The demographic and social profile of rural and remote Australia has changed substantially over the last twenty years, as has the way health care is delivered and funded. Hospital stays are shorter; there is expanding use of technology; more services are delivered in the community; and, increasingly older people are choosing to be cared for at home. Further, there is greater emphasis on primary health care including health improvement and prevention programs, as part of better integrated health care.
The traditional hospital structure and models of care have needed to change to reflect the changing rural and remotes environments. For these small communities, flexible service models need to be developed which are more client-focussed, responsive to the community’s needs, and offer better integration of services.
MPSs offer opportunities to integrate a range of health services, including acute care, subacute care (including respite and palliative care), emergency, allied health, oral health, primary health and community services. Informed by robust service planning and community support, NSW Health has established and continued to develop the MPS model, even where the Commonwealth may not initially support the level of need for their investment in local aged care provision because the model continues to provide the optimal opportunity to best meet the needs of smaller communities in a sustainable manner.
NSW Health has provided over $400 Million in capital funding for the redevelopment of 64 facilities to increase service quality and efficiency, with the flexibility to expand into the future. The program has great diversity, from Wilcannia and Menindee in the far west, to Gundagai and Batlow in the Murrumbidgee, to Eugowra and Gilgandra in the central west. They comprise small primary care and outpatient health services to larger acute and aged care services. Not all MPSs have required capital investment to establish the Service.
The NSW Government has a history of working collaboratively with the Australian Government in the development of the MPS Program. The provision of aged care services is undertaken by the NSW Government when they can be accommodated within the State and Local Health District Healthcare Plans for capital investment, though primary responsibility for meeting the aged care needs of the population rests with the Australian Government. Increasingly, the MPS involves the inclusion of GP services, again to improve the integration of care to the whole community.
MPS facilitate innovation to respond to the usual program guidelines and constraints so that smaller communities can consolidate services, better match services to community needs, achieve gains in productivity, reduce administration overheads and share resources. The objectives of the MPS delivery model are:
- Improved access to health and aged care services available in the local community.
- Increased service co-ordination through integration, innovation, and flexibility in the delivery of health and ageing care services.
- Improved economic viability and cost effectiveness of service delivery.
- Improved community participation in the planning of local health and aged care services.
The MPS model uses a funds pooling approach from the State and Australian governments, available to the service the assorted NSW Health program areas and Australian Government (aged care resources) available to rural and remote communities. This is undertaken under one management structure, to deliver, easily assessable, sustainable health, aged and community services.
The characteristics of rural communities and service delivery which best support the implementation of the MPS model include:
- Insufficient catchment populations to sustain separate acute hospital, residential care, community health and home care services (generally from around 1,000 to 4,000 persons).
- Inability to access the mix of health and aged care services appropriate to the needs due to isolation.
- Complementary (rather than competing) services.
- Service catchments which reflect a common sense of community.
- Consumer and community involvement in, and commitment to, the MPS model.
- Support for the MPS from existing services, including local health professionals such as general practitioner(s).
- Capacity to achieve financial viability under MPS funding arrangements.
- Willingness and capacity to participate in the change management processes essential to gaining the most benefit from the flexibility of the model.
- No adverse impact on services in nearby towns.