HON NICK GOIRAN (South Metropolitan) [1.03 pm]: I move —
That this house notes with grave concern the ongoing lack of proper access to primary health care in many regional and rural areas in our state, and calls on the government to prioritise this as a matter of urgency.
Supporting comments from Hon Nick Goiran
HON ALISON XAMON (North Metropolitan) [1.23 pm]: I rise to also speak on this motion. I thank the member for bringing this issue forward because, as we know, access to health care in regional and rural areas is particularly pertinent in a state such as this because most of our state has been classified by the Australian Bureau of Statistics as being very remote. This motion is very broad and any number of issues could be looked at, but it will be of no surprise to any member that today I will focus specifically on access to mental health services in rural and regional Australia. I also want to highlight some findings that came out of the recently released Auditor General’s report. We know that people who live in rural and remote communities face a combination of factors linked to very low rates of access to mental health services, and there is also a very high rate of suicide. A recent Senate report into this issue titled “Accessibility and quality of mental health services in rural and remote Australia” listed a number of factors including poor access to primary and acute health care, social and geographical isolation, limited mental health services, funding restrictions, ongoing stigma surrounding mental illness and, of course, the important issue of the cost of travelling to and accessing mental health services. In addition to those elements facing everyone living in the regions, Aboriginal people also face specific cultural barriers and a lack of culturally appropriate mental health services. I have already spoken at length in this place about some of these issues in response to the coroner’s report on the tragic deaths by suicide of 13 young people from the Kimberley.
As I said, I particularly draw the attention of the house to the Auditor General’s report “Access to State-Managed Adult Mental Health Services”, which was released only last week. This report paints a pretty damning picture of what is described as a disjointed state-funded mental health care system that is out of touch with how people use services, and results in an inefficient system that relies heavily on crisis-style care. One of the Auditor General’s key findings was limited progress in implementing the 10-year mental health plan since its release in 2015. That was no surprise to me, because I have been getting up in Parliament and banging on about that repeatedly since I took my seat in 2017. The Auditor General specifically found that against the plan’s baseline proportional spend, the funding for hospital beds has increased from 42 per cent to 47 per cent, but that the proportion of funding for community treatment services has remained the same, at 43 per cent. I remind members that that was meant to see a significant boost in investment. Unbelievably, the proportion of funding for both prevention and community support has decreased. That was also an area that was meant to be getting a significant boost in funding.
The Mental Health Commission’s 2019 progress report noted that it had only finalised 24 per cent of the projects it had expected to complete by 2017. Although the veracity of the 10-year plan—a good plan—is widely recognised, the Auditor General found that the lack of a system-wide implementation plan or funding strategy to support that coordinated approach means that any meaningful progress is unlikely. Accordingly, one of the three key recommendations made in the Auditor General’s report was the development of an implementation and funding plan. Unsurprisingly, in its response to the report, the Department of Health could not accept this recommendation, because, as we know, the plan has not been fully funded to enable full implementation. However, the department did say that it would work with the Mental Health Commission and the Department of Treasury to secure either full or phased funding for the implementation of the plan. I stress that this clearly needs to happen as a matter of urgency, as anyone here who deals with people currently in crisis in the mental health sector, either in their personal lives or through their constituents, would know. This came home to me very sharply last weekend, with the suicide of a young woman who was a friend of mine.
The sale of Graylands Hospital represents a rare opportunity to make a significant investment in the mental health system, as has been identified as being so desperately needed. I urge the government to commit to ring-fencing the proceeds of the sale for this purpose. Every time I raise this issue I am told that a decision is yet to be made. We know what the right decision is and what needs to happen. As it currently stands, without this injection of additional funding we still have a great 10-year plan, but no realistic prospect of achieving it.
I would also like to take a moment to acknowledge, for the purposes of this motion, that primary healthcare providers and private clinical mental health providers fell outside the scope of the Auditor General’s report and that the report does not differentiate between rural and regional services and those provided within the metropolitan area. However, the response of the WA Country Health Service to the report quite cogently sums up why the Auditor General’s quite sobering findings are even more alarming for Western Australians living in rural and regional areas.
I quote from page 16 of the report —
WACHS supports the OAG’s conclusion that this imbalance in the mix of services and settings is a consequence of broader system-wide complexity in funding, accountability and governance. Such imbalances are often further amplified in rural settings where State-managed Mental Health services are sometimes the only provider of care, and where, for urgent and emergency presentations, rural hospitals are frequently the only point of access to MH care. Often it is the only “accommodation” available to a consumer at that point in time.
It makes sense, then, that the Auditor General’s findings on the strain on our emergency departments are particularly pertinent in rural and regional areas in Western Australia. The report highlights that, across the state, emergency departments are being used as a gateway and that hospital care has become harder to access, with people spending more time in emergency departments in order to access a secure mental health bed. We know that from 2013 to 2017, almost half the people seeking care first accessed state-funded mental health services through an emergency department. This suggests that community pathways to hospitals are not working for a significant number of patients.
The latest modelling presented in the 2018 update of the 10-year plan also provides some quite staggering numbers, highlighting the dire situation in rural and regional Western Australia. For example, in the northern and remote regions—we are talking about the goldfields, Kimberley, Pilbara and midwest—the figures in the update show that the actual number of hours of mental health community treatment services provided for older adults in 2017 was 8 000 hours, but the optimal number of hours needed by 2020 will be 47 000 hours. That is a significant disparity. The plan tells us that we need an almost sixfold increase in services for older adults in the northern and remote regions. That is a massive gap, yet we have not made any progress towards closing it. There are many, many other examples in the update of areas in which we are falling way short of required services, as identified in the plan.
Another of the Auditor General’s findings that I find deeply concerning is that the total cost of providing mental health care in our emergency departments simply is not known. This seems to be a continuing theme when it comes to service provision in the regions. The same issue has been raised about palliative care services. I note that in its submission to the Joint Select Committee on End of Life Choices, the WA Country Health Service advised that there is limited oversight, coordination and governance of medical palliative care services across Western Australia’s country health services. Clearly, significant structural problems within the Department of Health and WACHS are preventing them from being able to gain an accurate understanding of where our money is currently being spent, and are therefore compromising their ability to deliver effective services in the regions.
Finally, the Auditor General’s third finding was that the Mental Health Commission and WA Health do not use existing data effectively to manage service delivery and reform. Currently, the Mental Health Commission and WA Health know the volume of care they are providing, but do not know how many individual people are accessing that care, or if they are using the service as it was intended in the first place. A particularly revealing part of this audit involved the Auditor General undertaking a data analytics exercise that enabled the Auditor General to follow people’s pathways across state mental health services over time. It is actually very interesting; the report goes into quite a lot of detail. Essentially, this data has, for the first time, quantified how Western Australians are using mental health services. Through this method, the Auditor General was able to conclusively show that 10 per cent of people using state-managed mental health services accessed 90 per cent of the hospital care provided and almost 50 per cent of both emergency department treatment and the care provided by community treatment services. This clearly demonstrates that a number of vulnerable individuals are not getting the pathways for support that they need, despite the fact that they are presenting over and over. This exercise led the Auditor General to recommend that the Mental Health Commission and the Department of Health examine and analyse people’s pathways across all state mental health services to better understand the capacity, effectiveness and efficiency of care options currently provided. On the face of it, this recommendation makes complete sense and I note that both the Mental Health Commission and the Department of Health supported it. However, it is significant, particularly for the purposes of this motion, that the WA Country Health Service was much more circumspect in its response. Its submission went on to state —
WACHS supports the finding that a better understanding of how individuals interact with existing services should enable targeted, lower cost care options to be developed. However, such a reconfiguration needs to have sufficient capacity to manage redirected demand, as WACHS has seen previous efforts to meet specific needs overwhelmed as the rest of the system seeks to move people elsewhere. This has occurred with early psychosis services, personality disorders, ADHD clinics and with secure extended care beds. Demand booms, waiting lists develop, responsiveness wanes, confidence is lost and services are mainstreamed again—failures from their own success.
The level of data analysis undertaken by the OAG exceeds WACHS and most likely all other HSPs capacity to produce. The application of business intelligence processes to MH service delivery is still quite rudimentary and leveraging it for meaningful planning and evaluation is not yet well developed. It is our understanding that access to further data analysis and breakdown into HSP level data may be available in the future and WACHS would welcome the opportunity this presents.
This is exactly the kind of blunt analysis that we need to hear. Time and again agencies on the front line have had to implement, unfortunately, seemingly ad hoc reform that simply serves to shift the problem elsewhere. Comments from WACHS add further weight to the need for whole-of-system reform, as is articulated in the 10-year plan, which needs to be backed up by adequate funding to ensure that we do not end up merely shifting the problem around. There is no doubt that the Auditor General’s report provides further evidence of a mental health system in crisis, and nowhere is this more evident than in the regions.
Although I welcome this report, and believe that some really interesting work has taken place behind it, particularly, as I mentioned, the data analytics, how many more reports do we need before we can start ensuring that we are doing something to support people in rural and remote areas to get the level of health services they require? As we have said, the outcomes for people living in rural and remote Western Australia, from a health perspective, are poorer, and that is of grave concern. This state is meant to be providing for all, bearing in mind that health services are fundamental. This is a core business of government.
The Greens support the motion and believe that it is really important that we start looking at the sorts of plans that have already been created, the sort of analysis that is already being done, and see what we can do to finally get some statewide, appropriate implementation.
Comments and speeches from various member
Question put and passed.