NACCHO Aboriginal healthly debate: Medicare Locals (MLs) their future is unclear ?


We are committed to reducing waste and spending on administration

and bureaucracy, so that greater investment can be made in services

that directly benefit patients and support health professionals who

deliver those services to patients.”

Health Minister Peter Dutton:

For more info about review

NACCHO has provided our members the following viewpoint in the interest of “healthy debate”


Adjunct Associate Professor Public Health at University of Canberra

Primary health care in Australia is a messy beast, with many heads and all sorts of body parts. But it’s centrally important because it plays a major role in achieving public health outcomes, such as better co-ordinated care for people with chronic conditions, good immunisation rates and programs to help people quit smoking and lose weight.

Medicare Locals (MLs) now have a role in coordinating and improving this care, but their future is unclear.

MLs were set up during the Rudd-Gillard health reforms to tame the beast, plan for better preventive health, fill gaps in service and improve coordination by drawing on local knowledge.

This means working with hospitals, Aboriginal medical services, community health services, patient advocacy groups, the aged, refugees and immigrants, as well as state and local governments.

Before the election, health minister Peter Dutton derided MLs as merely an “extra layer of bureaucracy”, foreshadowing the possibility they could be axed under a Coalition government. Professor John Horvath, chief medical officer from 2003 to 2009, is now reviewing the role and function of MLs. Submissions closed last month and he will report to government in March.

There are 61 Medicare Locals across the country, the first of which have been operating for a little over two years. Since MLs have now provided more than 500,000 services and 4,700 professional development and education sessions for health professionals, it will take more than a click of the fingers to cut them out and return to the pre-2011 system where the Divisions of General Practice did some (but nowhere near all) of this work.

Submissions to the review

There are many more services and providers involved in Medicare Locals than general practitioners and specialists, though listening to some of the dominant voices involved in the review gives the opposite impression.

Disappointingly, the submission of the Australian Medical Association (one of the doctors’ advocacy groups with a big voice in policy debates) takes the simple view that Medicare Locals don’t work because they are not dominated by doctors. The AMA role is to protect the earnings and interests of doctors but its submission is a thin piece of analysis referring to none of the successes, strengths or potential of MLs.

On the other side, the submission from the Australian Medicare Local Alliance is all sunshine and flowers. It gives a very positive set of reasons to give MLs a longer go and is thin on the real criticisms that may have to be addressed. Helpfully, it attaches appendices with some statistics and many examples of the work and success stories so far.

The Greater Metro South Brisbane Medicare Local, for instance, has offered 11 Chronic Disease Self-Management Programs to Aboriginal and Torres Straight Islander peoples, including for diabetes.

In between these extremes we have some mixed views in other submissions.

On the positive side, there is some great work on health promotion and coordination which might deliver considerable health savings in the longer term if not cut off at the knees. There are also more voices at local level getting together to map what services exist, weigh up what is needed and plan to get the care the community prioritises.

But there is some duplication and wasted effort when MLs provide services now that are competing with other providers rather than filling gaps.

The name is also a problem, as people think they can make payment claims at the ML – a role for the national Medicare offices.

Overall, there is a strong case to let the MLs have a few more years to prove their worth and to see what savings elsewhere in the health system may be countable by the ML-driven effect on reducing hospital costs, unnecessary tests, screening and doctor visits and the burden of chronic conditions. The current UNSW-Monash-Ernst and Young evaluation, (separate to the review), should shine some light on these questions.

What are the likely review outcomes?

There are three broad categories of possible outcomes and we may not know before the federal budget in May.

The first is a “let it run longer and see what the evaluation says” approach, with minor tweaks to clarify roles and perhaps changing the name.

The second is more drastic: to cut the ML roles by, for example, taking much of the preventive health planning and education functions out. This would leave a focus on service delivery, while trying to reduce duplication of effort.

The third is to axe the MLs entirely and phase a return to something more like the old Divisions of General Practice.

The two more drastic approaches would weaken Australia’s primary health care system. It would go against the professional and community input to the national health reform discussions in 2008-09. And state governments might have very negative views about radical chopping and changing of this scale at this time.

How do the economics stack up?

MLs were set up with a modest budget. Depending how they are counted, the savings from axing them are likely to be less than A$1 billion over four years, allowing for transition arrangements and current contract commitments to be met.

There are certainly bigger fish to fry in health savings. These include the Grattan Institute’s proposed Pharmaceutical Benefits Scheme reform, which might save A$1.3 billion a year, or removing the private health insurance rebate. Reducing the rebate by 25% could save A$549 million per year.

We need a rational analysis rather than an ideological knee-jerk reaction to another Labor hangover; we need to give Medicare Locals a chance to improve health outcomes and consider building on their strengths after more

NACCHO welcomes your COMMENTS in the section below

NACCHO Aboriginal Health news: Prevention rather cure lost in medical jumble

sunset 2

“Lack of an effective infrastructure to help us avoid illness is a serious flaw in our healthcare system that needs urgent attention. Its establishment will require more money for Medicare but save us a fortune and provide us with a healthier population. We are frustratingly insular when it comes to introducing the changes contemporary Australia needs to meet health-related demands”.

John Dwyer  emeritus professor of medicine at the University of NSW writing in THE AUSTRALIAN

THERE is a lot that is disturbing about the federal government’s flirtation with a $6 co-payment for a service from a GP. Certainly no signal to the community that healthcare is expensive is needed. Last year we spent more than $29 billion from our hip pockets to subsidise our taxpayer-funded health system.

Most commentators have criticised a co-payment, as it will act as a further deterrent for poorer Australians to seek the care they need, yet provide only paltry savings in a $120bn-a-year health system. Studies show that already too many patients delay seeking help and fail to take prescribed medications because of the costs involved. With the exception of illness caused by excessive alcohol consumption, all risk factors for serious disease are more prevalent in less advantaged Australians. Healthcare in our wealthy country is distressingly and increasingly inequitable.

However, the major frustration with the current debate is associated with the lack of political understanding of the changes we do need to make to provide better health outcomes from a system that is financially sustainable. We do need to extract far more health from the dollars we invest in our health system but cost-effectiveness can only be tackled with a whole-of-system analysis not just a focus on the federally funded Medicare program that supports the delivery of primary care.

If the government were serious about reducing the cost of our health system while improving outcomes and equity, it would start by tackling the appalling waste and inefficiency associated with having nine departments of health to care for 23 million people. Not only does this result in duplication costs estimated to be between $3bn and $4bn annually, the associated jurisdictional mess that sees states responsible for hospitals and the federal government responsible for primary care perpetuates all the inefficiency associated with a lack of patient-focused integrated services. We are the only OECD country so burdened.

This compartmentalisation is represented by Health Minister Peter Dutton’s focus on the cost of Medicare. Hospital expenditure dwarfs primary care expenditure. In the real healthcare delivery world, the success or otherwise of our Medicare-funded primary care system has a significant influence on how much we need to spend on hospital care. Indeed the pertinent truth is that hospital funding into the future will be manageable only if a modernised and remodelled primary care system can reduce the demand for hospital admissions.

The Productivity Commission reports that between 600,000 and 750,000 public hospital admissions could be avoided annually with an effective community intervention in the three weeks prior to hospitalisation. An average hospital admission costs at least $5000 while a community intervention to prevent that admission would cost about $300. Better quality control and attention to the evidence base supporting procedures to avoid unnecessary interventions would also save us billions of dollars.

Most of the $18bn provided annually by Medicare is utilised for treatment available from our GPs. Primary care is doctor-centric and sickness-orientated. We visit our GP because we have a problem, not to get help to stay well. GPs are swamped with patients with chronic and complex diseases most of which could have been avoided or minimised as they are related to unhealthy lifestyle practices.

Lack of an effective infrastructure to help us avoid illness is a serious flaw in our healthcare system that needs urgent attention. Its establishment will require more money for Medicare but save us a fortune and provide us with a healthier population. We are frustratingly insular when it comes to introducing the changes contemporary Australia needs to meet health-related demands.

Around the world the trend is to establish primary care systems that encourage citizens to enrol in a wellness maintenance program and benefit from the delivery of healthcare by teams of health professionals working as “first among equals” in the one practice, integrated primary care. Medicare would cover the services provided by the team.

The psychology associated with voluntary enrolment is important. The philosophy involves acceptance of the concept that we need to take more responsibility for our own health but, when necessary, with personalised and ongoing assistance from appropriate health professionals. The infrastructure involves having such a prevention program available from one’s primary care practice and is not necessarily delivered by doctors.

Contemporary primary care should also provide earlier diagnosis and intervention in potentially chronic conditions, team management for established chronic disease, and care in the community for many who are currently admitted to hospital.

The benefit of spending more on Medicare to reduce hospital admissions is a no-brainer if one is looking at the cost of the entire system but, of course, our governments don’t do this. The savings would more than cover the expense of introducing integrated primary care into Australia.

The Abbott government will probably govern us for six years. It should commit to taking us on a health reform journey so that in six years the above changes and the introduction of a single funder for our health system are providing us with far more health from the available healthcare dollars. To be talking about $6 is to trivialise a major policy challenge.

John Dwyer is emeritus professor of medicine at the University of NSW.

NACCHO Aboriginal health news: INVITE :Webcast forum on Registration for Aboriginal Health Practitioners


A forum/webcast on Registration for Aboriginal and Torres Strait Islander Health Practitioners

Wednesday 18 December 2013  Time: 9.30 am to 12.00 pm

The Aboriginal and Torres Strait Islander Health Practice Board of Australia, in partnership with the Aboriginal Health & Medical Research Council, National Aboriginal and Torres Strait Islander Health Workers’ Association, the Australian Medicare Local Alliance, and the NSW Ministry of Health invite you to attend a stakeholder forum via webcast from Sydney.

This is an opportunity for you and your colleagues to understand more about Registration for Aboriginal and Torres Strait Islander Health Practitioners.

You can log onto a webcast of the event (see link attached below) and view live on the day or view the recorded version at a later date.

Board members, partner organisations and AHPRA staff will be present to answer your questions on registration, accreditation and scope of practice.

You must register via the attached link for the forum.

Webcast-Registration Forum for Aboriginal and Torres Strait Islander Health Practitioners

When you have entered the page you must click on the Enter Webcast button and enter your details. Also please test the compatibility of your webcast viewing computer via the Internet Speed Test and Video Compatibility Test links on the website page; before the date of the webcast.

Please forward this email to any colleagues who would be interested in attending the forum via our live webcast.

Date:    Wednesday 18 December 2013

Time:   9.30 am to 12.00 pm

Please feel free to contact James Porter on (02) 92124777 or

via email if you have any questions.

Kind regards

James Porter

Workforce Initiatives Project Officer (WIPO) | Member Services Support Unit

Aboriginal Health & Medical Research Council

Acknowledging the traditional Aboriginal custodians upon whose ancestral lands the AH&MRC and AHC stand.


NACCHO political alert: Complacent parties taking eye off the ball in Aboriginal health

Question Time in the House of Representatives

This time next week Tony Abbott could be the PM and Peter Dutton Health Minister but:

Closing the health gap between Indigenous and non-Indigenous Australians should be one of the highest priorities for government. Yet Indigenous health has barely been mentioned by either major party during this campaign.


NACCHO chairman Justin Mohamed says the only thing missing is political attention, with indigenous health hardly mentioned so far in the federal election campaign. At the National Press Club Health debate last week Peter Dutton announced that Tony Abbott would be making an announcement before Saturday about Aboriginal health but so far nothing.

“I think to be honest both parties at different times do talk about Aboriginal community control, do talk about Aboriginal health, but I think what we’re seeing in the election process at the moment is that I would like to see more of the parties to let us know what their platform is or what their thoughts are around Aboriginal health, not just health in general.”

Mr Mohamed argues that Aboriginal community-controlled health bodies have proven their expertise and efficiency, and whoever wins government on September 7 must show greater faith in the sector.

Press release from Australian Healthcare Reform Alliance (AHCRA).

Health care is one of the most important issues to voters at this election but the policies of both major parties fail to deliver on key measures, according to the Australian Healthcare Reform Alliance (AHCRA). “Whilst there are some valuable initiatives from both sides, they fail to add up to a genuine effort to address the scale of the current health system problems.

There is insufficient action to address serious inequities in health and health care or longer term problems – they have taken their eye of the ball,” said Tony McBride, AHCRA chair.

“Closing the health gap between Indigenous and non-Indigenous Australians should be one of the highest priorities for government. Yet Indigenous health has barely been mentioned by either major party during this campaign.

“The current Labor Government has introduced some promising reforms, such as Medicare Locals and national funding of children’s dental services and more public adult services, a move that will address inequities. AHCRA therefore welcomes the Coalition’s broad support for these positive reforms, but is very concerned that there are too few details of how they will be progressed if they win power.

“Another major threat to our health system is the increasingly high co-payments faced by people when accessing care. Unless co-payments are addressed, they will continue to be a severe barrier that undermines the equity and universality of health programs such as Medicare and reverses any gains made by the reform process.

“Most importantly, neither major party has their eyes on the future and on how the looming health funding crisis in the next decade can be avoided as health care costs escalate. Neither party has a robust plan to keep people well and out of hospital by supporting prevention, by seriously addressing the social determinants of health that cause so much ill-health or by effectively managing chronic disease in the community. Without such action, the pressure on hospitals will simply grow to unaffordable levels and society as a whole and health care will become increasingly inequitable.

AHCRA welcomes Labor’s commitments to mental health, medical research, and better stroke care. But overall its initiatives and vision are far too modest.

AHCRA welcomes the Coalition’s significant investment in support for general practice teaching and the 500 additional nursing and allied health scholarships for students and health professionals in areas of need. AHCRA also supports the Coalition’s more detailed plans for mental health research and other initiatives to improve care, especially for young people. However it is concerned about the

Coalition’s plans to hand back hospitals to local rather than regional boards which will not serve consumers’ needs for a highly integrated system unless there is a universal commitment to consumer-centred care. Additionally the plan to restore the private health insurance rebate to the wealthiest Australians makes no financial or health policy sense given the take up of private health insurance has actually increased since the rebate was cut.

AHCRA strongly supports the Greens’ universal dental plan but disappointingly even they do not place health among their top ten policies.

Mr McBride called on both major parties to “address the holes in your health policies before the 7th September and commit to building on the early gains of the reform agenda. Deliver a world class health system for Australia’s future that is effective and financially sustainable by addressing equity and focussing much more on prevention and primary health care” he concluded.


Tony McBride, Chair, 0407 531 468;

Bruce Simmons

NACCHO political debate alert :Aboriginal policy- check out where the parties stand

    Indigenous health   

According to the latest census figures from 2011, there are 548,370 people in Australia who identify as Aboriginal or Torres Strait Islander.

From the ABC website Anna Henderson CLICK here for page

NOTE: Provided for the information of NACCHO members and stakeholders but not endorsed in anyway

In the Northern Territory just under 27 per cent of the population identified as Indigenous.

Across the rest of the country, the proportion of the state or territory population who identified as Indigenous was 4 per cent or less.

But Aboriginal and Torres Strait Islander people remain over-represented in prison system, have lower average life expectancy, higher child mortality rates and a higher likelihood of living in poverty.

Earlier this year, then prime minister Julia Gillard delivered the latest report card on the Government’s efforts to close the Indigenous disadvantage gap. She said the Federal Government’s investment in the portfolio has been unprecedented but she noted eliminating disadvantage would take a sustained commitment over many years from all governments, the business sector, non-government organisations, Indigenous people and the wider community.

What aspects of Indigenous Affairs policy do the major parties agree on?

Constitutional Recognition of Indigenous People

The major parties have given in principle backing for this goal. Former prime minister Julia Gillard originally agreed to hold a referendum by the 2013 election but shelved that plan because of a lack of public awareness about the issue.  Instead an Act of Recognition was passed in Federal Parliament in February 2013 on the anniversary of the national apology with a two-year sunset clause for holding a referendum. The Coalition has also committed to put forward a draft amendment to the Constitution within 12 months of winning government and establish a bipartisan process to assess its success. There are some differences of opinion between the parties about the exact wording that should be used to make the constitutional amendment. Federal Parliament has established a Joint Select Committee on Constitutional Recognition of Aboriginal and Torres Strait Islander Peoples. They are working with the funded group Recognise.

Despite the bipartisan agreement to hold a referendum, the issue became political divisive in July when Kevin Rudd announced his intention to hold a referendum within two years and asked the Opposition Leader Tony Abbott to “join that journey”. Mr Abbott reacted by pointing out the Coalition’s one-year timeframe for an amendment means an Abbott government would act more quickly on the issue than a re-elected Labor government.

Closing the Gap

The major parties have backed Labor’s 2008 targets:

  1. Close the life expectancy gap within a generation.
  2. Halve the gap in mortality rates for Indigenous children under five within a decade.
  3. Ensure access to early childhood education for all Indigenous four-year-olds in remote communities within five years. The Government says this will be met this year.
  4. Halve the gap in reading, writing and numeracy achievements for children within a decade
  5. Halve the gap for Indigenous students to stay on for Year 12 or equivalent attainment rates by 2020
  6. Halve the gap in employment outcomes between Indigenous and non-indigenous Australians within a decade

Indigenous representation in Federal Parliament

All parties have expressed interest in ensuring there are Aboriginal and Torres Strait representatives holding seats in Federal Parliament. The Coalition welcomed the first Indigenous Lower House MP, the member for the WA seat of Hasluck Ken Wyatt at the last election. The former prime minister Julia Gillard intervened in local preselections in the Northern Territory this year to appoint a “captain’s pick” for the top spot on Labor’s NT Senate seat, Nova Peris. She will be the first Aboriginal woman to represent the party in the Federal Parliament if successful. The Greens have a policy aim to ensure Aboriginal people have political representation, and the party has recruited a number of Aboriginal candidates for this year’s election.

Economy and jobs

The major parties have all promoted the idea of ensuring Aboriginal people living in remote communities have access to a job. The high unemployment rates in the communities are partially due to the lack of economically viable industry in those areas. Labor has been promoting private investment to create jobs. The Coalition is also focused on the need for economic investment and has flagged the prospect of flying workers in and out of nearby resources projects so they remain connected to their home country but are also earning money to support their families. The Greens policy emphasises the importance of Aboriginal communities determining the kinds of economic projects they have in and around their communities.

What are the key differences between the major parties?

The Indigenous Affairs portfolio

Under Labor the portfolio has been held by Minister Jenny Macklin. The Coalition has appointed NT Senator Nigel Scullion as its spokesman. Opposition Leader Tony Abbott has announced that if elected, the portfolio would become part of Prime Minister and Cabinet. Senator Scullion would remain as spokesman but Mr Abbott says he would also effectively be the Prime Minister for Indigenous Affairs. The Greens have also had a spokeswoman Rachel Siewert appointed to oversee the portfolio.

The Northern Territory Intervention

The Coalition announced an Intervention into the Northern Territory under former Prime Minister John Howard. Labor changed some elements of it when it implemented the Stronger Futures legislation. The Greens want to rescind those laws.

Homelands (also known as outstations)

In the 1970s, family groups in the Northern Territory, Queensland, Western Australia and South Australia began to reject the mission and settlement communities where they had been relocated, and wanted to move back to their traditional and ancestral lands. The remote Homelands have been an ongoing political issue because it is expensive and inefficient to provide services to them. It is estimated that thousands of people are continuing to live in the Homeland environment, particularly in the Northern Territory. The Federal Government was responsible for Homelands until the former Liberal prime minister John Howard handed responsibility to the NT government as part of the Northern Territory Emergency Response in 2007.

As part of Labor’s 2012 Stronger Futures package, the Federal Government has committed $206 million for basic services in the NT, including water, power, roads, sewerage and other infrastructure. The Coalition’s Indigenous Affairs spokesman Nigel Scullion has criticised the Government for not providing enough funding for adequate service provision. He has also stated the Government should not be funding the services and they should be paid for with council rates. The Greens have a strong view that Aboriginal people should have government support to maintain a connection with their traditional lands.


Labor is hoping to seal a deal with all the states and territories, along with the Catholic and independent sectors on its Better Schools package as recommended in an expert report conducted by David Gonski. The report outlines a funding formula with a base figure for all students and extra loadings. Some of those loadings are specific to remote areas and Indigenous students. The Coalition has sent mixed messages about whether it would honour the deal in government but it is unlikely unless most, or even all, schools sign up. The Coalition is more likely to extend the existing funding model if elected. The Greens say remote communities should have access to government services and the party advocates for culturally appropriate education incorporating language and culture.

What we know


  • Want to see parliament revisit a referendum on recognition of Indigenous people in the constitution within two years
  • Close the Gap targets, agreed to by COAG in 2008. Results collated and presented in parliament each year by the PM
  • Funding through national partnerships agreements for health, education and housing
  • Stronger Futures package of measures in the NT
  • Cape York welfare reform trial
  • Constitutional recognition of Aboriginal people – latest progress report
  • Funding land and sea ranger programs


  • The Indigenous Affairs portfolio would be move into the Department of Prime Minister and Cabinet
  • Changing the constitution to acknowledge Aboriginal people – draft amendment would be put forward within 12 months
  • If elected Tony Abbott would spend a week each year in Aboriginal communities and take senior decision makers with him
  • Consideration of tailored governance processes for different communities
  • Concentration on creating economic opportunities
  • Look at fly in, fly out job prospects for Indigenous people in remote communities to work in the mining industry
  • Attendance data for all schools would be published (not just Indigenous schools, to avoid stigma)
  • Income quarantining- supported but not linked to school attendance. Instead it is proposed there would be on-the-spot fines for parents.
  • Encourage longer term postings at remote schools and clinics and aim to attract high quality teachers and health professionals
  • All larger Indigenous communities would have a permanent police presence


  • Compensation for the Stolen Generation
  • End the NT Intervention
  • Close the Gap targets
  • Recognise Aboriginal and Torres Strait Islander people in the Constitution
  • Respect the link between Indigenous people and the land
  • Comply with international agreements on Indigenous rights including he Declaration on the Rights of Indigenous Peoples
  • Aboriginal people have the right to self determination and political representation and must partner in programs and services that affect them
  • Aboriginal people should benefit financially from their cultural heritage and the biodiversity of their lands and waterways
  • Dispossessed Aboriginal people have a right to be assisted to acquire or manage land and waterways that belong to them
  • All Australians including those living in remote communities have the equal right to essential government services
  • Protection of Aboriginal cultural traditions
  • Culturally appropriate health, housing and infrastructure
  • Culturally appropriate education incorporating language and culture
  • Allowing Aboriginal people to control their own education system when they want to
  • Qualified interpreters at hospitals, courts and government meetings
  • Rescind Stronger Futures legislation
  • Full implementation of recommendations from key Indigenous Affairs reports
  • Strategies to deal with impacts of climate change on indigenous communities
  • Food security for Aboriginal people in remote areas
  • Long term sustainable funding for land and sea ranger programs

What don’t we know about the major parties’ policies?

Policy release

The major parties had not released their full Indigenous Affairs election policies by the middle of the year, though Mr Abbott and Ms Macklin have delivered key speeches outlining their vision for the portfolio this year. The Greens have a policy document on their website and have flagged the prospect of some further announcements before the election is held.

What we don’t know

  • Whether the Coalition would be open to changing the structure of the powerful land councils
  • How the Greens would fund the full suite of policies that have been put forward

Key reports on Indigenous Affairs

Bringing Them Home

The Royal Commission into Aboriginal Deaths in Custody

NT, WA and SA Coroner’s recommendations on petrol sniffing

The Little Children are Sacred report

HREOC reports on petrol sniffing, suicide

The Evatt Review

NACCHO Croakey NEWS:What is the future for Medicare Locals and Aboriginal health partnerships?


Everything you always wanted to know about Medicare Locals amd Indigenous health  but were afraid to ask

To mark the first anniversary of the Australian Medicare Local Alliance (AML Alliance), Croakey contributors including NACCHO were asked to suggest questions they’d like answered about the organisation and the country’s 61 Medicare Locals more broadly.


Once again we must thank Melissa Sweet for her ongoing support of NACCHO and members

Their questions broadly fell into six categories:

• Where is the value? • What about Indigenous health? • Governance and resourcing issues • What about population health? • Some rural health concerns • What about mental health?

You can read Indigenous Health below


Many thanks to the AML Alliance and CEO Claire Austin (pictured) for taking the time to answer the questions. It was no small effort!


Questions around Indigenous health

Q: Aboriginal partnership – what structures does AMLA have in place to ensure national partnerships with Aboriginal community controlled health services (ACCHs)? How does this work and is there a formal alliance with NACCHO?

Claire Austin: The AML Alliance is working on a Letter of Agreement with NACCHO. This engagement is paramount to the primary health care sector and will be a key focus of the AML Alliance. The signals from both sides have been all about cooperation and partnership and it is definitely a space to watch in terms of progressive opportunities between the two agencies.


Q: Aboriginal accountability – how does AMLA show real accountability to Aboriginal and Torres Strait Islander people, with how they are providing effective services and use of Closing the Gap money? Is this on their website? Not inputs but programs and numbers of Aboriginal and Torres Strait Islander people accessing services?

Claire Austin: Data on the number of Aboriginal and Torres Strait Islander people accessing Closing the Gap services are provided to the funding bodies through regular reporting.

Details of the Closing the Gap programs coordinated by the AML Alliance are available on the AML Alliance website. Similarly, details of the Closing the Gap programs run locally by MLs are available on their respective websites.

It is imperative that we keep the dialogue flowing with other peak bodies like NACCHO and the Indigenous Health Leadership Group and respect the partnerships to maintain constructive progress in Indigenous health. That is what I want to see and I expect to see improvements in Indigenous health, now that an organised and systematic approach to primary health care, underpinned by culturally safe programs, is underway. Accountability is paramount but our accountability will be ultimately measured by the gains we can contribute towards closing the gap in life expectancy and disadvantage for Indigenous Australians.


Q: How many MLs have formal robust partnerships with Aboriginal and Torres Strait Islander ACCHS?

Claire Austin: Working with the Aboriginal Medical Services (AMS) and Aboriginal Community Controlled Health Services (ACCHS) sectors is paramount for MLs, and many have strong working partnerships in this regard – for example, the Aboriginal Medical Services Alliance Northern Territory (AMSANT) is a founding member and partner of the Northern Territory Medicare Local. AML Alliance and MLs are working with the Indigenous health sector to build on the gains made to date.


Q: Aboriginal investment – How many MLs are working in collaboration and subcontracting to ACCHSs to improve coordination and health outcomes? How are MLs deciding when this subcontracting is appropriate?

Claire Austin: MLs work in partnership with AMSs, ACCHSs and the broader Indigenous community to conduct their population health needs assessments and to subsequently develop local population health plans. These partnerships allow for the needs of Aboriginal and Torres Strait Islander peoples to be well defined and for the resulting services to be comprehensive and targeted in meeting those needs.

MLs subcontract health providers subject to that provider’s proven ability to most efficiently and effectively meet the needs of the Indigenous community. It is important to note that subcontracting is only a small way in which MLs engage Indigenous health providers. Genuine partnership (formal and informal) in the design, delivery and coordination of Aboriginal and Torres Strait Islander services proves a very effective means through which to best meet the health needs of Aboriginal and Torres Strait Islander people.


Q: What percentage of Aboriginal health outcomes is directly attributed to MLs?

Claire Austin: It is important for AML Alliance and MLs to be guided by Aboriginal and Torres Strait Islander health organisations and peoples as to what they consider are the appropriate measures for Aboriginal health outcomes.  We are currently guided in this respect with the health issues addressed under national Closing The Gap initiatives.

Some of the initiatives MLs are running to contribute to Aboriginal health outcomes include:

• Working with Aboriginal and Torres Strait people and/or organisations to encourage Aboriginal people to self-identify with mainstream services so that they can receive culturally safe care and gain access to Indigenous health services and benefits.

• Educating and training non-Indigenous health providers around cultural safety and informing them of Indigenous entitlements to specific programs and benefits.

• Supporting Indigenous chronic disease management through the Care Coordination and Supplementary Services program.

• Delivering an Otitis Media program for Indigenous communities.

• Employing and supporting Indigenous project officers and outreach workers in Indigenous communities.


Q: There are specific issues related to primary healthcare service delivery between urban, rural and remote areas including the islands of the Torres Strait. What are the highlights, challenges and risks for MLs, especially in remote areas where the divisions of general practice had no footprint?

Claire Austin: MLs are governed locally and they have the remit and flexibility to respond directly to local needs. This means remote residents are shaping their services in accordance with local context. Supporting this is MLs’ mandate to build and maintain local partnerships which are necessary for meeting those needs.

The challenges associated with this are often going to revolve around funding and capacity, so as long as MLs are sufficiently supported by all levels of government and their local communities then they will be well-positioned to overcome these challenges.


Q: How many Aboriginal and Torres Strait Islander staff are employed across Australia by MLs or within AMLA? And how many at manager or higher-level management?

Claire Austin: We know that at least 80 FTE Aboriginal and Torres Strait Islander Outreach Workers (ATSIOWs) and 80 FTE Indigenous Health Project Officers (IPHOs) are employed/funded through MLs.

It is important to note though that MLs do not report to AML Alliance so this type of information is not readily available.

The AML Alliance is privileged to have Uncle Brian Grant as its Special Adviser on Closing the Gap. Uncle Brian is an Elder of the Merriganoury Clan of the Wiradjuri Nation and is a Member of the Council of Elders of the Wiradjuri Nation. Brian provides national leadership advice, assistance and support to the Chief Executive Officer, the AML Alliance Board and operations to assist AML Alliance achieve its aims through the Closing the Gap initiative.

***** Q: It is very rare for a national peak body to receive the Government funding at the level provided to the AML Alliance. Most rely on subscriptions from their member organisations. Why do you merit such special treatment? Wouldn’t the AML Alliance speak with greater authority if it was more obviously accountable to those it purports to represent?

Claire Austin: The Commonwealth is cognisant of the value that the AML Alliance provides to MLs as a peak body. It acknowledges that investment in AML Alliance is helping to meet the health needs of Australians by offering leadership, coordination and support of health system reform.

Many peak bodies receive government funding so I am not sure how our case can be construed as ‘special treatment’.

Our funding requirements very clearly state our duty to serve and support the work of MLs, and our governance arrangements have been set up to ensure we perform this task in the absence of undue influence.

The Alliance is committed to supporting and enabling capacity development and excellence for service delivery in primary care through the ML network.  It also has a role in identifying opportunities for policy and program improvement at the national scale.

In addition, it should be noted that the Not for Profit Sector Freedom to Advocate Bill 2013 was passed on 5 June, safeguarding the ability of Not-For Profit entities to advocate freely on behalf of the community – which impacts on Commonwealth agreements. The Act invalidates or prohibits clauses that restrict or prevent NFPs from commenting on, advocating support for, or opposing changes to Commonwealth Law, policy or practice.

NACCHO 2013 budget press release:Lack of detail leaves a question mark over Aboriginal health


 The $777 million commitment to Close the Gap initiatives in the 2013 Federal Budget is welcome however the Aboriginal health Community Controlled sector remains concerned about the lack of detail on how and where the money will be spent.

National Aboriginal Community Controlled Health Organisation (NACCHO) Chair, Justin Mohamed, said it was critical that adequate funding was dedicated to support and grow Aboriginal Community Controlled Health services where the biggest gains were being made in improving Aboriginal health.

Download the Aboriginal Health Budget here also see executive summary below

Download Federal Government Press release on Aboriginal spending here

“The lack of clarity in the Budget around how funding will flow to Aboriginal primary Community Controlled Health services is very concerning,” Mr Mohamed said.

“Aboriginal Community Controlled Health services need to be at the forefront of any comprehensive primary health care model.

“It is these services – run by Aboriginal people, for Aboriginal people – that are making the biggest improvements to the health of their communities.

“The Federal Government also needs to put greater effort into getting the states and territories to re-commit to the National Partnership Agreement – due to expire in just over a month.

“It is simply not OK to leave the fate of Aboriginal health hanging while everyone plays politics up to the 11th hour.”

Mr Mohamed said NACCHO was disappointed that the Budget did not spell out how the upcoming National Aboriginal and Torres Strait Islander Health Plan would be funded.

“The Health Plan will not work unless it is properly resourced and after yesterday we are no clearer on how much of the $777 million will be directed to this critical initiative.

“It is also disappointing to again see the focus on Medicare Locals in the Budget. Medicare Locals are yet to prove their effectiveness in the Aboriginal health space where the community controlled model has made positive health gains.

“If we’re serious about closing the appalling gap in life expectancy between Aboriginal and non-Aboriginal Australians, then Aboriginal health needs to be given the attention it deserves and community controlled services better supported.”

Mr Mohamed said NACCHO would be consulting widely with the Aboriginal Community Controlled sector and providing further comment upon further analysis of the budget papers in the coming days.

Media contact: Colin Cowell 0401 331 251,


Through Outcome 8, the Australian Government aims to improve access for Aboriginal and Torres Strait Islander people to effective health care services essential to improving health and life expectancy, and reducing child mortality.

The Australian Government, through the National Indigenous Reform Agreement, is committed to ‘closing the gap’ between Indigenous and non Indigenous Australians in health, education and employment. This requires a concerted and coordinated effort from all Government agencies and two of the targets in the agreement relate directly to the Health and Ageing Portfolio: to close the gap in life expectancy within a generation; and to halve the gap in mortality rates for Indigenous children under five years of age within a decade.

In 2013-14, the Government will work with states and territories through a renewed National Partnership Agreement (NPA) to consolidate and embed the reforms implemented under the current NPA on Closing the Gap in Indigenous Health Outcomes, including continuing implementation of the Indigenous Chronic Disease Package. This commitment will provide a continued framework for working collaboratively to close the gap in life expectancy within a generation.

The Australian Government is also developing a National Aboriginal and Torres Strait Islander Health Plan, which will build on the gains already being achieved through the Australian Government’s Closing the Gap initiatives. The Health Plan is being developed as a collaborative effort and after extensive consultation with Aboriginal and Torres Strait Islander people and their representatives and is being informed by advice from the National Aboriginal and Torres Strait Islander Health Equality Council. It will involve building links with current initiatives and strategies, identifying gaps for further action and expanding existing initiatives where appropriate.

The Australian Government recognises that closing the gap in life expectancy in the Northern Territory continues to present a significant challenge. The Stronger Futures in the Northern Territory – health initiative focusses on this challenge by providing ongoing funding to deliver a comprehensive health package for Aboriginal and Torres Strait Islander people in the Northern Territory.

The Department is working with Aboriginal and Torres Strait Islander people and organisations, as well as in collaboration with state and territory government agencies to implement these programs.

The Office for Aboriginal and Torres Strait Islander Health leads the work for Outcome 8 by funding the delivery of primary health care services and other

Download the Aboriginal Health Budget here also see executive summary below

Download Federal Government Press release on Aboriginal spending here

NACCHO health news alert:NT program will educate students on Foetal Alcohol Disorder


NT Minister for Education, Peter Chandler, today announced the development of programs that will educate students about the problems of Foetal Alcohol Spectrum Disorder and support affected children.

“While there are already significant resources in schools to assist with education about alcohol these programs will focus on the disorder.

“New educational programs will address the consumption of alcohol in pregnancy as a way to prevent further cases.

“The Department of Education and Children’s Services will work with non-government organisations to deliver programs to middle and senior school students on the consequences of drinking alcohol during pregnancy.

“An educational psychologist will be employed to work with schools on programs to support children affected by the disorder,” Mr Chandler said during a visit to Centralian Senior College in Alice Springs.

“The Government is taking a broad approach to addressing the effects of alcohol, which includes this week’s announcement of mandatory rehabilitation for problem drunks and education in schools.

“The Country Liberals understands we need to address the cause of alcoholism and support prevention efforts.”

Member for Stuart, Bess Price, who also visited Centralian Senior College, said Foetal Alcohol Spectrum Disorder, which has lifelong complications for children, is preventable by avoiding the consumption of alcohol during pregnancy.

“There are a range of effects on children whose mothers drink alcohol during pregnancy.

“These include physical, mental, behavioural and learning disabilities.

“School programs are unable to reverse these problems but can do a lot to support children in their social and learning development.”

NACCHO Aboriginal health funding alert:Targeted Community Care (Mental Health) $61 million over the five years closes 4 April


Close The gap

Targeted Community Care (Mental Health) Program Family Mental Health Support Services (FMHSS)


About this funding

Community organisations across Australia can apply for Australian Government funding to establish new Family Mental Health Support Services (FMHSS) to provide early intervention and intensive support to vulnerable children and young people affected by mental illness and their families.

This round of funding will establish FMHSS in 20 additional locations across the nation.

The 2011–12 Budget allocated an additional $61 million over the five years from 2011–12 to 2015–16 for additional FMHSS to assist around 32,000 children and young people at risk of or affected by mental illness, and their families.

It is anticipated the roll-out of new services will occur in June 2013 and April/May 2014. New FMHSS will need to be fully operational six months after signing a Funding Agreement. Successful service providers will be required to work closely with FaHCSIA and participate in evaluation activities during the life of the Funding Agreement.

For instructions on how to apply for please see the information below.

  • How much?
    The Australian Government has committed $61 million over five years to 30 June 2016 to expand the FMHSS initiative.
    This round of funding will establish 20 additional FMHSS service across Australia
  • Apply when?
    Applications for new FMHSS sites close at 5:00pm (Eastern Daylight Time) on Thursday 4 April 2013.
  • Who to contact?

What is New FMHSS?

New FMHSS are Family Mental Health Support Services funded through the 2011–12 Budget, and established from 2012.

New FMHSS provide flexible and responsive services for children and young people up to the age of 18 who are at risk of, or affected by mental illness, and their families.

New FMHSS work with children, young people and families to identify risk factors or issues which may lead to poor mental health outcomes later in life and work with the child, or young person and their family to address these issues, and strengthen protective or positive factors.

New FMHSS operate in close cooperation with and with other family and children’s services and with the local network of “first to know” agencies such as schools, early childhood centres and child welfare agencies which are vital in identifying at-risk children or young people.

New FMHSS deliver a community-based support service, focused on early intervention to improve mental health outcomes for children and young people at risk or affected by mental illness and their carers and families.

Each New FMHSS service provides three levels of support to vulnerable children, young people and their families:

  • Intensive, long term, early interventions specifically for children and young people, and practical whole-of-family assistance to improve the long-term outcomes for vulnerable children and young people at risk of, or affected by, mental illness. This can include targeted therapeutic group work.
  • Information and referral for families requiring short-term immediate assistance, and
  • Community outreach, mental health promotion/education and community development activities to increase local capacity to understand and respond to children or young people and their families/carers.

As at January 2013 there were 52 FMHSS operating in geographically defined sites across Australia. Thirteen of the 40 New FMHSS announced in the 2011-12 Budget were funded from mid-2012, including two remote services. This round of funding will establish a further 20 New Family Mental Health Support Services.

Program Guidelines

These guidelines provide the framework for the implementation and administration of the Targeted Community Care (Mental Health) Program.

They provide the key starting point for parties considering whether to participate in the Program and form the basis for the business relationship between FaHCSIA and the funding recipient. Applicants are strongly advised to read the Program Guidelines prior to completing an Application. The Program Guidelines comprise the following documents:

New FMHSS identifies groups of children and young people that face additional disadvantage and risk factors for poor mental health outcomes as special needs groups.

Special needs groups for New FMHSS include but are not limited to:

• Indigenous Australians

• People from CALD backgrounds, including humanitarian entrants and recently arrived refugees and migrants

• Children in contact with the child protection system

• Young people leaving out-of-home care, and

Terms and Conditions

Applicants should also review the Terms and Conditions of the Standard Funding Agreement as these are the terms and conditions that will apply to the funding if the Applicant is successful. Applicants are required to indicate their agreement to these terms in their Application.

Application Form

Applicants for New FMHSS must complete the Application Form available on the FaHCSIA website electronically and email it to Organisations applying for more than one site must submit separate applications. Applications should be tailored to each site.

Word limits have been specified for each criterion. Information provided beyond the word limit will not be considered in assessment of the application. Applicants should only attach additional information where requested to do so.

Further Information

Further information on FMHSS is available in a Resource Kit.

If you have any questions, or experience technical problems when completing or submitting an application, please contact FaHCSIA for assistance at Please ensure you include contact details so that we can respond to your query directly.
The Department will post its answers to questions about this round of funding on this webpage by 5.00pm (Eastern Daylight Time) every Wednesday until the relevant Closing date. Please note that the Department will not respond to any questions received after 5:00pm (Eastern Daylight Time) on Tuesday 2 April 2013.

Medicare Locals and the Aboriginal Community Controlled Health Sector: Where are we? Where are we going?

Published in CROAKEY 12 November 2012: Melissa Sweet editor

The National Primary Health Care Conference has just wrapped up in Adelaide, and you can get an idea of some of the wide-ranging discussions from the #nphcc Twitter stream.(refer NACCHOAustralia TWITTER)

One of the obvious implications is that we must hope Medicare Locals are skilled in the art and science of setting and implementing priorities, given the smorgasbord of expectations upon them.

Engaging with the Aboriginal community controlled health sector should be a priority, suggests NACCHO’s senior policy officer on health reform, James Lamerton.

In the article below, he has some practical suggestions for how Medicare Locals can go about this.

Medicare Locals and the Aboriginal Community Controlled Health Sector: Where are we? Where are we going?

James Lamerton writes:

At the National Primary Health Care Conference in Adelaide last week the daunting terrain that Medicare Locals are expected to navigate was on display.

Medicare Local CEOs and directors must be tearing their hair or turning to drink after hearing, on the first day, from the Department of Health and Ageing’s David Butt and, on the final day, from the Coalition’s Andrew Southcott; both confirmed that the ML ground will be not only rugged but continually shifting.

One thing, however, does offer the Medicare Locals some degree of certainty and considerable promise; the ongoing presence, in the primary health care environment, of the Aboriginal Community Controlled Health Service (ACCHS) sector that has been providing comprehensive primary health care, based on the social determinants of health thinking, for forty years.

Though Aboriginal health was not a theme at the conference, those representatives of the sector present made it clear that partnerships between Aboriginal Community Controlled Health Service and Medicare Locals are not only possible but highly desirable.

From population health planning, through treatment of chronic conditions to primary mental health care initiatives like the Access to Allied Psychological Services and Partners in Recovery programs, the Aboriginal Community Controlled Health Service sector will be an essential, effective and enduring partner for Medicare Locals.

Examples of high functioning partnerships between Aboriginal Community Controlled Health Services and Medicare Locals abound.

From the Pilbara to the NT; from Brisbane to NSW’s northern rivers and Sydney’s western suburbs, these two crucial players in the primary health care environment have carved out partnerships that are not only rolling out Aboriginal health programs and initiatives together but are also building respect and trust between and within communities.

Meanwhile, many Medicare Local CEOs at the conference, whose organisations do not have formal partnerships with the Aboriginal Community Controlled Health Service within their footprint, showed that they were open to partnering but may need support and guidance.

Tips for engagement

So is there a sure-fire, foolproof recipe that Medicare Local CEOs and their teams can follow that will lead to a successful partnership?

The short answer is no – or, at least, not that I know of – but following are some basic tips that should help.

Research the Aboriginal Community Controlled Health Service in your area and get your head around its operating environment – in other words, show an interest.

Have a look at the constitution, find out who the board members are and where they come from. What programs/projects does the Aboriginal Community Controlled Health Service run, and what is it really good at? What are its pressure points? Maybe in those pressure points there’s a potential partnering opportunity.

Ensure that your local Aboriginal Community Controlled Health Service is a member of your Medicare Local. Why not even look at Aboriginality and experience in the community controlled sector as essential skills for at least one of your directors?

Meet. Get a knock down to the Aboriginal Community Controlled Health Service CEO this week and follow it up, as soon as possible, with a Chair & CEO to Chair & CEO meeting.

Is it possible for the two boards to come together? Not only can this be an excellent trust-building opportunity but it’ll also allow your board members to hear the voice of the Aboriginal community directly (NB be prepared to hear some confronting messages).

Don’t rush it. If you’re building a new relationship or repairing an old one, it’ll most likely take time.

To you and your team, it might seem that things move at a glacial pace within your local Aboriginal Community Controlled Health Service, but this is usually because it is using its community feedback loops to see what people think.

It might be frustrating but this is where the strength of the Aboriginal Community Controlled Health Service lies; see what you can learn from it and extrapolate to your relationships with your traditional and emerging constituencies. (NB: These feedback loops will invariably appear idiosyncratic and puzzlingly opaque: stay cool, they’ve been in place and working pretty well for 60,000 years).

Remember Grandma’s advice: you were born with two ears and one mouth – there’s a reason for that. Active and appreciative listening to a problem will often produce the seeds of a solution. In the Aboriginal Community Controlled Health Service environment, silence not only implies consent but also shows respect.

Start with something small and achievable. We’re not going to close the gap in one fell swoop; agree a project that you can work on together (truly ‘work on together’), even if there are some residual trust issues, and see it through to its conclusion – come hell or high water.

Jointly evaluate it, pick the eyes out of it and carry the characteristics of the relationship into something new. Initial success may prove to be sub-optimal but cast your mind back to when you were learning to swim. That’s right, you started out simply trying not to drown and eventually ended up swimming to Rottnest Island.

Meet 2. Arrange informal but regular meetings between your clinicians and those of the Aboriginal Community Controlled Health Service. It’s amazing what can be shared and learned by both groups in an environment of enquiry.

Own what’s yours but respect what isn’t. Enough said.

The mixed Medicare Local messages coming from Government and Opposition are certainly testing the patience and resolve of the Medicare Local movement; it’s hard to plan when the map is redrawn regularly.

However, the opening whistle’s blown and it’s game-on.

This reform agenda presents us with a potentially epoch-altering opportunity to make serious inroads into comprehensive primary health care and public health thinking based on a ‘rights’ ethos.

To the politicians, the future of Medicare Locals may appear uncertain but the only infallible way for us to predict the future is for us to create it.

More reading: Mark Metherell’s report for Croakey from day one of the conference on the need to shift the funding imbalance between hospitals and primary health care.