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4.2 Better connect the regions

Regional Victoria’s longer distances make it more difficult for people to access the services and supports that underpin their wellbeing, and for businesses to connect with customers, compared with those in Melbourne. A better road and freight rail network can improve physical connections between regional businesses and markets and improve safety for all road users. But further opportunities remain to improve regional connectivity.

In regional Victoria, most people work and access services within their local area or nearby.1 But local public transport often does not provide the connections required to do this easily. Around a third of people living in regional and remote areas have reported difficulty accessing services.2 As jobs and services increasingly concentrate in regional hubs, this is only likely to continue. Fit for purpose transport solutions which allow regional Victorians to access essential services and employment opportunities are therefore a priority.3 Digital connectivity can also break down the barriers of cost and distance for regional Victorians, and open up new markets and opportunities for regional businesses.4

The COVID-19 pandemic dramatically illustrated the importance of reliable digital technologies, triggering a surge in internet use as people turned to digital alternatives to remain connected to work, education, services, family and community.

At the same time, there was a change in digital demand from central Melbourne to suburban and regional areas that revealed areas with inadequate internet access.5

People living in regional areas still have less access to education, health and community services than those in Melbourne, compounding inferior outcomes for vulnerable and disadvantaged Victorians.6

Infrastructure interventions alone cannot remove the underlying causes of disadvantage. But infrastructure can reduce the impact, by improving access to jobs, education, health and social services, for example through transport and digital connectivity. It can also improve access via new or better facilities or by supporting new service models.7

Infrastructure can reduce the impact of disadvantage caused by a lack of connectivity in the regions by improving access to jobs, education, health care and services through transport and digital technology.

Limited transport connectivity affects opportunities and outcomes for regional Victorians

Traditional scheduled public transport services perform best when moving many people to a shared destination. This makes it ideal in urban areas, but creates challenges in regional areas with dispersed populations, large distances and disparate travel patterns. Regional Victoria’s diversity means challenges accessing transport are not uniform, varying by regions, subregions, towns and rural areas. Public transport is stretched in areas of rapid population growth in regional hubs while in rural areas, smaller populations combined with longer travel distances mean that traditional public transport services can be infrequent, unreliable and potentially unviable.8

As a result, transport disadvantage – difficulty accessing public transport due to cost, availability or accessibility of services – is high in Victoria’s regions, where owning a car is often the only means of transport. However, car ownership can lead to financial stress, particularly among low-income households.9

The lowest 20% of income earners are much more likely to experience transport disadvantage than the highest income earner (at rates of 9.9% and 1.3% respectively), and low-income families living in regional areas face particular difficulties.10 Transport disadvantage is linked to social exclusion, where some people cannot fully participate in social and economic life.11 The groups most likely to experience social exclusion include young people, single parents and families with young children, older people, Aboriginal communities and people with a disability.12 Regional Victorians most in need of public transport are being left with either poor quality or non-existent transport services.13 The local transport system in regional areas can be designed to better meet the needs of residents. Responding to the different access needs and challenges of diverse local communities requires a flexible and adaptable transport system, and different models of delivery to those in Melbourne.

Improving digital connectivity in the regions will help break down the barriers of distance

Digital connectivity is increasingly fundamental to people’s lives.14 Digital technologies are changing how people live, work and interact with each other, and opening up new opportunities to access previously unavailable information and services.15 High speed and reliable internet connections can create regional jobs through telework,16 and allow businesses to expand beyond their local market.17 However, these benefits are not being shared equally across Victoria.

People living in regional Victoria often have slower internet speeds, fewer connection choices, and worse mobile coverage from fewer providers compared with Melbourne.18 In some regional areas, inadequate connectivity can make it harder to do business, access information, engage with remote services or even make mobile phone calls.19 The quality of regional mobile services is significantly and persistently worse than in Melbourne.20 For example, regional Victoria contains more than 94% of Victoria’s 2609 identified mobile black spots.21

Better quality, more reliable digital services can support innovative remote service delivery models and remote working, and reduce community vulnerability in emergencies. Better online access can help reduce the disadvantage experienced by people with lower levels of digital inclusion or skills.22,23

Agriculture, tourism, manufacturing and service industries across Victoria’s regions have advised us that better mobile and internet connectivity would support business opportunities.24

The combined impact of the 2019–20 bushfires, which damaged existing telecommunications infrastructure, and the COVID-19 pandemic has exacerbated digital inequality for some regional communities as unreliable internet connectivity has made home schooling, work and access to online services difficult.25 The ‘digital divide’ is evident not just between metropolitan and regional areas, but also within regional cities, towns and localities.26 Without the full benefits of new technologies, regional communities are likely to experience further inequality and reduced quality of life, especially as services continue to shift online,27 and regional businesses will continue to face barriers to growth and development. The Victorian Government can support targeted interventions to boost digital connectivity in regional Victoria, where the digital divide is most pronounced and where the market is less responsive.28 The Victorian Government is improving regional mobile coverage and broadband access through its Digital Future Now initiative,29 but there are further opportunities to provide more equitable access to affordable and reliable digital technologies, so regional businesses and communities can reap the full benefits.

Case study: Improving agricultural productivity via an on-farm Internet of Things trial

The Victorian Government’s $12 million on-farm Internet of Things (IoT) trial is exploring the agricultural industry’s digital needs. Agriculture is Australia’s least digitised sector. Digital technology could lift agricultural production values by as much as $20 billion30 by improving productivity, sustainability, profitability and resilience to weather and climate challenges.

IoT enables devices embedded with sensors to connect to and interact with each other via the internet. IoT devices can measure information such as soil moisture and livestock health, and monitor fences, vehicles and weather, to help farmers make more informed decisions and improve farm performance. The trial will establish up to 600 IoT-enabled farms across regional Victoria, partnering with farmers to evaluate the impact.31 Trials are still underway, and Infrastructure Victoria will continue to monitor the evidence being generated.

Insight: Is there a need for Very Fast Rail for the regions?

It is sometimes argued that Very Fast Rail services, operating over 200 kilometres per hour, can improve employment and education connections from regional centres to Melbourne, and from major regional centres to surrounding towns and the outer suburbs of Melbourne. Others have suggested that Very Fast Rail services encourage people to move out of Melbourne to help reduce congestion. However, little evidence suggests Very Fast Rail could significantly induce many people to move to regional Victoria from Melbourne.39

The COVID-19 pandemic has demonstrated the importance of reliable internet connectivity in the regions, a potential substitute in some instances for fast public transport access into central Melbourne. Likely costs and future demand suggest Very Fast Rail will also not be an appropriate solution for addressing Melbourne’s growth challenges. The Victorian Government is already making significant rail investments under the Regional Network Development Plan40 to improve service quality and capacity between Melbourne and large regional centres, including on the Geelong, Ballarat, Bendigo, Shepparton and Traralgon lines. The Regional Network Development Plan aims to deliver a modern commuter-style service for major centres and service improvements across the state, including through:

  • A minimum frequency of a train every 20 minutes at peak times and every 40 minutes in off-peak periods for services to Geelong, Bendigo, Ballarat, Seymour and Traralgon
  • Five services every weekday on the outer regional rail lines of Warrnambool, Bairnsdale, Albury-Wodonga, Echuca, Swan Hill and Shepparton.

However, the growth of Melbourne’s outer suburbs is placing pressure on some regional services as residents of these areas also use regional services. The capacity of services, rather than their speed, is the biggest challenge.41 For instance, building the Melbourne Metro Two tunnel (see recommendation 61) helps improve public transport access from Geelong. Similarly, reconfiguring the City Loop (see recommendation 60) and capacity improvements in the outer metropolitan rail corridors (see recommendation 74) will help regional access on those lines. Rather than investing in Very Fast Rail services, the Victorian Government can cater for more capacity by planning and monitoring how well current connections are being used, particularly between major regional centres and Melbourne, and improving services as required. The Regional Rail Link project is an example of this approach, as it responded to identified regional and suburban train capacity issues. Very Fast Rail is very expensive and does not necessarily result in a net benefit for regional areas. It may also lead to unintended consequences, such as further strengthening the ability of industry and education providers in Melbourne to compete with regional areas.42

While Very Fast Rail would lead to faster travel times from regional centres to Melbourne, this would contrast to travel times for residents in outer metropolitan Melbourne, who have lower levels of access to employment than other parts of the city. Current travel times from regional Victoria are already similar to, and in some cases faster than those in Melbourne’s outer suburbs.43

Connecting people to essential resources at major life stages can have a more profound impact

Different people and communities have different resources and experiences, meaning the advantages and opportunities they face in life vary. In general, people with fewer advantages have fewer resources, and can access fewer services, influencing their life opportunities and outcomes.32

Regional Victorians tend to have less access to services, resources and opportunities because of distance. This can compound other types of disadvantage they may experience, such as poverty or social exclusion.33 For example, an estimated 15% of regional Victorians live in poverty, rising to 23% in children, compared with 13% of people in Melbourne, and 17% of children.34 The impact of bushfires, followed by the COVID-19 pandemic, may cause these levels to rise.

Young people in regional areas are less likely to finish school, find work, or undertake tertiary study.35 By age 16, nearly one in six young people in regional Victoria have left full-time secondary education compared with one in eight in Melbourne. At age 24, a third of regional Victorians are not engaged in education, employment or training.36 For some, poverty or disadvantage can become entrenched. Interventions which help break the cycle of persistent disadvantage can deliver enduring benefits for the individual, for local communities and Victoria.37 Infrastructure which connects people to services and supports at major life stages – including early years, the transition from school to work, family wellbeing and ageing – are likely to have bigger positive impacts.38

Recommendations to better connect the regions

Infrastructure Victoria is making the following recommendations to improve connectivity in regional Victoria. These interact with other recommendations to align social infrastructure with better service delivery (see section 3.3), unlock economic growth opportunities (see section 4.1) and improve the resilience of communities (see section 1.3)

Recommendation 83: Redesign regional public transport to meet local needs

In the next five years, redesign existing regional transport services so they are integrated, based on regional needs assessments, and sustainably funded. Use significant technological and reform opportunities to deliver innovative service models that meet local needs.

Transport disadvantage – difficulty accessing public transport due to cost, availability or accessibility – is high in Victoria’s regions. Around 30% of residents in outer regional and remote areas have reported difficulty accessing services.44 Limited transport options reduce access to work, education, health care, shops, services and social connections.

Regional Victorians depend heavily on owning their own car for transport. Owning a car often leads to financial stress, especially amongst people with low incomes, who are also much more likely to experience transport difficulties than people with high incomes.45 Better public transport access means everyone can stay connected to their communities and access employment, education and services.

Regional Victoria’s relatively low population density and long travel distances make regional public transport challenging and expensive to operate. Excluding fare recovery, the Victorian Government spent $807 million operating regional public transport in 2019–20.46 This is a quarter of Victoria’s public transport operating spend but supports only 6% of trips. Of this regional expenditure, only around 20% goes to local bus services, despite these carrying nearly 40% of regional passengers.47 Opportunities exist to redirect committed regional public transport funding to modes and service models that best meet local needs, before considering whether more funding is needed. Victoria’s regions have a patchwork of transport services, including local and regional scheduled public transport, school buses, local community transport services, subsidised taxis, and specialist transport funded by the National Disability Insurance Scheme48 and Commonwealth Home Support Program.49 At present these services are largely funded and delivered independently, without coordination, and often overlap or leave gaps in coverage. For instance, many regional school buses currently lay idle outside of school travel times.50,51 Removing existing regulatory barriers and deploying new technologies potentially allows existing bus fleets to be used for new innovative service models (see recommendation 22) and better use the existing bus fleet.52,53 A number of these reforms are proposed in Victoria’s bus plan.

The Victorian Government must continue to design regional public transport for regional circumstances, and not simply replicate city-style models. The four-year Flexible Local Transport Solutions Program demonstrates some alternative possibilities. The program provides financial support to help seed small-scale initiatives that address transport disadvantage, integrate with other local transport options and improve transport access across regional Victoria.54 However, funding is time-limited, and imposes a heavy burden on communities to demonstrate feasibility, innovation, and social, economic and sustainability benefits. ConnectU is another example of a small-scale demand responsive travel service for people in need around Warrnambool.55

To respond, the Victorian Government should work collaboratively with local transport providers and communities to determine local transport needs,56 using regional needs assessments focused on disadvantaged groups, including a common measure of access to services, as well as adopting a clearer classification of regional routes as provided for in Victoria’s bus plan. Local collaborative governance and planning arrangements can give communities a voice and help coordinate local transport options, including bus services, community transport, school buses, commercial passenger vehicles and car-sharing. It can also guide development of an integrated and flexible service mix that meets community needs, and for services to seamlessly connect. Technology also provides opportunities for better coordination. New flexible transport services ultimately need to move away from short-term trial funding to recognise the value of access to services for disadvantaged regional Victorians, with ongoing funding to be determined following a successful pilot. Integrated governance can also link with service planning for integrated facilities (see recommendation 88), so people can access local services.

Insight: Improving education access in Gippsland.

When the Wonthaggi campus of Chisholm TAFE closed its building and construction program in 2017, Bass Coast and South Gippsland students needed to travel to Korumburra to enrol in the only regionally available course. The Flexible Local Transport Solutions Program funds charter buses so students can travel to vocational education providers in Korumburra and Leongatha. The services run several days each week, picking up vocational education students from Phillip Island, Leongatha, Wonthaggi and Inverloch. With local contributions, a weekly community bus service from Mirboo North has been added.57

The service allows many local students to attend training. There is no other public transport service available to transport students to the region’s vocational education providers, including for building and construction courses such as carpentry and plumbing. Access to these training opportunities improves young people’s employment prospects and opens career pathways which would otherwise be unavailable. The service currently runs on Victorian Government funding of $107,000, with other contributions from partner organisations. However, as a pilot program, funding is set to cease in 2021.

Recommendation 84: Address regional Victoria’s digital connectivity gaps

In the next five years, continue delivering regional digital connectivity improvements, and monitor and review the need for further government investment following the roll-out of the Digital Future Now initiative.

Digital access is increasingly indispensable for everyday life, underpins the economic and social development of communities and provides a virtual alternative to face-to-face contact.58 The COVID-19 pandemic has starkly illustrated the importance of reliable, high-speed internet. People now more frequently use digital technologies for work, education, health care and other service delivery, and to maintain social connections.59 It reveals the need for all Victorians to have the same opportunities to remain digitally connected, wherever they live.60

Communities distant from Melbourne and major centres have most to gain from reliable digital connectivity, but currently have the worst connections. Inferior digital connectivity is a significant problem throughout regional Victoria.61 It affects community safety, access and business productivity.62 All Victoria’s Regional Partnerships have identified poor mobile coverage in their region.63 They also show an unmet need for reliable and cost-effective business-grade broadband in many regional cities, towns and localities.64

Access to high speed internet benefits communities and businesses by supporting remote access to health and education, and by improving access to markets and workers. It can support new jobs and businesses,65 and increase productivity in industries like agriculture by helping farmers adopt smart technologies.66 High speed internet can influence where businesses locate, and improve local economic performance.67 Businesses without access are disadvantaged, and those operating in regional Victoria identify inadequate digital services as a barrier to business growth.68

Limited internet competition in some regional areas means businesses and communities do not have the same access to fast, reliable, and affordable broadband as those in city centres. High upfront costs can discourage individuals and businesses from paying for extensions to high speed internet infrastructure, and they may experience more detriment by restricted access to future technologies.69

The Victorian Government’s $626 million Digital Future Now initiative aims to improve mobile coverage and broadband access in regional areas, and deliver upgrades in communities with only satellite and fixed wireless access.70 Running until 2025, it includes business-grade broadband upgrades for certain suburbs and regional towns, to address gaps in reliable high speed business broadband. It also incorporates a six-year mobile black spot eradication program for populated areas of regional Victoria. Both initiatives are co-funded by the Australian Government. The Australian Government’s Regional Connectivity Program also funds telecommunications infrastructure projects aiming to deliver fast, affordable, and reliable digital connectivity in regional and rural Australia.71

The Victorian Government should continue to monitor the state of digital connectivity across regional Victoria and review the need for more government support after the term of Digital Future Now. The review should consider broadband and mobile coverage, speed, and reliability, and whether available technologies meet changing business and community needs. It should evaluate the impact of service upgrades, focusing on those places which did not benefit, or which experience ongoing connectivity issues, and on any ongoing barriers to digital access for vulnerable Victorians.72 A review is merited because digital technologies will continue to evolve, and community expectations of connectivity will increase in future.

Case study. Horsham’s enhanced broadband project.

In 2018, the Victorian Government’s Connecting Regional Communities Program funded a $1.7 million pilot scheme in Horsham to demonstrate new ways of delivering high speed broadband in regional areas.

After a competitive tender process, Spirit Telecom was awarded the contract to construct five towers across five districts in Horsham. Each tower transmits fixed wireless broadband at 5G standard with speeds up to one gigabit per second in both directions. Each tower covers a 10-kilometre radius throughout Horsham, including the Horsham Central Business District, Horsham Enterprise Park, aerodrome and freight terminal precincts.

These increased broadband speeds will also be available to homes across Horsham to give the entire community access to internet services on par with metropolitan Melbourne.

Horsham-based farm equipment machinery franchise Emmetts is one of the first businesses to sign up to Spirit’s new broadband network, functioning as an ‘anchor tenant’ to help the project succeed. The business operates across Horsham, Swan Hill, Rupanyup, Warracknabeal and parts of South Australia, and now has dramatically faster broadband speeds with fewer dropouts, boosting their business across regional Victoria and beyond.73,74,75

Recommendation 85: Improve regional telecommunications infrastructure resilience

In the next five years, develop more resilient regional telecommunications infrastructure so communities can stay safe during emergencies, including better mobile coverage, back-up systems and power supply, and emergency mobile roaming.

Telecommunications services keep communities safe, connected and informed during emergencies.76 Victorians can access emergency information and warnings via VicEmergency and other online services,77 allowing them to stay informed and take appropriate action.

People most commonly access the internet using mobile devices.78 However, regional Victoria experiences significant problems with mobile coverage.79 Victoria’s Regional Partnerships identify particular problems with poor mobile coverage near tourist attractions,80 along transport corridors,81 and in smaller settlements and farming areas.82 This confirms our own research into regional infrastructure needs.83

The 2019–20 bushfire season starkly demonstrated the vulnerability of Victoria’s regional telecommunications infrastructure, beyond patchy mobile coverage. Thirty-eight towns lost communication, mostly caused by power outages, and impassable roads cut off 17 of these towns.84 In emergency situations, communities expect to be able to make calls for emergency assistance, access relevant mobile apps, receive text-based emergency alerts, and communicate with family and loved ones. The Australian Government has established a program to improve mobile connectivity in bushfire prone areas on the fringe of Australia’s cities,85 but more can be done. Telecommunications services are essential for public safety during natural disasters, and to transmit urgent information to emergency response workers.86

The Victorian Government should co-invest with the Australian Government, telecommunications companies, and energy providers to develop more resilient telecommunications infrastructure so communities can stay safe during emergencies. High emergency risk areas should be the priority, as well as road and rail routes, population centres, tourist attractions and areas of agriculture and other economic activity. More resilient communications will need a comprehensive approach across fixed, mobile and Wi-Fi networks. This can include more co-investment to improve regional mobile coverage (see recommendation 84), stronger power supply back-up systems and greater telecommunications network continuity, potentially including third-party use of mobile towers.87 The Victorian Government should also work with the Australian Government and telecommunications providers to require emergency roaming between mobile network operators, to provide backup coverage for mobile users out of range of their own network during an emergency.88

Preparing for emergencies can also include educating communities on residential power back-up options, including alternative charging methods or battery powered communication devices. For example, the Australian Government’s Strengthening Telecommunications Against Natural Disasters package is improving community awareness about access to telecommunications during national disasters, so people consider a communication plan as part of their bushfire preparation.89 Better community awareness complements improved telecommunications infrastructure resilience to reduce the impacts of emergencies.

Recommendation 86: Fund regional libraries to provide better internet access

In the next year, start a five-year funding program for libraries in regional towns and rural areas to improve community access to fast, free internet services, leveraging existing library infrastructure.

In an increasingly digital age, Victoria’s public libraries are evolving to support lifelong learning, community engagement and wellbeing.90 They provide greater – and free – access to digital technologies such as computers, software, broadband and Wi-Fi, and training in using them.91 A higher proportion of regional households lack access to the internet, particularly those in remote communities, on low incomes, or in social housing.92 All Victorian households and businesses should have equal access to reliable internet services (see recommendation 84).

Many people use libraries to access digital services, participate in social networks and use online public services,93 as they are often the only source of free internet access and Wi-Fi in regional areas.94 Local libraries also support business needs, with start-ups, small businesses and workers using them for research, access to technology, digital training, co-working spaces and training rooms.95 These digital services can be especially critical during and following emergencies, for example libraries may be places of refuge during high heat days and bushfire smoke events (see recommendation 90).

Libraries in rural areas are often efficient and effective.96 They do, however, face greater financial challenges than their metropolitan counterparts. Many rural and regional councils have limited resources to invest in libraries, as they have a smaller number of rate payers and fund multiple services to geographically dispersed towns with small, but often high-need, populations.97 Local community impact is likely greater, as public Wi-Fi is usually only available at libraries in regional areas during restrictive opening hours, while extended hours and other options are more common in Melbourne.98 To continue to provide free and reliable access to digital services, libraries in rural and regional Victoria need more investment.

The Victorian Government should provide new dedicated funding to help regional libraries provide access to secure, fast, scalable, resilient, and reliable free internet services. To meet local community needs, libraries would be invited to propose solutions for enhancing internet access, leveraging existing facilities and infrastructure. Specific investments may include: upgrades for reliable, modern digital infrastructure; security systems and layout upgrades to support out-of-hours access; extending library Wi-Fi to surrounding public spaces outside normal library hours; and installing Wi-Fi technology in mobile libraries. Out-of-hours access would not be a condition for eligibility, though upgrades may support extended hours.

The new funding stream should be established, with a budget of $7 million to $10 million over five years. An investment of $6.5 million to $7 million would support upgrades to half of the 140 public libraries in regional and rural Victoria over this period99 at up to $100,000 each.100 Smaller sums could also support the technical fit-out of the fleet of 24 mobile libraries.101 An evaluation should inform funding beyond the first five years.102 This funding should complement that already provided through the Living Libraries Infrastructure Program, which funds library infrastructure upgrades and is already oversubscribed.103 The Victorian Government could provide this funding through a new library technology fund, with local government retaining responsibility for ongoing operational costs.

Case study. Foster Library, West Gippsland.

Foster, in Victoria’s Gippsland region, has a population of fewer than 1200 people. The town’s library serves as a gathering point for the community. Foster Library is the first in Victoria to open 24 hours a day, seven days a week. From August 2019, approved library members have been able to swipe to enter the library after hours, giving them secure access to books, workspaces and free Wi-Fi (those under the age of 18 years cannot enter unless accompanied by an adult with a valid family pass).

West Gippsland Libraries first envisaged the model in response to community requests for increased opening hours. During community consultation, they determined that round-the-clock access would best suit community needs because over half of the community work more than 35 hours a week and a quarter of people do not have internet access at home.

The library extended its opening hours, beyond its normal staffed hours. Security systems, alarms and video cameras have been installed for safety and security. The Victorian Government funded the upgrade cost of $92,000, with $20,000 from West Gippsland Libraries, and $3000 from the Friends of the Foster Library. As at the end of March 2020, Foster Library has seen a 14% increase in active memberships and a 54% increase in visits compared with the prior year. Following the success of the trial in Foster, West Gippsland Regional Library Corporation plans to roll out 24/7 access to more libraries across its network.104

Recommendation 87: Use rural schools for children’s specialist and allied telehealth services

Retrofit or better use selected rural school infrastructure for children’s specialist and allied telehealth services to improve children’s health and development. In the next year, begin a trial in a remote region, such as Wimmera Southern Mallee, to demonstrate the value of adopting the approach in other rural locations.

Children’s health and development milestones in regional and remote areas are consistently behind those in urban areas, with paediatricians struggling to meet their emerging needs.105 More children have developmental or behavioural concerns in disadvantaged regional communities.106 Those families experiencing the greatest disadvantage have the most to gain, but are least likely or able to engage with health and education services. Better quality and easier access to health care and support services for families can help children before and during school.107 This includes the need to Close the Gap in life outcomes and support Aboriginal children and families to connect with Aboriginal and other services in a culturally competent way.108

Victoria’s regions face a critical shortage of skilled health and support workers. Allied health workers in rural and remote areas service a population at least five times greater than their metropolitan counterparts. Greater use of telehealth services could help. While not appropriate for all health needs, telehealth services can complement in-person services by using digital infrastructure to provide access to specialist and allied health services (for example, paediatricians).110 Specialist telehealth services have substantial capacity for expansion. For example, in the Wimmera Southern Mallee region from January 2017 to August 2019, only 77 out of 2315 specialist outpatient appointments at the Royal Children’s Hospital were delivered by telehealth.111 Current government funded health and education services vary widely in quality and effectiveness, and are often not well coordinated.112 Government schools across Victoria already have technology and facilities for e-learning.113 This technology could also be used to deliver paediatric and allied telehealth services, with a focus on prevention and early intervention for all children 0–18 years. Some Victorian secondary schools already deliver health services such as consultations with doctors114 and mental health practitioners.115 As schools are not set up for patient monitoring and diagnostics, these types of telehealth services should remain on health sites. However, extending health services on school sites to paediatrics and allied telehealth would improve access to appointments with health professionals, reducing the need to travel long distances.116

The Victorian Government should fund a trial to develop and run a range of paediatric and allied telehealth services from selected rural schools, as part of moving to a more integrated service model.117 These services would complement a greater focus on improving models of care (recommendation 25). Victoria’s Wimmera Southern Mallee region is among those most able to benefit. Families travel long distances from this region to access specialist support and health care. Families also experience difficulties receiving the right information, education, health care support and expertise once children start school.118 This region already has willing partners in place, a pre-requisite for successful delivery of local responses.119 Trialling this approach in the Wimmera Southern Mallee region can show its potential benefits and find improvements through an evaluation before any decision to expand the service. The choice of sites and delivery models should be informed by local service planning, and address any regulatory, transport or other barriers to effective delivery. Minor infrastructure upgrades may be needed on some sites, such as more video screens.

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