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Outcome 6 Rural Health

Access to health services for people living in rural, regional and remote Australia, including through health infrastructure and outreach services.

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Outcome Summary

Outcome 6 aims to improve access to health services for people living in rural, regional and remote Australia, by supporting targeted rural health programs and activities through its ongoing reform agenda.

This chapter reports on the major activities undertaken by the department during the year, reporting against each of the key strategic directions and performance indicators published in the Outcome 6 chapters of the 2009-10 Health and Ageing Portfolio Budget Statements and 2009-10 Health and Ageing Portfolio Additional Estimates Statements. It also includes a table summarising the estimated and actual expenditure for this outcome.

Outcome 6 was managed in 2009-10 by the Office of Rural Health within the Primary and Ambulatory Care Division.

Program Administered under Outcome 6 and 2009-10 Objectives

Program 6.1: Rural Health Services

Improve access of people in rural and remote communities to health services.
Enhance specialist, general practice, allied health and primary and community health services.
Strengthening of rural and remote health infrastructure.
Introduce incentives to encourage doctors and health workers to work in rural and remote communities.

Major Achievements

Improved health infrastructure and access to healthcare services in rural and remote communities by funding 67 projects for capital works and equipment.
Improved access to specialist health services for Aboriginal and Torres Strait Islander people living in rural and remote Australia through support for 148 services under the Medical Specialist Outreach Assistance Program – Indigenous Chronic Disease measure.
Funded the Royal Flying Doctor Service to purchase and medically fit out four replacement aircraft and helped amend laws to allow the service to distribute by post certain pharmaceuticals for the medical chest program.
Supported 1,399 medical specialist services through the Medical Specialist Outreach Assistance Program.

Challenges

Recruiting and retaining appropriately qualified health professionals to deliver health services in rural and remote communities due to the workforce shortage, isolation of the communities, problems with access to necessary infrastructure and the higher costs of living and working in these areas.

Table 6.1.1: Rural Health Initiatives by Outcome

Outcome	Rural Health Activity
Outcome 2	Rural Pharmacy Maintenance Allowance Rural Pharmacy Start-up Allowance Rural Pharmacy Succession Allowance Rural Pharmacy Workforce program Rural Pharmacy Pre-Registration Incentive Allowance
Outcome 3	Visiting Optometrists Scheme Higher Bulk Billing Incentives for GPs in Regional, Rural and Remote Areas, Tasmania and Metropolitan Areas (also Outcome 5) Additional Practice Nurses in Rural and Remote Australia and Other Areas of Need – Medicare Items
Outcome 4	Multi-purpose Services program Rural and Remote Building Fund Aged Care Adjustment Grants for Small Rural Facilities Training for Rural and Remote Aged Care Staff Viability Supplement for Community Aged Care in Rural and Remote Areas Capital Infrastructure Support (provides funding for the Indigenous Taskforce)
Outcome 5	Practice Incentives program including: Domestic Violence Incentive; Procedural GP Payment; Rural Loading; and Rural Practice Nurse incentive Higher Bulk Billing Incentives for GPs in Regional, Rural and Remote Areas, Tasmania and Metropolitan Areas (also Outcome 3) Mental Health Services in Rural and Remote Areas (Council of Australian Governments) (also Outcome 11) Mental Health Support for Drought Affected Communities initiative Training for Rural and Remote Procedural GPs program Expansion of Training for Rural and Remote Procedural GPs program Remote Vocational Training Scheme Rural and Remote General Practice program Prevocational GP Placements program HECS Reimbursement Scheme Rural Registrars Incentive Payments Scheme Workforce Support for Rural General Practitioners (Divisions of General Practice)
Outcome 6	Royal Flying Doctor Service program Rural Women’s GP Service Regional Health Services program (until 31/12/09) More Allied Health Services (until 31/12/09) Multipurpose Centres program (until 30/6/10) Rural Primary Health Services program (new from 1/1/10) Medical Specialist Outreach Assistance program National Rural and Remote Health Infrastructure program
Outcome 10	Supporting Women in Rural Areas Diagnosed with Breast Cancer
Outcome 11	Mental Health Services in Rural and Remote Areas (Council of Australian Governments) (also Outcome 5)
Outcome 12	Rural Other Medical Practitioners program Rural Locum Relief program Rural Health Multidisciplinary Training program (incorporates the following programs): Rural Clinical Schools program; University Departments of Rural Health program; Dental Training Expanding Rural Placements program; Rural Undergraduate Support and Coordination program; and John Flynn Placement program. Recruitment, Support, Coordination and Assistance for Overseas Trained Doctors Rural Australian Medical Undergraduate Scheme Medical Rural Bonded Scholarships Scheme Medical Rural Bonded Scholarships Support Scheme Bonded Medical Places Scheme Bonded Medical Places Support Scheme Consolidation of Continuing Education and Training Support for Rural Health (incorporates the following programs): Rural Health Support, Education and Training program; Rural Health Education Foundation; Rural Advanced Specialist Training Support; and Support Scheme for Rural Specialists.
Outcome 13	Improving Access to Primary Care Services in Rural and Remote Areas (Council of Australian Governments)

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Program 6.1: Rural Health Services

The aim of program 6.1 is to improve the access of people in rural and remote communities to a range of health services.

Key Strategic Direction for 2009-10

In 2009-10, the department’s strategy to achieve this aim was to:

improve access to rural and remote health services.

Under other outcomes, the department also aimed to:

improve the supply of health professionals in rural and remote Australia (Outcome 5); and
improve the distribution and support of the health workforce in rural and remote Australia (Outcome 12).

Major Activities

Improved Access to Rural and Remote Health Services

Rural Primary Health Services

On 1 January 2010, the department established the Rural Primary Health Services Program by consolidating four rural primary and allied health care programs – Regional Health Services, More Allied Health Services, Multipurpose Centres, and Building Healthy Communities in Remote Australia. The new program supports service providers such as state and local government health services, Divisions of General Practice, Indigenous health services, and other non-government organisations. The program also provides access to a wider range of additional primary health care services such as allied health, mental health services, community nursing, Aboriginal health services as well as community health promotion and preventative health services to rural and remote communities. The department further improved access by removing the need for GP referral for services provided under the Rural Primary Health Services Program. The department also simplified and streamlined funding and reporting requirements. These changes allow Rural Primary Health Services greater flexibility to better respond to the needs of their target communities. Particular challenges are faced by Multipurpose Centres, which coordinate health and community services in rural areas to ensure that they are effectively integrated into the broader Rural Primary Health Services Program.

The Preventative Health Initiative, funded by the Rural Primary Health Services Program, aims to sustain preventative health messages and activities by building the capacity of the community to manage their own health. In 2009-10, the department ran a competitive funding process for organisations receiving funding through the Rural Primary Health Services Program to direct additional funding to organisations operating in remote and very remote communities or communities in rural areas which demonstrated high health needs and limited access to health services. The department has implemented 34 projects through the Preventative Health Initiative. The projects use innovative approaches to preventative health and build capacity for more than 140 target communities to find local solutions to local health problems, and to develop sustainable preventative health programs. Activities include community gardens, local physical activity gyms, walking programs and nutrition programs, and training for local community members to take a health leadership role. Through community engagement, skills development and local partnerships, the Preventative Health Initiative allows communities to develop tailored solutions to local health issues and provides a foundation for preventative health activities to be continued in the communities after the end of the funding period.

In 2010-11, the department will link the Medicare Locals program with the Rural Primary Health Services Program. This has the potential to reduce duplication in service delivery and improve the already strong links with local communities. This will also drive improved access to and integration across primary health care as well as helping to address the difficulty in recruiting and retaining suitably qualified staff for primary health care service delivery in rural and remote areas. The Rural Primary Health Services Program serves some of the smallest communities in some of the hardest to reach and most isolated areas of Australia. Medicare Locals will work with primary health care providers to improve service planning and access. For further information on Medicare Locals please refer to Program 5.2.

Rural and Remote Health Outreach Services

In 2009-10, the department improved access to medical specialist services, through the Medical Specialist Outreach Assistance Program, by providing medical specialists with financial assistance to remove the disincentives associated with providing services in rural and remote locations. The program covers costs associated with delivering outreach services, including travel, accommodation and consulting room hire costs, and for up-skilling and/or professional support.

The department supported 1,399 services to specific rural and remote locations in 2009-10. This support enabled rural and remote patients to access local medical specialist services and distance services using tele-health in more than 100 specialty and sub-specialty disciplines such as psychiatry, surgery and paediatrics. Tele-health is the transmission of images, voice and data between two or more locations via digital telecommunications, to provide clinical advice, consultations, education and training services. Medical Specialist Outreach Assistance supported tele-health services to enable rural and remote practitioners seek specialist diagnostic advice.

In 2009-10, the department gave financial support for 148 services provided by medical professionals (specialists, GPs, allied health providers and nurses) in rural and remote New South Wales, Western Australia and Queensland under the Indigenous Chronic Disease expansion of the Medical Specialist Outreach Assistance Program.

The program is an important component of the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes initiative, and provides multi‑disciplinary, team based treatment and management of diabetes, cardiovascular disease, chronic respiratory disease, chronic kidney disease and cancer to rural and remote Indigenous communities.

The department consulted with state and territory governments through the Medical Specialist Outreach Assistance Program advisory forums as a part of the planning and implementation process. Implementation of the program in the remaining states and the Northern Territory will commence in 2010-11.

Royal Flying Doctor Service

The Royal Flying Doctor Service provides vital aero-medical evacuations, primary and community health clinics, remote consultations and medical chests in rural and remote Australia.

In 2009-10, the department funded the Royal Flying Doctor Service to purchase and medically fit out four replacement aircraft. It also contributed capital funding for the Royal Flying Doctor Service hangar redevelopment at Alice Springs, and base redevelopments at Dubbo and Port Hedland.

The department facilitated an amendment to the Crimes Act 1914 in 2009-10. Previously, the Act made it an offence for Australia Post or the Royal Flying Doctor Service to arrange for the distribution by post of pharmaceuticals containing prescribed narcotic substances. The legislative amendment enables Australia Post to deliver medicines to Royal Flying Doctor Service medical chest holders, ensuring that emergency medicines are available to treat serious illness or injury in rural and remote areas.

Rural Women’s GP Service

The Rural Women’s GP Service aims to improve the health of rural women across Australia. The department supported the travel of female GPs to rural communities that have little or no access to a female GP. In 2009-10, female GPs saw 18,953 patients at 165 clinic locations. Consultations were provided for a range of health issues, including cervical screening, advice and treatment for depression, contraception, menopausal issues, diabetes and drug, alcohol and tobacco use. The Rural Women’s GP Service is provided at no cost to the patient and is open to all members of the community, including men and children. The department has contracted the Royal Flying Doctor Service to administer this program.

Rural and Remote Health Stakeholder Support

In 2009-10, the department consulted with the six rural and remote health stakeholder organisations (including the National Rural Health Alliance and the Rural Doctors Association of Australia) funded through the National Rural and Remote Health Stakeholder Support Scheme to develop a single set of funding criteria and guidelines. These guidelines provide the basis on which the six stakeholder organisations received funding, and will enable them to contribute to the development of better policy and programs which address rural and remote health issues. The consolidation of core funding for the six organisations into a single program provides a consistent funding approach to support each organisation’s core secretariat functions. Each of the six organisations funded through the scheme has a common goal of improving health outcomes for rural and remote communities.

Rural and Remote Health Infrastructure

A lack of health infrastructure can be a barrier to recruiting and retaining health professionals to rural and remote communities. It can also hinder the establishment of new health services, or the enhancement of existing services. In 2009-10, the department continued to provide funding through the National Rural and Remote Health Infrastructure Program for essential health infrastructure (capital works and equipment) for rural and remote communities with populations of up to 20,000, and strategic service planning for small rural private hospitals. These grants help improve opportunities for partnerships and multidisciplinary approaches to the delivery of health care in these areas.

In 2009-10, the department conducted three competitive funding rounds under this program, which generated more than 900 applications. Of the three funding rounds conducted, two were announced in 2009-10, resulting in 67 grants being awarded for equipment and infrastructure projects.

These grants resulted in the establishment and refurbishment of health facilities, which will provide a range of primary care services, including privately insurable health services such as podiatry, physiotherapy, speech pathology and dental health services. Facilities to support the training of medical students and registrars in rural and remote communities were also established. Funding was also provided for medical and surgical equipment such as endoscopic and orthopaedic telescopes, monitors and electrocardiogram machines, as well as upgrades to information technology systems to support better patient management. The department will conduct further funding rounds in 2010-11.

Funding for the above activities was sourced from Program 6.1 – Rural Health Services and Outcome 10 Health System Capacity and Quality (Program 10.7 – Health Infrastructure).

Development of a National Strategic Planning Approach

In 2009-10, the department, on behalf of the Rural Health Standing Committee of the Australian Health Ministers’ Advisory Council, led the development of a new National Strategic Framework for Rural and Remote Health, in collaboration with state governments, the Northern Territory Government, and the National Rural Health Alliance. The framework aims to develop a national approach to address the issues facing rural health services, particularly access, sustainability, health workforce, service delivery models, and collaborative planning and policy development. The framework will respond to some of the more urgent service priority areas in rural and remote health, namely: maternity services; Aboriginal and Torres Strait Islander health; emergency care; health promotion and prevention; chronic disease management; drugs and alcohol; mental health; oral health; and the care of older people.

The department engaged consultants in December 2009 to assist in the development of the framework, and coordinate stakeholder consultation workshops in each capital city of Australia and the regional centres of Burnie (Tasmania), Townsville (Queensland) and Alice Springs (Northern Territory) between February and March 2010. More than 230 participants attended these workshops, representing a cross-section of stakeholders including local, state and territory, and Australian Government, representatives from the health workforce, consumer interest groups, Aboriginal and Torres Strait Islander health, and peak rural and remote stakeholder groups. The department will continue to refine the framework’s objectives and strategies in consultation with key rural health stakeholders including the National Rural Health Alliance. The department plans to finalise the framework in mid to late 2010-11.

Performance Information for Outcome 6

Program 6.1: Deliverables

Qualitative Deliverables

Improved Access to Rural and Remote Health Services
Qualitative Deliverable:	Regular stakeholder participation in program development through stakeholder participation in the national assessment panel for the National Rural and Remote Health Infrastructure program; and in the Medical Specialist Outreach Assistance Program Advisory Forum in each state and the Northern Territory.
Result: Deliverable met.
In 2009-10, the department, through the National Rural and Remote Health Infrastructure Program, consulted with representatives from key organisations with an interest in rural health workforce and service delivery. The department, through the Medical Specialist Outreach Assistance Program, consulted with fund holders, in each state and the Northern Territory, state based advisory forums (including membership from Aboriginal and Torres Strait Islander health agencies, state and territory health departments, and consumer representatives and medical professionals) to prioritise outreach service delivery.

Quantitative Deliverables

Improved Access to Rural and Remote Health Services
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-0.8%
Result: Deliverable substantially met.
The Administered expenses for Program 6.1 underspent by 0.8 per cent. In 2009-10, the department transitioned four programs to consolidate the Rural Primary Health Services Program. A small number of service providers did not completely meet the new planned service levels. The remaining targeted rural health measures were implemented and met all planned expenditure. Service providers in the Rural Primary Health Services Program will complete transitioning from superseded programs during 2010-11.
Quantitative Deliverable:	Streamlined number of funding agreements in place for the provision of primary health services to rural and remote communities through the Rural Primary Health Services program.
2009-10 Target:	183	2009-10 Actual:	173
Result: Deliverable substantially met.
As a result of service consolidation and streamlining being more successful than anticipated, a lower than expected number of funding agreements were entered into. As the purpose of this program was to consolidate services where possible, a reduction in the number of funded organisations is a success. All funded services have a funding agreement in place. A majority of funding agreements are for the three and half years to 30 June 2013. The number of funding agreements will increase in 2010-11 as the former Multipurpose Centres move into the consolidated program.
Quantitative Deliverable:	Number of new projects funded through the National Rural and Remote Health Infrastructure Program.
2009-10 Target:	36	2009-10 Actual:	67
Result: Deliverable met.
In 2009-10, the department awarded funding to 67 projects through the National Rural and Remote Health Infrastructure Program. It was anticipated that only one funding round would be announced in 2009-10. However, two funding rounds were announced in 2009-10 which resulted in 67 new projects being funded in total.
Quantitative Deliverable:	Number of Rural Women’s GP Services operational locations.
2009-10 Target:	168	2009-10 Actual:	165
Result: Deliverable substantially met.
The Rural Women’s GP Program aims to provide access to a female GP service where there is no other female GP service available. A reduced number of operational locations indicates that local female GP services have become available at that location and results in a reduced requirement for the program. Nationally, the program provided services to 18,953 patients, which was above the target of 17,500.

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Program 6.1: Key Performance Indicators

Qualitative Key Performance Indicators

Improved Access to Rural and Remote Health Services
Qualitative Indicator:	Provision by funded organisations of ongoing primary health care and allied health services to rural and remote communities. Measured by the service delivery plans agreed with the department which reflect community needs.
Result: Indicator met.
During 2009-10, the department developed new needs assessments, service delivery plans and budgets in preparation for implementation of the Rural Primary Health Services Program. The department also funded services which continued to provide access to allied and primary health care services to people in rural and remote communities using approved pre-existing plans. A challenge was to maintain continuity of services to target communities as providers moved to the new funding arrangements. A six month changeover period was provided to ensure a smooth move into the new program. In 2010-11, the department will continue to implement transition arrangements for Multipurpose Centres and ensure that funded activities are consistent with the Rural Primary Health Services Program guidelines.
Qualitative Indicator:	Continued access by people in rural and remote areas to primary aero-medical evacuation services and primary health care services provided by the Royal Flying Doctor Service. Measured by the number of aero-medical evacuation services and primary health care services provided in accordance with service plans agreed with the department.
Result: Indicator met.
In 2009-10 the department’s funding enabled the Royal Flying Doctor Service to continue to provide essential health services to rural and remote Australia. These services included 4,840 aero-medical evacuations and 5,461 primary health care clinics. Funding was provided for the purchase and medical fit out of four replacement aircraft for health service delivery.

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Quantitative Key Performance Indicators

Improved Access to Rural and Remote Health Services

Quantitative Indicator:

Rural Primary Health Services program – number of communities receiving services.

2009-10 Target:

1,700

2009-10 Actual:

1,700

Result: Indicator met.

The number of communities receiving services through the program was as forecast. The department funded providers using approved and pre-existing service delivery plans during the preparation for, and transition to, the new program.

There is no trend data available for this indicator as it was new in 2009-10.

Quantitative Indicator:

Rural Women’s GP Service – estimated number of patients seen.

2009-10 Target:

17,500

2009-10 Actual:

18,953

Result: Indicator met.

The number of patient consultations provided through the Rural Women’s GP Service was greater than forecast due to the successful take-up of the program nationally. The number of patients seen has increased steadily from 17,174 in 2007-08 to 18,200 in 2008-09 and 18,953 in 2009-10.

Quantitative Indicator:

Number of services provided through the Medical Specialist Outreach Assistance Program (excluding Indigenous services and maternity services).

2009-10 Target:

1,400

2009-10 Actual:

1,399

Result: Indicator met.

In 2009-10, the Medical Specialist Outreach Assistance Program provided 1,399 services. The table below shows the number of services delivered through the Medical Specialist Outreach Assistance Program since 2007-08.

Year	Number of services
2007-08	1,400
2007-08	1,400
2008-09	1,430
2009-10	1,399

Quantitative Indicator:

Number of Indigenous services provided through the Medical Specialist Outreach Assistance Program.

2009-10 Target:

2009-10 Actual:

148

Result: Indicator met.

A total of 148 services were provided through multidisciplinary teams in 2009-10 in Western Australia, Queensland and New South Wales, with the majority of services scheduled to commence in 2010-11.

In 2009-10, the department achieved a higher than expected number of services through working with fund holders in Western Australia, Queensland and New South Wales to identify additional communities to receive services.

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Outcome 6 – Financial Resources Summary

	(A) Budget Estimate 2009-10 $’000	(B) Actual 2009-10 $’000	Variation (Column B minus Column A) $’000	Budget Estimate 2010-11 $’000
Program 6.1: Rural Health Services
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill ¹)	175,111	173,658	( 1,453)	183,289
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill ¹)	12,724	12,499	( 225)	10,520
Revenues from other sources	220	149	( 71)	230
Unfunded depreciation expense¹	-	-	-	263
Operating loss / (surplus)	-	7	7	-
Total for Program 6.1	188,055	186,313	( 1,742)	194,302
Outcome 6 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill ¹)	175,111	173,658	( 1,453)	183,289
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill ¹)	12,724	12,499	( 225)	10,520
Revenues from other sources	220	149	( 71)	230
Unfunded depreciation expense¹	-	-	-	263
Operating loss / (surplus)	-	7	7	-
Total Expenses for Outcome 6	188,055	186,313	( 1,742)	194,302
Average Staffing Level (Number)	98	94	( 4)	83

¹ Reflects the change to net cash appropriation framework implemented from 2010-11.

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