The new National Strategic Framework for Rural and Remote Health

We waited three years for this new National Strategic Framework for Rural and Remote Health (November 2011), the successor to the 1999 Healthy Horizons Framework 1999-2003 and its successor the Healthy Horizons Framework: Outlook 2003-2007. Was the wait worth it? What’s new?

To answer the last question first: not much. Nor could we have expected much change in the fundamentals. Surely the slightly reworded vision of people in rural and remote Australia being as healthy as other Australians is as fair and incontrovertible now as it was a decade or so ago. Nor would it have been reasonable to expect significant change in the main health issues over that relatively short period, though an indication of trends in these areas would have been helpful.

There are some differences, though, and how these play out over the next few years will tell whether or not the new Framework is a worthy successor to what has gone before. We are told that the new Framework was necessary to reflect contemporary issues in rural and remote health and to identify new and innovative solutions. Yet it pays scant attention to the impact of natural disasters or climate change and there is relatively little reference to the potential of eHealth.

There are, however, examples of innovative service delivery, like networked cancer services in Western Australia, and constructive workforce developments like Queensland’s recognition of rural generalist medicine and pathways into it.

The big change, though, is that the new Framework will be operationalised within the paradigms of the recent national health reform and through the governance structures established to implement it. Which places the Framework right in the middle of the crucial dilemma of Australia’s healthcare (and other) systems: it is a national policy guide wrought under the aegis of a Federal Government that must rely for the greater part of its implementation on seven other governments (of all the States and the Northern Territory) that operate in very different political, fiscal and geographical environments.

While earlier iterations of national rural health frameworks stated that State and Territory health authorities should develop regional strategic plans consistent with the national guidelines, the latest in the series takes a gentler approach. It “allows” the various governments to develop their own plans and is explicitly designed to integrate existing policies and plans and “does not restrict governments from developing [more of them].” This subtle shift is particularly noteworthy in the context of the national health reform agenda.

Unsurprisingly, the key outcome areas retain previous priorities: access, service delivery and workforce. The other two areas – collaborative partnerships and local planning, and strong leadership, governance and performance – could be viewed as instrumental to achieving goals in the first three.

The objectives set out for each outcomes area are not new, either: enhanced access to timely, affordable and quality services, improved cross-network and cross-border arrangements, an increased and better distributed workforce. Nor would anyone quibble with the strategies, though they are also very generalised: bundle financial and non-financial recruitment and retention strategies; support consumer engagement in planning and evaluation; facilitate national standards for patient travel schemes.
We will have to wait until a national plan evolves from the Framework for the measurable performance indicators needed to assess progress towards its goals. There is no indication of its reporting lines or timeframes in the document. Co-ordinated monitoring and evaluating the effectiveness of a loose collation of activities, many of them pre-dating this Framework, going on under eight governments is highly problematic.

Building on work already in train gets the Framework off to a constructive start, but dedicated funding is needed to sustain its impetus.

While a number of ongoing Commonwealth programs are mentioned in the Framework, so far there is no hint of any support for new work like the cluster of Federal budget measures introduced to strengthen the National Maternity Services Plan. Perhaps new funding must also wait until there is National Rural and Remote Health Plan.
The Framework is presented as a tool for all those engaged in planning, funding and delivering health services in non-metropolitan Australia. The Alliance and others see it as a good basis for a national plan, notwithstanding the challenge of coordinating the activities of jurisdictions that have with their own agendas and political priorities.
The answer to meeting this challenge may lie in the emphasis on consumer and community engagement that is one of the heartening strengths of the document. Another of its strengths is the reiteration of principles, goals and outcome areas that indicate a sustained approach that builds on what has already delivered success or promise and reflects input and advocacy from the NRHA and other stakeholders.

So to answer the first question last: yes - it was worth the wait.