Our Aim is to Improve the patient’s journey and access to comprehensive primary health care services to the Spinifex People in Tjuntjuntjara and thereby contribute to “closing the gap”: through
The delivery of high quality evidenced-based comprehensive primary health care services in Tjuntjuntjara in an accredited primary health care service;
Improving community access to an appropriate level of aged and disability services; and
Building resources such as workforce, infrastructure and funding.
The Spinifex Health Service provides a range of services in Tjuntjtuntjara including a youth program, a HACC program, and a primary health care service. In addition, there is a suite of visiting services to support the primary clinical care being provided in the community. A list of these services are contained in Table 1: Visiting Services. As one of three communities supporting the Kakarrara Wilurrara Health Alliance (KWHA), an Alliance servicing related communities, SHS benefits from the ongoing clinical and allied services delivered by KWHA and through visiting specialist services from Western Australian clinical networks.
Child health checks are now provided regularly up to school aged children and regular ear screening twice weekly at the school means that child ear health remains a priority and staff remain vigilant.
Service gaps remain in areas of GP time, community based renal dialysis, access to dietetic advice, SEWB, particularly young men, and health promotion. Face to face GP time remains low – 3 days per month with the threat of this being halved with the potential cut of RFDS visiting services to the community. The clinic continues to rely on RFDS for all emergency support with ongoing chronic care being provided by the KWHA visiting GPs. This also means that health checks and GP management plans for patients with a chronic condition may not be up to date.
In recent times, links have been developed with community program deliverers in Kalgoorlie: Centrecare and Hope communities. Regular visits are now being organised to support alcohol and drug programs and positive parenting and reducing family and domestic violence. Further links will be explored to bring services to Tjuntjuntjara that would otherwise not be provided.
Deliver high quality evidenced-based comprehensive primary health care services in Tjuntjuntjara in an accredited primary health care service;
Over the next three years, the aim is to maintain a high level of care, continue a regular program of clinical and other audits and ensure the incident reporting system and consequent quality action plans remain current and are regularly reviewed.
Key work being undertaken is the development of a comprehensive management plan for social and emotional wellbeing that can be reviewed and actioned by staff on the ground with supervision by a visiting psychologist. SEWB remains a key issue for the community and to sustain a highly functioning community. Therefore ensuring young men and women, particularly newly initiated young men remain connected to the community and continue to receive appropriate support and training drives the agenda for SEWB.
SHS was also fortunate to have commissioned a dental unit in early 2014. This facility now provides rooms for the visiting dental service equal to an urban service. The dental service has proved to be valued by the local community with the visiting dentist receiving around 30 patient visits per four day visit. Funding for this program is not secured and therefore maintaining this service and ensuring key infrastructure (the dental unit) is used, is a key priority for the next three years.
Increasing GP time in the community is also a key priority so that all community members undergo a health check within 12 months and all patients with a chronic condition have a regularly monitored and reviewed GP management plan and where necessary, a shared care plan.
Renal function remains a key health problem with the expectation that more people will have to leave the community to receive dialysis. It is therefore important that these leaders of the community remain in the community and working actively towards community based dialysis with the options of either self care PD or CAPD or nurse led care being explored over the next 12 months.
There are still some gaps in the breadth of allied health services to be delivered with the need for at least one annual visit from a dietitian to advise on patient diets and HACC menus.
Improving community access to an appropriate level of aged and disability services;
SHS has run a successful HACC program for around 25 clients since 2005. However this cohort is aging and their needs are increasing. Already several members have had ACAT assessment indicating that there care needs are higher than can be provided through a HACC program. In 2014, SHS has applied for aged care provider status with a view to applying for community packages for those community members who are been assessed by ACAT as requiring this higher level of need. In June 2014, the HACC service underwent its first quality review for four years and this allowed the HACC service to consolidate its policies and procedures and set clear goals for the future service. Changes in the aged care program in the state now means that clients are more likely to receive an ACAT assessment regularly and SHS needs to be in a position to respond to the HACC client needs. Having aged care provider status means that more comprehensive care programs can be put in place and local community people can be employed to deliver these services.
Building resource such as workforce, infrastructure and funding for remote Aboriginal health service delivery
Resource development is key to building a high quality health service. This means building the workforce, infrastructure suited to deliver the services and resources for service expansion. The current clinic space has now outgrown the services being delivered. The need to extend the current clinic to include additional training rooms and clinical spaces to cater to the increasing number of fly in fly out specialists and allied health services is now dire. The extension remains contingent on excision of the Tjuntjuntjara community living area from the Great Victoria Desert Nature Reserve. This is expected to occur this year. This also affects any
plans for additional staff housing where the priority lies with housing for the female Aboriginal Health Worker and the newly recruited male trainee AHW.
Staff resource development remains a priority with training being planned for the trainee AHW to a certificate three Level and ongoing training for the AHP (female). Mandatory training for the nursing staff include the Remote Emergency Care, and pharmacotherapy. As well each is being encouraged to seek additional qualifications in their respective portfolios: child health and chronic disease.
Other training being provided includes training for HACC Support workers, and youth work. Over the next 12 months efforts will be made to employ a local male to run and youth program with the employed youth worker mentoring the person in that role.
Tjuntjuntjara has an aging cohort of community members who currently receive HACC but are slowly needing more aged care support. Expanding the range of aged care support that can be provided to the community remains a key priority for the coming years. This will also mean more dedicated facilities for aged care and funding to expand the HACC and aged care remains a key priority for the next three years. Independent living units for the aging population remain a key priority along with improved facilities from which HACC and other aged care services can be delivered.
Along with the aging population, increasing requirements for renal dialysis for community people is a major issue. Facilities for community base dialysis will be pursued as a priority. Key community leaders are being lost to the community when they are put on dialysis and this can mean the loss of traditional authorities in the community. The maintenance of community cohesion as the social and emotional wellbeing of the community means that much more needs to be done to assist people to remain in their community for dialysis and where necessary for palliation. Increasingly community people are choosing to remain on their lands to die and this means an increasing need for support and training for local clinical staff when that occurs.