A long-awaited report into the troubles facing Aboriginal people who require dialysis in Central Australia – at least some of which are a result of the enduring dysfunctional health divide between territory/state and federal governments – was recently released.
The inquiry followed concerns about the lack of culturally appropriate services, and some heart-wrenching examples of people having to travel far from home under often distressing conditions, or choosing to not have life-prolonging treatment to avoid such travel.
The Federal Government responded to the report with an announcement that Alice Springs and Tennant Creek will receive $13 million for accommodation to assist Aboriginal and Torres Strait Islander families affected by renal disease.
So it looks as if progress is being made? Not according to Greens Senator Rachel Siewert, who says the report is a watered down version of what was initially recommended by the researchers.
Saving money but costing Aboriginal health?
Senator Rachel Siewert writes:
Poor kidney health is a huge problem for Aboriginal people in central Australia with an alarming growth in the need for dialysis both now and in the future. While I welcome the much delayed release of the Central Australia Renal Study report, I think it raises many questions about the Federal Government’s role in the development of the report and more importantly the role of the Federal Government in kidney health.
The draft copy of the report I have is substantially different from the final version and I have grave concerns about a series of dramatic changes, removing the majority of recommendations and significantly reducing the potential resource implications for the Federal Government.
The changes are so marked that I have cause to question what exactly happened over the six months between the draft and the final version being released.
A logical line to draw is that a seemingly independent report has been changed to allow the Federal Government financial breathing room at the expense of Indigenous health outcomes.
The draft version of this report recommends immediate action with measurable outcomes. It would require leadership and investment from the Federal Government.
Rather than being the cornerstone of future action, this report falls short, almost providing the Federal Government with an opportunity to step back from funding dialysis.
The Study was originally commissioned as a response to the growing demand for dialysis services in Central Australia, the strain on health services, the alarming health outcomes faced by Aboriginal people and the constant conflict between the States, Territory and the Federal Government over funding responsibilities.
The draft report contained two action plans for the periods 2011-2012 and 2013-2015, based on 76 separate recommendations which the final version makes no mention of. In their place is a drastically reduced ‘Potential Implementation Scenario’, outlining a vague series of measures which places substantially less obligations on the Federal Government, and if implemented, would begin mid 2012.
The 2011-12 action plan in the draft was based on 38 of the study’s recommendations, the majority of which would require the commitment of additional resources. In essence, they would cost the Federal Government money.
Shockingly, all the recommended actions for 2011 seem to have gone. After the pruning, we have been left with a report that discusses key issues without linking them to specific recommendations. The recommendations that remain are broad, hard to define and even harder to apply.
The draft report – from January 2011 – includes the following recommendation (number 26):
Based on identification of particular sites that might be suitable for conversion to in-community dialysis facilities, during 2011 the following sites/facilities should be assessed for suitability for in-community haemodialysis:
– The purpose-built Substance Misuse Centre in Amata; and
– The Ngaanyatjarra Health Service renal ready room in Warburton.
A comparable statement appears in the final report – but is no longer a formal recommendation:
The following sites should be assessed for conversion to facilities for maintenance dialysis: the purpose‐built substance misuse centre in Amata and the Ngaanyatjarra Health Service renal ready room in Warburton.
This conveniently lets the South Australian Health Minister off the hook in terms of taking any immediate action.
The Federal Government leadership and resourcing role on this issue is essential, this is what the Federal Government did for the rollout of Opal fuel, proving the effectiveness of well developed, resourced and implemented policies.
The effective roll-out of Opal fuel across the tri-state cental Australian region only worked because of Federal leadership and funding.
This is what is needed now from the Federal Government.
But instead the Renal Study Report was drafted with enough ambiguity to allow the Government to keep the issue at arm’s length and its seems we haven’t made much progress in resolving the conflicts between the State, Territory and Federal Government on the provision of dialysis services in Central Australia.
And this from a Federal Government that is supposedly committed to closing the gap.
PS: Croakey will seek further comment from the relevant parties…