NACCHO Aboriginal Health NEWS ALERT : @AMAPresident speech to Indigenous Doctors @AIDAAustralia #AIDAConf2018 – Making Indigenous health an election issue -Together we can indeed turn vision into action.

 

” The latest data indicate that only three of the seven Closing the Gap targets are on track to be met.

This is a potent political message to get the attention of the major parties and the broader Australian community – the voters.

And we now have a significant opportunity to advocate strongly for Government action to do better – a Federal Election is drawing closer.

The coming months are the perfect time to campaign and advocate to improve the health of Aboriginal and Torres Strait Islander people and communities.”

Everybody knows that health policy changes votes.

There will be more significant funding announcements across the health portfolio in the next six to nine months.

We must ensure that Indigenous health gets its fair share.”

Tony Bartone AMA President AIDA Conference 28 September

Picture above : Dr Bartona congratulating Dr Kris Rallah-Baker new AIDA president and looking forward to welcoming him at AMA Federal Council. 

Picture below Dr Bartone meeting with the Minister and NACCHO Executive team

Read over 30 NACCHO Aboriginal Health posts from the AMA

I acknowledge the Wadjuk Noongar people – thetraditional owners and custodians of the land, and pay respects to their elders, past and present.

My thanks to the Australian Indigenous Doctors’ Association for the invitation to speak here today. It is a great privilege.

Aboriginal and Torres Strait Islander people face adversity in many aspects of their lives.

There is arguably no greater indicator of disadvantage than the appalling state of Indigenous health.

Aboriginal and Torres Strait Islander people are needlessly sicker, and are dying much younger than their non-Indigenous peers.

What is even more disturbing is that many of these health problems and deaths stem from preventable causes.

There are many groups and organisations dedicated fulltime to changing things – AIDA, NACCHO, Lowitja, Aurora, the Medical Colleges, the universities, AMSA (our medical students), the nurses and midwives, and other foundations and agencies. Too many to mention.

And there are many individuals who campaign long and loud and hard – people like our MC today, Dr Jeff McMullen.

The AMA places improving Indigenous Health always as a major priority in our advocacy.

I see our role more as a catalyst for political action.

We have significant influence within Federal politics in Canberra across the whole spectrum of health.

We have policy, much of it contained in our annual Report Cards.

And we respond to policy or funding announcements – or lack of them – at Budget time.

Tragically, we have seen more cuts than top-ups. Funding is going backwards.

The core of AMA policy is the same as everybody at this Conference – proper funding for proven targeted programs and services that are delivered in a community-controlled way.

The AMA will work closely with all stakeholders to ensure all our policies get the attention and responses they deserve.

But, as we all know, the battle to gain meaningful and lasting improvements has been long and hard, and it continues.

The statistics speak for themselves:

  • A life expectancy gap of around ten years remains between Aboriginal and Torres Strait Islander people and other Australians.
  • The death rate for Aboriginal and Torres Strait Islander children is still more than double the rate for non-Indigenous children.
  • Preventable admissions and deaths are three times higher in ATSI people.
  • Medicare expenditure is about half the needs-based requirements, and PBS expenditure is about one third the needs-based requirements.

On top of this, we have the Closing the Gap targets to map progress – or measure failure.

The latest data indicate that only three of the seven Closing the Gap targets are on track to be met.

The target to halve the gap in child mortality by 2018 is on track.

The target to have 95 per cent of all Indigenous four-year-olds enrolled in early childhood education by 2025is on track.

The target to close the gap in school attendance by 2018is not on track.

The target to halve the gap in reading and numeracy by 2018 is not on track.

The target to halve the gap in Year 12 attainment by 2020 is on track.

The target to halve the gap in employment by 2018 is not on track.

The target to close the gap in life expectancy by 2031 is not on track.

Three out of seven is not good.

This is a potent political message to get the attention of the major parties and the broader Australian community – the voters.

And we now have a significant opportunity to advocate strongly for Government action to do better – a Federal Election is drawing closer.

The coming months are the perfect time to campaign and advocate to improve the health of Aboriginal and Torres Strait Islander people and communities.

Everybody knows that health policy changes votes.

The Coalition almost lost Government in 2016 because of health policy.

It is not surprising that we are currently seeing a much higher profile for health issues.

We currently have a focus on aged care. The Government has announced a Royal Commission.

This week the Government announced more funding for meningococcal vaccine.

There is an ongoing review of the Medicare Benefits Schedule.

The Health Minister relishes making regular ‘good news’ announcements of new drugs and treatments under the Pharmaceutical Benefits Scheme – the PBS.

Changes to private health insurance will be announced soon.

And there will be a bidding war on public hospital funding, just like we saw this week on MRI machines.

All these things cost money – lots of money.

There will be more significant funding announcements across the health portfolio in the next six to nine months.

We must ensure that Indigenous health gets its fair share.

The AMA has repeatedly said that it is not credible that Australia, one of the world’s wealthiest countries, cannot address the health and social justice issues that affect three per cent of its citizens.

We will continue to work with all governments and all political parties to improve health and life outcomes for Aboriginal and Torres Strait Islander people.

More importantly, we will work tirelessly with you to achieve our shared goals.

Together we can indeed turn vision into action.

NACCHO Aboriginal Health Workforce and Training News : Our peak bodies @KenWyattMP and @CPMC_Aust Building the Aboriginal and Torres Strait Islander health workforce and strengthening alliances to address the health priorities of Indigenous Australians.

 

” NACCHO stresses the importance of continuing to grow the depth and number of Indigenous people in the health sector.

Improving the health of our people can only occur through partnership, and integrating health care providers with community controlled services is the key.

Ms Patricia Turner, CEO of the National Aboriginal Community Controlled Health Organisation (NACCHO)

 “Background :  On 31 May 2017 the Australian Government joined with the Council of Presidents of Medical Colleges, the Australian Indigenous Doctor’s Association and the National Aboriginal Community Controlled Health Organisation as partners to improve the good health and wellbeing for Aboriginal and Torres Strait Islander peoples.

Focussing on Tier Three of the National Aboriginal and Torres Strait Islander Health Plan, partners are working in collaboration to improve system performance by focussing on two key comprehensive areas for collective strategic action: increase the health workforce and embed cultural safety and competency in the system

Download a full copy of the signed agreement 

Signed Agreement

Australia’s peak bodies for Indigenous health and specialist medicine have reaffirmed their commitment to working with the Australian Government as partners in reducing the current gap in health outcomes and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians under the Closing the Gap strategy.

Introducing the forum held on Wednesday 12th September at Parliament House, Minister Ken Wyatt AM, welcomed the opportunity to continue discussions under the National Partnership, highlighting the Australian Government’s commitment to Closing the Gap as the platform for improving the health and wellbeing for Aboriginal and Torres Strait Islander peoples.

The decision by Australian Health Ministers through the Council of Australian Governments Health Council to develop a National Aboriginal and Torres Strait Islander Health Workforce Plan by 2019 was welcomed by the collaborative partners.

Discussing the key areas of the partnership, cultural safety and access to services remain top priorities.

The Chair of the Council of Presidents of Medical Colleges (CPMC) Dr Philip Truskett AM reported that the key focus area of increasing the Indigenous specialist medical workforce by focussing on support, mentoring, role modelling was core business for Australia’s specialist Medical Colleges.

Indigenous Health Minister Ken Wyatt AM said the collaborative group was ideally placed to play an essential role in the COAG Health Council resolution to develop a National Aboriginal and Torres Strait Islander Health and Medical Workforce Plan – to ensure more Aboriginal doctors, nurses and health workers on country and in our towns and cities, local warriors for health among our families and communities.

Dr Kali Hayward, President Australian Indigenous Doctor’s Association (AIDA) reflected on building culturally appropriate health workforce and the need to discover champions in the system to support training.

Ms Janine Mohammed, CEO Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) highlighted the merit in greater coordination of services to deliver improvements in health outcomes.

Mr Karl Briscoe, CEO, National Aboriginal and Torres Strait Islander Health Workers Association (NATSIHWA) highlighted the importance of building the Aboriginal and Torres Strait Islander health workforce and strengthening alliances to address the health priorities of Indigenous Australians.

All partners acknowledged a National Aboriginal and Torres Strait Islander Health Workforce Plan will form the framework for furthering collective action to increase the Indigenous health workforce and embed a cultural safety capability in Australia’s health system.

 

NACCHO Aboriginal Health joins other health peak bodies @AMAPresident @RACGP @RuralDoctorsAus @NRHAlliance welcoming the reappointment of the health ministry team but #ruralhealth no longer a distinct portfolio

 ” The Chairperson of the National Aboriginal Community Controlled Health Organisation (NACCHO) John Singer today joined other peak health bodies welcoming the election of Scott Morrison MP as the 30th Prime Minister of Australia and reappointments of Greg Hunt MP as the Federal Minister for Health, Ken Wyatt AM MP as the Federal Minister for Indigenous Health, and Senator Bridget McKenzie as the Federal Minister for Regional Services. “

See Part 1 NACCHO Media 

“With an election due in the first half of 2019, new Prime Minister Scott Morrison has made the right call in leaving Health in the safe hands of Greg Hunt.

A fourth Health Minister in five years would have undermined the priority that Australians place on good health policy,”

AMA President, Dr Tony Bartone see in full part 2 Below

‘Health is an integral part of any Governments agenda and I look forward to working with Minister Hunt on the future direction of healthcare in Australia,’ 

Minister Hunt has worked closely with the RACGP over the past two years, achieving positive results, including investment into general practice research, the removal of the Medicare freeze and the return of general practice training to the RACGP.’

Dr Nespolon told newsGP see in full Part 3 Below

It was only on Friday last week that rural health sector stakeholders met in Canberra, for a meeting convened by the (former) Minister for Rural Health, to discuss the issues and solutions for achieving better health outcomes for rural Australia’, 

The key message of the Roundtable meeting was very clear. The health and wellbeing issues faced by rural and remote Australia cannot be addressed using market-driven solutions that work in the cities.’

We need a genuine, high level commitment from the Commonwealth, State and Territory Governments to deliver a new National Rural Health Strategy that will address the unacceptable gap in health outcomes for rural Australians. This is not the time to be relegating Rural Health to the back burner’.

National Rural Health Alliance Chair, Tanya Lehmann see in full Part 4 below

With Minister McKenzie receiving an expanded set of other portfolio responsibilities, we are worried that the significant level of focus she has given to Rural Health to-date will, due to her increased workload in other

There has never been a more important time for Rural Health to retain a distinct portfolio.

As a sector, Rural Health continues to face significant challenges, but also significant opportunities.

Rural Australians continue to have poorer health outcomes than their city counterparts, and poorer access to healthcare services.

There continues to be an urgent need to deliver more doctors, nurses and allied health professionals to rural and remote communities, with the advanced training required to meet the healthcare needs of those communities.”

Rural Doctors President, Dr Adam Coltzau see Part 5 below in full 

Part 1 NACCHO

I was very pleased to hear Mr Morrison’s at his first media conference after winning the leadership say that chronic disease was one of his top three priorities as he  ” was distressed by the challenge of chronic illness in this country, and those who suffer from it ” Mr Singer said from Hobart where he was hosting Ochre Day a National Aboriginal Men’s Health Conference opened by the Minister Ken Wyatt

“ Chronic disease is responsible for a major part of the life expectancy gap and  accounts for some two thirds of the premature deaths among our Aboriginal and Torres Strait Islander community.

A large part of the burden of disease is due to chronic diseases such as cardiovascular disease, diabetes, cancer, chronic respiratory disease and chronic kidney disease. With the Prime Ministers increased support our 302 ACCHO clinics can be reduce by earlier identification, and management of risk factors and the disease itself.

Recently I attended the Council of Australian Governments Health Council meeting in Alice Springs, when it made two critical decisions to advance First Nations health. Firstly, it has made Aboriginal and Torres Strait Islander health a national priority, including by inviting the Indigenous Health Minister to all future meetings.

The Council also resolved to create a national Indigenous Health and Medical Workforce Plan, to focus on significantly increasing the number of First Nations doctors, nurses and health professionals.

However, NACCHO would also share our disappointment with Rural Doctors Association of Australia (RDAA) that Rural Health, while still being an area of responsibility for Minister McKenzie, will no longer have its own distinct portfolio under the revamped Coalition Government . ”

Minister Ken Wyatt Statement

I am honoured to be appointed as the Minister for Senior Australians and Aged Care and Minister for Indigenous Health in the Morrison Government. My focus will be building on the strong foundations we have in place through the 2018–19 Budget to deliver better outcomes for senior Australians and Aboriginal and Torres Strait Islander Australians.

We are investing an additional $5 billion in aged care over the next five years — a record amount — and our investments in the health of First Australians will be more targeted and based on what we know works. Our senior Australians are among our country’s greatest treasures.

They have earned the right to be cared for with dignity through our aged care system and this is something the Morrison Government is absolutely committed to delivering.

The aged care reform agenda we are implementing has already delivered senior Australians greater choice in the care they receive, and greater scrutiny of the sector — something that will be reinforced by the new independent Aged Care Quality and Safety Commission that will open its doors on 1 January 2019.

My administrative responsibilities will not change in the Morrison Government. However, the change to the Minister for Senior Australians and Aged Care reflects my focus on taking a broader, whole-of-government approach to advancing the interests of senior Australians.

Part 2 AMA 

AMA President, Dr Tony Bartone, said today that the AMA is pleased that Greg Hunt has been re-appointed Minister for Health.

Dr Bartone said that the health portfolio is broad and complex, and it takes time for Ministers to get fully across all the issues and get acquainted with all the stakeholders.

“Greg Hunt has been a very consultative Minister who has displayed great knowledge and understanding of health policy and the core elements of the health system,” Dr Bartone said.

“In his time as Minister, he has presided over the gradual lifting of the Medicare freeze and the major reviews of the Medicare Benefits Schedule (MBS) and the private health insurance (PHI).

“And he has acknowledged that major reform and investment is needed in general practice.

“These are all complex matters that would have been challenging for a new Minister.

“It takes months for new Ministers to gain command of the depth and breadth of the Health portfolio.

“With an election due in the first half of 2019, new Prime Minister Scott Morrison has made the right call in leaving Health in the safe hands of Greg Hunt.

“A fourth Health Minister in five years would have undermined the priority that Australians place on good health policy,” Dr Bartone said.

Dr Bartone said that the AMA looked forward to continuing its strong working relationship with the Minister for Senior Australians and Aged Care, Ken Wyatt, who is also Minister for Indigenous Health.

The AMA has been advised that Senator Bridget McKenzie will retain Rural Health as part of her Regional Services, Sport, Local Government, and Decentralisation portfolio.

Part 3 RACGP 

Dr Nespolon believes Minster Hunt understands the fundamental role primary care plays in the wellbeing of all Australians and will continue to make general practice a focal point of Government health policies.

‘Health is an integral part of any Governments agenda and I look forward to working with Minister Hunt on the future direction of healthcare in Australia,’ Dr Nespolon told newsGP.

‘Minister Hunt has worked closely with the RACGP over the past two years, achieving positive results, including investment into general practice research, the removal of the Medicare freeze and the return of general practice training to the RACGP.’

Dr Nespolon said he is particularly keen to discuss matters that lie at the heart of general practice.

‘The RACGP will continue to work with Minister Hunt on our core patient priority areas, including preventive health and chronic disease management,’ Dr Nespolon said.

Minister Hunt was re-appointed to his position on the frontbench following a cabinet reshuffle that took place in the wake of last week’s Liberal Party leadership challenge. Ken Wyatt was also re-appointed as the Federal Minister for Indigenous Health and for Aged Care.

Part 3 National Rural Health Alliance 

The Ministerial line-up announced by Prime Minister Scott Morrison has a glaring omission.

At a time when great swathes of rural and remote Australia are experiencing the impact of devastating drought conditions, including significant impacts on the health and wellbeing of our communities, the key portfolio of Rural Health is nowhere in sight.

The new Morrison Ministry does not include a Minister for Rural Health. That key responsibility was on Friday held by the Deputy Leader of the Nationals, Senator Bridget McKenzie. By Sunday it was gone.

‘It was only on Friday last week that rural health sector stakeholders met in Canberra, for a meeting convened by the (former) Minister for Rural Health, to discuss the issues and solutions for achieving better health outcomes for rural Australia’, National Rural Health Alliance Chair, Tanya Lehmann said.

‘The key message of the Roundtable meeting was very clear. The health and wellbeing issues faced by rural and remote Australia cannot be addressed using market-driven solutions that work in the cities.’

‘We need a genuine, high level commitment from the Commonwealth, State and Territory Governments to deliver a new National Rural Health Strategy that will address the unacceptable gap in health outcomes for rural Australians. This is not the time to be relegating Rural Health to the back burner’.

‘We call upon the Morrison Government to demonstrate it is fair dinkum about improving the health and wellbeing of rural Australians by reinstating Rural Health as a Ministerial portfolio and committing to the development of a National Rural Health Strategy’, Ms Lehmann said.

The Alliance welcomes the re-appointment of the Hon Greg Hunt MP, Federal Minister for Health and the Hon Ken Wyatt AM MP, Minister for Aged Care and Minister for Indigenous Health, and acknowledges their continuing contribution to addressing the health and aged care needs of all Australians. We also welcome Senator the Hon Bridget McKenzie’s contribution to regional services, sport, Local Government and decentralisation, however we remain concerned that rural health, as a separate Ministerial portfolio has been overlooked.

‘While we understand Minister McKenzie will continue to be responsible for Rural Health — and we very much look forward to continuing to work with her — we are concerned that this critical area will no longer have its own dedicated portfolio’, Ms Lehmann said.

Background:

The National Rural Health Alliance is the peak body for rural, regional and remote health. The Alliance has 35-member organisations representing the peak health professional disciplines (eg doctors, nurses and midwives, allied health professionals, dentists, pharmacists, optometrists, paramedics, health students, chiropractors and health service managers), Aboriginal and Torres Strait Islander health peak organisations, hospital sector peak organisations, national rurally focused health service providers, consumers and carers.

Some of the worst health outcomes are experienced by those living in very remote areas. Those people are:

  • 1.4 times more likely to die than those in major cities
  • More likely to be a daily smoker, obese and drink at risky levels
  • Up to four times as likely to be hospitalised

Part 5 Rural Doctors Association of Australia (RDAA) 

Ministerial reappointments welcomed, loss of Rural Health portfolio not

The Rural Doctors Association of Australia (RDAA) has welcomed the reappointment of Greg Hunt MP as the Federal Minister for Health, Ken Wyatt AM MP as the Federal Minister for Indigenous Health, and Senator Bridget McKenzie as the Federal Minister for Regional Services.

However, the Association is disappointed that Rural Health, while still being an area of responsibility for Minister McKenzie, will no longer have its own distinct portfolio under the revamped Coalition Government.

“We strongly welcome the continuation of the federal health leadership team under the new Prime Minister, Scott Morrison” RDAA President, Dr Adam Coltzau, said.

“The Coalition has been making significant progress on important health policy issues, and looking forward there remain big reform agendas to be delivered in the health policy space, so it makes sense to have continued stable leadership here

“While we understand Minister McKenzie will continue to be responsible for Rural Health — and we very much look forward to continuing to work with her — we are concerned that this critical area will no longer have its own dedicated portfolio.

“With Minister McKenzie receiving an expanded set of other portfolio responsibilities, we are worried that the significant level of focus she has given to Rural Health to-date will, due to her increased workload in other

“There has never been a more important time for Rural Health to retain a distinct portfolio.

“As a sector, Rural Health continues to face significant challenges, but also significant opportunities.

“Rural Australians continue to have poorer health outcomes than their city counterparts, and poorer access to healthcare services.

“There continues to be an urgent need to deliver more doctors, nurses and allied health professionals to rural and remote communities, with the advanced training required to meet the healthcare needs of those communities.

“Retaining Rural Health as a distinct portfolio would assist in progressing solutions in this area.

“For example, the development of a National Rural Generalist Pathway — to deliver more of the next generation of doctors to the bush with the advanced skills needed in rural settings — would benefit greatly from continuing to receive the strong political focus of a dedicated Rural Health portfolio.

“There also continues to be an urgent need to make the most of new technologies like telehealth, to broaden access to healthcare for rural and remote Australians, in particular with their own GP.

“We strongly urge Prime Minister Morrison to consider retaining Rural Health as a dedicated portfolio under Minister McKenzie’s stewardship, to ensure the focus can remain firmly on delivering the best healthcare outcomes for rural and remote Australians.

NACCHO Aboriginal Health celebrates #AMAFDW18 AMA Family Doctor Week : @amapresident Speech to @PressClubAust #NPC Includes support #ulurustatement #prevention investment #obesity #Chronic Disease funding #MentalHealth

 

” I am very pleased that one of my first announcements as AMA President was the AMA endorsement of the Uluru Statement from the Heart.

The Uluru Statement expresses the aspirations of Aboriginal and Torres Strait Islander people with regard to self-determination and status in their own country.

The AMA has for many years supported Indigenous recognition in the Australian Constitution.

The Uluru Statement is another significant step in making that recognition a reality.

The AMA is committed to improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples.

It is simply unacceptable that Australia, one of the wealthiest nations in the world, cannot solve a health crisis affecting fewer than three per cent of its citizens.”

AMA President Dr Tony Bartone speaking at the National Press Club 25 July 2018

 ” This week just happens to be AMA Family Doctor Week – a tribute to hardworking GPs.

GPs of Australia, I salute you. We all salute you.

Your hard work and dedication is highly valued. The AMA will always support you and promote you.

Your GP – your family doctor – will ensure that your health needs are met throughout all stages of your life.

Be it immunisation, preventative health care, age specific medical checks, chronic disease management, or aged care, the life long relationship with your GP underpins continuous and appropriate care.

This is especially the case for patients who are from culturally or linguistically diverse backgrounds. For them, GPs truly are their trusted health advocates.”

 ” The burden of chronic disease in Australia is significant.

Chronic disease is responsible for around 83 per cent of premature deaths and 66 per cent of the burden of disease.

Chronic disease has a significant impact on the health system, but the reality is that most of these conditions can be prevented.

It simply makes enormous sense to invest in prevention.

Taxes collected from tobacco and alcohol excise generate around $16 billion each year for the Government.

In return, total Government spending on prevention is around $2 billion a year, which equates to about $89 per person.

If we are to reduce the impact of chronic disease in Australia, all our governments must invest more in prevention.

Tackling obesity is a priority.

Doctors are well placed to identify and support patients who are overweight or obese. Two thirds of adults are either overweight or obese. ”

Full Speech : Health reform: Improving the patient journey

I acknowledge the traditional owners of the land on which we meet, and pay my respects to their elders past and present.

It is a humbling experience to be elected President of such a proud and respected organisation as the AMA.

It is an equally humbling experience to speak here at the National Press Club in Canberra. I thank the Press Club for this opportunity.

I am a GP, and I have been in practice in the northern suburbs of Melbourne for more than 30 years.

Some of you may know that I was inspired to become a GP by watching my own family doctor, who cared for my ill father when I was growing up.

Even now, my mother reflects on the care and dedication my family GP displayed in caring for her family. It’s no surprise that he became an early mentor in my professional life.

I have seen it all as I have looked after the health of my community and my patients, including generations of the same families.

I like to think that my experience has given me some credibility in knowing what works and what doesn’t work in the health system, especially in primary care.

My overarching concern has always been the patient journey – ensuring that people get the right care at the right time in the right place by the right practitioner.

The priorities for me are always universal access to care, and affordability.

Today, I will share my views on what can be done to make our great health system even better – how to improve the patient journey.

I will also introduce you to some of my patients, and reflect on the barriers in their access to timely care, to further illustrate our concerns.

General practice and primary care reform

On the day I was elected, I made it very clear that one of the hallmarks of my Presidency would be stridently advocating for significant investment in general practice.

This week just happens to be AMA Family Doctor Week – a tribute to hardworking GPs.

see intro for text

However, there is something really crook about how GPs have been treated by successive Governments.

They have paid lip service to the critical role GPs play in our health system, often borne out of ignorance and often in a misguided attempt to control costs.

General practice has been the target of continual funding cuts over many years. These cuts have systematically eaten away at the capacity of general practice to deliver the highest quality care for our patients.

They threaten the viability of many practices.

I talk to my GP members regularly, both metropolitan and rural.

The message is simple – some are at a tipping point and have a very bleak view of the future.

They see general practice becoming increasingly corporatised, burdened with more red tape, and GPs are less able to spend the necessary time with patients.

This is not the future that GPs want to see.

This is not the future that our patients want to see.

We can and must avoid these bleak predictions, but it requires significant real and immediate investment from the Government with a clear pathway to long-term reform.

Let me be very clear about this: we must put general practice front and centre in future health policy development.

We have seen too many mistakes. Too many poor policy decisions.

Despite the Government’s best intentions – and lots of goodwill within the profession – the Health Care Homes trial and implementation failed to win the support of GPs or patients.

Instead of real investment, the Trial largely shifted existing buckets of money around.

It has fallen well short of its practice enrolment targets, and it looks like only a small fraction of the targeted 65,000 patients will sign up.

There is no doubt that the challenge of transforming general practice was severely underestimated by policy makers. At least with this model.

But general practice still needs transformation and rejuvenation to meet growing patient demand and to keep GPs working in general practice.

The AMA has a plan for reform of general practice and primary care.

It is patient-centred and focuses on better access to long-term continuous quality care and managing patients more effectively in the community.

It takes the best elements of the ‘medical home’ concept and adapts them to the Australian context.

It is a plan that will require upfront and meaningful new investment, in anticipation of long-term savings in downstream health costs.

In the short term, the AMA plan for general practice will involve:

  • significant changes to Chronic Disease funding, including a process that strengthens the relationship between a patient and their usual GP, and encourages continuity of care;
  • cutting the bureaucracy that makes it difficult for GPs to refer patients to allied health services;
  • formal recognition in GP funding arrangements of the significant non-face-to-face workload involved in caring for patients with complex and chronic disease;
  • additional funding to support enhanced care coordination for those patients with chronic disease who are at risk of unplanned hospital admission – a similar model to the Coordinated Veterans Care Program funded by the Department of Veterans Affairs;
  • a properly funded Quality Improvement Incentive under the Practice Incentive Program – the PIP;
  • changes to Medicare that improve access to after-hours GP care through a patient’s usual general practice;
  • support for patients with chronic wounds to access best practice wound care through their general practice;
  • better access to GP care for patients in residential aged care; and
  • annual indexation of current block funding streams that have not changed for many years … including those that provide funding to support the employment of nursing and allied health professionals in general practice.

In the longer term, we need to look at moving to a more blended model of funding for general practice.

While retaining our proven fee-for-service model at its core, the new funding model must have an increased emphasis on other funding streams, which are designed to support a high performing primary care system.

This will allow for increasing the capability and improving the infrastructure supporting general practice to allow it to become the real engine room of our health system.

It is about scaling up our GP-led patient-centred multidisciplinary practice teams to better provide the envelope of health care around the patient in their journey through the health system.

A good example is the Blacktown Hospital Diabetes Outpatient Clinic in New South Wales.

This Clinic has a waiting time of less than a week because the service is distributed to its catchment GPs with the appropriate funding and support for both personnel and infrastructure.

This is a small example, but a significant one when you consider the scale and prevalence of diabetes across Australia, let alone the western suburbs of Sydney, and the average access times for outpatient hospital clinics.

We cannot continue to do things the way we always have.

The bulk-billing rate should not be the metric by which we judge the performance of general practice.

Chronic conditions have become more prevalent in Australia. The ones causing most concern are:

  • arthritis;
  • asthma;
  • back pain and problems;
  • cancer;
  • cardiovascular disease;
  • chronic obstructive pulmonary disease;
  • diabetes; and
  • mental health conditions.

One in two people now report having at least one of these eight common chronic conditions.

These conditions account for around 60 per cent of the total disease burden, and they contribute to nearly 90 per cent of deaths in Australia.

We must reshape our primary care system to meet these challenges.

We must put in place the funding support that general practice needs to better manage patients in the community – and keep people out of hospital.

Our plan is a smarter and more sustainable blueprint … a better plan for general practice. A better plan for Australians.

Public hospitals

We also need a better plan for public hospitals.

In an election year, voters tend to focus very closely on public hospitals when they are comparing health policies.

Public hospitals are a critical part of our health system. They are highly visible. They are greatly loved institutions in the community. They are vote changers.

The doctors, nurses, and other staff who work in our public hospitals are some of the most skilled in the world.

In 2016-17, public hospitals provided more than six and a half million episodes of admitted patient care. They managed 92 per cent of emergency admissions.

If the state of general practice is crook, then our public hospitals are on permanent code yellow.

Despite their importance, and despite our reliance on our hospitals to save lives and improve quality of life, they have been chronically underfunded for too long.

Between 2010-11 and 2015-16, average annual real growth in Federal Government recurrent funding for public hospitals has been virtually stagnant – a mere 2.8 per cent.

The AMA welcomes that, between 2014-15 and 2015-16, the Federal Government boosted its recurrent public hospital expenditure by 8.4 per cent.

But a one-off modest boost from a very low base is not enough.

I deal with the results of stressed public hospitals every day and manage the impact it has on my patients.

Ollie is a patient with well-controlled Parkinson’s disease. He now also has a recently diagnosed lung cancer, which has been caught early, resected, and appropriately managed.

But he has been denied care for his resulting poor control of his Parkinson’s disease in the same hospital’s neurology outpatient department and referred back to me.

I have been advised that I must source an alternative option for his neurological care.

Another of my patients, Carlo, is a victim of the never ending Federal-State buck passing when it comes to health.

Having developed poorly controlled reflux and having been referred to the local hospital outpatient department for a gastro consult, Carlo was referred back to me.

I was advised that I had to arrange a referral at the same hospital’s diagnostic imaging service for a possible coordination and swallowing problem, which ultimately proved correct.

He was then referred back to the gastroenterology department to manage his newly diagnosed oesophageal condition.

Barbara is another very common example of the funding chaos.

She is a very active 68-year-old lady who was troubled by severe osteoarthritis of the knee for many years. She was placed on a waiting list for surgery two years ago.

She has had to attend our practice regularly for pain management and supportive referrals for physiotherapy, while I continued to manage the consequences of her inability to lose weight due to her exercise restrictions and worsening diabetes and blood pressure profile.

She has just finally had her knee joint replaced.

These are the experiences of everyday patients.

They underpin the troubling headlines that came from the AMA’s 2018 Public Hospital Report Card. Our hospitals are stretched to the limit.

Likewise, the AMA’s Safe Hours Audit is a window into the lived experience of dedicated doctors, struggling to deliver quality care in over-crowded, under-funded hospitals.

But instead of helping the hospitals improve safety and quality, governments decided to financially punish hospitals for poor safety events.

There is no evidence to show that financial penalties work.

Health care is complex. Not all patient complications can be avoided.

The 2020-25 hospital funding agreement does little to improve the situation.

Funding levels stay the same, but public hospitals will have to do more with it to help coordinate patient care post-discharge.

The AMA supports better discharge planning and integrated care, especially for patients with complex and chronic disease.

But this will cost money – and public hospitals need extra funding.

The AMA calls on the major parties to boost funding for public hospitals beyond that outlined in the next agreement.

There must be a plan to lift public hospitals out of their current funding crisis, which is putting doctors and patients at risk.

Governments must stop penalising hospitals for adverse patient safety events.

We need policies to fully fund hospitals. We must help them improve patient safety and build their internal capacity to deliver high value care in the medium to long term.

They must link up and work with primary care to deliver better coordinated care.

I note that Labor has pledged an extra $2.8 billion for public hospitals.

I expect that the Coalition will match that as the election draws nearer.

They do not want another Medi-scare style campaign.

Medical care for older Australians

Older Australians are voters, too.

Aged care was, until very recently, one of the highest profile segments of the health system – but for all the wrong reasons.

It is now emerging as an area in need of significant reform as the population ages and lives longer.

Older Australians all too frequently do not have the same access to medical care as other age groups – a longstanding result of inadequate funding in the aged care system.

This inequity will likely only grow as the Australian population ages with more complex, chronic medical conditions requiring more medical attention than ever before.

We have witnessed numerous consultations and reviews.

Enough! Now is the time for action.

There is already sufficient information to underpin the final recommendations. It is simply unfair and unjust to delay this any further.

An increase in funding for GP visits to aged care facilities would result in many savings, including from reduced ambulance transfers to hospital emergency departments.

Changes to after-hours care remuneration must consider services that are currently provided under ‘urgent’ item numbers to patients in aged care facilities.

We also need to ensure that the critical role that nurses play in caring for older Australians is recognised in those facilities.

The AMA wants to see Medicare rebates that adequately cover the time that doctors spend with the patient assessing and diagnosing their condition and providing medical care.

We want new telehealth Medicare items that compensate GPs, and other medical specialists, for the time spent organising and coordinating services for the patient.

This includes the time that they spend with the patient’s family and carers to plan and manage the patient’s care and treatment.

There must be funding for the recruitment and retention of quality, appropriately trained aged care staff.

And we must reverse the decline in the proportion of Registered Nurses in aged care.

The AMA Aged Care Survey, released today, shows that AMA members who work in aged care have identified the shortage of Registered Nurses – who should be available 24 hours a day – as the biggest priority for aged care reform.

The survey also shows that one in three doctors are planning to cut back on, or completely end, their visits to patients in aged care facilities over the next two years.

This is largely because the Medicare rebates are inadequate for the amount of time and work involved.

The AMA will ensure that aged care gets the attention and profile it deserves in the election campaign.

Private health insurance:

Private health insurance has been in the headlines for much of the past year – again, for all the wrong reasons.

The AMA has always called for a simpler and fairer private health insurance system.

Without the private system, the public system would likely collapse.

But we cannot expect the private system to thrive – or even survive – if there is not value in insurance policies.

Patients are smart – they know there is no point outlaying thousands of dollars every year if the coverage isn’t there.

Affordability means very little without value.

We are clearly at a crisis point in private health insurance. And the Government knows it.

Hence the latest Review, and the recent announcement by the Minister of new categories of policies … and greater transparency.

We support the concept of developing Gold, Silver, and Bronze insurance categories.

We can’t expect consumers to understand the many different definitions, the carve outs, and exclusions of some 70,000 policy variations.

Australians want reasonable and simple things from their insurance.

They want coverage.

They want a choice of the practitioner, and a choice of the hospital.

They want treatment when they need it.

We can’t have patients finding out they aren’t covered after the event, or when they require treatment and it’s all too late.

To that end, we have been very clear – we don’t support the use of restrictions in Gold, Silver, and Bronze.

Restrictions lead people to believe they are covered, when in reality they are exposed to additional costs.

We don’t support junk policies. If a Basic policy category doesn’t provide much coverage, that should be made crystal clear.

We don’t support dismantling community rating. This must be protected to maintain equity of access to private health treatment.

When the objective is to support a strong private health sector to take pressure off the public sector, it makes no sense to financially discourage the patients who are most likely to need access to private health.

We support standard clinical definitions. Whatever is involved for coverage for heart conditions should not vary between insurers and policies.

I urge the Government to continue to work with the Colleges to ensure that these definitions are robust.

There is increasing corporatisation of private health and the market power is shifting in favour of private health insurers.

Insurers, whether private or via Medicare, cannot determine the provision of treatment in Australia.

They cannot and must not interfere with the clinical judgement of medical practitioners.

Australians do not support a US-style managed care health system. Neither does the AMA.

One area we are disappointed with in the recent announcements is pregnancy cover.

It does not make sense to us, as clinicians, to have pregnancy cover in a higher level of insurance only.

Many pregnancies are unplanned – meaning people are caught out underinsured when pregnancy is restricted to high-end policies.

Pregnancy is a major reason that the younger population considers taking up private health insurance.

They are less likely to be able to afford the higher-level policies. We need to make sure it is within reach.

I having female reproductive services at a different level to pregnancy coverage is, to us, problematic, and will leave a lot of people caught out.

There will be much more to talk about as the private health reforms are finalised and bedded down.

Mental Health

As a suburban GP who sees the whole range of health ailments and conditions, an area of special interest to me is mental health.

I do not think the unique role and special skills of GPs are used enough at the front line of mental health care.

The AMA earlier this year called for a national, overarching mental health “architecture”, and proper investment in both prevention and treatment of mental illnesses.

Almost one in two Australian adults – that is more than seven million people – will experience a mental health condition in their lifetime.

Almost every Australian will experience the effects of mental illness in a family member, friend, or work colleague.

The statistics are startling. For example:

  • More than half a million children and adolescents, aged four to 17, experienced mental health disorders in 2012-13.
  • Australians living with schizophrenia die 25 years earlier than the general population, mainly due to poor heart health.

And yet mental health and psychiatric care are grossly underfunded.

Strategic leadership is needed to integrate all components of mental health prevention and care.

For mental health consumers and their families, navigating the system and finding the right care at the right time can be difficult and frustrating.

There is no vision of what the mental health system will look like in the future.

Poor access to acute beds for major illness leads to extended delays in emergency departments.

Poor access to community care leads to delayed or failed discharges from hospitals.

And poor funding of community services makes it harder to access and coordinate prevention, support services, and early intervention.

Significant investment is urgently needed to reduce the deficits in care, fragmentation, poor coordination, and access to effective care.

We have repeatedly called for support for carers of people with mental illness, which is often the result of necessity, not choice.

Access to respite care is vital for many people with mental illness and their families, who are the ones who bear the largest burden of care.

Indigenous health

I am very pleased that one of my first announcements as AMA President was the AMA endorsement of the Uluru Statement from the Heart.

The Uluru Statement expresses the aspirations of Aboriginal and Torres Strait Islander people with regard to self-determination and status in their own country.

The AMA has for many years supported Indigenous recognition in the Australian Constitution.

The Uluru Statement is another significant step in making that recognition a reality.

The AMA is committed to improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples.

It is simply unacceptable that Australia, one of the wealthiest nations in the world, cannot solve a health crisis affecting fewer than three per cent of its citizens.

Prevention

There is not enough time today to cover all the issues I would like to cover in one speech.

I could deliver a whole speech on each of the following topics – medical workforce, rural health, medical research, genetic testing, e-cigarettes and vaping, opioids, medicinal cannabis, scope of practice, asylum seeker health, the NDIS, or palliative care, to name just a few.

I could probably manage a few words about the My Health Record, too. No doubt there will be questions about that.

But I have to talk to you about prevention, if only briefly.

The burden of chronic disease in Australia is significant.

Chronic disease is responsible for around 83 per cent of premature deaths and 66 per cent of the burden of disease.

Chronic disease has a significant impact on the health system, but the reality is that most of these conditions can be prevented.

It simply makes enormous sense to invest in prevention.

Taxes collected from tobacco and alcohol excise generate around $16 billion each year for the Government.

In return, total Government spending on prevention is around $2 billion a year, which equates to about $89 per person.

This amounts to a measly 1.34 per cent of all health spending. This is considerably less than comparable countries such as Canada, the United Kingdom, and New Zealand.

If we are to reduce the impact of chronic disease in Australia, all our governments must invest more in prevention.

Tackling obesity is a priority.

Doctors are well placed to identify and support patients who are overweight or obese. Two thirds of adults are either overweight or obese.

The evidence shows that advice to lose weight given by a doctor increases the motivation to lose weight. It also increases engagement in weight loss behaviours.

But the support and advice from doctors can only achieve so much.

Population level measures are needed. We need to see action on a sugar tax, banning junk food advertising to kids, and improving urban planning to help get people moving and active.

Governments have the tools to implement these measures. A sugar tax would be a good start.

In closing, I know the challenges ahead for the health system.

I will dedicate my Presidency to improving health policy so that we have a system that delivers the best possible care to our patients.

The AMA will be a very strong and loud advocate.

There is nothing like a Federal election to help our political leaders share the public’s interest in good health policy.

The election will happen within twelve months, possibly this year.

Along with the members of the National Press Club, the AMA will be watching the political events of this weekend and the coming months with very close interest.

NACCHO Aboriginal Health and the #UluruStatement promoted during #NRW18 and @TheLongWalkOz Thanks to @AMAPresident @EssendonFC @VAHS1972 @quitvic @DeadlyChoices

” What you (Victorian Premier Daniel Andrews ) said about Aboriginal and Torres Strait Islander advancement being led by Aboriginal and Torres Strait Islander people is absolutely right,

The great Australian Chris Sarra said very wisely … governments have got to stop doing things to Aboriginal people and start doing things with them and that is my commitment.”

Prime Minister Malcolm Turnbull has told a Reconciliation event The Long Walk he is committed to following the lead of Indigenous people, less than a year after rejecting their call for an enshrined voice in parliament.

After Premier Daniel Andrews spoke of his government’s efforts to create a state Treaty at the Long Walk event at Melbourne’s Federation Square, Mr Turnbull said the two leaders were “starting to agree on more things all the time”.

During a summit at Uluru in May 2017, Indigenous leaders rejected symbolic constitutional recognition in favour of an elected parliamentary advisory body and a treaty.

But in October, Mr Turnbull said a new representative body was not desirable or capable of winning acceptance at a referendum

NACCHO Aboriginal Health #treaty : #Uluru Summit calls for the establishment of a First Nations Voice enshrined in the Constitution

Australian Medical Association has thrown its support behind last year’s Uluru Statement from the Heart: It was a fairly clear-cut decision for us to make.

We recognise the issue regarding the will to want to have the right to self-determination. We recognise the health inequities, the social justice inequities, the wellness inequities that confront our Indigenous population.

And this Statement is just another way of trying to ensure that we can continue to work and get all governments, both State, Federal, and Territory, to work towards closing the gap, improving the social determinants of health, and recognising the need and the required improvements that are necessary to address the gap that currently exists.

The ACCHOs, or Aboriginal Community Controlled Health Organisations, are a very important part of the health delivery process. It recognises that the usual relationships, when it comes to health facilities in a different way, it’s a different connectivity. “

The recently elected Australian Medical Association’s President, Tony Bartone, who participated in the Long Walk spoke with ABC Radio reporter, Dan Conifer . See full interview and AMA press release Part 1 and 2 below

 

 ” Politicians, footballers and campaigners have joined thousands of Australians in the Long Walk event to support moves to improve Indigenous health and celebrate Aboriginal and Torres Strait Islander culture.

It has been 14 years since AFL champion Michael Long’s momentous journey from his home in Melbourne to the Prime Minister to get the lives of Aboriginal and Torres Strait Islander people back on the national agenda.

Indigenous health is focal point of this year’s walk, with the Victorian Aboriginal Health Service Australian Medical Association (AMA) and Quit Victoria both throwing their support behind the event.

Ill health forced Essendon great Michael Long to miss this year’s Long Walk.

Part 1 : Australian Medical Association has thrown its support behind last year’s Uluru Statement from the Heart

The AMA Federal Council has endorsed the Uluru Statement from the Heart, which calls for a First Nations’ voice in the Australian Constitution.

AMA President, Dr Tony Bartone, said today that the AMA has for many years supported Indigenous recognition in the Australian Constitution, and that the Uluru Statement is another significant step in making that recognition a reality.

“The Uluru Statement expresses the aspirations of Aboriginal and Torres Strait Islander people in regard to self-determination and status in their own country,” Dr Bartone said.

“The AMA is committed to improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples.

“Closing the gap in health services and outcomes requires a multi-faceted approach.

“Cooperation and unity of purpose from all Australian governments is needed if we are to achieve meaningful and lasting improvements.

“This will involve addressing the social determinants of health – the conditions in which people are born, grow, live, work, and age.

“Constitutional recognition can underpin all these endeavours, as we work to improve the physical and mental health of Indigenous Australians.”

Dr Bartone said the AMA was proud to announce its endorsement of the Uluru Statement during National Reconciliation Week.

Part 2 :The recently elected Australian Medical Association’s President, Tony Bartone, who participated in the Long Walk spoke with ABC Radio reporter, Dan Conifer

ELIZABETH JACKSON: Within the next couple of years, your local doctor’s surgery could be adorned with posters supporting Indigenous Constitutional change. The highly influential

Australian Medical Association has thrown its support behind last year’s Uluru Statement from the Heart. The peak body says including Aboriginal and Torres Strait Islander people in the nation’s founding document could help make Indigenous patients healthier. The AMA’s President Tony Bartone has told our political reporter Dan Conifer the organisation is unequivocal in its support.

TONY BARTONE: It was a fairly clear-cut decision for us to make. We recognise the issue regarding the will to want to have the right to self-determination. We recognise the health inequities, the social justice inequities, the wellness inequities that confront our Indigenous population. And this Statement is just another way of trying to ensure that we can continue to work and get all governments, both State, Federal, and Territory, to work towards closing the gap, improving the social determinants of health, and recognising the need and the required improvements that are necessary to address the gap that currently exists.

DAN CONIFER: Can you just explain for us how something like the Uluru Statement from the Heart, and the changes that it calls for, would support health outcomes, would improve life expectancy and so on?

TONY BARTONE: They’re fairly fundamental aspirations that are part of the Uluru Statement, and those aspirations and recognitions really speak to a number of emotional, physical, and broader social, environmental issues that really will address, as we say, the social determinants of health. We can’t really seek to close the gap when it comes to health outcomes until we address the fundamental building blocks.

DAN CONIFER: Now, one of the key elements of the Uluru Statement is about involving Aboriginal and Torres Strait Islander Australians in decision-making processes. In the medical profession, how has involving Indigenous Australians driven improvements?

TONY BARTONE: The ACCHOs, or Aboriginal Community Controlled Health Organisations, are a very important part of the health delivery process. It recognises that the usual relationships, when it comes to health facilities in a different way, it’s a different connectivity. Put another way, it recognises the inherent qualities and behavioural patterns of our Indigenous population, and that is different from a traditional Western-type setting which we’ve become experienced with.

DAN CONIFER: And if a referendum were to be held on any of the elements of the Uluru Statement, how would the AMA, individual doctors and specialists around the country, take part or be involved in that campaign?

TONY BARTONE: We would use all avenues open to us, both in terms of our advocacy and communication with our members, to ensure that the information and the sharing of that information, in terms of the wider community, patients who come to our surgery, the access points that we do have, are used to the fullest in terms of ensuring a proper address of the Statement’s initiatives.

DAN CONIFER: So we could see Vote Yes posters or pamphlets or badges in GP surgeries when this, or if this comes to a vote?

TONY BARTONE: What we’d see is the Association taking a front foot in our communication and advocacy on behalf of members. Of course, each individual member is free and would be wanting to participate to perhaps even a fuller extent, which would lead to putting up of posters and sharing that material in a surgery environment. But we would take a front foot more at an Association level to ensure that we communicate with our stakeholders, with our leaders in Parliament, and with the community in general through our media connectivity to communicate that wish and desire.

Part 3 The Long Walk ,VAHS and Quit Victoria promotes Indigenous health

Smoking rates among Aboriginal and Torres Strait Islander people are almost three times the national average of non-Indigenous people, although the prevalence in Indigenous communities is falling steadily.

In Victoria, 41 per cent of the Aboriginal and Torres Strait Islander population are smokers.

Quit Victoria’s Aboriginal Tobacco Control Program Coordinator Jethro Pumirri Calma-Holt told SBS News the health of Indigenous Australians should be kept at the top of the agenda.

“Indigenous health is something that needs to be invested in by everyone and that’s part of national reconciliation week.”

“What Michael Long did all those years ago has created a really big legacy for everyone to follow in his footsteps,” he said

Check it out the legend himself Anthony McDonald-Tipungwuti wearing the VAHS Deadly Choices Shirt out during the warm up for Dream Time at the G. The other players also wore the shirts as well… What a moment !

If you want your very own VAHS Deadly Choices Shirt just like Tippa the only way you can get one is to complete a health check at VAHS. So call us and book your health check on 03 9419 3000

 

 

 

NACCHO Guide to Aboriginal Health and the #Budget2018NACCHO : What @NACCHOAustralia @AMAPresident @RACP @CroakeyNews and 21 peak health groups would like to see in tonight’s #Healthbudget18 ?

 

We need political will to #CloseTheGap. There are volumes of research, strategies and action plans sitting with governments – but they are not being properly resourced and funded. Make it right in tonight’s Budget “

AMA President, Dr Michael Gannon, said that the culmination of key reviews, under the guidance of Health Minister Greg Hunt, provides the Government with a rare opportunity to embark on a new era of ‘big picture’ health reform – but it will need significant long-term investment.

Also read NACCHO Aboriginal Health @AMAPresident Download AMA Pre-Budget Submission 2018-19 #Indigenous health reform – needs significant long-term investment

 ” The Federal Government must provide long-term funding certainty for the Medical Outreach Indigenous Chronic Disease Program, which is focused on preventing, detecting and managing chronic disease for Aboriginal and Torres Strait Islander people.”

RACP President Dr Catherine Yelland

Download the full submission here or read Aboriginal health extracts below

racp-2018-19-pre-budget-submission

Historical background RACP Associate Professor Noel Hayman

 “I’ve been working in the field of Indigenous health for 20 years now. The major changes, trends that I’ve seen over the years, has been improvements in infant mortality. But the one that contrasts that is the worsening mortality in middle age—we see high rates of mortality in Aboriginal people in their 40s and 50s. And this is due to chronic disease, particularly diabetes, ischaemic heart disease and chronic kidney disease.

Associate Professor Noel Hayman, Clinical Director of the Inala Indigenous Health Service in Brisbane.

He was the first Aboriginal GP in Queensland, and the first Aboriginal and Torres Strait Islander person to become a Fellow of the Australasian Faculty of Public Health Medicine at the RACP.

From Interview June 2016 Listen HERE

RACP Press Release

Doctors are calling for the Federal Government to provide long-term funding to programs that prevent, detect and manage chronic disease for Aboriginal and Torres Strait Islander people.
As detailed in the Royal Australasian College of Physicians’ pre-budget submission, these programs could help ensure better health outcomes and close the gap between Aboriginal and Torres Strait Islander health outcomes and those of the non-Indigenous community.

The RACP recommends that the Australian government :

Aboriginal and Torres Strait Islander Health

• Allocate secure long-term funding to progress the strategies and actions identified in the National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) Implementation Plan.

• Provide secure, long-term funding for the Rural Health Outreach Fund (RHOF) and Medical Outreach Indigenous Chronic Disease Program (MOICDP).

• Build and support the capacity of Aboriginal and Torres Strait Islander health leaders by committing secure long-term funding to the Indigenous National Health Leadership Forum.

• Reinstate funding for a clearinghouse modelled on the previous Closing the Gap clearinghouse, in line with the recommendations of the Fifth National Mental Health and Suicide Prevention Plan. Allocate sufficient funding for the implementation of the Fifth National Aboriginal and Torres Strait Islander Blood-Borne Viruses (BBV) and Sexually Transmissible Infections (STI) Strategy.

• Fund the syphilis outbreak short-term action plan and coordinate this response with long term strategies.

• Allocate long-term funding for primary health care and community- led sexual health programs to embed STI/BBV services as core primary health care (PHC) activity, and to ensure timely and culturally supported access to specialist care when needed, to achieve low rates of STIs and good sexual health care for all Australians.

• Invest in and support a long-term multi-disciplinary sexual health workforce and integrate with PHC to build longstanding trust with communities.

• Allocate funding for STI and HIV point of care testing (POCT) devices, the development of guidelines for POCT devices and Medicare funding for the use of POCT devices.

Extract from Pre budget submission

Aboriginal and Torres Strait Islander Health

Aboriginal and Torres Strait Islander people continue to experience poorer health outcomes than non-Indigenous Australians.

The latest ‘Closing the Gap’ report found that Australia is not on track to close the life expectancy gap by 2031 – with the gap remaining close to ten years for both men and women.

The gap for deaths from cancer between Aboriginal and Torres Strait Islander and non-Indigenous Australians has in fact widened in recent years, with Aboriginal and Torres Strait Islander cancer death rates increasing by 21 percent between 1998 and 2015, while there was a 13 per cent decline for non-Indigenous Australians in the same period8.

To address these inequities and improve access to care, continuing and strengthened focus and appropriate long-term funding is required. It is imperative that there is secure funding for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (NATSIHP) Implementation Plan.

Funding uncertainty and frequent changes create significant issues that impact the continuity of services to patients and organisations in their ability to retain and build their capacity.

Read in full NACCHO Aboriginal Health and #Sexual Health @TheRACP 2018-19 Pre-#budget submission : Long-term funding needed to improve #Indigenous health

 

”  A December 2017 report from the Australian Institute of Health and Welfare (AIHW) shows that the mortality gaps between Indigenous and non-Indigenous Australians are widening, not narrowing.

Urgent action is needed to reverse these trends to have any prospect of meeting the Council of Australian Governments’ goal to Close the Gap in life expectancy within a generation (by 2031).

The following submission by the National Aboriginal Community Controlled Health Organisation (NACCHO) in relation to the Commonwealth Budget 2018 aims to reverse the widening mortality gaps.

The following policy proposals are divided into four areas below and summarised in the following table:

  1. Proposals that strengthen and expand ACCHOs’ capacity and reach to deliver health services for Indigenous people
  2. Proposals that improve responsiveness of mainstream health services for Indigenous people
  3. Proposals that address specific preventable diseases
  4. Proposals that build in an Indigenous position into policy considerations that impact on health.

NACCHO is committed to working with the Australian Government to further develop the proposals, including associated costings and implementation plans and identifying where current expenditure could be more appropriately targeted ”

Download the full NACCHO submission HERE or part 3 below

NACCHO-Pre-budget-submisson-2018

Connect tonight with NACCHO #Budget2018NACCHO

Live coverage and interviews


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Twitter @NACCHOAustralia  Visit us on Twitter 

Facebook #NacchoAboriginalHealth Visit us on Facebook

YouTube #NACCHOTV  Visit us on YouTube

Besides our NACCHO live and recorded interviews

What will the 2018 Federal Budget mean for the health sector and consumers?

Consumers Health Forum of Australia Policy Team will be holding a free public webinar next Wednesday 16 May, 12:30pm AEST, to discuss the key health measures in the budget from a consumer perspective.

They will share our position on them, and take participants’ feedback and questions.

To join , register herehttps://chf.org.au/events/budget-2018-consumer-perspective

Part 2 Federal Budget 2018/19 – Preview and review of 21 health sector submissions

What is the number one health issue that the Government should address in tonight’s  Federal Budget?  Jennifer Doggett from Croakey analyses the pre-Budget Submissions from 21 health groups and finds surprising agreement among them on the urgent need for action in one key area.

Read on to find out what this issue is and the six key measures the Government should announce on Tuesday night if it wants to keep the health sector onside.  Check back on Wednesday to see how closely the Federal Government has followed the proposals from health and medical groups in this (possibly) pre-election Budget.

Bookmark this link for our coverage of the Federal Budget, and please use the hashtag #HealthBudget18 to share health-related budget news.

Read and subscribe here

Read full article here

2018/19 Federal Budget priorities

So what do this year’s crop of Pre-Budget submissions tell us about the current priorities of the health sector? After reviewing a slew of health-related pre-Budget submissions it is clear that there is one stand-out issue that has the overwhelming support of the health sector, with virtually every submission supporting action on this issue in some form or other.

That issue is prevention.  The clear message emerging from the submissions was that preventive health is the glaring gap in health policies at the federal level and the most pressing issue that needs to be addressed to improve the health of our community.

Almost every health-related pre-Budget submission included a strong focus on prevention, in particular those from the Public Health Association of Australia (PHAA), the Consumers Health Forum (CHF), the Australian Healthcare and Hospitals Association (AHHA), the Australian Medical Association (AMA), the Complementary Medicines Association (CMA), the Victorian Healthcare Association (VHA) and the Royal Australian College of Physicians (RACP).

The most strongly supported proposal overall was for the establishment of a national preventive health body to oversee and coordinate preventive health policies across all sectors and level of government.

The AMA’s submission reflected the reasons expressed in many submissions for such a national body: Obesity, nutrition, alcohol, tobacco and physical activity are health policy areas desperately in need of funded national strategies and measurable targets. These are best delivered through an independent, dedicated organisation.

Obesity was the most commonly mentioned health issue with a number of groups supporting a sugar tax, junk food advertising restrictions and physical activity programs.

Indigenous health

There was broad agreement across the submissions that we need to do more to close the health and life expectancy gap between Indigenous and non-Indigenous Australians and that supporting Indigenous community-controlled initiatives and services are the best way to achieve this.

Supporting and growing the Indigenous health workforce was a key feature of NACHHO’s submission, along with establishing an Aboriginal and Torres Strait Islander Commonwealth Advisory Group to support consideration, implementation and monitoring of an Indigenous position in efforts to Close the Gap and on jurisdictional agreements that have high impact on Indigenous peoples.

The AHHA and the AMA called for funding to implement the National Aboriginal and Torres Strait Islander Health Plan and the AMA also called for the Government to support the Redfern Statement.

Six key actions

After reviewing these submissions, the message is clear.  If the Government wants to win over the health sector on Tuesday night it needs to do the following:

  1. Establish a National Preventive Health Body (although this could be slightly awkward for the Government, given it abolished a similar body, the Australian National Preventive Health Agency in 2014)
  2. Announce a national obesity strategy
  3. Set up a Productivity Commission review of private health insurance
  4. Increase funding for the community-controlled Indigenous health sector
  5. Increase funding for public dental services
  6. Take action on mental health

Part 3

Widening mortality gaps require urgent action

The life expectancy gap means that Indigenous Australians are not only dying younger than non-Indigenous Australians but also carry a higher burden of disease across their life span, impacting on education and employment opportunities as well as their social and emotional wellbeing.

Preventable admissions and deaths are three times as high in Indigenous people yet use of the main Commonwealth schemes, Medicare Benefits Scheme (MBS) and Pharmaceutical Benefits Scheme (PBS) are at best half the needs based requirements.

It is simply impossible to close the mortality gaps under these conditions. No government can have a goal to close life expectancy and child mortality gaps and yet concurrently preside over widening mortality gaps.

Going forward, a radical departure is needed from a business as usual approach.

Funding considerations, fiscal imbalance and underuse of MBS/PBS

The recent Productivity Commission Report found that per capita government spending on Indigenous services was twice as high as for the rest of the population.

The view that enormous amounts of money have been spent on Indigenous Affairs has led many to conclude a different focus is required and that money is not the answer.

Yet, the key question in understanding the relativities of expenditure on Indigenous is equity of total expenditure, both public and private and in relation to need.

In terms of health expenditure, the Commonwealth spends $1.4 for every $1 spent on the rest of the population, notwithstanding that, on the most conservative assumptions, Indigenous people have at least twice the per capita need of the rest of the population because of much higher levels of illness and burden of disease.

This represents a significant market failure. The health system serves the needs of the bulk of the population very well but the health system has failed to meet the needs of the Indigenous population.

A pressing need is to address the shortfall in spending for out of hospital services, for which the Commonwealth is mainly responsible, and which is directly and indirectly responsible for excessive preventable admissions funded by the jurisdictions – and avoidable deaths.

The fiscal imbalance whereby underspending by the Commonwealth leads to large increases in preventable admissions (and deaths) borne by the jurisdictions needs to be rectified.

Ultimately, NACCHO seeks an evidenced based, incremental plan to address gaps, and increased resources and effort to address the Indigenous burden of disease and life expectancy.

The following list of budget proposals reflect the burden of disease, the underfunding throughout the system and the comprehensive effort needed to close the gap and ideally would be considered as a total package.

NACCHO recommends initiatives that impact on the greatest number of Indigenous people and burden of preventable disease and support the sustainability of the Aboriginal Community Controlled Health Organisation (ACCHO) sector – see proposals 1. a) to e) and 3. a) and b) as a priority.

NACCHO is committed to working with the Australian Government on the below proposals and other collaborative initiatives that will help Close the Gap.

National Aboriginal Community Controlled Health Organisation

NACCHO is the national peak body representing 144 ACCHOs across the country on Aboriginal health and wellbeing issues

In 1997, the Federal Government funded NACCHO to establish a Secretariat in Canberra, greatly increasing the capacity of Aboriginal peoples involved in ACCHOs to participate in national health policy development.

Our members provide about three million episodes of care per year for about 350,000 people. In very remote areas, our services provided about one million episodes of care in a twelve-month period.

Collectively, we employ about 6,000 staff (most of whom are Indigenous), which makes us the single largest employer of Indigenous people in the country.

The following proposals are informed by NACCHO’s work with Aboriginal health services, its members, the views of Indigenous leaders expressed through the Redfern Statement and the Close the Gap campaign and its engagement and relationship with other peak health organisations, like the Australian Medical Association (AMA).

Guiding principles

Specialised health services for Indigenous people are essential to closing the gap as it is impossible to apply the same approach that is used in health services for non-Indigenous patients.

Many Indigenous people are uncomfortable seeking medical help at hospitals or general practices and therefore are reluctant to obtain essential care. Access to healthcare is often extremely difficult due to either geographical isolation or lack of transportation.

Many Indigenous people live below the poverty line so that services provided by practices that do not bulk bill are unattainable. Mainstream services struggle to provide appropriate healthcare to Indigenous patients due to significant cultural, geographical and language disparities: ACCHOs attempt to overcome such challenges.

An ACCHO is a primary health care service initiated and operated by the local Aboriginal community to deliver holistic, comprehensive, and culturally appropriate health care to the community which controls it, through a locally elected Board of Management.

They form a critical part of the Indigenous health infrastructure, providing culturally safe care with an emphasis on the importance of a family, community, culture and long-term relationships.

Studies have shown that ACCHOs are 23% better at attracting and retaining Indigenous clients than mainstream providers and at identifying and managing risk of chronic disease.

Indigenous people are more likely to access care if it is through an ACCHO and patients are more likely to follow chronic disease plans, return for follow up appointments and share information about their health and the health of their family.

ACCHOs provide care in context, understanding the environment in which many Indigenous people live and offering true primary health care. More people are also using ACCHOs.

In the 24 months to June 2015, our services increased their primary health care services, with the total number of clients rising by 8%. ACCHOs are also more cost-effective providing greater health benefits per dollar spent; measured at a value of $1.19:$1.

The lifetime health impact of interventions delivered our services is 50% greater than if these same interventions were delivered by mainstream health services, primarily due to improved Indigenous access.

If the gap is to close, the growth and development of ACCHOs across Australia is critical and should be a central component to policy considerations.

Mainstream health services also have a significant role in closing the gap in Indigenous health, providing tertiary care, specialist services and primary care where ACCHOs do not exist.

The Indigenous Australians’ Health Programme accounts for about 13% of government expenditure on Indigenous health.

Given that other programs are responsible for 87% of expenditure on Indigenous health, it reasonable to expect that mainstream services should be held more accountable in closing the gap than they currently are.

Greater effort is required by the mainstream health sector to improve its accessibility and responsiveness to Indigenous people and their health needs, reduce the burden of disease and to better support ACCHOs with medical and technical expertise.

The health system’s response to closing the gap in life expectancy involves a combination of mainstream and Indigenous-specific primary care providers (delivered primarily through ACCHOs) and where both are operating at the highest level to optimise their engagement and involvement with Indigenous people to improve health outcomes.

ACCHO’s provide a benchmark for Indigenous health care practice to the mainstream services, and through NACCHO can provide valuable good practice learnings to drive improved practices.

NACCHO also acknowledges the social determinants of health, including housing, family support, community safety, access to good nutrition, and the key role they play in influencing the life and health outcomes of Indigenous Australians.

Elsewhere NACCHO has and will continue to call on the Australian and state and territory governments to do more in these areas as they are foundational to closing the gap in life expectancy.

Addressing the social determinants of health is also critical to reducing the number of Indigenous incarceration. Comprehensively responding to the Royal Commission into the Protection and Detention of Children in the Northern Territory must be a non-negotiable priority.

Proposals

The following policy proposals are divided into four areas below and summarised in the following table:

  1. Proposals that strengthen and expand ACCHOs’ capacity and reach to deliver health services for Indigenous people
  2. Proposals that improve responsiveness of mainstream health services for Indigenous people
  3. Proposals that address specific preventable diseases
  4. Proposals that build in an Indigenous position into policy considerations that impact on health.

NACCHO is committed to working with the Australian Government to further develop the proposals, including associated costings and implementation plans and identifying where current expenditure could be more appropriately targeted

Continued HERE NACCHO-Pre-budget-submisison-2018

NACCHO Aboriginal Health #ACCHO Deadly Good News stories : Features @AMAPresident Dr Michael Gannon visits our #NT ACCHO’s in Central Australia Plus News from #NSW #TAS #QLD #VIC #WA #SA #ACT

1. NT : This week the President of the AMA Dr Michael Gannon paid a flying visit to our ACCHO’s in Central Australia : His 2 day diary

2.1 NSW : Indigenous culture at the heart of new Katungul Aboriginal Corporation Community and Medical Services (ACC&MS) home care project

2.2 NSW : Yerin Incorporating Eleanor Duncan Aboriginal Health Centre inaugural Health Care Quality Committee

3. QLD : Apunipima celebrates the first anniversary of its Wellbeing Centres :  It has been a year of milestones and learnings for the team that ‘hit the ground running’ 12 short months ago.

4. SA : Nganampa Health Council’s 2017 Annual Report is now available

5. WA : Two Aboriginal women, leaders in Aboriginal health care in Western Australia, have been recognised for their lifelong dedication and commitment to improving the health and wellbeing of Aboriginal people.

6.VIC : The Commission for Children and Young People welcomes the appointment of  former NACCHO Chair Justin Mohamed as Victoria’s new Commissioner for Aboriginal Children and Young People

7. TAS : A yarn with Assoc. Professor Greg Phillips April 20

8.1 ACT : Winnunga ACCHO Download the April Newsletter

8.2 ACT : Winnunga has commenced a new program for first time mothers of Aboriginal and Torres Strait Islander babies

 View hundreds of ACCHO Deadly Good News Stories over past 6 years

How to submit a NACCHO Affiliate  or Members Good News Story ?

 Email to Colin Cowell NACCHO Media    

Mobile 0401 331 251

Wednesday by 4.30 pm for publication each Thursday /Friday

1. NT : This week the President of the AMA Dr Michael Gannon paid a flying visit to our ACCHO’s in Central Australia : Here is his 2 day diary

Day 1.1 Pintupi Homelands Health Service Kintore

Thank you for welcome to Pintupi Homelands Health Service, @WDNWPT Purple House Dialysis Unit in Kintore, NT.

Social, economic, human benefits of delivering health care on country, under community control in evidence

Day 1.2 Urapuntja Health Service Utopia

Fabulous welcome to Urapuntja Health Service Utopia, NT.

Innovative, impressive primary healthcare service delivery in difficult setting. Shocking Diabetes rates. Exciting new Dialysis service. Real answers of course lie in prevention, addressing social determinants of health

Day 2 .1 Congress Alice Springs

Thank you to Congress Alice Springs for the meeting/tour. Fabulous integration of doctors, nurses, midwives, AHWs, allied health experts. Disc. housing, water, social determinants of health, proposed rural training hubs as way to build medical workforce in regional Australia

Day 2.2 Congress Alice Springs; Harm caused by cannabis

Talking to Doctors, Aboriginal Health Workers about harm caused by cannabis in Alice Springs. Any permissive messaging on Gunja extremely harmful to local Indigenous population and their mental health.

Will impair prevention messages my colleagues working so hard on

Day 2.3 : NPY  Ngaanyatjarra, Pitjantjatjara and Yankunytjatjara Women’s Council  

Thank you to Andrea Mason, Angela Lynch NPY Women’s Council. Fascinating insights into the work of Ngangkari, wellness models, Mental

2.1 NSW : Indigenous culture at the heart of new Katungul Aboriginal Corporation Community and Medical Services (ACC&MS) home care project

 

“At the heart of our philosophy of Koori Health in Koori Hands is the health and wellbeing of our Elders,

By our Elders maintaining their lifestyle and connection to culture and country, we will be able to keep them independent and at home for longer.”

CEO of Katungul ACC&MS Robert Skeen also emphasised the connection to country experienced by Aboriginal Elders that is a key driver of the project

A new $1.4 million culturally-sensitive Indigenous seniors home care project, designed for Bateman’s Bay in New South Wales, has been agreed to and launched between aged care provider IRT Group and the Katungul Aboriginal Corporation Community and Medical Services (ACC&MS).

The project is designed to suit Indigenous cultural preferences and recognises that Aboriginal seniors have a connection to country and a desire to age in place, while also aiming to support older aboriginal people to stay in their own homes as they age.

Following the government grant funded project’s launch on 9 April signified by the signing of a Memorandum of Understanding (MoU), there is expected be a first meeting of the Project’s Steering Committee, formed to guide the project’s community-based and community-led approach to Indigenous aged care over the next three years.

IRT Group Chief Executive Officer (CEO) Patrick Reid says the project addresses barriers to accessing aged care by assisting Aboriginal seniors to apply for government home care funding assistance.

He also adds that IRT’s registered training organisations, IRT Academy, will support the project with delivery of a Certificate III training package for Indigenous trainees to provide culturally-appropriate home care services.

“Through the work of our IRT Foundation, we aim to provide equity in aged care service provisions to all seniors in the community,” Mr Reid says.

“We’re proud to partner with Katungul which has been working for the last 25 years to enable Aboriginal people to live healthy lives, enriched by a strong living culture, dignity and justice.”

Following the Project’s Steering Committee’s first meeting, a Koori Aged Care Community Yarn Up information session will also be held.

This session will have experts on hand to answer questions about the benefits of Koori Home Care, as well as the training offered by IRT Academy.

2.2 NSW : Yerin Incorporating Eleanor Duncan Aboriginal Health Centre inaugural Health Care Quality Committee

This week Yerin had their inaugural Health Care Quality Committee meeting.
The purpose of the Committee is to provide the Yerin Incorporating Eleanor Duncan Aboriginal Health Centre Board and CEO with expert clinical advice on clinical governance, patient experience and quality management of systems

3. QLD : Apunipima celebrates the first anniversary of its Wellbeing Centres :  It has been a year of milestones and learnings for the team that ‘hit the ground running’ 12 short months ago. 

“We have been able to employ community members into all positions in the centres, which include Receptionists, SEWB workers and Team Leaders.”

Our team leaders are also leaders in their community, which fits beautifully into the Apunipima Model of Care and is something that sets our service apart.”

Tanya Robinson, the Social Emotional Wellbeing Services Manager said it was important for the centres to have a strong local workforce

Last week marked the first anniversary of Apunipima’ s Wellbeing Centres in Cape York.

It has been a year of milestones and learnings for the team that ‘hit the ground running’ 12 short months ago, at centres in Aurukun, Coen, Hope Vale and Mossman Gorge.

The Social Emotional Wellbeing services were set up in 2009 by the Royal Flying Doctor Service, in April 2017 Apunipima assumed responsibility and took over the management of these centres.

The role of the Apunipima Wellbeing Centres is to support the broad social and emotional wellbeing needs of each community. Each centre works to the Apunipima Model of Care, a community driven, community led model that focuses on all aspects of cultural, emotional, environmental and spiritual wellbeing.

Setting up a new service arm within any organisation can be a challenging time, Apunipima took these challenges in their stride, keeping community at the forefront of all changes.

“It was really important that the transfer to Apunipima management of the centres had no negative impact on clients using the services. I think we can be really proud of how that unfolded; it was a seamless transition.” Said Bernard David, who was the Regional Manager for Social Emotional Wellbeing at Apunipima.

Apunipima’ s Social Emotional Wellbeing team spent a lot of time in each community, before, during and after the changeover, meeting with all of the stakeholders to ensure that community members were involved in how the program would be delivered into the future.“

Both Bernard and Tanya agree that the future is looking great for the Wellbeing Centres. “We are constantly looking at how we can better service our clients and that will be our focus in the coming months.” Said Tanya.

4. SA : Nganampa Health Council’s 2017 Annual Report is now available

The Annual Report highlights a number of significant achievements in the past year including:

Download copy here

• Excellent child and women’s health program outcomes
• An enhanced program of specialist visiting teams
• Strong Anangu employment and training outcomes
• An improved chronic disease management program leading to increased adult health checks
• Continuing high levels of participation in our sexual health screen and continued low levels of infection
• Innovative and collaborative public health programs
• Robust, leading edge information technology systems
• A continued strong financial position

To reduce our impact on the environment we have reduced the number of annual reports we have printed.

If you would like to receive a paper copy of this year’s report, or receive a notification next year by email, please send us a private message.

5. WA : Two Aboriginal women, leaders in Aboriginal health care in Western Australia, have been recognised for their lifelong dedication and commitment to improving the health and wellbeing of Aboriginal people.

 

Two Aboriginal women, leaders in Aboriginal health care were posthumously honoured with the Aboriginal Health Council of Western Australia’s prestigious lifetime achievement awards at the State Sector Conference Dinner

Donnybrook Elder Gloria Khan and Derby Elder Maxine Armstrong have dedicated their lives to advancing the agenda for Aboriginal health in WA.

AHCWA Chairperson Vicki O’Donnell said both women had made positive differences to their communities.

Maxine, who passed away in March 2018, was the last of five founding members of the Derby Aboriginal Health Service, and had served as the Derby Aboriginal Health Service Chairperson for over 15 years. Maxine was also Chairperson of the Kimberley Aboriginal Medical Service Board for over 10 years and a Director on the AHCWA Board for more than a decade.

“Maxine was a passionate advocate for Indigenous and Aboriginal health, with her driving force to ‘help her people’,” Ms O’Donnell said.

“In particular, she was steadfast in her commitment to address the alarming rate of chronic disease in indigenous communities, the unacceptable rate of suicide and the impact of drugs on individuals, their families and their communities.

“Maxine was particularly proud of her efforts to secure funding for key medical facilities such as the Derby Aboriginal Health Service Dialysis Hub and Renal Health Centres in Derby, Kununurra and Fitzroy Crossing. She was also integral to the establishment of a refuge for Indigenous women.”

Maxine’s dedication and commitment to Aboriginal primary health was passionate and instrumental in developing strong partnerships with many community stakeholders across WA and Australia.

Gloria, who passed away in February 2018, was a passionate leader who worked tirelessly to improve the health and wellbeing of Aboriginal people both in WA and across Australia.

She served as the AHCWA chairperson from 2005 to 2008, during which time she was also the Chair and the Deputy Chair of the South West Aboriginal Medical Service and Executive Director of the National Aboriginal Community Controlled Health Organisation.

Gloria also sat on several committees including the Ministerial Council for Suicide Prevention and the Telethon Kids Institute’s WA Aboriginal Child Health Survey Steering Committee, the largest and most comprehensive study into the health, wellbeing and development of Indigenous children.

“Gloria was a strong, proud Nyoongar woman who dedicated many years of service to Aboriginal health in WA and across Australia,” Ms O’Donnell said.

“Along with her kindness and compassion, she brought a wealth of knowledge to the sector as a nurse and a trained counsellor, with experience in the areas of domestic violence, sexual assault, grief and drug and alcohol abuse.

“Gloria’s depth of knowledge and understanding of Aboriginal health at the local, state and national level gave her the opportunity to advocate these issues in many forums.

“She showed true leadership, advocacy and commitment to help close the life expectancy gap between Aboriginal and non-Aboriginal people of Australia.”

Maxine and Gloria’s legacies will continue through the efforts of others to ensure the advances and progress they made will continue.

More than 260 delegates from around the state are attending AHCWA’s annual state sector conference at the Esplanade Hotel Fremantle over April 11 and 12.

Yesterday, AHCWA unveiled its revolutionary new health atlas, Mappa, which provides cutting edge mapping technology to help align patients with local healthcare providers.

Tomorrow will see Federal Indigenous Health Minister Ken Wyatt launch AHCWA’s Western Australia Aboriginal Youth Health Strategy 2018-2023: Today’s young people, tomorrow’s leaders.

Developed with and on behalf of young Aboriginal people in WA, the strategy is the culmination of almost a decade of AHCWA’s commitment and strategic advocacy in Aboriginal youth health.

Over the two days, 15 workshops and keynote speeches will be held. AHCWA will present recommendations from the conference in a report to the state and federal governments to highlight the key issues about Aboriginal health in WA and determine future strategic actions.

6.VIC : The Commission for Children and Young People welcomes the appointment of  former NACCHO Chair Justin Mohamed as Victoria’s new Commissioner for Aboriginal Children and Young People

The Commission for Children and Young People welcomes the appointment of Justin Mohamed as Victoria’s new Commissioner for Aboriginal Children and Young People.

Mr Mohamed is a proud Aboriginal man of the Gooreng Gooreng nation near Bundaberg in Queensland. He has dedicated the past 25 years to working towards building a stronger and healthier nation for Aboriginal and Torres Strait Islander peoples.

‘Mr Mohamed is well known as a strong and experienced advocate, and I look forward to working alongside him to advance the rights and interests of Aboriginal children and young people in Victoria,’ Principal Commissioner Liana Buchanan said.

The appointment comes at a time when Victoria has made significant commitments and some progress in tackling long-standing issues for Aboriginal children, particularly those in out-of-home care.

‘There remains much work to be done to tackle discrimination, improve services and ensure that Aboriginal children and young people in Victoria can fully enjoy the rights that many take for granted,’ Ms Buchanan said.

More information about the appointment can be found in the Minister for Families and Children media release: Introducing A New Champion For Aboriginal Young People

Mr Mohamed will begin his tenure on 28 May.

Listen to radio interview

Treaty is connected self worth and empowerment for Aboriginal youth: Justin Mohamed

Victoria has a new Commissioner for Aboriginal Children and Young People and he says the state is changing the course of the Indigenous community with its combined efforts on dealing with children in care and a treaty with the state’s Indigenous people.

Justin Mohamed will take up the position next month, well credentialed as a former head of the National Aboriginal Community Controlled Health Organisation, and a former chief executive of Reconciliation Australia.

Victoria is the only state to have a Commissioner for Aboriginal Children and Young people and the state has been grappling with a 60 per cent increase in the number of children entering care between 2013 and 2015

7. TAS : A yarn with Assoc. Professor Greg Phillips April 20

8.1 ACT : Winnunga ACCHO Download the April Newsletter

Download HERE Winnunga AHCS Newsletter April 2018 (003)

8.2 ACT : Winnunga has commenced a new program for first time mothers of Aboriginal and Torres Strait Islander babies

Download Brochure : ANFPP brochure

NACCHO Aboriginal Health and #CulturalSafety Debate : Media VS Health Sector : Should we have culturally appropriate spaces in hospitals ?

Once again the debate about cultural safety has escalated nationally thru News Ltd newspapers with the Daily Telegraph leading off on Tuesday (3 April ) with a front page “cultural safety expose “ and 4 hours nonstop coverage and commentary on SkyNews from the usual suspects Peta Credlin , Alan Jones , Andrew Bolt , Ben Fordham , Paul Murray, Troy Branston in addition to blanket radio coverage across Australia.

See 2 SkyNews Broadcasts below

The policy issue being heavily criticised by the media but not health authorities and experts is that the NSW Health has recommended its emergency departments to provide “culturally appropriate space’’ for the families of Aboriginal patients.

The new policy in NSW to provide a “culturally appropriate space’’ or “designated Aboriginal waiting room’’ was introduced after research found Indigenous patients were at least 1.5 times more likely to leave hospitals before emergency treatment.

In Victoria some hospitals and services have separate areas for Indigenous patients and their families to meet, rest or engage with specialist hospital staff.

See Part 1 Below for NSW Health policy extracts and download document

Above Editorial Daily Telegraph 3 April

Firstly those in favour of this cultural safety policy include

 ” Well, I think it’s good that issues like cultural safety are entering the popular narrative. We need to do better when it comes to delivering care to Aboriginal and Torres Strait Islander people, and I think we need to ask them what will and won’t work.

The truth is that health outcomes for Indigenous Australians are significantly worse than non-Indigenous Australians according to just about every possible metric.

The AMA strongly supports Aboriginal control when it comes to primary care and when it comes to Aboriginal and Torres Strait Islanders being in larger health facilities like our hospitals, I think we need to do everything we can to make them- the appropriate settings for them to seek care.

If that means spending a little bit of money on waiting areas, if that means making subtle changes to outpatient clinics or to inpatient wards to make Indigenous people feel more at home, I don’t think non-Indigenous people should find that threatening”

1.Dr Michael Gannon President AMA

For the Aboriginal and Torres Strait Islander population born in 2010–2012, life expectancy was estimated to be 10.6 years lower than that of the non-Indigenous population.

“Indigenous patients are over-represented in requiring public hospital services.

“In 2013-14, there were 392,142 public hospital emergency department presentations by Indigenous people, accounting for 5.4% of all such presentations.

As a doctor working in south western Sydney and at an Aboriginal Medical Service, I see every day the barriers to accessing healthcare faced by our Indigenous patients.

“Hospitals are complex, overwhelming places and care is too often fragmented.

“For this reason, everyone involved in healthcare has an obligation to break down the barriers to accessing care and to improve health outcomes.

2. AMA (NSW) President, Prof Brad Frankum

“ It isn’t mandatory in the sense they’ve got to do it, it’s mandatory in the sense you’ve got to think about what is culturally appropriate (and) what might help the local community,”

3.Health Minister Brad Hazzard­ said many hospitals had already decided to introduce a culturally appropriate­ space.

“Among other benefits, culturally competent care increases accurate and timely diagnosis and increases attendance rates at follow-up appointments

Positive results such as these worked to overcome reluctance to engage with mainstream healthcare services, as well as improving rates of self-discharge against medical advice.”

4.President Simon Judkins the Australasian College for Emergency Medicine said it believed emergency departments must move towards a place of respect and acknowledgment of Indigenous culture

The college also called for a focus on increasing the numbers of Aboriginal and Torres Strait Islander people working across all health professions, including emergency medicine.

“All healthcare providers need to consider the cultural dimension of the services they are providing, and embrace culturally safe care which is determined to be safe by Aboriginal and Torres Strait Islander patients and their families.

This includes making hospital waiting rooms a welcoming and supportive environment for Aboriginal and Torres Strait Islander people, which will help to build trust between them and their healthcare providers and enhance cultural sensitivity in medical treatment.

It is vitally important that these waiting areas are designed and implemented in close consultation with relevant local Aboriginal and Torres Strait Islander communities and Aboriginal Community Controlled Health Organisations.”

5.Carmen Parter, PHAA Vice-President (Aboriginal and Torres Strait Islander) affirmed PHAA’s support for such an initiative.

” The policy was about improving the health of Aboriginal people and people who are not Aboriginal should not be threatened by the fact we’re trying to look out for a very vulnerable part of our community ”

6.NSW Health deputy secretary Susan Pearce

” The policy is flexible, allowing local health districts to carry out initiatives in consultation with their local Aboriginal community to make their hospital settings more culturally inclusive, in ways that best suit the community,”

7.NSW Health spokeswoman .

“Within the hospital system Aboriginal and Torres Strait Islander people face racist barriers to gaining appropriate health care. Despite the increased burden of disease they carry, Aboriginal and Torres Strait Islander patients are only three-quarters (73%) as likely to undergo a procedure once admitted to hospital

Racism is a significant barrier to Aboriginal health improvement say Donna Ah Chee 2015 Read in full here or Part 4 Below

” Cultural safety requires embedding in not only course accreditation for each health profession — including measures to reduce resistance — but also in the standards governing clinical professionalism and quality, such as the Royal Australian College of General Practitioners Standards for general practices,19 and the Australian Commission on Safety and Quality in Health Care National safety and quality health service standards.20

Such commitment will need investment in clinician education and professional development, together with measures for accountability. The stewards of the National Aboriginal and Torres Strait Islander Health Plan5 (ie, the Department of Health and their expert implementation advisory group), accreditation bodies, and monitors of the existing frameworks of safety and quality standards in health care need to formally collaborate on a systematic revision of standards to embed culturally safe practice and develop health settings free of racism.”

Martin Laverty, Dennis R McDermott and Tom Calma see Part 5 Below

Part 1 NSW Policy

Download The Policy document in full

NSW Policy Doc

Local processes should be in place to monitor numbers of patients who ‘Did not Wait’ for treatment following triage, including rates for Aboriginal and non-Aboriginal patients.

Strategies to address issues identified should be implemented and evaluated

2.1.3 Considerations for Aboriginal patients

 Section 4.1 acknowledges the higher rates of Aboriginal patients who choose not to wait for treatment in ED when compared to non-Aboriginal patients.

An important contributor to this issue is Aboriginal patients feeling safe to stay and wait. The use of local Aboriginal art in ED waiting rooms can provide links to culture and community; advice should be sought on appropriate art from the local Aboriginal community.

If available in the hospital, relatives may access the designated Aboriginal waiting room for families and carers. If no room exists, a culturally appropriate space within the local hospital should be identified.

Patients identifying as Aboriginal people should be provided with information regarding access to Aboriginal Health Workers that may be available. Access to any of these services may

4.1 Monitoring of rates of patients who ‘Did not Wait’

 EDs should maintain a local auditing system to monitor trends in rates of DNW. Review of data should also be undertaken by Aboriginal and non-Aboriginal patients as there is significant evidence in the literature of higher rates of DNW among Aboriginal patients presenting to ED

Addressing this issue is in line with the Australian Commission on Safety and Quality in Healthcare’s guidance on Improving care for Aboriginal and Torres Strait Islander People.

Locally designed strategies to manage identified reasons for patients who DNW should be implemented with outcomes reviewed. Consideration may be given to follow up of patients who DNW who are considered to have high risk issues or are from a vulnerable patient group.

Part 2 AMA (NSW) President: culturally appropriate spaces in EDs are a welcome addition to NSW public hospitals

Access to healthcare is critical to the wellbeing of all Australians and removing barriers to it is important, AMA (NSW) President, Prof Brad Frankum, said.

“It is essential that hospitals and all healthcare facilities make an effort to provide safe and welcoming spaces to facilitate access to care.

“Public hospitals try to do this in a range of ways, including the design of spaces, the provision of information in different languages, access to translators and other services to ensure patients get the best from their healthcare.

“For this reason, AMA (NSW) applauds the NSW Government for encouraging hospitals to ensure that they consider the needs of Indigenous patients in creating a safe and welcoming environment in hospitals,” Prof Frankum said.

“Indigenous patients continue to suffer unacceptably poorer health outcomes compared to other Australians.

“For the Aboriginal and Torres Strait Islander population born in 2010–2012, life expectancy was estimated to be 10.6 years lower than that of the non-Indigenous population.

“Indigenous patients are over-represented in requiring public hospital services.

“In 2013-14, there were 392,142 public hospital emergency department presentations by Indigenous people, accounting for 5.4% of all such presentations,” Prof Frankum said.

“As a doctor working in south western Sydney and at an Aboriginal Medical Service, I see every day the barriers to accessing healthcare faced by our Indigenous patients.

“Hospitals are complex, overwhelming places and care is too often fragmented.

“For this reason, everyone involved in healthcare has an obligation to break down the barriers to accessing care and to improve health outcomes.

“It is disappointing to see those who clearly do not have the same personal experiences of navigating our healthcare system making inappropriate comments about such an important health policy,” Prof Frankum said

Part 3 : Culturally safe healthcare starts in the waiting room

The Public Health Association of Australia (PHAA) called for cultural safety in Aboriginal and Torres Strait Islander healthcare last week, along with a number of other leading health groups and medical practitioners.

As an extension of this, the PHAA supports all viable and suitable cultural safety measures in the provision of healthcare to Aboriginal and Torres Strait Islander people, including culturally appropriate waiting rooms.

Carmen Parter, PHAA Vice-President (Aboriginal and Torres Strait Islander) affirmed PHAA’s support for such an initiative, saying, “All healthcare providers need to consider the cultural dimension of the services they are providing, and embrace culturally safe care which is determined to be safe by Aboriginal and Torres Strait Islander patients and their families.”

 

“This includes making hospital waiting rooms a welcoming and supportive environment for Aboriginal and Torres Strait Islander people, which will help to build trust between them and their healthcare providers and enhance cultural sensitivity in medical treatment,” she said.

Ms Parter continued, “It is vitally important that these waiting areas are designed and implemented in close consultation with relevant local Aboriginal and Torres Strait Islander communities and Aboriginal Community Controlled Health Organisations.”

“The history of the stolen generations and the role that Australian hospitals held during these events has left a strong effect on Aboriginal and Torres Strait Islander people, and in order to overcome this and move toward Reconciliation we need to work together to ensure Australian hospitals are a safe space for all,” Ms Parter said.

Michael Moore, CEO of the PHAA supported Ms Parter’s statements, saying, “Evidence shows that healthcare has the best outcomes when the patient and provider can share knowledge and understanding in a respectful and welcoming environment.

We also know that Aboriginal and Torres Strait Islander patients are at least 1.5 times more likely to leave hospital before receiving treatment compared to non-Indigenous patients.”

“This resembles the gaps in health outcomes which Close the Gap campaigners are working hard to resolve, and a trial on the mid-north coast in NSW showed that culturally appropriate waiting rooms resulted in a 50% reduction in Aboriginal and Torres Strait Islander patients leaving before accessing treatment. This really demonstrates the strength of this type of cultural safety initiative in a tangible way,” Mr Moore said.

“We ensure that hospitals are safe environments for children, elderly people, disabled people, and other groups with certain needs, it’s now time we ensure that the cultural needs of patients are also taken into careful consideration,” Mr Moore said.

 

Part 4 Racism and the hospital system : Donna Ah Chee

 Read in full here

“Within the hospital system Aboriginal and Torres Strait Islander people face racist barriers to gaining appropriate health care. Despite the increased burden of disease they carry, Aboriginal and Torres Strait Islander patients are only three-quarters (73%) as likely to undergo a procedure once admitted to hospital (3).

This difference led one key study to conclude that ‘there may be systematic differences in the treatment of patients identified as Indigenous’ in Australia’s public hospitals (4), a conclusion supported by studies showing poorer survival rates for cancer for Indigenous people, due to their being less likely to have treatment, having to wait longer for surgery, and being referred later for specialist treatment (5). This is not good enough and we need to use the current spotlight on racism to look at these deeper issues as well”, she suggested.

“Such systemic differences in care provided by hospitals contribute to Aboriginal and Torres Strait Islander people’s low level of trust for hospitals as institutions – the 2008 National Aboriginal and Torres Strait Islander Social Survey found that little more than 60% of Aboriginal and Torres Strait Islander people said that they felt hospitals could be trusted (6).

This level of distrust is reflected in the fact that Aboriginal and Torres Strait Islander people are five times as likely to leave hospital against medical advice or be discharged at their own risk compared to other Australians (7).

“Addressing these institutional barriers to appropriate care is complex but possible and we can do it as a nation of we finally come to terms with the seriousness of the problem (8).

“It will take a strong commitment to action. There needs to be a greater awareness in the Australian community about the adverse health consequences of racism for Aboriginal people.

If any good is to come out of the racism shown towards Adam Goodes I hope it is an awareness of the harm this does to our people across the nation which is currently symbolised by the suffering of one man: Adam Goodes.

Racism is a serious problem that Australia is yet to properly address. It should never be trivialised. It needs to be dealt with”, she concluded.

References

  1. Paradies, Y., Harris, R. & Anderson, I. 2008, The Impact of Racism on Indigenous Health in Australia and Aotearoa: Towards a Research Agenda, Discussion Paper No. 4, Cooperative Research Centre for Aboriginal Health, Darwin.
  2. ANTaR website http://www.antar.org.au/node/2… accessed September 26 2011
  3. Australian Health Ministers Advisory Council (2012). Aboriginal and Torres Strait Islander Health Performance Framework 2012 Report. AHMAC. Canberra. page 131
  4. Cunningham J (2002). “Diagnostic and therapeutic procedures among Australian hospital patients identified as Indigenous.” Medical Journal of Australia 176(2): 58-62
  5. Condon J R, Barnes T, et al. (2005). “Stage at diagnosis and cancer survival for Indigenous Australians in the Northern Territory.” Medical Journal of Australia 182(6

 

 ” Cultural safety requires embedding in not only course accreditation for each health profession — including measures to reduce resistance — but also in the standards governing clinical professionalism and quality, such as the Royal Australian College of General Practitioners Standards for general practices,19 and the Australian Commission on Safety and Quality in Health Care National safety and quality health service standards.20

Such commitment will need investment in clinician education and professional development, together with measures for accountability. The stewards of the National Aboriginal and Torres Strait Islander Health Plan5 (ie, the Department of Health and their expert implementation advisory group), accreditation bodies, and monitors of the existing frameworks of safety and quality standards in health care need to formally collaborate on a systematic revision of standards to embed culturally safe practice and develop health settings free of racism.”

Martin Laverty, Dennis R McDermott and Tom Calma

Originally published by MJA here

Download a PDF of this Report Paper for references 1-20

MJA Cultural Safety

Read 20 + previous NACCHO articles Cultural Safety  

In Australia, the existing health safety and quality standards are insufficient to ensure culturally safe care for Indigenous patients in order to achieve optimum care outcomes.

Where “business as usual” health care is perceived as demeaning or disempowering — that is, deemed racist or culturally unsafe — it may significantly reduce treatment adherence or result in complete disengagement,1,2 even when this may be life-threatening.3

Peak Indigenous health bodies argue that boosting the likelihood of culturally safe clinical care may substantially contribute to Indigenous health improvement.4 It follows that a more specific embedding of cultural safety within mandatory standards for safe, quality-assured clinical care may strengthen the currently inadequate Closing the Gap mechanisms related to health care delivery.

The causes of inequitable health care are many. Western biomedical praxis differs from Indigenous foundational, holistic attention to the physical, emotional, mental and spiritual wellbeing of the person and the community.5 An article published in this issue of the MJA6 deals with the link between culture and language in improving communication in Indigenous health settings, a critical component of delivering cultural safety.

Integrating cultural safety in an active manner reconfigures health care to allow greater equity of realised access, rather than the assumption of full access, including procession to appropriate intervention.

As an example of the need to improve equity, a South Australian study found that Indigenous people presenting to emergency departments with acute coronary syndrome were half as likely as non-Indigenous patients to undergo angiography.7 More broadly, Indigenous people admitted to hospital are less likely to have a procedure for a condition than non-Indigenous people.8

Cardiovascular disease is the leading cause of death in Indigenous Australians.9 Cancer is the second biggest killer: the mortality rate for some cancers is three times higher for Indigenous than for non-Indigenous Australians.10 Clinical leaders in these two disease areas have identified the need for culturally safe health care to improve Indigenous health outcomes.

Cultural safety is an Indigenous-led model of care, with limited, but increasing, uptake, particularly in Australia, New Zealand and Canada. It acknowledges the barriers to clinical effectiveness arising from the inherent power imbalance between provider and patient,11 and moves to redress this dynamic by making the clinician’s cultural underpinning a critical focus for reflection.

Moreover, it invites practitioners to consider: “what do I bring to this encounter, what is going on for me?” Culturally safe care results where there is no inadvertent disempowering of the recipient, indeed where recipients are involved in the decision making and become part of a team effort to maximise the effectiveness of the care. The model pursues more effective practice through being aware of difference, decolonising, considering power relationships, implementing reflective practice, and by allowing the patient to determine what safety means.11

Along with an emphasis on provider praxis, cultural safety focuses on how institutional care is both envisaged and delivered.12 Literature on cultural safety in Australia is scant but growing.13 Where evidence is available, it identifies communication difficulties and racism as barriers not only to access but also to the receipt of indicated interventions or procedures.11

There is evidence of means to overcome these barriers. An Australian study undertaken across ten general practices tested the use of a cultural safety workshop, a health worker toolkit, and partnerships with mentors from Indigenous organisations and general practitioners.13 Cultural respect (significant improvements on cultural quotient score, along with Indigenous patient and cultural mentor rating), service (significant increase in Indigenous patients seen) and clinical measures (some significant increases in the recording of chronic disease factors) improved across the participating practices.

In addition, a 2010 study by Durey14 assessed the role of education, for both undergraduate students and health practitioners, in the delivery of culturally responsive health service, improving practice and reducing racism and disparities in health care between Indigenous and non-Indigenous Australians. The study found that cultural safety programs may lead to short term improvements to health practice, but that evidence of sustained change is more elusive because few programs have been subject to long term evaluation..

Newman and colleagues10 identified clinician reliance on stereotypical narratives of indigeneity in informing cancer care services. Redressing these taken-for-granted assumptions led to culturally engaged and more effective cancer care. In a similar manner, Ilton and colleagues15 addressed the importance of individual clinician cultural safety for optimising outcomes, noting that provider perceptions of Indigenous patient attributes may be biased toward conservative care.

The authors, however, went beyond the clinician–patient interaction to stress the outcome-enhancing power of change in the organisational and health setting. They proposed a management framework for acute coronary syndromes in Indigenous Australians.

This framework involved coordinated pathways of care, with roles for Indigenous cardiac coordinators and supported by clinical networks and Aboriginal liaison officers. It specified culturally appropriate warning information, appropriate treatment, individualised care plans, culturally appropriate tools within hospital education, inclusion of families and adequate follow-up.

Willis and colleagues16 also called for organisational change as an essential companion to individual practitioner development. Drawing on 12 studies involving continuous quality improvement (CQI) or CQI-like methods and short term interventions, they acknowledged evidence gaps, prescribing caution, and argued for such change to be undertaken in the service of long term controlled trials, as these would require 2–3 years to see any CQI-related changes.

Sjoberg and McDermott,17 however, noted the existence of barriers to change: the challenge (personal and professional) posed by Indigenous health and cultural safety training may not only lead to individual but also to institutional resistance.17 Dismantling individual resistance requires the development of a critical disposition — deemed central to professionalism and quality18 — but in a context of strengthened and legitimating accreditation specific to each discipline. The barriers thrown up by institutional resistance, manifesting as gatekeeping, marginalisation or underfunding, may require organisational change mandated by standards.

NACCHO Aboriginal Health and #Pain Advice @AMAPresident @RuralDoctorsAus @ACRRM @CRANAplus @NRHAlliance Changes to the availability of #codeine containing medicines come into effect 1 February 2018

” From 1 February 2018, codeine will no longer be available over the counter. This means you will need to get a prescription from your ACCHO doctor to buy codeine. For people with ongoing chronic pain, there are other treatments in addition to or instead of medication that can be very helpful

There are many different ways that people can manage their pain without using codeine. Research shows low-dose codeine is not superior to over-the-counter alternatives such as a combination of paracetamol and ibuprofen for pain relief.”

From Real Relief

Opening graphic courtesy of Redfern AMA ACCHO

From 1 February 2018 medicines containing codeine will only be available by prescription. These medications are used to treat pain. Codeine is also sometimes used in cold and flu medicines.

If you live in a rural or remote area and you think that this change will affect you, it’s a good idea to know your options and plan ahead.


If you normally take medicines with codeine for ongoing (chronic) pain you should talk to a health practitioner about your pain management options. Codeine is only recommended for a maximum of three days and is not considered an effective treatment for chronic pain.

The best place to get advice and assistance will depend on the health services available in your area and your personal preference.

Visit your health practitioner

If you have access to a local GP, they can provide information and help with managing your pain and write you a prescription if you need one. If they feel you need extra help to manage chronic pain they might refer you to see a specialist – either in person or through a service called Telehealth that is used to deliver health services across Australia without the need for travel.

Go to a community health centre or remote health service

If you don’t have a local GP, you can get advice and help at a community health centre or a remote health service in your area. Remote area nurses and registered nurses can also provide advice and, in some areas, they can write prescriptions.

Visit your local Aboriginal and Torres Strait Islander Health Service

Aboriginal and Torres Strait Islander Health and Medical services can provide holistic and culturally appropriate advice and care on all health and medical issues including pain management.

Get free advice over the phone

For free health advice 24 hours, 7 days a week, you can call Healthdirect Australia on 1800 022 222. Healthdirect can provide you with advice on all health topics, including pain management. They can also help you locate your nearest health services and chemists.

Download our NRHAM resources

Click here to download the NRHA Codeine Fact Sheet 

Click here to download the NRHA Posters

If pain is ongoing the best way to manage it is with a combination of strategies that suit your condition and personal situation. Medication alone is not effective.

Multidisciplinary pain management will address all of the factors associated with pain – including emotions, mental health, social relationships and work – to help you get the best results.

One of the best ways to manage pain is to take control of it. With access to the right education and strategies, most people with chronic pain can successfully regain quality of life without the need for opioids, surgery or other invasive treatments.

You can learn more about multidisciplinary pain management through your ACCHO GP who can refer you to your nearest pain service.

Rural Doctors RDAA are working with ACRRM, CRANAplus and the National Rural Health Alliance (NRHA) to ensure that all rural doctors, rural and remote nurses and Aboriginal and Torres Strait Islander Health Workers can access relevant training and information so they can advise and/or prescribe the best and most appropriate form of treatment available to consumers following the change

AMA Interview

Well, first of all, the myth that something’s changing for people who have already required a prescription for opioids. We are more and more concerned about the use of opioids in our community. It’s not unique to Australia. So many of the people who die from heroin overdoses in the United States and Australia started off on prescription opioids. So, if anything good has come of the Guild’s advocacy on low dose codeine, it’s been shining a light on the opioid epidemic we have.

But the most important myth to bust is that – for those people who reach occasionally for one of these preparations for a headache, for backache, for period pain – an anti-inflammatory alone, paracetamol alone, is every bit as effective, and in fact it’s better, because for a lot of people codeine causes headaches, it doesn’t make them better.”

AMA President, Michael Gannon see interview in full Part 2

President of the Rural Doctors Association Australia (RDAA), Dr Adam Coltzau, said that while the up-scheduling of codeine has been well publicised, some patients will remain surprised when they can no longer buy their preferred pain medication over the counter.

“I have no doubt that starting today there will be disgruntled people who were either unaware of the coming change or who did not make plans to change their medication,” Dr Coltzau said.

“Everyone should be aware that they may consult with their pharmacist where available or where there is no pharmacist their health clinic team regarding alternative over-the-counter medications. It is imperative that consumers who have previously used over-the-counter codeine to manage pain see their health care provider regarding alternative medications or therapies that are available to them.

“And of course for those patients whose doctor or nurse practitioner recommends codeine-based products these remain available to them by prescription.

“The up-scheduling of codeine has provided a positive opportunity for both patients and prescribing practitioners to increase their knowledge of the safer and more effective pain relief medications and treatments, review their condition and re-assess their approach to management of these conditions,” Dr Coltzau said.

President of the Australian College of Rural and Remote Medicine (ACRRM), Associate Professor Ruth Stewart, said that patients should start a conversation with their GP about their pain problems to find a treatment that works for them.

“There’s no clinical evidence to suggest that over-the-counter codeine products are more effective analgesics than similar medicines without codeine,” A/Prof Stewart said.

“Talking to your GP about your pain is the best way to address it, as they’re equipped to suggest a pain management strategy based on your symptoms.

“Medication alone is often not the most effective way of treating many conditions, and a multidisciplinary pain management plan will help get the best results.

“In rural and remote areas, where people may have to travel to access their health care provider to review the management of their condition, it is important for consumers to schedule a visit with their

GP or other health care provider. Where pharmaceutical services are available, consumers can take advantage of the Government’s new Pain MedCheck program that will be rolled out across community pharmacies for a one-on-one consultation with your pharmacist.

“Online resources such as http://www.realrelief.org.au can provide consumers with the facts and information on the proven alternative pain medications that are available and there may also be specialist and allied health services available via telehealth for people living in rural and remote communities,” A/Prof Stewart said.

RDAA is working with ACRRM, CRANAplus and the National Rural Health Alliance (NRHA) to ensure that all rural doctors, rural and remote nurses and Aboriginal and Torres Strait Islander Health Workers can access relevant training and information so they can advise and/or prescribe the best and most appropriate form of treatment available to consumers following the change.

Visit www.rdaa.com.au for more information.

 Part 2

LAURA JAYES:   AMA President, Michael Gannon, joins us now live from Perth. Dr Gannon, thanks so much for your time. Is the AMA on board with this decision?

MICHAEL GANNON:   The AMA supports the decision made by Minister Greg Hunt, who in turn was taking the advice from the TGA, the Therapeutic Goods Administration. They’re the bureaucrats who have looked at the science and made a decision that brings Australia into line with 25 other countries.

LAURA JAYES:   There’s been a bit of reaction to this, you would’ve noticed, Dr Gannon, but most people do use these codeine products in a very responsible way. Are you concerned about what this might do in regional areas, where people don’t have access to this, they have to find a GP? That might delay them in seeking this medication.

MICHAEL GANNON:   Look, the Pharmacy Guild stands alone in their opposition to this change, and we’ve seen a lot of mythology out there. The important message – for people who have always required a prescription for higher doses of codeine, nothing’s changed.

Now, we’ll have more to say about that. This is a drug that is causing more harm than good in our community, and ideally over time we’ll see fewer and fewer prescriptions for opioids.

But for the lower doses of codeine that this change affects, it’s very important to deliver the message to people that there’s very clear scientific evidence that the low dose codeine-containing preparations are no more effective than the paracetamol or the anti-inflammatory alone.

That’s the message that should be delivered to a patient presenting to a community pharmacy today or in coming weeks: here’s some paracetamol, here’s some ibuprofen – it’s every bit as effective, and it’s a lot safer.

LAURA JAYES:   Well, you said myth-busting; what kind of myths did you want to bust? I’ll give you the platform to do it right here and now.

MICHAEL GANNON:   Well, first of all, the myth that something’s changing for people who have already required a prescription for opioids. We are more and more concerned about the use of opioids in our community. It’s not unique to Australia. So many of the people who die from heroin overdoses in the United States and Australia started off on prescription opioids. So, if anything good has come of the Guild’s advocacy on low dose codeine, it’s been shining a light on the opioid epidemic we have.

But the most important myth to bust is that – for those people who reach occasionally for one of these preparations for a headache, for backache, for period pain – an anti-inflammatory alone, paracetamol alone, is every bit as effective, and in fact it’s better, because for a lot of people codeine causes headaches, it doesn’t make them better.

LAURA JAYES:   You sound like the AMA is preparing to actually look more deeply into opioids other than codeine. It seems like codeine is the first frontier. Why is codeine any worse than some of the others?

MICHAEL GANNON:   Well, the reason that codeine is worse is that it’s unique amongst the opioids in that’s it’s being treated in such a permissive manner. You still need a prescription for fentanyl; you still need a prescription for oxycodone; you still need a prescription for morphine.

But if anything good has come out of this conversation in recent months, it’s been that we, as doctors – whether that’s surgeons dispensing opioids after surgery, whether it’s emergency departments dispensing them in people who have presented with trauma or some other form of pain – we need to do something, because oxycodone, fentanyl, higher doses of codeine, are also causing damage in our community.

We need to look carefully at better opioids. Codeine is very much yesterday’s drug, it would not be licensed if it was invented next week. But we need to look carefully at our prescription of other opioids and really look carefully at non-pharmacological approaches to chronic pain.

LAURA JAYES:   What ones are you concerned about? Are you concerned about pseudoephedrine? Because I believe if I’ve got a bit of the flu, I go to the chemist, I get some cold and flu tablets that contain pseudoephedrine. You can certainly get through a day of work with those drugs, but are they an addictive substance? If codeine is the first one you’re concerned about, what are the next?

MICHAEL GANNON:   Pseudoephedrine is not an opioid, so it’s not used for pain relief, and the main reason to be careful with its use is it’s used to cook up methamphetamine in criminal backyard laboratories.

But you raised an important issue there, the need to monitor. We support real-time prescription monitoring. We’ve been very supportive of what’s existed in Tasmania until now. State Minister Jill Hennessy in Victoria, Federal Minister Greg Hunt, have made noises about real-time prescription monitoring. We agree with the Pharmacy Guild that that’s the way forward, especially for other licit opioids that have become drugs of abuse, like fentanyl, like oxycodone.

LAURA JAYES:   Okay, so those are the main concerns that are being abused if the opportunity is given?

MICHAEL GANNON:   Well, we are concerned about these drugs as drugs of abuse. I mean, the evidence comes from coronial reports in Victoria and other States.

LAURA JAYES:   How do people get them, though? Do they doctor shop?

MICHAEL GANNON:   Well, there is no question that some people doctor shop, but that’s a pretty ambitious effort to doctor shop for 8mg codeine tablets. But there’s no question that some people, they cook up all sorts of stories, they’re very sophisticated in how they go around collecting prescriptions for codeine 30mg tablets.

We know that fentanyl patches, that people use them, and they get the drug out of the patch for intravenous or subcutaneous administration. Australia has long been a high user of opioids, we’re a big exporter of opioids, and the story of the harm they do in the community is not a new one. But this decision, it’s at least two or three years overdue, and it brings us into line with much of the rest of the developed world.

 LAURA JAYES:   Dr Michael Gannon, thanks so much for your time today. This is a fascinating area that I agree with you we need to look a lot more closely at. We’ll get you back another time and deep-dive into that issue. Thanks so much for your time.

 MICHAEL GANNON:   Thank you, Laura.    

 

 

 

 

 

 

 

NACCHO Aboriginal #MentalHealth Alert : @AMAPresident calls for a national, overarching mental health “architecture”, and proper investment in both #prevention and #treatment of mental illnesses

 

“Almost one in three (30 per cent) of Indigenous adults suffered high or very high levels of psychological distress in 2012-13. Indigenous adults are 2.7 times as likely as non-Indigenous adults to suffer these levels of distress.

General practitioners manage mental health problems for Indigenous Australians at 1.3 times the rate for other Australians, and mental health-related conditions accounted for 4.4 per cent of hospitalisations of Indigenous people in 2012-13.”

AMA President, Dr Michael Gannon – Source: Australian Institute of Health and Welfare

Download the AMA 2018 Position Paper

Mental-Health-2018- Position-Statement

Read over 168 NACCHO Mental Health articles published over 5 Years

The AMA is calling for a national, overarching mental health “architecture”, and proper investment in both prevention and treatment of mental illnesses.

Almost one in two Australian adults will experience a mental health condition in their lifetime, yet mental health and psychiatric care are grossly underfunded when compared to physical health, AMA President, Dr Michael Gannon, said today.

Releasing the AMA Position Statement on Mental Health 2018, Dr Gannon said that strategic leadership is needed to integrate all components of mental health prevention and care.

“Many Australians will experience a mental illness at some time in their lives, and almost every Australian will experience the effects of mental illness in a family member, friend, or work colleague,” Dr Gannon said.

“For mental health consumers and their families, navigating the system and finding the right care at the right time can be difficult and frustrating.

“Australia lacks an overarching mental health ‘architecture’. There is no vision of what the mental health system will look like in the future, nor is there any agreed national design or structure that will facilitate prevention and proper care for people with mental illness.

“The AMA is calling for the balance between funding acute care in public hospitals, primary care, and community-managed mental health to be correctly weighted.

“Funding should be on the basis of need, demand, and disease burden – not a competition between sectors and specific conditions. Policies that try to strip resources from one area of mental health to pay for another are disastrous.

“Poor access to acute beds for major illness leads to extended delays in emergency departments, poor access to community care leads to delayed or failed discharges from hospitals, and poor funding of community services makes it harder to access and coordinate prevention, support services, and early intervention.

“Significant investment is urgently needed to reduce the deficits in care, fragmentation, poor coordination, and access to effective care.

“As with physical health, prevention is just as important in mental health, and evidence-based prevention can be socially and economically superior to treatment.

“Community-managed mental health services have not been appropriately structured or funded since the movement towards deinstitutionalisation in the 1970s and 1980s, which shifted much of the care and treatment of people with a mental illness out of institutions and into the community.

“The AMA Position Statement supports coordinated and properly funded community-managed mental health services for people with psychosocial disability, as this will reduce the need for costly hospital admissions.”

The Position Statement calls for Governments to address underfunding in mental health services and programs for adolescents, refugees and migrants, Aboriginal and Torres Strait Islander people, and people in regional and remote areas.

It also calls for Government recognition and support for carers of people with mental illness.

“Caring for people with a mental illness is often the result of necessity, not choice, and can involve very intense demands on carers,” Dr Gannon said.

“Access to respite care is vital for many people with mental illness and their families, who bear the largest burden of care.”

The AMA Position Statement on Mental Health 2018 is available at https://ama.com.au/position-statement/mental-health-2018

Background

  • 7.3 million Australians (45 per cent) aged 16 to 85 will experience a common mental health disorder, such as depression, anxiety, or substance use disorder, in their lifetime.
  • Almost 64,000 people have a psychotic illness and are in contact with public specialised mental health services each year.
  • 560,000 children and adolescents aged four to 17 (about 14 per cent) experienced mental health disorders in 2012-13.
  • Australians living with schizophrenia die 25 years earlier than the general population, mainly due to poor heart health.
  • Almost one in three (30 per cent) of Indigenous adults suffered high or very high levels of psychological distress in 2012-13. Indigenous adults are 2.7 times as likely as non-Indigenous adults to suffer these levels of distress.
  • General practitioners manage mental health problems for Indigenous Australians at 1.3 times the rate for other Australians, and mental health-related conditions accounted for 4.4 per cent of hospitalisations of Indigenous people in 2012-13.
  • About $8.5 billion is spent every year on mental health-related services in Australia, including residential and community services, hospital-based services (both inpatient and outpatient), and consultations with GPs and other specialists.

(Source: Australian Institute of Health and Welfare)

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