In conversation with Sandy Gillies, CEO of the Western Qld PHN
Before Sandy Gillies became Chief Executive of the Western Queensland Primary Health Network (PHN), she knew from firsthand experience the challenges she might be confronted with.
As a First Nations woman “born and bred in the bush”, Gillies already understood the plight of rural and remote Australians in accessing health care, long before she took on the role that would address it.
Her drive to enhance health equity began at a young age and was cemented numerous times following the premature deaths of multiple close contacts. Gillies believes these people may have seen a different fate had they resided in a different postcode.
“I was really born into the social justice and equity agenda, given my cultural background. But it’s an agenda that has sadly been reinforced time and time again throughout my personal life and career,” she told Hospital + Healthcare.
“In a city like Brisbane, you get sick, you get seen and have all the tests under the sun, often right away. Out here in the bush, it’s sometimes a week and a 400 km round trip. There’s this assumption that you have money, a motor vehicle and the literacy to understand what’s going on, when that isn’t the case for so many.”
Changing the tide
Indeed, disadvantage is rife in Western Queensland, where First Nations people account for 17.2% of the population — significantly higher than the state average of 4%. In some areas, particularly remote, this translates to high levels of health inequity.
While Gillies is committed to improving equity for these groups, she says legacy systems — like policy and funding — are so entrenched that it is like “trying to turn the Titanic”.
“With policy and funding mechanisms baked into the enamel, progress sometimes feels much slower than I would like it to be. We are dealing with finite resources and policies that sadly don’t cater for all postcodes equally,” she said.
“But no matter how monumental the task, we won’t stop our quest to increase services in the physical and mental health space and bring health outcomes for disadvantaged postcodes on par with that of metropolitan areas.”
A value-based healthcare roadmap
To this end, Gillies and her team have worked hard to advocate for rural and remote Queenslanders and change the status quo when it comes to service delivery and funding.
“We want people to be funded according to the way they like to consume our services. That’s why we are carving out a roadmap towards value-based health care. Here, our core focus will be on improving patient outcomes, but in a way that matches the needs and preferences of our residents,” she said.
Gillies believes an outright shift to value-based health care will take time, but that it is ultimately achievable.
“It will take a generation, but we need to change the levers at the top and define what policy and funding might look like, when filling in the gaps of the current system.
“I’m confident that our work with communities is putting us on the right path. We are having conversations about how we can shift the dial from outputs to outcomes and it’s informed by the very people we serve. That’s the basis of the Healthy Outback Communities initiative we are currently trialling in remote Western Queensland.”
While Gillies believes the environment in Western Queensland is right for value-based health care, she says work is still needed to lift systemic and cultural barriers.
“In remote communities, we all look after each other — and in that way, we have the groundwork to make value-based care a success. That said, we do have some challenges.
“In value-based care, you are treating the entire person, not just the disease. And that becomes incredibly difficult if people aren’t connected to their wellbeing, or if they are treated unfairly by the system. When that happens, we tend to see poor compliance with medication and GP attendance.”
Gillies is working to improve these issues through a range of initiatives. Among them is a program designed to destigmatise help-seeking behaviour in the realm of mental health.
“It’s important to remind people that it’s okay to not be okay and get help when they need it. Equally, to spend time on the ground and involve people in any decisions that will affect them. When individuals are considered and heard across all levels of government, we see greater participation.”
While these tasks are not easy, Gillies appears to have the stamina to see them through.
“I don’t see what I do as work. It’s a passion for me and something I’ve lived and breathed from a young age.”
“In bush culture, our word is our word — and I’ve given my word that we’ll see change in my lifetime,” she concluded.
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