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Policy, Lobbying & Advocacy Update
Michael Barrett,OTA National Manager, Government and Stakeholder Relations
Ensuring access to healthcare in regional, rural and remote areas of the country is a perennial challenge for all Australian governments and, as such, is a high priority for OTA’s policy and advocacy team.
In our most recent pre-budget submission to the federal treasury, OTA wrote:
‘In a land as vast as Australia, and with a population as urbanised as Australia’s, it is unsurprising that our health, aged care and disability workforce is stretched so thinly between our major cities. But while the problem comes as no surprise, it nonetheless remains a problem … The federal government should work to address this maldistribution as a matter of urgency, ensuring those Australians living outside our major cities and regional centres enjoy reasonable access to health services befitting one of the world’s most advanced countries. The stated determination of all governments to ‘close the gap’ of Indigenous disadvantage is another compelling reason to ensure such access.’
We went on to note that education must play a key role in any long-term solution to this problem. Regular and meaningful rotations through regional and remote locations during the training of medical and allied health professionals heighten the possibility that students will eventually settle and practice in such locations. And we stated:
‘We also join with other organisations in calling for the development and implementation of a comprehensive rural and remote health strategy.’
It was heartening that the 2020-21 federal budget, delivered on 6 October—five months late, owing to the economic turmoil caused by COVID-19—included several initiatives in line with OTA’s recommendations.
The Morrison government announced that it would implement a $550 million Stronger Rural Health Strategy. This aims to give doctors more opportunities to train and practise in rural and remote Australia, and gives nurses and allied health professionals a greater role in the delivery of multidisciplinary, team-based primary care.
Funding of $50.3 million over four years will expand the Rural Health Multidisciplinary Training (RHMT) program, which has been in place for more than 20 years. Incorporating 16 University Departments of Rural Health (UDRH), the program provides training to students across a range of health disciplines, including nursing and allied health, in such fields as aged care, disability and rehabilitation, childcare, education, community facilities, and Aboriginal Community Controlled Health Organisation settings.
According to the government’s budget statement, the expansion of the RHMT will deliver four key elements:
Funding a new UDRH Increasing training in five remote communities through existing UDRHs (including student accommodation) Funding five projects to enhance aged care training A feasibility study to identify best approaches to increase dental training in regional locations
The budget also funds trials of a new way to provide health services to smaller, connected rural communities across western and southernNew South Wales, focusing on models to create efficient, coordinated networks of general practitioners, nurses and other health providers. The selection of new primary care models was based on their readiness for implementation, and was the product of collaboration between local primary health networks, state government health districts, and local medical leaders. The government has indicated that outcomes of these trials will inform wider primary care reform in rural Australia.
The government also committed to expanding the National Rural Health Commissioner’s function, indicating the office would take a system-wide view of rural health, ensuring initiatives were integrated and address gaps.
These announcements largely align with recommendations made by OTA in recent years, and are welcome.
But amid the good news were inevitable disappointments.
Occupational therapists working with veterans have been disappointed yet again, with the Morrison government failing to lift the rates paid to occupational therapists by the Department of Veterans’ Affairs (DVA).
This is despite the fact that the number of occupational therapists able to sustain DVA work has fallen sharply in Far North Queensland, which is home to a large number of veterans. Like their counterparts in the Northern Territory, these veterans must now seek occupational therapy at their nearest public hospital. They deserve better.
It should be a source of national shame that occupational therapists with longstanding clinical relationships with wounded, disabled and ageing veterans are having to cut these ties because DVA is unable or unwilling to pay them a living wage.
OTA will continue to advocate in this space and has recently been in touch with two government backbenchers on the issue. These backbenchers are rurally based, reflecting the fact that this problem is much more pronounced outside our capital cities.
Another budget measure was funding of an additional $92.9 million over the next four years to ensure the NDIS Quality and Safeguards Commission has the resources required to carry out its role in regulating NDIS providers.
OTA reiterates its strong belief that those NDIS providers registered by one arm of the Federal Government—the Australian Health Practitioner Regulation Agency (AHPRA)—should not be subjected to the trouble and expense of being registered by another arm of the Federal Government, the NDIS Quality and Safeguards Commission.
Moreover, by supporting the commission’s existing role and arrangements, the Morrison government contradicts its stated objective of supporting access to health services in rural and remote Australia.
In our recent submission to the Australian parliament’s inquiry into the NDIS Quality
and Safeguards Commission, OTA addressed the inordinate trouble and expense involved in undergoing certification by the commission, in particular the cost of the associated audit. We wrote:
‘… the fact remains that the audit is unnecessarily expensive, a fact attributable in part to the limited number of approved auditors. Despite repeated assurances by the commission, the number of approved auditors has not increased over the past 18 months; in fact, it seems to have been cut from 16 to 15.
While these firms claim to provide services across all of Australia, they are all metropolitan-based, meaning that NDIS providers based in regional and rural parts of the country must bear the additional cost of the visiting auditors’ travel and accommodation.
If OTA is incorrect about this, and measures have been taken to address this injustice, we would be delighted to hear it. We urge the Joint Standing Committee to inquire into this particular matter, given that thin provider markets in regional and rural Australia will never be meaningfully addressed if there are institutionalised disincentives to practising in these areas.’
Finally, no discussion of regional, rural and remote healthcare is complete without reference to the phenomenal, if enforced, take up of telehealth in 2020.
Almost overnight, scores of thousands of health professionals, including thousands of occupational therapists, began delivering care by means of a variety of telehealth platforms. Surveys conducted by several allied health peak bodies, including OTA, alongside significant anecdotal evidence, indicate that telehealth is an efficient and effective means of delivering care.
Ideally, occupational therapists would adopt a hybrid model, seeing clients face to face whenever necessary but opting for telehealth when appropriate. Significantly, many occupational therapists report that the time saved by not having to travel to see clients means more clients can be seen in a day, an important consideration given the shortage of occupational therapists across many parts of Australia, particularly rural and remote areas.
OTA is currently involved in a universityled study of the clinical effectiveness of telehealth, the findings of which will inform our advocacy going forward.
Occupational therapists were understandably pleased when in September the Federal Government announced the extension of MBS subsidised telehealth services to 31 March 2021. DVA announced the same extension to its telehealth services the following week.
We are conscious of the fact, however, that telehealth may not be an unalloyed blessing. While it ensured vulnerable Australians had access to much necessary allied healthcare in 2020, and thereby enabled many small allied health businesses to remain afloat, it must not be allowed to mark the beginning of the end for rural and remote practices.
While large city-based businesses should be able to provide telehealth services to rural and remote clients, these should supplement, rather than supplant, the great work of locally based occupational therapists, people who every day make emotional and economic investments in their communities.
