NACCHO Aboriginal Health News : $20 million Streamlined Support for Aboriginal Community Health Services

This is fundamental to the Turnbull Government’s policy of partnership, our commitment to doing things with, not to, the Indigenous community

Under the agreement, NACCHO will receive the funding and will form a collaborative network with its State and Territory counterpart organisations to finance and support local health services.

The agreement provides the network with funding certainty, allowing organisations to plan for the future and improve their effectiveness.”

Federal Indigenous Health Minister Ken Wyatt

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NACCHO Ken Wyatt Press Release June 20 2017

Minister Wyatt says a new Network Funding Agreement will streamline the provision of $20 million a year in health service support through the National Aboriginal Controlled Community Health Organisation (NACCHO).

The unified funding arrangements, signed on Friday, will allow the Commonwealth to work better with Australia’s peak indigenous community health organisation.

Minister Wyatt said the agreement was focussed on outcomes, allowing service funding to be administered through an Aboriginal-controlled agency.

“I have been hearing from Aboriginal and Torres Strait Islander people about the kind of care they want, and this agreement will help deliver it,” he said.

“We know that strong, Aboriginal-administered care plays a pivotal role in improving health outcomes, but it can face challenges supplying services on the ground.

“‘This new approach will allow service providers to access the assistance they need to enable them to deliver crucial, quality care to their clients.”

Minister Wyatt said the new network would also ensure that Aboriginal and Torres Strait Islander voices were heard clearly at all levels of health administration.

“The aim is to streamline funding and communication, to continue our shared commitment to Closing The Gap,” he said.

NACCHO Aboriginal Health : The #NTIntervention 10 years on – history and evaluations

 ” And when the government announced the Intervention and commenced it, they sent in what they called ‘government business managers’ who were, in effect, the old, you know, ‘protectors’ of Aboriginals, the, you know, the old superintendents, the mission managers.

I mean, this is 10 years ago, this is not a hundred years ago, and Aboriginal people were being treated like this. It was almost a violation of every possible human right you could think of.”

Pat Turner AM CEO NACCHO speaking to Nick Grimm ABC (see full Interview Below

 

 Picture above : Powerhouse panel at UTS Sydney last night talking about the 10th anniversary of the #NTIntervention: @KylieSambo @Bunbajee Pat Turner & @LarissaBehrendt #IndigenousX

  ” In August 2007 the Howard Liberal Government enacted the Northern Territory National Emergency Response Act, or, “the Intervention”. Liberal politicians marketed it as a solution to problems within Indigenous communities in the Northern Territory.

These problems include health, housing, employment and justice.  When Labor was in power it continued the Intervention’s major initiatives.

See 10 Years history of the NT Intervention Below Part 2 after the Interview

 Major General David Chalmers, of the Inter-Agency Northern Territory Emergency Response Task Force, and Mal Brough, indigenous affairs minister, are greeted by David Wongway, a member of the Imanpa Local Community Council

 ” In 2008, following the change of government after the 2007 Federal Election, the Rudd Labor Government re-framed the intervention through a new national policy focus on “Closing the Gap”. Rudds’ intention to re-work the Intervention to focus more closely on reforming the welfare system linked closely with the already existing targets of the Close the Gap Campaign.

The aims of the campaign are set out in the 2012 National Indigenous Reform Agreement ”

 The Intervention and the Closing the Gap Campaign see part 3

 ” Evaluating the Intervention is not an easy task. Impartial data is difficult to find and there is a mass of complex and conflicting information. However, by looking at the Closing the Gap targets that were set by the Government and considering human rights concerns, we have provided our assessment. Below we give major features of the Intervention a score out of 10.  We also score it for compliance with human rights.”

Issues with Evaluating the Interventionhow did we work out our grades? Part 4

NT Intervention – nothing has changed for the better: Pat Turner

Hear Interview HERE

NICK GRIMM: Ten years ago this week, one of the defining moments in Australian national life began unfolding in remote communities in the outback.

The Northern Territory intervention was launched by the then Howard government in response to reports of social dysfunction and allegations of endemic abuse of women and children in remote communities.

Since then, the policy has continued under governments of both persuasions.

But 10 years on critics of the Intervention say it’s fixed nothing.

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

She was previously a CEO of the Aboriginal and Torres Strait Islander Commission, ATSIC, and had a long career as a senior Commonwealth public servant.

I spoke to Pat Turner a little earlier.

Pat Turner, can I start by asking you this: Ten years on, what’s the best thing you have to say about the Northern Territory Intervention?

PAT TURNER: (Laughs) Nothing, really, I’m afraid.

It was a complete violation of the human rights of Aboriginal people in the Northern Territory.

It came out of the blue, following the Commonwealth Government’s reading and response to The Little Children Are Sacred report.

NICK GRIMM: So how would you describe the legacy of the process that began 10 years ago?

PAT TURNER: Well, I think it’s still a shambles.

You know, both sides of politics were responsible.

While it was introduced by the Liberal government, the Coalition under John Howard and Mal Brough, it was carried on also by Jenny Macklin and Kevin Rudd and Gillard and so on.

So the legacy is that Aboriginal people were completely disempowered.

They had the Army going into communities in their uniforms. They had no idea why the Army was there.

You know, to send the Army in at a time like that was just totally confusing. People were terrified that they’d come to take the kids away. There would be no explanation as to why they were going in.

And it wasn’t their fault; it was the way the Government handled it.

The government also, at the time, insisted that every child under 16 have a full medical check. Now, actually what they were looking for, I think, was whether a child had been sexually abused.

And we said, at the time, those of us who were opposed to the way the Government was handling this, “You cannot do that without parental permission. You must have parental permission. You would not do a medical check on any other child in Australia and you should not do that with our children without their parents’ say-so”.

And what’s more, fine, go ahead, do a full medical check, but what are you going to do when you find the otitis media, when you find the trachoma, when you find the upper respiratory diseases, when you find rheumatic heart disease? Where…

NICK GRIMM: All those common medical conditions in those areas.

PAT TURNER: Absolutely, absolutely. And what are you going to do to treat these people?

Because you don’t have the health services that Aboriginal people should have. You don’t have those in place.

And they were paying doctors a phenomenal salary.

They also, of course, introduced the infamous cashless welfare card, called it ‘income management’, where 60 per cent of the income was quarantined for food and clothes and so on.

People weren’t allowed to get access to video, so that was a… and that was fine for X-rated videos and adult videos, but certainly not for entertainment, which a lot of families relied on in outlying communities.

And it had ramifications. I mean, there was a young Aboriginal businesswoman in Tennant Creek whose business went bust because she couldn’t hire out videos.

NICK GRIMM: Well, in your view, can we say that anything has changed for the better in those remote communities?

PAT TURNER: No.

Look, the other thing that happened at the time, Nick, was there was a reform in local government.

So, from the hundreds of Aboriginal community councils that were in place, they all became part of these super shires, nine super shires, so all the decision making at the local community level had evaporated.

And when the government announced the Intervention and commenced it, they sent in what they called ‘government business managers’ who were, in effect, the old, you know, ‘protectors’ of Aboriginals, the, you know, the old superintendents, the mission managers.

I mean, this is 10 years ago, this is not a hundred years ago, and Aboriginal people were being treated like this. It was almost a violation of every possible human right you could think of.

And what’s more, I called it at the time the Trojan Horse to get the land that our people have under freehold inalienable title in the Northern Territory.

And I thought it was a land grab, and I still believe that, you know, the Commonwealth certainly wanted to have a greater say over Aboriginal land in the Northern Territory – as did the Northern Territory Government, by the way.

NICK GRIMM: Yeah, well we’ve talked about the situation on the ground there in the Northern Territory.

What then would you say have been the national implications of the Intervention?

PAT TURNER: Well, I think without the evidence they’ve adopted – you know, Alan Tudge is very keen on the cashless welfare card, as is Twiggy Forrest, who promoted it.

While I see that, you know, there may be, you know, some opportunity for women to buy more food, it’s fine if you have access to fresh produce at a reasonable price that you could expect to pay in a major regional centre like Alice Springs.

You go out to the communities, the prices are at least double if not tripled, and they’re stale, rotten, old vegetables and meats and so on.

So, you know, that’s where government services need to step up through their outback stores and make sure that people are getting really fresh produce all the time, and healthy produce.

NICK GRIMM: Alright, Pat Turner, thanks very much for talking to us.

PAT TURNER: You’re most welcome. Thank you.

NICK GRIMM: Pat Turner is CEO of the National Aboriginal Community Controlled Health Organisation.

Part 2

” In August 2007 the Howard Liberal Government enacted the Northern Territory National Emergency Response Act, or, “the Intervention”. Liberal politicians marketed it as a solution to problems within Indigenous communities in the Northern Territory.

These problems include health, housing, employment and justice.  When Labor was in power it continued the Intervention’s major initiatives. “

See 10 Years history of the NT Intervention

Intervention was directed at addressing the disproportionate levels of violence in Indigenous communities in the Northern Territory, as well as the endemic disadvantage suffered in terms of health, housing, employment and justice.

It was also a direct response to the Ampe Akelyernemane Meke Mekarle Report (‘Little Children are Sacred Report’) into sexual abuse of Indigenous children. This report was commissioned by the then Northern Territory Chief Minister Clare Martin following an interview on the ABC’s Lateline program, in which Alice Springs Senior Crown Prosecutor Dr Nanette Rogers SC commented that the violence and sexual abuse of children that was entrenched in Indigenous society was ‘beyond most people’s comprehension and range of human experience’. The then Commonwealth Minister for Families, Community Services and Indigenous Affairs, Mal Brough, indicated in his second reading speech introducing the NTNERA that “[t]his bill… and the other bills introduced in the same package are all about the safety and wellbeing of children.”

The Little Children are Sacred Report was the result of in-depth research, investigation and community consultation over a period of over eight months by members of the Northern Territory Board of Inquiry. The focus of their inquiry was instances of sexual abuse, especially of children, in Northern Territory Indigenous communities. The findings were presented to Chief Minister Martin in April 2007 and released to the public in June. The striking facts, graphic imagery and ardent plea for action contained in this report saw this issue gain widespread attention both in the media and in the political agenda, inciting divisive debate and discussion.

The NTNERA was enacted by the Howard Government just two months after the report was released to the public, allowing little time for consultation with Indigenous communities. It was framed as a ‘national emergency’ with army troops being deployed to Indigenous communities in the Northern Territory. This took place in the lead up to the 2007 Federal Election, in which the Labor Party under Kevin Rudd defeated the Howard Government after four terms of Liberal government.

The Intervention in 2007

The Intervention was a $587 million package of legislation that made a number of changes affecting specified Indigenous communities in the Northern Territory. It included restrictions on alcohol, changes to welfare payments, acquisition of parcels of land, education, employment and health initiatives, restrictions on pornography and other measures.

The package of legislation introduced included:

  • NorthernTerritory National Emergency Response Act 2007.
  • Social Security and Other Legislation Amendment (Welfare Payment Reform) Bill 2007.
  • Families, Community Services and Indigenous Affairs and Other Legislation Amendment. (Northern Territory National Emergency Response and Other Measures) Act 2007.
  • Appropriation (NorthernTerritory National Emergency Response) Bill (No. 1) 2007-2008.
  • Appropriation (NorthernTerritory National Emergency Response) Bill (No. 2) 2007-2008.

In order to enact this package of legislation, several existing laws were affected or partially suspended, including:

  •  Racial Discrimination Act 1975.
  •  Aboriginal Land Rights (Northern Territory) Act 1976.
  • Native Title Act 1993(Cth).
  • Northern Territory Self-Government Act and related legislation.
  • Social Security Act 1991.
  • IncomeTax Assessment Act 1993.

A raft of reforms and regulations were introduced by this package of legislation, including:

  • Restricting the sale, consumption and purchase of alcohol in prescribed areas. This included the prohibition of alcohol in certain areas prescribed by the legislation, making collection of information compulsory for purchases over a certain amount and the introduction of new penalty provisions.
  • ‘Quarantining’ 50% of welfare payments from individuals living in designated communities and from beneficiaries who were judged to have neglected their children.
  • Compulsorily acquiring townships held under title provisions of the Native Title Act 1993 with the introduction of five year leases in order to give the government unconditional access. Sixty-five Aboriginal communities were compulsorily acquired.
  • Linking income support payments to school attendance for all people living on Aboriginal land, and providing mandatory meals for children at school at parents’ cost.
  • Introducing compulsory health checks for all Aboriginal children.
  • Introducing pornography filters on publicly funded computers, and bans on pornography in designated areas.
  • Abolishing the permit system under the Aboriginal Land Rights Act 1976 for common areas, road corridors and airstrips for prescribed communities,.
  • Increasing policing levels in prescribed communities. Secondments were requested from other jurisdictions to supplement NT resources.
  • Marshalling local workforces through the work-for-the-dole program to clean-up and repair communities.
  • Reforming living arrangements in prescribed communities through introducing market based rents and normal tenancy arrangements.
  • Commonwealth funding for the provision of community services.
  • Removing customary law and cultural practice considerations from bail applications and sentencing in criminal trials.
  • Abolishing the Community Development Employment Projects (CDEP).

Changes under successive governments

After an initial focus on preventing child sexual abuse, successive federal governments re-designed and re-framed the Intervention. This involved linking the Intervention with the broader ‘Closing the Gap’ campaign, introducing new measures such as the BasicsCard and tougher penalties for the possession of alcohol and pornography. Changes were also made to the operation of the Racial Discrimination Act (see section on Human Rights). The current package of legislation retains the support of the Liberal Government and is due to expire in 2022.

2008 Changes

The Intervention was introduced in 2007 by the Howard Government, but a change of government in September of that year saw the Labor Government under Kevin Rudd gain power. After some consultation and minor changes, the NTNERA and associated legislation were initially maintained.

In 2008 Rudd apologised to the members of the Stolen Generations on behalf of the nation. In 2009, Rudd also declared support for the most substantive framework for the rights of Indigenous peoples, the UN Declaration on the Rights of Indigenous Peoples. The previous Howard government had voted against the ratification of this treaty. Article 3 of the Declaration states that:

‘Indigenous peoples have the right of self-determination. By virtue of that right they freely determine their political status and freely pursue their economic, social and cultural development’.

The failure to recognise this right to self-determination would become one of the major points of criticism for the Intervention.

In 2009 Rudd implemented the BasicsCard.  The card is used to manage income in certain areas of the Northern Territory. It cannot be used to purchase alcohol, tobacco, tobacco-products, pornography, gambling products or services, home-brew kits or home-brew concentrate.

During the period 2009-2010 the Rudd Government committed itself to a re-design of the Intervention, with a focus on reinstating the suspended provisions of the Racial Discrimination Act (RDA). The Social Security and Other Legislation Amendment (Welfare Reform and Reinstatement of Racial Discrimination Act) Act 2010 (Cth) repealed the ‘special measures’ that had been created under the original Intervention to suspend the operation of the RDA. However, this new legislation still did not comply with the RDA as it continued to discriminate against Indigenous Australians through land acquisition and compulsory income management.These measures overwhelmingly  affect Indigenous people.

The focus of the government then shifted slightly, concentrating more closely on the need to ‘tackle the destructive, intergenerational cycle of passive welfare’ (see then Minister for Families, Community Services and Indigenous Affairs Jenny Macklin’s second reading speech). The Rudd government explicitly linked the Intervention to the ‘Closing the Gap’ targets, changing the focus of the Intervention from the protection of children from sexual abuse to the reform of the welfare system.

2012 changes

The legislative basis for the Intervention was due to expire in 2012.  Decisions regarding its future had to be made. Under the Gillard Government, the StrongerFuturesin the Northern Territory Act 2012 (Stronger Futures) replaced the NTNERA and extended the Intervention for a further ten years to 2022.  The StrongerFutureslegislation comprises three principal Acts (the Stronger Futures package), plus associated delegated legislation. The three Acts are:

  • Stronger Futures in the Northern Territory Act 2012;
  • Stronger Futures in the Northern Territory (Consequential and Transitional Provisions) Act 2012; and
  • Social Security Legislation Amendment Act 2012.

In 2013, the  Parliamentary Joint Committee on Human Rights examined Stronger Futures and the related legislation in their 11th Report. They noted that although the StrongerFutureslegislative package repealed the Northern Territory Emergency Response (‘NTER’) legislation, it retained three key policy elements:

  • The tackling alcohol abuse measure: the purpose of this measure was ‘to enable special measures to be taken to reduce alcohol-related harm to Aboriginal people in the Northern Territory.
  • The land reform measure: the land reform measure enabled the Commonwealth to amend Northern Territory legislation relating to community living areas and town
  • camps to enable opportunities for private home ownership in town camps and more flexible long-term leases.
  • The food security measure: the purpose of this measure was ‘to enable special measures to be taken for the purpose of promoting food security for Aboriginal communities in the Northern Territory’; modifying the legislation involves a 10 year timeframe with most provisions other than the alcohol measures being reviewed after 7 years.

The key changes imposed under the 2012 Stronger Futures legislation package consist of:

  • Expansion of income management through the BasicsCard and the increase of ‘quarantined’ payments to 70%.
  • Increased penalties related to alcohol and pornography, with as much as 6-months jail time for a single can of beer.
  • Expansion of policy that links school attendance with continued welfare payments.
  • Introduction of licences for ‘community stores’ to ensure the provisions of healthy, quality food.
  • Commonwealth given power to make regulations regarding the use of town camps.

{Sources: SBS Factbox, Stronger Futures in the NT, Listening but not Hearing Report}

Although consultation with Indigenous communities did take place, there was much criticism of the nature of the consultative process and the extent to which it was acted upon. The ‘Listening butnot Hearing’ report by the Jumbunna Indigenous House of Learning concluded that “the Government’s consultation process has fallen short of Australia’s obligation to consult with Indigenous peoples in relation to initiatives that affect them”.

The Australian Council of Human Rights Agencies has also stated that it was ‘invasive and limiting of individual freedoms and human rights, and require[s] rigorous monitoring’. Amnesty International commented that the new package of legislation was the same as the original ‘Intervention, but with the pretence of being non-discriminatory.’

2014 changes

The current Intervention legislation is not due to expire until 2022. During his time as Opposition Leader, Tony Abbott supported extending the intervention into the future.

In a speech in February of 2014, then Prime Minister Abbott identified the importance of closing the gap through investment in indigenous programs, with a specific focus on school attendance. However, this speech was followed by massive budget cuts to Aboriginal legal and health services, early childhood education and childcare, and the consolidation of 150 Indigenous programs into 5 core programs. While the 2015 Budget reinstated funding to Family Violence legal services, these ongoing cuts are expected to detrimentally affect attempts to Close the Gap of Indigenous disadvantage.

The 2015 Budget modified the  Stronger Futures NPA, redirecting $988.2 million in funds to the new National Partnership Agreement on Northern Territory Remote Aboriginal Investment  (NPA) over eight years. This new NPA prioritises schooling, community safety and employment. This funding also aims to help the Northern Territory Government take full responsibility for the delivery of services in remote Indigenous communities. Additional funding will also be made available to extend the income management scheme until 2017. However, the new NPA has halved the spending allocated to health measures, and means that the Federal Government will have less control over target outcomes.

Government administered funding of $1.4 billion, previously available under Stronger Futures, will not be transferred to the new NPA, but will be delivered by the departments of Prime Minister and Cabinet and Social Services, outside the NPA framework. The new NPA will be complemented by a Remote Indigenous Housing Strategy that will receive $1.1 billion nationally.

Part 3 The Intervention and the Closing the Gap Campaign

The Council of Australian Governments (COAG) had identified six areas of Indigenous disadvantage to target as the basis for the Closing the Gap Campaign. These were:

  1. Early childhood;
  2. Schooling;
  3. Health;
  4. Economic Participation;
  5. Safe Communities; and
  6. Governance and Leadership (see Right to Self Determination below).

The Closing the Gap in the Northern Territory National Partnership Agreement (2009) ceased on the 30 June 2012. The Stronger Futures in the Northern Territory package which started on 1 July 2012 continued to support the Closing the Gap reforms.

The 6th Annual Progress Report on Closing the Gap was tabled in Parliament by then Prime Minister Tony Abbott on 12 February 2014. It outlined the commitments made by the Coalition government, including:

  • Consolidating the administration of Indigenous programs from eight government departments into the Department of the Prime Minister and Cabinet.
  • Establishing the Prime Minister’s Indigenous Advisory Council.
  • Increasing indigenous school  attendance  through  providing  $28.4 million funding for a remote school attendance program.
  • Improving indigenous  access to employment by commissioning a review and funding employment initiatives.
  • Supporting a referendum for the recognition of the First Australians in the Australian Constitution.

However, in the seventh annual progress report of 11 February 2015, then PM Tony Abbott labelled progress as ‘profoundly disappointing‘. The report concluded that 4 out of 7 targets were not on track to be met by their deadlines, with little progress in literacy and numeracy standards and a decline in employment outcomes since 2008.

Link to 2012 National Indigenous Reform agreement here.

Part 4 Issues with Evaluating the Intervention – how did we work out our grades? Part 4

Quantity of Evaluation:

The controversial nature of the Intervention and the need for expenditure to be accounted for has meant that there have been a large number of evaluations undertaken regarding various aspects of the Intervention. Within five years of the establishment of the Intervention, by December 2012, 98 reports, seven parliamentary inquiries and hundreds of submissions had been completed. However, the sheer quantity of these reports actually hinders the evaluation process, as it obstructs proper evaluation of effectiveness.

Impartiality of Evaluation:

The majority of evaluations of the Intervention have been undertaken by government departments and paid consultants. Australian National University researchers Jon Altman and Susie Russell suggest that the evaluation of the Intervention, instead of being an independent objective process, has been merged into the policy process and, in many cases, is performed by the policy-makers themselves. This means there is a real risk of evidence being ignored or hidden to suit an agenda.

Independent reports and government commissioned reports have often contradicted each other, with the government seeking to discredit independent reports rather than gathering additional data. This includes independent reports by researchers at Jumbunna Indigenous House of Learning at the University of Technology Sydney, Concerned Australians and the Equality Rights Alliance, all of which have often come to different conclusions than government reports.

Quality and Consistency of Evaluation:

The ‘final evaluation’ of the Intervention under the NTNER occurred in November 2011 with the publication of the Northern Territory Emergency Response Evaluation ReportHowever, the Stronger Futures legislation did not come into effect until August 2012. This left eight months unaccounted for.

Closingthe Gap in the Northern Territory Monitoring Reports are conducted every six months. A significant criticism is that they focus on bureaucratic ‘outputs’ rather than outcomes. Income management studies, for example, have reported on ‘outputs’ such as the number of recipients of the Basics Card or the total amount of income quarantined, rather than focusing on the card’s effectiveness for health and child protection outcomes.

Much of the data collected has also relied on self-assessment in the form of surveys, such as asking individuals to rate their own health rather than collecting and analysing data on disease. Another issue is the ad hoc nature of some reports. For example, the review of the Alcohol Management Plan in Tennant Creek was only conducted once. This makes it difficult to make comparisons over the life of the policy and evaluate the effectiveness of particular measures.

Independent statistical data can be hard to find, since information compiled by the Australian Bureau of Statistics is national in scope and cannot be translated directly into the context of the individual Indigenous communities in the Northern Territory. Indigenous Australians also have a lower median age than other Australians, meaning data on employment rates or incarceration rates can be statistically skewed.

Benchmarks for Evaluation:

ANU researchers Jon Altman and Susie Russell have noted that the “absence of an overarching evaluation strategy has resulted in a fragmented and confused approach”. They found that the 2007 Intervention did not have any documentation articulating the basis of the policy, nor how it should be evaluated. The first document to address this was the unpublished Program Logic Options Report which was developed in 2010; three years after the Intervention began. This means that there are no original benchmarks for evaluation, and that the decision to extend the program in 2012 was made without clear evidence as to its effectiveness. Furthermore, there is a limited connection between the benchmarks proposed in the 2010 Report and those used in later evaluations.

Aboriginal Health and #prevention : New report : @Prevention1stAU health : How much does Australia spend and is it enough?

 ” The verdict is in: Prevention is better than cure when it comes to tackling Australia’s chronic disease burden, but is Australia pulling its weight when it comes to tackling the nation’s greatest public health challenge?

A new economic report looking at what Australia invests in preventive health has found Australia ranks poorly on the world stage and has determined that governments must spend more wisely to contain the burgeoning healthcare budget.

Treating chronic disease costs the Australian community an estimated $27 billion annually, accounting for more than a third of our national health budget.

Yet Australia currently spends just over $2 billion on preventive health each year, or around $89 per person.

One in two Australians suffer from chronic disease, which is responsible for 83 per cent of all premature deaths in Australia, and accounts for 66 per cent of the burden of disease.”

The report, Preventive health: How much does Australia spend and is it enough? was co-funded by the Heart Foundation, Kidney Australia, Alzheimer’s Australia, the Australia Health Promotion Association and the Foundation for Alcohol Research and Education.

Download the report HERE

Preventive-health-How-much-does-Australia-spend-and-is-it-enough_FINAL

Produced by La Trobe University’s Department of Public Health, the report examines trends in preventive health spending, comparing Australia’s spending on preventive health, as well as the funding models used, against selected Organisation for Economic Co-operation and Development (OECD) countries.

The report also explores the question: ‘how much should Australia be spending on preventive health?’

Treating chronic disease costs the Australian community an estimated $27 billion annually, accounting for more than a third of our national health budget.

Yet Australia currently spends just over $2 billion on preventive health each year, or around $89 per person. At just 1.34 per cent of Australian healthcare expenditure, the amount is considerably less than OECD countries Canada, New Zealand and the United Kingdom, with Australia ranked 16th out of 31 OECD countries by per capita expenditure.

Michael Thorn, Chief Executive of the Foundation for Alcohol Research and Education (FARE), a founding member organisation of the Prevention 1st campaign, says that when looking at Australia’s spend on prevention, it should be remembered that one third of all chronic diseases are preventable and can be traced to four lifestyle risk factors: alcohol and tobacco use, physical inactivity and poor nutrition.

“We know that by positively addressing and influencing lifestyle factors such as physical activity, diet, tobacco and   alcohol consumption, we will significantly reduce the level of heart disease, stroke, heart failure, chronic kidney disease, lung disease and type 2 diabetes; conditions that are preventable, all too common, and placing great pressure on Australian families and on Australia’s healthcare systems,” Mr Thorn said.

Report co-author, Professor Alan Shiell says we should not simply conclude that Australia should spend more on preventive health simply because we spend less than equivalent nations, and instead argues that Australia could and should spend more on preventive health measures based on the evidence of the cost effectiveness of preventive health intervention.

“The key to determining the appropriate prevention spend is to compare the added value of an increase in spending on preventive health against the opportunity cost of doing so.

“If the value of the increased spending on preventive health is greater than the opportunity cost, then there is a strong case to do so,” Professor Shiell said.

Professor Shiell says there is clear evidence that many existing preventive health initiatives are cost-effective.

“Studies suggest Australia’s health could be improved and spending potentially even reduced if government was to act on existing policy recommendations and increase spending on activities already considered cost-effective.

“We also suspect that the choice of funding mechanism, or how money is allocated to whom for prevention – is an important factor for the overall efficiency of health prevention expenditure,” Professor Shiell said.

The report highlights England’s efforts in evaluating and monitoring the cost effectiveness and success of its public health interventions and Mr Thorn believes Australia would do well to follow their lead.

“In the United Kingdom we have a conservative government no less, showing tremendous leadership to tackle chronic disease, with bold policy measures like the recently introduced sugar tax and broad-based physical activity programs, all of which are underpinned by robust institutional structures,” Mr Thorn said.

The report will be launched at a Forum at Parliament House in Canberra today, where public health experts, including the World Health Organization’s Dr Alessandro Demaio will explain how they would invest in preventive health if given $100 million to spend.

 

 

 

NACCHO Aboriginal Health : MBS Review Taskforce – Next round of public consultation now open

 ” As you are aware, the Medicare Benefits Schedule (MBS) Review Taskforce is considering every one of the more than 5,700 items on the MBS, with a focus of how the items can be better aligned with contemporary clinical evidence and practice to improve health outcomes for all Australians.
 
Today, the recommendations were made available for public consultation for the following clinical committees:
  • Dermatology, Allergy & Immunology
  • Diagnostic Imaging – knee imaging
  • Diagnostic Imaging – pulmonary embolism and deep vein thrombosis
  • Renal Medicine
  • Spinal Surgery
  • Urgent after-hours primary care services funded by the MBS

Examples

The online survey is open from today until Friday July 21, 2017.
 
It is important to note that these recommendations are not final and are being released publicly for the purpose of obtaining stakeholder feedback.

Your input as a stakeholder is critical in shaping the Review. Please use the online surveys (rather than emailing your comments directly) for accuracy and transparency when analysing your feedback.

 

If you have any questions or queries on the Review or the work of the Taskforce please contact the MBS Review Team.

NACCHO Aboriginal Health #CarersGateway : Free online resources to support #Aboriginal #carers

It’s rewarding work, but without help Dolly finds herself emotionally and physically drained. Dolly reached out and found that she could get services to help her.

Like Dolly, millions of people in Australia care for others who need help with their everyday lives.

A carer may be someone who looks after their husband or wife, partner, grandparent, uncle, aunty, cousin, child, grandchild or any other family member, a neighbour, a friend or someone in their community who needs help.

Everyone’s situation is different. Some carers look after someone who is an older person or who is unwell or has difficulties getting around. Some carers may look after someone who has a disability, a mental illness or dementia, a chronic condition or a long-term illness or drug and alcohol problems.

Many people looking after someone else don’t think of themselves as carers. They just see caring as what they do to help their families or friends or people in their communities.

Carers need help too – someone they can talk to and find out about services that can help. Carer Gateway is a free, Australian Government funded service that provides information for carers and helps people get in touch with their local services. People can ring up and have a private chat or go online and find out about support in their area, free financial and legal help and what to do in emergencies.  They can also get tips on how to look after themselves so they don’t get burnt out while caring for someone else.

Carer Gateway has short videos about real-life carers in the community – showing how they cope and deal with problems – and how they make the most of the time they spend caring for someone in need.

The videos include Dolly’s story. Dolly is a mother and full-time carer for her two adult daughters, who both need support with their everyday needs.

“It’s pretty much 24/7 around the clock. Four years ago, I realised I was doing a care role and I was also a working mum so quite busy. I thought you know what, it’s time for me to step back and start looking after my own,” she said.

There are free online resources to support Aboriginal carers, including a guided relaxation audio recording and information brochures and posters for use by health and community groups  which can also be ordered from the Carer Gateway ordering form and a Carer Gateway Facebook page to keep up to date on services and supports for carers.

To find out more, Carer Gateway can be contacted on 1800 422 737, Monday to Friday between 8am and 6pm,

or by visiting carergateway.gov.au

You can join the Carer Gateway Facebook community by visiting https://www.facebook.com/carergateway/

 

 

 

Aboriginal Health Programs-Debate : Evaluating #Indigenous programs : a toolkit for change

 

 ” The Federal Government recently announced it will allocate $10 million a year over four years to strengthen the evaluation of Indigenous programs.

However, given that the average cost of an evaluation is $382,000, the extra $10 million a year for Indigenous program evaluations will not go far.

To make the most of this additional funding the government must change the way it evaluates and monitors programs.”

Sarah Hudson Researcher The Centre for Independent Studies

Download the report HERE

Evaluating Indigenous programs a tool kit for change

” Aboriginal community-controlled organisations treat health not just as a physical problem, but see it as tied in with the social, emotional and cultural wellbeing of the whole community, in which each individual is able to achieve their full potential as a human being.

While this has its roots in Aboriginal cultural norms, she says, it also mirrors well-known social determinants of health.”

 ” Victoria’s peak Aboriginal health body was recently given two days to respond to a draft family violence plan “the size of a PhD”, its CEO says. It’s another example of governments just not getting how to work with Aboriginal communities.

Co-design with community groups cannot work if government asks for input after the big decisions have already been made or rush consultation, warns the head of Victoria’s peak body for the Aboriginal community health system.

“It’s not an equal partnership. We’re at their whim, and we’ve got to run to their agenda,”

Victorian Aboriginal Community Controlled Health Organisation CEO Jill Gallagher said last week in a speech at the University of Melbourne. See Article 2 Below

” Evaluation at the contract, program and outcome level will ensure we not only know where the money is being spent, but we will know what works and why.

“This is important for the government and taxpayers, but more important for communities in whose name the money is spent.

“It will also mean we will be better able to assess where our investm­ent needs to be focused in the future — and ensure the IAS continues to deliver outcomes for indigenous communities.”

From Indigenous Affairs Minister Nigel Scullion Article 3 below

 Feb 3 2017 NACCHO Aboriginal Health #IAS Funding : Turnbull government to spend $40m evaluating effectiveness of Indigenous programs 

Although formal evaluations for large government programs are important, evaluation need not involve outside contractors. Government must adopt a learning and developmental approach that embeds evaluation into a program’s design as part of a continuous quality improvement process.

It is not enough just to evaluate, government must actually use the findings from evaluations to improve service delivery. Unfortunately, many government agencies ignore evaluations when making funding decisions or implementing new programs.

Analysis of 49 Indigenous program evaluation reports, found only three used rigorous methodology.

Overall, the evaluations were characterised by a lack of data and the absence of a control group, as well as an overreliance on anecdotal evidence.

Adopting a co-accountability approach to evaluation will ensure that both the government agency funding the program and the program provider delivering the program are held accountable for results.

An overarching evaluation framework could assist with the different levels of outcomes expected over the life of the program and the various indicators needed to measure whether the program is meeting its objectives.

Feedback loops and a process to escalate any concerns will help to ensure government and program providers keep each other honest and lessons are learnt.

Analysis of Indigenous program evaluations

Mapping of total federal, state and territory and non-government/not-for-profit Indigenous programs identified 1082 Indigenous specific programs. Of these:

49 were federal government programs;

• 236 were state and territory programs; and

• 797 were programs delivered by non-government organisations.

The largest category of programs were health related programs (n=568) followed by cultural programs (n=145) then early childhood and education programs (n=130) — see Figure 1.

The program category with the highest number of evaluations was health (n=44), followed by early childhood and education (n=16). However, percentage wise, more programs were evaluated under the jobs and economy category (15%) than the other program categories.

Of the 490 programs delivered by Aboriginal organisations, only 20 were evaluated (4%). The small number of businesses delivering a program (n=6) meant that while there were only two evaluations of Indigenous programs provided by a business, this category had the highest percentage of programs evaluated (33%).

Similarly, while only six of the 33 programs delivered by schools and universities were evaluated, this category had the second highest percentage of programs evaluated (23%). Conversely, government and non-Indigenous NGO delivered programs had the highest number of evaluations, n=36 and n=24, but much lower percentages of evaluations as the number of overall programs was higher, n=278 and n=276.

A total of 49 evaluation reports were analysed and assessed against a scale rating the rigour of the methodology. Only three evaluation reports utilised strong methodology (see Figure 4).

In general, Indigenous evaluations are characterised by a lack of data and the absence of a control group, as well as an over-reliance on anecdotal evidence

Suggestions for policy makers and program funders include:

  • Embedding evaluation into program design and practice — evaluation should not be viewed as an ‘add on’ but should be built into a program’s design and presented as part of a continuous quality improvement process with funding for self-evaluation provided to organisations.
  • Developing an evidence base through an accountability framework with regular feedback loops via an online data management system — to ensure data being collected is used to inform practice and improve program outcomes and there is a process for escalating concerns.

Suggestions for program providers include:

  • Embedding evaluation into program practice — evaluation should not be viewed as a negative process, but as an opportunity to learn.
  • Developing an evidence base through the regular collection of data via an online data management system to not only provide a stronger evidence base for recurrent funding, but also to improve service delivery and ensure client satisfaction with the program

Article 2 Govt co-design ‘not an equal partnership’: Aboriginal health CEO

Victoria’s peak Aboriginal health body was recently given two days to respond to a draft family violence plan “the size of a PhD”, its CEO says. It’s another example of governments just not getting how to work with Aboriginal communities.

Co-design with community groups cannot work if government asks for input after the big decisions have already been made or rush consultation, warns the head of Victoria’s peak body for the Aboriginal community health system.

“It’s not an equal partnership. We’re at their whim, and we’ve got to run to their agenda,” Victorian Aboriginal Community Controlled Health Organisation CEO Jill Gallagher said last week in a speech at the University of Melbourne.

A particularly vivid example of this is engagement on the establishment of family violence hubs around the state. Gallagher, who is on the family violence industry taskforce, said she was handed a draft plan already outlining the main priorities on Monday, and asked to provide a written response by Wednesday. “A report the size of a PhD,” she added.

“So when they say ‘we want to co-design with you guys’, always ask them what their version of co-designing is,” she told the audience. “Without systematic change in mainstream attitudes and practices, and incorporation of Aboriginal peoples in all stages of policy design, health policies will remain unproductive.”

While Gallagher says she understands the challenges of trying to co-design with a community, government needed to make a more concerted effort to do it properly.

“It doesn’t give us due respect of being part of the beginning right through to the evaluation.”

Culture is strength

Aboriginal culture is often seen in the wider Australian population as a barrier to health, implying that assimilation is the only way forward, Gallagher said.

She rejects this idea. “Cultural differences need to be celebrated and preserved. They are a source of strength and resilience for our peoples, which offer protective factors against traumatic life events.”

Cultural safety and trust can have a big impact on engagement with institutions. She points to the fact that around the country, Aboriginal people are discharged against medical advice or at their own risk at eight times the rate of the rest of the population. This has obvious flow on effects for overall wellbeing.

“When we have a culturally safe place for patients and our people, we improve access to services and improve health for individuals, therefore health for families, therefore health for communities.”

Also in The MandarinIndigenous policy evidence, where it exists, over-relies on anecdotal evidence

Creating that environment should not only be up to Aboriginal employees or a good CEO, but come out of an organisation’s systems. This means more than just creating a few identified positions — it’s everyone’s responsibility.

Aboriginal community-controlled organisations treat health not just as a physical problem, but see it as tied in with the social, emotional and cultural wellbeing of the whole community, in which each individual is able to achieve their full potential as a human being. While this has its roots in Aboriginal cultural norms, she says, it also mirrors well-known social determinants of health.

“Possessing a strong sense of cultural identity is also vital for one’s self-esteem. A positive cultural connection not only contributes to better mental health and physical health, but may lessen the consequences of social prejudice against Aboriginal peoples.”

Yet despite plenty of experience to show the importance of culture as a source of resilience, it “remains largely unexplored” as a public health resource, she says.

Funding models that don’t fit

Governments ignoring the role of culture creates other problems, Gallagher explains.

The Commonwealth made a capital investment a few years ago to create a childcare centre and kindergarten in Melbourne’s northern suburbs called Bubup Wilam. Recurrent funding was only given for two years, with the idea that it would become self-sustaining by the end of that short period.

“Bubup Wilam grew and evolved and it’s a beautiful childcare centre and kindergarten for Aboriginal children, where they can learn and express aboriginal culture but also have access to what every other kid has access to.

Despite the success, it’s “struggling to continue that at the moment” and is trying to raise funds in the community, she says, “because it doesn’t just provide a kindergarten like for a mainstream nuclear family.”

“Because a lot of the kids and families that access Bubup Wilam are families that live well under the poverty line, a lot of them are touched by the child protection system. What Bubup Wilam tries to do is work with the children, but also work with the families — the mum or the dad or the caregiver — and that takes a lot of resources.

“So our model there does not fit within the mainstream model of how they fund a nuclear, non-Aboriginal childcare centre. … So that’s an example of how the differences and different needs and funding formulas don’t fit what we need to achieve.”

This comes back to the co-design problem: governments aren’t paying enough attention to what the community says, and end up designing the system to fit what they think the community needs, which is different to what it really needs.

“It’s about involving us from the word go,” says Gallagher.

“What Fitzroy might need is different to what Fitzroy Crossing might need.”

Part 3 : Indigenous Affairs Minister Nigel Scullion

The Turnbull government will spend $40 million evaluating its indigenous affairs programs in an attempt to counter a national audit office report expected to be harshly critical of the way billions of dollars have been allocated.

Sidelined prime ministerial indigen­ous adviser Warren Mundine said yesterday the report, to be tabled today, was expected to be “damning”, as was the official Clos­ing the Gap report due within days.

The audit office report follows a Senate inquiry last year that blasted the 2014 implementation of the Abbott government’s flagship multi-billion-dollar Indigenous Advancement Strategy.

A 2015 Productivity Commission report found there was insufficient evidence being collected about the outcomes of indigenous programs and that “formal rigorous evaluations of indigenous programs that set the benefits of particular policies for reducing disadvantage against the costs are relatively scarce”.

Spending on mainstream and indigenous-specific programs and services has been estimated by the government to be worth $30 billion. A Centre for Independent Studies report last year found only 8 per cent of 1082 indigenous-spec­ific programs, worth $5.9bn, had been effectively evaluated.

However, Indigenous Affairs Minister Nigel Scullion, who will announce the four-year evalua­tion program today, said reporting, monitoring and evaluation of the IAS had already been improved­, and accounting for how much was being spent in the portfolio was now possible.

“However, we need to continually build on this and further strengthen the evaluation of our investment to ensure that money allocated through the IAS is invest­ed in ways that make the greatest difference for our first Australians,” Senator Scullion said. “By establishing a multi-year funding allocation, we are ensuring there will be a long-term plan for evaluation and a formal strategy to monitor and review how individ­ual contracts and program streams are contributing to our effort­s to deliver better outcomes for indigenous Australians.

Senator Scullion said the evaluation would be rolled out in close consultation with Aborigines and Torres Strait Islanders, including­ indigenous-run firms. “Indig­enous-run companies are currently delivering rigorous evaluation for the government and this new framework will continue this partnership,” he said.

 

NACCHO Aboriginal Mental Health : Download report “Mental health in remote and rural communities “

 ” The poorer mental health of remote and rural Indigenous Australians is also impacted by the social determinants of Indigenous health, which are well recognised nationally and internationally.

These relate to the loss of language and connection to the land, environmental deprivation, spiritual, emotional and mental disconnectedness, a lack of cultural respect, lack of opportunities for self-determination, poor educational attainment, reduced opportunities for employment, poor housing, and negative interactions with government systems

The relationship of remoteness to health is particularly important for Indigenous Australians, who are overrepresented in remote and rural Australia (Australian Institute of Health and Welfare, 2014a).

The National Mental Health Commission (2014a, p. 19) identified that “the mental health needs of Aboriginal and Torres Strait Islander people are significantly higher than those of other Australians.”

Photo above

“ The women of Inkawenyerre, a small settlement in the Utopia community four hours by road north of Alice Springs, regularly take part in a different kind of mental health therapy, known as ‘narrative therapy.’

Narrative therapy taps into the centuries-old tradition among Aboriginal people of story-telling and expression through art. At the family Urapuntja Clinic, both women and children take part in narrative therapy.

They recreate what is commonly seen on any given evening in an Aboriginal community—people sitting around the fire, relating to one another and telling stories.

The activity is enjoyable for participants with group members often laughing and supporting one another as they tell stories and work on their painting—all while promoting good mental health living practice,”

Lynne Henderson, former RFDS Central Operations mental health clinician.

“People who live in the country get less access to care. And they become sicker,”

To increase the access to care, the RFDS said it needed a massive increase in funding. Country Australians see mental health professionals at only a fifth the rate of those who live in the city,

So there should be a five-fold increase in access to mental health care for country Australians.”

RFDS CEO Martin Laverty see story Part 2 below

Mental health in remote and rural communities

Mental health disorders are not more common in rural and regional Australia than they are in Australia’s cities, according to a new report from the Royal Flying Doctor Service (RFDS), but they are a lot harder to treat.

The report, Mental Health in Remote and Rural Communities, found about one in five remote and rural Australians — 960,000 people — experience mental illness.

Download the report HERE

RN031_Mental_Health_D5

But a combination of lack of access to facilities, social stigma, and cultural barriers present challenges to getting people the help they need.

AHCRA believes that’s something that everyone should be concerned about, with access to care regardless of location.

 

Part 1  Indigenous mental health and suicide

Data from the 2011 Australian Census demonstrated that 669,881 Australians, or 3% of the population, identified as Indigenous (Australian Bureau of Statistics, 2013b), and that 142,900 Indigenous Australians, or 21% of the Indigenous population, lived in remote and very remote areas (Australian Institute of Aboriginal and Torres Strait Islander Studies, 2014).

Around 45% of people in very remote Australia (91,600 people), and 16% of people in remote Australia (51,300 people) were Indigenous (Australian Bureau of Statistics, 2013b; Australian Institute of Aboriginal and Torres Strait Islander Studies, 2014).

In 2011–2012 around one-third (30%) of Indigenous adults reported high or very high levels of psychological distress—almost three times the rate for non-Indigenous Australians (Australian Bureau of Statistics, 2014).

In 2008–2012, in NSW, Queensland (Qld), WA, SA and the NT, there were 347 Indigenous deaths11 from mental health-related conditions (Australian Institute of Health and Welfare,

2015a). Specifically, age-standardised death data demonstrated that Indigenous Australians (49 per 100,000 population) were 1.2 times as likely as non-Indigenous Australians (40 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a). Age-standardised deaths from mental and behavioural disorders increased with increasing age in both Indigenous and non-Indigenous Australians in 2008–2012.

Very few Indigenous and non-Indigenous Australians under the age of 35 years died as result of mental and behavioural disorders in 2008–2012. However, Indigenous Australians aged 35 years or older were more likely to die from mental and behavioural disorders than non-Indigenous

Australians in 2008–2012. Specifically, Indigenous Australians (7.2 per 100,000 population) aged 35–44 years were 5.7 times as likely as non-Indigenous Australians (1.3 per 1200,000 population) to die from mental and behavioural disorders (Australian Institute of Health and

Welfare, 2015a). In 2008–2012, Indigenous Australians (14.7 per 100,000 population) aged 45–54 years were 4.9 times as likely as non-Indigenous Australians (3.0 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a).

In 2008–2012, Indigenous Australians (18.3 per 100,000 population) aged 55–64 years were 2.7 times as likely as non-Indigenous Australians (6.9 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a). In 2008–2012,

Indigenous Australians (91.2 per 100,000 population) aged 65–74 years were 2.9 times as likely

as non-Indigenous Australians (31.3 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a).

Further exploration of death data from mental and behavioural disorders illustrates the significant impact of psychoactive substance use (ICD-10-AM codes F10–F19) on Indigenous mortality (Australian Institute of Health and Welfare, 2015a). In 2008–2012, 29.1% of Indigenous deaths due to mental and behavioural disorders were the result of psychoactive substance use, such as alcohol, opioids, cannabinoids, sedative hypnotics, cocaine, other stimulants such as caffeine, hallucinogens, tobacco, volatile solvents, or multiple drug use. During this period, Indigenous Australians (7.3 per 100,000 populations) were 4.8 times as likely as non-Indigenous Australians to die as a result of psychoactive substance use (Australian Institute of Health and Welfare, 2015a).

Similarly, in 2006–2010, there were 312 Indigenous deaths from mental health-related conditions (Australian Institute of Health and Welfare, 2013a). Indigenous Australians living in NSW, Qld, WA, SA and the NT were 1.5 times as likely as non-Indigenous Australians to die from mental and behavioural disorders in 2006–2010 (Australian Institute of Health and Welfare, 2013a).

11 Deaths from mental and behavioural disorders do not include deaths from intentional self-harm (suicide). Intentional self-harm is coded under ICD-10-AM Chapter 19—Injury, poisoning and certain other consequences of external causes.

Age-standardised death data demonstrated that Indigenous males (49 per 100,000 population) were 1.7 times as likely as non-Indigenous males to die from mental and behavioural disorders. Indigenous females were 1.3 times as likely as non-Indigenous females to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2013a).

The greater number of deaths from mental and behavioural disorders with age may also represent the impact of conditions associated with ageing, such as dementia. For example, in 2014, Indigenous Australians (50.7 per 100,000 population) in NSW, Qld, SA, WA and the NT were 1.1 times as likely as non-Indigenous Australians (45.3 per 100,000 population) to die from dementia (including Alzheimer disease) (Australian Bureau of Statistics, 2016a).

In 2014–2015, Indigenous Australians (28.3 per 1,000 population) were 1.7 times as likely as non-Indigenous Australians (16.3 per 1,000 population) to be hospitalised for mental and behavioural disorders (Australian Institute of Health and Welfare, 2016a).

In 2011–2013, 4.2% of Indigenous hospitalisations were for mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a). Age-standardised data demonstrated that Indigenous Australians (27.7 per 1,000 population) were twice as likely as non-Indigenous Australians (14.2 per 1,000 population) to be hospitalised for mental and behavioural disorders in 2011–2013 (Australian Institute of Health and Welfare, 2015a).

In 2008–2009, Indigenous young people aged 12–24 years (2,535 per 100,000 population) were three times as likely to be hospitalised for mental and behavioural disorders than non-Indigenous young people (Australian Institute of Health and Welfare, 2011).

 

The leading causes of hospitalisation for mental and behavioural disorders amongst Indigenous young people were schizophrenia (306 per 100,000 population), alcohol misuse (348 per 100,000 population) and reactions to severe stress (266 per 100,000 population) (Australian Institute of Health and Welfare, 2011).

A preliminary clinical survey of 170 Aboriginal and Torres Strait Islander Australians in Cape York and the Torres Strait, aged 17–65 years, with a diagnosis of a psychotic disorder, was undertaken to describe the prevalence and characteristics of psychotic disorders in this population (Hunter, Gynther, Anderson, Onnis, Groves, & Nelson, 2011).

Researchers found that: 62% of the sample had a diagnosis of schizophrenia, 24% had substance-related psychoses, 8% had affective psychoses, 3% had organic psychoses and 3% had brief reactive psychoses; Indigenous Australians aged 30–39 years were overrepresented in the psychosis sample compared to their representation in the population (37% of sample versus 29% of population) with slightly lower proportions in the 15–29 years and 40 years and older age groups; almost three-quarters (73%) of the sample were male (versus 51% for the Indigenous population as a whole); Aboriginal males (63% in the sample compared to 46% for the region as a whole) were overrepresented; a higher proportion of males (42%) than females (5%), and Aboriginal (44%) than Torres Strait Islander patients (10%) had a lifetime history of incarceration; comorbid intellectual disability was identified for 27% of patients, with a higher proportion for males compared to females (29% versus 20%) and Aboriginal compared to Torres Strait Islander patients (38% versus 7%); and alcohol misuse (47%) and cannabis use (52%) were believed to have had a major role in the onset of psychosis (Hunter et al., 2011).

In 2015, Indigenous Australians (25.5 deaths per 100,000 population) in Qld, SA, NT, NSW and WA were twice as likely as non-Indigenous Australians (12.5 deaths per 100,000 population) to die from suicide (Australian Bureau of Statistics, 2016b). In their spatial analysis of suicide, Cheung et al. (2012) concluded that higher rates of suicide in the NT and in some remote areas could be explained by the large numbers of Indigenous Australians living in these areas, who demonstrate higher levels of suicide compared with the general population.

The poorer mental health of remote and rural Indigenous Australians is also impacted by the social determinants of Indigenous health, which are well recognised nationally and internationally.

These relate to the loss of language and connection to the land, environmental deprivation, spiritual, emotional and mental disconnectedness, a lack of cultural respect, lack of opportunities for self-determination, poor educational attainment, reduced opportunities for employment, poor housing, and negative interactions with government systems

Part 2 Flying Doctors fight barriers to treat mental illness in rural Australia

Source ABC

Like so many in the bush, Brendan Cullen has a lot on his plate.

He manages a 40,000-hectare property south of Broken Hill. There are 8,000 sheep to keep track of. And that’s just a fraction of the number he looked after previously at another station.

A few years ago, the mustering, the maintenance, juggling bills and family — it all caught up to him.

“You just bottle stuff up. And sometimes you can’t find an out,” he said.

“In the bush you have a lot of time by yourself.”

He spent a lot of that time thinking about his problems. But Mr Cullen was lucky.

He heard about a mental health clinic being run by the Royal Flying Doctor Service (RFDS) in a nearby community and decided to go along.

“Catching up with one of the mental health nurses gave me the tools to be able to work out how I go about living a day-to-day life,” he said.

“My life’s a hell of a lot easier now than what it used to be.”

Mental health disorders are not more common in rural and regional Australia than they are in Australia’s cities, according to a new report from the RFDS, but they are a lot harder to treat.

The report, Mental Health in Remote and Rural Communities, found about one in five remote and rural Australians — 960,000 people — experience mental illness.

But a combination of lack of access to facilities, social stigma, and cultural barriers present challenges to getting people the help they need.

“People who live in the country get less access to care. And they become sicker,” RFDS CEO Martin Laverty said.

To increase the access to care, the RFDS said it needed a massive increase in funding.

“Country Australians see mental health professionals at only a fifth the rate of those who live in the city,” Mr Laverty said.

“So there should be a five-fold increase in access to mental health care for country Australians.”

The impact of distance and isolation when it comes to treating mental disorders can be seen in suicide rates. In remote Australia, the rate is nearly twice what it is in major metropolitan areas — 19.6 deaths per 100,000 people.

The suicide rate is even greater in very remote communities.

If you or anyone you know needs help:

The RFDS has responded by increasing its mental health outreach. In communities like Menindee, about an hour’s drive from Broken Hill in the far west of New South Wales, a mental health nurse is on call once a fortnight.

“I have needed them in the past. I got down to rock bottom at one stage. Even now I appreciate that support,” Menindee resident Margot Muscat said.

Ms Muscat plays an active role in the remote community. But she has also felt pressure in the past to manage that role, her work, and family commitments.

Mental health counselling has given her a valuable outlet.

“Just to know that I wasn’t alone. And that you don’t have to take the drastic step of suiciding, so to speak,” Ms Muscat said.

Some the RFDS’s mental health counselling is done over the airwaves. From its regional base in Broken Hill, mental health nurse Glynis Thorp counsels patients over the phone. Often calls are simply people checking in.

“It’s critically important…often there might only be two people on the property. So no one to talk to maybe,” she said.

“We might get out to a clinic every fortnight, but we might have follow up phone calls to check how people are going. For myself it’s probably a ratio of four to one.”

The RFDS report reveals every year hundreds of serious mental illness incidents require airplanes to be dispatched to remote areas to fly patients out for treatment.

Over three years from July 2013 the RFDS conducted 2,567 ‘aeromedical retrievals’.

The leading causes for evacuation flights due to mental disorder are

The RFDS also uses airplanes to carry its mental health nurses to very remote areas. On a typical day in Broken Hill, the medical team takes off just after dawn to head to three communities hundreds of kilometres away: Wilcania, White Cliffs and Tilpa.

In the opal mining town of White Cliffs, the mental health nurse sees patients at the local clinic. One is “Jane”, who doesn’t want her full name used.

“Without them, we would really be lost here,” she said.

Jane has been counselled by the RFDS and was recently directed to mental health treatment in Broken Hill. But she’s still reluctant to talk openly in town about the help she’s getting.

“In a small community it’s not wise to talk to other people in town,” she said. “And mental health, it does carry a stigma.”

Back on his station south of Broken Hill, Mr Cullen believes that stigma over mental health is slowly changing in the bush.

“People get wind that someone’s had a mental health problem, people talk now. As opposed to, let’s go back five years even, 10 years. It was a closed book,” he said.

“With these clinics, once upon a time you might have had a dental nurse, a doctor, and the like.

“But now you have a mental health nurse…And these clinics are close by. So you’re able to go to them. They come to you.”

Aboriginal Health #NRW2017 Good News Alert 2 of 2 : Download @AIHW 4th National report Indigenous nKPIs primary health care

 ” This fourth national report on the Indigenous primary health care national Key Performance Indicators (nKPIs) data collection presents annual data on indicators collected from the June 2012 to the June 2016 reporting period.

 Information is presented for 22 ‘process-of-care’ and ‘health outcome’ indicators for June 2016, which focus on maternal and child health, preventative health, and chronic disease management.

The report shows continuous improvements for the majority of indicators.

Yes the good news is , improvements were seen in 12 of the 16 process-of-care measures for which time trend data were available (Table S1 below ).

For 10 of these measures, the change was statistically significant.”

Download HERE NACCHO Resources 7.00 MB

NACCHO AIHW Aboriginal Health 2 National Key Performance Indicators June 2016

Or from AIHW website

You can read NACCHO 1 of 2 HERE

You can read NACCHO 1 of 2 HERE

Data for this collection are provided to the AIHW by primary health care organisations that receive funding from the Department of Health to provide services to Aboriginal and Torres Strait Islander people.

Some primary health care organisations that report receive additional funding from other sources, including state and territory health departments, while a small number are funded solely by the Northern Territory Government (see ‘Chapter 1 Introduction’).

The purpose of the nKPIs is to support policy and service planning at the national and state/territory levels, by monitoring progress and highlighting areas for improvement.

The nKPIs can also be used to improve the delivery of primary health care services, by supporting continuous quality improvement (CQI) activity among service providers.

Over the period June 2012 to May 2015 (the period for which time trend data are available), improvements continue to be made across the majority of measures—indicating that health organisations continue to show progress in service provision.

The good news

Improvements were seen in 12 of the 16 process-of-care measures for which time trend data were available (Table S1).

For 10 of these measures, the change was statistically significant. The largest improvements (between 16 and 19 percentage points) were seen in data recording practices for the measurement of:

  • alcohol consumption, which rose from 38% in June 2012 to 57% in May 2015
  • birthweight, which rose from 51% in June 2012 to 69% in May 2015
  • smoking status, which rose from 64% in June 2012 to 80% in May 2015.

Results for process-of-care measures related to Medicare Benefits Schedule (MBS) health assessments (for children and adults) exceeded the 2016 trajectory of the Implementation Plan goals for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023.

Improvements were also seen in 3 of the 5 health outcomes measures for which time trend data were available. For 1 of these, the change was statistically significant:

• Health of clients with type 2 diabetes—those with an HbA1c (glycosylated haemoglobin), with a result of ≤7% in the previous 6 months, rose from 32% in June 2012 to 35% in May 2015. (An HbA1c result of ≤7% is the optimum target encouraged by Diabetes Australia to ensure good glycaemic control and reduce the incidence of diabetes-related illness.)

Things to work on

Results for 3 process-of-care measures related to immunisation against influenza—clients aged 50 and over; clients with type 2 diabetes; and clients with chronic obstructive pulmonary disease (COPD)—and for the 1 process-of-care measure relating to cervical screening saw small decreases of between 1.3 and 2.6 percentage points. However, these were not statistically significant.

Results for 2 health outcome measures showed increases: the proportion of babies born with a low birthweight increased by 0.9 percentage points and people whose body mass index (BMI) score classified them as overweight or obese increased by 4.3 percentage points.

However, these increases were not statistically significant.

These results also remain in line with national data for Indigenous Australians.

Aboriginal Health #NRW2017 Good News Alert 1 of 2 : Download @AIHW 8th National report Aboriginal health organisations

 ” This eighth national report presents information from 277 organisations, funded by the Australian Government to provide one or more of the following health services to Aboriginal and Torres Strait Islander people: primary health care; maternal and child health care; social and emotional wellbeing services; and substance-use services.

These organisations contributed to the 2015–16 Online Services Report downloadable.

Good News see in full below

Many health promotion group activities were provided, including around 7,600 physical activity/healthy weight sessions, 3,300 chronic disease support sessions and 2,000 tobacco-use treatment and prevention sessions.

With respect to maternal and child health care, around 12,900 home visits, 3,300 maternal and baby/child health sessions, 2,800 parenting skills sessions and 1,000 antenatal group sessions were done.

Download HERE NACCHO Resources 9.7 MB

NACCHO AIHW Aboriginal Health Organisations 2015-16

Or from AIHW website

Information is presented on the characteristics of these organisations; the services they provide; client numbers, contacts and episodes of care; staffing levels; and service gaps and challenges.

Key characteristics

Of the 204 organisations providing Indigenous primary health-care services:

  1. 72% (147) delivered services from 1 site, while 11% (23) had 2 sites and 17% (34) had 3 or more sites.
  2. 67% (136) were ACCHOs.
  3. 78% (159) had a governing committee or board and of these 72% had 100% Indigenous membership.
  4. 79% (162) were accredited against the Royal Australian College of General Practitioners (RACGP) and/or organisational standards.
  5. 28% (57) had more than 3,000 clients (see Table S3.2).

Policy context  : The health of Indigenous Australians

An estimated 744,956 Australians identified as Aboriginal and/or Torres Strait Islander in June 2016, representing 3% of the total Australian population (ABS 2014). In 2011, 10% of the Indigenous population identified as being of Torres Strait Islander origin, and almost two-thirds of the Torres Strait Islander population lived in Queensland.

The Indigenous population has a younger age structure compared with the non-Indigenous population.

In June 2011, the median age of the Indigenous population (the age at which half the population is older and half is younger) was 21.8, compared with 37.6 for the non-Indigenous population.

The birth rate for Indigenous women is also higher (2.3 babies per woman in 2013 compared with 1.9 for all women) (AIHW 2015d).

Most Indigenous Australians live in non-remote areas (79% in 2011); however, a higher proportion live in remote areas (21%), compared with non-Indigenous Australians (2%)

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The gap in health outcomes between Indigenous and non-Indigenous Australians is well documented, especially around life expectancy, infant mortality, child mortality, chronic disease prevalence, potentially preventable hospitalisations and the burden of disease (AIHW 2015a).

For example, a recent burden of disease study found that Indigenous Australians experienced a burden of disease 2.3 times the rate of non-Indigenous Australians, with diabetes 6 times as high.

Chronic diseases were responsible for more than two-thirds (70%) of the total health gap in 2011 and for 64% of the total disease burden among Indigenous Australians in 2011.

The 5 disease groups that caused the most burden were mental and substance use disorders (19% of total disease burden), injuries (which includes suicide) (15%), cardiovascular diseases (12%), cancer (9%) and respiratory diseases (8%).

The same study also suggests that much of this burden could be prevented and reducing exposure to modifiable risk factors may have prevented over one-third (37%) of the burden of disease in Indigenous Australians.

The risk factors contributing most to the overall disease burden were tobacco and alcohol use, high body mass, physical inactivity, high blood pressure and dietary factors (AIHW 2016a).

While there have been improvements in the health and wellbeing of Indigenous Australians, they remain disadvantaged compared with non-Indigenous Australians.

There are a number of interlinking issues that contribute to this gap, including the disadvantages Indigenous people experience in relation to the social determinants of health such as housing, education, employment and income; behavioural risk factors such as smoking, poor nutrition, and physical inactivity; and access to health services (AIHW 2015a).

In addition, a broader range of social and emotional wellbeing issues result from colonisation and its intergenerational legacies: grief and loss; trauma; removal from family and cultural dislocation; racism and discrimination (DoH 2013).

Policy responses

In 2008 a framework was developed to tackle Aboriginal and Torres Strait Islander disadvantage, with 6 targets established to close the gap between Indigenous and non-Indigenous people. These targets were agreed with all states and territories through the Council of Australian Governments (COAG).

National Aboriginal and Torres Strait Islander Health Plan

Following on from the COAG targets, the Australian Government worked with Aboriginal and Torres Strait Islander people to produce the National Aboriginal and Torres Strait Islander Health Plan 2013–2023.

This sets out a 10-year plan for the direction of Indigenous health policy and provides a long-term, evidence-based policy framework to close the gap in Indigenous disadvantage.

The vision outlined in the Health Plan around health system effectiveness is that the Australian health system delivers primary health care that is evidence-based, culturally safe, high quality, responsive and accessible to all Aboriginal and Torres Strait Islander people (DoH 2013).

An Implementation Plan sits alongside the Health Plan, detailing the actions to be taken by the Australian Government and other key stakeholders to implement the Health Plan (DoH 2015b).

It identifies 20 goals to support the achievement of the COAG targets around the effectiveness of the health system and priorities across the life course, from maternal health and parenting, childhood health and development, adolescent and youth health, healthy adults and healthy ageing.

A technical companion document to the Implementation Plan outlines these goals and how they will be measured (AIHW 2015b).

The second stage of the Implementation Plan will be released in 2018 and will further develop actions and goals in the domain of social and cultural determinants of health and health system effectiveness.

It will also seek to increase engagement between Australian Government agencies, state, territory and local governments, the Aboriginal community-controlled health sector, the non-government sector and the corporate/private sector (DoH 2017).

Progress on achieving the Implementation Plan goals will be reported every two years in line with the release of the Aboriginal and Torres Strait Islander Health Performance Framework. The findings will be incorporated into the Department of Health’s Annual Report and will inform the Prime Minister’s annual Closing the Gap report. Progress on the goals will also be publically reported on the DoH and AIHW websites from mid-2017 (DoH 2015b).

The good news

• In 2015–16, 204 organisations provided a wide range of primary health-care services to around 461,500 clients through 3.9 million episodes of care. Over 1 million episodes of care (26%) were in Very remote areas and these areas had the highest average number of episodes of care per client (10). Over time there has been an increase in the average episodes of care per client, from 5 in 2008–09 to 8 in 2015–16.

• Around 7,766 full-time equivalent staff were employed and just over half (53%) were Aboriginal and Torres Strait Islander. Nurses and midwives were the most common type of health worker, representing 15% of employed staff, followed by Aboriginal and Torres Strait Islander health workers and practitioners (13%) and doctors (7%). Nurses and midwives represented a higher proportion of employed staff in Very remote areas (24%).

• Many health promotion group activities were provided, including around 7,600 physical activity/healthy weight sessions, 3,300 chronic disease support sessions and 2,000 tobacco-use treatment and prevention sessions. With respect to maternal and child health care, around 12,900 home visits, 3,300 maternal and baby/child health sessions, 2,800 parenting skills sessions and 1,000 antenatal group sessions were done.

• In the 93 organisations funded specifically to provide social and emotional wellbeing services, 216 counsellors provided support services or Link Up services to around 18,900 clients through 88,900 client contacts.

• In the 80 organisations funded specifically to provide substance-use services, around 32,700 clients were seen through 170,400 episodes of care. Most clients (81%) and episodes of care (87%) were for non-residential substance-use services.

Things to note

• Over half the organisations providing primary health-care services reported mental health/social and emotional wellbeing services as a service gap (54%), and two-thirds (67%) reported the recruitment, training and support of Aboriginal and Torres Strait Islander staff as a challenge in delivering quality health services.

• Some organisations felt clients with high needs had to wait too long for some services, in particular to access specialist and dental services. For example, 53 (28%) organisations providing on-site or off-site access to dental services still felt clients with high needs often had to wait a clinically unacceptable time for dental services.

For most specialist and allied health services, more organisations in Remote and Very remote areas felt clients with high needs had to wait too long to access services.

 

NACCHO Aboriginal Health #NRW2017 Elder Care : Audit report Aged Care services were delivered to 35 083 Indigenous elders

 

 ” Health conditions associated with ageing often affect Aboriginal and Torres Strait Islander people earlier than other Australians.3

This is reflected in the Australian Government policy to provide Aboriginal and Torres Strait Islander people access to aged care services from 50 years old, in comparison to 65 years old for the broader population.

Aboriginal and Torres Strait Islander people are also designated as a special needs group under the Aged Care Act 1997 and all aged care service providers must have regard to the particular physical, physiological, social, spiritual, environmental and other health related care needs of individual recipients.4″

From ANAO Audit report Download here

Dep of Health Audit report Indigenous Aged Care

Image above from here

Background

1. The Australian Government provided $15.2 billion in funding to the aged care sector in 2014–15 and $16.2 billion in 2015–16.

Aged Care services were delivered to 35 083 Aboriginal and Torres Strait Islander people in 2014–15 at an estimated cost of $216 million1 (approximately 1.4 per cent of the total aged care budget).2

2. See above intro 4

3. The Australian Government funds aged care services to assist frail older people, and the carers of frail older people, to remain living at home as well as residential aged care services. The programs funded include:

  • the Commonwealth Home Support Program, which provides entry-level home support for older people who need assistance to keep living independently;
  • the Home Care Packages Program, which provides services tailored to meet individuals’ specific care needs including care services, support services, clinical services and other services to support older people to remain living at home and connected to their communities; and
  • residential aged care, which provides supported accommodation services for older people who are unable to continue living independently in their own homes.

4. Aboriginal and Torres Strait Islander people also have access to aged care services funded through the National Aboriginal and Torres Strait Islander Flexible Aged Care Program (Flexible Program). In 2015–16 funding for the Flexible Program was approximately $37 million, based on agreed funded places rather than occupancy. The Flexible Program aims to provide aged care services that meet the specific needs of Aboriginal and Torres Strait Islander people in a culturally appropriate setting, close to home and community. The majority of Flexible Program services are delivered in regional, remote and very remote locations.5

5. The Department of Health is responsible for leading the development of evidence based policy, determining the allocation of funding, and regulation of the Commonwealth aged care system to improve the wellbeing of older Australians as well as the implementation of the aged care reforms. The Australian Aged Care Quality Agency is responsible for assessing the quality of care of Australian Government funded aged care service providers. This is done through:

  • the accreditation of residential aged care service providers;
  • quality reviews of aged care provided to people living in their own homes or in the community; and
  • education and training on quality aged care to the aged care sector.

Audit objective and criteria

6. The objective of the audit was to assess the effectiveness of Australian Government-funded aged care services delivered to Aboriginal and Torres Strait Islander people. To form a conclusion against the audit objective, the ANAO adopted the following high level criteria:

  • Is there an effective framework in place to support access by Aboriginal and Torres Strait Islander people to quality aged care services?
  • Do the Department of Health and the Australian Aged Care Quality Agency have effective frameworks to oversee the delivery of aged care services to Aboriginal and Torres Strait Islander people?
  • Does the Department of Health have appropriate arrangements in place for monitoring and reporting on the achievement of program objectives and supporting the cost effectiveness and service continuity of aged care delivery to Aboriginal and Torres Strait Islander people?

Conclusion

7. Australian Government-funded aged care services are largely delivered effectively to Aboriginal and Torres Strait Islander people.

8. The ageing of Australia’s population and growing diversity among older people, in terms of their care needs, preferences and socioeconomic status, are placing pressure on the depth and agility of Australia’s aged care system. There are additional challenges in ensuring access to culturally appropriate care and service continuity for Aboriginal and Torres Strait Islander people, particularly for those living in remote and very remote communities. Some Aboriginal and Torres Strait Islander people may also have language or cultural preferences that influence their specific requirements.

9. The National Aboriginal and Torres Strait Islander Flexible Aged Care Program has been effective in increasing the access to culturally appropriate aged care services for elderly Indigenous Australians. The direct selection and recurrent funding approach of the National Aboriginal and Torres Strait Islander Flexible Aged Care Program provides few opportunities for new service providers to enter the market. There would be benefit in the Department of Health extending the application process to new service providers and better aligning the funded places with service capacity.

10. The Department of Health has developed sufficient guidance materials and provides supplementary funding to support Indigenous-focused services that operate under the Commonwealth Home Support, Home Care Packages and residential programs. However, not all Indigenous-focused services are aware of the Department of Health’s sector support programs.6

11. The Department of Health and the Australian Aged Care Quality Agency have been largely effective in their administration of Australian Government-funded aged care services delivered to Aboriginal and Torres Strait Islander people. Each entity has developed sound administrative arrangements to manage the delivery of aged care services and to review the quality of care delivered through aged care programs. The Department of Health can strengthen its administration by implementing a coordinated approach that ensures the timely sharing of relevant information to facilitate risk assessments across the Ageing and Aged Care Group.

12. Consistent with its policy intent, the National Aboriginal and Torres Strait Islander Flexible Aged Care Program is a more cost effective and viable model for specialised aged care delivery to Indigenous Australians when services are located in remote and very remote communities. A 25.8 per cent share of National Aboriginal and Torres Strait Islander Flexible Aged Care Program funding is allocated to services located in major cities and inner regional areas. To optimise recurrent funding decisions, it is important the Department of Health ensures that the existing service providers, their location and number of places, remain the most appropriate.

13. Given that the majority of Aboriginal and Torres Strait Islander people access aged care through Commonwealth Home Support Program, Home Care Packages Program and residential aged care programs, further work is required by the Department of Health to maintain the service continuity of Indigenous-focused service providers in areas where there are no culturally secure alternatives. The Department of Health has an opportunity to leverage its datasets to improve the targeting of sector support initiatives to Indigenous-focused services and to monitor the ongoing impacts of aged care policies and programs on Aboriginal and Torres Strait Islander people.

Supporting findings

Access and use of aged care services by Aboriginal and Torres Strait Islander people

14. Aboriginal and Torres Strait Islander people were most likely to access aged care services through the Commonwealth Home Support Program or the Home Care Packages Program, at rates consistent with their share of the aged care population. Fewer than one per cent of residential aged care places were taken up by Aboriginal and Torres Strait Islander people.

15. The Department of Health has created clear and consistent pathways for individuals to access and progress through the aged care system. The My Aged Care Contact Centre and website are the main entry points to the aged care system. Aboriginal and Torres Strait Islander people are encouraged to connect with the My Aged Care Contact Centre, and can call directly or use a trusted representative to speak on their behalf. Following an initial screening undertaken by Contact Centre staff, the Regional Assessment Service assesses older people’s needs for lower intensity services available under the Commonwealth Home Support Program. Aged Care Assessment Teams assess the more complex needs of people requiring access to higher intensity care available under Home Care Packages, Transition Care, and within residential aged care.

16. A key challenge in targeting aged care services is assessing the eligibility of individuals seeking to access them as well as the scope of services. This can be particularly challenging in the context of facilitating access for individuals in remote or very remote areas, including Aboriginal and Torres Strait Islander people.

17. The Department of Health advised the ANAO that it is working with the aged care sector to identify opportunities to improve client pathways for diverse groups, including Aboriginal and Torres Strait Islander people, to address the specific difficulties they may experience.

18. The Department of Health manages the planning and allocation of aged care residential places and Home Care packages for service providers based on the national planning benchmark, population projections and the current level of service provision. The Commonwealth Home Support Program and the National Aboriginal and Torres Strait Islander Flexible Aged Care Program are funded through a grants process.

19. Between 2012–13 and 2015–16 the number of Home Care Level 1‒2 packages allocated to Indigenous-focused service providers has not grown at the same rate as those allocated to mainstream service providers. However, the growth in Home Care Level 3‒4 package and residential place allocations to Indigenous-focused service providers have both been higher than for mainstream counterparts.

20. The distribution of the National Aboriginal and Torres Strait Islander Flexible Aged Care Program funding has remained largely unchanged since its inception. This is largely due to the continuation of grant agreements to existing services that have been in place over the life of the program. These arrangements limit the potential for new providers to access the program.

21. The Department of Health has developed operational manuals and/or guidelines to support providers in the delivery and management of aged care services for the programs reviewed as part of the audit. The Department of Health also funds two peak bodies to develop additional resources to assist with managing the change introduced by aged care reforms (including resources targeted towards remote and very remote Indigenous-focused service providers).

22. The Department of Health funds a Remote and Aboriginal and Torres Strait Islander Aged Care Service Development Assistance Panel (SDAP) to support aged care providers. ANAO consultations with Indigenous-focussed service providers indicated that awareness of SDAP funding varied across states and territories. There would be benefit in the Department of Health raising the awareness of this assistance in a consistent manner across jurisdictions, and measuring the financial management and governance capacity that has been built and maintained among service providers as a result of having received the funding.

Administration and regulation of aged care services

23. The Department of Health has internal governance committees, templates and guidance to coordinate program administration. Health’s state and territory offices have also adopted various local strategies for engaging with Indigenous-focused service providers. The department has commenced work to strengthen relationships between its National Office and its state and territory offices, to improve links between policy development and program implementation, while still allowing for specific approaches within each jurisdiction.

24. The Department of Health has developed an Enterprise Risk Management Plan that is updated annually as part of the department’s business planning processes. Each of the programs reviewed as part of the audit included risk management (identification, analysis and evaluation) in its business processes. Risk is considered against the type of activity being funded and may result in different risk ratings being given to the same organisation across each activity or program being funded. For service providers that are funded under multiple programs, there is an opportunity for Health to implement a more coordinated approach that facilitates the timely sharing of relevant information across program areas.

25. The Australian Aged Care Quality Agency has developed policies, procedures and guidance materials to support the accreditation of residential aged care service providers, and specific policies for the quality review of Home Care Packages, Commonwealth Home Support Program and National Aboriginal and Torres Strait Islander Flexible Aged Care Program service providers. Documents reviewed by the ANAO demonstrate that the relevant accreditation and quality review procedures were followed internally.

26. The Australian Aged Care Quality Agency has collected information on assessments of all residential service providers against the accreditation standards. This information shows that between 2000-01 and 2015-16, 95 per cent of residential Indigenous-focused service providers had at least one episode of non-compliance, in comparison with 53 per cent of non-Indigenous-focused Residential service providers. Reported instances of non-compliance mostly related to governance, including regulatory compliance, risk management and human resources as opposed to issues relating to quality of care.

27. In 2014–15 the Australian Aged Care Quality Agency delivered 716 courses, seminars and compliance assistance training events to 10 638 participants from residential and Home Care service providers. Flexible service providers receive compliance assistance training as determined through a case management process. There would be benefit in the Australian Aged Care Quality Agency expanding the proposed cost recovery model to include the indirect and direct costs recovered from courses and workshops to be consistent with the Australian Government’s stated policy intention, as well as the Australian Government Cost Recovery Guidelines.