Senate Community Affairs Legislation Committee, , 3:34:32 to 3:41:42
Officials outline accountability mechanisms within the National Health Reform Agreement to ensure states and territories deliver on workforce and service commitments.
Topics: Health, Infrastructure
Speakers: Prof Jennifer May, Hon Anne Ruston, Blair Comley, Natalie Bekis, Speaker 35
One of the things that there was much fanfare about, and I'm a huge supporter of was um the development of IMOS for these communities. Do you know where that all ended up? Is that something that's come past you?
Um not specifically, but what I would I think it points to, and there is continuing discussion and I think we need to continue to keep a focus on it, is that we very clearly need to look at different models of care in different rural and regional locations. And we've already heard this morning about where there are service access issues related to general practice. And that example was in those small one to 3,000 towns, in that case in Western Australia. But that's certainly something that we see overall. Now, absolutely no doubt that we do need to move to a different understanding of what need is in those communities, a different um way of managing workforce availability and keying into that as a key thing, and also understanding the increased costs of delivery in locations like that. Because unless we get the whole picture together, we aren't going to meet the need going forward. And I guess that that is my reflection. I think there are mechanisms that are available, and I point to the NRHA and Section F 18 as an opportunity, and I'm sure the department could speak to that. Or that and also Schedule G and the workforce schedule, which I hope will speak to that distribution issue with the states and territories in the Commonwealth.
Yeah, hopefully that those schedules are just something that gets parked on a shelf because I think for the first time in the NHA negotiations, there seemed to be a lot more effort had gone into those schedules than we'd seen in previous agreements, but um they're only worth the paper or they're written on if they're actually delivered on. And we do know that the states and territories have a bit of a habit of perhaps not delivering on those.
It's definitely a joint issue. It is no good thinking that we can develop a workforce and drop it into primary care in rural and you know, bypass the states and territories, they're huge plans.
Yeah, so I suppose that's sort of probably a question to the department about what kind of um enforcement and compliance is going to be um required from the states and territories in terms of delivering on those schedules. And you know, given that we're talking about rural and regional. I mean is there anything embedded, Secretary, in the um in the requirements from the states and territories about their delivery on those schedules.
So in the so the probably the most myself, but the the quick um version of this is that part of the um agreement has performance and data requirements that um map performance across the schedules, and so um that was a significant part of the negotiations have greater transparency in what happened, and we'll continue to work with state and territory colleagues to make sure that they're follow-through on all those agreements.
So, what's the consequence if they don't? What's the mechanism built into the agreement in terms of the consequence if they don't do it?
Um I might ask my colleagues to comment, but as you'd be aware, most Commonwealth State Agreements don't, for example, have a whole penalty schedule that says you don't do this and you do that. So there is an element that we are all having to act in good faith on the basis that we effectively are in the federation forever.
Um braver than I am.
Sorry?
Braver than I am.
Well, I I think it's the it's the reality that we we have we both have obligations to meet the agreement from time to time, both states and territories will corriccize the Commonwealth for not meeting commitments, and we will criticize the states and territories for me not making commitments and we'll work through them. Some of those are embedded in bilateral agreements where we we can actually say we will terminate funding. We try to avoid that, to be honest, because that typically means that we're terminating funding that supports services delivering for the people of Australia. So we generally kind of work through it. Do you want to add anything, Ms. Street?
There's not a lot to add there. So Celia Street, Deputy Secretary Assistant Strategy Group. Um what I'd say is we do have a strong performance framework. As you said, a lot of time has gone into the negotiation of the agreement, and there's actually quite a lot of embedded deadlines and things like that to help us hold it, um, hold both sides to account. Also in relation to the national health, um, we've got the national health reform strategy, which is outlining the kind of almost the roadmap in terms of the the implementation, which will continue to be reviewed and would have an annual updates. So I think there's a lot in there in terms of making sure we hold each other to account, uh, but there isn't specific clauses to say repercussions of you will not. Receive your hospital funding because we do want to make sure we have that behavioural shift and updates.
So do you the expert in rural, regional and remote health is sitting right next to you? So what what use do you make of the expertise of the rural health commissioner in in sort of like assessing the delivery on some of these things?
Because I mean I might as well answer that, Senator, if I can, if that's okay. So we're working very closely with the Commissioner and as part of our internal governance group, particularly for workforce schedule G. There is a commitment by the Commonwealth together with the states and territories and the accountability will sit with the health workforce task force that reports to the Chief Executive Forum up to Health Ministers to work on national strategic workforce planning. We intrinsically understand what the Commissioner is saying to us around the complexity of our problem. Our workforce in the last 10 years has doubled, and yet we continue to have persistent problems with male distribution of our workforce. We also definitely understand that we have huge growth corridors, particularly in outer metro, particularly New South Wales and Victoria. And so whilst we just keep growing more and more and more, um, the challenge is much more complex than just that, and we must have the states and territories around the table to think about the reform that we need. Scope of practice, as you know, is just one. And so Schedule G does outline a number of things that we're going to do together, particularly around better evidence-based data sharing, commitment around scope of practice reforms and other things that we will be doing as part of that. There are about 10 deliverables that we need to report to the groups that uh Miss Street has referred to.