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Royal Flying Doctor Service T 02 6269 5500 '111!!!!!!!!!!!~-~ .r"il!!!!!!!!!!!!!~
PO Box 4350 E enquiries@rfds.org.au
Kingston ACT 2604 W www.flyingdoctor.org.au Royal Flying Doctor ServiceAustralia '
Ms Libby Coker MP
Chair, Joint Standing Committee on the
National Disability Insurance Scheme
Dear Ms Croker
RFDS Submission to the Inquiry into National Disability Insurance Scheme participant experience in rural, regional and remote Australia
For over 90 years, the RFDS has been a vital part of remote and rural communities, providing critical health services to areas of great need. This is particularly in locations where low population numbers are unviable to support permanent local health services such as hospitals, emergency departments, pharmacies, General Practitioners and other health services.
Today, the RFDS provides a comprehensive suite of services to people living, working and travelling in remote and rural Australia. This includes:
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a 24 hour, seven-days-a-week (24/7) aeromedical retrieval service for those who experience a medical emergency;
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patient (road) transport;
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mobile, fly-in fly-out, and a small number of permanent local GP and nursing clinics, providing primary healthcare services to over 200 rural and remote communities;
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mobile, fly-in-fly out and drive-in drive out dental health services;
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mobile, fly-in-fly out and drive-in drive out mental health, alcohol and other drug, and social and emotional wellbeing services;
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a growing number of chronic disease management, health promotion, specialist and allied health services;
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all supported by a 24/7 telehealth service. In the last year the RFDS provided over 336, 000 patient contacts; provided almost 37 000 aeromedical retrievals; transported over 58,000 patients by road; provided almost 138,000 face to face primary healthcare consultations; almost 20,000 face to face mental health consultations; almost 11,000 dental health consultations; and, almost 72,000 telehealth consultations. With 81 aircraft across the country at 23 aerobases, the RFDS last year flew almost 28,000,000 km to provide critical health services across the country – equivalent to 34 return trips to the moon.
Federation Patron: His Excellency General the Honourable David Hurley AC DSC (Retd),
Governor-General of the Commonwealth of Australia
Royal Flying Doctor Service of Australia. ACN 004 213 067 ABN 74 438 059 643
Health outcomes and service access in rural and remote Australia
On almost any health indicator, residents of remote and rural Australia fare worse than residents of Australian cities. For example, as recently as 2021, people living in the most remote parts of our country were likely to die 14.3 years earlier than their counterparts in major cities - 13.1 years earlier for males and 16.0 years earlier for females. Mortality rates for both males and females in very remote Australia are also 1.6 times higher than for people in major cities.
Burden of disease is also much high in rural and particularly remote and very remote areas, with total burden of disease being 1.4 times higher in these areas than in major cities. The disparity in total burden of disease rates for Australians living in remote and very remote, and major cities, is also evident in many other specific disease and injury categories, including:
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Kidney and urinary diseases (remote and very remote areas rate was 2.7 times as high as for major cities)
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Injuries (2.4 times as high)
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Infectious diseases (2.3 times as high)
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Ischaemic heart disease (2.2 times as high)
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Suicide/self-inflicted injuries (2.0 times as high). 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, at a minimum, all Australians should have reasonable access to services, which it defines to be access within a 60-minute drive time. In the soon to be released RFDS Best for the Bush Health Baseline Report 2023, it has been mapped through RFDS Strategic Planning and Operational Tool (SPOT) to show that in rural and remote areas:
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234,165 people did not have access to nurse-led services
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114,566 people did not have access to general dental services
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101,963 people did not have access to general mental health services
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32,359 people did not have access to general practitioner services
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109,706 Indigenous Australians did not have access to an Aboriginal health service. The RFDS notes that in some areas, this 60-minute “proxy” measure is not on its own sufficient to
properly demonstrate challenges in service access. In addition to the 60-minute drive time,
acknowledging that this can be in places where terrain and poor availability of public transport options make this significantly difficult, consideration should be given to other physical accessibility factors as well as the financial affordability, cultural safety and acceptability of services.
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 funding (e.g billing under the Medical Benefits Scheme (MBS). It is for this reason that RFDS services operate predominantly outside of the MBS through carefully coordinated outreach services. Similarly, it is likely that small population numbers in individual communities will not provide an adequate market for permanently-based NDIS and related services and supports. Indeed, it is the understanding of the RFDS that in many rural and particularly remote locations, there has not been the capacity for NDIS assessments to be undertaken, ultimately meaning that access to the Scheme for people in these areas is not possible, let alone the services required.
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Of relevance in seeking to effectively implement the NDIS, and in addition to some of the gaps in access outlined above, RFDS mapping through SPOT also 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. To provide a demonstration of the capabilities of SPOT, the
following maps are provided for speech therapy (Figure 3); occupational therapy (Figure 4);
physiotherapy (Figure 5); and, audiology services (Figure 6). In each, orange diamonds represent where there are services, and grey dots indicate populations that have no access to any allied health services within a 60-minute drive time. The size of the dot represents the size of the population without services.
Figure 3: Speech pathologists or therapists
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Figure 5: Physiotherapists
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Figure 6: Audiology services •
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Ongoing service delivery challenges in unique markets
The RFDS has significant experience in 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. Similarly, a carefully coordinated outreach model for the NDIS and related services and supports are likely most suitable for many rural and remote communities
Given the unique, challenging and varied service context of rural and particularly remote Australia, the RFDS strongly advocates for focused work and investments to address these challenges. As such, the RFDS proposes and strongly supports development of remote-specific implementation plans for services and strategies, such as the NDIS, for the benefit of rural and remote people. These should recognise the likely need for varied funding arrangements and incentive measures to enable certainty and successful, viable and sustainable implementation in these unique places.
In summary, the RFDS recommends the following principles for the implementation and delivery of NDIS services in rural and remote Australia to best meet the needs of and identify patients:
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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;
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A community-based approach, focused on whole of community engagement and relationship building through trusted service delivery partners, particularly in remote Indigenous
communities;
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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;
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A focus on workforce sustainability, ensuring that rural and remote clinicians are adequately trained and receive appropriate supports.
In regards to enhanced implementation of the NDIS, the RFDS notes the potential opportunity associated with current trends in increased telehealth services across many health disciplines. Over recent years, and particularly in the context of the COVID-19 pandemic, the RFDS has increasingly pursued the delivery services to rural and remote communities via videoconferencing. Where these services are successfully operating, this is cost effective for patients, with reduced travel time to access care, and the potential for additional care to be provided. It is also valuable for rurally isolated health professionals, and provides opportunities for coordinated care between patients, rural clinicians and specialists.
However, our experience to date, and particularly throughout the COVID-19 pandemic shows poorer uptake of this mode of service delivery by both patients and clinicians in rural and remote areas. These include, for example, insufficient bandwidth allocated for healthcare – often resulting in frozen screens, lagging, and dropouts– or the unaffordability of necessary infrastructure or available services. It must be ensured that internet connections throughout rural and remote areas are sufficient, reliable and affordable enough to enable these populations to access the benefits of comprehensive telehealth services, and not be left behind. There also remains the need for continued development of technology
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including reliable videoconferencing systems that ensure the privacy and security of personal data. These systems need to be affordable, adaptable and easy to use, particularly for those with low digital literacy. Further, telehealth services will only be successful where they are well integrated into the full service model, supporting face to face to face services.
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.
Thank you for the opportunity to contribute to this inquiry, I would be pleased to discuss any of the matters raised in this submission with the Committee further.
Yours faithfully,
Frank Quinlan
RFDS Federation Executive Director
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