Beyond the Big Smoke No discipline is an island R Adams ...

1 Beyond the big Smoke : No discipline is an island Robyn Adams James Cook University Dispersed health Common issues Action to address Evaluation and Professionals identified identified issues dissemination linked This could not have been achieved without joining in the bigger picture Programs Rural Health Replication of Advocacy and developed to Movement successful Lobbying support rural initiatives health professionals Critical success factors Organisations Product, Networks and and Funding Policy Partnerships united voices and politics Dispersed health Common issues Action to address Evaluation and Professionals identified identified issues dissemination linked Rural allied health Hodgson 1991 Recommendations professional Nihill 1991.

2 Project reports associations 1st R&R AH conf 1993 published articles Hodgson &Berry 1993 and Taylor 1994 recommendations Millsteed 1995 Projects/initiatives for Bishop 1998 addressing long term committed SARRAH 2000 workforce structural individuals and service change networking issues Rural training Clinician Support Innovations in service delivery models Benchmarks Rural training Rural background and undergraduate clinical experience remain predictors of rural work Scholarships and Clinical placement grants Rural universities providing AH courses University Departments of Rural Health Rural Health Training Units Rural training Scholarships and Clinical placement grants Commonwealth Rural Allied Health Undergraduate Scholarship (RAHUS) Scheme State Rural Health Scholarships Schemes Rural Health training Units University Departments of Rural Health RDA NSW website Physio-15.

3 Speech-16. OT-17. SW-24. Psychology-28. Clinician support Scholarship Schemes (national, state and local). Support for specific study and research Mentoring Career path options Locums Organisations, networks and advocacy Resources and literature Clinician support National Australian Rural and Remote Health Professional Scholarship Scheme (ARRHPSS). QLD. Graduate Certificate in Health (Remote Health Practice - Allied Health). Allied Health Research Scholarships . The Study and Research Scheme (SARAS) . Rural Connect Allied Health Conditional Clinical Advancement Scheme Clinician support Victoria Mentorlink Locum optometrist support Country Education Program Victorian Allied Health Postgraduate Rural Retention Bonus Rural Professional Improvement Assistance Fund Continuing Professional Education Program for Rural Allied Health Practitioners Podiatry self-care demand management strategy Allied Health Workforce Enhancement Physiotherapy Locum Pilot Clinician support NSW.

4 The Rural Health Taskforce has recently funded an Allied Health Locum trial across three areas Health services IRCST-Rural Allied Health Project The NSW Rural Allied Health Project Officer The NSW Rural Allied Health Conference 2007. CW Mentoring trial Organisations, networks and advocacy Senior State Allied Health officers Services for Australian Rural and Remote Allied Health (SARRAH). National Rural Health Alliance (NRHA). Allied Health Professions Australia (AHPA). Rural committees of professional associations Resources Improved access to computers Improves access to internet to support EBP eg CIAP.

5 Websites, relevant to rural practice eg NRHA and SARRAH. Data SARRAH report AIHW workforce reports State Workforce reports ABS data analysis Literature Peer review journals eg AJRH. Conference proceedings Rural allied health conferences 1993-2006. Rural Health Conferences 1991-2007. State based rural allied health conferences Project reports RHSET funded projects and Regional Health Services funded projects Innovations in funding and service delivery More Allied Health Services Program The Regional Health Services Program NWQAHS. Katherine West Rural Private Access Program Medicare access through EPC.

6 WA Allied Health Assistants project Community rehabilitation project QLD. Allied health benchmarks a number of approaches focussed on specific clinical areas predominantly inpatient workloads Relevance to rural too specific for many rural settings lack the concentration of services, particularly inpatient services Rural and remote examples Rural Physiotherapy Remote AH services allied health benchmarks approaches individual staff member to a number of patients in specific clinical areas. Eg Rehabilitation guidelines Victorian Allied Health in Rehabilitation Consultative Committee and Christie (which both include outpatients).

7 Clinical time as a percentage of an FTE. eg use of the NAHCC workload distribution categories Benchmarking examples Langhorne and Dennis 1998 study Staffing in British acute stroke units (ASU's) Stroke Units: an Evidence Based approach . recommendations for average Allied Health Staffing per 10 beds. Heather Christie recommendations based on the number of patients to FTE for specific caseloads. Eg general medical inpatients 8-14 per FTE; Paediatric outpatients 4-6 per FTE. Relevance to rural too specific for many rural settings lack the concentration of services, particularly inpatient services reduces their applicability Beyond metropolitan and perhaps major regional areas One approach.

8 Public sector NSW ARIA levels HA, MA, A. P+R+I+O = recommended minimum Physiotherapy staffing level P=Population (1:5000). R=number of Rehab (1:10). I= number of ICU beds (1:6). O=the number of Orthopods (1:2). P/5000+R/10+I/6+O/2= recommended FTE. Remote area recommendations have been developed and reviewed for ARIA levels R and VR and recommend the capacity for a minimum of monthly visits from a physiotherapist to all remote communities with a population of over 100. residents New and ongoing challenges Workforce Supply Staffing level recommendations Distribution Critical mass Education and training Recruitment and retention in rural and remote areas New and ongoing challenges Service delivery Ageing population Chronic diseases Workforce changes Data -workforce planning Service planning.

9 There are many ways forward .. all will require the consistent and collaborative effort that has produced the results described during this conference Dispersed health Common issues Action to address Evaluation and Professionals identified identified issues dissemination linked This could not have been achieved without joining in the bigger picture Programs Rural Health Replication of Advocacy and developed to Movement successful Lobbying support rural initiatives health professionals Critical success factors Organisations Product, Networks and and Funding Policy Partnerships united voices and politics The progress to date reflects the gains made by the collaborative work of many, and that within rural and remote areas, No discipline is an island in allied health ".

10 Thank you References 1. Adams , R. Distribution and Utilisation of Physiotherapy Services in Rural NSW: Preliminary findings 1997 National Rural Health Conference Proceedings 2. Adams R, (Unpublished) The development of recommended physiotherapy FTE's : feasible or or fantasy? Workshop presentation at 2002 International Physiotherapy Congress Sydney 3. Adams , R Is it possible to develop recommended staffing levels for rural allied health services? 1st NSW Rural Allied Health Conference proceedings December 2003. 4. NSW Health Services Comparison Data Book 1998/1999 Volume 1. 5. Department of Health and Aged Care, October 2001 Measuring Remoteness: Accessibility/Remoteness Index of Australia Australia (ARIA) Revised Edition Occasional Papers: New Series Number 14 (Also available on the Department of Health and Ageing website 6.)