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2.14 Drivers of Change in Delivery of Remote Healthcare

Remote nurses do not work in environments divorced from external forces of change. Such forces may range from macroscopic to microscopic in size and effect, be national or local, or health-related or not. Faced with any of these forces of change, remote nurses must adapt in order to remain in the field. Humphreys and Wakerman (2008) identified a number of drivers of change to the delivery of healthcare, including mental healthcare, in Australia: • Demographic change : Australia’s ageing society faces increases in chronic diseases, and therefore greater demand for health services. Older mental health patients present with comorbidities, which increase remote nurses’ workloads (see Chapter 2). • Epidemiological change : Increases in the prevalence of chronic conditions, combined with an ageing population, requires seamless integrated care by multidisciplinary teams, not fragmented and insular health services (‘silos’). This is the challenge for the future of delivering remote mental healthcare, for if there is no change, the burden will increase on remote generalist nurses. • Workforce changes : The combination of an ageing health workforce, changing values of new graduates and their reluctance to work remotely makes workforce succession planning difficult (see Chapter 2). • Fiscal constraints : Escalating costs combined with limited resources ensure continuing debate about how to fund the public healthcare system in a way that is politically acceptable. While beyond the control of the individual remote nurse organisations, the Council of Remote Area Nurses of Australia (CRANA) Plus and