The Freo Street Doctor – Past Present & Future?

Many of us have seen the Freo Street Doctor’s van delivering health services around Freo over the years.

The service is run by Black Swan Health. It’s been such a great initiative.

And it’s a registered charity, so your donations are tax deductible.

But funding is still an issue.

The State and federal governments do not directly contribute to operational costs.

But local governments, especially Fremantle, have done their best to assist.

Since State Government funding ceased in 2019, the City of Fremantle has stumped up $20,000 a calendar year to help out.

Funding remains a year to year proposition.

Black Swan Health currently receives support from local governments and philanthropic donations, some larger than others.

It’s now that time of the year when Black Swan Health are needing support again.

There is currently an application before the Freo Council requesting a renewal of the $20,000 annual sum.

The Council Officers have assessed the application as worthy and have recommended to the Council that it be supported.

The recommendation is that –
1. Supports the budget allocation of $20,000 for Black Swan Health for the Freo Street Doctor mobile health clinic as a part of the 2021/2022 budget deliberation process.
2. Acknowledge and thank the Freo Street Doctor team for the service they have provided to the most vulnerable members of the community through the pandemic.

The reason Council Officers support the grant is perhaps obvious, but it bears repeating.

Continued funding for the Freo Street Doctor is supported because it assists and supports the most vulnerable and marginalised members of the community,Manx has done so for seventeen years. And because the service is a visible, accessible and non- judgemental primary health care service for members of the community who are marginalised, disadvantaged and experiencing homelessness.

The Officers also observe that working to improve the health outcomes of the community, the Freo Street Doctor aims to improve a client’s capacity to develop social interaction, employment opportunities and to become more connected and involved within the community. Whilst individuals receive direct health care, the service supports the health of the broader community by addressing chronic health conditions through health education, harm minimisation strategies and dedicated treatment plans for health needs and substance abuse issues prevalent in the Fremantle community.

The recommendation comes before the Finance, Policy, Operations and Legislation (FPOL) Committee of Council on 12 May 2021. It’s hard to imagine the Committee will do anything but adopt the recommendation. But we will confirm that after the 12 May meeting.

You might be interested, however, as we were, to know a little more about the facts and stats of the service today. Here’s what we can tell you.

Black Swan Health has been delivering the Freo Street Doctor mobile health service in Fremantle for 17 years, since 2004, providing vital free medical and mental health support to homeless, at-risk, marginalised, disadvantaged and vulnerable people in the Fremantle community.

The service is delivered by General Practitioners, supported by Registered Nurses, Outreach Workers and Counsellors. The team of health professionals deliver physical and mental health care, as well as linking and referring clients with complementary social services to support their complex needs.

Since 1 July 2019, Black Swan Health has received no State funding, or Federal Government funding either, for the Freo Street Doctor’s operational needs. Medicare Benefits Schedule payments are claimed for General Practitioner delivered services, supporting the cost of General Practitioner salary.

While the City has encouraged the State’s Health Department to reinstate financial support, their request has fallen on deaf ears. The City has been advised by he Department that the program is considered a primary health program funded by the Commonwealth. A classic responsibility shuffle we the citizens are well used to hearing.

You’ll be pleased to hear that the Freo Street Doctor continued face-to-face service delivery during the Covid pandemic restriction periods in 2020 and 2021, allowing clients to continue to receive primary health care support.

Here’s some stats on the Freo Street Doctor service delivery for the 9 month period 1 July 2020 to 31 March 2021.

Service Delivery
• 188 x three-hour clinics within Fremantle;
• 1303 medical consultations;
• 1070 mental health interactions.

Presenting Health Conditions
• 68% of patients have at least two chronic health conditions;
• 22% of clients have three of more chronic health conditions.

During the reporting period the highest number of presentations were for:
• Respiratory conditions;
• Musculoskeletal conditions;
• Mental health conditions;
• Cardiac conditions;
• Diabetes;
• Ear, nose and throat conditions;
• Gastrointestinal conditions;
• Dental conditions.

On two occasions the service funded ambulance transport to Emergency Department for acute health conditions.

• 37% of Freo Street Doctor clients identify as female;
• Notably at the Davis Park clinic 65% of clients identify as female.

• 3% of clients are aged below 14 years;
• 4% of clients are aged between 15 and 24 years;
• 27% of clients are aged between 25 and 44 years;
• 57% of clients are aged between 45 and 64 years;
• 9% of clients are aged over 65 years.

Cultural Diversity
• 24% of patients identified as Aboriginal or Torres Strait Islander people; • In the reporting period, three clients identified as having culturally diverse

Social Status
• 22% of patients are homeless or in crisis accommodation;
• 97% of patients have no other source of healthcare support.

Client Feedback
• Freo Street Doctor clients are regularly requested to provide feedback on the
service they received at clinics;
• 100% of clients rated the level of respect they received as ‘excellent’;
• 100% of clients rated the treatment received as ‘excellent’.

Davis Park trial

Through partnerships with Imagined Futures (Fremantle District Leadership Group) and the participating organisations, agencies and local government authorities, most notably the City of Fremantle, Freo Street Doctor also commenced a trial clinic at Davis Park in Beaconsfield early in 2021.

The trial clinic was initially conducted on a fortnightly basis, however demand for the service now supports a weekly clinic. As an example, the clinic delivered at Davis Park on 23 April 2021 in which 16 consultations were delivered.

Current locations

The current location for the mobile health clinics in Fremantle includes the following locations:
• Monday – Foundation Housing, 100 Hampton Road;
• Tuesday and Thursday – St Patrick’s Community Support Centre;
• Wednesday – Fremantle Oval;
• Friday – Fremantle Oval;
• Friday – Davis Park, Beaconsfield (new service based on need).

The sustainability of the service.

It is important to note that Council Officers recognise that termination of State funding in 2019 has impacted the sustainability for the Freo Street Doctor to provide regular clinics for the Fremantle community.

As a result, Black Swan Health, supported by the City of Fremantle and other stakeholders, has initiated a multi-focus sustainability strategy to safeguard the future of Freo Street Doctor, including through –
• Ongoing advocacy to all levels of government for service funding to meet the needs of the increasing cohort of people accessing the service;
• Successful development of volunteer workforce of Registered Nurses and outreach workers;
• Development of philanthropic giving and sponsorship program to secure ongoing financial support from a range of funders;
• In-kind support from business to provide medical supplies;
• Identification and pursuit of all available funding and grant opportunities;
• Development and maintenance of long-term, collaborative partnerships that enable streamlined referral pathways, maximise client attendance through co-location of services and support shared knowledge of trends and issues within the community.

The Council Officers also recognised that Black Swan Health has received philanthropic funding for the service from a number of trusts within the Fremantle area and is currently in discussion with a new potential donor.

Community service groups also continue to support Freo Street Doctor, for example Soroptimist International Fremantle, Freo Fins Swimming Club and North Fremantle Football Club. SMYL provides free of charge secure parking for both Fremantle Street Doctor vehicles.

The wonderful thing about Freo Street Doctor is that the service has developed strong community linkages with the most vulnerable people in the local community. Relationships are built with clients to support their wellbeing, from a person-centred approach, based on their individual needs. But, while the General Practitioner costs are covered from the Medicare Benefits Schedule, further financial support is imperative for the operational costs to meet the service provided. A reduction or cessation of City funding could impact the most vulnerable within the community.

Let’s hope the future of the Freo Street Doctor can be put on a more sustainable footing than it currently has before too many more years pass.

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