Submission to the National Commission of Audit

The National Commission of Audit is currently reviewing the activities of the Commonwealth Government. The Alliance has made a submission outlining the special interests of people in rural and remote Australia and the reasons why those interests should be recognised in the recommendations the Commission will make to the Government.

The Commission has been asked to:

• ensure taxpayers are receiving value-for-money from each dollar spent;
• eliminate wasteful spending;
• identify areas of unnecessary duplication between the activities of the Commonwealth and other levels of government;
• identify areas of programs where Commonwealth involvement is inappropriate, no longer needed or blurs lines of accountability; and
• improve the overall efficiency and effectiveness with which government services and policy advice are delivered.

The financial uncertainties (and cost shifting) between Commonwealth and State/Territory Governments in the health sector are better known and more damaging to the interests of Australian citizens than in any other sphere of governance.

In its submission the Alliance has indicated support for the following.

• A 'whole of government' or 'joined up government' approach to health to save substantial costs by keeping people healthy and out of hospital for longer.
• 'Regional impact statements' (or their equivalent) as a means of applying a transparent rural lens to the decisions of agencies whose policies and programs might have particular impact (or much less impact than expected) on rural and remote communities because of their particular characteristics.
• New technologies as one means through which the tyranny of distance can be mitigated. Good examples are telehealth and the Personally Controlled Electronic Health Record, both of which have the potential to be particularly beneficial for people in rural and remote areas, as long as special consideration is given to people for whom connectivity is still a problem.
• A renewed focus on efficiency and effectiveness of government expenditure through improvements to productivity, service quality and delivery of services. The Alliance has urged the Government to strike an appropriate balance between savings and revenue measures. It points out that cuts to essential services (such as for health and education) impact most heavily on people who are already vulnerable. Progressive taxation, on the other hand, does not. And in aggregate, Australia's vulnerable people include those who live in rural and remote areas.
• The concept of Medicare Locals and the considerable expectations of them, including for such things as filling service gaps and being involved in local workforce recruitment and retention, after-hours primary care and the provision of mental health services.
• The illness prevention and health promotion activity of the Australian National Preventive Health Agency (ANPHA). The fact that the rate of smoking reduction has been much less in rural and remote areas than in the major city areas is a matter of the gravest concern. Australia currently directs a very small proportion (estimated to be around 3 per cent) of total health expenditure to illness prevention and health promotion and the early focus of ANPHA on smoking, alcohol misuse and overweight and obesity demonstrates its capacity to be effective in relation to such things as anti-smoking campaigns that better target the specific challenges for rural and remote areas.
• The availability of health data and evidence as the basis for reducing the inequities and improving the health of the 6.7 million people in rural and remote Australia. The National Health Performance Authority (NHPA) and the Independent Hospitals Pricing Authority (IHPA) have demonstrated effectiveness in developing baseline measures for health differentials affecting people who live outside the major cities to ensure that the effectiveness of health program implementation and development can be monitored and held to account. The Alliance also acknowledges the critically important work of the ABS, the Australian Institute of Health and Welfare and the COAG Reform Council, including for the special reporting by rurality they have undertaken or enabled. The Alliance is aware of the difficulty the AIHW has in sustaining a rural and remote focus in the work that it does and reconfirmed its call for a new allocation of resources to the AIHW for rural and remote staff capacity.

The Alliance indicated its ongoing special interest in:

• mental health services in rural and remote areas and the review to be undertaken by the Mental Health Commission;
• the way in which rural hospitals are funded and its intention to remain engaged with the Independent Hospitals Pricing Authority (IHPA) and its work on block funding of smaller hospitals; and
• the Multi-Purpose Service model, which sees pooling of State/Territory funds with those from the Commonwealth and provides good examples of the intergovernmental flexibility in funding that is so important, particularly in rural and remote areas.

The Alliance stressed its hope that, once provided with some understanding through the submission of the areas of particular import for the health of people in rural and remote Australia, the Commission of Audit will seek further information as necessary from the Alliance.

Read the Alliance’s submission.