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Reforming the rural workforce

Kate Leaver reports on the latest developments in Health Workforce Australia's (HWA) reform agenda.

It's more than three decades since a group of 130 remote area nurses congregated in Alice Springs with a collective goal in mind; getting the government to address the needs of the rural health workforce.

Since that initial meeting in 1983 CRANAplus, as the organisation is known today, has been laboring towards the same goal.

Despite numerous initiatives and strategies in the intervening years, the profound challenge confronting the health workforce in rural and remote areas remain as acute today.

On the one hand, poor health is doggedly higher in rural and remote area communities; the rates of mortality, substance abuse, mental health, and crime are consistently higher.

Between 2004 and 2006, there were 4600 'excess deaths' outside major cities from coronary disease, circulatory disease chronic obstructive pulmonary disease, motor vehicle accidents, and suicide, according to the Australian Institute of Health and Welfare.

On the other hand, and compounding the issue, the rural and remote health workforce remains largely underfunded, and resources are often insufficient or inaccessible.

There is hope, however.

The government body responsible for implementing reform in the sector, Health Workforce Australia, has recently released a background paper outlining its Rural and Remote Health Workforce Innovation and Reform Strategy.

National coordinator of professional services at CRANAplus, Geri Malone, says the paper is positive but "it does not attempt to solve any particular issues because it is a discussion paper".

Commenting on the paper's outline, she says CRANAplus has been advocating similar changes for many years - for example, a minimum of one third of all health funding be quarantined for preventative care measures; a weakness in the current distribution of resources in rural Australia.

CRANAplus has also called for an urgent structured plan to phase out single nurse posts, arguing that they are unsafe for patients and clinicians. The challenge here is to find and allocate more nurses willing to work in remote environments - just one of many hurdles that must be cleared in order to implement effective reform in the sector.

"Essentially we will be looking for recognition of the role of nurses, in the context of providing, through a national approach, support and facilitation for nurses to work across their full scope of practice with national guidelines, and clear standards underpinned by quality and safety," says Malone.

The RRHWR strategy paper and accompanying literature finds there is a serious problem in terms of the distribution of the health workforce nationally. Medical staff in remote and rural hospitals work longer, in isolation, with fewer resources. They work longer on-call periods, with little or no support.

The situation is dire, and as such communities continue to struggle with higher incidence of illness, addiction, injury, and overall poor health.

Mortality among rural Australians has been consistently 10 per cent higher than in metropolitan areas. In these communities, people are 10 per cent more likely to have a mental disorder during their lifetime, more likely to develop alcoholism, obesity, more likely to smoke, and more likely to have untreated dental problems.

To set the parameters for discussion on this issue, the RRHWIR collates data that confirms the issues healthcare professionals deal with, and invites feedback from appropriate experts. Malone says that if the paper is to succeed, it must be dependent upon strategies that are "brave, innovative and reflective of the true workforce and their capacities".

Stakeholders in the health care workforce are invited and encouraged to give feedback on the objectives of the paper. Go to www.hwa.gov.au/work-programs/workforce-innovation-and-reform/rural-and-remote-health-workforce.

About the paper

* Health Workforce Australia (HWA) prepared the background paper as part of a national consultation process to develop the Rural and Remote Health Workforce Innovation and Reform Strategy (2012-2015).

* The paper provides a snapshot of population health issues and health workforce issues in regional, rural and remote Australia; an overview of existing government initiatives; and an examination of the broad issues that a national strategy for regional, rural and remote Health Workforce would need to address.

* The Rural and Remote Health Workforce Innovation and Reform Strategy (2012- 2015) will be linked to three key pieces of work: the National Health Workforce Innovation and Reform Strategic Framework for Action (WIR Framework), the National Training Plan (NTP) and the National Rural and Remote Health Strategic Framework (RRHS Framework)

* Clear themes and issues emerge from the literature about the priorities and directions of health care in rural and remote Australia, the paper says. These issues include the need for locally-planned, needs-based service models; the importance of holistic, culturally safe care and cognisance of the social determinants of health and wellbeing; and, an emphasis on health promotion, illness prevention and primary health care.

* Five key domains are highlighted. These are: health workforce reform for more effective, efficient and accessible service delivery; health workforce capacity and skills development; leadership for the sustainability of the health system; health workforce planning; and, health workforce policy, funding and regulation.

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