Transcript: Dr Andrew Pesce, with Deborah Cameron, ABC 702 Sydney

Subject:           Indigenous health policy; AMA Indigenous Health Report Card

DEBORAH CAMERON: Health was another critical discussion point for the new Government and the election campaign; $1.8 billion has now been set aside by Labor to improve health and hospital services, mostly with a special emphasis on regional Australia.

But just how far will that health dollar reach? Will it reach Indigenous communities?

Dr Andrew Pesce is President of the AMA. His Vice President is Dr Steve Hambleton, and together they’re travelling in the Northern Territory visiting hospitals and health services, and meeting with local health care providers with an aim to producing a report before the end of the year – the Indigenous Health Report Card for the Australian Medical Association.

And Dr Pesce joins me now. Good morning.

DR ANDREW PESCE: Good morning, Deborah.

DEBORAH CAMERON: Now the starting position on Indigenous health is poor. So from what you are seeing now, how alarmed do you remain?

DR ANDREW PESCE: Look, I think it’s important to recognise that there’s a lot of really good work that’s being done here and it’s easy to often focus on where we’re not achieving as much as we want to achieve. That often hits the news and hits the headlines very dramatically. But there are some great success stories.

We’ve seen some examples of some clinics where a lot of good work is done to prevent disease, to manage chronic disease and not just respond to the acute emergencies that are the tail end of a long disease process.

But there’s no doubt that, because of the remote location, these health services work under a huge amount of pressure and that needs to be taken into account when models of funding and service delivery are organised.

And I must say, as a city-based obstetrician, the more I listen to people, the more I see that they’ve got in common with what they want out of their health services to what city people want out of their health services.

They want to be able to have some choice. They want to be able to determine the services that they use and, because of the remote location, that has different implications for the way that we will deliver those services, compared to a city where people exercise that choice in self-control by having a number of different providers.

So these remote communities will often only have one health service for many hundreds of kilometres. So when they want to exercise choice, it’s got to be through the control of what that community-controlled health service delivers, rather than the fact that they might be able to go off and choose someone else.

DEBORAH CAMERON: Now we’ve also talked a fair bit about the potential for new technology to provide choice in a way that has been not available in remote areas.

The National Broadband Network has been something that people have really looked to for great promise in this area.

Do you think choice might come in non-standard ways?

DR ANDREW PESCE: Look, I think that the concept of electronic health and telemedicine with offsite consultations with different providers will always be the icing on the cake of health delivery, but you need a cake to start with.

The broadband interconnectivity which gives you access to maybe some types of specialists and some sort of health service professionals that can’t come to your community can always support the basic services, but you’ve got to get the basic services right in the first place.

So, my answer is that electronic health will have a good role in coordinating health care, especially when people do travel from one community to another, to make sure the community health centres have access to their complete health records so that they know what all of the health problems that that individual may have had over the years have been.

But, in terms of tele-consultation, as I said, that can only be the icing on the cake and we’ve got to bake a good cake first.

DEBORAH CAMERON: Then it’s about priorities. The AMA, over decades, has done a lot to draw attention to the shortcomings in Indigenous health services. What are the new priorities that you see working well.

I mean, you mentioned that clinic before. Was that a newly built clinic? Was it a clinic that had been sort of enhanced with new staff or services?

DR ANDREW PESCE: No, in fact the most successful models are those where there has been some stability and where you’ve got some constancy of a good doctor, a good nurse, and good Aboriginal health workers.

Ideally, they’re the three arms of health delivery in any community clinic and, where you see inspired leadership from a few of those individuals and a commitment to staying there over time, being able to institute a long-term strategy, you get results.

Unfortunately, because of remoteness and because of difficulties in the workforce, some communities don’t have access to that and they get attendance from people who are trying to help but are only there for a short time and can’t build a continuity-of-care model that wins the trust of the community and can deliver good outcomes.

So, it’s not so much a question of coming up with radical new proposals. It’s a way of just entrenching those principles that we know work and it is getting good people to stay there, stay committed, having the confidence of the community, an interface between the Indigenous communities and the health care professionals through Aboriginal health workers.

And then apart from the health service delivery increasingly recognising that a whole lot of things that aren’t usually considered core business for health care delivery. Things like good nutrition in the community, attendance at schools, security and safety for children.

These things which fall outside the usual remit of a health service provider, they need to be looked at and provided for in a very deliberate way.

DEBORAH CAMERON: Dr Pesce, thank you very much for taking time out of your tour to talk to us this morning.

DR ANDREW PESCE: Thank you very much, Deborah.

DEBORAH CAMERON: Dr Andrew Pesce heads the Australian Medical Association. He’s on a tour through the Northern Territory, compiling a report which will be delivered before the end of the year – the AMA’s Indigenous Health Report Card.

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9 September 2010

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