NACCHO Aboriginal health news: Bureaucratic overhaul, meaningful partnership can fix the Aboriginal health gap

Ian Ring

A bureaucratic overhaul and a more meaningful partnership with  Aboriginal people are essential changes according to Ian Ring who is a professorial fellow at the Australian Health Services  Research Institute at the  University of Wollongong.

Opinion article Canberra Times

A recent episode of Q&A echoed traces of the widespread view  that much money has been spent on Aboriginal health and other matters, with  relatively little to show for it – and that the money must have been eaten up by  a bloated bureaucracy, was misdirected, or corruptly or incompetently used.

All of these may be true but only to a very limited extent. The reality is  that, until recently, the federal government, through its own programs, was  spending less per capita on Aboriginal health than it was on the rest of the  population – despite Aboriginal people being at least twice as sick

That changed with the introduction of the National Partnership Agreements  (NPAs) involving the Commonwealth and all state and territory governments, which  injected $1.6 billion into Aboriginal health and $4.6 billion over four years to  2012-13 into health, education, housing, employment and remote services as part  of the Closing the Gap programs. Australia went from having a degree of  international opprobrium because of its  neglect of Aboriginal issues to  becoming internationally competitive in terms of indigenous policy and  funding.

But what results have we seen from this allocation of additional funds? In a  four-year program, the funds start out at low levels in the first year and build  up progressively over the next three. The funds then need to be used to employ  people, who need to be recruited and trained, and then it takes more time for  the programs in which they work to become fully effective.

Taking the  $100 million allocated to smoking, for example, the very earliest  we could hope to see any kind of significant change in smoking would be picked  up by the next smoking surveys, the results of which will be available next  year.

Given the lag between smoking reduction and improvements in smoking-related  diseases, the earliest we could  see measurable changes in heart and lung  mortality may not be until 2020.

The apparent lack of progress from data currently available tells us about  the lack of progress before the additional $1.6 billion hitting the ground and  is just what we would expect to see at this stage rather than indicating  waste  of funds or misallocation of resource.

But was the money optimally allocated? Almost certainly not and for reasons  that are crying out to be dealt with by the Mundine review. The programs funded  by the NPAs all made sense individually but, collectively, they missed the point  and in no sense approximated the comprehensive long-term action plan promised in  the statement of intent. The problem was not in the policy determined by  governments, or in the funding, but in the bureaucratic implementation of those  policies.

The programs were determined by officials in state and territory governments  with insufficient genuine consultation with   the people who run the Aboriginal  community controlled health services (ACCHS).

Nobody seemed to have asked if we want to halve the child mortality gap in 10  years and the life expectancy gap in a generation, what services do we need to  achieve those goals?

And nobody seems to have wondered how it was possible to have healthy mothers  and babies and to get on top of chronic diseases without adequate provision for  mental health services.

The limited evidence available clearly shows that ACCHS  run by and for  Aboriginal people eclipse mainstream general practice in the identification of  risk factors, performance of health checks, care planning and the management of  Aboriginal and Torres Strait Islander patients.

So instead of asking  what services would produce the best return on  investment, the decision seems to have been taken to allocate new funds to  perpetuate current patterns of use between mainstream (GP) and ACCHS.

Too many senior officials still cling to the notion that in Australia’s  cities and towns mainstream services are the answer – in the absence of   evidence that  this is so and in the face of evidence that it isn’t. There is a  real risk that mainstreaming will be seen as some kind of solution, when the  reality is that there needs to be sensible arrangements for mainstream and ACCHS  services to work together, as in the Urban Indigenous Health Institute.

While current levels of indigenous health funding go a long way to redressing  the previous shortfall in health expenditure, estimated by health economists at  about $500 million a year, inequities in  the share of mainstream program  funding received by Aboriginal people is still an issue.

So what does this mean for the Mundine review and the new  government? Three  issues stand out.

First, bureaucratic reform is  essential. That means substantially fewer  public servants but those that remain need to have the requisite skills and  experience. There is broad agreement that the main functions of Aboriginal  health should remain with the Department of Health,  preferably led by an  indigenous official, but a small, high-level group in the Department of the  Prime Minister and Cabinet, to ensure the new Prime Minister’s requirement to  deliver for Aboriginal people, is an essential component of the new  arrangements.

Second, the recently formulated National Aboriginal and Torres Strait  Islander Health Plan isn’t really a plan in any meaningful sense but could  become one if the implementation plan foreshadowed in it is developed in genuine  partnership with Aboriginal people and involves officials with the requisite  skills, experience and training. But that implementation plan needs to also  include mental health and,  this time, to wrestle successfully with  mainstreaming.

Third, and most important, there seems to be an increasing recognition that  non-Aboriginal people really can’t make indigenous people healthy.  It is time  for Aboriginal communities to play a more central role in the design and conduct  of their own services, bearing in mind that  some of the best health services in  Australia are run by the ACCHS sector.

If the Mundine review and the Abbott government can successfully address  these issues,  Australia, in the not too distant future,  could complete the  long transition from international opprobrium to leading the world in indigenous  health.

  • Ian Ring is a professorial fellow at the Australian Health Services  Research Institute at the  University of Wollongong.

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NACCHO political health news: Abbott Government creates new Indigenous Health Service Delivery Division to replace OATSIH.

Question Time in the House of Representatives

“Funding responsibility for most Indigenous health services remains in the Health Department, to be coordinated by a new Indigenous Health Service Delivery Division (which replaces OATSIH).”

As previously noted, in both Croakey and NACCHO Aboriginal Health Alerts there has been a deal of uncertainty about the fate of Indigenous health programs and services administered by the Federal Health Department and the Office of Aboriginal and Torres Strait Islander Health (OATSIH) under the new Federal Government.

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Our thanks to Melissa Sweet (CROAKEY) for providing this Information

While no doubt there are still issues to resolve, at last there is some news – some programs will transfer to the Department of Prime Minister and Cabinet, as outlined below.

But funding responsibility for most Indigenous health services remains in the Health Department, to be coordinated by a new Indigenous Health Service Delivery Division (which replaces OATSIH).

No doubt many will be interested in the prediction that the new arrangements will mean less red tape for service providers.

The departmental statement below has been distributed to the major stakeholders.

“A number of stakeholders have been asking how OATSIH is affected by the Machinery of Government (MoG) changes announced by the Prime Minister recently.

The Prime Minister has indicated that Indigenous affairs will be a significant priority for this Government and has decided to bring together many of the Indigenous policies and programmes under his own Department.

The Health Department has now received clarity on the changes and I am able to confirm that the following programmes or functions will move from Health to the Department of Prime Minister and Cabinet:

  •  A number of strategic policy functions including responsibility for the health performance framework, health expenditure analysis, and life expectancy modelling
  • Bringing them Home and Expanding Link-up programmes
  • Combating petrol sniffing–expanding the supply and uptake of low aromatic fuel         Indigenous Drug and Alcohol treatment services (including staff working on these programmes in State and Territory Offices)
  • Stronger Futures NT Mobile Outreach Service Plus
  • National Sorry Day Committee
  • Indigenous Sport and Active Recreation Programme currently managed by the Sport Branch (previously in the Department of Regional Australia, Local Government and Sport).

The funding responsibility for the majority of Indigenous health services remains in the Health department, to be coordinated by a new Indigenous Health Service Delivery Division (which replaces OATSIH).

This decision recognises the importance of the critical links between Indigenous health programmes and mainstream health structures.

While there are a number of structural changes required as part of the movement of policies and programmes to PM&C, the key priority for Government is to continue to deliver uninterrupted services to Indigenous people. 

It will be business as usual with service providers and funding arrangements during this transition period from both the Health Department and PM&C.

The consolidation of policies and programmes into PM&C will provide significant opportunities, including reducing the red tape burden on service providers.”

Croakey and NACCHO will be interested to hear your response to these changes.

Please leave comments below.

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NACCHO Aboriginal news : Abbott ,Mundine and Dutton make major Aboriginal and health announcements

Abbott and the Mandine

 In a series of interviews yesterday throughout Australia The Prime Minister Tony Abbott, Warren Mundine Chair of the new Indigenous advisory council and the new Health Minister Peter Dutton have made a series significant annoucements including;

  •  PRIME Minister Tony Abbott’s new indigenous advisory council will complete a review of indigenous spending by early next year.
  • Mr Abbott has begun recruiting people for the council, which will oversee a shake up of indigenous affairs. (see email contact below)
  • HEALTH Minister Peter Dutton supports raising tobacco taxes but won’t raise taxes on alcohol because he says it doesn’t cut consumption.
  • The new minister says boosting community-based mental health services will be one of his priorities in government.
  • The Abbott Government will do more to stop indigenous Australians taking up smoking.
  • Warren Mundine on Wednesday officially signed on to be the council’s chairman.
  • He said his preference was for the council to have seven or eight members.
  • The membership will be finalised before the end of October.
  • And finally todays rumour “There are some OATSIH program areas being considered for transfer but there will be 3 month consultation”

Mr Mundine spoke to Lisa Martin from AAP

“It’s not a representative committee … it’s a council of experts, indigenous and non-indigenous, who will be working in this space to get the socio-economic outcomes for indigenous people,” Mr Mundine told AAP.

“It will be based on expertise, but the majority will be indigenous people on the council.”

Mr Mundine confirmed former Department of the Prime Minister and Cabinet boss Peter Shergold will be on the council.

In the early 90s Dr Shergold headed the now defunct Aboriginal and Torres Strait Island Commission.

The council will meet Mr Abbott and senior ministers three times a year.

Mr Mundine, a former Labor national president, will meet with Mr Abbott and Indigenous Affairs Minister Nigel Scullion on a monthly basis.

Mr Mundine flagged that some meetings would be held in indigenous communities.

“We want to get out and about,” he said.

The council’s first task is to conduct a review of indigenous spending and how to get value for money.

Mr Mundine has stressed the review is not about budget cuts.

He expects the review to be finalised by February or March 2014.

* People can register their interest to be on the council by emailing

indigenousadvisorycouncil@pmc.gov.au

And the new Health Minister also spoke to the media

Tanya Plibersek and Peter Dutton Debate
HEALTH Minister Peter Dutton supports raising tobacco taxes but won’t raise taxes on alcohol because he says it doesn’t cut consumption.

The new minister says boosting community-based mental health services will be one of his priorities in government.

And he’s warned bureaucrats working in 18 health agencies they could be axed or merged into the department.

The government’s Mental Health Commission will be absorbed back into the Health Department, where it will outline how to fix a fragmented system of service delivery, he said.

And the Australian Institute of Health and Welfare and the National Health Performance Authority – which both collect health data – can expect to be merged.

“There are several bodies collecting data and we’ve got to make sure we’re doing it in the most efficient way possible,” Mr Dutton told ABC Radio National.

“We want to make sure we’re getting the most efficient spend possible for taxpayers money so that we can get as much money as we can to frontline services,” he said.

The minister refused to comment on reports that he also has the National Preventive Health Agency in his sights.

In Opposition, Peter Dutton says he proposed a hike in the tobacco tax to cut smoking rates that was finally supported by the Rudd Government.

“I think wherever we can discourage the take up of tobacco we should because we know of the health outcomes and we should do whatever we can,” he said.

However, he says increasing alcohol taxes to combat Australia’s binge drinking culture won’t work.

“The (previous) government imposed the so-called alcopops tax and, in actual fact, the consumption of spirits has gone up since the introduction of that tax,” he said.

“It didn’t work,” he said.

The Abbott Government will do more to stop indigenous Australians taking up smoking, he said.

Mr Dutton says he wants to boost community-based services for the mentally ill and break down the stigma around mental illness that prevents 65 per cent of those with a problem seeking help.

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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.

Register your current or future interest with our HR TEAM HERE