The Turnbull Government has been offering half-truths to voters once gain

In its 2017-18 Budget the Turnbull Government announced it would commence the phased re-introduction of Medicare Benefits Schedule rebates indexation.

Treasurer and Liberal MP for Cook Scott Morrison stated in his Budget Night speech that “We are lifting the freeze on the indexation of the Medicare Benefits Schedule. We are also reversing the removal of the bulk-billing incentive for diagnostic imaging and pathology services and the increase in the PBS co-payment and related changes.”

It now appears that it was premature to expect that out-of-pocket expenses for a number of radiology and diagnostic imaging services might be contained after the rebate freeze was lifted for these services in three years time.

The Sydney Morning Herald, 16 May 2017:

The Medicare rebate thaw will not apply to 93 per cent of scans, including the X-rays, MRIs and ultrasounds used to diagnose some of the most common forms of cancer.

Health Minister Greg Hunt's staged four-year thaw has been widely welcomed by doctors' groups such as the Australian Medical Association and the Royal Australian College of GPs. Under the plan, indexation will gradually be reapplied to bulk-billing incentives, visits to the doctor and allied health services.

On budget night, the Turnbull government said the final stage of the thaw, due in July 2020, would lift the freeze on "targeted" radiology and diagnostic imaging services - the first indexation since 2004.

Prime Minister Turnbull puts pressure on the Senate to back the increase to the Medicare levy after the release of two new opinion polls. Vision courtesy Seven News Melbourne.

But new Department of Health figures reveal precisely how "targeted" the changes will be: the freeze will be lifted on 59 of the 891 radiology items listed on the Medicare Benefits Schedule - just 7 per cent.

While mammograms and a number of CT scans will be indexed under the plan, X-rays, MRIs, PETs and ultrasounds for such common conditions as brain, lung, breast and ovarian cancer will not. The rebate on common scans for arthritis and nuclear medicine will also remain frozen. [my yellow highlighting]

As for the promised reversing of the increase in the Pharmaceutical Benefits Scheme (PBS), this is only the potential for a flow-on effect from other changes in the PBS and is in no way guaranteed to occur.

How the NSW public hospital system still fails those with mental health issues

“To see a mentally ill person in 2014 at a public hospital in NSW treated in such an appalling manner is really beyond comprehension. The sight of the deceased wandering the corridor naked and covered in excrement while the senior nurse is seen to mop the floor apparently oblivious to her is horrific. While this appears not to be a system failure it is clearly a serious human failure. It is for another place to take such disciplinary proceedings as appear necessary.” [Excerpt from a NSW coronial inquest judgment delivered on 7 September 2016]

ABC News, 12  May 2017:

The daughter of a woman who died after she was left to wander the halls of a New South Wales hospital while naked and covered in faeces says nurses there lied to her about what happened.

Miriam Merten died in 2014 from a brain injury after she fell over more than 20 times at the Mental Health Unit of Lismore Base Hospital, on the state's north coast.

A coronial inquest heard she was locked in a seclusion room for hours, and when the two nurses supervising her unlocked the door they allowed her to wander around naked, covered in faeces.

She continued to fall over outside the seclusion room.

Coroner Jeff Linden found she died from "traumatic brain injury caused by numerous falls and the self-beating of her head on various surfaces, the latter not done with the intention of taking her life".

"The sight of the deceased wandering the corridor naked and covered in excrement while the senior nurse is seen to mop the floor, apparently oblivious to her is horrific," he said.

The state's chief psychiatrist Murray Wright said he was equally shocked.

"I can't speak for what was happening in the minds of those nurses but I think it's an absolutely appalling incident," he said.

Ms Merten's daughter, Corina Leigh Merten, said she only found out exactly how her mother died when a journalist contacted her recently.

She said that at the time of her mother's death, nurses gave her a different version of how her mother died.

"I was in school, in Year 12, my dad came and picked me up and we went straight to the hospital," she said.

"At the time they told me she slipped and fell in the shower."

Now 20, Corina Merten said she did not know the coronial inquest was on.

"I'm so disappointed that it took a reporter for me to know what actually happened to my mum," she said.

ABC News, 13 April 2017:

The New South Wales Health Care Complaints Commission said it had found that two nurses caring for a patient who later died from a brain injury kept no record of about 20 falls captured on CCTV.

The woman, known as Patient A, was filmed wandering naked and covered in faeces in Lismore's Adult Mental Health Unit in mid-2014.

CCTV footage showed that in the seven hours before she was transferred to intensive care she fell 24 times.

For most of that time she was alone in a locked room, but nursing records of her confinement made no mention of any falls.

During a five-hour period in the seclusion room, no-one entered to check the patient's temperature, pulse, respiration or blood pressure.

Patient A was not offered any food or water and had no access to a toilet.

The woman died from a brain injury the following day.

The HCCC found the two nurses charged with her care guilty of professional misconduct.

Far too late to benefit Miriam Merten, Health Minister Brad Hazzard said the State's Chief Psychiatrist and a parliamentary committee would review whether failures in mental health care persist.

See: Civil and Administrative Tribunal New South Wales, Health Care Complaints Commission v Borthistle [2017] NSWCATOD 56 decision concerning “Patient A” and Health Care Complaints Commission v Burton [2017] NSWCATOD 57 decision concerning “Patient A” .

NSW Health Care Complaints Commission (HCCC), Annual Report 2015-16:

Each year complaints relating to mental health make up around 12% of all complaints received by the Commission.

In 2015-16, there were 759 complaints in this category.

This means that over the five years from 2011 to 2015-16 the Commission has received 3,051 complaints concerning mental health….

Over the last five years the Commission received:

807 complaints about medical practitioners;

647 complaints about psychologists;

438 about mental health services in a public hospital and 299 about psychiatric hospitals;

302 about nurses; and,

220 about community health services.

In addition to the 12% of all health complaints being listed as complaints concerning mental health providers, another 5.4% of all health complaints are complaints concerning psychiatry providers.

This annual report also stated that 21% of all mental health complaints between 2011-12 to 2015-16 related to professional conduct and 31.9% related to treatment.

Of the mental health complaints received in 2015-16 there were:

46 referred to professional council;

40 resolved during assessment;

55 referred for local resolution;

23 investigation conducted by the HCCC;

46 referred to the HCCC's Resolution Service;

12 discontinued with comments;

7 referred to another body/person; and

226 discontinued with no reasons stated.

Case study included in HCCC Annual Report 2015-16 at page 58:

The Commission investigated a complaint against a mental health inpatient unit in a regional public hospital. The key facts were that:

* Patient A was scheduled under the Mental Health Act 2007 (NSW) with a dual diagnosis of schizophrenia and alcohol abuse

* The patient was difficult to manage due to lack of insight, non-compliance with medication and high level aggression.

* The decision to co-locate the patient in a double room with Patient B – both unpredictable and potentially violent patients – without any a risk assessment.

* On a night shift, required observations either not carried out at all or were not carried out in the manner required, but staff signed off that all care level checks were completed

* Overnight Patient B was killed by Patient A.

The investigation found that care and treatment of Patient A was inadequate. His care plan was ineffective, rigid and failed to improve his condition. There were lost opportunities in terms of appropriate, alternative ways to manage and treat him. Furthermore, his safety and that of others was put at risk through the decision to co-locate him with patient B and because staff failed to carry out the required observations.

SANE Australia 2013 report:

A Mental Health Council of Australia study (2011) found that people with mental illness reported similar levels of stigma from health professionals as from the general community.

Some of the study’s key findings are that:

* Almost 29% reported that a health professional had ‘shunned’ them. These figures rose to over 50% for people with post-traumatic stress disorder and borderline personality disorder.

* Over 34% had been advised by a health professional to lower their expectations for accomplishment in life.

* Over 44% agreed that health professionals treating them for a physical disorder behaved differently when they discovered their history of a mental illness.

NSW Health Care Complaints Commission decisions recorded in 2016 & 2017 re other nursing staff complaints relating to treatment of patients with a psychiatric illness:

RNs Haridavan Pandya and Sumintra Prasad – Unsatisfactory professional conduct, 2 February 2017, concerning their care of a mental health patient at Bungarribee House mental health unit in Blacktown hospital on 28 February 2014.

RNs Abraham Thomas and Donna Hayden, and Ms Julie Rumble – Unsatisfactory professional conduct, 11 May 2017,concerning the death of a mental health inpatient at Dubbo Mental Health Inpatient Unit on 28 February 2014.

Mr Stephen Woods – disqualified from being registered as an enrolled nurse for a period of 12 months, 16 May 2016, concerning a physical and verbal attack of a patient in the Mental Health Intensive Care Unit at Hornsby Hospital on 9 April 2014.

Mr Neil Mullen (RN) – Unsatisfactory professional conduct – Reprimand and conditions imposed, 18 July 2016, concerning care of care of nine patients in the Shellharbour Hospital mental health unit on 30 and 31 July 2014. 

Mr Mike Siebe Greive - Registered Nurse - Disqualified for 18 months, 30 March 2016, concerning a female mental health patient at the Hornsby Hospital Adult Mental Health Unit between October and December 2013. 

Registered Nurses Wendy Kennedy, Christopher Parker and Jisnu Dowsett cautioned and Stewart Thompson reprimanded by a Nursing and Midwifery Professional Standards Committee, 1 June 2015, concerning care of a patient at Lismore Adult Mental Health Unit’s eight bed High Dependency Unit on 19 and 20 February 2013.  The patient was found deceased in his room on the morning of 20 February 2013.

Mr Ronnie Obusan - finding of unsatisfactory professional conduct – reprimand and conditions, 19 January 2016, concerning the nurse’s interactions with a patient in the mental health unit at Nepean Hospital in 2012. 

I'm sure NSW residents would all like to believe that each and every time they present at a public hospital they will be treated with professional care and respect.

Unfortunately that is not always the case as prejudice, discrimination and racism are rarely acknowleged by government as existing within the state health care system and are therefore tolerated by default.

“Stigma against people who have experienced a mental illness is deeply entrenched in our culture. It finds expression everywhere from the Parliament to the front bar. From courtrooms and pulpits to playgrounds it is possible to hear people who experience mental illness cast in an unfair light.”  [National Survey of Mental Health and Wellbeing Bulletin 6, Carr & Halpirin 2002, Stigma and discrimination]

National Rural Health Alliance welcomes Labor commitment to National Rural Health Strategy and implementation

Medianet Release
26 Apr 2017 7:24 PM AEST - Welcome commitment to National Rural Health Strategy and implementation The National Rural Health Alliance today welcomed the commitment of the Federal Opposition to the development of a dedicated National Rural Heath Strategy and Implementation Plan. The commitment was made by Shadow Minister for Health Catherine King in the opening session of the 14th National Rural Health Conference, which started in Cairns today. Alliance Chair, Geri Malone, said today that the commitment by Ms King represented an important breakthrough for the seven million people who live in rural and remote Australia. "The Alliance has been encouraging broad, non-partisan support for a national strategy for rural and remote health and wellbeing," Ms Malone said. "For too long, Australia has been without an overarching strategy and implementation plan which is dedicated to bridging the health divide between the city and the bush. "There is overwhelming evidence which shows that where you live impacts on your health and wellbeing – that the further you are away from a capital city, the worse your health, and your access to services, tends to become. "But we are now in a rare period in decades of rural health planning and reform where we do not have a current National Rural Health Strategy, and that needs to change." Ms Malone said the first National Rural Health Strategy was released in 1994.   "There were various updates and revisions of the strategy over the ensuing years, with the last being the National Strategic Framework for Rural and Remote Health, endorsed by Health Ministers in November 2011.    "At the time, the Alliance called for a National Rural and Remote Health Plan to be developed to operationalise the goals set out in the Framework, but it never eventuated. "So the Framework has not been actioned in a consistent, comprehensive way, there are no national reports on progress against the Framework, and no action has been taken to update it." Ms Malone said the Alliance recognised the effort being put into health workforce programs, including for rural and remote Australia. "We also know workforce is only one part of a more complex equation about what's different and what needs to be done to fix the divide in health outcomes for rural Australia," she said. "We constantly seem to have to remind the non-believers in our cause, be that politicians and funders, metro centric decision makers and influencers, that firstly as 30 percent of the Australian population, we are entitled to equity in health service provision.  "This does not mean doing the same. One size does not fit all. We know there are many ways of achieving the same end result, but that requires adaptation and contextualization to make it work – contextualized to place, place-based and individualised care. "It is not an easy task and it can become somewhat disheartening to have to plead our case repeatedly.  "We therefore see a national rural health strategy and plan not as ends in themselves but rather they provide the framework within which policies should be developed, planned, implemented and measured. Distributed by AAP Medianet JN#:877826
	© Australian Associated Press, 2017

Every man and his dog may soon have access to your personal medical history if you live in Australia

A federal government digital medical information storage and retrieval system, which will eventually contain information on every person permanently residing in Australia and which was hacked even before it publicly went online, is now going national – and it still has significant privacy problems.

The Daily Telegraph, 10 April 2017:

THE private health records of Australians can be accessed by more than half a million people under the latest bungle with the $2.2 billion electronic My Health Record.

News Corp Australia has learned that the privacy settings on the government’s computerised My Health Record, which lists every medicine a patient takes and records every medical visit and procedure, are automatically set on “universal access”.

This means every registered health practitioner in the nation — 650,000 people — can view them, not just the family GP, unless the patient specifically requested to opt out.

Occupational therapists working for an employer, doctors working for insurance companies, a dietitian, an optometrist or a dentist or their staff can view the record and see if individuals have a sexually transmitted disease, a mental illness, have had an abortion or is using Viagra.

“Potentially your employer’s occupational therapist can look at your record and get information they really shouldn’t be getting access to, its confidential data,” says former AMA president Dr Mukesh Haikerwal who was a government consultant on the My Health Record.

The bungle came about because the record was originally set up as an opt in system and when people set up their record they were given the option to set a PIN number to protect the information and determine who got to see it.

Nearly four million people set up a My Health Record under the opt in system but doctors weren’t using it because four years after it was established 83 per cent of Australians still did not have one.

Last year the Turnbull Government trialled turning the failed record into an opt out system.

One million people in the Nepean Blue Mountains area of NSW and Northern Queensland were given a record unless they opted out.

News Corp has now learned only 147 of these one million Australians automatically given a record under the trial set up a PIN number to protect their health information.

“147 My Health Records created in the trials have access controls set to restrict which healthcare providers can see the record, or have controls restricting access to certain documents in the record,” the Department said.

“This equates to 0.0151 per cent of My Health Records automatically created in the trials. This is consistent with the rates of access controls set by those who have opted to register for a My Health Record,” a spokeswoman for the department said.

The My Health Record lists a person’s medications and allergies, doctors can upload a health summary about the person’s health problems, eventually the system will include X-ray results, pathology results, hospital discharge summaries and other data that for the first time can be shared between medical practitioners.

The privacy problem is about to affect everyone because two weeks ago state and federal health ministers agreed to give every Australian a My Health Record unless they opt out.

This decision was made even though the results of the original opt out trial have never been made public.

And it means the health records of every Australian will soon be on open access.

The Australian, 27 March 2017:

Companies bidding for the Medicare digital payments system have been given the option of proposing a new identity card to protect against fraud and improve system capabilities.

As the federal government pushes ahead with electronic health records, in anticipation of a digital health revolution, The Australian has learned the Department of Health has made identity management a key part of the new payments system and left it open to companies to propose alter­natives.

Companies may suggest alternatives to the green Medicare card — which holds no data, just a magnetic strip and numbers for indiv­iduals whose information is stored in a database — and forms of identity for veterans’ affairs, aged care and related payments.

It would be the biggest shift since the Howard government proposed the Australian Access Card, a broad-function smartcard that attracted privacy concerns and comparisons to the ill-fated Australia Card of the 1980s and was dumped by the incoming Rudd government.

A departmental spokeswoman emphasised that there was no proposal for a new identity card under moves to develop a new digital payments system.

“While the Depart­ment of Health has not been prescriptive, the presumption is that the Medicare card and number will continue to be the basis for identification,” she said.

The option for a new identity management solution came after health ministers decided on Friday that the My Health Rec­ord system would be opt-out, making electronic medical records compulsory for all Australians unless they said otherwise, despite trials of that model having yet to report.

Australian Doctor, 27 March 2017:

Australian health ministers have officially agreed to a national opt-out model under which every patient will have a MyHealth Record created for them by default.

Yet precisely when the model will be rolled out remains to be seen.

Federal, state and territory health ministers met in Melbourne on Friday, where, according to a communique, they agreed "to a national opt-out model for long-term participation arrangements" in the My Health Record system.

The agreement precedes the release of findings from two pilot trials of opt-out enrolment systems, in North Queensland and NSW's Blue Mountains, which included nearly one million patients.

A little history…….

News.com.au, 11 September 2016:

THE man who led the dumped UK digital health record system has been put in charge of Australia’s bungled $1 billion e-health record and is being paid as much as the Prime Minister to fix it.

Former journalist Tim Kelsey will be paid a total remuneration package worth $522,240 a year, almost the same as Malcolm Turnbull and just shy of the $548,360 paid to the Chief of the Navy and more than the Chief Scientist, the head of the Fair Work Commission and the Inspector General of Taxation, a remuneration tribunal determination reveals.

The former NHS executive is an interesting appointment as CEO of the Australian Digital Health Agency because he was in charge of the UK digital health records scheme Care.data dumped by the UK’s National Health System in July.

The Department of Health stated that Mr Kelsey is uniquely suited to the role because of his experience with data and digital platforms in health and personal privacy.

The Care.data scheme to store patients’ medical information in a single database suffered multiple delays and was then scrapped after major problems emerged over patient confidentiality.

It was similar to Australia’s My Health Record that Mr Kelsey will now oversee.

Oi, Malcolm! Where's our NBN?

With only three years of borrowed money left to complete roll out of the National Broadband Network (NBN) and still not yet at the halfway mark, serious questions about this increasingly sub-standard telecommunications infrastructure are being asked.

Australian Medical Association, media release, 17 January 2017:

Better Access to High Speed Broadband for Rural and Remote Health Care - 2016

1

10 Jan 2017

---

1.  Introduction

Approximately 30 per cent of Australia’s population lives outside the major metropolitan areas[1]. Regional, rural and remote Australians often struggle to access health services that urban Australians would see as a basic right. These inequalities mean that they have lower life expectancy, worse outcomes on leading indicators of health, and poorer access to care compared to people in major cities.

In 2016 the AMA conducted a Rural Health Issues Survey, which sought input from rural doctors across Australia to identify key solutions to improving regional, rural and remote health care. The survey identified access to high-speed broadband for medical practices as a key priority.

This result reflects not only the increasing reliance by medical practices on the internet for their day to day operations, but also the increasing opportunities for the provision of healthcare services to rural and remote communities via eHealth and telemedicine. For the full potential of these opportunities to be realised, good quality, affordable, and reliable high-speed internet access is essential.

The AMA recognises that technology-based patient consultations and other telehealth initiatives can improve access to care and can enhance efficiency in medical practice, but the need for better access to high speed broadband goes beyond supporting rural and remote health. In today’s world, it is a critical factor to support communities in their daily activities, education, and business, and has the potential to drive innovation and boost the rural economy.

This position statement outlines the importance of better access to high speed broadband for medical practices, other healthcare providers and institutions, and patients, to improve regional, rural and remote health care in Australia, and highlights key solutions for achieving this.

2. Internet access in regional rural and remote Australia

Despite its tremendous growth, internet access is not distributed equally within Australia, and internet use by country people has yet to reach the level of use in capital cities, for a wide range of reasons.

In many country areas the internet connection is still very poor.^[2] In 2015, 80 percent of non-urban Australians had an internet connection at home compared with 89 percent of those in capital cities^[3]. Internet use via mobile phone was much lower in non-urban areas, at 37 percent, compared to 60 percent for capital cities^[4]. This reflects the patchy, unreliable or absent mobile coverage in many rural and remote areas. While mobile broadband use was highest in non-urban areas, at 29 percent, compared to 25 percent in capital cities, mobile broadband is currently not a good solution for business or eHealth, due to the relatively small amounts of data on the relatively costly plans available.

Internet services, particularly in more isolated areas, only make available relatively small download allowances and these come at a much higher cost and slower speed than those services available in metropolitan areas.

3. Supporting regional rural and remote health

3.1   The need for better access for health services

The health sector needs telecommunications connectivity for health service delivery and management, doing business with Government and complying with Government requirements, continuing professional development, online education, mentoring, and clinical decision and other support.

Health was identified in the Regional Telecommunications Review report[5] as one of the particular segments of the community requiring special consideration. To effectively leverage telecommunications technology to deliver better health outcomes at lower cost in regional, rural and remote areas and to implement new models of health care, both mobile and broadband technology must be reliable, affordable, and supply adequate capacity.

However, the utilisation of telehealth and telemedicine in rural and remote Australia remains patchy and is not used to full potential, because of no, or inadequate internet access. As noted in the Regional Telecommunications Review report[6], the ability of hospitals and clinics to support remotely located clinicians and patients via video conferencing and remote monitoring could be severely limited in areas serviced by satellite, which may not be able to consistently and reliably deliver the necessary capacity and technical capability.

The AMA Rural Health Issues Survey received many comments from rural doctors on the problems encountered with poor internet access. For example:

• High-speed broadband [is the] single most critical issue to run practices now, many areas not getting the best from NBN.
• Internet services by satellite are slow and time consuming. Reliable internet services at reasonable speed and reliability is critical.
• Internet services are a critical area [of concern]. The NBN has been deficient in providing a comprehensive coverage even in areas that are under 25km from a major regional centre i.e. Orange and Dubbo. 

As mainstream healthcare provision becomes increasingly technology based and requires more and faster broadband services to operate, there is a real risk that regional, rural and remote areas of Australia will be left further and further behind in their ability to provide quality health services.

3.2. The benefits of high speed broadband for rural and remote health care

High-speed affordable broadband connectivity to the Internet has become essential to modern society, and offers widely recognised economic and social benefits, with numerous studies showing a strong link between broadband growth and rapid economic development^[7]. Affordable and reliable broadband access can support the development of new content, applications and services that allow people to work in new ways, changing business processes in ways that stimulate productivity and potentially increase labour-force participation^[8].

3.2.1  Economic benefits

It has been estimated that in New Zealand, the benefits from broadband-enabled health care could reach around $6 billion over a 20-year period^[9]. These benefits come from reduced hospital, travel and drug costs and improvements in care. A case study by Deloitte Access Economics shows savings to a single older Australian of $7,400 per year, with savings to the Government, through reduced health and service provision costs, of over $14,500^[10].

3.2.2 Driving greater efficiency and reducing costs

Telehealth practice will be one of the most important online services in the broadband future, enabling significant changes to work practices to drive greater efficiency and reduce costs^[11].

If sufficiently supported, telehealth services, such as video-conferencing, could become more effective in complementing local health services. They could be used to expand specialty care to patients in areas with shortages of health care providers as well as extend primary care to remote areas, reducing the need to travel, and increasing the frequency of patient and primary care provider interactions. By providing timely access to services and specialists, telehealth could improve the ability to identify developing conditions, and thereby reduce the need for more costly treatments and hospitalisations in the future. Telehealth could also help to educate, train and support remote healthcare workers on location and support people with chronic conditions to manage their health.^[12]

A CSIRO report on home monitoring of chronic disease[13], for example, shows that a modest investment in home monitoring technology, allied to risk stratification tools and remote monitoring, could save the healthcare system up to $3 billion a year in avoidable admissions to hospital, reduced length of stay and fewer demands on primary care.

3.2.3 Supporting eHealth solutions now and into the future

eHealth encompasses patient access to doctors via online consultation, remote patient monitoring, online tools and resources for patients and doctors, clinical communications between healthcare providers, and professional’s access to information databases and electronic health record systems. If sufficiently supported with affordable, high-speed broadband services, eHealth has potential to improve health outcomes at all levels, from preventative health, specialist and acute care and self-management of chronic conditions, through to home monitoring for people living with disabilities[14].

Advances in information technology will act as a catalyst for the development of a range of potential eHealth solutions to some of the challenges faced by rural and remote communities. If available and accessible, improved connectivity will facilitate new and emerging best practice models of health care, such as those which incorporate high definition video conferences, data exchange and high resolution image transfer[15].

Technological advancements in health care that could become the way of the future, if affordable and sufficient access to broadband services becomes available, include better point of care diagnostics, resulting in faster, cohesive patient care; biosensors and trackers to allow real time monitoring; 3D printed medical technology products; virtual reality environments that could accelerate behavioural change in patients; and social media platforms to improve patient experience and track population trends^[16].

3.2.4 Supporting education and training

The internet also plays a big part in the lives of doctors and their families, assisting with education and social cohesion. It enables rural doctors to learn from the most current resources, explore treatment options, watch demonstrations of procedures and attend live discussions with experts.

Access to high speed broadband has the potential to change the way medical education, training and supervision is delivered in rural and remote areas [17]. As pressure on access to prevocational and vocational training places increases, harnessing this technology to support training is a viable strategy to create additional training places in rural and remote locations and ultimately improve access to specialist services for rural and remote patients.

The use of telehealth and telesupervision as an adjunct to face-to-face teaching will allow doctors in training to remain in rural and remote settings to complete their training, and enhance the likelihood that they will choose to work long term in a rural areas. Improved information and communications technology will enhance the learning experiences for trainees at rural sites and during rural rotations, provide exposure to innovative models of care, and improve supervisor capacity by allowing supervisors to transfer knowledge, supervise and mentor trainees remotely. 

Improved telehealth and communication technology infrastructure to support teaching and training at rural sites will also enhance professional collaboration between rural and remote medical generalist practitioners and other specialists in the provision of shared care, skills transfer and education.

The requirement for doctors to maintain their skills is a fundamental component of medical registration. It is important that processes mandated by the Medical Board of Australia, including in revalidation proposals, do not discriminate against medical practitioners working in rural and remote Australia. Access to high speed broadband is an essential support for rural and remote practitioners who must comply with these requirements.

4. What can be done to improve broadband access for country Australians?

The AMA is of the view that high-speed broadband should be available to the same standard and at the same cost to all communities, businesses and services across the whole of Australia. The platforms used must be able to accommodate future developments in information and communications technologies and provide connectivity through suitable combinations of fibre, mobile phone, wireless, and satellite technologies. For rural practices, in order to be incorporated routinely in everyday practice (clinical, educational and administrative), network connectivity must be sufficient, reliable, ubiquitous and dependable.

The Government must ensure that broadband services are affordable in regional, rural and remote Australia. Lack of affordability is regarded as one of the most important barriers to good internet access for country people whose incomes, on average, are 15 per cent lower than those of city people[18].

Government policies play a tremendous role in bringing internet access to underserved groups and regions. Unless issues around equitable and affordable access to telecommunications in regional, rural and remote Australia are addressed, the potential benefits of the digital economy for non-urban Australians will go unrealised.

The AMA urges the Government to consider the following actions:

·       Fully consider the recommendations of the 2015 Regional Telecommunications Review, and, in particular, adopt Recommendations 8, 9, and 12, to:

o    Develop a new Consumer Communication Standard for voice and data which would provide technology neutral standards in terms of availability, accessibility, affordability, performance and reliability.

o    Establish a new funding mechanism, the Consumer Communication Fund to replace the existing telecommunications industry levy and underwrite over the longer term, necessary loss-making infrastructure and services in regional Australia.

o    Collect benchmark data on availability and affordability of broadband data and voice services (including mobile services), to be reported annually, in order to improve the understanding of the changing circumstances of regional telecommunications.

·       Extend the boundaries of the NBN’s fibre cable and fixed wireless footprints and mobile coverage wherever possible.

·       Begin an incremental process of terrestrial network expansion over the longer term to address increase in usage over time.

·       Develop measures to prioritise or optimise the broadband capacity available by satellite for hospitals and medical practices, such as exempting or allocating higher data allowance quotas, or providing a separate data allowance (as is the case with distance education[19]).

·       Create universal unmetered online access to government, hospital and health services for people and businesses in rural and remote areas.^[20]

·       Establish an innovation budget for development of local infrastructure solutions for rural and remote areas.^[21]

·       Engage with state and local government and related stakeholders who wish to co-invest or coordinate planning to achieve the optimum overall infrastructure outcome for their area. This could involve public-private partnerships or the leveraging of philanthropic infrastructure funding through, for example, tax concessions.

---

^[1] Australian Institute of Health and Welfare (AIHW) (2015), Australia’s Welfare 2015

^{[2] Curtin J (2012), A digital divide in regional and rural Australia.}

^[3] Australian Communications and Media Authority (2016), Regional Australians Online

^[4] Ibid

^[5] Australian Government Regional Telecommunications Review (2015)

^[6] Ibid.

^[7] Alcatel-Lucent (2012), Building the Benefits of Broadband. How New Zealand can increase the social & economic impacts of high-speed broadband

^[8] Centre for Energy-efficient Telecommunications (CEET)(2015), Economic Benefit of the National Broadband Network

^[9] Alcatel-Lucent (2012), op.cit.

^[10] Deloitte Access Economics (2013), Benefits of High-Speed Broadband for Australian Households. Commissioned by the Australian Department of Broadband, Communications and the Digital Economy

^[11] CEET (2015), op.cit.

^[12] National Rural Health Alliance (2013), eHealth and telehealth in rural and remote Australia. Accessed October 2016

^[13] Prof. Branko Celler et al (2016), Home Monitoring of Chronic Disease for Aged Care, CSIRO Australian e-Health Research Centre.

^[14] National Rural Health Alliance (2013) op. cit.

^[15] National Rural Health Alliance (2016), website accessed October 2016

^[16] Deloitte (2016), Design, service and infrastructure plan for Victoria’s rural and regional health system discussion paper, commissioned by the Victorian Department of Health and Human Services.

^[17] Wearne S M (2013), Using telehealth infrastructure for remote supervision could create medical training places where they are needed. Medical Journal of Australia, 198 (11): 633-634. 17 June 2013.

^[18] AIHW (2016), Are things different outside the major cities? Accessed October 2016.

^[19] Australian Government (2016), Australian Government Response to the Regional Telecommunications Independent Review Committee Report: Regional Telecommunications Review 2015.

^[20]Broadband for the Bush Alliance (2016), Broadband for the Bush Forum V: Digital Journeys Communiqué

^[21]Broadband for the Bush Alliance (2014), Broadband for the Bush Forum III: Building a Better Digital Future Communiqué

Related document (Public): 

 Better access to high speed broadband PS_Final.pdf