Recently the National Rural Health Alliance published an article in which it asserts that rural Australians are being shortchanged by $850 pa each in terms of health service expenditure. There is no doubt that rural and remote Australians do have difficulty with access to the health services that they need. However, the story is not that simple.
If funding was evenly distributed between metropolitan and rural health services, would Central Highlands Rural Health be able to deliver better health to its local population? Possibly, but other factors need to be considered, such as the need to locate expensive and limited-use equipment in big centres; the need for some highly trained staff undertaking some specialist services to be located in big centres; the efficiency of locating big centres in metropolitan areas both for meeting health service needs and being able to staff services. These factors skew the equity argument.
Public health funding in Victoria is an obscure dance between funded health services and the funding body. In addition to which the Federal Government funds aged care. Not simple. However, it can be noted that Central Highlands Rural Health has been able to deliver on or close to budget and weaves its way through the funding round with grace.
In 2019 Hepburn Health amalgamated with Kyneton Health to create Central Highlands Rural Health.
Both the Kyneton Health Board and the Hepburn Health Board believed, prior to the amalgamation, that a bigger health service would be able to deliver a wider range of health services, achieve the standards of health care that are required, and to do so sustainably – both financially and in terms of service quality. The case for amalgamation that the two boards took to State Government was supported, even though it would have been simpler in terms of the State’s regional approach, to absorb Hepburn Health into Ballarat Health, and Kyneton into Bendigo. So, it is significant to acknowledge that the model of a small/medium health service crossing two regions and relating to two major regional services, was seen as challenging but possible, and aimed to demonstrate a new form of local and accessible service delivery. Performance over the last four years is demonstrating success.
With the separate campuses of Kyneton, Creswick, Daylesford, Clunes and Trentham brought together to form Central Highlands Rural Health, the first challenge was for the new Board and management, to understand the history and needs of each campus, and to find a way of acknowledging local expectations, whilst putting in place the management and accountability requirements of one entity.
From the outset, the Board was concerned to ensure that bigger did not diminish local. There was a commitment to support the ongoing life of the five campuses and to improve their capacity. To a degree this approach is counter to the predominant health service planning undertaken by the Victorian State Government which looks to deliver many services in regional centres such as Ballarat and Bendigo, arguing that it is efficient and cost-effective to do so. Central Highlands Rural Health has maintained that the humanity of its approach needs to respond to the life circumstances of its population base, for whom ready access to care is as important as the technical excellence of health services.
The upgrade of local services by Central Highlands Rural Health over the last four years, has meant different things for each campus. Whilst excellent results have been achieved in formal accreditation reports for each campus, projects that would have been difficult to achieve under a smaller organizational umbrella are progressing and provide tangible evidence of commitment to local service delivery.
Creswick has seen the major upgrade of its residential aged care and hospital services with the fifth and final tranche of building works about to begin. The new building and the staff working in it, provide excellent care, particularly for frail elderly, and the local community is justifiably proud.
Kyneton is upgrading its pharmacy to meet the increased demands of service provision over the last few years, driven in large part by the provision of chemotherapy and other day medical infusions locally and increased operating theatre activity.
Trentham has seen major improvements to its residential aged care infrastructure, with improvements such as wider doorways, and better lifting equipment, and is in the process of commissioning a refurbishment of its common areas. They also had a wonderful mural painted in the dining area by a local artist, with the residents contributing ideas as it was being painted.
Clunes now accommodates an onsite ambulance and is working towards establishing a rehabilitation gym and a sensory garden.
And Daylesford has seen the development of a masterplan for its entire campus with the first tranche – the operating theatre – now under construction. The completion date is March 2024. Detailed planning work for an upgrade of its residential aged care is well advanced with the aim to bring these services to the same excellent standard as Creswick.
The Daylesford residents’ community campaign directed a spotlight on the inadequacy of the Daylesford Hospital building and the lack of facilities for community health. The Daylesford community strongly supported the case for upgrading the entire campus, recognizing that to withdraw from the provision of services such as routine surgery, and emergency care, would permanently and negatively affect the local access to these and other services which are valued highly by the community. Similarly, the Central Highlands Rural Health Board has given high priority to the Daylesford upgrade and continues to do so. The masterplan is now providing the basis for planning Daylesford’s residential aged care upgrade.
Central Highlands Rural Health has also shown its adaptability and readiness in responding to major emergencies like the COVID-19 pandemic and the 2021-2022 storms. Their exemplary response ranged from rapid testing of nearly 100,000 people and administering 13,000 vaccinations to providing mental wellbeing support within 24 hours for those affected by two major storm events and the flood event in and around Creswick.
No service system is perfect, and there is always the need to strive for better. Central Highlands Rural Health is open to hearing from any member of its catchment about their experience of the health service as a patient, family member, visitor or staff member. Central Highlands Rural Health is not a remote or closed organization but the provider of local and locally responsive services.
Kate Redwood is a board member and Deputy Chair of Central Highlands Rural Health.