Support Systems for Indigenous Primary Health Care Services Alister Thorpe, Kate Silburn #, Ian Anderson 23 March 2010 # La Trobe University

The ‘Support Systems’ Project Corporate support for community controlled Aboriginal health organisations identified as a research priority area by the CRCAH. Cooperative Research Centre for Aboriginal Health, Primary Healthcare, Heath Systems & Workforce Program Two related projects: –Quality standards in Aboriginal & Torres Strait Islander health project –The ‘Overburden Project’ - funding and regulation of PHC services for Aboriginal & Torres Strait Islander people

The ‘Support Systems’ Project To identify corporate support needs To find out how organisations got support for corporate functions Document case studies of organised support structures Develop some resources for organisations Recommendations about what needs to happen now.

Context Corporations world-wide looking for ways to ‘unlock value’ – maximise use of resources through collaboration Many ACCHOs have significant challenges –The broader environment Complex funding & policy arrangements Constant change and ‘reform’ –Organisational factors Location and size Often in transition Difficult to obtain funding for corporate functions –Workforce availability & retention –Community capacity & expectations

Corporate functions Where might support be required? –Many areas –eg: governance, human resource management, finances, legal, IT Within each area, what can be obtained externally & what needs to be done internally? –Human resources IR advice, specialist HR advice (eg PDs) VS Employment decisions Four main types of support –‘Foundational aspects’ – required on regular basis for basic ongoing functioning of an organisation – eg aspects of finance, HR –Expert skills required infrequently but in an ongoing way (eg IR) –One-off changes affecting a whole sector (eg changes to legislation) –One off organisational/systems changes (eg IT systems)

Existing ways of getting corporate support Affiliate / Peak Body support

Existing ways of getting corporate support Affiliate Brokerage Affiliate Private Service Provider Brokerage Member ACCHO Member ACCHO Member ACCHO

Existing ways of getting corporate support Centrally provided support

Existing ways of getting corporate support Peer Support Network

Existing ways of getting corporate support Direct Support Including: Government Affiliates Funding bodies Private provider Larger ACCHO Mainstream org ACCHO

Existing ways of getting corporate support Joint outsourcing to the private sector $ $ Private Service Provider Organisation A Organisation C Organisation B

Ways of getting corporate support Government funded facilitator / consultant Facilitator / Consultant Government Agency $ $ ACCHO

Corporate support structures – advantages Economies of scale, resource sharing/pooling and maximising value for each dollar spent Reduced duplication of effort –sharing and standardising policies & protocols –developing joint responses to issues of common concern Building capacity for increased revenue generation Supporting smaller or transitioning organisations & those with difficulties

Corporate support structures – advantages Developing capacity in a network to facilitate change & improve effectiveness Facilitating development of ‘good’ or possibly common business practices across services Facilitating access to high quality, timely, specialist advice Coordinating aspects of employment/ workforce organisation Enabling services to focus on their ‘core business’ (service provision)

Corporate support structures – challenges & potential risks/issues Agreeing on what the model will look like, the corporate functions that will be included & making choices about resource use Significant time, resources & skill required to set up & maintain support structures Concern about diminished community and/or organisational ownership (and less localised services) Divisions between different organisations with different agendas Ensuring mutual/equitable benefit to all participants Might be seen as opportunity to reduce funding Ensuring local capacity is built Members opting out

Themes from case studies Support for idea of services having access to good quality corporate support There is no one support structure that ‘fits all’ –the process for developing structures, for decision making within the structure & for ensuring support can be tailored to the needs of services are more important Balance between ‘bottom up’ and ‘top down’ – or what can be shared & what must be locally determined

Some features of successful models Developed to respond to need Principles –Supporting self determination & community control –Strengthening capacity of organisations Leadership (vision, change) – political, organisational, operational Governance structures & negotiated agreements Good communication processes Careful planning – for establishing & reviewing the support structure to take account of changing services, changing practices Capacity building approach Highly skilled and responsive staff Integration - corporate functions and service delivery functions

Some issues Potential for support provider role to undermine original role of organisation (peak body, health service) Potential for purpose to change without revision of structure – this could create conflict Relationship based – how to build stable structures that take this into account?

Next steps Case studies completed National workshop 21 & 21 June in Melbourne –Gaps in knowledge –Develop tools –Develop a corporate support map – what might need to occur at different levels –Recommendations/ suggestions about how to get there Newsletter – link will go out in CRCAH e bulletin