Latest / 360 with Katie Woolf / Central Australian Aboriginal Congress Chief Medical Officer Dr John Boffa says a health worker crisis is impacting service delivery in rural and remote areas, which has also forced it to close one service

Transcript

Central Australian Aboriginal Congress Chief Medical Officer Dr John Boffa says a health worker crisis is impacting service delivery in rural and remote areas, which has also forced it to close one service · 360 with Katie Woolf

• 0:00
  Speaker 1: Now we know that the spotlight has remained on Alice Springs,
• 0:03
  Speaker 1: this time on the health workforce crisis, and we'd heard
• 0:07
  Speaker 1: from congress Chief Medical Officer of Public Health, doctor John Boffer,
• 0:11
  Speaker 1: who had said that the primary healthcare workforce in rural
• 0:14
  Speaker 1: and remote Northern Territory is at breaking point and the
• 0:18
  Speaker 1: critical shortage of doctors, nurses, Aboriginal health practitioners, Allied health
• 0:23
  Speaker 1: and other staff has forced Congress to make some temporary closures.
• 0:28
  Speaker 1: So joining me on the line right now is doctor
• 0:31
  Speaker 1: John Boffer. Good morning to you, Doctor Boffer. Good morning Katie,
• 0:35
  Speaker 1: Thanks so much for your time this morning. Now, doctor Boffer,
• 0:38
  Speaker 1: I know that Central Australian Aboriginal Congress has met with
• 0:42
  Speaker 1: Professor Brendan Murphy AC as well as the Chief Minister
• 0:46
  Speaker 1: to discuss these issues. How did those talks go.
• 0:51
  Speaker 2: I think they've gone very well. I think everyone's aware
• 0:54
  Speaker 2: that we've got a big problem and we've got a
• 0:57
  Speaker 2: crisis and it's deeply affecting the capacity to maintain the
• 1:02
  Speaker 2: delivery of effective primary healthcare services in rural and remote areas,
• 1:07
  Speaker 2: but particularly in the remote areas, and the situation, you know,
• 1:10
  Speaker 2: I go back a long way. We were in this
• 1:12
  Speaker 2: situation in the nineties. And you know, I remember I
• 1:15
  Speaker 2: was the only doctor of the Winter ten and Creek
• 1:17
  Speaker 2: in nine eight. It was there on my own. We
• 1:19
  Speaker 2: couldn't get doctors, we couldn't get locans. But the Cornwath
• 1:22
  Speaker 2: government in that period a whole series of reforms happened.
• 1:26
  Speaker 2: We got the Rural Incentives Program, which gave remote area grants,
• 1:30
  Speaker 2: it gave local support grants, it produced a local support program.
• 1:33
  Speaker 2: We had retention payments, and a whole range of things
• 1:36
  Speaker 2: came in. We had a holy of reforms in the
• 1:38
  Speaker 2: university sector. We had university departments of Rural Health, we
• 1:41
  Speaker 2: had Rural Health Training in it set up. We had
• 1:44
  Speaker 2: Rural Workforce AISY set up. And then we also freed
• 1:47
  Speaker 2: our access to international medical graduates and health professionals. And
• 1:52
  Speaker 2: ninety ninety nine we got the Overseas Trained Office scheme
• 1:54
  Speaker 2: which Michael Woolridge left, which was really quite revolutionary in
• 1:57
  Speaker 2: terms of us being other access pece from overseas. Now,
• 2:01
  Speaker 2: all of that has made a big difference for twenty years,
• 2:04
  Speaker 2: and this is an unprecedented situation for Congress. Congress has
• 2:09
  Speaker 2: never previously closed the clinic. We've had to close one
• 2:12
  Speaker 2: town clinic for now. We'll look at you again in April.
• 2:16
  Speaker 2: But in order to maintain our remote clinics, we've done
• 2:19
  Speaker 2: that because in town we have multible clinics. We've got
• 2:21
  Speaker 2: sermon clinics in town, so one of those closes, so
• 2:24
  Speaker 2: people have got options, it's not like there aren't options,
• 2:27
  Speaker 2: but also one of our main clinics we've had to
• 2:30
  Speaker 2: really set up a very big part of that clinic
• 2:32
  Speaker 2: as an urgent care clinic, which is again non optimal.
• 2:36
  Speaker 2: We can meet demand on the day for urgent issues,
• 2:39
  Speaker 2: but then we're not going to be able to do
• 2:41
  Speaker 2: as much as we need to be able to do
• 2:42
  Speaker 2: to address the complex kindic conditions that people have got
• 2:46
  Speaker 2: with this workforce crisis. The impact.
• 2:50
  Speaker 1: Do you continue?
• 2:52
  Speaker 2: Yep, that will impact. We've seen big gains in premature
• 2:57
  Speaker 2: death and life expectancy for every people in Central Australia
• 3:00
  Speaker 2: since nineteen ninety eight for the last twenty years, bigger
• 3:03
  Speaker 2: gains than anywhere else in the territory. We've started from
• 3:05
  Speaker 2: the lower base and we've seen bigger improvements than other
• 3:08
  Speaker 2: parts of the Turkey, and particularly in premature death rates,
• 3:12
  Speaker 2: which in the gaps closing more quickly in that than
• 3:15
  Speaker 2: it is in life expectancy because there's a lag in
• 3:17
  Speaker 2: life expectancy data. But life expectancy improved ten years for men,
• 3:22
  Speaker 2: and this has been because of better primary healthcare and
• 3:25
  Speaker 2: better healthcare in general. The hospitals improved a lot in
• 3:28
  Speaker 2: that un as well. Now these gains will be lost
• 3:31
  Speaker 2: if we can't do what we need to do at
• 3:33
  Speaker 2: the primary health care level to manage complex chronic conditions. Well, well,
• 3:38
  Speaker 2: we're going to see preventable deaths and preventable premiature and
• 3:42
  Speaker 2: mortality start to return. And we just can't afford to
• 3:45
  Speaker 2: go backwards. And this is a solvable crisis. There are
• 3:48
  Speaker 2: things we can do that will make an immediate difference,
• 3:51
  Speaker 2: and we need where people are really screaming out for help. Now,
• 3:55
  Speaker 2: the situation's urgent, talk through collection.
• 3:59
  Speaker 1: Can you just talk us through. I mean, how many
• 4:01
  Speaker 1: staff are you short at the moment? What's the situation
• 4:04
  Speaker 1: for Congress right now? When it comes to those staffing levels?
• 4:08
  Speaker 2: Seven full time GP short, that's about a third. We're
• 4:12
  Speaker 2: twenty two nurses short, that's about a third of our
• 4:15
  Speaker 2: nurse workforce. We're nine average and health workers health practitioners short.
• 4:20
  Speaker 2: That's been over a third, getting close to fifty percent
• 4:23
  Speaker 2: of that workforce, and we're seventeen allied health staff short.
• 4:27
  Speaker 2: That's the start. It is not ass educated, so you know,
• 4:30
  Speaker 2: that's a very significant proportion of our workforce. And these
• 4:35
  Speaker 2: that's the town and remote so it's very difficult. You
• 4:39
  Speaker 2: can't maintain normal service delivery with those sorts of shortages,
• 4:42
  Speaker 2: so you know, and this has come on quite for us.
• 4:45
  Speaker 2: We were holding out and doing reasonably well till towards
• 4:49
  Speaker 2: September October last year and then it's really hit us hard.
• 4:52
  Speaker 2: So this is the covid era was hard. But coming
• 4:56
  Speaker 2: out of the covid era, health presents are exhausted, they're
• 4:59
  Speaker 2: taking lay, they're resigning leading the profession. There's a shortage everywhere.
• 5:04
  Speaker 2: We get that, but there's some policy leaders that have
• 5:08
  Speaker 2: to be pushed now to make a difference. And one
• 5:11
  Speaker 2: of the most important we've started. Australia has relaxed and
• 5:15
  Speaker 2: it's working to relax further the way international graduates can
• 5:18
  Speaker 2: come into the country doctors, nurses and others. But unfortunately
• 5:22
  Speaker 2: they're allowed to go and work in the outer suburbs
• 5:25
  Speaker 2: of Melbourne and Sydney. Now now that's a new thing.
• 5:27
  Speaker 2: They used to only be allowed to come and work
• 5:29
  Speaker 2: in Roland remote areas, but now you know the out
• 5:33
  Speaker 2: of subs and Melbourne, the out of Suthers of Sydney,
• 5:35
  Speaker 2: the big regional centers can all get these international health professionals.
• 5:41
  Speaker 2: That's unfair, it is and needs to be stopped. We've
• 5:44
  Speaker 2: got to stop these people going to work where they're
• 5:46
  Speaker 2: not needed and we have to make sure they come
• 5:49
  Speaker 2: in and work where they're needed.
• 5:50
  Speaker 1: It seems like a no brainer, like it honestly seems
• 5:53
  Speaker 1: like a no brainer.
• 5:55
  Speaker 2: Well it should be an no brainer. Look if there
• 5:57
  Speaker 2: are pockets of disadvantage and the out of suthers, and
• 5:59
  Speaker 2: then look at those pockets. But don't make a blanket rule,
• 6:03
  Speaker 2: because there's not a severe workforce shortage in those parts
• 6:06
  Speaker 2: of the country compared to what we're dealing with. So
• 6:09
  Speaker 2: that's that's something. And we've got a further relax and
• 6:12
  Speaker 2: work on streamline the way in which international graduates are
• 6:17
  Speaker 2: assessed in Australia because there's too much, too much time
• 6:21
  Speaker 2: put into over scrutinizing. We've got to make sure we
• 6:25
  Speaker 2: get people that are at the right standard, but we
• 6:28
  Speaker 2: don't want to take too long, so that's that's one
• 6:31
  Speaker 2: aspect of what could make an immediate difference. But look
• 6:35
  Speaker 2: a country like this, we can't just rely on overseas
• 6:38
  Speaker 2: trained health professions. We've got to train more of our own.
• 6:42
  Speaker 2: There's forty medical undergraduate places up for grabs right now
• 6:45
  Speaker 2: that are already funded by the Cornwell the Cornwall Department
• 6:47
  Speaker 2: of Education determine where they go. We think they must
• 6:51
  Speaker 2: go to Charlesdowne University. The Northern Churchy needs its own
• 6:55
  Speaker 2: medical undergrad its own medical school and to compliment and
• 7:00
  Speaker 2: nursing the Deity Allied Health. You know a range of
• 7:03
  Speaker 2: things that we are gett We're getting phantasy back, we're
• 7:06
  Speaker 2: treating training our own occupation of therapose through Charlestown University.
• 7:10
  Speaker 2: But what we don't have is a medical school. We've
• 7:12
  Speaker 2: got sixty five intern positions a year that we have
• 7:15
  Speaker 2: to fill and if we fill them with doctors who
• 7:18
  Speaker 2: are more from the Northern Churchy, they're more likely to
• 7:21
  Speaker 2: stay and then that's the pipeline into general practice. Some
• 7:24
  Speaker 2: of those doctors then come and work in primary health
• 7:27
  Speaker 2: care do GP training. So that's a long term thing.
• 7:30
  Speaker 2: But we've got to look at short term, medium term
• 7:32
  Speaker 2: and long term virtues. Money is part of the issue
• 7:35
  Speaker 2: at the moment. We've got to be able to pay
• 7:38
  Speaker 2: significantly more money to track people into remote areas and
• 7:41
  Speaker 2: we're sitting on two and a half percent CPI increases
• 7:45
  Speaker 2: through our core funding, which is completely inadequate. Because wages
• 7:48
  Speaker 2: have exploded in this area, they've gone through the roof.
• 7:52
  Speaker 2: And there was that publicity about the Health Department having
• 7:56
  Speaker 2: to pay fifteen hundred dollars a day to keep a
• 7:58
  Speaker 2: remote clinic open. Now we under sound why they are
• 8:00
  Speaker 2: paying that money, and I think some of the publicity
• 8:04
  Speaker 2: was suggesting, you know, you've got to keep remote clinics
• 8:07
  Speaker 2: open to some extent. You've got to do what you've
• 8:09
  Speaker 2: got to do. But those sorts of if you start
• 8:11
  Speaker 2: paying fifteen hundred dollars a day for eMTA and Earth,
• 8:13
  Speaker 2: that's five hundred thousand a year for AMATA.
• 8:15
  Speaker 1: And nurse, it's unbelievable.
• 8:18
  Speaker 2: The system's not funded at that level, nor should it be.
• 8:21
  Speaker 2: We've got to look at policies that distribute. See, we've
• 8:24
  Speaker 2: got a problem with NOLL distribution in this country, a
• 8:26
  Speaker 2: big problem. We haven't dealt with that. In nineteen ninety nine,
• 8:30
  Speaker 2: Minister Warriage at the time was about to introduce what
• 8:32
  Speaker 2: we call geographic provider numbers. Now the medical profession said,
• 8:36
  Speaker 2: don't do that. Don't do that. We'll make sure we
• 8:38
  Speaker 2: soort this out through incentives, mainly financial centers. We don't
• 8:42
  Speaker 2: need to dictate where people work. So look here we
• 8:46
  Speaker 2: are in twenty twenty three. We're back to where we
• 8:48
  Speaker 2: were in the mid nineties and we're back to having
• 8:50
  Speaker 2: to have a discussion about how does Australia regulate where
• 8:54
  Speaker 2: health professionals work. We can't just let them set up
• 8:56
  Speaker 2: shop where they want to and work in areas where
• 8:59
  Speaker 2: they're not needed.
• 9:00
  Speaker 1: It's pretty unbelievable. It is honestly pretty unbelievable. Dr boff Ray.
• 9:04
  Speaker 1: I'm going to have to wrap up, but we did
• 9:05
  Speaker 1: just speak to Kath Hatcher from the Nursing Union a
• 9:08
  Speaker 1: little bit earlier this morning as well about the shortages
• 9:10
  Speaker 1: that they've got when it comes to staff in Alice Springs.
• 9:14
  Speaker 1: I mean, you're obviously talking about the situation for Congress
• 9:17
  Speaker 1: for Central Australian Aboriginal Congress right now in the Red Center.
• 9:23
  Speaker 1: I mean, are we at a crisis point here in
• 9:25
  Speaker 1: Central Australia when it comes to health staff I.
• 9:29
  Speaker 2: Think we need to. We are at a crisis point
• 9:31
  Speaker 2: when it comes to remote health staff. It's not just
• 9:33
  Speaker 2: Central Australia. I think that the recent publicity hasn't helped us,
• 9:38
  Speaker 2: but the alcohol restrictions have been so effective that this
• 9:42
  Speaker 2: town is back to normal. It's back to where it was.
• 9:44
  Speaker 2: So there's no longer the property offenses, they're a third
• 9:47
  Speaker 2: of what they were, the domestic bond, the salts are
• 9:50
  Speaker 2: gone from seven a day to two a day. So
• 9:53
  Speaker 2: we've sent a transformation in the town and we need
• 9:55
  Speaker 2: to get that message out. That's not a reason not
• 9:58
  Speaker 2: to come here. This is a great place to come
• 9:59
  Speaker 2: and work. But there's a crisis in remote and rural health,
• 10:03
  Speaker 2: but particularly remote health more generally, and Congress is caught
• 10:06
  Speaker 2: up in that. So I think we need national we
• 10:10
  Speaker 2: need Commonwealth government to act here. This is not a
• 10:12
  Speaker 2: Turkey driven crisis. Is a crisis in the way that
• 10:16
  Speaker 2: health professionals are regulated, the way they're trained, and the
• 10:20
  Speaker 2: way that primal healthcare systems funded. There's no loadings on
• 10:24
  Speaker 2: Medicare for really remote areas, so we think we've got
• 10:27
  Speaker 2: to do that. We've got to make substantive more loadings
• 10:30
  Speaker 2: on Medicare for rural and remote areas. So there's lots
• 10:32
  Speaker 2: of things were like we were in the nineties, this
• 10:35
  Speaker 2: won't be There's no quick fix here. And we can't
• 10:38
  Speaker 2: just align international health professionals, and particularly we can't pull
• 10:43
  Speaker 2: the Man of Africa around third world countries. So our
• 10:46
  Speaker 2: first world countries workforce bonds. We've got to grow our own.
• 10:49
  Speaker 2: We've got to make sure when we train them they
• 10:52
  Speaker 2: work with our needed and that's going to require some
• 10:54
  Speaker 2: regulatory leaves, not just financial and other incentives. We've got
• 10:58
  Speaker 2: to look at a system that ensures we do not
• 11:02
  Speaker 2: continue to allow health professors to work with or not
• 11:05
  Speaker 2: needed for instances. Doctor, how many orthopedic surgeons do you
• 11:08
  Speaker 2: think there are in Sydney in the in the area
• 11:11
  Speaker 2: around the racecourse, you know now around Bondi. People meant
• 11:14
  Speaker 2: to look at the way these these health professors are
• 11:18
  Speaker 2: distributed is a massive issue for the parts of the
• 11:22
  Speaker 2: country that aren't popular.
• 11:23
  Speaker 1: Dr Boffer. I really appreciate your time this morning and
• 11:27
  Speaker 1: your passion. Thank you so very much for having a
• 11:29
  Speaker 1: chat with us. We are going to have to leave
• 11:30
  Speaker 1: it there. Thank you for your time.
• 11:33
  Speaker 2: Thanks Katie, Thank you