Western Australia's Country Regions; Going Forward Together - Kim Snowball, Director, Rural Health Policy Unit Helen Morton, Regional Director ...
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Western Australia’s Country Regions; Going
Forward Together
Kim Snowball, Director, Rural Health Policy Unit
Helen Morton, Regional Director, Central Wheatbelt Health Region
2nd National Rural Health Conference
Armidale, 12-14 February 1993
ProceedingsWestern Australia’s
Country Regions:
Going Forward Together
Kim Snowball Helen Morton
Director Regional Director
Rural Health Policy Unit Central Wheatbelt Health Region
The Rural Health Policy Unit in Western Australia was established in October, 1992, it is
based in Geraldton, 442 kilometres north of Perth. It has a staff of three and reports to the
Country Regional Directors Council, which in turn reports to the Commissioner of Health.
Why have a Rural Health Policy Unit?
Most public health systems have planning and policy development capacities that are directed
towards key client groups like:
l Women’s health;
l Aboriginal health;
l Mental health, and
l Aged care
These groupings recognise that there are clients that require dedicated policies and programs to
meet their unique health needs.
The Western Australia Health Department has recognised that people living in remote and rural
communities also require dedicated and flexible policies and programs to satisfy several unique
features of rural and remote communities:
Isolation
l Geographic isolation and the tyranny of distance is exceptional in Western Australia, with
many communities amongst the most isolated in the world.
l The large number of small, isolated communities often means dedicated health care
facilities cannot be supported.
l Many communities lack infrastructure and are also unattractive to health services in such
communities.
These factors mean that logistical problems become overwhelming if attempts are made to
replicate metropolitan health services in such communities.
Diversity
Communities in rural and remote areas are rarely generic in their composition, with perhaps
three broad groups being most often represented:
l Aboriginal communities;
l Mining communities, and
l Farming communities.
Western Australia’s Country Regions: Going Forward Together 55Within these communities there are often further features which demand different health
delivery systems, for example:
l Mining communities are moving to fly in, fly out arrangements.
l Many North West Aboriginal communities are developing outstation movements.
l Farming communities have declining and ageing populations often with an established but
underutilised hospital service.
Given these factors it makes very little sense to attempt to overlay health delivery systems
and policies from a metropolitan area to such isolated and diverse communities.
For example
l A policy to reduce the oversupply of medical practitioners includes a restriction on
overseas trained doctors. That is quite appropriate in metropolitan area, but in the country
38% of general practitioners are overseas trained docl.ors and there is a 5% vacancy rate in
existing practices.
l Fifty of Western Australia’s rural and remote communities have no Home and Community
Care resourcing, this makes the principle that elderly people should be able to remain in
their local communities extremely difficult, and often nearby hospitals adopt this
additional role.
The challenge for the Rural Health Policy Unit is to influence policy development at state and
national levels so that they are sufficiently flexible to accommodate the unique features of
rural and remote communities and, more importantly, to empower those communities to make
choices about how their health services are delivered.
Role of the Rural Health Policy Uni-t
Management and funding arrangements that are flexible and responsive to rural and remote
health needs.
Consultative mechanisms with rural and remote communities and other stakeholders to
ensure health needs are clearly identified, and that communities are informed about, and
have input into, decisions concerning their health services.
3. Fair and equitable resource distribution, based on population needs.
4. Influence and input to both the National and State Health agendas and strategies.
5. The provision of an effective, efficient and motivated workforce in rural and remote areas.
The range of rural health issues assigned to the Rural Health Policy Unit include:
l Implementation of a select committee report on country hospitals and nursing posts
l Population based resource allocation model
l MPS - development of concept
l NGO’s
l Innovative programs - best practice
l PATS
l Access to specialist services
l Aged care policy
l Mental health policy
l Attraction and retention of key staff
l Casemix funding and management
56 2nd National Rural Health ConferenceRural Health Reference Group
In addressing the range of statewide rural health issues before it the Rural Health Policy Unit
works closely with Regional Directors and their staff and consults widely with local
communities, health professionals, managers and other stakeholders.
The Director also convenes a rural health reference group
The rcfcrence group is comprised of the following members:
Mr Kim Snowball Director, Rural Health Policy Unit
Dr Rob Kirk AMA (Professional Input)
Ms Linda Richardson Health Advisory Network (N/West)
Mrs Barbara Dinnie Country Women’s Association
Mr Sandy Davies Aboriginal Medical Service
Dr Don Gunning Rural Doctors’ Association
Dr Brian Williams Centre for Remote and Rural Medicine
Mr Alan Wilson Department of Health, Housing & Community Services
Ms Irene Mills Country Hospitals Board Council
Ms Anne Kreger Remote Area Nurses’ Association
Mr Ken Pech WA Municipal Association
Ms Pauline Sievnarine ANF (Professional Input)
Mr Steve Anderson Assistant Commissioner, Health Policy
Dr Darcy Smith Chair, Country Regional Directors Council
Ms Helen Morton Deputy Chair, Country Regional Directors Council
The referencing group is the prirnary vehicle for informing a wide range of stakeholders about
major health initiatives in rural and remote Western Australia and provides the opportunity for
input during the development phase of these policies. It has representation from broadly based
community groups, consumer groups and health professionals.
It is already very clear that despite the diverse backgrounds of individuals members we all
share a common purpose in improving the quality, accessibility and relevance of rural and
remote health services.
For this reason I am confident that Western Australian country health regions and the
communities they serve will continue going forward together.
Part 2: Helen Morton
Background
The Health Department of Western Australia (HDWA) was created in 1984 by amalgamating
the former Departments of Public Health, Mental Health and Hospital and Allied Services.
Further changes flowed from the Western Australian government functional review of the
health system, HDWA initiatives and government policy commitments. These changes were
directed at improving the economy, efficiency and effectiveness of the health system as the
cost of health care escalated.
The Minister for Health established a health system task force, to further examine the health
system in Western Australia, including issues raised by the Functional Review Committee in
1988.
Western Australia’s Country Regions: Going Forward Together 57The task force detcrmincd that its primary objcctivc was to dcvclop an organisational structure which would dcccntralise operational decision making, scrvicc management and rcsourccs to the local level. The recurrent costs associated with any new structure were to come from within the Department’s existing budget. In a number of oases, the task force rccommcndcd that functions falling under the control of dcccntraliscd management. should be delivered from the central office for various practical or technical reasons. In these cases, it believed that the ‘bureau service’ arrangements could bc extended. Under this arrangement, the decentralised management would pay for the portion of service delivered from the central office and would also have the power to review the cffectivencss of the service it rcceivcd. This would only happen if decentralised management held the budget for these services. The task force recommended that seven country health service management regions be established. Existing staff employed in country areas were of the strong view that a Country Service Policy be developed. The task force recommended that the development of such a policy bc given a high priority. Formation of Council Country Regional Directors (CRDs) were appointed mid 1989. Clearly the tools for operational decision making, service management and resource allocation were still centrally located. The implementation of regional management had its critics. The shift of responsibilities and resources did not progress at the speed many would have desired, but it was a relatively smooth transition. During the next two years, the CRDs and the Assista:% Commissioner Country Operations (ACCO) met about every six weeks to collectively develop and strengthen regional structures and reduce the central office influence over regional operations. At the same time, central office ‘downsizing’ was occurring and regions had to prevent inappropriate dcvolution of function without resources. With the advent of a new Commissioner of Health, it was determined that the regions should move towards full autonomy within a framework that held them accountable for the achievement of health outcomes within each region. Consequently in September 1991, the ACCO position and the support team was abolished, some of the resources going to each region. The Country Regional Directors Council (CRDC) was formally created, composing the seven CRDs with an Executive Officer. Plans to create a Rural Health Policy Unit were announced, although it took another twelve months before it was up and running. Progress of the Council The CRDC went from strength to strength. The country regions had developed clear strategic and operational plans, were involved in country service policy formulation, had achieved representation on major decision making bodies, were successful in lobbying for a better share of resources and had significantly raised the Council’s profile and the general profile of country based health services and issues in Western Australia. It also established the Rural Health Policy Unit. At the same time the CRDC gained a reputation within the HDWA as being arrogant and began to acquire some destructive behaviours along with its many qualities and strengths. It was clear that business rules needed to be clocumcnted and agreed to. In October 1992 a consultant was commissioned to assis:: the CRDC to develop a ‘new look’, a more business-like approach to !strategic direction both within, and external to, the HDWA. It was also necessary to deal with some internal conflict which may have become self destructive. Primarily, we wanted to build on the strengths and qualities of the Council and eliminate the destructive behaviours. 58 2nd National Rural Health Conference
Current Status
The CRDC Statement of Understanding was developed following the October meeting and
outlines the role and function of the Council today. The Statement of Understanding covers:
The Country Regional Directors’ Council exists to enhance country health services in Western
Australia.
I Terms of Reference
I. I To represent country Western Australian health issues to the Commissioner of
Health, State Health Executive and other state and national health structures. This
representation extends to interactions with other government departments, non-
government organisations, and health stakeholders.
I .2 To formulate and review health policy in general and, specifically, country health
policy.
1 .3 To provide direction, input and feedback on program development
I .4 To advise the Commissionr of Health on the method of resource allocation for
country health services.
I .5 To facilitate a network amongst country health providers.
Membership
Country Regional Directors’ Council full membership extends to seven country Regional
Directors, and the Commissioner of Health.
The Director of the Rural Health Policy Unit, the Senior Operations Consultant representing
the Commissioner of Health and the Executive Officer arc in attendance at meetings. For all
meetings there exists an open invitation to the Minister for Health.
The Statement of Understanding goes on to include the role of the Chair and Deputy Chair,
how they are elected, the roles of the ex efficio members, the relationship the CRDC has with
the COH, RHPU, other HDWA branches and the State Health Executive, and it includes
business rules for meetings.
Of particular note is the CRDC role in resource allocation: ‘To advise the COH on the most
appropriate methods of resource allocation for country health services’.
Portfolio arrangements arc also of particular interest. The scope of a portfolio is to be
determined and documented by the Country Regional Directors’ Council as each portfolio is
identified.
Regional Director portfolio allocation will be determined by the Commissioner of Health,
after recommendation from the Country Regional Directors’ Council.
The role of portfolio holder is to include:
l fostering policy and program development in relevant areas (in conjunction with the Rural
Health Policy Unit);
. monitoring, evaluating and communicating to CRDC, service issues and developments in
relevant areas, especially major or key issues;
. representing the CRDC on committees consistent with the portfolio;
. liaising on behalf of the Council with HDWA branches and other organisations in the state
and nationally as ratified by the CRDC;
. responding on behalf of the Council to portfolio relevant ministerial enquiries and
correspondence which is not specific to a region, and
. recommending to the CRDC appropriate resource allocation resulting from, or relating to,
the portfolio.
Western Australia’s Country Regions: Going Forward Together 59The Country Regional Directors’ Council is now recognised, in conjuction with the Rural Health Policy Unit, as a strong collective and well respcctcd voice for country services within Western Australia’s health industry.
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