SPEECH BY DR JOE AT LOCAL GOVERNMENT NSW 2023
Speech by Dr Joe at Local Government NSW 2023
Thank you very much Scott
Can I begin by acknowledging the traditional owners, the Gadigal of this land. I also acknowledge the traditional owners of the land of the Riverina, that is the Wiradjuri.
Thank you very much for giving me the opportunity to speak to such an erudite and powerful group of people. I am passionate about rural health.
Can I acknowledge my parliamentary colleagues Jenny Aitchison and importantly the Minister Bronnie Taylor and Shadow Minister Ryan Park.
The Minister has been a very strong advocate I have to say for rural health and has brought enormous change to this portfolio and I have enjoyed working with her
I also want to acknowledge the work done by Ryan and the opposition in the New South Wales Upper House which I thought produced an extremely and unusually so good report from the Upper House - it was!
What a great platform going forward!
Today I want to speak about an issue I have and that is I think we need to change the machinery of Government. That is we need to develop a standalone Rural Health Department.
We know that we have a problem with rural health, it has been on the agenda today it has spoken about throughout this morning, Dariea, Phyllis, Scott, it’s part of the LG NSW election agenda.
Clearly you all know it’s a huge issue and we have heard from both Ryan and Bronnie that rural health is in the spotlight.
There is a five to eight year life expectancy difference depending on where you live in this state. We know we have an issue
In my view the best health outcomes for rural, regional and remote NSW are achieved when the community is at the centre of health service activity and of course Local Government is key to local community.
The heart of the community is local government and that is why you need to be part of this. Collaboration and partnership with all levels of Government is essential for improving rural healthcare
Of course it is also critical to ensure partnerships are well maintained for improving First Nations Health.
We already have developed some solutions and the Minister talked about a program in my region. Those solutions begin in our local health districts the key is how do we harness those?
How do we get the focus back to the community? I think we need a standalone rural health department
A rural health department that is run by rural, regional and remote New South Wales; for rural, regional and remote New South Wales and in rural, regional and remote New South Wales.
I am not talking about a duplication of laundry, catering, cleaning, the general machinery of the health service, I am not talking about that!
We are talking about a concept similar to the Department of Regional New South Wales where we have a department that focuses on strategic objectives that is outside the central bureaucracy.
I don’t mind where it is located but it should be in regional New South Wales.
I want to again acknowledge that the Minister has made great progress. She has established a division of rural health, which is sort of part way there Minister and I know you want to get fully established, I know you want that .. and I think we do need to do this!
I want to outline what are the functions of this department and thereby provide a sense of why I think it is important.
There are four functions
The first is workforce, which Ryan Park has mentioned. Workforce is absolutely fundamental but this department must also be an advocate, it must also to act to maintain services so services can’t be reduced and it must work with the Commonwealth.
The first priority would have to be workforce which we know is affecting us everywhere.
There is strong evidence that to attract and keep health workforce we need an inclusive workplace – where people like to work. We also need to provide career pathways for professionals.
And finally as the evidence is now emerging (and I am referring to the work of Dr Cath Cosgrave here) we need a sense of belonging for health professionals to come to, work in and live in our communities and enjoy their amenities. A sense of being at home in those communities.
Look, my own experience is that when I moved to Wagga 30 years ago I had a good place to work, I had a career pathway that I could see and above all I felt I belonged to my new community and they went out of their way to make me feel at home.
In fact in Wagga, we started to formalise that process in recent years - for 20 years in fact - we have had someone in Wagga whose job is just to welcome people to the community. But that person is not employed by the health department, they act outside of the health department. They form a partnership with local government and the community.
It’s the whole idea of a “health workforce connector” outside of the bureaucracy. It is an important concept. It is the sort of position that creates connections and human bonds and it just won’t come from a Sydney based bureaucracy; it just won’t come from a large impersonal bureaucracy driven department driven by policies and procedures, it needs to be a community based solution
The second priority of the rural health department is to act as an advocate to government so the rural health voice is heard and we get services we need that impact people in rural, regional and remote New South Wales. Decisions to relocate autopsy services don’t get made without realising the impact it has on rural people.
The third priority should be for the Rural Health Department to maintain services. It wouldn’t accept any reduction in services. In reality over the years to focus on needing certain volumes of services that has been a cost shifting exercise where in fact patients and families end up travelling and bearing the costs because there is no local service. But with a bit more effort the Local Health District could’ve provided services locally or found a way to do provide locally
And finally the fourth priority is to work with the Commonwealth. And everyone talks about working with the Commonwealth and Minister I applaud the work that you have done with your Commonwealth colleagues which is similar to the work we did with Brad Hazzard when we established the Murrumbidgee model of healthcare. We had a round table in Wagga! But why does it take the Ministers to come together? Why aren’t the bureaucracies working together? And I think the Rural Health Department should be focused on that.
We have a crisis in General Practices in this country, our health system actually relies on General Practices. It is the key foundation of health but it is in disarray! We have a training system that has been directionless for a decade, it has a renumeration system that has been left to slide, and it is not regarded with prestige. And if anyone is affected by the lack of General Practices it is certainly rural, regional and remote areas, and I actually think we need to stop passing the buck between Governments and particularly the bureaucracies need to stop passing the buck and they need to start focusing on how we can make this work in rural, regional and remote areas again.
But how do we recruit, retain and support a primary care workforce to get into rural, regional and remote areas? Why shouldn’t we require junior doctors in their first two years complete a term in general practice, especially in a rural location and go to a small community and work there for a term?
The value of rural General Practice would open their eyes. They would also get to see and feel the great experience of a rural community.
Currently the training is based around hospital medicine which is very much a specialist profession.
So in other words just to summarise .. people look at me and go ‘a rural health department .. really?’ Well what I am really talking about is breaking the mould of recruitment and retention. And exploring new solutions. That is why I am a strong advocate and that is why I appreciate the opportunity to talk to you today