NACCHO #5RRHSS Health Alert : Dr David Gillespie speech ” The challenges of delivery of health in rural and remote Australia “

david-gillespie

 “Rural and remote health is a partnership effort. And the challenges inherent in the delivery of health in rural and remote Australia – are also genuine opportunities for finding the best ways, and the most innovative and tailored ways to deliver health that suits the client and the community.

And I really feel that I come here as one of you – and that I am here to work with you, and listen to you – so we can achieve the health outcomes we all want for the diverse rural and remote communities across Australia.”

The Assistant Minister for Rural Health, Dr David Gillespie opened the 5th Rural and Remote Health Scientific Symposium at Old Parliament House, Canberra on 6 September 2016 Minister site

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SEE SITE FOR FULL PROGRAM and SPEAKERS

First I would like to acknowledge the traditional custodians of the land where we are meeting today, and pay my respects to Elders past, present and future, and to acknowledge any Aboriginal and Torres Strait Islander people here this morning.

I am very pleased to be here to open your event this morning.

This Symposium brings together some very important people.

People who make an invaluable contribution to the health of Australians.

And particularly to a group of Australians who themselves make an invaluable contribution to the economic and cultural life of this country.

And they are the people who live in rural and remote Australia.

These are the communities that are the heart and soul of Australia.

And their health and wellbeing is my key responsibility, as the new Assistant Minister for Rural Health.

I am honoured to have been appointed to this role, and feel genuinely humbled to have been entrusted with a portfolio that is really so close to my heart.

Health is in fact the one portfolio in which every Australian – every single one of us – is a stakeholder.

And as a farmer and a rural doctor and specialist, and the son of a rural doctor and a rural nurse, I come with insider knowledge.

And a real understanding of the incredible merits and strengths of rural health and all the people who work in rural health, and also the real challenges we face.

This personal investment, and the personal understanding of the issues, I hope will mean a very strong, very collaborative approach to the work ahead we have to do together.

Rural and remote health is a partnership effort. And the challenges inherent in the delivery of health in rural and remote Australia – are also genuine opportunities for finding the best ways, and the most innovative and tailored ways to deliver health that suits the client and the community.

The challenges of delivery of health in rural and remote Australia

And I really feel that I come here as one of you – and that I am here to work with you, and listen to you – so we can achieve the health outcomes we all want for the diverse rural and remote communities across Australia.

Rural and remote health is built on the commitment, the expertise and the courage of the rural and remote health workforce.

It takes a special kind of energy – a toughness and a boldness coupled with a deep sensitivity – to work in health in rural and remote areas.

Without that kind of workforce – we just can’t deliver healthcare to Australians in rural and remote areas.

And by workforce I mean all the contributors – our doctors, our nurses, our Aboriginal Health workers, our midwives, our researchers, our scientists and social scientists, our specialists, our mental health workers, our ambulance drivers, aged care workers, cleaners, paramedical – everyone here.

Sometimes here in Canberra – life can be contained within the confines of the office and the chamber, meetings and car rides – but you only have to look out to the Brindabellas to be reminded, if you need reminding, of the incredible distances across our beautiful country, the ruggedness, and the diversity of the terrain.

And as I travel around, it is so striking how distance and remoteness are almost defining features of Australia.

Our history, our economy, our character – shaped by the rural and remote experience, the towns miles and miles from any others, the farming communities, the mining communities, the vibrant, culturally diverse Indigenous communities living on traditional lands and elsewhere.

The ties to land and place, the industry, the hard work, the resilience, the humour, the courage – rural and remote communities in all their shapes and colours – are defined by these truly ‘Australian’ characteristics.

And all of those special rural and remote communities need access to health care.

And it’s our job to ensure this.

The Government is very clear that we are in Health for the long game – pursuing bold reforms that put patients at the centre of a system that is both equitable and sustainable into the future.

Australia’s health system is world-class, and Australians believe in universal health. We all want a health system that can meet the diverse needs of Australia’s population.

In order to deliver sustainable universal health care into the future – we need to be clear-headed.

We need the research to give us the data to make sure our policy is strong, innovative, and able to respond in changing times.

We need to bring together the fundamental strengths, the skills and contributions from all areas of the health sector – and build on this, in cooperative and collaborative ways.

The Government has been methodically reviewing many aspects of the system – and the broader reform agenda is built on the principle of a strong and sustainable health system, a strong and healthy Medicare, patient-focussed, flexible and responsive.

Where decisions about health services are devolved out to regional Primary Health Networks, and local communities can commission the services that suit them best.

Integrated health care components working together – so that the individual patient has more say over the kind of care they get, and when and how they access it.

Primary health care for instance is undergoing transformative reform.

The Health Care Homes program – is a new way of managing chronic and complex conditions – with individuals assigned a health care home base – and a GP or Aboriginal Health Worker or other health professional taking the role of care coordinator.

They work with the patient to help them access different health care they need – educating them about their conditions and how to manage their own health – in a partnership with the individual.

And with bundled payments replacing a fee-for-service model.

People with chronic and complex conditions are some of the highest users of the health system – people who have some of the highest avoidable hospital admissions in the community.

And the Health Care Homes reforms are seeking also to address this – to free the system up – to better utilise the services available and to improve cost-effectiveness.

Sometimes it’s a matter of turning ideas on their head, and applying expertise but also innovation – this is where the real and valuable change can come.

The good ideas often come from the community, from the grassroots experience of health issues and different ways to address challenges.

Where necessity stimulates innovation – and the particularities of local situations produce ideas that we want to foster and encourage.

We want to create the conditions to support these ideas and help them proliferate.

In fact, the principles of the Government’s broad health reform agenda can be seen in action, and really are distilled, in the rural and remote setting.

Community driven, patient-focussed, adapted to particular community needs – using innovation to address the challenges of distance or meet cultural needs with culturally appropriate services, for instance.

I believe that the challenges of rural and remote health delivery – prompt the kinds of approaches and the kinds of ideas – that provide a real model for the broader health system.

That your ideas and your research into rural and remote health – can provide answers to the bigger questions about the health system as a whole.

If we are looking for innovation, devolution, integration, patient driven and patient focussed, streamlining and collaboration –

Then there is lots to learn from rural health practitioners, rural health service providers, rural communities, and rural health policy developers and researchers.

It’s at the intersection of the community experience and the local practitioners experience, the researchers and scientists and the policy makers – in conversation, exchanging ideas, combining different kinds of expertise – that’s how we will progress.

Two very important election commitments made by the government have arisen out of this kind of collaboration and sharing of knowledge and views.

One key one for me is establishing a Rural Health Commissioner.

The Commissioner will be an advocate and a leader – making sure rural and remote health is a central priority for government, and leading on the development of the first ever National Rural Generalist Pathway to increase the number of highly skilled doctors in rural, regional and remote areas.

The Commissioner will have a broad remit and will work with all of you.

With rural, regional and remote communities, the health sector, universities, specialist training colleges and across all levels of government to improve rural health policies and champion the cause of rural practice.

The Commissioner will work with the health sector and training providers to define what it is to be a Rural Generalist.

We all know that the Rural Generalists is a special kind of practitioner – as is often called for in rural and remote health.

Frequently with advanced training in areas such as general surgery, obstetrics, anaesthetics and mental health.

How do we adequately and appropriately recognise their substantial scope of practice and extended working hours?

This will also be part of the job of the new Commissioner – to develop options for increased access to training and appropriate remuneration for Rural Generalists, recognising their extra skills and hours and giving them more incentive to practise in the bush.

The Commissioner will also consult with stakeholders about the nursing and allied health workforce in rural and remote Australia.

This Government is committed to building a health workforce that meets the needs of rural communities. One example of this is the Rural Health Multidisciplinary Training Program – which ensures more doctors, nurses and allied health workers are being trained in rural and remote locations.

The Integrated Rural Training Pipeline, or the IRTP, is another key element of reform.

Nearly $94 million over four years to develop an integrated, prevocational, postgraduate medical training pathway in rural and regional areas.

More health practitioners completing the different stages of their medical training, from student to specialist, in rural areas.

The formation of up to 30 regional training hubs to better coordinate training opportunities across the stages of training for medical students.

The establishment of a Rural Junior Doctor Training Innovation Fund to provide general practice rotations for junior doctors undertaking their internship in a rural area.

An expansion of the Specialist Training Program to fund a further 100 training places in rural areas.

Young people in rural and remote areas often sacrifice so much to train away from their families and their communities.

Indigenous students, and non-Indigenous students, from rural and remote communities – often really want to be able to stay connected, and its only training that keeps them away from home.

Their commitment to giving back to their own communities – we can build on that – we can ensure they keep those ties, and do their training in the settings where they want to work, with the issues that they know and want to work with.

But also this initiative will help us draw people into communities who maybe did not grow up rural and remote, but will learn to love the life as many of us do, and bring new perspective and new blood into the regions – if we just make it easier for them to train there.

That’s why the government has committed this funding to integrated training – it’s innovative, but it’s also simple.

Another important aspect for me is to continue the rural and remote health stakeholder roundtable meetings.

This is fundamental – consultation and collaboration.

Buzzwords – but meaningful ones in this context.

I know the value of the contribution of rural and remote practitioners in developing policy. I was one.

It would be false economy to not take full advantage of this incredibly valuable resource – and again I want to emphasise the partnership approach that I expect, from my perspective, and I know the Minister’s perspective – will become business as usual for us all as we look ahead.

The third election commitment I want to mention this morning is to the Royal Flying Doctor Service – as well as extending current funding for the service until 2020, we have made a commitment to provide $11 million over two years to expand the delivery of outreach dental services to rural and remote Australians.

The $11 million will provide access to mobile dental services in areas where there are no private or state / Northern Territory government funded public dental services.

The additional services will address the gap in access to dental services for rural and remote Australians over the next two years.

Then the Child and Adult Public Dental (CAPD) Scheme will be implemented – expanding public dental services through funding to the states and territories.

The Royal Flying Doctor Service is such an institution in this country – and has saved so many lives – and the statement on their website about innovation summarises for me the rural and remote health experience:

      “Operating across vast distances, harsh landscapes, and in far from ideal conditions, necessitates resilience, resourcefulness, innovation and a continual striving for excellence.”

This is exactly my point – that the nature of rural and remote health delivery in Australia – the challenges and problems that you all grapple with in your work on a daily basis – attracts the very best people with that deep commitment and that ability to find solutions in the most difficult of circumstances – and it becomes a role model for the rest of the health system.

Research is fundamental to the conversation about how to improve rural and remote health services.

Strong reliable data – helps us allocate resources in effective ways.

Innovative, courageous research can force governments to rethink previous outdated assumptions.

I notice your planned conversation later in the Symposium around small rural hospitals, and local maternity services – such re-evaluation of the decisions of previous governments in previous times cannot be done without the science and research to help us understand the reality of impacts and prosecute our case for change.

Responding innovatively and respectfully to the health needs of Indigenous communities – can be greatly facilitated by strong research to back up taking the action we absolutely need to take.

The Prime Minister and the Health Minister recently announced the next stage of the National Suicide Prevention Strategy for example – and have identified the Kimberley as one of the trial sites.

Because we have the data – as shocking and devastating as it is – about the heartbreaking suicide statistics – it is clear that we need to make not a small difference, but a fundamental and transformative difference.

It is a health imperative, but it is also a moral and social imperative. The Kimberley has the highest concentration of remote Aboriginal and Torres Strait Islander communities in the nation.

The cultural and historical value of this region, the sacred sites, the complex traditional practices, the walking in two worlds, the depth and the richness – is a national treasure.
But our people, the people of the Kimberley are suffering.

There are complex reasons – mental, spiritual, economic, social and historical – why this is happening.

But the problem before us now is urgent, and the only way forward are culturally appropriate, tailored services developed in consultation with communities and community health workers and Elders – to reach people in the way they want and need to be reached, in ways that will save lives.

The new strategy is built on this principle.

Intelligent, respectful, compassionate and practical solutions – working together, responding to needs, in ways that work, based on local knowledge.

Consultation and collaboration.

I spent 33 years working as a doctor in regional and rural areas.

My wife and I have also run a beef cattle farm in the Hastings Valley and raised our kids there.

I love the rural life. I am a doctor, but I’m also a farmer, and I place enormous value on the contribution of our rural communities to our country.

As I mentioned at the beginning of my remarks, some of you may know that I also grew up in a country town, as the son of a doctor and a nurse – one of seven kids, with my father the local GP running his surgery in the front two rooms of the house!

They were busy times – lots of people coming and going from the house – and it provided fertile ground for me to hatch my dreams to follow Dad into medicine.

When I was appointed to this role as Assistant Minister for Rural Health I thought of my father.

The life we lived growing up – his time always belonging to the community as well as to all of us, his ability to show compassion and patience, to respond to the needs of people from all walks of life, the farmers and the labourers, and everyone in between.

And that country NSW culture that is still alive in the towns and villages of that state, and its different permutations in all the states and territories – the bush, and the coast, the Big Top End, the villages in Tassie, all over the country.

Technology and changing times and demographics have made some things easier since then, and some things give us new challenges.

E-health can help a lot to reach people who live remotely.

But nothing can replace the person-to-person contact.

The relationships.

The connections.

The sense of community.

The working together.

The local people finding their own solutions to their own needs.

With our support.

With the strong evidence base, and the right policy settings.

We are going to go from strength to strength.

I’m really looking forward to what we can achieve together.

And I thank you all for your incredible contribution to improving health outcomes for all Australians, regardless of where they live and where they come from.

Good luck with the Symposium, and I look forward to the outcomes.

 

NACCHO Rural Health News Alert : What are the priorities for new Assistant Minister for Rural Health Dr David Gillespie ?

David

” Dr Gillespie is a medical specialist (a gastroenterologist and consultant specialist physician) and grazier. Depending on how he uses them, those two things could either equip him well for his new job or be lifestyle contexts from which he must escape.

To win the confidence of health consumers and the majority of the health workforce, medical specialists need to continually demonstrate their understanding of, respect for and trust in other health professionals and in a teamwork approach to services.

And it is devoutly to be hoped that his view of rural health is not restricted to just the two matters discussed here.  There is so much more than needs to be urgently considered in rural and remote health and on which his leadership is sought.

Recently retired CEO  of the National Rural Health Alliance Gordon Gregory

Picture above new Assistant Minister for Rural Health Dr David Gillespiebeing sworn in as Minister last month ( NACCHO Image)

Croakey Originally published in Croakey Subscribe and donate

Editor: Marie McInerney Author: Gordon Gregory

In the first of two articles for Croakey, Gordon Gregory outlines his concern that the initial agenda for the new Assistant Minister for Rural Health Dr David Gillespie appears to be narrow and medically-dominated.

In particular, he says the role of the new Rural Health Commissioner should look to the National Mental Health Commission as a model, rather than the role of the Health Department’s Chief Allied Health Officer, which was welcomed with much fanfare in 2013 but seems to have faded away.

The second piece will describe some of the other critical issues that Gregory says should be on the Minister’s agenda.

You can see some of the tributes paid to Gregory for his long-standing work in rural health in this piece published previously at Croakey, and follow him on Twitter at @gnfg.

Updated: See at the bottom of the post too a response from the Department of Health on the status of the Chief Allied Health Officer.

Gordon Gregory writes:

The new Assistant Minister for Rural Health, David Gillespie, is a member of the National Party and has held the regional New South Wales seat of Lyne since 2013. So he knows about regional health services.

Dr Gillespie is a medical specialist (a gastroenterologist and consultant specialist physician) and grazier. Depending on how he uses them, those two things could either equip him well for his new job or be lifestyle contexts from which he must escape.

To win the confidence of health consumers and the majority of the health workforce, medical specialists need to continually demonstrate their understanding of, respect for and trust in other health professionals and in a teamwork approach to services.

And to be an inclusive and successful rural leader, a farmer must continually demonstrate that ‘rural’ means much more than ‘agricultural’.

Judging from what’s been heard around the traps, Dr Gillespie’s initial focus in his portfolio appears to be the Rural Generalist Pathway (a general practice training program) and action on the Coalition’s promise of a Rural Health Commissioner.

Both of these issues are important. But the first is not at all new, while, to be useful, the second needs to be well-resourced and empowered, like the National Mental Health Commission.

It would be a wasted opportunity if the rural health agenda was pared back to just these two elements.

The Rural Generalist Pathway – not just for doctors?

The Rural Generalist Pathway (RGP) has nothing but support from medical interests throughout Australia.  Development of the pathway, led by Denis Lennox and others, has been underway in Queensland since 2007. A description of its history, purpose and first evaluation was outlined at the 13th National Rural Health Conference in a paper by Tarun Sen Gupta, Dan Manahan, Lennox and others.

For those not familiar with it, the Rural Generalist Pathway is now “a fully-supported, incentive-based career pathway for junior doctors wishing to pursue a vocationally registered medical career in rural and remote areas in Australia”.

It was originally designed to reverse the withdrawal of services that had long been provided by ‘procedural GPs’ in rural Australia, including birthing, anaesthetics and emergency medicine, and the deskilling of rural hospitals that resulted. The idea was to have a cluster of procedural GPs who could work together to cover anaesthetics, obstetrics and emergency medicine through pooling their skills.

With an expanded scope of medical practice locally, this model of service would require nurses, allied health professionals and midwives, for example. However, those other professions seem to have been left behind somewhat in the wash of the medical entity the RGP has become.

The Australian College of Rural and Remote Medicine (ACRRM) is now the standard-bearer for rural generalism and information about the RGP in all jurisdictions is available at its website.

It’s an idea whose time came some while ago. So well-developed and accepted is it that the concept is internationally recognised in the Cairns Consensus 2014, endorsed by 23 national and international medical organisations.

Both the Commonwealth and the States/Territories are involved with medical training. For a mature and settled Rural Generalist Pathway, the States and the Commonwealth will have to work together and presumably share its costs.

One of the questions that needs to be asked by the Minister is how the principles and lessons from the RGP can be used for the benefit of other (rural and remote) health practitioners.

Role and scope of the Rural Health Commissioner

Which brings us to the role and operational scope of the promised Rural Health Commissioner.

Judging from Fiona Nash’s June 2016 media release about the matter, the prognosis is poor for a broad, multi-professional and patient-focused approach to the work of the Rural Health Commissioner. The announcement implied a very close relationship between the Commissioner’s work and the Rural Generalist Pathway. Here are the key excerpts:

“A re-elected Turnbull-Joyce Government will develop a National Rural Generalist Pathway to address rural health’s biggest issue – lack of medical professionals in rural, regional and remote areas.

Australia’s first ever Rural Health Commissioner will be appointed to lead the development of the pathway as well as act as a champion for rural health causes.

Minister Nash said the Rural Health Commissioner will work with the health sector and training providers to define what it is to be a Rural Generalist. Importantly the Commissioner will also develop options to ensure appropriate incentives and remuneration for Rural Generalists, recognising their extra skills and hours and giving them more incentive to practice in the bush.

Extra recognition and financial incentives for Rural Generalists will help attract more medical professionals to the bush and help keep the ones we already have.

As a first order of business, the National Rural Health Commissioner will be tasked with developing and defining the new National Rural Generalist Pathway and providing a report to Government which lays out a pathway to reform.

The Commissioner will work with rural, regional and remote communities, the health sector, universities, specialist training colleges and across all levels of Government to improve rural health policies and champion the cause of rural practice.

The Commissioner will also lead the development of the first ever National Rural Generalist Pathway, which will significantly improve access to highly skilled doctors in rural, regional and remote Australia.

The National Rural Health Commissioner will be a champion of rural health, working with Government and the health sector to enhance policy and promote the incredible and rewarding opportunities of a career in rural medicine, Minister Nash said.”

Even more important than this apparent narrow focus is the question of whether the appointed Commissioner will be a single person within the Department of Health or the head of a Commission – being an agency with resources, including staff, and political support and authority.

The difference between these two models can be powerfully illustrated by comparing and contrasting the work done through two offices which, coincidentally, have both been filled by the same individual, David Butt.

One is the Department of Health’s Chief Allied Health Officer, the other the CEO of the National Mental Health Commission.

When the position of Chief Allied Health Officer was announced by then Labor Health Minister Tanya Plibersek n March 2013 it was widely welcomed, in the belief that it would strengthen the role of allied health professionals in health, aged and disability care, lead allied health workforce initiatives, and facilitate better integration with medical and nursing services.

There is little evidence of such developments. Allied health is still the forgotten professional grouping in health policy matters, particularly at the national level.

This is reflected in the Department’s current Management Structure Chart. It lists one Chief Medical Officer, seven Principal Medical Advisers in various areas of the Department, two Senior Medical Advisers, and one Chief Nurse and Midwifery Officer. But the Chart has no reference to a Chief Allied Health Officer.

Look to Mental Health Commission as a model

In contrast to the apparent lack of political support or clout given for a Chief Allied Health Officer is the significant contribution of the National Mental Health Commission (NMHC), led by its Commissioners and its CEO (also a Commissioner).

The NMHC was established on 1 January 2012 as an independent executive agency, originally reporting to the Prime Minister. It now reports to the Minister for Health. It has high-profile Chair (Professor Alan Fels), Commissioners and CEO, and a staff complement of 14 positions (though nine were not filled as at 30 June 2015).

In 2012, 2013 and 2014 the Commission produced annual National Report Cards on Mental Health and Suicide Prevention. It advises the Government on how Australia can promote mental wellbeing, and prevent and reduce the impact of mental ill-health. And it collaborates with other agencies to influence positive change.

The Commission also drives a number of projects and initiatives, including the National Seclusion and Restraint Project, the Mentally Healthy Workplace Alliance, the National Mental Health Future Leaders Project, the National Contributing Life (survey) Project, the Mental Health Peer Workforce Capabilities Project and National Standards for Mental Health Services.

In 2014 the Commission undertook a national review of mental health services and programs  across all levels of government and the private and non-government sectors. It received more than 2,000 submissions and consulted with individuals and organisations around Australia.

The report from the review, Contributing Lives, Thriving Communities, was released to the public on 16 Aril 2015. The Government’s response was released in November 2015.

Although some of the steam seems to have gone out of the endeavour, this is an important body of work – and it stands in stark contrast to achievements through the Chief Allied Health Officer.

It is imperative that Minister Gillespie sees the Rural Health Commissioner as a position akin to that of the Mental Health Commissioner.

And it is devoutly to be hoped that his view of rural health is not restricted to just the two matters discussed here.  There is so much more than needs to be urgently considered in rural and remote health and on which his leadership is sought.


Croakey asked the Department of Health for information about the current status and past work of the Chief Allied Health Officer. Here is its response:

Yes, the role does exist.  Mr Mark Cormack, Deputy Secretary of the Australian Government Department of Health, is the Commonwealth Chief Allied Health Officer.

In this role, Mr Cormack has engaged closely with allied health stakeholders to strengthen the contribution of allied health to the health system, including speaking engagements at Allied Health Professions Australia Board meetings, most recently 5 August 2016; National Allied Health Advisory Committee meetings, most recently on 6 June 2016; the 11th National Allied Health Conference in November 2015; and Australian Allied Health Forum meetings, in August 2015, and planned for later this month.