Over the last two days I have been in Lismore and Port Macquarie talking to health professionals and community representatives about long term reform of our health and hospitals system.
For the 7 million or so Australians living in rural and regional areas, universal entitlement under Medicare does not always translate into equal access to services.
Already the Rudd Government is tackling the critical issue of workforce shortages out bush as part of a broader package of more than $134 million in the last budget for targeted rural health programs, in addition to significant funding provided to rural communities through the MBS, PBS, the National Healthcare Agreements and infrastructure commitments for regional hospitals and cancer centres.
But clearly more needs to be done.
The Health Reform Commission makes a range of recommendations. Some of the questions they ask include: Should under-served remote and rural communities be provided with 'top up ' funding? Do we need a greater emphasis on telehealth services? What role do networks of primary health care services play in new and innovative models of rural and remote care? Do we need, as well as the Rural Health Workforce Agency, a Clinical Education and Training Agency to take the lead in unifying strategies such as university fee relief, study leave and locum support?
I am keen to get your feedback – especially if you live in rural and remote areas – on how we can reform the health system to ensure it serves all Australians, equally.
Hi PM,
I am concerned about the equity gradient running down from the capital city centres to the outer suburbs regions remote and aboriginal health.. there is the problem of the "critical mass" of patients / doctors nurses / other service providers needed to deliver services in this scenario. The ViCCU project using the capablilities of broadband technology (which we were delighted to be able to show you last week) offers the abiity to levrage off the available skills in the big smoke and then truly any hospital can become an entry point to atrue system of care dispersed in space and possibly even time but offering equal outcome even if geography must be conquered.
Patrick Cregan
Dear PM,
access to care is the major issue in the bush and workforce shortages are the underlying cause. Taking the figures from your audit of workforce done last year, we need at least 18,000 additional health professionals in rural and remote Australia if we are to address poor rural/remote health outcomes.
The initiatives implemented in the last budget are just a drop in the bucket and $134m over 4 years does not come close to addressing the health underspend, compared to city dwellers, of around $400-500pa (close to $2b over 4 years). Some of the changes will actually disadvantage some rural areas by equating them with State capitals i.e. Tumut and Hobart are categorized the same and the only similarity I can see is that they are both cold.
Yes rural/remote areas should be provided with top up funding but this should be invested in getting health professionals to work in rural Australia not establishing a 2nd class system for rural people. Without doctors and nurses no amount of top up will help as there is no-one to deliver the care. Similarly e-health is a important support to rural health professionals but it cannot replace them.
We don't to need additional programs that make the system more complex - what we need is simple financial, professional and educational support for health professionals and health students. We know what works but unfortunately the public servants don't listen and provide poor quality advice to ministers and cabinet.
If you want to sustainable rural/remote communities you must support them with health infrastructure and to do this you need a workforce. We must invest now or many rural communities will cease to exist over the next decade.
Steve Sant
CEO
RDAA
Dear PM, I agree asa nation our health is trilu the most important issue facing us.
Your infrastructure plans seems to be a good place to kick start outcomes for many communties. I agree with some of the other bloggers that simple targetted support for health workers and simple targetted education programmes for all of us would develop healthy life styles and help cut costs into the future.
I have another issue that I think can help cut the costs in our health system and that is over servicing. I have been unwell for over a year now and so have been in the "system" doing as I am told as I am unsure of what will work and what wont.
As a Logistics person for many years I live and die by keeping costs down and delivering excellent service to my customers. You do this by getting it right first time and never double handling what you can do once.Thats the KEY Paladin
Telehealth is about providing healthcare at a distance and involves transmission of voice, data and video. Successful telehealth requires 1) suitable payment and incentive structures at BOTH ends of the service; 2)a national standard for equipment types and connectivity - simplicity of operation; and 3) the ability to be integrated with clinical workflow practice at both ends. NSW Health operates over 150 telehealth and telemedicine 'pilots' which siphon millions of dollars. Most can not scale. Queensland Health claims to have the most advanced telehealth service with over 200 nodes. On a national basis we need: 1) two or three clinical focus areas such as depression counselling and chronic care support for diabetes 2; 2)national funding for JUST THESE for quick wins and demonstrated clinical outcomes; 3) a national telehealth connectivity architecture; 4) standrads for end point devices to keep costs and maintenance down and 5) national governance. Cheers, Michael Gill (Chair, Australian Consultative Committee on Electronic Health)
Dear PM, I live on the Mid North Coast. Over the years I have witnessed the fall of the Public health Systems. The more the Government messed with a system that worked perfectly the worse it all became...
I am on a disability pension.
I waited for 14 years for dentures. I was forced to go private through the Care program
I have severe spine injuries, last taken to the Port Macquarie hospital on the 15 March 09. I received no treatment and was sent home. I teetered on quadriplegia... I was referred to the John Hunter Hospital by my GP. 5 months have now elapsed - I have received no treatment. I refused to allow an un-known to place an epidural directly into a spine which is broken at the neck, curved above the lumbar and two rotating lumbar discs which came to rest squashing the spinal cord nerve.
I have had to self treat.I do not take drugs.
I question the need for more hospitals when we do not appear to have the professional staff required to operate the ones that we have.
In the 50's, 60 and 70, our GPS plastered, injected, issued tablets, pat us on the head gave us a lolly and sent us on our way. Hospitals were used purely for more traumatic/urgent treatments. It was a perfect balance and all and sundry were happy.
What was wrong with that system? Where did it go? And why are we in crisis now?
Thank you for your time.
You will find your answer here
Doctors paid less and less in real value terms by successive goverments
Doctors have to see 9 to 11 patients per hour to make a living, they can't afford to do anything complex, and if they do the lawyers are waiting to sue.
Politicians can make mistakes but doctors are expected to be perfect.
If a GP wants to deliver babies the insurance payment per year is over $50,000
That's why all babies have to be delivered by specialists and why some mothers have to travel 100's of miles to a hospital to do something that is so natural
cdcdent
cdcdent
Hi PM,
It Can't be done effectively unless its all under one control.STATE or FEDERAL ???? F E D E R A L must be. Our health system and institution is no different to a disorganised army, at present with no single chain of command most service providers confused with having to serve two masters. Whilst so many fronts to attend too. We keep spending time and effort addressing evaluation as to how far we're winning or not, who's responsible for what and from what point, instead of attending to the health needs of all.
Taking a national issue out of hands of the states is not anything other but an endorsement of why we made the federation in the first place. A medical treatment for what ever the unfortunate problem of the person may be is treated or should be treated the same way all over our federation. Under one policy, one system and one master a better evaluation can be obtained. Other specific regional issues should be left to the states.
edincns
Dear Kevin,
My children and I have been major consumers of the health care system in NSW for several years now due to the children's rare, chronic and complex medical conditions.
We live on the Mid north coast and in fact you briefly met my 2 sons on Tuesday this week. Although, we did not have a chance to speak with you on health issues.
The biggest issues we have had to contend with over the past several years have mainly included access to necessary health professionals, clinics and programs that are not available in our region.
Needless to say we spend many hours travelling the Pacific Highway to and from Metropolitan Sydney and Newcastle to obtain treatment and care. We do (at the present time) an average of 8-10 trips per year outside of the region for this purpose.
In 2005 when things were critical for one of my boys we did 18 trips to Sydney and back and spent over 1 month in total at Sydney hospitals. The travelling we do has gone on now for the past 7 years and is likely to continue that way for at least another 6 years unless the services start comming to us.
I also spoke with Julia Gillard on Tuesday about the impact of health problems on other areas of our lives - such as education. Both boys are home schooled - via distance education- due to their conditions and difficulties surrounding their ability to actually attend school.
The main point I would like to make is that not having access to medical treatments and services locally has a significant impact on our lives - the issues briefly mentioned above are pervasive, they permeate every aspect of our day to day routines and future capacity to fully participate in society.
Anything that can be done to expand and build on our local health services and allied health clinics will not only improve our infrastructure and provide localised health care but will also improve many other aspects of people's lives in regional/rural areas.
K.Bevan B.Soc.Sc.
(Taree)
Remote
I worked in a remote aboriginal community for 3 years as a nurse/midwife in Central Australia and the midwifery care provided was and still is a very low standard. They are not given the choice to birth on their land but rather sent in to their regional centres often alone to sit and wait for the birth of their babies. I had the privelege of supporting several women to birth on their land and it was truly a wonderful empowering event for all involved and the community. I am not suggesting it is appropriate for all births but with appropriate screening and support is should be achievable and should be a basie choice available to all women and their families.
Rural
I have now been working in rural south west WA for 10 years, proposed changes to legislation that will not allow independent midwives to attend homebirths from July next year is a breach of human rights for a woman and her family not being able to choose where they feel/know/understand they should birth. This will take away a choice that is currently avaialable. If you are truly genunie about supporting primary health care then start with birthing and provide the support via commmunity based models both public and private.
Kevin,
Generally, I support the comments of Michael Gill. Telehealth has a powerful role to play in driving equitable provision of services across rural and remote communities. What is lacking is an overarching telehealth strategy which encompasses all the issues associated. A national strategy for telehealth would be the driving document, States and other jurisdictions should be required to develop their own strategies that adhere to the standards outlined in the national document. This approach would provide a national convergence point but would allow the States and jurisdictions time to change in line with the strategy. There needs to be resolution of major barriers preventing the significant uptake of telehealth services, 1. telehealth needs to be compensable and 2. there needs to be telehealth standards of care established. Incentives to support the provision (and expansion) of services through telehealth would assist also. considering the fact that Australia is one the most geographically challenged nations it would be remiss of us not to exploit the benefits associated with telehealth. The NBN will provide the highway, we should be building the vehicles now!
Michael Leddin - Rural Health Service CIO