Presenter: Wayne Bucklar
Guest: Gordon Gregory
Guest Bio: Gordon Gregory (OAM) is CEO of the National Rural Health Alliance (NRHA) – a position he has filled since August 1993. The NRHA is the peak non-government body working to improve the health of people throughout rural and remote Australia, organiser of the biennial National Rural Health Conference, and owner of the Australian Journal of Rural Health. Before 1993 he worked at the University of New England and as a Ministerial adviser in Canberra. He has had a longstanding interest in policies and services for rural and remote communities in Australia.
Segment overview: Learn about Australia’s peak non-government organisation for rural and remote health, National Rural Health Alliance, as discussed by Gordon Gregory in today’s segment. The Alliance comprises 37 Member Bodies, each of which is a national organisation. They include consumer groups (such as the Country Women’s Association of Australia), representation from the Aboriginal and Torres Strait Islander health sector, health professional organisations (representing doctors, nurses, allied health professionals, dentists, pharmacists, paramedics, health students, chiropractors and health service managers) and service providers (such as the Royal Flying Doctor Service and Frontier Services of the Uniting Church in Australia).
Health Professional Radio
Wayne Bucklar: You’re listening to Health Professional Radio. My name is Wayne Bucklar. This morning my guest is the CEO of the Rural Health Alliance, Gordon Gregory. Gordon is going to tell us about his organization and how it fits into the health system in Australia. Gordon, tell us first of all about the footprint that you cover for our international audience?
Gordon Gregory: Well Wayne, thanks for the chance to talk about it. The National Rural Health Alliance is the peak non-government organization in Australia for rural and remote health so we bring together 37 national bodies. It’s a huge network, really is. So when I say national bodies, what I mean obviously is we don’t have any state ones or territory ones. We don’t have any regional ones or local ones but we’ve got 37 national organizations. Now these 37 can be categorized to give clarity to what they are in a number of ways. Firstly there are, if you like, organizations that are self-defined because they got three characteristics – they are national bodies which are rural or remote and health. So a good example is the Rural Doctors Association of Australia, it’s a national body, it’s about health and it’s rural. Another example would be the Council of Remote Area Nurses which is you can tell from the title, is again remote not rural, it’s nurses and it’s national. So the first group of organizations among these 37 are those that are self-defined because they’re national, rural or remote health bodies. The second group are comprised of the rural interest groups of national health organizations, so an example is the Australian Healthcare and Hospitals Association – it may not be a member in the rural health alliance because it’s not rural but it has a rural interest group, a rural polity group which is a member. And we’ve got quite a number of these, another example would be the rural interest group with the Australian Psychological Society. The APS the Australian Psychological Society as you and your listeners know, is not a rural organization but it has a rural interest group comprised obviously of rural psychologists. So it’s that rural interest group which is in the alliance. What this means is that all 37 of our member base are passionately rural and remote. So we have few organizations which are, if you like, city centric. In fact we have none which is city centric. The third class of member, a smaller one, is comprised of national rural organizations that are not actually health bodies per say but which have a demonstrated interest in health. And the best example is the Country Women’s Association that has been around for many, many decades as you know. It’s a national rural organization which is not actually a health body, but which it got clearly demonstrated interest in health. So if we all know that Country Women’s Association as being weaning babies and having baby center clinics for many, many decades. So these 37 member bodies in the alliance – they consist, some of them are consumers groups, many of them are provider groups, and some of them are health professional groups. So we’ve got organizations which are icons of this establishment like the RFDS, The Royal flying Doctors Service. We’ve got smaller organization which don’t take any government money at all like the Country Women’s Association. We’ve got service providers like Frontier Service of the United Church. We’ve got National Aboriginal Community Controlled Health Organization which is one of three indigenous body, the other two being Indigenous Allied Health Australia and Australian Indigenous Doctors’ Association. So we’ve got consumers, we’ve got health service providers, and we’ve got clinicians all of who are passionately rural. And obviously you can tell that what this means is that we’re not just a health alliance, we’re an extremely strong and useful voice for rural affairs so even though we’re called the Rural Health Alliance, we look very, very broadly at the field. We’re concerned with the circle of social and economic determinants of health so things like jobs, how can we get more jobs in rural and regional areas. Things like public transport, people will be well aware that in remote and rural parts of Australia there are basically isn’t any, things like aged care, care for people living with disabilities. So we have a very, very broad mandate and we bring that to bear thru the good relationship we have with the department of health and with governments and shadow our positions in Canberra.
W: Good. The image that comes to me in my mind is of a lot of cats running across the attic and you’re trying to herd them in one direction. It’s an extraordinary collection of organizations. How does it fit together and make decisions? How do you get a consensus with such a broad church?
G: That’s a very good question, Wayne. It is sometimes a bit like herding cats but it’s a wonderful sector with reach to deal. I mean the people in Australia’s rural and health sector are wonderful. They are passionate, they’re all minded to do the same thing that is to make sure the people in country areas do not have any worse health than people in the city – why should they – and to make sure they have access to good services. So what happens is, briefly, is that these 37 member bodies nominate one person each to our council. So we have a council comprised of 37 plus, 4 other individuals who are nominated for particular skills. So the council of the National Rural Health Alliance is the body which will determine how we spend our scarce time. So we’ve got a relatively small team of quality people and we got 3 ½ or 4 policy persons here in the office working with myself here in Canberra which is where we’re based. So it’s council that is the groups coming together will determine whether we’re gonna work on lots of alternatives of birthing services, or whether we’re gonna work on … issues related to economic growth and development or whether we’re gonna work on chronic disease or work for shortages, shortage of whatever it is. So the council will say, “We want to put this as a priority.” I’ll come back in a moment if you like and talk what some of the priorities are. We are then, our job as a staff here based in Canberra is to draft a proposal relating to that issue. So the council would have selected it because there’s a challenge. So let’s see an example let’s say mental health, so mental health is a particularly troublesome or challenging functional area in rural remote areas. So the council will say, “We must be on the agenda where mental health is concerned.” So our job as a staff here in Canberra is to write what it is about mental health, mental poor health, and mental illness in rural areas which is particular to the bush. And how in particular it can be resolved so what are the programs or policies which we might be proposing to state or commonwealth government which can help? So the council is one that do the inner work on mental health, council is the ones who help provide us with the information because they’re all at the real world who are actually working in health. And then this document will go back and forth as you would imagine by email to members of council, who bring to bear the view of their member body, until finally we’ve got an agreed position. And as you say does, it does as you implying to your question, it does sometimes take a while. Once you’ve got an agreed position Wayne this is quite authoritative, this is quite influential, we can go to the government of the day, the commonwealth government of the day or we can go to the state authority government or we can go to the opposition who of course are busy considering their policy positions with the next election. We can go to them and say, “Look, guess what, in relation to rural mental health, 37 bodies in the Rural Health Alliance have agreed on this.” And of course we’re always trying to be positive so there’s no sense in simply reiterating what people know about the challenges, people know that things can be cooked. So our role is always to try to come to the table with suggestions for how policies or programs can be improved and changed so that mental health in the bush is better for the mental health services in the bush are better. Now sometimes we don’t agree, I mean that’s the implication of your reference to herding cats. So I’m sure it’s been the case over the years, that we have actually, one of the benefits of the work of Rural Health Alliance has done is to discuss things behind closed doors on which we have not readily had an agreed position. So for instance, some of the workforce issues, some of the nurse practitioners. I mean nurse practitioners as you well know, is – if you like sort of – a moot point. I mean why do we not have hundreds of nurse practitioners in rural and especially remote areas during the job of quality doctors if I can call on that? The answer is of course that there are differences of opinion about whether this would constitute as second rate health service, whether who’s gonna be responsible for their work, whether overseen directly by medical doctors and so on. So there are lots of issues and we might come out of the room, the locked door, when it becomes unlocked, there’s a bit of blood on the floor but we’ve actually developed something closer to an agreed position but don’t have one. So there are a number of issues like that which we discuss over many years and the discussion of which is being useful but we still do not have an agreed, strong and unequivocal national Rural Health Alliance position.
W: Gordon, it’s an extraordinary task you’ve undertaken in combining to one position but it is something that governments can essentially really only want to deal with one organization with a unified voice. So you have to be congratulated on the extent to which you’ve brought together the various arms in rural health into a single unified view. You’ve been listening to Wayne Bucklar on Health Professional Radio and I’ve been chatting with CEO of the Rural Health Alliance, Gordon Gregory about the organization and how it fits together. Gordon, we’re running out of time here but let me ask you one final question. If there’s one thing, one misconception amongst your clients, the politicians, patients, that drives you nuts and keeps you awake at night, what is the one message you’d like to leave with us?
G: Well, I think it’s the balance between the good news and the bad news. I mean, the essence of the National Rural Health Alliance’s work is that we are saying to policy makers and health service managers across the nation, we’re saying, “Don’t forget that things are worse in the bush. Don’t forget that the health status is poorer. Don’t forget that access to services and workforces is more difficult. Don’t forget that the cost of delivering any bundle of health services is greater because of the transport cost and so on and so forth. Don’t forget that the … people in rural areas have lower incomes. Don’t forget that the greater proportion of older people in rural areas. Don’t forget that some of the health risk factors are poorer so there is a greater rate, sadly, there’s a greater rate to smoking.” This an issue which interest us in particular, we want to know why the smoking rate come down in the cities not in the country areas. There is a greater rate of dangerous use alcohol. Surprisingly, there is a greater rate of sedentary lifestyle so people often think that rural areas has been places where people sort of naturally fits them well, well that’s not the case. Sedentary lifestyle is actually more common on rural areas. So on the one hand Wayne, we’re saying to anybody who would listen but in particular those who in the position to make a difference like researchers, parliamentarians, ministers in particular, government departments. We’re saying to them, “Hey look, there are particular issues and challenges and we would like to meet them and we’ve got some suggestions. We want to work with you, we’ve got some suggestions on how these challenges can be overcome.” Two different policies, two different programs, multi-purpose services, what a wonderful example of a model of health service, the multi-purpose service. There are 126 of them scattered all around small communities in Australia. And they see the formal acceptance of the need to merge or cool the funding from the commonwealth for aged care with the funding from the state for acute care or hospital care, either these wonderful things called multipurpose services which cover all those basis and more on the side. So on the one hand our job is constantly to say, “Look at us. Look at us. Don’t forget us because in many respects, we’re …” But on the other hand, and this is what I would like you and your listeners to understand, if you’ve got the basic requisites for life – meaning by that I mean a good job, a good family, a good home and access to some of the other things which access to health service and educational service, then life in rural remote Australia the best in the world. So what we’re saying is in a sense I suppose, we don’t want to be too successful which reminding everybody that things can be cooked because then of course we’re shooting ourselves on the foot. People won’t come, people won’t be happy, people will be stressed. We won’t be able to get podiatrists to come to the bush, we don’t be able to get mental health and nurses to come to the bush, we won’t be able to get doctors to come to the bush. So we’re always trying to balance things Wayne as between the “Look at us. We are a critical part of the Australian community, society and economy but we’ve got special needs we want to you take account of” But also, “Look at us. We’re wonderfully creative people we’re innovative, some of the services we’ve created in the bush couldn’t happen in the city areas because of the greater institutional or organizational barriers.” In the country, there are a few people around so the organizational or institutional barriers each are much lowers or smaller. So we’re proud of the innovation, we are proud of our resilience, we’re proud the fact that in country areas you can get greater community spirit, we’re proud of the fact that people actually self-declare that they are more happy whatever that means in rural areas than in the city areas. We’re proud of that we don’t have a congestion and traffic problems and so on and so forth. So the Rural Health Alliance has got a job to do, but the best way we can do is by projecting this balance that life in the rural areas is in some instances, particular in need but in others, it’s the best in the world.
W: A balance … indeed. Gorgon Gregory, thank you for your time this morning. Gordon’s the CEO of Rural Health Alliance, now if you want more information on the Rural Health Alliance by all means go to the website www.ruralhealth.org.au. We’ll also have a transcript to this interview and a sound archive up on our website www.hpr.fm. You’ve been listening to Wayne Bucklar on Health Professional Radio.