NACCHO #ACCHO Aboriginal Health News : Sir Michael Marmot inspired by Aboriginal community controlled health

 marmot

” I hold no illusions. There are deep-seated structural problems that account for the dramatic life expectancy gap between indigenous and non-indigenous Australians.

But I challenge anyone to come away from a visit to Tharawal and say it is all hopeless. I saw evidence of community empowerment: a community controlling the services needed for its population.

To repeat, funding for services is vital, as are good schools and job opportunities. But here was a centre dedicated to improving things for its own community.

Inspiring, indeed.”

Professor Sir Michael Marmot is Director of the UCL Institute of Health Equity, which works to reduce health inequities through action on the social determinants of health :

NACCHO Thanks Dr Tim Senior for ACCHO promotion

The Institute of Health Equity

It is easy to find accounts of Australian Aboriginal health – strictly Aboriginal and Torres Strait Islanders – that are lacking in hope. The standard narrative is that $billions have been spent, but aboriginal families are characterised by violence, alcohol, drugs, worklessness and high rates of crime.

Billions have been spent and Aboriginal health is bad compared to the non-indigenous population – 11 years shorter life expectancy for men and just under 10 years for women. But a different account says that when people’s lives are characterised by betrayal of trust and systematic destruction of identity and self-worth leading to powerlessness perhaps it is no surprise that this Spiritual Sickness can lead to destructive behaviours.

Money spent is not irrelevant. But the psychosocial issues are central. My starting position is that if communities and individuals are empowered it is more likely that money spent will lead to progress.

On my recent trip to Sydney to give the first Boyer Lecture for the ABC, the Australian Medical Association wrote to ask how could they help.

I said I would like to see examples of doctors in action on social determinants of health. Prof Brad Frankum, President, and Fiona Davies, Chief Executive of the New South Wales Branch of AMA took me to Tharawal Community Centre in Campbelltown, a suburb 50 km South-West of Sydney. Sydney spreads and spreads and spreads…

As I understand it, the two names are emblematic of Australian history. The Tharawal people were the original Aboriginal residents of the area. The Colonial Administration established a settlement named after the Governor Macquarie’s wife, Elizabeth Campbell. Indigenous people make up just over 3% of the Campbelltown population, compared to 1.2% of greater Sydney.

The Centre was an inspiration. I was shown around by two enthusiasts, Aboriginal women, who were key in the administration. I was also greeted by one of the doctors, Tim Senior, with a sign: #Fantasyland (Warren Mundine Q and A)

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The evening before, on ABC Television’s national discussion programme, QandA, I had talked of a fairer distribution of power, money and resources, and was told I was in Fantasy Land. This aboriginal centre was making a difference. It was making fantasy a reality.

Among its many roles is providing medical care:

But it is a prime example of what we mean by doctors working in partnership. As I went round the Centre, I was shown where the ante-natal classes took place, and activities at every stage of the life course: from early childhood to older age:

“Bringing them home” is significant.

A psychologist at the Centre told me that she works with the psychological consequences for children and the family of a child’s removal from home. I asked if she was talking about the stolen generations – Aboriginal children taken from their families between the 1890s and 1970s with the presumed intent of destroying aboriginal culture.

The psychologist said that it is still going on. Children are removed because of family disruption but the consequences are severe.

There is also a variety of services that deal with the reality of people’s needs:

Not to mention subsidised fruit and vegetables to make healthy eating more of a possibility:

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We then came to the part of the Centre that dealt with drug and alcohol problems:

I said to the woman in charge: you must have the toughest job in this whole centre.

No, she said, I have the most rewarding job.

She showed me a painting on the wall. The man who painted this had come to the centre with huge problems of drugs, alcohol and domestic violence. By the time he left, the centre had made a step difference to him. He came back with this painting to say thank you.

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NACCHO #RedfernStatement meeting today : Indigenous Affairs Minister Scullion to face some of his most vocal and influential critics

leaders

“We are looking forward to the workshop and a new narrative moving forward in the way that Aboriginal and Torres Strait Islander Affairs is negotiated,”

“We hope [the workshop] will bring some answers and some new direction, engagement and a new relationship.”

National Congress of Australia’s First Peoples co-chair Jackie Huggins 

Download Redfern Statement here

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“I would like to explore strategies to progress issues outlined in the Redfern Statement — and note there are significant areas in which it aligns with the Government’s Indigenous reform agenda,”

“I share the aspirations outlined in the Redfern Statement and see the workshop as an important step to bring about positive and sustainable change. We must connect through genuine dialogue, and I am looking forward to a continuing and constructive conversation.”

Indigenous Affairs Minister Nigel Scullion will face some of his most vocal and influential critics, when he holds a workshop with Aboriginal and Torres Strait Islanders leaders on the Redfern Statement today reports Anna Henderson on the ABC

NACCHO Aboriginal Health News Alert : Major #Redfernstatement by leadership for #healthelection16

Picture above NACCHO CEO Pat Turner with some of the leaders meeting today

During the election campaign, 18 Indigenous groups, backed by prominent human rights, legal, health and education organisations, launched the Redfern Statement.

The lengthy document called for urgent action to reverse half a billion dollars in federal funding cuts and a review of the way federal funding is distributed.

It further made a case for the inclusion of a specific Closing the Gap target for reducing Indigenous imprisonment.

One of the most controversial proposals was to reverse the Abbott government decision to move the Department of Indigenous Affairs into the Department of Prime Minister and Cabinet.

The statement calls for the department to be re-established and “managed and run by senior Aboriginal and Torres Strait Islander public servants”.

The National Congress of Australia’s First Peoples spearheaded the Redfern Statement, which has suffered significant funding cuts under the Coalition and has had a rocky relationship with the Minister.

But the organisation’s co-chair Jackie Huggins is optimistic about today’s meeting and what it can achieve.

Don Dale triggers new approach

Dr Huggins said the scandal engulfing the Northern Territory youth detention system appeared to have contributed to the Minister’s new approach to the portfolio.

National Congress of Australia's First Peoples co-chair Jackie Huggins speaks.

A number of the positions in the Redfern Statement are at odds with current government policy, but Senator Scullion has stressed his interest in finding common ground.

Dr Huggins has agreed there is room for compromise on all fronts.

“There is room for negotiation tomorrow and into the future,” she said last night.

Senator Scullion released a statement announcing the workshop at the end of last month, and said it will “build on the Government’s reforms” and provide an opportunity for stronger ties with the signatories.

“I would like to explore strategies to progress issues outlined in the Redfern Statement — and note there are significant areas in which it aligns with the Government’s Indigenous reform agenda,” Minister Scullion said.

“I share the aspirations outlined in the Redfern Statement and see the workshop as an important step to bring about positive and sustainable change. We must connect through genuine dialogue, and I am looking forward to a continuing and constructive conversation.”

The National Congress is hoping the workshop will be followed by a meeting with Prime Minister Malcolm Turnbull directly.

Dr Huggins said she thought the Government and Indigenous groups were in agreement on about 80 per cent of the statement.

Statement calls for Indigenous-run portfolio

Dr Huggins said there was a strong case for Indigenous public servants to run a stand-alone portfolio.

“It’s not working at the moment and obviously there is a flaw in the system and we would say certainly, with people who are doing those jobs, in terms of the bureaucracy, in terms of really having the cultural capability to carry out the work that needs to be done, there’s a real bottleneck here,” she said.

“The best way to address it is to employ senior Aboriginal bureaucrats who can transcend the barriers, that know within their own communities what’s happening.”

Former prime minister Tony Abbott carried through an election promise to move Indigenous Affairs into the prime minister’s department.

Mr Abbott promoted Indigenous Affairs to be one of his top priorities and argued the departmental change would ensure the portfolio was given the prominence it deserved.

A number of Abbott government policy and budget decisions face criticism in the Redfern Statement

NACCHO Aboriginal health : #AIHW #AustraliasHealth2016 : What are the health experts saying about the report ?

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” The report has also pointed out ongoing areas of health inequality in Australia, driven by socioeconomic factors and social determinants.

Communities suffering socioeconomic disadvantage continued to have systematically poorer health including lower life expectancy, higher rates of chronic disease and higher smoking rates.

Aboriginal and Torres Strait Islander peoples recorded improved health indicators in some areas, including lower rates for smoking and infant mortality.

However, the report found life expectancy was shorter by 10 years than for non-Indigenous Australians, and Aboriginal and Torres Strait Islander peoples continued to suffer higher rates of diseases such as diabetes, coronary heart disease and end-stage kidney disease.

The impact of risk factors such as smoking, physical inactivity, poor nutrition and harmful alcohol use have been emphasised as significant contributors to Australia’s rising rates of chronic disease.

This is an opportunity for health leaders and the Commonwealth Government to heed the report’s message that lifestyle factors and social determinants are significant contributors to ill-health, and to address the issues of health inequality and the importance of reform across all of our care systems “

AHHA Chief Executive Alison Verhoeven

Download the report here australias-health-2016

 #AIHW and Minister Sussan Ley press releases from launch #AustraliasHealth2016 report

Life expectancy gap between Indigenous and non-Indigenous Australians remains about one decade

The life expectancy gap between Indigenous and non-Indigenous Australians remains about one decade, according to new statistics.

The latest report from the Australian Institute of Health and Welfare (AIHW) said that while health outcomes had improved for Aboriginal and Torres Strait Islander people, they still remain below those of non-Indigenous Australians.

The biennial report, published today, shows Indigenous males born between 2010 and 2012 have a life expectancy of 69.1 years, a decade less than their non-Indigenous counterparts.

The gap for women was slightly lower at 9.5 years.

Between 2009 and 2013, 81 per cent of all Indigenous deaths were of people under 75. This is more than twice the rate of non-Indigenous Australians, which stands at 34 per cent.

The latest statistics come 10 years after the establishment of the Closing the Gap campaign, which aims to end the disparity on life expectancies.

Earlier this year, Prime Minister Malcolm Turnbull pledged that the Government would better engage with Indigenous people in “hope and optimism rather than entrenched despair”.

Indigenous sobriety rate higher than non-Indigenous Australians

While smoking rates have been falling nationally, they remain high among Indigenous Australians, with 44 per cent of Aboriginal and Torres Strait Islander people aged 15 and over describing themselves as a current smoker.

The report states that 42 per cent smoke daily, 2.6 times the rate of their non-Indigenous counterparts.

However, Indigenous Australians drink less alcohol than non-Indigenous counterparts — 26 per cent of Aboriginal and Torres Strait Islander people aged 15 and over had not consumed alcohol in past 12 months.

This equates to a sobriety rate 1.6 times that of non-Indigenous Australians.

Potentially avoidable deaths — categorised as deaths that could have been avoided given timely and effective health care — accounted for 61 per cent of deaths of Indigenous Australians aged up to 74 years between 2009 to 2013.

This was 10 per cent more than their non-Indigenous counterparts.

Australians are living longer than ever but with higher rates of chronic disease, the latest national report card shows.

Reports below from the Conversation

According to the Australian Institute of Health and Welfare’s Australia’s Health 2016 report, released today, Australian boys can now expect to live into their 80s (80.3), while the life expectancy for girls has reached the mid-80s (84.4).

A boy born and girl born in 1890 could only expect to live to 47.2 and 50.8 years respectively. AIHW

The single leading cause of death in Australia is coronary heart disease, followed by:

Grouped together, cancer has overtaken cardiovascular disease (heart disease and stroke) as Australia’s biggest killer. Cancer is also the largest cause of illness, followed by cardiovascular disease:

Burden of disease, by disease group, Australia, 2011 AIHW

Chronic diseases are becoming more common, due to population growth and ageing. Half of Australians (more than 11 million) have at least one chronic disease. One quarter have two or more.

The most common combination of chronic diseases is arthritis with cardiovascular disease (heart disease and stroke):

AIHW

Australians have high rates of the biomedical risk factors that increase the risk of heart disease and stroke. Almost a quarter (23%) of Australian adults have high blood pressure and 63% have abnormal levels of cholesterol.


Lifestyle choices

Fron Jackson-Webb, Health + Medicine Editor, The Conversation

The good news is Australians are less likely to smoke and drink at risky levels than in the past.

Australia now has the fourth-lowest smoking rate among 34 OECD countries, at 13% in 2013. This is almost half that of 1991 (24%).

AIHW

The volume of alcohol Australians consume fell from 10.8 litres per person in 2007–08 to 9.7 litres in 2013–14. This is the lowest level since 1962–63. But 16% of Australians are still drinking to very risky levels: consuming 11 or more standard drinks on one occasion in the past 12 months.

AIHW

Around eight million Australians have tried illicit drugs in their lifetime, including 2.9 million in the last 12 months. The most commonly used illicit drugs are cannabis (10%), ecstasy (2.5%), methamphetamine (2.1%) and cocaine (2.1%).

Use of methamphetamine has remained stable in recent years. However, more methamphetamine users are opting for crystal (ice) rather than powder (speed).

The bad news is Australians are still struggling with their weight. Around 63% are overweight or obese, up from 56% in 1995. This equates to an average increase of 4.4kg for men and women. One in four children are overweight or obese.

Junk foods high in salt, fat and sugar account for around 35% of adults’ energy intake and around 39% of the energy intake for children and young people.

Most Australians (93%) don’t consume the recommended five serves of vegetables a day and only half eat the recommended two serves of fruit. Just 3% of children eat enough vegetables, though 70% consume the recommended amount of fruit.

Almost half (45%) of adults aged 18 to 64 and 23% of children aren’t meeting the national physical activity recommendations. These are for adults to accumulative 150 to 300 minutes of moderate intensity physical activity or 75 to 150 minutes of vigorous intensity physical activity each week. Children are advised to accumulate at least 60 minutes of moderate to vigorous physical activity every day.

Lifestyle choices have a huge impact on the risk of chronic disease; an estimated 31% of the burden of disease in Australia could have been prevented by reducing risk factors such as smoking, excess weight, risky drinking, physical inactivity and high blood pressure.

Proportion of the burden attributable to the top five risk factors

AIHW

Preventing chronic disease

Rob Moodie, Professor of Public Health, University of Melbourne

This report outlines a number of positives in Australia’s health – our life expectancy, the health services at our beck and call, major declines in tobacco and road deaths. We’re doing well, it says, but we could do better.

If we took prevention and health promotion far more seriously, we could do a lot better.

The report nominates tobacco use, alcohol, high body mass and physical inactivity as the chief causes of preventable illness and the chief causes of our increasing level of chronic illnesses. Yet national investment in prevention is declining.


Further reading: Focus on prevention to control the growing health budget


Tobacco use is rapidly declining because of really effective measures (plain packaging, advertising bans and increasing price through taxes) that save lives and enormous amounts of money over a lifetime for people who used to smoke.

However, we can’t seem to make any major dent in the commercial, industrial and lifestyle diseases related to junk food and drinks, harmful consumption of alcohol and car dependency.

We’ve known what will work for many years but the power of some of these unhealthy industries is still overwhelming – a situation in which our politicians fear these industries and their associations more than they fear the voters.

Our collective health would have been much better if we’d been able to follow the guidance of our own national task forces and learnt from other countries. The report card should read, “Doing well, but could have done a lot better”.


Inequities

Fran Baum, Matthew Flinders Distinguished Professor and Foundation Director at the Southgate Institute for Health, Society & Equity, Flinders University

Australia’s Health 2016 shows many Australians are not getting a fair go at health. There is a gradient across society whereby the richer the area you live in, the longer you can expect to live. The difference between the highest and lowest is four years.

Deaths by socioeconomic group: 1 = lowest; 5 = highest

AIHW

The gradient is evident from early life. Children most at risk of exclusion – those from poor areas who experience problems with education, housing and connectedness – are most likely to die before they reach 15 years from potentially preventable or treatable causes.


Further reading: Want to improve the nation’s health? Start by reducing inequalities and improving living conditions


Our most glaring inequity is the ten-year life gap between Aboriginal and Torres Strait Islander Australians and others. Indigenous life expectancy is 69.1 years for males and 73.7 years for females.

Compared with the non-Indigenous population, Indigenous Australians are:

  • 3.5 times as likely to have diabetes and four times as likely to be hospitalised with it or to die from it
  • five times as likely to have end-stage kidney disease
  • twice as likely to die from an injury
  • twice as likely to have heart disease.

Australians living outside major cities have higher rates of disease and injury. They also live in environments that make healthy lifestyles choices harder (such as more difficulties buying fresh fruit and vegetables) and so their risk of chronic diseases is increased.

AIHW

The data on who has private health insurance coverage points to the emergence of a two-tiered health system, where those who can afford to pay receive better access and quality of care. Just 26% of those in the lowest socioeconomic group have cover compared to about 80% of the top group.

Coverage with private health insurance and government health-care cards

AIHW

Cost of care

Professor Stephen Duckett, Director of the Health Program at Grattan Institute

Over the last decade, health expenditure grew about 5% each year, above the 2.8% average growth in Gross Domestic Product (GDP). As a result, health took up an increasing share of GDP.

Spending more on health means Australia spent less on other things. This is not necessarily bad, as long as the benefits from that increased expenditure – such as increasing life expectancy or increased quality of life – are worth the increased costs.

But spending above GDP growth cannot continue indefinitely. And the last few years saw an increase in rhetoric about health spending increases being “unsustainable” from so-called “futurists” and politicians.

Informed commentators have generally rejected the unsustainability claim, some labelling it a “myth”, while others take a more nuanced view.

Australia’s Health 2016 shows a slowing of the real growth rate in the most recent two years to about half that of the previous decade – 1.1% from 2011-12 to 2012-13 and 3.1% from 2012–13 to 2013–14.

Annual growth rates in health expenditure AIHW

This suggests the “unsustainability” rhetoric is at least overblown and potentially prompting budget decisions which are counter-productive, such as introducing a co-payment for general practice.

Commonwealth government expenditure was more or less stable over these most recent two years, declining 2.5% initially then increasing 2.4% in the last year.

Health expenditure by area (adjusted for inflation)

AIHW

Savings to the government came from shifting costs to consumers, by slowing the growth in government subsidies to private health insurers, and also by slowing spending on pharmaceuticals.

This latter slowdown was achieved through tighter controls on payments to drug manufacturers and because some big-selling drugs came off patent, resulting in falls in prices.

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NACCHO Aboriginal Health Alert : #AIHW and Minister Sussan Ley launch #AustraliasHealth2016 report

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 ” A new snapshot of Australia’s health has found we are living longer than ever before, but the rise of chronic disease still presents challenges in achieving equal health outcomes for Indigenous Australians and people living outside metropolitan areas.

Minister for Health Sussan Ley pictured above with Dr Mukesh Haikerwal

Download the Report Here

australias-health-2016

As well as looking at factors influencing individuals’ health, today’s report also examines the health of particular population groups, and shows considerable disparities.

‘For example, while there have been some improvements overall in the health of Aboriginal and Torres Strait Islander Australians—including falls in smoking rates and infant mortality—Indigenous Australians continue to have a lower life expectancy than non-Indigenous.

Indigenous Australians, at 69.1 years for males and 73.7 for females, more than 10 years shorter than for non-Indigenous Australians,’

Indigenous Australians also continue to have higher rates of many diseases, such as diabetes, end-stage kidney disease and coronary heart disease.”

AIHW Director and CEO Barry Sandison

                     AIHW website Australia’s Health 2016

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The Minister today launched the Australian Institute of Health and Welfare’s (AIHW) publication Australia’s health 2016, which provides an update on the health of Australians and the performance of Australia’s health system.

“Australia’s health 2016 shows us that about 85 per cent of Australians rate their health as good, very good or excellent, which is a testament to the significant investment of the Turnbull Government into the health of our nation, with about one-quarter of total government revenue attributed to health spending,” Minister Ley said.

“Our Government’s priority is to ensure the high performance and sustainability of our health system over the long term. This is why the Turnbull Government is working closely with stakeholders to progress a range of health system reforms.”

Total Commonwealth investment in health will grow to more than $71 billion in 2015-16 and this will increase to $79 billion within four years. The Turnbull Government’s investment in Medicare is at $23 billion per year and this will increase by $4 billion over the next four years.

“The report indicates that health outcomes for Australians have improved over time with life expectancy at an all-time high of 80.3 years for males, while a baby girl could expect to live for 84.4 years. Survival rates for cancer are also improving,” Minister Ley said

Minister Ley said that despite plenty of good news on health in the report, managing chronic conditions and their impact on Australia’s health system remained one of our greatest health challenges.

“The report shows that half of Australians have a chronic disease – such as cardiovascular disease, arthritis, diabetes or a mental health disorder – and one-in four have two or more of these conditions,” Minister Ley said.

“This is why our initial investment of almost $120 million in the Health Care Homes initiative is so important. It will help to keep those with chronic conditions healthier and out of hospital. It will give GPs the flexibility and tools they need to design individual care plans for patients with chronic conditions and coordinate care services to support them.

“We recently announced the 10 geographic regions that will deliver Stage One of this important initiative from 1 July next year, and we hope the results will lead more broadly to a better, consumer-focused approach to health care.”

Australia’s health 2016 is available on the Australian Institute of Health and Welfare’s website.

85 out of 100 Australians say they’re healthy—but are we really? AIHW Press Release

Most Australians consider themselves to be in good health, according to the latest two-yearly report card from the Australian Institute of Health and Welfare (AIHW).

The report, Australia’s health 2016 is a key information resource, and was launched today byfederal Health Minister, the Hon. Sussan Ley.

AIHW Director and CEO Barry Sandison said the report provided new insights and new ways of understanding the health of Australians.

‘The report shows that Australia has much to be proud of in terms of health,’ he said.

‘We are living longer than ever before, death rates continue to fall, and most of us consider ourselves to be in good health.’

If Australia had a population of just 100 people, 56 would rate their health as ‘excellent’, or ‘very good’ and 29 as ‘good’.

‘However, 19 of us would have a disability, 20 a mental health disorder in the last 12 months, and 50 at least one chronic disease.’

Mr Sandison said the influence of lifestyle factors on a person’s health was a recurring theme of the report. ‘13 out of 100 of us smoke daily, 18 drink alcohol at risky levels, and 95 do not eat the recommended servings of fruit and vegetables.

‘And while 55 do enough physical activity, 63 of us are overweight or obese.’

Mr Sandison said that while lifestyle choices were a major contributor to the development of many chronic diseases, other factors such as our income, education and whether we had a job—known as ‘social determinants’—all affected our health, for better or worse.

‘As a general rule, every step up the socioeconomic ladder is accompanied by an increase in health.

‘Compared with people living in the highest socioeconomic areas, people living in the lowest socioeconomic areas generally live about 3 years less, are 1.6 times as likely to have more than one chronic health condition, and are 3 times as likely to smoke daily.’

As well as looking at factors influencing individuals’ health, today’s report also examines the health of particular population groups, and shows considerable disparities.

‘For example, while there have been some improvements overall in the health of Aboriginal and Torres Strait Islander Australians—including falls in smoking rates and infant mortality—Indigenous Australians continue to have a lower life expectancy than non-

Indigenous Australians, at 69.1 years for males and 73.7 for females, more than 10 years shorter than for non-Indigenous Australians,’ Mr Sandison said.

Indigenous Australians also continue to have higher rates of many diseases, such as diabetes, end-stage kidney disease and coronary heart disease.

For people living in rural and remote areas, where accessing services can be more difficult, lower life expectancy and higher rates of disease and injury—particularly road accidents— are of concern.

In Australia, health services are delivered by a mix of public and private providers that includes more than 1,300 hospitals and about 385,000 nurses, midwives and medical practitioners.

Of the $155 billion spent on health in 2013–14, $145 billion was recurrent expenditure. Hospitals accounted for 40% of recurrent expenditure ($59 billion), primary health care 38% ($55 billion), with the remaining 22% spent on other health goods and services.

For the first time, the report examines how spending by age for people admitted to hospital has changed over time.

Mr Sandison said the analysis showed that the largest increase in spending between 2004–05 and 2012–13 was for Australians aged 50 and over.

‘This was due to more being spent per person in the population as well as the increased number of people in these age groups.’

Mr Sandison also said that while Australia’s health 2016 provides an excellent overview of Australia’s health at a point in time, there is still scope to expand on the analysis.

New to this edition is information on the changing nature of services provided by publicand private hospitals over the last 10 years; information about how geography affects

Indigenous women’s access to maternal health services; and about the increasing role ofinstitutions such as hospitals and residential aged care in end-of-life care.

‘Good data is essential to inform debate and policy and service delivery decision-making— and improving its quality and availability is at the core of the AIHW’s work.

‘We’re committed to providing meaningful, comprehensive information about Australia’s health and wellbeing—to help create a healthier Australia.’

  • Preliminary material
    • Title and verso pages
    • Contents
    • Preface
    • Acknowledgments
    • Terminology
  • Body section
    • Chapter 1 An overview of Australia’s health
      • Introduction
      • What is health?
      • Australians: who we are
      • How healthy are Australians?
    • Chapter 2 Australia’s health system
      • Introduction
      • How does Australia’s health system work?
      • How much does Australia spend on health care?
      • Who is in the health workforce?
    • Chapter 3 Leading causes of ill health
      • Introduction
      • Burden of disease and injury in Australia
      • Premature mortality
      • Chronic disease and comorbidities
      • Cancer
      • Coronary heart disease
      • Stroke
      • Diabetes
      • Kidney disease
      • Arthritis and other musculoskeletal conditions
      • Chronic respiratory conditions
      • Mental health
      • Dementia
      • Injury
      • Oral health
      • Vision and hearing disorders
      • Incontinence
      • Vaccine preventable disease
    • Chapter 4 Determinants of health
      • Introduction
      • Social determinants of health
      • Social determinants of Indigenous health
      • Biomedical risk factors
      • Overweight and obesity
      • Illicit drug use
      • Alcohol risk and harm
      • Tobacco smoking
      • Health behaviours and biomedical risks of Indigenous Australians
    • Chapter 5 Health of population groups
      • Introduction
      • Health across socioeconomic groups
      • Trends and patterns in maternal and perinatal
      • health
      • How healthy are Australia’s children?
      • Health of young Australians
      • Mental health of Australia’s young people and adolescents
      • Health of the very old
      • How healthy are Indigenous Australians?
      • Main contributors to the Indigenous life expectancy gap
      • Health of Australians with disability
      • Health of prisoners in Australia
      • Rural and remote health
    • Chapter 6 Preventing and treating ill health
      • Introduction
      • Prevention and health promotion
      • Cancer screening
      • Primary health care
      • Medicines in the health system
      • Using data to improve the quality of Indigenous health care
      • Indigenous Australians’ access to health services
      • Spatial variation in Indigenous women’s access to maternal health services
      • Overview of hospitals
      • Changes in the provision of hospital care
      • Elective surgery
      • Emergency department care
      • Radiotherapy
      • Organ and tissue donation
      • Safety and quality in Australian hospitals
      • Specialised alcohol and other drug treatment services
      • Mental health services
      • Health care use by older Australians
      • End-of-life care
    • Chapter 7 Indicators of Australia’s health
      • Introduction
      • Indicators of Australia’s health
  • End matter
    • Methods and conventions
    • Symbols
    • Acronyms and abbreviations
    • Glossary
    • Index

 

 

NACCHO Aboriginal Health News : Minister Scullion to host #RedfernStatement workshop with our leaders

Pat

“Indigenous leaders from the 18 lead organisations that signed the #RedfernStatement have been invited to attend the workshop with Senator Scullion ( including NACCHO )  to discuss key issues including health, early childhood, justice, preventing violence and disability.

These leaders  met on 9th of June 2016, in Redfern where in 1992 Prime Minister Paul Keating spoke truth about this nation – that the disadvantage faced by First Peoples affects and is the responsibility of all Australians. “

Photo above NACCHO CEO Pat Turner addressing the national media ; Redfern Statement details below

The Minister for Indigenous Affairs, Nigel Scullion, will host a workshop with the leaders of key Indigenous organisations that signed the Redfern Statement.

The workshop, to be held in coming weeks, will build on the Government’s reforms over the past three years and provide a valuable opportunity for Indigenous leaders who represent a range of sectors to come together with the Minister to hold strategic discussions about ways engagement within Indigenous Affairs can be further strengthened.

Minister Scullion said the workshop would draw on the skills and expertise that participants brought to the table, and build on his commitment to work with Indigenous people and organisations at all levels – from community and grassroots organisations through to those on the state, territory and national stage.

“I would like to explore strategies to progress issues outlined in the Redfern Statement – and note there are significant areas in which it aligns with the Government’s Indigenous reform agenda,” Minister Scullion said.

“I share the aspirations outlined in the Redfern Statement and see the workshop as an important step to bring about positive and sustainable change. We must connect through genuine dialogue, and I am looking forward to a continuing and constructive conversation.

“I want this workshop to identify ways we can enhance government and community engagement to bring about a real difference on the ground. We are committed to getting this right, learning from the past and building strong relationships for the future.”

The Redfern Statement

An urgent call for a more just approach to Aboriginal and Torres Strait Islander Affairs

“Social justice is what faces you in the morning. It is awakening in a house with adequate water supply, cooking facilities and sanitation. It is the ability to nourish your children and send them to school where their education not only equips them for employment but reinforces their knowledge and understanding of their cultural inheritance. It is the prospect of genuine employment and good health: a life of choices and opportunity, free from discrimination.”

Mick Dodson, Annual Report of the Aboriginal and Torres Strait Islander Social Justice Commissioner, 1993.

The Redfern Statement

Download the 18 Page document here

Redfern Statement June 2016 Elections 18 Pages

Redfern Statement

A call for urgent Government action

In the past 25 years – a generation in fact – we have had the Royal Commission into Aboriginal Deaths in Custody, the Bringing them home Report and Reconciliation: Australia’s Challenge: the final report of the Council for Aboriginal Reconciliation. These reports, and numerous other Coroner and Social Justice Reports, have made over 400 recommendations, most of which have either been partially implemented for short term periods or ignored altogether.

In the last 25 years we have seen eight Federal election cycles come and go, with seven Prime Ministers, seven Ministers for Indigenous Affairs, countless policies, policy changes, funding promises and funding cuts – all for the most marginalised people in Australia.

For the last quarter century, then, we’ve seen seminal reports which have repeatedly emphasised that our people need to have a genuine say in our own lives and decisions that affect our peoples and communities. This, known as self-determination, is the key to closing the gap in outcomes for the First Peoples of these lands and waters.

All of these reports call for better resourcing of Aboriginal and Torres Strait Islander organisations and services for Aboriginal and Torres Strait Islander communities.

All of these reports call for real reconciliation based on facing the truths of the past and creating a just and mature relationship between the non-Indigenous Australian community and the First Peoples.

The next Federal Government will take on the same responsibility to right this nation’s past injustices as the last eight Federal Governments have had. The next Government of Australia will take power with our First Peoples facing the same struggles as they were in 1992. But this next Federal Government also has an unprecedented nation-building opportunity to meaningfully address Aboriginal and Torres Strait Islander disadvantage. They have the mandate to act. We therefore call on the next Federal Government to:

  • Commit to resource Aboriginal and Torres Strait Islander led-solutions, by:
  • Restoring, over the forward estimates, the $534 million cut from the Indigenous Affairs portfolio in the 2014 Budget to invest in priority areas outlined in this statement; and
  • Reforming the Indigenous Advancement Strategy and other Federal funding programs with greater emphasis on service/need mapping (through better engagement) and local Aboriginal and Torres Strait Islander organisations as preferred providers.
    • Commit to better engagement with Aboriginal and Torres Strait Islander peoples through their representative national peaks, by:
  • Funding the National Congress of Australia’s First Peoples (Congress) and all relevant Aboriginal and Torres Strait Islander peak organisations and forums; and
  • Convening regular high level ministerial and departmental meetings and forums with the Congress and the relevant peak organisations and forums.
    • Recommit to Closing the Gap in this generation, by and in partnership with COAG and Aboriginal and Torres Strait Islander people:
  • Setting targets and developing evidence-based, prevention and early intervention oriented national strategies which will drive activity and outcomes addressing:
    • family violence (with a focus on women and children);
    • incarceration and access to justice;
    • child safety and wellbeing, and the over-representation of Aboriginal and Torres Strait Islander children in out-of-home care; and
    • increasing Aboriginal and Torres Strait Islander access to disability services;
  • Secure national funding agreements between the Commonwealth and States and Territories (like the former National Partnership Agreements), which emphasise accountability to Aboriginal and Torres Strait Islander peoples and drive the implementation of national strategies.
    • Commit to working with Aboriginal and Torres Strait Islander leaders to establish a Department of Aboriginal and Torres Strait Islander Affairs in the future, that:
  • Is managed and run by senior Aboriginal and Torres Strait Islander public servants;
  • Brings together the policy and service delivery components of Aboriginal and Torres Strait Islander affairs and ensures a central department of expertise.
  • Strengthens the engagement for governments and the broader public service with Aboriginal and Torres Strait Islander people in the management of their own services.
    • Commit to addressing the unfinished business of reconciliation, by:
  • Addressing and implementing the recommendations of the Council for Aboriginal Reconciliation, which includes an agreement making framework (treaty) and constitutional reform in consultation with Aboriginal and Torres Strait Islander peoples and communities.

The health and wellbeing of Aboriginal and Torres Strait Islander peoples cannot be considered at the margins.

It is time that Aboriginal and Torres Strait Islander voices are heard and respected, and that the following plans for action in relation to meaningful engagement, health, justice, preventing violence, early childhood and disability, are acted upon as a matter of national priority and urgency.

National Representation for Aboriginal and Torres Strait Islander Peoples

It is critical that Australia’s First Peoples are properly represented at the national level to ensure meaningful engagement with Government, industry and the non-government sectors to advance the priorities of our people.

Since 2010, the National Congress of Australia’s First Peoples (Congress) has gone some way to fill the gap in national representation since the demise of the Aboriginal and Torres Strait Islander Commission in 2005.

However, there remain too many gaps in adequate national level representation for Aboriginal and Torres Strait Islander people – particularly for employment and education. Without Congress or equivalent national bodies where Aboriginal and Torres Strait Islander leaders are supported to engage with Government it will be difficult for the next Federal Parliament to meet the multi-partisan priority and commitment to work ‘with’ Aboriginal and Torres Strait Islander people.

We call on the next Federal Government to commit to:

  1. Restoration of funding to the National Congress of Australia’s First Peoples

The National Congress of Australia’s First Peoples (Congress) was established in 2010 to be the representative voice of Aboriginal and Torres Strait Islander peoples and to advocate for positive change. The decision to defund Congress, just as it is beginning to emerge as a unifying element among Aboriginal and Torres Strait Islander groups, is a mistake.

Without support, Congress’ ability to do its job of representing Aboriginal and Torres Strait Islander interests is severely compromised. Congress must be supported to provide a mechanism to engage with our people, develop policy, and advocate to Government.

Congress should be supported to reach sustainability and independence as soon as possible.

 

  1. A national Aboriginal and Torres Strait Islander representative body for Education

Although there are many good quality Aboriginal and Torres Strait Islander organisations, and strong leaders, working at the State and local level in the education sector, there is currently no national body to promote and engage in education policy for Australia’s First Peoples.

The education sector is fragmented across early childhood, primary and secondary education, vocational education and training, and higher education, with each of state and territory having public, catholic and private school systems. In the absence of a single national education voice for Aboriginal and Torres Strait Islander people, Congress has been active in coordinating and promoting unity across these sectors. Congress has consulted widely with its members, educators and organisations, many of which have a long history of working in this area.

We call on the next Federal Government to establish a national body that can call for policies support Aboriginal and Torres Strait Islander students and communities across all of these educational systems.

  1. A national Aboriginal and Torres Strait Islander representative body for Employment

The highly disadvantaged employment and income status of Aboriginal and Torres Strait Islander peoples is well documented. While we appreciate attempts at advancing opportunities for Aboriginal and Torres Strait Islander peoples, the many issues around employment require a unified and expert voice.

Beyond skills training, mentoring and targeted employment services to enhance the job readiness of

Aboriginal and Torres Strait Islander peoples, concerted effort needs to be directed to creating jobs that are suitable and meaningful for our people. This is of particular concern in remote areas, where mainstream commercial and labour market opportunities are limited. In urban and rural areas, Aboriginal and Torres Strait Islander people are faced with issues of racism and discrimination in the workplace.

 

The next Federal Government should establish and fund a national representative body of Aboriginal and Torres Strait Islander leaders to drive employment and economic solutions for our people, in order to:

  • Work with our communities to develop their own strategies for economic development, and promote community participation and management;
  • Promote strategies to create Aboriginal and Torres Strait Islander-friendly workplaces; and
  • Work with Government to design welfare policy that encourages, rather than coerces, Aboriginal and Torres Strait Islander peoples into employment.
    1. A national Aboriginal and Torres Strait Islander representative body for Housing

Federal and State Government policies concerning Aboriginal and Torres Strait Islander housing is currently disjointed, wasteful and failing. For example, Aboriginal and Torres Strait Islander people in urban and regional markets face many barriers in accessing and securing safe and affordable housing, including discrimination and poverty.

The next Federal Parliament should support the development of a national representative body of Aboriginal and Torres Strait Islander leaders who can focus on housing security for Aboriginal and Torres Strait Islander peoples, and:

  • Advocate for the ongoing support for remote communities to prevent community closures;
  • Work with communities to develop a national Aboriginal and Torres Strait Islander housing strategy, with the aim of improving the housing outcomes for our people across all forms of housing tenure; and
  • Provide culturally appropriate rental, mortgage and financial literacy advice.

First Peoples Health Priorities

Closing the Gap in health equality between Aboriginal and Torres Strait Islander people and non-Indigenous Australians is an agreed national priority. The recognised necessity and urgency to close the gap must be backed by meaningful action.

All parties contesting the 2016 Federal Election must place Aboriginal and Torres Strait Islander affairs at the heart of their election platforms, recognising the health equality as our national priority.

Despite the regular upheaval of major policy changes, significant budget cuts and changes to Government in the short election cycles at all levels, we have still managed to see some encouraging improvements in Aboriginal and Torres Strait Islander health outcomes. But much remains to be achieved and as we move into the next phase of Closing the Gap, enhanced program and funding support will be required.

We appeal to all political parties to recommit to Closing the Gap and to concentrate efforts in the priority areas in order to meet our goal of achieving health equality in this generation.

We call on the next Federal Government to commit to:

  1. Restoration of funding

The 2014 Federal Budget was a disaster for Aboriginal and Torres Strait Islander people. This is not an area where austerity measures will help alleviate the disparity in health outcomes for Australia’s First Peoples.

The current funding for Aboriginal health services is inequitable. Funding must be related to population or health need, indexed for growth in service demand or inflation, and needs to be put on a rational, equitable basis to support the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan (2013–2023).

  1. Fund the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan (2013–2023)

Future Budgets must adequately resource the Implementation Plan’s application and operation. As a multi-partisan supported program, the Implementation Plan is essential for driving progress towards the provision of the best possible outcomes from investment in health and related services.

  1. Make Aboriginal Community Controlled Services (ACCHS) the preferred providers

ACCHS should be considered the ‘preferred providers’ for health services for Aboriginal and Torres Strait Islander people. Where there is no existing ACCHS in place, capacity should be built within existing ACCHS to extend their services to the identified areas of need. This could include training and capacity development of existing services to consider the Institute of Urban Indigenous Health strategy to self-fund new services. Where it is appropriate for mainstream providers to deliver a service, they should be looking to partner with ACCHS to better reach the communities in need.

  1. Create guidelines for Primary Health Networks

The next Federal Government should ensure that the Primary Health Networks (PHNs) engage with ACCHS and Indigenous health experts to ensure the best primary health care is delivered in a culturally safe manner. There should be mandated formal agreements between PHNs and ACCHS to ensure Aboriginal and Torres Strait Islander leadership.

  1. Resume indexation of the Medicare rebate, to relieve profound pressure on ACCHS

The pausing of the Medicare rebate has adversely and disproportionately affected Aboriginal and Torres Strait Islander people and their ability to afford and access the required medical care. The incoming Federal Government should immediately resume indexation of Medicare to relieve the profound pressure on ACCHS.

  1. Reform of the Indigenous Advancement Strategy

The issues with the Indigenous Advancement Strategy (IAS) are well known. The recent Senate Finance and Public Administration Committee Report into the tendering processes highlighted significant problems with the IAS programme from application and tendering to grant selection and rollout.

The next Federal Government must fix the IAS as an immediate priority and restore the funding that has been stripped from key services through the flawed tendering process.

  1. Fund an Implementation Plan for the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy

The National Aboriginal and Torres Strait Islander Suicide Prevention Strategy encompasses Aboriginal and Torres Strait Islander peoples’ holistic view of mental health, as well as physical, cultural and spiritual health, and has an early intervention focus that works to build strong communities through more community-focused and integrated approaches to suicide prevention.

The Strategy requires a considered Implementation Plan with Government support to genuinely engage with Aboriginal and Torres Strait Islander communities, their organisations and representative bodies to develop local, culturally appropriate strategies to identify and respond to those most at risk within our communities.

  1. Develop a long-term National Aboriginal and Torres Strait Islander Social Determinants of Health Strategy

The siloed approach to strategy and planning for the issues that Aboriginal and Torres Strait Islander people face is a barrier to improvement. Whilst absolutely critical to closing the gap, the social determinants of health and wellbeing – from housing, education, employment and community support – are not adequately or comprehensively addressed.

The next Federal Government must prioritise the development of a National Aboriginal and Torres Strait Islander Social Determinants of Health Strategy that takes a broader, holistic look at the elements to health and wellbeing for Australia’s First Peoples. The Strategy must be developed in partnership with Aboriginal and Torres Strait Islander people through their peak organisations.

Please note the balance of document can be read here

Redfern Statement June 2016 Elections 18 Pages

NACCHO Aboriginal News Alert : Scullion’s Indigenous policy approach trapped in CLP’s Territory wreck

NT MON

” The overwhelming anti-CLP bush vote wasn’t just Aborigines reacting against four wasted years. The return to Labor was a sophisticated demonstration that a decade after the federal government intervention in the face of a “national emergency” — including a suspension of the Racial Discrimination Act to make it possible — people are sick of having a surveillance-based, punitive regime with uncertain results forced upon them .

The matey, blokey relationship between Scullion and Adam Giles, even as a sizeable sector of the Territory’s indigenous community feared CLP plans to enact changes to the Land Rights Act, will likely not be reproduced with Michael Gunner.

The Australian 29 August picture above NACCHO file : see results of NT election below

Nigel Scullion departs Darwin for Canberra with his Northern Territory Country Liberal Party in smoking ruins and a clear warning that the experiment with a coercive, big-stick approach to Aboriginal and Torres Strait Islander advancement is at an end.

The Indigenous Affairs Minister, who as Territory senator is the CLP’s only representative in the Turnbull government and whose mantra has been mostly “more kids at school, more adults in real jobs”, watched ashen-faced on Saturday evening as the election results came in.

Criticism of Scullion’s handling of his portfolio, already sharp, will increase. A pending Australian National Audit Office review of the Indigenous Advancement Strategy, the government’s centrepiece funding policy, will likely be even more devastating than the recent Senate inquiry into the same vehicle.

That audit is due in December — the Senate inquiry reported in March that the strategy’s 2014 implementation, involving the collapsing of 150 indigenous-specific programs into five streams and the corralling of an $8.6 billion four-year budget into the Department of Prime Minister and Cabinet, had been a shambles.

“It was a bureaucratic process of officers of the department out there deciding what was needed by communities, when in fact … you should be engaging with the community to work out what the community is saying,” Mick Gooda, whose royal commission into juvenile detention in the NT is about to get under way, told the committee.

Which is a key takeaway of Saturday’s vote. The candidates who did best in the bush were those with strong local support bases and who were seen to be listening to communities’ needs. Nor, it should be noted, do people necessarily distinguish between Territory and federal programs and funding.

The matey, blokey relationship between Scullion and Adam Giles, even as a sizeable sector of the Territory’s indigenous community feared CLP plans to enact changes to the Land Rights Act, will likely not be reproduced with Michael Gunner.

The new chief minister will be acutely aware of the indigenous affairs policy landscape that helped get him elected, and surely will be at pains to press Scullion on it.

From the Conversation

Labor easily win the NT election

At the 2012 Northern Territory election, the Country Liberal Party (CLP) won 16 of 25 seats, to 8 for Labor and 1 Independent. During a chaotic term, 4 CLP and 1 Labor members defected to sit as Independents, so the pre-election parliamentary numbers were 12 CLP, 7 Labor and 6 Independents.

At yesterday’s NT election, the ABC is calling 15 of 25 seats for Labor, 1 for the CLP and 3 for Independents, with 6 in some doubt. The ABC’s prediction is 18 Labor, 3 CLP and 4 Independents. Even if Labor loses all doubtful seats, they would still have a clear majority.

Two of the doubtful seats – Blain and Nhulunbuy – are cases where the incorrect final two candidates were selected on election night. The electoral commission will need to redo the two candidate count in those seats. Former chief minister Terry Mills, who was deposed by Adam Giles in the last term, will need a strong flow of preferences from the CLP in Blain.

Giles himself is in trouble in his own seat of Braitling, trailing Labor by 21 votes on a swing of almost 20 points. Former Labor leader Delia Lawrie is likely to hold her seat of Karama as an Independent; she leads by 51.2-48.8.

Overall primary votes were 43.1% for Labor (up 6.6), 31.7% for the CLP (down 18.9), 3.5% for the new 1 Territory Party, 2.8% for the Greens (down 0.5) and 18.9% for all Others (up 9.3). The Others were mostly Independents. The Poll Bludger has a breakdown of the votes and seats for each region.

There are still some booths that have not yet been added to counts, particularly in remote seats. However, most electorates are reporting postal counts, so it is unlikely that the CLP’s position will improve post-election, in the way the Federal Coalition’s position improved. Counting will resume tomorrow morning.

At this election, the voting system was changed to optional preferential voting; previous NT elections used compulsory preferential voting. However, this change appears to have helped Labor. In Braitling, Labor trails by 10.4% on primary votes, but leads by 0.4% after preferences. It is likely that minor party voters who were hostile to the CLP put the CLP last, while those who were better disposed to the CLP followed the CLP’s advice, and just voted “1”.

 

 

NACCHO Health News : Doctor’s peak bodies speak up about problems with My Health Records

AMA Ley PM

” The Federal Government will drive better patient outcomes for Australians living complex chronic illness as part of its Healthier Medicare reform package, by improving digital heath records and data around health outcomes that will make it easier to co-ordinate their care and measure their progress. “

The Hon. Sussan Ley Minister for Health Press release

Doctors and other health workers need to have access to core clinical information in electronic medical records if the Federal Government’s My Health Record system is to deliver an improvement in patient care

Doctors treating a patient need to be confident that they have access to all relevant information, Shared electronic medical records have the potential to deliver huge benefits by giving health workers ready access to critical patient information when it is needed, reducing the chances of adverse or unwarranted treatments and improving the coordination of care.

AMA President Dr Michael Gannon

Pictured above meeting with the Health Minister and Prime Minister in Perth last week

“There is no question that individuals should have access to their own healthcare data but he believes that basic things need fixing first, such as making it easier for GPs to refer patients.

He says the technology was built by software vendors and NEHTA but has been gathering dust over the last few years and there is still no one secure, integrated system of referring people electronically.

“You start electronically, you finish electronically and everything in between is a mish-mash. You change the business model and then it’s really easy to send data to a national repository.”

Dr Pinskier, who chairs the RACGPs expert committee on e-health and practice systems. See full interview below

The AMA Position Statement on Shared Electronic Medical Records 2016 can be found here

Releasing the AMA’s updated Position Statement, Shared Electronic Medical Records 2016, AMA President Dr Michael Gannon said that giving patients the ability to block or modify access to critical information such as medications, allergies, discharge summaries, diagnostic test results, blood pressure and advance care plans compromised the clinical usefulness of shared electronic medical records loaded on the My Health Record system.

“But, if patients are able to control access to core clinical information in their electronic medical record, doctors cannot rely on it.

“Giving patients such control, as the My Health Record system does, is a big handicap to the clinical usefulness of shared electronic medical records.”

The Federal Government launched My Health Record earlier this year to replace Labor’s troubled Personally Controlled Electronic Health Record (PCEHR) system, and trials of its opt-out arrangements are due to commence in mid-July.

But the system, like the PCEHR, gives patients the power to control what goes on the health record, and who can view it.

The AMA said giving patients such control meant the My Health Record would never realise the full benefits of a national electronic health record system.

“All shared electronic health records must include core clinical information that is not subject to patient controls,” the AMA Position Statement said. “Certainty that shared electronic health records contain predictable core clinical information which is not affected, conditioned or qualified by the application of access controls, is critical to the achievement of the legislated objectives of the My Health Record.”

Like its predecessor, the My Health Record system has generated little interest among patients or doctors – in April just 798 health providers had uploaded a shared health summary to the system.

An AMA survey of 658 medical practices, undertaken last month, found GPs were reluctant to take part because of lack of confidence in the reliability of information it contained, combined with little patient demand and an absence of support for practices undertaking the task of creating shared health summaries.

Dr Gannon said the AMA encouraged individuals to take responsibility for their health and strongly supported the idea of a national shared health summary system, but it had to be the right one – one that supports clinical care.

“All health care workers involved in providing clinical care to a patient should have access to core clinical information,” he said. “Where specific information, other than core clinical information, is not made generally available, this should be made clear to treating doctors with a flag on the medical record.”

The AMA added that in ‘break glass’ emergency situations, implied consent must sometimes be assumed to allow access to the full medical record.

The Association said the system should also provide protections for doctors who acted in good faith but missed or were unable to locate critical data “because it is buried in a sea of electronic documents”.

Dr Gannon said shared electronic medical records should not be treated as a replacement for a patient’s medical record, and should not be treated as the single and definitive source of ‘truth’ regarding clinical information about a patient.

But he said it was an extra source of information, accessible at the point of care, that may otherwise have not been available.

My Health Record: Medics speak up

As the new trials of the My Health Record roll out in Queensland, NSW, WA and Victoria, Government News asks clinicians what might help – or hinder – the progress of the revamped national individual electronic health record.

A bit of history

The idea of a national individual electronic health record has been around for decades, routinely popping up in report recommendations from government health agencies.

It was an idea former Prime Minister John Howard helped spread and one the National Electronic Health Transition Authority (NEHTA) was set up to drive in 2005.

Labour introduced the Personally Controlled Electronic Health Record (PCEHR) in 2012 after two years of GP trials.

But from its inception, the electronic health record has been dogged with problems and fraught with complexities and it still has not had the uptake needed to fulfil the vision of a concise patient record available in an emergency.

Academic Dr Helen Cripps compared the Australian e-health experience to that of Slovenia in her 2011 research paper The Implementation of electronic health records: a two country comparison, and found Australia was making much slower progress.

In it, she lists a whole host of reasons for Australia’s sluggish progress in e-health: the country’s complex health care system, with state and federal involvement and a large private health sector; uneven adoption by clinicians;  problems securely sharing data electronically between GPs and other clinicians; the proliferation of different electronic health record formats and systems; fears about data protection and patient privacy; a lack of national direction; the cost of infrastructure, maintenance and training and a disconnect between government-led implementation and software vendors.

The new Australian Digital Health Agency opened its doors on July 1, and appointed ts first CEO UK digital whizz Tim Kelsey. It is a clear sign that e-health is seriously back on the government’s agenda but what about the clinicians the government is relying on to make the record valuable?

Both Dr Nathan Pinskier, Chair of the Royal Australian College of General Practitioners (RACGP) and Dr Tony Bartone, Vice President of the Australian Medical Association (AMA), have weathered the vicissitudes of the electronic health record over the years.

They spoke to Government News about what pitfalls should be avoided this time around and where the road to success lies.

Dr Pinskier, who chairs the RACGPs expert committee on e-health and practice systems, says there is no question that individuals should have access to their own healthcare data but he believes that basic things need fixing first, such as making it easier for GPs to refer patients.

At the moment, when doctors want to refer patients, for example to specialists, physios and hospitals, they must wrestle with a number of different electronic systems (including Argus, HealthLink and MEDrefer), as well as using fax machines, scanners, emails and letters.

He says the technology was built by software vendors and NEHTA but has been gathering dust over the last few years and there is still no one secure, integrated system of referring people electronically.

“You start electronically, you finish electronically and everything in between is a mish-mash. You change the business model and then it’s really easy to send data to a national repository.”

Prescription for change  

Data quality

Both clinicians say that the value of My Health Record will not be fully realised until there is decent data quality and coverage so that health providers can feel confident using the information.

Dr Pinskier says there are currently eight sources of data within the My Health Record and patients can also add their own data. Instead, he suggests homing in on the most vital pieces of information: bad reactions to medicines, current medications and allergies.

He recalls a hospital doctor searching through a jumble of sometimes conflicting records to find out what medication an out-of-town patient was on. The doctor eventually gave up and phoned the patient’s pharmacist.

“What’s the value if you have all these lists for providers to spend hours trawling through the records?” he asks.

Dr Pinskier says it is worth looking at alternatives, citing international examples such as Boston Open Notes, where local records of healthcare providers are made available to consumers. The patient sees exactly what the healthcare provider sees, which can also help reinforce medical advice, for example about how to take medication.

He says Scotland’s Emergency Care Summary is a good example of how local records work, calling it “simple, effective and functional.” The summary lists essential details such as a person’s name, age and GP and their medications, allergies and bad reactions to medicines, extracting the information from GP records.

“There is one source of truth, which is highly accurate and repeatedly uploaded to a national system. That is certainly regarded as a preferred model,” Dr Pinskier says.

Dr Bartone, Vice President of the nation’s peak body for GPs, agrees that the success of the individual electronic health record relies on good data and not just from GPs, who he says have always been “ahead of the curve” and early adopters of e-health.

The record also relies on getting good information from allied health providers, pharmacies and hospitals, amongst others, in order to get a useful medical summary. This could include pathology results, diagnostic imaging, immunisation, Medicare and Pharmaceutical benefit claims, organ donation, medication and advanced care directives.

He says records are not expected to be as detailed as those held by GPs, but a reliable, secure and useful summary.

“All of these things go into making up the record but at the moment we have got a situation where some hospitals’ IT platforms won’t allow them to upload information. For example, in Victoria whereas some hospitals were able to upload data right now,” Dr Bartone says.

“It’s about an emergency situation where the patient is unknown to the doctor who needs to get some information on them in a hurry. It’s never going to replace the GPs file … it’s not designed to be that.

“You don’t need all these details. Other providers need a snapshot of medications, tests and conditions; then they will move on.”

A Department of Health spokesperson said that the quality of information uploaded to the My Health Record system reflected the quality of the records kept in local clinical information systems.

“It is the responsibility of healthcare providers and is part of their professional standards that they keep accurate and up-to-date records about their patients,” said the spokesperson. “It is anticipated that records which are accessible by both patients and other healthcare providers treating that patient will see an improved quality over time.”

Getting clinicians on board

Dr Bartone believes the work needs to be clinically-led and the scheme’s practical implications for clinicians, such as cost and increased workload, properly thought through and addressed.

He says there has been a lack of engagement with clinicians, caused by “too many people with various agendas pushing different methodologies and ideas” holding the process back so that it failed to deliver enough value to consumers.

Although medics were consulted initially under the PCEHR, Dr Bartone believes this fell by the wayside when the project was delivered, with little thought to how it would actually work on the ground.

“They expected patients to be registered by doctors in their waiting rooms. That’s a cumbersome and difficult process and these are busy places,” he says.

“There was no awareness that this would impose a workload, red tape and duplication. There was lots of money but it wasn’t going to the right people.”

The results so far have been questionable in terms of outcomes and performance.

“The need to have a robust and reliable individual electronic health record is without question,” Dr Bartone says. “The issues thus far have been in terms of scope and implementation: how and who is controlling it and how it would be rolled out.”

But he says offering GPs payments to register a certain number of patients (which has been announced as policy) and making the scheme opt-out for patients, rather than opt-in (which has not, as yet), were both be good ideas.

The My Health Record trials have been a mixture of opt-in and opt-out, to test the public’s response. While the Nepean and Queensland trials were opt-out, two earlier trials in Western Australia and Ballarat, Victoria were opt-in.

Dr Bartone says it is imperative that the back-end of the system is easy for doctors to navigate and does not involve duplication of effort – which he says had only recent been possible through new software – so it does not impose an additional burden on doctors.

“There’s been lots of good will invested over the last four or five years. That will run thin if there are any further problems,” he says.

Another discouragement for doctors to use My Health Record has been anxiety that they may be prosecuted under privacy legislation for accessing or sharing information, a fear which Dr Bartone says resulted in disillusionment, even for rusted-on fans of electronic health records.

Government News put these concerns to the federal Department of Health.

A departmental spokesperson said the My Health Records Act 2012 specifically authorised the collection, use and disclosure of health information in the My Health Record so that there would be no breach of the Privacy Act 1988.

“This means that treating healthcare providers can access and use an individual’s My Health Record for healthcare purposes,” the spokesperson said.

The spokesperson said the penalties for unauthorised collection, use or disclosure of data – which can be up to $540,000 or two years’ imprisonment – did not apply to accidental misuse. Patients are also able to restrict or remove documents in their My Health Record.

“For example, if a healthcare provider inadvertently or accidentally accesses an individual’s My Health Record – they are not liable for a civil or criminal penalty,” said the spokesperson.

Healthcare providers can use their judgement about what they upload onto an individual’s My Health Record.  There is nothing in the My Health Records Act 2012 that requires them to upload if they choose not to.

Dr Pinskier says that some of the difficulty getting a national e-health record off the ground stems from earlier efforts to appease everybody, patients and multiple healthcare providers, ending in an extremely complex system.

The national individual electronic health record became a hybrid of a clinical and consumer record, without quite meeting the requirements of either, he says.

“I think we need to go back to basics and ask what we want to achieve – what’s its core purpose?

“We are not addressing the questions of utility and functionality. There is still a really good opportunity to see what is it we’re trying to achieve, how best to achieve it and the steps needed to do it.”

He is emphatic about how this should be done.

“This is not a technological questions, it needs to be clinically led,” Dr Pinskier says. “We need to start again but we need the key clinical stakeholders involved and the clinical community needs to be listened to.”

My Health Record trials

Opt-in trials began in July in Ballarat, Vic and Western Australia. The Ballarat Health Service help patients register when they are admitted to hospital and their discharge summaries are uploaded to My Health Record.

In Western Australia, the trial involves helping chronically-ill patients register at selected practices and modifying chronic disease management software. This will give treating healthcare providers, including specialists and allied health professionals, access to patients’ My Health Records using connected software.

Opt-out trials are underway in the Nepean Blue Mountains area and Northern Queensland.

The Department of Health says the trials are being conducted to gauge consumer reaction to an opt-out system of participation, as well as looking at healthcare provider use and how much clinical information is uploaded to the My Health Record when most patients have a My Health Record.

Federal Health Minister Sussan Ley announced last month that the number of My Health Records in Australia had surpassed four million, with an average of 2,200 new registrations every day in the preceding four weeks.

“With changes to the General Practice Incentive, healthcare providers are increasingly contributing and viewing on-line health information about their patients,” Ley said. “We are now seeing one upload of clinical health information from a healthcare provider every 21 seconds.”

Ley says that every day, one in five GPs saw a patient for whom they have little or no information but My Health Record would change that.

“This may be a Medicare claim or pharmacy prescription, or clinical information uploaded by other healthcare providers such as a specialist, hospital and pharmacy,” Ms Ley says.

“With a My Health Record, both a patient and their healthcare professional can gain immediate access to important health information on-line.

“This can improve co-ordinated care outcomes, reduce duplication and provide vital information in emergency situations.

Ley says My Health Record puts the power in the hands of health consumers to decide who they shared their health information with.

Patients can register through MyGov for a My Health Record online and then link the two.

NACCHO Aboriginal Health News: PM and Health Minister take action on Indigenous #suicideprevention

PM

” In any other country, in any other part of the world these statistics would be a cause of national shame and soul searching,

“And quite frankly, if these numbers applied to any group of non-indigenous kids in Sydney or Melbourne, there would be pages of newspaper print and no amount of money, resources or political effort spared to address the issue.

It’s time there was a full Royal Commission into failings in the system that are driving so many people in our communities to such levels of despair that suicide is the only answer; and into what systemic changes we need to put in place to reverse such appalling statistics.”

Matthew Cooke NACCHO Chair Press Release

” The rate of suicide among young Indigenous men is the highest in the world, according to a new report highlighting the challenges facing young Australians.

The index helps formulate youth development policy in the domains of education, health and wellbeing, employment as well as political and civic participation, measured across 16 key indicators “

The first ever Australian Youth Development Index (YDI) was compiled as part of International Youth Day.

Download the report here Australian_Youth Index 2016

“We must, as a nation, address the tragic over-representation of suicide rates in remote and indigenous communities such as the Kimberley, where the age-adjusted rate of suicide is more than six times the national average.

The Kimberley trial site will help us develop a model of suicide prevention we can tailor specifically to the unique and often culturally-sensitive requirements of remote and indigenous communities “

Health Minister Sussan Ley Press Release : Suicide prevention trial for Kimberley region Press Release :

Photo above : The Prime Minster “tweeting” his meeting with Professor Pat Dudgeon in Perth last week the challenge of Indigenous suicide

The Turnbull Government will establish a landmark suicide prevention trial site in Western Australia’s remote Kimberley region, helping lead the way in tackling suicide rates in indigenous communities across the country.

This is part of the additional $192 million we committed during the election and is one of 12 suicide prevention trial sites, and is on top of the bold reforms we had already set in motion last term.

We are a Government dedicated to action on improving the mental health of the nation and reducing suicide rates, and our announcements supporting indigenous and remote communities, youth and veterans in recent days demonstrates that.

We must, as a nation, address the tragic over-representation of suicide rates in remote and indigenous communities such as the Kimberley, where the age-adjusted rate of suicide is more than six times the national average.

The Kimberley trial site will help us develop a model of suicide prevention we can tailor specifically to the unique and often culturally-sensitive requirements of remote and indigenous communities

The Country WA Primary Health Network (PHNs) will commission the Kimberley suicide prevention trial, and follows on from the appointment of the Perth South PHN to lead similar trials into youth and indigenous suicide.

These trials will bring together best practice, expertise and local knowledge to tailor mental health solutions specific to their community needs. Commissioning them through local PHNs will ensure a focus on community education, integrating services at the local level and post-discharge follow up.

Consultation and collaboration is critical, with involvement from communities, elders, carers, local services, state government programs, health professionals and community health workers all essential if we are going to seriously tackle suicide prevention in high risk groups.

Health is a number one priority for the Coalition and we will leave no stone unturned in our effort to address the causes and impacts of suicide on our communities.

It is part of the Turnbull Government’s broader reform agenda to deliver stronger, more effective primary health care with a focus on person-centred care, delivering services that start with early intervention and prevention, regionally focussed, integrated and utilising digital technology.

Suicide rate for young Indigenous men highest in world, Australian report finds

The rate of suicide among young Indigenous men is the highest in the world, according to a new report highlighting the challenges facing young Australians.

The first ever Australian Youth Development Index (YDI) was compiled as part of International Youth Day.

The index helps formulate youth development policy in the domains of education, health and wellbeing, employment as well as political and civic participation, measured across 16 key indicators.

It rates a state or territory’s performance with a score between zero and one, with one being a perfect score.

Among the reports findings were alarming statistics on youth suicide, which showed Aboriginal and Torres Strait Islander men between 25 and 29 had the highest suicide rates in the entire world.

“What that says is that we as a country are failing that particular group of young men,” Youth Action chief executive Katie Acheson said.

“When we look at all the countries that are measuring suicide rates it is shocking that Aboriginal males are so stigmatised and that number is so high.

“We have to do something now.”

If you or anyone you know needs help:

The index found Tasmania and Queensland recorded an increase in suicide rates despite national rates remaining steady.

Health and wellbeing registered the most significant deterioration over a 10-year period, with the index’s authors attributing that to mental health issues and the increasing use of alcohol and other drugs.

Overall, the Australian Capital Territory had the highest YDI score at 0.851, while the Northern Territory had the lowest score at 0.254.

Research finds youth are struggling to gain employment

The report also found employment opportunities for young people had declined in every state and territory, with the NT recording a drop of 80 per cent since 2006.

It also found that in all states and territories, the percentage of young people not engaged in education, employment or training was significantly higher for rural youth than for those in the cities.

“What was really interesting is that there’s a really huge gap between rural and urban areas, so young people in urban areas are more likely to get a job and have education opportunities,” Ms Acheson said.

“Young people in regional areas have far greater inequality in that their access to education and employment is much worse than those young people in the city.”

However, the report suggested political participation by young Australians had grown.

“The data is saying that in some areas we’re doing pretty well, so political participation in Australia has gone up since 2006,” Ms Acheson said.

“Pretty much everywhere we’ve seen an increase in young people having more of a voice and taking more action.”

Australia’s Youth Development Index ‘very high’ in global terms

The index took information from the Australian Bureau of Statistics, including census data, as well as figures from health and education departments, such as NAPLAN data.

The report also found that despite a high level of youth development in Australia compared to other nations, there were gaps at a regional level, between city and country and Indigenous and non-Indigenous youth.

It also found that many important youth issues were not measured by data or were measured but those figures were not readily available or comprehensive enough for analysis by indexes such as the YDI.

Nonetheless, in a global context, Australia’s YDI was considered “very high”.

The report also found that Australia had improved in all domains except youth health and wellbeing, where it had gone backwards, against the global trend.

The report said the Northern Territory had the highest proportion of young people in its population out of any state or territory — around one in every three people — but had managed to register the biggest improvement in its performance over the 10-year period, with a 30 per cent increase in its overall YDI score.

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NACCHO News Alert : Newly elected Federal Govt. needs to commit to #WeAreIndigenous Health and Education

FNQ

” The International Day of the World’s Indigenous Peoples  was an opportunity for Australians to compare and contrast the position of Aboriginal and Torres Strait Islander peoples with Indigenous peoples in other countries.

Unfortunately, it falls at a time which Aboriginal and Torres Strait Islander leaders describe as a low ebb in Indigenous Affairs in Australia.

While the disparities in life expectancy and health and education outcomes of First and non- Indigenous Australians is well known, for the past several years we see that the gap stubbornly remains ever present.”

The National Congress of Australia’s First Peoples see both press releases below

PICTURE ABOVE : HEALTH and Education at  Apunipima Cape York Health Council Aboriginal Community Controlled Health SEE NACCHO TV

We have successive governments who say they are committed to Constitutional Reform to recognize Australia’s First Peoples, nevertheless show no leadership in achieving this goal.( See Below)

In spite of these and other demoralising recent events, the National Congress of Australia’s First Peoples is cautiously optimistic that with political will, the situation can be turned around.

The appalling treatment of juvenile detainees in the Northern Territory serves to remind Australians of the hugely disproportionate incarceration rate of Aboriginal and Torres Strait Islander people of all ages.

Meanwhile, media commentators like Bill Leak contribute to deteriorating race relations by publishing overtly racist cartoon in the national press.

  • What is the Australian Government’s track record in these events?
  • We have a batch of new senators baying for the repeal of Section 18C of the Racial Discrimination Act.
  • We have a Minister for Indigenous Affairs who openly says that reports of what might fairly be described as torture of juveniles did not pique his interest.
  • We have cut backs in expenditure for Indigenous programs to the tune of half a billion dollars.
  • We have a Prime Minister who having promised to work collaboratively with Aboriginal and Torres Strait Islander peoples, appointed a Royal Commissioner in a knee-jerk manoeuvre without any consultation whatsoever, only to have him resign after four days.

We call on the Commonwealth to commit to:

  • Meet with representatives chosen by Aboriginal and Torres Strait Islander peoples within the first hundred days of the new parliament in a National Summit to reset the relationship with Aboriginal and Torres Strait Islander peoples.
  • Implement the United Nations Declaration on the Rights of Indigenous Peoples, and
  • Adopt the Redfern Statement as a blueprint for improving race relations and the well-being of Aboriginal and Torres Strait Islander peoples.

This year, the theme of the International Day of the World’s Indigenous Peoples is education. The National Congress believes that education is key to the long term well-being, prosperity and integration of Aboriginal and Torres Strait Islander peoples in Australia’s social, political, economic and cultural life.

In particular, we call upon all educational institutions to be mindful of Articles 14 and 18 of the UN Declaration on the Rights of Indigenous Peoples which specifies: Indigenous peoples have the right to establish and control their educational systems and institutions providing education in their own languages, in a manner appropriate to their cultural methods of teaching and learning.

Indigenous individuals, particularly children, have the right to all levels and forms of education of the State without discrimination.

States shall, in conjunction with Indigenous peoples, take effective measures, in order for Indigenous individuals, particularly children, including those living outside their communities, to have access, when possible, to an education in their own culture and provided in their own language.

Indigenous peoples have the right to participate in decision-making in matters which would affect their rights, through representatives chosen by themselves in accordance with their own procedures, as well as to maintain and develop their own indigenous decision-making institutions.

This does not mean assimilationist education, but involving Aboriginal and Torres Strait Islander parents, carers, Elders and community leaders in all aspects of the education enterprise but particularly curriculum and teaching.

Only by making education culturally supportive and meaningful can we close the gap in education outcomes.

As a nation we could proudly recognize Aboriginal and Torres Strait Islander culture as our foundation and an important component of the national heritage.

A win-win outcome awaits us. All we need is courage and commitment, beginning with that of our elected representatives in the national parliament.

National Congress welcomes the Referendum Councils decision

The National Congress of Australia’s First Peoples has welcomed the decision of the Referendum Council to proceed with the Indigenous consultations for First Nations Peoples and ensuring there will be enough time for people to be informed and are able provide their views.

National Congress Co Chairs Mr Rod Little and Dr Jackie Huggins have had great concerns as there has been no time for a proper informed discussion on what this will mean for First Nations Peoples.”

“We have not had the debate; we have not had the conversations.

“It has taken a long time and people are concerned about that.” Dr Huggins said.

Both the Expert Panel and the Joint Select Committee on Constitutional Recognition Reports have been delivered, a significant body of work with a number of recommendations.

“As yet there has been no response at all from government to any of these reports.

“It would have been immensely useful to have some parameters within which to frame these discussions,” Mr Little Said.

The National Congress has committed itself to ensuring that our people are informed consulted and have a say in this process.

 

NACCHO #PCHCH Health Care Homes News : What can #PCHCH learn from our #ACCHO model ?

health

“Learning from Aboriginal Community Controlled Health Organisations:

ACCHOs have very successfully looked beyond the biomedical approach to health and reduced cultural and financial barriers to primary care. We should not ignore local examples of what works but rather look to implement them more widely.

Building the take-up of evidence-based models: A commitment to the continued development and implementation of the PCHCH model beyond the three-year pilot is essential. What is needed is an embedded commitment to innovation and a culture of continuous improvement, rather than the stop-start approach of a limited pilot program.”

Lesley Russell is an Adjunct Associate Professor at the Menzies Centre for Health Policy at the University of Sydney.

Originally published INSIDE STORY

See NACCHO HOME CARE Articles HERE

Copyright Congress

Earlier this week a diverse panel of healthcare stakeholders – including medical professionals, academics and consumer representatives – released a report spelling out how a “patient-centred health care home” model, or PCHCH, should develop in Australia.

The “home” in this case is a healthcare practice of primary care providers (usually headed by GPs), and the aim is to provide care that is patient-centred, team-based, comprehensive, and coordinated. These characteristics are what we all want; they are especially important for people with complex medical problems.

The panel was responding to sketchy details the Turnbull government has released in recent months about its Health Care Homes plan, which was originally proposed in a report by its own Primary Health Care Advisory Group in December last year. That group had been asked to examine opportunities for better management of people with complex and chronic diseases, and had put forward just one option: an Australian version of the PCHCH scheme operating in the United States. (It’s not clear whether the group was asked to focus on this option and, if so, why use wasn’t made of earlier work on such a proposal commissioned by the Department of Health when Tanya Plibersek was health minister.)

Reflecting the push for change, the April meeting of the Council of Australian Governments, or COAG, coupled an increased federal government focus on primary care services with extra funding for hospitals as a way of preventing unnecessary hospitalisations for people with complex and chronic diseases. The accompanying heads of agreement contained the first mention of Health Care Homes, providing details of a pilot program that would begin in July 2017 and run for three years. A contemporaneous media release from the prime minister and the health minister made the broad details public.

In May, the initiative was funded to the tune of $21.3 million in the 2016–17 budget, but no further details were released. Although the proposal was positively received, important questions remained about how the model (or models) would be developed, implemented, funded, evaluated, adjusted and expanded. Those questions are still unanswered. What we do know is that whatever the federal health department has in mind has been developed with minimal public consultation. The timelines for the pilot are unreasonably short, and the process of getting stakeholders involved is now urgent.

It’s this sequence of events that drove the panel to hold its roundtable in early July and produce this week’s report. Clear definitions and goals will be essential if we are to know whether this new model of care is working, and perhaps the most important thing the panel did was to define the core elements of an Australian PCHCH. This model of care is already operating elsewhere, especially in the United States, but the approach must be adapted to Australian needs.

The roundtable saw the key elements as:

  • patient-focused care with patients as informed and active partners,
  • comprehensive multi-disciplinary team-based care,
  • coordination of care across the care delivery system,
  • accessibility for patients using multiple communication modes,
  • evidence-based care and data-driven quality improvement,
  • payment models that support all of these elements.

Given that none of these elements exists comprehensively at the moment, the task of transforming general practices to PCHCHs will be significant. New infrastructure and improved e-health services are needed, as are additional staff with better training and skills in multidisciplinary care, increased patient and community involvement, and new Medicare payment mechanisms. The model/s to be tested should be sufficiently flexible to meet local needs, and increased resources will be needed in underserved areas.

The size of the task is greater than the federal government might imagine because the panel made important recommendations about the scope of the scheme. It recommended that PCHCH should be available to all Australians, not just those with chronic and complex conditions. This is sensible: it makes no sense for practices to wait until patients are really sick before offering them the best model of care.

The panel also highlighted the need to go beyond simply providing clinical services, and to ensure that patients have access to the social determinants of health: safe housing, good nutrition, home-based care as needed, transport and social interactions. And it argued that PCHCHs should be embedded in the local healthcare systems, with strong links to the Primary Health Networks and hospitals.

Delivering this new model of care will require fundamental changes. PCHCHs are not just general practices with add-ons. The two biggest barriers are likely to be finding a payment system that works and is acceptable to providers, and driving the necessary changes in culture.

The roundtable panel argued that a new payment system must reward quality, comprehensiveness and continuity of care, respond to context, and safeguard against cost-shifting and other perverse incentives such as under-treatment and “cherry picking” patients. Regrettably, it didn’t take the next step and outline the details of such a scheme. While there is a willingness on the part of medical professionals to look beyond fee-for-service, in reality there will be many challenges and barriers – and there are no great success stories to draw on from earlier Australian trials or from overseas.

All of which highlights how important cultural change will be. Partly, it will be a matter of developing a common language that is relevant to patients. Innovative leaders in the clinical world and the community must be used to be exemplars and advocates, and the government will need to invest additional resources to assist those areas where there are low levels of change readiness.

The panel’s report did not address a number of areas where more work will be needed. These include:

Encouraging enrolment: The government’s original proposal was to allow voluntary enrolment in a Health Care Home. To achieve the goals of coordinated and continuous care, though, there needs to be a formal doctor–patient relationship. This could be achieved by giving patients incentives to enrol rather than making it compulsory.

Outlining the full range of services to be provided, and dealing with out-of-pocket costs: If the focus of the PCHCH is to be on the whole patient, then integrating mental health and substance-abuse services is essential. Other needed services include pharmacy, dental, eye and hearing and a range of allied health care. These need not be co-located, but must be readily accessible and affordable. The roundtable report doesn’t mention the need to link in community-based specialist services, and it fails to address the consequences for the effective implementation of the PCHCH model if patients’ out-of-pocket costs for primary and specialist care continue to grow at the current rate.

Working with the wider health and social welfare system: The panel recognises the need to provide these services but doesn’t detail how this could be facilitated. One approach is to use Community Health Workers: these frontline public health workers have a close understanding of the communities in which they work and generally share the language and culture. Because they have trust and relationships, they can act as advocates and intermediaries between health and social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.

Learning from Aboriginal Community Controlled Health Organisations:

ACCHOs have very successfully looked beyond the biomedical approach to health and reduced cultural and financial barriers to primary care. We should not ignore local examples of what works but rather look to implement them more widely.

Building the take-up of evidence-based models: A commitment to the continued development and implementation of the PCHCH model beyond the three-year pilot is essential. What is needed is an embedded commitment to innovation and a culture of continuous improvement, rather than the stop-start approach of a limited pilot program.

Using data effectively and measuring success: The Australian healthcare system is notorious for collecting data and failing to use it to maximum effect. In designing the PCHCH model/s it will be imperative to have agreement on the most appropriate performance indicators. The data can then measure improved patient outcomes, indicate where efforts should be targeted, and benchmark quality and safety. This information can be fed back into the system at all levels.

Meeting reasonable expectations about funding and the time needed to deliver results: The roundtable didn’t comment on the government’s unrealistic funding and timing expectations. Even given the limited scope of the proposed trial (65,000 patients in 200 practices), $21 million over four years is minimal. A draft version of the COAG agreement, which doesn’t appear to be publicly available, stated that the Commonwealth would keep back $70 million annually for efforts to reduce avoidable hospitalisations and improve quality and safety, and intimated that the states and territories and private health insurers would also make contributions. This has not been further discussed, however.


The federal government expects to have an evaluation of the PCHCH pilot available to inform the next agreement on public hospital funding in 2018. That’s far too soon for any meaningful results. Done well, this is a more expensive model of primary care and the investment will be returned through reductions in costs in other sectors, especially in acute care. Moreover, the American experience shows that changes in outcomes and savings in costs will take time.

While it is essential that this initiative has a solid and evidential foundation, there is no need to start this work anew – and clearly no time to waste. The foundations have been laid by the roundtable report, by the work of the Primary Health Care Advisory Group, by the Royal Australian College of General Practitioners and other groups, and, as far back as 2009, by the National Health and Hospital Reform Commission. The health department’s archives contain other relevant papers, some of them specifically commissioned on this topic.

It’s time for engaged leadership at the top and enthusiastic healthcare workers at the coalface to get started on this much-needed project to transform Australian healthcare. •