Aboriginal Mental Health News : NACCHO welcomes consultation on Fifth National Mental Health Plan

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“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

You can download a copy of the draft plan;
Fifth National Mental Health Plan – PDF 646 KB
Fifth National Mental Health Plan – Word 537 KB

View all NACCHO 127 Mental Health articles here

View all NACCHO 97 Suicide Prevention articles here

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.

Additional info Mental health services—in brief 2016

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 Consultations

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.

Info here

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

Download or free NACCHO Contact APP

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

How you can share  health messages stories about Aboriginal Community Controlled Health issues ?

Closing this week

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More info and Advertising rate card

or contact nacchonews@naccho.org.au

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NACCHO Aboriginal Health Data : Aboriginal and Torres Strait Islander Social Health Atlas released

atlas

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:

  • Estimate Resident Population (ERP) data for 2015
  • Projected ERP data for 2016
  • Immunisation data for 2015
  • Deaths data now includes data for 2013

And new hospitalisations data for:

  • Hospitalisations by principal diagnosis and age
  • Ambulatory-sensitive hospitalisations

Maps for the Aboriginal and Torres Strait Islander  Atlas can be found at the link below:

http://phidu.torrens.edu.au/current/maps/atsi-sha/atlas.html

For those who prefer the data in a spreadsheet format, the data can be found below:

http://phidu.torrens.edu.au/current/data/atsi-sha/phidu_atsi_data_ia_aust.xls

If you have any questions regarding the Social Health Atlas, our contact details can be found at the link below:

http://phidu.torrens.edu.au/contact-us

 

 

NACCHO #WeAreIndigenous on International Day of the World’s Indigenous Peoples AMA calls for a whole-of- Government approach to close our health inequalities

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“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.

 

 

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

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“Learning from Aboriginal Community Controlled Health Organisations:

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

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

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

Originally published INSIDE STORY

See NACCHO HOME CARE Articles HERE

Copyright Congress

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

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

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

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

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

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

The roundtable saw the key elements as:

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

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

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

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

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

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

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

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

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

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

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

Learning from Aboriginal Community Controlled Health Organisations:

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

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

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

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


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

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

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

NACCHO Research News : Call for research priorities in Aboriginal and Torres Strait Islander health

Research

Purpose

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

Background

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:

  • Address a significant research knowledge gap or unmet need for which there is the potential to greatly advance our understanding of the issue; and/or
  • Link to Australian Government Priorities, including Aboriginal and Torres Strait Islander Health, and/or to Ministerially-agreed State and Territory health research priorities.

Specific Questions

To assist the assessment of research topics, please provide a brief statement in response to the following questions:

  1. What is the research priority (a significant research knowledge gap or unmet need) you are nominating? How would a TCR in this area greatly advance our understanding of this issue? (200 word maximum)
  2. What are the relevant Australian Government Priorities, and/or Ministerially-agreed State and Territory health research priorities linked to your nominated priority? (200 word maximum)
  3. How would a TCR in this area contribute to Aboriginal and Torres Strait Islander health and improve health outcomes for the individual and/or community? (200 word maximum)
  4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum)
  5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum)

You may nominate more than one priority, but please submit each priority separately.

Please note the Timezone is AEST.

Closing date:
Sunday, 4 September 2016 – 11:59pm
Extension:
Please note that for some NHMRC consultations no extensions will be given. Where extensions are available you will need to contact the project officer using the contact details at the bottom of this page. However, in order for NHMRC to extend the date of a submission you will need to have created an account and started a submission.

How to make your submission

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.

Contact for further information

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

 Kids

” 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

OZ

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

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” 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 News : AMA’s President commits to Taskforce on Indigenous health – an agreed national priority-

Newly elected Australian Medical Association (AMA) President Dr Michael Gannon speaks at a press conference at the National Convention Centre in Canberra, Sunday, May 29, 2016. (AAP Image/Mick Tsikas) NO ARCHIVING

 “As the new President of the AMA I will, like my predecessors, chair the AMA’s Taskforce on Indigenous health. This recognises and emphasises the importance of the AMA’s efforts to improve the health and wellbeing of Aboriginal and Torres Strait Islander people, and our desire to keep ‘Closing the Gap’ initiatives at the top of our agenda.

Closing the gap in health and life expectancy between Indigenous and non-Indigenous people is an achievable task – it is also an agreed national priority.

The Federal Government must build on existing platforms and ramp up its ambitions to achieve health equality for Aboriginal and Torres Strait Islander people.

Without commitment and action from our national leaders, the gap will remain wide and intractable. The Taskforce will inform the AMA’s advocacy in ensuring that this does not remain the case.”

Dr Michael Gannon President AMA 18 July 2016

The 2016 Federal election provided an opportunity for the AMA to present all political parties and candidates with the issues that the AMA sees as vital in meeting the challenge of closing the health gap including :

  • Increase investment in Aboriginal and Torres Strait Islander community-controlled health organisations. Such investment must support services to build their capacity and be sustainable over the long term;
  • Develop systemic linkages between Aboriginal and Torres Strait Islander community-controlled health organisations and mainstream health services to ensure high quality and culturally safe continuity of care;

Key Election Issues statement, the AMA urges the Federal Government :

The Taskforce, which was established in 2000, is comprised of representatives of the AMA Federal Council, AMA members and Indigenous health groups, including the National Aboriginal Community Controlled Health Organisation (NACCHO) and the Australian Indigenous Doctors’ Association (AIDA).

The Taskforce is a robust and dedicated entity which identifies, develops and recommends Indigenous health policy and strategies for the AMA and oversees the AMA’s annual Report Card on Indigenous Health.

This year, the 2016 Report Card on Indigenous Health will focus on rheumatic heart disease (RHD) – a major preventive health issue that significantly affects Indigenous people, particularly those in remote areas. As AMA WA President, I supported legislative change to improve reporting and reduce the burden of disease in Aboriginal communities in Western Australia.

RHD is a classic example of the many preventable chronic diseases that are largely responsible for the health gap between Indigenous and non-Indigenous people, with its burden largely extinguished in other parts of the Australian community. We can no longer allow the prevalence of chronic diseases like RHD to remain unaddressed.

While we have seen some recent improvements in Indigenous health, particularly in reducing infant mortality and smoking rates, the AMA wants to see the Commonwealth commit to improving resourcing for culturally appropriate primary health care for Aboriginal and Torres Strait Islander people.

The AMA has repeatedly said that it is not credible that Australia, one of the world’s wealthiest nations, cannot address the health and social justice issues that affect 3 per cent of its citizens. We say this again. The fact that it is our nation’s first people makes it an even greater moral imperative.

With the re-election of the Turnbull Government, the AMA will continue its call for long-term funding and commitments to Indigenous health. We will work closely with key ministers, government departments and other key stakeholders to ensure that appropriate action is taken.

As outlined in its Key Election Issues statement, the AMA urges the Federal Government to:

  • correct the under-funding of Aboriginal and Torres Strait Islander health services;
  • establish new, or strengthen existing, programs to address preventable health conditions that are known to have a significant impact on the health of Aboriginal and Torres Strait Islander people, such as cardiovascular disease (including rheumatic fever and rheumatic heart disease), diabetes, kidney disease, and blindness;
  • increase investment in Aboriginal and Torres Strait Islander community-controlled health organisations. Such investment must support services to build their capacity and be sustainable over the long term;
  • develop systemic linkages between Aboriginal and Torres Strait Islander community-controlled health organisations and mainstream health services to ensure high quality and culturally safe continuity of care;
  • identify areas of poor health and inadequate services for Aboriginal and Torres Strait Islander people and direct funding according to need;
  • institute funded, national training programs to support more Aboriginal and Torres Strait Islander people become health professionals to address the shortfall of Indigenous people in the health workforce;
  • implement measures to increase Aboriginal and Torres Strait Islander people’s access to primary health care and medical specialist services;
  • adopt a justice reinvestment approach to health by funding services to divert Aboriginal and Torres Strait Islander people from prison, given the strong link between health and incarceration;
  • increase funding for family violence and frontline legal services for Aboriginal and Torres Strait Islander people;
  • appropriately resource the National Aboriginal and Torres Strait Islander Health Plan to ensure that actions are met within specified timeframes; and
  • support the establishment of a Central Australia Advanced Health Research and Translation Centre. Central Australia faces many unique and complex health issues that require specific research, training and clinical practice to properly manage and treat and this type of collaborative medical and academic research, along with project delivery and working in remote communities, is desperately needed.

 

 

NACCHO #HealthElection16 : Ongoing commitment required to close the gap says NACCHO CEO

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PHOTO ABOVE : Senator Rachel Siewert visiting the Broome Regional Aboriginal Medical Centre yesterday with Senator Richard Di Natale to announce the Greens Aboriginal Health policy. Prior to entering parliament, Richard was a general practitioner and public health specialist. He worked in Aboriginal health in the Northern Territory.

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“Perhaps the most important part of The Greens’ commitments is the restoring of over half a billion dollars in cuts since 2013 and their earlier promise to index Medicare rebates, which have been frozen for several years. This has been causing unnecessary hardship to medical services across Australia.

“The Greens policy is a very comprehensive plan for Aboriginal health and we challenge the other parties to outline in detail what their plans are in these areas of concern.”

NACCHO CEO Patricia Turner ( Pictured above ) has welcomed the release of The Greens’ Aboriginal Health policy yesterday.

Ms Turner said The Greens’ policy is so far the only one this election to focus specifically on Aboriginal health and make commitments in nearly all of the key areas in Aboriginal health.

Read Greens Press release HERE

Download the full Aboriginal Health Policy document

Greens Aboriginal Health platform 2016 Elections

“The Greens have touched on many issues of serious concern for the ACCHO sector,” Ms Turner said.

“Avoidable blindness accounts for 11 per cent of the gap between Aboriginal and non-Aboriginal health. $42.3 million will go a long way to providing spectacles and other eye health measures and implement the Roadmap to Close the Gap for Vision.

“Almost $100 million to Close the Gap in hearing is also very welcome. We know that educational outcomes improve when children can hear properly in class and the $4 million a year for sound field systems in classrooms will be a great help.

“There is a desperate need for mental health services for Aboriginal people and the $720 million The Greens have committed to this is very important.

“Hear our Voices -Aboriginal Health in Aboriginal Hands “

View our new NACCHO TV Interviews HERE

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#HealthElection16 

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Editorial Proposals Close 10 June 2016

Closing 17 June for publishing election week 29 June

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NACCHO #HealthElection16 #TowardsRecovery Mental Health , NDIS , PHN’s and Aboriginal Community Controlled Health

PHNs-in-scope

Current Commonwealth programs migrating to PHN’s

Indigenous ?

The mental health sector is in the midst of “a perfect storm” of change, as one speaker put it during the recent VICSERV #TowardsRecovery conference in Melbourne. This comes as the sector grapples with how to offer people with mental illness not just choices but control over their lives.

Mental Health Australia CEO Frank Quinlan told delegates that the system was in a period of “quite unprecedented change”, with the rollout of the National Disability Insurance Scheme (NDIS), the new role in mental health of Primary Health Networks (PHNs) and other reforms planned or underway in response to the National Mental Health Commission’s Review of Mental Health Programmes and Services.”

A delegate from an Aboriginal community controlled health organisation (ACCHO) raised issues for her sector, where Aboriginal communities are estimated to have twice the incidence of disability as non-Aboriginal communities but much less access to services, and agencies that are not specialists for disability support.

“If you focus most of the effort on transitioning current supports (to the NDIS), that will continue to leave Aboriginal communities under-supported,” she told the NDIS panellists.

She was told the NDIA had identified it needed to do a lot more work around Aboriginal disability, and would step up that engagement and transition work. Other culturally and linguistically diverse (CALD) communities will also get a bigger focus.

Another ACCHO representative voiced fears that if Aboriginal people with disability transitioned to other services under the NDIS, only to find they were not culturally safe for them, that the ACCHO workforce might not still be there for them to return to.

Marie McInerney writes: Melissa Sweets edits in

Croakey New

While many of the major system changes underway, including the NDIS, are welcomed in the mental health sector, there is confusion over details and concern that many people with mental health issues could fall through new gaps in the system.

Some at the conference said the upheaval rivals the days of deinstitutionalisation, particularly in Victoria which has just emerged from much criticised recommissioning of mental health services and where there is also uncertainty about what of its mental health community support funds will be committed to the NDIS.

These concerns are only exacerbated by the uncertainty surrounding the policy outcomes likely to result from the July 2 federal election, and the marathon eight-week election campaign and caretaker period.

Despite all the planning for the NDIS, which on 1 July begins its full national rollout after three years of trials, the fate of some programs such as the Personal Helpers and Mentors (PHaMs) program is still not known.

(As a measure of ‘reform fatigue’, Victorian Alcohol and Drug Association CEO Sam Biondo told one session that when he started out in the 1970s, all he wanted was change; now all he wants is some stability).

“Some organisations don’t know what contracted services they’ll be offering on July 1,” Quinlan told Croakey in a follow-up interview yesterday. “That means uncertainty for their clients, people who rely on them, and also for their workforce who don’t know whether they will have employment in six weeks time.”

At the weekend Mental Health Australia released its election platform, saying the important reforms that are underway “cannot be forgotten during the current electoral cycle”. It is calling on political leaders for long-term commitment to:

  • reducing the national suicide rate
  • improving the physical health of people with a mental illness
  • increasing employment rates for people experiencing mental illness and their carers
  • increasing mental health consumer and carer participation and choice in national policy design and implementation
  • maintaining current overall levels of investment in mental health, with measures that support full reinvestment of cost efficiencies and savings.

Mental Health Australia will produce a ‘report card’ to be released prior to the election, outlining the major parties’ response on these issues.

Meanwhile, just a few days after the conference ended, one of its speakers, Professor Jane Burns, CEO of the Young and Well Cooperative Research Centre, joined other mental health leaders in releasing details on suicide across 28 Federal electorates, calling on party leaders and candidates to spell out what they intend to do to address the rising toll of suicide and self-harm across Australia.

NDIS concerns

The mental health sector has welcomed the NDIS, saying a well funded and well run scheme will meet many needs.

But the numbers provide the context for some of the concerns raised at the conference: it is estimated that each year in Australia, there are around 600,000 people who experience severe mental illness, and 300,000 who experience severe mental illness with “complex inter-agency needs”.

By comparison, there are around 60,000 places in the NDIS for people with mental health issues.

VICSERV CEO Kim Koop said the conference message was: “The NDIS is a welcome addition to a contemporary mental health system but is not sufficient replacement for the current offering.”

She said Victorian community managed mental health services were “desperate for more information” about the NDIS.

But the State Government has an equal role to play, she said, pointing out that the bilateral agreement makes clear that the introduction of the NDIS is a shared responsibility between the States and the Commonwealth. “Both need to step up and provide information,” she said.

VICSERV has played a lead role in documenting the Victorian trial of the NDIS in the Barwon area, but is waiting to hear back on how its concerns will be addressed.

Koop said:

The NDIS is not a bad thing (for mental health).

The trouble is that the funding for the existing services is being transferred to the NDIS and that it is still very uncertain if the NDIS will offer a similar range of services.

At the moment it’s just really unclear. We’re waiting to hear from the NDIA (National Disability Insurance Agency) around the review of supports for people with mental illness but until that comes out, we just don’t know what kind of supports, what price they will be at, what workforce (levels) there will be required.”

Delegates at one conference session peppered a panel that included senior managers in the National Disability Insurance Agency (NDIA) about many details of the NDIS’s likely operation.

A delegate told the panel it had been great to have different trials conducted across Australia over the past three years but their different reports on different experiences have created “confusion and misinterpretation…trying to compare apples with oranges”.

Others expressed continuing concern about how people with episodic mental health issues would be included in a Scheme designed around permanent disability.

On markets and mental health

The session followed a keynote by UK philosopher Dr Simon Duffy raising issues such as citizenship and the need to focus on community rather than institutional and organisational interests. By contrast, the language of the NDIS discussions was all around markets, market failures, entrants and competition.

In an aside to me, one delegate questioned whether there is a “market” in people with mental illness.

Asked at another session whether there really was a “fair dinkum market’” for organisations to start competing in, National Mental Health Commissioner Rob Knowles said there wasn’t yet.

But he warned that one would develop as it has in other countries, and he was not sure people in the sector understood the significance of the changes that will occur.

When the UK went down this road, about 80 per cent of existing services were provided by not for profit organisations, the remainder by private providers. That was soon reversed, he said.

A mistake many not-for-profits made was to think “people stick with us”. Knowles said: “People are much more fickle than that. I think there are significant challenges for those operating in this: how they make themselves be a service provider of choice”.

What will PHNs offer mental health?

Another panel session focused on the news, announced last year, that funds will be reallocated from Canberra to primary health networks (PHNs) to commission — but not deliver — mental health services.

Again, the sector has welcomed the move, particularly as a bridge between States and Commonwealth, but with concerns about how it all might work in practice.

Quinlan gaps

The aim of the PHNs, to make sure they get local services on the ground where they are needed, was very welcome, Quinlan said. The concern is how to maintain national standards.

He said: “For example with eating disorders and suicide prevention, you can quickly see you wouldn’t want 31 PHNs across the country all inventing their own way of doing things. Addressing how we tackle some national issues while ensuring local suitability is a big challenge.”

The PHN session involved panelists Jason Trethowan – Chief Executive, Western Victoria PHN, Lyn Morgain – Chief Executive, cohealth, and Christopher Carter – Chief Executive, North Western Melbourne PHN. They outlined what PHNs would cover, and what they wouldn’t.

The questions they sought to answer in their session demonstrated the issues of concern for many of the delegates there:

  • How will planning be undertaken that ensures the range of demographic, clinical, aged related, cultural, socio-economic and comorbidity of people is properly planned for?
  • How will the flexible funding pool work – be prioritised – is it flexible for service models of care?
  • How will PHNs work with the State system, and with each other to ensure continuity – especially given the transient nature of some consumers?
  • What does this mean for existing youth primary mental health services? Youth with severe mental health?
  • How will we ensure that services for Aboriginal and Torres Strait Islander people recognise the social determinants of health and cultural safety?
  • What are the potential approaches to reduce fragmentation (suicide prevention)?
  • What are the commissioning challenges and opportunities for rural communities?
  • There will likely be a gap with the move of specialist recovery based community mental health support services to the NDIS. Will PHN’s be able to fund recovery based CMH or will as suggested PHNs be limited to commissioning only “clinical primary MH” as has been suggested in some of the guidance documents?

PHNs not in scope

PHN perspectives

Croakey later asked panellist Chris Carter for his reflections on the session.

Q: What were the main messages you wanted to get across during the session on the role of PHNs within the context of national mental health reforms?

That the role of PHNs is developing – in the first phase this will be about development of a stepped care model that reflects regional needs, and is focussed around safe, quality mental health care.  There will be a number of stages and phases in the evolution of an integrated system given the high level of fragmentation in the healthcare system.

Q: What key concerns emerged from the session? What’s your response to them?

Not really concerns, but a genuine desire to participate in the conversation about reform – how PHNs will take into account the diversity of populations, families and individuals when considering future planning and investments in the mental health system.

Q: The Federal Opposition said recently: “The PHNs, as the critical commissioners under the new reform agenda, are stuck in an unenviable position, wedged between the enormous pressure to deliver the reforms with unreasonable demands and an information vacuum from the Department of Health and at the same time trying to manage an increasingly agitated mental health sector hungry for information and advice.” What’s your response to that?

Our role as PHNs is to help facilitate as much information sharing and participation in planning processes as is possible.  Some of the tension lies between acute and primary systems, as well as State and Commonwealth systems.  At a regional level, our job is to bring local intelligence / evidence and wisdom to try and meet the needs of consumers / citizens, whilst bringing along the sector – which we acknowledge is reform / change fatigued in Victoria.

Q: What do you want to see promised for mental health in the federal election? Has the campaign put major work on hold? What certainty is needed now?

I support Mental Health Australia’s call for a long-term strategy for mental health – and would add that we need to integrate State and Commonwealth responses at a regional level in order to target diverse populations and diverse needs.  The election campaign has not put our work on hold – we are on track to implement continuing and new arrangements ready for July 1 and beyond in partnership with stakeholders.

Some Twitter observations

PHNs twitterPHNs twitter2

Control, not choice

Another big theme at the conference was given a sharp focus by keynote speaker Simon Duffy – that the idea of ‘choice’ is not enough for people with disabilty.

Rather, he said, control is what’s vital. (See also Duffy’s views about the NDIS in this earlier Croakey story and in this interview on Radio National’s Life Matters).

In a similar vein, RMIT Associate Professor Paul Ramcharan told delegates about the It’s My Choice toolkit (DVD, discussion guide and booklets) developed with Inclusion Melbourne, a day service that supports people with intellectual disability. The project sought to inform people with disabilities, family, friends and others as well as service personnel about how to explore choices within complex lives and relationships. .

Ramcharan later told Croakey:

“Of the nine principles of choice (identified), one in particular challenges us to rethink the notion of choice. In this principle,  the important question is not whether people with disability have choice – given that no one really has a total choice in what happens in their lives and that choices are made within a complex of relationships, services and environments. The question should be whether the limitations placed on their choices are reasonable or not.

Organisations delivering services should be looking at discrimination and community norms and other barriers that get in the way of people expressing their choices not just about mundane matters like what to eat and wear (though important) but pervasive areas relating to health, education, work, family and intimacy.

Choice of services alone does not equate to personal choice. It’s the journey of life that counts, not formal academic indicators, but the rich fabric that enriches our lives day to day.”

(Note: this quote above was added to the original published story to give more context about the project).

See his slide below.

PRINCIPLE6
Conference perspectives

Quinlan view from front

Quinlan twitter

• Marie McInerney is covering the #TowardsRecovery conference for the Croakey Conference News Service. Bookmark this link to track the coverage.

NNEWS

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#HealthElection16 37 days to go

Advertising and editorial is invited from

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