meal ad hoc fashions. We saw this work for tobacco in Australia, we can apply the same principles for nutrition.

Free fresh Australian food to Aboriginal remote communities. Many exporters throw away fresh healthy food as it is not the right shape or other obsessive standard for export quality. This food can be transported to Aboriginal remote communities at the government’s expense. Government interventions is needed because of market failure and a public health need to provide fresh healthy food to Aboriginal remote communities.

Voting on the Sharing Shed recommendations closes tomorrow at 12.45pm and the input from delegates will be used to create a priority set of recommendations that will be taken to Government and other key influential bodies by the National Rural Health Alliance and its member bodies.

This will ensure that the ideas generated at the NRHC will continue to have an impact long after delegates have returned home.

• Jennifer Doggett is covering the #ruralhealthconf for the Croakey Conference Reporting Service. You can track her stories here.