The stark reality of ‘postcode lottery’ in healthcare access: Dr Rob Grenfell

In a compelling address at the inaugural Pathology Technology Australia congress, Dr Rob Grenfell, Chief Strategy and Regions Officer at Grampians Health and former CSIRO Director of Health and Biosecurity, delved into the critical issue of healthcare disparities and the imperative for precision health.

Drawing from his extensive experience, he shared a personal anecdote highlighting the stark reality of the “postcode lottery” in healthcare. Dr Grenfell painted a vivid picture of the disparities in healthcare outcomes based on geographic location.

“If I have a heart attack in a remote, underprivileged community, I have double the chance of dying compared to if it happened in a metropolitan area,” he highlighted.

He added “We are moving from precision medicine to precision health and wellness. Consumers see it as ‘how do I stay well and if I get sick how do I get diagnosed early enough so that something effective can be done about it.”

Addressing the challenges faced in rural and remote healthcare settings, Dr Grenfell highlighted the stark differences in resources, citing a scenario where a multidisciplinary team of 22 in a metropolitan setting contrasted sharply with his rural team of only one and a half individuals.

“The workforce numbers are not going to increase significant so we need to work with what we’ve got. Let’s just get over our professional priors and start working at the idea that we need to solve a problem and that means we need to allow people to work within the full scope of what they’re actually trying to do,” Dr Grenfell asserted.

He showcased pioneering initiatives such as the Grampians Health Integrated Cardiac Care program, emphasising the importance of patient-centred care, streamlined processes, and innovative payment structures. He championed the adoption of virtual care solutions and point-of-care testing, noting the transformative impact on intensive care units and the necessity of rethinking traditional healthcare delivery models, especially in remote and rural areas.

“Understanding that intensive care can be managed remotely was a major breakthrough. Nurses were quick to adapt, showing readiness for this innovative approach. But getting into the heads of the intensivist to understand you can run an intensive care and not be in the building, that was a major step. They were probably the hardest,” he said.

Reflecting on successful initiatives, Dr Grenfell praised the work of Dr Philip Tideman and his team where they levelled off the differentials between rural and urban South Australians having heart disease.

He stated “Patient empowerment, point-of-care interventions, and remote support were instrumental in bridging healthcare gaps between rural and urban populations.”

Discussing the economic aspect of healthcare, Dr Grenfell highlighted the importance of investing in preventative measures to reduce hospital admissions and improve patient outcomes. He stressed the need for equitable distribution of resources.

He underscored the importance of incorporating broader societal benefits into Medical Services Advisory Committee (MSAC) applications including “social benefit, community benefit and the benefit for society.”

He added “We must invest more in those who have less, otherwise you will pay for it and they will pay for it many times over.”

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