Advocacy

THE GIVENS

Peo­ple liv­ing in remote and rur­al Aus­tralia suf­fer a much greater bur­den of dis­ease and poor­er health than their met­ro­pol­i­tan counterparts.

THE CON­TEXT

Health pro­fes­sion­als work­ing in remote Aus­tralia work in some of the most geo­graph­i­cal­ly, pro­fes­sion­al­ly and social­ly iso­lat­ing envi­ron­ments in the world. This requires them to be resource­ful, have a broad scope of prac­tice, use a com­pre­hen­sive pri­ma­ry health care approach, have pub­lic health knowl­edge and the skills to work cross culturally. 

WHO ARE THEY?

Nurs­es, mid­wives, doc­tors, allied & oral health pro­fes­sion­als and Abo­rig­i­nal and Tor­res Strait Islander health practitioners/​workers.

WHERE ARE THEY?

They work in Abo­rig­i­nal and Tor­res Strait Islander com­mu­ni­ties, farm­ing dis­tricts, on & off­shore min­ing, tourism, defence, Antarc­ti­ca, on islands, in deten­tion cen­tres, jus­tice health, aeromed­ical and small remote towns often with high­ly mobile populations

The fol­low­ing is a list of pri­or­i­ties that will improve the health of
peo­ple liv­ing in remote Australia.

1. The Social Deter­mi­nants of health are a sig­nif­i­cant causative fac­tor of poor health
out­comes for those liv­ing in remote Aus­tralia, par­tic­u­lar­ly for Abo­rig­i­nal and Tor­res Strait Islander peo­ple. Therefore:

• All health debates should occur in this context.
• A whole of gov­ern­ment and whole of soci­ety approach is required to rem­e­dy this
  prob­lem.

2. The inequal­i­ties expe­ri­enced by Abo­rig­i­nal and Tor­res Strait Island peo­ple must be
addressed to close the health and life expectan­cy gap, remove health dis­ad­van­tage and
elim­i­nate racism.

3. All remote women have access to con­tem­po­rary evi­dence-based mod­els of mater­ni­ty
care regard­less of where they live. This includes:

• Con­ti­nu­ity of care by a known midwife.
• Equi­table dis­tri­b­u­tion of mater­ni­ty services.

4. All remote con­sumers have a right to access safe, qual­i­ty emer­gency care, pro­vid­ed by clin­i­cians who are edu­cat­ed to a nation­al standard.

5. Remote­ly locat­ed old­er peo­ple have appro­pri­ate access to qual­i­ty aged care ser­vices.
These include:

• Sig­nif­i­cant resourc­ing to devel­op inno­v­a­tive mod­els of care and to sup­port active
  age­ing and qual­i­ty of life.
• Pro­vi­sion be made to address the grow­ing bur­den of dementia.

6. Remote com­mu­ni­ties are fund­ed to have a sus­tain­able flu­o­ri­dat­ed water sup­ply as a
mat­ter of pri­or­i­ty, along with increased access to afford­able oral health services.

7. Afford­able and reli­able high-speed Inter­net con­nec­tiv­i­ty is a high pri­or­i­ty for remote
areas.

8. The resourc­ing of, and access to health ser­vices must be based on local com­mu­ni­ty
needs, dis­ease preva­lence and pop­u­la­tion health plan­ning in col­lab­o­ra­tion with
rel­e­vant local stakeholders.

9. Cli­mate change impos­es sig­nif­i­cant pub­lic health risks to remote com­mu­ni­ties, requir­ing the devel­op­ment of proac­tive and respon­sive pol­i­cy changes across Australia.

10. Acknowl­edge­ment of the impact of mar­gin­al­i­sa­tion on the health of peo­ple with dis­abil­i­ties, the LGBTI com­mu­ni­ty and oth­er minor­i­ty groups.

11. Pal­lia­tive care ser­vices – those liv­ing in remote com­mu­ni­ties should have access to
con­tem­po­rary, sup­port­ive pal­lia­tive care services

12. The mod­el of health care in remote Aus­tralia is different.

• Remote health pro­fes­sion­als use a com­pre­hen­sive pri­ma­ry health care approach.
  Greater invest­ment is need­ed to edu­cate the remote work­force in this model.
• Need flex­i­ble mod­els of ser­vice deliv­ery in the remote context.
• The remote nurs­ing work­force is often the con­sis­tent pri­ma­ry provider of health care, includ­ing coor­di­na­tion and case man­age­ment, due to a mald­is­tri­b­u­tion of med­ical workforce.

13. Invest­ment and ini­tia­tives are required to increase and strength­en the remote Abo­rig­i­nal and Tor­res Strait Islander health work­force. This includes:

• Sig­nif­i­cant invest­ment and sup­port to improve the num­bers suc­cess­ful­ly com­plet­ing nurs­ing, mid­wifery, Abo­rig­i­nal & Tor­res Strait Islander health practitioner/​worker, allied health and med­i­cine training.

14. Cul­tur­al safe­ty and cul­tur­al respect edu­ca­tion is embed­ded in all aspects of remote
health care from novice to advanced practitioner.

15. Zero tol­er­ance for racism. It is iden­ti­fied and elim­i­nat­ed from all work locations.

16. Sole clin­i­cal posts in remote and iso­lat­ed loca­tions are not sup­port­ed for any discipline.

17. Safe­ty and secu­ri­ty of the work­force is para­mount. Each loca­tion must have
robust infra­struc­ture, poli­cies and sys­tems to ensure a safe and secure work­place and
accom­mo­da­tion. Par­tic­u­lar atten­tion must be giv­en to ensur­ing the safe­ty of the on call,
after hours workforce.

18. Remote area nurs­ing should be recog­nised as a gen­er­al­ist pro­fes­sion and assessed
against a nation­al­ly con­sis­tent stan­dard for remote nurs­ing practice.

19. Ini­tia­tives to grow and retain the future remote health work­force should include:

• Nurs­ing stu­dents being able to access fund­ed remote clin­i­cal place­ments, includ­ing
  assis­tance with trav­el and accommodation.
• Novice prac­ti­tion­ers are able to access remote employ­ment oppor­tu­ni­ties with
  ade­quate sup­port and resources.
• Wide­ly avail­able and well-resourced men­tor­ing programs.
• Cer­ti­fi­ca­tion process to val­i­date safe, qual­i­ty remote area nurse practice.

20. Invest­ment is pro­vid­ed to edu­cate and pre­pare remote health man­agers and lead­ers
through struc­tured pro­grams, in an effort to improve reten­tion of the workforce

21. Invest­ment to sup­port remote nurs­es, mid­wives and allied health pro­fes­sion­als to lead and deliv­er action-based research to improve patient outcomes.

22. Con­tin­ued roll-out of Tele­health and Tele-med­i­cine in remote areas to enhance
col­lab­o­ra­tive prac­tice amongst the remote health team and reduce trav­el cost for
remote con­sumers. Con­tin­ued sup­port must be pro­vid­ed on the ground for train­ing
and edu­ca­tion of the user.

23. Acknowl­edge­ment of the con­tri­bu­tion rur­al nurs­es make towards sus­tain­able health ser­vices in our coun­try towns.

24. Com­mon­wealth state and ter­ri­to­ry leg­is­la­tion and health ser­vice poli­cies are reviewed to remove bar­ri­ers that pre­vent remote nurs­es, mid­wives and allied health pro­fes­sion­als to prac­tice to their full scope.

25. Access to the MBS and PBS is reviewed and amend­ed to bet­ter reflect the actu­al
work­force break­down and deliv­ery of pri­ma­ry health­care in remote and rur­al Australia.