People living in rural and remote Australia have poorer access to health and social services in their local community than other Australians, and as a result have poorer health and life outcomes.
A new model of rural and remote health and community service delivery is needed to systemically address these poorer outcomes. This means moving away from short term programs and trials which are contributing to increasing fragmentation of services and which have failed to deliver systemic improvement for rural and remote people.
Some will recall the days when rural and remote communities had their own local community boards that ran the local hospital and primary health service, and dedicated local charitable groups provided everything from child care to primary health, community transport to housing for vulnerable members of the community.
In those days rural and remote towns had a vibrant multi-professional sector working collaboratively with each other and the community around local priorities.
Local GPs were treated with respect by both the community, and the hospital system, and community groups delivered heartfelt care to their own.
Of course, there were problems with community-led services. They relied heavily on locals with commitment and skills, and services were always vulnerable to collapse if key people moved on. At times, quality could be variable depending on the skills available.
To address these issues we took a sledge hammer to crack a nut. We collapsed local community-led hospitals into large corporate health districts, and centralised social services and outsourced them to commercial firms. In doing so, rural and remote people were relegated to the position of bystanders as their local services disappeared and community outcomes declined.
Towns that once had a vibrant local GP practice no longer have any services. Fly-in-fly-out services have replaced many of the social supports that were once locally available. One-size-fits-all solutions are now imposed with little to no community engagement or consultation.
In short, things are now worse - much worse - than the system we replaced.
Hindsight is a great thing. But it doesn't solve problems. But learning from the past may provide us with insights into future solutions.
What if we had not abolished local community hospital boards, or replaced community-led support services with outsourced solutions, but rather supported and strengthened these systems at a local level by providing governance support, more targeted funding and help for communities to better integrate services effectively to ensure long term sustainability and quality?
If we did this we would have today a world-leading health and social support system that is evidence-based and contributing to better health and life outcomes in rural and remote communities.
All the research today tells us that community-led health and social services work better than services delivered remotely from far away. Indeed, the World Health Organisation has recently approved a Framework on Integrated People-Centred Care that encourages governments around the world to rebuild local ownership and integrated community services to address declining rates of access to health and human services across the globe.
There is no longer any doubt that our current policy approaches have failed rural and remote people. If we continue on our current course, rural and remote towns will run out of doctors in less than 10 years and the burden of disease will continue to grow, costing the State Budget and taxpayers enormously.
According to the NSW Intergenerational Report 2022, if we do not begin to change our focus from acute care and hospitals to community health, health spending will continue to rise at an annual rate of 5.4 per cent on average, and grow from 29 per cent of total expenses in 2018-19 to almost 40 per cent by 2060-61.
Put another way, that means 11 percent less funding for schools, aged care, childhood development, regional development, roads and services that we need to improve the lives of residents and lower the burden of disease.
The Report concluded that a "national focus on keeping people healthy ... is needed to reduce demand for hospital care and keep health spending sustainable, whilst improving health outcomes".
Doing nothing is no longer an option. Doing the same thing is not longer an option. Doing something different is what rural and remote people need, and what they are expecting of their governments and policy makers.
We need new ideas and thinking about how we support rural and remote communities before it is too late.
That is why the Healthy Communities Foundation has released its Rural Community Hubs proposal ahead of the NSW 2023 Election. Based on evidence, and globally endorsed frameworks, the proposal aims to enliven the debate around the future of health care in this country and provide a proven solution designed by rural people for rural people.