The QCoal Foundation and Royal Flying Doctors Service Queensland share the story of how a new community dental service helped 8,000 patients in remote communities and achieved sustainability after securing federal government funding.
Nicole Richards, March 2018
Few people enjoy a trip to the dentist, but spare a thought for residents in some of Queensland’s most remote communities, whose check-up requires an onerous 600-kilometre trek just to get there.
The QCoal Community Dental Service, which operated for four years, provided $4 million in free dental treatment to 8,000 Queenslanders. The service was so effective that in 2017 the Australian Government announced a two-year, $11 million commitment to introduce the model across the country.
Here, QCoal Foundation Chair, Christopher Wallin, and RFDS Queensland CEO, Nino Di Marco, reflect on their enormously successful partnership.
What sort of outcomes or impact did QCoal hope to achieve through its support of the program?
Christopher Wallin, QCoal Foundation Chair: The aim of the QCoal Community Dental Service was to develop an alternate delivery model, mobile service delivery, to address the existing need. The QCoal Foundation Board insisted that the program be efficient in terms of cost, effective in reaching the greatest number of patients and provide comprehensive and comparable levels of oral care to those found in a metropolitan dental surgery.
The mobile dental service comprises two state-of-the-art dental surgeries in a purpose built semi-trailer and during the four-year trial the service treated over 8,000 patients in 21 rural and remote communities in Queensland. The trial also collected vital clinical and operational data to support the model of mobile oral health delivery as an effective, flexible and cost-efficient solution to address the lack of oral care and subsequent broader health impacts in remote communities.
How would you describe your partnership with RFDS Queensland? What has been the most rewarding aspect of this relationship?
CW - The RFDS is an iconic Queensland and Australian organisation with a very clear focus on service delivery to those regions that are also the focus of the QCoal Foundation.
The most rewarding aspect for the QCoal Foundation has been watching the success of the program and seeing the real improvements to overall health across the regional and remote communities on the dental route. This would not have been possible without the clinical expertise of the RFDS.
What was the process for securing the Australian Government’s ongoing funding support of the program?
CW - The clinical and operational data gathered during the trial period formed the basis of the “Bridging the Gap” report written by the RFDS. This report presented a national picture of the state of oral health across regional and remote Australia and clearly articulated the impact of this to overall community health. The compelling data in the report led to increased interest amongst both state and commonwealth governments and formed the basis for further advocacy.
The RFDS National Office led the discussions with the Commonwealth Government with the QCoal Foundation providing support, particularly with Queensland representatives. Based on the outcomes of the QCoal Community Dental Service, the RFDS was successful in demonstrating strong need for frontline dental service delivery and secured $11 million in Commonwealth Government funding to facilitate access to dental service for people living and working across rural and remote Australia.
The QCoal Foundation, as Founding Partner of the QCoal Community Dental Service, was very pleased that through the Government’s commitment, the longer-term future of the service was assured.
The Government’s funding support also endorsed the model of mobile service delivery, as proven by the QCoal Community Dental Service, as an effective way to meet the needs of patients in rural and remote communities. Additionally, the support aligned with the QCoal Foundation’s focus on long term sustainability for programs and initiatives.
What has been the most valuable philanthropy lesson learned through this experience?
How did RFDS work with QCoal Foundation in the design and establishment of the community dental program?
Nino Di Marco, CEO RFDS Queensland: The development of the mobile dental service was inspired by discussions between QCoal Managing Director, Chris Wallin and RFDS Queensland Section, CEO, Nino Di Marco back in 2011.
Chris during his years of working in rural and remote areas of Queensland witnessed the poor state of oral health amongst the people who live in these isolated areas, a major determinant being a lack of access. With some communities more than 500km for the nearest dental service, the notion of “taking the service to the people”, was discussed – something the RFDS is known for with its fleet of aircraft.
Instead of developing a fly in fly out model where RFDS could supply dentists into communities with “fixed chairs” – dental surgery facilities in community – the concept was to develop a mobile service that could travel by road and be much more portable.
RFDS committed to seeking Commonwealth funding for a purpose-built airconditioned semi-trailer, equipped with two dental surgeries, x-ray equipment and IT connectivity, while QCoal Foundation pledged to support the operational funding of the program should the opportunity be realised.
In 2012, RFDS received $1.12million from the Government to construct the mobile dental unit and in February 2013, the service commenced. The commitment from QCoal Foundation to fund the operational needs of the service, around $1million per annum, allowed the RFDS to deliver dental clinics to between 15-20 rural and remote communities across central and north western Queensland on a per annum basis.
The service was appropriately named – QCoal Community Dental Service – in recognition of the significant contribution of its Founding Partner.
What were the biggest challenges in delivering the service?
NDM: There are many challenges when operating a service of this type. The logistics associated with moving the mobile dental unit via a prime mover to and from remote locations requires meticulous planning with issues such as road access, internet services, access to three phase power all needing to be considered. Then there’s the staff themselves ( two dentists and three dental assistants) for whom we must find accommodation and arrange their travel and roster commitments. The team work on a 2 weeks on and 1 week off basis. Workforce continuity is therefore probably our biggest challenge as while we operate on a similar FIFO model to many mining operations we have the added complexity of moving to and from different locations.
Aside from logistics and workforce issues, funding is also a challenge as there is still plenty of unmet demand. Both RFDS and QCoal Foundation throughout the four-year partnership were equally committed to looking at ways to sustain its future. Service planning and future funding aspirations were the subject of numerous discussions with the both state and federal governments, so we were both thrilled when the Commonwealth Government decided to announce funding for an RFDS national rural and remote dental program with an initial two-year commitment of $11 million across Australia – modelled on what it had seen delivered by our mobile service in rural and remote Queensland.
How would you describe your partnership with QCoal Foundation? What was the most rewarding aspect of this relationship?
NDM: The partnership with QCoal Foundation is a much celebrated one by the RFDS in Queensland as it allowed us to develop an entirely new primary health program. As our rural GP’s and child and maternal health nurses have witnessed in the remote communities we serve, the lack of accessibility to dental treatment is not only the cause of poor standards of oral health but also symptomatic of other health issues such as cardiovascular disease, diabetes and other chronic diseases. So, to be able to commence addressing this disparity and improve access was very rewarding.
Equally though, one of the most rewarding outcomes of our association with QCoal Foundation, was being able to develop a proof of concept around the cost effectiveness of mobile health service delivery and being able to advocate for its integration into public health program commitments.
The fact that the Service has now transitioned into a federally funded program, now linked to RFDS’ other rural and remote health responsibilities ( 24/7 aeromedical emergency, primary health clinics, mental health and tele-medicine), is something both organisations are both proud to have accomplished. Another outcome of this collaboration was recognising the importance of integration and service mapping with other dental service providers, private or public, so as to avoid duplication and identify areas of most need.
This program ticks a lot of ‘impact’ boxes from the philanthropic perspective (innovative initiative responding to real community need, government engagement and sustainability plus positive community outcomes). Are you seeing more philanthropists engaging in different ways with the work of RFDS?
NDM: Our partnership with QCoal Foundation has certainly sparked some interest amongst our philanthropic supporters. It was a substantial commitment to underwrite a multi-million dollar program and commit to its future until alternate source of funding and a sustainable model could be achieved. For that we are extremely indebted to Chris and his team.
For similar partnership models to work and for our range of health services and programs to achieve real outcomes, requires long-term vision and commitment – but this philanthropic initiative has achieved its three-pillared approach:
Develop and conceive a new program
What we are finding more and more amongst our philanthropic supporters is a desire to be involved in delivering successful health outcomes.
While assisting us to help fund our infrastructure needs (aircraft, medical equipment, operating bases/hangars) is still crucial, delivering better health outcomes via investment into tele-health/video conferencing, the professional and skills development of our people (doctors, nurses, mental health workers) is of increased focus nowadays.
To parallel the advances made in our oral health program, via our association with QCoal Foundation and come up with another “big idea” is our next challenge. Mobile service delivery has proven a successful business model in rural and remote health care access, so whether its heart health, cancer screening, hearing/audiology services, or chronic disease management remains to be seen.
What are your plans/objectives for the program going forward?
NDM: The RFDS Dental Service as it is now known, currently operates under a similar business model to the QCoal Foundation funded service, visiting 15-20 remote communities across Queensland per annum. Community need is identified through consultation with Hospital and Health Services (HHS’) with pre-existing dental outreach programs and our own waiting list information from communities we have visited since our Service’s inception in 2013.
Current funding is approximately $1.3 million per annum. Our objective for the program is to re-negotiate a further three to four-year term with the Commonwealth Government through until June 2022, as this aligns with our other traditional service commitments. The current program is funded through until June 2019.