An independent review recommends a new biennial rural health report to Parliament and longer four-year terms for future commissioners.
The National Rural Health Commissioner should be tasked with delivering a regular report card on the state of rural health to Parliament and future commissioners should be appointed for four-year terms instead of two, according to an independent review of the office’s legislative framework.
The review, conducted by independent reviewer Mark Booth and released this month, found the National Rural Health Commissioner (NRHC) was a “respected and effective advocate for rural health” and recommended it continue operating under its current legislative and operational arrangements.
The review rejected suggestions that the office be given stronger regulatory or investigative powers, instead backing its role as an independent adviser to government on rural health policy.
“The Review has found that the NRHC commands a high degree of respect and is perceived as a truly independent voice that can ‘funnel’ the views of many stakeholder organisations,” the report said.
“The Review confirms that the NRHC performs a valuable role within the health sector and this role should continue.”
Among the review’s key recommendations is the creation of a new biennial report providing a strategic overview of major issues affecting rural, regional and remote health.
The proposed report would identify areas of concern and examples of good practice and would be tabled in parliament.
“The main vehicle suggested for this is a biennial overview of key issues in rural health,” the report said.
“This is not intended to be a ‘rural health strategy’ … rather, it is a document that would highlight the key issues that the NRHC is seeing in the performance of its activities and the key areas of both concern and good practice.”
The review said the report would help establish priorities for future policy work and could guide future Statements of Expectations issued to the commissioner by government.
Related
The reviewer also found the current two-year appointment term for commissioners was unusually short compared with other statutory office holders and should be doubled to four years.
“The 2-year appointment term has some clear disadvantages,” the report said.
“It produces uncertainty for both the incumbent and the sector.
“It militates against longer term projects.”
The review said extending the appointment term would improve certainty, support longer-term planning and strengthen perceptions of independence.
While largely endorsing the current model, the report identified several areas where the legislative framework should be strengthened.
These include explicitly recognising Aboriginal and Torres Strait Islander people and consumers as stakeholders within the legislation, increasing the time allocation for deputy commissioners, and establishing stronger mechanisms for national coordination of rural health policy across jurisdictions.
The review also highlighted ongoing challenges in rural and remote healthcare, including workforce shortages and poorer health outcomes compared with metropolitan Australia.
It noted that almost 30% of Australians live outside major cities and that health outcomes continued to worsen with increasing remoteness.
Despite those challenges, the review concluded the commissioner had fulfilled its statutory functions effectively and had become an influential voice in workforce reform, rural generalism, multidisciplinary care, and rural maternity services.
“This Review concludes that the NRHC is a respected and effective advocate for rural health, operating efficiently within its advisory remit,” the report said.
“While the current legislative framework is robust, targeted amendments and increased resourcing will strengthen the NRHC’s ability to address evolving rural health challenges and ensure its continued impact.”
Explicit First Nations recognition
The review also recommended that legislation governing the NRHC should be amended to explicitly recognise Aboriginal and Torres Strait Islander people and healthcare consumers as key stakeholders.
The review found the current legislative framework did not specifically identify either group despite contemporary policy expectations around consumer-centred care and shared decision-making.
“Aboriginal and Torres Strait Islander peoples’ input to the activities of the NRHC” should be emphasised in the legislation, the report said.
The review noted that Aboriginal and Torres Strait Islander people “are not separately identified as being a stakeholder within the legislation”.
“The inclusion of Aboriginal and Torres Strait Islander people would be consistent with Priority Reform One in the National Agreement on Closing the Gap.”
The report also found consumers were “absent as a separately identified stakeholder”, which it said was “not in line with contemporary approaches that emphasise consumer-centred approaches and involvement in health care”.
Under the current Health Insurance Act, the commissioner is required to consult with health professionals, governments, industry groups and other health stakeholders.
The review recommended amending section 79AD(f) to explicitly identify Aboriginal and Torres Strait Islander people and consumers, with stakeholder groups listed alphabetically.
