” A 715 it’s a health check that Aboriginal and Torres Strait on the people’s can have done on an annual timetable.
But it should be comprehensive in nature, and offer you not just the usual, hi, how are you?
What’s your name? Where do you live?
But take full consideration of your social background and social histories, ask you about your family history.
Is there anything important not just in your own personal medical background, but that of your family, so we can take that into consideration?
We know that we have many families with long backgrounds of chronic disease, for example, diabetes, cardiovascular risk, and they’re super important we’re considering how we tailor our history, our examination, our investigations, and then a treatment plan for you.
It goes through the steps of that history and they’ll ask you questions about, you got a job at the moment, where are you working?
What are you exposed to? What are your interest? Do you play sport?
Are you involved in any other sort of social activities, cultural activities, for example, which I think is really important.
They’ll then make determinations around the kinds of examination if they need to tailor that at all, depending upon your age, and where you live and your access to services and what your history brought up, for example, male, female, young or old.
And then the investigations and X-ray, for example, or some bloods taken, and referrals as appropriate.
For allied health professionals, pediatrists, nutritionists, diabetes educators, but also perhaps you might need to see a cardiologist or a diabetes and endocrinologist as a specialist.
And then we wrap that all up in a specific and individualised kind of plan for you, that we discuss and we negotiate and we try to educate so that you then are able to play a part in your own health and take responsibility for some of those aspects.
But also you then get to choose what you share with family and the other providers.
It’s supposed to be a relationship and partnership for your health, that you understand, that you agree to and then together, you can move forward on how to be healthy and stay healthy.
Annual health checks for Aboriginal and Torres Strait Islander Australians
Aboriginal and Torres Strait Islander people can access a health check annually, with a minimum claim period of 9 months. 715 health checks are free at Aboriginal Medical Services and bulk bulling clinics to help people stay healthy and strong.
We acknowledge that many individuals refer to themselves by their clan, mob, and/or country. For the purposes of the health check, we respectfully refer to Aboriginal and Torres Strait Islander people as Aboriginal and Torres Strait Islander throughout.
Your Health is in Your Hands
Having a health check provides important health information for you and your doctor.
Staying on top of your health is important. It helps to identify potential illnesses or chronic diseases before they occur. It is much easier to look at ways to prevent these things from occurring, rather than treatment.
The 715 Health Check is designed to support the physical, social and emotional wellbeing of Aboriginal and Torres Strait Islander patients of all ages. It is free at Aboriginal Medical Services and bulk billing clinics.
What happens at the health check?
Having the health check can take up to an hour. A Practice Nurse, Aboriginal Health Worker or Aboriginal and Torres Starlit Islander Health Practitioner may assist the doctor to perform this health check. They will record information about your health, such as your blood pressure, blood sugar levels, height and weight. You might also have a blood test or urine test. It is also an opportunity to talk about the health of your family.
Depending on the information you’ve provided, you might have some other tests too. You’ll then have a yarn with the doctor or health practitioner about the tests and any follow up you might need. It’s also good to tell them about your family medical history or any worries you have about your health.
Information for patients
Only about 30 per cent of Aboriginal and Torres Strait Islander people are accessing the 715 health check. Resources have been developed to help improve the uptake of 715 health checks in the community.
These are available for patients, community organisations, PHNs and GP clinics to download or order
Health checks might be different depending on your age.
Having the health check should take between 40-60 minutes. A health practitioner might check your:
blood pressure
blood sugar levels
height and weight
You might also a have blood test and urine test.
It’s also good to tell your health practitioner about your family medical history or any worries you have about your health.
Follow up care
Once you finish the check, the Practice Nurse, Aboriginal Health Worker or Doctor might tell you about other ways to help look after your health. They might suggest services to help you with your:
heart
vision
hearing
movement
mental health
You may also get help with free or discounted medicines you might need. Your Doctor can give you information about Closing the Gap scripts if you have or at risk of having a chronic disease.
Where can you access a 715 health check?
You can choose where you get your 715 health check. If you can, try to go to the same Doctor or clinic.
This helps make sure you are being cared for by people who know about your health needs.
Do I need to pay for the 715 health check?
The health check is free at your local Aboriginal Medical Service. It is also free at bulk billing health clinics. If you are unsure whether it will be free at your local Doctor, give them a call to ask about the 715 health check before you book.
Why Should I Identify?
It’s important to tell the Doctor if you are Aboriginal and/or Torres Strait Islander so that they can make sure you get access to health care you might need. Medicare can help record this for you, and their staff are culturally trained to help.
Call the Aboriginal and Torres Strait Islander Access line on 1800 556 955.
The Department of Health is currently reviewing the Practice Incentives Program Indigenous Health Incentive (PIP IHI).
They would like to improve the efficiency and effectiveness of the PIP IHI in supporting general practices to care for Aboriginal and Torres Strait Islander people with chronic disease.
A consultation paper on the PIP IHI is available on the Department of Health’s webpage and the deadline for written submissions has been extended to 15 July 2019.
In addition to the consultation paper, we are running 10 face-to-face workshops and a webinar across Australia.
This consultation builds on an initial round of targeted stakeholder consultation that the Department of Health undertook in late 2018, with the National Aboriginal Community Controlled Health Organisation, specific Aboriginal Community Controlled Health Services and mainstream peak bodies.
At the end of this consultation period, ThinkPlace will produce a report documenting what we have heard during our engagement. This report will support the Department of Health in considering options to retarget the PIP IHI and provide advice to Government.
About the workshops
The workshops are seeking to understand how the PIP IHI currently influences the care of Aboriginal and Torres Strait Islander people with chronic disease. You do not need to have responded to the consultation paper to take part in a workshop or the webinar.
We are seeking input from all who have experience delivering health care services associated with the PIP IHI including;
Advisory and professional bodies from mainstream health.
Peak body representatives in Indigenous health.
Doctors, nurses and health workers in metro and regional areas.
During the workshops, we will be asking people to share their knowledge and experience.
As we are undertaking recruitment activities now, so we may need to adjust the schedule pending interest in our locations.
We will provide an agenda and information about the venue to any people who register interest by emailing engagePIPIHI@thinkplace.com.au or telephone the PIP IHI team (02) 6282 8852.
Schedule of workshops for your stakeholders are:
Date
Location
Monday 17 June
Brisbane
(1pm – 5pm)
Tuesday 18 June
Adelaide
(9am -1pm)
Tuesday 18 June
Dalby
(9am -1pm)
Wednesday 19 June
Mildura
(9am -1pm)
Thursday 20 June
Canberra
(9am -1pm)
Friday 21 June
Webinar
(Timing TBC)
Monday 1 July
Darwin
(9 -1pm)
Monday 1 July
Perth
(9am -1pm)
Wednesday 3 July
Cairns
(9am -1pm)
Wednesday 3 July
Sydney
(9am -1pm)
Thursday 4 July
Coffs Harbour
(9am -1pm)
Please note: this schedule is subject to change based on stakeholder engagement and availability.
” A Health Care Home is an existing Aboriginal Community Controlled Health Service (ACCHS) — or Aboriginal clinic or health service — that cares for people with long-term conditions such as diabetes, arthritis, heart and lung conditions.
Mainstream general practices can also be Health Care Homes.
Under a two-year trial beginning in late 2017, up to 200 practices around Australia, including ACCHS, will become Health Care Homes.”
” Up to 65,000 Australians will soon be receiving improved care for their ongoing chronic conditions, with the expansion of the Turnbull Government’s trial of Health Care Homes.
An additional 168 general practices and Aboriginal Community Controlled Health Services (ACCHS) will offer Health Care Home services from today, building on the 22 clinics already in the trial.
Additional practices are expected to sign on in the coming weeks.
Patients with two or more chronic conditions – such as diabetes, arthritis and heart and lung conditions – are eligible to enrol at a Health Care Home to receive integrated, team-based care.”
In an important reform for primary care in Australia, close to 200 Health Care Homes around Australia are now enrolling patients.
These practices and Aboriginal Community Controlled Health Services (ACCHS) will provide better coordinated and more flexible care for up to 65,000 Australians who are living with chronic and complex health conditions.
The stage one trial of Health Care Homes will run until November 2019.
What is a Health Care Home?
A Health Care Home is an existing Aboriginal Community Controlled Health Service (ACCHS) — or Aboriginal clinic or health service — that cares for people with long-term conditions such as diabetes, arthritis, heart and lung conditions.
Mainstream general practices can also be Health Care Homes.
Under a two-year trial beginning in late 2017, up to 200 practices around Australia, including ACCHS, will become Health Care Homes.
Health Care Homes is an Australian Government-funded program. It’s about giving people with long-term conditions the best possible care for their health needs.
Here are some of the good things about Health Care Homes:
My own care plan — my doctor talked to me about my health needs. Then we came up with a plan which suits me and my health.
My own care team — my care team at my clinic are there for me if I want to have a yarn or if I have any health worries.
Connecting my care — I still see my doctor and Aboriginal health worker. When I need to, I go to the physio or my heart or kidney doctor. But my care team makes sure that all the care I receive is connected.
Care that’s right for you
If you have long-term health conditions, there are a lot of things to keep an eye on symptoms, your medicines, visits to the clinic and to other doctors, like your heart or kidney doctor.
Wouldn’t it be good if there was one team looking after all this for you?
That’s what Health Care Homes is all about. If you become a Health Care Homes’ patient, you will have your own care team.
Your care plan
The care team will talk to you about a care plan. This plan contains all the care you receive from your usual doctor, Aboriginal health worker and others. It includes health goals — like eating healthy food, quitting smoking or keeping an eye on your diabetes.
With this plan, all the people who look after you can see the same information about your health anytime they need to.
So can you and your family members or carers.
That way, when you see your heart doctor or kidney doctor you won’t have to explain about any new medicines or anything that’s changed since your last visit. Your doctor can see it all on your care plan.
What if I like everything just the way it is?
You can keep going to your clinic and still see the doctors and Aboriginal health workers who know you.
You don’t have to change anything that you like about your care.
But if you become a Health Care Homes’ patient, your care will be better organised. And if something changes in the future, you and your care team can change your care or medicines in a way that works for you.
For more information:
Talk to your Aboriginal health worker or clinic about Health Care Homes.
health.gov.au/healthcarehomes-consumer
Coordinated care for people with chronic conditions
One in four Australians have at least two chronic health conditions1. For these people, our health system can seem hard to navigate and disjointed. Different health professionals and services work in isolation from each other; care is often un-coordinated; and patients can find it difficult to get to different services and appointments.
A Health Care Home is a general practice or Aboriginal Community Controlled Health Service (ACCHS) that coordinates care for patients with chronic and complex conditions.
People with chronic and complex conditions, who could benefit from Health Care Homes’ flexible, coordinated care can enrol as Health Care Homes patients.
What are the benefits for patients?
My care team — you have a committed care team, led by your usual doctor.
My shared care plan — with the support of your care team, you will develop a shared care plan. This plan helps you have a greater say in your care; and makes it easier for all the people who look after you, both inside and outside the Health Care Home, to coordinate your care.
Better access and flexibility — with a care team behind you, you have better access to care. Health Care Homes can also be more responsive and flexible. If you want to talk to someone in your care team, you won’t always need an appointment with your GP. You might call or message the practice team. Or they might call you to see how you’re going.
Better coordinated — your care team will do more to coordinate all your care from your usual doctor, specialists and other health professionals.
would benefit from the Health Care Home model of care
and are assessed as eligible by a participating Health Care Home
then you could enrol as a patient.
If you would like to become a Health Care Home patient, ask your GP if their practice is a Health Care Homes.
More about Health Care Homes
What will it cost me if I become a Health Care Homes’ patient?
Ask your doctor or practice receptionist about this. Some people don’t have any out-of-pocket expenses when they go to see their doctor; while others are asked to pay a contribution. This will be the same under Health Care Homes.
What if I don’t want to change my care? I like everything just the way it is.
Joining Health Care Homes is voluntary. You don’t have to become a Health Care Home patient.
If you do sign up for Health Care Homes, you can keep seeing the doctors you know and trust.
The benefit of Health Care Homes is that it makes it easier for all the people who look after you — from your doctor to your specialist doctors and others — to share information about your health and to coordinate care based on your needs.
My doctor and my usual clinic already coordinate my care. Why should I sign up for Health Care Homes?
Doctors and practices already work hard to coordinate care for their patients.
The Health Care Homes’ trial gives practices the opportunity to improve the services they provide and the flexibility of these services.
For example, Health Care Homes’ patients can see their practice nurse, without needing to see their GP for every visit.
Health Care Homes will also give patients better access to appointments with either their GP or another member of their care team.
No two patients are the same. Health Care Homes helps doctors and clinics tailor care to each patient.
The government pays Health Care Homes in a different way, to reflect the responsive, flexible way in which they look after their patients.
I already have a GP management plan, a team care management plan or mental health treatment plan. What will happen to these if I join Health Care Homes?
These plans will form the basis of your new shared care plan. For example, if you have a GP management plan, you will continue to be eligible for up to five allied health services each calendar year.
With Health Care Homes, can I see my doctor whenever I want to?
Some Health Care Homes will keep their appointment schedules free at certain times, so that Health Care Homes’ patients can drop in, or get an appointment that day.
But every Health Care Home will be different. Ask your doctor or practice receptionist how this will work in your practice.
If after-hours access is important to you, ask about this too.
Another advantage of Health Care Homes is that patients may not always have to physically come in to the practice to receive care. Instead, patients may be able to Skype, call or email the practice.
If I am enrolled in a Health Care Home can I see another doctor?
When you are at home, you should always try to go to your Health Care Home. If you are travelling, however, you can see another doctor.
What if I get really sick? Or go to hospital?
If you get really sick, your care team will continue to care for you. They may also work with you to adjust your care plan as needed.
If you go to hospital, the care team will follow up with the hospital.
How does Health Care Homes fit in with state-funded isolated travel and accommodation allowance payments?
Being a Health Care Homes’ patient will not affect your eligibility for any state-based isolated travel and accommodation allowance payments.
Can I stop being a Health Care Homes’ patient?
Yes, you can withdraw from your Health Care Home. However, it is a good idea to first talk to your care team if you are unhappy about any aspect of your care. They might be able to help.
If you withdraw from Health Care Homes, you will not be eligible to reapply during the stage one trial, which runs from October 2017 to December 2019.
I am Aboriginal/Torres Strait Islander. Will my care change under Health Care Homes?
If your local ACCHS or the practice you usually visit becomes a Health Care Home you can ask your doctor or practice receptionist for more information about Health Care Homes.
If you enrol as a Health Care Home patient then your care team at the practice will coordinate your care, from visits to the GP, through to specialist visits, scripts, blood pressure checks, physiotherapy, podiatry and other health services.
Each Health Care Home will also work with the integrated team care (ITC) program arrangements for chronic care; and will coordinate other health services provided by state, territory and local governments or by community groups.
“Tobacco smoking is the most preventable cause of ill health and early death among Aboriginal and Torres Strait Islander people and is responsible for around one in five deaths,”
Through the Council of Australian Governments (COAG), the Australian government has committed to six targets to close the gap in disadvantage between Indigenous and non-Indigenous Australians across health, education and employment.
Two of these targets relate directly to the health portfolio: to close the gap in life expectancy within a generation (by 2031); and to halve the gap in mortality rates for Indigenous children under five within a decade (by 2018).”
As the federal government seeks to raise the average lifespan of Indigenous individuals closer to levels enjoyed by the rest of the population smoking remains under the gun, blamed for one-fifth of the Indigenous death rate.
A recent Health Department tender seeks to add a national organisation to run a drive against smoking by Aboriginal and Torres St Island individuals, to complement existing anti-tobacco regional programs run under the banner of Tackling Indigenous Smoking.
The organisation or consortium chosen to support the current TIS program will be referred to as the National Best Practice Unit for TIS.
Closing date for applications is September 1, Melbourne-based tenders specialist TenderSearch says. Contract execution is listed for October-November and release of operational guidelines for January-February 2016.
The NBPU managing supervisory body will be expected to work mainly with grant recipients funded under the TIS program for regional tobacco control activities, with support and leadership from Professor Tom Calma, the national co-ordinator tackling Indigenous smoking.
The to-do list starts with developing and maintaining operational guidelines for tobacco use reduction among Aboriginal and Torres Strait Islander people. It will provide organisational support to grant recipients responsible for implementing evidence-based approaches to tobacco control.
It will help them develop and implement performance indicators and data collection methods, and
The NBPU will facilitate workforce development for the project, disseminating evidence and information on best practice, building a community of practice, and promoting a culture of evaluation and continuous improvement for the TIS program. There will also be advice and assistance to the department.
“Tobacco smoking is the most preventable cause of ill health and early death among Aboriginal and Torres Strait Islander people and is responsible for around one in five deaths,” the tender document said.
“Through the Council of Australian Governments (COAG), the Australian government has committed to six targets to close the gap in disadvantage between Indigenous and non-Indigenous Australians across health, education and employment.
“Two of these targets relate directly to the health portfolio: to close the gap in life expectancy within a generation (by 2031); and to halve the gap in mortality rates for Indigenous children under five within a decade (by 2018).
“Under the COAG National Healthcare Agreement, Australian governments have committed to halve the daily smoking rate among Aboriginal and Torres Strait Islander adults (18 or older) from 44.8 per cent in 2008 to 22.4 per cent by 2018.
“Work to reduce high rates of smoking has resulted in a reduction of seven percentage points since 2002, accompanied by a significant increase in the proportion of Aboriginal and Torres Strait Islander people who have never smoked.”
Indigenous-specific activities were required because the strong history and impact of mainstream action in Australia had failed to deliver equivalent reductions in smoking rates within the Aboriginal and Torres Strait Islander population, the tender document said.
“Despite the need and the promises, Commonwealth funding for Indigenous Affairs as a percentage of both total outlays and GDP is in decline. And it is disconcerting to see Indigenous voices and input into decision-making being side-lined. Indigenous groups and spokespeople have called the government on the absence of real engagement and consultation – something which has long been recognised as the key to failure or success in Indigenous affairs. “
Dr Lesley M Russell Adj Assoc Professor, Menzies Centre for Health Policy University of Sydney
“It is not credible to suggest that one of the wealthiest nations in the world cannot solve a health crisis affecting less than 3 per cent of its citizens. Research suggests that addressing Aboriginal and Torres Strait Islander health inequality will involve no more than a 1 per cent per annum increase in total health expenditure in Australia over the next ten years. If this funding is committed, then the expenditure required is then likely to decline thereafter.”
Tom Calma, in his role as Aboriginal and Torres Strait Islander Social Justice Commissioner and Race Discrimination Commissioner, pointedly stated in 2008:
Notes
This work does not represent the official views of the Menzies Centre for Health Policy or NACCHO
This analysis looks at the Indigenous provisions in the 2015-16 federal Budget. This is done in the light of current and past strategies, policies, programs and funding, and is supported, where this is possible, by data and information drawn from government agencies, reports and published papers.
Similar analyses from previous budgets are available on the University of Sydney e‐scholarship website.[1]
The opinions expressed are solely those of the author who takes responsibility for them and for any inadvertent errors.
Introduction
The 2015-16 Budget from the Abbott Government has no major announcements on Indigenous issues, and they did not rate a mention in the Treasurer’s budget night speech.
However the Budget is far from benign in its support for Indigenous programs and advocacy groups say it has failed to undo the damage done and anxiety caused by funding cuts in last year’s Budget. Many programs and services must continue to operate with uncertain funding into the future and in the absence of clear strategies and policies from the Abbott Government.
This comes on top of the threat of remote community closures in Western Australia, attempts to weaken protection from racial vilification under the Racial Discrimination Act, and concerns about the implementation of and outcomes from the Indigenous Advancement Strategy (IAS) tendering process. Indigenous organisations are losing out in the competition for funds to deliver Indigenous programs and services and after last year’s Budget cuts, there is no new funding for key representative groups such as the National Congress of Australia’s First Peoples.
Despite the need and the promises, Commonwealth funding for Indigenous Affairs as a percentage of both total outlays and GDP is in decline. And it is disconcerting to see Indigenous voices and input into decision-making being side-lined. Indigenous groups and spokespeople have called the government on the absence of real engagement and consultation – something which has long been recognised as the key to failure or success in Indigenous affairs.
In March 2015 the Minister for Indigenous Affairs, Nigel Scullion, took delivery of ‘The Empowered Communities Report’, produced of a group of Indigenous leaders from across Australia brought together by the Jawun Indigenous Partnerships Corporation. The report outlined ways for Indigenous communities and governments to work together to set priorities and streamline services at a regional level, in line with the Government’s approach. The Minister committed that the Government would consider carefully the report’s recommendations and respond ‘in due course’. That has yet to happen.
What emerges most strikingly from this year’s Budget analysis is that little has been done over the past twelve months to assess the implications of commissioned reports and reviews, to capitalise on the restructure and realignment of Indigenous programs, to develop promised new policies and to roll them out. All that has been done to date is to shift responsibility for programs to the Department of Prime Minister and Cabinet and to rebrand programs that may or may not be effective. It’s a policy-free zone, where ad hoc decisions are the norm and budgets continue to be constrained in ways that limit the effectiveness and reach of programs and services.
There are a number of examples where program funding has been provided at the expense of other needed programs – taking $11.5 million from Indigenous Safety and Wellbeing programs to reverse funding cuts to the Indigenous Legal Assistance Program is perhaps the most egregious example.
There are also concerns that proposed changes to mainstream programs such as increased co-payments and safety net threshold in health, reduced Commonwealth funding for public hospitals, increased costs for higher education, and changes to the collection of census data will have a disproportionate impact on Indigenous Australians.
Small wonder then that most Closing the Gap targets remain out of reach and the sector is struggling to keep programs functioning and retain staff.
The inequality gap between Indigenous peoples and other Australians remains wide and has not been progressively reduced. With a significant proportion of Indigenous Australians in younger age groups, and without funded commitments to actions now and into the next several decades to improve their socio-economic status, future demands for services will burgeon.
Implementation of the National Aboriginal and Torres Strait Islander Health Plan
The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 was developed to provide an overarching framework which builds links with other major Commonwealth health activities and identifies areas of focus to guide future investment and effort in relation to improving Indigenous health.
On 30 May 2014 the Assistant Minister for Health, Fiona Nash, announced that an Implementation Plan would be developed for this Health Plan.
This was supposed to be available from 1 July 2015 to enable the progressive implementation of the new funding approach for the Indigenous Australian’s Health Program. The new approach will target funds to those regions whose populations experience high health need and population growth. The Budget Papers explicitly mention NACCHO as the nominated community stakeholders along with States/Territories in the development of this mechanism.
At June 2015 Senate Estimates PM&C officials said that the implementation plan was still being developed by DoH in collaboration with the National Health Leadership Forum, AIHW and PM&C. Its release was expected within a ‘short period of time’.
The Close the Gap Campaign Steering Committee believes that the Implementation Plan requires the following essential elements:
Set targets to measure progress and outcomes. Target setting is critical to achieving the COAG goals of life expectancy equality and halving the child mortality gap;
Develop a model of comprehensive core services across a person’s whole of life including end of life care with a particular focus, but not limited to, maternal and child health, chronic disease, and mental health and social and emotional wellbeing; and which interfaces with other key service sectors including, but not limited to, drug and alcohol, aged care and disability services;
Develop workforce, infrastructure, information management and funding strategies based on the core services model;
A mapping of regions with relatively poor health outcomes and inadequate services. This will enable the identification of service gaps and the development of capacity building plans, especially for ACCHS, to address these gaps;
Identify and eradicate systemic racism within the health system and improve access to and outcomes across primary, secondary and tertiary health care;
Ensure that culture is reflected in practical ways throughout Implementation Plan actions as it is central to the health and wellbeing of Aboriginal and Torres Strait Islander people;
Include a comprehensive address of the social and cultural determinants of health; and
Ensure the development and implementation of the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Wellbeing 2014-2019 as a dedicated mental health plan for Aboriginal and Torres Strait Islander peoples, and in coordination with the implementation of the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy and the National Aboriginal and Torres Strait Islander Drug Strategy.
Establish partnership arrangements between the Australian Government and state and territory governments and between ACCHS and mainstream services providers at the regional level for the delivery of appropriate health services.
The Health Portfolio Budget Statement says that in n 2015-16, the Government will implement a National Continuous Quality Improvement Framework for Indigenous primary health care through the expansion of the Healthy for Life activity. This will support the delivery of guideline-based primary health care and support improved health outcomes.
Health
There were no specific Indigenous issues included in the Health budget, and there are questions about the future of some programs.
Aboriginal Community Controlled Health Organisations
The Abbott Government has provided $1.4 billion /3 years ($448 million / per year) for Aboriginal Community Controlled Health Organisations (ACCHOs). This will include a 1.5% CPI increase over the 3 year period. NACCHO and Affiliate funding of $18 million is provided for 18 months and in that time DoH will commence a review of NACCHO’s role and function.[2]
In addition, NACCHO has secured confirmation of an extension of the exemption from Section 19.2 of the Health Insurance Act 1973 which expires on 30 June 2015, which enables ACCHOs to receive financial benefit from Medicare rebates in addition to Government funding. This extension will be granted until June 2018.
The freeze on MBS rebate indexation will have a significant financial impact on ACCHOs as will any increase in Medicare and PBS co-payments.
Flexible Funds
In combination the 2014-15 and 2015-16 Budgets will cut $500 million / 4 years from 14 of the 16 DoH flexible funds. There is still no clarity in relation to how these savings are to be achieved, although the Aboriginal and Torres Strait Islander Chronic Disease Fund will not be cut. However cuts to other funds such as those that support the provision of essential services in rural, regional and remote Australia, that manage responses to communicable diseases and that deliver delivering substance abuse treatment services will affect Indigenous Australians.
Aboriginal and Torres Strait Islander Chronic Disease Fund
Within the Health portfolio, the Aboriginal and Torres Strait Islander Chronic Disease Fund supports activities to improve the prevention, detection, and management of chronic disease in Indigenous Australians and to contribute to the target of closing the gap in life expectancy. The Fund consolidates 16 existing programs, including the majority of initiatives under the Indigenous Chronic Disease Package, into a single flexible fund. The three priority areas targeted are:
Tackling chronic disease risk factors
Primary health care services that can deliver
Fixing the gaps and improving the patient journey.
The Fund was established in the 2011 Budget and came into operation on 1 July 2011. The funding is $833.27 million / 4 years (from 1 July 2011 to 30 June 2015). The majority of funding has been directly allocated to organisations to support activities under the Fund’s Indigenous Chronic Disease Package programs.
At June 2015 Senate Estimates it was confirmed that most, but not all, of the activities under this fund were continuing. Local community campaigns and the chronic disease self-management program were named as two programs that were not continued.
Tackling Indigenous Smoking Program
The 2014-15 Budget cut $130 million / 5 years from the Tackling Indigenous Smoking Program, despite the fact that 44% of Indigenous people smoke. The program was reviewed in 2014 and the DoH website says that this review will “provide the Government with options to ensure the program is being implemented efficiently and in line with the best available evidence. The outcome of the review will inform new funding arrangements from 1 July 2015.” However there were no announcements in the Budget.
The redesigned program was announced on 29 May 2015, but with no increase in funding It is not clear when or if the review of this program, conducted by the University of Canberra, will be released.
Funding in 2014-15 was $46.4 million; this is reduced to $35.3 million in 2015-16. Staffing levels have also fallen significantly, from 284 FTEs in May 2014 to 194 FTEs in May 2015. There will be further disruption to this important program as current contracts cease at the end of June 2015 and the 49 organisations that deliver the program must go through the IAS Invitation to Apply Process for further funding. Transitional funding will be available for the next 6 months.
Australian Nurse Family Partnership Program and New Directions: Mothers and Babies Services
In the 2014-15 Budget there was additional funding for a Better Start to Life will improve early childhood outcomes :
$54 million expansion, from 2015-16, of New Directions from 85 to 137 sites (52 additional sites overall) to ensure more Indigenous children are able to access effective child and maternal health programs.
$40 million expansion, from 2015-16, of the Australian Nurse Family Partnership Program from 3 to 13 sites (10 additional sites overall) to provide targeted support to high needs Indigenous families in areas of identified need.
In 2015 the Australian Nurse Family Partnership Program will grow from three to five sites and New Directions: Mothers and Babies Services will reach an additional 25 services, bringing the total to 110 services, with an enhanced capacity to identify and manage Fetal Alcohol Spectrum Disorder in affected communities
Prevention – Shingles vaccine
The Budget provides for the listing of Zostavax vaccine for the prevention of shingles to be listed on the National Immunisation Program for 70 year olds from 1 November 2016. This measure includes a 5-years program to provide a catch-up program for people aged 71-79.
There is concern that the 70-79 year old age cohort largely excludes Indigenous people because of their lower life expectancy.
Pharmaceutical Benefits Scheme
Close the Gap PBS Co-payment
This is an ongoing measure and although it was not mentioned in the Budget, it was stated in Senate Estimates that this would continue as currently.
QUMAX Program
The QUMAX program is a quality use of medicines initiative that aims to improve health outcomes for Indigenous people through a range of services provided by participating ACCHO and community pharmacies in rural and urban Australia. It commenced in 2008 as a two year pilot. It was later approved for a transition year outside the 4th Community Pharmacy Agreement and for a further four years under the 5th Community Pharmacy Agreement.
NACCHO and the Pharmacy Guild of Australia have been negotiating 1 year transition funding of QUMAX to enable development of an Implementation Plan under the 6th Community Pharmacy Agreement. NACCHO will seek to expand QUMAX from 76 services to 134 services.
Medicare
MBS Practice Incentive Program (PIP) Indigenous Health Incentive
This is an ongoing program (although it may be subject to an indexation freeze). It is expected to be considered as part of the new MBS Review.
Healthy Kids Check
The Budget cut Medicare funding for the Healthy Kids Check, a consultation with a nurse or GP to assess a child’s health and development before they start school, on the basis that this measure is a duplication with existing State and Territory based programs. NACCHO states that this change will not impact ACCHOs or Indigenous children as ACCHOs can continue to bill health assessments through a separate item (MBS item 715).
Primary care – PHN Funding
The current transition of Medicare Locals (MLs) to Primary Health Networks (PHNs) is proceeding slowly and many details relating to specific programs remain unknown, perhaps even undecided.
To date, 21 of 61 MLs outsource the provision of services for Indigenous Australians directly to ACCHOs. The provision of these services will now move to a competitive commissioning process, leading to concerns about issues such as cultural safety and sensitivity.
The Minister for Health, Sussan Ley, has advised NACCHO that funding for Complementary Care and Supplementary Services will transition to the PHNs.
Mental Health
The Budget has nothing that responds to the National Mental Health Commission’s review of programs and services. The report describes Indigenous mental health as ‘dire’. It’s a dominant over-arching theme throughout, and there is a recommendation to make Indigenous mental health a national priority and agree an additional COAG Closing the Gap target for mental health.
Despite this, the Government has delayed any action and has established an Expert Reference Group to develop implementation strategies. There is no Indigenous representation on the Reference Group.
Substance and alcohol abuse
Alcohol abuse
Alcohol abuse has been identified as a major public health concern among Indigenous people, with serious physical and social consequences. Indigenous Australians between the ages of 35 and 54 are up to eight times more likely to die than their peers, with alcohol abuse the main culprit and alcohol is associated with 40% of male and 30% of female Indigenous suicides.
Fewer Indigenous people drink alcohol than in the wider community, but those who do drink do so at levels harmful to their health. Culturally appropriate intervention approaches are needed and ‘dry zones’ are only seen as stop gap measures.
Cuts made in Flexible Funds affect drug and alcohol programs. Professor Kate Conigrave reports that there are now only 5 dedicated Indigenous drug and alcohol services nationally.
Ice campaign
This Budget commits $20 million / 2 years for a new stage of the National Drugs Campaign primarily aimed at the use of ice. No consultation has been undertaken in the lead up to the announcement of this health promotion campaign.
It almost certainly will not achieve tangible outcomes for Aboriginal people, despite concerns about a growing ice epidemic in remote Indigenous communities.
Opal fuel
There are 123 petrol stations selling Opal fuel in remote parts of Australia but some retailers in the roll-out zones don’t and there are pockets of sniffing near state borders. In December 2014 it was announced that a bulk storage tank for low-aromatic unleaded fuel (LAF or Opal ) is to be installed in northern Australia as part of the roll-out of OPAL in the fight to curb the problem of petrol sniffing.
The Department of Health are looking for ‘Health Heroes’ and are sending a call out to health professionals and students who would like to come down to the Careers Expos listed below to be a speaker and assist in promoting careers within indigenous health.
If you or know someone who would be interested in attending to be a speaker please contact
On 2 April the NACCHO chair Justin Mohamed will be appearing at the National Press Club in Canberra
Watch live on ABC-TV at 12.30 pm (see below)
“Investing in Aboriginal Community Control makes economic $ense”
The good news is that ACCHS deliver the goods – not only health gains, but also substantial economic gains.
In all the rhetoric about Closing the Gap, what is missing from the picture is this — the ACCHS network of clinics, community health centres and health-based co-operatives throughout Australia generates substantial economic value for Aboriginal people and their communities. ACCHS are a large-scale employer of Aboriginal people. This provides real income and economic independence for many people. They contribute enormously to raising the education and skill levels of the Aboriginal workforce.
Investing in ACCHS is a good business proposition. It provides value for money and is highly cost-effective for four main reasons:
ACCHS deliver primary health care that delivers results
Like your local GP does but more effectively for Aboriginal people because the ACCHS model combines the best of clinical know-how with culturally enriched local knowledge and wisdom. It takes care of the whole person, not separate body parts. People work as part of a team that includes Aboriginal Health Workers, allied health, and social and emotional wellbeing counsellors in the front line. GPs as well, although not always. It runs health promotion and health screening to identify and treat health problems before they get serious. It organises access to medical specialists and hospitals if necessary. The ACCHS model considers individuals and families as part of a community and it responds effectively to community-based needs and issues.
This model of health care works for Aboriginal people. Evidence-based inquiries and reports show that ACCHS outperform mainstream services in terms of treatment and prevention. They reduce the need for highly expensive hospital-based services. And they save lives.
ACCHS employment boosts Aboriginal education and training levels
ACCHS employ people with high skill levels. Most have tertiary level qualifications and several have multiple qualifications. This increases the education and skill base of the Aboriginal workforce. Organisational pathways in ACCHS are based on continuing and further education. The message is that ACCHS have education benefits. A single investment by government in ACCHS deals effectively with the two main problems in Aboriginal communities – high unemployment and low levels of education.
“The Healthy Early Years – Getting the Right Start in Life”
The AMA Indigenous Health Report Card 2012-13, The Healthy Early Years – Getting the Right Start in Life, was released today by Assistant Minister for Health, Senator the Hon Fiona Nash, at Parliament House in Canberra.(see Senator Nash Press Release below )
AMA President, Dr Steve Hambleton, said it is the right of every Australian child to have the best start in life but in Australia today not every child benefits from this right.
“In their early years, children need to be safe, have adequate opportunities for growth and development, and have access to adequate health, child development, and education services,” Dr Hambleton said.
“Many of our children are missing out, but none more so than Aboriginal and Torres Strait Islander children.
“There have been some improvements in recent years with many Aboriginal and Torres Strait Islander children making a successful transition to healthy adult life, but there are still far too many who are being raised in community and family environments that are marked by severe early childhood adversity.
“This adversity in early life can affect educational and social functioning in later life, and can increase the risk of chronic illness.
“Without intervention, these problems can be transmitted from one generation to the next – and the cycle continues.
“Good nutrition, responsive care and psychosocial stimulation can have powerful protective benefits to improve longer-term health and wellbeing.
“Strong culture and strong identity are also central to healthy early development.
“The costs to individuals, families, and society of Aboriginal and Torres Strait Islander children failing to reach their developmental potential continue to be substantial.
“Robust and properly targeted and sustained investment in healthy early childhood development is one of the keys to breaking the cycle of ill health and premature death among Aboriginal peoples and Torres Strait Islanders.
“We are seeing improvements through government commitment and cooperation on closing the gap initiatives, but much more action is needed
“It is crucial for the momentum to be sustained by renewing the COAG National Partnership Agreements on Indigenous Health and on Indigenous Early Childhood Development for another five years,” Dr Hambleton said.
The AMA makes several recommendations in the Report Card to improve the health and wellbeing of Aboriginal and Torres Strait Islander children in their early years, including:
a national plan for expanded comprehensive maternal and child services that covers a range of activities including antenatal services, childhood health monitoring and screening, access to specialists, parenting education and life skills, and services that target risk factors such as smoking, substance use, nutrition, and mental health and wellbeing;
the extension of the Australian Nurse Family Partnership Program of home visiting to more centres;
support for families at risk with interventions to protect infants and young children from neglect, abuse and family violence;
efforts to reduce the incarceration of Aboriginal people and Torres Strait Islanders;
efforts to improve the access of Aboriginal people and Torres Strait Islanders to the benefits of the economy, especially employment and entrepreneurship;
efforts to keep children at school;
building a strong sense of cultural identity and self-worth;
improving the living environment with better housing, clean water, sanitation facilities, and conditions that contribute to safe and healthy living; and better data, research and
Background – some key factors impacting on Aboriginal and Torres Strait Islander health and wellbeing in the early years:
Pregnancy and Birth
Aboriginal and Torres Strait Islander women have a higher birth rate compared with all women in Australia (2.6 babies compared to 1.9), and are more likely to have children at a younger age: 52 per cent of the Aboriginal women giving birth in 2010 were aged less than 25 years, and 20 per cent were less than 20 years, compared with 16 per cent and 3 per cent, respectively, for the broader community [AIHW, 2012];
Aboriginal women remain twice as likely to die in childbirth as non-Aboriginal mothers, and are significantly more likely to experience pregnancy complications and stressful life events and social problems during pregnancy, such as the death of a family member, housing problems, and family violence [Brown, 2011];
around half of Aboriginal and Torres Strait islander mothers who gave birth in 2010 smoked during pregnancy, almost four times the rate of other Australian mothers; and
while infant mortality continues to fall, low birth weight appears to be increasing.
Infancy and early years
Aboriginal and Torres Strait Islander children are twice as likely to die before the age of five than other Australian children of that age group. However, the Closing the Gap target to halve this gap in mortality rates by 2018 will be reached if current trends continue;
between 2008 and 2010, Aboriginal and Torres Strait Islander children less than five years of age were hospitalised at a rate 1.4 times greater than other children of the same age [AIHW 2013];
Aboriginal and Torres Strait Islander children suffer from nutritional anaemia at 30 times the rate of other children [Bar-Zeev, et. al., 2013]; and
Aboriginal and Torres Strait Islander children between 2 and 4 years of age are almost twice as likely to be overweight or obese compared with all Australian children in that age range [Webster et. al., 2013].
Family Life
More than 20 per cent of Aboriginal and Torres Strait Islander families with children younger than 16 years have experienced seven or more life stress events in a year [Zubrick et al, 2006]. The greater the number of family life stress events experienced in the previous 12 months, the higher the risk of children having clinically significant social and emotional difficulties [FaHCSIA, 2013];
for Aboriginal and Torres Strait Islander children, risk factors such as: a close family member having been arrested, or in jail or having problems with the police, being cared for by someone other than their regular carers for more than a week; being scared by other people’s behaviour had the greatest impact on a child’s social and emotional difficulty scores; especially if these factors were sustained over a number of years [FaHCSIA 2013];
between 2006 and 2010, the injury death rate for Aboriginal and Torres Strait Islander children was three times higher than that for other children. In 2010–11, the rate of hospitalisation for injuries was almost 90 per cent higher for children from remote and very remote areas than for children in major cities. Overall, hospitalisation due to injury among Aboriginal and Torres Strait Islander children was almost double that of other children, with the greatest disparity relating to assault [AIHW, 2012];
Aboriginal and Torres Strait Islander children were almost eight times as likely to be the subject of substantiated child abuse and neglect compared with other Australian children [AIHW 2012].
Early Childhood Education and Schooling
Aboriginal and Torres Strait Islander children were almost twice as likely to be developmentally vulnerable than other Australian children, and to require special assistance in making a successful transition into school learning;
the Closing the Gap target for all Aboriginal and Torres Strait Islander four-year-olds living in remote communities to have access to 15 hours of early childhood education per week was achieved in 2013;
across the country, the proportion of Aboriginal and Torres Strait Islander children achieving the national minimum standards decreases as remoteness increases. For example, in 2012, only 20.3 per cent of Aboriginal and Torres Strait Islander year 5 students in very remote areas achieved national minimum standards in reading, compared with 76 per cent in metropolitan areas;
only modest progress has been made in achieving the Closing the Gap target to halve the gap for Aboriginal and Torres Strait Islander students in NAPLAN reading, writing and numeracy assessment scores by 2018.
10 December 2013
CONTACT: John Flannery 02 6270 5477 / 0419 494 761
National initiatives to close the gap in Aboriginal and Torres Strait Islander life expectancy and to build the supporting health workforce will be discussed and debated at Health Workforce Australia’s (HWA) 2013 national conference in November.
The life expectancy of Aboriginal and Torres Strait Islander people is more than 10 years less than other Australians. In 2008, the Council of Australian Governments (COAG) agreed to close the gap in life expectancy within a generation by 2031.
This commitment affects all health professionals and the way care is provided.
Greg Craven, Deputy Chair of the COAG Reform Council and Adrian Carson (pictured above ), Chief Executive Officer of the Institute for Urban Indigenous Health, will take part in a panel discussion at HWA’s conference, Skilled and Flexible – The health workforce for Australia’s future.
The session will feature a discussion on the progress made to improve health outcomes to close this gap and how Australia is tracking against its commitment. Mr Craven will also focus on flexible service delivery and funding.
“Any effort to close the gap must acknowledge that Aboriginal and Torres Strait Islander Health Workers make an invaluable contribution,” HWA Acting Chief Executive Ian Crettenden said.
“They are often the first point of contact because Aboriginal and Torres Strait Islander people find it easier to access healthcare services from someone who they can relate to, who understands them and their culture.”
Romlie Mokak, Chief Executive of the Australian Indigenous Doctor’s Association, and Janine Milera (pictured above) , Chief Executive of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, will reveal initiatives underway to help increase the numbers of Aboriginal and Torres Strait Islander health professionals in the Australian health workforce.
Murra Mullangari – Pathways Alive and Well is a national Aboriginal and Torres Strait Islander health careers development program, established by the Australian Indigenous Doctors’ Association to encourage Indigenous senior secondary school students to remain in school and pursue health careers.
Ms Milera will describe initiatives to overcome the challenge of many Aboriginal and Torres Strait Islander people being uncomfortable using mainstream healthcare services.
More than 50 local and international speakers will explore the latest ideas on leadership, innovation and workforce reform at the event at the Adelaide Convention Centre from 18 to 20 November.
Registrations are now open for this year’s conference.
Concession tickets cost $350 and full price tickets are $600.
“AGPAL accreditation demonstrates our ability to provide the highest quality care. This award means we are providing the highest quality of care possible in a rural and remote setting.
This award is significant as we were competing against mainstream organisations from across Australia.
To be recognised as the Rural and Remote General Practice of the Year sends a clear message that Aboriginal Health Organisations are providing the best care in the country.’’
Mossman Gorge Primary Health Care Centre – Rural & Remote General Practice of the Year
Mossman Gorge Primary Health Care Centre (PHCC) has been named Australian General Practice Accreditation Limited’s (AGPAL’s) Rural & Remote General Practice of the Year at a gala event in Sydney on Friday September 27.
Mossman Gorge PHCC, the only community controlled primary health care centre on Cape York, is run by Apunipima Cape York Health Council which provides culturally appropriate, family centred comprehensive primary health care to 11 Cape York communities.
AGPAL is the leading provider of accreditation and related quality improvement services to general practices. Accreditation is based on standards developed by the Royal Australian College of General Practitioners.
Apunipima Program Manager: Family Health Leeona West says the award was a significant milestone for Apunipima, Mossman Gorge PHCC and most importantly, the people and communities of Cape York.
‘AGPAL accreditation demonstrates our ability to provide the highest quality care. This award means we are providing the highest quality of care possible in a rural and remote setting. This award is significant as we were competing against mainstream organisations from across Australia. To be recognised as the Rural and Remote General Practice of the Year sends a clear message that Aboriginal Health Organisations are providing the best care in the country.’
‘The people of Cape York deserve the very best care. This award recognises that our service is providing it.’
The health picture in Mossman Gorge has changed significantly since Apunipima took over the community’s small Queensland Health clinic in 2009.
‘Back then, the clinic had paper records and doctors who visited the community for four hours a week. Anecdotally, health outcomes were poor with high rates of smoking, drinking and chronic disease,’ Ms West explains.
‘Apunipima took over the clinic in December 2009, rebuilt it to AGPAL standards by June 2010, introduced electronic records and billing and was accredited by AGPAL in January 2011.’
‘We even implemented an Aboriginal patient friendly recall system which was so successful that the Brisbane Aboriginal and Islander Community Health Service copied our system for their clients.’
NACCHO JOB Opportunities:
Are you interested in working in Aboriginal health?
NACCHO as the national authority in comprenhesive Aboriginal primary health care currently has a wide range of job oppportunities in the pipeline.
