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

NACCHO Aboriginal Health #RUOKDay : Download @RACGP Report underlines crucial role of GPs in #mentalhealthcare

“With a shortage of psychologists and other mental health professionals in rural and remote areas, the role of rural doctors in providing mental healthcare is already absolutely critical, and is becoming more so.

“Feedback from many rural and remote doctors backs up the findings in today’s RACGP report — namely, that there is a significant mental healthcare load in general practice.

“And this area of general practice care is growing.

“Many rural doctors already undertake additional upskilling in advanced mental healthcare.”

President of the Rural Doctors Association of Australia (RDAA), Dr Ewen McPhee

Download a PDF Copy of report

Health-of-the-Nation-2017-report

Read over 150 Aboriginal Mental Health Articles published over the past 5 years by NACCHO

A major report released today on general practice care in Australia shows that the most frequent visits to GPs are for psychological care, demonstrating that the sector plays a critical role in helping patients with their mental health as well as physical health.

The report, General Practice: Health of the Nation, is the first of what will be an annual insight into the state of general practice in Australia, published by the Royal Australian College of General Practitioners (RACGP).

Dr Ewen McPhee continued

“And under the National Rural Generalist Pathway that the Federal Government is progressing, medical graduates training as Rural Generalist doctors will be able to undertake advanced mental healthcare as a key element of their training, alongside other advanced skills.

“Earlier this year, we also welcomed an announcement by the Federal Government that, from November, it will increase access for rural and remote Australians to Medicare-rebated psychological care delivered by video consultations.

“Under the change, psychologists will be able to deliver up to 7 of the currently available 10 face-to-face sessions accessed through a General Practitioner. The rebates for these sessions have previously only been available if provided by a GP.

“This change will help to significantly improve access to tele-psychology services for many rural and remote Australians and the Government deserves full credit for implementing it.”

RDAA has supported concerns raised by the RACGP, however, that despite the fact that over 85% of the Australian population visits their GP each year, the general practice sector receives only 5% of the total annual health budget.

“This should be sending significant warning bells to governments” Dr McPhee said.

“Given the reliance that Australians have on general practice for their primary care — and the ability of investment in general practice to generate significant budget savings by reducing hospital admissions — it is clear that additional investment in general practice needs to be made, sooner rather than later.”

Consumers Health Forum MEDIA RELEASE :

The finding that psychological issues are a leading reason patients see GPs highlights the importance of the GPs’ role as the first base for health concerns in the community.

The Health of the Nation report released by the Royal Australian College of GPs today reveals mental health issues like depression and anxiety are among the most common ailments reported by 61 per cent of GPs.

“That is a disturbingly high figure.  It is also the issue causing GPs most concern for the future,” the CEO of the Consumers Health Forum, Leanne Wells, said.

The next most commonly mentioned as emerging issues by GPs are obesity and diabetes.  The prevalence of these conditions, all of which raise complex challenges for the most skilled GP, underlines the need for a well-coordinated and integrated health system in the community.

“The Consumers Health Forum recognises the GP as the pivotal figure in primary health care who needs more support through such measures as the Government’s Health Care Homes, initiating more integrated care of those with chronic and complex conditions.

“At a recent Consumers Roundtable meeting with Health Minister, Greg Hunt, we set out priorities for a National Health Plan to strengthen Australia’s primary health system, making it more consumer-centred, prevention-oriented and integrated with hospital and social care.

“We also called for more investment in health systems research, shaped by consumer and community priorities, to stimulate services that reflect advances in health sciences and knowledge.

Too often Australians, particularly those with chronic illness, are confounded by our fragmented health system.

We have world class health practitioners and hospitals. But these are disconnected so that patients don’t get the comprehensive top-quality care that should be routine.

“Investing in primary health care led by GPs is the way to a better performing and more consumer-responsive health system,” Ms Wells said.

 

 

NACCHO NEWS ALERT: COAG Health Ministers Council Communique acknowledge the importance #ACCHO’s advancing Aboriginal health

 

  Included in this NACCHO Aboriginal Health News Alert

  1. All issues 11 included in  Communique highlighting ACCHO health
  2. Health Ministers approve Australia’s National Digital Health Strategy
  3. Transcript Health Minister Hunt Press Conference

” The Federal Minister for Indigenous Health, Ken Wyatt, attended the COAG Health Council discussed the Commonwealth’s current work on Indigenous health priorities.

In particular this included the development of the 2018 iteration of the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 that will incorporate strategies and actions to address the social determinants and cultural determinants of health.

Ministers also considered progress on other key Indigenous health issues including building workforce capability, cultural safety and environmental health, where jurisdictions can work together more closely with the Commonwealth to improve outcomes for Aboriginal and Torres Strait Islander peoples.

Ministers acknowledged the importance of collaboration and the need to coordinate activities across governments to support a culturally safe and comprehensive health system.

Ministers also acknowledge the importance of community controlled organisations in advancing Aboriginal and Torres Strait Islander health. ”

1.Development of the next iteration of the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023 COAG Health Council 

Read over 50 NACCHO NATSIHP Articles published over past 50 years

INTRODUCTION

The federal, state and territory Health Ministers met in Brisbane on August 4 at the COAG Health Council to discuss a range of national health issues.

The meeting was chaired by the Victorian Minister for Health, the Hon Jill Hennessy MP.

Health Ministers welcomed the New South Wales Minister for Mental Health, the Hon Tanya Davies MP, the Victorian Minister for Mental Health, the Hon Martin Foley MP, the ACT Minister for Mental Health Mr Shane Rattenbury and the Minister for Aged Care and Minister for Indigenous Health, the Hon Ken Wyatt AM, MP who participated in a joint discussion with Health Ministers about mental health issues.

Major items discussed by Health Ministers today included:

2.Andrew Forrest and the Eliminate Cancer Initiative

Mr Andrew Forrest joined the meeting to address Health Ministers in his capacity as Chairman of the Minderoo Foundation to discuss the Eliminate Cancer Initiative. The Minderoo Foundation is one of Autralia’s largest and most active philanthropic groups. It has established the Eliminate Cancer Initiatve (the Initiative), a global initiative dedicated to making cancer non-lethal with some of the world’s leading global medicine and anti-cancer leaders.

The Initiative is a united effort to convert cancer into a non-lethal disease through global collaboration of scientific, medical and academic institutes, commercially sustained through the support of the philanthropic, business and government sectors worldwide.

Australia has a critical role to play in this highly ambitious and thoroughly worthwhile goal.

3.Family violence and primary care

Today, Health Ministers discussed the significant health impacts on those people experiencing family violence.

Health Ministers acknowledged that health-care providers, particularly those in a primary care setting, are in a unique position to create a safe and confidential environment to enable the disclosure of violence, while offering appropriate support and referrals to other practitioners and services.

Recognising the importance of national leadership in this area, Ministers agreed to develop a plan to address barriers to primary care practitioners identifying and responding to patients experiencing family violence.

Ministers also agreed to work with the Royal Australian College of General Practitioners to develop and implement a national training package.

Further advice will be sought from Primary Health Networks on existing family violence services, including Commonwealth, State and NGO service providers in their regions, with a view to developing an improved whole-of-system responses to the complex needs of clients who disclose family violence

4.Fifth National Mental Health and Suicide Prevention Plan

Health Ministers endorsed the Fifth National Mental Health and Suicide Prevention Plan 2017-2022 and its Implementation Plan.

The Fifth Plan is focused on improvements across eight targeted priority areas:

1. Achieving integrated regional planning and service delivery

2. Effective suicide prevention

3. Coordinated treatment and supports for people with severe and complex mental illness

4. Improving Aboriginal and Torres Strait Islander mental health and suicide prevention

5. Improving the physical health of people living with mental illness and reducing early mortality

6. Reducing stigma and discrimination

7. Making safety and quality central to mental health service delivery

8. Ensuring that the enablers of effective system performance and system improvement are in place

The Fifth Plan also responds to calls for a national approach to address suicide prevention and will be used to guide other sectors and to support health agencies to interact with other portfolios to drive action in this priority area.

Ongoing collaboration and engagement across the sector and with consumers and carers is required to successfully implement the Fifth Plan and achieve meaningful reform to improve the lives of people living with mental illness including the needs of children and young people.

Health Ministers also agreed that mental health workforce issues would be considered by the Australian Health Ministers’ Advisory Council.

5.The National Psychosocial Supports Program

Health Ministers agreed to establish a time-limited working group to progress the Commonwealth’s National Psychosocial Supports program. This will have the objective of developing bilateral agreements to support access to essential psychosocial supports for persons with severe mental illness resulting in psychosocial disability who are not eligible for the NDIS.

Those bilateral agreements will take into account existing funding being allocated for this purpose by states and territories.

6.Strengthened penalties and prohibition orders under the Health Practitioner Regulation National Law

Health Ministers agreed to proceed with amendments to the Health Practitioner Regulation National Law (the National Law) to strengthen penalties for offences committed by people who hold themselves out to be a registered health practitioner, including those who use reserved professional titles or carry out restricted practices when not registered.

Ministers also agreed to proceed with an amendment to introduce a custodial sentence with a maximum term of up to three years for these offences.

These important reforms will be fast tracked to strengthen public protection under the National Law. Preparation will now commence on a draft amendment bill to be brought forward to Ministers for approval, with a view to this being introduced to the Queensland Parliament in 2018. The Western Australian Parliament is also expected to consider legislative changes to the Western Australian National Law.

7.Amendment to mandatory reporting provisions for treating health practitioner

Health Ministers agree that protecting the public from harm is of paramount importance as is supporting practitioners to seek health and in particular mental health treatment as soon as possible.

Health Ministers agreed that doctors should be able to seek treatment for health issues with confidentiality whilst also preserving the requirement for patient safety.

A nationally consistent approach to mandatory reporting provisions will provide confidence to health practitioners that they can feel able to seek treatment for their own health conditions anywhere in Australia.

Agree for AHMAC to recommend a nationally consistent approach to mandatory reporting, following discussion paper and consultation with consumer and practitioner groups, with a proposal to be considered by COAG Health Council at their November 2017 meeting, to allow the amendment to be progressed as part of Tranche 1A package of amendments and related guidelines.

8.National Digital Health Strategy and Australian Digital Health Agency Forward Work Plan 2018–2022

Health Ministers approved the National Digital Health Strategy and the Australian Digital Health Agency Work Plan for 2018-2022.

Download Strategy and work plan here  

The Strategy has identified the priority areas that form the basis of Australia’s vision for digital health.

This Strategy will build on Australia’s existing leadership in digital health care and support consumers and clinicians to put the consumer at the centre of their health care and provide choice, control and transparency.

Expanding the public reporting of patient safety and quality measures

Health Ministers supported Queensland and other interested jurisdictions to collaboratively identify options in relation to aligning patient safety and quality reporting standards across public and private hospitals nationally.

Ministers agreed that the Australian Commission on Safety and Quality in Health Care (ACSQHC) would undertake work with other interested jurisdictions to identify options in relation to aligning public reporting standards of quality healthcare and patient safety across public and private hospitals nationally.

The work be incorporated into the national work being progressed on Australia’s health system performance information and reporting frameworks.

 

9.National human biomonitoring program

Health Ministers noted that human biomonitoring data can play a key role in identifying chemicals which potentially cause adverse health effects and action that may need to be taken to protect public health.

Health Ministers agreed that a National Human Biomonitoring Program could be beneficial in assisting with the understanding of chemical exposures in the Australian population.

Accordingly, Ministers agreed that the Australian Health Ministers’ Advisory Council will explore this matter in more detail by undertaking a feasibility assessment of a National Human Biomonitoring Program.

Clarification of roles, responsibilities and relationships for national bodies established under the National Health Reform Agreement

States and territories expressed significant concern that the proposed Direction to IHPA will result in the Commonwealth retrospectively not funding activity that has been already delivered by states and territories but not yet funded by the Commonwealth.

States and territories were concerned that this could reduce services to patients going forward as anticipated funding from the Commonwealth will be less than currently expected.

The Commonwealth does not agree with the concerns of the states and territories and will seek independent advice from the Independent Hospital Pricing Authority (IHPA) to ensure hospital service activity for 2015-2016 has been calculated correctly. The Commonwealth committed to work constructively and cooperatively with all jurisdictions to better understand the drivers of increased hospital services in funding agreements.

10.Legitimate and unavoidable costs of providing public hospital services in Western Australia

Health Ministers discussed a paper by Western Australia on legitimate and unavoidable costs of providing public hospital services in Western Australia, particularly in regional and remote areas, and recognised that those matters create a cumulative disadvantage to that state. Health Ministers acknowledged that Western Australia will continue to work with the Commonwealth Government and the Independent Hospital Pricing Authority to resolve those matters.

11.Vaccination

Health Ministers unanimously confirmed the importance of vaccination and rejected campaigns against vaccination.

All Health Ministers expressed their acknowledgement of the outgoing Chair, the Hon Ms Jill Hennessy and welcomed the incoming Chair Ms Meegan Fitzharris MLA from the Australian Capital Territory.

Health Ministers approve Australia’s National Digital Health Strategy

Digital information is the bedrock of high quality healthcare.

The benefits for patients are signicant and compelling: hospital admissions avoided, fewer adverse drug events, reduced duplication of tests, better coordination of care for people with chronic and complex conditions, and better informed treatment decisions. Digital health can help save and improve lives.

To support the uptake of digital health services, the Council of Australian Governments (COAG) Health Council today approved Australia’s National Digital Health Strategy (2018-2022).

Download Strategy and work plan here  

In a communique issued after their council meeting in Brisbane August 4 , the Health Ministers noted:

“The Strategy has identified the priority areas that form the basis of Australia’s vision for digital health. It will build on Australia’s existing leadership in digital health care and support consumers and clinicians to put the consumer at the centre of their health care and provide choice, control, and transparency.”

Australian Digital Health Agency (ADHA) CEO Tim Kelsey welcomed COAG approval for the new Strategy.

“Australians are right to be proud of their health services – they are among the best, most accessible, and efficient in the world.

Today we face new health challenges and rapidly rising demand for services. It is imperative that we work together to harness the power of technology and foster innovation to support high quality, sustainable health and care for all, today and into the future,” he said.

The Strategy – Safe, seamless, and secure: evolving health and care to meet the needs of modern Australia – identifies seven key priorities for digital health in Australia including delivery of a My Health Record for every Australian by 2018 – unless they choose not to have one.

More than 5 million Australians already have a My Health Record, which provides potentially lifesaving access to clinical reports of medications, allergies, laboratory tests, and chronic conditions. Patients and consumers can access their My Health Record at any time online or on their mobile phone.

The Strategy will also enable paper-free secure messaging for all clinicians and will set new standards to allow real-time sharing of patient information between hospitals and other care professionals.

Australian Medical Association (AMA) President Dr Michael Gannon has welcomed the Strategy’s focus on safe and secure exchange of clinical information, as it will empower doctors to deliver improved patient care.

“Doctors need access to secure digital records. Having to wade through paperwork and chase individuals and organisations for information is

archaic. The AMA has worked closely with the ADHA on the development of the new strategy and looks forward to close collaboration on its implementation,” Dr Gannon said.

Royal Australian College of General Practitioners (RACGP) President Dr Bastian Seidel said that the RACGP is working closely and collaboratively with the ADHA and other stakeholders to ensure that patients, GPs, and other health professionals have access to the best possible data.

“The Strategy will help facilitate the sharing of high-quality commonly understood information which can be used with confidence by GPs and other health professionals. It will also help ensure this patient information remains confidential and secure and is available whenever and wherever it is needed,” Dr Seidel said.

Pharmacy Guild of Australia National President George Tambassis said that technology would increasingly play an important role in supporting sustainable healthcare delivery.

“The Guild is committed to helping build the digital health capabilities of community pharmacies and advance the efficiency, quality, and delivery of healthcare to improve health outcomes for all Australians.

“We are working with the ADHA to ensure that community pharmacy dispensing and medicine-related services are fully integrated into the My Health Record – and are committed to supporting implementation of the National Digital Health Strategy as a whole,” George Tambassis said.

Pharmaceutical Society of Australia (PSA) President Dr Shane Jackson said that the Strategy would support more effective medicationmanagement, which would improve outcomes for patients and improve the efficiency of health services.

“There is significant potential for pharmacists to use digital health records as a tool to communicate with other health professionals, particularly during transitions of care,” Dr Jackson said.

The Strategy will prioritise development of new digital services to support newborn children, the elderly, and people living with chronic disease. It will also support wider use of telehealth to improve access to services, especially in remote and rural Australia and set standards for better information sharing in medical emergencies – between the ambulance, the hospital, and the GP.

Consumers Health Forum (CHF) Leanne Wells CEO said that the Strategy recognises the importance of empowering Australians to be makers and shapers of the health system rather than just the users and choosers.

“We know that when consumers are activated and supported to better self-manage and coordinate their health and care, we get better patient experience, quality care, and better health outcomes.

“Digital health developments, including My Health Record, are ways in which we can support that to happen. It’s why patients should also be encouraged to take greater control of their health information,” Leanne Wells said.

Medical Software Industry Association (MSIA) President Emma Hossack said that the Strategy distils seven key themes that set expectations at a national level.“The strategy recognises the vital role industry plays in providing the smarts and innovation on top of government infrastructure.

This means improved outcomes, research, and productivity. Industry is excited to work with the ADHA to develop the detailed actions to achieve the vision which could lead to Australia benefitting from one of the strongest health software industries in the world,” Emma Hossack said.

Health Informatics Society of Australia (HISA) CEO Dr Louise Schaper welcomed the Strategy’s focus on workforce development.

“If our complex health system is to realise the benefits from information and technology, and become more sustainable, we need clinical leaders with a sound understanding of digital health,” Dr Schaper said.

The Strategy was developed by all the governments of Australia in close partnership with patients, carers and the clinical professionals who serve them – together with leaders in industry and science.

The Strategy draws on evidence of clinical and economic benefit from many sources within Australia and overseas, and emphasises the priority of patient confidentiality as new digital services are implemented.

The ADHA has established a Cyber Security Centre to ensure Australian healthcare is at the cutting edge of international data security.

The ADHA, which has responsibility for co-ordinating implementation of the Strategy, will now be consulting with partners across the community to develop a Framework for Action. The framework will be published later this year and will detail implementation plans for the Strategy.

The National Digital Health Strategy Safe, seamless and secure: evolving health and care to meet the needs of modern Australia is available on

https://www.digitalhealth.gov.au/australias-national-digital-health-strategy (https://www.digitalhealth.gov.au/australias-national-digital-health-strategy)

Greg Hunt Press Conference

Topics: COAG Health Council outcomes; The Fifth National Mental Health and Suicide Prevention Plan; support for doctors and nurses mental health; hospital funding; same-sex marriage

GREG HUNT:
Today was a huge breakthrough in terms of mental health. The Fifth National Mental Health Plan was approved by the states.

What this is about is enormous progress on suicide prevention. It has actually become the Fifth National Mental Health and Suicide Prevention Plan, so a real focus on suicide prevention.

In particular, the focus on what happens when people are discharged from hospital, the group in Australia that are most likely to take their own lives.

We actually know not just the group, but the very individuals who are most at risk. That’s an enormous step.

The second thing here is, as part of that plan, a focus on eating disorders, and it is a still-hidden issue. In 2017, the hidden issue of eating disorders, of anorexia and bulimia, and the prevalence and the danger of it is still dramatically understated in Australia.

The reality is that this is a silent killer and particularly women can be caught up for years and years, and so there’s a mutual determination, a universal determination to progress on eating disorders, and that will now be a central part of the Fifth National Mental Health and Suicide Prevention Plan.

And also, as part of that, we’ve included, at the Commonwealth’s request today, a real focus on early intervention services for young people under 16. Pat McGorry has referred to it as CATs for Kids, meaning Crisis Assessment Teams, and the opportunity.

And this is a really important step because, for many families, when they have a crisis, there’s nowhere to turn. This is a way through. So those are all enormous steps forward.

The other mental health area where we’ve made big, big progress is on allowing doctors to seek routine mental health treatment.

There’s an agreement by all of the states and territories to work with the Commonwealth on giving doctors a pathway so as they can seek routine mental health treatment without being reported to the professional bodies.

JOURNALIST:
What has led to the increased focus on eating disorders? Has there been an uptick in the number of suicides resulting from that, or has there been an uptick in the number of cases?

GREG HUNT:
No, this has been silently moving along. It’s a personal focus. There are those that I have known, and then when we looked the numbers shortly after coming in, and dealt with organisations such as the Butterfly Foundation, they explained that it’s been a high level issue with the worst rate of loss of life amongst any mental health condition.

And so that’s a combination both of suicide, but also of loss of life due to physical collapse. And so it’s what I would regard as a personal priority from my own experience with others, but then the advocacy of groups like Butterfly Foundation has finally landed. It should’ve happened earlier, but it’s happening on our watch now.

JOURNALIST:
That would be my next question, is that I’m sure advocacy groups will say this is great that it’s happened, but it’s taken the Government so long. Why is it that you’re focussing on it now as opposed to…?

GREG HUNT:
I guess, I’ve only just become Minister. So from day one, this is one of the things I’ve wanted to do, and I’m really, personally, deeply pleased that we’ve made this enormous progress.

So I would say this, I can’t speak for the past, it is overdue, but on our watch collectively we’ve taken a huge step forward today.

Then the last thing is I’ve seen some reports that Queensland and Victoria may have been upset that some of their statistical anomalies were referred to what’s called IHPA (Independent Hospital Pricing Authority).

The reason why is that some of their figures simply didn’t pass the pub test.

The independent authority will assess them, but when you have 4000 per cent growth in one year in some services, 3300 per cent growth in some years in other services, then it would be negligent and irresponsible not to review them.

It may be the case that there was a more than 40-fold increase in some services, but the only sensible thing for the Commonwealth to do is to review it.

But our funding goes up each year every year at a faster rate than the states’ funding, and it’s gone up by $7.7 billion dollars since the current health agreement with the states was struck.

JOURNALIST:
Is that, sorry, relating to private health insurance, or is that something separate?

GREG HUNT:
No, that’s just in relation to, a couple of the states lodged claims for massive growth in individual items.

JOURNALIST:
Thank you. So was there a directive given today regarding private health policies to the states? Was that something that was discussed or something that …?

GREG HUNT:
Our paper was noted, and the states will respond. So we’ve invited the states to respond, they’ll respond individually.

JOURNALIST:
And regarding that mental health plan, besides their new focus on eating disorders, how is it different from previous mental health plans?

GREG HUNT:
So, a much greater focus on suicide prevention, a much greater focus on eating disorders, and a much greater focus on care for young children under 16.

JOURNALIST:
Is that something that you can give more specific details about? You’re saying there’s a much greater focus, but is there any specific information about what that would mean?

GREG HUNT:
As part of the good faith, the Commonwealth, I’ve written to the head of what’s called the Medical Benefits Schedule Review, so the Medicare item review, Professor Bruce Robinson and asked him and their team to consider, for the first time, specific additional treatment, an additional treatment item and what would be appropriate for eating disorders.

NACCHO #Aboriginal Health and #Immunisation @AIHW reports Aboriginal children aged 5 national immunisation rate of 94.6%

 ” Aboriginal and Torres Strait Islander people suffer a disproportionate burden from communicable diseases (diseases that can be transmitted from person to person), with rates of hospitalisation and illness due to these conditions many times higher than other Australians.1

Part 2  below presents results for children who were identified as Aboriginal and/or Torres Strait Islander on the AIR. “

 In 2015–16, Aboriginal and Torres Strait Islander children aged 5 had an even higher national immunisation rate of 94.6%. However, there was wider variation across PHN areas, ranging from 98.8% in the Gold Coast (Qld) to 89.4% in Western Victoria.”

Download Healthy Communities:

AIHW_HC_Report_Imm_Rates_June_2017

See Previous NACCHO Aboriginal Health and #WorldImmunisationWeek : @healthgovau Vaccination for our Mob

Part 1 Overview MORE INFO HERE

Immunisation is a safe and effective way to protect children from harmful infectious diseases and at the population level, prevent the spread of these diseases amongst the community.

Australia has generally high immunisation rates which have increased steadily over time, but rates continue to lag in some local areas.

This report focuses on local area immunisation rates for children aged 5 and shows changes in immunisation rates over time. It also presents 2015–16 immunisation rates for all children and Aboriginal and Torres Strait Islander children aged 1, 2 and 5.

Results are presented for the 31 Primary Health Network (PHN) areas. Where possible they are broken down into smaller geographic areas, including for more than 300 smaller areas and across Australian postcodes.

Further detailed rates are available in the downloadable Excel sheet and a new interactive web tool allows users to compare results over time by geography and age group.

This local-level information assists professionals to use their knowledge and context for their area, to target areas in need and develop effective local strategies for improvement.

The report finds:

  • Since 2011–12, childhood immunisation rates have improved nationally and across smaller areas, for all children and for Aboriginal and Torres Strait Islander children. Variation in rates still exists across local areas, however the gap between those areas with the highest and lowest rates is diminishing
  • Nationally 92.9% of all children aged 5 were immunised in 2015–16. All PHN areas achieved an immunisation rate of 90% or more, ranging from 96.1% in Western NSW to 90.3% in North Coast (NSW).

Summary

In 2015–16, childhood immunisation rates continued to improve nationally and in most local areas. Although rates vary across local areas, the gap in rates between the highest and lowest areas is diminishing.

This report focuses on immunisation rates for 5 year olds and presents results since 2011–12. It also provides the latest information for 1, 2 and 5 year olds for Australia’s 31 Primary Health Network (PHN) areas and smaller local areas.

From 2011–12 to 2015–16, there were notable improvements in rates for fully immunised 5 year olds. National rates increased from 90.0% to 92.9%. Rates increased for PHN areas too, as all areas reached rates above 90% in 2015–16.

Rates in smaller local areas (Statistical Areas Level 3, or SA3s) have also improved. In 2015–16, 282 of the 325 local areas had rates of fully immunised 5 year olds greater than or equal to 90%. This is up from 2011–12 when only 174 areas had rates in this range. Further, the difference in rates between the highest and lowest areas has decreased over time (Figure 1).

In 2015–16, the rate of fully immunised children varied across PHN areas for the three age groups:

  • 1 year olds – 95.0% to 89.8% (national rate 93.0%)
  • 2 year olds – 93.2% to 87.2% (national rate 90.7%)
  • 5 year olds – 96.1% to 90.3% (national rate 92.9%).

Part 2 Aboriginal and Torres Strait Islander children

Aboriginal and Torres Strait Islander people suffer a disproportionate burden from communicable diseases (diseases that can be transmitted from person to person), with rates of hospitalisation and illness due to these conditions many times higher than other Australians.1

This section presents results for children who were identified as Aboriginal and/or Torres Strait Islander on the AIR. These data are based on Medicare enrolment records.

For Aboriginal and Torres Strait Islander children, national immunisation rates in 2015–16 for 1 and 2 year olds were lower than the rates for all children (89.8% compared with 93.0% for 1 year olds, and 87.7% compared with 90.7% for 2 year olds).

In contrast, the national immunisation rate for Aboriginal and Torres Strait Islander children aged 5 years was higher than the rate for all children (94.6% compared with 92.9%).

Primary Health Network areas

In 2015–16, the percentages of fully immunised Aboriginal and Torres Strait Islander children varied across PHN areas for all three age groups as shown in Figure 6. The range in immunisation rates across PHN areas for the three age groups is outlined below.

  • 1 year olds – 94.2% in Tasmania to 76.1% in Perth North (WA)
  • 2 year olds – 93.4% in South Western Sydney (NSW) to 76.0% in Perth South (WA)
  • 5 year olds – 98.8% in Gold Coast (Qld) to 89.4% in Western Victoria.

Statistical Areas Level 4 (SA4s)

For Aboriginal and Torres Strait Islander children, Statistical Areas Level 4 (SA4s) were used instead of SA3s as the smallest geographic areas. There are larger populations in SA4s and this allows more reliable reporting for smaller population groups such as Aboriginal and Torres Strait Islander children.

Across more than 80 SA4s, the percentage of Aboriginal and Torres Strait Islander children fully immunised in 2015–16 varied considerably:

  • 1 year olds – ranged from 95.9% in Central Coast (NSW) to 72.4% in Perth–North West (WA)
  • 2 year olds – ranged from 96.0% in Coffs Harbour–Grafton (NSW) to 71.2% in Perth–South East (WA)
  • 5 year olds – ranged from 100% in Murray (NSW) to 87.6% in Perth–South East (WA).

Figure 6: Percentage of Aboriginal and Torres Strait Islander children fully immunised and numbers not fully immunised, by Primary Health Network area, 2015–16

# Interpret with caution: This area’s eligible population is between 26 and 100 registered children.

Notes

  • Components may not add to totals due to rounding.
  • Data are reported to one decimal place, however for graphical display and ordering they are plotted unrounded.
  • These data reflect results for children recorded as Aboriginal and Torres Strait Islander on the AIR. Levels of recording may vary between local areas.

Source Australian Institute of Health and Welfare analysis of Department of Human Services, Australian Immunisation Register statistics, for the period 1 April 2015 to 31 March 2016, assessed as at 30 June 2016. Data supplied 2 March 2017.

ADDED June14

Influenza Vaccination During Pregnancy

Vaccination remains the best protection pregnant women and their newborn babies have against influenza.

Despite influenza vaccination being available free to pregnant women on the National Immunisation Program, vaccination rates remain low with only 1 in 3 pregnant women receiving the influenza vaccine.

Influenza infection during pregnancy can lead to premature delivery and even death in newborns and very young babies. Pregnant women can have the vaccine at any time during pregnancy and they benefit from it all through the year.

Health professional:

Pregnant women:

 

Aboriginal Health : Second Atlas of Healthcare Variation highlights higher Aboriginal hospitalisation rates for all 18 clinical conditions

 

“The report, compiled by the Australian Commission on Safety and Quality in Health Care, shows us that high hospitalisation rates often point to inadequate primary care in the community, leading to higher rates of potentially preventative hospitalization

The most disturbing example of this  has been the higher hospitalisation rates for all of the 18 clinical conditions surveyed experienced by Aboriginal and Torres Strait Islander Australians, people living in areas of relative socioeconomic disadvantage and those living in remote areas.

 Chairman of Consumers Health Forum, Tony Lawson who is a member of the Atlas Advisory Group.

 “Additional priorities for investigation and action are hospitalisation rates for specific populations with chronic conditions and cardiovascular conditions, particularly:

  • Aboriginal and Torres Strait Islander Australians
  • People living in remote areas
  • People at most socioeconomic disadvantage.

Please note

  • Features of the second Atlas include: Analysis of data by Aboriginal and Torres Strait Islander status

DOWNLOAD Key-findings-and-recommendations

Mr Martin Bowles Secretary Dept of Health  launches the Second Australian Atlas of Healthcare Variation

A new report showing dramatic differences in treatment rates around Australia signals a pressing need for reforms to ensure equitable access to appropriate health care for all Australians, the Consumers Health Forum, says.

“A seven-fold difference in hospitalisation for heart failure and a 15-fold difference for a serious chronic respiratory disease depending on place of residence, are among many findings of substantial variations in treatment rates in Australia revealed in the Second Australian Atlas of Healthcare Variation,” the chairman of Consumers Health Forum, Tony Lawson, said.

“While there are a variety of factors contributing to these differences,  the variation in health and treatment outcomes is, as the report states, an ‘alarm bell’ that should make us stop and investigate whether appropriate care is being delivered.

“These findings show that recommended care for chronic diseases is not always provided.  Even with the significant funding provided through Medicare to better coordinate primary care for people with chronic and complex conditions, fragmented health services contribute to suboptimal management, as the report states.

“We support the report’s recommendation for a stronger primary health system that would provide a clinical ‘home base’ for coordination of patient care and in which patients and carers are activated to develop their knowledge and confidence to manage their health with the aid of a healthcare team.

“The Atlas provides further robust reasons for federal, state and territory governments to act on the demonstrated need for a more effective primary health system that will ensure better and more cost effective care for all Australians.

“The Atlas also examined  variations in women’s health care, and its findings included a seven-fold difference in rates of hysterectomy and  21-fold  difference in rates of endometrial ablation.  The report states that rates of hysterectomy and caesarean sections in Australia are higher than reported rates in other developed nations.  These results highlight the need for continuing support and information on women’s health issues,” Mr Lawson said.

The Second Australian Atlas of Healthcare Variation (second Atlas) paints a picture of marked variation in the use of 18 clinical areas (hospitalisations, surgical procedures and complications) across Australia.

This Atlas, the second to be released by the Commission, illuminates variation by mapping use of health care according to where people live.  As well, this Atlas identifies specific achievable actions for exploration and quality improvement.

The second Atlas includes interventions not covered in the first Atlas, such as hospitalisations for chronic diseases and caesarean section in younger women. It also builds on the findings from the first Atlas – for example, examining hysterectomy and endometrial ablation separately, and examining rates of cataract surgery using a different dataset.

Priority areas for investigation and action arising from the second Atlas include use of:

  • Hysterectomy and endometrial ablation
  • Chronic conditions (COPD, diabetes complications)
  • Knee replacement.

Additional priorities for investigation and action are hospitalisation rates for specific populations with chronic conditions and cardiovascular conditions, particularly:

  • Aboriginal and Torres Strait Islander Australians
  • People living in remote areas
  • People at most socioeconomic disadvantage.

Healthcare Variation – what does it tell us

Some variation is expected and associated with need-related factors such as underlying differences in the health of specific populations, or personal preferences. However, the weight of evidence in Australia and internationally suggests that much of the variation documented in the Atlas is likely to be unwarranted. Understanding this variation is critical to improving the quality, value and appropriateness of health care.

View the second Atlas

The second Atlas, released in June 2017, examined four clinical themes: chronic disease and infection – potentially preventable hospitalisations, cardiovascular, women’s health and maternity, and surgical interventions.

Key findings and recommendations for action are available here.

View the maps and download the data using the interactive platform.

What does the Atlas measure?

The second Atlas shows rates of use of healthcare interventions (hospitalisations, surgical procedures and complications,) in geographical areas across Australia.  The rate is then age and sex standardised to allow comparisons between populations with different age and sex structures. All rates are based on the patient’s place of residence, not the location of the hospital or health service.

The second Atlas uses data from national databases to explore variation across different healthcare settings. These included the National Hospital Morbidity Database and the AIHW National Perinatal Data Collection.

Who has developed the second Atlas?

The Commission worked with the Australian Institute of Health and Welfare (AIHW) on the second Atlas.

The Commission consulted widely with the Australian government, state and territory governments, specialist medical colleges, clinicians and consumer representatives to develop the second Atlas.

Features of the second Atlas include:

  • Greater involvement of clinicians during all stages of development
  • Analysis of data by Aboriginal and Torres Strait Islander status
  • Analysis of data by patient funding status (public or private).

Table of Contents

Chapter 1 Chronic disease and infection: potentially preventable hospitalisations

1.1 Chronic obstructive pulmonary disease (COPD)
1.2 Heart failure
1.3 Cellulitis
1.4 Kidney and urinary tract infections
1.5 Diabetes complications

Chapter 2 Cardiovascular conditions

2.1 Acute myocardial infarction admissions
2.2 Atrial fibrillation

Chapter 3 Women’s health and maternity

3.1 Hysterectomy
3.2 Endometrial ablation
3.3 Cervical loop excision or cervical laser ablation
3.4 Caesarean section, ages 20 to 34 years
3.5 Third- and fourth-degree perineal tear

Chapter 4 Surgical interventions

4.1 Knee replacement
4.2 Lumbar spinal decompression
4.3 Lumbar spinal fusion
4.4 Laparoscopic cholecystectomy
4.5 Appendicectomy
4.6 Cataract surgery
Technical Supplement
About the Atlas
Glossary

Australian Atlas of Healthcare Variation data set specifications are available at http://meteor.aihw.gov.au/content/index.phtml/itemId/674758

 

Aboriginal Health #NRW2017 Good News Alert 1 of 2 : Download @AIHW 8th National report Aboriginal health organisations

 ” This eighth national report presents information from 277 organisations, funded by the Australian Government to provide one or more of the following health services to Aboriginal and Torres Strait Islander people: primary health care; maternal and child health care; social and emotional wellbeing services; and substance-use services.

These organisations contributed to the 2015–16 Online Services Report downloadable.

Good News see in full below

Many health promotion group activities were provided, including around 7,600 physical activity/healthy weight sessions, 3,300 chronic disease support sessions and 2,000 tobacco-use treatment and prevention sessions.

With respect to maternal and child health care, around 12,900 home visits, 3,300 maternal and baby/child health sessions, 2,800 parenting skills sessions and 1,000 antenatal group sessions were done.

Download HERE NACCHO Resources 9.7 MB

NACCHO AIHW Aboriginal Health Organisations 2015-16

Or from AIHW website

Information is presented on the characteristics of these organisations; the services they provide; client numbers, contacts and episodes of care; staffing levels; and service gaps and challenges.

Key characteristics

Of the 204 organisations providing Indigenous primary health-care services:

  1. 72% (147) delivered services from 1 site, while 11% (23) had 2 sites and 17% (34) had 3 or more sites.
  2. 67% (136) were ACCHOs.
  3. 78% (159) had a governing committee or board and of these 72% had 100% Indigenous membership.
  4. 79% (162) were accredited against the Royal Australian College of General Practitioners (RACGP) and/or organisational standards.
  5. 28% (57) had more than 3,000 clients (see Table S3.2).

Policy context  : The health of Indigenous Australians

An estimated 744,956 Australians identified as Aboriginal and/or Torres Strait Islander in June 2016, representing 3% of the total Australian population (ABS 2014). In 2011, 10% of the Indigenous population identified as being of Torres Strait Islander origin, and almost two-thirds of the Torres Strait Islander population lived in Queensland.

The Indigenous population has a younger age structure compared with the non-Indigenous population.

In June 2011, the median age of the Indigenous population (the age at which half the population is older and half is younger) was 21.8, compared with 37.6 for the non-Indigenous population.

The birth rate for Indigenous women is also higher (2.3 babies per woman in 2013 compared with 1.9 for all women) (AIHW 2015d).

Most Indigenous Australians live in non-remote areas (79% in 2011); however, a higher proportion live in remote areas (21%), compared with non-Indigenous Australians (2%)

 DOWNLOAD THE FREE +NACCHO APP                                                        to find location of our ACCHOS

Here are the URL links to the App – alternatively you can type NACCHO into both stores and they come up!

iPhone/iPad

ios.giveeasy.org/naccho

Android

android.giveeasy.org/naccho

The gap in health outcomes between Indigenous and non-Indigenous Australians is well documented, especially around life expectancy, infant mortality, child mortality, chronic disease prevalence, potentially preventable hospitalisations and the burden of disease (AIHW 2015a).

For example, a recent burden of disease study found that Indigenous Australians experienced a burden of disease 2.3 times the rate of non-Indigenous Australians, with diabetes 6 times as high.

Chronic diseases were responsible for more than two-thirds (70%) of the total health gap in 2011 and for 64% of the total disease burden among Indigenous Australians in 2011.

The 5 disease groups that caused the most burden were mental and substance use disorders (19% of total disease burden), injuries (which includes suicide) (15%), cardiovascular diseases (12%), cancer (9%) and respiratory diseases (8%).

The same study also suggests that much of this burden could be prevented and reducing exposure to modifiable risk factors may have prevented over one-third (37%) of the burden of disease in Indigenous Australians.

The risk factors contributing most to the overall disease burden were tobacco and alcohol use, high body mass, physical inactivity, high blood pressure and dietary factors (AIHW 2016a).

While there have been improvements in the health and wellbeing of Indigenous Australians, they remain disadvantaged compared with non-Indigenous Australians.

There are a number of interlinking issues that contribute to this gap, including the disadvantages Indigenous people experience in relation to the social determinants of health such as housing, education, employment and income; behavioural risk factors such as smoking, poor nutrition, and physical inactivity; and access to health services (AIHW 2015a).

In addition, a broader range of social and emotional wellbeing issues result from colonisation and its intergenerational legacies: grief and loss; trauma; removal from family and cultural dislocation; racism and discrimination (DoH 2013).

Policy responses

In 2008 a framework was developed to tackle Aboriginal and Torres Strait Islander disadvantage, with 6 targets established to close the gap between Indigenous and non-Indigenous people. These targets were agreed with all states and territories through the Council of Australian Governments (COAG).

National Aboriginal and Torres Strait Islander Health Plan

Following on from the COAG targets, the Australian Government worked with Aboriginal and Torres Strait Islander people to produce the National Aboriginal and Torres Strait Islander Health Plan 2013–2023.

This sets out a 10-year plan for the direction of Indigenous health policy and provides a long-term, evidence-based policy framework to close the gap in Indigenous disadvantage.

The vision outlined in the Health Plan around health system effectiveness is that the Australian health system delivers primary health care that is evidence-based, culturally safe, high quality, responsive and accessible to all Aboriginal and Torres Strait Islander people (DoH 2013).

An Implementation Plan sits alongside the Health Plan, detailing the actions to be taken by the Australian Government and other key stakeholders to implement the Health Plan (DoH 2015b).

It identifies 20 goals to support the achievement of the COAG targets around the effectiveness of the health system and priorities across the life course, from maternal health and parenting, childhood health and development, adolescent and youth health, healthy adults and healthy ageing.

A technical companion document to the Implementation Plan outlines these goals and how they will be measured (AIHW 2015b).

The second stage of the Implementation Plan will be released in 2018 and will further develop actions and goals in the domain of social and cultural determinants of health and health system effectiveness.

It will also seek to increase engagement between Australian Government agencies, state, territory and local governments, the Aboriginal community-controlled health sector, the non-government sector and the corporate/private sector (DoH 2017).

Progress on achieving the Implementation Plan goals will be reported every two years in line with the release of the Aboriginal and Torres Strait Islander Health Performance Framework. The findings will be incorporated into the Department of Health’s Annual Report and will inform the Prime Minister’s annual Closing the Gap report. Progress on the goals will also be publically reported on the DoH and AIHW websites from mid-2017 (DoH 2015b).

The good news

• In 2015–16, 204 organisations provided a wide range of primary health-care services to around 461,500 clients through 3.9 million episodes of care. Over 1 million episodes of care (26%) were in Very remote areas and these areas had the highest average number of episodes of care per client (10). Over time there has been an increase in the average episodes of care per client, from 5 in 2008–09 to 8 in 2015–16.

• Around 7,766 full-time equivalent staff were employed and just over half (53%) were Aboriginal and Torres Strait Islander. Nurses and midwives were the most common type of health worker, representing 15% 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 (24%).

• Many health promotion group activities were provided, including around 7,600 physical activity/healthy weight sessions, 3,300 chronic disease support sessions and 2,000 tobacco-use treatment and prevention sessions. With respect to maternal and child health care, around 12,900 home visits, 3,300 maternal and baby/child health sessions, 2,800 parenting skills sessions and 1,000 antenatal group sessions were done.

• In the 93 organisations funded specifically to provide social and emotional wellbeing services, 216 counsellors provided support services or Link Up services to around 18,900 clients through 88,900 client contacts.

• In the 80 organisations funded specifically to provide substance-use services, around 32,700 clients were seen through 170,400 episodes of care. Most clients (81%) and episodes of care (87%) were for non-residential substance-use services.

Things to note

• Over half the organisations providing primary health-care services reported mental health/social and emotional wellbeing services as a service gap (54%), and two-thirds (67%) reported the recruitment, training and support of Aboriginal and Torres Strait Islander staff as a challenge in delivering quality health services.

• Some organisations felt clients with high needs had to wait too long for some services, in particular to access specialist and dental services. For example, 53 (28%) organisations providing on-site or off-site access to dental services still felt clients with high needs often had to wait a clinically unacceptable time for dental services.

For most specialist and allied health services, more organisations in Remote and Very remote areas felt clients with high needs had to wait too long to access services.

 

#ClosetheGap NACCHO Chair Matthew Cooke and Minister @KenWyattMP #ClosetheGapDay Press Releases

  

“ Close the Gap Day is a day to acknowledge the critical role Aboriginal medical services and health professionals must play in turning around the significant health gap 

Last month, the government said it was committed to a new partnership with Aboriginal groups who presented the Redfern Statement to the Prime Minister, and the Indigenous Health Minister Ken Wyatt said Primary Health Networks must start working properly with ACCHOs.

“Yet right now just three or four of the 31 Primary Health Networks are genuinely working with theACCHO sector and the bulk of funding is going to mainstream services that are not showing results.

“Today, it’s time to remind governments of all levels that Aboriginal people must be equal partners in every single program and policy that affects them. It’s time for action not just more words.”

NACCHO Chair Matthew Cooke pictured above with Minister Ken Wyatt at the launch of NACCHO Healthy Futures last December

Download todays 2017 Close the Gap Report HERE : CTG Report 2017

Download copy NACCHO Healthy Futures Report Card Here

“As Minister for Indigenous Health it is my job to work for better health outcomes for Aboriginal and Torres Strait Islander people in this country.

Today, is National Close the Gap Day. We all want health outcomes for Aboriginal and Torres Strait Islander people that are equal to those of non-Indigenous people.

Vaccination coverage rates are the highest ever among Aboriginal and Torres Strait Islander children entering school and since 2009 there has been an increase in children fully immunised – particularly at five years of age – from 76.8 per cent in 2008 to 95.2 per cent in 2016.

I want to acknowledge the role the Aboriginal Medical Services and State and Territory health systems for supporting the Commonwealth to achieve these figures.

Increasing immunisation is part of Closing the Gap and is community-driven, tailored, innovative and sensitive to individual and community needs “

The Hon Ken Wyatt AM, MP  Minister for Indigenous Health see full story article 2 below

Close the Gap Day: a greater role for Aboriginal health services essential

Close the Gap Day is a day to acknowledge the critical role Aboriginal medical services and health professionals must play in turning around the significant health gap between Aboriginal and Torres Strait Islander people, the National Aboriginal Community Controlled Health Organisation said today.

NACCHO Chair Matthew Cooke said after a decade of the Close the Gap campaign, programs andprojects managed by Aboriginal services on the ground in local communities are the only model proven to be making inroads in closing the Indigenous health gap.

In the past 12 months, Aboriginal Community Controlled Health Organisations provided almost 3 million episodes of care to over 340,000 clients and employed 3,300 Indigenous staff across Australia.

“Despite endless reports, studies and recommendations – just one in seven of the targets under the Closing the Gap Strategy are on track to be met by 2030,” Mr Cooke said.

“The lives of Aboriginal and Torres Straight Islander people are still on average 10 years shorter, we have far higher incidences of chronic diseases such as Diabetes and cancer and our children have less access to good quality education than the average non-Indigenous Australians.

“The evidence tells us that Aboriginal people respond best to health care provided by Aboriginalpeople or controlled by the Aboriginal community.

“Last month, the government said it was committed to a new partnership with Aboriginal groups who presented the Redfern Statement to the Prime Minister, and the Indigenous Health Minister Ken Wyatt said Primary Health Networks must start working properly with ACCHOs.

“Yet right now just three or four of the 31 Primary Health Networks are genuinely working with theACCHO sector and the bulk of funding is going to mainstream services that are not showing results.

“Today, it’s time to remind governments of all levels that Aboriginal people must be equal partners in every single program and policy that affects them. It’s time for action not just more words.”

Mr Cooke said at least one-third of the health gap can be attributed to the social and cultural determinants of health.

“If we are serious about improving health outcomes for Aboriginal people, governments at all levels must do more to join the dots between education, housing, employment and other determinants and make sure that Indigenous led solutions are at the centre of strategies that make those links.”

The political needle recently swung to the issue of childhood vaccination with a call for parents to do their own research before deciding if they would or should immunise their children.

The issue of childhood vaccination is too important to be left hanging as just another claim by a politician in a “post-truth” world where facts are less influential in shaping public opinion than appeals to emotion and personal belief.

I believe it is important for parents to be fully informed of the medical facts before they make what can be life or death decisions affecting their children – and the children of others.

Immunisation is the most significant public health intervention in the past 200 years because it provides a safe and effective way to prevent the spread of many diseases that cause hospitalisation, serious ongoing health conditions and sometimes death.

Since the introduction of vaccination for children in Australia in 1932 deaths from vaccine-preventable diseases have fallen by 99 per cent despite a threefold increase in the Australian population.

As Minister for Indigenous Health it is my job to work for better health outcomes for Aboriginal and Torres Strait Islander people in this country.

Today, is National Close the Gap Day. We all want health outcomes for Aboriginal and Torres Strait Islander people that are equal to those of non-Indigenous people. Until that happens we cannot claim to have a truly universal health system that meets the needs of all Australians.

This year’s Closing the Gap Report has mixed results and provides us with an opportunity to consider our course and reinvigorate our commitment to this fundamental task. We are making some strides in tackling Indigenous health issues, however, we have to do more.

Immunisation rates for Aboriginal and Torres Strait Islander children are improving. Five-year-old Indigenous children have higher immunisation coverage than non-Indigenous five-year-olds.

In December 2016, Australian Immunisation Register data showed that 95.20 per cent of Aboriginal and Torres Strait Islander children aged five were fully immunised compared with 93.19 per cent of all children of the same age.

These statistics confirm that we have nearly achieved the 2023 goal of 96 per cent of children aged five being fully immunised.

Vaccination coverage rates are the highest ever among Aboriginal and Torres Strait Islander children entering school and since 2009 there has been an increase in children fully immunised – particularly at five years of age – from 76.8 per cent in 2008 to 95.2 per cent in 2016.

I want to acknowledge the role the Aboriginal Medical Services and State and Territory health systems for supporting the Commonwealth to achieve these figures.

Immunisation is one of the key goals of the Implementation Plan of the National Aboriginal and Torres Strait Islander Health Plan 2013-2023, which guides national action on Closing the Gap on health

Immunisation is critical for the health of children and the wider community. Interventions within the first three years of life have been shown to have the greatest impact on health and life outcomes.

There is a close relationship between health and educational outcomes. Developmental delays, including sight and hearing issues, and early incidence of chronic diseases directly impact a child’s ability to grow and learn.

I recently announced $27 million for children and maternal health programs. This funding will go towards services such as antenatal and postnatal care, breastfeeding assistance, health and development checks and also ensuring children are properly immunised.

When I was a teacher I saw children with measles. I suffered from whooping cough and ended up with lung damage and I do not want to see children compromised because of a philosophical stance that some parents may have because they are influenced by Doctor Google or misinformation from anti-vaxxers.

It’s not just about protecting your child, it is about protecting other children who use child health centres or childcare. The more people who are vaccinated the fewer opportunities a disease has to spread.

The success of the National Immunisation Program and policies such as No Jab, No Pay has not happened by accident. It is backed by science and virtually every medical and health expert in Australia.

Increasing immunisation is part of Closing the Gap and is community-driven, tailored, innovative and sensitive to individual and community needs. We want to see parents empowered by information, supported by appropriate services and accessing care in ways that suit them.

Increasing immunisation coverage is the result of community action and I want to see that continue.