p//g

Working for good health and well-being in rural and remote Australia CONTENTS Part 1: Core Activity ...... 1 Policy Work ...... 1 Medicare ...... 1 Primary Health Care and General Practice ...... 3 The Pharmaceutical Benefits Scheme (PBS) ...... 4 Rural and Remote Nursing Workforce ...... 4 Rural and Remote Allied Health ...... 6 Healthy Horizons ...... 7 Aged care ...... 8 Telstra and telecommunications ...... 8 Advocacy ...... 11 Promoting Policy ...... 11 Submission on Ageing ...... 12 PARTYline ...... 14 Conferences ...... 15 6th National Undergraduate Rural Health Conference (NURHC) ...... 15 7th National Rural Health Conference ...... 15 From Energy to Shared Action ...... 18 Planning for the 8th National Rural Health Conference ...... 20 Frontier Services ...... 20 Toowoomba: where it all started ...... 20 Meetings ...... 22 Council, Executive, AGM ...... 22 CouncilFest 2002 ...... 22 Networking and collaboration ...... 23 NRHA’s membership in other organisations ...... 23 NRHA’s representation on committees ...... 23 National Rural Health Alliance 2004 Rural Sub-committee of AHMAC ...... 24 Yearbook and Annual Report 2002-2003 Australian Health Reform Alliance ...... 25 National Healthcare Alliance ...... 26 ISSN 1441-8002 Rural Education Forum Australia (REFA) ...... 26 National Rural Women’s Coalition (NRWC) ...... 27 ISBN 0 9751220 2 9 Australian Rural and Remote Workforce Agency Group ...... 28 RHSET ...... 28 Editorial: NRHA COMMUNITYLife ...... 28 Design: Spectrum Graphics, www.sg.com.au

Photographs: Irene Lorbergs, Sam Rosewarne, Stewart Roper Part 2: Managed Projects ...... 30 RAMUS Scholarships ...... 30 Overview ...... 30 Introduction of the Web-based Scholarship Database ...... 31 Implementation of a Range of Changes to Ongoing Eligibility ...... 32 Use of a Modified Application Process ...... 33 Evaluation of the Administration of the Scheme ...... 34 friends of the Alliance ...... 35 Australian Journal of Rural Health ...... 35 The John Flynn Scholarship Scheme (JFSS) ...... 37 Part 3: The Context for Rural Health ...... 39 Budget 2003-2004 ...... 39 AIHW — Australia’s Health in 2002 ...... 40 Highlights ...... 40 Pressure points ...... 41 Pillars of the (Australian Rural Health) establishment ...... 44 We Need vets too ...... 45 A Country Commission? ...... 46 Part 4: NRHA Secretariat ...... 47 Relocating the Office ...... 47 Birth of Oscar ...... 47 NRHA Staff ...... 48 Consultants to the NRHA in 2002-2003 ...... 50 Organisations Co-Located at the NRHA’s address ...... 50 Internship Program ...... 51 Part 5: Reports and Financial Statements ...... 52 Chairperson’s Report ...... 52 Financial Statement and Directors’ Report 2002-2003 ...... 54 Indemnification of Officers ...... 54 Principal Activities ...... 54 Results of Operations ...... 54 Dividends ...... 54 Taxation ...... 54 Review of Operations ...... 54 Significant change in the state of affairs of the NRHA ...... 54 Significant post-balance date events ...... 54 Directors’ Benefits ...... 54 Directors ...... 65 Gallery ...... 65 Meeting attendance ...... 67 Part 1: Core Activity

Policy Work Medicare In the period covered by this Yearbook the Alliance responded to proposed changes to Medicare, stressing the need to retain the principle of universality, and arguing that changes affecting bulk-billing would not fix fundamental rural health workforce and AARN service issues. The Alliance urged the Government to make Medicare more effective Association for Australian for people in rural and remote areas by enhancing its capacity so that it covers the costs of primary health care in areas where there is no sustainable fee-for-service Rural Nurses Inc general practice. Member since May 1992 The Alliance worked through its normal processes to agree and publish a Position Paper on Medicare, A More Effective Medicare for Country Australians. It is available — like all of the Established in 1991, AARN is the Alliance’s publications — on the website at www.ruralhealth.org.au peak body representing rural nurses in Australia. The purpose of the association The Alliance was represented at the Roundtable on Bulk Billing and Medicare convened by is to promote quality health care through Senator Lyn Allison, the Democrats spokesperson on health, on Thursday 10 April 2003. excellence in rural nursing practices. Major themes to emerge included the central importance of universality and working to retain it. There is a strong and growing national interest in promoting access to primary health care through multidisciplinary teams that include doctors, nurses, allied health professionals, pharmacists, dentists, managers, nurse practitioners and practice nurses. On 19 May there was a special meeting of the NRHA Council at which Andrew Stuart, from the Department of Health and Ageing, formally briefed the Alliance on the changes to Medicare then proposed. Council members explained that access to a GP was the preliminary step to accessing Medicare, and that some small communities do not have a patient base sufficient to pay a Registrar’s salary. There are also towns that are able to sustain one GP, but not two. This leads to GPs who are terribly overworked. Council expressed the view that it was important for the Medicare package to address such issues. The Alliance made a submission to the Senate Select Committee on Medicare in June. It focused on Medicare as a contract between the national Government and the people of Page 1 Australia to provide all people with the ac- cess to health care that is determined by ACHSE their need for it, not by their income or location. The main means of delivering on Australian College of this contract are through GPs, the PBS and Health Service Executives public hospitals. In remote areas all three are (rural members) less readily available and, when they are present, the cost to their patients is higher. Alison Coleman, Fiona Patterson and Member since May 1992 The Alliance urged the Government to find Shelagh Lowe alternative ways of delivering on the contract Established in 1945, the ACHSE is in such areas. The submission stressed the importance of preserving the universality now Australia’s largest professional body principle before moving on to enhance it through the addition of alternative systems to representing health management. ACHSE provide improved levels of accessibility and affordability in rural and remote areas. aims to develop and foster excellence in health service management through The Alliance remained concerned that there was still no overall strategic approach to the health workforce for rural and remote areas, and outlined a goal which would include ap- education and ongoing professional propriate and adequately resourced models of health care services for the special circum- development for existing and potential stance of rural and remote areas, particularly Indigenous communities. health service managers. These issues were addressed by the Alliance in the Executive Director’s presentation to the special seminar held by the Institute for Health Policy at Sydney University on 22 May. One of the elements of the Medicare package relates to Overseas Trained Doctors, a subject of special importance to people in rural, regional and remote areas of Australia. Dr Bruce Harris and Ms Judy Harris (NSW Rural Doctors Network Locum Project Co- ordinator) had a meeting on OTDs with the Workforce Policy Branch which was at the time (June 2003) establishing a Task Force to lead its work on OTDs.

Page 2 Primary Health Care and General Practice The NRHA advocates the provision of primary health care services for all Australians. ACRRM It uses a definition of primary health care that has international acceptance. For its purposes, primary health care is “essential health care based on practical, scientifically Australian College of Rural sound and socially acceptable methods and technology, made universally accessible to and Remote Medicine individuals and families in the community through their full participation, and at a cost that the community and country can afford to maintain at every stage of their dev- Member since December 1998 elopment, in the true spirit of self reliance and self determination” (from the Alma Ata Declaration of Primary Health Care, World Health Organisation, 1988). ACRRM is the peak professional organisation for rural medical education This approach to primary health care recognises a continuum of care from primary care and training in Australia. Our members (provided at the first point of contact) to community-based programs that build the are committed to providing the highest capacity of communities to provide environments that enhance health and well-being. The quality of medical care to patients in Alliance is committed to the concept of general practice as a central and co-ordinating regional, rural and remote communities focus for the provision of primary health care services, working in collaboration with other throughout Australia. health professionals. The NRHA’s work recognises the importance and value of people in rural and remote areas being able to realise their full potential in their environment. Its work is based on principles of social justice, equity and improved access to the range of goods, services and entitlements that impact on health status. (An analysis of over two million Medicare claims found that people from poorer areas have on average shorter consultations. Shorter consultations are associated with lower patient satisfaction, less patient empowerment and poorer health outcomes.) The Alliance continues to play a role in broadening and deepening the provision of primary health care to rural people, and in particular to people in remote areas where there may be no GP or community pharmacist. Page 3 The Pharmaceutical Benefits Scheme (PBS) ADGP (Rural An Interdepartmental Committee examined the effectiveness of the PBS, with a number of Sub-committee) organisations selected by the Department as ‘key stakeholders’ invited to make written submissions. A Bill to increase PBS co-payments was subsequently drafted but was twice Rural Sub-committee of defeated in the Senate. This was the background for the release by the Treasurer of the the Australian Divisions of Inter-Generational Report in the Budget in May 2002 which dealt with some of the General Practice assumptions and future trends affecting health and welfare expenditures in Australia. The Alliance views the PBS as an important and successful public program that identifies Member since October 2002 ‘value for money’ drugs, negotiates prices that are reasonable to both taxpayer and manufacturer, and provides guidance to doctors and patients on appropriate drug use. ADGP is the peak national body Rapidly increasing expenditure on the PBS must not be allowed to result in decisions that representing 120 Divisions of General will damage the Scheme or its effectiveness for people in rural and regional areas. Practice across Australia, and was established in 1998. The first local Rural and Remote Nursing Workforce Divisions were established in 1992. Measures to help improve the distribution, numbers and preparedness of the rural and About 94 per cent of GPs are members remote nursing workforce were selected by Council as the priority workforce policy task for of a local Division of General Practice. the Alliance for 2002-2003. There are about seven times as many nurses as doctors employed in their respective professions outside the capital cities (about 75,000 compared with about 10,000). In addition there are plenty more trained as nurses but not working in the profession. The starting point for the project was the call at the 6th Conference (Canberra, March 2001) for a nursing summit. The purpose of the project is to ensure that current and proposed developments in nursing policy and practice are informed by the particular characteristics of people and health settings in non-metropolitan areas, and of the nurses who work in them. Page 4 The proposed Summit was postponed until October 2002 and re-styled as a Workshop. The 2002 Rural and Remote Area Nursing AHA (RPG) Workshop was held in Canberra on 18 October 2002. It was organised by the Rural Policy Group of the Alliance for its three nursing bodies. The Australian Healthcare event recognised the major developments Association underway for nursing and the 100 people who attended from all parts of Australia were Rosemary Crowley and Marg Conley at Member since December 1995 addressed by two of the main players. ‘Action on Nursing in Rural and Remote Patricia Heath spoke about the National Areas, 2002-2003’ The Australian Healthcare Association Review of Nursing Education that she chaired (Our Duty of Care), and Senator Rosemary is the peak industry association for Crowley about the Senate Inquiry she chaired that resulted in the report The Patient publicly funded healthcare agencies and Profession: Time for Action. Other speakers were Richard Eccles from the Department of organisations including public and not-for- Health, and Project Convenor David Lindsay. Margaret Conley was the Workshop profit hospitals, aged and extended care, Facilitator. and primary and community health. The main purpose of the Workshop was to develop a charter for rural and remote nursing AHA provides advocacy and so that future developments are informed by the circumstances of health settings in non- representation to all those who work in metropolitan areas and of the nurses who work in them. Three background papers had these agencies, as well as services, been prepared and are available on the Alliance website: Issues Paper, Vision and information and support. Required Conditions, and a draft set of Recommendations. Victoria Gilmore, Sally Goold, Karen Francis, Melanie van Haaren, Lesley Siegloff, Jan Fletcher and David Lindsay led discussion of the recommendations. Workshop participants agreed on a 7-Point Plan for rural and remote nursing and a further nine recommendations. The Alliance and other members of the Project Committee undertook to follow-up on the Plan. It deals with a range of issues including incentives for rural and

Page 5 remote area practice; workplace resources and structures; risk management; the image of rural and remote nursing; undergraduate and postgraduate nursing programs; and ANF information technology. A media release was agreed and issued on 23 October 2002. Australian Nursing Federation The Workshop itself and several participants were supported by financial support from the Department of Health and Ageing. Member since May 1992 The Alliance’s three nursing bodies are leading the project: the Association for Australian The ANF is the national union for nurses Rural Nurses (AARN); the Australian Nursing Federation (ANF); and the Council of Remote and the largest professional nursing Area Nurses of Australia Inc (CRANA). It is being run in conjunction with the Australian organisation in Australia with more than Council of Deans of Nursing (ACDN), the Australian Nursing Council (ANC), the Congress 120,000 members. The ANF’s core of Aboriginal and Torres Strait Islander Nurses (CATSIN), the National Rural Health Network (NRHN) and the Royal College of Nursing Australia (RCNA). business is the industrial and professional representation of nurses The Member Bodies of the Alliance are supporting the work. and nursing through the activities of a national office and branches in every Rural and Remote Allied Health State and Territory. A new project called the National Rural and Remote Allied Health Advisory Service (NRRAHAS) began in July 2002 and was located at the Office of the Alliance. The project was run by Services for Australian Rural and Remote Allied Health (SARRAH) — one of the Alliance’s two allied health Member Bodies. Staff of the Alliance were pleased to welcome to the office Ann O’Kane, the Project Officer for NRRAHAS. The Alliance was also involved in activity led by the University of Tasmania and associated groups to promote scholarships for a range of allied health and other health professionals. A submission was made to the Federal Department of Health in September 2002.

Page 6 Healthy Horizons In March 1999 Healthy Horizons: A Health Framework for ARHEN Rural, Regional and Remote Australians 1999-2003 was launched at the 5th National Rural Health Conference. It was Australian Rural Health a joint initiative between the National Rural Health Alliance and Education Network Ltd the Commonwealth, State and Territory governments. The framework provides direction for the development of strategies and Member since October 1992 allocation of resources for rural and remote areas. The Australian Rural Health Education The National Rural Health Policy Sub-committee provides advice to AHMAC on rural Network (ARHEN) was established to link and remote health policy issues at a national level and oversees progress against the and support the University Departments Healthy Horizons Framework. In 2002 the Sub-committee agreed that the existing of Rural Health (UDRHs) across Australia. document should be revised to ensure that current and emerging issues were covered to The UDRH program is a Commonwealth build on the existing framework. Kim Snowball was engaged to undertake the update of Government initiative focused on the Healthy Horizons framework. expanding and enhancing the rural and The Alliance worked with the Sub-committee on the revision, which resulted in Healthy remote health workforce through Horizons Update 2003-2007. It was made public and discussed at the 7th Conference in education and training, professional Hobart in March 2003. support, research, and service The Alliance continued to advocate for the formal launch and promotion of the updated development. ARHEN aims to optimise document, which is in effect the national rural health strategy. A copy can be found on the the outcomes of the UDRH program Alliance’s website. by facilitating co-ordination and collaboration between the individual UDRHs, and by adding value to the strategic direction of the program as a whole.

Page 7 Aged care ARRAHT of the HPCA As part of the House of Representatives Standing Committee inquiry into long-term strategies to address the ageing of Australia’s population, a public hearing was held in Australian Rural and Remote Canberra on 7 March. The Committee heard evidence from the Federation of Ethnic Allied Health Taskforce of the Community Councils of Australia, the Australian Medical Association, the National Aged Health Professions Council of Care Alliance, the Australian Nursing Federation, Carers Australia, the Pharmacy Guild of Australia and the National Rural Health Alliance. Australia The Alliance provided a rural and remote focus to a study into factors influencing the move Member since May 1992 of older people from retirement villages to residential aged care — a study conducted by the University of South Australia and Village Care Ltd. Moving from a retirement village to ARRAHT was formed in 1992 as the a residential aged care facility involves both physical and psychological dislocation. rural sub-group of the Australian Council It affects the older person’s sense of self, so that minimising the need for changing an of Allied Health Professions (now the older person’s place is an important strategy. The process should be made as stress-free Health Professions Council of Australia) and affirming of a sense of self and place as possible. The study explores the process of and is a founding member of the NRHA. why and how older people move from retirement villages into residential aged care It represents and promotes the interests facilities and what may have assisted these older people to continue to live in the and issues of the rural and remote retirement village. members of the Allied Health Professional Associations that are Telstra and telecommunications the member bodies of the HPCA. In August 2002 the Government announced a second inquiry into telecommunication services to rural, regional and remote Australia, chaired by Dick Estens from Moree. The Inquiry was part of the Government’s decision not to proceed to a full sale of Telstra “until the services are of a standard that regional and rural Australians should expect”. Other members of the review panel were Jane Bennett and Ray Braithwaite.

Page 8 The inquiry was asked to consider service reliability and performance in key areas, such as mobile phone and broadband coverage; the performance of Telstra as the primary Universal Service Provider; what exactly is “an acceptable standard of service”, and how ATSIC to ensure that people from regional, rural and remote areas have equality of service. Aboriginal and Torres Strait The Alliance made a submission to the review. Its main points were as follows. Islander Commission • Good access to telecommunications is a human rights issue for people in rural and remote Australia — part of the essential infrastructure for quality of life. Member since February 1993 • Any inquiry must take into account the current status of services and the full impact of privatisation on services in the future. ATSIC is Australia’s national policymaking and advocacy organisation for Indigenous • Telehealth initiatives, while valuable, should be seen as adjuncts to an adequate local people. ATSIC is an independent health workforce, rather than as replacements for it. statutory authority established by the • Access to reliable and affordable telephone services is fundamental Commonwealth government in 1990 for many small non-government health organisations in rural under the ATSIC Act. Australia. These small organisations are often the ‘lifeline’ for promotion and advocacy in terms of the needs of their communities and jurisdictions. Their survival is tied to their ongoing capacity to access affordable and reliable telephone services. • In order to achieve ‘equivalent access and service for equivalent need’, there will need to be cross-subsidisation, special programs for particular areas and positive discrimination, and the Alliance supports market intervention by governments in order to provide a guaranteed level of service. • Internet is important in rural areas for health services and information, for education and training support for health professionals, to enable participation in community and national life,

Page 9 and for its contribution to recreation and social participation for general health and well-being. Rural people expect that their cost of access to internet should be no more CRANA than in cities, including for connect and download time. Council of Remote Area Nurses • People in rural and remote areas need assurances that Community Service Guar- antees and Universal Service Obligation will be monitored effectively. of Australia Inc • Telstra Country Wide has had a direct and positive impact on services and represents Member since May 1992 a useful devolution of resources and authority away from capital cities. • There needs to be a regular review process about regional service levels and init- CRANA was founded in 1983 to put iatives, aimed at maintaining reasonable equity with metropolitan Australia. remote health issues on the national agenda. CRANA promotes the The Estens Report was handed down in November 2002. Its recommendations development and delivery of safe, high acknowledged: quality health care to remote areas of • the need for a review and assessment of the Universal Service Obligation, including Australia and her external Territories with regard to Indigenous communities; (CRANA Constitution). • the need to identify areas where extending terrestrial mobile phone service is feasible; • a growing priority for equitable access in regional, rural and remote Australia to higher bandwidth internet services and a reduction in connection times; • a need for improved data collection and monitoring of needs and services in remote Indigenous communities; • the need to require Telstra to regularly report on its achievements of the Government’s broad objectives; and • the importance of planning for the future which takes into account a flexible, informed and strategic approach to the special needs of regional, rural and remote areas.

The risks inherent in the potential full privatisation of Telstra remain of concern to families and businesses in rural, regional and remote areas. Page 10 Advocacy Promoting Policy The Alliance continued to advocate on its agreed positions in a variety of ways. Letters were sent to those in a position to act on suggestions, and meetings held as appropriate. Media Releases were produced and distributed in hard copy and by CRHF of CHA email. Subscribers to the fortnightly e-forum increased from 1,150 in July 2002 to Catholic Rural Hospitals Forum around 1,700 by the end of the financial year. The website received an average of 280- 354 visitors per day in various months in the year under review. The Alliance’s CD ROM of Catholic Health Australia on research reports in rural and remote health was updated. Member since October 2002 After the 7th National Rural Health Conference a special workshop was held — From Energy to Shared Action — to agree on and initiate early action on the priority Conference Catholic Health Australia is the national recommendations. (See the separate item below.) organisation representing more than 680 Catholic health care sponsors, systems, The Alliance’s advocacy work helps with ‘capacity building’ for rural communities, which is facilities, and related organisations and founded on education, health and transport. High quality and accessible health services services. This represents the largest non- add to the attraction of certain areas for local families, industries, workers and tourists. government provider grouping of health, One of the most important national health policy developments during the year was the aged and health related community care negotiation between the Commonwealth and States/Territories of a new 5-year Australian services in Australia. Health Care Agreement (AHCA). As part of this process a number of Reference Groups were established, including two on which the Alliance was represented: Interaction Between Hospital Funding and Private Health Insurance (Dr Nola Maxfield), and Improving Rural Health. Face-to-face meetings were held and a number of teleconferences. Final Reports were produced in September 2002, following consideration of drafts by the Groups’ Chairs and the Health Minister responsible for each.

Page 11 A substantial amount of effort was put into the nine reports and it was expected that the negotiated AHCAs would contain directions and initiatives reflecting that work. CWAA These hopes were not met. A period of uncertainty was followed by another bout of blameshifting, before the Commonwealth and the States/Territories eventually signed the Country Women’s Association new Agreements. of Australia The Final Report from the Improving Rural Health AHCA Reference Group can be found on Member since May 1992 the Alliance website.

The CWA enables the Member Submission on Ageing Associations to speak with one voice In February 2003 the Alliance made a submission to the Inquiry into long-term strategies on national and international matters to address the ageing of the Australian population over the next 40 years conducted by through the National President. It the House of Representatives Standing Committee on Ageing. The Submission was represents the concerns of Member structured around the principles of the National Strategy for an Ageing Australia. Associations to the Federal Government, Although remote centres have a youthful population, Australia’s s trend towards an ageing non-Government Organisations population is more pronounced in rural and remote areas overall than in the cities. and other national bodies. While rural, regional and remote areas are extremely diverse, some generalisations are possible about the circumstances of older people in non-metropolitan areas that distinguish them from their capital city peers. The Submission focused on these rural aspects of ageing and defined the following risks: • the adverse effects of distance on access to services (most significantly the poor supply of local aged care places and services); • the more common absence of growth and, as a consequence, the more common existence of poor physical infrastructure; • poor communications (including transport);

Page 12 • small numbers, which impacts on the unit costs of services and the relative shortage of support staff; FS • the greater incidence of some health risk factors such as smoking, obesity, and avoidable injury and accidents; and Frontier Services of the Uniting • stigma, caused by the greater visibility of circumstances. Church in Australia These risks to well-being are counter-balanced by some of the positive factors for older rural people, such as having peace and quiet, lower housing costs, the relative absence Member since October 1999 of community violence and the greater visibility of aberrant behaviours and, for those who Frontier Services provide some 60 can grow old where they were brought up, a great sense of comfort from being in known services operating in rural and outback surroundings. Australia, reaching many isolated Overall the major limitations in the health and aged care systems for older people in individuals and families. Its 300 country areas relate to access and inequitable resource allocation. The outstanding areas specialist staff cover Health Centres of under-resourcing are in the areas of capital resources for the development and and Clinics; Aged Care, and Home and upgrading of aged care places; training, support and remuneration of workers in the health Community Care; Family Support and aged care sector; oral and dental health; income and/or capital support for people Services; Community Services; Student in rural and remote areas whose financial means have been adversely affected by Group Home. developments beyond their control; and some special consideration for ageing Indigenous people (from a realistic age for their particular circumstances). The submission presented 20 key strategies (in the spirit of the National Strategy) and, under each of them, some specific recommendations. A copy of the submission is available at www.ruralhealth.org.au The Alliance appeared before the Committee in March 2003.

Page 13 PARTYline HCRRA PARTYline is the Alliance’s quarterly newsletter, sent in hard copy to around 8,000 people on the database. Editor of PARTYline is Michele Foley. Health Consumers of Rural In 2002-2003 one of the objectives was to have 80 per cent of the content contributed and Remote Australia by readers and health professionals or consumers in the field. The target was exceeded for the later issues in the financial year. Member since May 1992 A small survey of selected readers was undertaken to ascertain views on content. HCRRA is a not-for-profit organisation that The majority of those who responded felt that the articles were about the right length and works to improve rural health outcomes relevant to their work. A small number wanted a different mix of stories from the different by involving consumers in the planning, professions — but whereas some of these wanted more on a particular discipline, others implementation, management and wanted less. (One respondent wanted an extra day in the week so they could read evaluation of health services throughout PARTYline properly!) non-metropolitan Australia. Members of On the whole, people were happy with PARTYline. It will remain one of the central means HCRRA are given the opportunity to for the Alliance to promote good news stories in rural and remote health while also represent the views of people who live in retaining some focus on outstanding unmet needs. rural and remote Australia in the planning and implementation of a broad range of health issues that directly affect them.

Page 14 Conferences 6th National Undergraduate Rural Health Conference (NURHC) The postponed 6th NURHC was successfully ICPA – Aust held on the Tasman Peninsula from 8-12 August 2002. Of the 250 delegates who attended, Isolated Children’s Parents’ about 200 were undergraduates from the rural health clubs around Australia. Association of Australia Inc 7th National Rural Health Member since May 1995 Conference ICPA (Aust) is a voluntary national parent Over 900 delegates gathered in Hobart from Senator Kay Patterson with students at the body dedicated to ensuring that all 1-4 March 2003 for the 7th National Rural 6th NURHC geographically isolated students have Health Conference. equality with their non-isolated peers, of access to an appropriate education. The following is extracted from Weaving Healthy Communities: The Story of the 7th National Rural Health Conference, written by Ray H Walker and published by the Alliance The Association has over 3,300 in July 2003 (available on the website). member families, residing in the more The 7th National Conference was held at a time when the Commonwealth and the State remote parts of Australia, who all share Governments were setting the broad parameters of the health system for the next four to a common concern of gaining access five years. to education for their children and the provision of services required to The Commonwealth Government is concerned about the sustainability of the Pharma-- achieve this. ceutical Benefits Scheme because of its increasing cost over the long term. The current Medicare arrangements are under strain as the proportion of bulk-billed pa- tients continues to drop. This has led to significant concerns about whether Australia will continue to have a universal health insurance system. The NRHA strongly supports the principle that people have universal access to affordable care irrespective of their location. The Alliance believes Medicare should be restructured to ensure that rural people pay no Page 15 more in out-of-pocket costs than city people, while recognising the real costs to medical NACCHO practitioners of providing services in rural and remote areas National Aboriginal Community Controlled Health Organisation The Commonwealth and the States have neg- Florence Manguyu addresses the 7th Conference otiated new 5-year agreements under the Member since December 1993 Australian Health Care Agreement to apply from July 2003. These new arrangements will determine the nature of public hospital services NACCHO is the national peak Aboriginal available to the Australian community. health body. It has a membership of The NHMRC is developing its priorities for the next research triennium to apply from around 100 Aboriginal community July 2003. controlled health services throughout Australia, which operate in urban, rural These major issues will have significant implications for the and remote areas. structure and costs of Australian health care system with clear implications for the nation’s capacity to provide an effective NACCHO represents the health health care system in rural and remote areas. interests of Aboriginal communities at the national level. It promotes holistic The Conference sought to promote a whole-of-life approach to and culturally appropriate health to improving health, particularly in rural and remote Australia. It aimed to bring community, professional and government Aboriginal communities. interests in health, education, the arts, environment, transport, community services, and economic development together with people and ideas from rural and remote areas. This was expressed by the Conference motto: ‘The Art and Science of Healthy Community — sharing country know-how’.

Despite the progress made over the past decade, the health Bake Lite Girls at the of rural and remote Australians still lags behind that of their 7th Conference Page 16 city compatriots. The Conference sought to encourage the necessary continuing effort through tapping com- munity experience and knowledge, learning from the NARHERO past and by emphasising inter-sectoral, inter-professional and inter-governmental collaboration. National Association of Rural Health Education and The opportunities for interaction and cross-pollination Research Organisations between consumers and providers, and between all Laughter therapy at the 7th Conference professions involved in rural community development Member Since November 1994 and the health of people in country areas, were intended to enable the Conference as a whole to identify the barriers to enabling rural Australians to be as healthy as other The National Association of Rural Health Australians. The resulting Conference recommendations make demands on participants, Education and Research Organisations their communities, their professions and their governments as they work toward this vision. (NARHERO) is a collaborative group of They also provide a charter for the work of the NRHA over the next two years. organisations working together for the To reach its conclusion and recommendations the Conference included four types of support and development of the activity. First, twenty keynote speakers provided insights into various aspects of the Australian rural and remote health Conference themes. Second, the presentation of papers educated, challenged and workforce through research and education. promoted discussion among participants. The Infront Outback stream for refereed research papers made a key contribution here. Third, the ‘Art of Healthy Community’ activities gave opportunities to experience and conceptualise the themes through an alternative group of intuitive and creative activities. Finally, all the Conference participants had opportunities to be involved in drawing up the Conference recommendations. The Conference recommendations were considered at the From Energy to Shared Action workshop the day after the Conference. This workshop established an agenda and work program for the NRHA and other bodies to promote and encourage the actions the Conference had recommended.

Page 17 Immediately before the Conference a symposium organised by the National NRHN Aboriginal Community Controlled Health Organ-isation (NACCHO), in collaboration National Rural Health Network with the Australian Indigenous Doctors’ Association and the Congress of Aboriginal Member Since October 1997 and Torres Strait Islander Nurses, provided an Recipients of Des Murray Scholarship: Brett The primary aim of the NRHN is to opportunity to review progress in Aboriginal Gibson and Monica Walley with Mary Murray provide a communication network and Torres Strait Islander health services. between rural health clubs, for the At the same time a symposium on procedural rural medicine, organised by RDAA, ACRRM sharing of ideas and information. The and the State Rural Workforce Agencies, considered issues associated with reversing the ideal in providing rural clubs with ideas decline in the numbers of GPs providing obstetric, anaesthetic and surgical services to and information is to enable them to rural communities. The results of both of these symposiums informed the considerations become pro-active in issues affecting of the Conference. rural health. From Energy to Shared Action On 4 March 2003 Norman Swan facilitated a planning meeting — From Energy to Shared Action — to begin taking foward priority recommendations from the 7th Conference. Sixty- five representatives from national bodies and grassroots health workers developed statements on eleven key issues: 1. improving the status of Indigenous health, including through evaluations of the per- formance of ‘mainstream health services’ by community controlled Indigenous health services, greater use of joint planning forums, the employment of greater numbers of Indigenous people in health professions, Indigenous content in curriculums, and staff exchanges between the community controlled and mainstream health sectors;

Page 18 2. an integrated plan for improving the rural and remote health workforce, and clear lines of responsibility for delivering on it; RDAA 3. work to develop a sustainable, equitable and high-quality placement system for students and short-term health staff in rural, regional and remote communities; Rural Doctors’ Association of 4. a rescue package for procedural medical services, based on collaboration between Australia local, State and Commonwealth Governments, academia, the professional Colleges, and hospitals; Member since May 1992 5. reassessment of the systems of classification used for funding and resource allocation in rural and remote health (RRMA, ARIA and ASGC); RDAA’s vision is for excellent medical care in Australia’s rural and remote 6. endorsement of Conference’s support for the seven goals and eight principles of communities. Our motto is ‘caring for Healthy Horizons Outlook 2003-2007; the country’. 7. endorsement of Conference’s call for the implementation of the 7-Point Action Plan on Nursing in Rural and Remote Areas (and support for the proposal to convene a RDAA advocates for highly skilled and national meeting on issues affecting rural and remote allied health professionals); motivated medical practitioners who 8. a call for more work on the post-trauma crises associated with flood, drought and are adequately trained, remunerated fire, and for additional investment in infrastructure and services enabling communities and supported, both professionally to rebuild; and socially. 9. a funded strategic approach to rural and remote health research, building on the By working closely with our members existing infrastructure in rural, regional and remote areas, and driven by the agenda and key stakeholders such as the in rural areas so that the research is closely related to real health improvements; Commonwealth Government, RDAA 10. the need for major rural, regional and remote investment in early intervention in child provides support, policy development, and adolescent health; and research, submissions and strategic advice on relevant issues.

Page 19 11. a call for increased commitment to a comprehensive system of aged care and other RF of RACGP services for the elderly in rural and remote areas. Full details about the 7th Conference and its recommendations are at www.ruralhealth.org.au Rural Faculty of Royal Australian College of GPs Planning for the 8th National Rural Health Conference The Alice Springs Convention Centre has been booked as the venue and plans are well Member since May 1992 underway for the 8th National Rural Health Conference to be held 10-13 March 2005. The Faculty of Rural Medicine of the The location of the Conference will provide a natural opportunity to focus on remote health Royal Australian College of General issues. (See 8th Conference on the website.) Practitioners (RACGP) was established on 26 April 1992 by a group of dedicated Frontier Services rural GPs who believed that a stronger On 26-28 September, Frontier Services, a Member Body of the Alliance, held its rural voice was needed within the RACGP. Conference “Back to the Outback — Sustaining Community Beyond 2002” in Alice Springs. The Conference was a combination of open conference, team building, and personal and Over the last 10 years, the National professional development. Those at the Conference reflected the broad community and Rural Faculty (as it became in 2002) has professional roles of Frontier Services: senior Church leaders, patrol ministers, remote been a most progressive, dynamic and area nurses and aged care professionals, Student Group Home parents, migrant workers, innovative Faculty within the RACGP, now financial advocates, counsellors, volunteers and support group leaders, and admin- representing over 1300 members. istrative staff from city and remote offices. Toowoomba: where it all started The 1st National Rural Health Conference was held in Toowoomba in February 2001. Since then The Garden City has been a key centre for developments in the rural, regional and remote health sector. A number of the Alliance’s key players have been based in Toowoomba. Michael Bishop was closely involved in the establishment of ARRAHT and Page 20 SARRAH. Desley Hegney was Foundation Editor of the Australian Journal of Rural Health. Lesley Fitzpatrick has been centrally RFDS involved with recent National Rural Health Conferences, especially after the decision The Australian Council of the was made to amalgamate the Infront Royal Flying Doctor Service of Richard Eccles, Sue Wade and Desley Hegney Outback conference with it. Lyn Hodgson was Australia an allied health delegate to Council of the Alliance in earlier days and Lisa Hudson, Danielle Hornsby and Ans Van Erp are other leading rural allied health professionals who Member since December 1993 are in Toowoomba. Other long-term Toowoomba Alliance friends include Louis Ariotti, Glenys Cockfield, David Hardie, Natalie Hindmarsh, Denis Lennox, Mary-Rose McNaught The Royal Flying Doctor Service of and Peter Rookas. The city is home to the Cunningham Centre and the Toowoomba Australia is a not-for-profit charitable Hospital Foundation (THF), with which many of these people have been associated. service providing aeromedical emergency and primary health care services together The THF sponsors the Infront Outback Research Grants Program to promote and support with communication and education research relevant to rural and remote health. The Program provides seeding grants for assistance to people who live, work and research in rural and remote health. travel in regional and remote Australia. The Foundation also sponsors the Louis Ariotti Award, named in honour of a legendary bush practitioner who has contributed significantly to improving rural health. The Louis Ariotti award encourages excellence and innovation in rural and remote health by recognising those who have made a significant contribution to it in Australia. The Award is made very second year. Ray Taylor, Chairman of the Toowoomba Hospital Foundation, welcomed Lesley Fitzpatrick and the Executive Director to the THF Board meeting in August 2002. This was part of the formal agreement between the Foundation and the Alliance about ongoing collaboratrion with the biennial Conference.

Page 21 Meetings Council, Executive, AGM Council met by teleconference five times during the year, face-to-face at CouncilFest RGPS (including the AGM), and on two occasions at the 7th National Rural Health Conference in Hobart. The Executive met by teleconference on six occasions during the year and in Regional and General person at CouncilFest. All Member Bodies had the opportunity to be represented at the Annual General Meeting held during CouncilFest. Paediatric Society CouncilFest 2002 Member since October 1999 Council of the Alliance met face-to-face in Canberra RGPS is a group of more than 130 from Friday 18 to Tuesday 22 October 2002. Council regional, rural, remote and urban met in camera at the beginning of the meeting and paediatricians. They are specialists in then had a facilitated day of learning (with staff) led hospital care, neonatal care, child by Paul Martin and Eric Leape. The Strategic Plan, development and behavioural issues Business Plan and Draft Budget for calendar 2003 as well as children’s and adolescent were signed off, and a framework for the Alliance’s medicine. Members work in rural and commercial activities (including the provision of of- remote hospitals, private rooms, fice space and administrative support for co-located community health centres, and hospital bodies) was agreed. Project reports were discussed with staff and written reports from Member Bodies and outreach clinics. considered. Work was done on draft Position Papers, and on some outstanding governance issues. There was a discussion of the Alliance’s ongoing involvement with Indigenous health issues. On the Monday Councillors met with a number of Par- Members of NRHA Council liamentarians in Parliament House. On the last day of CouncilFest 2002 the Alliance met with representatives of the AIHW, AMWAC, ARHEN, PHAA, the Office of Rural Health, the General Practice Branch of the Department, and Aged and Community Services Australia.

Page 22 Networking and collaboration NRHA’s membership of other organisations The National Rural Health Alliance is a member of the following organisations: • Alcohol and Other Drugs Council of Australia RPA • Australian Council of Social Service • Australian Health Reform Alliance Rural Pharmacists Australia — • Australian Research Alliance for Children and Youth the Special Interest Group of the • Board of Management for the Australian Journal of Rural Health Pharmacy Guild of Australia, the Pharmaceutical Society of • Health Consumers Council Australia and the Australian • Mental Health Council of Australia Society of Hospital Pharmacists • National Healthcare Alliance • National Rural Women’s Coalition Member since November 1994 • Public Health Association of Australia The PSA is the national professional • Rural Education Forum Australia organisation for pharmacists in Australia. NRHA’s representation on committees The Society of Hospital Pharmacists of Australia is the professional body In addition to its formal membership of the organisations listed above, during 2003 the which represents pharmacists National Rural Health Alliance was represented on the following: practising in Australian hospitals and • AMWAC General Practice Working Party similar institutions. • Board of Mental Health Council of Australia The Guild was established in 1928 and is • Commonwealth Aged Care Nursing Scholarship Scheme Implementation the national employers' organisation that Advisory Group represents some 4,500 pharmacies • Commonwealth Postgraduate Nursing Scholarships Committee throughout Australia. • Community Capacity Building in Palliative Care Committee, Department of Health and Ageing Page 23 • Health Services Advisory Committee SARRAH • HealthConnect Business Architecture Committee • National Arthritis and Musculo-Skeletal Conditions Advisory Group Services for Australian Rural • National Project Advisory Panel for the Project on Options, Opportunities and and Remote Allied Health Older People • National Project Advisory Panel for Making Choices: How older people living in Member since May 1995 independent living units decide to enter the acute care system Services for Australian Rural and • National Public Health Partnership Advisory Group Remote Allied Health is a ‘grassroots’ • National Review Committee of Tele and Web Counselling Services organisation whose membership consists • Nursing Scholarships Committee on Re-entry and Upskilling of individual allied health professionals • Queensland University Palliative Care Curriculum for Undergraduates across rural and remote Australia. SARRAH is nationally recognised as a Janine Watts attended an Emergency Care Forum in Melbourne (26 June 2003) for the Alliance. peak body representing rural and remote Allied Health professionals. Rural Sub-committee of AHMAC The Alliance continued to meet regularly with the Rural Sub-committee of the Australian Health Ministers’ Advisory Council (AHMAC). For the meeting held in Darwin in June Rosemary Jeffery attended in person and Nigel Stewart and the Executive Director called in by phone. The Alliance reiterated its concern about the future of the medical workforce which, despite the expenditure of substantial sums of money, is still experiencing something of a ‘slow demise’. Globalisation of the health workforce is a phenomenon that will impact on all professions, including nursing and allied health. The Alliance discussed its support for the proposals in the Government’s Medicare package for additional undergraduate places, Registrar training positions and practice nurses for outer metropolitan areas. It did not support the proposed changes to Page 24 arrangements for bulk billing. The Alliance wants to preserve the universality of the health insurance system and then to see improvements in the Medicare system so that it is more equitable for people in rural and even remote areas. Although the Alliance had not commented publicly on the stalled AHCA negotiations, it indicated its disappointment that the earlier promise of the Improving Rural Health Reference Group established over a year ago as part of the AHCA negotiations did not seem to have been delivered. The Alliance wrote to the Government asking that the PBS be not included as a bargaining chip in negotiations with the US on a Free Trade Agreement. The Alliance had also written to the NH&MRC about the Conference recommendation for more mainstream health research to be located in rural institutions and for more to be on rural issues. The Alliance pointed out that together these four — Medicare, the Australian Health Care Agreements, the PBS and the NH&MRC — will continue to provide the policy context in which rural health status is determined. Australian Health Reform Alliance The Alliance was a founding member of the new Australian Health Reform Alliance, (AHRA) convened by Professor John Dwyer. The AHRA was stimulated by the opportunity to use the negotiation of a new Australian Health Care Agreement to institute change in health policies and financing. Planning meetings were held by teleconference and in Sydney. The meeting in Sydney in June 2003 began planning for a Health Care Summit to discuss the desired principles to be applied to the national health system, major policy issues that should be incorporated into a revised set of Australian Health Care Agreements, and the creation of an instrument to move forward into the future in a way that would end, once and for all, the arguments between State, Territory and Federal Governments. Representatives of the Alliance met with Minister Patterson and continue to propose ideas for the future of healthcare in Australia. Page 25 National Healthcare Alliance Developments following the Inter-Generational Report released with Budget 2002 led to the establishment in 2002-2003 of a new National Healthcare Alliance (NHA). It is led by the Pharmacy Guild of Australia and was designed as an independent Think Tank on health policy. The NRHA was a founding member of the NHA. Several national bodies are mem- bers of both the NHA and the Australian Health Reform Alliance. The projections in the Inter-Generational Report were based on three variables: growth in population, ageing and selected non-demographic factors. The NHA is working to provide alternative models for projecting health expenditures (including on the PBS). Following a number of planning meetings the NHA held a workshop on 18-19 June on the future of medicines policy. Dr Bruce Harris and the Executive Director attended the workshop for the Alliance. Rural Education Forum Australia Key parties behind the push for the Rural Education Forum Australia (REFA) were the Isolated Children’s Parents’ Association (ICPA) and the National Farmers’ Federation (NFF), in particular Megan McNicholl and Ben Fargher. The Alliance also played a key role and was used as a model for the establishment of the new body. A substantial amount of networking and grassroots work led to the formal establishment of REFA in 2002-03. The Minister for Education, Brendan Nelson, announced seed funding for the REFA Secretariat at the Federal ICPA Conference in Charleville in August. At the first meeting after that announcement (Canberra, Wednesday 21st August 2002) the following decisions were made:

Page 26 • to sign off on the REFA Constitution and prepare application for Incorporation in the ACT; • to agree on the business plan and develop a work agenda setting priorities for the next 12 months; • to establish a management committee to oversee operations until Incorporation takes place; • to establish a process for the selection of staff for the REFA Secretariat; and • to start planning for the November Roundtable. The first REFA Roundtable was held in Canberra on 30 May. Shelagh Lowe and Sue Wade represented the Alliance. National Rural Women’s Coalition The National Rural Women’s Coalition comprises: • Country Women’s Association of Australia; • Australian Local Government Women’s Association; • Australian Women in Agriculture; • Foundation for Australian Agricultural Women; • Isolated Children‘s Parents’ Association; • National Rural Health Alliance; • Women’s Industry Network Seafood Community; and • a rural Indigenous woman.

The Alliance was a founding member of the NRWC. The first face-to-face meeting was held in Canberra on 10-11 March. The Inaugural Roundtable was held on 1-2 June, also in Canberra. Shelagh Lowe, Carmel Brophy and Sue Wade attended for the Alliance. Page 27 The Coalition is to encourage and support input from rural women into Federal Govern- ment policy, to assist women to access information and education, and to be a conduit between the women’s sector and Government. It is funded by the Commonwealth Office of the Status of Women (OSW) and joins three other national secretariats representing business women (Australian Federation of Business and Professional Women), young women (YWCA of Australia) and older women (National Council of Women in Australia). Australian Rural and Remote Workforce Agency Group In July 2002 the Australian Rural and Remote Workforce Agency Group (ARRWAG) decided to move its office to Canberra. RHSET The Alliance provided representatives to the Advisory Committee on the Rural Health Support, Education and Training Support Program (RHSET). On behalf of the people of rural and remote areas, thanks to the Government for retaining this valuable program over the years. And thanks to Lesley Fitzpatrick, Victoria Gilmore and Sue McAlpin for representing the Alliance on this Committee this year. CommunityLIFE The CommunityLIFE project is part of the National Suicide Prevention Strategy and is funded by the Commonwealth Department of Health and Ageing. It aims to support groups in the community to plan and develop suicide prevention activities and programs. It is based on the Living Is For Everyone or the LIFE Framework, the national framework for suicide prevention activities in Australia. The LIFE Framework takes a holistic approach, addressing risk factors and strengthening those factors known to be protective against suicide and suicidal behaviours. There is a mainstream and an Indigenous component to the CommunityLIFE Project. Page 28 The LIFE Framework has four broad goals: 1. Reduce deaths by suicide across all age groups in the Australian population, and reduce suicidal thinking, suicidal behaviour, and the injury and self-harm that result. 2. Enhance resilience and resourcefulness, respect, interconnectedness and mental health in young people, families and communities, and reduce the prevalence of risk factors for suicide. 3. Increase support available to individuals, families and communities affected by suicide or suicidal behaviours. 4. Provide a whole-of-community approach to suicide prevention and to extend and enhance public understanding of suicide and its causes. The Centre for Developmental Health of Curtin University of Technology, Western Australia, has overall responsibility for the management of the project in collaboration with the Australian Network for Promotion, Prevention and Early Intervention in Mental Health (Auseinet) based in Adelaide, Suicide Prevention Australia (SPA) in Sydney, and the National Aboriginal Community Controlled Health Organisation (NACCHO) in Canberra. NACCHO has the lead role in overseeing the implementation of the Indigenous component of the project. The Alliance was involved in 2002-03 in planning meetings for the project.

Page 29 Section 2: Managed Projects

RAMUS Scholarships Overview In 2002-2003, the NRHA’s Rural Australia Medical Undergraduate Scholarship Team comprised Carmel Brophy (Manager), Alison Coleman, Janine Sahlqvist and Gordon Gregory, with information technology consultancy back-up from Web Management Systems. Nicole Allen and Office Manager, Leanne Coleman, provided accounts support. Casual staff were engaged to assist the Scholarship Team during the peak workloads. The co-operative working relationship between stakeholders in the RAMUS Program further developed in the twelve months under review. The period was a period of significant change covering: • the introduction of the web-based scholarship database; • the implementation of a range of changes to ongoing RAMUS scholar eligibility; • the use of a modified application process; and • an evaluation of the administration of the Scheme.

Page 30 Introduction of the Web-based Scholarship Database The administration of RAMUS, like the Alliance’s other activities, was enhanced by the introduction of OSCAR (the Operating System for Contacts, Administration and Response) in September 2002, and its web-based component covering the scholarship database. The introduction was not without attendant problems, and these had to be addressed. Scholarship holders and administrative staff can access OSCAR remotely via the Internet to check contact and payment details, with personal contact information able to be amended as required. This facility was tested well when all members of the Scholarship Team were absent from the office during the 7th National Rural Health Conference in Hobart in March this year, when the Team was able to maintain its high level of service to stakeholders. OSCAR also offers flexibility in administration. For example, through OSCAR’s compre- hensive programs, members of the team can take account of the individual financial

Male/female percentage of RAMUS scholars as at 30 June 2003

Page 31 situations experienced by postgraduate and undergraduate scholars. Postgraduate scholars have a longer academic year and their scholarship payments have been spread over that longer year whilst maintaining the same level of personal service to under- graduate scholars. Implementation of a Range of Changes to Ongoing Eligibility The changes in the ongoing RAMUS scholar eligibility have progressed well. Scholars responded to the changed requirements by providing appropriate supporting paperwork with a minimum of fuss, with the majority of scholars providing the required supporting paperwork in the required timeframes. The Scholarship Team received a large number of telephone calls requesting information about the changed requirements from scholars who did not receive advice of the changes despite notifying them by email and by post. The

Scholars by university as at 30 June 2003

100

80

60

40

20

0

JCU UQ UTAS UWA UNSW Sydney Flinders Monash Adelaide Page 32 Newcastle Melbourne outcome of this contact has been a realisation by scholars of the importance of keeping the Scholarship Team informed of their current contact details. Having the payment of scholarships linked directly to acquittal requirements has produced a welcome sense of responsibility and proactive contact by all stakeholder groups — ie scholars, mentors and university administration centres. The receipt of mentor and scholar reports also underpinned the ongoing operation of the Scheme. Mentors have responded positively to the mentor pro forma reporting format introduced at the end of 2002. Use of a Modified Application Process The new application procedures introduced during the 2003 application round worked well. They made best use of staff resources by streamlining the quality control process called for in the application process. Applications on-line via OSCAR far exceeded paper- based applications this round. This meant that small inconsistencies in the on-line system were identified and addressed. The data obtained through the on-line system fed into the computerised ranking process for the first time this year. The detailed testing carried out confirmed the accuracy of this automated ranking process. The issues that arose related to discrepancies between income figures stated in the application form and the actual figures contained in certified evidence provided to confirm eligibility. Some discrepancies required the applicants to be re-ranked to ensure their eligibility was confirmed. In 2003, 78 scholarships were allocated through the ranking process and 10 scholarships through the appeals process. Stakeholder feedback from the application and appeals processes was passed to the Department of Health and Ageing to inform the process for successive years.

Page 33 Evaluation of the Administration of the Scheme The purpose of this evaluation is to check with stakeholders that the service being offered by the Alliance in its administration of RAMUS is appropriate and is meeting their require- ments. Participants in the evaluation included scholars, mentors, university administration staff, other Alliance staff and Alliance Councillors. Participants were urged to be honest and to offer suggestions about what would make the service delivered by the Scholarship Team at the Alliance more appropriate to their requirements. An independent consultant undertook the analysis and report.

RAMUS scholars by gender, 2000-2003

70%

60%

50%

40% Male 30% Female

20%

10%

0% 2000 2001 2002 2003 Total

Page 34 friends of the Alliance friends of the Alliance is a membership body for individuals and organisations wanting to have a special relationship with the Alliance. In return for a small membership fee, friends receive the CD ROM and PARTYline, and are asked to contribute directly to the development of policy in areas that particularly interest them. During 2002-03 friends met its income target. It had 144 individual and 32 organisational members. An Advisory Committee was established of friends members. The draft position paper on Child Health will be circulated to friends of the Alliance once it has been seen by Council. Being such a practical document, and because child health affects so many of our members either directly or indirectly, there should be a high level of response. Anecdotal experiences of friends members will be included to give weight to the document in the same way as for the Aged Care Submission. Members of friends led the substantial consumer participation at the 7th Conference in Hobart.

Australian Journal of Rural Health The last twelve months have seen many changes for the Australian Journal of Rural Health. There have been changes in personnel, some small changes in content and look of the Journal (more changes to come!), changes in terminology for the new publishing agreement, and a change of location for the Journal managers. In July 2002, the Board of Management welcomed new Editor, Professor John Marley, who is Pro Vice-Chancellor (Health) in the Faculty of Health at the University of Newcastle, and his Editorial Team: Margaret McMillan (Deputy Editor), Juliane Ward (Editorial Assistant) and Samantha Brookes (Executive Officer). The significant contribution of the Journal’s founding Editor, Professor Desley Hegney, was publicly recognised at the 7th National Rural Conference in Hobart in March 2003.

Page 35 With the resignation of Shirley Preston and Karen Francis during the year, the Board also welcomed new members Renae Moore (SARRAH) and Pam Brinsmead (AARN). Renae and Pam join existing Board Members, Tony Balston (ACRRM), Chris Moorhouse (CRANA), Gordon Gregory (NRHA) and Alma Ross (BPA). John Marley’s earliest innovations included the introduction of structured abstracts with each article, as well as the inclusion of “What is already known” and “What this study adds” boxes to enable the scanning reader to identify articles of interest. Preparatory work has begun for the development of a new cover design. John has a major interest in increasing the mix of articles that appear in the Journal — to include more papers from allied health professionals — and to reduce the average length of articles, so that more articles can be included in each issue. The Board of Management has this year agreed to the inclusion of Journal Associate logos on the inside front cover of the Journal, and to allow full-colour advertising on the back cover. The back cover sponsorship by Mercke Sharp and Dohme first appeared in February 2003. The National Rural Health Alliance has re-signed Publishing Agreements with Blackwell Publishing Asia and with the four Journal Associates: Association for Australian Rural Nurses, Australian College of Rural and Remote Medicine, Council of Remote Area Nurses of Australia and Services for Australian Rural and Remote Allied Health. Very early in John’s tenure, the Board of Management carried out a Readership Survey. The findings of this survey will form the basis for much discussion at a forthcoming Special Planning Day for the Journal. The Board of Management met five times during the year, four times by teleconference. A successful Writing for Publication Workshop was held in February this year in conjunction with the National Rural Health Conference in Hobart. Page 36 The National Rural Health Alliance, which owns and manages the AJRH, moved premises in May from 4 Campion Street to 10 Campion Street in Deakin. Most members of the BOM and some other people took advantage of the opportunity to stock up on back copies of the AJRH which had been ‘discovered’ in the move. John Marley and his Editorial Team at Newcastle are now well-established in its work. They are always seeking quality contributions for the Journal, and there is a current need for people willing to serve as referees. Please send articles and/or expressions of interest to the Editor at: PO Box 98 Union Building CALLAGHAN NSW 2308 or by email to [email protected]

The John Flynn Scholarship Scheme (JFSS) Having handed over administration several months previously, in July 2002 the Alliance wrote its final reprt to the Department on administration of the John Flynn Scholarship Scheme. The NRHA had assumed responsibility for national administration of the JFSS in March 2000. Prior to this the individual medical schools had administered it. In calendar 2000 the Scheme reached its full complement of 600 recipients: 150 in each of four calendar years. Almost all of the scholars in the first and second group under the JFSS have now com-pleted their four years’ placement and are full of praise for the Scheme. There are several benefits from national administration of the Scheme, including

Page 37 improved co-ordination and consistency, the greater availability of interstate placements and better co- ordination of rural student placements. The NRHA JFSS Project Team comprised Alison Miles (Manager), Gordon Gregory, Ali Coleman and Holly Neale, with technical support from Barry Cameron and ongoing support from the balance of NRHA staff (see picture). Regular consultation with Departmental Project Officers was of great benefit over the two and a half years for which Pop-Eyed Circus Theatre at the the Alliance did the work. 7th Conference Through the NRHN the student network was very supportive. Existing John Flynn Scholars were the best advocates encouraging applications. The JFSS continued to enjoy the support of many rural GPs who commented that the Scheme was of mutual benefit. Key members of the JFSS selection panel provided added intelligence for the identification and selection process of GP mentors and host communities. Two and a half years into the national administration, there was widespread support for the work undertaken by NRHA. The last six months saw a shift in attitude and perceptions with improved information dissemination enabled by the revised scholar agreement. There was strong support from most of the medical schools regarding NRHA’s work to bring a national approach to a disparate system. The JFSS is a large logistical project requiring intensive support. The NRHA has taken ser- iously its administrative role of the JFSS and wishes the new administrators the very best.

Page 38 Part 3: The Context for Rural Health

Budget 2003-2004 Following the Budget in May 2003, the Alliance confirmed its opposition to the changes which threatened the principle of Medicare’s universality. However, it wel- comed the Government’s intention to provide more undergraduate medical places and GP Registrar training positions for rural areas, and practice nurses for outer metropolitan areas. The Alliance used the Budget’s emphasis on ‘prevention’ to en- courage the Government to build on its rural initiatives for nursing, pharmacy, and allied health — and to work with the States on oral health. The Alliance said that alternatives exist for increasing the rate of bulk-billing, for instance through a meaningful increase in the rebate and the possibility of differential rural rebates. It also expressed the view that co-ordinated primary health care can be enhanced by more direct means, including in more remote areas. The existing Medicare system could cover the work of psych. nurses for mental illness and physiotherapists for musculoskeletal illness — to provide a more cost-effective system overall. The Alliance commended the ideals of lifelong education, proposals for investing in children’s health, and positive differentiation for rural areas that were outlined in Simon Crean’s Budget Reply Speech.

Page 39 AIHW — Australia’s Health in 2002 The Australian Institute of Health and Welfare (AIHW) was established in 1987 as the nation’s official statistical and research agency. Its headquarters are in Canberra and there are collaborating centres in Perinatal Statistics (UNSW), dental health (Adelaide), injury (Flinders), GP statistics (Sydney), Indigenous data (ABS Darwin), and health classification (QUT). The Institute deals with data on hospitals, disease registers, disease monitoring, population health, health priority areas, labour force, expenditure, mental health and disability. The AIHW produces a formal report to Parliament every two years, published as ‘Australia’s Health’. Its report shows that, by world standards, Australians live long lives, health risks are being actively tackled, and access to high quality health services is generally very good and generally improving. The 2002 report showed that these results were being delivered by a complex health system employing 640,000 people, and accounting for around $54 billion a year in health services (which was 8.5% of GDP). Highlights The highlights of Australia’s Health 2002 included: • Health status improving in general, the health system delivers, but lifestyle invest- ment needed. • Life expectancy continues to increase; now 82.1 females and 76.6 males. • Coronary death rates have continued to decrease, about 6% per year in the last 5 years. • Cancer survival better — now 57% males and 63% females (all cancers) survive after 5 years compared with 44% and 55% five years ago. Breast cancer 5 year survival rate is now 84%. • Hypertension decreasing — 22% of adults (25-64) now compared with 45% in 1980s. • Less than 16% of adults smoke daily — 24% in 1997.

Page 40 However: • Disability rate has not improved. • 50% of adults have high cholesterol levels. • Diabetes increased, double the number in 20 years — now 7.5% of the population, half not knowing they have it. • Overweight and obesity affect 65% of men, 45% of women, and 20% of children. • Physical inactivity increased, 38% in 1997 to 45% in 2000; tertiary educated increased more, from 29% to 38%. • Indigenous health has not improved — life expectancy still 20 years behind. Pressure points Ageing of population • Stable disability rates, in particular for those who require a high level of assistance. • Risk factors not reduced. • Residential aged care expenditure increased considerably — now over $4 billion. • Pharmaceutic expenditure increased considerably. • Hospital length of stay reduced — now 3.7 days total, 6.4 days excluding same day (last year 3.8 and 6.6 days). • Waiting time for elective surgery not reduced — median still 27 days (orthopaedic — median 44 days, many wait more than a year).

Page 41 Health and medical labour force • 640,000 (60% full time). Increased since 1995 by 12% (higher than other sectors — 10%), mostly in the part-time category. • ‘Enrolled’ nurse declined between 1996/7 and 2000/1 by 24%. New enrolment for basic nursing fell 2%, and bachelor level enrolment fell 68%. • Radiographers: shortage in comparison to demand. • Pharmacist enrolment increased slightly (570 in 1995 and 770 in 2000). • General shortage in the public sector, perhaps except GPs in cities. Health Expenditure • 1990-2000 health expenditure was 8.5% of GDP — $54 billion. • 71% funded by governments; private health insurance rebate pushed Federal share to 48%. • At $2,817 per person per year it is much lower compared with USA, lower than Canada and Germany; slightly higher than France and Japan, much higher than NZ and UK.

Page 42 Pharmaceutical Expenditure • $7.6 billion in 1999-00, 14% of total. • Government funded $4.4 billion (58%). • Real growth per year ranged from 5% (1996-7 to 1997-8) to 9.6% (1993-4 to 1994-5). 1997-98 to 1998-99 increase 8.8%. • About double the annual real growth (4%) for all health expenditure. Prescriptions by GPs • Problems managed varied immensely — hypertension 6%, upper respiratory tract infection 5%, vaccination 3%, depression 3%. • No prescription in 40% GP consultations; 38% with one. • 33% with no repeats, but 27% with 5 repeats (one month supply). • Antibiotics 15%, central nervous system 12%, psychological 8%, musculoskeletal and respiratory each 7%, hormones 6% and skin 5%. • Large increase in non-steroid anti-inflammatory drugs.

Page 43 Pillars of the (Australian rural health) establishment After many years as a key player in the rural and remote health sector in Australia, Professor Roger Strasser left Australia in August 2002 for Canada. Roger is now at the Northern Ontario Medical School in Sudbury. Sarah Strasser, previously Director of Training with the RACGP in Melbourne, is currently Consultant Director of Faculty and Staff Development for the Northern Ontario Medical School. Elaine Duffy moved to Canada where she is Professor and Dean of the Faculty of Nursing, University of Windsor in Jack Beach Southern Ontario. Karen Francis was appointed Professor President — ICPA (Rural Nursing) in the School of Nursing, Monash, Gippsland Campus. She was previously Head of the School of Clinical Sciences, at Charles Sturt University, Wagga. In February 2003 Don Perlgut took up his appointment as Chief Executive Officer of the Rural Health Education Foundation. He is continuing the Foundation’s work of developing, planning and broadcasting high quality distance education programs for health pro- fessionals living and working in regional and remote areas of Australia, as well as seeking further strategic opportunities for it. Judy Swann was appointed Executive Director of the newly-formed National Rural Women’s Coalition. The NRWC is co-located with the Alliance in Deakin. The North West Rural Clinical School appointed Judi Walker as its Chief Executive. Previously Judi was Head of the Tasmanian University Department of Rural Health based in Launceston. Jack Beach was elected President of the Isolated Children’s Parents’ Association (ICPA), the office formerly held by Megan McNicholl.

Page 44 Myra Pincott was elected National President of the CWAA, succeeding Marie Lally in the position. In July 2002, Wonca Melbourne closed up shop, as it were. Leanne Renfree, one of the key people behind the scenes at Wonca Melbourne, thanked delegates and their families “for making the effort to attend the conference and help create the wonderful friendly and inspirational atmosphere that existed during the four days of the conference”. She gave a special thank you to the overseas visitors and those who overcame various obstacles in order to attend. The ABC website http://www.abc.net.au/rural/worldhealth continues to hold information on the WONCA 2002 World Conference on Rural Health, which included development of The Melbourne Manifesto. The Melbourne Manifesto can be downloaded from the Alliance’s website under ‘Publications and News’.

We Need vets too In 2002 the Australian Government initiated a review of rural veterinary services because of a perceived shortage of vets in rural areas — particularly large animal vets. Peter Frawley undertook the Review. Because of similarities with issues relating to the shortage of doctors, nurses and other health professionals, the Alliance was able to provide some input to the review. An Issues Paper on rural veterinarians was prepared and the final report went to Government in February 2003. It is likely that there will be an Australian Veterinary Reserve which would use the skills of vets based in rural areas. Rachael Treasure, Axle and Danielle Wood Page 45 A Country Commission? In July 2002 the NSW Farmers’ Association called for establishment of a Country Australia Commission to focus on rural disadvantage and to help bridge the country–city divide. President, Mal Peters, said there is a mental as well as physical divide between city and country Australia, which affects the way governments make decisions regarding the country. Mr Peters suggested that the Commission would need to be established at the Com- monwealth level and would research and monitor policies from all levels of government that impact on country areas. It would carry forward the work done by the Regional Australia Summit 1999 and provide ongoing monitoring of relevant indicators, to track trends in services and opportunities available in country and city areas. This could be done through an annual report on the state of Country Australia — similar to the State of the Regions report prepared by Local Government and the State of the Environment report prepared to monitor and highlight environmental issues. This would assist in creating and maintaining a greater focus on the need to ensure all Australians, but particularly those living in country areas, have access to equitable and sustainable levels of services and opportunities in their communities.

Page 46 Part 4: NRHA Secretariat

Relocating the Office The Office of the NRHA moved in May 2003 from upstairs at the home of the Australian Health Insurance Association to upstairs at the home of the Australian Information Industry Association. It was a move of fifty metres but a thousand boxes, so thanks to all those who helped. (That’s 20 boxes per metre.) Leanne bore the brunt: thanks Leanne. The AHIA had been a great landlord so thanks also to Russell, Liz, Gayle, Peter and Wayne. They set a high standard for the AIIA to follow — which we are sure they will! We moved to a larger and better appointed office. Thanks also to the Office of Rural Health for their understanding and support. In the new Office we have Health Consumers of Rural and Remote Australia, AARN, the National Rural Women’s Coalition, NRRAHAS and SARRAH’s administration of the allied health scholarships as co-located colleagues. It makes for a pleasant sized group.

Birth of Oscar OSCAR, the Operating System for Contacts, Administration and Response, was born of the need to provide on-line registration facilities for the John Flynn Scholarship and RAMUS Scheme applicants. OSCAR was also developed to accommodate the entire range of NRHA contacts. It is accessible online, and by means of a user number and password contacts are able to keep their own records up to date. So if we need an address or a contact’s other details, all we have to do now is to Look Under ‘Contacts, Information, Notes, Delegations and Action’. Easy.

Page 47 NRHA Staff

Nikki Allan Carmel Brophy Alison Coleman Leanne Coleman Accounts Manager Manager, RAMUS Project Co-ordinator, Office Manager RAMUS

Lyn Eiszele Michele Foley Kristin Ginnivan Gordon Gregory Conference Manager Manager, friends, Database Manager Executive Director Editor of PARTYline and Speaker Liaison

Page 48 Kate Henley Justin Neale Fiona Patterson Executive Assistant – IT Manager Conference Secretary until September 2002 – from September 2002

Janine Sahlqvist Lexia Smallwood Assistant Co-ordinator, Manager, AJRH, and RAMUS Executive Assistant to the NRHA

Page 49 Consultants to the NRHA in 2002-2003 Kathy Cook (Policy Writing) Jim Groves (Webmaster) Robert Latta and Greg Latta (NRHA and Scholarships Database) Joan Lipscombe (Policy Writing) George Neale (Accreditation and Governance) Debbie Phillips (Conference publications) Ray Walker (Conference report)

Organisations Co-Located at the NRHA’s address • Secretariat for the Association of Australian Rural Nurses (AARN) • Commonwealth Allied Health Rural and Remote Scholarships (CAHRRS) • Health Consumers of Rural and Remote Australia (HCRRA) • National Rural and Remote Allied Health Advisory Service (NRRAHAS) • National Rural Women’s Coalition (NRWC)

Page 50 Internship Program From 3 April – 12 May, the NRHA welcomed Mariper Mercader to its office as part of an internship program being facilitated by the Queensland University of Technology. Mariper is the Local Governance Specialist at the Institute of Primary Health Care (IPHC) at the Davao Medical School Foundation in Davao City in the Philippines. The IPHC works in the rural areas of Mindanao to realise its vision to provide quality of life among the communities it serves there. The internship program had the dual goals of providing a valuable learning experience to help develop Mariper’s capacities in her own job and career, while making a contribution to the NRHA. During her time with the Alliance, Mariper initiated work on a draft position paper for the Alliance on child and adolescent health — a project which suited her personal skills and the interests of both the NRHA and the IPHC. The final paper on Child and Adolescent Health will be launched at CouncilFest 2003. Exposing Mariper to the Alliance’s role in ad- vocacy was a valuable exercise because it is something that NGOs can usefully do. Mariper Mercader and Gordon Gregory Alliance staff members also gained an insight into the rural health situation in the Philippines, where not only doctors are in exceed- ingly short supply, but also medical supplies, such as stretchers. Mariper looks forward to the chance to trial particular projects (eg mentoring, lobbying and advocacy) when she returns.

Page 51 Part 5: Reports and Financial Statements

Chairperson’s Report The core work of the Alliance in 2002-03 has been the National Rural Health Conference and our policy development and advocacy. Policy has been developed from the 7th Conference and by Executive and full Council, with support from friends of the Alliance. There has been a Workforce Policy Group. Rural and remote issues have come off the boil a little, but the Alliance is well placed to continue to promote rural health and related issues. As a child health specialist I am pleased that a Position Paper on Child and Adolescent Our Honorary Treasurer, Jane Greacen, with support from staffers Nikki Allen, Health is being developed. We have continued with considerable activity on health work- Leanne Coleman and John Nicholls, has brought our finances a long way. They are on an force issues. There is the Rural and Remote Nursing Project, an increased focus on allied excellent footing, with appropriate professional accounting practices. health, and we have also maintained our commitment to GPs and pharmacists. Staff of our organisation continue to do great work. We have good relationships with pol- Mainstream health policy issues have assumed more of our time over the past year, in iticians and a number of areas in the Department of Health and Ageing, as well as with particular Medicare, the Australian Health Care Agreements and the Pharmaceutical Ben- other national organisations and the States and Territories. I want to thank all of those efits Scheme. parties for their ongoing interest and involvement in rural and remote health. We have continued to administer the Rural Australia Medical Undergraduate On a personal note, I have thoroughly enjoyed the last three years. It has Scholarship (RAMUS) Scheme. I believe we have done this very well, thanks been great to work with Council, a knowledgeable Executive Director and to the excellent input of Carmel Brophy as Manager and her team. There a very professional staff. It has been hard work and quite time consuming, has been a RAMUS sub-committee of Council. The RAMUS contract has now but I have received excellent support from everyone. I would particularly been renewed for the period until 30 June 2005. We must continue to ensure acknowledge the support of Shelagh Lowe as the Deputy Chair, and that we have appropriate business structures for such work. the great work of our Treasurer, Jane Greacen. Thanks also to everyone else who has served on the Executive from time to time. Finally, I wish again to We have in place good governance structures and have become more knowledge- thank all the correspondents of the Alliance for the support for our work, and to Council able about the responsibilities that our work places on staff and Council. for the opportunity for me to have been your Chairperson over the past three years. The last few years have been a time of change for the National Rural Health Alliance and its Council, as rural issues have waxed and waned, and our focus has shifted. Some of our long-term and original Councillors have retired and new people have come on board. I welcome them all and commend them for their commitment of time and energy. The National Rural Health Alliance has matured and we have acquitted ourselves Dr Nigel Stewart well in developing new directions for the organisation during my period as Chairperson. Council members have dealt with issues in an open, collegial and consultative manner. Chairperson

Page 52 Page 53 Financial Statement and Directors’ Report Review of Operations 2002-2003 The NRHA’s operational funds for the financial year were in the form of grants from the Australian Government (Department of Health and Ageing), project income, membership NATIONAL RURAL HEALTH ALLIANCE INCORPORATED fees, fees-for-service and co-location. The expenditures of the NRHA were on its policy dev- Registered in New South Wales: Number Y17753-06 elopment, communication and information activities, and projects, including on the staf- The Directors present their annual Financial Statement and Directors’ Report covering fing and operation of its Office in Canberra and meetings of its Council of Directors. operations of the NRHA for the year ended 30 June 2003. Significant change in the state of affairs of the NRHA Indemnification of Officers There was no significant change in the state of affairs of the NRHA during the year ended The NRHA maintains Association Liability Insurance for professional indemnity for directors 30 June 2003. and members of staff. Significant post-balance date events Principal Activities No matter or circumstances have arisen since the end of the financial year which sig- The principal activities of the NRHA during the financial year were policy development, nificantly affected or may significantly affect the operations of the NRHA, the results of communication, administration, and information activities to improve the health of people those operations, or the state of affairs of the NRHA in financial years subsequent to the in rural and remote areas of Australia. There were no significant changes in the activities financial year ended 30 June 2003. of the NRHA during the year. Directors’ Benefits Results of Operations Neither since the financial year nor during the financial year has a Director received or The operating surplus for the financial year was $79,412. become entitled to receive a benefit (other than a benefit included in the aggregate am- ount of emoluments received or due and receivable by Directors shown in the Accounts, Dividends or the fixed salary of employees of the NRHA) by reason of a contract made by the NRHA with the Director or with a firm of which the Director is a member, or a company in which The NRHA did not pay any dividends during the financial year as it is precluded from doing the Director has a substantial financial interest. so by its Constitution. Signed in accordance with a resolution of the Executive on 15 September 2003. Taxation The NRHA is an association endorsed as an income tax exempt charitable entity (ITEC) under Subdivision 50-5 of Income Tax Assessment Act 1997 — Item 1.1 — charitable institution. Nigel Stewart Jane Greacen Director, Chairperson Director, Treasurer Page 54 Statement of Income and Expenditure for the Year Ended 30 June 2003 Note 2003 $ 2002 $ Income Australian Journal of Rural Health 7 11,608 84,985 Conference 8 606,213 57,154 Friends of the Alliance 9 - 41,248 National Rural Health Alliance 10 1,081,929 657,484 Total Income 1,699,750 840,871

Expenditure Australian Journal of Rural Health 7 10,844 38,529 Conference 8 589,557 81,036 Friends of the Alliance 9 - 19,151 National Rural Health Alliance 10 991,211 627,693 Total Expenditure 1,591,612 766,409

Operating Surplus 108,138 74,462

Abnormal Items 4 28,726 - Surplus After Abnormal Items 79,412 74,462 Opening Accumulated Funds 110,673 36,211 Closing Accumulated Funds 190,085 110,673

Page 55 Balance Sheet As At 30 June 2003 Note 2003 $ 2002 $ Current Assets Cash 2 267,474 162,604 Debtors 3 24,929 23,321 Total Current Assets 292,403 185,925

Non Current Assets Property Plant & Equipment 4 - 28,726 Total Non Current Assets - 28,726

Total Assets 292,403 214,651

Current Liabilities Provision for Annual Leave 61,684 54,406 Provision for Long Service Leave 5 40,890 19,016 Creditors 6 (256) 30,556 Total Current Liabilities 102,318 103,978

Total Liabilities 102,318 103,978

Net Assets 190,085 110,673

Members' Equity 190,085 110,673

Page 56 Notes To And Forming Part Of The Financial Statements For The Year Ended 30 June 2003

Note 1 - Summary Of Significant Accounting Policies The accounting policies adopted by the Alliance follow the accounting standards issued by the Australian Accounting Bodies. [a] Basis Of Accounting The statements have been prepared under the historical cost convention and accordingly do not reflect the changing value of money. They are presented, as is practicable, on a cash basis, adjusted only when to provide a more correct reflection of the true financial situation. [b] Income Tax The Association is exempt from income tax under Section 50-10 of the Income Tax Assessment Act 1997 [c] Depreciation Of Non-Current Assets On advice, the Board have decided to adopt a new policy this year. From now on, all assets are to be expensed in the accounts in the year of purchase. It is felt that this will provide accounts that are more understandable, and provide a more accurate picture of the financial situation [d] Statement Of Cash Flows Accounting Standard AASB 1026 "Statement of Cash Flows" has not been adopted as in the opinion of Councillors, sufficient additional and materially useful information would not thereby be incorporated into the financial statements were such an Accounting Standard adopted in this year.

Note 2 - Cash Note 2003 $ 2002 $ Westpac Conference Account 39,165 7,691 Westpac Term Deposit 1 20,000 20,000 Westpac Term Deposit 2 30,000 30,000 Westpac Term Deposit 3 30,000 - Westpac NRHA Account 86,088 56,181 Bank Guarantee 15,230 - Westpac AJRH Account 46,992 48,732 267,474 162,604

Page 57 Note 3 - Debtors Note 2003 $ 2002 $ Owed by JFSS -7,194 Owed by RAMUS - 6,922 Owed by HCRRA 3,679 - Trade Debtors - 2,955 Conference Deposits 21,250 6,250 24,929 23,321

Note 4 - Property, Plant & Equipment Note 2003 $ 2002 $ Property, Plant & Equipment (at cost) 119,402 119,402 Accumulated Depreciation (119,402) (90,676) - 28,726

This note will not be relevant in future years due to the new policy of expensing assets. An Asset Register is kept to keep control of these assets. This year, the write off of the balance of this account has been shown as an Abnormal Item in the accounts, as follows:

Note 2003 $ 2002 $ Australian Journal for Rural Health 7 128 - Conference 8195- National Rural Health Alliance 10 28,403 - 28,726 -

Note 5 - Provision For Long Service Leave This provision is taken up this year on a pro-rata basis for the Executive Director, Ms Coleman and Ms Smallwood. Mr Gregory commenced service on 9 August 1993, Ms Coleman on 8 August 1995 and Ms Smallwood on 18 April 1996. After 7 Years it is prudent to take up this provision, although it is not payable until after 10 years of service.

Page 58 Note 6 - Creditors Note 2003 $ 2002 $ Owed to NRHN - 790 ATO - Net GST For June Quarter (8,484) 18,674 ATO - PAYG For June 8,228 10,314 Superannuation -779 (256) 30,556

Note 7- Australian Journal Of Rural Health Note 2003 $ 2002 $ Income Editorial Fee 9,597 - Interest Income 157 - Journal Subscription 1,223 - RHSET 98302C - 37,500 Royalties - 36,459 Other Income 631 349 Transfer Of Editorial Assistant Fund - 10,677 Total Income 11,608 84,985

Expenditure Bank Fees 61 5 Depreciation -564 Personnel 8,534 14,121 Stationery -501 Subscriber Shortfall - 5,000 Subscription Subsidy -14,106 Teleconferences 2,039 - Travel And Accommodation 210 4,231

Page 59 Note 7- Australian Journal Of Rural Health continued Note 2003 $ 2002 $ Total Expenses 10,844 38,529

Operating Surplus/(Deficit) 764 46,456 Less: Abnormal Item 4 128 - Surplus/(Deficit) 636 46,456

Note 8 - Conference Note 2003 $ 2002 $ Income Bank Interest 234 5 Cancellation Fee -45 Conference Proceedings - 296 DHAC Grant - 50,000 NRHA Publications -10 Registration Fees 455,720 7,173 Satchel Inserts 2,818 - Sponsorships 34,545 - Tied Grants 30305 (375) Trade Displays 82,591 - Total Income 606,213 57,154

Expenditure Advertising And Promotion 731 - Arts Program 24,042 5,981 Audio Visual & Staging 96,192 - Audit Fees 1,363 - Bank Fees 5,855 1,331 Catering 161,781 - Page 60 Note 8 - Conference continued Note 2003 $ 2002 $ Conference Dinner 81,974 - Council Attendance 3,792 - Depreciation -575 Des Murray Scholarship 6,347 - Exhibition 13,060 - Freight 2,424 - Management Fee 20,000 - Office Setup 3,231 9,610 Personnel 15,039 59,117 Photocopying 3,636 - Photographer 2,560 - Postage 2,999 5 Printing 45,243 4,293 Satchels 16,800 - Speakers 23,932 144 Telephones 7,273 - Tied Grants (Indigenous) 30,327 - Travel 12,229 - Venue 8,727 (20) Total Expenses 589,557 81,036

Operating Surplus/(Deficit) 16,656 (23,882)

Less: Abnormal Item 4 195 - Surplus/(Deficit) 16,461 (23,882)

The 7th National Rural Health Conference was held in March 2003. Page 61 Note 9 - Friends Of The Alliance Note 2003 $ 2002 $ Income Membership -41,248 Total Income -41,248

Expenditure Depreciation -112 Operational -724 Personnel - 18,315 Total Expenses -19,151

Operating Surplus/(Deficit) - 22,097

It was decided to include Friends in NRHA accounts from now on, as it was felt that a separate statement was not warranted.

Note 10 - National Rural Health Alliance Note 2003 $ 2002 $ Income Advertising in Partyline 800 750 Bank Interest 1,389 1,668 Copyright Income 19,499 - Fee-for-service 108,305 104,597 Membership Fees - friends 16,055 - Membership Fees - NRHA 10,750 10,000 NRHA Publications 704 725 Nursing Workshop 51,000 - Office Move 51,000 - Office of Rural Health 625,000 420,000 Other Income 94,216 -

Page 62 Note 10 - National Rural Health Alliance continued Note 2003 $ 2002 $ Reimbursements 83,211 119,743 Sponsorship 20,000 - Total Income 1,081,929 657,484

Expenditure Audit & Accounting 7,900 4,650 Bank fees 2,000 1,585 CD Rom Update 18,038 - Cleaning 983 1,560 Communications (Partyline) 18,229 17,398 Depreciation - 14,589 Electricity 5,495 3,863 Email, Internet & Website 14,648 15,359 Equipment purchases 9,870 2,903 Friends/Outreach 1,733 - Insurance/Legal 12,300 2,872 Media Services 4,018 5,958 Memberships 3,833 2,792 Miscellaneous 1,561 401 Motor Vehicle 41,788 11,509 Nursing Project 51,253 12,578 Office Move 71,905 - Official Hospitality -1,248 Online Database 55,004 - Personnel 464,745 328,897 Photocopying 2,648 2,030 Page 63 Note 10 - National Rural Health Alliance continued Note 2003 $ 2002 $ Post Conference Workshop 12,579 - Postage 40,063 43,807 Printing 40,231 57,513 Publications 93 719 Publicity and Promotion 2,557 720 Rent 47,382 33,921 Stationery 13,156 5,494 Telephones 27,529 20,660 Travel & Council Meetings 19,672 34,667 Total Expenses 991,211 627,693

Operating Surplus/(Deficit) 90,718 29,790

Less: Abnormal Item 4 28,403 - Surplus/(Deficit) 62,315 29,790

Page 64 Directors

Gallery

Kris Malko-Nyhan David Lindsay Sue McAlpin Jane Greacen Keith Fletcher Mark Cormack AARN AARN ACHSE ACRRM ADGP AHA

Lynda Summers Victoria Gilmore Judi Walker Shelagh Lowe Christine Corby Bruce McKay AHA ANF ARHEN & NARHERO ARRAHT ATSIC CRANA

Janine Watts Lynne Sheehan Marie Lally Rosemary Jeffery Marg Brown Helen Hyde CRANA CRHF CWAA Frontier Services HCRRA HCRRA Page 65 Megan McNicholl Colleen Prideaux Lesley Fitzpatrick Ellen Downes Jon Lane Bruce Harris ICPA NACCHO NARHERO NRHN NRHN RACGP (Rural Facility)

Nola Maxfield Jenny May Barbara Ryan Nigel Stewart Mark Dunn Bruce Robertson RDAA RDAA RFDS RGPS RPA RPA

Robyn Adams Sue Wade Irene Mills SARRAH Co-opted individual Co-opted Chair of “friends” Page 66 Meeting attendance The table below lists the Directors during the period of this report, the organisation they represent, any Executive responsibilities they undertook, and their (or their proxy’s) attendance at meetings during 2002-2003.

Member Director Special Period Representative Total attendance No of Council MeetingsTotal attendance atNo of Executive Meetings Body Responsibilities on Council at Council Meetingseligible to attend Executive Meetings eligible to attendat AGM AARN Kris Malko-Nyhan Jul 02-Sept 02 1 1 Sue Wade (proxy) David Lindsay Oct 02-Jun 03 7 8 ACHSE Sue McAlpin Executive Member Full year 5934Sue McAlpin (Oct 02-Jun 03) ACRRM Jane Greacen Executive Member Full year 7967Jane Greacen (from Jul 02-Oct 02) Hon Treasurer (Oct 02-Jun 03) ADGP Without a delegate Oct 02-Jan 03 0 1 N/A Keith Fletcher Feb 03-Jun 03 6 7 AHA Mark Cormack Executive Member Jul 02-Mar 03 3625Mark Cormack (to March 2003) Lynda Summers Apr 03-Jun 03 1 3 ANF Victoria Gilmore Executive Member Full year 7924Victoria Gilmore (Oct 02-Jun 03) ARHEN Judi Walker Executive Member Oct 02-Jun 03 3835N/A ARRAHT Shelagh Lowe Deputy Chairperson Full year 8977Shelagh Lowe ATSIC Christine Corby Moderator Full year 0903unrepresented (to October 2002)

Page 67 Meeting attendance continued

Member Director Special Period Representative Total attendance No of Council MeetingsTotal attendance atNo of Executive Meetings Body Responsibilities on Council at Council Meetingseligible to attend Executive Meetings eligible to attendat AGM CRANA Bruce McKay Executive Member Jul 02-Sept 02 0112Janine Watts (Jul02-Sept02) Janine Watts Oct 02-Jun 03 3 8 CRHF Without a delegate Oct 02-Feb 03 1 3 N/A Lynne Sheehan Moderator Mar 03-Jun 03 4511 (May 03-Jun 03) CWAA Marie Lally Full year 5 9 Marie Lally FS Jeffery, Rosemary Full year 8 9 Rosemary Jeffery HCRRA Without delegate Jul 02 0 0 Barbara Ryan (proxy) Marg Brown Aug 02-Dec 02 3 3 Without a delegate Jan 03 0 1 Helen Hyde Feb 03-Jun 03 3 5 ICPA Megan McNicholl Executive Member Full year 3912Nigel Stewart (proxy) (Jul 02-Sep 02) NACCHO Colleen Prideaux Full year 0 9 unrepresented NARHERO Judi Walker Executive Member Jul 02-Oct 02 1202Judi Walker Lesley Fitzpatrick Moderator Nov 02-Jun 03 7711 (May 03-June 03) NRHN Ellen Downes Jul 02-Oct 02 1 2 Ellen Downes Jon Lane Nov 02-Jun 03 5 7 RACGP Bruce Harris Executive Member Full year 9911Bruce Harris Page 68 Member Director Special Period Representative Total attendance No of Council MeetingsTotal attendance atNo of Executive Meetings Body Responsibilities on Council at Council Meetingseligible to attend Executive Meetings eligible to attendat AGM (Rural Faculty) (May 03-Jun 03) RDAA Nola Maxfield Hon Secretary Jul 02-Sep 02 1122Jenny May (Jul 02-Sep 02) Jenny May Executive Member Oct 02-Jun 03 8844 (Oct 02-Jun 03 RFDS Barbara Ryan Full year 2 9 Barbara Ryan RGPS Nigel Stewart Chairperson Full year 9967Nigel Stewart RPA Mark Dunn Hon Treasurer Jul 02-Dec 02 3333Mark Dunn (Jul 02-Oct 02) Bruce Robertson Dec 02-Jun 03 3 6 SARRAH Robyn Adams Full year 8 9 Robyn Adams Co-opted Sue Wade Full year 8 9 Sue Wade Individual Co-opted, Irene Mills Executive Member Full year 9911Irene Mills Chair of friends (May 03-Jun 03)

Page 69 p//g

PO Box 280 Deakin West ACT 2600 Phone 02 6285 4660 Fax 02 6285 4670 Email [email protected] Website www.ruralhealth.org.au www.sg.com.au 4391 www.sg.com.au www.sg.com.au 4391 www.sg.com.au