Submission to the Senate Inquiry into Regional Inequality in Australia This paper has been prepared by Michael Bishop on behalf of and for Central Highlands Healthcare Introduction Central Highlands Health was established as a charitable organisation to support primary health care services within the Central Highlands Region of Central Queensland. Central Highlands Healthcare received funding from the Commonwealth Department of Health to under the GP Superclinic program to build a fit for purpose building on a green-fields site in Emerald. Central Highlands Healthcare has been in operation for three years and has been strongly supported by the Central Highlands Regional Council. As a primary health care service Central highlands Healthcare has achieved considerable success and the attached info graphic is a summary of the 2017/18 Financial Year. The success is because people of the Central Highlands (a remote area) can access a range of primary health care services in one place, seven days a week. Services offered include: A full range of General Practitioner services with male and female GPs and both overseas and Australian-trained Doctors; Occupational Medicine including Nominated Medical Advisor Services for a number of resource companies; Specialist Plastics surgery; Endocrinologist; Cardiologist; Gastroenterologist; Audiology Physiotherapy; Occupational Therapy; Speech Pathology; Dietetics; Psychology; Diabetes education and chronic disease management; Diagnostic ultrasound; Dedicated women’s health; Dedicated men’s health; Pharmacy; Pathology; and Emerald Skim ( a speciality skin cancer service) Page | 1 The indictors and impact of regional inequality in regional Australia The literature abounds with statistics about the indicators of inequality in regional Australia. This submission focuses on some of the detrimental aspects of rural life, however there are many positives which will not be discussed here. Central Highlands Healthcare sees the health impact of inequality and differential access to services. The impacts can be seen clearly by considering: Delays in accessing appropriate diagnostic services leading to an increased severity and complexity of health conditions Delays in accessing specialist treatment options leading to a limitation of treatment options Limited lifestyle choices in harsher environment Increased health costs due to the need to travel to access both primary care and specialist services Poorer Health outcomes and increase in suffering as well as a loss in productivity. To illustrate the points two de-identified case examples are used. Case Example 1 Liz is a 43 year old woman who has had a radical mastectomy to have a suspected cancerous lump in her breast removed. Liz had to go to Rockhampton to have the treatment and she was offered a range of options but all required her to be away from the farm and so she chose the radical mastectomy. Rural women are much more likely to have a radical mastectomy and have a poorer cosmetic result because of access to follow such as breast reconstruction service not being available locally and being very expensive. Liz lives on a farm which supports 120 head of cattle. The farm is over an hour’s drive from Emerald and it is struggling financially so her husband is working in a mine on a rotational roster of 10 days on and 4 days off. His shifts are long and when he comes home he is tired but works hard with the farm work that Liz has not been a bit to manage in his absence. Liz and her husband have two children in primary school and Liz drives then to the bus stop each day and picks them up so they can go to the local school. Liz takes her young child to see the doctor because he has hurt (broken his collar bone) on the trampoline. During the consultation her doctor asks her how she is going. Liz bursts into tears and it is clear that her priorities are her children, next her husband, then the farm and lastly herself. She is exhausted and has been treating a low grade urinary tract infection with home remedies and has been experiencing headaches and dizzy spells which require further investigation. Her blood pressure is very high. Liz needs further assessment and follow-up but says that she can only get away from the farm every so often. On the way out Liz makes an appointment for two months’ time. Experiences of individuals and localities of unequal access to opportunities and unequal outcomes in non-metropolitan areas Page | 2 Research has clearly shown that health professionals with a lived experience of rural and regional life are much more likely to return to rural life as health professionals post-graduation. The Commonwealth Department of Health has spent a considerable amount of money pursuing this objective of building local workforce capacity as the fly-in- fly- out approach is expensive and ultimately unsustainable except in times of great need and urgency. Central Highlands Healthcare has a major role in supporting the local and developing workforce. An infographic is attached to demonstrate the contribution that the organisation is making to the medical workforce over the last year. Without a workforce with appropriate skills, experience and ability services are not able to be provided locally. Communities also need to trust and have confidence in their doctor and primary health care provider. Without adequate medical and primary health care services communities become unsafe places to live. An example of unequal access to opportunity is provided. Case example 2 A local University accepts about 65 Central Highlands’ students into their nursing undergraduate course each year. But by the end of the course graduate only two or three from the area. One of these graduates is Gill. Gill made an appointment to see the CHH Practice Manager seeking work at the end of her nursing degree. Gill expressed concern that as part of her undergraduate degree, she had not been able to procure a clinical placement at either Emerald Hospital or Central Highlands Healthcare in spite of placements being offered by both services, because there was not the capacity or systems from the university to support her placements from afar. Gill was also concerned that she was inadequate skilled to work in either setting because she was aware that nurses needed to have a full set on clinical and practical skills to work in a rural community, that is, everyone needed to work at the top of the scope if possible. Gill described that she did not feel confident in any splinter skills required in the general practice, such as wound management, vaccination, chronic disease assessment and management, ear care or spirometry. Gill therefore could not be offered a position in the practice. Medical, Nursing and Allied Health Professional degrees require many weeks of clinical placement and metropolitan based students are able to live at home and be supported by their parents during the placement. Gill had had to go away to Boarding School because her family lived in a small rural community in the Central Highlands and the local school was not considered to be adequate to support her ambitions of going to university. Gill’s family struggled financially to support her academically through high school and university and Gill’s mother especially missed her daughter’s company as she grew up. Metropolitan students do not have to leave home to access high quality education. It is much much harder for rural students to get into health professional courses and complete them compared to their metropolitan counterparts. Page | 3 Causes of inequality between regions, especially between capital cities and other areas Central Highlands Healthcare is unashamedly parochial and is vocal in supporting the central Highlands Communities over regional centres such as Rockhampton, Mackay and Townsville. It takes strong leadership for the Hub regional centres to maintain outreach support and direct services to Spoke communities. If there is a crisis in the centre all resources and efforts are withdrawn back to the regional city. Outreach and dispersed services are easily identifiable and become easy targets for budget and rationalisation. Regional centres have much easier access to the political process which is why Central Highlands Healthcare supports the Senate for taking the considerable effort to conduct the regional hearings. Even though the consequences of even short term disruption of services from the centre can be catastrophic for health and wellbeing of people who live in the Central Highlands, it happens time and time again. The cancellation of a flight from Emerald to Brisbane (70) might mean that: Someone misses their specialist medical appointment which they have waited months for; A business misses an opportunity to present their case for case government funding A lobbyist misses a meeting in Parliament House A doctor misses their professional development opportunity Someone’s parent dies in Palliative care without saying goodbye A lost holiday weekend Central highlands people manage the inconsistencies of travel by given up their time. They arrive the day earlier and stay overnight or two nights or drive the 10 hours to the city. There are economic and social costs to unreliable infrastructure including airports, roads, trains and information and communication technology. Central highlands people pay a premium to participate at a state, national and global level. Is there a consideration of the economic powerhouse that the Central Highlands provide to State and National coffers or multinational company profits? Analysis of economics of regional inequality, including wider impacts Rural communities require a reliable source of workers to support a range of industries from farming to mining for electricity generation to social services. Fly-in-fly-out processes are expensive and unsustainable over time leading to a drain on regional areas. Workforce aged adults are likely to have children so birthing services, health care, education and aged care service must be provided.