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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 Strategy

Outcome 6 aims to improve access to health services for people living in regional, rural and remote Australia, by supporting a range of targeted rural health programs and activities. The department worked to achieve this Outcome by managing initiatives under the program outlined below.

This chapter reports on the major activities undertaken by the department during the year, reporting against each of the major activities and performance indicators published in the Outcome 6 chapter of the 2010-11 Health and Ageing Portfolio Budget Statements (PB Statements) and the
2010-11 Health and Ageing Portfolio Additional Estimates Statements (PAES). It also includes a table summarising the estimated and actual expenditure for this Outcome.

Outcome 6 was managed in 2010-11 by the Primary and Ambulatory Care Division. The department’s state and territory offices also contributed to the achievement of this Outcome.

Program Name Program Objective in 2010-11
Program 6.1:
Rural Health Services Improve access to health services for people living in rural, regional and remote areas.

Program Name	Program Objective in 2010-11
Program 6.1: Rural Health Services	Improve access to health services for people living in rural, regional and remote areas.

Major Achievements

Supported 1,328 medical specialist outreach services to rural and remote communities.
Improved rural and remote health infrastructure in 42 communities through the National Rural and Remote Health Infrastructure Program.
Improved access to specialist health services for Aboriginal and Torres Strait Islander Peoples living in rural and remote Australia through support for 541 outreach health services under the Medical Specialist Outreach Assistance Program – Indigenous Chronic Disease Program.
Commenced establishment of Regional Health Australia, to provide health consumers with a single entry point for information on regional health and aged care programs, policies and service delivery.
Contributed funds to the Royal Flying Doctor Service for the replacement of two aero-medical aircraft and redevelopment of an aeroplane hangar at the Royal Flying Doctor Service in Alice Springs.

Challenges

Recruiting and retaining appropriately qualified health professionals to deliver outreach and additional primary and allied health care services in rural and remote communities.
Ensuring that the National Strategic Framework for Rural and Remote Health aligns with national health reform activity.

Trends

Nationally, the Royal Flying Doctor Service provided more than 40,900 patient contacts during 2010-11 through the provision of general practice (GP) clinics and community health nurse clinics. Over the total period of the current funding agreement (2007-08 to 2010-11), the number of patient consultations has gradually increased from 38,662 in 2007-08 to 40,981 in 2010-11. In total, there were 161,642 patient consultations provided through Australian Government funded GP clinics and community health nurse clinics over the four year period.

Figure 2.4.6.1: Royal Flying Doctor Service Combined GP and Community Nurse Clinics Patient Consultations

Figure 2.4.6.1: Royal Flying Doctor Service Combined GP and Community Nurse Clinics Patient Consultations
Text version of this chart

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Table 2.4.6.1: Rural Health Initiatives by Outcome

The following table lists all programs that contribute to improving health outcomes in rural and remote areas.

Outcome Rural Health Activity

Outcome 2 Rural Pharmacy Maintenance Allowance
Rural Pharmacy Workforce Program

Outcome 3 Visiting Optometrists Scheme
After Hours Other Medical Practitioners Program
MedicarePlus for Other Medical Practitioners Program
Rural Other Medical Practitioners Program
Temporary Resident Other Medical Practitioners Program
Higher Bulk Billing Incentives for GPs in Regional, Rural and Remote Areas, Tasmania and Metropolitan Areas (also Outcome 5)

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 Aged Care Plan)

Outcome 5 Practice Incentives Program including: Domestic Violence Incentive; Procedural General Practitioner (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 (COAG)) (also Outcome 11)
Mental Health Support for Drought Affected Communities Initiative
Australian General Practice Training Program
Rural Retention 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
Rural Primary Health Services Program
Medical Specialist Outreach Assistance Program
National Rural and Remote Health Infrastructure Program
Regional Health Australia

Outcome 10 Supporting Women in Rural Areas Diagnosed with Breast Cancer
Health and Hospitals Fund Regional Priority Round

Outcome 11 Mental Health Services in Rural and Remote Areas (COAG) (also Outcome 5)

Outcome 12 General Practice Rural Incentives Program
Rural Procedural Grants 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
National Rural Locum Program

Outcome 12 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 (COAG)

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Outcome	Rural Health Activity
Outcome 2	Rural Pharmacy Maintenance Allowance Rural Pharmacy Workforce Program
Outcome 3	Visiting Optometrists Scheme After Hours Other Medical Practitioners Program MedicarePlus for Other Medical Practitioners Program Rural Other Medical Practitioners Program Temporary Resident Other Medical Practitioners Program Higher Bulk Billing Incentives for GPs in Regional, Rural and Remote Areas, Tasmania and Metropolitan Areas (also Outcome 5)
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 Aged Care Plan)
Outcome 5	Practice Incentives Program including: Domestic Violence Incentive; Procedural General Practitioner (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 (COAG)) (also Outcome 11) Mental Health Support for Drought Affected Communities Initiative Australian General Practice Training Program Rural Retention 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 Rural Primary Health Services Program Medical Specialist Outreach Assistance Program National Rural and Remote Health Infrastructure Program Regional Health Australia
Outcome 10	Supporting Women in Rural Areas Diagnosed with Breast Cancer Health and Hospitals Fund Regional Priority Round
Outcome 11	Mental Health Services in Rural and Remote Areas (COAG) (also Outcome 5)
Outcome 12	General Practice Rural Incentives Program Rural Procedural Grants 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 National Rural Locum Program
Outcome 12	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 (COAG)

Program 6.1: Rural Health Services

Program 6.1 aims to improve access to health services for people living in rural, regional and remote areas.

Improve Access to Health Services for Rural and Remote Areas

Rural Primary Health Services

The Rural Primary Health Services Program funds state health entities, local governments, Indigenous health services, the Divisions of General Practice Network, and other non-government organisations to provide a broad range of supplementary allied health and other primary health care services to rural and remote communities. The program provides significant flexibility to service providers in responding to identified needs in their local communities, taking into account the availability of health professionals and other primary health care workforce.

From July 2011, the Rural Primary Health Services Program will be consolidated into the Regionally Tailored Primary Health Care Initiatives through the Medicare Locals Fund. The Fund will provide Medicare Locals with increased flexibility to respond to health and ageing priorities as they emerge, as well as the potential to address some of the difficulties in recruiting and retaining suitably qualified staff for primary health care service delivery in rural and remote areas.

Qualitative KPI:	The Rural Primary Health Services Program meets the needs of the community.
2010-11 Reference Point:	Services delivered through the Rural Primary Health Services Program are delivered in line with service delivery plans that reflect current and emerging community need.
Result: Indicator met.
In 2010-11, funded organisations continued to provide services in line with service delivery plans that reflect identified community need and available workforce.
Quantitative KPI:	Number of communities receiving services through the Rural Primary Health Services Program.
2010-11 Target:	1,700	2010-11 Actual:	1,700
Result: Indicator met.
In accordance with agreed service delivery plans, targeted communities continued to receive a wide range of primary and allied health care services which are tailored to meet local need.

Preventative Health Initiative

The department also delivered the Preventative Health Initiative, a sub program of the Rural Primary Health Services Program, which targets rural, remote and very remote communities to increase their capacity to address local health issues. In 2010-11, this program supported the establishment of community gardens, gyms and kitchens and a range of other locally tailored health promotion activities. Importantly, local people in areas of high health need are increasing their skills, knowledge and ability to address chronic disease risk factors by actively participating in their local projects.

During 2010-11, the department worked with the existing Rural Primary Health Service providers and Multipurpose Centre providers to transition funding from the 32 Multipurpose Centres into the Rural Primary Health Services Program. The department, through this new arrangement, will ensure that assistance is provided to meet community needs.

Royal Flying Doctor Service

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

In 2010-11, the department provided 50% of the capital funding for the replacement of two aero-medical aircraft. Funds were also provided for the redevelopment of a hangar at the Royal Flying Doctor Service in Alice Springs, a stretcher reconfiguration for the Royal Flying Doctor Service aircraft at the Alice Springs base and to improve the rostering and disaster recovery systems for the Royal Flying Doctor Service in Queensland. Rural and remote communities will benefit from these improvements to the Royal Flying Doctor Service.
In 2011-12, the department will implement the first year of the new four year funding agreement with the Royal Flying Doctor Service. Investment in the Royal Flying Doctor Service will ensure that essential health services can continue to be delivered to the community in an effective and efficient manner.

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What is a Medical Chest

The Royal Flying Doctor Service maintains and equips rural and remote areas of Australia with secure Medical Chests. Medical Chests hold a range of pharmaceutical and non-pharmaceutical items (such as dressings), which can be used to treat people living or working in remote areas. There are more than 2,700 Medical Chests located in isolated areas such as pastoral properties, Indigenous communities, roadhouses and lighthouses. It is a condition of use that prescription pharmaceuticals can only be used on the advice of a Royal Flying Doctor Service medical practitioner. Medical Chests are vital in the early treatment of emergency and other medically ill patients awaiting aero-medical evacuation by the Royal Flying Doctor Service.

Qualitative KPI:	Continued access by people in rural and remote areas to primary aero-medical evacuation services and primary health care services.
2010-11 Reference Point:	Service delivery plans for aero-medical evacuation services continue to reflect continued access.
Result: Indicator met.
During 2010-11, the Royal Flying Doctor Service continued to provide aero-medical evacuation services and essential primary health care services to rural and remote communities. Royal Flying Doctor Service delivery plans identified the expected level of demand for both these health service elements.
Quantitative KPI:	Number of patients attending Royal Flying Doctor Service clinics.
2010-11 Target:	38,000	2010-11 Actual:	40,981
Result: Indicator met.
The Royal Flying Doctor Service continued to provide essential general practice (GP) and community health clinics in areas beyond the normal medical infrastructure.

Rural Women’s GP Service

The department continued to fund the Royal Flying Doctor Service to manage the Rural Women’s GP Service. This program improves access to primary health care services for women in rural and remote Australia, who currently have little or no access to a female GP. This program facilitates the travel of female GPs to these communities. The Rural Women’s GP Service is open to all members of the community, including men and children.

Quantitative Deliverable:	Number of Rural Women’s GP Service operation locations.
2010-11 Target:	170		2010-11 Actual:	159
Result: Deliverable substantially met.
A reduction in the actual number of locations receiving Rural Women’s GP Services is due to a range of factors including the increased availability of female GPs in rural and remote areas.
Quantitative KPI:	Number of patients seen through the Rural Women’s GP service.
2010-11 Target:	17,500	2010-11 Actual:		16,715
Result: Indicator substantially met.
The small reduction in the number of patient consultations reflects the reduced number of locations receiving the Rural Women’s GP Service.

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Rural and Remote Health Infrastructure

In 2010-11, the department funded 42 projects nationally in rural and remote communities under the National Rural and Remote Health Infrastructure Program. These projects will assist 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. The program has also established facilities to support the training of medical students and registrars in rural and remote communities. More information on this topic can be found in Program 10.7 Health Infrastructure.

Funding was also provided for optical and medical equipment such as an optical coherence tomography unit (laser scanning technology that maps the back of the eye), vital signs monitor and defibrillator, autoclaves, spirometers (instruments for measuring the volume of air entering and leaving the lungs), and an oculus pentacam camera (a device used to examine the front part of the eye).

Quantitative Deliverable:	Number of new projects funded annually through the National Rural and Remote Health Infrastructure Program.
2010-11 Target:	36	2010-11 Actual:	42
Result: Deliverable met.
42 new projects were funded through the National Rural and Remote Health Infrastructure Program in 2010-11. Funding was also provided to develop a strategic plan to ensure that appropriate health services are being provided to the community.

National Strategic Framework for Rural and Remote Health

In 2010-11, the department collaborated with the Rural Health Standing Committee of the Australian Health Ministers’ Advisory Council to develop the National Strategic Framework for Rural and Remote Health. The framework identifies strategies for governments to work together with rural and remote communities to improve access to health care services, address health workforce distribution issues, and to foster more appropriate and innovative models for service delivery.

Qualitative Deliverable:	New National Strategic Framework for Rural and Remote Health accepted by state and Northern Territory governments.
2010-11 Reference Point:	The new National Strategic Framework for Rural and Remote Health is accepted by 31 December 2010.
Result: Deliverable not met.
In 2010-11, the department, on behalf of the Rural Health Standing Committee of the Australian Health Ministers’ Advisory Council, continued to work on the development of the National Strategic Framework for Rural and Remote Health with all state and the Northern Territory health departments. Developing the new framework required significant consultation and the timeframes for the drafting framework were extended to allow national health reforms to be agreed by COAG in February 2011. This resulted in a delay in finalising the new framework. The department aims to provide the framework to Health Ministers for consideration in late 2011.

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National Rural and Remote Health Stakeholder Support Scheme

On 1 July 2010, the department established the National Rural and Remote Health Stakeholder Support Scheme. The scheme introduced a consistent funding approach for the six peak rural and remote health stakeholder organisations to provide support for their core secretariat functions. This support will help these organisations to contribute to better policy and program development which, over time, will help improve health outcomes for rural and remote communities. The department entered into three year funding agreements with each organisation in June and July 2010.

The organisations funded by the scheme are: the National Rural Health Alliance; Services for Australian Rural and Remote Allied Health; Rural Doctors Association of Australia; Health Consumers of Rural and Remote Australia; Council of Remote Area Nurses of Australia; and National Rural Health Students’ Network.

Qualitative KPI:	Provision by funded organisations of ongoing specialist, emergency health care and allied health services in rural and remote communities.
2010-11 Reference Point:	Service delivery plans reflect community need.
Result: Indicator met.
Needs assessment processes were undertaken by the funded organisations (listed above) to identify community needs, which informed the development of service delivery plans.

Rural and Remote Health Outreach Services

In 2010-11, the department improved access for rural and remote patients to medical specialist services, through the Medical Specialist Outreach Assistance Program (MSOAP). Under MSOAP the department provides financial assistance to medical specialists to cover the costs associated with delivering outreach services, including travel, accommodation and hire of consulting rooms. MSOAP also supports local health care professionals by providing training and professional support.

The department expanded MSOAP in late 2010-11, to include maternity and ophthalmology services in rural and remote Australia.

Quantitative KPI:

Number of services provided through the Medical Specialist Outreach Assistance Program:

total number of services (excluding services provided under the Indigenous Chronic Disease, ophthalmology and maternity services expansions of Medical Specialist Outreach Assistance Program);
number of multidisciplinary outreach team services provided through the Indigenous Chronic Disease Measure;
number of outreach maternity team services provided through the Maternity Services Measure; and
number of ophthalmology services provided through the Medical Specialist Outreach Assistance Program.

2010-11 Target:

1,400
199
59
≤75

2010-11 Actual:

1,328
541
Nil
One

Result: Indicator substantially met.

In 2010-11, the MSOAP provided 1,328 services. The table below shows the number of services delivered through the MSOAP since 2007-08.

Year	Number of services
2007-08	1,400
2008-09	1,430
2009-10	1,399
2010-11	1,328

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MSOAP Services

In 2010-11, the department supported 1,328 medical specialist outreach services for patients living in rural and remote Australia. Services covering over 100 specialties and sub specialty disciplines were provided locally in targeted areas of need. Paediatrics, obstetrics and gynaecology, and psychiatry were the most commonly supported services.

MSOAP Indigenous Chronic Disease

The department supported 541 MSOAP Indigenous Chronic Disease services delivered nationally through the Closing the Gap initiative. These services expand the scope of the program to include general practitioners and allied health professionals working together in multidisciplinary teams. The introduction of multidisciplinary teams aims to improve the continuity of care and provide greater access to health services for Aboriginal and Torres Strait Islander people living in rural and remote communities.

MSOAP Maternity Services

The MSOAP Maternity Services Program will coordinate multi-disciplinary teams of health professionals to provide outreach maternity care for women and their families living in rural and remote communities. This will increase and improve access to high quality, safe, evidence-based maternity care for women and their families in rural and remote communities primarily for, but not limited to, the antenatal and postnatal stage of pregnancy. This program reduces the need for pregnant women to travel long distances for maternity services. In 2010-11, the department started service planning for multidisciplinary teams to commence outreach visits in 2011-12.

MSOAP Ophthalmology Services

The department, in collaboration with the Australian Society of Ophthalmologists, implemented a national pooled funding model for the new Ophthalmology Program. The program provides advice in priority locations to deliver services such as cataract surgery. The department introduced the first ophthalmology service in Karratha Western Australia in June 2011. In 2011-12, the department will continue to provide further services in Karratha and other rural and remote locations across Australia.

Regional Health Australia

About one-third of Australia’s population lives outside our major cities. For these regional Australians, accessing information about local health and aged care programs and services can be a challenge.
In 2010-11, the department commenced work to establish Regional Health Australia, an agency within the department. People living in regional, rural and remote areas of Australia will benefit from a single entry point to information on regional health and aged care programs, policies and service delivery in their local area through a 1800 information line, email facility and website. On 1 July 2011, the department commenced operation of the information line and the email facility. The department also plans to launch the Regional Health Australia website in late 2011 with information being added progressively from that date. The website will provide place-based (local level) information drawn from existing sources within the department and, over time, will provide a mix of static reports and searchable databases that can also be tailored to their specific location using a search function. Information accessible through the website will assist health and aged care service planning at a local level and provide support to regional Medicare Locals and Local Hospital Networks.

The department will continue to develop Regional Health Australia during 2011-12. This will include establishing and strengthening the advocacy role of Regional Health Australia to ensure regional health and aged care matters are understood and addressed across other government departments and agencies and provide a rural health stakeholder focal point. Regional Health Australia will also provide high level input to budget and policy development on key regional, rural and remote health and ageing funding issues.

Whole of Program Performance Information

Qualitative Deliverable:	Produce relevant and timely evidence‑based policy research.
2010-11 Reference Point:	Relevant evidence‑based policy research produced in a timely manner.
Result: Deliverable met.
The department continued to provide timely evidence-based policy research and advice through a number of avenues in 2010-11. This included advice to the Minister for Health and Ageing, a number of committees including the Australian Health Ministers’ Advisory Committee and sub committees, and the newly established Secretaries Committee on Regional Australia. The department provided policy advice on a range of issues affecting regional, rural and remote Australia ranging from disaster recovery to rural services programs administration. This required data and evidence drawn from a number of services such as the Australian Institute of Health and Welfare, the departments own geospatial data systems and a range of published literature and journals. The department also worked closely with the Department of the Prime Minister and Cabinet and the Department of Regional Australia, Regional Development and Local Government to ensure policies affecting rural Australia are consistently formulated and implemented.
Qualitative Deliverable:	Stakeholders participate in program development through a range of avenues.
2010-11 Reference Point:	Stakeholders participated in program development through avenues such as regular consultative committees, conferences, stakeholder engagement forums, surveys, submissions on departmental discussion papers and meetings.
Result: Deliverable met.
Through the Medical Specialist Outreach Assistance Program, the department consulted with fund holders in each state and the Northern Territory, and state based advisory forums (including membership from Aboriginal and Torres Strait Islander health agencies, state and territory health departments, consumer representatives and medical professionals) to prioritise outreach service delivery.
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2010-11 Target:	≤0.5%	2010-11 Actual:	-1.6%
Result: Deliverable not met.
The administered expenses for Program 6.1 were underspent by 1.6% in 2010-11. The Medical Specialist Outreach Assistance Programs experienced a number of problems including extreme weather, workforce availability and slow uptake of services which contributed to the underspend. In 2011-12, the department established the Rural Health Outreach Fund which will provide increased flexibility to direct funding to areas of greatest need.

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Outcome 6 – Financial Resources Summary

	(A) Budget Estimate¹ 2010-11 $’000	(B) Actual 2010-11 $’000	Variation (Column B minus Column A) $’000
Program 6.1: Rural Health Services
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	184,610	181,564	(3,046)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	10,760	10,744	(16)
Revenues from other sources (s31)	220	196	(24)
Unfunded depreciation expense	261	349	88
Operating loss / (surplus)	-	1	1
Total for Program 6.1	195,851	192,854	(2,997)
Outcome 6 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	184,610	181,564	(3,046)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	10,760	10,744	(16)
Revenues from other sources (s31)	220	196	(24)
Unfunded depreciation expense	261	349	88
Operating loss / (surplus)	-	1	1
Total expenses for Outcome 6	195,851	192,854	(2,997)
Average Staffing Level (Number)	87	90	3
¹ Budgeted appropriations taken from the 2011-12 Health and Ageing Portfolio Budget Statements and re-aligned to the 2010-11 outcome structure.

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