NACCHO Aboriginal Health #AusVotesHealth #VoteACCHO : What the coalition’s Indigenous-specific and related budget measures reflect for #Election2019 @ScottMorrisonMP @KenWyattMP @GregHuntMP #SenatorNigelScullion

Indigenous-specific and related budget measures

As with previous budgets, the 2019–20 Budget includes both Indigenous-specific measures, listed here, and many mainstream measures that are likely to disproportionately affect Indigenous people, positively or negatively, due to Indigenous people’s level of disadvantage (including higher rates of disabilityunemployment, and mental illness) and relative geographical concentration in remote and very remote areas.

The extent to which mainstream services have a positive effect depends in large measure on whether their design and delivery is culturally safe and appropriate.

For consistency with other reporting frameworks, such as the Overcoming Indigenous Disadvantage report and the Indigenous Expenditure Report, measures are categorised according to the Council of Australian Governments’ (COAG) ‘building blocks’, commencing with those areas the Government regards as key priorities (Portfolio Budget Statements 2019–20: Budget Related Paper No. 1.14: Prime Minister and Cabinet, p. 30).

Since the Mid-Year Economic and Fiscal Outlook 2018–19 (MYEFO) the Government has announced a number of other Indigenous measures which are probably funded from grants programs, departmental funds, or the MYEFO’s ‘decisions taken but not yet announced’ allocation. They are not listed in this brief unless they are directly relevant to a Budget measure.

Unless otherwise stated all page references are to Budget Paper No. 2: Budget Measures 2019–20.

James Haughton of the Parliamentary library about the Indigenous specific announcements by government in MYEFO, Budget and as part of their election campaign:

 “NACCHO has developed a set of policy #Election2019 recommendations that if adopted, fully funded and implemented by the incoming Federal Government, will provide a pathway forward for improvements in our health outcomes.

We are calling on all political parties to include these 10 recommendations in their election platforms and make a real commitment to improving the health of Aboriginal and Torres Strait Islander peoples and help us Close the Gap.”

Read all the 10 Recommendations HERE

Stakeholder reactions to Coalition Budget

National Aboriginal Community Controlled Health Organisations (NACCHO) provides a round-up and summary of Indigenous peak body responses to the Budget.

The CROAKEY health blog provides a summary of pre-budget submissions on Indigenous issues from the health and community sector here.

National Indigenous Television summarised Indigenous peak body reactions to the Budget as ‘lacklustre’ and ‘too little, too late’ despite some ‘glimmers of hope’, such as increased funding for ATSILS and Indigenous health research, although many stakeholders expressed concern at the rolling of the Indigenous Legal Assistance Program into a mainstream funding mechanism.

Many stakeholders expressed concern or outrage that the Budget only allocated $5.0 million in new Budget allocations to preventing Indigenous youth suicide.

The Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention noted the additional $10.0 million announced by the Minister for Indigenous Health (see above) but suggested that if funding were to be in proportion to demand, then Indigenous-specific measures should have been about nine per cent of the total mental health package, or about $70.0 million

Indigenous budget drivers

Over the last decade, the Productivity Commission’s Indigenous Expenditure Reports (IER) have consistently shown that total Commonwealth, state and territory government per capita expenditure on Aboriginal and Torres Strait Islander people is approximately double the per capita expenditure on non-Indigenous Australians.

The Australian Government directly spends around 1.5 times as much on Indigenous people on a per-capita basis, or 1.64 times as much if indirect spending (via transfers to the states and territories) is included (calculation based on IER 2017 supplementary data tables).

In 2015–16, the Australian Government directly spent $14.7 billion on Indigenous people, of which 77 per cent ($11.3 billion) was through mainstream programs such as Medicare, social security payments, child care benefits and support for university places accessed by Indigenous people. Around 23 per cent ($3.3 billion) was on Indigenous-specific programs such as ABSTUDY, Indigenous-specific health programs, or Indigenous rangers programs.

When state and territory government spending is included, mainstream spending climbs to over 80 per cent of the total expenditure on Indigenous people.

The main driver of Indigenous expenditure is thus not Indigenous-specific programs, but higher use of all government programs.

Some of this higher use is due to demographic differences—for example, Indigenous people are on average younger and have higher fertility rates than non-Indigenous Australians, leading to more per-capita demand for pre-school, school and university places, and child care services (IER 2017, p. xii).

However, much of it is caused by Aboriginal and Torres Strait Islander people’s higher levels of disadvantage, leading to higher use of hospitals, social security, and social housing, as well as higher rates of child protection interventions and imprisonment.

These circumstances give rise to demand for Indigenous-specific programs, such as those detailed below, to divert people from these undesirable outcomes. Government per capita spending on Indigenous people and programs can be expected to remain above the per capita average in future budgets until there is real progress on closing the gaps.

In this context, there is currently no provision in the budget to continue the following National Partnerships[1] over the forward estimates period:

  • National Partnership Agreement on Universal Access to Early Childhood Education[2]
  • national partnerships on cross border issues in the Torres Strait, including health issues, mosquito control, and blood borne viruses and sexually transmissible infections
  • National Partnership on Northern Territory remote Aboriginal investment (formerly the National Partnership on Stronger Futures in the NT) and
  • national partnerships on improving trachoma control and the rheumatic fever strategy.

Furthermore, no support will be provided beyond 2018–19 for remote housing outside the Northern Territory. With the possible exception of trachoma, the issues addressed by these National Partnerships are unlikely to radically improve in the near future.

Health

Education and early childhood

  • Closing the Gap refresh—Indigenous Youth Education Package. Announced in the Prime Minister’s Closing the Gap statement, this provides $200.0 million for scholarships and mentoring for Indigenous students, $70.6 million to freeze or waive Higher Education Loan Program debts for teachers in very remote schools, and $5.0 million to promote school attendance. Only $86.7 million is new money, with the remainder being found from ‘existing resources of the Department of the Prime Minister and Cabinet’, possibly referring to the Indigenous Advancement Strategy grant program (p. 153).
  • Extending Family Tax Benefit to ABSTUDY recipients aged 16 or over who study away from home: $36.4 million over five years (p. 159).
  • As well as enabling Indigenous children to access preschool (a Closing the Gap target), the one-year $453.1 million extension of the National Partnership Agreement on Universal Access to Early Childhood Education includes $1.4 million specifically to increase preschool attendance among Indigenous children, 41 per cent of whom do not make full use of the available 15 hours a week (pp. 67–8).
  • An unspecified portion of $62.4 million allocated to the Skills Package—Delivering Skills for Today and Tomorrow measure will go to pilot four Indigenous ‘second chance’ language, literacy, numeracy and digital skills education services in remote communities (p. 69).
  • $15.0 million under the Community Development Grants Programme measure to fund the William Cooper Centre at Punt Road, an educational hub for Indigenous students run by the Richmond Football Club (p. 126).

Employment and economic participation

  • Securing Tourism and Jobs in Kakadu: $216.2 million over ten years on several programs to boost tourism and upgrade and develop facilities in the Jabiru township. Funding has ‘already been provided for’, possibly in the 2018–19 MYEFO (p. 77). After criticism from the Northern Territory (NT) Government over lack of information on the timing of funding, Minister for Indigenous Affairs Nigel Scullion has stated that $150.0 million will be spent over four years, including $20.0 million from the Indigenous Affairs portfolio.
  • The Support for the Australian Music Industry measure includes $2.7 million for a grant program for Indigenous musicians (p. 60).
  • The Barkly Regional Deal ‘redirects’ $8.5 million in funding from the Indigenous Advancement Strategy to support economic development projects in the Barkly region of the NT (p. 125).
  • The Northern Territory Infrastructure Investment Program includes $60.0 million for road upgrades on the Tiwi Islands (p. 133). Other road projects under this program and the Queensland (pp. 134–5) and Western Australia (p. 143) Infrastructure Investment Programs also include roads in remote areas with high Indigenous populations, which may increase economic opportunities, particularly if Indigenous employment and procurement targets are included.
  • The Indigenous Procurement Policy will be extended to introduce a three per cent value target alongside the three per cent number of contracts target.

Community safety

  • $128.8 million to extend the Cashless Debit Card trials and transition people on Income Management to the Cashless Debit Card (pp. 157­–8). This measure includes:
    • funding to extend the trials in the current sites until 30 June 2021
    • changes to the payments system that will enable merchants to automatically decline transactions that involve restricted items, such as alcohol or gambling products, and
    • moving people who currently use the BasicsCard under income management onto the cashless debit card.

Most people subject to these income quarantining measures are Indigenous. This measure will require legislation, and will be covered in more detail in a separate Parliamentary Library publication.

Governance, leadership and culture

Housing

The Department of the Prime Minister and Cabinet’s (PM&C) Review of Remote Housing estimates that South Australian remote Aboriginal communities need an additional 300 houses by 2028 to address existing overcrowding and accommodate population growth. The review found that in South Australia (which achieved the highest value for money in remote housing construction) it cost approximately $480,500 to build new houses, plus 6.9 per cent ancillary costs. On these figures, $37.5 million will build approximately 73 new houses, so will not meet the identified demand, although as noted, this item is only ‘part of transition arrangements’. No information is yet available on any longer term programs.

 


[1].          See Budget Paper No. 3: Federal Financial Relations or the Federal Financial Relations website for more information on the National Partnerships.

[2].          The Budget extends this National Partnership by one calendar year, but it still ends within the forward estimates. See the Parliamentary Library’s Education and training budget brief for more details.

[3].          Whether this strategy continues or replaces the National Partnership on addressing blood-borne viruses and sexually transmissible infections in the Torres Strait, which has a cross-border focus, is not clear.

NACCHO Aboriginal #AusVotesHealth and #Budget2019 5 of 5 : Download or Read Opposition Leader @billshortenmp full #BudgetReply Speech Includes a #FirstNations #Voice in the #Constitution #Medicare #Education and #Training #NDIS #Cancer

“To summarise what our first four years of Labor’s Medicare cancer plan means for Australians – up to 6 million free cancer scans, 3 million free appointments with specialists and an affordable medicine guarantee.

This is our vision for the future, our vision to build Medicare. We can pay for it and we can deliver it because of our reform decisions. We choose our healthcare system over bigger tax loopholes.

So in conclusion, my fellow Australians, I suspect that some in the government will spend a lot of time telling you to be afraid, afraid of change, afraid of new ideas, afraid of our future, afraid of each other. I expect we will see more of that in the campaign ahead. I have a different view.

I’m optimistic about our nation’s future because this country has so much going for us, a continent to call our own, next to the fastest growing economies in the world. The resources to be an energy superpower. We have the skills and science and get up and go to create new industries, and best of all, we have our people. Australians are hardworking, caring, brave, smart and generous.

We will never be the biggest country many the world, we will never seek to impose our ideology on other nations but I believe if we’re not the biggest, we should still aim to be the best, the best in education and skills, the best in health and aged care and looking after people with dementia, the best in fair wages and fair reward for your work.

That is the real choice that our country faces at this election, it is the decision which every Australian has the right to make. Do we want the best healthcare system in the world or the biggest tax loopholes? Do we want our children to get the world’s best education or the world’s most generous tax subsidies? Do we want a fairer, more equal country where the economy works in the interests of everyone, or do we want another three years of drift with the top end of town profiting much better than everybody else? My team and I have made the reformed decisions to put a fair-go action plan forAustralia, so Australia can be the best we should be.

Labor offers stability and unity and a vision for the nation, we choose hope over fear, we choose the future over the past. We choose the best support possible for people with cancer. We choose fair wages and good jobs. We choose Tafe and apprenticeships

We choose a voice to First Australians enshrined in our constitution.

We choose renewables and we choose real action on climate change. We choose the ABC. We choose equality for women of Australia, equality for everyone. If these things matter to you, if you believe that when all is said and done about politics the most important things are family and health, if you believe that handing on a better deal to your kids than the one you inherited from your parents, if you believe that is what is the sort of vision we should have for Australia, then when you cast your vote in May, choose a Labor government for all Australians.

Bill Shorten Budget reply speech read in full below or Download HERE

Bill Shorten Budget Reply Speech

This weeks NACCHO Budget Coverage 

Post 1: NACCHO Intro #AusVotesHealth #Budget2019

Post 2: NACCHO Chair Press Release

Post 3:  Health Peak bodies Press Release summary

Post 4 : Government Press Releases

Post 5 : Opposition responses to Budget 2019 

Read all Budget 2019 Posts 

View NACCHO TV interview with NACCHO Chair HERE

Women and men of Australia.

A Budget should sketch the big picture.

Build for the long term, write Australia large.

Be ambitious, be as bold as the Australian people.

That’s what a Labor Government will do, strive for the best.

Because Australians deserve the best.

But instead, on Tuesday night, we received an exercise in numerology.

A recitation of numbers. No passion, no national story, no vision laid out to divine where the country is and where the country is going. And no reform.

The same promises made and broken, six years running.

Yes, there is a third Prime Minister.

A third Treasurer.

But where it mattered, the same Liberal Budget.

The same void where an energy policy should be.

The same failure on stagnant wages and rising cost-of-living.

The same denial on climate change.

The same $14 billion cut to schools.

And the same $2.8 billion cut to hospitals.

So tonight, the first commitment I can give Australians – and one of the most important:

If we win the next election, we will put back every single dollar the Liberals have cut from public schools and public hospitals.

Now Mr Speaker, to be fair –

There was one new feature in this Budget, albeit troubling.

The short-changing of the National Disability Insurance Scheme by $1.6 billion, to prop up a flimsy budget surplus forecast.

Now it looks a lot more like dodgy accounting than good economic management.

I freely acknowledge government members sincerely care about people with disability.

But the truth is, the record of the last six years, the government has made a record of poor decisions regarding the NDIS.

Sacking the board.

Delaying the signing of funding agreements with the states.

Capping staff numbers for the National Disability Insurance Agency – leading to an outbreak of contractors and consultants undermining the system.

And then – after all these policies that hamstring delivery of services – the

Government shrugs, and say the $1.6 billion wasn’t needed, because of a lack of demand.

There are thousands of Australians who have embraced the promise of the NDIS but whose legitimate demands have simply not been met.

The young man in Ballarat who has waited more than two years for a wheelchair, waited so long that he ended up in hospital with pressure sores.

The family whose daughter has an intellectual disability, who have waited ten months for funding for the speech therapy she needed to learn to make friends at school.

Or the family of a profoundly deaf young man who was denied interpreters and training in Auslan and has spent the last two and a half years appealing the decision.

All these people… the carers seeking modest respite…the parents, the loved ones, filling out the forms, calling time and time again for promises not fulfilled, waiting on the phones….

They do not tell me there is a lack of demand, they’re talking about a desperate need.

Working with the Member for Jagajaga, with people with disability, their carers and an army of advocates to help create the National Disability Insurance Scheme is one of the most rewarding things I’ve ever been part of.

And tonight I can give every Australian living with disability and the people who love them this personal commitment: that if we are elected as the next government

We will lift the NDIA cap on staff numbers, so we can get the support out the door, keep the promises made to people with disabilities.

And we will put people with disability back at the centre of decision-making in the National Disability Insurance Scheme.

We will get the NDIS back on track.

I acknowledge our opponents have finally seen the light on supporting the bigger, better and fairer tax cuts for 10 million Australians that I put put forward at my last budget reply speech.

And tonight I can confirm that, from 1 July –

If you earn between $48,000 and $126,000 – no matter who you vote for in May – you will get the same tax refund.

But the Liberal tax plan does not do enough for 2.9 million Australians who earn less than $40,000. About 57 per cent of these are women. Child care workers and classroom assistants. Hairdressers, office managers.

And they are parents returning to work, part-time.

In a lot of cases, these are the very same workers in retail, hospitality, pharmacy and fast food who have already had their penalty rates arbitrarily cut.

Tonight, I am pleased to say that in Chris Bowen’s first Budget –

Labor will provide a bigger tax refund than the Liberals for 3.6 million Australians.

All told, an one billion dollars, for low-income earners in this country.

There’s always a lot of talk about tax from those opposite – but here is the simple truth:

6.4 million working people will pay the same amount of income tax under Labor as the Liberals.

And another 3.6 million will pay less tax under Labor.

But we will not be signing-up to the Liberals’ radical, right-wing, flat-tax experiment, way off in the future.

A scheme which would see a nurse on $50,000 paying the same tax rate as a surgeon on $200,000. We won’t back a plan that gives a retail worker on $35,000 less than $5 a week… …while an investment banker pockets more than $11,000 a year.

This is not a tax plan, it’s a ticking debt bomb.

And it is neither fair nor responsible to lock-in these billions of dollars in tax giveaways flowing disproportionately to a relatively few Australians – and so far into the future.

Especially when you consider the foreboding we see in the global environment.

  • Brexit
  • Trade wars
  • The write-downs in global growth  The massive increase in global debt
  • The drop in the 10-year bond yields.

This is the time when Australia should be building a strong surplus, a fiscal buffer.

The Liberals talk about being back in the black – but the Budget papers reveal a much paler shade of grey.

What we need is a fighting fund for the nation, a strong surplus to protect us from international shocks.

Surpluses built on real reform – not cutting schools and hospitals, not shortchanging the NDIS and not banking on the price of ore in a blue sky environment.

And tonight I recommit that is what Labor will take to the next election – stronger surpluses, paying down national debt faster.

Guaranteeing everything from our commitment to defence spending at 2 per cent of GDP, drought relief for farmers and keeping our borders secure.

Nearly six years ago, my united team and I made a choice.

We decided not to be the kind of Opposition who just stay quiet, cross our fingers and hope the Government would tear itself apart.

We decided to lead the reform debate, with a bold agenda.

We believe the Australian people are hungry for a united, stable government with a real vision for the future, one that can make hard decisions.

We believe government has a responsibility to leave the place better than we found it.

That’s why we’re going to stop the intergenerational unfairness in our tax system.

If you’re currently negatively gearing the rules won’t change.

If you want to use it on new homes, you still can.

But we cannot have property investors playing with loaded dice against our young people, Generation Y and the Millennials.

And instead of patronising millions of young Australians with lectures about cutting back on smashed avo. Why don’t we tell them the truth:

Getting together a 20 per cent deposit – plus stamp duty – is so much, much harder than it was 20 or 25 years ago. And it’s even more difficult, when your government uses your taxpayer money to subsidise the property investors bidding against you.

The intergenerational bias that the tax system has against young people must be called out.

A government has to be brave enough and decent enough to stop the bias against first home buyers and young Australians. And we will be that government. The same goes for dividend imputation. If the tax office pays a tax credit to someone who pays no tax, this is a gift.

It’s a gift that is costing taxpayers nearly $6 billion every year – and growing so fast that it will soon be more than what we spend on public schools.

Now it’s not illegal, it’s not immoral – but it’s just not sustainable anymore.

And Mr Speaker – reform which delivers intergenerational fairness to our young must include real action on climate change. The climate change debate has poisoned this parliament for ten years – and it has most certainly paralysed the current Government. So tonight let’s deal in simple facts:

Climate change is real.

It’s doing real damage to our economy – and our environment.

And we can measure cost of inaction: bushfires, droughts, floods, in extreme weather and damage to our farmland and our Reef.

For the sake of the Australia that we hand on to our children, a Labor Government will reform, will not shirk the task of reform – it will take real action on climate change.

Now tonight – and at this election – Labor is offering the Australian people a fully funded Fair Go Action Plan.

  • Building an economy that works for everyone.
  • Investing in an education system that creates opportunity for everyone.
  • Fixing the wages system so it delivers for everyone.
  • Reforming the tax system so it is fair for everyone.
  • And funding a health system that is there for everyone.

We believe Australia does best when working class and middle class Australia gets a fair go.

When the economy is managed in the interests of everyone.

When the people who create our national wealth, get their fair share of the national wealth.

And when everyone has an equal chance to fulfil their potential.

This is why investing in the future, always begins with education.

This is where the difference between Labor and the Government could not be more stark.

Nine out of ten new jobs created in the next four years will require either a university degree or a TAFE qualification. Only a Labor Government will be prepared to properly fund both. We’ll uncap university places, opening the doors of higher education to an additional 200,000 Australians.

And when it comes to vocational education, Labor is backing public TAFE all the way. I’ve been fortunate to have visited about 30 TAFEs around Australia since the last election. The teachers and students are inspirational.

So tonight I’m pleased to announce that we are going to double the size of our Rebuilding TAFE fund – up to $200 million to renovate campuses in regional and outer-suburban Australia.

This will mean:

  • This will mean new facilities for training nurses in Caboolture and Devonport.
  • New workshops in Midland and Bellevue, to make sure the METRONET train carriages work goes to apprentices.
  • A new construction centre for tradies in Chadstone and Frankston.

And so much more.

Labor will also pay the upfront fees for 100,000 TAFE places to get more Australians training in high-priority courses.

And tonight I am proud to announce that 20,000 of these places will be allocated to a new generation of aged care workers and paid carers for the National Disability Insurance Scheme.

My mother was a great teacher. She taught me that you can measure a nation’s values by how much it values education. I want every child in Australia to get the one-on-one attention that they need to thrive.

I want Aboriginal kids to get genuine equal opportunity, children with disability or learning difficulties getting the support they need.

I want every child participating in sport, trying drama, learning music, going on camps, getting access to new technology.

And not as optional extras, to which parents pay increasing levies, not and luxuries that rely on the teachers raising the money themselves.

I want it guaranteed.

Guaranteed because every school in Australia should offer every child the same world of opportunity.

And there’s one more thing that we will do to make Australian schools the best in the world – we’ll make Tanya Plibersek the Minister for Education.

Experts tell us ninety per cent of a child’s brain develops before the age of 5.

And two years of preschool or kindergarten is the rule in countries at the top of the global education ladder:

  • South Korea
  • Norway
  • New Zealand
  • France
  • And the United Kingdom

Last year, China enrolled 46 million three year olds in pre-school programs. Australia is falling behind in the early years education – and that affects our children right through their educational lives.

If you vote Labor, we will guarantee universal access to pre-school or kinder for every three year old and every four year old in Australia. 15 hours a week, 40 weeks a year.

Two years of pre-school is global best practice – and it’s only just good enough for our kids.

Our vision for education and training is all about putting Australia on the high road to the future:

High skill workers. High quality products. High value services. And higher-wage jobs. This means backing local businesses and industries. We backed a tax cut for small and medium businesses.

And we will provide an extra 20 per cent tax break for every business that invests in productivity-boosting equipment above  $20,000 – whether that’s a big manufacturer buying new technology, or a tradie getting a new ute.

And we will invest in industries where Australia can be best in the world – I speak of:

  • Agriculture and Tourism
  • Hydrogen Energy
  • Science and research
  • Advanced Manufacturing
  • Mineral exploration, to unearth new wealth

Defence industry – and commercial ship-building, to revive our Merchant Marine and see more Australian ships, flying the Australian ensign. Embracing renewables will also create thousands upon thousands of new jobs for Australia.

Labor will provide a $2000 payment to families who want to join the fight against climate change and the fight to lower their power bills by installing a battery storage system.

And here’s the remarkable thing – we already have every single resource to make a lithium battery, right here in Australia.

So instead of the usual trope of shipping the minerals overseas and buying back the finished product at vastly inflated prices, let’s make the batteries here.

And let’s do this with electric vehicles and charging equipment and stations too.

Supported by Australia’s first Electric Vehicle Policy. And rather than relying on China and India to accept our plastic and waste… …or to leave it choking our waterways and killing our marine life, let’s recycle it here at home.

When it comes to clean technology, I believe we can make three words famous right around the world: Made in Australia.

Building an economy that works for everyone means a massive building program, right across our nation.

We will reinvigorate jobs in the construction sector:

  • With our Build-to-Rent plan.
  • Targeting Negative Gearing to new housing.
  • Renovating the national energy grid with new pipelines, interconnectors, hydro and storage.
  • Launching the biggest affordable housing program since the Second World War – building a quarter of a million new homes.

And we will invest in safe accommodation for women fleeing violent relationships.

Because too often, when the worst happens, people still say: “Why didn’t she leave?” What we should ask is: “Where would she go?”

Labor has transport plans and projects ready to go in every state and territory:

  • Cross River Rail in Brisbane
  • Western Sydney Metro
  • Suburban Rail Loop in Melbourne
  • The Bridgewater Bridge in Tassie
  • South Road in South Australia
  • METRONET in Perth
  • Upgrading the roads around Kakadu  And Phase 2 of the ACT light rail.

And – thanks to Albo’s hard work – the work is just beginning.

Labor will continue to develop and support the development Northern Australia: including overdue upgrades for the beef roads and the Rocky ring road.

And tonight I can announce we will deliver $1.5 billion to upgrade the Gateway Motorway from Bracken Ridge to the Pine River – and the next stage of the Bruce Highway from the Northern Suburbs to Caboolture.

There’s another big difference between Liberal and Labor on infrastructure.

In their budget you have to vote for the current Prime Minister at this election… … then you have to vote for whoever is their leader at the next election……and that’s before anyone even digs a hole.

Our projects are not on the never-never, they are locked in to our first budget.

There’s another difference that I offer the Australian people, frustrated by the constant short-termism in the infrastructure debate.

If we are elected, I will invite the then-Opposition Leader to be involved in nominating directors to Infrastructure Australia, so we take the politics out and we make generational decisions in infrastructure for once and for all time.

And every time we invest Commonwealth dollars in infrastructure projects.

We’ll make the rule that 1 in 10 people employed must be an Australian apprentice.

The bad news is that over the last six years under the Liberals, apprenticeships have fallen by 150,000.

The good news is because of our vision:

  • in infrastructure
  • housing construction
  • the NDIS
  • TAFE and training
  • early childhood education
  • energy
  • and the digital economy

…a Labor Government can repair the damage done.

Tonight, I say we will help train 150,000 apprentices for the jobs of the future. We will provide additional support for businesses which take them on – both young people and mature age workers looking to re-train and to learn new skills.

And we’ll create an Apprentice Advocate – because the tragic death of an 18 year old apprentice on the Macquarie Park site last week, reminds us that we’ve got to protect our apprentices and they have the same right to come home safe as everybody else.

The next election will be a referendum on wages.

We need to get wages growth going again – for workers, for the economy, for confidence and consumption. Because when we boost the spending power of working people, that money flows back into the tills of small businesses.

In the last six years, three Liberal Prime Ministers and three Liberal Treasurers have signed-off on official forecasts for wages growth…they have been wrong 27 times in a row.

27 times they have promised and not delivered.

On Tuesday night, the Treasurer boldly said he would “like” wages growth to be higher. He would “like” that.

After six years of stagnation: liking and wishing and hoping is not a plan for working people.

For the last six years, we’ve tried it their way, the Government’s way, the invisible hand, leave it to the market – we know how that ends

Since the last election, wages have risen by around five per cent – while company profits have increased nearly forty per cent.

Only Labor has a concrete, practical plan to get wages moving again.

  1. If we win the election we will legislate to restore the arbitrary cuts to Sunday and public holiday penalty rates in our first 100 days.
  2. We will stop companies using sham contracts and dodgy labour hire arrangements to cut people’s pay.
  3. Our Tradie Pay Guarantee means that subbies working on Commonwealth projects get paid on time, every time.

And we will help the 1.2 million lowest-paid Australians, by creating a living wage. Of course, we will consult with employers and the independent umpire, and of course we will take into account the capacity of business in the economy to sustain the wages’ growth. But I don’t want any Australian adult who works full time, to be trapped in poverty.

A sensible, overdue plan to achieve moderate but meaningful improvement in wages.

And whenever we talk about fair pay, it includes equal pay and fairer conditions for the women of Australia.

  • A new push for better pay in women-dominated industries like early education.
  • New measures to help boost the superannuation of working women.
  • And 10 days of paid leave for people dealing with family violence.

This is what you get from a political party that walks the walk on equality for women – and has so many talented women in our ranks in parliament right now.

At this election, Mr Speaker, we are offering a genuine alternative for regional Australia.

  • Better support for our dairy farmers to get a fair deal.
  • Working to restore the Murray Darling to health.
  • Helping restock the cattle herd of North Queensland.
  • New investments in eliminating mobile black spots – and a more reliable NBN for small business.

And not only will we put back the $83 million the Liberals cut from the ABC…

We’ll provide another $10 million to support regional news and emergency broadcasting, especially in areas affected by natural disasters such as Townsville, Tasmania and regional Victoria.

We can also give regional communities this simple, important pledge: no more privatising and out-sourcing human services in the bush. If you’re a pensioner or a veteran living in the regions, you shouldn’t be stuck on hold for hours waiting for help.

You should be able to speak to a human being, face-to-face.

You deserve no less.

And to my fellow Australians

Tonight I want to conclude by talking to you directly in your lounge rooms, about our vision for the most significant investment in Medicare in a generation.

Cancer is one of the biggest killers in our national. Not for nothing is it called the Emperor of all Maladies. One in two of us will be diagnosed with cancer at some stage in our life.

145,000 of our fellow Australians are diagnosed with cancer each year.

And 50,000 die.

One way or another, we will all witness the ordeal. I saw it with my Mum and her battle with breast cancer. Chloe and I have seen it with dear friends of ours – some old, some far too young. Cancer is frightening, it’s isolating, it’s exhausting.

And – all too often though – it is impoverishing.

For so many people, cancer makes you sick and then paying for the treatment makes you poor.

And I think a lot of Australians would be surprised to learn that all those vital scans and tests and consultations with specialists are not fully covered by Medicare. Instead, they cost hundreds of dollars, adding up to thousands, out of your own pocket.

Australia has the highest rates of skin cancer in the world – and most people pay over $5000 for the first two years of their treatment. One in four women diagnosed with breast cancer pay over $10,000 for two years of scans and tests.

Some men with prostate cancer are paying more than $18,000. And if you’re in Stage 4 cancer, you have to quit work, so your finances are already under horrendous strain. If you live in the regions, there are the added costs of travel and accommodation.

Every year 300,000 Australians who need radiology just don’t get it – because they can’t afford it.

That’s three hundred thousand of us.

We are a smart country, we’ve got the best health care staff, we are a rich country, we are a generous country – and we are better than the statistics I read out.

If someone you love has cancer, you’d sell the roof over your head if it would help, you’d sell the shirt off your back – but should you have to?

Our fellow Australians pay your taxes to Canberra. You pay your Medicare levy.

And if I am elected Prime Minister, I’m going to make sure the health care system is there for you when you need it most.

So tonight, I am announcing the most important investment in Medicare since Bob Hawke created it.

Labor’s $2.3 billion Medicare Cancer Plan.

To my fellow Australians, I will explain what that will be used for.

First, if we win the election, we will invest $600 million towards eliminating all of the out-of-pocket costs for diagnostic imaging.

Over four years, this will mean six million free cancer scans, funded by Medicare.

  • CT scans
  • PET scans
  • Mammograms
  • X Rays
  • Ultrasounds

Reducing the out-of-pocket costs for cancer patients from hundreds of dollars, to zero. And this will apply to MRIs too.

Today, only half the MRI machines, that amazing technology – half the machines in Australia are covered by Medicare.

People in the bush and the regions often have to drive hours, or pay thousands.

If we win the election, not only will we provide new MRI machines to communities where they are needed most. We are going to change the game.

We will guarantee that every single MRI machine which meets national standards, every single machine is covered by Medicare for cancer scans – full stop.

The second part of our plan is to deal with the cost of seeing a specialist.

As anyone knows, treating cancer relies on a marvellous team of experts.

  • Medical oncologists in charge of your diagnosis and ongoing chemotherapy and immunotherapy.
  • Surgeons performing your operations and monitoring your recovery.
  • Radiation oncologists designing targeted radiation therapy plans to destroy cancer cells.

These appointments are part of your weekly routine, often for years.

There is the trips, the waiting, the treatment, the recovery. Thousands of dollars.

A new Labor Government will invest $433 million to immediately cover specialist consultations for cancer patients.

What this means over the next four years, is it means that an additional 3 million appointments will be bulk-billed – with no out-of-pocket costs.Reducing what you pay from hundreds of dollars – to zero.

And thirdly: our Affordable Medicine Guarantee.

Every drug recommended by the independent experts, will be listed on the Pharmaceutical Benefits Scheme.

Not just cutting the cost of your treatment – cutting the cost of your cancer medication too.

Cancer is a curse.

I wish I could stand here tonight and guarantee you that we will find a cure.

But no politician can give that promise.

We will continue to support our scientists in their work, we will invest in the research and the clinical trials. And until the day that we find a cure, I promise the men and women of Australia this:

Under Labor – if you are battling cancer, you can focus on getting well, without worrying about going broke.

I can promise that if you are in the fight of your life – a Labor Government will be alongside you every step of the way.

To summarise what our first four years of Labor’s Medicare Cancer Plan means for Australians:

  • Up to 6 million free cancer scans
  • 3 million free appointments with specialists
  • And an affordable medicine guarantee

This is our vision for the future.

This is our vision to build Medicare.

And we can pay for it – and deliver it – because of our reform decisions.

We choose our health care system over bigger tax loopholes.

So in conclusion, my fellow Australians – I suspect that some in the government will spend a lot of time telling you to be afraid.

Afraid of change. Afraid of new ideas.

Afraid of the future. Afraid of each other.

I expect we’ll see more of that in the campaign ahead.

I have a different view.

I’m optimistic about our nation’s future, because this country has so much going for us.

A continent to call our own, next to the fastest-growing economies in the world.

The resources to be an energy superpower.

The skills and the science and the get-up and go to create new industries.

And best of all, we have our people: Australians are hard-working, caring, brave, smart and generous.

We will never be the biggest country in the world, we will never seek to impose our ideology on other nations  – but do I believe that if we’re not the biggest, we can still aim to be the best.

The best in education and skills.

The best in health and aged care and looking after people with dementia.

The best in fair wages and fair reward for your work.

That is the real choice that our country faces at this election, that’s the decision every Australian has to make.

Do you want the best health care system in the world?

Or the biggest tax loopholes?

Do you want your children to get a world’s best education?

Or the world’s most generous tax subsidies?

Do we want a fairer, more equal country where the economy works in the interests of everyone?

Or do we want another three years of drift, with the top end of town profiting much better than everybody else.

My team and I have made the reform decisions to put forward a Fair Go Action plan for Australia, so that Australia can be the best that we should be.

Labor offers stability and unity and a vision for the nation.

We choose hope over fear.

We choose the future over the past.

We choose the best support possible for people with cancer.

We choose fair wages and good jobs.

We choose TAFE and apprenticeships.

We choose a Voice for the First Australians enshrined in our constitution.

We choose renewables and we choose real action on climate change.

We choose the ABC.

We choose equality for women of Australia – equality for everyone.

And if these things matter to you, if you believe that when all is said and done about politics, the most important things are family and health.

If you believe that handing on a better deal to your kids than the one you inherited from your parents –

If you believe that’s what sort of vision we should have for Australia –

Then – when you cast your vote in May – choose a Labor Government, for all Australians.

 

 

 

NACCHO Aboriginal #AusVotesHealth and #Budget2019 3 of 5 : ACCHO Peaks and Aboriginal and Torres Strait Islander community Stakeholders express disappointment in #Budget2019 @VACCHO_org @QAIHC_QLD @AMSANTaus @_PHAA_ @amapresident @LowitjaInstitut @congressmob @NationalFVPLS

1.QAIHC : Federal budget once again fails the Aboriginal and Torres Strait Islander community

2. VACCHO :Federal Budget robbing Aboriginal people with disabilities to pay for tax cuts

3. AMSANT : The Federal Indigenous Affairs Minister has all but admitted today there is no major item in the Federal budget for First Nations people.

4 .PHAA : Not enough investment in disease prevention

5.AMA : Government’s Budget announcements have set up a genuine health policy competition for the upcoming election.

With NACCHO TV Interview

6. Lowitja Institute : “An investment in Aboriginal and Torres Strait Islander health and wellbeing

7. HealthInfoNet : How the #Budget2019 impacts Aboriginal and Torres Strait Islander

8 .Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention

9. The National Congress of Australia’s First Peoples Australia’s Need More Than Promises.

10. Change the Record

11.National Peak Body for the Aboriginal and Torres Strait Islander Legal Services

12.Family Violence Prevention Legal Services

13. Reconciliation Australia : Greater vision and investment needed for First Nations as progress sidelined in federal budget

14. Indigenous groups denounce Australian budget as ‘punishing people in poverty

This weeks NACCHO Budget Coverage 

Post 1: NACCHO Intro #AusVotesHealth #Budget2019

Post 2: NACCHO Chair Press Release

Post 3:  Health Peak bodies Press Release summary

Post 4 : Government Press Releases

Post 5 : Opposition responses to Budget 2019 

Read all Budget 2019 Posts 

View NACCHO TV interview with NACCHO Chair HERE

1.QAIHC : Federal budget once again fails the Aboriginal and Torres Strait Islander community

Josh Frydenberg’s budget has failed to fund Aboriginal and Islander Community Controlled Health Organisations (AICCHO) to enable them to continue their work towards Closing the Gap.

The burden of disease for Aboriginal and Torres Strait Islander people in Queensland is unacceptable. 10% of our babies are born with low birthweight. Our children make up 49% of Queensland’s new and recurrent cases of acute rheumatic fever. Chronic diseases including diabetes continues to be on the rise. For our men aged 15-34 years, suicide rates are more than three times higher than non-Indigenous men.

Previous attempts by the Federal Government to achieve better health for Aboriginal and Torres Strait Islander people through the Closing the Gap agenda, have failed. Chronically under-funded government programs in AICCHOs contribute to this. This budget has funded a selection of specific projects for collaboration with community-controlled organisations at a strategic level, however the benefits will take years to trickle down to real action on the ground. Inadequate primary health care is a burden on the tertiary care system, contributing to excessive public expenditure.

“From health promotion and health literacy through to diagnosis, treatment, management and end of life care, investment in the health system is essential now if health equity is to be achieved.” Neil Willmett, CEO of Queensland Aboriginal and Islander Health Council (QAIHC) said.

“The AICCHO Sector is already achieving ground-breaking results in health for Aboriginal and Torres Strait Islander people in Queensland. We are achieving more than ever before for less funding, but our Members are being expected to do even more because of the government’s continual failure to adequately resource the sector.”

QAIHC Chairperson, Gail Wason, explains “Community driven solutions are proven to be most effective. Our AICCHOs have been driving the solutions. Equitable to need, the sector receives 47% less Commonwealth funding than mainstream health services. This doesn’t equate to government supporting community led solutions. Government needs to prioritise greater investment in AICCHO’s, rather than just talking about Close the Gap.”

In Queensland there are 26 AICCHOs offering culturally appropriate comprehensive primary health care to over 180,000 Aboriginal and Torres Strait Islander people. Aboriginal and Torres Strait islander people make up 4.6% of Queenslanders, and that percentage is growing.

QAIHC is calling for political parties to respect and resource the Aboriginal and Islander Community Controlled Health Sector to achieve real results this election. You can follow the campaign via QAIHC’s social media platforms.

2. VACCHO :Federal Budget robbing Aboriginal people with disabilities to pay for tax cuts

Barriers to Aboriginal people accessing NDIS services are effectively funding tax cuts, according to Victorian Aboriginal Community Controlled Health Organisation (VACCHO) Acting CEO Trevor Pearce.

“While the Federal Government is claiming it will deliver a surplus and is offering pre-election tax cuts, part of that money is coming from the fact that two thirds of the funding allocated for Aboriginal people living with disabilities for NDIS services is unspent. It’s not unspent due to a lack of need but due to significant barriers preventing people from accessing the NDIS,” Mr Pearce said.

“How are we supposed to Close the Gap when there are 60,000 Aboriginal people living with disabilities who aren’t getting support, according to the First Peoples Disability Network?

“The fact that two thirds of all funds allocated to Aboriginal NDIS participants has been left unspent speaks volumes about the difficulties so many people in the community face in accessing the NDIS, especially in Aboriginal Communities.

“Knowing that pre-election tax cuts are being handed out while 60,000 Aboriginal people living with disabilities aren’t able to access services is nothing short of appalling.”

Mr Pearce said it was disappointing the Budget delivered nothing of substance for the working poor.

“We’re very concerned about the extension of the failed Cashless Debit Card trials and what that could mean for Victoria. Many of our Members are worried they could come here,” he said.

“It’s critical that the funding allocated to Aboriginal mental health and family violence issues not only be focused on delivery in remote areas. The majority of Aboriginal people live in urban and regional areas and live with similar levels of disadvantage, especially on these key issues.

“We know from data from our Members that the second highest prescribed medication in SOME clinics is antidepressants, just behind relievers commonly known as Ventolin. This tells us how prevalent mental health issues are in our Communities. An allocation of $5 million over four years nationally for youth suicide prevention is not going to make an impact on that significant a problem.

“We are also disappointed that dental health received no additional funding given spending in dental health actually saves money by preventing additional, more expensive health conditions.”

Mr Pearce said the Federal Budget did appear to have some highlights for Aboriginal people but the lack of clarity around much of the funding, and apparent lack of new money especially around Closing the Gap measures, meant it was difficult to be certain.

“The $10 million allocated to the Lowitja Institute is great, as funding Aboriginal-led and designed research is so important as part of self-determination,” Mr Pearce said.

“It’s good to see that the Medicare freeze has been lifted, and we hope that any GP practices that aren’t currently bulk billing Aboriginal people will start doing that given their increased funding.

“We look forward to further clarification on the Closing the Gap refresh spending and the realisation that self-determination and community control are fundamental to attaining this aim.”

3. AMSANT : The Federal Indigenous Affairs Minister has all but admitted today there is no major item in the Federal budget for First Nations people.

Indigenous leaders and lobby groups are outraged because there are several items they say are priorities for funding including money to help drive the reform of the Closing The Gap process.

Featured:

Nigel Scullion, Indigenous Affairs Minister
Dr Jackie Huggins, National Congress.
Peter Yu, Broome indigenous leader
Marion Scrymgour, Tiwi Islands Regional Council
Wayne Butcher, Lockhart River mayor
John Paterson, Aboriginal Medical Services Alliance

Listen HERE

4 .PHAA : Not enough investment in disease prevention

The 2019 federal Budget does too little to prevent Australia’s major illnesses, according to Public Health Association of Australia CEO Terry Slevin.

“Australia is one of the lowest investors in illness prevention of any OECD nation at less than 2% of our national health spending,” Mr Slevin said.

“Two of our biggest killers were conspicuous by their absence in the Budget – obesity and alcohol.”

“Nonetheless this Budget has some valuable and welcome investments:

  • Extension of the Child Dental Benefits Schedule ($1 Billion)
  • Mental health and suicide prevention commitments ($736M) – these are sorely needed
  • Research investment via the Medical Research Future Fund (MRFF) guarantees ($260M over 10 years) for preventive and public health research plus another $160M in Indigenous health research over 11 years
  • Global health research focused on antimicrobial resistance ($28M) is welcome
  • A tobacco control campaign at $20M over 4 years is a starting point, but smoking remains one of our biggest killers. We need to do much more to kick start serious tobacco control efforts.
  • Promoting social inclusion and being physically active via sports ($23.6M)
  • Take Home Naloxone Program ($7.2M) “Spending on good health care, effective drugs and research is important and essential.

But a continual downward spiral in real prevention is a trend we must seriously address.”

“We should have ambitious goals for real life-long health. To reach that point we need major action to contain the explosion of obesity and overweight in our community.”

“We need to do so much more to limit the harms of misuse of alcohol. And we have a massive gap to close regarding Aboriginal and Torres Strait Islander Australians.”

“But the long-term wellbeing of the community has not figured sufficiently in this budget,” said Mr Slevin.

“Like inaction on climate change, the budget does little to prevent a future illness tsunami.”

5.AMA : Government’s Budget announcements have set up a genuine health policy competition for the upcoming election.

AMA President, Dr Tony Bartone, said this that the Government’s Budget announcements have set up a genuine health policy competition for the upcoming election.

“The Health Minister, Greg Hunt, has listened closely to the AMA and delivered a strong Health Budget, with a particular emphasis on primary care, led by general practice,” Dr Bartone said.

“Australia’s hardworking GPs will be happy to see a commitment of almost $1 billion to general practice. This includes matching Labor’s promise to bring forward by a year the lifting of the freeze on rebates for a range of Medicare GP items.

“Overall, the Government has delivered a much-needed significant investment to general practice – the driving force of quality primary health care in Australia.”

The GP package includes:

  • $448.5 million to improve continuity of care for patients over 70 with chronic conditions;
  • Quality Incentive Payments for general practices ($201.5 million);
  • $62.2 million for rural generalist training; and
  • $187.2 million for lifting of the freeze on GP items.

The AMA also welcomes:

  • Funding for new Pharmaceutical Benefits Schedule (PBS) medicines;
  • Retention of the Aged Care Access Incentive (ACAI); and
  • A rural workforce program.

Dr Bartone said there are obvious gaps in mental health, prevention, Indigenous health, pathology, and public hospital funding to improve all hospitals.

“We expect to hear more on these key areas from all parties before the election,” Dr Bartone said.

“Health Minister Hunt has worked closely with the AMA, especially on the primary care element of this Budget.

“Overall, the Government has produced a good start for a quality health policy platform for the election.

“We look forward to the Opposition making health a real contest when they roll out all their policies.”

Dr Bartone said there is still unfinished business with the Private Health Insurance reforms as they are implemented from this month, and with the ongoing work of the Medicare Benefits Schedule (MBS) Review, which must return any savings to new and improved MBS items.

6. Lowitja Institute : “An investment in Aboriginal and Torres Strait Islander health and wellbeing

The Lowitja Institute welcomes the funding announcement in the Budget delivered by the Treasurer the Hon Josh Frydenberg MP.

The Institute is Australia’s national institute for Aboriginal and Torres Strait Islander health research. We have a strong track record working with communities, researchers and policymakers. Aboriginal and Torres Strait Islander community priorities and self-determination must be built into the national research agenda that informs state and federal policies and programs.

Our work embeds First Nations creativity, ingenuity and leadership in the decision making; this is critical to improving the health and wellbeing of Australia’s First Peoples.

We look forward to expanding our work in key research areas such as the cultural and social determinants of health, and health system improvements for Aboriginal and Torres Strait Islander people. We also look forward to continuing to build the Aboriginal and Torres Strait Islander health research workforce, and growing our national and international networks. Our innovations in knowledge translation will ensure the ongoing positive impact of our research.

7. HealthInfoNet : How the #Budget2019 impacts Aboriginal and Torres Strait Islander

Find information on and read about how it impacts Aboriginal and Torres Strait Islander , here:

8 .Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention

Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention (CBPATSISP) Director Professor Pat Dudgeon and National Aboriginal and Torres Strait Islander Leadership in Mental Health (NATSILMH) Chair Mr Tom Brideson cautiously welcomed yesterday’s mental health and suicide prevention budget announcements but looked forward to more detail being released before committing to a response. Professor Dudgeon said:

I am especially pleased to see commitments to a National Suicide Information System. This is something that CBPATSISP and, prior to that, the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP)called for. But it must operate in our communities and it’s not clear on the information provided whether it will. This is critical, such a system should help us get the people and resources to where they are needed faster, to help prevent suicide ‘clusters’, and better assist Indigenous families and communities after a suicide.

Professor Dudgeon also welcomed a $5 million commitment to an Indigenous leadership group to implement an Indigenous suicide prevention strategy; and similar funding for Indigenous youth leaders to respond to Indigenous youth suicide. She said:

A national Indigenous suicide prevention strategy was developed in 2013 and about $20 million implementation funding given to the Primary Health Networks (PHNs). While many PHNs are doing the best they can, the key ingredient – Indigenous governance and leadership in how that money is spent – has too often been lacking. It is my hope that the new Indigenous leadership group will not only lead a more effective and efficient national and regional response to Indigenous suicide, but also address these accountability problems. But again, we need more information about how these bodies will operate, and the leaders must be Indigenous and enjoy wide community support. 

Mr Brideson called for greater funding for Indigenous mental health and suicide prevention:

$15 million Indigenous specific funding in a $461 million youth mental health and suicide prevention package, within a $736 mental health package, is not enough to meet our needs. Indigenous people comprise 3% of the population and have about double the suicide prevention needs, and three times the mental health needs, of other Australians. In terms of equity, we estimate about 9% of the total package, about $70 million, should be dedicated Indigenous expenditure. While this may seem a significant amount, it should not be forgotten that the bulk of Indigenous mental ill-health is preventable with access to primary mental health care, and yet the social costs of untreated Indigenous mental health difficulties are likely to run into the billions.

In fact, a long called for reinvestment funding approach to our mental health, particularly justice reinvestment, should eventually enable the Australian Government to make savings in many areas as well as making a big contribution to ‘Closing the Gap’ and Indigenous wellbeing. This is particularly in relation to the enormous cost of imprisoning over 13,000 Indigenous people, many of whom are in prison because of untreated mental health and related issues.  

Professor Dudgeon and Mr Brideson closed by calling on Ministers Wyatt, Hunt and Scullion, their shadow ministry counterparts and the newly announced Suicide Prevention Coordinator to meet with them and other Indigenous mental health and suicide prevention leaders to discuss the detail of the package, and ensure that Indigenous peoples get their fair share of the mainstream elements of the mental health, suicide prevention, drug strategy and other budget initiatives:

We will be working with other Indigenous mental health and suicide prevention leaders to ensure our people, and young people in particular, benefit from all the budget measures according to their greater need. This includes the extra funding for headspace, the adult mental health centres and many other promising mainstream initiatives. CBPATSISP and NATSILMH want to see a partnership approach with the Australian Government to help ensure we get the detail right, and that the total $736 million package results in better mental health and suicide prevention outcomes for Indigenous Australians.

9. The National Congress of Australia’s First Peoples Australia’s Need More Than Promises.

The National Congress of Australia’s First Peoples welcomes the Australian Government’s commitment of additional funding to address key challenges; however, the budget lacks concrete measures in areas of high importance for First Peoples. More needs to be done to remedy the structural causes of the gap between Aboriginal and Torres Strait Islander and non-Indigenous Australians.

Read more

10. Change the Record

Change the Record has condemned the Federal Government’s Budget, demanding that the Government stays committed to self-determined legal services and stops punishing people struggling to make ends meet.

“Research shows that our people are locked up at such high rates because of the poverty we experience, especially for First Nations people with disability,” said Damian Griffis, co-chair of Change the Record.

“Instead of Budget providing a roof over our heads and meeting basic needs, this Government is punishing our people who are caught in the poverty trap. Sacrificing critical legal services and NDIS and punishing women through ParentsNext for budget surplus is inhumane – these are our lives they are playing with.

Read More Here

11.National Peak Body for the Aboriginal and Torres Strait Islander Legal Services

National Peak Body for the Aboriginal and Torres Strait Islander Legal Services (NATSILS) released the following statementwarning abandoning the standalone Commonwealth Indigenous Legal Assistance Program after a 50 year long commitment threatens self-determination and cultural safety

NATSILS welcomes the overturning of the planned and ongoing cuts to the Aboriginal and Torres Strait Islander Legal Services (ATSILS), introduced in a 2013 ongoing savings measure.

However, Attorney-General Christian Porter is also walking away from the Commonwealth’s 50-year long commitment to ATSILS by disbanding the Indigenous Legal Assistance Program (ILAP), days after the Government’s Independent Review into the Indigenous Legal Assistance Program recommended retaining a standalone specific program.

12.Family Violence Prevention Legal Services

Also missing was core funding needed for the Family Violence Prevention Legal Services which released the following statement:

For the sixth year in a row, the Federal Budget brings no additional core funding for the crucial supports provided by Family Violence Prevention Legal Services (FVPLSs), with funding to end 30 June 2020. Antoinette Braybrook, Convenor of the National FVPLS Forum called on all parties to commit to ongoing funding and to keeping Aboriginal and Torres Strait Islander women safe.

13. Reconciliation Australia : Greater vision and investment needed for First Nations as progress sidelined in federal budget

Reconciliation Australia has described the federal budget as “a disappointing missed opportunity to present a cohesive national narrative around closing the gap in social outcomes for First Nations people and addressing unfinished business of reconciliation.”

Chief executive, Karen Mundine, said the Prime Minister’s recent closing the gap report outlined the urgent need for further investment.

“Governmental support for Aboriginal and Torres Strait Islander services has not met the level of need of First Nation’s peoples,” said Ms Mundine.

“The frustration felt by First Nations people and other Australians with the results of the Closing the Gap Framework has been compounded with the lack of any national narrative in this federal budget,” she said.

Ms Mundine said this was illustrated by two significant funding decisions outlined in the budget; an insufficient $15 million investment into suicide prevention, despite the ongoing the crisis facing young Aboriginal and Torres Strait Islander young people, and the decision to end the national stand-alone Indigenous Legal Assistance program and roll funding for Aboriginal and Torres Strait Islander legal services into mainstream legal aid programs.

“The high level of suicide in First Nations communities and the growing rates of incarceration of First Nations women, men and children are two clear indicators of the need for greater investment but instead this budget has fallen short.”

“We urge the Government to reconsider, and increase investments in these two critical areas.”

Ms Mundine also said there was little in the budget to address the unfinished business of reconciliation and some of the foundational issues that require settlement.

“I also note this morning’s comments from the peak body representing the Aboriginal and Torres
Strait Islander health sector decrying the lack of funding in the budget for Aboriginal and Torres Strait Islander health services and the Aboriginal community-controlled health sector.”

“The connection between the material and cultural wellbeing of First Nations people and our national progress towards reconciliation are clear and we are concerned that the stalling of progress towards equity for Aboriginal and Torres Strait Islander people will not be remedied by this budget,” said Ms Mundine. “The lack of investment in services, further exacerbated by cuts to legal services, means that funding levels will not meet the clear needs of First Nations peoples.”

Ms Mundine said concerns about the budget were intensified by the optimism generated by last week’s signing of a partnership agreement between the Government and a Coalition of Aboriginal and Torres Strait Islander Peaks to progress closing the gap.

“Sadly, this optimism has not been supported by the budget with its lesson that ambitions for a surplus trump the needs of Australia’s First Nations peoples.”

Ms Mundine said the Australia is at a critical juncture in the reconciliation journey with constitutional reform and agreement-making stalled in Parliament notwithstanding strong public support.

“Despite our disappointment Reconciliation Australia hopes for greater bipartisan support for truth telling initiatives and progress constitutional reform and meeting the goals of Aboriginal and Torres Strait Islander peoples as expressed in the Uluru Statement from the Heart.”

“These hopes are buoyed by the strong support for such initiatives shown by the Australian public, most recently in the results of our Australian Reconciliation Barometer survey which found that 95% of Australians believe that ‘it is important for Aboriginal and Torres Strait Islander people to have a say in matters that affect them’ and 80% believe it is important to
‘undertake formal truth telling processes’”.

“The imminent election provides an opportunity for Government and Opposition to clearly spell out their respective visions for how we this nation can improve the lives of First Nations people and bring us closer to a just, equitable and reconciled Australia,” Ms Mundine said.

14. Indigenous groups denounce Australian budget as ‘punishing people in poverty

Key Aboriginal organisations have expressed anger and disappointment with the budget, criticising the $129m expansion of the controversial cashless welfare card and the lack of new funding for health and legal services.

The chief executive of the National Coalition of Aboriginal Community Controlled Health Organisations, Donnella Mills, said she was frustrated none of its budget priorities had been included.

“We called for an increased base funding for our health organisations, and an increase in capital works and infrastructure. We need funds for housing, which is a vital key to good health, and we sought a strengthening of support for mental health,” Mills said.

The government set aside $461m for youth mental health but only $5m over four years is earmarked for addressing Indigenous youth suicide, recently described by suicide prevention campaigner Gerry Georgatos as a “moral and political abomination.”

Mills said: “We welcome $5m for suicide prevention. That amount is just a starting point, and we have no detail on how it will be allocated.

“How is that $5m going to get into communities? How is it going to address housing, family violence?

“The treasurer kept on about how we are geared towards surplus. I would hope there’d be room in [the] government’s thinking to address the unmet needs of the most vulnerable people in our communities.”

Read all Peak Comments 

 

 

 

NACCHO Aboriginal #AusVotesHealth and #Budget2019 4 of 5 : Press Release from Ministers @GregHuntMP @KenWyattMP : But have the major health threats been ignored in this 2019/20 Federal Health Budget ?

This weeks NACCHO Budget Coverage 

Post 1: NACCHO Intro #AusVotesHealth #Budget2019

Post 2: NACCHO Chair Press Release

Post 3:  Health Peak bodies Press Release summary

Post 4 : Government Press Releases

Post 5 : Opposition responses to Budget 2019 

Read all Budget 2019 Posts 

Overview Health Expenditure Croakey and Sean Parnell The Australian

1.Guaranteeing Medicare

2.Strengthening primary care

3.Improving access to medicines Includes Aboriginal and Torres Strait Islander Health 

4.Supporting our hospitals

5.Addressing youth mental health and suicide prevention

6. Investing in life saving and job creating medical research

7.Patients

8.Investing in preventive health

9. Supporting senior Australians

10. Department of the Prime Minister and Cabinet

More detailed information on various components of Aboriginal and Torres Strait Islander expenditure below  OR

Department of the Prime Minister and Cabinet

Overview Health Expenditure  Croakey and Sean Parnell The Australian

Back in Black or Highway to Hell? Major health threats ignored in 2019/20 Federal Budget

  “Prime Minister Scott Morrison may be ‘Back in Black’ but his 2019/20 Health Budget is unlikely to make him number one with the health sector.

While there are a few new numbers in the Budget’s hit parade, the bulk of the spending initiatives are a hackneyed playlist of old tunes that fail to deliver the reforms called for repeatedly by health groups and experts.

Warning bells are sounding all over the health sector – increased obesity levels, the health threats of climate change and record rates of chronic disease – yet the current government doesn’t appear to be listening.

Our health system already can’t cope with current levels of demand and there is little in tonight’s Budget that will relieve this pressure. Ignoring the calls from experts and health groups for a re-orienting of our health system away from acute care towards prevention and public health, this Budget provides a suite of short-term measures which barely deal with the symptoms of an ailing system, let alone address their underlying causes.

The frustration of health groups about this failure to acknowledge the looming threats to our health system was evident in many post-Budget statements, including the Public Health Association of Australia which stated that “the budget does little to prevent a future illness tsunami.”

Below, Jennifer Doggett revisits the songs from AC/DC’s classic album to highlight the positives and negatives of this important pre-election Budget. “

Read Croakey article Here

Overview Health Expenditure Sean Parnell The Australian

Doctors will get more funding to help older Australians manage chronic illness, mental healthcare providers will be able to reach more people in need, and researchers will benefit from a 10-year grants program.

In its $104 billion health budget, the Morrison government has made targeted investments in Medicare, but also brought forward the restoration of indexation for 176 GP items to July 1. Thawing that aspect of the Medicare freeze six months early will cost $187.2 million, but comes as the Coalition faces calls from health groups for higher rebates and the prospect of another Labor ­“Mediscare” campaign.

While the government has yet to decide the fate of the healthcare homes initiative, or respond to primary care proposals from its Medicare review, it has allocated $201.5m more for practice incentive payments.

Its most promising, yet underdeveloped, primary care announcement in the budget involves $448.5m over three years for a new model of funding chronic disease care. The approach, to be introduced in July 2020, will allow GPs to enter into agreements with patients over 70 and be given more personalised, co-ordinated care funded through Medicare.

The details will be subject to further consultation.

With Australia’s rising suicide rate, and continued concern over the comparatively high number of deaths in indigenous communities, the government has also allocated $736.6m to improve the nation’s mental health resources.

This will include 30 more headspace centres — most expected to be announced during the election campaign — to take the total number funded by the commonwealth to 145 by 2021, at an ongoing cost of $120m a year.

“It’s a national tragedy that we lose so many people to suicide and that so many people live a life of quiet desperation,” Josh Frydenberg said last night. “Tonight I say: we hear you and we are with you.”

There was funding for a further 23 MRI machines — taking the total to 53 — and continued investment in drug subsidies as recommended by a committee of experts.

With the Medical Research ­Future Fund to achieve its $20bn balance in 2020-21, the government has outlined a $5bn, 10-year funding plan, while maintaining its $3.5bn commitment to the ­National Health and Medical ­Research Council. The $5bn will come from MRFF distributions, established using savings from health cuts in the 2014 budget.

Health Minister Greg Hunt has already announced research ‘‘missions’’ into brain cancer, mental health, genomics, ageing, aged care and dementia, indigenous health, stem cells, cardiovascular disease and traumatic brain injury. Another $1.2bn will be dedicated to translation and commercialis­ation, taking ideas from the laboratory to hospital bedsides, while new institutes will also be funded.

Any perceptions of interference in the grants program will be addressed by the creation of a Health and Medical Research Office for the MRFF, at a cost of $20m over four years, although the NHMRC will have a small reduction in its budget next year.

The government has factored in the states agreeing to its public hospital funding proposal, even though Victoria and Queensland are holding out. The ­Coalition will continue to announce projects to benefit from its $1.25bn community health and hospitals program ahead of the election.

RECORD INVESTMENT ADVANCES LONG TERM NATIONAL HEALTH PLAN

Federal Treasurer, Josh Frydenberg, delivered his first Australian Government Budget on Tuesday evening, 2 April 2019.

The following links provide information on the Budget and its implications for Aboriginal and Torres Strait Islander health.

Australian Government Budget details:

The Liberal National Government is investing a record $104 billion in 2019—20, up from

$75 billion in 2012—13, as part of a comprehensive, patient-focused investment of

$435 billion over the next four years. It guarantees Medicare, makes a range of life-saving medicines and services more accessible and affordable, reduces out-of-pocket costs, strengthens primary care and mental health and invests in breakthrough medical research.

The Budget consolidates and continues our health reform agenda. It reinforces the four pillars of our long term national health plan — guaranteeing Medicare and improving access to medicines, supporting our hospitals, prioritising mental health and preventive health and investing in health and medical research.

We are addressing community need through a range of investments under our $1.25 billion landmark Community Health and Hospitals Program (CHHP) to keep people healthy and out of hospital.

We are acting on aged care reform. Improvements to accessibility, quality and safety continue apace with a further investment of $7 billion since the last Budget.

The Government is investing record funding for Health:

  • Medicare boosted by $6 billion o with $1.1 billion for Primary Care Hospital funding boosted by $5 billion

0 on top ofthe $1.25 billion CHHP

  • Aged Care funding boosted by $7 billion
  • $40 billion for life-saving and life-changing medicines provisioned in the forward estimates
  • $5 billion for a 10 year Medical Research Future Fund investment plan
  • $736.6 million for mental health including youth suicide prevention
  • $1 billion for Indigenous health
  • Over $1 billion for child dental services

1.Guaranteeing Medicare

We are increasing Medicare funding by $6 billion, up from $19.5 billion in 2012—13, to $24.9 billion in 2018—19, to $30.7 billion in 2022—23. The Medicare Guarantee Fund, established in 2017—18, allocates $36.6 billion in guaranteed funds for spending on the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS) in 2019-20.

We are increasing the Medicare rebate for important diagnostic services, including ultrasound and X-ray imaging to reduce the costs to patients. This will support Australians’ access to bulk-billed diagnostic imaging services. It will encourage radiologists, obstetricians, cardiologists and other specialties to maintain or increase their level of bulk-billing. The Government is investing $198.6 million in this initiative.

We are investing $151.9 million to expand the number of Medicare-eligible MRI machines to more than 50 newly funded units in the past 12 months. New MBS services for MRI of the breast, costing $32.6 million over four years, will help diagnosis for around 14,000 breast cancer patients each year.

The independent experts continue to recommend improvements to the MBS. New and amended Medicare-eligible services will support breast cancer, prostate cancer and brain        surgery patients, people having X-rays, and patients in private hospital emergency departments and intensive care units.

We are committed to reducing out-of-pocket health care costs for Australians. The

Government supports all the recommendations of, and will implement the first stage of our response to, the report of the Ministerial Advisory Committee on Out-of-Pocket Costs.

We will make publicly available the fees and resulting out-of-pocket costs charged by medical specialists, with an initial focus on specialist fees for gynaecology, obstetrics, and cancer services. This will be supported by a community awareness campaign, including a website. It will increase transparency, and enable people, particularly those with private health insurance, to be more informed about costs when choosing a specialist.

2.Strengthening primary care

Improving Indigenous health remains a key target of our refreshed Closing the Gap framework. Funding is boosted to $4.1 billion from 2019—20 to 2022—23 and more than $10 billion over a decade.

Download Budget Report

2019-20_Health_PBS_2.02_Outcome_2

We are delivering a $1.1 billion ‘Strengthening Primary Care’ package, building on the $512 million package in the 2018—19 MYEFO, to support Australia’s doctors and specialists to deliver improved access and outcomes for patients. The Government will invest

$448.5 million in increased funding to deliver a new population based funding approach to support GPs to provide enhanced care and services, initially focussing on Australians over 70 years.

Australians over the age of 70 will be able to voluntarily enter into an agreement with their general practiioner, and receive more personalised, coordinated care, with usual services continuing to be rebatable for the patient under Medicare. GPs and others in their practice will be able to provide consultations, referrals, scripts and test results remotely — without seeing patients face-to-face. This will make it easier and more convenient for people to access timely care and medical advice.

Our investment complements and strengthens Medicare. Doctors will be further supported by a $201.5 million boost for the Practice Incentives Program Quality Improvement Initiative, including retention of the Aged Care Access Incentive, and $187.2 million to increase rebates for 176 GP services from I July 2019.

We will further tackle the ever increasing burden of chronic disease through our Public Health and Chronic Disease program. Funding of $17.2 million over five years will develop several national strategic action plans aimed at improving the lives of Australians living with chronic conditions — specifically, osteoporosis, kidney health, rare diseases, heart disease and stroke, and children’s health. We will also provide a new heart health check under Medicare to better address cardiovascular disease.

Eligible Australian children will continue to be able to access basic dental services and claim up to $1 ,000 in benefits under the Child Dental Benefits Schedule, with the Government investing over $1.0 billion for the next three years from 1 January 2020.

We will spend $12 million over the next three years to extend the reach of the childhood immunisation education campaign to save lives by protecting children from serious diseases.

We are implementing a National Rural Generalist Pathway, allocating $62.2 million over five years to ensure rural generalists are trained, recognised and resourced to meet the critical health needs of rural Australians.

Improving Indigenous health remains a key target of our refreshed Closing the Gap framework. Funding is boosted to $4.1 billion from 2019—20 to 2022—23 and more than $10 billion over a decade.

3. Improving access to medicines

The Liberal National Government has provisioned $40 billion in the forward estimates for life-saving and life-changing medicines. We are averaging 31 new or amended listings per month — approximately one per day.

We continue our commitment to ensure people have affordable access to medicines when they need it, through listing all medicines on the PBS that have received a positive recommendation from the Pharmaceutical Benefits Advisory Committee (PBAC).

From I May 2019, Ibrance@ will be available on the PBS for the treatment of inoperable advanced metastatic breast cancer. Patients will pay $6.50 or $40.30 for the drug. Without subsidy, they would pay $55,000 per year.

From 1 May 2019, Bavencio will be available on the PBS for the treatment of metastatic merkel cell carcinoma, a rare and highly aggressive type of skin cancer. Without subsidy, they would pay $150,000 per year.

From 1 May 2019, Besponsa@ will be available on the PBS for the freatment of acute lymphoblastic leukaemia. Without subsidy, they would pay $120,000 per year.

Tagrisso@ is now available on the PBS for the treatment of lung cancer, which would otherwise cost patients $88,000 per course of treatment.

Opdivo@ + Yervoy@ is now available on the PBS for the treatment of advanced renal cell carcinoma, which would otherwise cost patients $254,200 per course of treatment.

Venclexta@ is now available on the PBS, in combination with rituximab for the treatment of adult patients with chronic lymphocytic leukaemia, which would otherwise cost patients around $165,000 per course of treatment.

We are allocating $15 million for a one-off increase to community pharmacy to continue providing support to consumers, to improve the safe use of medication.

4.Supporting our hospitals

We have increased funding for the nation’s public hospitals by $5 billion, up from

$13.3 billion in 2012-13, to $21.7 billion in 2018-19, to $26.2 billion in 2022-23.

In addition, patients in every state and territory will have access to improved health and hospital services under our landmark $1.25 billion Community Health and Hospitals Program (CHHP).

Projects will be delivered through Primary Health Networks, grant funding, and transfer payments to state and territory governments. They include the Comprehensive Children’s Cancer Centre at Sydney’s Children’s Hospital, NSW; Centre for Excellence in Cellular

Immunotherapy at the Peter MacCallum Cancer Centre, Victoria; James Cook University — Cairns Tropical Enterprise Centre, Queensland; Repatriation Hospital — Brain and Spinal Centre, South Australia; improved health outcomes for individuals living with brain and spinal cord injuries in Queensland; Peel Health Campus, Western Australia; Ambulatory Care Centre, Alice Springs, Northern Territory; Canberra Hospital Intensive Care Unit, Australian Capital Territory; and North West Cancer Centre linear accelerator, North West Regional Hospital, Tasmania.

The CHHP complements our record investment in public hospitals, which will more than double from $13.3 billion in 2012—13 to $29.1 billion in 2024—25. Our new five year National Health Reform Agreement will deliver more than $30 billion in additional public hospital funding from 2020—21 to 2024—25.

5.Addressing youth mental health and suicide prevention

The Government is boosting mental health funding by $736.6 million, with $461.1 million focused on addressing youth mental health and suicide prevention. The high rate of suicide, particularly among young people, is a national tragedy which we are taking strong action to address. Recognising that the causes of suicide are complex and extend into social services and finances, the Prime Minister will make suicide prevention a key personal priority by creating a Suicide Prevention Co-ordinator in his department to coordinate suicide prevention initiatives across the whole of Government.

The Government’s $461.1 million commitment to addressing youth mental health and suicide prevention is guaranteed, including by providing:

  • $15 million to ensure that communities and services can respond quickly to areas affected by high incidences of suicides and self-harm by creating a new national information system.
  • $15 million to empower Indigenous suicide prevention.
  • $111 million to expand the headspace network by 30 — from the current 115 services to 145 by 2021, to enable more young people to access support.
  • $152 million to reduce wait times at headspace centres around the country. This will bring our total investment in headspace to over $120 million a year.
  • $2 million investment in the Young Ambassadors for Mental Health project, which will enrich these services by enabling young ambassadors with lived experience of mental health issues to get out into the community to promote mental health literacy, and improve how people seek help.
  • $110 million to continue the Early Psychosis Youth Services program at 14 headspace centres to provide specialist clinical services for young people at the early stages of severe mental illness.

Our Government is also dedicated to supporting the mental health of adults around the country in order to promote wellbeing and prevent suicides. To improve how people access care, and the quality of services, we will deliver a trial of adult mental health centres in eight locations nationally, at a cost of $115 million. These will provide walk-in, coordinated care and advice for anyone with concerns, and will address what is seen by many as a missing gap in the health system. We will improve perinatal mental health services by providing $43.9 million to support Australians affected by perinatal mental illness during or after pregnancy, or experiencing grief after the death of an infant. By investing $11.5 million in a National Mental Health Workplace Initiative we will support businesses — from sole traders to multinationals — and workers to create a mentally healthy workplace, giving workers the opportunity to maintain the best possible mental health and wellbeing.

We are also investing an additional $112 million in mental health through the CHHP with a focus on youth and Indigenous mental health and suicide prevention, and integrated community mental health.

6.Investing in life saving and job creating medical research

The Government is ensuring record funding of $6 billion over the forward estimates for medical research, with $3.5 billion for the National Health and Medical Research Council, $0.5 billion for the Biotechnology Translation Fund, and $2.3 billion for the MRFF — up from $222 million in 2018-19 to $650 million in 2022-23.

The Government is committing to a new $5 billion 10-year MRFF investment plan across four themes Patients, Researchers, Missions and Translation. Under the Patients theme, the government will invest $614 million in the rare cancers, rare diseases clinical trials program.

The Government’s 10-year investment plan will give researchers and industry certainty and direction through the four key areas:

7.Patients

The Government will commit a further $931.0 million for a total of $1.3 billion allocated under the Investment Plan to improve the health of Australians through the development of new treatments and cures informed by the latest research and using cutting edge technology, which includes:

  • Clinical Trials for Rare Cancers, Rare Diseases and Unmet Needs – a further

$354.0 million for a total of $614.2 million;

  • Emerging Priorities and Consumer Driven Research – a further $554.0 million for a total of $633.0 million; and
  • Global Health – Tackling Antimicrobial Resistance and Drug Resistant Tuberculosis – a further $23.0 million for a total of $28.4 million.

Researchers

The Government will commit a further $444.6 millionfor a total of $792.8 million allocated under the Investment Plan to support our best health and medical researchers to make breakthrough discoveries, develop their skills and progress their careers in Australia, which includes:

  • Frontier Health and Medical Research – a further $330.0 million for a total of $570.0 million;
  • Industry Researcher Exchange and Training – existing allocation of $32.0 million; and Clinical Researchers – a further $114.6 million for a total of $190.8 million.

Missions

The Government will commit a further $1.2 billion for a total of $1.4 billion allocated under the Investment Plan for long tenn focused missions to address complex and sizeable health issues requiring a concerted effort to transition great ideas through to proof-of-concept and beyond, which includes:

  • Australian Brain Cancer Mission — a further $2.0 million for a total of $ 123.6 million (including $65.3 million in philanthropic contributions, $5.0 million in clinical trials funding and $3.4 million in research funding);
  • Million Minds Mental Health Research Mission – existing allocation of $125.0 million;

Genomics Health Futures Mission – a further $430.2 million for a total of $500.0 million;

  • Ageing, and Aged Care and Dementia Mission – a new investment of $ 185.0 million;
  • Indigenous Health Futures – a new investment of $125.0 million for a total of $160.0 million;
  • Stem Cell Mission – a new investment of $ 150.0 million;
  • Cardiovascular Mission – a new investment of $220.0 million; and Traumatic Brain Injury – a new investment of $50.0 million.

Translation

The Government will commit a further $1.2 billion for a total of $ I .5 billion allocated under the Investment Plan to progress research ideas from the lab to the clinic, ensuring new medical discoveries are part of the clinical practice of GPs, specialists and hospitals, which includes:

  • Preventive and Public Health Research – a further $60.0 million for a total of $260.4 million.
  • Primary Health Care Research – a new investment of $45.0 million;
  • Rapid Applied Research Translation Centres – a further $ 143.0 million for a total of $218.0 million;

Medical Research Commercialisation – a further $254.0 million for a total of $311.3 million;

  • National Critical Infrastructure – a new investment of $605.0 million; and Data Infrastructure – focus on registries, biobanks & linkage platforms – a new investment of $80.0 million.

8.Investing in preventive health

The Budget funds a range of preventive health initiatives to tackle some of Australia’s most pressing social and health challenges. These include lifestyle-related blood diseases, drugs, family and domestic violence, and unhealthy eating.

We are allocating $45.4 million to implement national awareness and prevention strategies to reduce the impact of blood borne viruses, such as HIV, hepatitis B and hepatitis C, and sexually transmissible infections, such as syphilis, gonorrhoea and chlamydia. These strategies focus on the needs of Aboriginal and Torres Strait Islander people.

More alcohol and other drug treatment and support services will be established in remote, rural and regional areas, costing $9.6 million. An additional 65 specialist service providers will operate after hours and on weekends across hundreds of under-serviced areas.

Funding of $4.3 million will provide local support for families and communities struggling with the impacts of illicit drug misuse, including ice.

We will also invest $7.2 million establishing a take-home naloxone program to reduce deaths associated with opioids. Naloxone is a proven treatment in reversing the effect of an opioid overdose.

Family and domestic violence has a profound impact on women and children’s health and wellbeing, families and communities, and society. A ‘Recognise, Respond, Refer’ pilot, already under way in Brisbane, will receive a $7.5 million boost to be extended across five Primary Health Network regions to train GPs and their staff to recognise and manage family violence. A complementary $2.1 million training initiative will further improve the domestic violence response of GPs and primary care workers nationally.

The Government will allocate $20 million for a pivotal anti-smoking campaign.

9.Supporting senior Australians

We have increased funding for aged care by $7 billion over the forward estimates, up from $13.3 billion in 2012-13 to $20.5 billion in 2018-19 to $25.4 billion in 2022-23.

We have increased the number of home care packages from 60,308 in 2012—13 to 124,032 in 2018—19 and 157,154 in 2022—23 as part of our ongoing response to senior Australians’ clear preference to receive aged care in their own homes and live independently for longer.

With the rapid growth in home care, the Government is providing $5.6 million to strengthen compliance to tackle the risk of poor quality service and fraud. The Aged Care Quality and Safety Commission — Australia’s new cop on the aged care beat — will have a key role, including increasing home care audits.

The Commonwealth Home Support Program will be extended for a further two years to

30 June 2022, representing an investment of $5.9 billion. This will give certainty to around 1500 organisations, such as meals-on-wheels, supporting almost one million older Australians as they age and start to require assistance while still living in their own home.

In residential aged care, the Government has invested $320 million in 2018—19 as a one-off increase to the general subsidy through to 30 June 2020. This will support the increase in residential places from 186,000 in 2012-13 to 212,000 in 2018-19 to 243,000 in 2022-23. We will also work to significantly improve monitoring and reporting of serious incidents involving residents, including incidents involving physical or chemical restraint.

Funding of $7.7 million will help to ensure the use of medication, in particular inappropriate use of psychotropics and antibiotics, in residential aged care is brought into line with best practice and community expectations. Clinical pharmacists will work directly with aged care providers to better inform them about appropriate use. Providers will be obliged to provide medication management data.

Building the aged care workforce for the future is a high Government priority. We are allocating $2.6 million to step up industry-led implementation of the Aged Care Workforce Strategy. This will improve capability, conditions and career opportunities for more than 366,000 aged care workers.

10. Department of the Prime Minister and Cabinet

The Coalition Government has delivered a stronger economy that ensures we can make record investments in services and opportunities for First Australians.

The 2019-20 Budget includes measures across many Departments that delivers record investments into health, safety, education and employment for Aboriginal and Torres Strait Islander people.

For the first time in a decade the budget will be back in surplus and we are investing the dividends of our strong budget management to make lives better for First Australians.

“This Budget focusses on empowering communities and through job creation, through education and by continuing to deliver the services that keep communities safe, healthy and culturally prosperous.

“The Government’s investments announced in the Budget ensure Indigenous Australians can seize the opportunities we are creating for all Australians from a stronger economy.”

The budget continues the Coalition Government’s efforts to invest in Aboriginal and Torres Strait Islander organisations to deliver services for their communities. Since coming to government we have doubled the number of Aboriginal and Torres Strait Islander service providers from 30 per cent to 60 per cent.

The cross-portfolio investment in initiatives to improve outcomes for Aboriginal and Torres Strait Islander Australians include:

  • The continued investment of $5.2 billion in the Indigenous Advancement Strategy (IAS).
  • An additional $5.3 billion to support more than 224,000 Aboriginal or Torres Strait Islander students through the Indigenous loading component of our schools funding package (to 2029).
  • $1 billion for Indigenous health through the Department of Health.
  • $37.5 million to support better housing for residents of remote Indigenous communities in South Australia.
  • $276.5 million for the Indigenous Youth Education Package to give more Indigenous students the support and mentoring they need through their secondary studies.
  • $35 million to support initiatives to address drivers of violence under the Fourth Action Plan of the National Plan to Reduce Violence against Women and their Children 2010-2022.
  • $2.5 million for the eSafety Commissioner as part of the Fourth Action Plan of the National Action Plan to Reduce Violence Against Women and their Children.The eSafety Commissioner will work with and assist Aboriginal and Torres Strait Islander women in communities across Australia to identify, report and protect themselves and their children form technology-facilitated abuse.
  • $5 million towards regionally specific Indigenous Suicide Prevention Initiatives that are tailored to the needs of each community and led by local Indigenous Youth leaders.
  • $35 million contribution to support securing tourism and jobs in Kakadu in Jabiru.
  • $7.3 million to undertake a co-design process with Aboriginal and Torres Strait Islander Australians to detail options for Constitutional Recognition and a Voice to Parliament.
  • $62.4 million over four years under the Skills Package to support participation in the labour market with VET,language, literacy, numeracy, and digital literacy skills assistance in remote communities.
  • $36.4 million over five years for extending the Family Tax Benefit to families of ABSTUDY recipients aged 16 and over who study away from home.
  • A $45.4 million commitment by the Commonwealth over four years for the Barkly Regional Deal to deliver a suite of short, medium and long-term initiatives to support economic and social development in the Barkly region.
  • Regional deals in Hinkler, Albury/Wodonga and Adelaide will pursue opportunities for Indigenous Businesses and employment.
  • Legal Assistance Package – annual increases to baseline funding for Legal Aid Commissions, Community Legal Centres and Aboriginal and Torres Strait Islander Legal Services with a single National Mechanism to be developed by the end of 2019.
  • $5 million for getting kids to school through working community by community and school by school to invest in remote and very remote areas for projects that support and promote school attendance.

The $5.2 billion Indigenous Advancement Strategy includes targeted programmes and activities to ensure that Aboriginal and Torres Strait Islander Australians can take advantage of the opportunities the economy is creating. The Indigenous Advancement Strategy delivers on the ground funding in partnership with communities, ensuring children are attending school, adults are in employment and communities are safe.

The $200 million Indigenous Youth Education Package includes initiatives to support Aboriginal and Torres Strait Islander secondary school students. The package will fund additional secondary school scholarships and residential support for students who move away from home to study, and more student support through academy and mentoring projects.

Additionally, the Government is supercharging growth in the Indigenous business sector by expanding the Indigenous Procurement Policy (IPP) by introducing a new 3 per cent value target for all Commonwealth contracts to be awarded to Indigenous business within the next decade. The IPP has resulted in more than $1.83 billion in contracts to more than 1,470 Indigenous companies since it was created in 2015. In contrast fewer than 30 Indigenous companies won a paltry $6.2 million worth of contracts across the Australian Government in the 2012-13 financial year.

Through the Indigenous Business Sector Strategy we are already delivering the $90 million Indigenous Entrepreneurs Fund, $27 million for the Indigenous Entrepreneurs Capital Scheme, $55 million for the Business Development Assistance Program, $21 million for additional microfinance as well as a $20 million Performance Bond Facility.

Through our commitments to housing, better services,reducing the incidents of family and domestic violence,empowering Aboriginal and Torres Strait Islander Australians, driving investment in the Indigenous businesses, all through deeper engagement and more local decision making, we are delivering a better future for First Australians.

 

Aboriginal Health #Budget2019 2 of 5 CEO Pat Turner NACCHO Press Release and @NACCHOChair Donnella Mills #NACCHOTV Interview : Funding for #IndigenousHealth Absent from Federal Budget

This weeks NACCHO Budget Coverage 

Post 1: NACCHO Intro #AusVotesHealth #Budget2019

Post 2: NACCHO Chair Press Release

Post 3:  Health Peak bodies Press Release summary

Post 4 : Government Press Releases

Post 5 : Opposition responses to Budget 2019 

Read all Budget 2019 Posts 

Part 1 Acting Acting Chair Donnella Mills discusses #Budget2019

The National Aboriginal Community Controlled Health Organisation (NACCHO) is disappointed at the lack of funding allocated in the 2019-2020 federal budget for Aboriginal and Torres Strait Islander health services and the Aboriginal Community Controlled Health Sector. 

The gap between the health outcomes in Aboriginal and Torres Strait Islander peoples and other Australians will continue to persist unless there is a significant commitment to supporting the work of Aboriginal community controlled health organisations,

NACCHO has long called for an increase to the baseline funding for Aboriginal Community Controlled Health Services to support the sustainable delivery of high quality, comprehensive primary health care services to Aboriginal and Torres Strait Islander people and communities. 

We know that closing the gap will never be achieved until primary health care services are properly funded and our clinics have good infrastructure and are fit for purpose; until our people are living in safe and secure housing; until there are culturally safe and trusted early intervention services available for our children and their families; and until our psychological, social, emotional and spiritual needs are acknowledged and supported.

The physical and mental health and wellbeing of Aboriginal and Torres Strait Islander communities needs to be a priority for the Australian government. Our communities suffer disproportionately higher rates of suicide, cancer, kidney disease and obesity compared to non-Indigenous Australians,”

We are disappointed that the Federal funding commitment does not match this critical need,” she said.

We call on the all political parties to put Aboriginal and Torres Strait Islander health and full funding of the Aboriginal Community Controlled Health Sector at the heart of their election commitments. ” 

Pat Turner CEO NACCHO

Read and or DOWNLOAD Full NACCHO Budget Press Release Here

NACCHO Aboriginal #AusVotesHealth and #Budget2019 1 of 5 : @nakarithorpe @NITV Reports  : A cash splash but what’s in it for Indigenous mob like @NACCHOChair @LowitjaInstitut @congressmob @NATSILS_ @NationalFVPLS?

This weeks NACCHO #Budget2019 Coverage

Post 1: NITV Indigenous mob #AusVotesHealth #Budget2019

Post 2: NACCHO Chair Press Release

Post 3:  Health peak bodies Press Release summary

Post 4 : Government Press Releases

Post 5 : Opposition responses to Budget 2019

“The treasurer kept on about how we are geared towards surplus. We need to focus on the most vulnerable and marginalised in our community, but this budget does nothing for my mob.

I don’t need another reminder that colonisation is still living. I don’t need to be reminded of that; we see it every day. I need to be reminded of the Uluru statement from the heart.

It just shows we have a long way to travel toward real equity and real social justice outcomes.”

Chair of NACCHO (the National Aboriginal Community Controlled Health Organisation) Donnella Mills told the Guardian ( and expressed frustration)  that there’s $12m in the budget for a Captain Cook memorial, but only $15m to address Indigenous youth suicide :

See full NACCHO Press Release and NACCHO TV interviews to be posted later this morning

Post 1: NITV Indigenous mob #AusVotesHealth #Budget2019 Nakita Thorpe NITV

 

For more discussion of Budget 2019, watch NITV’s The Point, 8.30pm tonight on Channel 34.

Originally published Here

Federal treasurer, Josh Frydenberg, has handed down his first budget and has described it as being “back in the black” with a budget surplus of $7.1 billion expected to be delivered next financial year, but the treasurer acknowledged “serious challenges” lay ahead.

“The global economy is slowing. Communities are feeling the impacts of flood, fire and drought. Families face cost of living pressures. And every one of us wants to see wages growing faster. But let me be clear: the answer to these challenges is not higher taxes,” he said.

The 2019 Budget sees further tax relief for low to middle-income earners. It also includes a record $100 billion National Infrastructure Plan and a $525 million skills package which the treasurer said will create 80,000 apprenticeships.

However, despite the Coalition’s rhetoric about a “stronger economy”, spending on Indigenous programs and services was lacklustre, with specific expenditure buried deep in the budget papers.

The government said it will invest $160 million for Indigenous health, with $10 million going to the Lowitja Institute, the national institute for Aboriginal and Torres Strait Islander health research.

Ms Janine Mohamed, interim CEO fro the institute welcomed the investment and thanked Ken Wyatt, the minister for Indigenous Health.

“The new funding will ensure that the Lowitja Institute continues to deliver public value of more than $3 per every $1 invested, and will enable us to remain as a key component of the national research architecture,” she said.

$35 million will go toward funding Aboriginal and Torres Strait Islander-specific solutions to family violence.

$5 million over four years will also go toward implementing Indigenous suicide prevention, to be led by young Indigenous leaders.

A further $4.5 million will be for Indigenous leadership to create a national plan for culturally appropriate care, and $3 million for a centre of excellence in childhood wellness.

Chief executive of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINAM), Melanie Robinson, said she was disappointed about the lack of expenditure in youth suicide.

“As we know there is a massive issue going on in our communities around suicide and lots of our young people are struggling,” she told NITV. “I thought there would have been more of a commitment … in that space.”

An additional $60 million will be spent upgrading roads in the Tiwi Islands, as part of a $492.3 million Roads of Strategic Importance to the Northern Territory, which was provided for in last year’s federal budget.

The government will also put $276.5 million over five years into supporting Indigenous students as part of its  Closing the Gap refresh. A further $5 million will go to promote school attendance in remote communities.

Another $70.6 million will cover the cost of extinguishing Higher Education Loan Program (Help) debts for teachers after they undertake a four-year placement in very remote locations, as announced in February.

An increase of less than $20 million has gone towards legal assistance, prompting the Law Council of Australia to label the allocation “abysmal”. They say the figure falls well short of the additional $310 million per year needed to provide adequate access to legal justice.

“The Budget may be in surplus but Australia will remain in a significant justice deficit so long as the government fails to deliver adequate funding for Legal Aid Commissions (LACs), Community Legal Centres (CLCs), Aboriginal and Torres Strait Islander Legal Services (ATSILS) and Family Violence Prevention Legal Services,” said Arthur Moses, the president of the Law Council of Australia.

Mr Moses did however acknowledge that reversing proposed cuts and providing additional funding of $16.7 million over three years for ATSILS was welcome, saying the decision to dissolve the Indigenous Legal Assistance Program and roll funding for ATSILS into a single funding mechanism could threaten the independence of those services.

“ATSILS provides specialised and culturally appropriate legal services for some of the most marginalised people in our community,” he said. “They need to maintain independence to effectively continue their vital work.”

National Congress of Australia’s First Peoples Co-Chair, Dr Jackie Huggins, said it was still too early to know the “actual detail” of the impact of the budget on funding for Aboriginal and Torres Strait Islander organisations and interests.

There are some glimmers of hope, said Ms Huggins, particularly around the Royal Commission into the abuse and neglect of people with a disability, women’s safety and health initiatives and education, but she said Congress still had questions.

“No progress has been made on the economic empowerment of Aboriginal and Torres Strait Islander peoples,” she said.

Ivan Simon, co-chair of the National Aboriginal and Torres Strait Islander Housing Authority, said he was sad and disappointed about the lack of remote housing commitment.

“I didn’t see much in there. I guess the devil is in the detail,” he told NITV News.

Mr Simon said he was concerned about how Indigenous housing service providers will be involved in the rollout of a $315 million social bond into mainstream community housing.

“We find it very difficult to play in that mainstream system,” he said.

Finance Minister Matthias Cormann told NITV News his government considered Indigenous Australians a priority.

“From Tony Abbott to Malcolm Turnbull and Scott Morrison, it’s been a very strong personal priority of three prime ministers, and of course it’s a priority for Nigel Scullion… We are strongly committed to Closing the Gap and there is increased funding right across the board,” he said.

  • For more discussion of Budget 2019, watch NITV’s The Point, 8.30pm tonight on Channel 34.

 

 

 

NACCHO Aboriginal Health Pre- #Budget2019 -2020 : #RefreshTheCTGRefresh :The following #ClosingTheGap policy proposals are informed by NACCHO’s consultations with its Affiliates and our 145 Aboriginal Community Controlled Health Services:

 

The proposals included in this submission are based on the extensive experience NACCHO member services have of providing many years of comprehensive primary health care to Aboriginal and Torres Strait Islander peoples.

We have long recognised that closing the gap on Aboriginal and Torres Strait Islander health and disadvantage will never be achieved until primary health care services’ infrastructure hardware is fit for purpose; our people are living in safe and secure housing; culturally safe and trusted early intervention services are available for our children and their families; and our psychological, social, emotional and spiritual needs are acknowledged and supported.=

If these proposals are adopted, fully funded and implemented, they provide a pathway forward where improvements in life expectancy can be confidently predicted. “  

Pat Turner AM NACCHO CEO on behalf of our State and Territory Affiliates and 145 Aboriginal Community Controlled Health Services operating 302 ACCHO Clinics

Download this 20 Page NACCHO Submission

NACCHO Budget Submission 2019-20 FINAL

NACCHO is the national peak body representing 145 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 provide about one million episodes of care in a twelve-month period.

Collectively, we employ about 6,000 staff (56 per cent whom are Indigenous), which makes us the single largest employer of Indigenous people in the country.

The following policy proposals are informed by NACCHO’s consultations with its Affiliates and Aboriginal Community Controlled Health Services:

  1. Increase base funding of Aboriginal Community Controlled Health Services;
  2. Increase funding for capital works and infrastructure;
  3. Improve Aboriginal and Torres Strait Islander housing and community infrastructure;
  4. Reduce the overrepresentation of Aboriginal and Torres Strait Islander children and young people in out-of-home care and detention; and
  5. Strengthen the Mental Health and Social and Emotional Wellbeing of Aboriginal and Torres Strait Islander peoples.

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.

1. Increase base funding of Aboriginal Community Controlled Health Services

Proposal:

That the Australian Government:

  • Commits to increasing the baseline funding for Aboriginal Community Controlled Health Services to support the sustainable delivery of high quality, comprehensive primary health care services to Aboriginal and Torres Strait Islander people and communities.
  • Works together with NACCHO and Affiliates to agree to a new formula for the provision of comprehensive primary health care funding that is relative to need.

Rationale: 

The Productivity Commission’s 2017 Indigenous Expenditure 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.

The Commonwealth Government spends $1.4 for every $1 spent on the rest of the population, while Aboriginal and Torres Strait Islander people have 2.3 times the per capita need of the rest of the population because of much higher levels of illness and burden of disease. In its 2018 Report Card on Indigenous Health, the Australian Medical Association (AMA) states that spending less per capita on those with worse health, is ‘untenable national policy and that must be rectified’.1 The AMA also adds that long-term failure to adequately fund primary health care – especially Aboriginal Community Controlled Health Services (ACCHSs) – is a major contributing factor to failure in closing health and life expectancy gaps.

Despite the challenges of delivering services in fragmented and insufficient funding environments, studies have shown that ACCHSs deliver more cost-effective, equitable and effective primary health care services to Aboriginal and Torres Strait Islander peoples and are 23 per cent better at attracting and retaining Aboriginal and Torres Strait Islander clients than mainstream providers.2 ACCHSs continue to specialise in providing comprehensive primary care consistent with clients’ needs.

This includes home and site visits; provision of medical, public health and health promotion services; allied health, nursing services; assistance with making appointments and transport; help accessing child care or dealing with the justice system; drug and alcohol services; and providing help with income support.

                                                        

1https://ama.com.au/system/tdf/documents/2018%20AMA%20Report%20Card%20on%20Indigenous%20Heal th_1.pdf?file=1&type=node&id=49617, page 6.

2 Ong, Katherine S, Rob Carter, Margaret Kelaher, and Ian Anderson. 2012. Differences in Primary Health Care

Delivery to Australia’s Indigenous Population: A Template for Use in Economic Evaluations, BMC Health

Services Research 12:307; Campbell, Megan Ann, Jennifer Hunt, David J Scrimgeour, Maureen Davey and

Victoria Jones. 2017. Contribution of Aboriginal Community Controlled Health Services to improving Aboriginal

There are limits, however, to the extent that ACCHSs can continue to deliver quality, safe primary health care in fragmented and insufficient funding environments. This is particularly challenging to meet the health care needs of a fast-growing population.3 There is an urgent need to identify and fill the current health service gaps, particularly in primary health care, and with a focus on areas with high preventable hospital admissions and deaths and low use of the Medical Benefits Scheme and the Pharmaceutical Benefits Scheme.

An appropriately resourced Aboriginal Community Controlled Health sector represents an evidence-based, cost-effective and efficient solution for addressing the COAG Close the Gap and strategy and will result in gains for Aboriginal and Torres Strait Islander peoples’ health and wellbeing.

Strengthening the workforce

NACCHO welcomes COAG’s support for a National Aboriginal and Torres Strait Islander Health and Medical Workforce Plan. A long-term plan for building the workforce capabilities of ACCHSs is overdue. Many services struggle with the recruitment and retention of suitably qualified staff, and there are gaps in the number of professionals working in the sector.

NACCHO believes that the plan will be strengthened by expanding its scope to include:

  • metropolitan based services;
  • expanding the range of workforce beyond doctors and nurses; and
  • recognising that non-Indigenous staff comprise almost half of the workforce. While Aboriginal and Torres Strait Islander health staff are critical to improving access to culturally appropriate care and Indigenous health outcomes, consideration to the non-Indigenous workforce who contribute to improving Aboriginal and Torres Strait Islander Health outcomes should also be given.

An increase in the baseline funding for Aboriginal Community Controlled Health Services, as set out in this proposal will enable our sector to plan for and build workforce capabilities in line with the Health and Medical Workforce Plan objectives.

2. Increase funding for capital works and infrastructure upgrades

Proposal:

That the Australian Government:

  • Commits to increasing funding allocated through the Indigenous Australians’ Health Programme for capital works and infrastructure upgrades, and  Telehealth services; noting that at least $500m is likely to be needed to address unmet needs, based on the estimations of 38.6 per cent of the ACCHO sector, and we anticipate that those needs may be replicated across the sector (see Table A below).

Rationale: 

There is a current shortfall in infrastructure with a need for new buildings in existing and outreach locations, and renovations to increase amenities including consultation spaces. Additional funding is required for additional rooms and clinics mapped against areas of highest need with consideration to establishing satellite, outreach or permanent ACCHSs.

Many of the Aboriginal health clinics are 20 to 40 years old and require major refurbishment, capital works and updating to meet increasing population and patient numbers. The lack of consulting rooms and derelict infrastructure severely limits our services’ ability to increase MBS access.

Further, whilst there may be some scope to increase MBS billing rates for Aboriginal and Torres Strait Islander peoples, this cannot be achieved without new services and infrastructure. A vital priority is seed funding for the provision of satellite and outreach Aboriginal Community Controlled Health Services that Aboriginal and Torres Strait Islander people will access, and which provide the comprehensive services needed to fill the service gaps, to boost the use of MBS and PBS services to more equitable levels, and to reduce preventable admissions and deaths.

Improvements to the building infrastructure of ACCHSs are required to strengthen their capacity to address gaps in service provision, attract and retain clinical staff, and support the safety and accessibility of clinics and residential staff facilities. However, the level of funding of $15m per annum, under the Indigenous Australians’ Health Programme allocated for Capital Works – Infrastructure, Support and Assessment and Service Maintenance, is not keeping up with demand.

In our consultations with Affiliates and ACCHSs, NACCHO is increasingly hearing that

Telehealth services,[1] including infrastructure/hardware and improved connectivity, is required to support the provision of NDIS, mental health and health specialist services. A total of 22 out of 56 survey responses (see Table A below) identified the need for Telehealth to support service provision.

NACCHO believes that insufficient funding to meet capital works and infrastructure needs is adversely impacting the capacity of some ACCHSs to safely deliver comprehensive, timely and responsive primary health care; employ sufficient staff; to improve their uptake of Medicare billing; and to keep up with their accreditation requirements. In January 2019, we surveyed ACCHSs about their capital works and infrastructure needs, including Telehealth services. We received 56 responses, representing a response rate of 38.6 per cent.

 

Survey respondents estimated the total costs of identified capital works and infrastructure upgrades (see Table A below). The estimated costs have not been verified; however, they do

suggest there is a great level of unmet need in the sector. Please note that not all respondents were able to provide estimates.

Table A. Estimated costs of capital works and infrastructure upgrades identified by ACCHSs

Type Number of respondents Percentage of respondents Total estimated costs
Replace existing building 43 76.7% 207,559,043
New location/satellite clinic 21 37.5% 53,480,000
Extension 24 42.8% 18,310,000
Refurbishment 29 51.7% 35,251,000
Staff accommodation 25 44.6% 39,450,000
Telehealth services 22 39.2% 6,018,763
Total estimated costs of capital works and infrastructure upgrades $361,068,806

 

37 survey respondents applied for funding for infrastructure improvements from the Australian Government Department of Health during 2017 and/or 2018. Of the 11 that were successful, four respondents stated that the allocated funds were not sufficient for requirements.

ACCHSs believe that the current state of their service infrastructure impedes the capacity of their services as depicted in Table B, below:

Table B: Impact of ACCHSs’ infrastructure needs on service delivery

Infrastructure impeding service delivery Highly affected Somewhat affected
Safe delivery of quality health care 48.1% 51.9%
Increase client numbers 74.1% 25.9%
Expand the range of services and staff numbers 83.3% 16.7%
Increase Medicare billing 66% 34%

 

An extract of feedback provided by ACCHSs relating to their capital works and infrastructure needs is at Appendix A.

3. Improve Aboriginal and Torres Strait Islander housing and community infrastructure

Proposals:

That the Australian Government:

  • Expand the funding and timeframe of the current National Partnership on Remote Housing to match AT LEAST that of the former National Partnership Agreement on Remote Indigenous Housing.
  • Establish and fund a program that supports healthy living environments in urban, regional and remote Aboriginal and Torres Strait Islander communities, similar to the Fixing Houses for Better Health program. Ensure that rigorous data collection and program evaluation structures are developed and built into the program, to provide the Commonwealth Government with information to enable analysis of how housing improvements impact on health indicators.[2]
  • Update and promote the National Indigenous Housing Guide, a best practice resource for the design, construction and maintenance of housing for Aboriginal and Torres Strait Islander peoples.[3]

Rationale: 

Safe and decent housing is one of the biggest social determinants of health and we cannot overlook this when working to close the gap in life expectancy.

1. Remote Indigenous Housing

The National Partnership Agreement on Remote Indigenous Housing 2008-2018 was a COAG initiative that committed funding of $5.4b towards new builds, refurbishments, housing quality, cyclical maintenance, and community engagement and employment and business initiatives.

In 2016, the National Partnership Agreement on Remote Indigenous Housing was replaced by the National Partnership on Remote Housing. Under this new partnership, the Commonwealth Government committed:

  • $776.403m in 2016, to support remote housing in the Northern Territory, Queensland, South Australia, Western Australia, and the Northern Territory over a two-year period; and
  • $550m in 2018, to support remote housing in the Northern Territory, over a five-year period.

New South Wales, Victoria and Tasmania are not part of discussions with the Commonwealth Government on housing needs.

A review of the National Partnership Agreement on Remote Indigenous Housing (2018) found that:

  • An additional 5,500 homes are required by 2028 to reduce levels of overcrowding in remote areas to acceptable levels
  • A planned cyclic maintenance program, with a focus on health-related hardware and houses functioning, is required.
  • Systematic property and tenancy management needs to be faster.
  • More effort is required to mobilise the local workforces to do repairs and maintenance work.[4]

There is currently a disconnect between the levels of government investment into remote housing and the identified housing needs of remote communities. This disconnect is increasingly exacerbated by population increases in Aboriginal communities.[5]

There is a comprehensive, evidence-based literature which investigates the powerful links between housing and health, education and employment outcomes.[6] Healthy living conditions are the basis from which Closing the Gap objectives may be achieved. Commonwealth Government leadership is urgently needed to appropriately invest into remote housing.

2.Environmental health

The importance of environmental health to health outcomes is well established. A healthy living environment with adequate housing supports not only the health of individuals and families; it also enhances educational achievements, community safety and economic participation.10

Commonwealth and State and Territory Governments have a shared responsibility for housing. Overcrowding is a key contributor to poor health of Aboriginal and Torres Strait Islander peoples. In addition to overcrowding, poor and derelict health hardware (including water, sewerage, electricity) leads to the spread of preventable diseases for Aboriginal and Torres Strait Islander peoples. Healthy homes are vital to ensuring that preventable diseases that have been eradicated in most countries do not exist in Aboriginal and Torres Strait Islander communities and homes.

4. Reduce the overrepresentation of Aboriginal and Torres Strait Islander children and young people in out-of-home care and detention

Proposals:

That the Australian Government:

  • Establishes an additional elective within the existing Aboriginal Health Worker curriculum, that provides students with early childhood outreach, preventative health care and parenting support skills
  • Waives the upfront fees of the first 100 Indigenous students to undertake the Aboriginal Health Worker (Early Childhood stream) Certificate IV course.
  • Funds an additional 145 Aboriginal Health Worker (early childhood) places across ACCHSs.

Rationale:

The overrepresentation of Aboriginal and Torres Strait Islander children and young people in the child protection system is one of the most pressing human rights challenges facing Australia today.[7]

Young people placed in out-of-home care are 16 times more likely than the equivalent general population to be under youth justice supervision in the same year.[8]

Government investment in early childhood is an urgent priority to reduce the overrepresentation of Aboriginal and Torres Strait Islander children in out of home care and youth detention. Research reveals that almost half of the Aboriginal and Torres Strait Islander children who are placed to out of home care are removed by the age of four[9] and, secondly, demonstrates the strong link between children and young people in detention who have both current and/or previous experiences of out of home care.[10] There is also compelling evidence of the impact of repetitive, prolonged trauma on children and young people and how, if left untreated, this may lead to mental health and substance use disorders, and intergenerational experiences of out-of-home care and exposure to the criminal justice system.15

Despite previous investments by governments, the Aboriginal and Torres Strait Islander children and young people remain overrepresented in the children protection and youth detention systems. The Council of Australian Governments (COAG) Protecting Children is Everyone’s Business National Framework for Protecting Australia’s Children 2009–2020 (‘National Framework’) was established to develop a unified approach for protecting children. It recognises that ‘Australia needs a shared agenda for change, with national leadership and a common goal’.

One of the six outcomes of the National Framework is that Aboriginal and Torres Strait Islander children are supported and safe in their families and communities, with this overarching goal:

Indigenous children are supported and safe in strong, thriving families and communities to reduce the over-representation of Indigenous children in child protection systems. For those Indigenous children in child protection systems, culturally appropriate care and support is provided to enhance their wellbeing.16

Findings presented in the 2018 Family Matters Report reveal, however, that the aims and objectives of the National Framework have failed to protect Aboriginal and Torres Strait Islander children:

Aboriginal and Torres Strait Islander children make up just over 36 per cent of all children living in out-of-home care; the rate of Aboriginal and Torres Strait Islander children in out-ofhome care is 10.1 times that of other children, and disproportionate representation continues to grow (Australian Institute of Health and Welfare [AIHW], 2018b). Since the last Family Matters Report over-representation in out-of-home care has either increased or remained the same in every state and territory.17

Furthermore, statistics on the incarceration of Aboriginal and Torres Strait Islander children and young people in detention facilities reveal alarmingly high trends of overrepresentation:

  • On an average night in the June quarter 2018, nearly 3 in 5 (59%) young people aged 10– 17 in detention were Aboriginal and Torres Strait Islander, despite Aboriginal and Torres Strait Islander young people making up only 5% of the general population aged 10–17.
  • Indigenous young people aged 10–17 were 26 times as likely as non-Indigenous young people to be in detention on an average night.
  • A higher proportion of Indigenous young people in detention were aged 10–17 than non-Indigenous young people—in the June quarter 2018, 92% of Aboriginal and Torres

Strait Islander young people in detention were aged 10–17, compared with 74% of non-

Indigenous Islander young people.18

towardtraumainfo/Orygen_trauma_and_young_people_policy_report.aspx?ext=.; https://www.facs.nsw.gov.au/__data/assets/pdf_file/0016/421531/FACS_SAR.pdf

NACCHO believes an adequately funded, culturally safe, preventative response is needed to reduce the number and proportion of Aboriginal and Torres Strait Islander children in child protection and youth detention systems. It is vital that Aboriginal and Torres Strait Islander families who are struggling with chronic, complex and challenging circumstances are able to access culturally appropriate, holistic, preventative services with trusted service providers that have expertise in working with whole families affected by intergenerational trauma. The child protection and justice literature are united in that best practice principles for developing solutions to these preventable problems begin with self-determination, community control, cultural safety and a holistic response.[11] For these reasons, we are proposing that the new Aboriginal Health Worker (Early Childhood) be based within the service setting of the Aboriginal Community Controlled Health Service.

The cultural safety in which ACCHSs’ services are delivered is a key factor in their success. ACCHSs have expert understanding and knowledge of the interplays between intergenerational trauma, the social determinants of health, family violence, and institutional racism, and the risks these contributing factors carry in increasing Aboriginal and Torres Strait Islander peoples’ exposure to the child protection and criminal justice systems.

Our services have developed trauma informed care responses that acknowledge historical and contemporary experiences of colonisation, dispossession and discrimination and build this knowledge into service delivery.

Further, they are staffed by health and medical professionals who understand the importance of providing a comprehensive health service, including the vital importance of regular screening and treatment for infants and children aged 0-4, and providing at risk families with early support. Within the principles, values and beliefs of the Aboriginal community controlled service model lay the groundwork for children’s better health, education, and employment outcomes. The addition of Aboriginal Health Workers with early childhood skills and training will provide an important, much needed role in preventing and reducing Aboriginal and Torres Strait Islander children and young peoples’ exposure to child protection and criminal justice systems.

 

Aboriginal Peak Organisations of the Northern Territory, Submission to the Royal  

Commission into the Protection and Detention of Children in the Northern Territory, 2017

NACCHO supports the position and recommendations of Aboriginal Peak Organisations in the NT, that:

•        Aboriginal community control, empowerment and a trauma informed approach should underpin the delivery of all services to Aboriginal children and their families. This applies to service design and delivery across areas including early childhood, education, health, housing, welfare, prevention of substance misuse, family violence prevention, policing, child protection and youth justice.

•        The Australian Government develops and implements a comprehensive, adequately resourced national strategy and target, developed in partnership with Aboriginal and Torres Strait Islander peoples, to eliminate the over-representation of Aboriginal and Torres Strait Islander children in out-of-home care.

•        There is an urgent need for a child-centred, trauma-informed and culturally relevant approach to youth justice proceedings which ultimately seeks to altogether remove the need for the detention of children.

•        Early childhood programs and related clinical and public health services are provided equitably to all Aboriginal children (across the NT) through the development and implementation of a three-tiered model of family health care – universal, targeted and indicated – to meet children’s needs from before birth to school age. Services should be provided across eight key areas:  o quality antenatal and postnatal care;

o clinical and public health services for children and families; o a nurse home visiting program; o parenting programs; o child development programs; o two years of preschool; o targeted services for vulnerable children and families; and o supportive social determinants policies.

•        These services need to be responsive to, and driven by, the community at a local level.

5. Strengthen the mental health and social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples

Proposal:

That the Australian Government:

  • Provide secure and long-term funding to ACCHSs to expand their mental health, social and emotional wellbeing, suicide prevention, alcohol and other drugs services, using best practice trauma informed approaches.
  • Urgently increase funding for ACCHSs to employ staff to deliver mental health and social and emotional wellbeing services, including psychologists, psychiatrists, speech pathologists, mental health workers and other professionals and workers; and
  • Urgently increase the delivery of training to Aboriginal health practitioners to establish and/or consolidate skills development in mental health care and support, including suicide prevention; and
  • Return funding for Aboriginal and Torres Strait Islander suicide prevention, health and wellbeing and alcohol and other drugs from the Indigenous Advancement Strategy to the Indigenous Australians’ Health Programme.

Rationale: 

The Australian Institute of Health and Welfare has estimated that mental health and substance use are the biggest contributors to the overall burden of disease for Aboriginal and Torres Strait Islander peoples. Indigenous adults are 2.7 times more likely to experience high or very high levels of psychological distress than other Australians.[12] They are also hospitalised for mental and behavioural disorders and suicide at almost twice the rate of non-Indigenous population and are missing out on much needed mental health services.

Suicide is the leading cause of death for Aboriginal people aged 5-34 years, the second leading cause of death for Aboriginal and Torres Strait Islander men. In 2016, the rate of suicide for Aboriginal and Torres Strait Islander peoples was 24 per 100,000, twice the rate for non-Indigenous Australians.[13] Aboriginal people living in the Kimberley region are seven times more likely to suicide than non-Aboriginal people.

Many Aboriginal Community Controlled Health Services deliver culturally safe, trauma informed services in communities dealing with extreme social and economic disadvantage that are affected and compounded by intergenerational trauma and are supporting positive changes in the lives of their members. The case study provided by Derby Aboriginal Health Service demonstrates not only the impact that this ACCHS is having on its community. It also illustrates the rationale for each of the proposals described in this pre-budget submission.

Case Study: Derby Aboriginal Health Service, WA

Derby Aboriginal Health Service’s Social and Emotional Wellbeing Unit (SEWB) have partnered with another organisation to employ someone in our SEWB unit to work directly with families on issues that contribute to them losing their children to Department of Child Protection (DCP). This program is designed to help prevent the children from being removed by DCP by working one to one with families on issues such as budgeting, education, substance misuse, a safe and healthy home etc.

Our SEWB unit has a community engagement approach which involves working directly with clients and their families, counselling with the psychologist and mental health worker, the male Aboriginal Mental Health Worker taking men out on country trips as part of mental health activities for men, the youth at risk program (Shine), the Body Clinic, the prenatal program working directly with mums, dads and bubs around parenting, relationships between mums, dads and children etc. The team work directly with the community.

We are now introducing a new SEWB designed program into the Derby prison which focuses on exploring men and women’s strengths and abilities rather than looking at their deficits. Using a strengths based program was very successfully delivered with a group of 22 Aboriginal men and 16 Aboriginal women where, for many of the participants, they were told for the first time in their lives that they matter and that they have good things about them and they are strong men and women (this naturally brought in some behavior modification that they could attempt in making changes in their lives; e.g. one participant said that when he went home, he was going to make his wife a cup of tea instead of expecting her to make him tea – he said he had never thought of that before). The SEWB team presented this at the National Mental Health Conference in Adelaide, August last year.

Given the deep and respectful footprint the SEWB team has in the town and surrounding communities, they, and the people, deserve and need a new building in which to continue their important work. If we can help people deal with the issues above, then they will be much more empowered to prevent/deal with their own health issues – perhaps then we can Close the Gap.

Given the burden of mental, psychological distress and trauma that our communities are responding to and the impact this has on Aboriginal and Torres Strait Islander peoples’ life expectancy, educational outcomes, and workforce participation, NACCHO believes it is imperative that a funded implementation plan for the National Strategic Framework for Aboriginal and Torres Strait Islander Mental Health and Social and Emotional Wellbeing

2017-2023 (‘the Framework’) be developed as a priority. The following Action Areas of the Framework relate to this proposal:

  • Action Area 1 – Strengthen the foundations (An effective and empowered mental health and social and emotional wellbeing workforce);
  • Action Area 2 – Promote wellness (all outcome areas);[14] and
  • Action Area 4 – Provide care for people who are mildly or moderately ill (Aboriginal and Torres Strait Islander people living with a mild or moderate mental illness are able to access culturally and clinically appropriate primary mental health care according to need).

As the above case study suggests, our trusted local Aboriginal community controlled services are best placed to be the preferred providers of mental health, social and emotional wellbeing, and suicide prevention activities to their communities. Australian Government funding should be prioritised to on the ground Aboriginal services to deliver suicide prevention, trauma and other wellbeing services. Delivering these much-needed services through ACCHSs, rather than establishing a new service, would deliver economies of scale and would draw from an already demonstrated successful model of service delivery.

Further, NACCHO believes that the current artificial distinction between separating mental health, social and emotional wellbeing and alcohol and drug funding from primary health care funding, must be abolished. Primary health care, within the holistic health provision of ACCHS, provides the sound structure to address all aspects of health care arising from social, emotional and physical factors. Primary health care is a comprehensive approach to health in accordance with the Aboriginal holistic definition of health and arises out of the practical experience within the Aboriginal community itself having to provide effective and culturally appropriate health services to its communities.

The current artificial distinction, as exemplified by program funding for ACCHS activities being administered across two Australian Government Departments, does not support our definition of health and wellbeing. It also leads to inefficiencies and unnecessarily increases red tape, by imposing additional reporting burdens on a sector that is delivering services under challenging circumstances.     

APPENDIX A

Qualitative feedback from Aboriginal Community Controlled Health Services  capital works and infrastructure needs 

The following comments from ACCHSs have been extracted from a survey administered by NACCHO in January 2019:

  • Currently at capacity and as the government focusses more on Medicare earnings and less on funding we need the ability to expand into this area as well as the NDIS in order to meet our client service needs and build sustainability.
  • The facility that our service currently occupies is state government owned, on state crown land, is over 40 years old and is ‘sick’ – it is not fit for purpose with an irreparable roof, significant asbestos contamination, water ingress, mould and recurrent power outages. The maintenance costs are an unsustainable burden, it is unreliable, unsuitable and unsafe for clients and staff, and there is no room for expansion for program and community areas. We applied for funding from the Australian Government Department of Health, but the application was not successful. This figure is inclusive of early works transportable – temporary accommodation, building works, demolition works, services infrastructure, external works, design development contingency, construction contingency, builder preliminaries and margin, loose furniture and equipment, specialist/medical equipment, ICT & PABX, AV equipment, professional including.

disbursements (to be confirmed), statutory fees, locality loading, and goods and services tax.

  • We are in need of kitchen renovations to each of our community care sites that do meals on wheels. The WA Environmental Health unit has informed us that we need to upgrade all our kitchens to meet Food Safety requirements or they will enforce closure of some of our kitchens, which would then mean we are unable to do our Meals on Wheels service in some communities
  • Currently limited by space to employ support staff and increase our GP’s, our waiting room is around 3x4m and we are always having clients standing up or waiting outside until there is space for them. We currently have three buildings in the one township with two being rentals, if we could co-locate all services, we could offer a higher level of integrated care and save wasted money on rent.
  • Not currently enough space to house staff and visiting clinicians.
  • Have been applying for grants in infrastructure and included in Action Plan for quite a few years and still not successful.
  • We need a multi-purpose building to bring together our comprehensive range of services in a way that enables community to gather, express their culture and feel safe and welcome whilst receiving a fully integrated service delivery model of supports. We have more than doubled in staffing and program delivery and are still trying to operate out of the same space. The need for further expansion is inevitable and the co-operative welcomes the opportunity to bring more services to our community, but infrastructure

is a barrier and we have taken the strategic decision to acquire vacant land near our main headquarters with the view to obtaining future infrastructure funding – it is much needed.

  • The three sites we currently lease are all commercial premises and we have to make our business fit, the buildings are not culturally appropriate nor are they designed for a clinical setting.
  • For eight years we have struggled to grow in line with our community service needs and the requirement to become more self-sufficient in the face of a funding environment which is declining in real terms (not keeping pace with CPI and wages growth). Further to this, every time we add a building our running costs go up so even capital expansion comes at a cost to the organisation as it takes time to build up to the operating capacity that the new/improved buildings provide. This is the ongoing struggle in our space.
  • Our service was established in 1999 and has been operating from an 80 year old converted holiday house, with a couple of minor extensions. The clinic does not meet the contemporary set up for an efficient clinic from viewpoint of staff, medical services and for community members. Space is very limited, and service delivery is also limited due to room availability. Demand for services both for physical and mental health/SEWB is growing strongly. We have 425 Community Members (with 70 currently in prisons in our region) and our actual patient numbers accessing services over 12 months have increased 50%.
  • We never received support or funding to acquire a purpose-built facility from the outset and as there was no suitable accommodation for rent or lease, we acquired two small houses to deliver our services from. These were totally inadequate but all we could acquire at the time. We have 31 staff accommodated through three locations and require a purpose-built facility to deliver quality primary health care to our Community.
  • Over the last two years we have been able to purchase the site it is currently located on. This site is based on five contiguous residential properties, with each property containing a 2-3 bedroom, approximately 40 year old house. Two of these houses have been joined together to form the Medical Clinic, the other three houses have all been renovated and upgraded to various levels in order to make them usable by the service. The next step in the plan is to redevelop the entire site to build an all-in-one centre to replace the current four separate buildings. In our 12 years of service we have moved from renting at a number of locations to being able to purchase our current site. The current site of old, converted residential buildings while viable in the short term, does not allow for efficient use of the site nor capacity for growth. Parking is scattered around the site, staff are scattered and continually moving from building to building to serve clients. There is no excess accommodation capacity to allow for growth of services. Our intention is to re-develop the site to house all staff in one building, which will be configured for growth over the long term and allow efficient use of the available grounds for parking, an Elders shed, and so on.
  • We have run out of room. Every office is shared, including the CEO’s office. We can’t hire any staff – nowhere to house them. Whenever a visiting service is operating – GP clinic, podiatry, optometry, audiology, chiropractor etc, offices have to be vacated to house

them, displaced staff basically have nowhere to go. Fine balancing act to schedule things to displace as few people as possible.

  • We are currently located in two refurbished community buildings as there is no suitable accommodation for lease. Our organisation is growing very quickly, and we need all services located under one roof – one identity, one culture.
  • Rapidly reaching the point where services will be diminished because of failing infrastructure or insufficient housing for the nursing staff required.
  • Some clinical rooms are not fit for purpose. Clinicians working from rooms without hand washing facilities. Medical Clinic is old, out of date, some rooms not fit for purpose, ineffective air conditioning, clinical staff sharing rooms, no room for expansion, difficult to house students due to lack of appropriate space.
  • We have made a number of applications to improve infrastructure, and to replace current infrastructure, all have been unsuccessful, in some cases we have purchase buildings & land to try and demonstrate a commitment to ongoing growth and servicing of clients. We get little feedback in relation to funding applications.
  • Spread across three sites with some providers having to share rooms and staff being required to work outside on laptops at times. Desperately needing to build a purposebuilt facility in order to stop paying high amounts of rent and allow effective primary health care to an increasing client number.

Derby Aboriginal Health Service

The Derby Aboriginal Health Service (DAHS) Social and Emotional Wellbeing (SEWB) unit is housed in a 60+ year old asbestos building that was originally a family home. It has an old and small transport unit connected to the house by an exposed verandah. There are 6 staff working from the house who provide individual and family counselling and support. The clients who come to SEWB experience mental health issues, family violence, poverty, Department of Child Protection (DCP) issues around removal of children, alcohol and other drug issues and supporting those released from the Derby local Prison (approx. 200 prisoners). It is difficult to safely secure SEWB to the extent it is required given the age and asbestos nature of the building (security alarms etc). In the photos, you can see the buildings are old and are of asbestos. The transportable out the back houses the manager who is also the psychologist – this means she is in a vulnerable position when counselling should the session not go as planned (potential for a violent situation – see photo showing external verandah connecting to the donga).

The size of the house means that counselling clients privately is difficult as everything happens in close quarters. The number of clients the team work with exceeds the capacity of the building which impacts on the number of Aboriginal clients the team can help. The SEWB building has been broken into a number of times the last being during the long weekend in September 2018 where significant damage was done. Given the age of the house, during the past 18 months, parts of the internal ceiling including cornices have been falling away from the structures creating potential issues of asbestos fibre being released into the air. In addition, there are plumbing problems and the wooden floor is becoming a safety issue in one area of the building.

SEWB runs a vulnerable youth programme (the Shine Group) and a Body Shop clinic for youth who will not attend the main clinic for shame and fear reasons (special appointments are made with a doctor so that the young person doesn’t have to wait in the waiting area. In addition, a doctor runs a monthly session at the SEWB building with youth around health education and also sees them if there is a clinical need). These programmes run out of another 60+ year old asbestos family house some distance from the main SEWB house. Not only is the house not suitable but there may be security risks for the staff member working with vulnerable youth.  The Shine House was also broken into in September 2018 where significant damage was done (see photos).

The DAHS main building has no further office or other space to house staff.  This is particularly the case for 2019 as DAHS takes on new programmes (e.g. 2 staff for the new Syphilis Programme).  DAHS is acutely aware of the need to source funding to build new administration offices in order to release current admin offices for clinical and programme purposes.

DAHS requires a new or upgraded SEWB building. DAHS first applied for service maintenance funding in March 2017 but were unsuccessful. DAHS applied in June 2018 for Capital Works but were unsuccessful because it didn’t fit in with IAHP Primary Health Care as it was about mental health. DAHS also paid for an Architect to draw up the plans for a new SEWB building.  It is my view that one of the main issues is that the government separates SEWB from primary health care.

Social and emotional wellbeing issues CANNOT be separated from primary health care.  As is well known, a person’s SEWB impacts on the physical health of an individual.  Physical illhealth is frequently caused by the SEWB condition of an individual (i.e. historical and current experiences of trauma frequently commencing in the pre-natal phase of a child’s life, family violence, alcohol and other drug use, smoking, anxiety, removal of children, mental health issues etc). Aboriginal people suffer greatly from SEWB issues which impacts on their overall physical health.  Mental health in all its forms is part and parcel of physical health so it must be included in primary health care.

However, both state and commonwealth governments do not seem to prioritise or even support funding for SEWB (such as service and maintenance work, capital works or funding to continue key positions in the SEWB team – in fact, the government actively separates funding for SEWB and primary health care).  DAHS also provides clinical services to 7 remote communities most of whom are up to 400 kms away with Kandiwal Community 600kms away where we supply a fly in/fly out clinical service. There are many demands placed on a team of SEWB workers stationed in a working environment that does not allow them to function to the best of their abilities or offer increased services to our clients. Passion for the cause alone does not help in Closing the Gap. Working with one hand tied behind one’s back is not effective in reducing mental health issues and chronic diseases.

Part of an upgrade we requested was to renovate reception to make it safer for receptionist staff and to increase confidentiality when clients speak with reception staff (it also doesn’t meet the needs of disabled clients). There are a number of times throughout the year when receptionist staff are verbally abused with threats of physical harm. The current reception was designed prior to more recent events of aggression exhibited by clients under the influence of drugs.  The design now enables abusive clients to quite easily reach across the reception counter and hurt staff or can jump over the same counter to gain access to staff.  In addition, given there is no screen and the current open nature of the reception area, sharing confidential information can be compromised. DAHS applied for services and maintenance funding to make the changes but were unsuccessful.

[1] ACCHSs may apply for Telehealth funding through the Indigenous Australians’ Health Programme, Governance and System Effectiveness: Sector Support activity.

[2] https://www.anao.gov.au/work/performanceaudit/indigenoushousinginitiativesfixinghousesbetterhealthprogram  

[3] http://web.archive.org/web/20140213221536/http://www.dss.gov.au/sites/default/files/documents/05_201 2/housing_guide_info_intro.pdf  

[4] https://www.pmc.gov.au/resourcecentre/indigenousaffairs/remotehousingreview, page 3.

[5] https://www.caac.org.au/uploads/pdfs/CongressHousingandHealthDiscussionPaperFinalMarch2018.pdf

[6] https://www.pmc.gov.au/resourcecentre/indigenousaffairs/healthperformanceframework2017report; https://www.mja.com.au/journal/2011/195/11/closinggapandindigenoushousing;  https://probonoaustralia.com.au/news/2016/02/housingkeyclosinggap/; https://ama.com.au/positionstatement/aboriginalandtorresstraitislanderhealthrevised2015; https://www.caac.org.au/uploads/pdfs/CongressHousingandHealthDiscussionPaperFinalMarch2018.pdf. 10 https://www.anao.gov.au/work/performanceaudit/indigenoushousinginitiativesfixinghousesbetterhealthprogram  

[7] Australia Human Rights Commission Social Justice and Native Title Report 2015, cited in the Australian Law

Reform Commission publication, Pathways to JusticeInquiry into the Incarceration Rate of Aboriginal and Torres Strait Islander Peoples (ALRC Report 133)https://www.alrc.gov.au/publications/crossoverouthomecaredetention.

[8] https://www.alrc.gov.au/publications/crossoverouthomecaredetention; https://www.aihw.gov.au/getmedia/06341e00a08f4a0b9d33d6c4cf1e3379/aihwcsi025.pdf.aspx?inline=true  

[9] https://www.snaicc.org.au/ensuring-fair-start-children-need-dedicated-funding-stream-aboriginal-torresstrait-islander-early-years-sector/

[10] https://www.alrc.gov.au/publications/crossoverouthomecaredetention;

https://aifs.gov.au/cfca/publications/intersectionbetweenchildprotectionandyouthjusticesystems 15 https://aifs.gov.au/cfca/sites/default/files/publicationdocuments/cfcapracticebraindevelopmentv6040618.pdf; https://www.orygen.org.au/PolicyAdvocacy/PolicyReports/TraumaandyoungpeopleMoving

[11] http://www.familymatters.org.au/wpcontent/uploads/2018/11/FamilyMattersReport2018.pdf; Thorburn, Kathryn and Melissa Marshall. 2017. The Yiriman Project in the West Kimberley: an example of justice reinvestment? Indigenous Justice Clearinghouse, Current Initiatives Paper 5; McCausland, Ruth, Elizabeth McEntyre, Eileen Baldry. 2017. Indigenous People, Mental Health, Cognitive Disability and the

Criminal Justice System. Indigenous Justice Clearinghouse. Brief 22; AMA Report Card on Indigenous Health 2015. Treating the high rates of imprisonment of Aboriginal and Torres Strait Islander peoples as a symptom of the health gap: an integrated approach to both; Richards, Kelly, Lisa Rosevear and Robyn Gilbert. 2011.

Promising interventions for reducing Indigenous juvenile offending. Indigenous Justice Clearinghouse, Brief 10.

[12] Australian Institute of Health and Welfare. 2018. Australia’s Health 2018. Australia’s health series no. 16. AUS 221. Canberra: AIHW.

[13] Ibid

[14] Outcome areas: Aboriginal and Torres Strait Islander communities and cultures are strong and support social and emotional wellbeing and mental health; Aboriginal and Torres Strait Islander families are strong and supported; Infants get the best possible developmental start to life and mental health; Aboriginal and Torres Strait Islander children and young people get the services and support they need to thrive and grow into mentally healthy adults.