NACCHO Aboriginal Health and #SuicidePrevention News Alerts : #Closethegap : #NACCHO and @TheRACP Peak Health bodies call for Prime Minister and state and territory leaders to declare Aboriginal youth #suicide crisis an urgent national health priority

The recent Aboriginal youth suicides represent a national emergency that demands immediate attention.

Aboriginal community controlled health services need to be properly resourced to ensure our children are having regular health checks and to develop community led solutions.’

NACCHO CEO, Ms Patricia Turner : See NACCHO RACP press release : see Part 1 below

See all 130 + NACCHO Aboriginal Health and Suicide Prevention articles published over last 7 years 

“Funded programs are not required to demonstrate a measurable reduction in suicide and mental health risk factors, which is staggering,

We just aren’t demanding that basic level of accountability

The first priority must be analyses of suicide mortality data to identify the causal pathways,  

Suicide risk is the most complex thing to assess and monitor … communities are crying out for specialist assistance and just not getting it. “Children as young as 10 are dying by suicide … this is no longer an Aboriginal issue, it’s a national one,

Indigenous psychologist Adjunct Professor Tracy Westerman said Australia had failed to collect crucial evidence to determine what intervention strategies work. See Part 2 below 

 ” Community driven action plans to prevent suicide are extending across the Kimberley, with four more communities implementing plans to save lives and improve health and well-being.

As part of the Kimberley Aboriginal Suicide Prevention Trial, Kununurra, Balgo, Wyndham and Halls Creek now have local plans, joining Broome, Derby and Bidyadanga.

Each community receives up to $130,000 to help roll out its action plan which reflects and responds to local issues

See Minister Ken Wyatt Press Release and Communique Part 3 and 4 Below

Part 1 RACP and NACCHO Press Release

JOINT STATEMENT

HEALTH BODIES DECLARE ABORIGINAL YOUTH SUICIDE AN URGENT NATIONAL PRIORITY

  • Health bodies call for Prime Minister and state and territory leaders to declare urgent national health priority
  • Immediate investment in Aboriginal-led mental health and wellbeing services needed to stop child deaths
  • Long-term solution of Aboriginal and Torres Strait Islander self-determination requires commitment to Uluru Statement from the Heart

The Royal Australasian College of Physicians (RACP), the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the National Aboriginal Community Controlled Health Organisation (NACCHO) are calling on the Prime Minister to make tackling Aboriginal and Torres Strait Islander youth suicides a national health priority.

Suicide was once unknown to Aboriginal and Torres Strait Islander peoples but now every community has been affected by suicide.

In response to the recent Aboriginal youth suicides and the release of the WA Coroner’s report on the inquest into the deaths of thirteen children and young persons in the Kimberley Region, we are calling on the Prime Minister and state and territory leaders to put the issue at the top of the COAG agenda and to implement a coordinated crisis response to urgently scale up Aboriginal led mental health services before more young lives are tragically lost.

An urgent boost to Aboriginal community controlled health services is required to build on the existing range of initiatives that are being rolled out. We also call on the Government to expand upon evidence-based resilience and cultural connection programs to be adapted and attuned to local needs.

We are calling on the Federal Government to:

  • Provide secure and long-term funding to Aboriginal community controlled health services to expand their mental health, social and emotional wellbeing, suicide prevention, and alcohol and other drugs services, using best-practice traumainformed approaches
  • Increase funding for ACCHSs to employ staff to deliver mental health and social and emotional wellbeing services, including psychologists, psychiatrists, speech pathologists, mental health workers and other professionals and workers;
  • Increase the delivery of training to Aboriginal health practitioners to establish and/or consolidate skills development in mental health care and support, including suicide prevention
  • Commit to developing a comprehensive strategy to build resilience and facilitate healing from intergenerational trauma, designed and delivered in collaboration with Aboriginal and Torres Strait Islander communities

RACP spokesperson Dr Mick Creati, said: “The unspeakable child suicide tragedy that has been unfolding requires a national response and the attention of the Prime Minister. Unless we see urgent boost to investment in Aboriginal-led mental health services then the deaths will continue.”

RANZCP President Dr Kym Jenkins, said: ‘We must address the factors underlying suicidality in Aboriginal and Torres Strait Islander communities, including intergenerational trauma, disadvantage and distress. For this, we urgently need an increased capacity of mental health and wellbeing services to help people and communities recover from trauma and build resilience for the future.’

Part 2 Leaders urged to declare Aboriginal child suicides a ‘national crisis’

 Kate Aubusson From the Brisbane Times 20 March 

Prime Minister Scott Morrison must declare Indigenous child suicides a national emergency and overhaul current strategies, peak medical and health bodies have demanded.

The call comes in the wake of harrowing Aboriginal and Torres Strait Islander child suicide rates, and the WA coroner’s inquest into the deaths of 13 young people, five aged between 10 and 13 years in the Kimberley region.

A joint statement from the Royal Australasian College of Physicians (RACP), the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the National Aboriginal Community Controlled Health Organisation (NACCHO) has urged Mr Morrison and all state and territory leaders to make Indigenous youth suicides an “urgent national health priority”.

The organisations called on the leaders to launch a “coordinated crisis response” and invest in Aboriginal-led strategies “before more young lives are tragically lost”.

In January, five Aboriginal girls aged between 12 and 15 years took their own lives.

The latest ABS data shows Indigenous children aged 10 to 14 die of suicide at 8.4 times the rate of non-Indigenous children. One in four aged under 18 who suicided were Aboriginal.

None of the 13 children who died by suicide had a mental health assessment, according to the coroner’s report.

The international journal The Lancet Child and Adolescent Health recently called Australia’s Indigenous youth suicide rate an “unmitigated crisis”.

NACCHO CEO Pat Turner said the recent Aboriginal youth suicides was “a national emergency that demands immediate attention”.

The joint statement called for Indigenous community-led solutions, long-term funding boosts to Aboriginal Community Controlled Health Services (ACCHS) for best-practice and trauma-informed mental health, suicide prevention, and drug and alcohol programs.

The organisations also pushed for more ACCHS funding to employ more psychologists, psychiatrists, speech pathologists and mental health workers, increase training for Aboriginal health practitioners to develop a comprehensive strategy focused on resilience and intergenerational trauma healing.

In September the Morrison government announced $36 million in national suicide prevention projects.

Paediatrician with Victorian Aboriginal Health Service Dr Mick Creati said Indigenous suicides could not be prevented by a “white bread psychiatry model”.

Aboriginal suicides were often radically different from those among the general population, research shows. They were more likely to be impulsive, potentially triggered by some kind of interpersonal conflict.

The crisis demanded a “different, culturally appropriate model”, Dr Creati said.

“We don’t know exactly what the right model is yet … but Aboriginal people need to be included [in their development] to make sure they are appropriate for Aboriginal populations.”

But Indigenous psychologist Adjunct Professor Tracy Westerman said Australia had failed to collect crucial evidence to determine what intervention strategies work.

“Funded programs are not required to demonstrate a measurable reduction in suicide and mental health risk factors, which is staggering,” Professor Westerman said.

“We just aren’t demanding that basic level of accountability”.

The first priority must be analyses of suicide mortality data to identify the causal pathways,  Professor Westerman said.

“Suicide risk is the most complex thing to assess and monitor … communities are crying out for specialist assistance and just not getting it. “Children as young as 10 are dying by suicide … this is no longer an Aboriginal issue, it’s a national one,” she said.

Part 3 The eighth meeting of the Kimberley Suicide Prevention Trial Working Group was held on 14 March in Broome communique

The Working Group discussed the findings of WA Coroner’s Report into suicide deaths in the Kimberley and continued its consideration of resources and strategies to support activity as part of the suicide Prevention trial.

The meeting today was chaired by the Hon Ken Wyatt, Minister for Indigenous Health (Commonwealth) and attended by the Hon Roger Cook, Deputy Premier and Minister for Health (WA State Government), Senator the Hon Patrick Dodson (Commonwealth) and Member for the Kimberley, the Hon Josie Farrer MLC (WA State Government). Apologies were received from the Hon Ben Wyatt, Minister for Indigenous Affairs (WA State Government).

The meeting was also attended by over 40 representatives from communities, organisations and government agencies.

Key messages from today’s discussion included:

  • A shared commitment to work together at all levels of government to develop place-based, and Aboriginal-led and designed responses.
  • A commitment to ongoing collaboration.
  • Acknowledgement of the good work achieved thus far – but noting more needs to be done.
  • The role of the community liaison officers on the ground across Kimberley communities was highlighted as an example of good progress – connecting services and projects with what people want.
  • The need to continue mapping services was agreed.
  • The need for holistic approaches was highlighted.
  • Community organisations are keen to work with the State and Commonwealth Governments on solutions that address the recommendations in relation to the report of the WA Coronial Inquest and all other referenced reports.

Part 4 Minister Wyatt Press release

Community driven action plans to prevent suicide are extending across the Kimberley, with four more communities implementing plans to save lives and improve health and well-being.

As part of the Kimberley Aboriginal Suicide Prevention Trial, Kununurra, Balgo, Wyndham and Halls Creek now have local plans, joining Broome, Derby and Bidyadanga.

Each community receives up to $130,000 to help roll out its action plan which reflects and responds to local issues.

However, the four new plans have a common thread – they are centred on people working and walking together on country, with a series of camps involving high-risk groups.

The camps are planned to provide a range of supports around suicide including healing and sharing and respecting cultural knowledge and traditions. They will also support close engagement with Elders.

A strong cultural framework underpins all the Trial’s activities and all the projects identified by the communities fit within the systems-based approach, guided by the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP).

Nine communities are involved in the Kimberley Aboriginal Suicide Prevention Trial, with Community Liaison Officers playing a critical role.

The outcomes will contribute to a national evaluation which aims to find the most effective approaches to suicide prevention for at-risk populations and share this knowledge across Australia.

The Morrison Government is supporting the Kimberley Aboriginal Suicide Prevention Trial with $4 million over four years, from 2016-2020.

It is one of 12 Suicide Prevention Trials being conducted across the nation, with total funding of $48 million.

NACCHO Aboriginal Health and #Sexual Health @TheRACP 2018-19 Pre-#budget submission : Long-term funding needed to improve #Indigenous health

“Doctors are seeing high rates of mortality in Aboriginal and Torres Strait Islander people and this is largely attributable to chronic disease,

The Federal Government must provide long-term funding certainty for the Medical Outreach Indigenous Chronic Disease Program, which is focused on preventing, detecting and managing chronic disease for Aboriginal and Torres Strait Islander people.”

RACP President Dr Catherine Yelland

Download the full submission here or read Aboriginal health extracts below

racp-2018-19-pre-budget-submission

Historical background RACP Associate Professor Noel Hayman

 “I’ve been working in the field of Indigenous health for 20 years now. The major changes, trends that I’ve seen over the years, has been improvements in infant mortality. But the one that contrasts that is the worsening mortality in middle age—we see high rates of mortality in Aboriginal people in their 40s and 50s. And this is due to chronic disease, particularly diabetes, ischaemic heart disease and chronic kidney disease.

And this accounts for about 70% of Indigenous mortality. But it’s not all gloom and doom. I think if we all work strongly together, I do believe we can improve Aboriginal and Torres Strait Islander health significantly. For example, what we’ve been able to do is we’ve actually got Aboriginal people to attend primary care. But more importantly now, my aim is to integrate specialist care.

So now we have a visiting endocrinologist, we’ve got a paediatrician, we’ve got a cardiologist, we’ve got a registrar from rehabilitation medicine, we’ve got an ophthalmologist. So private physicians and also hospital-based physicians, and the ones that are hospital-based, they come out here. The cardiologist, for example he does two sessions a month. He does his echocardiograms here and also exercise stress tests.

To me, integrating specialist care into a centre of excellence is to me is a “one stop shop” and Aboriginal people are more likely to attend. And we’ve actually shown that. And we’ve got better outcomes and we’ve got data on that through continuous quality improvement.”

Associate Professor Noel Hayman, Clinical Director of the Inala Indigenous Health Service in Brisbane.

He was the first Aboriginal GP in Queensland, and the first Aboriginal and Torres Strait Islander person to become a Fellow of the Australasian Faculty of Public Health Medicine at the RACP.

From Interview June 2016 Listen HERE

RACP Press Release

Doctors are calling for the Federal Government to provide long-term funding to programs that prevent, detect and manage chronic disease for Aboriginal and Torres Strait Islander people.
As detailed in the Royal Australasian College of Physicians’ pre-budget submission, these programs could help ensure better health outcomes and close the gap between Aboriginal and Torres Strait Islander health outcomes and those of the non-Indigenous community.

The RACP recommends that the Australian government :

Aboriginal and Torres Strait Islander Health

Allocate secure long-term funding to progress the strategies and actions identified in the National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) Implementation Plan.

• Provide secure, long-term funding for the Rural Health Outreach Fund (RHOF) and Medical Outreach Indigenous Chronic Disease Program (MOICDP).

• Build and support the capacity of Aboriginal and Torres Strait Islander health leaders by committing secure long-term funding to the Indigenous National Health Leadership Forum.

Reinstate funding for a clearinghouse modelled on the previous Closing the Gap clearinghouse, in line with the recommendations of the Fifth National Mental Health and Suicide Prevention Plan. Allocate sufficient funding for the implementation of the Fifth National Aboriginal and Torres Strait Islander Blood-Borne Viruses (BBV) and Sexually Transmissible Infections (STI) Strategy.

• Fund the syphilis outbreak short-term action plan and coordinate this response with long term strategies.

• Allocate long-term funding for primary health care and community- led sexual health programs to embed STI/BBV services as core primary health care (PHC) activity, and to ensure timely and culturally supported access to specialist care when needed, to achieve low rates of STIs and good sexual health care for all Australians.

• Invest in and support a long-term multi-disciplinary sexual health workforce and integrate with PHC to build longstanding trust with communities.

• Allocate funding for STI and HIV point of care testing (POCT) devices, the development of guidelines for POCT devices and Medicare funding for the use of POCT devices.

Extract from Pre budget submission

Aboriginal and Torres Strait Islander Health

Aboriginal and Torres Strait Islander people continue to experience poorer health outcomes than non-Indigenous Australians.

The latest ‘Closing the Gap’ report found that Australia is not on track to close the life expectancy gap by 2031 – with the gap remaining close to ten years for both men and women.

The gap for deaths from cancer between Aboriginal and Torres Strait Islander and non-Indigenous Australians has in fact widened in recent years, with Aboriginal and Torres Strait Islander cancer death rates increasing by 21 percent between 1998 and 2015, while there was a 13 per cent decline for non-Indigenous Australians in the same period8.

To address these inequities and improve access to care, continuing and strengthened focus and appropriate long-term funding is required. It is imperative that there is secure funding for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (NATSIHP) Implementation Plan.

Funding uncertainty and frequent changes create significant issues that impact the continuity of services to patients and organisations in their ability to retain and build their capacity.

Press release continued

The RACP strongly supports existing programs that improve access to specialist care, including the Rural Health Outreach Fund (RHOF) and Medical Outreach Indigenous Chronic Disease Program (MOICDP). The RACP recommends that the Australian Government continue its investment in these programs, undertaking evaluation to ensure the programs are targeted at the most appropriate issues and achieving positive health outcomes for Aboriginal and Torres Strait Islander peoples.

Aboriginal and Torres Strait Islander health leadership and authentic community engagement is crucial to achieving improved health outcomes. The Aboriginal Community Controlled Health sector is of vital importance in delivering effective, culturally safe care to Australia’s First Peoples; and service development and provision should be led by Aboriginal and Torres Strait Islander health organisations where ever possible. The sector must have long-term, sufficient and secure funding to both retain and grow their capacity.

Given the recent focus by the Australian government on improving mental health and reducing suicide rates in Aboriginal and Torres Strait Islander communities, The RACP supports the analysis, reporting and implementation of evidence-based solutions, with input from and led by these communities, to improve the quality and delivery of mental health promotion and suicide prevention services. The RACP recommends the establishment of clearinghouses which enable effective access to relevant, high quality information and resources to support these efforts.

Sexual Health

There continue to be ongoing outbreaks of infectious syphilis across Australia affecting Aboriginal and Torres Strait Islander people, which has occurred in the context of increasing rates of other Sexually Transmitted Infections (STIs) and some Blood Borne Viruses (BBVs) in some Aboriginal and Torres Strait Islander communities. STIs are endemic in some regions; an unprecedented syphilis epidemic in Queensland began in 2011 and extended to the Northern Territory, Western Australia and South Australia.

Since 2011 there have been six fatalities in Northern Australia from congenital syphilis, and a further three babies are living with serious birth defects in the Northern Territory. In addition, there has been one reported case of congenital syphilis so far in 2017 in South Australia. Despite the existence of a number of Federal and state-level sexual health strategies, the situation remains dire.

Appropriate funding needs to be allocated to the implementation of the Fifth National Aboriginal and Torres Strait Islander Blood-Borne Viruses and Sexually Transmissible Infections Strategy

A Healthy Future for all Australians: RACP Pre-Budget Submission 2018-19 13

and sexual health services; particularly to ensure sufficient capacity for the delivery of core STI/BBV services within models of care that provide comprehensive primary health care services (particularly Aboriginal and Torres Strait Islander community controlled health services). People should have access to specialist care when needed, through integration with comprehensive primary health care services to ensure sustainable and culturally appropriate service provision.

We welcome the plans to activate a short-term response across the state and territories on the continuing syphilis outbreaks, coordinated by the Federal Department of Health. However, whilst this Action Plan and short-term funding is urgently needed; the short-term activities need to be coordinated with and contribute to longer-term strategies and investments.

 

 

 

NACCHO Aboriginal Health and @TheRACP #Budget2017 submission : Healthy people, Healthy Lives

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” Aboriginal and Torres Strait Islander health leadership and authentic community engagement is crucial to achieving improved health outcomes.

The Aboriginal Community Controlled Health sector is of vital importance in delivering effective, culturally appropriate care to Australia’s First Peoples; and service development and provision should be led by Aboriginal and Torres Strait Islander health organisations where possible.

The sector must have long-term and secure funding to both retain and grow their capacity.”

Extract from  The Royal Australasian College of Physicians (RACP)  pre-budget submission for 2017-2018, Healthy people, Healthy Lives, which outlines key health funding recommendations for the Australian Government.

First Aboriginal eye doctor Kris Rallah-Baker working at Sunrise health clinic at Mataranka in the Northern Territory. Photo: Michael Amendolia

Download the full submission here :

healthy-people-healthy-lives-racp-pre-budget-submission-2017-18

The submission addresses various topics including child and adolescent health, Aboriginal and Torres Strait Islander health, preventive health, climate change and health, as well as health system reform.

The submission makes a range of recommendations including:

  •  increased investment in early childhood development to give all Australians the best, healthiest start in life
  •  concerted efforts to close the gap in health outcomes between Aboriginal and Torres Strait Islander people and non-Indigenous Australians
  •  strong preventive health measures which will reduce preventable illness and disease, focusing in particular on reducing the harms of alcohol and increasing the availability of alcohol treatment services to those who need them
  •  funding for a national campaign to encourage conversations about end-of-life care preferences, and the development of flexible models of care that enable people to receive palliative care at home.

Aboriginal and Torres Strait Islander Health :

Healthy People, Healthy Lives:

RACP Pre-Budget Submission 2017-18

Aboriginal and Torres Strait Islander people continue to experience poorer health outcomes than non-Indigenous Australians. The latest ‘Closing the Gap’ report found that Australia is not currently on track to close the life expectancy gap by 2031 – with the gap remaining close to ten years for both men and women.

To address the inequity that exists between Aboriginal and Torres Strait Islander people and non-Indigenous Australians and improve access to care, continuing focus and appropriate funding is required.

The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (NATSIHP) Implementation Plan in 2015 has not been supported with sufficient, secure funding and resources, which is risking its success.

Funding uncertainty and changes creates significant issues for the continuity of services to patients and for organisations in retaining and building their capacity.

The RACP strongly supports existing programs to improve equitable access to specialist care, including the Rural Health Outreach Fund (RHOF) and Medical Outreach Indigenous Chronic Disease Program (MOICDP). The RACP recommends that the Australian Government continue its investment in these programs, undertaking evaluation to ensure the funding models are achieving positive health outcomes for Aboriginal and Torres Strait Islander peoples.

Given the recent focus by the Australian government on improving mental health and reducing suicide rates in Aboriginal and Torres Strait Islander communities, the RACP supports the analysis, reporting and implementation of evidence-based solutions, with input from and led by these communities, to improve the quality and delivery of mental health promotion and suicide prevention services. The RACP supports the establishment of clearinghouses which enable effective access to relevant, high quality information and resources to support these efforts.

The RACP recommends that the Australian government:

  • Allocate secure long-term funding to progress the strategies and actions identified in the NATSIHP Implementation Plan.
  • Provide secure, long-term funding for the Rural Health Outreach Fund (RHOF) and Medical Outreach Indigenous Chronic Disease Program (MOICDP).
  • Allocate sufficient and secure long-term funding to the Aboriginal Community Controlled Health Sector to support the sector’s continued provision of Indigenous-led, culturally sensitive healthcare.
  • Build and support the capacity of Indigenous health leaders by committing secure long-term funding to the Indigenous National Health Leadership Forum.
  • Reinstate funding for a clearinghouse modelled on the previous Closing the Gap clearinghouse, as recommended in the latest draft of the Fifth National Mental Health Plan.

Healthy People, Healthy Lives:

RACP Pre-Budget Submission 2017-18

Preventive Health

A clear, appropriately funded, nationally-coordinated strategy for preventive health must be prioritised in the Federal Budget.

Preventive health measures can have a powerful impact on the overall health of a population, particularly as the number of Australians living with chronic conditions continues to grow. Chronic illnesses such as heart disease, stroke, kidney disease, cancer, and type II diabetes account for 85 per cent of the burden of disease in Australia.

Investing in reducing the harms of alcohol

As a causal factor in more than 200 disease and injury conditions, it is clear that alcohol is a major risk factor for chronic disease, and efforts to reduce alcohol consumption must be central to preventive health measures. Alcohol-related harms create enormous social and economic costs to Australian society, with estimates putting the annual costs of alcohol misuse at between $15 billion and $36 billion.

 The RACP calls on the Australian government to increase funding for alcohol treatment and prevention services, with specific funding allocated towards making these services available outside major metropolitan centres and to groups at greatest risk, including young people, risky drinkers and Aboriginal and Torres Strait Islander people.

The RACP has long considered the WET and rebate to be particularly dangerous as they encourage the production and consumption of cheap wine, whose low price makes its attractive to underage and problem drinkers. The RACP is very disappointed that the Australian Government has watered down its proposed tightening of the WET rebate announced in the 2016-17 Federal Budget. The RACP considers this a backward step in efforts to reduce the harms of alcohol.

The RACP recommends that the Australian government:

Develop a national preventive health strategy to address and lower risk factors for preventable illnesses and diseases.

• Increase funding for alcohol treatment including workforce development to address unmet demand for treatment.

• Increase funding for prevention services in order to reduce the incidence of alcohol use disorders.

• Reform alcohol taxation to introduce a volumetric taxation system for all alcohol products and abolish the Wine Equalisation Tax (WET) and rebate.

• Allocate a proportion of the increased revenue raised from volumetric taxation to funding alcohol treatment and prevention services.

Press Release

RACP President Dr Catherine Yelland said that the Australian Government must commit sustained funding to ensure the Australian healthcare system is able to support the health needs of all Australians.

“We need a health system that gives all Australians the best chance of living long and healthy lives; offering high quality, patient-centred care underpinned by clinical best practice.

“We need a system that is innovative, with a focus on integrated care and preventive health so that unnecessary health costs and avoidable illnesses are minimised.

“RACP members provide specialist medical care to Australians at every stage of their lives and their recommendations to the Government on healthcare policy are summarised in this submission. We hope the Australian Government is listening closely,” said Dr Yelland.

About The Royal Australasian College of Physicians (RACP):

The RACP trains, educates and advocates on behalf of more than 15,000 physicians and 7,500 trainee physicians across Australia and New Zealand.

The College represents a broad range of medical specialties including general medicine, paediatrics and child health, cardiology, respiratory medicine, neurology, oncology, public health medicine, occupational and environmental medicine, palliative medicine, sexual health medicine, rehabilitation medicine, geriatric medicine and addiction medicine. Beyond the drive for medical excellence, the

RACP is committed to developing health and social policies which bring vital improvements to the wellbeing of patients.

The College offers 60 training pathways. These lead to the award of one of seven qualifications that align with 45 specialist titles recognised by the Medical Board of Australia or allow for registration in nine vocational scopes with the Medical Council of New Zealand.