- Dermatology, Allergy & Immunology
- Diagnostic Imaging – knee imaging
- Diagnostic Imaging – pulmonary embolism and deep vein thrombosis
- Renal Medicine
- Spinal Surgery
- Urgent after-hours primary care services funded by the MBS
” This fourth national report on the Indigenous primary health care national Key Performance Indicators (nKPIs) data collection presents annual data on indicators collected from the June 2012 to the June 2016 reporting period.
Information is presented for 22 ‘process-of-care’ and ‘health outcome’ indicators for June 2016, which focus on maternal and child health, preventative health, and chronic disease management.
The report shows continuous improvements for the majority of indicators.
Yes the good news is , improvements were seen in 12 of the 16 process-of-care measures for which time trend data were available (Table S1 below ).
For 10 of these measures, the change was statistically significant.”
Download HERE NACCHO Resources 7.00 MB
Data for this collection are provided to the AIHW by primary health care organisations that receive funding from the Department of Health to provide services to Aboriginal and Torres Strait Islander people.
Some primary health care organisations that report receive additional funding from other sources, including state and territory health departments, while a small number are funded solely by the Northern Territory Government (see ‘Chapter 1 Introduction’).
The purpose of the nKPIs is to support policy and service planning at the national and state/territory levels, by monitoring progress and highlighting areas for improvement.
The nKPIs can also be used to improve the delivery of primary health care services, by supporting continuous quality improvement (CQI) activity among service providers.
Over the period June 2012 to May 2015 (the period for which time trend data are available), improvements continue to be made across the majority of measures—indicating that health organisations continue to show progress in service provision.
The good news
Improvements were seen in 12 of the 16 process-of-care measures for which time trend data were available (Table S1).
For 10 of these measures, the change was statistically significant. The largest improvements (between 16 and 19 percentage points) were seen in data recording practices for the measurement of:
Results for process-of-care measures related to Medicare Benefits Schedule (MBS) health assessments (for children and adults) exceeded the 2016 trajectory of the Implementation Plan goals for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023.
Improvements were also seen in 3 of the 5 health outcomes measures for which time trend data were available. For 1 of these, the change was statistically significant:
• Health of clients with type 2 diabetes—those with an HbA1c (glycosylated haemoglobin), with a result of ≤7% in the previous 6 months, rose from 32% in June 2012 to 35% in May 2015. (An HbA1c result of ≤7% is the optimum target encouraged by Diabetes Australia to ensure good glycaemic control and reduce the incidence of diabetes-related illness.)
Things to work on
Results for 3 process-of-care measures related to immunisation against influenza—clients aged 50 and over; clients with type 2 diabetes; and clients with chronic obstructive pulmonary disease (COPD)—and for the 1 process-of-care measure relating to cervical screening saw small decreases of between 1.3 and 2.6 percentage points. However, these were not statistically significant.
Results for 2 health outcome measures showed increases: the proportion of babies born with a low birthweight increased by 0.9 percentage points and people whose body mass index (BMI) score classified them as overweight or obese increased by 4.3 percentage points.
However, these increases were not statistically significant.
These results also remain in line with national data for Indigenous Australians.
“With Aboriginal and Torres Strait Islander Australians still 20 times more likely to die from RHD, the AMA’s call for firm targets and a comprehensive and consultative strategy is welcome. We encourage governments to adopt these recommendations immediately.
“As noted by the AMA, it is absolutely critical that governments work in close partnership with Aboriginal health bodies. Without strong community controlled health services, achieving these targets for reducing RHD will be impossible.
While this is a long term challenge, the human impacts on Aboriginal and Torres Strait Islander communities are being felt deeply right now. Action is required urgently.
NACCHO is standing ready to work with the AMA and governments to develop and implement these measures. We have to work together and we have to do it now.”
National Aboriginal Community Controlled Health Organisation (NACCHO) Chairperson Matthew Cooke pictured above at Danila Dilba Health Service NT with AMA President Dr Michael Gannon (right ) and the Hon Warren Snowdon MP Shadow Assistant Minister for Indigenous Health (left )
” RHD, which starts out with seemingly innocuous symptoms such as a sore throat or a skin infection, but leads to heart damage, stroke, disability, and premature death, could be eradicated in Australia within 15 years if all governments adopted the recommendations of the latest AMA Indigenous Health Report Card.
AMA President, Dr Michael Gannon see full AMA Press Release below
” We have many of the answers, we just need commitment from Govt to help implement necessary changes ”
Ms Olga Havnen is the CEO of Danila Dilba Biluru Binnilutlum Health Service in Darwin
NACCHO Press Release
The peak Aboriginal health organisation today welcomed the release of the Australian Medical Association’s Report Card on Indigenous Health as a timely reminder of the importance of community controlled services.
The 2016 Report Card on Indigenous Health focuses on the enormous impact that Rheumatic Heart Disease (RHD) is having on Aboriginal and Torres Strait Islander people in Australia with a ‘Call to Action to Prevent New Cases of RHD in in Indigenous Australia by 2031’.
DOWNLOAD the Report Card here :
AMA RELEASES PLAN TO ERADICATE RHEUMATIC HEART DISEASE (RHD) BY 2031
AMA Indigenous Health Report Card 2016: A call to action to prevent new cases of Rheumatic Heart Disease in Indigenous Australia by 2031
The AMA today called on all Australian governments and other stakeholders to work together to eradicate Rheumatic Heart Disease (RHD) – an entirely preventable but devastating disease that kills and disables hundreds of Indigenous Australians every year – by 2031.
AMA President, Dr Michael Gannon, said today that RHD, which starts out with seemingly innocuous symptoms such as a sore throat or a skin infection, but leads to heart damage, stroke, disability, and premature death, could be eradicated in Australia within 15 years if all governments adopted the recommendations of the latest AMA Indigenous Health Report Card.
The 2016 Report Card – A call to action to prevent new cases of Rheumatic Heart Disease in Indigenous Australia by 2031 – was launched at Danila Dilba Darwin Friday 25 November
Dr Gannon said the lack of effective action on RHD to date was a national failure, and an urgent coordinated approach was needed.
“RHD once thrived in inner-city slums, but had been consigned to history for most Australians,” Dr Gannon said.
“RHD is a disease of poverty, and it is preventable, yet it is still devastating lives and killing many people here in Australia – one of the world’s wealthiest countries.
“In fact, Australia has one of the highest rates of RHD in the world, almost exclusively localised to Indigenous communities.
“Indigenous Australians are 20 times more likely to die from RHD than their non-Indigenous peers – and, in some areas, such as in the Northern Territory, this rate rises to 55 times higher.
“These high rates speak volumes about the fundamental underlying causes of RHD, particularly in remote areas – poverty, housing, education, and inadequate primary health care.
“The necessary knowledge to address RHD has been around for many decades, but action to date has been totally inadequate.
“The lack of action on an appropriate scale is symptomatic of a national failure. With this Report Card, the AMA calls on all Australian governments to stop new cases of RHD from occurring.”
RHD begins with infection by Group A Streptococcal (Strep A) bacteria, which is often associated with overcrowded and unhygienic housing.
It often shows up as a sore throat or impetigo (school sores). But as the immune system responds to the Strep A infection, people develop Acute Rheumatic Fever (ARF), which can result in damage to the heart valves – RHD – particularly when a person is reinfected multiple times.
RHD causes strokes in teenagers, and leads to children needing open heart surgery, and lifelong medication.
In 2015, almost 6,000 Australians – the vast majority Indigenous – were known to have experienced ARF or have RHD.
From 2010-2013, there were 743 new or recurrent cases of RHD nationwide, of which 94 per cent were in Indigenous Australians. More than half (52 per cent) were in Indigenous children aged 5-14 years, and 27 per cent were among those aged 15-24 years.
“We know the conditions that give rise to RHD, and we know how to address it,” Dr Gannon said.
“What we need now is the political will to prevent it – to improve the overcrowded and unhygienic conditions in which Strep A thrives and spreads; to educate Indigenous communities about these bacterial infections; to train doctors to rapidly and accurately detect Strep A, ARF, and RHD; and to provide culturally safe primary health care to communities.”
The AMA Report Card on Indigenous Health 2016 calls on Australian governments to:
Commit to a target to prevent new cases of RHD among Indigenous Australians by 2031, with a sub-target that, by 2025, no child in Australia dies of ARF or its complications; and
Work in partnership with Indigenous health bodies, experts, and key stakeholders to develop, fully fund, and implement a strategy to end RHD as a public health problem in Australia by 2031.
“The End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRC) is due to report in 2020 with the basis for a comprehensive strategy to end RHD as a public health problem in Australia,” Dr Gannon said.
“We need an interim strategy in place from now until 2021, followed by a comprehensive 10-year strategy to implement the END RHD CRC’s plan from 2021 to 2031.
“We urge our political leaders at all levels of government to take note of this Report Card, and to be motivated to act to solve this problem.”
The AMA Indigenous Health Report Card 2016 is available at https://ama.com.au/article/2016-ama-report-card-indigenous-health-call-action-prevent-new-cases-rheumatic-heart-disease
Labor calls on the Turnbull government to take heart and address Rheumatic Heart Disease, an entirely preventable public health problem which is almost exclusively affecting First Nation Peoples.
Labor welcomes the release of the Australian Medical Association’s 2016 Aboriginal and Torres Strait Islander Health Report Card, A Call To Action To Prevent New Cases Of Rheumatic Heart Disease In Indigenous Australian By 2031.
Poor environmental health conditions, like overcrowded housing remain rampant in Aboriginal and Torres Strait Islander communities, devastating families and the lives of young people.
“As the AMA’s report card suggests, we must build on the success of the 2009 Commonwealth Government Rheumatic Fever strategy, established to improve the detection and monitoring of Acute Rheumatic Fever and Rheumatic Heart Disease.
Funding under the Rheumatic Fever strategy is uncertain after this financial year,” Ms King said.
The Productivity Commission’s report Overcoming Indigenous Disadvantage [OID] released last week found 49.4% of Aboriginal and Torres Strait Islander peoples in remote communities live in overcrowded housing. Additionally, the report details no significant improvement in Aboriginal and Torres Strait Islander Peoples access to clean water, functional sewerage and electricity.
“We know Rheumatic Heart Disease is a disease of poverty and social disadvantage, which is absolutely preventable. Aboriginal and Torres Strait Islander communities, especially in the Top End of the Northern Territory, suffer the highest rates of definite Rheumatic Heart Disease,” Mr Snowdon said.
Labor applauds the work of the Take Heart Australia awareness campaign, and their work to educate and advocate putting Rheumatic Heart Diseases on the public health agenda.
“Like always, Aboriginal and Torres Strait Islander communities need to be front and centre in taking action. The most positive outcomes will come through communities working with Aboriginal and Community Control Health Organisations to design and deliver programs tailored to their needs,” Senator Dodson said.
The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 noted more than three years ago the association of RHD with ‘extremes of poverty and marginalisation’, these conditions remain and are almost exclusively diseases of Indigenous Australia.
If we are serious about closing the gap, we must take heart, and address this burden of Rheumatic Heart Disease facing First Nation Peoples.
ACTION TO END RHEUMATIC HEART DISEASE (RHD) IN 15YRS
The Heart Foundation has today supported the Australian Medical Association (AMA) call for governments to work together to eliminate Rheumatic Heart Disease (RHD) in 15 years, by 2031.
Heart Foundation National CEO, Adjunct Professor John Kelly (AM) said RHD was an avoidable but widespread disease that kills and harms hundreds of Indigenous Australians every year.
“Considering how preventable RHD is, it is a national shame that our Indigenous population are left languishing.
“The Heart Foundation has strongly advocated from the RHD strategy. We continue to call on the government to fund the National Partnership Agreement on Rheumatic fever strategy and Rheumatic Heart Disease Australia (RHD Australia) with a $10 million over 3 years’ commitment, “Adj Prof Kelly said.
With the AMA predicting that RHD could be eradicated in Australia within 15 years if all governments adopted its recommendations, the time to act is now.
“We need to boost funding for the national rheumatic fever strategy. New Zealand is allocating $65 million over 10 years. A robust approach can put an end to RHD as a public health issue within 15 years,” Adj Prof Kelly said.
This call to action was part of the release of the AMA’s 2016 Indigenous Report Card – A call to action to prevent new cases of Rheumatic Heart Disease in Indigenous Australia by 2031.
“We want a strong and robust strategy to tackle this challenge. We will be working with the AMA to support and advocate for these recommendations which include:
” Closing the gap in Aboriginal and Torres Strait Islander health inequality unfortunately remains a persistent challenge for our society.
There is no shortage of statistics and data demonstrating that we need to do better – it can sometimes feel like there is a new report every week flagging indicators of concern.
The real challenge is translating headlines into consistent effort and real results – beyond news and political cycles.
There is legitimate concern that the centrality of ACCHOs to improving health service delivery and health outcomes for Aboriginal and Torres Strait Islander peoples is not being adequately recognised.
I have consistently argued that there are ACCHOs which are the finest examples of comprehensive primary health care in the country.”
Warren Snowdon as Shadow Assistant Minister for Indigenous Health
Article from Page 10 NACCHO Aboriginal Health Newspaper out Wednesday 16 November , 24 Page lift out Koori Mail : or download
naccho-newspaper-nov-2016 PDF file size 9 MB
This is one of the goals of the National Aboriginal and Torres Strait Islander Health Plan 2013 – 2023 – a ten year framework for Aboriginal and Torres Strait Islander health policy. It articulates a vision for closing the gap in Aboriginal and Torres Strait Islander health inequality.
Significantly, the Health Plan was developed by Labor in partnership with Aboriginal and Torres Strait Islander peoples, their community organisations and their peak bodies.
NACCHO was a key partner and collaborator in the development of the plan, as was the National Congress of Australia’s First Peoples.
This is because Labor has a strong commitment to the belief that Aboriginal community controlled health organisations (ACCHOs) and the National Congress are central to improving health outcomes for Aboriginal and Torres Strait Islander peoples and should be partners in developing policy.
Importantly, the Plan has bipartisan support. An Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan was launched in 2015 by the Abbott Government.
Again, this plan was developed in partnership with the National Health Leadership Forum. However, despite this and the strong bipartisan support for the Health Plan, we are now in the fourth year of the Plan and still no resources have been identified for the Implementation Plan.
It is clear that without resources, the vision of the Health Plan will be impossible to achieve.
Although Labor remains committed to working in a bipartisan manner with the current Government to improve Aboriginal and Torres Strait health outcomes, to address the obvious inequalities and to close the gap, this does not mean that Labor will not hold the government to account.
Advancing the priorities of Aboriginal and Torres Strait Islander peoples, communities and their organisations remains an absolute commitment. Working in partnerships is paramount to achieve these.
There are obvious issues with the failure of the current government to develop a comprehensive approach to dealing with the social determinants of health or to demonstrate any real appreciation of how a human rights approach is required in the development of our health policy.
Additionally, we are very aware of the need to address issues of racism to ensure that the health system is not discriminatory.
There is legitimate concern that the centrality of ACCHOs to improving health service delivery and health outcomes for Aboriginal and Torres Strait Islander peoples is not being adequately recognised. I have consistently argued that there are ACCHOs which are the finest examples of comprehensive primary health care in the country.
They are community based and controlled, they are responsive, innovative, accountable and have good governance. Most importantly, they deliver primary care, allied health services and prevention strategies which are examples for the rest of the world. ACCHOs also provide services that are culturally appropriate and safe.
Having said this, there are some organisations that need to do better. They need to be more accountable and reform their governance and their record of service delivery.
NACCHO and the state and territory affiliates have an important role to play in this regard in terms of leadership, accountability and mentoring. They need to be alive to the threats that exist as well as opportunities for the sector to grow further by expanding the reach of services and consequently, achieving better health outcomes for Aboriginal and Torres Strait Islander peoples.
For our part, Labor will continue to review our current policy settings, particularly as we approach the next election.
As a matter of course we will continue to work with NACCHO, the affiliates and their member organisations as well as other health advocacy and membership groups, such as doctors, nurses, health workers and allied health practitioners and of course other health experts from universities and the like.
We acknowledge the need to continue to address the dramatic levels of chronic disease that are endemic in many Aboriginal and Torres Strait Islander communities.
The fundamental importance of good primary care services being readily available is abundantly clear.
In primary health care, broader health policy has an inevitable impact, and this is why Labor has consistently opposed changes to the Medicare system that increase costs or limit services to those who most need Medicare. We are very conscious of the need to protect ACCHOs from the impact of these policy threats.
There is also an absolute need to look at prevention strategies to intervene and stop the onset of chronic disease in the first place. We support the life course approach that drives the National Health Plan as well as the requirement to address the broader social determinants.
In this context we are currently giving priority to what can be done in maternal and child health, parenting and adolescent health.
We need to ensure that all children are born healthy, have a healthy childhood and grow up to be healthy adults, without the chronic disease that has beset their parents and grandparents.
Improvements cannot happen in isolation. There is a concurrent need to do something about the poverty that is such a major driver of poor health outcomes. Policies and strategies around education, employment, housing, drug and alcohol policies, mental health and social and emotional wellbeing as well as food security are integral to elevating and sustaining health outcomes.
We will continue to advocate for the development and provision of appropriate aged care services. And we will continue to support treatment models driven by Aboriginal and Torres Strait Islander peoples that are culturally appropriate from their inception.
Another area where Labor is keen to see more progress is in the health workforce. It is vital that we see more Aboriginal and Torres Strait Islander people across all disciplines, engaged in treating and supporting Aboriginal and Torres Strait Islander people.
Labor recognises that one size will not fit all. There is a need to appreciate and address the difference and diversity that exists for Aboriginal and Torres Strait Islander peoples across the country.
Labor is absolutely committed to both this underlying principle in our policy development process, as well as recognising that the framework we are using remains the National Aboriginal and Torres Strait Islander Health Plan 2013 – 2023.
“ The acknowledgement of racism as a critical component for health in the National Health Plan was a huge step forward and I’m delighted the Implementation Plan had sown seeds to tackle social and cultural determinants of health , which contributed to 31 per cent of the gap in life expectancy between Indigenous and non-Indigenous Australians.”
Assistant Minister for Health and Aged Care Ken Wyatt see his comments about 18C below
At the #LowitjaConf2016 Assistant Minister Wyatt announced the makeup of a new advisory group established to assist with the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan (NATSIHP)
Download PDF copy of NATSIHP implementation plan here
Download PDF copy of NATSIHP here
He said it would include representatives of the Department of Health and Prime Minister and Cabinet and of the Australian Institute for Health and Welfare.
Indigenous health sector representatives would include:
1.Healing Foundation CEO Richard Weston (as co-chair)
2.National Aboriginal Community Controlled Health Organisation (NACCHO) CEO Pat Turner
3.Apunipima Cape York Health Council’s Dr Mark Wenitong,
See NACCHO TV interview here with Dr Mark
4.Central Australian Aboriginal Congress Aboriginal Alice Springs Ms Donna Ah Chee, CEO
See NACCHO TV Interview here with Donna
5.Winnunga Nimmityjah Aboriginal Health Service Canberra Julie Tongs OAM, CEO
See NACCHO TV Interview here with Julie
Jurisdictional members of the National Aboriginal and Torres Strait Islander Health Standing Committee would also join, he said.
The National Aboriginal and Torres Strait Islander Health Plan is an evidence-based policy framework designed to guide policies and programmes to improve Aboriginal and Torres Strait Islander health over the next decade until 2023.
The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 was developed to provide an overarching framework which builds links with other major Commonwealth health activities and identifies areas of focus to guide future investment and effort in relation to improving Aboriginal and Torres Strait Islander health.
On 30 May 2014 Senator the Hon Fiona Nash, Assistant Minister for Health, announced that an Implementation plan would be developed outlining the Commonwealth’s coordinated efforts to improve Aboriginal and Torres Strait Islander health outcomes.
Assistant Minister for Health and Aged Care Ken Wyatt comments about 18C
Speaking to Croakey, he indicated he may support a move, heralded by Prime Minister Malcolm Turnbull, to replace the words “insult” and “offend” with “vilify” in Section 18C of the Racial Discrimination Act, as a move to meet demands from ultra Coalition conservatives while not scrapping the provision.
His comments came as the Federal Government set up a parliamentary inquiry into the Act to determine whether it imposes unreasonable limits on free speech and to recommend whether the law should be changed.
Wyatt said he would always fight to ensure people are not “racially vilified” but he said he did not want to see Parliament persuaded to “repeal” Section 18C.
“I would rather see a reconstruction that has strong words that stood the test against vilification and racism.”
“The release of this much awaited Draft Fifth National Mental Health Plan is another important opportunity to support reform, and it’s now up to the mental health sector including consumers and carers, to help develop a plan that will benefit all.”
A successful plan should help overcome the lack of coordination and the fragmentation between layers of government that have held back our efforts to date.”
NACCHO and Mental Health Australia CEO Frank Quinlan have welcomed the release of the Draft Fifth National Mental Health Plan and is encouraging all ACCHO stakeholders to engage with the plan during the upcoming consultation period.
Download the Draft Fifth National Mental Health Plan at the link below:
PDF Copy fifth-national-mental-health-plan
The Consultation Draft of the plan identifies seven priority areas;
1. Integrated regional planning and service delivery
2. Coordinated treatment and supports for people with severe and complex mental illness
3. Safety and quality in mental health care
4. Suicide prevention
5. Aboriginal and Torres Strait Islander mental health and suicide prevention
6. Physical health of people with mental illness
7. Stigma and discrimination reduction
Summary of actions
Aboriginal and Torres Strait Islander mental health and suicide prevention
|1. Governments will work collaboratively to develop a joined approach to social and emotional wellbeing support, mental health, suicide prevention, and alcohol and other drug services, recognising the importance of what an integrated service offers for Aboriginal and Torres Strait Islander people.
2. Governments will work with Primary Health Networks and Local Hospital Networks to implement integrated planning and service delivery for Aboriginal and Torres Strait Islander people at the regional level.
3. Governments will renew efforts to develop a nationally agreed approach to suicide prevention for Aboriginal and Torres Strait Islander people.
4. Governments will work with service providers, including Aboriginal Community Controlled Health Organisations, to improve Aboriginal and Torres Strait Islander access to and experience with mental health and wellbeing services.
5. Governments will work together to strengthen the evidence base needed to inform development of improved mental health services and outcomes for Aboriginal and Torres Strait Islander people.
6.Governments will develop suitable public health and communication strategies to better inform the community about suicide and suicide prevention.
released: 14 Oct 2016 author: AIHW media release
Download Summary mental-health-serives-in-australia-aiw-report
Mental health services—In brief 2016 provides an overview of data about the national response of the health and welfare system to the mental health care needs of Australians.
It is designed to accompany the more comprehensive data on Australia’s mental health services available online at <http://mhsa.aihw.gov.au>.
Mental Health Australia is pleased to be partnering with the Department of Health to run consultation workshops on the plan during November which is an important opportunity for members to provide feedback and guidance on the plan.
National consultation activities to assist with the development of the Fifth Plan will run from November to early December 2016.
A series of face-to-face workshops will be conducted in all states and territories throughout this period. These workshops will be complemented by local consultation events convened by some states and territories.
An opportunity to submit general feedback on the Fifth Plan via this webpage will also be available throughout the duration of the consultation period.
Further details on the consultation activities and how you can participate will be available here shortly
If you need support you can contact one of our 302 Aboriginal Community Controlled Health Services clinics
or the following services:
|Lifeline Freecall||13 11 14|
|Kids Helpline||1800 551 800|
|NT Mental Health Help Line||1800 682 288|
|Headspace (12-25 years)||1800 659 388 or 8931 5999|
|Beyond Blue||1300 224 636|
or contact email@example.com
Colin Cowell Editor Mobile 0401 331 251
The Public Health Information Development Unit (PHIDU) has published an Aboriginal and Torres Strait Islander Social Health Atlas.
This presents a range of demographic, socioeconomic, health outcomes and service use data for Aboriginal and Torres Strait Islander peoples at the Indigenous Area level.
The 2016 release of the atlas includes updated data for the following:
And new hospitalisations data for:
Maps for the Aboriginal and Torres Strait Islander Atlas can be found at the link below:
For those who prefer the data in a spreadsheet format, the data can be found below:
If you have any questions regarding the Social Health Atlas, our contact details can be found at the link below:
“Aboriginal and Torres Strait Islander people will not achieve equal health outcomes until their educational, economic, and social disadvantages have been eliminated.
“We still have much work to do as a nation to close the gap in life expectancy and the overall health of Indigenous Australians compared with the rest of the community.
“The AMA remains committed to improving the health outcomes for Indigenous people by working in partnership with Aboriginal and Torres Strait Islander groups to advocate for greater Government investment and cohesive coordinated strategies.”
AMA President, Dr Michael Gannon
On International Day of the World’s Indigenous Peoples, the AMA is calling for a whole-of- Government approach to close the health inequalities that exist for Aboriginal and Torres Strait Islander peoples.
This year’s International Day of the World’s Indigenous Peoples is dedicated to supporting the right to education.
AMA President, Dr Michael Gannon, said today that we need genuine collaborative action to improve health and education outcomes for Aboriginal and Torres Strait Islander people.
“There are clear links between education and health,” Dr Gannon said.
“We know closing the gap and improving the health outcomes for Aboriginal and Torres Strait Islander people also means closing the gap in education and literacy.
“Now is the time to develop a whole-of-Government approach to improve access to education and provide health services in culturally appropriate ways to improve the physical and mental wellbeing of Aboriginal and Torres Strait Islander peoples.
“All current and future policies addressing education, employment, poverty, housing, taxation, transport, the environment, and social security should be assessed according to their impact on health and equity.
The AMA strongly endorses the UN Declaration on the Rights of Indigenous People and the goal of equal access to all education and training for Indigenous peoples.
“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
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:
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. •
NHMRC invites stakeholders and members of the public to submit research priorities in Aboriginal and Torres Strait Islander health, which could form the subject of a Targeted Call for Research (TCR).
Information must be provided to substantiate the nominated priority and how the research could contribute to improved health outcomes.
Download PDF NACCHO tcrpubliccallconsultationdocument
The NHMRC Corporate Plan 2015-2016 identifies as a Major Health Issue, the need to “improve the health of Aboriginal and Torres Strait Islander peoples.” NHMRC supports research that will provide better health outcomes for Aboriginal and Torres Strait Islander peoples. Furthermore, NHMRC is committed to allocating at least 5% of the Medical Research Endowment Account to Aboriginal and Torres Strait Islander health research.
NHMRC’s work has been guided by The NHMRC Road Map: A Strategic Framework for Improving Aboriginal and Torres Strait Islander Health Through Research (2002) and NHMRC Road Map II: A Strategic Framework for improving the health of Aboriginal and Torres Strait Islander people through research (2010). However, it is timely to consult on current research priorities.
A TCR is a one-time solicitation for grant applications to address a specific health issue. It is intended to stimulate or greatly advance research in a particular area of health and medical science that will benefit the health of Australians. Examples of recent TCRs in Indigenous health include Suicide Prevention in Aboriginal and Torres Strait Islander Youth and Fetal Alcohol Spectrum Disorder among Aboriginal and Torres Strait Islander people.
Principles for consideration
Proposed TCRs must:
To assist the assessment of research topics, please provide a brief statement in response to the following questions:
You may nominate more than one priority, but please submit each priority separately.
Please note the Timezone is AEST.
The preferred option for public submissions is the Online method below. If you have already registered on this site please login here.
For further information please view the Submission Guidelines page.
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