NACCHO Aboriginal Health and #Alcohol : Download Creating change – #roadmap to tackle #alcohol abuse , Recommendations , Responses and Action Plan : With Press Release from @AMSANTaus

 ” The Territory Labor Government has outlined sweeping alcohol reforms to achieve generational change, in today’s response to the Riley Review into alcohol policy and legislation.

The Attorney-General Natasha Fyles said there’s too much alcohol fuelled violence and crime in the Territory, it affects every community and it has to be addressed. See Part 1 full NT Govt Press Release : Part 4 Download 3 reports

 “ Following the tragic events that have occurred in Tennant Creek in the last fortnight, the most tragic of which has received national media attention, AMSANT reinforces the need to continue to support the nation-leading reforms being undertaken by the Northern Territory Government.

Everyone has acknowledged in all media coverage that the current upsurge in domestic and other violence that has occurred in Alice Springs, Tennant Creek and Katherine is alcohol caused.

The NT Government is in the process of implementing world-leading alcohol policy reforms following the Riley review. Reforms of this magnitude do not happen overnight and AMSANT understands this,”

AMSANT CEO, John Paterson see full press release Part 2 or HERE

 ” The Northern Territory will become the first Australian jurisdiction to put a floor price on alcohol, the Government has announced.

On Tuesday morning, the NT Government unveiled its response to a wide-ranging alcohol review commissioned by former NT Supreme Court chief justice Trevor Riley, and said it would implement a minimum $1.30 floor price per standard drink for all alcoholic beverages.”

Northern Territory to be first jurisdiction in Australia with minimum floor price on alcohol see Part 3 or View HERE

ABC NT Media Report

Graphic price comparison from The Australian 28 Feb

Update 10.00 Am 28 February

Licensing – Further restrictions on sale of takeaway alcohol in Tennant Creek

The Director-General of Licensing Cindy Bravos has acted to further restrict the sale of takeaway alcohol in Tennant Creek effective 28 February 2018, for the next seven days.

The restrictions will apply to the six venues currently licensed to sell takeaway alcohol, being:

Tennant Creek Hotel

Goldfields Hotel

Headframe Bottle Shop

Sporties Club Incorporated

Tennant Creek Golf Club Incorporated

Tennant Creek Memorial Club Incorporated.

Ms Bravos said her decision was in response to widespread concerns about the significant increase of alcohol related offences, particularly domestic violence incidents, in Tennant Creek over the past four weeks.

“Licensing NT has an important role in supporting the right of all Territory residents to live in a safe community,” Ms Bravos said.

“For the next seven days takeaway sales will only be available between 3pm and 6pm Monday to Saturday and all takeaway sales will be banned on Sunday.

There will also be limits on the amount of takeaway alcohol that can be purchased per person per day.

“These restrictions will be in place for seven days. I will then assess their effectiveness and the options available for implementing longer term measures if the restrictions prove to be successful in reducing the levels of harm associated with the consumption of alcohol in Tennant Creek.”

Fast Facts:

The varied conditions of the licences impose these restrictions:

Takeaway liquor will only be available for sale Monday through to Saturday between the hours of 3pm and 6pm. Takeaway liquor sales on Sunday is prohibited.

Sale of these products will be limited to no more than one of the following per person per day:

30 cans or stubbies of mid-strength or light beer; or

24 cans or stubbies of full strength beer; or

12 cans or bottles of Ready to Drink mixes; or

One two litre cask of wine; or

One bottle of fortified wine; or

One bottle of green ginger wine; or

Two x 750 ml bottles of wine; or

One 750 ml bottle of spirits.

The sale of port, wine in a glass container larger than 1 litre and beer in bottles of 750ml or more remains prohibited.

Part 1 NT Government Press Release

Territorians want and deserve safe communities and today we are releasing the most comprehensive framework in the Territory’s history to tackle the Territory’s number one social issue.

We promised Territorians we would take an evidence based approach to tackling alcohol related harm and the government’s response to the Riley Review provides a road map to address that.

The Northern Territory Alcohol Harm Minimisation Action Plan 2018-19, also released today, provides a critical framework for how more recommendations will be progressed over the coming year.”

Minister Fyles was handed the Riley Review in October 2017, giving in-principle support to consider implementing all but one recommendation around a total ban on the trade of take away alcohol on Sunday.

Today’s detailed response now outlines the government:

  1. SUPPORTS 186 recommendations to be implemented in full
  2. Gives IN-PRINCIPLE SUPPORT to 33 recommendations

Minister Fyles said work is well underway with 22 Recommendations completed and a further 74 in progress.

“We have worked efficiently to reintroduce the Liquor Commission, establish a community impact test for significant liquor licensing decisions, extend and expand a moratorium on all new takeaway liquor licences and establish a unit in the Department of the Chief Minister to drive reforms (the Alcohol Review Implementation Team- ARIT).

“There is still considerable work to be done in consultation and modelling to address the 33 recommendations that we support in-principle. While we support the outcomes of these recommendations, we’ll work with community and stakeholders to consider the best possible models of implementation for the Territory context.”

Territorians are urged to review the government’s plan to tackle alcohol fuelled violence and crime and provide feedback at www.alcoholreform.nt.gov.au

Part 2 AMSANT Press Release

Following the tragic events that have occurred in Tennant Creek in the last fortnight, the most tragic of which has received national media attention, AMSANT CEO, John Paterson today reinforced the need to continue to support the nation-leading reforms being undertaken by the Northern Territory Government.

“Everyone has acknowledged in all media coverage that the current upsurge in domestic and other violence that has occurred in Alice Springs, Tennant Creek and Katherine is alcohol caused. The NT Government is in the process of implementing world-leading alcohol policy reforms following the Riley review. Reforms of this magnitude do not happen overnight and AMSANT understands this,” he said.

“However, the immediate increase in alcohol consumption and violence has primarily been caused by the police walking away from the alcohol outlets in terms of full time POSIs or what is known as “lock down”. The government and the people of the NT have been badly let down by our police force and the buck must stop with the Commissioner.

“The ‘on again off again’ approach to point of sale supply reduction is not effective and we are seeing the results of this across the NT but mainly in the regional centres in which full time POSIs had made such a dramatic difference – reducing interpersonal violence by up to 70%.

“AMSANT also understands better than most that there are major problems in the NT Child Protection system,” he continued.

“Along with others, we have offered many solutions to these problems which have been endorsed by the recent Royal Commission. These include the need for an increased investment in parenting, family support services and other early childhood services and much more action on the broader social determinants of these problems such as unemployment and overcrowding. The NT Government has not sat back but has established a new department to lead the large-scale reforms that we know are desperately need in child protection and youth justice and has other major plans in early childhood, housing and other key social determinants.

“In this process, we are confident Aboriginal leaders will be listened to and we can ensure that when our children need to be removed they are placed with kinship carers in their extended families. We can also do much better at preventing our children and families reaching these crisis points and we have the blueprint for change and a government that is up to the task. Again, these reforms will take time to implement as successive governments in the past have failed to listen to Aboriginal leaders and do what is needed.

“In terms of child protection, there should be no need to remind people that the key cause of child neglect is alcohol abuse amongst parents. It is not the only cause, as parental education, mental illness, overcrowding and other social determinants also contribute, but action on alcohol supply will
make an immediate difference in preventing the removal of more our children and helping families recover and keep their children.

“This take us back to the failure of the Police Commissioner to do his job in protecting public safety and maintaining law and order.

“We must implement the Riley review and the many relevant recommendations of the Royal Commission as quickly as is possible but for now, full-time POSIs is one of the most immediate and effective ways to make a difference and the Commissioner must stop deferring to the Police Association and instruct his force to get back on the outlets all day, every day,” this is his duty.

“Finally, there needs to be an immediate needs-based investment in Tennant Creek through our member service Anyinginyi Health Service to deliver important service and programs in accordance with the views of the local Aboriginal community”.

Part 3 The Northern Territory will become the first Australian jurisdiction to put a floor price on alcohol, the Government has announced.

On Tuesday morning, the NT Government unveiled its response to a wide-ranging alcohol review commissioned by former NT Supreme Court chief justice Trevor Riley, and said it would implement a minimum $1.30 floor price per standard drink for all alcoholic beverages.

The recommendation was for a $1.50 floor price, NT attorney-General Natasha Fyles told Mix 104.9 in Darwin, and the Government hopes to have it in place by July 1.

“$1.30 doesn’t affect the price of beer but it will get rid of that cheap wine, we see wine that costs less than a bottle of water… and that is just not acceptable,” Ms Fyles said.

“A bottle of wine has on average around seven alcohol units per bottle, so it’s $1.30 per unit of alcohol. That would put a bottle of wine around $9, $10, so you won’t see that $4 and $5 bottle of wine.”

Ms Fyles said the price of beer would not be affected because it already retailed at a higher cost; neither will the cost of spirits be changed.

“It’s getting rid of cheap wine, particularly, that has a higher alcohol content of beer, so it affects [people] quicker,” Ms Fyles said.

She said the NT Liquor Act was “ad hoc and not fit for purpose” and would be rewritten over the next year, and that a blood alcohol limit of 0.05 would be introduced for people operating boats; there is currently no drinking limit for skippers.

Major recommendations of the Riley Review:

  • The NT Liquor Act be rewritten
  • Immediate moratorium on takeaway liquor licences
  • Reduce grocery stores selling alcohol by phasing out store licences
  • Floor price/volumetric tax on alcohol products designed to reduce availability of cheap alcohol
  • Shift away from floor size restrictions for liquor outlets and repeal 400-square-metre restrictions
  • Reinstating an independent Liquor Commission
  • Legislating to make it an offence for someone to operate a boat or other vessel while over the limit
  • Establish an alcohol research body in the NT
  • Trial a safe spaces program where people can manage their consumption and seek intervention

The People’s Alcohol Action Coalition has long campaigned for many of the changes, and praised the Government for its “world-leading” action.”

Of course, it’s not going to touch the price of beer; the cheapest a carton on beer sells for is about $1.48 a standard drink… at $1.30 cheap wine will still be the preferred drink of heavy drinkers.”

“Our view was we should fall in line with everything that’s in the Riley report,” he said.

Alongside parts of Canada and Scotland, the NT is one of the few jurisdictions in the world to move towards legislating a floor price for alcohol.In his review, Mr Riley said the NT had the highest per-capita rate of alcohol consumption in Australia, one of the highest in the world, and the highest rate of hospitalisations due to alcohol misuse.

In 2004-2005, the total social cost of alcohol in the NT was estimated to be $642 million, or $4,197 per adult, compared to a national estimate of $943 per adult.

Ms Fyles denied the Government had brought forward the legislation as a response to the spike.186 of the recommendations will be implemented in full, with in-principle support for a further 33 recommendations, Ms Fyles said.

“There’s many Territorians that do the right thing and they should be able to access the beverage of their choice, but when we know the harm it causes it’s important we put in place the recommendations of the Riley review,” she said.

The increase in the cost of alcoholic beverages will benefit alcohol retailers, as it is not a tax.

The volumetric tax has been identified as the preferable measure but the Federal Government has refused to move on that so we are taking the step of putting in place a price measure that has shown to have an impact on the consumption of alcohol,” she said.

Making voluntary liquor accords law

In Central Australia, the minimum price for a standard drink is already $1 under the accords.NT Police patrolling bottle shops

It’s a package of measures which is going to be a watershed moment for addressing the scourge alcohol is causing in Tennant Creek,” Dr Boffa said.”

They should be instructing police to keep those police officers in front of bottle shops until they have liquor inspectors there… I would have seen them as a bigger priority than the establishment of a liquor commission,” he said.

Dr Boffa agreed. “It’s ideological opposition — ‘drinking’s an individual responsibility, this is not the police’s job’ — that’s the message we’re getting now,” he said.”The harm that’s being caused by what the police have done in walking away from outlets is preventable. People are dying as a result of that decision

“It’s not about the workforce. Given that we now know it’s not about workforce, there’s no excuse.

He said they addressed crime and antisocial behaviour on the streets of Katherine, Tennant Creek and Alice Springs, but communities recently complained that police had stopped patrolling as often in Central Australia, leading to a rise in alcohol-fuelled crime.

Mr Higgins criticised the Government’s delay in designating uniformed licensing inspectors to monitor bottle shops, and said it was was “copping out” on stationing police officers at bottle shops by saying police should determine how they resource and manage their staff.

Dr Boffa said the NT would also be a world leader in risk-based alcohol licensing, and supermarkets making more than 15 per cent of their turnover from alcohol sales would eventually be outlawed.

There are already alcohol restrictions in place in Alice Springs and Tennant Creek, but they are voluntary liquor accords that are unenforceable, which the Government is seeking to formalise.

“Currently it’s $200 per liquor licence, which is cheaper than some nurses and teachers pay for their licences.”

However, Ms Fyles said the Government would increase liquor licence fees for retailers.

“These are people’s businesses, their livelihoods, and in like any industry there’s a few bad eggs that cause harm and we need to make sure in implementing these reforms we’re working with the community to ensure lasting change.”

Ms Fyles said the NT Labor Government was working through the recommendations and would be consulting the community and the alcohol industry.

Mr Riley made 220 recommendations, of which the NT Government supported all but one, refusing to ban Sunday liquor trading.

Alcohol misuse leads to crime, drink-driving, anti-social behaviour, and wider economic consequences such as adverse impacts on tourism and commercial opportunities, as seen recently in Tennant Creek with tourists repeatedly fleeing during its spike in crime.

Forty-four per cent of Territorians drink at a risky level at least once a month, compared to a quarter of people nationally.

NT has highest alcohol consumption rate in Australia

“They said they’d adopt everything that was in there… While I would have liked to see the Riley $1.50, I can live with $1.30.”

Country Liberals Party Opposition leader Gary Higgins said he broadly supported the Government’s move and felt an approach to alcohol policy should be depoliticised.

“The cheapest you can get alcohol for now in Darwin is 30 cents a standard drink, so this is a dollar more a standard drink — that’s a big change,” John Boffa said.

The Government is also looking at expanding the Banned Drinkers Register from takeaway outlets to late-night venues.

Part 4 Northern Territory Government’s Response to the Final Report

In March 2017, the Northern Territory Government commissioned the Alcohol Policies and Legislation Review to deliver an analysis of alcohol use in the Northern Territory.

The Final Report was handed down on October 2017.

Read the Northern Territory Government’s Response to the Final Report (1.3 mb).

NT Government’s Position and Action Plan

The Northern Territory Government’s Response to the Alcohol Policies and Legislation Review Final Report comprises two important elements:

Cover image for NT Government Position on Alcohol Policies and Legislation Review Final Report Recommendations

1. NT Government Position on Alcohol Policies and Legislation Review Final Report Recommendations (719.7 kb).

This sets out the NT Government’s position in relation to each of the 220 recommendations in the Final Report. 186 of the recommendations are accepted by Government, 33 are accepted in principle and 1 is not supported (to ban Sunday trading).

The Northern Territory Alcohol Harm Minimisation Action Plan 2018-19

2. The Northern Territory Alcohol Harm Minimisation Action Plan 2018-19 (6.7 mb).

The Action Plan sets out the policy and legislative reforms, enforcement and compliance activities and harm management strategies/services that the NT Government is committed to delivering, in order to prevent and reduce harms associated with alcohol misuse.

The Action Plan comprises four key areas:

  1. Strengthening Community Responses – Healthy Communities and Effective and Accessible Treatment
  2. Effective Liquor Regulation
  3. Research, Data and Evaluation
  4. Comprehensive, Collaborative and Coordinated Approach by Government

NACCHO Aboriginal health news : Honorary doctorate awarded to Aboriginal health pioneer and advocate Ms Pat Anderson

Dr Pat

The chair of NACCHO Justin Mohamed on behalf of all NACCHO members, board and affiliates today congratulated Pat Anderson Aboriginal health pioneer and advocate being awarded an honorary doctorate.

Pictured above receiving a degree of Doctor of the University (DUniv) from Flinders University’s receiving the degree at the Adelaide Convention Centre (photo Mary Buckskin)

” Ms Pat Anderson is an Alyawarre woman from the Northern Territory with a national and international reputation as a powerful advocate for disadvantaged people, with a particular focus on the health of Australia’s First Peoples. Chair of the Lowitja Institute, she has extensive experience in all aspects of Aboriginal health, including community development, advocacy, policy formation and research ethics, and has had a close association with Flinders University for many years.” Mr Mohamed said.

READ HER RECENT ARTICLE :Racism a driver of Aboriginal ill health

After growing up on Parap Camp in Darwin, Ms Anderson travelled and worked overseas before working for the Woodward Royal Commission into Aboriginal Land Rights (1973-74) as a legal secretary.

She then became one of the first Aboriginal graduates of the University of Western Australia. After working in Tasmania, Western Australia and Victoria as an advocate for improved education for Aboriginal children, she returned to the Northern Territory in the early 1990s to become CEO of Danila Dilba Aboriginal Health Service.

This led to the start of her involvement with Flinders, supporting the placement of medical students based at the University’s Darwin Clinical School.

She played a key role in establishing the Aboriginal Medical Service Alliance of the Northern Territory (AMSANT), the representative body for the Aboriginal community-controlled health organisations.

After leading the founding of the Cooperative Research Centre (CRC) for Aboriginal and Tropical Health in 1997, she retained a leading role in the successive CRCs that came to constitute the core of the newly created Lowitja Institute, in which Flinders is a partner.

The Lowitja Institute, now recognised as Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research, received an additional $25 million in research funding from the 2013 Federal Budget. Author of numerous essays, papers and articles, Ms Anderson was co-author with Mr Rex Wild QC of Little Children Are Sacred, a highly influential report on abuse of Aboriginal children in the NT.

NACCHO eHealth review submissions close 22 Nov :eHealth vital for Aboriginal Community Controlled Health

Front Page

Front page story from this weeks NACCHO Health News -Australia’s first Aboriginal health newspaper (Out this week in the KOORI MAIL)

The chair of National Aboriginal Community Controlled Health Organisation’s  (NACCHO) has welcomed the Federal  Health Minister Peter Dutton’s recent announcement for  a review of the current Personally Controlled Ehealth Records (PCEHR ) program, but has called on the Federal Government to support the continued use by Aboriginal community controlled health services (ACCH’S).

Update 21 November from NACCHO/AMSANT

The Federal Government have announced a review of the national eHealth Record System (PCEHR) with submissions to be completed by this Friday 22nd November.

 This is a very important review for the Aboriginal Community Controlled Health Sector to be involved in, as the sector has a 10 year history of being early, enthusiastic and skilled implementers and utilisers of eHealth, a basic foundation tool towards closing the gap through improved record sharing and data accuracy to ultimately improve health service provision and outcomes for Aboriginal people.  

 Note that the submission must be less than 1000 words and address the following areas:

  • Your  experience on the level of consultation with key stakeholders during the  development phase
  • The level  of use of the PCEHR by health care professions in clinical settings
  • Barriers  to increasing usage in clinical settings
  • Comments on standards for Terminology, language and technology
  • Key clinician utility and usability issues
  • Key patient usability issues
  • Suggested Improvements to accelerate adoption of the platform

Please return the submission or any comments today  Simon.Stafford@amsant.org.au who will complete it and ensure it is submitted by Friday 22nd November.. Thank you.

Mr. Mohamed said he agreed with the minister that the concept of electronic health records must be fit for purpose and cost effective and that the review should be able to put the controversial electronic health records program back on track.

“Given the state of Aboriginal health in this country and the fact the our Aboriginal population is expected to grow to over a million by 2031 we need to educate healthcare professionals on the role of Telehealth and ehealth technology can play to help close the gap.

We recognised in our recent Investing in Healthy Futures for Generational Change plan 2013-2030 that five years on from setting targets to “Close the Gap”, Aboriginal Community Controlled Health Organisations (ACCHOs) have been responsible for many of the health gains achieved  and that ehealth records have and will have into the future play a vital role  in recording improvements ,identifying risk factors, performing health checks, planning care, and managing and treating high-risk individuals” Mr Mohamed said

“The ACCHS sector has successfully embraced the concept of a national ehealth program to ensure continuity of care for a frequently mobile population with high incidence of illness. ACCHSs are often small health organisations that rely on external providers, including cardiac and renal specialists, physiotherapists, pathologists and radiographers.

If a patient say from Tennant Creek is visiting a clinic in Alice Springs   the administering health professional has in the past been locked out of the patient’s complex medical history, unless they go through the cumbersome process of requesting a health summary from the home clinic, which in turn may also be limited in historic information.

A shared electronic health record has enabled will our Aboriginal patients to receive health care consistent with their condition, treatment history and specialist advice, reducing risk of over treatment or testing.

“Our ACCHs PCEHR systems will meet the needs of a mobile population; enabling a patient to receive health care consistent with their condition, treatment history and specialist advice, reducing risk of over treatment or testing; captures important data that is otherwise easily lost; allows for information sharing and broad analysis; empowers the patients, affording greater flexibility and choice of health care provider.

“The national ehealth record system would do well to mimic the model of Aboriginal Community Controlled Health Services – regional, locally controlled health services that promote participation and are responsive to local need rather than a big one size fits all model.” Mr Mohamed said

The goals of PCEHR already align well with NT Aboriginal Health KPI Information System to contribute to improving primary health care services for Aboriginal Australians in the Northern Territory by building capacity at the service level and the system level to collect, analyse and interpret data that will:

  • Inform understanding of trends in individual and population health outcomes;
  • Identify factors influencing these trends; and
  • Inform appropriate action, planning and policy development.

Mr Mohamed as active implementers of the PCEHR, the ACCHS sector looks forward to participating in this review in its pursuit of the highest quality and continuity of health care for Aboriginal people towards Closing the Gap.

NACCHO Aboriginal health news: Closing the Gap in NT Aboriginal health outcomes

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“An Aboriginal community controlled comprehensive primary health care service?

A bloody mouthful of a description, but nonetheless a symbol and practical evidence of what Aboriginal people and their supporters have achieved—and continue to achieve.”

Chips Mackinolty NT Aboriginal health legend (Ex AMSANT)

Photograph by Therese Ritchie

This is a guest post by Chips Mackinolty that was first published, in edited form, in the NT News on 7 September 2013

NACCHO would also like to acknowledge a pay tribute to the support Chips has given NACCHO over the years

Intro Bob Gosford Crickey

After more than 30 years in the Territory, Chips Mackinolty is taking a year off: for “a pre-pension gap year” as he describes it. After all, he says, “gap years are wasted on the young”.

Across most of that time he has worked for organisations which haven’t allowed him to have a public personal opinion. This has included working for Aboriginal organisations, writing as an interstate journalist for both Fairfax and Murdoch, designing for private enterprise clients, and even a stint as a Labor Party ministerial appointee. For the last four years he has worked for the Aboriginal Medical Services Alliance Northern Territory [AMSANT].

Apart from an irreverent political approach in his artwork, which has occasionally been touted by the NT News, Mackinolty has pretty much stayed out of the world of public opinion.

A day after quitting AMSANT, he writes an opinion piece for the NT News on an ongoing commitment: Aboriginal health. It is published on the day of the Federal election, but with no intent to influence votes. In his words, “that’s deliberate: whoever wins the election today must commit to the most successful bipartisan strategy in recent Territory history, closing the gap in Aboriginal health outcomes”. He tells a story that suggests that the Territory is hitting well above its weight.

But it’s not as simple as that, as he tells us.

Four or five years ago I made the decision to pretty much stop going to funerals. Of course since then I have been to many—too many. There came a time when it had got too much, with the vast majority of funerals for Aboriginal people. And the people were dying younger.

It was a difficult decision, for many were from the Katherine region. It might sound peculiar to readers, but Katherine was where I “grew up”. I got there in the early ’80s in my late 20s. An evening of fireworks for the third celebration of Self Government in Darwin then, bizarrely a day or so later for the final shoot in Mataranka of We of the never never with Aboriginal artists I then spent the next four years with.

But nevertheless it was a town, at that age, in which I “grew up”. Whatever I thought I had learnt on the streets of inner city Sydney were, frankly, SFA when it came to the Territory.

Most of that learning was with Aboriginal people across an area greater than Victoria: from Borroloola to Elliot; to Lajamanu and Kalkarindji and west to the Kimberley: Halls Creek, Kununurra and Wyndham. And then across via Timber Creek to Bulman, Numbulwar and Angurugu, south through Numbulwar to Ngukurr and back up through Jilkminggan, Barunga, Manyallaluk and Wugularr. It was an astonishing education in land, language and law. But it was a period I spent far too much time learning about death: the death of the artists I worked with, their families, and their children.

But I also learnt from whitefellas in Katherine: from the legendary Judy King and John Fletcher; from Francesca Merlan, Paul Josif, Mick Dodson and Toni Bauman, to Anne and John Shepherd and John O’Brien.

In different ways they, and many others, all taught me about living in the Territory.

In the late 1990s the CEO of the Jawoyn Association, the late Bangardi Lee, recruited me, Jawoyn woman Irene Fisher and Dr Ben Bartlett to put together a seemingly endless series of submissions that resulted—some years later—in the establishment of the Sunrise Health Service: an Aboriginal community controlled comprehensive primary health care service.

An Aboriginal community controlled comprehensive primary health care service? A bloody mouthful of a description, but nonetheless a symbol and practical evidence of what Aboriginal people and their supporters have achieved—and continue to achieve.

Across the NT, from remote clinics such as that run by the Pintupi Homelands Health Service to Danila Dilba in Darwin, the Aboriginal community controlled primary health sector serves roughly half our Aboriginal population, the rest through NT Government health services.

Over time, the process of privatising into the community controlled health sector will increase as services are devolved from government. It’s not been an easy process—and slower than many of us want. Nevertheless, it has had bipartisan support federally and locally for more than a decade. Famously, former CLP health minister Steve Dunham “rescued” the Sunrise Health Service in its early development stage when it met resistance from some health bureaucrats. His intervention saved what is now one of the NT’s great success stories.

The evidence, internationally, nationally and locally is that community controlled primary health care is more efficient and effective in delivering the goods.

According to recent data produced by COAG, the Northern Territory is the only jurisdiction in Australia on track to meet the closing the gap target of reducing the difference in life expectancy between Aboriginal and non-Aboriginal people. This is a good news story that has been barely reported in the NT outside the pages of this newspaper.

There are a number of reasons for this success. The last decade has seen a dramatic rise in hospital spending; more importantly greater resources have been distributed more equitably to the bush. The increased resources to primary health care through the Intervention, now known as Stronger Futures, has been a prime reason this has been possible.

But we are also doing it better—and in many instances better than anywhere else in the nation. For example, childhood immunisation rates in the community controlled sector is better than in many affluent suburbs down South.

And we are doing it smarter: led by the Aboriginal community controlled health sector, there has been an increased use of electronic data collection and analysis. Clinical Information Systems are used at the individual patient level to keep up-to-date, easily accessible health histories, as well as to alert clinicians to possible allergies, and efficiently prompt clinics to recall patients for regular checks as well as follow ups.

The data analysed can be tailored by individual health services, but all clinics in the NT now contribute the to Northern Territory Aboriginal Health Key Performance Indicators, which have a commonly shared set of clinical measures. Access to this data is strongly protected through privacy protocols.

The big picture of this is the capacity for these systems to allow for public health data to be analysed at a community and regional level, and for subsequent follow up. For example, a regular system of patient interaction through Child and Adult Health Checks has the capacity to identify “spikes” in particular conditions such as childhood and maternal anemia or otitis media in children.

This not only keeps an individual clinic alert to changes in local health, but also in ways to respond. This is achieved through a process called Continuous Quality Improvement [CQI], and is carried out by all clinicians at a service and the data collected is a key part of this process. For example, with otitis media it will guide individual treatment (are we always checking following the national guidelines? what evidence-based treatments are we giving? are we referring the patients to specialist diagnosis and care?), but also to the community as a whole (are we working with the council, school and families? what sort of other public health campaigns might we undertake?)

At regional level this data can be very powerful. As well as the regional Aboriginal Community Controlled Health Services we already have, such as Katherine West Health Board and the Sunrise Health Service, other regions are now working together through Clinical and Public Health Advisory Groups [CPHAGs]. The CPAHGS meet regularly and work cooperatively to share experiences and data, and ways to do things better. Some have identified particular regional health problems which would otherwise might be “lost” in large scale data bases.

The Northern Territory is the first jurisdiction in Australia in which all remote clinics now have electronic health records for their patients.

Further to this, our sector, along with government clinics, has pioneered the idea of a “shared electronic health record”. Over half the Aboriginal people in the NT have signed up to such a record, and we are in the process of readying the system so as to be part of a national network. This allows, with full permission from the patient or carer at every consultation to update their health record to a data base that can then be accessed by other clinics and hospitals. For example, a patient at Ngukurr may fall ill at another community, and get the appropriate treatment through their shared electronic health record. A hospitalisation will allow the clinicians to see someone’s record, know what medications they are on, and past conditions. After discharge from hospital, the health records are updated, and an electronic discharge summary is available to the home clinic.

These and many other innovations are behind the improved statistics—but there is a long way to go. It’s a welcome trend—but the good results will flatten out and perhaps reverse if we do not tackle the other social determinants of health. These include housing, education, early childhood development, substance abuse, food security, incarceration rates and social exclusion. It is reckoned that health services alone will only be able to deal with about 25 per cent of “the gap”: the rest is down to the other social determinants.

And that’s where governments of all stripes come in, and where the need for truly bipartisan approaches must prevail. Whatever the result of today’s election, Aboriginal health remains the Territory’s major challenge. Aboriginal children yet to be born will benefit if only our politicians are working, in the words of the AMSANT slogan, “together for our health”.

NACCHO Aboriginal health alert:All Northern Territory prisons will be totally smokefree from Monday 1 July

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Aboriginal and Torres Strait Islander people are more than twice as likely to smoke as other Australians, with those who have been incarcerated nearly four times more likely to smoke than other Indigenous people. 

Tobacco Action Workers from Aboriginal health services and the NT Department of Health have been involved in providing information and support for inmates in the lead up to 1 July

Smoke-Free1

Current NACCHO projects include:

Talking About The Smokes (TATS)

Smoke Free Project

Many thanks to Associate Professor David Thomas for this article on the implementation of a health policy first, launched in the Northern Territory today.

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All Northern Territory prisons will be totally smokefree from Monday 1 July.  No one will be able to smoke indoors or outdoors within these prisons, or on surrounding correctional centre land including carparks: neither prisoners, visitors nor staff.  Prison staff (and inmates) will now be protected from the dangers of secondhand smoke just like many other Australian workers.

The Northern Territory will be the first Australian jurisdiction to make all its prisons smoke free.  Other jurisdictions are watching and will probably follow this lead.   This will be challenging with very high smoking rates among both inmates and staff.

As always there are the skeptics who say this will not work, or more commonly that it will make other things worse.  Some staff have expressed concerns about increased tension and violence associated with nicotine withdrawal and because staff previously offered inmates a cigarette when trying to defuse tense situations.  What did they do in similar situations with non-smokers?

There are good signs that this new policy will work.  Some other correctional facilities are already smokefree.  The Don Dale Juvenile Detention Centre near the main Darwin prison has been smokefree for years, although until now staff have been able to smoke in the adjacent carpark.

The Northern Territory has also closely modelled its approach on the successful introduction of smokefree prisons in New Zealand in July 2011. An evaluation  identified three key elements in New Zealand’s success: careful and long preparation, increased access to services to help staff and inmates to quit smoking, and having a comprehensive rather than a partial smoking ban.

The comprehensive nature of the New Zealand’s policy has made it more straightforward to enforce than ‘indoor only’ smoking bans.  Some initial problems of smoking contraband tobacco or smoking nicotine patches and tea leaves have diminished.  It does appear that successful enforcement of the policy by prison staff was crucial to many other elements of the policy’s success, so close work with staff, and clear guidelines and training, will be essential in the NT.

A positive side effect of the New Zealand ban has been the dramatic reduction in arson-related prison fires, as matches and lighters are also banned, as they will be in NT prisons.

As in New Zealand, the Northern Territory Correctional Services have increased the availability of smoking cessation support services, including free Nicotine Replacement Therapy for staff and inmates since 1 January.

In the Northern Territory, more than 80% of prisoners are Aboriginal or Torres Strait Islander people.  Aboriginal and Torres Strait Islander people are more than twice as likely to smoke as other Australians, with those who have been incarcerated nearly four times more likely to smoke than other Indigenous people.  Tobacco Action Workers from Aboriginal health services and the NT Department of Health have been involved in providing information and support for inmates in the lead up to 1 July.

Smokefree prisons will protect the health of this particularly disadvantaged group of Aboriginal and Torres Strait islander Australians, but it will obviously continue to be much more important to reduce the disproportionate numbers of Aboriginal and Torres Strait Islander people in prisons.

Associate Professor David Thomas is a National Heart Foundation Fellow at the Menzies School of Health Research and the Lowitja institute in Darwin.

Kidney action group launches in Alice Springs: Family,country,compassion and hope

Kidney Mob.jpg Low Res

Download press release,speeches and letters of support

Speakers Left to right: John Paterson (CEO AMSANT), Donna Ah Chee (CEO Central Australian Aboriginal Congress), Preston Thomas (Deputy Chair of Ngaanyatjarra Health / Director of Western Desert Dialysis), Sarah Brown (CEO Western Desert Dialysis), Andrea Mason (Coordinator, NPY Women’s Council)

FamilyCountry.   CompassionHope.

KAN Launch_NPY ladies

 These words, written onto a sea of purple balloons, were a poignant symbol of unity for almost 100 people who gathered in Alice Springs today to launch the Kidney Action Network.

 Those gathered yesterday – World Kidney Day – included representatives from Aboriginal health organisations, NGOs, health workers and renal patients and their families, many of whom have had to relocate into town to access the dialysis services they rely on to survive.

 John Paterson, CEO of Aboriginal Medical Services Alliance NT (AMSANT) said in his address that kidney disease affects Aboriginal people in the Northern Territory at greater rates than anywhere in Australia.

 “Its impact is felt most acutely in our remote communities, where the social and cultural structures and everyday wellbeing of our communities depends on the presence of our old people. We need them to be present as long as possible.”

 Mr Paterson called on the SA, WA and NT governments to work together with the Commonwealth and the community sector to “engage in proper planning and provide the extra services and infrastructure that are essential for a fair deal for remote area kidney patients.”

 “The Kidney Action Network has been established to put life at the front and centre of health policy here in the NT.”

 Bobby West, Chair of Western Desert Dialysis, also called on governments to work together on solutions for renal patients in the NT.

 “Instead of fighting each other, governments should be working together,” Mr West commented. “We just want to live longer.”

 Messages of support from Dr Mandawuy Yunupingu and Mick Gooda, Aboriginal and Torres Strait Islander Social Justice Commissioner were read out.

 Most touching were the words spoken by renal patients themselves:

 “Every day I’m in two places. I’m here [in Alice Springs] for my family who are on renal but I’m also back home where my country and my family are. Families are worried for families. Governments should build something out on the lands so that everybody can be safe and healthy.”  Margaret Smith from Imanpa, NT

 “We are worrying for our families back home when we here [in Alice Springs] for renal. We cry because we lost our family here. We need something to help people to go back home and sit down with family. We been talking about this one for long time and we still talking. We are crying for our family. Lot of Aboriginal people they all got renal.” Janet Inyika from Amata, APY Lands, SA

 Also speaking at the launch was Donna Ah Chee, CEO of Central Australian Aboriginal Congress; Sarah Brown, CEO of Western Desert Dialysis; Andrea Mason, Coordinator of NPY Women’s Council; Preston Thomas, Deputy Chair of Ngaanyatjarra Health / Director of Western Desert Dialysis.

 The importance of tri-state planning – between Northern Territory, South Australia and Western Australia – was emphasized as one of the critical issue for the Network to lobby state and territory governments.

 Preston Thomas, in his address, summed it up very well:

 “Expecting people to seek renal treatment thousands of kilometres from home is not Closing the Gap.”

For more information, please contact:

Sarah Brown, CEO Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation
Mobile:  0488 685 610

Kidney Action Network Member Organisations

  • Aboriginal Medical Services Alliance Northern Territory (AMSANT)
  • Central Australian Aboriginal Congress Aboriginal Corporation
  • NPY Women’s Council
  • Ngaanyatjarra Health
  • Miwatj
  • Waltja
  • WDNWPT (Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation – Western Desert Dialysis)
  • Central Land Council
  • Red Cross
  • Papunya Tula Artists
  • Uniting Communities
  • Poche Centre for Indigenous Health
  • Business Council of Australia
  • Baker IDI
  • Desert Knowledge Australia