For 2013/2014 and 2014/2015, CQ RAICCHO has set itself the following four strategic priorities.
1. Governance Best Practice
CQ RAICCHO will continuously improve the standards of corporate governance for its own Board and for the Governing Committees/Boards of Member Services, so as to protect and enhance the reputation of Aboriginal and Torres Strait Islander community controlled health organisations.
CQ RAICCHO took advantage of the 2013 Annual General Meeting to consider a number of Constitutional amendments aimed at enhancing the integrity of the Board of Directors and to position CQ RAICCHO itself as a reliable, no risk partner with the key funding bodies of the Australian and Queensland Governments. The Board of CQ RAICCHO will also formally adopt a “Charter of
Corporate Governance” aligned to the requirements of the Corporations Act 2001 (Cth), that will also include a Member Charter, spelling out rights and responsibilities. A Special General Meeting was convened for 18th February 2014 to discuss the adoption of the amended Constitution, the “Charter of Corporate Governance” and the Members’ Charter. CQ RAICCHO will also conduct an annual forward training program to enhance the knowledge and capabilities of its Directors; this could take the form of a series of topic-specific workshops and seminars, or even a commitment by interested Directors to complete an accredited/industry recognised qualification.
CQ RAICCHO will strengthen its constitutional capacity to step-in and ensure continuity of service delivery to Aboriginal and Torres Strait Islander clients, families and communities where circumstances warrant, including where funding bodies de-fund a Member Service or where a regulatory body appoints an Administrator/Financial Administrator. Associated constitutional changes will clarify the capacity of the Board of Directors to suspend or cease a Director or a Member Service where this intervention is triggered.
CQ RAICCHO will work with Member Services to support and assist them with implementation of their own governance reform programs, in particular composition of their Boards. This will include Skills-Based Directors.
2. Member Service Suppor
CQ RAICCHO will expand its endeavours to support the workforce, operational, and service delivery capacity of Member Services.
CQ RAICCHO will endeavour to negotiate for the devolution of funded support positions from regional and state-level organisations to be managed directly by CQ RAICCHO.
Priority is being given to two support positions originally funded by the DoHA for QAIHC servicing Central Queensland and a new, third regional support position. The Board and the General Manager commenced multi-party negotiations in August/ September 2013 involving QAIHC and the IUIH Ltd to effect the transfers of these positions to CQ RAICCHO. Their job roles will focus on direct assistance to all four Member Services for service delivery/Model of Care roll out, and for workforce development. The three positions are:
- Regional Workforce Support Coordinator and the Regional Coordinator role, funded directly to QAIHC; and
- Outreach Regional Coordinator, funded to a consortium comprising Check-Up and QAIHC.
CQ RAICCHO is seeking a formal sub-contracting arrangement with QAIHC for the first two positions for the remainder of 2013/2014; this is needed because the new Commonwealth Department of Health has taken the attitude that it does not and will not fund CQ RAICCHO directly. With regard to the third position, the job role of the Regional Outreach Coordinator is to support primary health care providers to coordinate access and follow-up to specialist service providers for clients under General Practice Management Plans and Team Care Arrangements. The Member Services of CQ RAICCHO will not be the exclusive beneficiaries of this support. A position description for this job role was being finalised in late-January 2014 for recruitment into CQ RAICCHO in February 2014.
CQ RAICCHO has been able to secure additional workforce for Aboriginal and Torres Strait Islander health in Central Queensland in 2014 through its negotiations around the Multidisciplinary Outreach Indigenous Chronic Disease Packages (MOI CDP). This achievement demonstrates what is possible when the AICCHSs have a regional organization that can intervene at State and regional levels; this was one of the benefit propositions for establishing CQ RAICCHO (refer to Appendix 2).
Part of CQ RAICCHO’s support will be to work with Member Services to complete the full installation of the highly productive and Board-approved Model of Care in their Clinics; work on this commenced in the second half of 2012/2013. Installing the Model of Care in every clinic of every Member Service will require sustained support from and to all Practice Managers. This will be the primary responsibility for the CQ RAICCHO General Manager who will be assisted by the contracted-in “Spearhead” – a change management role based on change management experience with such a position in ‘greenfield’ and ‘brownfield’ Clinics by the IUIH Ltd in south-east Queensland. The detailed workplace reforms will vary from clinic to clinic but what will be constant will be the need to support the micro-management of the installation program. The success of the Model of Care is linked directly to the competitive edge of Member Services over and against alternative (mainly private sector) providers and to the financial sustainability of clinical services over time.
Two of the key success factors for improving the productivity of the workforce employed in Member Services so that each employee contributes fully to the Model of Care endorsed by the CQ RAICCHO Board will be:
(i) to ensure that every employee works to the full extent of her/his job role ‘licence’; and
(ii) that skills audits are implemented to identify the competence and qualification gaps for individual employees.
Responsibility for the systematic approach to productivity improvement by CQ RAICCHO Members in 2013/2014 and 2014/2015 will rest with the CQ RAICCHO Regional Workforce Support Coordinator, whose position is to be transferred from QAIHC to CQ RAICCHO in February 2014, assisted by the contracted-in “Spearhead”.
The Commonwealth Department of Health and Ageing indicated its intention to de-fund Barambah Regional Medical Service (BRMS) in September/ October 2013. As at end-January 2014, the new Commonwealth’s Department of Health was considering contracting with IUIH Ltd to be the funds holder for the delivery of primary health services in Cherbourg/Burnett in 2014 and going forward. However, there is no certainty that this will occur.
As part of its commitment to project manage new business development, in late 2013 CQ RAICCHO commenced multi-party negotiations to take operational management responsibility for a fully-equipped Mobile Health Clinic (a Van) funded by Queensland Gas and Coal (QGC), and managed until November 2014 under the control of QAIHC. CQ RAICCHO has been progressing a Memorandum of Agreement with QAIHC and approval from QGC to transfer operational control. The aim is for CQ RAICCHO to be managing the Mobile Health Clinic from February 2014. Final legal approval is expected from QGC during February 2014. The Mobile Health Clinic would be staffed with a GP, RN and a Driver/Aboriginal Health Worker. The Clinic’s operator is obliged to deliver outreach services to regional towns and rural areas of relevance to QGC’s business operations, and fortunately these coincide with areas CQ RAICCHO has to service under the MDMC Regional project. This especially benefits Nhulundhu Wooribah (head office in Gladstone), Bidgerdii (especially the under-serviced Central Highlands), and Barambah (particularly in North Burnett where BRMS has almost no service presence). Discussions were initiated in late-2013 with the Chief Executive Officer of the Central Queensland Rural Division of General Practice about the possible involvement of the Rural Division’s GPs with scheduled visiting clinics by the Van to the communities where these GPs operate. CQ RAICCHO will coordinate further discussions to try to sign a Partnership Agreement with the Rural Division.
Other dimensions to CQ RAICCHO’s business development assistance will include help with diversifying into complementary service provision, including aged care (especially integrating primary health care with Home Care Packages), preventative health, and social health – drug and alcohol, and mental health services. The State Director of the Department of Health and Ageing met with the Board of CQ RAICCHO on 22nd October 2012 and highlighted the options for Member Services such as Bidgerdii to enter the aged care service delivery arena and simultaneously offered to assist CQ RAICCHO to broker a region-wide drug and alcohol program with a mental health component. The best endeavours of CQ RAICCHO to obtain funding for the regional proposal were ultimately defeated by bureaucratic issues, but this experience does not invalidate the strategic approach that was actioned. Experience with IUIH Ltd in south-east Queensland has had more successful outcomes, both with regard to substance misuse and mental health programming and with aged care: IUIH Ltd secured the first 52 Aboriginal Consumer Directed Care Home Care Packages for North Brisbane from an Application lodged through one of its Member Services for ACAR 2013 and has subsequently secured several hundred HACC packages through its partnership with a Medicare Locals Consortium in North Brisbane. CQ RAICCHO will actively explore the potentials for its region during 2014 and 2015.
3. Health System Integration
CQ RAICCHO will assist Member Services to integrate into the new policies and resource allocating structures as they are introduced for the health industry by the Australian and Queensland Governments.
Given the uncertainties in the health industry from both Australian and Queensland Governments, CQ RAICCHO will need to be adaptive and entrepreneurial in responding to business opportunities as they arise. As at the commencement of the second quarter of 2013/2014, it seems that:
- The funding responsibility for the majority of Indigenous health services remains in the Health Department, to be coordinated by a new Indigenous Health Service Delivery Division (which replaces OATSIH).
- Responsibility for Indigenous Drug and Alcohol treatment services (including staff working on these programmes in State and Territory Offices) is with the Prime Minister’s Department.
- Responsibility for Aged Care services – including HACC and Home Care Assistance Packages – is with the Department of Human Services.
In this multi-jurisdictional environment at the Commonwealth’s level, CQ RAICCHO will endeavour to seek out and secure new funding investments for Member Services through regional business cases not only for existing but also for new lines of business, in particular aged care, mental health, substance misuse, preventative health and disability services.
CQ RAICCHO’s original Strategic Plan identified Medicare Locals as important regional structures for Member Services. The focus was on the Wide Bay Medicare Local because it was one of the most active members of the consortium that submitted the costed proposal that led to the MDMC Regional Project being funded by Queensland Health. The relationship with the Wide Bay Medicare Local started out positively and then deteriorated, but in October 2013, CQ RAICCHO, working with IUIH Ltd, re-activated negotiations originally commenced in October 2012 with Wide Bay Medicare Local for the transfer of a range of positions dedicated to Aboriginal and Torres Strait Islander health. Appendix 4 identifies the extent of the potential transfers. The arrangement is that day-to-day operational supervision and performance monitoring would be undertaken by the Practice Manager of Galangoor Duwalami, the CQ RAICCHO’s Member Service for Fraser Coast (Hervey Bay and Maryborough). Wide Bay Medicare Local could retain responsibility for payroll.
The Federal Coalition Government has not yet confirmed its pre-election policy to abolish Medical Locals. The previous (Labor) Government created Medicare Locals and channelled much of the new growth funding for Aboriginal and Torres Strait Islander health through these bodies. These Labor funding arrangements could change: the Commission of Audit announced by the Prime Minister, which is reviewing all expenditure, will provide recommendations for the Government’s 2014/2015 Budget considerations. It is expected that the policy and funding situation regarding Aboriginal health generally and for AICCHSs in particular will become clearer as the 2014/2015 Budget unfolds.
In Queensland, if Medicare Locals do indeed disappear, it may be that they could be folded in to or be absorbed by local Hospital and Health Services (HHSs) run by Boards. If this does occur, CQ RAICCHO would need to re-position itself with the HSSs of Wide Bay and Central West, much as it had to do with Medicare Locals in the previous three years when they were established. In addition, CQ RAICCHO would have to assist the Member Services to position themselves with their relevant HSS with the aim of accessing HHS funding to provide primary health care to Aboriginal and Torres Strait Islander clients, families and communities. As at January 2014, it is not possible to be precise about the achievable action plan milestones; these will become more apparent as the possible Medicare Local/Hospital and Health Service transition progresses.
The Queensland Minister for Health has decided that ‘contestability’ processes will be applied to organisations who seek to be funded by the State Department to provide primary health care to Aboriginal and Torres Strait Islander clients, families and communities. It is unclear whether this decision will encourage new competitors into this sector of the health industry, but CQ RAICCHO should plan on the basis that there will be a more competitive environment. CQ RAICCHO’s assistance will extend to service mapping and planning, compliance with the tender processes, through to constructing consortia and securing partnerships.
The Queensland Department of Health apparently intends to regain complete authority over primary health care; previous devolution processes for example in Far North Queensland will be undone. To enhance ‘contestability competitiveness’, and to demonstrate performance excellence, one of the priorities for CQ RAICCHO in 2013/2014 and 2014/2015 will be to assist Member Services to connect directly with partner organisations in the health sector and other sectors; and to embed these connections indirectly through CQ RAICCHO acting on behalf of Member Services – such as developing partnership arrangements with tertiary education institutions that can contribute to the workforce supply of Member Services. Opportunities for partnerships are expected to arise throughout the period. For example, currently CQ RAICCHO is aware of five Indigenous Scholarships valued at $5,000 each sponsored by BMA Coal available at Central Queensland University; and further potential could occur as Central Queensland University and Central Queensland TAFE merge. CQ RAICCHO will be seeking suitable partners for a program of applied research – similar to the annual program that IUIH Ltd manages – and suitable partners for placements in Member Service Clinics of GP Registrars (e.g. UQ Rockhampton’s School of Rural Medicine), Nurses (RN, EEN), dental students, and allied health students.
4. Service Innovation and Business/Operational Cost Efficiencies
CQ RAICCHO will coordinate a system of shared electronic client records across all Member Services, and work with Member Services to install cost-effective shared procurement solutions.
CQ RAICCHO will review the experience of IUIH Ltd and its Member Services in south-east Queensland with their introduction of MMEx as a system of shared personal electronic client records across Clinics and population health programs. Shared PECHRs will become increasingly important for two strategic reasons:
(a) To deliver de-identified analyses for programming, service enhancement and planning; and
(b) To facilitate the coordinated service delivery that the Outreach Coordinator is tasked to promote.
This review should position CQ RAICCHO to reduce start-up time, effort and costs with Member Services in their participation in a region-wide shared PECHR system. CQ RAICCHO will be willing to manage discussions with Hospital and Health Services to develop acceptable arrangements for secure sharing of clinic and hospital records for Aboriginal and Torres Strait Islander patients.
CQ RAICCHO will intensify its collaboration with Member Services to reduce their costs of doing business. Together, CQ RAICCHO and Member Services have been able in the period October 2012 to September 2013 to make a lot of progress in streamlining top management in clinics and administration. For instance, Practice Managers are now standard in all four Member Services, and three Member Services have General Managers instead of ‘chief executive officers’. In 2013/2014 and 2014/2015, CQ RAICCHO will work with Member Services to put in place targeted shared procurement solutions for a number of operations and functions, which may span such ‘administration’ costs as ICT, fleet, insurances, recruitment through a regional electronic ‘job bureau’, and specialised professional services such as accounting, audit, human services/industrial relations, and legal services. It is important for CQ RAICCHO to be able to demonstrate to both the Australian and to the Queensland Governments, to their Health Ministers and Health Department officials, that Member Services are acutely aware of budgetary pressures on the health system and are actively contributing within their capacities to minimise those pressures.