NACCHO Aboriginal Health #refreshtheCTGRefresh @jackietrad Queensland Minister for Aboriginal and Torres Strait Islander Partnerships : How Queensland reform will #ClosetheGAP

 ” We asked the Queensland Productivity Commission to examine how res­ources devoted to service delivery in remote Aboriginal and Torres Strait Islander communities could be best used to meet their needs. It was clear from those findings, delivered in June, that we must reform and reframe the way we work with the state’s 19 remote communities.

They have given us a clear message: “Stop consulting us. Stop engaging us. Stop doing things to us and start doing things with us. Start to hear what we’re saying, and make us equal partners and key enablers in turning around the disadvantage our people face.”

Jackie Trad is Queensland Deputy Premier, Treasurer and Minister for Aboriginal and Torres Strait Islander Partnerships. see extracts from Health Report here

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Chapter-17-Health-and-wellbeing

This year marked 10 years since the release of the landmark report Closing the Gap, which for the first time held governments accountable for addressing the endemic inequality that exists between indigenous and non-indigenous Australians. There has been significant progress in areas such as Year 12 completion, employment and reducing infant mortality, but in some areas the gap has widened.

Does that mean we have been too ambitious? Of course not. It is incumbent on this generation to be ambitious in pursuing a better future for First Nations people and to right the wrongs of the past by tackling injustice, poverty and disadvantage. We cannot hope to achieve this unless we learn from mistakes, build on good work and acknowledge what doesn’t work.

In 2016, the Productivity Commission was scathing in its assessment of 1000 government programs to tackle indigenous disadvantage, finding that just 34 of them had been properly evaluated. It recommended more robust evaluation and publication of results.

These requests are central to achieving real change. We must stop punishing people and start empowering them. I am steadfast in my desire to make this happen. I want the Palaszczuk government’s response to be more than just a shopping list of things we are providing communities. We must throw away the bureaucratic playbook that has hampered change, and must work together to give real meaning to local authority, local decision-making and self-determin­ation.

I have tasked my director-general, Chris Sarra, to work with communities to test and work through the QPC recommendations and to put in place a framework that will enable commun­ities to thrive. It’s an agenda not devised and proselytised from Brisbane but shaped by the people who live in the unique communities across our state — communities such as Cherbourg, Yarrabah, Doomadgee and Thursday Island.

Thriving Communities will build on past successes and acknowledge failures. There is a clear place for the policy agenda advanced by Noel Pearson’s welfare reform trial and the Families Responsibilities Commission. For 10 years the FRC has been fac­ilitating behavioural change through conditional access to welfare payments in five communities in Cape York. Like Closing the Gap, the program has had mixed success.

Despite its protestations, the federal government knows this too. In June 2015, Indigenous Affairs Minister Nigel Scullion wrote to the Queensland government seeking support for a new “lower cost approach” to the FRC, citing the current model as expensive and with limitations. Consequently, for two years, all parties have been engaged in a review of the model — a fact notice­ably absent from Scullion and special envoy Tony Abbott’s recent commentary. There also has been no mention of their failure to allocate funds to the program beyond this month.

While the federal government remains distracted by internal turbulence, we are committed to working with communities to give them the self-determination they need.

About the Inquiry

In September 2016, the Queensland Government announced the Queensland Productivity Commission (QPC) would inquire into service delivery in remote and discrete Aboriginal and Torres Strait Islander communities. The Inquiry was announced in response to concerns expressed by Indigenous leaders that the level of investment in all services (federal, State and non-government) was not delivering higher outcomes for members of their communities.

The QPC was asked to consider investment in remote and discrete Indigenous communities and what works well, and why, with a view to improving outcomes for Aboriginal and Torres Strait Islander people.

The QPC has released its final report which is available on the QPC website.

The QPC Inquiry Recommendations

The QPC Inquiry final report and recommendations are based on extensive consultation with more than 500 stakeholders and remote and discrete Indigenous communities in Queensland.

The QPC Inquiry final report shows examples of good service delivery that can be built upon but most stakeholders agree that there are opportunities to improve how services are designed, funded and delivered that will work towards better outcomes for Aboriginal and Torres Strait Islander Queenslanders.

The QPC Inquiry final report provides 22 recommendations and proposes a substantial reform agenda for policy and service delivery that includes structural reform, service delivery reform and economic reform, to be supported by capacity and capability building of all stakeholders, and timely and transparent transfer of data to measure performance and evaluation.

The Queensland Government Response to the QPC Inquiry

The Queensland Government makes a long-term commitment to work with the 19 remote and discrete Aboriginal and Torres Strait Islander communities, their leaders and Mayors and other stakeholders to implement the intent of the reform agenda proposed by the QPC.

The Queensland Government has provided its response to the final report (PDF, 521 KB).

Key points Health Delivery (text added by NACCHO ) 

􀁸 Indigenous people in remote Queensland experience a burden of disease and injury 2.4 times the non-Indigenous rate—mainly chronic disease, mental disorders, cancers and intentional injuries.

􀁸 Socioeconomic determinants (education, income, overcrowding), racism and discrimination play a significant role in the health gap, along with behavioural and environmental risk factors.

􀁸 The health system is a multifaceted network of services and settings, involving a variety of public and non-government providers, funding arrangements, participants and regulatory mechanisms.

System issues

􀁸 The ‘silo’ approach to service delivery is problematic for communities. It is difficult to ensure services are adequate, appropriate, coordinated and not unnecessarily duplicated, and meet community priorities and user needs.

􀁸 Mainstream mental health services do not meet the cultural needs of Indigenous people, who view social and emotional wellbeing as incorporating individuals, their families and communities.

􀁸 Service providers and institutions are not well-equipped to respond effectively to the distress Stolen

Generations can experience when using those services—distress that arises from the role of those institutions in past injustices.

􀁸 Anecdotally, Foetal Alcohol Spectrum Disorder is prevalent, and access to diagnosis limited.

􀁸 Access to healthcare can be problematic—issues include ineffective, nil or confusing referral pathways, lower screening rates and limited access to renal care and rehabilitation centres. There are significant gaps in the Indigenous health workforce.

What is working

􀁸 Aboriginal and Torres Strait Islander community-controlled health services provide effective, culturally appropriate and multidisciplinary models of comprehensive primary healthcare.

􀁸 Family Wellbeing is an example of a cultural healing program that has been found to increase the capacity of participants to exert greater control over their health and wellbeing.

The reforms proposed by this inquiry can provide an enabling environment for stakeholders to develop collaborative and flexible solutions to these challenges.

 

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