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.

NACCHO Aboriginal Health #RefreshtheCTGRefresh : Read and /Or Download #ClosingtheGap response Press Releases from Pat Turner NACCHO CEO @June_Oscar @congressmob @closethegapOZ @amapresident @RACGP @RecAustralia @Change_Record @Mayi_Kuwayu

Close the Gap Campaign

AMA

RACGP

Reconciliation Australia

Change the Record

AMSANT Darwin

Mayi Kuwayu /ANU

Greens

Introduction NACCHO Closing the Gap response CEO Pat Turner AM 

On the floor of Parliament yesterday, the Prime Minister spoke of a change happening in our country: that there is a shared understanding that we have a shared future- Indigenous and non-Indigenous Australians, together. But our present is not shared. Our present, and indeed our past is marred in difference, in disparity. This striking disparity in quality of life outcomes is what began the historic journey of the Closing the Gap initiatives a decade ago.

But after ten years of good intentions the outcomes have been disappointing. The gaps have not been closing and so-called targets have not been met. The quality of life among our communities is simply not equal to that of our non-indigenous Australian counterparts.

Yes change must come from within our communities, but change must also come from the whole of Australia. We must change together.

The time has come for our voices to be heard and for us to lead the way on Closing the Gap. We are ready for action. ”

Pat Turner AM is the CEO of the National Aboriginal Community Controlled Health Organisation.

But I’m ever hopeful that change is near. I was heartened by the statement made by the Prime Minister yesterday on the floor of Parliament. For the first time, I heard a genuine acknowledgement of why the Closing the Gap outcomes seem steeped in failure. I heard an acknowledgement that until Aboriginal and Torres Strait Islander people are brought to the table as equal partners, the gap will not be closed and progress will not be made. This is a view that our community has expressed for many years – a view I am encouraged has finally been heard.

Historically, Aboriginal and Torres Strait Islander community leaders have not been equal decision-makers in steering attempts to close the unacceptable gaps between Aboriginal and Torres Strait Islander Australians and the broader community. Our struggle as community-controlled organisations to even gain a voice at the table  – let alone for governments to actually listen to us – has long been at the crux of the disappointing progress.

Last year, an accord on the first stage of the Closing the Gap Refresh languished because discussions were not undertaken with genuine input from community members. We turned an important corner in December when an historic agreement was reached to include a coalition of peak bodies as equal partners in refreshing the Closing the Gap strategy.

We now need to ensure that the agreement blossoms into genuine action.

We simply cannot let this opportunity to make a real difference to the lives of our people slip by. Government cannot be allowed to drag the chain on this until it becomes another broken promise.

We are doing the heavy lifting and have drafted a formal partnership agreement for the Commonwealth, state and territory governments to consider. We are determined to do all that we can to fulfil COAG’s undertaking to agree formal partnership arrangements by the end of February.

The agreement sets out how we all work together and have shared and equal decision making on closing the gap. We are confident that a genuine partnership will help to accelerate positive outcomes to close the gaps.

The lack of progress under Closing the Gap is the lived reality of our people on the ground everyday. They are being robbed of living their full potential. Sadly, attending the funerals of people in our community – including increasingly young people taking their own lives – is all too common.

A coalition of Aboriginal and Torres Strait Islander peak bodies from across the nation has formed to be signatories to the partnership arrangements. We are now almost 40* service delivery, policy and advocacy organisations, with community-control at our heart. This is the first time our peak bodies have come together in this way.

Our coalition brings a critical mass of independent Indigenous organisations with deep connections to communities that will enhance the Closing the Gap efforts. We are a serious partner for government. We want to ensure our views are considered equal and that we make decisions jointly.

We cannot continue to approach Closing the Gap in the same old ways. The top-down approach has reaped disappointing results as evidenced by the lack of progress of previous strategies to reach their targets.

We must not lose sight of the most crucial point of Closing the Gap, which is to improve the everyday lives of our people. We must ensure our people are no longer burdened with higher rates of child mortality, poorer literacy, numeracy and employment outcomes and substantially lower life expectancies.

Yesterday on the floor of Parliament, the Prime Minister said that this will be a long journey of many steps. And I say, we have been walking for centuries. We have journeyed far and we will keep walking forward and climbing up until we reach a place where we are all on equal ground.

I also heard the Leader of the Opposition say that the burden of change needs to be carried by non-Indigenous Australians in acknowledging that racism still exists, that our justice system is deeply flawed and that generational trauma cannot be ignored.

Yes change must come from within our communities, but change must also come from the whole of Australia. We must change together.

The time has come for our voices to be heard and for us to lead the way on Closing the Gap. We are ready for action.

1 .Close the Gap Campaign

“We have had so many promises and so many disappointments. It’s well and truly time to match the rhetoric. We cannot continue to return to parliament every year and hear the appalling statistics,

 Last December, the Council of Australian Governments (COAG), led by the Prime Minister, agreed to a formal partnership with peak Indigenous organisations on Closing the Gap.

We strongly support the Coalition of Aboriginal and Torres Strait Islander Peak bodies that has formed to be signatories to the partnership agreement with COAG, and for them to share as equal partners in the design, implementation and monitoring of Closing the Gap programs, policies and targets.

This partnership really does have the potential to be a game changer. It means active participation in decisions about matters that affect us. It will allow the voices of Indigenous Australians at community, local and national levels to be heard. “

The Co-Chairs of the Close the Gap Campaign, the Aboriginal and Torres Strait Islander Social Justice Commissioner June Oscar AO and the Co-Chair of the National Congress of Australia’s First Peoples Rod Little, say that commitment must be followed by action.

It was imperative for Australian governments to have an agreement in place by the end of February with the coalition of more than 40 Aboriginal and Torres Strait Islander health and justice groups, so all stakeholders can get onto the “nitty gritty” of the Closing the Gap Refresh with new targets set to be finalised by mid year. ”

National Family Violence Prevention Legal Services (FVPLS) Forum convenor Antoinette Braybrook 

Download CTG Press Release

1.Close the Gap response to CTG

2.AMA

“After more than a decade, the lack of resourcing and investment in the health and well-being of Aboriginal and Torres Strait Islander peoples continues to see unacceptable gaps across a range of outcomes.

The lack of sufficient funding to vital Indigenous services and programs is a key reason for this.”

The AMA supports the comments made by Ms Pat Turner, CEO of Aboriginal Community Controlled Health Organisation (NACCHO) who said: ‘While our people still live very much in third-world conditions in a lot of areas still in Australia … we have to hold everybody to account’.

Closing the Gap targets are vital if we are to see demonstrable improvements in the health and well-being of Aboriginal and Torres Strait Islander people.

The call for a justice target and a target around the removal of Aboriginal children should be considered.

The AMA welcomes the decision of the Council of Australian Governments (COAG) to agree a formal partnership with us on Closing the Gap. This is an historic milestone in the relationship between Governments and Aboriginal and Torres Strait Islander peoples.” 

AMA President, Dr Tony Bartone

Download the AMA Press Release

2 AMA Closing the Gap progress disappointing

See all NACCHO AMA posts

3.RACGP

‘This year’s Closing the Gap report reminds us that whilst we are making important progress, we are still not doing enough for Aboriginal and Torres Strait Islander peoples.

It’s critical we get this right. Our people deserve to live full and healthy lives, like every other Australian. We know the best way to achieve this is when Aboriginal and Torres Strait Islander peoples have a say in the decisions that impact them.

Governments must acknowledge the critical role of primary healthcare and particularly the culturally responsive care offered by Aboriginal Community Controlled Health Services in Closing the Gap “

Chair of RACGP Aboriginal and Torres Strait Islander Health, Associate Professor Peter O’Mara, told newsGP he welcomes the Prime Minister’s commitment to establishing a formal partnership with Aboriginal and Torres Strait Islander peoples on the Closing the Gap Strategy.

Read full Press Release HERE

Read NACCHO RACGP articles HERE

4.Reconciliation Australia

“Aboriginal and Torres Strait Islander leaders and peak bodies have been demanding a greater say in the policy priorities, and design and implementation of programs around the CTG since its inception over a decade ago. Today’s commitment by the Prime Minister, supported by the Opposition Leader, is welcome albeit overdue, and builds on the COAG commitment in December.

It is simple common sense that people, who live each day with the problems CTG is trying to address, will have the greatest knowledge and understanding of the causes and solutions to these problems “

Karen Mundine, CEO of Reconciliation Australia, said her organisation was disappointed by the failure but remained hopeful that a bipartisan commitment to a greater First Nations’ voice in the planned refresh of the CTG would lead to more effective programs being delivered in partnership with communities.

Download the Press Release

4.Reconciliation Aust CTG Response

5.Change the Record

 “Change the Record calls on the Prime Minister to listen to the majority of        Australians who believe governments must act to close the gap on justice, as shown by the 2018 Australian Reconciliation Barometer results.

“Almost 60% of Australians want the Federal Government to include justice in Closing the Gap, and 95% agree our people should have a say in matters that affect us,”

In the past year the Government engaged selected stakeholders in a nation-wide consultation, however many Aboriginal and Torres Strait Islander organisations were excluded. Change the Record stands in support of the Coalition of Aboriginal and Torres Strait Islander community-controlled peak bodies as they push for a formal partnership agreement to finalise the Closing the Gap Refresh.

This historic step to make our peak bodies equal partners with Government is critical to our self-determination and to Closing the Gap,”

Change the Record co-chair Damian Griffis.

Download the CTG Press Release

5. Change the Record

6. AMSANT Darwin

We would have loved to be part of those discussions about what to prioritise. We absolutely support education being a top priority target, but we need to ensure we are also prioritising some of those targets such as housing.”

You are not going to get kids to go to school if they haven’t had a decent night’s sleep because of an overcrowded house, you are not going to get kids to go to school if they haven’t got food in their tummy … you ain’t going to get kids to go to school if parents are not encouraging them to go to school due to lack of support services for parents”,

John Paterson AMSANT Darwin

From SMH Interview

7.Mayi Kuwayu /ANU

 ” The refreshed targets help us focus on progress and achievement. Most of these refreshed targets are not dependent on how things are going within the non-Indigenous population (they are not moving targets) — they are absolute, fixed targets that we can work towards. For example, the old target of “halve the gap in employment by 2018” is replaced by “65 per cent of Aboriginal and Torres Strait Islander youth (15-24 years) are in employment, education or training by 2028”.

Further, the refreshed targets are evidence-based and appear to be achievable.

This is a change from the original targets which the evidence showed could never have been met. They were always going to fail. This is a problem because it has reinforced the idea held by many in the wider Australian community that Aboriginal and Torres Strait Islander inequality was “too big of a problem” and could never be overcome. Or even worse, it supported the myth that Aboriginal and Torres Strait Islander people themselves were the problem

Ray Lovett, Katherine Thurber, and Emily Banks are part of the Aboriginal and Torres Strait Islander Health Program at the National Centre for Epidemiology and Population Health, Australian National University, and conduct research on the social and cultural determinants of Aboriginal and Torres Strait Islander health and wellbeing.

Their approach is to conduct research in partnership with Aboriginal and Torres Strait Islander individuals, communities, and organisations, and to frame research using a strengths-based approach, where possible. Follow the program @Mayi_Kuwayu Professor Maggie Walter is the Pro Vice-Chancellor Aboriginal Research and Leadership at the University of Tasmania.

 Read Article in Full 

8.Greens

” Mr Morrison’s closing the gap address was paternalistic and patronising and a clear indication that he doesn’t get it.

Mr Morrison lectured the Parliament about co-design and collaboration but he does not practice what he preaches

The Coalition was dragged kicking and screaming to a co-design approach and the Government’s failure to listen when the process started was in fact the reason we are so delayed with the Close the Gap refresh.

You would think that he was the first person to think of collaboration and co-design!

Senator Rachel Siewert 

Download the Greens CTG Press Release

8.Greens Party CTG Response

NACCHO Aboriginal Health #RefreshTheCTGRefresh : Read or Download @billshortenmp speech plus @Malarndirri19 @LindaBurneyMP @SenatorDodson Press Release and annual #Closingthegap report to Parliament

 “So in that spirit, I welcome the new partnership between the Commonwealth, the States and the Coalition of Aboriginal Peak bodies – and the change in thinking that that represents. I’m conscious that the Peak organisations have done the heavy lifting too, to date, with limited resources.

And I congratulate them for persevering, for refusing to meekly accept the draft framework that was presented to you as a fait accompli in the past and instead, asserting your right to a permanent place at the table.

My colleagues and I deeply respect your role as advocates, as experts and as Aboriginal community-controlled organisations, committed to Closing the Gap. If we are successful at the next election, you will be central to setting policy and seeing that it is implemented, collaborating with frontline services and community leaders at local and regional level.

Partnership in action, not just words. Plainly, after ten years, refreshing the Closing the Gap targets is necessary. But this can never mean lowering our sights, reducing our targets, limiting our ambitions. ” 

Bill Shorten MP Opposition Leader Closing the Gap speech see Part 2 Below or Download 

Download Speech HERE

Bill Shorten Speech

Download CTG Report

 NACCHO Members Service 2019 CtG Report –

Watch Coverage

One day after the eleventh anniversary of the Apology to the Stolen Generations, the Prime Minister handed down his Close the Gap report – highlighting another year of stalled progress on this critical national project.

The report reminds us of the little progress we have made in addressing the structural inequalities facing First Nations peoples.

While we are pleased to see improvements in early childhood and Year 12 retention, we cannot deny the reality: only two targets out of seven are on track.

As a nation, this is an indictment upon us all.

First Nations people are frustrated, as is Labor. The Abbott- Turnbull- Morrison Government’s delay and dysfunction has no justification.

The targets have not failed. Governments have failed. It is our collective failure to not match well-intentioned rhetoric with action.

While a refresh of the Close the Gap framework is necessary, and we welcome the government new commitment to working in partnership with First Nations people, we cannot ignore the fact that until now, the government has failed to adequately engage with First Nations people.

If the government is truly committed to ensuring First Nations people have a say in matters that affect them, then they should immediately reverse their opposition to a constitutionally enshrined Voice for First Nations people.

The government has also failed to provide national bipartisan leadership on the refresh process. Labor was not consulted at any point in this process.

Whether it’s Close the Gap, the Community Development Program, the Indigenous Advancement Strategy or Constitutional Recognition, this government has constantly pursued flawed policies and failed to engage with First Nations people in their design or implementation.

Paternalism does not work. First Nations peoples must have a say in the matters that affect their lives and policies must be co-designed with full free and prior informed consent. This is how we achieve self-determination and properly address the substantial and structural inequality facing First Nations peoples.

This is how we close the gap.

If Labor is elected at the next election, a Voice for First Nations people, enshrined in our constitution, will be our first priority for constitutional reform.

Business as usual is no longer an option.

Only when First Nations people have a permanent and ongoing say in the issues that affect their lives, will we ever close the gap.

Part 2 Bill Shorten MP Opposition Leader Closing the Gap speech

I congratulate the Prime Minister on the address he’s just given. I acknowledge the traditional owners of this land and I pay my respects to elders past and present.

At the heart of reconciliation is a profound and simple truth: Australia is, and always will be, Aboriginal land. First Nations people loved and cared for this continent for millennia, long before our ancestors first arrived by boat.

They fished the rivers, hunted the plains, named the mountains, mapped the country and the skies. They made laws and administered justice here, long before this parliament stood. They fought fiercely to defend their home and they have battled bravely ever since, against discrimination and exclusion, preserving, for their children and for all of us, the world’s oldest living culture.

In addition to the acknowledgments made by the Prime Minister, I would like to specifically acknowledge the work of Prime Minister Rudd and the member for Jagajaga, Jenny Macklin, who helped initiate this annual Closing the Gap address.

Yesterday, I was consulting my Indigenous colleagues about this morning’s address. And I asked them: What could I say to prove this day has value and meaning to our first Australians, to all Australians, to people who have listened to Closing the Gap reports and speeches for 11 years running.

How do we, in this place, demonstrate this is not just an annual exchange of parliamentary platitudes and rhetoric. And Senator Malarndirri McCarthy said to me: “Just tell the truth about how you feel”.

And the truth is that feels a bit an ambiguous, doesn’t it? I feel that there is good news, but not enough good news. I feel there is hope, but not enough hope. That there is progress, but not enough progress. And I feel ambiguous, because how do you talk about the good without varnishing and covering up the bad?

How do you talk about the bad without presenting such a view that you ignore the good work? But the truth is that at this 11th Closing the Gap exchange, I’m frustrated. I suspect many members of the House feel that frustration too.

Frustration, disappointment that after a decade of good intentions, tens of thousands of well-meaning, well-crafted and well-intentioned words, heartfelt words, from five Prime Ministers, we assemble here and we see that not enough has changed. Mind you, I was halfway through expressing these views to the colleagues, when Senator Pat Dodson cut me off, and he said: “Comrade, how do you think we feel?”

And, really, that is our task, to put ourselves in the shoes of all the people who are giving everything to this endeavour. I speak of the heroes at Deadly Choices driving huge improvements in frontline health services.

The brilliant kids of Clontarf and Stars and Girls Academy and so many other great education and mentoring programs.

I speak of brave women and communities leading initiatives against family violence. I speak of the fearless campaigners for justice at Change the Record. I speak of the Indigenous Rangers right now on country, ensuring that all of us can understand and share in the wonders of country their people have called home for 60,000 years.

I speak of the First Australians who enrich every facet of our national life: as leaders and achievers in education and sport, medicine and the law, environmental conservation and academia and politics and art and music and comedy.

I speak of the mums and dads and aunties and uncles, the elders and the grannies doing their very best to keep children and families safe, to keep community together. There is no question, that we should recognise and celebrate their boundless hope and patience and perseverance, often in the face of overwhelming odds

. But we must recognise their frustration too. We should today acknowledge, that it’s not just the gap in life expectancy or health or educational results or employment opportunities. It’s the gap between words and actions, the gap between promises and results. The good ideas and practical initiatives of people on the frontline that get swallowed up in the morass of paperwork and process and waste and lethargy.

The committee recommendations, coroner’s reports, judicial inquiries and Royal Commissions that have been left to gather dust. Of course these years of neglect and indifference are punctuated by bursts of unilateral ‘interventions’ and ‘crisis meetings’ and ‘emergency action’.

And law after law, policy after policy, about Aboriginal and Torres Strait Islander peoples, written without Aboriginal and Torres Strait Islander peoples.

So in that spirit, I welcome the new partnership between the Commonwealth, the States and the Coalition of Aboriginal Peak bodies – and the change in thinking that that represents. I’m conscious that the Peak organisations have done the heavy lifting too, to date, with limited resources.

And I congratulate them for persevering, for refusing to meekly accept the draft framework that was presented to you as a fait accompli in the past and instead, asserting your right to a permanent place at the table.

My colleagues and I deeply respect your role as advocates, as experts and as Aboriginal community-controlled organisations, committed to Closing the Gap. If we are successful at the next election, you will be central to setting policy and seeing that it is implemented, collaborating with frontline services and community leaders at local and regional level.

Partnership in action, not just words. Plainly, after ten years, refreshing the Closing the Gap targets is necessary. But this can never mean lowering our sights, reducing our targets, limiting our ambitions.

And while I understand the Prime Minister is trying to make a point about the dangers of a ‘deficit model’, even the mindset of a ‘gap’.

The uncomfortable truth is that there is a stark gap between the Australia we inhabit and the lives of too many First Nations people.

There are deficits, in justice and jobs, in health and housing, in the opportunities afforded to Aboriginal children who go to school far from where we send our own kids. It is not the targets that have failed. It’s we who have failed to meet them. It is not the targets that have failed. It is we who have failed to meet them.

This is the hard truth this report demands we confront. The truth about ongoing discrimination and disadvantage. The truth about families and communities being broken by poverty, violence, abuse, addiction and alcohol.

The truth that there are still men and women being arrested, charged and jailed – not because of the gravity of their offence, but because of the colour of their skin. If this parliament can’t admit that racism still exists in 2019, then we’re just wasting the time of our First Australians today.

If we can’t admit that racism still exists, then how on earth do we ever fix it? This isn’t political correctness, it’s just stating the obvious, it’s the truth.

The truth that Aboriginal people are still suffering from diseases the rest of us never know, still dying at an age when the rest of us are contemplating retirement.

And the truth about children and young people who are suffering violence, taking their own lives in numbers and circumstances that should shame us all to action.

Last week, Senator Pat Dodson responded to the coroner’s report from those 13 indescribably tragic deaths in the Kimberley. He spoke of ‘unresolved trauma’, a sense of suffering, hopelessness and disillusionment.

And above all, he said, none these can be fixed by answers imposed from outside. The solutions depend on a say and a sense of empowerment and self-worth for young people. And a sense of hope for communities and regions, power in the hands of people who truly live and understand the challenges they face.

Simply put, if we seek to see real change in the lives of First Nations people, then we need to change. Change our approach, change our policies. And above all, change the way that we make decisions.

We need to let First Nations have real control in how decisions are made. So this is where partnership, the word partnership, where the rubber hits the proverbial road. If we say that we want partnership with our first Australians, then we don’t get to pick and choose our partners’ values or priorities.

For more than a decade now, Prime Ministers and Opposition Leaders of both the main parties have stood in this place and said we want to work with Aboriginal and Torres Strait Islanders in partnership.

But you don’t get to tell your partner what to think. It is that spirit of partnership which we saw at Uluru in 2017. First Nations people took up the invitation, 250 delegates presented this parliament with their vision. Countless dialogues, thousands of people consulted. I concede that what the First Australians came back to us with wasn’t what we were expecting. But that’s the challenge of partnership, isn’t it?

When the partner says: “I have a different set of priorities and if you really respect me, you will listen to me.”

They came back with a Makarrata Commission to work with National Congress, Land Councils, First Nations leaders and states and territories to continue the work of truth-telling and agreement-making.

And our partners said to us, “We seek a Voice enshrined in the Constitution.” An institution with national weight and local connection, bringing a powerful sense of culture, community and country to the shape of policy and its delivery.

A meaningful, permanent say for Aboriginal people in the decisions that affect their lives. Not a long demoralising slog measured in inches of progress.

Not starting from square one every time a particular issue breaks into the broader national consciousness.

Not a sense of ‘us’ and ‘them’ in the backdrop of everything that we do. Our partners want genuine engagement with humility on the Parliament to acknowledge their role, to recognise that genuine empowerment has to involve the sharing of real power.

You can’t have a partnership of unequals. Partnership means giving as well as taking, listening as well as telling. Today I am proud to declare again that enshrining a Voice for the First Australians will be Labor’s first priority for constitutional change.

If we are elected as the next government of Australia, we intend to hold a referendum on this question in our first term, as our partners have asked us to do. I am optimistic that reform can succeed, the referendum can succeed, because the proposition we should include our First Australians in the nation’s birth certificate is an idea whose time has come. It enjoys powerful support across communities, business and Australians young and old. We will seek bipartisan support.

This is not about building a “third chamber” of parliament, it is not a matter of “separatism” or “special treatment”.

How on earth, in the light of this Closing the Gap Report, with such devastating statistics and tragedies behind these numbers, can we say that we’re giving special treatment to people who don’t even get the same treatment?

This isn’t about favouritism, or conferring unfair advantage. It is about recognising inequalities, centuries old. Bringing honour to our nation.

It’s about recognising that powerlessness is created by prejudice and by discrimination and breaking these chains which hold, not just our First Australians back, but actually chain us all back. It’s as simple as the fact that Aboriginal and Torres Strait Islander peoples do not start from a level playing field now.

And that true equality of opportunity is measured not by legal standing, or theoretical notions but by lived experienced, by the tangible chance every Australian deserves to get a great education, a good job, to live a happy, fulfilling and healthy life, to see their children grow up and flourish.

And to those who dismiss constitutional recognition as “symbolism” or “identity politics”. Perhaps, unwittingly, that final phrase is closest to the truth. Because enshrining a Voice in the constitution is most certainly about identity.

About our national identity, all of us. It’s about who we are, as Australians. Are we a people who can recognise our First Australians in our constitution, as part of our national identity. Are we big enough, are we brave enough, are we smart enough and generous enough to recognise historical truth, to commit ourselves to equal opportunity and to write that into our constitution.

And in the end, this is why, despite all the well-known impediments, the historical difficulties of changing our constitution, I remain optimistic that the referendum can and should gain support. Because beyond the specific wording of any particular question, as important as that is, this represents a simpler, more elemental test. A test about what we say about ourselves to the world, a test of what we teach our children about what it means to be Australian.

It’s a test of our generosity, of our basic, human decency. It’s a test of whether or not we are fair dinkum partners in the journey to the future. A test of our innate and instinctive sense of fairness. I believe that if we trust the people of Australia with the opportunity to broaden the definition of the fair go, to make our constitution more true to who we are, to describe who we are, they will repay the trust of parliament in overwhelming numbers.

And, Mr Speaker I say to those who somehow believe that constitutional change stands in the way of progress on other fronts, I can promise this. If we are elected as the next government of Australia, seeking to enshrine a Voice in the constitution doesn’t stop us from building the new houses that we need to. It doesn’t stop us from embracing the initiatives to encourage more teachers that we’ve heard about.

It doesn’t stop us training more Aboriginal apprentices or doubling the number of Rangers. It won’t prevent us from bringing together, in our first 100 days, people from all over the nation, the police, the child saftey people, families, to work out what must be done to protect the next generation of First Nations children.

Because we must address the two-pronged crisis in the abuse occurring in communities and the trauma being inflicted in out-of-home care. A Labor Government committed to a Voice will still invest in Aboriginal health care providers, the champions who make such a difference to new mothers and their babies.

A Labor Government will make justice reinvestment a national priority, because youth detention and jail time for young people should be a rarity, not a rite-of-passage. I acknowledge the Prime Minister’s announcement today regarding HECS relief for teachers, commitment to education is welcome. But we want people teaching in remote schools because they want to be there, and we will work to encourage that. And we want more local Aboriginal people, trained as teachers and nurses in their communities.

And to achieve real improvements, there must be not just specific funding, but real needs-based funding for schools and investments in early education, universities and TAFE.

Not just in the bush but in our cities and suburbs, where our first Australians also live, so Aboriginal and Torres Strait Islander children everywhere get the same chance as every other Australian child to get a great education.

This is the focus and purpose of Labor’s policies. We will support Australian languages in this International year of Indigenous Languages. We will provide compensation to survivors of the Stolen Generations from Commonwealth jurisdictions and create a National Healing Fund for descendants managing intergenerational trauma.

Because saying sorry must always mean making good. And we will abolish and replace the Community Development Program, not just because it is discriminatory, demoralising and punitive but because it is completely counterproductive and ineffective. Labor believes in the dignity of work and that is why we want people living in remote communities to work with dignity. And this isn’t just a job for government alone, I want to work with business and the unions to launch a trades and skills offensive, this is a call to arms.

A mass-mobilisation of training, TAFE and apprenticeships, to bring good jobs to country. Because funding projects in remote communities should not involve bringing contractors and tradies from the other side of Australia. We should give our own young people in these communities the pathway to be the tradespeople of their communities. This will be our approach, not grants without evidence or accountability but programs that put communities and regions back in control of their resources and their futures.

In conclusion, Mr Speaker, yesterday, you and I were present at the unveiling of the striking portrait of the Member for Barton.

This portrait of Australian Labor frontbencher Linda Burney, the first Aboriginal woman elected to the House of Representatives, will be displayed in a gallery dominated by white, male former prime ministers and presiding officers.

She wasn’t counted in a Commonwealth census until she was 14 years old. Now her painting will hang on the wall of the Commonwealth Parliament as an inspiration for generations to come. And if we are successful at the next election, she will be one of two First Australians in our new Cabinet, there on merit, for First Australians, and all Australians.

For those who seek to visit Linda’s portrait, it’s near the Barunga statement. A bare 327 words presented to Prime Minister Hawke in 1988. It was a vision for self-determination, for local control, for treaty, truth-telling, national reconciliation.

And just like the bark petitions from Yirrkala. Like the tent embassy on the Federation Lawns. Like Clinton Pryor’s Walk for Justice, or Michael Long’s a decade ago. All represent a message of hope. Proof that despite all the failures and shortcomings and the unfulfilled promises of political generations past, there is still a belief out there amongst our First Australians and indeed all Australians, that this place, this parliament, can play a worthwhile, valuable role in reconciling Australia.

The Uluru Statement offers us that chance, a chance to capture the spirit of the signatories at Barunga.

The Gurunji at Wave Hill. The grand campaigners of 67. The extraordinary victory against the odds of Eddie and Bonita Mabo.

The Apology. And all the other peoples and cultures and communities who have fought and won for their own patient struggles for justice.

We have a chance for Australians to celebrate the unique culture of our First Nations people, their ongoing contribution to the life of our nation.

A chance for us to affirm their special place in our nation’s history and its future. We have a chance for healing and unity and reconciliation.

And to take a further step to ensure that the next generation live to see and know an Australia where the gap is closed and the suffering has subsided.

So, with hope, with pride and with trust and faith in all of us, let us take up that challenge.

NACCHO Aboriginal Health and #RefreshTheCTGRefresh : Prime Minister Scott Morrison will today unveil a revamped #ClosingtheGap strategy which will give First Nations leaders equal standing with government in designing targets to overcome Indigenous disadvantage.

Prime Minister Scott Morrison will today unveil a revamped “Closing the Gap” strategy which will give First Nations leaders equal standing with government in designing targets to overcome Indigenous disadvantage.

In the run-up to the last COAG meeting in November, the head of the National Aboriginal Community Controlled Health Organisation, Pat Turner, called for Aboriginal bodies to be given “full partnership” in the process

From SMH 14 February 

Read NACCHO COAG CTG Article HERE 

Mr Morrison is expected to tell Parliament that the decade-old framework used by federal and state governments to “close the gap” had been well-intentioned, but “doomed to fail” because it did not sufficiently share “objective and process” with Indigenous Australians and did not hold different levels of government to account.

He will say previous targets have been too narrow, sometimes with counterproductive effect.

“The very nature of looking at this from a ‘closing the gap’ point of view takes a deficit mentality to the task which can sometimes mask progress being made,” Mr Morrison will say.

“The progress may not be fast enough or far enough but it still can discourage further efforts because of that approach, so we do always need to mark what’s been accomplished.”

The 11th Closing the Gap report to Parliament is expected to show that the targets set in 2008 have “by and large” not been met, though there is some positive news.

CLOSING THE GAP TARGETS

* Early education: 95 per cent of all indigenous four-year-olds enrolled in early childhood education by 2025. ON TRACK.

* Year 12 attainment: Halve the gap in Year 12 attainment by 2020. ON TRACK.

* Life expectancy: Close the gap in life expectancy between indigenous and non-indigenous Australians within a generation by 2031. NOT ON TRACK.

* Child mortality rates: To halve the gap in mortality rates for indigenous children under five within a decade, by 2018. NOT ON TRACK

* Employment: Halve the gap in employment by 2018. NOT ON TRACK

* Reading and Numeracy: Halve the gap in reading and numeracy for indigenous students by 2018. NOT ON TRACK

* School attendance: Close the gap in school attendance within five years, by 2018. NOT ON TRACK

Progress towards meeting two of seven goals – for getting more Indigenous children into early childhood education and for halving the year 12 attainment gap – are on track, but progress on five others are not.

Closing the gap in life expectancy between Indigenous and non-Indigenous Australians by 2031 is not on track, nor is a halving of the gap in child mortality rates by 2018, halving the employment gap, halving the gap in reading and numeracy for Indigenous students and closing the gap in school attendance.

On reading and numeracy, results are mixed. The share of Indigenous students meeting national minimum standards in years 3 and 5 reading, and years 5 and 9 numeracy, increased by around 11 to 13 percentage points. But only year 9 numeracy was on track in all states.

The Indigenous child mortality rate has declined by 10 per cent but the gap has not narrowed, as the non-Indigenous rate has declined even faster. Just over half the Indigenous Australians of working age living in major cities were employed, while in remote areas the figure was as low as 31 per cent.

New targets are expected to be more evidence-based and “strike the balance between ambition and what is achievable”, Mr Morrison is expected to say.

The government also wants to see a pivot towards increasing opportunities for economic development,  not reflected in the current closing the gap framework.

The fresh approach to Closing the Gap builds on work under way since 2017, when the Council of Australian Governments (COAG) agreed to a “refresh” of the strategy, in line with calls from Indigenous leaders for a greater role in deciding and designing the targets.

In the run-up to the last COAG meeting in November, the head of the National Aboriginal Community Controlled Health Organisation, Pat Turner, called for Aboriginal bodies to be given “full partnership” in the process.

However for  many Indigenous leaders, a top priority is achieving a First Nations “Voice” to be embedded in the Constitution, in line with the historic 2017 Uluru Statement from the Heart.

Labor has promised a referendum on the issue in its first term if elected, while the Coalition remains wary of the move, saying it runs the risk of becoming a “third chamber” of Parliament.

FROM AAP 14 February 

Efforts to close the health and education gap for indigenous Australians will be revised and broadened to get more input from the people they’re meant to help.

Just two of the seven Closing the Gap targets are on track to be met, more than a decade after the original report.

Prime Minister Scott Morrison will deliver the 11th annual Closing the Gap report today , detailing proposed changes to how it works.

The report shows efforts to get more indigenous children into early education are on track, but improving life expectancy, infant mortality and employment status were not.

Mr Morrison will say the targets need to be revised to make states and territories more accountable, and give indigenous Australians more ownership of them.

“The Closing the Gap targets have been well intentioned but ‘top down’, so it was always doomed to fail in both its ambitions and also its process,” Mr Morrison will say on Thursday.

“It didn’t genuinely bring on board states and territories in making sure they have accountabilities and sharing the objective and process with indigenous Australians.”

Mr Morrison says the current way of measuring the targets masks progress, discouraging further efforts.

For instance, child mortality among indigenous Australians has decreased 10 per cent since 2008 – but the target is not on track because the non-indigenous figure has declined at a faster rate.

The “refresh” of the Closing the Gap targets, announced in 2016, will ask indigenous Australians to develop the targets.

It will also hold different levels of government to account, and include new priorities on housing, employment, family violence and land and water rights.

The draft targets include an effort to reduce the rate of Aboriginal and Torres Strait Islander young people in detention by 11 to 19 per cent, and adults held in incarceration by at least five per cent by 2028.

CLOSING THE GAP TARGETS

* Early education: 95 per cent of all indigenous four-year-olds enrolled in early childhood education by 2025. ON TRACK.

* Year 12 attainment: Halve the gap in Year 12 attainment by 2020. ON TRACK.

* Life expectancy: Close the gap in life expectancy between indigenous and non-indigenous Australians within a generation by 2031. NOT ON TRACK.

* Child mortality rates: To halve the gap in mortality rates for indigenous children under five within a decade, by 2018. NOT ON TRACK

* Employment: Halve the gap in employment by 2018. NOT ON TRACK

* Reading and Numeracy: Halve the gap in reading and numeracy for indigenous students by 2018. NOT ON TRACK

* School attendance: Close the gap in school attendance within five years, by 2018. NOT ON TRACK

© AAP 2019

 

NACCHO Aboriginal Health and #ClosingTheGap : Download Queensland’s first Closing the Gap report card

“For the past decade the greatest progress towards Closing the Gap has been in areas where Aboriginal and Torres Strait Islander peoples have led the design and implementation from the very start.

Gone are the days of doing things “to” people as we reframe our relationship to ensure Aboriginal and Torres Strait Islander peoples have every opportunity to truly thrive across all aspects of life.

Deputy Premier, Treasurer and Minister for Aboriginal and Torres Strait Islander Partnerships Jackie Trad said partnering with Aboriginal Torres Strait Islander peoples to co-design policies and programs was vital for guaranteed outcomes.

Please Note : The Prime Ministers Closing the Gap report (10.00 AM ) and the Oppositions reply speech will be covered by NACCHO Media extensively over next 2 days

Download CTG Snap Shot

ctg-snapshot

Download Full CTG report 

ctg-full-report

The Palaszczuk Government has today, on the anniversary of the National Apology to Stolen Generation, become the first state to release a whole-of-government report card on efforts towards Closing the Gap.

Premier Annastacia Palaszczuk said the public report, a historic first, documented the state’s progress and highlighted opportunities for improvement, a decade on from the landmark Closing the Gap Report.

“Closing the Gap is a nationwide effort with all governments accountable for driving change in partnership with Aboriginal and Torres Strait Islander peoples,” the Premier said.

“Queensland is making significant progress in key areas including in early childhood education, Year 3 reading and numeracy, Year 9 numeracy and Year 12 attainment and we want to duplicate this success across all areas including school attendance, employment and child mortality targets.

“Latest available data shows Aboriginal and Torres Strait Islander Queenslanders now have the highest life expectancy in Australia for Aboriginal and Torres Strait Islander peoples.

“But we still have a lot more to do. This report card is a reality check and sets the tone as we develop meaningful, communityled solutions to create real change.

“The Queensland Government welcomes the Council of Australian Governments’ decision to finalise Closing the Gap targets and implementation through a genuine, formal partnership between the Commonwealth, state and territory governments and Aboriginal and Torres Strait Islander peoples through their representatives.

The COAG partnership announced on 12 December will include a Ministerial Council on Closing the Gap and is anticipated to be in place by late February 2019.

Deputy Premier, Treasurer and Minister for Aboriginal and Torres Strait Islander Partnerships Jackie Trad said partnering with Aboriginal Torres Strait Islander peoples to co-design policies and programs was vital for guaranteed outcomes.

“Queensland is proudly home to the nation’s second highest Aboriginal and Torres Strait Islander population and we are determined to move towards an approach underpinned by the strengths, knowledge and rich cultural traditions of the world’s oldest living cultures.

“We must work better together to guarantee improvements as Aboriginal and Torres Strait Islander children, families and communities are empowered to move beyond surviving to thriving.”

Ms Trad said Queensland’s approach towards Closing the Gap, including any new and revised targets, would be informed by community consultation and Queensland voices.

“The Queensland Government supports calls for the next phase of the Closing the Gap agenda, including every priority and target, to be guided by overarching principles of healing, eliminating racism and systemic discrimination, and self determination.”

Consultation also identified additional targets for national consideration including out-of-home care, family violence, adult imprisonment, youth justice (10-17 years), housing, entrepreneurship (economic development), land and waters, social inclusion and disability, and culture and language.

For more information visit https://www.datsip.qld.gov.au/programs-initiatives/closing-gap

About Closing the Gap

Closing the Gap is a long-term framework that builds on the foundation of respect and unity provided by the 2008 National Apology to Aboriginal and Torres Strait Islander peoples. It acknowledges that improving opportunities and life outcomes for Indigenous Australians requires intensive and sustained effort from all levels of government, as well as the private and not-for-profit sectors, communities and individuals.

In 2008, the Council of Australian Governments (COAG) endorsed the National Indigenous Reform Agreement (NIRA) (PDF), which included the following targets:

  • close the life expectancy gap within a generation (by 2031)
  • halve the gap in mortality rates for Indigenous children under 5 within a decade (by 2018)
  • ensuring that 95% of all Indigenous 4-year-olds are enrolled in early childhood education (by 2025)
  • halve the gap for Indigenous students in reading, writing and numeracy within a decade (by 2018)
  • halve the gap for Indigenous people aged 20-24 in Year 12 attainment or equivalent attainment rates by 2020, and
  • halve the gap in employment outcomes between Indigenous and non-Indigenous Australians within a decade (by 2018)
  • close the gap between Indigenous and non-Indigenous school attendance within 5 years (by 2018).

Queensland Closing the Gap Report Card 2018

This Queensland Closing the Gap Report Card 2018 (Report Card) is an important step in the Queensland Government’s commitment to closing the gap between Aboriginal and Torres Strait Islander and non-Indigenous Queenslanders. It moves away from the deficit model and towards an approach underpinned by the strengths, knowledge and rich cultural heritage of Aboriginal peoples and Torres Strait Islander peoples.

The Report Card also:

  • supports ongoing and regular reporting to track progress, identify and build on strengths and success stories, and inform areas of focus
  • informs a partnership and co-design approachwith Aboriginal and Torres Strait Islander stakeholders and communities, moving away from ‘doing to’ to ‘doing with’
  • uses the latest data to measure Queensland’s progressin the COAG Closing the Gap targets
  • provides additional data on other priority areasraised by Aboriginal and Torres Strait Islander Queenslanders including through nine community consultations held across remote, regional and urban Queensland.

The Queensland Government is committed and dedicated towards working in genuine partnership to guarantee improved outcomes that move Queensland’s Aboriginal and Torres Strait Islander children, families and communities from surviving to thriving.

 

NACCHO Aboriginal Health #refreshtheCTGRefresh 2 of 2 : Download the #COAG 9 page statement on the #ClosingTheGap refresh

 ” One of the lessons governments have learned over the last ten years is that effective programs and services need to be designed, developed and implemented in partnership with Aboriginal and Torres Strait Islander peoples.

We must place collaboration, transparency, and accountability at the centre of the way we do business with Aboriginal and Torres Strait Islander Australia. Working in genuine partnership with Aboriginal and Torres Strait Islander peoples is fundamental to Closing the Gap.

All governments remain committed to engaging with Aboriginal and Torres Strait Islander Australians and other stakeholders to finalise and implement the Closing the Gap Refresh “

From the COAG Statement

1.Download CTG COAG 6 Page Statement

2.Download CTG  COAG 3 Page Draft Targets Outcomes

3. Download COAG Communique Dec 12

Where we actually let Aboriginal and Torres Strait Islander Australians lead the discussion, determine the outcome, own the outcome,”

The Victorian premier, Daniel Andrews, said the partnership provided a meaningful opportunity, the “likes of which we’ve not seen before”. From The Guardian 

“We can’t close the gap unless we do this in partnership with Aboriginal people,” he told reporters on Wednesday.

“I think the wording of what we’re doing so far on Closing the Gap is good but we have to talk funding at some stage.”

The Northern Territory chief minister, Michael Gunner, said on Wednesday it was a vital partnership and initiative could not afford to “go off the rails again”.

“ COAG’s commitment to a genuine formal partnership approach between the government and Aboriginal and Torres Strait Islander peoples on the Closing the Gap strategy is a welcome step in the right direction

This is something that we’ve long campaigned for – because involving Aboriginal and Torres Strait Islander people in decisions that affect their lives will lead to far better outcomes.

We as a sector are looking forward to working with the Prime Minister and COAG to negotiate and agree the refreshed framework, targets and action plans which will be finalised through the committee by mid-2019.

NACCHO Chief Executive Officer Pat Turner AM see NACCHO Press Release HERE

In December 2016, the Council of Australian Governments (COAG) agreed to refresh the Closing the Gap agenda ahead of the tenth anniversary of the agreement and four of the seven targets expiring in 2018.

In June 2017, COAG agreed to a strengths-based approach and to ensure Aboriginal and Torres Strait Islander peoples were at the heart of the development and implementation of the next phase of Closing the Gap.

In 2018, a Special Gathering of prominent Aboriginal and Torres Strait Islander Australians presented COAG with a statement setting out priorities for a new Closing the Gap agenda. The statement called for the next phase of Closing the Gap to be guided by the principles of empowerment and self-determination and deliver a community-led, strengths-based strategy that enables Aboriginal and Torres Strait Islander peoples to move beyond surviving to thriving.

Since the Special Gathering identified priorities, all governments have worked together to develop a set of outcomes and measures for inclusion in the Closing the Gap Refresh. COAG has now agreed draft targets for further consultation to ensure they align with Aboriginal and Torres Strait Islander peoples and communities’ priorities and ambition as a basis for developing action plans.

PARTNERSHIPS WITH ABORIGINAL AND TORRES STRAIT ISLANDER AUSTRALIA

COAG recognises that in order to effect real change, governments must work collaboratively and in genuine, formal partnership with Aboriginal and Torres Strait Islander peoples as they are the essential agents of change.

This formal partnership must be based on mutual respect between parties and an acceptance that direct engagement and negotiation will be the preferred pathway to productive and effective agreements. Aboriginal and Torres Strait Islander peoples must play an integral part in the making of the decisions that affect their lives – this is critical to closing the gap.

COAG will ensure that the design and implementation of the next phase of Closing the Gap is a true partnership. Governments and Aboriginal and Torres Strait Islander people will share ownership of and responsibility for a jointly agreed framework and targets and ongoing monitoring of the Closing the Gap agenda.

The refreshed Closing the Gap agenda recognises and builds on the strength and resilience of Aboriginal and Torres Strait Islander peoples and communities.

CLOSING THE GAP – A VISION FOR THE FUTURE

Closing the Gap requires us to raise our sights from a focus on problems and deficits, to actively supporting and realising the full participation of Aboriginal and Torres Strait Islander peoples in the social and economic life of the nation. COAG recognises there is a need for a cohesive national agenda focussed on important priorities for enabling Aboriginal and Torres Strait Islander families, children and communities to thrive.

COAG has listened to Aboriginal and Torres Strait Islander communities and stakeholders. COAG has heard there is a need to focus on the long term and on future generations, to strengthen prevention and early intervention initiatives that help build strong families and communities, and to prioritise the most important events over the course of a person’s life and the surrounding environment.

COAG acknowledges Closing the Gap builds on the foundation of existing policies and commitments within the Commonwealth and each state and territory. Closing the Gap does not replace these policies, but provides a people and community centred approach to accelerate outcomes.

COMMUNITY PRIORITIES FOR THE NEXT TEN YEARS

The Special Gathering Statement to COAG in February 2018 recommended the priority areas for the next phase of Closing the Gap:

 Families, children and youth

 Housing

 Justice, including youth justice

 Health

 Economic development

 Culture and language

 Education

 Healing

 Eliminating racism and systemic discrimination.

All priority areas are important and interconnected, and COAG is committed to achieving positive progress in all areas.

The Commonwealth, states and territories have consulted widely on these priorities. Aboriginal and Torres Strait Islander peoples and communities, peak bodies, service providers, technical experts and members of the public had the opportunity to provide their views on the future of Closing the Gap.

In considering where to set targets, there was a focus on the priority areas that lend themselves to the design of specific, measurable, achievable, relevant and time-bound targets. This focus on evidence and data enables COAG to effectively track progress over time.

CROSS SYSTEM PRIORITIES

Governments must deepen their relationships with Aboriginal and Torres Strait Islander peoples. This means understanding what matters to communities and continuing to build capability for genuine collaboration and partnership, acknowledging the differing priorities and challenges in different places across urban, regional and remote Australia.

All Australian governments are committed to working cooperatively in partnership with Aboriginal and Torres Strait Islander peoples, and their communities, to positively transform life outcomes for Aboriginal and Torres Strait Islander peoples.

COAG recognises that progress reports over the past decade confirm that closing the gap in remote Australia requires particular focus, recognising the rich cultural strengths as well as the need for targeted approaches to address disadvantage in these areas.

COAG acknowledges that culture is fundamental to Aboriginal and Torres Strait Islander peoples’ strength and identity. COAG further acknowledges the impacts of historical wrongs and trauma faced by Aboriginal and Torres Strait Islander peoples and families.

All Australian governments recognise the need to address intergenerational change, racism, discrimination and social inclusion (including in relation to disability, gender and LGBTIQ+), healing and trauma, and the promotion of culture and language for Aboriginal and Torres Strait Islander peoples. These will be taken into account as cross system priorities for all policy areas of the Closing the Gap agenda. Cross system priorities require action across multiple targets.

REFRESHED TARGETS

The Commonwealth, states and territories share accountability for the refreshed Closing the Gap agenda and are jointly accountable outcomes for Aboriginal and Torres Strait Islander peoples. COAG commits to working together to improve outcomes in every priority area of the Closing the Gap Refresh.

The refreshed Closing the Gap agenda will commit to targets that all governments will be accountable to the community for achieving. This approach reflects the roles and responsibilities as set out by the National Indigenous Reform Agreement (NIRA), and specified in respective National Agreements, National Partnerships and other relevant bilateral agreements.

While overall accountability for the framework is shared, different levels of government will have lead responsibility for specific targets. The lead jurisdiction is the level of government responsible for monitoring reports against progress and initiating further action if that target is not on track, including through relevant COAG bodies.

The refreshed framework recognises that one level of government may have a greater role in policy and program delivery in relation to a particular target while another level of government may play a greater role in funding, legislative or regulatory functions. Meeting specific targets will require the collaborative efforts of the Commonwealth, states and territories, regardless of which level of government has lead responsibility. Commonwealth, state and territory actions for each target will be set out in jurisdictional action plans, and may vary between jurisdictions. COAG acknowledges that all priority areas have interdependent social, economic and health determinants that impact the achievement of outcomes and targets.

Through a co-design approach, jurisdictional action plans will be developed in genuine partnership with Aboriginal and Torres Strait Islander communities, setting out the progress that needs to be made nationally and in each jurisdiction for the targets to be met. Action plans will clearly specify what actions each level of government is accountable for, inform jurisdictional trajectories for each target and establish how all levels of government will work together and with communities, organisations and other stakeholders to achieve the targets. Starting points, past trends and local circumstances differ, so jurisdictions’ trajectories will vary and may have different end-points.

COAG recognises that promoting opportunities for Aboriginal and Torres Strait Islander peoples to be involved in business activities contributes to economic and social outcomes for families and communities, and has committed to publishing jurisdiction specific procurement policies, and Aboriginal and Torres Strait Islander employment and business outcomes annually.

PUBLIC ACCOUNTABILITY

Closing the Gap is a whole-of-government agenda for the Commonwealth and each state and territory. To provide direct accountability to Aboriginal and Torres Strait Islander peoples and the Australian public as a whole, each jurisdiction will report publicly each year on its Closing the Gap strategy. The Prime Minister will make an annual statement to parliament.

Governments will engage with the community to develop a meaningful framework for transparently tracking and reporting progress with Aboriginal and Torres Strait Islander leaders.

INDEPENDENT REVIEW

The Productivity Commission’s Indigenous Commissioner will conduct an independent review of progress nationally and in each jurisdiction every three years. All governments will provide input into the Productivity Commission’s review, taking into account differences between urban, regional and remote areas.

The Closing the Gap targets may be subject to refinement, where appropriate, through the review of the NIRA and periodic Productivity Commission reviews.

WHERE WE ARE GOING FROM HERE

A new formal partnership with Aboriginal and Torres Strait Islander peoples, through their representatives, will be established by the end of February 2019.

Building on the work undertaken to date, working through this new partnership, the Commonwealth, and states and territories, will by mid 2019:

 finalise all draft targets;

 review the NIRA; and

 work with the Productivity Commission’s Indigenous Commissioner to develop an independent, Aboriginal and Torres Strait Islander-led approach to the three-yearly comprehensive evaluation and review of progress nationally and in each jurisdiction.

One of the lessons governments have learned over the last ten years is that effective programs and services need to be designed, developed and implemented in partnership with Aboriginal and Torres Strait Islander peoples. We must place collaboration, transparency, and accountability at the centre of the way we do business with Aboriginal and Torres Strait Islander Australia. Working in genuine partnership with Aboriginal and Torres Strait Islander peoples is fundamental to Closing the Gap.

All governments are committed to broadening and deepening their partnerships with Aboriginal and Torres Strait Islander peoples and communities over the lifetime of the refreshed agenda. This includes strengthening mechanisms to ensure Aboriginal and Torres Strait Islander peoples have an integral role in decision making and accountability processes at the national, regional and local levels, building on existing arrangements and directions within different jurisdictions.

To guide the development of Commonwealth, state and territory action plans by mid-2019, COAG has endorsed a set of Implementation Principles informed by Aboriginal and Torres Strait Islander communities:

Shared Decision-Making – Implementation of the Closing the Gap framework, and the policy actions that fall out of it, must be undertaken in partnership with Aboriginal and Torres Strait Islander peoples. Governments and communities should build their capability to work in collaboration and form strong, genuine partnerships in which

Aboriginal and Torres Strait Islander peoples can be an integral part of the decisions that affect their communities.

Place-based Responses and Regional Decision Making – Programs and investments should be culturally responsive and tailored to place. Each community and region has its own unique history and circumstances. Community members, Elders and regional governance structures are critical partners and an essential source of knowledge and authority on the needs, opportunities, priorities and aspirations of their communities.

Evidence, Evaluation and Accountability – All policies and programs should be developed on evidence-based principles, be rigorously evaluated, and have clear accountabilities based on acknowledged roles and responsibilities. Governments and communities should have a shared understanding of evidence, evaluation and accountability.

Targeted investment – Government investments should contribute to achieving the Closing the Gap targets through strategic prioritisation of efforts based on rigorous evaluation and input from Aboriginal and Torres Strait Islander communities, especially as it relates to policy formation, outcomes and service commissioning.

Integrated Systems – There should be collaboration between and within Governments, communities and other stakeholders in a given place to effectively coordinate efforts, supported by improvements in transparency and accountability.

WHERE WE HAVE COME FROM – TEN YEARS OF CLOSING THE GAP

In 2008, COAG agreed to the NIRA to implement the Closing the Gap agenda. In signing the agreement, governments acknowledged that a concerted national effort was needed to address Aboriginal and Torres Strait Islander disadvantage in key areas.

At the time, Closing the Gap was the most ambitious commitment ever made by governments to improve outcomes for Aboriginal and Torres Strait Islander peoples. However, the agreement was negotiated with little to no input from Aboriginal and Torres Strait Islander peoples, and without an adequate understanding of the mechanisms and timeframes needed to deliver lasting change. It also perpetuated a deficit-based view that framed Aboriginal and Torres Strait Islander policy as a series of responses to disadvantage and inequality, and under-emphasised the strength and agency of Aboriginal and Torres Strait Islander peoples.

While some progress has been made to improve outcomes for Aboriginal and Torres Strait Islander peoples with respect to life expectancy, child mortality, educational achievement, employment and early childhood education, only three of the seven current targets were on track at the agreement’s ten-year anniversary in 2018. There is a shared view among Aboriginal and Torres Strait Islander peoples, the broader Australian community and Australian governments that we must do better.

PUBLIC ENGAGEMENT

Public engagement on the Refresh has been led by the Commonwealth at the national level, and by states and territories at the local and regional levels.

COAG Public Discussion Paper and Consultation Website:

In December 2017 the COAG public discussion paper and Closing the Gap Refresh consultation website were launched, with the website open for feedback and submissions from the public until the end of April

  1. Feedback from the website, including over 170 major submissions, was collated and used to inform the technical workshop process and COAG’s consideration of target areas for the next phase of the agenda.

Special Gathering of Prominent Aboriginal and Torres Strait Islander Australians:

In February 2018, COAG leaders agreed that the priority areas identified in the statement of the Special Gathering would form the basis for remaining community consultations on the Refresh. The Special Gathering priority areas were tested in the national roundtables and other engagement processes led by the Commonwealth from February 2018 and have been strongly supported by stakeholders.

Consultations: The Commonwealth held 18 national roundtables in state capitals and regional centres across the country, ending with a national peaks workshop in Canberra in April. Roundtables sought feedback from participants on the priorities identified in the Special Gathering statement. Over 1,000 people were directly engaged through the meetings and roundtables hosted by the Commonwealth in this first phase of public engagement.

In May and June 2018 the Commonwealth hosted a series of technical workshops to develop potential targets and indicators for the refreshed agenda. The workshops brought together academics, business and Aboriginal and Torres Strait Islander community experts and data custodians with Commonwealth and state officials in a co-design process structured around the Special Gathering priority areas. The first technical workshop in May was attended by officials from all jurisdictions and over 70 subject matter experts, including representatives from Aboriginal and Torres Strait Islander organisations and communities, academics and practitioners. A similar number attended the second technical workshop in June, which had a stronger emphasis on data issues and technical design.

A second series of national roundtables were conducted to test the analysis arising from the initial consultations, submissions and technical workshops. This phase of consultation sought to return to stakeholders who had previously been engaged in the process or lodged submissions to the public consultation website, including members of the Redfern Alliance, national peak bodies, national service providers, and other individuals and organisations. The outcomes of this phase of consultations were fed into discussions between governments in the lead up to the COAG meeting in December 2018.

States and territories held consultations over the same period to ensure views from across the country were heard and incorporated into the Refresh.

All governments remain committed to engaging with Aboriginal and Torres Strait Islander Australians and other stakeholders to finalise and implement the Closing the Gap Refresh

National Aboriginal Community Controlled Health Organisation (NACCHO) and peak bodies welcome #COAG announcement to a formal partnership approach to the #ClosingtheGap Refresh #RefreshtheCTGRefresh

“ COAG’s commitment to a genuine formal partnership approach between the government and Aboriginal and Torres Strait Islander peoples on the Closing the Gap strategy is a welcome step in the right direction

This is something that we’ve long campaigned for – because involving Aboriginal and Torres Strait Islander people in decisions that affect their lives will lead to far better outcomes.

We as a sector are looking forward to working with the Prime Minister and COAG to negotiate and agree the refreshed framework, targets and action plans which will be finalised through the committee by mid-2019.

We are pleased that the Prime Minister and COAG have finally recognised that Aboriginal and Torres Strait Islander people must play an integral part in the making of the decisions that affect their lives – and it’s the only way forward to closing the gap.”

NACCHO Chief Executive Officer Pat Turner AM see COAG full communique Part 1 below

Pictures above and below taken in PM office last Thursday 6 December meeting the peaks

Download full COAG communique HERE

COAG Communique 5 Pages 12 December

The National Aboriginal Community Controlled Health Organisation (NACCHO) has today welcomed COAG’s announcement to a formal partnership approach to the Closing the Gap Refresh.

Following the tireless campaigning from NACCHO and other Aboriginal and Torres Strait Islander peak bodies across Australia, Prime Minister Scott Morrison last week agreed to a full partnership approach between Indigenous people and governments to agree the Closing the Gap framework and targets and to put it to COAG for their consideration.

Before the Aboriginal and Torres Strait Islander peak bodies intervened, COAG was due to settle a new Closing the Gap framework and targets without the full involvement and agreement of Aboriginal and Torres Strait Islander people through their representatives.

The details of formal partnership between COAG and Aboriginal and Torres Strait Islander peoples will be settled in February 2019. It will include a Ministerial Council on Closing the Gap with expanded membership to include representation from COAG and Aboriginal and Torres Strait Islander peoples through their peak bodies.

Part 1 Closing the Gap COAG Communique

Press Conference at close of COAG today

COAG is listening to Aboriginal and Torres Strait Islander peoples, communities and their peak and governing bodies. Leaders are committed to ensuring that the finalisation of targets and implementation of the Closing the Gap framework occurs through a genuine, formal partnership between the Commonwealth, state and territory governments and Aboriginal and Torres Strait Islander people through their representatives.

This formal partnership must be based on mutual respect between parties and an acceptance that direct engagement and negotiation is the preferred pathway to productive and effective outcomes. Aboriginal and Torres Strait Islander peoples must play an integral part in the making of the decisions that affect their lives – this is critical to closing the gap.

Today, COAG issued a statement outlining a strengths based framework, which prioritises intergenerational change and the aspirations and priorities of Aboriginal and Torres Strait Islander peoples across all Australian communities.

The finalisation of this framework and associated draft targets will be agreed through a formal partnership.

Governments and Aboriginal and Torres Strait Islander representatives will share ownership of, and responsibility for, a jointly agreed framework and targets and ongoing monitoring of the Closing the Gap agenda. This will include an Aboriginal and Torres Strait Islander-led three yearly comprehensive evaluation of the framework and progress.

The arrangements of the formal partnership between COAG and Aboriginal and Torres Strait Islander representation will be settled by the end of February 2019, and will include a Ministerial Council on Closing the Gap, with Ministers nominated by jurisdictions and representation from Aboriginal and Torres Strait Islander peoples.

The framework and draft targets will be finalised through this Council by mid-2019, ahead of endorsement by COAG. A review of the National Indigenous Reform Agreement will be informed by the framework.

Joint Select Committee on Constitutional Recognition

COAG acknowledged the release of the Report of the Joint Select Committee on Constitutional Recognition and endorsed the concept of co-design recommended by the Committee.  COAG looks forward to discussing the work on co-design at its next meeting.

 

NACCHO Aboriginal Health #SocialDeterminants #refreshtheCTGRefresh @KenWyattMP announces 4 year$18.6 million evaluation into Aboriginal and Torres Strait Islander primary healthcare : Designed for faster progress in #Closingthegap in health equality.

” A top priority has been placed on ensuring local communities that are involved in receiving and providing primary healthcare have a strong voice throughout the process,’

Federal Minister for Indigenous Health Ken Wyatt

From Dr Evelyn Lewin RACGP NewsGP 

A four-year $18.6 million evaluation into Aboriginal and Torres Strait Islander primary healthcare aims to produce sustained improvements in service delivery and health outcomes for Aboriginal and Torres Strait Islander peoples.

A main focus of the Federal Government program will be considering how Commonwealth investment in the Indigenous Australians’ Health Programme (IAHP) links with the broader health system.

This is designed to help improve healthcare access and drive faster progress in closing the gap in health equality.

With $3.6 billion being invested in the IAHP across four years (2018–19 to 2021–22), this evaluation will help maximise the value and impact of health funding and guide program design.

The evaluation also aims to learn how well the primary healthcare system is working for Aboriginal and Torres Strait Islander peoples, demonstrate the difference the IAHP makes, and inform efforts to accelerate improvement in health and wellbeing for Aboriginal and Torres Strait Islander peoples.

The evaluation will establish up to 20 location-based studies to collect information from various Aboriginal and Torres Strait Islander health services around the country.

‘The project is another important step in assessing the impact on First Peoples’ health from the provision of effective, high-quality, culturally appropriate healthcare,’ Minister Wyatt said.

According to a report by the Australian Institute of Health and Welfare’s (AIHW), The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples: 2015, 3% of the Australian population (just over 760,000 people) are Aboriginal or Torres Strait Islander peoples.

The report states that one in four (24%) of Aboriginal and Torres Strait Islander peoples aged 15 and over assessed their health as ‘fair or poor’ in 2012–13, making them 2.1 times as likely as non-Indigenous Australians to report such results.

The AIHW report also noted that 39% of the gap between Aboriginal and Torres Strait Islander people and non-Indigenous Australians health outcomes can be explained by social determinants

NACCHO Aboriginal Health we need to #refreshtheCTGRefresh to #closethegap : At COAG on December 12 : Which states and territories will support a formal partnership with Aboriginal and Torres Strait Islander peoples ?

“ We understand that at this stage it is intended that new Closing the Gap targets will be settled at COAG’s December meeting,

We are calling on COAG to hold off doing this and instead put in place a proper partnership mechanism with us. The new targets haven’t been published and Indigenous peaks are uncertain what the targets will be and therefore we cannot provide our support.

NACCHO and the peak bodies engaged with the process, took time to submit written submissions and attend workshops to discuss refreshing the Closing the Gap strategy earlier this year. But we can’t see how our input has been taken into account,

As a first step we propose a meeting with COAG representatives and the peak bodies to discuss a way forward that includes a genuine partnership approach.

Aboriginal people need to be at the centre of the Closing the Gap Refresh policy; the gap won’t close without our full engagement and involvement.

Having Aboriginal people involved in the design of the Refresh and proposed revised targets will lead to Aboriginal people taking greater responsibility for the outcomes. It’s been proven that Aboriginal community control is vital and delivers better outcomes for our people.” 

NACCHO Chief Executive Pat Turner AM see interview Part 3 below 

Download the NACCHO Press Release Here

NACCHO media release Refresh The CTG Refresh

Part 1 NACCHO Press Release continued 

The National Aboriginal Community Controlled Health Organisation (NACCHO) and other Aboriginal peak bodies across Australia have written to COAG First Ministers seeking a full partnership approach between Indigenous people and governments in refreshing the Closing the Gap Strategy, scheduled to be put to COAG for consideration in Adelaide on 12 December.

The letter, signed by 13 peak bodies, proposes an urgent meeting of Aboriginal and Torres Strait Islander peak bodies to meet with COAG representatives to determine a framework for reaching agreement on a refreshed Closing the Gap strategy.

It’s the second letter the group has written to COAG after failing to receive a response to their initial letter in early October from any government except the Northern Territory.

Part 2 Letter to Council of Australian Government First Ministers

Dear Council of Australian Government First Ministers 16/11/2018

We write again, further to our letter of 4 October 2018, concerning the Closing the Gap Refresh, a joint initiative of the Council of Australian Governments (COAG), to seek a formal partnership mechanism between Aboriginal and Torres Strait Islander peoples and governments in the Closing the Gap Refresh policy. We have only received a response from the Northern Territory Government.

As stated in our original letter, all of us believe it is essential that agreement is reached on the Closing the Gap Refresh policy between Indigenous organisations, on behalf of communities across Australia and Australian governments. What we propose is entirely consistent with the commitment made by COAG to set a new relationship with our communities based on a partnership.

If governments alone, continue to make decisions about the Closing the Gap, without an opportunity for us to be at the table, it will not be possible to advocate with any confidence or motivate our communities to support Closing the Gap and to take joint responsibility with governments for achieving the targets.

 

Pictures above and below from our #refreshtheCTGRefresh Campaign

The evidence is strong that when Indigenous people are included and have a real say in the design and delivery of services that impact on them, the outcomes are far better. We are certain that Indigenous peoples need to be at the centre of the Closing the Gap Refresh policy: the gap won’t close without our full involvement and COAG First Ministers, who are responsible for the Closing the Gap framework, cannot expect us to take responsibility and work constructively with them to improve outcomes if we are excluded from the decision making.

We have proposed a reasonable way forward to Australian Governments in our original letter without making it public to give everyone a reasonable opportunity to consider it. However, we understand that it is the intention of Australian Governments to still settle on targets at the forthcoming meeting of COAG on 12 December 2018.

We also understand that implementation arrangements are to be left over for COAG to agree in 2019. We make the points that neither ourselves nor anyone else outside government have seen the proposed targets which we think is way short of being partners and transparent and we cannot see how the targets can be agreed without considering at the same time how they are to be achieved.

 

We assume that Australian Governments will justify agreeing to targets by referring to the consultations earlier this year. Those consultations were demonstrably inadequate. They were conducted at a very superficial level without an opportunity for Indigenous interests to be prepared for the workshops held across Australia.

They were based on a discussion paper produced by the Department of the Prime Minister and Cabinet in December 2017 and which stated that only one of the seven targets was on track which two months later was contradicted by the former Prime Minister who said that three targets were on track. Critical elements of the original Closing the Gap framework, particularly COAG’s National Indigenous Reform Agreement, were not referred to at all in the consultations and the focus was on new targets instead of how we could make sure that this time around they were achieved.

There was no independent report prepared on the outcomes of the consultations and there is no way of telling if what was said in the consultations is reflected in the proposed Refresh policy including the targets.

The consultations started far too late which has left us with 4 targets having expired in June 2018. We do not accept that we have been properly consulted let alone given the opportunity to negotiate a mechanism that allows a proper partnership to be put in place in relation to the design, delivery and monitoring of Closing the Gap.

 

There is a now a significant opportunity to put this disappointing process back on track and in particular to establish a robust Closing the Gap framework founded on a genuine partnership between Indigenous people and governments.

It is open to governments on 12 December 2018, to endorse a partnership approach and establish a mechanism to initiate negotiations between representatives of COAG and Peak organisations with a view to developing a genuine partnership as part of the Closing the Gap Refresh. This would be endorsed by the Peak Organisations across Australia.

Subject to COAG endorsing a partnership approach, we propose a meeting of Aboriginal and Torres Strait Islander Peak bodies to meet with COAG representatives to determine a framework for reaching agreement on a refreshed closing the gap strategy.

We stand ready to do this quickly and would work with COAG on having a partnership framework in place in early 2019 with a revised approach agreed by the middle of the year.

Ms Pat Turner AM, the CEO of the National Aboriginal Community Controlled Health Organisation, is our contact for the purpose of responding to this vital matter and we ask that you contact her.

We look forward to working with you on the Closing the Gap Refresh through an established partnership mechanism.

Yours sincerely,

 

Part 3 Going backwards’: Aboriginal bodies take aim at Closing the Gap

Aboriginal peak organisations have slammed federal, state and territory governments for failing to give Indigenous leaders an effective role in re-energising the faltering Closing the Gap process.

In a letter written jointly to Prime Minister Scott Morrison, chief ministers and premiers, the leaders of the 13 peak bodies say they have been shut out of meaningful consultation about refreshed targets to overcome Aboriginal disadvantage.

By Deborah Snow SMH 19 November

Pat Turner, chief executive of the National Aboriginal Community Controlled Health Organisation, said "it's all gone backwards".
Pat Turner, chief executive of the National Aboriginal Community Controlled Health Organisation, said “it’s all gone backwards”. CREDIT:GLENN CAMPBELL

And they want the Coalition of Australian Governments – due to consider an update to Closing the Gap next month – to defer setting new targets until a fresh pact is hammered out giving “full partnership” to Aboriginal bodies.

“I think it’s all gone backwards,” the chief executive of the National Aboriginal Community Controlled Health Organisation (NACCHO), Pat Turner,  told the Herald.

“In the last few years, governments seem to have dropped the ball a lot. I hope they are giving serious consideration to our letter. They can’t go on having two bob each-way. They are there to lead and they have to have a bit of backbone. [The state of] Aboriginal affairs is a national shame, it is something that they should be wanting to get fixed.”

Ms Turner said only one government – the Northern Territory – had bothered replying to the group when they first wrote a letter a month ago seeking better consultation over new targets and implementation strategies.

“NACCHO and the peak [Indigenous] bodies engaged with the process took time to submit written submissions and attend workshops to discuss refreshing the Closing the Gap strategy earlier this year” she said. “But we can’t see how our input has been taken into account.”

The peak bodies decided on Sunday to release a second letter they wrote to all governments at the end of last week.

The letter says the “disappointing” Closing the Gap process has to be put “back on track” with Indigenous people taking part in the design and delivery of services on the basis of “genuine partnership”.

“As a first step we propose a meeting with COAG representatives and the peak bodies to discuss [such an] approach” Ms Turner said.

The Herald sought a response from Aboriginal Affairs minister Nigel Scullion but was unable to contact his office on Sunday.

Closing the Gap was first conceived of a decade ago as a way to measure Aboriginal disadvantage and set clear targets to redress it.

Earlier this year a report from the Department of Prime Minister and Cabinet said three of seven targets were “on track”: to halve the gap in year 12 attainment and halve the gap in child mortality by 2018, and to have 95 per cent of Indigenous four-year-olds enrolled in early childhood education by 2025.

However it said that other targets, including halving the gap in reading and numeracy, and halving the gap in employment, as well as closing the gap on life expectancy, were not on track.

NACCHO Aboriginal Health #refreshtheCTGRefresh : @NACCHOchair Welcomes the release of the @AMAPresident 2018 Report Card on Indigenous Health and joins its call for rebuilding the #ClosingtheGap health strategy from the ground up

It’s been a decade since the Council of Australian Governments (COAG) launched the Closing the Gap Strategy, with a target of achieving life expectancy equality by 2031

But 10 years on, progress is limited, mixed, and disappointing. If anything, the gap is widening as Aboriginal and Torres Strait Islander health gains are outpaced by improvement in non-Indigenous health outcomes.

The Strategy has all but unravelled, and efforts underway now to refresh the Strategy run the risk of simply perpetuating the current implementation failures.

The Strategy needs to be rebuilt from the ground up, not simply refreshed without adequate funding and commitment from all governments to a national approach.”

The Closing the Gap Strategy is unravelling, and must be rebuilt from the ground up to have any chance of closing the life expectancy gap between Indigenous and non-Indigenous Australians, AMA President, Dr Tony Bartone said today at the launch of the AMA report at the ATSICHS ACCHO in Brisbane : Interview with The Guardian Part 3 Below 

Download the 24 Page AMA Report 

AMA Indigenous Health Report Card 2018 (2)

Dr Tony Bartone (left ) and Ms Donnella Mills ( Second left ) on tour of ATSICHS

We congratulate the AMA on their work to support closing the gap and endorse the recommendations in the report.”

The report highlights research which indicates the mortality gaps between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians are widening, not narrowing.

Urgent and systematic action is needed to reverse these failures and to have any prospect of meeting the Council of Australian Governments’ goal to Close the Gap in life expectancy by 2031

NACCHO calls for the immediate adoption of the Report Card’s recommendations.

We are seeking a formal partnership between Aboriginal and Torres Strait Islander peoples and governments to be included in the Closing the Gap Refresh policy , Aboriginal people need to be at the centre of Closing the Gap strategies; the gap won’t close without our full engagement and involvement.

The Chairperson of the peak body for Aboriginal controlled health services Ms Donnella Mills today welcomed the release of the AMA’s 2018 Report Card on Indigenous Health and joined its call for rebuilding the Closing the Gap from the ground up. See full NACCHO Press Release HERE 

It doesn’t mean that things aren’t improving, because health outcomes for our people are improving

The challenge is that we’re trying to actually improve the pace of that improvement faster than some of the healthiest people in the world, which is what Australians enjoy – one of the healthiest countries on the globe.

So you’re trying to actually close the gap between some of the sickest people in the world to some of the healthiest people in the world – it was always an ambitious target.”

Adrian Carson, CEO of the Urban Institute of Indigenous Health, said while national outcomes lagged behind, he had seen “significant” health improvements at a local level in south-east Queensland. see Part 3 below or in full here 

Busting the myth that Indigenous-led organisations ‘don’t deliver’

Dr Bartone today launched the AMA Indigenous Health Report Card 2018, the AMA’s annual analysis of an area of Aboriginal and Torres Strait Islander health across the nation.

This year’s Report Card scrutinises the 10-year-old Closing the Gap Strategy, and recent efforts to “refresh” the Strategy.

“It’s been a decade since the Council of Australian Governments (COAG) launched the Closing the Gap Strategy, with a target of achieving life expectancy equality by 2031,” Dr Bartone said.

“But 10 years on, progress is limited, mixed, and disappointing. If anything, the gap is widening as Aboriginal and Torres Strait Islander health gains are outpaced by improvement in non-Indigenous health outcomes.

“The Strategy has all but unravelled, and efforts underway now to refresh the Strategy run the risk of simply perpetuating the current implementation failures.

“The Strategy needs to be rebuilt from the ground up, not simply refreshed without adequate funding and commitment from all governments to a national approach.”

The Report Card outlines six targets to rebuild the Strategy:

  • committing to equitable, needs-based expenditure;
  • systematically costing, funding, and implementing the Closing the Gap health and mental health plans;
  • identifying and filling primary health care service gaps;
  • addressing environmental health and housing;
  • addressing the social determinants of health inequality; and
  • placing Aboriginal health in Aboriginal hands.

“It is time to address the myth that it is some form of special treatment to provide additional health funding to address additional health needs in the Aboriginal and Torres Strait Islander population,” Dr Bartone said.

“Government spend proportionally more on the health of older Australians when compared to young Australians, simply because elderly people’s health needs are proportionally greater.

“The same principle should be applied when assessing what equitable Indigenous health spending is, relative to non-Indigenous health expenditure.

“The Australian Institute of Health and Welfare estimates that the Aboriginal and Torres Strait Islander burden of disease is 2.3 times greater than the non-Indigenous burden, meaning that the Indigenous population has 2.3 times the health needs of the non-Indigenous population.

“This means that for every $1 spent on health care for a non-Indigenous person, $2.30 should be spent on care for an Indigenous person.

“But this is not the case. For every $1 spent by the Commonwealth on primary health care, including Medicare, for a non-Indigenous person, only 90 cents is spent on an Indigenous person – a 61 per cent shortfall.

“For the Pharmaceutical Benefits Scheme, the gap is even greater – 63 cents for every dollar, or a 73 per cent shortfall from the equitable spend.

“Spending less per capita on those with worse health, and particularly on their primary health care services, is dysfunctional national policy. It leads to us spending six times more on hospital care for Indigenous Australians than we do on prevention-oriented care from GPs and other doctors.

“We will not close the gap until we provide equitable levels of health funding. We need our political leaders and commentators to tackle the irresponsible equating of equitable expenditure with ‘special treatment’ that has hindered efforts to secure the level of funding needed to close the health and life expectancy gap.”

AMA Media Coverage 

The AMA 2018 Indigenous Health Report Card is at https://ama.com.au/article/2018-ama-report-card-indigenous-health-rebuilding-closing-gap-health-strategy-and-review

Part 2 : The Chairperson of the peak body for Aboriginal controlled health services Ms Donnella Mills today welcomed the release of the AMA’s 2018 Report Card on Indigenous Health and joined its call for rebuilding the Closing the Gap from the ground up.

Download the full NACCHO Press Release HERE

National Aboriginal Community Controlled Health Organisation (NACCHO) Chairperson, Ms Donnella Mills said, “We congratulate the AMA on their work to support closing the gap and endorse the recommendations in the report.”

The report highlights research which indicates the mortality gaps between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians are widening, not narrowing.

The AMA estimate that the Commonwealth government spend on Aboriginal and Torres Strait Islander health is only 53% of needs-based requirements. Aboriginal and Torres Strait Islander peoples have at least twice the per capita need of the rest of the population because of much higher levels of illness and burden of disease.

“This underspend represents a significant failure” Ms Mills said. “Genuine commitment by Australian governments to Closing the Gap requires equitable funding.”

The funding shortfall is particularly important for primary health care services where big gains could be made in improving health, keeping people out of hospital and preventing premature deaths. Funding for Aboriginal Community Controlled Health Services, which deliver accessible, culturally safe, comprehensive primary health care across Australia, is not keeping up with need.

Alongside the increased funding for Aboriginal Community Controlled Health Service there is an urgent need for government to address the environmental health, housing and other social determinants of health inequality.

NACCHO, its Affiliates and members will continue to work with the AMA to urge the adoption of the Report Card’s recommendations by Australian governments.

Part 3 Busting the myth that Indigenous-led organisations ‘don’t deliver’

From NITV

Adrian Carson, CEO of the Urban Institute of Indigenous Health, said while national outcomes lagged behind, he had seen “significant” health improvements at a local level in south-east Queensland.

He urged governments to place more trust in Indigenous-led organisations to deliver services.

“This country’s still got a crisis in terms of its relationship with the First People,” Mr Carson told NITV News.

“The narrative’s a negative one, it’s always deficit-based, but we turn around and look at what parts of our sector are doing… we’re actually coming up with improved health outcomes within our community – they’re actually solutions that could benefit the whole country.

So this whole idea that somehow our communities can’t be trusted, or that we don’t have the capacity to deliver, is a myth.”

Mr Carson said while he welcomed the AMA’s report, it was important to take a proactive approach rather than dwelling on negative statistics.

“It doesn’t mean that things aren’t improving, because health outcomes for our people are improving,” he said.

“The challenge is that we’re trying to actually improve the pace of that improvement faster than some of the healthiest people in the world, which is what Australians enjoy – one of the healthiest countries on the globe.

“So you’re trying to actually close the gap between some of the sickest people in the world to some of the healthiest people in the world – it was always an ambitious target.”

Part 4 The Guardian Interview

The Australian Medical Association says the Closing the Gap strategy has “all but unravelled” and insists that the policy needs to be rebuilt from the ground up, starting with boosting health expenditure on Indigenous Australians and putting Aboriginal healthcare in Aboriginal hands.

A refresh of the program is expected to be considered at the December meeting of the Council of Australian Governments, but the AMA president, Tony Bartone, says Closing the Gap needs root-and-branch reform, not changes “without adequate funding and commitment from all governments to a national approach”.

Read in full