Issues Accessing Health Care outside the big cities

According to the RACGP, (Royal Australian College of General Practitioners).

Australia ranks first among OECD countries for equity and healthcare outcomes, and holds third place for overall healthcare performance, behind Norway and the Netherlands.

In terms of access, Australian patients reported having high levels of access to face-to face care when needed, but lowest levels of same-day responses to questions by email or phone. Dr Wright notes, however, that this has potentially changed since the introduction of telehealth after the report’s survey was completed.

The majority of Australians live in our 6 largest cities or nearby, and that’s where the majority of the medical resources are. It’s easy to overlook how it is for a minority living elsewhere?

What works well in rural and regional Australia for health care, and what can be be better or differently to improve the outcomes?

Edit: note Australia has approx 31,000 GP’s, or one for every 850 of us.
Medical doctors and specialists in Australia | Australian Government Department of Health and Aged Care

Opening post inspired by the following.

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In rural areas we would take any doctors even if suspended we are so DESPERATE.

I could write a book on the appalling status of rural health. It is diabolically appalling.

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A minor point, except for those rural businesses depending on grey nomad tourism for income.

We city people are relatively spoilt for health care. As a result of the declining availability of medical services outside cities, we have regretfully stopped caravanning due to chronic health problems and ageing.

I am horrified by the deterioration of health and other services afforded to many rural areas now. Many such places contribute a lot to GDP, work their guts out doing it, and pay taxes. I was hoping a change of government would help them. Is the National Party still rural stakeholders’ advocate in Canberra?

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Yes, particularly in remote areas. We ought not assume that the lack of GP, specialist services and major equipment is the only reason that life is shorter in the bush.

There are other reasons, a few that come to mind are; doing hard labour all your life and in some cases never really retiring, poverty, lack of sick leave, substance abuse, a life in the sun and the stoic attitude “I’m not that sick and the XYZ still needs to be done”. Several of these are related.

Better direct medical services are important to start with but broader services would also give education, support and counselling which would help with some of the other problems.

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Unfortunately so much of the issues of poor rural health in the Hunter New England Region are due to appallingly low standards of management and lack of professional expertise across the board. We have one local doctor who would be the most skilled who refuses to go anywhere near the hospital because of the way they have treated patients. Because of the poor standard of management, goes down all through the staff. Maintenance staff probably spend more time doing their own or private jobs than attending to the cleaning and maintenance of the hopital.
For example they have released a building contract for a new $50M hospital. The current hospital could do with an upgrade of bathrooms, some four bed wards could be made three bed wards with ensuite facilities to make it easier for nurses and patients. Building doesn’t have a crack in it, needs some general maintenance. Is a three story building, with the top floor ununsed, 16 beds on the first floor - to my knowledge never full. Reason why never full they don’'t have a full time doctor or sufficient local doctors to attend to patients - so off they get shipped to Armidale, Tamworth or Newcastle.
In the current hospital they have spent conservatively in excess of $2M in upgrades over the past six years. New power from street to completely new switchboards internally, new switchboards in the hospital, new media and entertainment system, new nurses call system, oxygen and suction to every bed, plus a major remodelling of the western first floor to accommodate private patients. No private patient would be silly enough to stay at the Glen Innes ‘Hospital’.
3 years ago they fitted a glass riser to the lower balcony. April last year they fitted a glass riser to the top balcony. Thing is NOBODY can access the balconies at any time. What is more, while they had all the scaffolding up, they didn’t paint the two balconies or repair and repaint some of the efflorescence. Pictures I took myself of the balcony folly.
They also installed around September last year $600,000 for four dongas for visiting doctors or specialists. No visiting doctor wants to stop in a donga without breakfast delivered to the donga, and meals of restaurant standard been on site. There is not even parking close/adjacent to the dongas.
Now if they had financed two houses suitable to house full time doctors of suitable standard to attract some permanent doctors would have been a substantially and correct plan. Being a low-socio economic town and area with a very low SEIFA index, the standard of housing suitable for rental to house a doctor are lacking.
The large three storey building in the aerial view at the top right hand side is the old nurses home when Glen Innes was a nurse training centre. That is going to be demolished at a cost of $5.5M for the new hospital. The new hospital will operate in conjunction with the old and x-ray, pathology, dental will be staying in the old hospital with a connecting corridor. Consequently the new hospital will need at least another six staff for cleaning and maintainence over and above. The new hospital will have 22 bed capacity and 8 yes EIGHT reception rooms for visiting doctors or specialists. They are flat out getting a $5k a weekend locum from Friday 7:00pm to Monday 7:00am.
Glen Innes as a locality has had a virtually unchanged population since 1940

Services at the Glen Innes Hospital are lacking. Booking for an Ultrasound is two to three weeks, and always remained the same. Contracted sonographer services are three days a week. Consequently the NSW Gov pays out a fortune for IPTAAS (Inland Patients Trael and Accommodation Assistance Scheme) $0.40c km. Round trip from Glen Innes to Armidale, 200km, $80.00
Last year September when in theatre in Armidale asked people where they were from. Nearly everyone was from Inverell. I asked them what are they doing here when they have a two year old hospital, two brand new state of the art operating theatres - answer no staff, no doctors.
In Glen Innes the two local surgeries won’t even put potential new patients on a waiting list. Regional city like Armidale they say is twelve doctors short. My excellent physician and surgeon I used to see at Armidale Hospital left purely because of management. The sorrowful story he told me is woeful.
No wonder people are dying so much earlier in rural areas.
Town like Glen Innes has no public tennis courts, no table tennis, no badminton, skate park for children that would fit into 50m2, brand new $5.5M indoor sports centre so badly designed with no community consultation so only suitable for 150 children to pay netball. Glen Innes has the highest suicide rate prorata in youth and adult, and consequently figures no longer published. Has fifth highest domestic violence, fourth highest excess alcohol consumption, NSW highest unemployment.
There is also zero communication of any sort from the local council.
Unfortunately people that live in the city have no idea how bad and dire the situation is in rural areas. Rural dwellers have no voice and of any form that can get heard that will achieve a positive outcome. All you get from the NSW Government is weak pathetic excuses or they don’t answer what you ask.

https://hneinfra.health.nsw.gov.au/news-and-publications/latest-news/2022/master-plan-for-glen-innes-hospital-released

https://hneinfra.health.nsw.gov.au/projects/glen-innes




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Locations like Glen Innes don’t have basically any grey nomad tourism. They have a disused railway station with must be 3ha going to waste in a lovely part of town with the only concrete/bitumen path to town of 800m. Showground facilities are sub-standard and too expensive. Tenterfield is the same to worse. Armidale used to allow camping at Dumeresq Dam - constant turnover of RV’s of around 30. Armidale was known as a good place to get your vehicle serviced, tyres, Jaycar agent store with a big range of 12V gear, and a local guy that did some repair and installation of electrical and solar systems at Dumeresq Dam. They closed Dumeresq Dam because the toilet system needed $5k worth of repairs. Well they had so much of a problem with vandalism and illegal dumping with no campers, the council then engaged the local security company to drive out there every night at 7:00pm to lock the chain and go out again 7:00m to unlock the chain. The caravan repairer closed down, the Jaycar agent closed, the bowling club closed their buffet. When I asked the manager fo the bowling club what happened to the buffet, he said you came in from Dumeresq Dam a couple of times a week for lunch. I said yes, and he said once they closed Dumeresq Dam they lost nearly half their lunch customers.
Bingara attributes up to 15% of their local economy to grey nomads.
I do travel extensively for at least six months of the year, and with my deep life long interest to passion in local and regional economic development look at towns and poke around towns in a different manner to others. I walk around and ask questions to get to grips what is going on or not going on in a town. The opportunities going wanting are sad, especially when it comes to youth/young adults.

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It’s not always bad news. Although it’s taken 10 years and $12.4M.
Windorah rejoices as upgraded health clinic opens after decade-long battle in outback Qld - ABC News

Barcoo Shire, QLD has a population of approx 265 spread across Stonehenge, Jindabyne, Windorah plus out of town. It’s unlikely to ever justify a full time GP. It relies on scheduled RFDS visits and 2 full time nursing staff.

In case of something more serious.
Ambulance services are delivered by the DON and volunteer drivers, pending arrival of the Flying Doc. Yes, the local airstrip operated by the Shire has lights for night time operation. They do need to be turned on first.

P.S.
For those not into maps, Windorah is in SW QLD, a convenient last stop off for those travelling to Birdsville, by road or light aircraft from the east coast.

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To show you how bad situation is. Had to wait from the 30/11/2022 to 03/02/2023 for a nuclear scan.
Been waiting from the 30/11/2023 for a lump breast biopsy, and that is now scheduled for 01/03/2023.

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I know Windorah, Jundah, Stonehenge well. Windorah started with a nurse who married a local (Sandy Kidd - also a legend) who did the job as a volunteer. Eventually she was employed part time by Qld Health. The work got more intense with the increase in tourist numbers. No doctor, but thank God for the RFDS!

When I was at Winton, patients were dying because they could not get timely medical care. When referred to Brisbane (that’s a very long drive or two planes at big dollars) it was months before they could be transported or seen, and then had to stay down there “indefinitely” waiting for follow-up.

Even closer to civilisation I get the “we don’t have anybody who can do that - we will contact you when we do” and waiting months. Mr Z has an “urgent” issue, his GP was away for 2 months, then our referral passed from one hospital to the next and now is in Brisbane and we still don’t have a date to be seen, let alone treated.

The other issue is accommodation. Hospitals lost their Staff Quarters in upgrades (it being old hat and social trends for nurses to have partners and family) and left to find their own. Our town of less than 800 couldn’t get staff because there was no where to rent. I bought a near new house and made it available, thus avoiding the downgrading of our medical facility.

Our town was brilliant. When Qld Health said it would cost $100k or it would close, the town raised that in a fortnight. Amalgamated Council said private strips that the RFDS used - they would no longer assist with up-keep. Again, the community of less than 1,000 raised the funds to light them, to grade, to maintain them. They raised thousands to build a community Aged Care. I hope people don’t see rural & remote as just whinging about not getting gold plated service.

We have sacrificed a lot of services, like Maternity, as we were told it was unsustainable, but the services have been retreating to the coast and costing a lot to access. Wages are low, especially in drought, so donating, travelling etc is a big impost. Then the item fund raised for gets taken away from the community to go “where it could be better used” and the town ends up with something at the end of its useful life. Very disheartening.

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One place I know of has trouble attracting health professionals (or really anyone for that matter) in the first place due to fear for personal and property safety. It’s always been suggested “when in pain, take the plane” but it is becoming a necessity in some places …

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The ABC is currently looking for support from anyone able to share first hand experiences.

There are a great many reasons for even routine medical events to require travel and access to specialists. Commitments in time and expense many cannot afford. For those no longer able to drive or with the means, regional and rural living adds one more challenge.

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To help assuage some of the costs of travel above what is considered normal, every State and Territory to my knowledge have some form of Patient Transport assistance. This payment helps to offset or cover the cost of travel and accommodation, In some cases Accommodation providers accept the payment from the Government as full reimbursement. I hope the following links will help those who may be unaware of the assistance offered.

Qld

NSW
https://www.iptaas.health.nsw.gov.au/about

SA

Vic

ACT
https://www.canberrahealthservices.act.gov.au/before,-during-and-after-your-care/staying-at-canberra-hospital/before-you-arrive/getting-here-and-getting-around/travelling-from-outside-canberra

NT
https://nt.gov.au/wellbeing/health-subsidies-support-and-home-visits/patient-assistance-travel-scheme/what-you-can-claim-for

WA

Tas

In some cases if no medical support is available even for GP visits in a town/area, then ringing the most local hospital may help arrange PATS for the patient. A distance that has to be traveled will need to be met to be eligible, but it at least may offer some cost alleviation if the criteria are met. Some States/Territories only make the PATS scheme available for Specialist treatment, e.g. Qld has a 50 km travel requirement one way and must be for Specialist treatment not for GP visits. NSW has a more lenient treatment of who a patient is referred to, e.g a Doctor may refer to another Doctor (No specialist requirement), but the distance needed to be traveled one way is 100 km.

NSW

An article in The Conversation outlines 6 reasons why it is harder to get to see GPs. Among those reasons is a decreasing amount of Doctors choosing to become GPs with an estimated shortfall in the number of GPs required.of 11,500 by 2032 (https://www2.deloitte.com/content/dam/Deloitte/au/Documents/Economics/deloitte-au-cornerstone-health-gp-workforce-06052022.pdf).

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Another potential service for those living in regional and some remote locations to access service is

The aircraft are all privately or corporately owned and range from single and twin engine props to corporate jets that have empty seats available.

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As do the RFDS (Royal Flying Doctor Service)

Flying Doctor bases around Australia | Royal Flying Doctor Service.

The following is about their Primary care role which nowadays is about two thirds of their daily workload. It covers all the usual needs e.g. vaccinations, health checks, diabetes management . If in a rural or remote area with a lack of medical resources it may be useful to contact them to see if they offer a service that could be used.

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I had forgotten the RFDS provides routine transport in addition to its other responsibilities so thanks for adding it @grahroll.

For clarity there is a difference between RFDS and an Angel Flight. RFDS is a funded service while Angel Flights are a 100% charitable operation and lacks RFDS crews’ medical expertise.

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A new hospital was completed in Bega a few years ago. Most of the facilities are there. But it is way understaffed.

There is generally only one doctor working at night in Emergency, and It’s common to wait for half a day in the waiting room. Ambulance ramping is also very common. I have experienced both, while suffering from two C. diff relapses. I really should have been in immediate isolation, but the resources were just not available and staff were apologetic but unable to do anything more.

There are frequently not enough beds for patients, not because of the wards, but because there are not enough nurses to look after any more.
As it is, nurses are stretched across more patients than they should be.

I don’t know if this is due to a lack of funding or a lack of applicants for jobs. But the outcome is pretty bad.

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It is true that a significant aspect of government funding is for infrastructure, eg bricks and mortar, with the community involved expected to contribute the staff. Sometimes the funding is not there to hire staff so there are near empty edifices with pretty plaques often with pollies’ names straining under too few staff. In other cases such as recruiting specialists of any profession to locate to a regional area is difficult.

Many GPs do not want to live in a small town for various reasons. Specialists need a large enough customer base to support their practice as well as necessary equipment/facilities. Will enough money above what they could earn in a metro area attract them? So far it has not been very successful based on media articles. It might not improve markedly until the facilities and services in regional areas get upgraded or government mandates regional service be required as a step toward full professional registration.

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I believe it’s a lack of funding for staff.
The hospital has been recruiting outside Aus for quite some time and has a great nursing staff with most of the newer ones being from SE Asia.

This area is reasonably popular for GPs and other workers looking for a sea and tree change. Not for specialists though. But still, plenty visit regularly from Canberra ao it’s not too bad in that regard.
I’m not sure about Doctors for the Hospital, whether that’s a shortage of applicants or money.

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A timely report from The Australia Institute titled “The Unlucky Country”.

Life expectancy in Far West NSW is almost six years lower than in Sydney, with the divide getting worse.

Those in the Far West are twice as likely to die prematurely compared to those in Sydney, and ‘potentially avoidable’ deaths are two and a half times more likely.

Suicide is twice as likely for residents in the Far West, with rates trending up.

Figure 3 is quite alarming. Before 2000 people in the far west lived as long or longer than in Sydney. Since then the West has stayed the same while Sydney improved by some 6 years.

From the conclusion

This report presents a compelling case for significant investment into health services in regional NSW. All the information on which it is based is publicly available, and in 2023, there is no excuse for the bush being considered out of sight, out of mind. While there will be no silver bullet to address the situation, the first step to addressing a problem is admitting there is one.

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