ARHEN Pre-Budget submission 2018 The Australian Rural Health Education Network (ARHEN) is the peak representative body for university departments of rural health (UDRHs). The UDRH Program delivers clinical training opportunities for allied health, nursing and medical students, offers research and educational opportunities for students and health professionals, and provides a university presence in rural areas which contributes economically, socially and culturally to the region. ARHEN is committed to better health in rural, regional and remote Australia through advocating for, and enhancing the work of, UDRHs. Representatives from each of the 15 UDRHs make up ARHEN s Board (see Appendix A). ARHEN is resourced through membership funds from each of the UDRH to provide a united voice and work on common strategic issues to optimise the impact of UDRHs and strengthen training for health workers in rural and remote practice. This Pre-Budget Submission has been developed to summarise key strategic areas identified by ARHEN for consideration in the Government s budget deliberations. Yours sincerely Dr Lesley Fitzpatrick National Director Proposed priority initiatives 2018/19 1. Ensuring the best outcomes from the Australian Government s investment in rural health through the UDRH component of the Rural Health Multidisciplinary Training Program The Australian Government s significant and ongoing investment in the development and support of rural health professionals and regional areas through the funding of Australia s 15 UDRHs is crucial the development and stabilisation of the rural health workforce. ARHEN calls on the Australian Government to continue to fund UDRHs through the Rural Health Multidisciplinary Training Program (RHMTP) and to maintain their resource base in real terms by increasing the current grant by the consumer price index (CPI), continuing to fund lapsing programs (see Items 2 & 3) and improving funding security. It is now 20 years since the first UDRH was funded and thus, it is reasonable to view the initiative as a continuing program. Despite this, RHMTP resources which support UDRHs are still allocated using 3-year block funding. The current 3-year block-funding contract arrangement is a major constraint on the effective operation of UDRHs. It incorporates a lack of timeliness in advising UDRHs on the continuation of their funding, with renewals often delayed until so late in the final year of the contract, or even extending into the following year, thus impacting significantly on the retention and recruitment of quality staff as UDRHs can only offer short term contacts in line with their assured funding. In many cases UDRHs are limited to offering contracts of less than 3 years if staff are recruited part-way through the funding triennium.
Page 2 of 5 The current funding structure effects the stability of the academic workforce in rural and remote communities, the ability to undertake the longer term developmental work required to build training capacity, access to internal grants within the university, and the ability to secure competitive grants of benefit to the regions. In view of this, ARHEN recommends that Government strengthen its support for UDRHs through a shift to three year rolling contracts mirroring the funding approach for the primary health networks (PHNs). The move to rolling three-year contracts, as per the funding arrangements for PHNs, would provide more stability in terms of the ability to confirm on-going staff contracts half way through existing employment periods i.e. 18 months before expiry of existing contracts. It will also enable UDRHs to: attract appropriate staff to live and work in the regions by providing more secure employment opportunities which is critical to encouraging appropriate personnel to make the significant decision to relocate and develop their skills and experience improve their competitiveness in attracting staff given other more secure employment arrangements offered through PHNs and the NDIS implement plans which need longer lead times due to complexity, isolation, workforce issues and distance e.g., establishing more service-based learning and training sites in remote and under-served communities, and work more effectively towards meeting the targets of expanding the number and the length of student placements. Government s continued support of UDRHs through the RHMTP funding stream will also enable ARHEN, which is funded by membership fees from UDRHs, to provide advice to inform policy development, program enhancements and decision making. Resources: Re-investment of established RHMTP allocations + CPI with rolling 3-year funding contracts. 2. Continuing and strengthening rurally-based clinical training in mental health through UDRHs ARHEN strongly recommends the continuation of the component of the COAG Mental Health Better Access program (initially established in 2006/7) which provides funds to UDRHs to employ mental health academics. These roles have been crucial to the development of mental health training in the rural and remote health workforce. They have expanded the mental health components of undergraduate training offered by UDRHs, provided services to rural communities, contributed to the stability of the workforce and strengthened research and professional support in these areas. ARHEN recommends that further resources be made available to provide equivalent funding for mental health academics in the three newly established UDRHs based in Toowoomba QLD, Broome WA and Wagga Wagga NSW. If funding for these positions is not renewed, UDRHs will suffer a real-term cut in their funding as resources will need to be re-directed from other areas to continue to fund these roles. Some UDRHs may be able to do so while others may not, which would reduce their educational capacity in this area. Likewise, not providing equivalent funding to the three new URDHs for mental health academics puts them in a less equitable funding position in real terms compared with their counterparts. Resources: Extension of established COAG Mental Health Better Access Measure allocations + CPI for a 5-year period and additional resources for mental health academic positions in the three new UDRHs.
Page 3 of 5 3. Continuing and strengthening rurally-based clinical training in pharmacy through UDRHs ARHEN has emphasized the need to continue to the funding of UDRHs in real terms. The Rural Pharmacy Liaison Officer (RPLO) program plays a significant role in the rural workforce development activity undertaken by UDRHs. The importance of the program, which involves a modest level of funding of around $80,000 for 11 UDRHs, prompted ARHEN s submission to the recent program review undertaken by HMA Consulting on behalf of the Department of Health. Pharmacies are a vital part of rural communities and important to improving patient healthcare and wellbeing and rural Australia bears the brunt of the geographic maldistribution of pharmacists. Despite the numbers of graduates in the discipline, recruiting pharmacists in rural and remote areas is a growing challenge. In view of this and the significant role pharmacists play in improving patient health, pharmacy is a priority discipline for training and workforce development in UDRHs. The RPLO Program provides support to community pharmacies and pharmacy students involved in clinical placements; promotes inter-professional collaboration, strengthens mentoring and advisory arrangements, and facilitates professional development and networking. To ensure its continuity and effectiveness, ARHEN recommends that the RPLO funding stream is continued and integrated into the RHMT Program and that the it be implemented though UDRHs to align it more effectively with the broader objectives of the RHMTP. If funding for the RPLO positions is not renewed, UDRHs will suffer a real-term cut in their funding as resources will need to be re-directed from other areas to continue to fund these roles. Some UDRHs may be able to do this while others may not, thus it could reduce their educational capacity and community engagement in this field. ARHEN also requests that the RPLO funding is extended to the three new URDHs to ensure capacity in this area and an equitable funding position in real terms compared with their counterparts. Resources: Existing funding (+ CPI) continued and extended to expand the program to include the three new UDRHs. Funding to be allocated through the RHMTP. 4. Development of rural generalist pathways for the allied health professions that is supported by, and strengthens the work of, UDRHs The maldistribution of the health workforce in rural and remote areas is not limited to medicine. ARHEN recommends that Government provides funding to undertake the work required to extend rural generalist pathway approaches to training to the allied health professions. Rural generalist allied health professionals would provide a network of highly skilled resident clinicians who, as well as providing services for the community, could work with UDRHs, contributing to teaching, supervision and support for health workers in training. Allied health rural generalists would strengthen the delivery of quality, cost-effective services to rural communities and could contribute to teaching and research capacity of UDRHs and provide professional models and mentors for those considering a career in rural health. An allied health rural generalist pathway should be designed to build the capacity, value and sustainability of allied health services in multi-disciplinary teams in rural and remote areas and should include: service models that address the challenges of providing the broad range of healthcare needs of rural and remote communities workforce and employment structures that support the development of rural generalist practice capabilities
Page 4 of 5 an education program tailored to the needs of rural generalist practitioners, and structural links to the UDRH network. To ensure a variable and sustainable allied health rural generalist pathway it needs to be strongly embedded in the UDRH network, not just in terms of developing and providing the educational components required to train rural generalists, but also in offering career pathways, providing professionally rewarding employment opportunities and ensuring collegial support. UDRHs represent a significant investment in building a strong educational, clinical and academic presence in rural and remote regions. They currently drive the educational preparation of allied health professionals for rural practice, but without targeted, well supported jobs which offer career pathways, the benefits of this investment are not being fully realised and rural areas are not getting the best possible workforce outcomes. Good interested rural health practitioners need good rural jobs. Better, more interesting jobs can be offered within an environment of professional support by ensuring the involvement of rural generalists in locally-based UDRH-based teaching and research. This would also strengthen the regional clinical teaching and supervision capacity of UDRHs. To encourage a systems approach, developmental work in this area should be linked to the role and aegis of the Rural Health Commissioner. Pathway development should build on work being undertaken by the relevant peak sector bodies, colleges and credentialing bodies. ARHEN seeks project funding over a threeyear period to enable it to contribute strategically to the development of the allied health rural generalist pathway. Resources: Grant to ARHEN of $240,000 over a three-year period ($80,000 per year) to undertake a project that identifies opportunities and synergies that strengthen UDRHs and the rural allied health workforce during the scoping and development of an allied health rural generalist pathway. 5. Career development and leadership pathway for Aboriginal and Torres Strait Islander UDRHs academic/professional staff Within higher education, Indigenous academic and professional staff are central to the development of Indigenous knowledge systems, teaching and research. There are many hidden aspects to their roles including the expectation to offer complex support services and sensitive cultural advice and liaison in complex contexts. They are called upon to provide cultural safety advice, knowledge frameworks, and to support both Indigenous and non-indigenous staff and students involved in the higher education system. These staff also provide critical links to the local Indigenous community which is particularly important to the education of health professionals and the development and provision of appropriate health services. Indigenous higher education staff are significantly under-represented in the university sector with 0.8 per cent of all full-time equivalent academic staff and 1.2 per cent of general university staff (2010) being Aboriginal and Torres Strait Islander people. 1 The low numbers and the high expectations and extensive roles placed upon them, often means that these staff experience significant workplace and Community pressure. To support them in undertaking these complex and demanding roles, specific development programs are needed to provide appropriate and supported career and leadership pathways. UDRHs are committed to developing an Aboriginal and Torres Strait Islander academic workforce, and through this Project, aim to build their capacity to achieve this goal. The Project will provide professional development opportunities for UDRH Aboriginal and Torres Strait Islander staff to gain the skills and 1 Universities Australia, Indigenous Higher Education (2014) https://www.universitiesaustralia.edu.au/uni-participation-quality/indigenous-higher-education#.vdy3kxzepmi
Page 5 of 5 support to optimise their effectiveness in their roles and build a more resilient rural and remote health workforce. Professional development activities will be identified through personal development plans and provided to UDRH Aboriginal and Torres Strait Islander staff in order to: provide effective cultural training programs relevant to the local Community for health students increase the understanding and use of culturally safe practices among health professionals, higher education providers and health services support and lead educational and research activities, and work with their Community to ensure the development and delivery of culturally appropriate health care. The Project will contribute to achieving parity in education and employment for Aboriginal and Torres Strait Islanders. It will draw on the relationships, experience and infrastructure of UDRHs and involve input from Elders representing the local Community into the selection of participants. It is expected that the Project will make a significant difference to the development and evaluation of health services in Aboriginal and Torres Strait Islander communities and enhance education in Indigenous health and culturally competent practice for the health students and staff associated with the UDRH network. Staff involved in the Indigenous Professional Development and Leadership Project will be supported and mentored to lead educational and research activities and Community capacity building. Supporting and developing rural and remote Aboriginal and Torres Strait Islander UDRH staff through this Project will also help to build the health workforce. The selected staff will engage with regional primary, secondary and higher education students in promoting health career pathways, raise aspirations to improve participation in education, and facilitate improvements to health services. The Project will also strengthen UDRHs effectiveness in Indigenous health. It will: ensure strong consultation and liaison with Community to develop local solutions to issues provide a focal point for enhancing partnerships with Indigenous communities and a conduit for engagement in health service development, education and evaluation build capacity to undertake Aboriginal-led research that informs how health services should be delivered to Aboriginal and Torres Strait Islander peoples and their active engagement in the development of those services provide support and encouragement to Indigenous health workers, researchers, educators and students, working within and for rural and remote communities facilitate the recognition and incorporation of Aboriginal knowledge into health-related educational activities and program delivery participate in the delivery of locally responsive cultural safety to ensure that non-indigenous health workers, professionals and academics are conversant with cultural safety and the appropriate protocols for dealing with Indigenous health issues, and establish aspirational pathways from secondary schooling to higher education which will lead to higher rates of student engagement, completion, future employment and more robust service delivery in rural and remote Australia. Resources: Total of $M2.25 $50,000 per annum for three years to each of the 15 UDRHs (2017/18 = $750,000; 2018/19 = $750,000; 2019/20 =$750,000)
ARHEN BOARD 2017 Chair - Assoc Professor Martin Jones RN MSc D Proff Director, UDRH, University of South Australia, Whyalla, SA. Associate Professor Jones has worked in the UK National Health Service, having pursued a career in mental health. He has specialist experience leading and developing services for people with serious mental illness. Deputy Chair - Assoc Professor Vincent Versace BSc (Hons, H1) PhD Director, Deakin Rural Health, Warrnambool Campus, Deakin University, VIC. Associate Professor Versace is committed to reducing rural health disparities. Collaborating widely with academic institutions, NGOs and government departments, he seeks to contribute to high quality research through the robust application of biostatistics and spatial methods. Treasurer - Professor Megan Smith PhD, MAppSc(Cardiopulmphysio), BAppSc (Physio), GCUT&L Director, Three Rivers University Department of Rural Health, Charles Sturt University, Wagga Wagga, NSW Professor Smith is a trained clinical physiotherapist who has practiced in metropolitan Australia and the UK. She joined Charles Sturt University in 1999 as an inaugural member of the team who developed the first rurally-based physiotherapy program in Australia. Her goal is to positively impact on the health of people whose preference, like hers, is to live, work and study in rural Australia. Professor Sabina Knight RN MTH FRCNA FCRANAPlus FRLA Director, Mount Isa Centre for Rural and Remote Health, QLD. Professor Knight has an extensive background in remote and Indigenous primary health care, public health and education. She is a recognised leader in nursing, rural and remote health and education and health system reform. Professor Darryl Maybery PhD Director, School of Rural Health, Monash University Department of Rural Health, Moe, Victoria Since 1999 Professor Maybery has implemented over 45 research grants totalling more than $5 million, published 14 reports, made over 100 conference presentations and key note addresses, co-edited a book and written 15 chapters and had over 90 peer reviewed journal publications. His central research area focuses on vulnerable families and the impact of parental mental health problems on children, with the aim of reducing the cycle of mental illness. Professor David Lyle MBBS PhD FAFPHM Director, Broken Hill UDRH, University of Sydney, NSW. Professor Lyle is a public health physician who has worked in senior positions in the NSW public health system and university sector since 1990. He has a track record of achievement in teaching, research and health services development. Professor Sandra Thompson BSc(Med) (Hons) MB BS (Hons) PhD MPH FAFPHM Grad Dip Health Management. Director, Western Australia Centre for Rural Health, Geraldton, WA. Professor Thompson has worked in the health industry for over 20 years in a variety of roles - as a medical practitioner, laboratory based researcher, public health researcher and epidemiologist, manager and public health practitioner. 1 ARHEN BOARD
Assoc Professor Tony Barnett PhD BAppSc Med RN FRCNA FRSA. Director, Centre for Rural Health, University of Tasmania, Launceston, TAS. Associate Professor Barnett trained as a nurse in South Australia and has worked in a number of hospitals in both SA and Victoria. He has previously held senior academic positions at both Monash and Deakin universities. Professor Lisa Bourke BSc BSW MSc PhD Director, UDRH, Department of Rural Health, The University of Melbourne, Shepparton, VIC. Professor Bourke is a rural sociologist with almost 25 years experience as a social researcher in rural communities. Her research and community projects focus on the health and wellbeing of rural, remote and Aboriginal Australians, particularly young people. Professor Tim Carey Dip T(Prim and Pre) Grad Dip Spec Ed (Sev/ Prof) BA Hons, MSc (Statistics) PhD (Clinical Psychology) MAPS GAICD PGCertBiostatistics. Director, Centre for Remote Health, Alice Springs, NT. Professor Carey has worked in the NHS in Scotland. In his current role he conducts research into health service delivery, provides supervision and training on mental health issues and operates a clinical psychology service in the public mental health system. Professor Jennifer May AM PhD BMed (Hons) FRACGP FACRRM Director, University of Newcastle Department of Rural Health, NSW. Professor May is a practising rural GP and educator and has an abiding interest in rural health policy. Her research interests focus on rural workforce and health access. She has been fortunate to work in remote, rural and regional contexts in Australia and Canada. She is the RDAA rep on the NRHA (having been Chair 2008-2011) and is currently on the Australian National Advisory Committee on Alcohol and other Drugs. She was named Telstra RDAA Rural Doctor of the Year in 2014 and awarded an AM in recognition of her services to medicine, community health and education in 2016. Professor Ross Bailie MBChB MPhil MD FAFPHM MRNCGP Director, University Centre for Rural Health, North Coast, Lismore, NSW. Professor Bailie is a public health physician who has worked as a GP and a public health academic in New Zealand, South Africa and Australia. He has a strong record of applied public health and health services and systems research, particularly in Aboriginal and Torres Strait Islander communities. Professor Jennene Greenhill PhD Director, Flinders Rural Health, SA. Professor Greenhill is committed to building the rural health workforce and mental health services. She has a long relationship with rural health education in rural South Australia and western Victoria delivering longitudinal integrated rural programs for medical, nursing, paramedic and allied health students. Assoc Professor Geoff Argus BSc (Hons), MPsych (Clinical), MAPS, FCCLP Director, Southern Queensland Rural Health, Toowoomba, Queensland Associate Professor Argus is a clinical psychologist by training and has worked extensively across the public and private health sector and community sector in senior clinical and management roles. He is passionate about evidence-based mental health service delivery in regional and rural communities with a particular interest in the social determinants of health as they relate to chronic physical and mental health conditions. Dr Lindy Swain BPharm PhD Director, Kimberley Rural Health Alliance, Broome, WA Dr Swain is a pharmacist by profession and has an extensive background as a clinical academic. She was previously Allied Health Academic Lead at Sydney University s Centre for Rural Health, Lismore and has a particular interest in improving medication management for Aboriginal and Torres Strait Islander people. Dr Swain s work has been influential in shaping the strategies of the Pharmaceutical Society of Australia on Aboriginal and rural health. Dr Swain was the society s Pharmacist of the Year in 2014 for her work in Aboriginal health. ARHEN BOARD 2