NACCHO Aboriginal Health News: QAIHC comments on vax rates

feature tile text 'vulnerable First Nations communities could be at risk of being overwhelmed according to QAIHC' & image of cartoon drawing of two Aboriginal people wearing masks & 'QAIHC' along footer

QAIHC comments on vax rates

Vulnerable indigenous communities could be at risk of being ‘overwhelmed’ by COVID-19 if their vaccination rates continue to dwindle, the Queensland Aboriginal and Islander Health Council (QAIHC) has said.

Modelling based on current vaccination rates for indigenous populations suggests the 80% inoculation target for First Nations Queenslanders won’t be achieved until February 2022. The QAIHC says current health data shows 34.2% of Indigenous Queenslanders have had at least one vaccine dose. The state’s lowest vaccinated Indigenous population is in central Queensland at 17.78% fully vaccinated, with Townsville second last at 19.19%.

With target vaccination rates being set, and the notion of opening the borders to ‘live with the virus’, Queensland’s First Nations communities face the very real threat of being completely overwhelmed by COVID-19, QAIHC chair Matthew Cooke says.

“Targeted investment is needed immediately from both levels of government, otherwise our mob will be left behind when the borders open and be left most vulnerable to this virus”, Mr Cooke said. He says the vaccination gap is a grave cause for concern, particularly as discussions shift to reopening borders.

To view the full article in The West Australian click here.

Aboriginal woman with mask & health worker with mask & face shield

Image source: Yahoo! News website.

Min Wyatt outlines COVID-19 activities

The Minister for Indigenous Australians, the Hon Ken Wyatt MP has outlined a number of activities being undertaken by the Commonwealth to support states and territories, and Indigenous communities against the threat of COVID-19, including the formation of a National Food Security Taskforce. The role of this taskforce is to address food security issues in remote Indigenous communities, and work in close collaboration with states and territories under the National Coordination Mechanism to coordinate responses in a range of sectors. Ensuring a reliable supply of essential goods, groceries, pharmaceuticals and other critical supplies during the COVID-19 pandemic remains a high priority.

The National Indigenous Australians Agency (NIAA) has been working closely with the Department of Health from the beginning of the COVID-19 outbreak and, with its regional presence and on-the-ground contacts, has coordinated with other jurisdictions throughout the pandemic. The Minister for Indigenous Australians and NIAA continue to receive correspondence from a range of organisations and individuals regarding COVID-19 and includes this information as part of its ongoing communication with relevant Commonwealth and State and Territory bodies.

To view Minister Wyatt’s statement in full click here.

AUSMAT’s longest deployment on home soil

The Australian Medical Assistance Team, or AUSMAT, is a crack team of emergency disaster responders who deploy overseas providing emergency humanitarian support during major disasters. They never imagined their longest deployment would be on home soil.

Emergency nurse practitioner Angela Jackson has been at the frontline of many AUSMAT international rescue missions but this deployment, although closer to home, is shaping up to be a much bigger challenge. Angie and her team were tasked with providing COVID-19 vaccination support to remote communities that are home to many isolated, vulnerable, and Indigenous Australians.

Regional local health services in the NSW far-western region were faced with the monumental task of covering this vast remote area to provide vaccinations with already pre-pandemic stretched resources.

To view the full ABC News article click here.

two health professionals full PPE country road back of van

Namatjira community vaccine rollout in Dareton, NSW. Image source: ABC News website.

Calls for clean water continue

The WA government is under pressure to ensure remote Aboriginal communities have access to clean drinking water.

WA Shadow Minister for Water James Hayward has called on “the Departments of Water, Communities and Health, to work together cohesively to deliver a program to identify and test drinking water supplies in Aboriginal communities that have been left untested for going on a decade. It is in no way appropriate for a first world country to dismiss a community’s cry to ensure they have clean drinking water.“

Kimberley Labor MP and Yawuru, Nimanburr and Bardi woman, Divina D’Anna said she would “continue to advocate for better quality services to remote communities. It is critical that we provide services to remote communities. I am passionate about ensuring that the people of the Kimberley, especially Aboriginal people in remote communities, are afforded the same opportunities and access to essential services that city people are.”

To view the National Indigenous News article in full click here.

old broken water tap in outback

Image source: National Indigenous Times.

Dementia cases to double by 2058

A major report on dementia from the Australian Institute of Health and Welfare (AIHW) was recently release, finding that dementia is the second leading cause of death in Australia and the number of people developing the disease is growing at an alarming rate. It is expected that by 2058, dementia cases will double to 849,300 Australians from the estimated 386,000 – 472,000 people living with dementia in 2021.

The Dementia in Australia report was launched by the Minister for Senior Australians and Aged Care Services, Richard Colbeck on Monday. Also announced at the launch was the establishment of AIHW’s National Centre for Monitoring Dementia. The aim of the Centre is to undertake routine monitoring of dementia, find data gaps and address them, and help inform policy that meets the needs of Australians with dementia.

For people who are Aboriginal or Torres Strait Islander, rates of dementia are three to five times higher than non-Indigenous Australians. Due to an ageing Indigenous Australian population, AIHW believes the numbers of dementia among this group will continue to rise in the future.

To read the article in full click here.

Aged care worker Faye Dean (left) is supporting Winnie Coppin (right), who has dementia. Photo: Erin Parke, ABC Kimberley. Image source: ABC News.

New process for job advertising

NACCHO have introduced a new system for the advertising of job adverts via the NACCHO website and you can find the sector job listings here.

Click here to go to the NACCHO website where you can complete a form with job vacancy details – it will then be approved for posting and go live on the NACCHO website.


dice spelling JOBS resting on keyboard

Stride4Stroke campaign

The Stroke Foundation’s flagship campaign Stride4Stroke is back. For many Australians, the various lockdowns around the country have made keeping fit and active a challenge. That’s why this November you’re invited to join Stride4Stroke your way, wherever you are, and raise vital funds to help prevent, treat and beat stroke.

Get together with friends, colleagues, or family to create a team or go solo.

Ask your friends and family to donate to your online fundraising page. Every conversation and dollar raised will help prevent stroke, save lives and enhance recovery.

Simply select any activity – we’re talking any activity, such as swimming, exercise bike, yoga, walking, running – set your Moving Minutes target, and stride your way this November.

Register here by Friday 15 October 2021 to go in to the draw to WIN your very own Apple Watch for access to the latest in fitness tracking technology.

NACCHO Aboriginal Health News: First Nations COVID-19 vaccine implementation plan released

feature tile text 'Australian Government releasesCOVID-19 Vaccination Program Implementation Plan: Aboriginal and Torres Strait Islander People', photo of purple gloved hands injecting person's arm

First Nations COVID-19 vaccine implementation plan released

The Australian Government has released its COVID-19 Vaccination Program – Aboriginal and Torres Strait Islander Peoples Implementation Plan. This Implementation Plan is for the COVID-19 vaccination program for all Aboriginal and Torres Strait Islander peoples over 18 years of age. This plan has been developed in consultation with the Aboriginal and Torres Strait Islander health sector, and with state and territory governments.

To view the plan click here.cover of Australian Government Department of Health COVID-19 Vaccination Program Implementation Plan: Aboriginal and Torres Strait Islander Peoples

Sydney hospital goes from worst to best

It’s one of the busiest and most esteemed emergency rooms in the country, but for decades some of the most vulnerable have slipped through the cracks. Located in the heart of Sydney’s nightlife district, St Vincent’s Hospital has saved thousands of lives — but it was considered the worst in the state when it came to caring for certain patients. “A high number of Aboriginal people were coming in through our emergency department and were leaving us, not completing their treatment,” said Pauline Deweerd, director of Aboriginal health at the hospital.

Some months, as many as one in three patients left the hospital before receiving the vital care they needed. “It was because of past bad experiences, they didn’t like waiting, and they didn’t like the way we treated them,” Ms Deweerd said. It was a persistent, hard to address problem, even for a hospital that has a reputation for providing top-notch emergency medicine.

But in the middle of a global pandemic the hospital found a solution, and doctors are certain the rest of the country can learn from it. “It’s our attempt at closing the gap for our small part of the health world; we not only brought it to the level of the general population, we made it a little better,” Dr Preisz said.

To view the full ABC News article click here.

Aboriginal Health Manager Scott Daley in scrubs sitting on patient bed at St Vincent's Hospital

Aboriginal Health Manager Scott Daley, St Vincent’s Hospital, Sydney. Photo: Brendan Esposito. Image source: ABC News website.

Former PM urges women to get COVID-19 vaccine

Julia Gillard has had her coronavirus jab, urging everyone – and particularly women – to get vaccinated. The former PM joined Health Minister Greg Hunt and Department of Health secretary Brendan Murphy to be among the first to receive the AstraZeneca COVID-19 vaccination at a Melbourne clinic on Sunday 7 March 2021. “Me being here today is a visible representation that no matter what side of politics you barrack for, no matter whom you intend to vote for, there is a united message,” Ms Gillard told reporters. “Please get the vaccine. And particularly to Australian women, can I say, please get the vaccine.

She understands that people might feel a little bit anxious, but recommended they get their information from reliable sources, such as the Australian government or from their local health practitioner. “Whether it’s smallpox, measles, mumps, rubella, whooping cough, influenza, and now COVID-19, vaccinations can save lives and protect lives,” Mr Hunt said.

AstraZeneca and Pfizer doses from overseas are being given to frontline health and hotel quarantine workers, as well as aged and disability care residents and staff, as part of phase 1a. The AMA said more than 130 respiratory clinics and over 300 Aboriginal community controlled health service sites will support the phase 1b rollout.

To view the full SBS News article click here and to listen to a Julie Gillard urging Australians to get the COVID-19 vaccine click here.

portrait photo of ex-PM Julia Gillard

Former Australian Prime Minister Julia Gillard. Image source: SBS News website.

Umoona Tjutagku frontline staff receive COVID-19 vaccine

“South Australia’s economic and health response to the COVID-19 threat has been world-leading, and we are focused on working with our health experts to deliver a safe and quick roll out of the vaccines,” SA Premier Marshall said. “This is the biggest peacetime operation in our state’s history, and a big plank in our plan to keep South Australia safe and strong. “The roll out is happening right across the State, with our three key hubs in the north, south and centre of Adelaide all operational, and our regional hubs also progressing .”

Minister Wade said the rollout continues to expand into regional areas with 240 doses of the vaccine arriving at Coober Pedy Hospital today.

“Frontline staff of the Coober Pedy Health Service, Umoona Tjutagku Aboriginal Health Service and Umoona Aged Care as well as aged care residents will receive their COVID-19 vaccine over the next four days.  It is an excellent example of cooperation across all sectors of Health and Aged Care in the Eyre and Far North Local Health Network, SA Minister for Health and Wellbeing Stephen Wade said.

To view the SA Premier’s media release in full click here.

two Aboriginal health workers at Umoona Tjutagku Health Service AC checking medicine box

Image source: Umoona Tjutagku Health Service Aboriginal Corporation website.

Over 55s in next phase of COVID-19 vaccine rollout

More GPs and health clinics will be involved in the vaccine rollout every week from March 22, as the mass COVID-19 vaccination program enters its next phase. Federal Health Department secretary Brendan Murphy says phase 1b of the vaccine rollout will include adults based on their vulnerability to getting COVID-19. “[It] will involve the over 80s who are most at risk as a general group, then the over 70s, and those who are immunocompromised. We will have our Indigenous Australians over 55 as well as frontline emergency service and defence workers.”

The staged commencement of general practices will be complemented by GP-led respiratory clinics and Aboriginal community controlled health services. The AMA said more than 130 respiratory clinics and over 300 Aboriginal community controlled health service sites will support the phase 1b rollout.

To view the full SBS News article click here.

Aboriginal woman and man both 50+ years

Image source: AbSec – NSW Child, Family and Community Peak Aboriginal Corporation website.

Professor Langton talks about the COVID-19 vaccine 

Professor Marcia Langton AO has warned of the ongoing dangers of COVID-19, the effectiveness of available vaccines and the importance of getting vaccinated as soon as possible.

You can view the short video and transcript here.

snapshot of Professor Marica Langton AO The Uni of Melbourne video for DoH on COVID-19 importance, standing in park with trees in background

Professor Marcia Langton AO, The University of Melbourne.

Pain treatment and opioid use – have your say!

NACCHO is working on a project to create some support materials for pain management and the use of opioid medicines, including for Aboriginal and Torres Strait Islander people and is looking for Aboriginal and Torres Strait Islander people consumers and health professionals to take part in group discussion to understand the important issues so that the materials made can be useful.

If you are a health consumer and experience pain and use opioids or are interested in pain management as a practitioner in your ACCHO we invite you to contribute to this project. NACCHO will provide financial compensation for your participation.

To apply or learn more please contact Fran Vaughan at NACCHO medicines@naccho.org.au.

bottles of tablets & blister packs

Image source: NPS Medicinewise website.

System must be held accountable for deaths in custody

Responding to news that two Indigenous people died in custody in NSW in the past week, Amnesty International Australia Indigenous Rights Lead Nolan Hunter said: “We’re coming up to the 30 year anniversary of the Royal Commission into Aboriginal Deaths In Custody (RCIADIC) and it feels as though very little has changed. For example, recommendation 165 called for the screening and removal of hanging points that could be used for self-harm; now nearly 30 years later, we hear of an Indigenous woman who used such a hanging point to tragically take her own life. Here we have two tragic deaths in custody and the Corrective Services Commissioner Peter Severin claims the system can be accountable, while not making these tragedies public.”

To view Amnesty International’s media quote in full click here. and a related article in The Sydney Morning Herald here.

crosses in row on grass with Aboriginal flag painted on them & words Black Deaths In Custody Cross For Loss

Image source: ABC News website.

World Kidney Day

Kidney disease is a non-communicable disease (NCD) and currently affects around 850 million people worldwide. One in ten adults has chronic kidney disease (CKD). Being diagnosed with kidney disease can be a huge challenge, both for the patient and those people around them. Its diagnosis and management, particularly in advanced stages of kidney disease, impacts severely upon their lives by reducing their, and that of family and friends, ability to participate in everyday activities like work, travel and socialising whilst causing numerous problematic side effects  – e.g. fatigue, pain, depression, cognitive impairment, gastrointestinal problems and sleep problems.

This year World Kidney Day continues to raise awareness of the increasing burden of kidney diseases worldwide and to strive for kidney health for everyone, everywhere. Specifically, the World Kidney Day Steering Committee has declared 2021 the year of “Living Well with Kidney Disease”. This has been done in order to both increase education and awareness about effective symptom management and patient empowerment, with the ultimate goal of encouraging life participation.

When compared to non-Indigenous Australians, Indigenous Australians

  • Are more than twice as likely to live with biomedical markers of chronic kidney disease – representing 1 in 5 Indigenous Australian adults
  • Experience an increased prevalence of significant medical co-morbidities
  • Have a median onset of ESKD around 30 years younger
  • Are almost 4 times as likely to die with CKD as a cause of death
  • Have incidence rates of renal replacement therapy (RRT) 8 – 9 times greater
  • Are less likely to receive dialysis in a home setting (either peritoneal or haemodialysis)
  • Are less likely to receive a kidney transplantation
  • Have worse outcomes from transplantation
  • Are more likely to live in very remote or remote areas which is associated with poorer health outcomes
  • Experience a greater psycho-social impact of their disease

For further information on World Kidney Day Thursday 11 March 2021 click here.

Aboriginal painting titled My Kidney Journey by Inawinytji Williamson, a Pitjantjatjara and Yankunytjara Woman and kidney patient

My Kidney Journey by Inawinytji Williamson, a Pitjantjatjara and Yankunytjara woman and kidney patient. Image source: World Kidney Day website.

2021 Indigenous Wellbeing Conference

The Australian & New Zealand Mental Health Association (ANZMHA) has announced details of its new conference, the 2021 Indigenous Wellbeing Conference to take place in Cairns from 7–8 October 2021.

Its theme will be “Honouring Indigenous Voices & Wisdom: Balancing the System to Close the Gap” and will showcase a high calibre of keynote speakers and presenters, covering four vital topics: (1) Promoting Wellness, (2) Social, Emotional & Cultural Determinants, (3) Community Care & Social Recovery and (4) Service Care & Recovery.

With a vision to “shine light on the key challenges in Indigenous communities and address the past and present issues contributing to inequities in mental health treatment and care,” the conference is set to enlighten, educate, and share the hard truths amongst keynote speakers, presenters and attendees.

For more information about the conference and to register click here.

NACCHO Aboriginal Health Research Alerts : Download @AIHW Report Indigenous primary health care results : Our ACCHO’s play a critical role in helping to improve the health of our mob

 ” Comprehensive and culturally appropriate primary health care services play a key role in improving the health and wellbeing of Indigenous Australians through prevention, early intervention, health education, and the timely identification and management of physical and psychological issues. “

Download the 77 Page AIHW Report HERE

Indigenous-primary-health-care-results-from-the-OSR-and-nKPI-collections

Primary health care organisations play a critical role in helping to improve the health of Indigenous Australians.

In 2018–19:

To this end, the Australian Government provides funding through the IAHP to organisations delivering Indigenous-specific primary health care services (referred to hereafter as organisations).

These organisations, designed to be accessible to Aboriginal and Torres Strait Islander clients, are administered and run by:

  • Aboriginal community-controlled health organisations (ACCHOs)
  • state/territory/local health services
  • non-government organisations (NGOs), such as women’s health services (a small proportion of services).

They vary in size, location, governance structure, length of time in operation, workforce composition, sources of funding, the services they offer, the ways in which they operate (for example, stand-alone or part of a consortium), and the needs of their clients.

What they all share in common is a holistic approach to meeting the needs of their Indigenous clients, which often involves addressing a complex mix of health conditions.

Each organisation provides contextual information about their organisation to the OSR once each financial year (covering the period July–June). The OSR includes all activities of the funded organisations, regardless of the percentage of those activities funded by IAHP.

This chapter presents a profile of organisations delivering Indigenous-specific primary health care services, including staffing levels, client numbers, client contacts, episodes of care and services provided. It excludes data from organisations that received funding only for maternal and child health services.

Trends over time are presented where possible, noting that the organisations providing data can vary over time which may limit comparability for some purposes (see Technical notes and Glossary for more information). Also, in 2018–19, the OSR collection underwent significant change and was scaled back to include only ‘core’ items. Plans are underway to reintroduce key items in a staged approach over the next few years.

The following boxes show key results for organisations providing Indigenous-specific primary health care in 2018–19.

Clicking HERE will go to more information on the selected topic.

Aboriginal Health #CoronaVirus Alert No 79 : June 11 #KeepOurMobSafe #OurJobProtectOurMob : 1.#COVID19 advice for #BlackLivesMatter protestors 2. New $24.2 million @headspace_aus mental health services funding for young people aged 12–25

Aboriginal and Torres Strait Islander Lives Matter: Many thousands of people around the country gathered in public places to give that message loud and clear over the weekend.

This has been followed by some mixed messages about the risks of catching COVID-19 and who needs to be tested.

Through following the health messages below, we can continue to keep COVID-19 infections low amongst Aboriginal and Torres Strait Islander peoples and all Australians.

1.People with coronavirus can spread the virus for at least 48 hours before showing symptoms. This is why it is important you continue with social distancing, regular hand washing and cough hygiene.If you can, avoid contact with Elders and with people with chronic medical conditions as these people are at much higher risk of serious COVID-19 illness if they get infected.

2.If you develop even the mildest of symptoms, stay home and get a COVID-19 test. The symptoms that warrant a COVID-19 test include a sore throat, cough, shortness of breath, chills, night sweats or a temperature over 37.5°C. The earlier we pick up infections, the quicker we can move to prevent further spread.

3.Testing is only recommended for people with symptoms.

Part 2 : Press Release : The Australian Government announced an additional $24 million in funding , to expand headspace services and reduce wait times for young people seeking mental health support.

The Federal Government is investing $24.2 million to reduce wait times – fast tracking access to mental health services for young people aged 12–25 seeking headspace appointments.

Mental health and suicide prevention remains one of our Government’s highest priorities.

One in four young Australians are affected by a mental health illness every year, and as we battle COVID-19 it’s more important than ever that we prioritise mental health.

The disruption to normal life caused by the COVID-19 pandemic and the required restrictions has had profound impacts on young Australians.

Funding will go to Primary Health Networks (PHNs) in NSW, Victoria, Queensland, South Australia, Tasmania, the ACT and headspace National.

Services provided through headspace centres are a safe place to turn to, somewhere young people can get professional help, peer support and feel comfortable enough to tackle their challenges in a way that is right for them.

headspace provides access to free or low cost youth-friendly, primary mental health services with a single entry point to holistic care in four key areas—mental health, related physical health, substance misuse, and social and vocational support.

Prior to the pandemic, headspace service centres were experiencing high demand across the country.

Our Government’s investment will ensure young Australians can get information, advice, understanding, counselling and treatment, when and where they need it.

Individual grants of up to $2 million will improve facilities, access and reduce waiting times at headspace services commissioned by PHNs.

The headspace Demand Management and Enhancement Program is an investment of $152 million over seven years from 2018-19 by the Morrison Government to reduce wait times at headspace services.

The headspace services which will receive funding through this grant opportunity are:

State/Territory headspace Service
New South Wales Bankstown, Bondi Junction, Camperdown, Dubbo, Griffith, Hurstville, Lismore, Lithgow, Liverpool, Maitland, Miranda, Nowra, Orange, Penrith, Port Macquarie, Queanbeyan, Tamworth, Tweed Heads, Wagga Wagga and Wollongong
Victoria Albury-Wodonga, Bairnsdale, Bendigo, Geelong, Greensborough, Shepparton, Werribee and Wonthaggi
Queensland Bundaberg, Capalaba, Hervey Bay, Inala, Maroochydore, Nundah, Rockhampton, Southport, Townsville and Warwick
South Australia Berri, Mount Gambier, Murray Bridge and Port Augusta
Tasmania Hobart and Launceston
ACT Canberra

Our Government continues to demonstrate its firm commitment to the mental health and wellbeing of all Australians.

Children, young people and their families have been identified as a vulnerable population in the National Mental Health and Wellbeing Pandemic Response Plan.

We know this group will experience the impact of the social and economic outcomes of the COVID-19 pandemic the most.

Through record investments in mental health services and support, the Morrison Government will invest an estimated $5.2 billion this year alone.

Since the beginning of the year, our Government has provided $8 billion as part of the Coronavirus (COVID-19) National Health Plan, which is supporting primary care, aged care, hospitals, research and the national medical stockpile.

This includes an additional $500 million for mental health services and support, including $64 million for suicide prevention, $74 million for preventative mental health services in response to the COVID-19 pandemic and $48 million to support the pandemic response plan.

Next COVID-19 Webinar

A reminder too that our next webinar on the COVID-19 response for mental health will be held on Wednesday 17 June, 11am – 11:30am AEST. We hope to see you then and, as always, you can catch up on all previous webinars on-demand.

COVID webinar survey

If you have also been one of the thousands of practitioners who have watched our COVID-19 webinars then we are especially grateful for your engagement. The questions and comments have helped shape the information we have been providing.

To make sure our communication activities continue to be useful as we enter the next phase of the pandemic response, we would like your feedback. Your responses will be anonymous, and should take less than 5 minutes to complete. We appreciate your time is extremely valuable.

This link will remain open until COB Tuesday 16 June.

Take survey HERE

NACCHO Aboriginal Health and Alcohol other Drugs: Peak public health bodies @_PHAA_ And @FAREAustralia respond to Health Minister @GregHuntMP launch of National Alcohol Strategy 2019-28 : Download Here

The federal government will spend $140m on drug and alcohol prevention and treatment programs but has ruled out measures such as hiking taxes on cask wine.

Health Minister Greg Hunt announced the National Alcohol Strategy 2019-28 has been agreed with the states following protract­ed negotiations.

The strategy outlines agreed policy options in four priority areas: community safety, price and promotion, treatment and prevention.

Health lobby groups have pushed for reform in two major areas: the introduction of a minimum floor price for alcohol by state governments, and the introduction of a volumetric tax, based on the amount of alcohol in a beverage, by the commonwealth. ”

From The Australian Health Editor Natasha Robinson (See in full part 1 below )

Read over 200 Aboriginal health and Alcohol other drugs articles published by NACCHO over the past 7 years 

” Overall, Aboriginal and Torres Strait Islander people are more likely to abstain from drinking alcohol than non-Aboriginal and Torres Strait Islander people (31% compared with 23% respectively).

However, among those who did drink, higher proportions drank at risky levels (20% exceeding the lifetime risk guidelines) and were more likely to experience alcohol-related injury than non-Aboriginal and Torres Strait Islander people (35% compared to 25% monthly, respectively).

For this reason, Aboriginal and Torres Strait Islander people experience disproportionate levels of harm from alcohol, including general avoidable mortality rates that are 4.9 times higher than among non-Aboriginal and Torres Strait Islander people, to which alcohol is a contributing factor.

The poorer overall health, social and emotional wellbeing of Aboriginal and Torres Islander people than non-Aboriginal and Torres Strait Islander people are also significant factors which can influence drinking behaviours. ” 

Page 8 of National Strategy Aboriginal and Torres Strait Islander people

Download the full strategy HERE

national-alcohol-strategy-2019-2028

 ” The Public Health Association of Australia (PHAA) is pleased the National Alcohol Strategy 2019-2028 is finally out but said it lacked ambition to prevent Australians suffering adverse health impacts of alcohol consumption.

“It is good news to have this strategy now finalised, albeit many years in the making and with too much influence from the alcohol industry,”

PHAA CEO Terry Slevin  : See part 2 below for full press release 

Australia has not had a national strategy since 2011 and we congratulate Health Minister Greg Hunt for spearheading this successful outcome. 

Given the high burden of harm from alcohol, including 144,000 hospitalisations each year, we trust that the NAS will support proportionate action from the Commonwealth, states and territories to protect Australians and their families,

 FARE has also welcomed the Minister’s announcement that the Government will commission a report to estimate the social costs of alcohol to the community.  

Australia faces a $36 billion a year alcohol burden, with approximately a third due to alcohol dependence, a third caused by injuries, and the final third due to chronic diseases such as cancer and cardiovascular diseases,

FARE Director of Policy and Research Trish Hepworth. See part 3 below for full press release 

 ” Alcohol places an enormous burden on our healthcare resources on our society and ultimately on us as a nation.

Alcohol is currently the sixth leading contributor to the burden of disease in Australia, as well as costing Australian taxpayers an estimated $14 billion annually in social costs.

The AMA has previously outlined the priorities we would like to see reflected in the Strategy, including action on awareness, taxation, marketing, and prevention and treatment services.

Implementing effective and practical measures that reduce harms associated with alcohol misuse will benefit all Australians.”

AMA President, Dr Tony Bartone : See Part 4 Below for full Press Release 

Part 1 The Australian Continued 

The National Alcohol Strategy lists the introduction of a volumetric tax as one policy ­option, but Mr Hunt said the commonwealth was ruling out such taxation reform.

“The government considers Australia’s current alcohol tax settings are appropriate and has no plans to make any changes,” the minister’s office said.

Mr Hunt said there were “mixed views” among the states on the introduction of a minimum floor price for alcohol — the Northern Territory is the only jurisdiction to introduce this measure — but such policy remained an option for the states.

Mr Hunt said the national strategy had laid out a path towards Australia meeting a targeted 10 per cent reduction in harmful alcohol consumption.

“There’s a balance been struck, what this represents is an attempt to lay out a pathway to reducing alcohol abuse and reducing self-harm and violence that comes with it,” Mr Hunt said.

“The deal-maker here was the commonwealth’s investment in drug and alcohol treatment. That was the most important part. Now we’d like to see the states match that with additional funds, but we won’t make our funds ­dependent upon the states.”

Health groups welcomed the finalisation of the national strategy. Alcohol Drug Foundation chief executive Erin Lalor said it was now up to governments to act on the outlined policies. “The strategy means we can now start doing and stop talking, because it’s been in development for a ­really long time,” Ms Lalor said.

“We’ve now got really clear options that we can focus on and it’s up to governments around Australia and other groups working to reduce alcohol-related harm and the alcohol industry to start to take serious measures and evidence-based measures that will reduce the significant harm from alcohol.”

Ms Lalor was disappointed the government had ruled out a volumetric tax. “We have been advocating for a long time for volumetric tax to be introduced. The strategy outlines it and we would hope to see pricing and taxation of alcohol being adopted to reduce alcohol-related harms.”

Canberra will spend $140m on programs to combat alcohol and drug addiction.

Primary Health Networks will receive $131.5m to commission new and existing drug and ­alcohol treatment services, while the government will commission a new report to estimate the social costs of alcohol to society.

Part 2 Belated alcohol strategy is a missed opportunity

The Public Health Association of Australia (PHAA) is pleased the National Alcohol Strategy 2019-2028 is finally out but said it lacked ambition to prevent Australians suffering adverse health impacts of alcohol consumption.

“It is good news to have this strategy now finalised, albeit many years in the making and with too much influence from the alcohol industry,” PHAA CEO Terry Slevin said.

“The strategy recommends important policy options that can reduce alcohol related harm via both national and state level efforts.”

“All governments should invest in and commit to reducing the health and social burden of excess alcohol consumption,” Mr Slevin said.

“It is a shame the federal government has again ruled out the option of volumetric tax on alcohol, which is a fairer and more sensible way of taxing alcohol.

“This is about stopping people from getting injured, ill or dying due to alcohol, so why rule out this option?”

“The current alcohol tax system is a mess and is acknowledged as such by anyone who has considered the tax system in Australia.”

“We hope this important reform will again be considered at a time in the near future.“

“Let’s remember that alcohol is Australia’s number one drug problem. Harmful levels of consumption are a major health issue, associated with increased risk of chronic disease, injury and premature death,” Mr Slevin said.

“The announcement of funding for drug treatment services is modest but we welcome the support for a report assessing the social cost of alcohol.”

“When that report is completed we hope it will influence alcohol policy into the future.”

Part 3 The Foundation for Alcohol Research and Education (FARE) congratulates Federal, State and Territory Ministers for finalising the National Alcohol Strategy 2019–2028 (the NAS).

“Australia has not had a national strategy since 2011 and we congratulate Health Minister Greg Hunt for spearheading this successful outcome,” said FARE Director of Policy and Research Trish Hepworth.

“Given the high burden of harm from alcohol, including 144,000 hospitalisations each year, we trust that the NAS will support proportionate action from the Commonwealth, states and territories to protect Australians and their families,” she said.

FARE has also welcomed the Minister’s announcement that the Government will commission a report to estimate the social costs of alcohol to the community.

“Australia faces a $36 billion a year alcohol burden, with approximately a third due to alcohol dependence, a third caused by injuries, and the final third due to chronic diseases such as cancer and cardiovascular diseases,” Ms Hepworth said.

“In implementation, we urge governments to take action to increase the community’s awareness of the more than 200 injury conditions and life-threatening diseases caused by alcohol,” she said.

FARE strongly encourages the Federal Government to revisit alcohol taxation reform, which would be the most effective way to reduce the death toll from alcohol-related harm, which is almost 6,000 people every year.

“We know from multiple reviews that alcohol taxation is the most cost-effective measure to reduce alcohol harm because measures can be targeted towards reducing heavy drinking, while providing government with a source of revenue,” Ms Hepworth said.

Part 4 AMA

The announcement that the National Alcohol Strategy 2019–2028 (the NAS) has been agreed to by all States and Territories is welcome, but it is disappointing that it does not include a volumetric tax on alcohol, AMA President, Dr Tony Bartone, said today.

“The last iteration of the NAS expired in 2011, so this announcement has been a long time coming,” Dr Bartone said.

“The AMA supports the positive announcements by the Government to reduce the misuse of alcohol. However, they simply do not go far enough.

“An incredibly serious problem in our community needs an equally serious and determined response.

“Doctors are at the front line in dealing with the devastating effects of excessive alcohol consumption. They treat the fractured jaws, the facial lacerations, the eye and head injuries that can occur as a result of excessive drinking.

“Doctors, and those working in hospitals and ambulance services, see the deaths and life-long injuries sustained from car accidents and violence fuelled by alcohol consumption.

“Healthcare staff, including doctors, often bear the brunt of alcohol-fuelled violence in treatment settings. Alcohol and other drugs in combination are often a deadly cocktail.

“Prolonged excessive amounts contribute to liver and heart disease, and alcohol is also implicated in certain cancers.

“All measures that reduce alcohol-fuelled violence and the harm caused by the misuse of alcohol, including taxing all products according to their alcohol content, should be considered in a national strategy.

“For this reason, we are extremely disappointed that the Government has ruled out considering a volumetric tax on alcohol.

“A national, coordinated approach to alcohol policy will significantly improve efforts to reduce harm.

“Alcohol places an enormous burden on our healthcare resources on our society and ultimately on us as a nation.

“Alcohol is currently the sixth leading contributor to the burden of disease in Australia, as well as costing Australian taxpayers an estimated $14 billion annually in social costs.

“The AMA has previously outlined the priorities we would like to see reflected in the Strategy, including action on awareness, taxation, marketing, and prevention and treatment services.

“Implementing effective and practical measures that reduce harms associated with alcohol misuse will benefit all Australians.”

Background

  • The Australian Institute of Health and Welfare found that alcohol and illicit drug use were the two leading risk factors for disease burden in males aged 15-44 in 2011.
  • The AIHW has linked alcohol use to 26 diseases and injuries, including six types of cancer, four cardiovascular diseases, chronic liver disease, and pancreatitis, and estimated that in 2013 the social costs of alcohol abuse in Australia was more than $14 billion.
  • A study conducted by the Australasian College for Emergency Medicine in 2014 found that during peak alcohol drinking times, such as the weekend, up to one in eight hospital patients were there because of alcohol-related injuries or medical conditions. The report noted that the sheer volume of alcohol-affected patients created more disruption to Emergency Departments than those patients affected by ice.

 

NACCHO Aboriginal #MentalHealth Download @NMHC National Report 2019 Released today : The Australian Government encourages PHNs to position Aboriginal Community Controlled Health Services as preferred providers for mental health and suicide prevention services for our mob

” Working to improve the health of Aboriginal and Torres Strait Islander people is a priority area for PHNs.

The PHN Advisory Panel Report recommended that PHN funds for mental health and suicide prevention for Aboriginal and Torres Strait Islander people should be provided directly to Aboriginal Community Controlled Health Services (ACCHS) as a priority, unless a better arrangement can be demonstrated.

The Senate Inquiry into the accessibility and quality of mental health services in rural and remote Australia also made a similar recommendation.

PHNs should continue to work on formalising partnerships with ACCHS.

The NMHC supports the recommendations made by both these reports and recommends that the Australian Government encourages PHNs to position ACCHS as preferred providers for mental health and suicide prevention services for Aboriginal and Torres Strait Islander people “

Extract from Page 14 

Recommendation 16: The Australian Government encourages PHNs to position Aboriginal Community Controlled Health Services as preferred providers for mental health and suicide prevention services for Aboriginal and Torres Strait Islander people.

The National Mental Health Commission today released its National Report 2019 on Australia’s mental health and suicide prevention system, including recommendations to improve outcomes.

Download the full 97 Page Report HERE 

National_Report_2019

or 9 Page Summary HERE 

National Report 2019 Summary – Accessible PDF

The Commission continues to recommend a whole-of-government approach to mental health and suicide prevention.

This broad approach ensures factors which impact individuals’ mental health and wellbeing such as housing, employment, education and social justice are addressed alongside the delivery of mental health care.

National Mental Health Commission Advisory Board Chair, Lucy Brogden, said we are living in a time when we’re seeing unprecedented investment and interest in making substantial improvements to our mental health system.

“Current national reforms are key, but complex, interrelated and broad in scope, and will take time before their implementation leads to tangible change for consumers and carers,” Mrs Brogden said.

“The National Report indicates while there are significant reforms underway at national, state and local levels, it’s crucial that we maintain momentum and implement these recommendations to ensure sustained change for consumers and carers.”

National Mental Health Commission CEO Christine Morgan said the National Report findings align with what Australians are sharing as part of the Connections Project, which has provided opportunities for the Commission to hear directly from consumers, carers and families, as well as service providers, about their experience of the current mental health system.

“What’s clear is we must remain focused on long term health objectives. Implementation of these targeted recommendations will support this focus,” Ms Morgan said.

The NMHC recommendations require collaboration across the sector.  As part of its ongoing monitoring and report role, the NMHC will work with stakeholders to identify how progress of the recommendations can be measured.

For your nearest ACCHO contact for HELP 

NACCHO Aboriginal Health #ClosingtheGap : Pat Turner Convener #CoalitionofPeaks Speech at the National #PHN Conference : Challenging the way Governments and Primary Health Networks work with us

The reform priorities, and that they are being discussed in a COAG forum with Aboriginal and Torres Strait Islander people at the table, as well as the upcoming engagements is a demonstration of how the conversation and approach is changing as a result of the Partnership Agreement on Closing the Gap.  

But this changed approach is not to be just contained to the Partnership Agreement and governments work with the Coalition of Peaks. It is to be applied to all your policy practice and service delivery.

It is a challenge for you (PHN’s) to reconsider how you develop policies and programs with and for Aboriginal and Torres Strait Islander people and communities.

The Partnership Agreement means that:

  • Aboriginal and Torres Strait Islander people are no longer government ‘stakeholders’ but are full partners in the development of policies and programs that impact on us.
  • Primary Health Networks need to develop formal arrangements with us, through our community controlled health organisations, to agree policy and programs, based on our own structures and not your own appointed advisory bodies.
  • The knowledge of Aboriginal and Torres Strait Islander peoples to determine their own solutions must be given primacy in policy and program design and delivery.

I ask that you all consider what the Partnership Agreement will mean to your own Primary Health Network, to the area and team that you work with, to start a conversation with your team members about it, to read further about the work we are doing and set up a time to speak to one of our Coalition of Peaks members to learn more.

The Partnership Agreement presents a significant opportunity for you all to think creatively and with innovation, to not just think about what is possible in the relationship between government and Aboriginal and Torres Strait Islander people, but to be at the forefront of the change.”

Pat Turner NACCHO CEO speaking at the PHN NATIONAL FORUM, 11TH September 2019 HYATT HOTEL, Canberra

Hello everyone, thank you for inviting me here today to speak to at the seventh Primary Health Network National Forum.

It is testament to the changing times that you now have delegates from national health peak bodies like mine, the National Aboriginal Community Controlled Health Organisation (NACCHO), attending your forums and being invited to share our own stories.

My name is Pat Turner. I am the CEO of NACCHO, and the Lead Convener of the Coalition of Peaks. Foremost, I am an Aboriginal woman, the daughter of an Arrente man and a Gurdanji woman.

Before we start, I want to acknowledge the traditional custodians of the lands where we are meeting today.

Canberra is Ngunnawal country. The Ngunnawal are the Aboriginal people of this region and its first inhabitants.

The neighbouring people are the Gundungurra to the North, the Ngarigo to the South, the Yuin on the coast, and the Wiradjuri inland.

It is a harsh climate and difficult country for hunter-gatherer people. To live here required great knowledge of the environment, skillful custodianship of it and close cooperation.

It is this knowledge and ways of working that continue to guide Aboriginal and Torres Strait Islander peoples across the in today’s Indigenous policy landscape.

As we navigate the changing policy environment, Aboriginal people draw strength from our lands and our customs. And we continue the cooperation amongst our many nations for the betterment of all of us. This is the approach that we take to the Coalition of Aboriginal and Torres Strait Islander Peaks Bodies and our work on Closing the Gap.

The Coalition of Peaks are made up of some forty national and state/territory community controlled Aboriginal and Torres Strait Islander Peak Organisations. We have come together to be formal partners with Australian Governments on Closing the Gap.

Today I want to share with you how a group of Aboriginal community controlled organisations, led by NACCHO, have exercised political agency by leading the way, challenging the possibilities and imagining a future of shared decision-making with governments on policies and programs that impact on our people and our communities.

Together, we are changing the way governments work with Aboriginal and Torres Strait Islander peoples on policies and programs that impact on us: we are setting a new benchmark for how our voices are heard in the design and implementation of policies and programs that impact on us.

I come before you to not only share the story of the Coalition of Peaks and their work with governments. Importantly, I also want to talk to you about what these new arrangements mean for Primary Health Networks and for your own daily work practices.

The new approach to Closing the Gap is a challenge you to change the way you work with and engage with Aboriginal and Torres Strait Islander people in the development of policies and delivery of health and wellbeing programs.

BACKSTORY

I will start by going back, to tell you how the Coalition of Peaks got to where we are today.

You might recall the Council of Australian Governments (COAG) in 2007 committed to ‘closing the gap’ in life expectancy between Aboriginal and Torres Strait Islander and other Australians, and a range of targets to end the disparity between Aboriginal and Torres Strait Islander peoples and other Australians in areas like infant mortality, employment and education.

  1. It was the first time that Australian Governments had come together in a unified way to address the disadvantage experienced by too many Aboriginal and Torres Strait Islander peoples.
  2. An unprecedented investment of around 4.6 billion dollars in programs and services to ‘close the gap’ as also made.
  3. Governments also agreed to new oversight, monitoring and reporting arrangements, including an annual report to the Commonwealth Parliament by the Prime Minister.

Aboriginal and Torres Strait Islander leaders at the time welcomed this new approach from governments and some of us were consulted in the early stages of the Commonwealth’s thinking.

However, despite this unprecedented coming together of Australian Governments and investment and initial engagement with our peoples, we were not formally involved in Closing the Gap, it was not agreed by us and it was a policy of governments and not for our people.

Many Aboriginal and Torres Strait Islander people felt that Closing the Gap presented the issue of our disadvantage as a technical problem built around non-Indigenous markers of poverty. This only served to hide the extent to which Aboriginal and Torres Strait Islander peoples’ disadvantage is a political problem requiring deep structural reforms about the way governments work with us.

Closing the Gap did not address the biggest gap that we face: the gulf between the political autonomy and economic resources of Aboriginal and Torres Strait Islander peoples and non-Indigenous people.

The policies and programs that then followed whilst making some difference to our peoples lives did not achieve their potential.

Over time government commitment to work together fell away. Funding to our programs and services were cut or not continued.

It is not surprising then, that, now ten years later, we have not made the progress against the closing the gap targets that had been hoped.

“REFRESH”

As you know, in 2017 the Commonwealth Government embarked on a ‘refresh’ of the Closing the Gap framework and undertook a series of consultations. In the view of many Aboriginal and Torres Strait Islander organisations, the consultations were inadequate and superficial. There was no public report prepared on their outcomes.

The lack of transparency and accountability surrounding these consultations were very disappointing, but also not surprising. Many of our organisations made submissions to government on Closing the Gap but we felt like our voices were ignored.

We were worried that governments commitment to work differently with us going forward was not backed by meaningful demonstrations. And we were concerned that governments wanted to walk away from the intergovernmental arrangements that brought a national integrated policy strategy needed to close the gap.

No new funding was announced to accompany the ‘refresh’ and there were no specific actions being discussed that we could see or feel confident would make a positive change to our lives.

As the ‘refreshed’ Closing the Gap strategy was being prepared for sign off by the Australian Governments, our dismay and disappointment galvanised a small group of community controlled organisations to come together to write to the Prime Minister, Premiers and Chief Ministers asking that it not be agreed.

We weren’t going away, and there were three important messages that we wanted governments to hear. These were:

  • When Aboriginal and Torres Strait Islander peoples are included and have a real say in the design and delivery of services that impact on them, the outcomes are far better;
  • Aboriginal and Torres Strait Islander peoples need to be at the centre of Closing the Gap policy: the gap won’t close without our full involvement; and
  • the Council of Australian Governments cannot expect us to take responsibility and work constructively with them to improve outcomes if we are excluded from the decision making.

Eventually, we were invited to meet with the Prime Minister, who acknowledged that the current targets were ‘government targets’ not ‘shared targets’, and that for Closing the Gap to be realised Aboriginal and Torres Strait Islander people had to be able to take formal responsibility for the outcomes through shared decision making.

On 12 December 2018, COAG publicly committed to developing a genuine, formal partnership with Aboriginal and Torres Strait Islander people, through their representatives, on Closing the Gap; and that through this partnership a new Closing the Gap policy would be agreed.

THE PARTNERSHIP AGREEMENT ON CLOSING THE GAP

The initial fourteen organisations then became almost forty, as we brought together Aboriginal and Torres Strait Islander Peaks bodies across the country to form a formal Coalition to negotiate a new Closing the Gap framework with Australian Governments. We include both national and state and territory based Aboriginal and Torres Strait Islander Peaks representing a diverse range of services and matter that are important to us as Aboriginal and Torres Strait Islander peoples and to Closing the Gap.

As a first step and through our initiative, we negotiated and agreed a formal Partnership Agreement between the Council of Australian Governments and the Coalition of Aboriginal and Torres Strait Islander peak organisations which came into effect in March 2019.

The Partnership Agreement sets out that the Coalition of Peaks will have shared decision making on developing, implementing and monitoring and reviewing Closing the Gap for the next ten years.

This is an historic achievement. It is the first time that Aboriginal and Torres Strait Islander Peaks have come together in this way, to work collectively and as full partners with Australian Governments. It’s is also the first time that there has been formal decision making with Aboriginal and Torres Strait Islander peoples and Australian Governments in this way.

WHERE ARE AT NOW

Progress is being made under the Partnership Agreement on Closing the Gap:

  • All Council of Australian Government members, including the local government association, have signed the Partnership Agreement.
  • The National Indigenous Reform Agreement (NIRA) has been reviewed by the Coalition of Peaks and officials from Australian Governments.
  • It has been agreed that the NIRA will be replaced with a new National Agreement on Closing the Gap covering the next ten years, to be signed off by the Council of Australian Governments and the Coalition of Peaks. It will continue the NIRA’s successful elements, strengthen others and address foundational areas that were previously excluded from consideration.
  • New accountability, monitoring and reporting arrangements are being developed for the new National Agreement that will strengthen public transparency and accountability.

Most importantly, the Coalition of Peaks have also proposed reform priorities to underpin the new National Agreement on Closing the Gap.

The reform priorities seek to change the way Australian Governments work with Aboriginal and Torres Strait Islander peoples and organisations, and accelerate life outcomes for Aboriginal and Torres Strait Islander peoples, these are:

  1. Establishing shared formal decision making between Australian governments and Aboriginal and Torres Strait Islander people at the State/Territory, regional and local level to embed ownership, responsibility and expertise on Closing the Gap.
  2. Building and strengthening Aboriginal and Torres Strait Islander community-controlled organisations to deliver services and programs in priority areas.
  3. Ensuring all mainstream government agencies and institutions undertake systemic and structural transformation to contribute to Closing the Gap.

These reforms have been agreed in principle by the COAG established Joint Council on Closing the Gap, made up of Ministers from each jurisdiction and Coalition of Peak representatives on 23 August 2019. And they have direct relevance to the Primary Health Networks and our work together.

The Joint Council also agreed to the Coalition of Peaks leading engagements with Aboriginal and Torres Strait Islander representatives of communities and organisations on new National Agreement.

These engagements are happening over the next two months and include open meetings across Australia agreed to and supported by governments. The Coalition of Peaks are also consulting with their own memberships and there is an online public opportunity for people to have their say.

The primary focus of the engagements is to build understanding and support for the reform priorities and to have a detailed discussion on what is needed to make those reform priorities a success. The discussions and input from Aboriginal and Torres Strait Islander communities will help inform the finalisation of the negotiations on the New National Agreement on Closing the Gap.

This is also a significant shift in the approach to policy development. It is the first time that governments have agreed to leaders of Aboriginal and Torres Strait Islander organisations engaging with representatives from our communities and organisations about important government policy.

Pat Turner Lead Convener of the Coalition of Peaks invites community to share their voice on #ClosingtheGap

This week a survey will be sent to hundreds of Aboriginal and Torres Strait Islander community-controlled organisations and their networks, inviting responses from both individuals and organisations.

There is a discussion booklet that has background information on Closing the Gap and sets out what will be talked about in the survey.

The survey will take a little bit of time to complete. It would be great if you can answer all the questions, but you can also just focus on the issues that you care about most.

To help you prepare your answers, you can look at a full copy here

The survey is open to everyone and can be accessed here:

https://www.naccho.org.au/programmes/coalition-of-peaks/have-your-say/

NACCHO Aboriginal Health #ClosingTheGap #NAIDOC2019 : @AIHW Key results report 2017-18 Aboriginal and Torres Strait Islander health organisations:

Findings from this report:

  • Just under half (45%) of organisations provide services in Remote or Very remote areas

  • In 2017–18, around 483,000 clients received 3.6 million episodes of care

  • Nearly 8,000 full-time equivalent staff are employed in these organisations and 4,695 (59%) are health staff

  • Organisations reported 445 vacant positions in June 2018 with health vacancies representing 366 (82%) of these
  • In 2017–18, nearly 200 organisations provided a range of primary health services to around 483,000 clients, 81% of whom were Indigenous.
  • Around 3.6 million episodes of care were provided, nearly 3.1 million of these (85%) by Aboriginal Community Controlled Health Services.

See AIHW detailed Interactive site locations map HERE

In 2017–18, Indigenous primary health services were delivered from 383 sites (Table 3). Most sites provided clinical services such as the diagnosis and treatment of chronic illnesses (88%), mental health and counselling services (88%), maternal and child health care (86%), and antenatal care (78%). Around two-thirds provided tobacco programs (69%) and substance-use and drug and alcohol programs (66%).

Most organisations provided access to a doctor (86%) and just over half (54%) delivered a wide range of services, including all of the following during usual opening hours: the diagnosis and treatment of illness and disease; antenatal care; maternal and child health care; social and emotional wellbeing/counselling services; substance use programs; and on‑site or off-site access to specialist, allied health and dental care services.

Most organisations (95%) also provided group activities as part of their health promotion and prevention work. For example, in 2017–18, these organisations provided around:

  • 8,400 physical activity/healthy weight sessions
  • 3,700 living skills sessions
  • 4,600 chronic disease client support sessions
  • 4,100 tobacco-use treatment and prevention sessions.

In addition to the services they provide, organisations were asked to report on service gaps and challenges they faced and could list up to 5 of each from predefined lists. In 2017–18, around two-thirds of organisations (68%) reported mental health/social and emotional health and wellbeing services as a gap faced by the community they served.

This was followed by youth services (54%). Over two-thirds of organisations (71%) reported the recruitment, training and support of Aboriginal and Torres Strait Islander staff as a challenge in delivering quality health services.

Read full report and all data HERE

This is the tenth national report on organisations funded by the Australian Government to provide health services to Aboriginal and Torres Strait Islander people.

Indigenous primary health services

Primary health services play a critical role in helping to improve health outcomes for Aboriginal and Torres Strait Islander people. Indigenous Australians may access mainstream or Indigenous primary health services funded by the Australian and state and territory governments.

Information on organisations funded by the Australian Government under its Indigenous Australians’ health programme (IAHP) is available through two data collections: the Online Services Report (OSR) and the national Key Performance Indicators (nKPIs). Most of the organisations funded under the IAHP contribute to both collections (Table 1).

The OSR collects information on the services organisations provide, client numbers, client contacts, episodes of care and staffing levels. Contextual information about each organisation is also collected. The nKPIs collect information on a set of process of care and health outcome indicators for Indigenous Australians.

There are 24 indicators that focus on maternal and child health, preventative health and chronic disease management. Information from the nKPI and OSR collections help monitor progress against the Council of Australian Governments (COAG) Closing the Gap targets, and supports the national health goals set out in the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023.

Detailed information on the policy context and background to these collections are available in previous national reports, including the Aboriginal and Torres Strait Islander health organisations: Online Services Report—key results 2016–17 and National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: results for 2017.

At a glance

This tenth national OSR report presents information on organisations funded by the Australian Government to provide primary health services to Aboriginal and Torres Strait Islander people. It includes a profile of these organisations and information on the services they provide, client numbers, client contacts, episodes of care and staffing levels. Interactive data visualisations using OSR data for 5 reporting periods, from 2013–14 to 2017–18, are presented for the first time.

Key messages

  1. A wide range of primary health services are provided to Aboriginal and Torres Strait Islander people. In 2017–18:
  • 198 organisations provided primary health services to around 483,000 clients, most of whom were Aboriginal and Torres Strait Islander (81%).
  • These organisations provided around 3.6 million episodes of care, with nearly 3.1 million (85%) delivered by Aboriginal Community Controlled Health Services (ACCHSs).
  • More than two-thirds of organisations (71%) were ACCHSs. The rest included government-run organisations and other non-government-run organisations.
  • Nearly half of organisations (45%) provided services in Remoteand Very remote
  • Services were delivered from 383 sites across Australia. Most sites provided the diagnosis and treatment of chronic illnesses (88%), social and emotional wellbeing services (88%), maternal and child health care (86%), and antenatal care (78%). Around two-thirds provided tobacco programs (69%) and substance-use and drug and alcohol programs (66%).

See this AIHW detailed Interactive site locations map HERE

  1. Organisations made on average nearly 13 contacts per client

In 2017–18, organisations providing Indigenous primary health services made around 6.1 million client contacts, an average of nearly 13 contacts per client (Table 2). Over half of all client contacts (58%) were made by nurses and midwives (1.8 million contacts) and doctors (1.7 million contacts). Contacts by nurses and midwives represented half (49%) of all client contacts in Very remote areas compared with 29% overall.

  1. Organisations employed nearly 8,000 full-time equivalent (FTE) staff

At 30 June 2018, organisations providing Indigenous primary health services employed nearly 8,000 FTE staff and over half of these (54%) were Aboriginal or Torres Strait Islander. These organisations were assisted by around 270 visiting staff not paid for by the organisations themselves, making a total workforce of around 8,200 FTE staff.

Nurses and midwives were the most common type of health worker (14% of employed staff), followed by Aboriginal and Torres Strait Islander health workers and practitioners (13%) and doctors (7%). Nurses and midwives represented a higher proportion of employed staff in Very remote areas (22%).

  1. Social and emotional health and wellbeing services are the most commonly reported service gap

Organisations can report up to 5 service gaps faced by the community they serve from a predefined list of gaps. Since this question was introduced in 2012–13, the most commonly reported gap has been for mental health and social and emotional health and wellbeing services. In 2017–18, this was reported as a gap by 68% of organisations.

 

NACCHO Aboriginal Health and #PHNs : David Coombs from @NuraGili : Primary Health Networks’ impact on Aboriginal Community Controlled Health Services

 

” The Abbott government’s creation of Primary Health Networks in 2015 has substantially affected the way that primary healthcare funding is administered at the Commonwealth level.

Primary Health Networks control a significant amount of Indigenous‐specific health funding, which Aboriginal Community Controlled Health Services have historically relied upon.

These Indigenous sector organisations have been delivering holistic and culturally appropriate healthcare to Aboriginal and Torres Strait Islander people for decades. They are run by and for Aboriginal Communities themselves, enacting Indigenous self‐determination at a local level.

The Primary Health Networks promote contestable funding and competitive service markets, destabilising the Indigenous health funding environment.

This new funding model does not account for the distinguishing feature of Aboriginal Community Controlled Health Services: self‐determination. Additionally, Primary Health Networks possess limited knowledge of Indigenous health contexts and have been resistant to engagement with Aboriginal organisations. All of this limits Indigenous self‐determination and threatens Indigenous health.

David Coombs, Nura Gili Indigenous Programs Unit, University of New South Wales, Sydney. Originally published Online HERE 

DOWNLOAD the 10 Page PDF version coombs-2018-australian_journal_of_public_administration

David Coombs from presenting at the 2018 Symposium: Aboriginal Medical Services in a challenging policy environment

”  Primary Health Networks are being encouraged to consider the skills of the National Aboriginal Controlled Community Health Organisation ( NACCHO ) and Aboriginal Community Controlled Health (ACCHO’s ) groups to assist delivering innovative health programs to Close the Gap in health outcomes.

Broadening the range of member organisations involved in the Primary Health Networks, and ensuring an appropriate range of skills on their boards, would help ensure the specific needs of the diverse groups in our community are considered when commissioning health services.”

The Minister for Indigenous Health, Ken Wyatt AM, MP NACCHO Post 2017

1 INTRODUCTION

In responding to the question: ‘what has happened to the project of Indigenous self‐determination?’ this paper examines self‐determination in practice with a particular focus on the operations of grassroots Indigenous Community organisations. Reflecting on evidence gathered from interviews with CEOs and senior managers from Aboriginal Community Controlled Health Services (ACCHSs), it considers the nature of power sharing and relations between Aboriginal Communities1 and the Australian state.

Now that the First Nations of this land have once again called on governments to give them a voice in their own affairs, it seems apposite to enquire into the current state of Indigenous self‐determination.

To appreciate the sentiment and motivations behind the Uluru Statement’s heartfelt plea for substantive institutional change, we must look closely at existing institutions. By understanding what is wrong with contemporary structures we will be more able to understand why change is needed.

This paper focuses on one important government funding framework which relies on a purchaser/provider model: the Primary Health Network (PHN). This recent policy initiative exemplifies the way that governments have excluded Indigenous Community organisations and representatives from the decision‐making processes that affect Indigenous peoples. In Indigenous health policy, the project of self‐determination appears to have been abandoned.

When Gough Whitlam adopted self‐determination as policy in 1972 his government encouraged Aboriginal people to form corporations for collective action. This new approach to State‐Indigenous relations allowed for the creation of an ‘Indigenous sector’, of which ACCHSs are a quintessential part.

The continuing Indigenous sector is the most important vestige of the self‐determination policy (Rowse, 2002). However, Primary Health Networks disempower and delegitimise Indigenous sector organisations and undermine self‐determination in the core area of health. This paper commences by outlining the Primary Health Network’s background and modus operandi.

Subsequent sections are organised around three prominent themes from the interview data: relationships, knowledge, and resources. Based on interview responses and previous scholarship the paper concludes that government should pursue a more relational mode of engagement with Aboriginal organisations, where power is more equally shared, investment is maintained over the longer‐term, and trust is fostered.

2 METHODS AND METHODOLOGY

This analysis is part of a larger research project based on a series of 25 interviews conducted at 20 ACCHSs across New South Wales, including the peak body, the Aboriginal Health and Medical Research Council.2 Informant voices have been de‐identified and are drawn from seven of these interviews (made up of three Indigenous and four non‐Indigenous interviewees) all from separate locations.

The interviews were conducted in 2017 and 2018 across urban, inner‐regional and outer‐regional3 areas of NSW as classified by the Australian Bureau of Statistics. In accordance with a decolonising methodology, following Hart (2010) and Sherwood et al. (2015), Tuhiwai‐Smith (1999), this article lets representatives from Aboriginal community‐controlled organisations speak for themselves.

This methodology is grounded in an ethical commitment to partnering with Indigenous communities in research. Indigenous voices have been consistently excluded from debates about Indigenous issues (Hart, 2010, 5) and non‐Indigenous researchers have often put their own careers ahead of the wellbeing of the Indigenous peoples they study (Simonds & Christopher, 2013, 2185).

Decolonising methodologies are a response to this silencing and they prioritise Indigenous perspectives because of it. This Indigenous‐centred methodology led me to privilege voices from the Indigenous sector.

3 PRIMARY HEALTH NETWORKS

The Abbott government established the Primary Health Network in 2015. This came in response to a review of the PHN’s precursor, Medicare Locals, which was an initiative of the Gillard Labor government.

The Liberal‐National government ordered the review upon taking power in 2013. The then Health Minister, Peter Dutton, stated that one of the review’s goals was ‘reducing waste and spending on administration and bureaucracy’ (Dutton, 2013).

This was consistent with Tony Abbott’s comments during the 2013 election campaign, where he called for a review ‘to try to ensure that we maintain the actual health services that are being provided by Medicare Locals while minimising the bureaucracy associated with them’ (Abbott quoted in RMIT and ABC 2016).

Abbott’s and Dutton’s message was that Medicare Locals were bureaucratic and wasteful. This echoed the Coalition election campaign’s emphasis on small government and fiscal austerity. In practice, though, PHNs are almost entirely bureaucratic and are only involved in direct service provision as a last resort. Moreover, the cost of winding up Medical Locals has been estimated to be as high as $200 million (Thompson, 2015).

There are now 31 PHNs across Australia, whereas there were 61 Medicare Locals. However, almost all of the PHNs are either consortia of former Medicare Locals or have a former Medicare local as lead partner (Thompson, 2015). Primary Health Networks function as ‘third party payers’ (Wade, Smith, Peck, & Freeman, 2006, 3) in the primary healthcare system, offering funding and support to primary healthcare providers.

Initially, PHNs were tasked with assessing primary healthcare needs and identifying service gaps (DoH 2015a, 3). More recently they have moved into a commissioning phase, which involves ‘co‐designing’ and purchasing additional services (including Indigenous‐specific services) to fill identified service gaps (DoH and PwC 2016, 4).

Purchasing has been by open competitive tender processes and contracting (Henderson et al., 2018, 80), but to date it is unclear whether service co‐design has occurred and with whom. Even though legally PHNs are independent companies, in a practical sense they are closely aligned with government.

They rely on government funding, and work towards government priorities. One of the PHN priority areas is Aboriginal and Torres Strait Islander health (DoH 2015b), a domain in which the ACCHS sector has unequalled expertise, experience and Indigenous cultural knowledge.

4 ABORIGINAL COMMUNITY CONTROLLED HEALTH SERVICES

See list of all NACCHO Members

The ACCHS sector, often referred to as the Aboriginal Medical Services or AMSs, delivers high‐quality, comprehensive, and culturally‐informed healthcare, and is run for and by Aboriginal and Torres Strait Islander communities (Campbell, Hunt, Scrimgeour, Davey, & Jones, 2017).

These Indigenous organisations deliver a range of clinical and allied health services and are also involved in community development and health promotion. ACCHSs provide approximately 50% of all primary health care to Aboriginal and Torres Strait Islander peoples (Panaretto, Wenitong, Button, & Ring, 2014, 649–50) and scholars have argued that ACCHSs are a practical embodiment of Indigenous self‐determination (Davis, 2013; Rowse, 2002).

This is because they are governed by Community‐based boards of directors, elected by members of the health service (Grant, Wronski, Murray, & Couzos, 2008, 8).

Aboriginal and Torres Strait Islander people own, run, and oversee their community‐controlled health services. ACCHSs are one significant example of Aboriginal self‐determination in practice, giving Aboriginal people a say on what their health services do and how.

5 COMMISSIONING

Primary Health Networks take a commissioning approach to the funding and management of Indigenous health services. Commissioning is an umbrella concept that covers a range of public‐service activities.

These include needs assessment, procurement, purchasing, contracting, service delivery and performance management, all of which are interrelated yet disinct processes (Dickinson, 2014, 15). Sturgess (2018, 165) expresses commissioning’s primary function as: ‘to design and manage the interface between policy/funding and delivery’.

Tasked with improving the efficiency, effectiveness and coordination of services, commissioning organisations, such as PHNs, act as intermediaries between policymakers/funders and service providers.

Commissioners are responsible for the strategic design and ‘stewardship’ of service‐provision systems (Sturgess, 2018, 163), gearing their overall functioning towards the efficient achievement of government’s strategic objectives. In theory, commissioning improves on previous attempts to improve the purchaser‐provider relationship because it acknowledges some of the complexities encountered at the service delivery coalface (Sturgess, 2018, 156).

However, as Dickinson notes (2015), commissioning’s definitional ‘fuzziness’ has meant that in practice the concept has been used ‘as a synonym for more contracting out or privatisation’. Theoretically providers are accorded a stakeholder role in commissioning, but commissioners actually follow the familiar governance approach that privileges the demand (‘purchaser’) side of the purchaser‐provider relationship.

The evidence on commissioning’s effectiveness is mixed. A recent report written for the Department of Health laments the ‘limited evidence that links commissioning with quality improvement or cost containment’ (King’s Fund et al. 2016, 4).

However, some observers are hopeful that commissioning can deliver broad benefits if commissioners’ ‘softer skills’ can be strengthened (Dickinson, 2014, 17). Robinson and colleagues (2016, 10) have argued that the crux of the commissioning task is to accommodate multiple and sometimes divergent values, goals, and practices.

In this way, successful commissioners are those who achieve ‘a meeting of the minds’ amongst diverse stakeholders (Sturgess, 2018, 164). Booth and Boxall (2016, 3–4) contend that fostering reciprocal and trusting relationships between commissioners (e.g. the PHNs) and providers (e.g. ACCHSs) is an indispensable component of successful commissioning.

Research on the policies and funding arrangements that apply to ACCHSs also highlights the importance of close and trusting relationships between purchaser and provider. This literature (e.g. Dwyer, Lavoie, O’Donnell, Marlina, & Sullivan, 2011, 43; Lavoie, Boulton, & Dwyer, 2010, 675–6) promotes relational contracting as the best way of funding ACCHSs to maximise Indigenous health gains.

Relational contracting involves purchasers and providers working closely together, under flexible long‐term contracts, towards the achievement of shared goals.

Governments have long known4 that, when commissioning for complex social services (of which Indigenous‐specific comprehensive primary healthcare are a clear example), commissioners should assess how well providers ‘understand the human dimensions’ of the service contracts for which they are tendering (Sturgess, Argyrous and Rahman 2018, 466). Providers need time to develop this expertise and relational contracting allows for this.

However, based on the testimony of ACCHS representatives, PHN contracting and decision‐making processes are more hierarchical than relational.

PHNs control both the needs‐assessment and funding processes, inevitably compromising the space available for Indigenous self‐determination. Under the PHN commissioning model it is ultimately government who ‘calls the shots’, to use Gingrich’s expression (2011).

This seems to follow from the Department of Health’s vision of commissioning as ‘proactive and strategic’, where commissioners (i.e. the PHNs), decide what services should be offered, how, and by whom (Smith et al. cited in DoH 2015a, 2).

The PHN’s power structure and contracting arrangements bind Aboriginal service‐providers to the demands of the PHN as purchaser. The PHN is in turn bound to the government which has the final say when determining who and what gets funded in Indigenous health.

The PHN’s commissioning hierarchy, and the conflicts (discussed below) that it engenders, supports Dickinson’s (2014, 17) contention that ‘commissioning is an inherently political (with a small ‘p’) process’. The PHN’s power dynamics also fundamentally undermine the principle of Indigenous self‐determination.

6 RELATIONSHIPS

Some ACCHS CEOs and managers are frustrated because PHNs have excluded them from key decision‐making forums on Indigenous health. PHN CEOs have the power to control who participates in key discussions around Aboriginal health services.

This runs contrary to the Government’s own PHN Grant Programme Guidelines, which state: ‘PHNs must have broad engagement across their region including with … Aboriginal Medical Services’ (DoH 2016a, 7, emphasis added).

It also contradicts the principle of ‘Aboriginal and Torres Strait Islander Community Control and Engagement’ that informs the National Aboriginal and Torres Strait Islander Health Plan 2013–20235 (Australian Government 2013, 10), and the associated Implementation Plan (DoH 2015c, 5).

Nevertheless, some PHNs have disregarded these nationally established guidelines and strategies, as this informant’s statement indicates:

The Commonwealth actually put out a guideline on how PHNs and AMSs should interact… We had a meeting with the CEO of the PHN and all the AMSs in the region. And I’m quoting the guidelines to him. And he said: ‘we didn’t have anything to do with putting them together, we don’t have to abide by them’. We’ve asked for Aboriginal representation on the board [of the PHN]. Nup. We asked for an Aboriginal Advisory Committee. Nup. (CEO, outer‐regional ACCHS, November 2017)

One way forward would be to institutionalise the principle of Aboriginal community control in all PHN actions and policies related to Indigenous health but this would be to seriously constrain the purchaser‐provider model and suggest it should cede place to a relational contracting approach.

Mandating agreements between ACCHSs and PHNs, as the Closing the Gap Steering Committee suggests (Wright & Lewis, 2017, 36), would give ACCHSs more say in how Indigenous health issues are approached by PHNs in their local areas.

In another example of PHNs ignoring Indigenous organisations, an ACCHS CEO alleges that her organisation was not consulted during the needs assessment stage of the commissioning process, and that the PHN’s picture of Indigenous communities’ healthcare needs is therefore based on incomplete information:

Well a good example is the current ITC program – so the Integrated Team Care arrangements. [The PHN] gave two thirds of the money to non‐Aboriginal organisations and one third to AMSs…It’s an Aboriginal‐specific program. And we said: ‘look, we should be getting more because we see more Aboriginal clients’. [The PHN replied]: ‘No you don’t’. I said: ‘well, where are you getting your stats from? Your stats aren’t accurate.’ Our stats’d be accurate because we know how many Aboriginal people live in our communities. No sense in using ABS because it’s not accurate. You know, our ABS, I think’s 823, or something like that, for [our town] … only. We know there’s more than 1000 Aboriginal people that live just in [our town]. (CEO, outer‐regional ACCHS, December 2017)

ACCHSs are frustrated because PHNs decide the level and nature of Aboriginal healthcare need without consulting Aboriginal Community organisations that have access to valuable sources of knowledge and information. This is a clear example of how the PHN, with a mandate from the Commonwealth, is able to dictate terms to Aboriginal organisations, a clear derogation of the principle of Indigenous self‐determination.

The non‐binding nature of the PHN and ACCHO Guiding Principles (DoH 2016b) has led to inconsistent PHN engagement with ACCHSs, as the following statement from an ACCHS CEO illustrates:

PHNs are regularly telling us, well, no they’re just guidelines from the Commonwealth and they’re right… They’re not policy direction that ensures that PHNs are making consistent decisions right across the 31 [PHN] regions in this country. You know, there’s some examples where PHNs are working incredibly respectfully and efficiently with Aboriginal organisations and there’s many that are not. (CEO, inner‐regional ACCHS, July 2017)

Some ACCHS CEOs have concluded that PHNs have too much flexibility when determining how best to work with ACCHSs.

The PHN Grant Programme Guidelines state that PHNs must use Community Advisory Committees but only minimally define their function as: to ‘provide community perspective to PHN boards’ (DoH 2016a, 8).

The lack of clear policy direction is one reason behind the varying levels of respect for Indigenous self‐determination across PHN regions.

7 KNOWLEDGE

ACCHS‐sector advocates and Indigenous health policy experts have argued that the PHN’s ability to improve Indigenous health outcomes is dependent on how well it engages ACCHSs’ skills and knowledge (e.g. Couzos, Delaney Thiele, & Page, 2016).

It is not clear that the PHN has a coherent strategy for engaging with ACCHSs and concerns have been raised over Indigenous cultural safety.

This is because the PHN’s competitive tendering processes clear the way for non‐Indigenous service providers to enter Indigenous healthcare settings (Russell, 2015, 77). The following excerpt emphasises this concern:

Who is PHN to say that an organisation is culturally safe or culturally appropriate? … And who says they’re culturally appropriate? And what happened to Aboriginal people’s freedom of choice? You know, they’re just being ignored, they’re not consulted about this… putting a dot art painting on the wall doesn’t mean you’re culturally appropriate, it’s just tokenistic… I just feel that Aboriginal people don’t get given… they don’t have a say and yet it’s their health that we’re talking about, you know. At least with us we give them a choice. (CEO, inner‐regional ACCHS, July 2017)

Some ACCHSs feel that the PHNs are not attuned to the culturally‐specific health needs and expectations of Aboriginal and Torres Strait Islander peoples. Moreover, this ACCHS CEO feels that Aboriginal peoples’ right to self‐determination was not respected in the top‐down decision‐making process that led to the creation of the PHN.

There is a feeling amongst some within the ACCHS sector that PHNs are not familiar with and have not sufficiently engaged with the ACCHS model of care or the Aboriginal definition of health (Cooke quoted in NACCHO 2017; Wright & Lewis, 2017, 33).

In response to a question about the differences and similarities between ACCHSs and non‐Indigenous health services, a very experienced CEO from an urban ACCHS had this to say:

No, they don’t even… they don’t even touch the surface of what we do. I’m on the PHN board. [The] PHN is mainly all doctors and they’re fascinated. I did a presentation to them and did a video. They couldn’t believe it, what we do. (CEO, urban ACCHS, March 2018)

This response suggests that PHN board members have limited knowledge of ACCHSs’ ways of working, and, that because the majority of PHN board members come from a conventional clinical health background, they do not understand ACCHSs’ holistic conceptualisation of Aboriginal Community wellbeing (see AH&MRC 2008, 32).

That said, these PHN board members being ‘fascinated’ by the CEO’s presentation indicates that there is potential for these organisations to learn from and work more closely with this ACCHS in the future.

8 RESOURCES

A number of ACCHS managers and CEOs commented on the PHN’s lack of investment in their sector. The government’s under‐funding of the ACCHS sector has attracted persistent criticism from Indigenous health and policy scholars for many years (Alford, 2014; Grant et al., 2008, 19).

The following comment came in response to a question about the Indigenous Advancement Strategy (IAS), another recent policy initiative that has been similarly criticised for not engaging with Indigenous Community organisations, underscoring how ACCHSs feel ignored by funding and policy bodies:

It’s the same as the PHN stuff, there was no – they didn’t come and talk to us and say ‘how many patients you got? What are your occasions of service like? What’s your health‐outcomes data like?’ None of that, so they don’t know what we could do, what we could deliver. (CEO, urban ACCHS, January 2018)

This ACCHS CEO sees value in a process where governments, or intermediaries such as PHNs, could directly approach Aboriginal services with long‐standing relationships with their Communities in order to assess the possibility of building upon what is already in place. This did not occur with the PHN in her region.

The following statement from the manager of an urban‐based ACCHS eloquently articulates the strongly held view that funding and policy bodies should work with and build on the work of Indigenous Community organisations:

We’ve already told them: ‘have more dialogue with us’… it’s about relationships, it’s about understanding the [Indigenous health] space. It’s not just contract management … It’s really about making sure that the funding isn’t piecemeal. … We don’t want to be set up for failure… So this is the issue: I think the reporting is important and I think the dialogue with our funders is really, really important. It’s about having healthy relationships and discussions with our funders around what the challenges are both at an organisational level and at a Community level… It’s stepping back and actually sharing the problem rather than administering a contract. (Operations Manager, urban ACCHS, January 2018, emphasis added)

This manager is urging PHNs to embrace a partnership approach to Indigenous community‐controlled organisations. He believes that PHNs need to invest more in the ACCHS sector and that they should share responsibility for Indigenous health outcomes. He also sees a need for PHNs and governments to better understand the challenges faced by ACCHSs and their Communities. However, this would require not just the PHNs but the Australian Government to give up its doctrinaire commitment to contestable funding, an approach that is based on the idea that there should be a competitive service market.

9 CONCLUSION

From the perspective of senior managers in Aboriginal Community Controlled Health Services, the creation of Primary Health Networks has had a negative impact on the delivery of health services to Indigenous communities.

ACCHSs now have a new administrative body to which they must appeal for funds. The PHNs do not appear to give substantial weighting to Indigenous self‐determination when making decisions about Indigenous health services.

The Department of Health’s PHN guidelines acknowledge that ACCHSs, as Indigenous Community representatives, make vital and unique contributions to Indigenous healthcare.

However, the Department has not institutionalised Aboriginal community control into the PHN funding system. This leaves the level of Indigenous Community engagement to the discretion of PHN boards.

As a result, ACCHSs have not received significant investment from PHNs, nor have they been consulted in key Indigenous health decision‐making processes. Moreover, PHNs do not appear to possess high levels of Indigenous primary health care knowledge or expertise and would do well to engage with and learn from ACCHSs. Relational contracting is suggested as a way to approach this.

This paper has argued that PHNs have had a negative impact on Indigenous self‐determination and health services. PHNs offer ACCHSs very few avenues through which to enact self‐determination.

If, as I would argue, this unequal power dynamic is indicative of the broader relationship between Indigenous Communities and the Australian state, then Indigenous peoples’ recent call for substantive institutional reform becomes all the more comprehensible and urgent.

ENDNOTES

  • A note on style: in this paper ‘Community’, when capitalised, refers to the relevant local Aboriginal community or the broader Aboriginal and Torres Strait Islander community in Australia, depending on the context. This is in line with the definition set out by the Aboriginal Health and Medical Research Council (AHMRC 2008, 6), the state‐level peak body that represents the interests of ACCHSs in New South Wales.
  • The AH&MRC Ethics Committee has provided ethics approval for the project, allocating it reference number 1225/16.
  • The categories ‘urban’, ‘inner‐regional’ and ‘outer regional’ used in this paper are based on the Australian Statistical Geography Standard Remoteness Structure used by the Australian Bureau of Statistics <http://www.abs.gov.au/websitedbs/d3310114.nsf/home/remoteness+structure>.
  • Sturgess, Argyrous and Rahman (2018), in their fascinating study of the contracting modes that governed the transportation of convicts from England to Australia in the 18th and 19th centuries, found evidence that a relational mode of commissioning, which considered potential service providers’ reputation, expertise, and motivation, delivered better human outcomes than transactional commissioning, where the primary consideration was price.
  • Thank you to Associate Professor Janet Hunt for reminding me of the contradictions between PHNs’ actions and the Commonwealth Government’s commitments under the National Aboriginal and Torres Strait Islander Health Plan.

NACCHO Aboriginal Health :The @AusHealthcare blueprint ‘Healthy people, healthy systems maps out how to give Australians a 21st century health system’

 

” We’re giving Health Ministers an early Christmas gift, over the past nine months Australian health leaders mapped out how to transform our healthcare system into a fit for purpose 21st century system that will meet the needs and expectations of Australians.

‘Healthy people, healthy systems is a solid blueprint with a range of short, medium and long term recommendations on how to reorientate our healthcare system to focus on patient outcomes and value rather than throughput and vested interests.”

Australian Healthcare and Hospitals Association (AHHA) Chief Executive Alison Verhoeven. see Part 1 Below

Download Healthy people, healthy systems  ahha_blueprint_2017

 “For Aboriginal and Torres Strait Islander people, institutional racism in hospitals and health services fundamentally underpins racial inequalities in health.

It forms a barrier to accessing healthcare, and must be acknowledged and addressed in order to realise health equality.

A matrix has been developed for identifying, measuring and monitoring institutional racism. Simple and cost-effective to administer, research to date shows its value as both an internal and external assessment tool “

(Marrie & Marrie 2014). See Section 2 Performance information and reporting

“ The need for integrated care, workforce development and reform and a reorientation to primary and preventive care were central recommendations.

We would welcome more performance reporting on such measures as patient reported health outcomes and experiences of care and deeper examination of how that care will be delivered in the future and by whom.

“Prevention funding needs to be increased and to be explicitly tied to evidence-based interventions.

We strongly support many of the aims of the report Healthy people, healthy systems.”

CEO of the Consumers Health Forum, Leanne Wells See Part 2 Below .

Great blueprint by AHHA  for a Post-2020 National Health Agreement. Fantastic to see it aligning with PHAA’s key principles of universal healthcare, a holistic view of health and well being, and health equity. ”

Public Health Association Australia

Part 1 AHHA Press Release

‘In 2018 Health Ministers and First Ministers will negotiate and agree new public hospital funding arrangements—if Ministers are committed to a healthy Australia supported by the best possible healthcare system they simply need to direct their health departments to begin rolling out the recommendations found in the blueprint.

‘Health Ministers must be more ambitious than agreeing what public hospital funding arrangements will look like after 2020. The health sector is adamant it’s time we move our system toward value-based care and away from more of the same and tinkering around the edges.

‘To do this we outline four steps with recommendations on governance arrangements, data and reporting that drives intelligent system design, health workforce reform and sustainable funding that is dependable yet innovative.

‘An independent national health authority distinct from Commonwealth, state and territory health departments  reporting directly to the Council of Australian Governments (COAG) or the COAG Health Council would help take the politics and finger pointing out of health reform and allow for a nationally unified and regionally controlled health system.

‘Requiring all health service providers delivering government funded or reimbursed services to supply data on patient outcomes and other service provision dimensions will better inform system performance and help us move toward publicly available outcomes data that will empower patients to make informed choices about treatment options and providers.

‘A national health workforce reform strategy is required that goes beyond the supply and location of health practitioners and considers roles and responsibilities needed to achieve a health workforce that is flexible, competent, working to the top of their scope of practice, and actively participating in the design and delivery of health services.

‘Maintaining current Commonwealth funding levels for public hospitals, including the growth formula, will provide sustainable and appropriate support, but we need to be more innovative in our move toward value-based care. In the short term, trialling a mixed funding formula with a 25% component for achieved health outcomes relating to the top 4 chronic diseases is a start.

‘It’s time to step out of our comfort zones and transform fragmented healthcare in Australia. The blueprint’s recommendations are a good place to start. We thank the many health leaders, clinicians and consumers who have contributed to this work.’

For more information on AHHA, see: http://ahha.asn.au

To read the Healthy people, healthy systems. Strategies for outcome-focused and value-based healthcare: a blueprint for a post-2020 national health agreement, see: http://ahha.asn.au/blueprint

The Consumers Health Forum welcomes the Australian Healthcare and Hospitals Association’s blueprint for a national health agreement as a much-need stimulus for a serious rethink of Australia’s health system.

“We strongly support many of the aims of the report Healthy people, healthy systems,”

the CEO of the Consumers Health Forum, Leanne Wells said.

“In too many corners of Australia’s health system, whether it be Medicare, primary care, prevention or health insurance, there is a lack of rigorous evaluation and less than optimal use of available data and knowledge to improve services.

“We back AHHA’s call for Australia to re-orientate the healthcare system over the next 10 years by enabling outcomes-focused and value-based health care,” Ms Wells said.

“We agree that the national hospitals agreement requires reform, that it, should be negotiated for the longer-term and that we need much better coordination and integration to promote consumer-centred health care.

“While there is undoubtedly a pressing need for a more nationally cohesive leadership and administration of health, we are not sure a national health authority as prescribed by AHHA would achieve this.  It could risk imposing another layer of management and decision-making with no certainty of any benefit.

“On the other hand, moves to greater regional coordination of health services, is the best way to achieve integrated locally responsive services. We know that integration is best achieved when decisions about how services are configured and organised are taken as close to the point of care delivery as possible by people who know and understand local services and need.  Joint planning, funds pooling and joint commissioning by PHNs and LHDs should be actively explored.

“We would urge governments to note the consistency of advice coming from Australian health leaders about how we can strengthen and improve our health system.

CHF presented an Issues Paper containing our ideas for health system improvements to Minister Hunt at our Consumer and Community Roundtable in August, see:

https://chf.org.au/sites/default/files/docs/chf_ministerial_roundatble_issues_paper_final.pdf

“The need for integrated care, workforce development and reform and a reorientation to primary and preventive care were central recommendations.

“We would welcome more performance reporting on such measures as patient reported health outcomes and experiences of care and deeper examination of how that care will be delivered in the future and by whom.

“Prevention funding needs to be increased and to be explicitly tied to evidence-based interventions.

“AHHA’s chair, Dr Deborah Cole, states that if there is a genuine commitment to delivering patient-centred care that improves health outcomes, consumers must be genuinely engaged in co-designing services and how the entire health system functions across hospitals, primary healthcare and prevention activities.

“We fully agree and hope all health leaders would actively support that rationale.  Only when we involve consumer insights in planning and evaluation will achieve better health, better experience of care and better value care” Ms Wells said.

The Healthy people, healthy systems report is at:

http://ahha.asn.au/sites/default/files/docs/policy-issue/ahha_blueprint_2017.pdf