Rural Regional Roundtable on COVID-19 preparedness

October 21, 2021

The Victorian Healthcare Association (VHA) held its first Rural Regional Roundtable (RRR) on Wednesday 13 October. Rural and regional health board directors, executives, and senior leaders from across the state joined virtual discussions on readiness and resilience as the health system braces for the COVID-19 peak. We are grateful that Chris Hotham, Deputy Secretary for Health Infrastructure, joined us to share his insights from the Department of Health.

We heard shared experiences from across the sector of a fatigued workforce, exhausted from a myriad of challenges compounded by the pandemic. In the past 18-plus months, the sector has navigated bushfire recovery, critical workforce shortages, inadequate infrastructure, system reform, and increased service demands.

The challenges faced by rural and regional health services are multifaceted and complex. There is no single solution or magic wand. However, it is apparent that coordinated, regional- and rural-centric action and investment is required to address the immediate workforce and infrastructure issues.

 

Potential challenges ahead

The VHA has identified three potential risks to rural and regional health service delivery as Victoria transitions to Phase C of the Victorian Roadmap: rising case numbers, increased domestic visitation, and risk of natural disasters. These risks are not new but the concurrent nature in which they may occur has the potential to significantly disrupt service delivery.

 

Rising case numbers

The Burnett Institute modelling predicts a peak in COVID-19 case numbers in late December 2021 to early January 2022, coinciding with increased hospitalisations and intensive care unit (ICU) demands. The majority of COVID-19 cases have predominantly occurred in metropolitan Melbourne. However, as Victoria transitions to Phase C of the National Plan, people from metropolitan Melbourne will be able to join regional Victorians in moving freely around the state, which will likely see the concentration of COVID-19 cases spread to the regions.

 

Increased domestic visitation

Under ‘normal’ circumstances, rural and regional populations swell over the holiday period, especially in popular tourist destinations, with some areas experiencing a 15x growth in population. Last year, without international tourism, Victoria recorded 13.2 million visitors to the regions and, for the first time, tourism spending in regional Victoria surpassed that in Melbourne.

 

Increased risk of natural disasters

Extreme weather events due to climate change disproportionately affect the regions, with an increased and extended fire danger period. For most municipalities, the fire danger period extends from November to April and in some cases stretches into late May. The increased risk of bushfires during this time coincides with the surge in tourists and projected peak for COVID-19 adding further complexity to summer preparedness efforts.

 

What are the immediate challenges affecting our rural and regional health services?

Two key themes through roundtable discussions were identified as immediate issues for the healthcare service system: workforce and infrastructure.

 

Workforce

Services are experiencing significant challenges in attracting and retaining staff. Graduate programs are below capacity and smaller rural services are sharing staff with larger regional sites. Through breakout-room discussion, the following issues were identified as contributing factors to workforce shortages:

Workforce complexity: Rural and regional services provide care across a variety of clinical settings. A health service is a hub of several types of clinical staff. As a result, health services must manage a myriad of different reporting structures, legislation requirements and enterprise agreements. The complexity of workforce mix make it challenging for services to employ the right mix of staff to meet service demands.

Coordinated communication and timely sharing of information: Members shared their desire for a clear and coordinated plan to respond to demands across the health service system. Communication was reported to be distributed in a series of ‘urgent’ and uncoordinated requests that often lacked an understanding of the resources required to meet the requests’ deadlines. Services felt continually in a reactive state, making it increasingly challenging to plan for future needs.

Reporting demands: Additionally, senior leadership emphasised the need for a review of reporting requirements as information was often duplicated across multiple portals. This demand is compounded for small services, as the same staff member is often responsible for multiple reporting requirements – unlike in larger services where reporting is localised to various team/program delivery.

Difficulty securing accommodation: Recruited staff are often forced to stay in hotel accommodation while others commute long distances from neighbouring towns or regional hubs. Staff commuting or staying in temporary accommodation inevitably led to staff turnover.

Staff fatigue and workplace stress: Due to the increase demands on services throughout the pandemic, workplace fatigue is system-wide. Staff fatigue has seen a decline in team culture, increased absenteeism, and staff uptake of employee assistance program (EAP) support services. Staff fatigue added further pressure to workforce shortages as there is limited capacity to backfill shifts. In some cases, clinical shifts were filled by executive and leadership staff with the appropriate skills.

 

Infrastructure

Members identified infrastructure and asset management as ongoing barriers to effective service delivery. Immediate issues identified included the following:

Asset management and capital planning expertise: Local health infrastructure and engineering expertise is often unavailable in rural areas. Members reported that readily available expertise would better support local asset management and capital works projects. 

Resilient infrastructure: External environmental pressures such as climate change and COVID-19 require upgrades to be made to health infrastructure to ensure patient and workforce safety. Smoke pollution from the 2019 bushfires was given as an example to demonstrate the need for increased climate-resilient infrastructure.

Infrastructure funding processes: Clear processes that show funding allocation are necessary to support long-term infrastructure planning and asset management for rural and regional services.

 

Preparedness

As the VHA has noted in its international case study analysis, a coordinated and systemic approach to addressing potential risks is required. In international examples where health systems retained a functional level of coordination, they were effective in withstanding increased demand.

The VHA continues to advocate across a range of issues to reduce the burden on Victorian health services and supports a whole-of-system response to the pandemic. It is paramount that a strong rural and regional lens is applied across health service preparedness that takes into consideration the unique challenges of rural and regional settings. Themes related to COVID-19 preparedness will assist in applying a strong rural and regional lens to VHA’s ‘Navigating COVID peak’ advocacy work and broader health system preparedness discussions.

 

Next steps

This was the first in a series of roundtable discussions that aim to place evidence and member experience at the heart of the advocacy agenda. As outlined throughout the article, workforce emerged as a strong theme and this is likely to be the next topic on the agenda in the RRR series. Stay tuned for more details.

 

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