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An Aboriginal health leader’s take on the budget

Selwyn Button, Chief Executive Officer of the Queensland Aboriginal & Islander Health Council (QAIHC), writes:

If the Federal Government is wanting to continue demonstrating its commitment towards closing the life expectancy gap for Aboriginal and Torres Strait Islander people across the country, then firstly we must ensure that any new budget announcements to support this work are highlighted in parliament and not just placed on the Treasury website for those interested in budget detail to find out for themselves.

As already pointed out by the Greens and Independent MPs, through the Treasurers speech last night there was no mention of Indigenous people at all, or ways and means of supporting their needs through this new budget cycle.

The announced commitment towards Mental Health expenditure over the next 3 years is welcomed across all layers of the health sector, although how these initiatives are rolled out will determine its true value over time.

It is well documented that the mental health needs of Aboriginal and Torres Strait Islander people require a response that supports community based interventions and includes the family and broader community to determine those needs.

Whilst some of the new announcements do support this approach, there is still limited research and evidence to suggest that the current best practice models developed in mainstream environments are working well for those who suffer the highest suicide rates in the country.

Evidence still suggests that the community controlled family centered-approach to delivering comprehensive primary health care is the ideal model to support the greatest improvement in health outcomes for Aboriginal and Torres Strait Islander people, although we need to ensure that any new measures are also supporting this modeling.

One aspect of the budget announcements that may impact upon this is the reduction in Medicare rebates for GPs developing mental health care plans, which in a community controlled environment where we are attempting to provide a holistic service for our clients, now presents a new challenge, as this may force clients whom we have built faith and trust in to access our service in the first instance, which is very difficult for mental health clients, now potentially having to go elsewhere for the care that they would be much more comfortable in accessing through a community controlled family based centre, who not only understand their needs, but also a aware of their family and social circumstances.

Additionally, we need to ensure that we have a dedicated and suitably qualified workforce to address these ever-growing needs within Indigenous communities, and they are well supported in their workplaces through appropriate peer support modeling, professional support and networking opportunities to ensure they are able to provide the best support possible for this group of deserved clients.

In support of this measure we need to look more globally at some of the solutions being provided through broader workforce initiatives in the latest budget to ensure the health sector can capitalize on things like school based traineeships, improved training opportunities for unemployed and building the Indigenous workforce capacity to respond to this growing health need.

QAIHC already supports SEWB, drug and alcohol, mental health and Link-up counsellors across Queensland which equates to a workforce of around 200 staff, and we need to continue investing in supporting and building upon this workforce as the growing need increases and we continue to recover from recent disasters across Qld.

The commitment towards health infrastructure in regional areas is a welcome investment, particularly supporting community controlled health services, where many of our services have outgrown their current space due to increased clients demands and population rises, without any new investments to support this for some time.

A good example of this has been the recent GP Superclinic initiative that was fundamentally modeled on community controlled models of service delivery, where you could access all required care for clients in a single location or service, although very little of this new investment went to support building on the good practice that was happening in community controlled services.

Improved access to dental services also gets a mention in the latest budget initiatives, which is supported in the community controlled environment, although we need to ensure that this is not done in isolation of any existing initiatives, particularly given the current focus on chronic disease management and direct connection between management of diseases like diabetes, heart disease, kidney and renal disease and appropriate dental care.  The provision of greater access to dental chairs in rural and remote areas is also required to support better chronic care management.

Certainly the most significant investment that we welcome from the budget is the continued support for quality and accreditation programs for community controlled health services.

As stated for some time now, community controlled models of care are well documented as the best service delivery model to support improved health outcomes for Aboriginal and Torres Strait Islander people, and through investing in quality improvement processes that benchmark our services and the care provided against international standards, continues to build credibility in the community controlled model of care.

Although we need to ensure that much of the new investment is able to get to where it is most needed and that is in the community controlled services themselves, and not caught up in wasted expenditure to create a bureaucracy that oversights this initiatives and limits the amount of resources getting to services.

Fundamentally, there are many new and continuing initiatives in the budget that have the ability to support closing the gap for Aboriginal and Torres Strait Islander people over the coming years, although as we commence the planning process now to unpack how these new initiatives are being rolled out will be the telling factor for government to determine their effectiveness and how well supported they are in communities.

What is required now is some collaborative partnerships between state, territory and federal governments with community controlled representation to determine the most effective planning and implementation process to support the new investment.

All levels of governments have expressed interest for continuing commitment towards closing the gap, although unfortunately continue to provide the same tailor made bureaucratic approach to addressing this, without the support and inclusion of experienced and willing community representatives working alongside them to ensure that community voices are heard and considered throughout the planning, implementation and monitoring processes.

We have a new opportunity for this to occur now with new investment, and whilst we are still in a tight fiscal environment to address the government deficit, let’s work together to spend resources wisely to ensure we can create successful outcomes in the future that build upon the solid foundations and expertise existing in community controlled health services.

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Australian Palliative Care Conference
2018 conferences
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