Recent announcements about federal funding for ‘local solutions’ to rural health issues are promising but I have an unsettling feeling of déjà vu. You see, I have been around awhile, and I have seen this before. Rural health professionals have always had good insights into what’s needed locally and many have made an art form of finding ways to fund canny ideas that make a difference.
As a new dietetics graduate (~40 years go) I landed green and alone in central west NSW. There were lots of community health needs but the poor outcomes for people with diabetes were truly alarming. What to do? Apart from being a squeaky wheel, activities such as forming alliances, identifying decision makers, getting buy-in, developing a plan and finding resources became part of my day-to-day work.
I was able to get executive support and the senior health promotion officer helped me apply for a grant that was the closest match to my plan. This resulted in $10,000 funding! The local base hospital was persuaded to donate a house that had been bequeathed to the hospital but was being inhabited by medical students.
The grant was partly used to renovate the house with lots of volunteer support for cleaning. Kitchen equipment from the decommissioned Callan Park Psychiatric Hospital was carted from Sydney back across the Blue Mountains. Having demonstrated that we could achieve a lot with a little, a full-time diabetes educator was funded and the base hospital agreed to provide support services. The regional psychiatric hospital with capacity in decommissioned wards provided the final piece of the puzzle; accommodation for patients from more remote areas.
In 1981 we opened the first rural diabetes education centre in Australia. The nature of the service has changed over the years, but it still exists and has made a difference to many people who would otherwise have no access to diabetes education because of where they live.
The keys to this exercise were lateral thinking, leveraging alliances and, importantly, building something sustainable, not a transient program that disappeared when the initial grant ran out. These will also be key factors in new collaborative models of care.
But truly innovative models of care take more than asking locals to come up with solutions to local problems that might be adaptable for other communities. We have done that for years. Innovation requires new ways of thinking. In my own example this new thinking involved a) prevention and b) allied health leadership.
The Murrumbidgee model being trialled in NSW will train rural generalist GPs in the region’s hospitals, but this focuses on boosting procedural and emergency medicine capacity rather than primary care or prevention. The just-announced Snowy Valleys model aims to better coordinate GPs, nurses and allied health professionals to deliver local services. I look forward to reading more about this model.
Investment in the rural health workforce and programs led by local health professionals must include allied health. The expertise of allied health professionals in primary care, chronic disease prevention and mental health must be acknowledged and harnessed.
Allied health professionals must also be seen as capable healthcare leaders. When I was setting up our rural diabetes education centre allied health was considered ‘support staff’ not leadership material, so there was a degree of surprise and alarm to be overcome.
We need to develop models of healthcare where allied health plays an integral and/or leadership role, particularly in rural and remote communities where prevention is so important because treatment options remain limited. If we don’t, I fear we’ve simply gone back to the future.