July 2, 2022

regional health

Labor’s ambitious health agenda

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Easier patient access to GPs and reduced pressure on hospital emergency departments are among a host of healthcare improvements promised under the incoming Labor federal government.

“Every day, everywhere I go, people talk to me about how it’s getting more and more difficult to see a doctor,” said Anthony Albanese during the election campaign.

Federal Labor comes to office promising to spend $750 million over three years on a “Strengthening Medicare” fund to roll out from 2023–24.

The fund will aim to improve patient access to GPs, particularly after hours. It includes Medicare Urgent Care Clinics as part of a trial of a new model of care.

The ALP also promised a $220 million grants program to upgrade local GP practices.

In summary, Labor’s healthcare promises include:

Medicare Urgent Care Clinics

Labor will deliver “at least 50” Medicare Urgent Care Clinics (MUCCs) across Australia, in a trial based on a similar New Zealand program.

Designed to take the pressure off hospital emergency departments, MUCCs will be located in the same general areas as EDs and will bulk bill.

Labor says that in 2020–21, 47 per cent of ED presentations were classified as either semi-urgent or non-urgent and could therefore have been addressed by doctors and nurses in MUCCs.

GP grants

Labor says that “almost a decade of Liberal neglect” has left primary care in crisis, particularly in outer suburbs and regional and rural communities.

Labor will give grants of up to $50,000 for GPs to train staff, upgrade IT telehealth systems, buy equipment and improve ventilation and infection control.

It will also boost workforce incentives for rural and regional GPs to hire nurses and allied health professionals and provide multidisciplinary team-based care.

National Nurse and Midwife Health Service

Labor wants to establish a coun-selling and referral service to help nurses and midwives who are “concerned about their stress levels, feel exhausted or anxious, or who are struggling with their mental health.”

Labor will spend $23 million to set up a National Nurse and Midwife Health Service.

It will provide free and confidential support, “delivered by nurses for nurses”, with information, advice, treatment and specialist referrals.

Labor says Victoria’s successful Nursing and Midwifery Health Program has been inundated with calls from nurses struggling with their mental health and wellbeing, after working beyond exhaustion.

It wants to expand such a service nationally, because “we can’t afford to lose more nurses because of unnecessary burn-out”.

National Melanoma Nurse Network

Melanomas kill one Australian every six hours and Labor wants to reduce the toll by giving more people early advice and better continuity of care from a melanoma nurse.

The Melanoma Institute of Australia has melanoma nurse programs in Sydney, Wagga Wagga, Perth and Hobart. Under Labor, this service will be expanded nationwide, with up to 35 more melanoma nurses by early 2025.

Telehealth support will also be available, “to make sure no one misses out based on where they live.”

Better First Nations Australians  health care

Labor promises to train 500 new First Nations health workers, increase access to lifesaving dialysis treatment for First Nations Australians  with chronic kidney disease, and expand efforts to eradicate rheumatic heart disease in remote communities.

The ALP says First Nations Australians are five times more likely to die from rheumatic heart disease, four times as likely to have kidney disease and more than twice as likely to die from suicide in youth.

It says it will work with community-controlled and other health services to help close this gap.

Promised measures include a First Nations Health Worker Traineeship Program to support up to 500 trainees to complete Certificate III or IV accredited training.

Cheaper medications

Millions of Australians will save $12.50 on medical scripts under Labor.

Labor has committed to reduce the Pharmaceutical Benefits Scheme (PBS) co-payment from the current maximum of $42.50 per script, to a maximum of $30 per script.

The changes to the PBS will take effect from 1 January 2023.

Commonwealth Seniors Health Card

An additional 50,000 Australians will be eligible for a Commonwealth Seniors Health Card from 1 July 2022.

The income test for access to the card will increase to $90,000 a year for singles (up from $57,761) and to $144,000 a year for couples (up from $92,416).

With a Commonwealth Seniors Health Card, you may get cheaper medicine under the PBS and other benefits.

Expanded newborn health screening

Australia hasn’t updated its newborn screening program since the 1980s and Labor says children consequently are going without treatment despite tests being available.

Labor promises to “end the newborn health screening lottery” by increasing the number of screened conditions from around 25 to 80.

The program is aimed at identifying a wider range of genetic and other early life conditions that are the leading cause of death for young girls and the third highest cause of death for boys.

Regional mental telehealth services

During the COVID pandemic, the Morrison government abolished Medicare Benefits Schedule item 288, a 50 per cent loading for videoconference consultations in telehealth-eligible areas in Australia.

Labor says this effectively ceased bulk-billed psychiatric consultations for patients in regional and rural areas and will reinstate the 50 per cent loading.

Saving lives and livelihoods in regional areas

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New research finds that public sector employment is an important foundation of regional economies and is particularly important during crises such as the bushfires and COVID-19 pandemic.

Nurses, teachers, police, firefighters and other public servants not only protect us, keep us healthy, safe and educated; they are also the backbone of regional economies, according to a report just released by the University of Wollongong.

In particular, the income and spending from public sector employment in times of economic downturn and crisis is critical to regional economic survival, it says.

But the report warns that “The stimulus to regional economies from public sector employment and income in times of crises, when many are working longer and often unpaid hours, is also at risk from government-imposed wage freezes imposed in these same times under the guise of austerity.”

The study, commissioned by the South Coast Labour Council, focused on nine regional economies and communities in the south east of New South Wales. Many of these regions were heavily affected by the bushfires of 2019–20, leaving little time for recovery before all regions were affected by COVID-19’s economic impact.

The author of the report, Associate Professor Martin O’Brien, said public sector income was a stable feature of regional economies, which are vulnerable to weather events or unpredictable crises.

“A characteristic of Shoalhaven and other South Coast LGAs is their reliance on tourism. Tourism can be quite volatile and go through many economic fluctuations throughout the year. So in 2019–20 when the bushfires hit, the tourism season didn’t exist for many businesses and then the same when COVID-19 hit as well,” he said.

NSWNMA Shoalhaven Branch President Michael Clarke says the report confirms what nurses and midwives in the area have long felt.

“They appreciate that public sector pay rises go a long way to supporting the villages and towns that rely on visitors to our region,” he said.

The report highlights how public sector income in these areas is much more significant to the regional economy than otherwise found in the Greater Sydney area or Australia.

While public sector income contributes approximately 6.37 per cent to the Greater Sydney economy and 7.8 per cent Australia-wide, the research estimates public sector income exceeds 9 per cent of Eurobodalla and Shoalhaven’s economy; over 10 per cent in Snowy Monaro, Shellharbour and Wollongong; approximately 20 per cent in Kiama; and over 35 per cent of Queanbeyan-Palerang’s economy.

Universities, schools and hospitals are big employers

The report points out that these areas have public sector workplaces that are very large individual employers. For example, the University of Wollongong has more than 2500 direct employees, as well as contractors on campus and other indirect employment flow-on effects.

Likewise, hospitals and high schools are large individual employers.

One public health system nurse from Shoalhaven told the researchers that there were more than 500 nurses who worked at
her hospital.

“You wouldn’t want to close the hospital and lose 500 people who could contribute to your local economy, because I’m sure that would have an impact,” she said.

NSWNMA Assistant Secretary Shaye Candish says regional communities are indirect casualties of the NSW Government’s rigid policies on pay and staffing.

“Nurses and midwives have experienced low wages growth for the last decade, largely due to the NSW Government’s draconian wages cap.

“Just last year our members were forced to suffer the impact of an insulting 0.3 per cent wage rise, despite grappling with a health pandemic and the significant events of the summertime bushfires.

“Low wages force nurses and midwives to reconsider their personal budgets and the contributions they can make in local shops, cafes and businesses,” she said.

“As a community we must demand that this government adequately invests in public sector wages and implements nurse-to-patient ratios, to ensure that regions like Shoalhaven can prosper well into the future.”

How public sector workers boost local economies:

  • most public sector workers spent approximately 80 per cent of their income at local businesses
  • the relative stability of public sector employment and income throughout the year provides sustained stimulus
    to regional economies in months when business is traditionally slow
  • resourcing large public sector organisations such as high school and hospitals in regions has a positive flow on effect to local business
  • the relocation of public sector offices to regional areas can boost a variety of sectors in the local economy.

You can read the full report here

 

Delta unmasks rural neglect

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The Berejiklian government plays the blame game as Sydney’s Delta outbreak spreads to regional areas with under-resourced healthcare facilities.

According to the NSW government, the Delta variant emerged on 16 June, when an air-crew driver working under lax NSW Public Health Orders that did not require him to wear a mask or be vaccinated, was diagnosed.

By then, the driver had visited a dozen sites in Sydney’s eastern suburbs. Gladys Berejiklian waited until 25 June before imposing a light lockdown on parts of the city’s east. The virus seeded into Western Sydney.

Loose regulations allowed movement between Sydney and the rest of NSW: for work, to look at real estate, to get COVID-19-tested, or to visit a second residence, for example. Delta subsequently spread across the state.

Rural communities with limited and under-resourced healthcare facilities have been grappling with the consequences.

Healthcare services for people outside of Sydney were dire even before COVID-19. This was made clear in a December 2020 sub-mission from the NSWNMA to a state parliamentary inquiry into health care in rural, regional and remote NSW.

The NSWNMA submission said: “It is not acceptable that residents in the rest of NSW are provided with an inadequately resourced, substandard system of healthcare while metropolitan Sydney residents enjoy far superior access and outcomes.”

It made 24 specific recommendations for improvements, including boosting nursing numbers at sites with no doctor to ensure a minimum of three per shift – two of whom would be RNs. It also recommended better staffing of emergency departments and recruiting more nurse practitioners.

Remote indigenous communities with higher rates of chronic illnesses such as diabetes or kidney disease and shamefully low vaccination rates – a shared federal and NSW responsibility – are particularly vulnerable to COVID-19.

“Indigenous Australians were one of our greatest concerns at the start of this pandemic,” Prime Minister Scott Morrison said in December.

Morrison’s actions failed to match his rhetoric.

Despite Aboriginal people over 12 being prioritised as 1B in the rollout, only 6.3 per cent of the Aboriginal population in Western NSW was fully vaccinated by 26 August, compared to 26 per cent of the non-Indigenous population in the region, ABC News reported.

Aboriginal communities dangerously exposed

Human Rights Watch accused both the federal and NSW governments of leaving Aboriginal people “dangerously exposed to COVID-19 with limited access to vaccines”.

The Maari Ma Aboriginal health service in the Far West warned both the NSW and federal governments in March 2020 that they needed to urgently prepare for an outbreak.

However, the Berejiklian government refused to take any responsibility.

Health Minister Brad Hazzard agreed the vaccination rollout to Aboriginal communities had been “challenging”, but said it was a federal government responsibility.

As The Guardian’s Anne Davies wrote: “The NSW Government’s response (to the worsening Delta crisis) has been a blame game … When it comes to the state’s role there is a stubborn reluctance to admit there may be a better way.”

On Aboriginal health, the NSWNMA submission says Aboriginal people in regional, rural and remote parts of NSW should have access to Aboriginal Community Controlled Health Services.

Epidemiologist Dr Peter Malouf, from the Aboriginal Health and Medical Research Council of NSW, told a parliamentary inquiry into the pandemic that the state government was “very lacking in engagement, particularly listening to the voices of Aboriginal people”.  

The remote settlement of Enngonia in north-west NSW has no hospital, no resident nurse, and no shop. Its mostly Aboriginal residents must travel 97 kilometres to Bourke for health care and groceries.

By the third week of September, COVID-19 had infected 25 – or about one third – of the township’s indigenous population, said Tannia Edwards, CEO of the Murrawarri Local Aboriginal Land Council in Enngonia.

The virus had also claimed the life of a beloved elder.

Ms Edwards told The Lamp that vaccinations were not provided at Enngonia until shortly before the township’s first infection, which followed positive cases in Bourke and Dubbo.

She said vaccination should have started once the virus reached Dubbo, almost 500 kilometres away, because Enngonia residents often travelled there on public transport.

She said government health messaging on COVID-19 had been poor.

“It’s not people’s fault they weren’t getting vaccinated. We needed better messaging, because not everyone can understand what’s happening on TV.”

She said it was hard to self-isolate when as many as 12 people could be living in a four-bedroom home.

“It’s not possible to tell small children they’ve got to stay in a room for 14 days. It’s not possible, and it’s cruel.”

She said rural fire service volunteers were doing a great job, delivering food parcels to the community.

Health service manager for the Bourke Aboriginal Health Service, Claire Williams, told The Guardian the public health response to Delta was “chaotic” and said it wasn’t clear who was in charge.

The Aboriginal Health Service is running a vaccination clinic in Enngonia and delivering medicines.

Western NSW Local Health District said it was doing “routine COVID-19 testing” in Enngonia and had begun “a household-by-household assessment of the community’s health and social needs”.

It said COVID-19 vaccination of indigenous Australians was a federal responsibility.

Understaffed rural hospitals brace for COVID-19

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COVID-19 is yet to infect the twin townships of Harden and Murrumburrah, but the local hospital already struggles to find enough nurses.

Nurses at Murrumburrah-Harden District Hospital, about 350 km south-west of Sydney, are in “a heightened state of preparedness” for any COVID-19 outbreak, says RN and clinical nurse educator Marilyn Wales.

“We conduct ‘desktop’ scenarios all the time,” Marilyn says. “What do you do if you get a potentially positive presentation, or a staff member develops symptoms? What do you do if you see a breach of PPE?”

“The reality is that COVID-19 is going to come out to small country hospitals like ours. Essential workers pass through our town all the time and stop for meals and fuel.”

An “essential worker” who visited Harden-Murrumburrah, population 2000, later produced a positive result but there was no local transmission.

Marilyn is secretary and delegate for the NSWNMA’s Harden branch. She shares ideas with NSWNMA members at hospitals across the state through fortnightly webinars and other teleconferencing.

“Every facility talks about staff shortages and inadequate skill mix and how hard it is to attract staff – especially experienced nurses – to small rural hospitals.

“Murrumburrah-Harden’s casual pool is very limited, and we often have difficulty engaging agency staff, partly because of COVID-19 restrictions.

“The nursing population is ageing and we are losing senior nurses who are FLECC (first line emergency care course) trained. That training gives us the ability to use the rural adult emergency care guidelines and administer certain drugs in the absence of a doctor.

“Senior nurses who leave are often replaced by RNs who have just completed their graduate year. They are put in charge of a hospital on weekends and nights with no doctor. That is just asking for trouble.”

Murrumburrah-Harden Hospital has nine acute beds and 20 residential aged care beds. It has a VMO on call.

Like many small sites, the RN in charge of the acute ward is also in charge of ED.

“If we had a respiratory presentation and had to isolate that person, it would take a staff member away for the entirety of that presentation,” Marilyn says.

“We don’t have the staff rostered on to manage that.

“If we get a COVID-19 case, one or more staff members may have to isolate for the required 14 days. If we take out two or three staff, we could be at service failure, because we don’t have the clinical staff resources to replace them.

“My heart broke when I heard that the department was thinking of fast-tracking students into hospitals. It’s an awful atmosphere to ask someone to start their career – in a pandemic.

“Students are already at risk of not being able to register with AHPRA (Australian Health Practitioner Regulation Agency) due to incomplete placements.

“Another government proposal was to bring back retired nurses. People retire for a reason and to bring them back and put their physical and mental health at risk is a big ask.

“Our Premier keeps saying our health system is coping. But staff are having to work 12- or 16-hour shifts and work on their RDOs.

“We might be coping at the moment, but we are not functioning in the proper manner, to the best of our abilities. For us to function we need to have enough staff with the required skills.”

Marilyn, who has nursed in Temora, Narrandera and Murrumburrah-Harden hospitals for 51 years, says she’s concerned for all nurses at this time.

“I’m especially concerned for the girls in Sydney. I cannot comprehend what some of them are going through.”

Bush the poor cousin in Pfizer rollout

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As COVID-19 spread from Sydney to regional NSW in late July, Gladys Berejiklian ordered 40,000 Pfizer doses to be redistributed from the regions to Sydney.

Berejiklian wanted the vaccine for Sydney Year 12 students so they could return to classes for the HSC.

With Pfizer in short supply due to the Morrison government’s bungled procurement process, Berejiklian’s decision did not go down well in the bush.

“There are frontline healthcare workers who [still] haven’t been vaccinated [in regional areas],” Rural Doctors Association of Australia’s CEO Peta Rutherford told ABC News.

Opposition came from the premier’s own side of politics.

Member for Calare and federal minister Andrew Gee called for the Central West to be exempted from the reallocation of Pfizer doses.

“Having just come out of lockdown, it’s not the right time to be diverting the Pfizer doses to the city. We’re only out of lockdown for two days and we’ve got COVID-19 traces in the sewer at Molong,” warned the National Party MP.

Roy Butler of the Shooters, Fishers and Farmers Party, whose state electorate of Barwon stretches from Walgett, Narrabri and Coonabarabran in the east to Broken Hill in the west, also expressed concern.

“There’s a stack of people in Walgett who were booked in to get the vaccination, only for them to have their appointments unexpectedly cancelled,” Butler said.

Less than a fortnight after Berejiklian’s announcement, health officials were rushing to send 1200 doses of Pfizer back to Walgett after the virus hit the town and large swathes of north-western NSW went into lockdown.

Country hospitals lose doctors and senior nurses

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What does it mean for a nurse to be made responsible for a hospital with no doctor?

Wee Waa Community Hospital, 576 km north-west of Sydney, is a 15-bed acute care hospital with a 24-hour ED.

Like many small health facilities in NSW, it has no regular Visiting Medical Officer and has lost its on-call GP. Occasionally, a locum is found to cover weekends.

At all other times, Wee Waa relies on nurses. The ratio is three on morning and afternoon shifts, and two on nights.

Often, however, only two nurses can be found to cover mornings and afternoons because the hospital can’t recruit enough staff – a common problem in small towns.

RN and NSWNMA member Susan Marshall has worked at Wee Waa hospital for 27 years. She says that since it lost its on-call GP, the hospital has found it harder to keep senior nurses and attract agency staff.

“When there are only two nurses on the ward, and they attend an ED presentation, they sometimes have to ask the domestic staff to keep an eye on the high-care patients.

“Two nurses are not enough, for example, to resuscitate a patient and cover the ward as well as make calls to a telehealth doctor.”

Some senior nurses have FLECC (first line emergency care course) qualifications, which allow them to initiate higher levels of assessment and treatment.

However, nurses often feel intimidated and vulnerable due to the absence of a doctor, Susan says.

“It seems the government wants staff to be FLECC-trained to plug the gap left by the doctor, but it’s not entirely safe.

“If you must work outside your scope of practice to get the job done, you can feel insecure.

“Not feeling professionally secure in the workplace can lead to unhappiness with the job – and many senior nurses have left.

“I feel I’m doing a job that’s not always recognised – and I don’t always feel supported by the system.”

Teleheath not enough

Susan does not believe that telehealth can always fill the gap created by the absence of a doctor.

“There will always be cases when you need a doctor on site.

“We are supposed to call the ED doctor in Tamworth, but they often don’t have time for a Wee Waa problem, though they are sympathetic to our predicament.

“I have rung them with triage 1 and 2 patients, and they say, ‘I’m running a resus here and I haven’t got time for you.’ Their workload has increased because we no longer have a doctor.”

Susan says having no medical coverage has led to more patient transfers – sometimes to Narrabri (30 minutes away) but mostly to Tamworth, which can be a six-hour round trip.

“This puts pressure on the ambulance service and leaves our community very exposed without ambulance cover.”

COVID-19 would be the last straw

It also puts more pressure on Wee Waa’s nurses, who are sometimes questioned by ambulance control over whether a transfer is necessary.

“The ambulance coordinator will say, ‘Do you really need to transfer this patient? I don’t have an ambulance to do it and my staff are on overtime.’

“To have to debate this with the ambulance coordinator, who isn’t local, is frustrating and eats up time that we don’t have.”

Wee Waa has so far been free of COVID-19 but if it strikes the hospital, “it could be the straw that broke the camel’s back,” Susan says.

“If someone had to get all PPE’d up to look after a possible COVID-19 presentation in ED, they would not be able to float back to the ward.

“If one or more nurses went into isolation, the department would have to draw staff out of a higher population area or reduce services.

“Compensating within the current roster is just not possible – even with overtime.”

Susan says the hospital has enough PPE, but staff are still waiting for fit testing to be provided.