Department of health and ageing annual report 2002-03
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- PART 1: OUTCOME PERFORMANCE REPORT
- Royal Flying Doctor Service
- Medical Specialist Outreach Assistance
- Rural and Remote Health Postgraduate Scholarships
- National Rural Health Network
- Aboriginal and Torres Strait Islander Pharmacy Scholarships
- Regional Health Services
- Performance Indicators (Effectiveness Indicators)
- OUTCOME SUMMARY—THE YEAR IN REVIEW
- Departmental Programs Specific to Rural Health
- Support, Education and Training for Rural Health Workers
- University Departments of Rural Health
- Australian Government Scholarships
- Remote and Rural Nursing Scholarships
- Rural and Remote Health Scholarships
- Rural Health Support, Education and Training
- Rural and Remote Pharmacy Workforce Development
- Support Scheme for Rural Specialists
- Advanced Specialist Training Posts in Rural Areas
- Developing Better Health Services for Rural Communities
- Royal Flying Doctor Service of Australia
- Outcome 5—Financial Resources Summary
- Performance Information for Departmental Outputs
OUTCOME 5 RURAL HEALTHImproved health outcomes for Australians living in regional, rural and remote locations. Did you know...?The Regional Health Services Program is funding the updating of a professional workshop package titled ‘Helping Others Ro Cope’ based on a series of workshops conducted in 1992 for people living in drought affected areas of New South Wales. Training will be provided Ro social workers and mental health staff Ro conduct 30 one-day community workshops in mid-western New South Wales. The program is also funding two Drought Support Workers Ro assist rural families in New South Wales. These services operate out of Bourke servicing the Far West Region (Bourke, Brewarrina, Cobar, Wilcannia and Wanaaring communities) and from Merriwa servicing the Hunter Region (Merriwa-Mudgee, Scone, Maitland, Gloucester and Denman communities). Drought affected families in these areas can now access counselling in areas such as grief, loss, stress management and mediation, as well as information, advice and referral services through this initiative. PART 1: OUTCOME PERFORMANCE REPORTOutcome 5 is managed by the Office of Rural Health in the Department’s Health Services Improvement Division. The Department’s State and Territory Offices, and other program areas across the Portfolio, also contribute to achieving this outcome. It is the role of the Office of Rural Health (the Office) to coordinate the integration and implementation of the Department’s overall rural health programs across a number of outcomes. The Office also has specific carriage of a number of targeted rural health programs. Major AchievementsMultipurpose ServicesThe Multipurpose Services Program supports small rural communities in providing flexible and sustainable health and aged care services. There was significant growth in the program in 2002-03, with the number of operational sites increasing by 27 per cent and the number of flexible care places increasing by 30 per cent. At June 2003, there were 83 Multipurpose Services nationally, an increase of 18 sites for 2002-03. The expansion of this program continues enhanced service integration for small rural and remote communities. Royal Flying Doctor ServiceThe Royal Flying Doctor Service (RFDS) provides significant primary and emergency care services for Australians beyond the normal health infrastructure. A new funding agreement has been negotiated to provide for greater cooperation between the States and Territories, the Australian Government and the RFDS. This should result in more efficient and integrated services to remote communities. Medical Specialist Outreach AssistanceThere was a substantial increase in the number of operational Medical Specialist Outreach Assistance Program services during 2002-03. At June 2003, more than 1,000 visiting specialist services had been approved in all States and the Northern Territory, and around 500 services had commenced. Some of the more remote Indigenous communities have found the program so beneficial that they have requested that more extensive visits be arranged. Rural and Remote Health Postgraduate ScholarshipsThe Australian Government has established the Commonwealth Rural and Remote Health Postgraduate Scholarship Scheme which targets rural health professionals who are not part of the medical and nursing workforce to increase and expand their professional qualifications. The first scholarship selection round was undertaken in 2002-03 with 138 scholarships awarded. National Rural Health NetworkThe Australian Government has committed to providing funding for the operation of student health clubs in Australian universities to support and encourage allied health and nursing students who have an interest in rural health issues. This funding has enabled the integration of seven new student clubs within the multi- disciplinary framework of the National Rural Health Network, which is now able to promote rural careers to all medical, allied health and nursing students. ChallengesAboriginal and Torres Strait Islander Pharmacy ScholarshipsScholarships are funded to raise the profile of rural pharmacy within pharmacy schools and to increase rural content in curricula. However, there is concern about the lack of uptake of the Aboriginal and Torres Strait Islander Pharmacy Scholarships. While remuneration for these scholarships is higher, there are very few applicants. The Australian Government is working with the Pharmacy Guild to better target advertising for the scholarship program to Indigenous communities. Regional Health ServicesDue to a variety of factors including slower consultation processes in more remote communities and the lack of service delivery and physical infrastructure, the Regional Health Services Program did not meet its forecast for new projects. Additional funds have been made available to extend planning processes so that projects can be brought to the point of service delivery, to build community capacity and governance structures, and to enhance existing infrastructure. Performance Indicators (Effectiveness Indicators)
The Department’s performance against these indicators is discussed in the following outcome summary. Specific references to these indicators are marked by footnote. OUTCOME SUMMARY—THE YEAR IN REVIEWImproving access to health services for people in rural, regional and remote areas continued as an Australian Government priority during 2002-03. This is based on the Australian Government’s role in supporting health services in rural areas, and in fostering and developing a workforce to deliver those services. Nowhere is this more important than in rural areas that have the highest health needs while at the same time having a relatively low capacity to develop and support solutions. Because of the differing sizes and varying needs of rural communities, health and aged care services, and ways of delivering them, need to be flexible and innovative. The Australian Government’s commitment to improving health outcomes for Australians living in rural locations is demonstrated by spending of around $2 billion on targeted programs for rural health and aged care since 1996-97. Overall annual Australian Government expenditure for specifically targeted programs in rural and remote areas has increased from approximately $190 million in 1996-97 to $685 million in 2002-03.86 There are numerous measures in place at the Australian Government level (collectively known as the Regional Health Strategy) which are helping to increase health care access for rural Australians. In 2002-03 significant progress was made both in workforce development through increasing support, education and training for rural health workers, and in developing better health services for rural communities. Departmental Programs Specific to Rural HealthThe Regional Health Strategy is being implemented across the Department. The following lists the outcomes responsible for various components of the strategy. Details on initiatives not funded through Outcome 5 can be found in the relevant outcome chapter.
In addition to rural-specific programs, mainstream programs, particularly the Pharmaceutical Benefits Scheme, Medicare and aged care programs, are constantly under improvement to increase equity of access. Support, Education and Training for Rural Health WorkersA priority for the Australian Government is to increase the overall numbers of health care professionals in rural areas for the long term through programs which aim to make it easier for rural people to choose rural health careers, while also introducing people from cities to the rural health experience. University Departments of Rural HealthThe Australian Government is providing opportunities for students of health professions to train in rural areas by directly funding specific courses and investing funding in rural-based higher education facilities such as University Departments of Rural Health (UDRHs). These facilities form the foundation of a national rural health education and training network87. They provide a supportive environment to students while they undertake their studies in rural and remote areas. At the same time, their presence attracts health professional academics who not only assist with the education of students but also provide clinical services to the region and undertake rural research. Since 1996, ten UDRHs have been established across regional Australia. They are located in Mt Isa, Alice Springs, Geraldton, Launceston, Whyalla, Shepparton, Warrnambool, Broken Hill, Lismore and Tamworth. During 2002-03 the Australian Government continued its commitment to this important program, providing funding for the operation of these facilities and for significant infrastructure projects which will support their activities. During the first half of 2002-03, 915 undergraduate health profession students completed placements involving rotations of two weeks or more88. The UDRHs now report on a six-monthly basis on the number of placements.
The Undergraduate Scholarship Scheme still proves to be very competitive. In 2002-03, 109 undergraduate scholarships were awarded, bringing the total number of scholarships granted since the scheme began to 249, with 19 of these being awarded to Aboriginal and Torres Strait Islander students. These scholarships target rural and remote students who, due to financial hardship, would not have been able to undertake undergraduate nursing education at University and show an intention to return to work in rural and remote areas following graduation. There is also a range of support measures, including a mentoring scheme, to assist these undergraduate scholarship holders through their years of study. The Postgraduate Scholarship Scheme provides funding to eligible rural and remote nurses to assist in overcoming the professional isolation often experienced by this group. In 2002-03 two scholarship selection rounds were conducted. Over 130 scholarships were awarded at a cost of over $500,000. Scholarships were awarded for postgraduate study in remote health practice or a nursing speciality area such as diabetes education. Scholarships were also awarded to assist nurses to travel to several significant health-related conferences. Following changes to the Re-entry and Up- skilling Scheme last year, there was a significant increase in interest during 2002-03. The new target of 200 scholarships was exceeded with 101 re-entry scholarships and 127 up-skilling scholarships awarded. The measures that were introduced to overcome barriers to undertaking these scholarships have been effective, especially the establishment of the call centre offering career advice and application information. During 2003 the Australian Government has been progressing the development of the enrolled nurse to registered nurse scholarship scheme to fill an identified gap in the existing Commonwealth Remote and Rural Nursing Scholarship Program. This scheme will provide a means of career progression for rural enrolled nurses while helping to address the overall shortage of registered nurses in rural and remote areas of Australia. Up to $500,000 has been provided for this initiative which will be attached to the Undergraduate Scholarship Scheme. Initially there will be up to 23 scholarships of $15,000 payable at $2,500 per semester for each year of study to assist enrolled nurses from rural backgrounds with the costs associated with undertaking a part-time undergraduate nursing degree.
Midwifery Up-skillingThe Australian Government provided funding to assist States and Territories to up-skill rural and remote midwives. In 2002-03 there were 1,664 participants in the various up-skilling courses operated by the State and Territory health authorities. The Midwifery Up-skilling Program was designed to promote retention of the rural midwifery workforce by providing opportunities for up-skilling and guaranteed back-filling when midwives were released to undertake up-skilling courses. This program assisted employing authorities to better plan and provide health services to rural and remote areas by having access to a more skilled and confident midwifery workforce. Rural and Remote Health ScholarshipsThe Australian Government established a scholarship scheme in January 2003 to support rural and remote health professionals, other than doctors and nurses, in furthering their professional qualifications. These professionals have an integral role in supporting medical practitioners and nurses in rural and remote areas and it is anticipated that this will assist in their retention in these areas. There were 138 scholarships awarded in June 2003 for a range of continuing professional education activities. Rural Health Support, Education and TrainingThe Rural Health Support, Education and Training (RHSET) program contributes towards the recruitment and retention of rural health workers through funding initiatives to provide them with appropriate support, education or training. The RHSET program has encouraged a wide range of professionals and community groups to attempt a range of innovative methods of addressing local health service problems. The RHSET program consists of three discrete streams that reflect its goal: the grants program (support), a range of workforce training satellite broadcasts using the Rural Health Education Foundation network (training) and a rural and remote health professional postgraduate scholarship scheme (education).A RHSET grant selection round was conducted during 2002-03 with 11 grants awarded. The RHSET secretariat also organised nine workforce training programs to be broadcast over the Rural Health Education Foundation network on topics such as osteoporosis, arthritis, breast cancer, prostate cancer, and primary health care focussing on cardiovascular disease and rehabilitation. Rural and Remote Pharmacy Workforce DevelopmentA range of Commonwealth-funded measures is also helping to strengthen and support the rural and remote pharmacy workforce in Australia89. Practising rural pharmacists are receiving support by way of financial assistance to undertake continuing professional education, access to a newly established emergency locum service and funding to improve infrastructure and support initiatives at a local level. Additionally, pharmacy academic positions have been funded to raise the profile of rural pharmacy within pharmacy schools and to increase rural content in curricula, so that pharmacy graduates will be equipped with the necessary skills to practise in rural areas. Scholarships are also funded under the program. There is concern about the lack of uptake of the Aboriginal and Torres Strait Islander Pharmacy Scholarships90—while remuneration for these scholarships is higher, there are very few applicants. The Commonwealth is working with the Pharmacy Guild to better target advertising the scholarship program to Indigenous communities. Support Scheme for Rural SpecialistsRural Australia continues to receive a lower level of service by medical specialists than metropolitan areas. To attract more medical specialists to work and remain in rural areas, the Australian Government established the Support Scheme for Rural Specialists to provide opportunities for specialists to upgrade their professional knowledge and skills and to reduce their professional isolation. Ten specialist medical colleges were funded to develop and deliver 22 professional development projects for rural specialists in the 2003 calendar year. Advanced Specialist Training Posts in Rural AreasTo attract advanced specialist trainees to placements in rural areas, in 2002-03 the Australian Government increased the number of planned new training posts from eight to 14 and maintained financial support for another 32 on- going posts, making 46 posts in all. Funding was also provided to six medical colleges with a significant rural presence to provide additional training support for advanced trainees. Bush Crisis LineHealth professionals working in rural and remote areas often have limited avenues available to them to access help and support in the difficulties they sometimes encounter. In September 2002 the Australian Government entered into a new three-year agreement with the Council of Remote Area Nurses of Australia to continue to provide the Bush Crisis Line. The Bush Crisis Line is a 24-hour freecall service that provides crisis debriefing and counselling for job-related trauma to isolated rural and remote health practitioners and their families. During 2002-03 the Bush Crisis Line received over 300 calls and provided over 200 hours of counselling support for multi-disciplinary remote area health practitioners and their families. The Bush Crisis Line is a free call from anywhere in Australia. Bush Crisis Line: 1800 805 391. These programs are all working towards addressing the challenge of recruiting health care professionals to rural areas and of supporting them so that they remain there long- term.
There has been rapid growth in the number of new health services supported by the Australian Government in rural areas. In 1996-97, 60 health services were supported. In 2002-03 this has increased to over 350 services with an impact extending to well over one thousand communities. Medical Specialist Outreach AssistanceThe Medical Specialist Outreach Assistance Program aims to improve the access of people living in rural, regional and remote Australia to medical specialist services, by addressing some of the financial disincentives in providing outreach or visiting services. The program also provides funding support for up-skilling and professional support to local specialists and general practitioners, and in some cases other health professionals. To date, funding under the program has been approved for over 1,000 specialist outreach services across Australia with over 500 services currently operational throughout the States and the Northern Territory (see Figure 5.1). While recruitment issues continue to be a challenge for the program, there was a substantial increase in the number of operational services during 2002-03.91 A welcome success of the program is the positive impact on the more remote indigenous communities, with more extensive visits being requested.
Source: Department of Health and Ageing Regional Health ServicesThe Australian Government’s Regional Health Services Program involves the planning and delivery of comprehensive primary health care services at the local level. Services supported include community nursing, mental health, social work and counselling, health promotion and education, palliative care, child and family health, youth services, drug and alcohol services, dietetics, podiatry, physiotherapy, and speech and occupational therapy. At the end of June 2003, there were 118 Regional Health Services in operation across all States and Territories, with 12 of these being approved in 2002-03. Another 10 Regional Health Services are expected to be approved within the next 12 months. In recognition of the fact that many high-need areas have a low capacity to identify local health priorities, 78 planning projects have been approved, three of which were approved in 2002-03. These projects support low-capacity areas in identifying their local health priorities and developing proposals to become Regional Health Services. While there has been sound progress in the provision of new service delivery projects, the Regional Health Services Program did not meet its forecast of 20 new service delivery projects and seven new service planning projects92. The under-achievement was caused by: delays in finalising planning projects in more remote communities due to slower and incremental consultation processes and final agreement on needs and priorities; and delays in commencement of services owing to a lack of service delivery and physical infrastructure and the need to build capacity and governance structures.
In 2002-03 negotiations were completed for a new four-year funding agreement with the RFDS. This agreement provides enhanced mechanisms for reporting on services and budgets for the RFDS. It also provides a formal consultative mechanism for States and Territories, the Australian Government and the RFDS to jointly plan service delivery in the relevant areas. This is expected to create greater efficiencies in service delivery. The new contract also provides a strengthened emphasis on joint planning by all the operating sections, which may result in efficiencies through joint purchasing of aircraft and other similar activities. Multipurpose ServicesThe Multipurpose Services Program supports small rural communities, generally with populations of less than 4,000, to provide sustainable health and aged care services. The Australian Government combines its aged care funding with State health service funding to integrate these services with a single management structure where separate services cannot be sustained. In 2002-03 the Australian Government allocated $37 million to the program. This funding is provided as flexible aged care places. There has been significant growth in the Multipurpose Services Program in 2002-03, with the number of operational sites increasing by 27 per cent and the number of flexible care places increasing by 30 per cent93. At June 2003, there were 83 Multipurpose Services nationally, with another 10 in advanced stages of planning. Figure 5.2 shows the growth of operational Multipurpose Services since 1996-97. The impact of the Multipurpose Services Program has been an improvement in the integration and provision of health and aged care services for small rural and remote communities. The program is highly flexible, as it can be adapted to consider the specific needs of each community, and also modified over time, as the community’s needs change. All of the above programs are directed towards the challenge of not only maintaining the current level of services within rural areas, but of ensuring continued growth in the availability of these services. Key challenges for the future include: ensuring the services the Department is supporting are achieving the best outcomes in improving the health of rural people; ensuring the Department is not missing high- need communities when targeting support; continuing to increase the number of general practitioners in rural areas; increasing the number of rural students undertaking health care and medical training; and continuing to consider ways of making a career and lifestyle as a rural health worker both viable and rewarding. Progress in these areas will ensure that rural Australians continue to receive improved access to essential health services. Figure 5.2—Numbers of operational Multipurpose Services, 1996–97 to 2002–03 Source: Department of Health and Ageing Outcome 5—Financial Resources SummaryPART 2: PERFORMANCE INFORMATIONPerformance Information for Administered Items
National Rural and Remote Health Support Services Program: Rural Health Support, Education and Training Grants Program; First Line Emergency Care; Rural and Remote Midwifery Up-skilling; Bush Crisis Line; Advanced Specialist Training Posts in Rural Areas; and Rural Specialist Workforce Support.
Rural and Remote Pharmacy Workforce Development Program;
Australian Remote and Rural Nursing Scholarships Program;
University Departments of Rural Health.
Health services for rural communities, including: Medical Specialist Outreach Assistance; Regional Health Services; Multipurpose Services; and Royal Flying Doctor Service.
Performance Information for Departmental Outputs
policy advice on strategic directions for rural health; advice on cross-portfolio and cross-jurisdictional rural health issues; and coordinating rural health policy development and implementation within the Portfolio.
Program management in relation to: Implementation of Budget reforms; National Rural and Remote Health Support Services Program; University Departments of Rural Health; Regional Health Services Program; Rural Health Information production and dissemination; and Financial management and reporting on Outcome 5.
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