These are the bits from the budget I’ve highlighted – at a first quick glance – that are particularly relevant for those with an interest in rural and remote health:

Infrastructure

Funding for regional cancer centres

$27 million for an integrated district health service in Narrabri, bringing together hospital, primary and community health services

$8.6 million for an expansion of renal dialysis services in the Kimberley

$7.9 million to replace the current paediatric ward at the Broome Hospital

$250 million to expand Townsville Hospital

$76 million to expand Rockhampton Hospital

$27.8 million for a NT Medical School – medical students will be able to complete their full medical degree without having to leave the NT

$13.6 million to build a new Emergency Department on the grounds of the Alice Springs Hospital and relocate the Medical Imaging Department

$18.6 million to build an accommodation complex of 50 units on the grounds of the Royal Darwin Hospital for patients and carers

$40 million to create an Acute Medical and Surgical Service Unit at Launceston General Hospital.

Workforce measures

$134.4 million package that will better target existing incentives and provide additional non-financial support to rural doctors. Based on the principle of ‘the more remote you go, the greater the reward’, the Government will focus on attracting a workforce to the places
that need it the most.

In 2009-10, the Government will introduce a Rural GP Locum program, under the auspices of the National Rural Locum program, and expand the
Training for Rural and Remote Procedural GPs program. The General Practice Rural Incentives program, which will be implemented in 2010-11, will consolidate and expand two existing rural health programs, targeting GP Registrars and GPs respectively. The consolidation of these programs will enable over 2,000 additional doctors in rural and remote areas to become eligible for rural retention grants. The relocation component of the program will enable the recruitment of a further 210 doctors into rural and remote areas.

The 2009-10 Budget includes a $120.5 million package of measures to improve choice  and access to maternity services for pregnant women and new mothers in Australia. Significantly these measures provide: MBS and PBS access for nurse practitioners and midwives working in collaboration with doctors; expansion of the Medical Specialist Outreach Assistance program; and extra scholarships for general practitioners and
midwives to expand the maternity workforce, particularly in rural and remote Australia.

Indigenous health

The Government will work through COAG’s Indigenous Health National Partnership to improve access to primary health care and follow-up services, and provide targeted prevention activities to reduce the burden of chronic disease on Indigenous Australians. In 2009-10 as part of this contribution, the Government, through the Divisions of General Practice Network, will provide funding for 80 full-time equivalent (FTE) local
Indigenous people to work as Indigenous outreach workers and be supported by 80 FTE project officers.

Mental health

There will be improved access to treatment options through services delivered via telephone and/or internet, providing a focus on service gaps in rural and remote areas, and other populations who are unable to access face to face services. More services will be rolled out to manage increases in
demand for mental health services brought about by the impact of bushfires, floods and other exceptional circumstances on the mental health of Australians. Through the Mental Health Response to the Victorian Bushfires additional targeted mental health support to individuals and communities affected by the Victorian bushfire will be provided. Changes will also be made to the Better Access initiative to improve targeting of primary mental health care services to those most in need, provide better quality services and improve patient outcomes.

Meanwhile, here’s the response from the The Rural Doctors Association of Australia, via its press release:

“RDAA has welcomed additional funding provided by the Rudd Government in this year’s budget as being a ‘first step’ towards fixing the rural health crisis—but it has warned that the additional funding is only a down-payment and major investment in the sector is still urgently required to make a real impact.

“It is good to see a modest amount of additional funding being allocated to this critical area, particularly at a time when the Government is facing some very hard financial decisions” RDAA President, Dr Nola Maxfield, said.

“However, total funding for rural health is still a long way off where it needs to be if we are to really improve access to rural healthcare for the one-third of Australians who live in the bush.

“Rural Australians continue to suffer from more complex health issues than those living in the city yet they increasingly are finding that their hospitals are being shut down or downgraded, and they are being forced to travel long distances to access the healthcare they need. At least 17,000 additional health professionals—including 1800 additional doctors—are needed urgently in rural and remote Australia just to ensure basic access to healthcare in the bush.

“In this context, the small amount of additional funding provided by the Government on rural-health related measures in this budget is really just the barest tip of what is needed.”

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The National Rural Health Alliance is also smiling. Here is its release:

Rural health programs, mainly for general practice, have received a welcome boost in the Budget despite the current tight fiscal environment.  A new system for classifying towns as regional, rural or remote will be used as the basis for a range of continuing incentive programs that includes some important new ones.  The revised system will see 2,400 additional doctors eligible for support – including some in places on the fringes of metropolitan areas.

“Added weightings for remoteness in the revised system is a sound idea given that both health status and access to health services deteriorate with increasing remoteness,” said Dr Jenny May, Chair of the National Rural Health Alliance.

“It’s great to see the Government giving midwives and nurse practitioners with advanced skills access to MBS and PBS and we support the circumstances in which this will occur – by working in a collaborative service with other health professionals.”

Further good news for rural patients is the intention to invest in a network of up to 10 specialised cancer treatment centres in regional areas.  Cancer diagnoses currently tend to be later in rural and remote areas, with ultimate poorer rates of survival.

Also announced tonight is a new GP relocation incentive scheme – again ‘scaled’ for remoteness – which could go a long way towards attracting locally-trained doctors to practise in more remote areas.

“We understand the need for savings measures in health, including the ‘rebalancing’ of support for Private Health Insurance and changes in the operation of the Medicare safety net.”

“There is to be a very welcome investment in improved maternity services from 1 November 2010, with a particular focus on rural areas,” Dr May said. “It will include expansion of the Medical Specialist Outreach Assistance program to include maternity service professionals, extra scholarships for GPs and midwives, and Government support for professional indemnity for eligible midwives.”

Around $150 million in new money over four years for incentives to rural practice is a good result for people in rural, regional and remote areas in a time of straitened circumstances.  The Alliance also applauds the refunding of existing targeted rural programs.

“Many of the big questions in the health sector will not be answered until the Government responds to the strategic reviews due in the next two months.  The Alliance looks forward to working with government to ensure that rural and remote services are further strengthened as a result of action that needs to be taken in the areas of governance, preventative services and primary care,” said Dr May.  “Tonight has provided some good news in the meantime.”

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NACCHO has some serious reservations as per its statement:

Dr Mick Adams, chair of NACCHO, the peak body for Aboriginal community controlled medical services has welcomed the government’s budget announcements for Aboriginal health which primarily put in place the COAG announcements from last November.

Dr Adams said “The emphasis in the COAG package on chronic disease, strengthening primary health care services, training, access to specialists, access to medicines and prevention programs are all welcome”

“New measures announced last night include $131m over three years for Aboriginal health services in the NT, $58m for improving ear and eye services over four years, $11m over four years for dental health in rural and regional areas and $13.8m over four years for Stolen Generation link up services.

“Incentives to encourage health professionals to work in remote areas along with other initiatives may help our services there recruit and retain staff. The means test for the private health insurance rebate and extra funding for public hospitals are also welcomed.

“However NACCHO is concerned over aspects of the COAG package where Aboriginal community controlled health services are being marginalised in favour of Aboriginal health funding going to mainstream GP services most of which never see Aboriginal clients.

“Aboriginal community controlled health services have over thirty years experience providing frontline primary health care in urban, regional and remote areas.

“If the Government is committed to the Close the Gap Statement of Intent it signed in March 2008 it is imperative to establish a partnership with NACCHO in setting Aboriginal health priorities.

“International examples show the greatest advances in closing the gap will be made when Aboriginal peoples have genuine control of their lives and over the design and delivery of their health services” Dr Adams said.

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