A National Rural Health Commissioner was an election promise of the Turnbull Government. Legislation has now been developed and is expected to be considered following the resumption of Parliament on 7 February 2017.
The National Rural Health Alliance has been advised that legislation has been prepared to establish the position as a Statutory Office, with the Commissioner making recommendations directly to the Minister. The Rural Health Commissioner is a new role to champion the cause of rural services.
The Department of Health and Assistant Minister for Health, the Hon Dr David Gillespie MP, advise that the Commissioner will work with rural, regional and remote communities, the health sector, universities, specialist training colleges and across all levels of Government to improve rural health policies.
But what does this mean? The election promise included an annual, ongoing budget of $1 million. That funding will need to cover the Commissioner’s salary, office establishment and maintenance, as well as what are expected to be significant travel and consultation costs.
There won’t be a lot left for necessary research and report writing support, someone to draft briefings and prepare discussion papers and monitoring of data on rural and remote health, so the Australian Department of Health will be tasked with providing that support. But if the Commissioner is to be truly independent, is the Department best placed to provide this support?
While pragmatic reasons may result in the Department having to take on the support role, it will be important to ensure the Commissioner’s work plan takes precedence over existing Departmental policy.
Another priority item on the agenda is the development of the National Rural Generalist Pathway. This will improve access to training for doctors in rural, regional and remote Australia, and recognise the unique combination of skills required for the role of a rural generalist.
We are at an interesting point in the management of national medical workforce policy. After many years of insufficient medical graduates, we have now reached a point where the issue is no longer that of an insufficient workforce, but of its maldistribution.
Part of the role of the Commissioner must be to monitor how this maldistribution is being addressed and develop additional options for Government.
As we start to see the effect of medical practitioners meeting their return of service obligations in rural and remote communities, there will need to be monitoring of whether this results in a long term increase of the medical workforce available in rural and remote communities.
It will also result in an increased need for access to a broader health workforce in rural and remote communities. Maintaining and supporting medical practitioners outside the major centres will generate additional needs for allied health and nursing support, and for other members of the multidisciplinary team, as well as access to digital technology, and for a considerable expansion of mental health services. This in turn will have an impact on health workforce policy and will highlight shortages and maldistribution in other health professions.
These demands will no doubt have a significant impact on the recruitment/appointment of an individual to take on such a diverse and significant role.
The new Commissioner must have a significant background in rural health. They will need to have the respect of the education, research and health practitioner communities, as well as the ability to forge partnerships with consumers and communities so that they can receive feedback on community priorities – not simply the feedback from service providers and professional bodies. They need to be able to demonstrate that they have a considerable understanding of health workforce policy from the perspective of educators and professional organisations, but also of the impact of the health workforce on the delivery of healthcare at the community level. And they need to have demonstrated innovation in the way they approach the development and analysis of rural health and workforce policy. They will need to have constructive working relationships across the health sector to maximise their impact.
This is a tall order to find in any one person albeit not impossible. It will be important that the Commissioner’s work be focussed on a few key priorities – not on a very broad agenda which traverses all of rural and remote health. It will be up to organisations such as the Alliance and its members to ensure those broader issues and considerations are kept in the public eye. In other words, the sector cannot expect the Commissioner to be all things to all people and all issues – we all still have important roles to play.
If you have views on the priorities which the Commissioner should tackle first off (and indeed on issues which are important but may not be the first priorities), the Alliance would be delighted to hear from you.