Access to services

Background

  • UnitingCare Queensland provides health and community services to thousands of people every day of the year through its service groups – UnitingCare Community, UnitingCare Health, Blue Care and more recently ARRCS (Australian Regional and Remote Community Services). People are at the centre of everything we do and we aim to be “the choice for care and service”. To continually improve our person centred care we listen to our clients and communities, monitor trends and tap into new and emerging evidence.  
  • UnitingCare Queensland has a strong footprint in rural and remote communities. In Queensland 52% of our services are in regional Queensland contributing $514 million per year to these economies. As a not-for profit organisation, we provide services in areas where private sector provision may not be possible due to economic viability of services. Blue Care’s contribution to regional Queensland is significant with 73% of Blue Care facilities located in 60% of Queensland’s most disadvantaged locations. In contrast, only 43% of for-profit providers are concentrated in similar areas (1).  
  • In 2012 Blue Care established Indigenous Services to provide crucial services to Indigenous communities in North Queensland. It also recently established Australian Regional and Remote Community Services (ARRCS), a not-for-profit aged care and community service provider that operates residential care facilities and community care programs in the Northern Territory.
  • UnitingCare Community works with Indigenous communities to help young people, families and older people across Queensland to access good quality and appropriate education, work through family disputes or problems and supports grandparents caring for their grandchildren.

Challenges 

  • Delivering appropriate, accessible and sustainable health and human services in Queensland is challenging. We are faced with declining and ageing populations in rural and remote communities. There is also potential growth in some regional areas supported by the state government policy to double the population of regions outside of South East Queensland in 30 years. 
  • The equitable delivery of health and human services in rural and remote and growing regional areas requires careful planning, new ways of delivering services and collaborative approaches. With governments increasingly focusing on market-based efficiencies, privatisation and user pays, providers need to develop new service models especially in small communities that have high need but may not have enough critical mass to support discrete services (2). Concurrently the regionalisation of health services into Hospital and Health Services and the establishment of Primary Health Networks to replace Medicare Locals should support the development of local responses and improved co-ordination. 
  • The need for ensuring a comprehensive range of well-coordinated health and human services is increasingly important given the escalating rates of chronic disease and older people in many rural areas and the persistent decade gap in life expectancy for Indigenous people. Importantly, service models need to focus on achieving a consistent quality and quantity of service delivery that is timely and preventive, not just driven by acute need. 

Current approaches

In planning for, and delivering health and human services in rural and remote areas it is critical to identify models that suit the needs and resources of the area. A range of service models are currently in place including a mix of traditional fixed or discrete services; “hub-and-spoke” models; outreach and visiting services, tele-health and tele-medicine and integrated delivery of a range of services. Aboriginal Community Controlled Health Services provide comprehensive primary health care including a focus of workforce training, governance and community capacity building.



Leadership and Innovation 

  • Our challenge is to design, deliver and support rural and remote health services using more flexible, innovative, and locally appropriate solutions, without compromising the quality and safety of care. Evidence suggests the following range of factors support the development of innovative service delivery approaches in rural communities. 
    • Supportive policy including co-ordination of policy across a range of areas, integrated or pooled funding and sustainable funding models.   
    • A supportive environment including community readiness for involvement in planning, implementing and monitoring services and collaboration between a range of service providers to plan for, design and deliver care. 
    • Investment in enabling technologies including expanded use of tele-health and telemedicine; and tapping into new opportunities offered by the roll out of the National Broadband Network and new applications that will allow home based monitoring of chronic health conditions. 
    • A focus on workforce including investing in developing a local workforce; redesign, new or better use of existing roles; and supporting and developing a professional and sustainable workforce.  
    • Strong Indigenous services including commitment to, and investment in, community engagement and participation, culturally appropriate services and robust governance. 
  • Planning for new services and infrastructure requires partnerships between a range of services providers, governments and other investors and local communities. Where local innovations are taking place we need to determine whether we can scale these up to meet the needs of population growth in some areas, and population decline in others, as well as changes in the structure of these populations (3). Service providers that already have a presence in rural, remote and regional areas can also take a supportive rather than direct service delivery role, for example by providing practical assistance such as shared accommodation or specialist support for local providers.    


UnitingCare Queensland Position

UnitingCare Queensland is committed to equitable access to services for people in regional, rural and remote areas including services that meet the needs of Aboriginal and Torres Strait Islander people. We seek to work in partnership with other service providers, governments and other investors, private sector and local communities to plan for, design and deliver appropriate, accessible, and sustainable service models in these areas. 


References

1 Economic and social value of UnitingCare Queensland, Deloitte Access Economics, 2014

2 Alston, M. (2009) Innovative human services practice: Australia’s changing landscape. Palgrave Macmillan, South Yarra.

3 Perkins, D. (2012) Population, projections and rural health. Australian Journal of Rural Health 22:1.

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