NDIA Accountability Project

Access to healthcare services for rural and remote Australians

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Royal Flying Doctor Service

T: 02 6269 5500 PO Box 4350 E: enquiries@rfds.org.au Kingston ACT 2604 W: www.flyingdoctor.org.au Australia

29 October 2021

The Hon Kevin Andrews Chair, Joint Standing Committee on the National Disability Insurance Scheme PO Box 6100 Parliament House Canberra ACT 2600

RFDS submission to the Inquiry into the RFDS submission to the Joint Standing Committee on the National Disability Insurance Scheme

deeply sorry for this error in our initial response.

Dear Chair,

The Royal Flying Doctor Service (RFDS) is pleased to provide this submission for consideration in the Committees Inquiry into the Current Scheme Implementation and Forecasting for the NDIS, and the Inquiry into General issues around the implementation and performance of the NDIS. The RFDS provides this response as an essential healthcare provider throughout rural and remote Australia, providing critical and comprehensive healthcare services to these areas for over 90 years. This includes on behalf of the Commonwealth since the early 1930s.

The RFDS

The RFDS provides a comprehensive suite of health services to people living, working and travelling in remote and rural Australia. In many instances, these are the only health services received by people living in these areas, and have been provided by the RFDS, with regularity and a focus on continuity of care, over many decades.

Our services comprise a 24 hour, seven-days-a-week (24/7) aeromedical retrieval service for those who experience a medical emergency requiring definitive care in a tertiary hospital, and extensive primary health care services. These include innovative and flexible models of comprehensive services to meet the health needs of rural and remote communities such as permanent, mobile or regular fly-in fly-out GP and nursing clinics, mental health and wellbeing services, dental health services, chronic disease management and a growing number of allied health programs, health promotion activities and road transport services. These are integrated with a 24/7 remote consultation (telehealth) system.

With 77 aircraft at 23 aerobases, along with 140 road vehicles at regional bases, the RFDS provides aeromedical retrievals and clinic services at almost 200 rural and remote sites, and in 2019/20 provided a total of over 320, 000 patient contacts. These include aeromedical retrievals for almost 40,000 patients; over 82,000 patients transported by road; almost 21,000 primary healthcare clinics (equating to an average of 55 per day); and, over 17,000 episodes of dental care. Figure 1 shows some of the most common flight paths across the country.

Access to Services on Rural and Remote Areas

Ensuring Access to Critical Health Services in Rural and Remote Parts of Our Country

Ensuring access to critical health services in rural and remote parts of our country is an ongoing challenge. In a recent report by the RFDS titled “Equitable Patient Access to Primary Healthcare in Australia”, the RFDS the inequities in access to primary healthcare services currently experienced by those in rural and remote areas were demonstrated. In the rural and remote context, where there are small populations spread across large geographical areas, it may not be realistic or practical for everyone to have access to permanent, local services. However, the Australian Institute of Health and Welfare proposes that all Australians should have reasonable access to services, which it defines to be access within a 60-minuite drive time. The RFDS found that 42,805 people had no access to place-based primary healthcare services within this 60-minute drive time. Furthermore, when looking at the specific primary healthcare type, it was found that 65,050 Australians had no face to face access to a GP; 440,387 had no access to a nurse-led clinic; 142,269 had no access to dental services; and 106,848 had no access to mental health services within a 60-minute drive time.

This report and the ongoing work of the RFDS in seeking to ensure access to comprehensive healthcare services draws on the capabilities of our Service Planning and Operational Tool (SPOT). SPOT was developed to assist in planning where services should be located, relative to need. This is done by mapping existing services and overlaying these with population data. Working from a geographic distribution of ‘demand (population)’ and a set of healthcare facilities that provide cover for a range of services, SPOT calculates the proportion of demand covered by those facilities within a user-specified drive time.

Of relevance in seeking to implement the NDIS, and in addition to some of the gaps in access outlined above, SPOT demonstrates that there are significant areas of rural and remote Australia where there is no or inadequate access to allied health services, which are often key services for people with disabilities. Figure 2 shows gaps in provision of all allied health services, with orange diamonds

The following maps illustrate areas in which allied health services are available, represented by green dots, and regions without such accessibility indicated through gray dots.

  • Green dots signify locations having at least some level of service availability,
  • Gray dots denote communities lacking complete coverage from these facilities within sixty minutes’ travel distance; furthermore, their sizes reflect respective demographic magnitudes affected accordingly.

These visualizations include specialized versions focusing exclusively upon two distinct professions:

  1. Speech Pathology - Referenced as Figure 3;
  2. Occupational Therapy - Documented under Figure 4

Figure 4: Occupational Therapists

Ongoing service delivery challenges in unique markets

The RFDS has significant experience providing health services throughout rural and remote areas, including some of the most hard to reach and isolated places. The RFDS understands that delivery of the NDIS in remote and very remote areas is of particular and current interest to the NDIA, and the success of our innovative service model in these areas over nine decades can offer some guidance.

The most significant challenge in service delivery to rural and particularly remote parts of this country are the small populations spread across very large geographical areas. In many instances, the small populations will not sustain a substantial permanently based health workforce locally if dependent on activity to drive billing under the Medical Benefits Scheme (MBS). It is for this reason that RFDS services operate predominantly outside of the MBS. Similarly, it is likely that small population numbers in individual communities will not provide an adequate market for permanently based NDIS services and supports. Instead, carefully coordinated outreach models are likely most suitable. In this context, the RFDS recommends the following principles for the implementation and delivery of NDIS services in rural and remote Australia.

  • Building on and expanding successful rural and remote service models, including outreach and with a focus on demonstrating a strong evidence base for best practice;
  • A community-based approach, focused on whole of community engagement and relationship building through trusted service delivery partners, particularly in remote Indigenous communities;

  • Adequate, flexible and long term funding arrangements that enable services to be delivered based on local need, and recognises the additional costs associated with providing services in remote and very remote locations;

  • A focus on workforce sustainability, ensuring that rural and remote clinicians are adequately trained and receive appropriate supports.

The Commonwealth has invested in RFDS services, including primary healthcare services for almost eight decades, providing funding which has contributed to the building of a significant RFDS asset base. This includes aircraft, equipment, experience, know-how and a strong brand in areas where services are provided. Importantly, communities across Australia, who consistently rate the RFDS as Australia’s most trusted charity, have co-invested in this endeavor. It is the view of the RFDS that in seeking to better deliver the NDIS to remote and very remote Australians, an opportunity exists for the RFDS and the Commonwealth to build on this partnership. The RFDS proposes that greater use of RFDS assets could be easily and effectively harnessed to see the NDIS reaching remote communities.

The RFDS is committed to improving the health of those living in the areas we serve, and seeks to work productively with communities, governments, other funders and healthcare providers to ensure all

have access to appropriate, affordable and effective health services.

| would be pleased to discuss any of the matters raised in this submission. Please contact me on to arrange a convenient time.

Yours faithfully,

Frank Quinlan

RFDS Federation Executive Director