This Conference calls on political parties to make a bi-partisan commitment to the delivery of high speed broadband for all families, businesses and communities in rural and remote areas.

There should be a national campaign to promote the importance and rewards of generalist health practice as a specialty in its own right, with well-supported and easily-navigated training pathways to rural generalist careers articulated in medicine, nursing and allied health.

Australia is ready for a surge of telehealth development. It will require additional program funds, a flexible approach (specialist to patient; Aboriginal Health Worker to specialist and patient; midwife to mother-to-be), store-and-forward services as well as real-time consultations and will be unaffected by state and territory borders. These new developments will have a focus on simple, daily interactions in the most challenging communication environments. Telehealth services should be driven by patients’ needs not by commercial gain and should not undermine the provision of face-to-face specialist services in rural and remote areas.

Eye health, including for Aboriginal people and Torres Strait Islanders, can be significantly improved through the simple expedient of correcting refractive error by providing spectacles. It is recommended that subsidised spectacle schemes of the States and Territories align with nationally-consistent best practice criteria and principles, as outlined by OAA and endorsed by Vision 2020 Australia. The feasibility of a national spectacle scheme specifically for Aboriginal and Torres Strait Islander Australians should be urgently considered.

Given the vital role Regional Eye Health Coordinators (REHCs) play in facilitating eye care services, there should be open dialogue with them to ascertain their training needs, and funds provided for effective training to meet their needs. The National Rural Health Alliance should urge the Department of Health and Ageing to make provision in their budget for funding in each State/Territory of an adequate number of Regional Eye Health Coordinators within Aboriginal Community Controlled Health Services, funded and distributed according to the eye care needs of the Aboriginal and Torres Strait Islander populations.

That all health organizations should engage with health students and early career health professionals in reforming healthcare in Australia. Health students and early career health professionals offer a unique perspective on the healthcare system in Australia and this should be actively engaged in health reform.

Nurse Practitioners are playing a valued part in Primary Health in rural and remote areas, working as part of the interdisciplinary team. There needs to be a review of the MBS items and benefits paid for their input. They play an important part to the system. There needs to be a review of the collaborative practice as this, as it currently stands limits the use of Nurse Practitioners where there are no GP’s. At present, where we utilize NP’s in remote areas, we are only able to cover approximately 50% of their costs and this is therefore not a sustainable model using The MBS. In WA we have evidence that demonstrates improved outcomes for people living in the bush where we have implemented NP’s as part of the system

Advocate to State and Federal ministers and opposition spokespersons for Arts and Health, in addition to your local members for a National Arts and Health Framework.

The NRHA supports the STAR Project in its contention that most health workers deeply opposes racism and discrimination in health. It supports
the Australian Human Rights Commission in the initiation of an anti-racism strategy for health, as part of its national anti-racism strategy.

That the Commonwealth manage the high risk behaviours occurring in the state based health systems which are divesting themselves of primary and community health services. We are losing these services such as health promotion and public health services at our peril.

To keep our rural and remote health workforce VITAL and EMPOWERED, the health sector must prioritise clinical supervision. A wealth of evidence confirms time and time again again that clinical supervision is ’bang for health buck’ in terms of retention, improved client outcomes and worker wellbeing. Some may say clinicians and health services could be negligent without clinical supervision. We want a bright future in rural and remote health? We want reflective rural leaders? We NEED a stronger commitment to clinical supervision on the ground.

We wiah to see meaningful community and cnsumer engagement with partnership in service ,design and a shared approach to delivring outcomes

Additional medical, nursing and allied health internship, new graduate and other postgraduate positions should be created in rural and remote areas in order to capitalise on the opportunity to recruit a reasonable proportion of the increased number of health graduates to the communities where they are most in need.

The scope of MBS item numbers for telehealth should be expanded to include store-and-forward services that do not require real-time video consultations. This would support a range of services involving image interpretation, such as tele-dermatology and colposcopy. To encourage community health centres to host telehealth clinics, telehealth MBS item numbers should be available to nurses and Aboriginal Health Workers without the need for a linked GP provider number.

To sustain and speed up improvements in Indigenous health (such as lower infant mortality and less infectious disease), urgent attention should be paid to addressing socio-economic risk  factors (lower incomes, higher rates of unemployment, lower educational attainment and more overcrowded houses), building on and learning from the significant achievements of some noteworthy central Australian Aboriginal-controlled organisations.

Climate change has been identified as the greatest public health threat of the 21st century (Lancet special edition 2011).
As highly trusted members of their communities, health professionals of all walks have a responsibility and the opportunity to influence peoples understanding of the issue.
Consequently, health professionals should:
have a sound understanding of the issue and it’s health consequences.
promote understanding of the issue, and the steps people can take to both adapt to and reduce their personal contributiuon to climate change.
be encouraged to incrimentally adapt their practices and workplaces to reduce both their contribution to climate change, and their exporure to its consequences.
A national resource centre to assist health professionals .in this regard should be established.

Given that not insignificant profits are generated by large food companies in urban settings at cost of smaller retailers, is there a case for facilitating shared responsibility to enhance healthy food choices in rural and remote Australia. How can health promotion ever be successful if refined foods are so much cheaper than a single tomato or apple

There is an obvious shared interest in a mutual alliance between remote health practitioners and remoteFOCUS. It is recommended that this conference establish a working group to determine the capacity for government governance reform to impact on and add value to local health programs across remote Australia.

As discussed during Plenary 4. A bipartisan approach to equitable access to high quality, reliable broadband is vital for remote Australia.

Good oral health is essential to general health and well being. Despite being mostly preventable, as socio-economic disadvantage grows so does the incidence and severity of dental disease. Within Australia, rural and remote populations, Indigenous Australians, the aged and socio-economically disadvantaged individuals, are most affected due to their lack of access to affordable, preventative and acute, oral health care.

To improve therapeutic benefit from current (face to face) and emerging consultations methods (telehealth, shared care, interdisciplinary and online care) there needs to be a focus on addressing health literacy at the interface between consumer (client, patient) and the clinician (medical, non-medical) as well as the clinical support personnel. This could be progressed through collaborations between health consumer groups and health profesional groups in the first instance. This is not about upskilling the consumer to be ’more health literate’ but about mutual monitoring of the clinical consultation to ensure the benefits of the health consumers’ journey is optimised.

There is increased funding for the provision and enhancement of palliative care for all in Australia’s most rural and remote areas.

Pharmacists can play an important role in assisting Aboriginal and Torres Strait Islander people manage their medicines and so reduce progression of chronic disease and hospitalisations due to medication mismanagement. Pharmacists in Aboriginal health Servicies could educate patients and health professionals about quality use of medicines, conduct medication reviews and be involved in health promotion and disease managment. Currently there is no funding or remuneration for pharmacists in Aboriginal Health Services. There is no point in flying in teams of health professionals if patients are not taking prescribed medicines. If the Commonwealth Governemtnent is serious about closing the gap they need to fund positions for pharmacists in Aboriginal Health Services.

This Conference calls on political parties to make a bi-partisan commitment in the context of the 2013 election to the principles embedded in WA’s Royalties for Regions program

The vulnerability of children in rural and remote communities, including Aboriginal and Torres Strait Islander children, those with a disability, homeless children and those exposed to violence, is compounded by the impacts of key social determinants of health in these settings such as family income levels, access to education, health care, transport and support services.

The broad health and community sector should recognise Medicare Locals as a valuable ally in improving primary health care services and seek ways to work effectively with them. For their part, governments should continue to provide levers for the MLs to improve primary health care and ensure their capacities are accessible to all population groups.

The current focus on the NDIS highlights the key role played by allied health professionals in disability and rehabilitation services. In rural areas, there is an opportunity to develop a significantly greater number of sustainable allied health positions, by integrating disability, aged and health care. To expand the availability of allied health services to meet the increased demand from this sectoral integration (health, aged care, disability), funds should be allocated to enable local residents to undertake Cert IV in Allied Health Assistance and to provide a supervision framework. This will increase access to allied health services, enable allied health professionals to take leave and professional development entitlements, and provide local employment for local people.

For additional rural placement programs to be established (or the guidelines for the current ones expanded) for nursing and allied health students to ensure that students across all health disciplines have equal access to placements in rural and remote communities. For these rural placements to be well supported; we need access to supervisors, transport, and financial assistance.

Greater use should be made of interprofessional student placements, both to meet service gaps and to expose students to innovative services in rural and remote areas.

Recommendations from ACHSM Pre-conference workshop:

1. There is a large variation that exists in the allocation of Commonwealth funds to support professional training and development for clinical and operational leaders and managers through their peak representative organisations at the national level. It is recommended that action be taken to redress this disproportionate allocation and that the Department of Health and Ageing seek to establish an equitable funding distribution mechanism for each of the representative organisations based on consistent criteria.

2. That a the Commonwealth commence discussions with the NRHA to establish a national approach to mentoring and coaching services for emerging and developing clinical and operational managers and leaders working in rural and remote Australia.

3. That work commence on the development of a national approach to the provision of graduate positions in rural areas as a key plank in the workforce recruitment and retention strategy for rural Australia.

4. cashing out unspent medicare $’s in country and the need to put the argument to the feds that unspent MBS and PBS needs to be reinvested – ie establish a funding pool specifically for the purpose of holding the funds and a process for determining the priorities upon which the funds should be spent in rural Australia!

Due to the significance of brain injury as a health and disability issue for Aboriginal and Torres Strait Islander peoples, it is recommended that training about brain injury and the significant impact on the individual, their family and community be included in the Health Worker training curriculum.

While strategies to ensure Rural and Remote communities can receive the care they need at home is vital, for some, there will always be a need to come to the city. What are we doing to review these journeys?? Currently each state has their own individual Patient Assistance Transport Schemes(PATS) guidelines/ criteria – varying greatly in patient eligibility to receive assistance. Rural patients are also often having to access services interstate due to closest specialist service available( i.e. NT and Broken Hill patients travelling to Adelaide). To ensure equity for all Australian Rural and Remote patients- National PATS Guidelines need to be developed with collective consultation, review, implementation and most importantly evaluation of outcomes/ the patient journey.

Background: The Patient Assisted Travel Scheme (PATS) provides a subsidy towards the cost of travel and accommodation for eligible permanent country residents, and their approved escorts, who are required to travel a long distance to access certain categories of specialist medical services (including Telehealth. Dental services are not included in the PATS scheme. Period. In general, a medical practitioner must raise the documentation for a medical condition. Dentists with patients requiring specialist dental services are excluded (except for children referred for treatment under GA).

Recommendation: That regional and remote dental patients who require specialist dental care or referral to an appropriate practitioner can be referred by the treating dentist and be eligible for the PATS scheme.

The model of care principles designed to address the differential in cardiovascular outcomes between urban and non-urban areas could be applied to other disease states, such as diabetes and stroke, to help combat the increasing burden disease from them in rural and remote areas.

To ensure that data collection strategies and practices are undertaken in Aboriginal communities in a sensitive and culturally appropriate way, it is critical that there is genuine and prior consultation with Elders and/or community representatives. Such planning is necessary to ensure quality data collection on health, and funding bodies should recognise the need to build such consultation into the funding of research.

There is a large and growing need for innovative person-centred (consumer directed) respite programs for people with dementia and their carers.

With the NDIS starting in limited form on 1 July 2013, it is vital that people in rural and remote areas take every opportunity to ensure that their views and their circumstances are accommodated by the Commonwealth and the States/Territories in the Scheme’s development. This done, a fully-formed NDIS will provide the best possible lifestyle and opportunities for people living with a disability in those areas.

Materials relating to advance care planning for older people living at home should be held electronically so that it can be shared across the continuum of care.  Health providers in all settings need to be educated and confident to conduct conversations to identify patients’ preferences and to assist in developing and modifying advance care plans.

Undirected empowerment does nothing to reduce health inequity. We need to use local health promotion and disease prevention campaigns as Tom Calma suggested this morning, not national ones using wealthy, elite athletes

As telehealth services are expanded it is essential that the system does not provide perverse incentives to specialists to substitute visiting clinics with telehealth services, potentially resulting in a net loss of services for rural communities and damage to the sustainability of local health care teams. The level of consultation covered by the item numbers (specialist-specialist, -GP, -nurse, -AHW or -patient) should be the simplest and cheapest required by the patient’s need and the driver should always be patient and community needs, not commerciality.

To help ensure the effectiveness of rural clinical placements, there need to be increased health and counselling services available to students engaged in them, and better understanding of how their perceptions of academic isolation can be mitigated.

Eye health, including for Aboriginal people and Torres Strait Islanders, can be significantly improved through the simple expedient of correcting refractive error by providing spectacles. It is recommended that subsidised spectacle schemes of the States and Territories align with nationally-consistent best practice criteria and principles, as outlined by OAA and endorsed by Vision 2020 Australia. The feasibility of a national spectacle scheme specifically for Aboriginal and Torres Strait Islander Australians should be urgently considered.

Increasing and enhancing the use of telehealth will broaden client care, education and networking for the Kimberley Cancer and Palliative Care Service and other similar services in more remote areas.

Rural local governments and Medicare Locals should collaborate to run social events for newcomers in health to meet and mix with people of the same age and interest. This might increase opportunities for practitioners to sprout roots and stay.

In order to utilise technology to improve service delivery for our patients, there needs to be adequate high speed Internet across Australia. With this we can better use (and value-add to) existing telehealth facilities, as well as develop other strategies that aide service delivery. We ask for a bipartisan commitment to this issue.

Clinical supervision is vital and should be fostered and supported. Effective distance supervision shoujld encorporate the following:
- more than one mode of distance supervision
- regular sessions of good length
- use of feedback
- training for supervisors
- a contract between the supervisor and employee
Other forms of supervision such as peer supervision, other discipline supervision should be considered where appropriate
Further research si required to explore the distance supervision- it’s effectiveness and use of technology

The transition to case-load models should be encouraged and supported by rural and regional health services, and employment of Bachelor of Midwifery graduates facilitated and encouraged within this model and by health services generally.

Projects looking at the impact of mining on health services need to have a multidisciplinary approach. Rather than just focussing on access to doctors, we need to investigate the impact of mining on Allied Health roles and other community health workers that are generally on lower incomes, especially nurses, aged care workers and even childcare services. These roles are essential for community health and well being and seem to be overlooked. Increasing this workforce in mining towns could be a strategy used to attract doctors to the area. Specific factors to look at in future projects could include access to infrastructure, lack of affordable housing or rent, and the cost of living in a mining town and how this impacts on lower paid healthcare workers and retention rates in these areas.

While there is better information available than ten years ago, there is an ongoing need for the funding of research into the allied health workforce and the factors that influence their recruitment and retention in rural areas, especially in light of the valuable role that allied health professionals play in the prevention and management of chronic disease conditions.

There need to be further programs to support the development of high calibre, effective rural leaders who create better industries and local businesses; stronger links between sectors and regions; more dynamic networks; innovation and development; and robust rural communities.

Develop guidelines for media-based Indigenous health promotion messages
Adequate funding and timelines for evaluation of health promotion resources
Build up a network of media industry advisers and mentors for media-based Indigenous health promotion messages
Centralise availability of Indigenous health promotion resources
Funding to make Blow Away The Smokes DVD available to all Indigenous smokers in Australia

Hospital pharmacists should be involved in medication reviews of all patients over 65 who taken 3 or more regular medications to decrease the risk of adverse outcomes due to discrepancies between GP medication list, the national inpatient medicines list and what the patient is actually taking

Medication review is a useful tool to increase Aboriginal patients knowledge of medicines and to empower these patients to make medicine choices. Current HMR guidelilnes require HMRs to be conducted in the home and if this is not possible require identification and approval 10 days prioir to visiting the Aboriginal Health Service. HMR travel allowances are capped at $125 and do not compensate pharmacists for travel time or expenses to travel to remote communities to coduct HMRs. Medschecks can only be conducted in community pharmacies.

Recommendation: HMR rules should provide incentives not disincentives for provision of HMRs in remote AHSs. Pharmacists should be remunerated to conduct Medschecks in Aboriginal Health Services. Aboriginal patients should be able to have a Medscheck every 3 months and the pharmacist should be chosen by the AHS and not necessarily be the local community pharmacist.

The Commonwealth recognize the contribution made by the States to build and subsidies the recurrent funding needed to operate
MPSs. It is asked that the Commonwealth provide access to capital funding for Govt organizations to continue to expand the MPS program and also to increase the recurrent funding for flexible health care.

Qualitative and quantitative research is needed into the effect of professional supervision on non-metropolitan allied health practice and client outcomes. The qualitative work could use a triangulation of perspectives (clinician, supervisor, line manager and client perspectives), while the quantitative research would investigate the impact on client quality of life and treatment progress.

Evidence is needed on the most effective practice models for telehealth, including on the health effects of various approaches to telehealth.

Acknowledgement of the need for critical mass to esnure specialist services and where there is not that specailist cvideoconferencing needs to be multidiscipinary and accessible to meet service gaps and better support gneralist porviders on the ground

The WWW and social media play an increasing role complementing traditional forms of health care delivery (including telehealth, which currently operates still largely in the traditional model – just remotely) leading to greater patient empowerment and engagement. The most disadvantage and needy communities lack the IT literacy necessary to engage. Providing access to the skills and means for those is integral to their participation in the new health care world. As health care providers we need to consider this as an integral part of our responsibility.

NHMRC should be required to allocate a percentage of their funds for Arts and Health research

That the alliance put pressure so That all governments declare their income from alcohol royalties and taxes

Health advocates are encouraged to become vocal about the benefits of managing chronic disease with a doctor in partnership with a Physician Assistant (as evidenced by the Mulungu model).

Telehealth initiatives should be designed to enable and support front line clinicians and not replace them.

Equity of access for all health students for rural and remote placements (funding for accommodation, travel etc) . Parity with medical students

Yesterday, it was mentioned there is a shortage of GPs, General Physicians and General Surgeons in rural Australia.

There is a strong medical student interest in specialty and surgical training. Development of a Dual Role physician and a Rural Surgical pathway are what students want to hear more about.

Example:

http://www.australiandoctor.com.au/news/latest-news/rural-physicians-to-train-for-dual-role

Both GP colleges have set an excellent example in promoting their rural programs, it would be great if other colleges are able to do the same. These pathways exist, but the champions of rural specialties still struggle to be heard.

Dream of a future where high quality, specialist care can be undertaken in regional centres, without referring a patient to the city. Much good would be done if we are able to reduce city referral rates or the distance patients currently travel.

We have the medical students, 5 years from now they will be working and choosing their choice of vocation. We need more training places and new specialty training programs that can be undertaken in a regional hospital.

In order to help address and reverse the decline in the rural procedural GP workforce, it is recommended that the GP Obstetrics Mentoring Program continue to receive funding and that longitudinal evaluation be undertaken at 5 and 10 year intervals to identify the impact on the retention of the GP obstetric procedural workforce.

It is recommended that subsidised education be available to both assist registered midwives to achieve eligible midwifery status and to facilitate continuing professional development for eligible midwives working in rural areas.

A range of initiatives would improve allied health professionals’ access to Continuing Professional Development – and thus their retention in rural areas at all career stages. New employees should be provided with orientation to rural practice, and family-friendly work conditions set in place. Typical late career progressions, including opportunities for teaching and mentoring, health services management, postgraduate study and research should be available, and better locum support provided.

This Conference calls on political parties to make a bi-partisan commitment in the context of the 2013 election to legislate more place-based models of community empowerment and program administration in areas such as education, housing, employment, arts and culture, transport, and families and community services.  Note: Medicare Locals and Regional Development Australia committees are examples of such place-based models in health and regional development.

A National Register details service specifications, key contacts and details on a template to ensure that all health care providers can identify services which are both currently available and accessible for advice and information.

That the major industry peak bodies include in National Disability Services (NDS), Leading Aged Services Australia (LASA) and Aged and Community Services Australia (ASCA) develop a joint training agenda pertaining to ageing with an intellectual disability, to address common educational needs.

A cross sectoral and collaborative approach should be used to develop an effective strategic approach to addressing food security in Australia. Such an approach could be based on the establishment of an inter-governmental and inter-agency Food Security Council.

NDIS must recognise that it costs more, is harder to attract trained support in rural and remote and that to deliver equal ”rights” ( Dougie Herd) of support specific rural strategies will be needed. The need for people with severe disabilities to leave their community, and move to a metro area to get the care and support they need , must stop.

A strong commitment to rural mental health services is demonstrated by a commitment to recurrent funding so we can continue on a journey towards a bright future

Eye Health Coordinators have critical roles to play if sustainable, continual eye health is to be maintained in Indigenous communities.

Aboriginal Child Well Health Checks should be undertaken in a manner that is not only appropriate where content and format is concerned, but also in such a way as to contribute to the Aboriginal community’s long term trust and positive connection with health services.

The National Rural Health Alliance should urge the Department of Health and Ageing to make provision in their budget for funding in each State/Territory of an adequate number of Regional Eye Health Coordinators within Aboriginal Community Controlled Health Services, funded and distributed according to the eye care needs of the Aboriginal and Torres Strait Islander populations.

Rural health services throughout Australia should take up the Dementia Challenge to identify three key actions they can undertake to assist people with dementia in their region.

Rural Medicare Locals should work with local stakeholders to implement rural youth peer support and education programs to improve equity of access to care for young people in rural areas.

The need for a national clearing house that endorses and directs people to the most appropriate mental health online resource.
In addition, these services need to be linked up, so people do not have to tell their story over and over again to different people.

Greater understanding and communication regarding the link between the mental health of communities and the environment in which we live will benefit us all.  It is therefore recommended that attention be given to the development of evidence based social and wellbeing measures that are appropriate for natural resource management planning.

Greater emphasis needs to be given in workforce programs to allied health, so that there is equity between allied health, nursing and medicine. The expanded and new programs should target both recruitment and retention, be determined by local service needs, and include the facilitation of public-private partnerships.

Recognising the effectiveness of early intervention programs for children provided by Community Health Teams, and the savings in cost and time to families when local access is provided, Health Departments should continue to support multi-disciplinary early intervention programs for children in rural and remote areas.

The Rural Health Professionals Program (RHPP), run by the Rural Workforce Agencies, must be continued and expanded, with the flexibility to adopt a highly individualised and evidence based approach with an emphasis on scaling of the support offered, so that the most remote communities, the professions in greatest shortage and positions in Aboriginal Community Controlled Health Services receiving the greatest financial support.

Medicare Locals participating in the Telehealth support program should commit to action on five priority areas:

1. Telehealth item numbers for GPs to consult directly to Residential Aged Care Facilities (RACFs)
2. Telehealth item numbers for After Hours services
3. Telehealth item numbers for GPs to consult direct with patients
4. Continuing incentives in RACFs
5. Government (or peak health organisations) to encourage/mandate/prescribe either a platform or interoperability in general.

Telehealth is just picking up and this is the time when doctors,both Gp’s & Specialists will need support & help to telehealth ready. cutting the TH funding in June 2013 is not a good timing. All the speakers are talking about TH, its benefits and how it is the future of rural & remote health, but no one is addressing the big issue of support funding running out in June 2013.

Specialist health services in rural areas should not be dependent on tenuous links with metropolitan services and the good will of visiting specialists. Such ad hoc relationships, whether in the public or private sectors, should be replaced by service agreements and clinical governance structures that ensure continuity of services in rural areas. There must be more formal arrangements between metropolitan and country services that withstand the test of time and changes in personnel, and which build workforce and service capacity in country locations by providing nurses and allied health professionals with links to tertiary services and specialists for timely advice and expertise.

There should be a national campaign to promote the importance and rewards of generalist health practice as a specialty in its own right, with well-supported and easily-navigated training pathways to rural generalist careers articulated in medicine, nursing and allied health.

While understanding local circumstances is vitally important in planning outreach services, assessment of need should be improved and be undertaken within a national framework that outlines the minimum expectations for core secondary health care services to be delivered through outreach, telemedicine or locally based service providers. The framework should set out population based planning benchmarks reflecting. The planning framework should be developed through a broad consultative process. The framework should emphasise and provide guidance on process to engage with local communities in planning for outreach services.

That the relevant industry bodies and disability organisations make representations to state and Commonwealth governments to obtain funding for groups, such as Carers Australia, to conduct and widely publicise further workshops across rural areas for families to assist them in future planning.

A framework needs to be developed to guide and support high quality, highly-translatable clinical research in non-university settings and to provide clear pathways for collaboration between government and research organisations.

Involving a hospital pharmacist in medication reconciliation should be considered for all elderly patients taking multiple medications who are admitted to rural and regional hospitals.

To be sustainable, the successful programs that involve Eye Health Coordinators need additional funding so that Aboriginal and Torres Strait Islander clients can continue to have access to basic eye care that may save them from blindness or give them the ability to see through a pair of glasses.

Given the vital role Regional Eye Health Coordinators (REHCs) play in facilitating eye care services, there should be open dialogue with them to ascertain their training needs, and funds provided for effective training to meet their needs.

There is an urgent and growing need for rehabilitation services provided outside major centres, using service delivery models that are flexible enough to meet the unique demands of individual clients and settings.

The education and training of nurses and allied health professionals should include a holistic approach to palliative care (including emotional and spiritual care), and minimum competency standards should exist for such care. Clinical staff can be supported in these areas by the provision of training and resources on pastoral care (eg relevant manuals), and clients and caregivers should have access to information regarding patients’ rights to receive pastoral care. To ensure access to such measures in rural, regional and remote areas, adequate funding will be required.

My clients know they’re overweight, they eat too much, don’t eat enough fruit or veg and don’t exercise enough. We need public health campaigns that decrease people’s guilt, empower them and give them direction ie is it more of a waste to leave your left overs on a plate or to eat them when you are already full? Rather than reinforcing the things they know they should be doing but are struggling with.

In developing and implementing the National Disability Insurance Scheme (NDIS), service providers and governments should take note of issues for a rural family raising a child with multiple disabilities. Currently a family can end up in ‘child protection’ purely because of a lack of any other alternative. Services which are bound by eligibility criteria, either due to funding or financial management or even case load management, and which are prescriptive in the nature of the service they will provide, invariably create gaps through which families and children will regularly fall. Good communication is key and families need support to understand the options for their child’s future, including for when they – the carers – are no linger able to fulfil the role.

In order to show the impact dedicated health promotion officers have had across their communities by linking all agencies, co-ordinating collaborated approaches and consistent messages and empowering the people we need to track what happens in states such as Queensland and SA who are currently decimating their prevention health workforce. Government needs to be reminded that health promotion is bigger than just telling someone to eat healthy and exercise more in a 1:1 appointment and removing the little we have been doing will only make matters worse!

The presentations from Louise Sylvan and Tom Calma make it clear that significant advances in rural and remote health would be made with Indigenous specific health promotion campaigns addressing hypertension, heart disease and diabetes. These targeted programs must be designed to fit local circumstances and demographic differences. They would address smoking, obesity, physical activity and alcohol consumption. To support health promotion activities, greater consideration needs to be given to how health literacy can be improved in target populations. Working in partnership, interested bodies can collaborate through such things as joint service agreements, the development of train-the-trainer resources, and the sharing of existing materials.

Strategic plans for population health should include measures to ensure food security, with specific funds available for ongoing and long-term community work on food security.   A cross sectoral and collaborative approach should be used to develop an effective strategic approach to addressing food security – driven by in an inter-governmental and inter-agency Food Security Council.  In the same way that Telstra has a Community Service Obligation, the major supermarket chains should share the responsibility of improving food security in rural and remote Australia.

The NRHA should continue to support multidisciplinary child health teams providing both personal health care and innovative programs. The NRHA needs to reaffirm its committement to clinical care for children and young adults in their region in the face of threats from case mix and activity based funding.

NRHA acknowledges children and you adults as a special group requiring a different approach and the need for more child and youth specific training and resources for staff working in these multidisciplinary teams.

We also recognise the current gap in services transitioning patients from peadiatric care to appropriate young adult support across rural and remote Australia, particularly in relation to psychosocial aspects of care. We recommend systems be investigated to facilitate improved care for the transitioning of young adults, including telehealth possibilties.

Over 20000 new diagnoses of prostate cancer annually. Significant and growing mens health issue. Early intervention provides more treatment option choices. Rural men and ATSI men have poorer outcomes. Links need to be made between health care practitioners, medicare locals, and NGOs in aged care and prostate cancer such as Prostate Cancer Foundation and Movember to imcrease community education and improve treatment pathways for men in rural and remote areas diagnosed with prostate cancer.

This Conference calls on political parties to make a bi-partisan commitment in the context of the 2013 election to legislate more place-based models of community empowerment and program administration in areas such as education, housing, employment, arts and culture, transport, and families and community services.

To maximise the effectiveness of telepsychiatry for older persons living in rural and remote regions, the approach should involve both a psychiatrist and other care providers. Even with the best technology, telepsychiatry should be used cautiously in the case of advanced dementia patients, patients with serious sensory deficits and those having disorders affecting psychomotor activity.

Given the number and significance of non-resident workers in Fly-In, Fly-Out communities, there is an urgent need to rethink the process of planning health services in such communities in order to ensure there is not an under-allocation of health resources (workforce, infrastructure, support) to them.

Given little or no access to public transport, and often having limited financial means, people living with a disability in rural and remote areas have particular and serious transport needs. These need to be met through a variety of community and governmental means, including the development and implementation of the National Disability Insurance Scheme.

The accreditation standards of all health professions need to be reviewed and updated to explicitly set the standard for education providers around the processes, structures and curriculum requirements to produce graduates who are able to deliver culturally responsive care to Aboriginal and Torres Strait Islander people, including those living in rural, remote and very remote locations.

national Indigenous guiding principles for policy relating to Indigenous access to medicines- see NACCHO’s paper

It is recommended that more longitudinal research be conducted with regards to rural intent and the relationship with subsequent rural practice, throughout university and postgraduate training, into regsitered practice. Other factors that are currently implement to encourage rural interest should be included in the research including community engagement during rural placements, cohort factors, academic support and perceived isolation and specific student characteristics such as age, grad/undergrad, learning styles and coping strategies.

There should be end-to-end economic evaluation of Australian telehealth initiatives to quantify and better understand the financial and quality of life benefits to patients against the potential economic discrepancies for health care providers.

1. A focus on maternity care is required, that supports families and community, not obstetric midwifery general practice. This will educate and allocate resources accordingly.
2. Professional development must be multidisciplinary, and supervision and mentoring must be provided across the entire team and equitably funded.
3. Electronic records should be implemented as a means of a safe information pathway across current multidisciplinary systems.
4. A contemporary culture of leadership and management is required, that introduces creative models of maternity care that meets families and communities needs.
5. Jurisdictions are required to lead in introducing contemporary, community orientated maternity care.

That a whole of health and care workforce development model be adopted. Two-thirds of the health and care workforce do not have a degree and are a key and growing element of health and care, especially in rural settings. Moves to consumer directed care, home and community delivery and a focus on wellness will look to the assistant workforce. The current focus and funding is on professionals with a degree (just look around the conference attendees and exhibitors…). Will there be enough GP’s and RN’s to go around?

I recommend that this worthwhile and colorful alliance develop a working group called RAGE: Rural Alliance for Gender Equality with the following aims
- actively work with our communities to change the culture around GLBT people… Stamp out homophobia!
- help to reduce obesity within the gay and gender diverse populations in rural Australia (see sports medicine Australia for current research)
- diversity houses have been implemented in the ACT, consider roll out of similar support structures across rural Australia
- improve mental health support for GLBT individuals in rural Australia with the aim of decreasing suicide rates in this cohort
- maintain current and look to increase support for rural and remote GLBT to support them in our communities so e don’t loose them to the city
- start a RAGE GLBT choir!

Facilitating a more optimal balance between acute and non-acute services in PHC requires understanding the difference between urgency and importance, and valuing both.

At next conference provide networking opportunity for rural health researchers.

Broad health workforce planning should be carried out across Australia. This planning should be based on regional population (mapped at several points throughout the year to allow for regular transience and seasonality of communities), known and predicted health needs of each region, physical and geographic factors and weighted for social disadvantage and proportion of high need people in the particular community.

Criteria for funding under the Rural Health Outreach Fund and MSOAP-Indigenous Chronic Disease extension be expanded to include support for:
a. regional outreach coordinator positions, focussed on outreach services into remote and very remote communities.
b. local coordination of outreach services in remote and very remote communities (e.g. the costs of community workers and other workers within local Community Controlled Aboriginal Health services and other primary care services involved with supporting outreach services).

As state operated health services recalibrate to work within sustainable budget, and activity based funding, and in the context of demand for tele health (specialist health review from afar), we need to avoid intensification (remedicalisation and reliance on diagnostic technologies) by preserving and developing low intensity and community level health services AND the rural and remote located health workforce. We will otherwise see an increase of the already (estimated) $2.1b primary health care rural health deficit. The full gamut of primary health service intent and practice must be preserved.

The department of Education, Employment and Workplace Relations consider the inclusion of risk factors for problem gambling throughout the school curriculum for ages 12-18 as a preventative approach.

Conference calls on the “Living Longer, Living Better” legislation, with its focus on greater support for older people to live in their own homes and communities, to address the particular vulnerabilities of older people living in rural and remote communities.  These include higher proportion of older people with low incomes, greater isolation and greater risk of heat waves, fires and floods.  Measures should include rural seniors’ fuel vouchers to compensate for less public transport, safe at home modifications that include timely access to falls prevention modifications as well as air conditioning, reflective roofing etc .  Pooled Commonwealth and state investment in aged and disability services should also be considered to increase the potential for viable home services in under-served rural communities.

Further investment made in standardising assessment tools across govt, non govt sector to minimise duplication and experience of poor and ineffective service delivery where consumers/ clients / citizens are askd the same question many times by different providers. Also greater emphasis to be place d on common data definitions again to rimprove accountability of service providers to service users.

The recommendation titled Child Health needs to be retitled towiden it’s meaning and reflect that it is about the support for health development and impacting upon the social determinants if health and the long term affect these have upon health and life outcomes. – the title could be Early Childhood.

Specialist health services in rural areas should not be dependent on tenuous links with metropolitan services and the good will of visiting specialists. Such ad hoc relationships, whether in the public or private sectors, should be replaced by service agreements and clinical governance structures that ensure continuity and networking of services in rural areas.

There should be a national campaign led by Health Workforce Australia to promote the importance and rewards of generalist health practice as a specialty in its own right, essential to leading and providing health care in rural and remote Australia.

Increased support to medical colleges to create more rural rotations, and rural training places for Medical Specialties other than General Practice and Rural Generalism.

To ease the assessment journey for older rural people, effective aged care assessments require local cross-agency collaboration. There needs to be a multi-level assessment process to assist simplicity and improve access of consumers to necessary service.

The effectiveness of extended scopes of practice training programs should be assessed, with the development of new health assistant roles undertaken only in consultation with key stakeholders including representatives from the most closely associated current health professional body and appropriate consumer groups.

Training for new health assistant roles should be accessible to individuals living in rural and remote communities, and the effectiveness of such roles closely monitored.

Mental health professionals should be equipped through their education and training, and supported by their employers, to use humour to improve therapeutic engagement with those with mental illness, including those with acute psychiatric symptoms.

To expand the availability of allied health services in rural areas, program funds should be available to allow local residents to undertake Certificate IV in Allied Health Assistance. Remote supervision of allied health assistants has been shown to be effective and greater numbers of assistants would help ensure that staff are able to access normal leave entitlements, thus improving the sustainability of local allied health services.

Children have the right to health information and therefore health care professionals need to understand how play can be integrated into various healing modalities.

Professional bodies, governments and regulatory agencies should recognise Accredited Exercise Physiologists as allied health professionals and understand the role they can and do have as members of the multidisciplinary teamin the prevention and management of chronic disease, and in restoring optimal physical function, health and wellness.

Strategic plans for population health should include measures to ensure food security, with specific funds available for ongoing and long-term community work on food security.

Consider the implementation of an ADHD treatment plan – similar to the Autism treatment plan – providing up to 20 medicare subsidised sessions of psychological and allied health interventions. Incorporate within this longtitudinal plan 2 to 3 measures of outcome, which might begin to provide much needed information on long term outcomes in ADHD.Include description of the General Practitioners’ role within this treatment plan. Consider piloting in regional,rural & remote areas where resources ( for desired multidisciplinary management) are less readily available.

The sector should learn from the Mulungu model of a doctor/PA team for chronic disease management that the benefits from the investment of time in learning the systems required by Medicare for appropriate care delivery and adapting individual clinic systems can be quickly reaped through increased revenue, improved efficiency and more time to devote to other important tasks. Doctors should promote this innovative role to those who make policy changes as a way to effect change in Australia – as happened in the US.

Encourage a university to develop a multidisciplinary rural allied health degree. The more rural and remote you go, regardless of the health discipline you are qualified in, you are consulted as a health professional outside your area of expertise, often the gaps in your knowledge can be filled with CPD, but a multi stream degree would be useful.

That telehealth solutions continue to have attached medicare item numbers, are locally tailored and well supported by integrated electronic health records.

data showing that rural origin is more likely to lead to rural placement.
There should be increased selection of people with these characteristics in health training programs
Create more numbers in optometry placements and increase duration of placements well over two weeks in the rural settings

Funding bodies need to take care in assessing the efficacy of these rural and remote health campaigns, taking into consideration the fact that behaviour and lifestyle change is a slow process.

Spouse support for rural relocation be given higher funding and support from all rural workforce agencies.
Extend ”BushBuddies/Mentors” beyon just medical professionals spouses and liase with other community or Gov’t agencies support programs such as John Flynn to extend range of network.

Funders and policy makers need to allow local providers to have the capacity to plan and deliver local health care solutions.

Would be great to see a website or similar where people could upload their innovative ideas and new uses for telehealth. Others could acess these ideas and contact the creators and/or add their own ideas. Save on doubling up and streamlining set ups.

A national approach be established through which data required for planning primary care and secondary care is collated and made available on a regular basis to all stakeholders involved with planning of these services. Core planning data is required at a common geographic unit that facilitates understanding of the level of needs of localities and current levels of service provision, which is generally at a level. Data should include analyses currently available at the Statistical Local Area (SLA) or Local Government Area (LGA) level (e.g through the Social Health Atlas of Australia data) but further disaggregated to provide an understanding of individual towns and communities within SLAs. Data available should be extended to include the utilisation of MBS supported specialist services (in and out of hospital) and in future years medical evacuations, levels of patient assisted travel and use of state/territory supported specialist and allied health non-admitted activity.

increase primary research and particularly support for research (e.g. employee research assistants, offer help with ethics applications and data management to reduce workload burdent and enable health care professionals to undertake research) into clinical supervision in non-mentropolitan Allied Health setting

That the Rural Health alliance focus attention on ways to involve Aboriginal people in Health Service planning.

This Conference calls on political parties to make a bi-partisan commitment to the delivery of high speed broadband for all families, businesses and communities in rural and remote areas.  This infrastructure needs to be based on pricing models that don’t discriminate against people in rural and remote areas, available to all who need it, and robust enough to accommodate future information technology developments.

In the context of the importance of nutrition to good health and wellbeing, strategic plans for population health in rural and remote Australia should include measures to ensure food security, with specific funds available for ongoing and long-term community work on food security.

Australia is ready for a surge of telehealth development that does not undermine the provision of face-to-face specialist services in rural and remote areas and is driven by clients’ needs, not by commercial gain and efficiency at the expense of quality care.—

That we ensure awareness of dementia (in all it’s forms) and the role of health professionals, policy makers and support groups, and the greater impact of this disease in the community.

The Bendigo Loddon Primary Care Partnership approach should be replicated in other communities and settings.

The Department of Health and Ageing and the Department of Regional Australia, Local Government, Arts and Sport (Office for Arts) should work collaboratively, using the arts, to achieve better health outcomes for all Australians.

The Department of Education, Employment and Workplace Relations should consider including materials relating to the risk factors for problem gambling in the school curriculum for 12-18 year olds.

Policy makers and program managers in the health sector need to consult with, and listen to, older individuals from diverse cultural backgrounds in rural areas in a manner which is truly culturally and linguistically sensitive (ie in their native language). By this means it is possible to determine what is important to them as older adults who are ‘ageing in a foreign land’.

Health care providers need to be aware of the impact on individuals of the trajectory of cancer and of its treatment, and make a stronger commitment to the provision of rehabilitation options in appropriate settings, including as outpatients. Given growth in the number of cancer patients, additional funding will be needed for the development of cancer services.

To help ease workforce shortages in rural areas, governments, professional associations, private sector service providers and recruiting agencies should collaborate on strategies to retain older health care workers. Further research is needed into how best to address the inherent disincentives and to enhance the rewards that currently exist for the retention of older workers.

Customising health curricula to fit the local health system is complex and needs active involvement from health services, clinical supervisors, patients and educational providers.

To decrease maternal and neonatal mortality and morbidity, women in rural and remote areas should have access to midwifery care.

It is recommended that the change from a “Named medical practitioner” to “Health provider organisation” in the Standing Council on Health Determination be legislated with minimal delay.

It is recommended that eligible midwives be included in the MSOAP and SOLS outreach services.

It is recommended that eligible midwifery access to the PBS be expanded to the full scope of midwifery practice; and that MBS benefits be made available for antenatal education, individually and in a group, both in person and utilising online health systems.

To help build health service capacity in areas like Far West NSW, there needs to be greater local autonomy to set recruitment strategies and provide financial and/or other incentives for maternity health professionals, particularly midwives, and strong partnerships between service entities.

It is recommended that health professions, educational institutions and governments do more to promote and support work-integrated learning placements (or ‘service-learning placements’) for early year health students. As well as excellent learning experiences, these also extend the capacity of local health services and provide additional placement options. Service-learning placements also provide universities with a vehicle for authentic community engagement and have the capacity to increase higher education participation for rural and regional secondary students who may lack positive role models. Universities’ course accreditation and registration requirements need to support growth in the number of work-integrated learning.

To support health promotion activities, greater consideration needs to be given to how health literacy can be improved in target populations. Working in partnership, interested bodies can collaborate through such things as joint service agreements, the development of train-the-trainer resources, and the sharing of existing materials.

After its further validation, the Australian Regional Birth Index (ARBI) should be used to inform the provision of maternity services in rural and remote areas of Australia.

To help ensure that the risk of violence against professionals working in rural and remote areas is minimised, there needs to be further work to understand the pros and cons of various formal and informal responses to such risk, and follow-up action to set in place the most appropriate measures.

Further research is required to assess the effectiveness of the current dietetic workforce in rural areas and to investigate ways in which there can be improvements in service delivery with current staffing levels.

Workforce policy should have a major focus on achieving greater equity and sustainability for health service provision in rural and remote areas as compared with the major cities.

One of the issues contributing to higher unit costs for outreach services in more remote communities is a low level of attendance at scheduled appointments. This can be mitigated through greater attention to local and regional coordination of services.

Multi-D placements, specifically following a longitudinal patient journey through all aspects of care, have many benefits including improved interprofessional collaboration. It is recommended that funding be allocated to facilitate the implementation of similar programs to WoSSP across Australia. It is acknowledged there are difficulties related to the set up of programs, specifically appropriate policy and systems for implementation, and it is recommended that information and resources are shared between sites both within a community and between Universities.

When developing new programs adequate time needs to be given to effective consultation and considered development.
- They need to be sensitive to the unique needs and contexts of the communities that they serve.

Attitudes and cultural barriers within government need to be challenged to snsure appropriate access to current social media communication networks

• More funding for the safe house, training, resources, etc
• Setting up a pro bono public defender service to support children and young people in need
• Adopt a child program- adopt a grand-parent program to be run on Norfolk Island. The potential, for this program exists on a number of levels for both the child and the surrogate grandparent.  The program would aim to assist children with book, uniforms, equipment in getting back to school. People could pay one up- front fee or set amount per month this in turn benefits specific students. Benefactors get anonymous thank you letters as acknowledgement from the child.
• More education for Child Welfare Officer.

Research is needed into the priority given to career progression and CPD access and to clarify the correlation of CPD needs with career stage to form evidence based strategies for rural allied health workforce development and retention.

Workforce data collection and profiling of rural allied health professionals needs to be improved.

Governance structures for health organisations should be designed to reflect the population and health needs of the community they serve.

Progress should be made towards legislative support for prescribing by PAs and their professional registration of PAs so that supervising doctors can be safely relieved of such time-consuming tasks as ordering tests, prescribing medications, approving refills and making specialist referrals

There should be greater awareness of and support for the initiative of the Australian Society of Physician Assistants (ASPA) to instigate a self-regulatory registration board, reflective of the Australian Health Practitioner Regulation Agency (AHPRA) and Australian Medical Association (AMA) guidelines.

That outreach rural services have permanent funding, separate from three year funding cycles, to maintain appropriate services and workforce stabilty.

Equity of access for all health students for rural and remote placements (funding for accommodation, travel etc) . Parity with medical students

Nursing students need to be taught at university to be teachers or mentors to students

That a SDH approach be adopted that acknowledges the need for cross sectorial collaborations that include shared responsibility and accountability that is sensitive and adaptable to the diversity of communities and regions. That we acknowledge that these collaborations extend beyond government agency representation if we are to achieve sustainable and meaningful change that is driven by solutions focused activity not deficit dependency.

There should be a voluntary internship program for overseas trained dentists as well to encourage them to move to rural areas.

Dentist should provide Oral Health Care Plans to all their patients. They can use item numbers 141 and 131 and charge the patient or their health fund for this.

That the Rural Health Alliance prioritise approaches to chronic disease that will reduce hospitalisations and release funds for prevention and patient-centered services. Services that reduce hospitalisations include Do it for life, Pulmonary and Cardiac rehabilitation programs and Rheumatic Fever action plans, and the many programs that reduce preventable diseases and mortality, particularly in the Aboriginal and Torres Strait Islander population.

As part of teh NHRA the State -Commonwealth Bilateral Agreements are currently being informed and negotiated April – June 2013 . This is an opportunity to include the significant PHC related recommendations in binding agreements between the States & Commonwealth.

CSG and other unconventional coal and gas projects should not proceed without guaranteed water and air quality monitoring, which is open and transparently available to community members
Companies must disclose the actual chemical nature of their proposed fracking fluids.
. Attention should also be paid to facilitating affordable baseline testing of communities at risk prior to mining. This must be independent of the company involved.

This Conference calls on political parties to make a bi-partisan commitment in the context of the 2013 election to the principles embedded in WA’s Royalties for Regions program.

Advocate to State and Federal ministers and opposition spokespersons for Arts and Health, in addition to your local members for a National Arts and Health Framework.

That all health organisations should engage with health students and early career health professionals in reforming healthcare in Australia. Health students and early career health professionals offer a unique perspective on the healthcare system and should be actively engaged in health reform.  Support for placements currently offered to medical students should be extended to students of all health professions.

As a key broader determinant of health for disadvantaged communities in remote Australia, Rural and Regional Australia prioritise the issue of access to public transport for remote Australians and acknowledge that, if mass public transport can be subsidized for metro Australians, certainly small scale public transport systems can be developed for remote Australians to ensure people become better better linked with family, friends and important services

We need increased investment in effective prevention programs which address the social determinants of health
We also need governments to address the “hidden damage” of alcohol and other related drugs through national taxation reform and legislative control e.g. through TV advertising
State and Federal Governments should also pubicly declare the funding they receive from alcohol related industries and agencies

That all sides of politics immediately adopt the recommendations of the Senate Committee inquiry into Australia’s domestic response to the World Health Organization’s (WHO) Commission on Social Determinants of Health report ”Closing the gap within a generation”

http://www.aph.gov.au/Parliamentary_Business/Committees/Senate_Committees?url=clac_ctte/completed_inquiries/2010-13/social_determinants_of_health/report/b01.htm

Summary of Key Recommendations

1. Develop guidelines for media-based Indigenous health promotion messages
2. Adequate funding and timelines for evaluation of health promotion resources
3. Build up a network of media industry advisers and mentors for media-based Indigenous health promotion messages
4. Centralise availability of Indigenous health promotion resources
5. Funding to make Blow Away The Smokes DVD available to all Indigenous smokers in Australia

Allocation of Commonwealth funding for oral health must reflect disease rates and cost of service delivery and not just generic population numbers.

To help meet the diverse needs of remote Indigenous communities in ways that are culturally appropriate and effective, health service managers should use a partnership approach, modelling a translational research framework that fosters open communication amongst stakeholders.

The Pass the Parcel Project has demonstrated how energy efficiency projects can be based on community development and behaviour change principles. Projects to increase energy efficiency for low income households need relationships to be built as a catalyst for their success.

Greater support needs to be provided for programs that connect with and inform young people (including through social media) about the source and value of nutritious food, healthy food choices, and the role of peer group leaders in modelling healthy eating choices.

Advocates should work together to raise the profile of food security as a priority for State and community organisations working in health and education, including those that run community  initiatives such as farmers’ markets and community BBQs.

Greater attention should be paid to the inclusion in professional development programs for rural clinicians of skills and competencies encouraging them to integrate online mental health resources into their everyday practice.

A Community Rehabilitation skill set should be part of the Certificate IV in Allied Health Assistance curriculum.

To enable child protection work on Norfolk Island to continue and be empowered, the report on Family and Children’s Services on Norfolk Island should be publicly released and its recommendations implemented.

There needs to be ongoing funding available, either from government or clients, to support the provision by community pharmacists of professional services such as PAMS, DMAS and Warfarin Monitoring.

Funding should be available through the States and Territories for health promotion outreach workers to small communities. These staff can link the State Health Department, Community Health Centres, and other local services (including those of local government).

A consistent policy for the management of aged care facility residents during periods of extreme heat (including sustainable options for cooling) should be developed in collaboration with aged care service providers, DoHA and the Aged Care Association of Australia. Continuous monitoring and review of clients’ and institutions’ responses to extreme heat should be part of regular continuous improvement strategies. Up-skilling staff on the importance of caring for the elderly in periods of extreme heat should be a part of regular in-service for all aged care facility staff and such training should be made mandatory prior to each summer season. Educational resources for aged care staff and service providers should be developed for this purpose.

To ensure that both paid and unpaid carers in the disability sector have a better understanding of the ageing process, relevant mainstream ageing resources need to be adapted specifically for that sector. Relevant industry bodies and disability organisations should make representations to State/Territory and Commonwealth Governments for funding for groups such as Carers Australia to conduct workshops across rural areas for families of people living with a disability to assist them in future planning for ageing. Peak bodies such as National Disability Services (NDS), Leading Age Services Australia (LASA) and Aged and Community Services Australia (ACSA) should develop a joint training agenda on ageing with an intellectual disability to address common educational needs. Rural disability organisations should establish better networking models with local specialists such as medical practitioners, allied health professionals and pharmacists as a mechanism to raise awareness and understanding of the issues associated with people with an intellectual disability who are ageing.

Specialised services in rural areas should not be dependent on tenuous links with metropolitan services and the good will of visiting specialists. Such ad hoc relationships, whether in the public or private sectors, should be replaced by service agreements and clinical governance structures that ensure continuity of services in rural areas. There must be more formal arrangements between metropolitan and country services that withstand the test of time and changes in personnel, and which build workforce and service capacity in country locations by providing nurses and allied health professionals with links to tertiary services and specialists for timely advice and expertise.

As I am a visitor to Austrralia my observation may lack perspective. However, I was impressed with the success of the Srathalbyn District Health Services (Sun. Bus tour) in achieving community support for health initiatives. Examples such as these could be developed as case studies and shared throughout the country in a number of ways, including reports in the NRHA monthly magazine. In effect, the ”no need to reinvent the wheel” perspective. A. Knox

South AAustralian Aboriginal Health Survey – utilise their methodology and community collaboritaions to consult about Indigenous health for data collection. This is a good model for collecting data.

For Indigenous programs, work with local people and communities in developing and designing programs that prioritise community ways of doing thingsto address social determinants of health

Acknowledge the importance of multi-faceted strategies to delover health information to rural consumers and the reality that they are not cost free and require ongoing targeted support

Address social disparity through healht financiing – financial status has an impact on access to health services and health outcomes ie private health insurance

First decide what you want from evidence then ensure that project evaluation funding matches the scale and nature of the evidence that you require.

Have an art worker within a medical local team.

James Cook RCS has shown that students that do not undertake surgical training are 9 times more likely to go rural, which may correlate with the lack of surgical training opportunities in rural and remote areas. It is recommended research be conducted to determine factors affecting this trend and the development of appropriate support systems for surgical training in these areas should be investigated and implemented if appropriate.

Australia needs a national exchange program that allows rural health policy makers to work alongside rural health researchers for a period of time, and vice versa. The policy and research worlds could learn a lot from each other and this could lead to more evidence-based decision-making.

Better coordination and less duplication of child protection services was a recurrent theme

need for more research and evaluation to avoid perpetuation of non-effective interventions

it works well to have one phone number or point of contact that connects the first responder to ALL the services, to avoid duplication and ensure all services including, health, police etc and other agencies are available

That paediatric orthopedic rural services need to continue to be supported by metropolitan centres to ensure accessibility of care.

That the lessons leraned by the Patient Liason Network in South Australia be examined and applied across other juristictions.

That financial incentives to complete discharge summaries be implemented to ensure appropriate follow-up and renumeration.

promotion of safe use of social media to expand outreach to peers and patients , and to empower users to embrace social media in the workplace.

Cooking and nutrition education programs result in a number of positive community level impacts. Similar programs implemented in other rural communities need to be adapted to suit that particular community to ensure the interventions offered meet that community’s needs. Funding must be secured for community work and community level organisations can assist researchers to understand the diverse needs of the community. Targeting school-aged children may be effective in terms of preventative interventions – perhaps more longitudinal research is required >6 months after the program to see if this is the case.

Yesterday we saw how IMGS drs are the bulk of new Drs rural and remote .They are to a large extent the backbone of health care but the Drs and their families are not eligible for something we all take for granted ie Medicare. This is a matter that must be addressed.

Spouses should be offered fully funded retraining and fully funded trial employment for 2 weeks where there is a definite prospect of permanent employment if the trail was successfully. Program to be delivered by Rural Workforce Agencies

Organisations that have the benefit of government support to facilitate their use of bespoke paid teleconference technology should consider the merits of using open source, freely available and widely compatible technologies and of not locking themselves and their organisations into one form of technology for telehealth. Consumers, NGOs and independent health practitioners do not have access to most of these bespoke solutions and the promotion or multiple expensive technologies merely makes the world of telehealth seem more daunting and complex than is necessary. Open source platforms and free platforms that are simple to use should be supported. Issues of individual privacy and security of consultation can be discussed with the consumer/patient who is agreeing to use this technology and they can make their own informed choice.

A consistent policy for the management of aged care facility residents during periods of extreme heat (including sustainable options for cooling) should be developed in collaboration with aged care service providers, DoHA and the Aged Care Association of Australia. Continuous monitoring and review of clients’ and institutions’ responses to extreme heat should be part of regular continuous improvement strategies. Up-skilling staff on the importance of caring for the elderly in periods of extreme heat should be a part of regular in-service for all aged care facility staff and such training should be made mandatory prior to each summer season. Educational resources for aged care staff and service providers should be developed for this purpose.

to systemise the S100, eg give people guidenece with templates etc to ensure a full system is in place for implementing the program in other rural/remote areas.

Education needs to be available for health professionals involved in palliative care

Commonwealth programs should adopt a community development approach and be peer led

Accommodate for time in consultations to allow for storytelling. If people are given the opportunity to tell their story, we get so much more.

a structured approach for advance care planning needs to be in place for transfer of information to electronic health records

Art, storytelling and culture allows a conceptualising of issues that inform workers to better hear bigger stories. How can we best facilitate this?

more allied health involvement post chemotherapy

Explore wellness indices athat are consistent across Australia (and promote these to relevant organisations e.g. Medicare Locals) in order to assist with needs assessment and planning for their regions, and enable comparison across rural and remote, and urban areas.

Formal clinical agreements between universities and placement sites with clear expectations of intended outcomes

We need to address the importance of data being accurate, informative, accessible and rural and remote specific, and, where possible, nationally comparable. This is critical in terms of planning and monitoring services.

Pursue the strong interest generated from this colloquium in following the presentation about the National Strategic Framework for Rural and Remote Health through the appropriate reporting of both quantitative data and qualitative data (including consistent frameworks for self reporting).

Great conference & loving the sharing shed! Please consider sharing participant list (with appropriate privacy consents) adding reference numbers to recommendations, building in search tool for recommendations so we can filter by subjects, programming in an opportunity for delegates to gather informally based on geographical areas, discipline. Ta

Programs including food gardens;
1. MUST be community initiated and developed in partnership with communities
2. MUST be part of a broader multi- strategy approach to address food security
3. MUST NOT be transplanted from programs run elsewhere

There must be support for programs that connect with, and inform people about, the value of healthy food.

The must be continued investment in community based food initiatives that integrate social elements

The profile of food security must be raised as a key priority area in addressing issues relating to socio- economic disadvantage

There must be a response to the research opportunities for the use of social media in food security

There must be a great emphasis on involving young people as peer leaders in modelling healthy food choices

A policy portfolio must be established for food security at both state and local levels that is appropriately resourced.

That every effort be made to develop clear and achievable measures of impact of the efficacy and achievements of health promotion teams in rural health, such as the COAG ICDP Tobacco Action teams, so that can monitor their work effectively with valid evidence and also so that the funding and sustainabillity of these teams can be assured in the face of any challenge to their roles in the future.

That the role and place of the Aboriginal & Torres Strait Islander Health Practitioner be appropriately acknowledged and promoted in Aboriginal PHC as a critical clinical team member and cultural expert within the multi-disciplinary team, and further that it be acknowledged that the viability of the profession is currenlty challenged in many remote regions as numbers of ATSIHPs approach retirement and there are very few trainees successfully completing training to take their places due to literacy and numeracy limitations. Consequent to this that HWA, DoHA and other relevant authorities be lobbied to further build their efforts and investment in the ATSIHP profession to ensure its viability into the future and its centrality in Aboriginal PHC.

Funding is needed to support locals to undertake certificate IV in Allied Health Assistance –> This may enable a rural organisation to realise the benefit and expansion of allied health services that the assistant workforce can bring

More than one Allied Health Assistance and supervising Allied Health Professional is needed in each organisation to ensure sustainability of allied health services

The Certificate IV in Allied Health Assistance should include the Community Rehabilitation skill set for maximal value of Allied Health Assistants in rural/remote communities

Looking at new models of care and ensuring that the community is engaged and involved in all aspects of rural health programs and infrastructure in their local. \also highlighting the need for rural health entities to use strategic business and marketing models to gain funding from local councils, governments, medicare locals and local hospital networks, whilst not being fully reliant on government funding.

That the Rural Health Alliance promote service approaches that are patient-centred rather than following a medical model. Patient centred approaches recognise patient achievements and social determinants to more efficiently reduce chronic disease and increase self determination.

Using a knowledge broker organisation such as PHCRIS to share knowledge and activities of the 61 Medicare Locals

Governance structure forhealth organisations shou;ld be designed to reflect the population and health needs of the communities they serve

Climate change is impacting on health. E.g. social and emotional well-being, physical health of vulnerable groups (elderly, infants, unwell, outdoor workers and tourists), and even the evacuation of whole hospitals (such as the evacuation of Cairns Base Hospital during cyclone Yasi 2011). Therefore, to address these health impacts, a National Policy and Action Plan is required. This should include:
- Increased heat awareness
- Teaching appropriate heat behaviours
- Developing community heat adaption strategies
- Support to increase the thermal efficiency of housing

Increasing natural disasters require emergency plans based on best practice and case studies. (E.g. The evacuation of Cairns Base Hospital during cyclone Yasi 2011.)

There is a significant mal distribution of GPs and and an inequity of MBS funding. Implement a license that is applied to GPs servicing those suburbs that have high numbers of GPs & Specialists ie ”leafy suburbs” and with that funding provide incentives for underserviced areas eg remote and rural and fund AMS’s adequately to pay GP and other MDT health providers at the same or better rates that the State pays.
This is based on recognition that there maybe ” no more money” and therefore applying a license to those medical practitioners working in high income places with relatively healthy consumers have high levels of access to GPs, Specialists and a range of health related services

94% of vision loss in Aboriginal and Torres Strait Islander peoples is preventable or treatable by simple solutions. A coordinated national framework should be developed to ensure a comprehensive approach to eye health. Conference calls on the Department of Health and Ageing and State and Territory governments to make provision in their budgets for:

Conference calls on the “Living Longer, Living Better” legislation, with its focus on greater support for older people to live in their own homes and communities, to address the particular vulnerabilities of older people living in rural and remote communities.  These include higher proportion of older people with low incomes, greater isolation and greater risk of heat waves, fires and floods.  Measures should include rural seniors’ fuel vouchers to compensate for less public transport, safe at home modifications that include timely access to falls prevention modifications as well as air conditioning, reflective roofing etc .  Pooled Commonwealth and state investment in aged and disability services should also be considered to increase the potential for viable home services in under-served rural communities.

The current focus on the NDIS highlights the key role played by allied health professionals in disability and rehabilitation services. In rural areas, there is an urgent need to increase sustainable allied health positions, by integrating disability, aged and health care.

The presentations from Louise Sylvan and Tom Calma make it clear that significant advances in rural and remote health would be made with indigenous specific health promotion campaigns addressing hypertension, heart disease and diabetes. These targeted programs must address the social determinants of health and be designed to fit local circumstances and meet the needs of various demographic groups. They would address smoking, obesity, physical activity and alcohol consumption.  They should be evaluated to provide guidance on the most effective approaches.

Occupational violence remains an ever present reality in rural and remote Australia with the need to minimise risk and ameloriate impact.
We propose an extension of the working safe project to develop a generic orientation program for health professionals & the police sector which could be customised and supported in rural Australia.
Cross-sectoral action and multi-faceted strategies (education and training, enforcing existing policies and improving work practices) to deal with perception and impact of violence for health professionals

Country health SA regional areas need to partner with local goverment agencies to develop local solutions to support healthy ageing – including support from other industries and sectors for continuing employment

Local autonomy in the governance for the PHC model/program to improve accountability in outcomes and inter-agency collaboration
ACHSE – should also have an “Indigenous Chapter” – education and support programs for indigenous health workers to develop leadership skills ?? (not sure about this one

Develop a multi-level/ tiered aged care assessment process to assist simplicity and improved access to services

Develop a different type of relationship between policy makers, planners and flexible indigenous aged care services

That the Tele-psychiatry service be expanded and that the barriers for example IT compatibility be resolved. Visiting services be enhanced and local services strengthened.

That the Tele-psychiatry service be expanded and that the barriers for example IT compatibility be resolved. Visiting services be enhanced and local services strengthened.

Need to continue RHCE1 & 2 funding to support CPD for rural & remote health professionals and ensure current local projects are successful and encouraged to continue.

Rural communities should work with Medicare Locals to meet local community needs – not just for health services, but for preventive health activities and all elements of the social determinants.

A further recommendation from the ACHSM workshop…
I am happy that the three above recommendations are submitted to the Sharing Shed to seek the wider support of conference delegates. I would like to see other recommendations around the lessening of bureaucracy, red tape and paperwork requirements of the Department; and also regarding training in tendering, commissioning and supervision of compliance issues, and assessment of capability of PHC services to deliver quality service with the devolution of contracts to Medicare Locals; and thirdly the encouragement of pooling of state and federal funding, and administrative cooperation to provide a more equitable primary health care service in rural and remote communities, one which reflects local need (by local assessment ), providing more flexibility and accessibility to local consumers. As we discussed in our table group. Alison Comparti

The focus on caring for the older person must be broader than the residential aged care sector.

More courses to better prepare nurses for caring for older people should be accessible, affordable and practical across Australia.

That relevant existing mainstream ageing resources be translated and adapted specifically for the disability sector to ensure that both paid and unpaid carers have a better baseline understanding of the ageing process.

That aged care and disability service providers who are located in close proximity in rural areas collaborate with respect to shared attendance at relevant sessions of their respected training and provide join community education programs.

That rural disability organisations be proactive in establishing better networking models with local specialists such as medical practitioners, allied health professionals and pharmacists as a mechanism to raise aware and understanding of the issues associated with people with an intellectual disability to are ageing.

To ensure improved awareness of and access to interpreter services, transport and health-related for patients, allowing for culturally and linguistically relevant health delivery that focuses on the subjective needs of a patient.

We recommend more research to understand cultural disadvantage amongst migrant groups throughout their life course and how this affect their interaction with health and welfare services, particular the ageing migrant population.

For a National Dementia Plan to be developed in order to ensure that the adequate support and access to services is met with the growing ageing population.

The therapeutic power of play should be recognised and integrated in all paediatric health care encounters

1. There is a strong need to develop innovative ways to support young indigenous women to remain at high school longer. This will enable them to complete their year 12 education and continue onto university to complete further higher education.
2. There is a strong need to promote cultural competence in university curriculum, to ensure the cultural traditions, practices and values of each culture are adequately understood and care is provided in accordance with these components.
3. Further funding, support and appealing programs are required to promote and encourage younger generations of nurses and midwives to work in rural locations.
4. Additional support and funding is required for nurse practitioners, in order for their role and their significance to be adequately understood.

There is the need to develop a new internet provider for the delivery of health care that takes into account privacy.

For rural and remote health practitioners there is an urgent need to start planning how we will get connected to the NBN and ensure optimal utilization of the service specific to business and practices in the multidisciplinary environment.

There is a pressing need to ensure effective access to ehealth and PCEHR for allied health professionals in order to facilitate optimal care for clients

Investigate ways to increase inter-operability between telehealth systems via bridging the current infrastructure and possibly developing one universal software package.

The issue of telehealth access in aged care facilities by GPs and Allied Health professionals needs to be addressed.as an important setting to link providers with aged clients. E.g. the implementation of current models existing in telehealth centres into these facilities by the placement of telehealth support officers in these settings.

Hearing loss in rural / remote Australia, particularly in Aboriginal and farming communities, requires more recognition and attention as a significant issue, with a focus on systematic surveillance

Long term health promotion projects are put in jeopardy by short term funding cycles

There needs to be support for young people in East Arnhem Land and equal attention for girls as well as boys. Male weighted programs are delivered through passions in AFL football. Similar ways must be found to engage girls; netball? softball? ??

Consider the efficient cost of Play2Grow model compared with traditional model

consider the improved health outcomes that are supported by evidence beyond that which can be measured in one funding cycle