NACCHO #Dondalekids : Refugees in their own land: how Indigenous people are still homeless


” Ultimately, health outcomes – including frequent presentation to hospital – are reflective of social conditions, especially homelessness.

Health, as we are witnessing in remote Indigenous Australia, is a reflection of individual, community and life circumstances.

By taking a socially-focused and compassionate approach to medicine, Katherine Hospital staff hope to alleviate unnecessary presentations to an already overburdened “

Geordan Shannon PhD Candidate, Institute of Global Health, UCL

Without anywhere that is home, Indigenous people have been without a physical space to reinvent themselves and their culture in modern Australia.

Since colonisation, Aboriginal people have been internally displaced from their country. The doctrine of terra nullius – a land without people – was established under British colonial government and persisted in Australian law until 1992). It served to reinforce the concept that Indigenous land was “empty”; it belonged to no one and so could rightly be claimed for Western exploitation or settlement. This doctrine arguably still persists in the collective Australian psyche, evidenced by social policies and government interventions which impact harmfully on Indigenous people and their connection to their land.

The Stolen Generation, in which Aboriginal children were forcibly removed from their families between the 1900s and the 1960s, is one government policy that led to Indigenous dispossession in the broadest sense of the word. Important Indigenous constructs around family, culture, community and the physical land were affected, and the impact was inter-generational . The Northern Territory Emergency Response Act (NTER) 2007 – often referred to as “The Intervention” – represented a suit of legislation that was enacted to address child abuse in remote communities through mandatory changes to welfare provision, land tenure, child health checks and law enforcement. It has been criticised nationally and internationally for ineffectual, non-consensual and mandatory measures, impacting on the autonomy of Indigenous people and causing humiliation, fear, and confusion among Indigenous communities. Evidence suggests that the intervention has also “increased levels of itinerancy and homelessness among Aboriginal people who have left their home communities in order to avoid the punitive and paternalistic aspects of the NTER”.

Town Camps

Warlpiri Transient Camp, established near the town of Katherine in the Northern Territory, has an interesting history that reflects Indigenous dispossession. In 1949, Lajamanu was forcibly established as an Aboriginal settlement on land that traditionally belonged to the Gurindji. Several hundred Warlpiri people – Australia’s largest tribal group – were trucked there against their will due to government concerns about overcrowding in Yuendemu, 600km to the south. Many simply walked back, with multiple walk-backs happening until 1968. Amid this, a large number of transient Warlpiri “mob” began coming to Katherine to camp, disconnected from their land.

A large number of homeless and itinerant Indigenous people now live in Katherine in town camps such as Warlpiri Transient Camp. These camps serve as a halfway house in towns, away from dilapidated and overcrowded housing and social decline in remote communities.

Conditions are unhealthy, overcrowded, and, at times, dangerous. Violence is common: cases such as the murder of a mother of five occurred in 2014 in Warlpiri Camp. Infrastructure is severely limited and neglected. This led to legal action by residents of Santa Teresa earlier this year.

Lack of a future

Imagine being a young person in Ngukurr, on the Roper River in Arnhem Land. There are very few employment opportunities and limited community infrastructure and housing. If you want a way out, Katherine is your next stop. However, there is a prolonged waiting time for public housing. According to the Northern Territory Department of Housing, the wait is now at least five years – that is to say, if you know how to apply. In reality, if you are a young person wanting to move to Katherine, then you are likely to end up homeless.

The situation has become so normalised that this is exactly what young people do on a regular basis. And while such issues are widely known, they are rarely spoken about.

Between neglected housing in remote communities and dangerous town camps, Aboriginal people live displaced from their land and culture. As Simon Quilty, head physician at Katherine Hospital, put it: “Indigenous people are like long-term refugees displaced on their own land. Nothing has changed and nothing has been done about it.” The staff also found that Indigenous people were attending the hospital with worrying regularity.

Katherine Hospital

Under the leadership of Quilty, Katherine Hospital is addressing homelessness as a health issue using a socially oriented approach. A team of doctors, nurses, social workers and Aboriginal liaison officers are looking at the factors behind why people are driven to attend the hospital so frequently. Using retrospective emergency department admission data, a recent paper published by the team found that some people attended the emergency department for non-medical conditions as frequently as every two weeks.

Such people were driven by issues such as homelessness, alcohol use, weather (including rainfall) and Indigenous identity. The study showed that people who frequently presented to the emergency department were more than 16 times more likely to live in temporary accommodation or be homeless. They were 2.2 times more likely to identify as Aboriginal, and 2.7 times more likely to have alcohol linked to their admission.

Although alcohol is commonly labelled as responsible for “the problems” in the town of Katherine, the study clearly showed that the fundamental issue was homelessness. Other recent research demonstrated that homelessness was a profound problem across the Northern Territory. Homelessness rates in the territory are 15 times the national average: 12% of all people in the Katherine region are homeless; six of the ten regions with the highest homeless rates in Australia are in the Northern Territory, regions that cover almost the entire state. An astonishing 28% of the population of East Arnhem are considered homeless.

Following these findings, the Katherine team is now implementing a social care pathway that provides a culturally appropriate intervention that addresses the whole range of problems experienced by those who present to the emergency department. The programme builds on existing evidence that social interventions for frequent presenters and homeless people, including housing provision and case management, reduces the number of people who attend emergency departments.

Patients who present themselves at the emergency department on more than five occasions within a year will trigger a “frequent presenter pathway”, where social, medical, drug and alcohol problems will be identified and addressed by trained professionals prior to discharge. This model of care has been investigated in urban, predominantly non-Indigenous settings only and this will be the first time such an investigation takes place in a rural Indigenous setting, with a large randomised trial planned for later in 2016.

Ultimately, health outcomes – including frequent presentation to hospital – are reflective of social conditions, especially homelessness. Health, as we are witnessing in remote Indigenous Australia, is a reflection of individual, community and life circumstances. By taking a socially-focused and compassionate approach to medicine, Katherine Hospital staff hope to alleviate unnecessary presentations to an already overburdened system, and focus on the drivers of overall health and community well-being.

NACCHO Opinion The Australian : Aboriginal self-determination key to life-saving health efforts


” Malcolm Turnbull’s decisive response, in the form of a royal commission into the unforgivable treatment of young Aboriginal detainees, shows that action can be taken quickly where needed.

Let’s hope this speed is the starting point for a wider inquiry — one that looks not just at what’s happening in Northern Territory detention centres, but why young Aboriginal people are 25 times more likely to end up in detention centres than non-Aboriginal youth, and what is going so wrong in regions such as the Kimberley that Aboriginal children left behind are up to six times more likely to commit suicide than non-Aboriginal children.

The fact that our children are living in a world where suicide and incarceration are so familiar is a national disgrace that should break the heart of every parent, politician and decent human being.”

Matthew Cooke is chairman of the National Aboriginal Community Controlled Health Organisation.

The Australian 1 August 2016


With the swift leadership shown by the Prime Minister, echoed by strong bipartisan support, this year must be the year that Australian government works with Aboriginal people to make a strong commitment to reverse policies that until now have hindered efforts to meet Close the Gap targets.

A new cabinet is a new beginning and the onus is on Health Minister Sussan Ley, Indigenous Affairs Minister Nigel Scullion and others to follow up on Turnbull’s response with a commitment to empowering and resourcing Aboriginal organisations in our own communities.

Now more than ever, self-determination must feature front and centre. It is imperative that Aboriginal communities and indigenous-controlled medical services are empowered to develop and run programs for Aboriginal people that are culturally appropriate and reach those who desperately need support. We know it’s the only model that works.

The Productivity Commission’s progress report from last November on the implementation of the National Indigenous Reform Agreement illustrates this in two statements: first, that inadequate progress is being made in Closing the Gap; second, more than 80 per cent of investments under the NIRA implementation have gone to non-indigenous organisations.

Unless investments under the NIRA — and in all indigenous-­focused programs — support self-determination and are channelled through reputable Aboriginal organisations, we will not make any gains. Aboriginal people need to be central to decision-making — their leadership as well as participation must be welcomed.

Better progress is being made in the area of Aboriginal health than in the other five NIRA target areas because successive Australian governments have channelled some of their Aboriginal grant funds through National Aboriginal Community Controlled Health Organisations — often referred to as Aboriginal Medical Services.

NACCHOs are Australia’s largest single national and preferred primary healthcare system for Aboriginal people. The importance of the sector is widely and formally acknowledged across the Australian health and social sectors — from GPs to hospital emergency facilities.

Importantly, the NACCHO sector is held accountable to national key performance indicators — which means it can demonstrate that it is a model that is showing the most health gains. NACCHOs increased the proportion of clients who received care in 10 out of 16 indicators. The sector also made the biggest contribution to achieving a 66 per cent reduction in child mortality rates and a 33 per cent reduction in overall mortality rates. NACCHOs are tangible evidence of the benefits of Aboriginal self-determination.

Crucially, the NACCHO sector is also the only nationwide network of service providers accountable to Aboriginal communities. NACCHO directors are elected by Aboriginal people from communities in urban, rural and remote locations all across Australia.

Last year all major political parties supported the 10-year implementation plan for the National Aboriginal and Torres Strait Islander Health Plan.

The plan communicates the ­integral role of the NACCHO ­sector, and the role it will play in more than 30 areas to improve the health and wellbeing of Aboriginal people. We are still to see any outline of how it will be fully funded.

During this new term of government, the complex set of policy and funding relationships that underpin the NACCHO sector must be acknowledged in a permanent and secure partnership, to reflect the glowing statements from current and former government ministers about the performance and value of the sector.

The royal commission needs to look at what’s happening in detention centres.

It also needs to look at why so many of our Aboriginal young people are ending up there in the first place and what’s broken in a system that is causing so many of our young people to despair.

Investing in non-indigenous services and organisations to deliver indigenous health and social services is widely acknowledged as failed policy — the solution must come from the indigenous community itself.

Matthew Cooke is chairman of the National Aboriginal Community Controlled Health Organisation.

NACCHO Members Press Releases #NT #DonDalekids #RoyalCommission Canberra, Tasmania and Tennant Creek




Three Northern Territory Aboriginal peak organisations say they are bitterly disappointed that the Prime Minister has ignored their request to be consulted about the terms of reference for the Royal Commission into child protection and youth detention in the Northern Territory, and utterly reject his choice of former NT Chief Justice Brian Martin as the Royal Commissioner.

The organisations are the Northern and Central Land Councils and the Aboriginal Medical Services Alliance NT (AMSANT).

On Tuesday, a wider group (APO NT – Aboriginal Peak Organisations Northern Territory) wrote to Prime Minister Turnbull, seeking an opportunity to comment on the terms of reference and urged him to ensure that the Royal Commission be led by an “independent” expert and include Aboriginal representation from the NT.

That wider group included two Aboriginal legal aid agencies, Central Australian Aboriginal Legal Aid Service (CAALAS) and North Australian Aboriginal Justice Agency (NAAJA) which are both unable to comment on today’s announcement of the Royal Commission appointment, because they will likely be representing parties before the Commission.

“Prime Minister Turnbull has comprehensively failed us,” said AMSANT Chief Executive John Paterson on behalf of the three organisations.

“Yet again the Commonwealth Government has refused to consult with Aboriginal people, in spite of Mr Turnbull’s commitment, now hollow, to ‘do things with Aboriginal people, not to us’.

“We are hurt and furious because, yet again, we have been ignored – this time on the most important matter of the safety of our children.

“We are also deeply disturbed that NT Chief Minister Adam Giles was party to developing the terms of reference and selecting the Royal Commissioner,” Mr Paterson said.

The Aboriginal organisations have challenged the statement by the Prime Minister and his Attorney General that the Royal Commission is independent of government.

“The appointment of Brian Martin does not satisfy any threshold of independence. On the facts and on perception, the appointment is unacceptable,” said AMSANT Deputy Chair Olga Havnen.

“Only a few weeks ago Brian Martin delivered to the NT Government a report about the establishment of a regime to investigate corruption, at the instigation of the now disgraced and former NT Corrections Minister, John Elferink. Mr Martin accepted that commission and was paid for it, so how can Mr Turnbull boast his independence from government?

“There are many other eminent former judges around the country who would qualify as truly independent, but the Prime Minister clearly did not canvas that field.

“This appointment is wrong for all manner of reasons, and Aboriginal people in the Territory will not have confidence in the appointment of Brian Martin. As Chief Justice, he sat at the apex of the NT’s justice system. He presided over all judicial officers who sentenced young Aboriginal offenders to detention, and he knew them all; he himself sentenced juveniles to detention.

“Worse, although Mr Martin retired as NT Chief Justice in 2010, he was later that same year appointed as an additional judge of the Supreme Court of the Northern Territory and he continues to hold that appointment.

“Finally, we are further upset that the terms of reference are not cast widely enough to include the wider NT youth justice system, rather than a narrow focus on youth detention, and that they do not specify an examination of the huge over-representation of Aboriginal youth in detention.

“Not only does the Northern Territory justice system lock up more juveniles than any other jurisdiction, more than 90 per cent of those detainees are Aboriginal.

“Mr Turnbull has let us down badly,” Ms Havnen said.


Winnunga Nimmityjah Aboriginal Health Service, in its capacity as the primary healthcare provider for more than 6,000 Aboriginal and Torres Strait Islander community members per year in the ACT region, calls on the prime minister for the whole nation, Malcolm Turnbull, to broaden the proposed Royal Commission into Juvenile Justice in the Northern Territory to have a truly national focus.

Winnunga CEO, Julie Tongs, OAM, says that there is a strong link between what is happening in the Northern Territory and what is happening to Aboriginal and Torres Strait Islander prisoners in the rest of the country. Ms Tongs cites the case of Aboriginal man, Steven Freeman who died earlier this year in the ACT’s Alexander Maconochie Centre (AMC) prison.

“He was on remand, he was put in with the general population of sentenced prisoners,” Ms Tongs said. “Within three hours of his arrival at AMC he was so badly bashed that he was taken to Intensive Care at The Canberra Hospital,” she said.

As has been stated in judicial inquiries, and previously reported in The Canberra Times, the CCTV camera covering Mr Freeman’s cell “was turned away from the front of (his) cell before he was viciously bashed behind bars in April”, something lawyers for the (then) injured Mr Freeman described as a “remarkable coincidence”.

The AMC’s Deputy General Manager, Paul Rushton, gave evidence that the CCTV camera controlled by AMC staff, that in its default position monitors an area including Freeman’s cell, was manually turned away prior to Mr Freeman’s bashing.

“After Steven Freeman died in the AMC, the ACT Coroner refused to investigate the original bashing saying he could not see a link between that and Steven’s death,” Ms Tongs said. “So Winnunga strongly believes the Prime Minister is mistaken when he says the Royal Commission must focus only on the NT and that other states and territories should investigate themselves,” she said.

“Given the treatment of Aboriginal prisoners, where our young men and women are going straight from a life-threatening juvenile system to a life-threatening adult system throughout the country, we need a national response, and that national response has to be a broadening of the Royal Commission’s Terms of Reference to have a national focus.

We can’t wait, and we can’t rely on the good will of any future government, or worse, the leaking of more of what WA Liberal (federal parliamentarian), Ken Wyatt called Abu Ghraib-like video to make the broader community sit up and take notice,” Ms Tongs said.


The refusal of Attorney-General George Brandis to expand the Northern Territory youth detention Royal Commission to include Tasmania and other jurisdictions has been slammed by the Tasmanian Aboriginal Centre.

Chief Executive Officer Heather Sculthorpe said, “Since George Brandis defunded the Tasmanian Aboriginal Legal Service, there has been little scrutiny of how our youth are treated at Ashley Detention Centre.

That implicates the Attorney General in the decision making processes that have left our children vulnerable. He should therefore be removed from the decisions about what the Royal Commission will examine and leave it to the Prime Minister to negotiate the terms of reference for the Commission.

It is decisions like those made by George Brandis and Nigel Scullion that need the Royal Commission’s scrutiny. Alternative programs operated by the Aboriginal community should have been funded to avoid the need for detention facilities like Don Dale and Ashley.”

Ms Sculthorpe said the Royal Commission should also examine the processes used by Tasmanian authorities when making funding decisions about Aboriginal programs, “Our complaint about young Tasmanian Aborigines being sent to residential programs in the Northern Territory was met by a public servant claiming our organisation was invited to apply for funds to run a similar program but we declined to do so.

That is factually incorrect. The State Government removed funding from our alternative to detention program: it was their decision, not ours. It is impossible for public scrutiny and transparency to apply when public officials feel free to mislead the public in the ways shown here as well as in the 4 Corners Program.”


The Tasmanian Aboriginal Centre has called for greater Aboriginal involvement in deciding the terms of reference for the agreed national Royal Commission into Juvenile Detention in the Northern Territory.

Chief Executive of the TAC, Heather Sculthorpe, responded to the swift political decision to establish the Royal Commission by calling on the government to expand the enquiry to the youth detention facilities of other States and Territories and to examining the role of all State and Territory authorities when they assume the place of parents to Aboriginal youth.

Ms Sculthorpe said, “The cover-up of wrong doing had started by lunch time today when the Northern Territory Chief Minister Adam Giles held a press conference where he included statements about the unacceptable rate of juvenile offending in the Northern Territory, and the role of Aboriginal parents in causing their children to be damaged offenders at a young age.

Such statements are side-tracking the issue of the very grave failures of State and Territory juvenile detention facilities to serve their role as correctional facilities rather than torture chambers like those designed for international terrorists.

“In Tasmania before Attorney General George Brandis defunded our legal service and gave the funds to Victoria, we had a very active presence at youth detention facilities and operated youth programs and alternative to detention programs which kept most Aboriginal youth out of State detention. We established those programs because the State was failing our young people. This new Royal Commission must be extended to include the treatment of Aboriginal youth in Tasmanian detention. It is totally erroneous to imagine that such abuses happen only in northern Australia,”

Ms Sculthorpe said the defunding of Aboriginal youth programs in Tasmania also needs external scrutiny, “The Hodgman government has shut off funds for our alternative to detention program but is now spending more to send young Aborigines to programs in the Northern Territory, so far removed from their own families and in disregard of the need of young people to form close connections with their own community and culture. The Tasmanian government has effectively blocked us out from participation in planning for better futures of these young Aborigines. A Royal Commission would highlight this failure and make recommendations for a better future”.

“The Federal Government must ensure truly independent examination of the role of the States and Territories in their treatment of young Aborigines and this must exclude any decision making role for those whose failings are under scrutiny. No State or Territory involvement or else there will be no impartial examination of the horrendous accounts which have, and are still, emerging.”



One of the major Aboriginal-community controlled organisations in the Barkly says it has lost any confidence in the NT Government’s ability to govern the Territory following the fallout from this week’s 4 Corners program. Anyinginyi Health Aboriginal Corporation chairperson Mr Ross Jakamarra Williams said the Giles Government had shown it was not fit to run the Northern Territory.

“The Chief Minister has conducted himself shamefully since the horrific revelations on 4 Corners by refusing to take responsibility, shift the blame and continuing to try and demonise our children,” Mr Williams said.
“This is a Government that has shown itself to be incompetent, inhumane and dysfunctional. We do not trust them to play any sort of role that involves caring for Aboriginal children.

“We call on Prime Minister Turnbull to take responsibility for children who are in detention, in the care of the Government, as we don’t trust the NT Government to not further damage these children.

“We commend the Prime Minister for moving quickly to establish the Royal Commission but ask him to make sure the current NT Government is not involved in setting the scope or Terms of Reference. This would be a complete conflict of interest.”

Mr Jakamarra Williams said AHAC was calling for a new model of providing services to children in the NT’s juvenile justice system.
“The lock them up mindset of the current Government can’t continue.

“We have seen the harm this is causing, it’s hurting our kids and it’s hurting our community. It’s doing nothing to make our communities safer.
“There are better ways of caring for our young people and Aboriginal community controlled organisations must be involved in implementing these.
“There are successful program models that involve young people going bush on country, learning from elders, gaining skills and respect for themselves and others.

“These programs should be supported and dreadful places like Don Dale closed immediately.” July 28, 2016

NACCHO #DonDaleKids #4corners : Mistreatment of detained youth a national crisis



“The NT government has led a concerted and sustained campaign to demonise young people without attempting to properly understand the social determinants causing the problems these young people face, including the young people featured in the Four Corners program on ABC last night,” said Congress CEO, Donna Ah Chee.

Specialised youth health services, such as headspace, have for many years trained health professionals working with young people to learn to ask the question, ‘what’s happened to you’ rather than the judgemental question, ‘what’s wrong with you’. This approach leads to compassion, empathy and a productive relationship focused on treatment and support rather than judgement, blame and a hostile, non-productive relationship focused on punishment.

“It seems the NTG requires similar training as it chooses to continually blame very young people for their problems rather than to understand and work to change the circumstances that have caused the problems in the first place,” said Ms Ah Chee.

“The issues covered in the Four Corners program have been documented by the NT Children’s Commissioners previously and are well known to government including the Chief Minister, NT Police and Correctional Services.

“The NTG continues to pass draconian laws targeting Aboriginal people and which are inconsistent with the recommendations made by the NT Children’s Commissioner’s report on Don Dale.

“Just recently, Congress was part of a campaign to stop proposed draconian changes to the Bail Act (NT) that would have otherwise enabled young people to be detained in jail prior to presenting at court. This was only just averted.

Ms Ah Chee confirmed that Congress supports the demands formed by key peak Aboriginal organisations including the following:

  • The Commonwealth Government should immediately sack the NTG and call a new election as it is collectively, directly responsible for the punitive, barbaric treatment of young people.
  • Solitary confinement and use of physical restraints on young people should be immediately suspended.
  • An alternate provider of youth correctional services should be appointed. The NT Department of Corrections cannot continue to deliver these services – kids are ‘at risk’. This could perhaps be done through the immediate transfer of responsibility into a new Youth Justice section within the NT DoH where the focus is on treatment and support rather than punishment.
  • Office of the NT Children’s Commissioner must be appropriately and adequately resourced to perform her statutory responsibilities. Congress believes that a new Aboriginal Children’s Commissioner position is also required, as key to strengthening the office in the NT. Such positions already exist in Victoria and Queensland.
  • All children from Central Australia should be returned immediately and no further children should be transferred from Central Australia to Darwin.
  • Therapeutic support services should be provided to families and children impacted by these events.
  • The terms of reference of the Royal Commission need to be broad enough to include prevention and not only how to better care for young people in detention. NT Aboriginal representation on the Royal Commission should also be included in the ToR.
  • There needs to be a review into each case of all young people currently in detention in the NT, to ascertain whether these young people have been detained unnecessarily.

Media Contact: Emily MacKenzie, 0408 741 691 or

NACCHO #4corners #DonDale Royal Commission: ‘do it with us, not to us’ NT Aboriginal organisations write to PM


The Northern Territory’s main Aboriginal land councils, medical and legal services have written to the Prime Minister, urging him to keep the Royal Commission into juvenile justice at arms’ length from the Giles government because it is part of the problem under investigation.

The coalition of peak NT Aboriginal organisations also asked the PM to honour his word and do things with rather than to Aboriginal people by involving them in the development of the commission’s terms of reference.

“We urge you to ensure that Aboriginal people and organisations are fully engaged in the
process and that it is one that is entirely independent of the Northern Territory Government,” the letter states.

The coalition, which represents the vast majority of Aboriginal people in the Territory, yesterday led calls on the Australian Parliament to dismiss the Northern Territory Government over the abuse of children in detention.

“We do not make this call lightly but any government that enacts policies designed to harm children and enables a culture of brutalisation and cover-ups, surrenders its right to govern,” the organisations write.

“In relation to the Royal Commission we would also like to make these specific requests of you:
1. Ensure that the Northern Territory Government has no role in the development or oversight of the Royal Commission, including the provision of funding or developing the terms of reference.We can have no confidence in the Northern Territory Government, given not only its protracted inaction in relation to the matters raised, but also the manner in which the public has been actively misled in relation to events.

2. The Aboriginal Peak Organisations of the Northern Territory (APO NT) be given an opportunity to comment on the draft Terms of Reference.

3. That the Royal Commission be chaired by an independent expert and must have Aboriginal representation from the NT.

4. The terms of reference must necessarily be broader than the incidents exposed in the Four Corners program. It is vital that it considers issues closely related to the treatment of young
people in detention, including:
• legislation and policies that underpin the treatment of young people in detention,
including the use of force and isolation;
• the over-representation of Aboriginal young people in detention, especially on remand;
• the role of the Department of Children and Families in caring for Aboriginal young
people who come in contact with the criminal justice system;
• the need for specialist approaches to the policing of young people;
• the availability of trauma support and counselling for Aboriginal young people in the
• examine all previous enquiries relating to youth justice in the NT for cover ups and
uncover why the recommendations were not implemented; and
• not limit how far into the past the Commission can inquire.

5. It is imperative that Aboriginal organisations are properly funded to provide support to people in connection with the Royal Commission, including legal representation and counselling.

The letter thanks the PM for his leadership in recognising the national importance of these issues.

The APO NT letter is signed by David Ross and Joe Morrison on behalf of the Central and Northern land councils, Priscilla Collins and Eileen van Iersel on behalf of the NT Aboriginal Legal Services NAAJA and CAALAS and John Paterson on behalf of the Aboriginal Medical Services Alliance of the NT, AMSANT.

27 July 2016
A copy of the letter is at

Media contact: Elke Wiesmann,, 0417 877 579

NACCHO Aboriginal Health :Report : Perils of place: identifying hotspots of health inequality


Hospitalisation rates for diabetes, tooth decay and other conditions that should be treatable or manageable out of hospital show how Australia’s health system is consistently failing some communities.

Perils of place: identifying hotspots of health inequality

Download report here : NACCHO download Perils-of-Place

Places such as Frankston and Broadmeadows in Victoria and Mount Isa and Palm Island in Queensland have had potentially preventable hospitalisation rates at least fifty percent above the state average in every year for a decade.


The problem can be addressed, but only if governments come up with targeted solutions for individual places. Australia is not a uniform country and a one-size-fits-all approach will not work. Local, tailored policy responses are required.

Reducing potentially preventable hospitalisations in hot spots in Victoria and Queensland — the two states the report studied – would save a total of at least $15 million a year. Indirect savings should be significantly larger.

The report introduces a method of identifying small areas where health inequalities are entrenched and, without intervention, are likely to endure.

To build up the limited evidence of what works in reducing place-based health problems, the report recommends that government combine with Primary Health Networks and local communities to run three- to five-year trials of tailored programs in selected places.

Rigorous evaluation is critical, so that the lessons from successful trials can be applied across the country.

Because persistent hotspots are rare, targeting them alone will not substantially reduce the growing burden of potentially preventable hospitalisations, but it’s an important first step.

Government and Primary Health Networks must ensure that all communities get a fair go. The government will save money and, more importantly, some of the most disadvantaged Australians will get the chance to lead healthier, more productive lives.



NACCHO #Healthelection16 : Shorten takes on Indigenous affairs in new shadow Ministry , King stays in health

Shorten and Dodson

The Opposition Leader vowed that his frontbench would champion Labor values and maintain pressure on the Coalition after it “scraped home” in the federal election.

“We’re adding great energy with a new team,” Mr Shorten said.

“We’re building on the strong policy foundation of the last three years and will bring fresh voices to the national conversation.”

PLEASE NOTE : we will be publishing details of the Coalition Indigenous health team when more info is made available from the Ministers office ;

Mr Shorten has reshuffled some key portfolios,

DOWNLOAD PDF all Shadow Ministry positions

New Shorten Shadow Ministry July 2016

Mr Shorten will take responsibility for Indigenous affairs.

The Opposition Leader said he would depend on the advice of Labor senator and Indigenous leader Pat Dodson, who will become shadow assistant minister for the portfolio.

“Patrick has been a great mentor and friend and adviser to me in the area and I will look forward to working closely with him, and will rely greatly upon his wisdom,” Mr Shorten said.


AMA President, Dr Michael Gannon, today welcomed the re-appointment of Catherine King to the Shadow Health portfolio, with the new title, Shadow Minister for Health and Medicare.

Dr Gannon said the AMA looks forward to continuing a cooperative working relationship with Shadow Minister King.

“Catherine knows the health policy landscape well, and was instrumental in making health policy a prominent battleground in the recent election,” Dr Gannon said.

“The AMA supported Labor’s position on lifting the Medicare freeze, scrapping the cuts to bulk billing incentives for pathology and medical imaging, and increasing public hospital funding – and we hope these policies are maintained for the new term of Parliament.

“Health policy will remain a major concern for the community.

“The health sector and patients are very fortunate to have two experienced and consultative operators in Sussan Ley and Catherine King back in charge of Health for the Government and the Opposition.

“They know the issues, they seek advice from health professionals, and they will be strong voices in their respective Parties to ensure Australian voters will be offered positive health policies at the next election.”

The AMA also congratulates Labor’s other health representatives:

  • Shadow Minister for Ageing and Mental Health, Julie Collins;
  • Shadow Assistant Minister for Medicare, Tony Zappia; and
  • Shadow Assistant Minister for Ageing, Senator Helen Polley.

Dr Gannon notes the Opposition’s emphasis on Indigenous Affairs with Opposition Leader Bill Shorten taking the Shadow Ministry for Indigenous Affairs and Aboriginal and Torres Strait Islanders, with Assistant Shadow Minister, Senator Pat Dodson.

Page 7 V2

Refer to Page 7 NACCHO Aboriginal Health Newspaper

Labor committed to addressing the injustice of poor health outcomes for Aboriginal and Torres Strait Islander peoples.

Presented by Catherine King, Warren Snowdon and Shayne Neumann

Labor is committed to the efforts to Close the Gap in Aboriginal and Torres Strait Islander Health and believes that central to this is the need to implement the Aboriginal and Torres Strait Islander Health Plan developed in partnership with Aboriginal and Torres Strait Islander people during the period of the Gillard Government.

A Shorten Labor Government would continue to work in partnership with Aboriginal and Torres Strait Islander Peoples, through the National Congress of Australia’s First Peoples and relevant health organisations such as NACCHO to implement the Health Plan.

In Government Labor would, in consultation with Congress, re establish the National Aboriginal and Torres Strait Islander Health Equality Council, with its costs being met through the Administered funds of the Commonwealth Department of Health.

Consistent with the Health Plan, Labor is committed to  improving preventative health strategies for Aboriginal and Torres Strait Islander Australians and helping to close the gap in chronic disease  and life expectancy  and this will be a major commitment of a Shorten Labor government.

Labor understands that a primary vehicle for improving health outcomes are community based Aboriginal and Torres Strait Islander Health Organisations who provide a very high standard of comprehensive primary health services in a culturally safe and respectful environment.

A Shorten Labor Goverment would continue to work closely with these services as they continue to grow in a sustainable way.

The shameful facts remain, despite the improvements in service delivery over recent years, that the burden of ill health among Aboriginal and Torres Strait Islander people is two-and-a-half times higher than that of other Australians.

In large part this is due to the higher incidence of chronic diseases such as diabetes, cardiovascular disease, respiratory disease and kidney disease; much of this is preventable.

This is simply unacceptable to Labor, is a national disgrace and must be addressed..

In response to this crisis and after having consulted widely, a Shorten Labor Government will invest in tailored, culturally-appropriate health programs aimed at preventing chronic disease for Aboriginal and Torres Strait Islander





NACCHO Aboriginal Health News Alert : Five tips to get the government started on real #health reform

” The health and well-being of the population depend on issues well beyond the health portfolio and require a health-in-all policy approach in all government portfolios. This is a matter of leadership and cultural change, not new expenditures and regulations.

“Wicked” issues such as obesity, mental health, healthy ageing and Closing the Gap on Indigenous disadvantage can only be effectively addressed through such whole-of-government approaches “

Indigenous disadvantage can only be reduced with effective, whole-of-government responses

Lesley Russell  Adjunct Associate Professor, Menzies Centre for Health Policy, University of Sydney writing in the Conversation

Since the election, the Turnbull government has received a great deal of advice on how to counter the pervasive public scepticism about its ongoing commitment to the universality of Medicare.

While the impacts of the so-called Mediscare campaign, the Medicare rebate freeze and the “zombie” policies left over from the 2014-15 budget have driven these calls for Coalition action, the real issue is that the previous Abbott-Turnbull government had no health policy agenda, other than budget cuts and the covert exploration of privatisation and competition in the delivery of health-care services.

In this new term, the government must do more to deliver the health-care system we need for the 21st century – not just to improve its standing with voters, but to meet the health needs of all Australians. Much of this can be achieved through new ways of thinking about policy development and implementation rather than new spending.

Even so, some new funds will be needed. The government and its bean counters must move beyond seeing the health-care budget as a drain on finances and treat it as an investment in the health, productivity and prosperity of the nation. This approach will help concentrate efforts on evidence and value rather than ideologically based, slash-and-burn approaches.

1. Patients must be the centre of the health system

The health-care system exists primarily for the benefit of patients, but their voices are so rarely heard. Every policy, budget measure and proposal must be considered through the patient lens.

That does not mean the impacts on providers (hospitals, clinicians and health insurers) should not be considered; they are also stakeholders and usually the decision-makers. But the government’s first instinct has been to consult with privileged groups such as the Australian Medical Association and private health insurers, rather than with the public, patients and providers at the coalface.

Importantly, viewing health reform through a patient lens will help policymakers identify disadvantaged groups so they can target their specific needs.

2. Invest in health promotion, not just illness treatment

Prevention is as much a responsibility of government as it is for individuals. This is particularly the case for obesity.

As a nation, we all bear the substantial and growing economic and social costs of obesity and its consequences, especially diabetes. Every day, 12 Australians have an amputation related to diabetes at a cost of A$875 million a year. Almost all of this is preventable.

The investments made in prevention must be proportional to the burden of disease in terms of resources and commitment. Concerns about sensible budget policies must override ideological concerns about the nanny state.

3. Make health-care reforms sustainable

This means ceasing the start-stop approach of small-scale pilot programs that never go beyond three years and are evaluated only after they are concluded in reports that never see the light of day. Real reforms will also require time frames well beyond those of the election cycle.

Labor has proposed a promising way forward: a permanent Australian Healthcare Reform Commission, which would include a new Centre for Medicare and Healthcare System Innovation to embed continuous reform into the health-care system.

This type of approach – where models can be seamlessly developed, implemented, assessed, adjusted and expanded – is essential for reforms such as the government’s proposed Health Care Homes trial to better manage chronic disease, and for complicated issues such as mental health reforms.


4. Apply a whole-of-government approach to health

The health and well-being of the population depend on issues well beyond the health portfolio and require a health-in-all policy approach in all government portfolios. This is a matter of leadership and cultural change, not new expenditures and regulations.

“Wicked” issues such as obesity, mental health, healthy ageing and Closing the Gap on Indigenous disadvantage can only be effectively addressed through such whole-of-government approaches.

5. Data is key

Research, data analyses and evaluation are key to health-care reforms.

The antipathy of the previous government to evidence-based policymaking was exemplified by the scrapping or downgrading of key agencies and the defunding of the Primary Health Care Research, Evaluation and Development (PHCRED) Strategy and the Better Evaluation and Care of Health (BEACH) study.

These losses must be rectified, but it is also time for the Department of Health to start mining the archives. There are mountains of reports, papers and evaluations, together with significant, policy-relevant primary health care research commissioned by the department through the Australian Primary Health Care Research Institute, to be used in improving the delivery and financing of health-care services.

At the same time, there should be a moratorium on shunting off difficult problems to committees as an excuse for inaction. There will be occasions when it is necessary to convene advisory groups. That should be done using the experts who will provide the advice that is needed, not the usual hacks who provide the advice the government wants.

So where do we start?

I rate the following as the key issues:

In 2007, my colleagues and I outlined the challenges to health care facing the incoming Rudd government. Regrettably this nine-year-old document could serve the same purpose today, so little has changed.

Will Prime Minister Malcolm Turnbull now bring to the health-care sector the innovation he says holds the key to Australia’s future?


NACCHO Aboriginal Health : AMA president would be ‘gobsmacked’ if Coalition sticks with Medicare rebate freeze


First QUESTION: The targets for closing the gap in Indigenous disadvantage, some of them aren’t moving, some are in fact going backwards.

What would you like to communicate to the Federal Government on making progress on those targets?

MICHAEL GANNON: Well, I suppose that brings us to one area of controversy during the election campaign and beyond, and that’s the freeze on rebates for patients when they see doctors. GPs, Aboriginal Medical Services, are heavily dependent on those.

That’s such an important issue to make sure that those services are well funded. It’s also very important that we look at prevention, that’s an area that’s potentially been underdone when it comes to health funding.

Prevention is so important in the area of Indigenous health, and the social determinants of health, the things that drive increased rates of perinatal mortality, increased rates of infant mortality, increased rates of maternal morbidity, they’re all things that can be dealt with with prevention.”

Read full Guardian report here or Full Transcript BELOW

The Australian Medical Association president, Michael Gannon, has said he would be “gobsmacked” if the government retained an ongoing GP rebate freeze at the next election after getting the “scare of its life” at the 2 July election.

Gannon said he thought the 2014 budget had resulted in a loss of trust in the Coalition on health and Malcolm Turnbull was sincere in acknowledging it needs to revamp its policies as a result.

He made the comments on Thursday after his first meeting with the health minister, Sussan Ley, since she was reappointed on Monday.

Transcript: AMA President Dr Michael Gannon, Doorstop – Parliament House, 21 July 2016

Subjects: Indigenous health, Medicare rebate freeze, health policy

MICHAEL GANNON: Good morning everyone. As you all know, I’ve just met with Minister Ley, the first of what I hope’s a number of productive meetings. The AMA took a set of policies to the election campaign, we supported elements of Labor policy leading into the election, we saw a Government get the scare of its life when it comes to health, but we look forward to a productive relationship with the Government during this term and I look forward to continuing the relationship with Minister Ley.


QUESTION: We’ve heard Sussan Ley in the past say that she would like to unfreeze the rebate indexation if not for Treasury. Did she give you an indication in that meeting that there are moves to unfreeze that rebate?

MICHAEL GANNON: Well, I look forward to further discussions on unravelling the freeze. I would be gobsmacked if the Government took an ongoing freeze to the next election. They got the scare of their life on health, and that was probably the policy which hurt them the most. It makes general practice and a lot of other areas of medical practice potentially unviable if it’s not unravelled. So I look forward to continuing this relationship, continuing that discussion. And we do want to see results; I would like to see a move on that in coming months. We need to unravel the freeze.

QUESTION: Doctor, what does it say about the Government’s priorities when it’s prepared to consider a change of policy that affects 4 per cent of superannuation savers, but won’t come out and say it’s going to reconsider a policy that affects 100 per cent of people who go to a GP?

MICHAEL GANNON: Health is important to everyone. It does, it affects 100 per cent of us and it affects our loved ones on a more regular basis. We need to fix these policies. It is true that the Government should try and find ways of balancing its books, but it’s not true to say that health spending is out of control. If we look at the area we’re most concerned about – primary care, general practice – it only makes up 6 per cent of health spending. Unravelling the freeze would be a great start, a good sign of good faith from the new Government.

QUESTION: But Doctor, you say the Government got the scare of its life from the Medicare- from the feedback from the public on the Medicare campaign, has anything you see in your talks with the Minister just now suggested to you that she’s taken on board this scare?

MICHAEL GANNON: Look, I’m conscious of the fact that Cabinet hasn’t yet met and it’s only a couple of days ago that the Minister was reappointed. So I didn’t expect any hard and fast undertakings from her today. But what we did have today was the start of a really positive and constructive relationship. I’m excited that the Minister chose to meet with the AMA as her first order of business, and I think that we can do things together to improve the health system.

QUESTION: So, in terms of having a good relationship between your organisation and the Government, what’s the number one thing the Minister must do? What’s first order of business?

MICHAEL GANNON: The first order of business is to have a serious timeline to unravel he freeze on patient rebates. At the same time, we want to talk more about a sustainable plan to fund public hospitals. We were pleased by the undertakings from both the Coalition and the ALP during the election campaign to have a serious formula for how we fund public hospitals going forward. I think one observation the Minister and I agreed on is that the states were fairly quiet, the States are happy with that formula. But we want to see a real robust formula to make sure that public hospitals are well funded well into the medium term.

QUESTION: What areas of common ground [indistinct] with the Government on health?

MICHAEL GANNON: I’m just pleased that the Government has shown a willingness to listen to the AMA and a willingness to engage more closely on health policy. There are policies that go back a couple of years – they still have the co-payments from 2014 hanging around their neck, there’s been a perception of a breach of trust with the Coalition and the people of Australia on Medicare. What I had is very early preliminary discussions with the Minister today was a willingness to listen to those concerns, and when governments talk to doctors, when doctors talk to government, we’ve got a really good chance of coming up with the best health policy.

QUESTION: Nothing specific though?

MICHAEL GANNON: I’m very conscious of the fact that the Cabinet hasn’t met. It would not be appropriate for the Minister to go making a great deal of promises. But our discussions did focus on the fact that health is not the problem with the budget, health is not the area to repair the budget.

QUESTION: How often do you expect to meet with the Minister?

MICHAEL GANNON: I would hope we would have regular meetings. The health system is big and complex, and there’s a lot to talk about – all the way from prevention, education, public health campaigns, through really important reforms to how we sustainably fund general practice through to public hospitals, and of course our fantastic hybrid of private and public medicine. So there’s a lot to talk about. My phone is always on to talk to the Minister. I look forward to engaging with her closely.

QUESTION: You said you would be gobsmacked if they took the Medicare freeze to another election but are you hopeful that the current freeze can be unravelled sooner than that?

MICHAEL GANNON: I think that a measure of good faith from the Government would be to have a serious timeline about when the freeze would be unravelled and the sooner the better. It does impair the viability of general practices, it does threaten the ability of general practices to bulk bill the most vulnerable in our community. That’s an important facet of universal health care, that the neediest in our community have no price barriers to seeking care. The sooner the freeze is unravelled the better. I will be looking for serious undertakings and a firm timeline from the Government.

QUESTION: So, what would be a serious timeline? What would be the end date of a serious timeline?

MICHAEL GANNON: Well, during the election campaign we welcomed the ALP’s policy to unravel the freeze on 1 January 2017. I won’t quib about when it needs to be undone but what we’ve seen is general practice suffer, you know, the death of a thousand cuts in many ways. The freeze first introduced by the previous Labor government is now more than four years old. This is what GPs are telling us is that they’ve been able to hold on for a period of time but they can’t hold on forever. We want to protect universal health care so that those who can afford to pay do make a contribution to their health care, but we must keep protections for the neediest in our community. Step one is unravelling the freeze.

QUESTION: The Minister said that she is prepared to look at that freeze if alternative savings can be found, are there any areas in health that you would be willing to work with her on finding savings or any areas you could nominate where there is wastage?

MICHAEL GANNON: Well, just today, the AMA’s released its position statement on stewardship. In other words, how do we look after every precious dollar in the health system and that’s something that is the responsibility of individual doctors, individual hospitals and health systems. There are inefficiencies in the health system. There are some areas where we could do better. But what I’ve heard from the Minister today is that she’s heard what the Australian people have had to say during the election campaign – health should not be the focus of budget repair in this Turnbull Government.

QUESTION: You said that people who can afford to pay to see a doctor should. Are you suggesting that co-payments be brought back into the mix?

MICHAEL GANNON: What we would like to see is a system where it’s easy for those who can afford a contribution to their health care, continue to make that. It’s already common for a majority of GPs in Australia to privately bill a proportion of their patients. The AMA supports GPs and other specialists being paid appropriately for their endeavour and their skill. What equally we want to see is protections inbuilt for the most vulnerable in our community and previous government policies didn’t enable GPs to protect those who can’t afford even a few dollars out of pocket.

QUESTION: But is a general practice the right place for people to decide who can afford to pay? How is an individual practice going to make those decisions?

MICHAEL GANNON: I think GPs really are in touch with the needs of their patients. I think they’ve proven that with high rates of bulk billing over a generation. That shows that GPs care about their patients, that shows that they understand when times are difficult, that shows that GPs, from time to time, GPs and other specialists from time to time will vary how they bill their patients according to their circumstances. The reason the co-payment models of 2014 were so wrong is that they didn’t give individual doctors the ability to make those judgements. They also didn’t give the system the ability to protect the neediest in the community and we know that even small $5, $6, $7 out of pocket expenses are enough to stop some people from going to see the doctor. We know that if we don’t have good preventable health care in general practice, people end up getting sicker, they end up in hospital, and that’s a lot more expensive.

QUESTION: Doctor, Malcolm Turnbull said that the Government has to address the fertile ground into which Labor planted its Medicare campaign. Do you think that shows a willingness to change policies on health or is it more an attempt to scapegoat the 2014 Budget for the election performance?

MICHAEL GANNON: No, I think that the Prime Minister was very sincere in his commentary, in knowing that he wants to see changes. The Prime Minister acknowledged that his party and their policies had left that fertile ground. If we go back to the 2014 Budget there were policies there that resulted in a loss of trust between the Australian people and the Coalition on health policy. What I want to see is the kind of policies that the Turnbull Government can turn up in three years time seeking re-election and saying look, we listened, this is what we’ve done for general practice, this is what we’ve done for public hospitals.

QUESTION: [Indistinct] the election campaign post-mortem has been that the Medicare or Mediscare wasn’t kicked(*) back hard enough by the Coalition and David Johnston even said that it was Politics 101 to get [indistinct] to take [indistinct] especially in a campaign. Do you agree with that sort of sentiment?

MICHAEL GANNON: I don’t think it’s smart to get doctors offside and I think it’s smart to listen to all stakeholders in the health industry. I think that the Government will make good policy if they talk to doctors, if they talk to nurses, if they talk to other people at the coal-face, dealing with patients everyday, whether that’s in the community, or in hospitals. Good health policy is listening to those people who deal with patients every day.

QUESTION: And I guess [indistinct] when you put the AMA [indistinct] relationship with the Government …

MICHAEL GANNON: I see no reason why we would not seek a more productive and positive relationship with government. Equally, we want to have an open dialogue with the Opposition and the crossbench. There’s a lot of new parliamentarians coming to Canberra later this month. The AMA is here to help them construct a good policy, to look at what might work well in the Senate in the months going forward.

QUESTION: How would you describe today’s meeting?

MICHAEL GANNON: Today’s meeting was warm and productive. I’ve met Minister Ley on a number of occasions in the past. She’s someone who I’ve welcomed the opportunity to work with in the future. I really look forward to that. Alright, thank you all.

NACCHO #Aboriginal Health : #AIHW releases specific Measures tool Item 715 MBS Health checks


All Aboriginal and Torres Strait Islander people are eligible for an annual Indigenous-specific health check: item 715 on the Medicare Benefits Schedule (MBS).

AIHW Press Release 21 July 2016

Medicare Health Assessment for Aboriginal and Torres Strait Islander People (MBS Item 715) – PDF 322 KB

See update 22 July For Aboriginal Health Workers
The aim of this MBS health assessment item is to help ensure that Aboriginal and Torres Strait Islander people receive primary health care matched to their needs, by encouraging early detection, diagnosis and intervention for common and treatable conditions that cause morbidity and early mortality.

For the purpose of this item, a person is an Aboriginal or Torres Strait Islander person if they, or their parent or carer, identify them as being of Aboriginal or Torres Strait Islander descent.

The MBS health assessment for Aboriginal and Torres Strait Islander people covers the full age spectrum, and should be used for health assessments for the following age groups:

  • Aboriginal and Torres Strait Islander children who are less than 15 years old
  • Aboriginal and Torres Strait Islander adults who are aged fifteen years and over but under the age of 55 years
  • Aboriginal and Torres Strait Islander older people who are aged 55 years and over

Indigenous specific measures tool 5th release (dynamic data display)

This tool shows numbers and usage rates of the checks at various geographic areas. Charts and tables in the tool can be customised to show different time periods and, where possible, disaggregations by age and sex.

The Australian Institute of Health and Welfare has released a new web product on 21 July, 2016:

Indigenous specific measures tool 5th release (dynamic data display)

1.The Indigenous health check (MBS 715) data tool provides information on use of MBS-rebated health checks for Aboriginal and Torres Strait Islander people displayed using SAS Visual Analytics.

2 The tool shows; numbers and rates of health check uptake at national, jurisdiction, Medicare Local and peer group, and Primary Health Network levels.

3 .This update adds national and jurisdiction data up to December 2015, updated from 30 June 2014.

The page can be viewed at this link:

Source data: Excel download (1.5MB XLS)

Helpline: 1800 223 919 or

Components of the Health Assessment

The health assessment includes an assessment of the patient’s health, including their physical, psychological and social wellbeing. It also assesses what preventive health care, education and other assistance should be offered to the patient to improve their health and wellbeing. It complements existing services already undertaken by a range of health care providers. This health assessment must include:

  • information collection, including taking a patient history and undertaking examinations and investigations as required;
  • making an overall assessment of the patient;
  • recommending appropriate interventions;
  • providing advice and information to the patient;
  • keeping a record of the health assessment, and offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment; and
  • offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

As part of a health assessment, a medical practitioner may develop a simple strategy for the good health of the patient. The strategy should identify any services the patient needs and the actions the patient, or parent or carer, should take. It should be developed in collaboration with the patient, or parent or carer, and documented in the written report on the assessment that is offered to the patient, and/or patient’s carer.