Understanding rural health services

Health services in Victoria operate under a long-established system of devolved governance for healthcare delivery. That means that responsibility for public health services is delegated to a facility which cares for the communities within a specific geographical area – local decisions and local services to match unique local needs. These local facilities are established as independent legal entities under the Health Services Act 1988. Lorne Community Hospital (LCH), and Otway Health (OH) based around the Apollo Bay Hospital, are two such services and each is governed by a separate unpaid board of management, the members of which are appointed by the Governor-in-Council on the recommendation of the Minister for Health.

Victoria’s public health services are grouped into regions, and both LCH and Otway Health (OH) are part of Barwon South Western Region which covers south western Victoria from Lara to the east and the border with South Australia to the west. The 18 independent services within the region range from small rural services like LCH and OH to large services like Barwon Health (centred on University Hospital Geelong) and South-West Healthcare (centred on Warrnambool Hospital).

Lorne Community Hospital is unusual in that the service is named for its hospital (like Portland and Casterton). Otway Health is like most other services and named for its region (Apollo Bay and Otways) rather than its hospital. That distinction aside, LCH and OH have many similarities in coastal location, population size and seasonal variation, clinical challenges, and service delivery and workforce needs. This natural compatibility is making the search for synergy rewarding.

What has happened since our last conversation?

A great deal has happened. Experienced, independent analysts have had a good look at both LCH and OH, and reported back with authoritative and thoughtful summaries of facts, qualitative observations and recommendations for improvements.

Importantly, and not surprisingly, their findings and recommendations are that both Lorne and Apollo Bay need their own local hospital providing, just as they do now, Urgent, Acute and Residential Aged Care. So, from a hospital perspective it should be business as usual in both towns.

Did they find areas for collaboration or integration?

Yes, they did, and it is quite exciting. Firstly, there are huge benefits to both services from an integration and consolidation of GP services at several locations along the coast. Secondly, closer collaboration on community health care would enable an increase in the range and quality of services at both towns, especially Lorne which would benefit from Apollo Bay’s longer and wider experience in that area.

What happens next?

So far, the process has been one of discovery. In order to formally integrate services we now need a process that is very purposeful and with clearly stated outcomes/objectives. So we are finalising a formal memorandum that sets out what each service brings to the table and what we expect to achieve through collaboration. It will also look at some operational issues, compliance and financial aspects.

Notwithstanding the formalities, because the benefits are so profound and immediately doable, we have already commenced integration of GP services. Dr Dave Mullen from our Lorne practice is now seeing patients at Apollo Bay and new doctors and registrars have been recruited to come on stream in the next months. Doctors are excited about being part of a team where they have back-up, where they can share and grow expertise, and which offers sustainability for a career in rural medicine.

Has the community feedback been positive?

As you know, we are trying very hard to be inclusive and transparent and community consultation has commenced in both towns to gauge community attitudes, sensitivities, wants, concerns and so on. To date the feedback is very positive. I encourage anyone who is curious to attend our ‘tea talks’ and discover first-hand what health services along our Great Ocean Road might look like in the future.

Dr Damien Smith
Lorne Community Hospital Board of Management President