Stakeholder views

Many stakeholders consulted considered that there was a need to improve planning approaches for MSOAP Core and MSOAP-ICD. Many recognised that there had been considerable efforts recently in planning for new ICD services. However, there was a widely held view that in most jurisdictions the allocation of MSOAP Core services had not been comprehensively reviewed since early in the program and that a new look at needs was warranted.

Fundholders have developed a range of approaches for undertaking higher level assessments of gaps in service delivery, and for obtaining local views on these gaps (see discussion in earlier chapters). Fundholders indicated there were challenges in obtaining a comprehensive view of outreach services, including those not funded by MSOAP.

Many, but not all participants in advisory fora and other planning processes believed that there was too much focus on individual service proposals, and insufficient attention to broader planning priorities and identification of gaps. Many stakeholders from outside the program did not have a good understanding of the planning processes for MSOAP and had a general impression that development of services had been ad hoc and opportunistic.

Evaluation findings

The methods used for evaluation of need vary by state/Northern Territory. Fundholders indicated that in most assessments of need, a starting point was information about where populations were located, the remoteness of the populations (in terms of either the ARIA index or the remoteness area), and the distribution of the Aboriginal and Torres Strait Islander populations. In some instance socio-economic status has also been considered (generally assessed in terms of the ABS SEIFA indices). Indicators related to health status have been considered but more as an additional consideration rather than informing variability in need between locations. Other information used in assessing needs by some fundholders is the relative level of potentially preventable hospitalisations.

This analysis has then been supplemented with local information about gaps in service delivery. Gaps in service delivery have generally been assessed by gathering information from more local organisations or service providers. For example, GP divisions who may in turn consult with local GP chapters, regional state/territory health managers, or regional health service fora. Two fundholders (both state health authorities), indicated that analysis of information from the local patient assisted travel schemes (PATS) was used in assessing needs.

Advisory fora may also identify particular specialities which they considered to be priorities for the development of outreach services. The major ways in which advisory fora have had input is through advice on draft annual plans and service proposals. In considering service proposals, some members of advisory fora reported that they felt that the process was ‘ad hoc’

There has been little mention of planning ‘benchmarks’ that might be referred to in deciding what the level of need might be across various specialties (e.g. compared with metropolitan areas). One exception has been work in the Northern Territory to develop a lists of core (outreach) visits that would be expected to be provided for communities of different sizes (see Table 69). Planning benchmarks have also been recommended by the Indigenous Eye Health Unit.

Table 69 – Visiting services required for communities of various sizes – MSOAP-ICD Annual Plan, Northern Territory, 2011-12

Specialty

Days per visit

Community population

100-300

300-500

500-1000

> 1000

Physician

3

1-2

2

4

4+

Paediatrician

3

1-2

3

4

5+

Surgeon

2

1

2

2

2+

O&G

2

1

2

3

4

Psychiatrist

3

1

1-2

2

3+

ENT

2

1

2

3

4

Ophthalmologist

2

1

2

2

3

Cardiologist

2

Nil

Nil

2

2



In general, fundholders and members of advisory fora indicated that the approaches to assessing need and priority were reasonable considering the constraints on the program. There was recognition that need assessment processes could be improved and a range of ideas was put forward on how this could be achieved.

Within the advisory fora there were generally no specific views held about the extent to which MSOAP was meeting needs. Stakeholders not directly involved with the program believed there were significant weaknesses in the way needs and priorities are assessed. Fundholders play a significant role in the assessment of need. Planning has been more difficult with multiple fundholders.

Recommendations - Assessment of need

7. While understanding local circumstances is vitally important in planning outreach services, assessment of need should be improved and be undertaken within a common national framework. The framework should be developed during the 2012 calendar year, through a collaborative process involving all MSOAP fundholders and each advisory forum. The framework should provide guidance on:
      1. the key steps in planning outreach services
      2. suggested planning benchmarks (see below)
      3. processes for obtaining input from local stakeholders on priorities
      4. other issues that impact the setting of priorities
      5. criteria for assessing individual proposals.
8. A common national approach be established through which data required for planning is collated and made available on a regular basis to fundholders and others for planning purposes. Core planning data is required at a common geographic unit. The geographic unit could be the Statistical Local Area (SLA) or equivalent. Data available at this level needs to be compiled from a variety of sources, including those set out in Table 70. Many of these components are already available through national data collections. Others will require the development of appropriate systems for collating data.
9. Planning benchmarks for visiting services should be developed across the most common specialist services. The benchmarks could identify a core set of required specialist services, and an appropriate level of visiting on an annual basis by the most common specialities by community size. These benchmarks would be provided as a guide only and could be modified by appropriate factors to reflect local circumstances and requirements. The planning benchmarks could also be supplemented by outlining possible alternatives to outreach services. The benchmarks should be developed during the 2012 calendar year through a collaborative process involving all MSOAP fundholders and advisory fora.
10. Fundholders should review processes for consulting with local stakeholders in developing service proposals, to ensure these processes are effective and appropriate. In each jurisdiction consultation on priorities at the local level should engage:
      1. existing local health planning fora where these exist
      2. Medicare locals and/or divisions of GP
      3. LHNs
      4. Aboriginal and Torres Strait Islander health services.
11. It is recommended that under the administrative allowance for MSOAP-ICD, some funding be made available for state level Aboriginal and Torres Strait Islander health organisations to assist with consultation with Aboriginal and Torres Strait Islander communities and health services in the identification of priorities across the jurisdiction and consideration of specific service proposals.
Table 70 – Data required for planning outreach services

Data type

ABS

AIHW

DoHA

State/ NT

MSOAP Fund-holders

Other

Demographic and socioeconomic data (populations, Aboriginal and Torres Strait Islander populations, ARIA and remoteness regions, SEIFA indices)

x

 

 

 

 

 

Indicators of health need such as standardised mortality ratios, fertility rates

 

x

 

x

 

 

Potentially preventable hospitalisation rates

 

x

 

x

 

 

Use of hospital services by the local population

 

x

 

x

 

 

Relative use of Medicare supported specialist and optometry services

 

 

x

 

 

 

Supply type and intensity of visiting specialist services

 

 

x

 

x

 

Supply and intensity of visiting optometrist services

 

 

x

 

 

 

Local specialists working is various rural and remote locations

 

 

 

x

 

 

Patient assisted travel from each region by specialty

 

 

 

x

 

 

Local optometrists working in rural and remote locations

 

 

 

 

 

x


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