NACCHO Aboriginal Health :Dr Lesley M Russell: Analysis of Indigenous provisions in the 2015-16 Federal Budget

Aboriginal-Mobs

“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

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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]

NACCHO Budget Analysis HERE

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.

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NACCHO 2015 budget update : Aboriginal groups question budget strategy

photoCongress

“Priorities identified in the Indigenous Advancement Strategy (IAS) guidelines were too limited to address disadvantage in a holistic way.  Additionally, the delivery of the IAS is devoid of decision-making procedures for Aboriginal and Torres Strait Islander Peoples, and appropriate definition for community wellbeing.The current policy of overcoming disadvantage is limited in its application and does not take account of significant disadvantage faced by Aboriginal and Torres Strait Islander Peoples, e.g. rates of incarceration and detention.“

 National Congress of Australia’s First Peoples (‘Congress’)

The Budget confirms that more than $145 million will be cut from Indigenous programs and services in 2015-16, including $46 million from Indigenous health”

Shadow Minister for Indigenous Affairs, Shayne Neumann

Budget 2015-16: information of relevance to Indigenous health

NACCHO 2015 Federal Budget Update : How the budget could Close the Aboriginal Health Gap ?

Report from Probono Australia

Picture above Press Conference Parliament HOUSE :LIVE on SKYNEWS

The Federal Government says Indigenous Australians will be the beneficiaries of fresh Budget shakeups in housing and jobs, but Aboriginal and Torres Strait Islander representatives have criticised the Government’s approach.

The 2015 Federal Budget includes $4.9 billion for the Government’s Indigenous Advancement Strategy, including the negotiation of a new Remote Indigenous Housing Strategy to replace the National Partnership Agreement on Remote Indigenous Housing.

According to the Government, the change will provide greater flexibility to respond to the housing needs of remote Indigenous communities and ensure that Government investment improves the condition of housing in those communities.

“The Government is reforming Indigenous Affairs to get adults into work, children to school and make communities safer,” Budget papers said.

“Under new arrangements, housing works will drive Indigenous training and employment and the states and the Northern Territory will be required to deliver positive outcomes in property and tenancy management, home ownership and land tenure.”

“These reforms will put in place practical change on the ground, supported by the Department of the Prime Minister and Cabinet regional network of staff who are located in the communities they serve and deliver on this Government’s priorities to provide better outcomes for First Australians.”

However, the National Congress of Australia’s First Peoples (‘Congress’) said priorities identified in the Indigenous Advancement Strategy (IAS) guidelines were too limited to address disadvantage in a holistic way.

“Additionally, the delivery of the IAS is devoid of decision-making procedures for Aboriginal and Torres Strait Islander Peoples, and appropriate definition for community wellbeing,” the organisation said.

“The current policy of overcoming disadvantage is limited in its application and does not take account of significant disadvantage faced by Aboriginal and Torres Strait Islander Peoples, e.g. rates of incarceration and detention.“

A jobs package in the Budget will also aim to boost Indigenous economic participation, with the Government promising that “clear and accountable targets will significantly increase the number of Indigenous employees in the Australian public sector”.

WM

Graphic from Warren Mundine tweets

“The Government is focused on achieving positive results and a number of key reforms which will improve employment outcomes for First Australians are set to commence,” according to Budget papers.

“From 1 July 2015, reforms to remote employment services will start to transform the economic life of remote communities. The majority of remote job seekers will be active and engaged in meaningful work-like activities that contribute to communities and build real-life work skills and experience. A key aim will be to provide each individual with a real pathway to employment.”

“Through the Employment Parity Initiative, the largest companies in Australia will be supported to increase the number of Indigenous Australians in their workforce to levels which reflect the size of the Indigenous population, approximately three per cent. This initiative will see 20,000 more Indigenous job seekers into work by 2020.”

Congress said the package was too focused on subsidies for business.

“A major portion of the Budget for Aboriginal and Torres Strait Islander Peoples is delivered to the private sector as jobs providers and trainers. However, the huge subsidies to major businesses are not providing real jobs and have not been successful in avoiding sustained high unemployment for Aboriginal and Torres Strait Islander Peoples,” Congress said.

“Grants should not be available to subsidise temporary employment in industries.  The employment programs should be linked to job creation through effective recruitment procedures and skills training provided whilst in permanent employment.”

Congress said the almost half a billion dollars worth of cuts from Aboriginal and Torres Strait Islander programs in the last Budget (2014-15) could still not be accounted for.

“The there is no evidence that significant savings were made and at the same time a number of community-based organisations were rejected in their applications under the Indigenous Advancement Strategy (IAS), on the basis that there were insufficient funds available.

“The cuts made in the last Budget should be restored until evidence of savings in the delivery of programs is available.”

Aboriginal and Torres Strait Islander rights advocacy organisation ANTaR said the Budget “failed the test of addressing the uncertainty, upheaval and cuts in Indigenous Affairs from the past 12 months.”

National Director Andrew Meehan said that last year’s Budget cut of $534 million to Indigenous Affairs, followed by an open competitive tendering process as part of the Indigenous Advancement Strategy (IAS), had left Indigenous Affairs in disarray.

“This last year has been one of real anxiety for many Aboriginal and Torres Strait Islander organisations and communities , and the Budget missed the opportunity to put that right,” he said.

The Shadow Minister for Indigenous Affairs, Shayne Neumann, said the “unfairness” of last year’s Budget continued, given “massive” cuts gutting Indigenous programs and frontline services.

“The Budget confirms that more than $145 million will be cut from Indigenous programs and services in 2015-16, including $46 million from Indigenous health.

“This Budget provides no relief for the hundreds of Indigenous organisations still reeling from the massive cuts delivered through the Government’s disastrous Indigenous Advancement Strategy in the last Budget.

“This year’s Budget rips $95 million from the National Partnership Agreement on Remote Indigenous Housing, in spite of serious overcrowding.

“We still don’t know where the cuts will fall, with many services facing an uncertain future.”

Congress said Indigenous engagement with the entire Budget process remained a concern.

“Since the demise of the Aboriginal and Torres Strait Islander Commission (ATSIC), Aboriginal and Torres Strait Islander Peoples have little or no capacity to monitor the Budget announcements, or to assess or innovate and improve as part of the Budget cycle.

“Expenditure in the Budget cycle on Aboriginal and Torres Strait Islander Peoples is difficult to gauge, as related Budget information is dispersed throughout portfolios and difficult to overview, including comparisons to previous reports on expenditures.  This complexity effectively prevents transparency and accountability and generates misinformation and controversy.”

Andrew Meehan agreed that it was time to elevate the importance of Indigenous Affairs in putting together the Budget.

“Across almost every social and economic measure, Aboriginal and Torres Strait Islander people are the most disadvantaged and are far more likely to experience poverty than other Australians,” he said.

“A Budget that doesn’t put addressing this front and centre is not a fair budget. Nor does it demonstrate that Indigenous Affairs is at the heart of this government, as the Prime Minister has previously proclaimed.”

Download Budget Papers 2015 HERE

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