Dr Tamsin Cockayne has spent her career working to improve health outcomes in regional and remote communities. Today, as Executive Director Remote Health and Primary Care at NT Health, she is taking the lead on implementing systems change to support changing community needs.
You’ve spent much of your career in the Northern Territory. What makes working in regional and remote communities so rewarding?
For me personally, it’s about the relationships with communities, great clinicians and individuals as well as the opportunity to make an impact. That’s what keeps drawing me back. I like working at the system level, there’s a lot you can do here in the NT that would be much harder to do in urban or bigger settings.
And personally, as a woman, I’ve found the Aboriginal women I’ve met in community completely inspiring in their resilience, their skill, and their responsibility for family and culture. In often incredibly difficult circumstances, their ability to lead families and communities is amazing. To work in a setting where women have such a prominent role is a real privilege.
What do you think those in metro and suburban centres don’t understand about the challenges faced in healthcare in regional Australia?
The fact is we have a healthcare crisis in remote Aboriginal communities of Australia. The healthcare need is growing, and the available health workforce is shrinking and the system funding and service delivery models that work in urban Australia don’t work in remote settings. At this point even bringing in more clinicians doesn’t solve the underlying problems. For me, the opportunity is to completely and radically change the system, led by true collaboration with our communities and our health workforce.
Not in my lifetime will we ever have ‘enough’ doctors and nurses living in remote communities. So, you automatically have to say we need a completely different kind of workforce. There is both a need and a real opportunity for us to grow health roles that help local Aboriginal people stay in community with really culturally appropriate healthcare jobs. Then to support those community-based health and wellbeing roles we need to maximise the input of virtual clinicians in Darwin or Sydney or Melbourne or elsewhere.
The challenge is here, like in much of Australia, a growing need and fewer workers. But add to that less resources, vast distances, isolated communities and lower digital adoption and it presents many challenges, but also exciting opportunities to turn traditional approaches on their head.
How would you describe the model of healthcare in the Northern Territory?
We’ve had a model in the Territory of delivering healthcare, which is interestingly what the rest of Australia is now aspiring to under the Strengthening Medicare reforms: multidisciplinary teams, with remote area nurses working hand in hand with Aboriginal health practitioners on the ground, everyone working at top of scope, and virtual health support, is what we’ve been doing for decades.
But now there is this very interesting inflection point where these models are no longer fit for purpose for us. We don’t have the workforce nor the budget to continue this model, so our model of care now doesn’t work. We are having to rethink that in a time where the rest of Australia is starting to talk about what we were doing.
But there is also this amazing opportunity that comes in thinking about health reform and new models of care where we’re finding we’re able to have good dialogue with the Commonwealth and help them to better understand where we in the NT could try new things in a way that could be scalable nationally. There is a number of projects we’re beginning to implement now where we are experimenting with completely different ways of delivering healthcare, which is quite exciting when you look at the potential for that across other remote parts of Australia.
How are digital technologies changing the delivery of healthcare in remote communities?
What you see really distinctly in remote NT is the inequity in Australia in access to both health care and digital connectivity. Digital health offerings represent great opportunities to improve access but there is a real risk of it widening the equity gap in many ways.
We saw during COVID that suddenly there was this whole new range of health services – telehealth, virtual care – available. But in many of the communities we work they don’t even have access to reliable internet. On top of that the digital access means more resources potentially funnel to those who can already access services and there is less resource for the hard-to-reach spots, so the digital divide has the risk of making health inequity even worse.
NT Health is currently working on a project with DHCRC to address this very issue?
Yes, with our project partners, we are looking at how we can enhance Comprehensive Primary Health care using digital technologies. We know primary health care is the critical building block of health care. If you get this right in any community then you get healthcare right. So, the question becomes how can we use digital tools to improve the access to comprehensive primary care when we have workforce shortages and systems that aren’t working.
The beautiful thing about this project is that it is really grounded in community conversations and patient experiences describing what community members would like to see improved. Aboriginal culture is very much based on relationships. And it’s the relationships that people always really worry about with virtual care and digital health.
Last month I had the privilege to travel with USyd Professor Tim Shaw, DHCRC CEO Annette Schmiede and government representatives Daniel McCabe and Simon Cleverly to Pirlangimpi in the Tiwi Islands to see directly how the community-based research model is working and its impact in a remote Indigenous community. Pirlangimpi is a great example of a community that’s really thriving at the moment and the culture really comes alive for people when they’re on the ground. I’ve been visiting there for the last 20 years, and it was wonderful to be able to introduce the team and hear them talk with community members and staff about their healthcare experiences.
We are now looking at the digital health stack – different layers of tools we can put in place and how they will work together in a culturally appropriate and accessible way. It is very much about talking to the communities and trialling new things. We’re really mindful that we want the solutions to be scalable to other sites too, across the Territory but also throughout Australia.
