Continuing Croakey’s series of pre-Budget articles, today’s post highlights some of the key Budget recommendations on Indigenous health from the health and community sectors.
See here for previous 2019/20 Budget articles on Prevention, Oral Health, Rural Health, and Climate Change.
National Association of Community Controlled Health Organisations
Key points from NACCHO’s Pre-Budget Submission
NACCHO has long recognised that closing the gap on Aboriginal and Torres Strait Islander health and disadvantage will never be achieved until primary health care services’ infrastructure hardware is fit for purpose; our people are living in safe and secure housing; culturally safe and trusted early intervention services are available for our children and their families; and our psychological, social, emotional and spiritual needs are acknowledged and supported.
NACCHO is committed to working with the Australian Government to further develop the proposals, including associated costings and implementation plans and identifying where current expenditure could be more appropriately targeted. If the following proposals are adopted, fully funded and implemented, they provide a pathway forward where improvements in life expectancy can be confidently predicted.
Recommendations
The following policy proposals are informed by NACCHO’s consultations with its Affiliates and Aboriginal Community Controlled Health Services:
- Increase base funding of Aboriginal Community Controlled Health Services;
- Increase funding for capital works and infrastructure;
- Improve Aboriginal and Torres Strait Islander housing and community infrastructure;
- Reduce the overrepresentation of Aboriginal and Torres Strait Islander children and young people in out-of-home care and detention; and
- Strengthen the Mental Health and Social and Emotional Wellbeing of Aboriginal and Torres Strait Islander peoples.
Early Childhood Australia
Key points from Early Childhood Australia’s Pre-Budget Submission
While so many Aboriginal and Torres Strait Islander children are thriving, the evidence indicates that they are twice as likely as non-Indigenous children to start school developmentally vulnerable in one or more of the domains reviewed in the Australian Early Development Census (AEDC). Irrespective of rising preschool enrolment levels for four year olds, policy makers must be focussed on measuring outcomes for children, and to this end, ECA advocates that new close the gap targets focus on the AEDC domains.
Barriers faced by First Nations children accessing early childhood services can exist at a number of levels: they can be individual, and involve the number of children in a family, employment, income, discrimination and housing; they can be service level barriers, which include issues such as service quality, and cultural competency; social and neighbourhood barriers that include how transient a community is, their living conditions and the level of social and geographical isolation; and importantly cultural barriers, such as a lack of trust in services or difficulty culturally engaging. Understanding these barriers must drive appropriate policy responses.
Two key opportunities have been identified to lift outcomes: the provision on integrated family- focussed programs that support families in meaningful ways across a range of areas (e.g. health, parenting support) to build engagement with families over the longer term; and participation in high quality early education, for up to thirty hours a week of high-quality early education (“preschool”) in the two years before school. This is a substantially higher level of participation than is supported by current policy, and higher than what is being achieved in terms of attendance. In 2018, only 68 per cent of Indigenous children are attending for the 600 hours of preschool in the year before school, and children’s attendance was found to be lower when they live in rural and remote areas.
Recommendations
Early Childhood Australia recommends:
- Establish new early childhood development targets to close the gap in the AEDC domains by 2030; and an accompanying strategy—through the Closing the Gap refresh.
- Commit to funding universal access to high-quality early education for three- and four-year-olds, including additional funding to ensure that Aboriginal and Torres Strait Islander children get access to a minimum of three days per week—determined by children’s needs— of high-quality preschool.
- Amend the Activity Test within the Child Care Subsidy to provide up to 30 hours per week of subsidised early education and care for Aboriginal and Torres Strait Islander children, without parents having to meet any work or study requirements.
- Invest in quality Aboriginal and Torres Strait Islander community-controlled integrated early years services, through a specific early education program, with clear targets to increase coverage in areas of high Aboriginal and Torres Strait Islander population, and high levels of disadvantage.
Royal Australasian College of Physicians
Key points from RACP’s Pre-Budget Submission
Australia is a rich country with quality infrastructure and a world-class health system. Australia’s First Peoples, the Aboriginal and Torres Strait Islander peoples, are one of the fastest growing populations (nearing 3%), who provide a continuous link to upwards of 60,000 years of culture on this continent.
Yet Australia’s Aboriginal and Torres Strait Islander First Peoples continue to suffer greater incidence of chronic disease and experience disadvantage and barriers to accessing appropriate and effective health care. Despite these long-standing inequities progress has been slow in reducing the health gap and concerted, sustained action is urgently needed.
To address these inequities and improve access to care, continuing and strengthened focus and appropriate long-term legislated 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 and hamper their ability to retain and expand their capacity.
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; as such, service development and provision should be led by Aboriginal and Torres Strait Islander health organisations wherever possible. The sector must have long-term, legislated, sufficient and secure funding to both retain and grow their capacity.
Recommendations
The RACP recommends that the Australian Government:
- Legislate for guaranteed long-term funding to progress the strategies and actions identified in the National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) Implementation Plan commensurate with the burden of disease.
- Commit to secure, long-term funding for the Rural Health Outreach Fund (RHOF) and Medical Outreach Indigenous Chronic Disease Program (MOICDP) commensurate with the burden of disease.
- Commit to sustained, secure funding for the evidence-based, locally-delivered Tackling Indigenous Smoking program to address the number one modifiable risk factor in the burden of disease in our Indigenous communities.
- 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.
- Commit to secure, long-term funding for primary health care, community-led sexual health programs and specialised sexual health services to deliver STI/BBV services, and to ensure timely and culturally supported access to specialist care in all regions, to achieve low rates of STIs and good sexual health care for Indigenous Australians.
Australian Healthcare and Hospitals Association
Key points from AHHA’s Pre-Budget Submission
We know that Aboriginal and Torres Strait Islander people are not accessing medicines in the community. Average PBS expenditure per person for Aboriginal and Torres Strait Islander Australians was estimated to be 33% of the amount spent for non-Indigenous Australians in 2013–14, despite higher rates of chronic disease and hospitalisation.
Patients not taking their medicines after discharge from hospital is a major problem resulting in clinical deterioration, re-hospitalisation and death. Acute separations and emergency department attendances present an opportunity to improve access to medicines. In 2016–17, there were 522,000 acute separations and 503,000 emergency department presentations for Aboriginal and Torres Strait Islander people.
All states and territories except NSW and ACT are participating in the Public Hospital Pharmaceutical Reforms, allowing hospitals to prescribe and dispense PBS medicines to outpatients and patients upon discharge. However, the Closing the Gap (CTG) PBS Co-Payment Measure cannot be applied when pharmaceuticals are dispensed from a public hospital.
Recommendations
A policy change to allow the CTG PBS Co-Payment measure to be applied when medicines are dispensed from a public hospital.
It should be noted that:
- Both the cost of the medicine and the cost of the co-payment relief are already incorporated into the current PBS budget as part of the CTG PBS Co-payment Measure.
- A policy change would only realign the location of supply of medicines to patient need, and theoretically should not lead to any additional PBS medicines being dispensed. Rather, it would address the under-utilisation of current CTG support in the community.
For states and territories participating in the Public Hospital Pharmaceutical Reforms, a policy change could be implemented immediately without renegotiating agreements. This would involve a re-direction of existing budgeted funds estimated to be $15.1 million.
If ACT and NSW were to participate, the total re-direction of funds is estimated to be $21.8 million.
The funds re-directed to hospitals have been estimated based on hospital presentations by Aboriginal and Torres Strait Islander people and the following estimates for medicines use (based on advice from the Society of Hospital Pharmacists of Australia through members and emergency physicians):
- Acute separation: A complex patient leaving hospital would require on average 6 medicines at discharge. Assuming a concessional patient status, this equates to co-payment re-direction of $39.00.
- Emergency or same-day acute discharge. A chronic patient leaving emergency or same-day acute discharge would require 3 medicines. Assuming a concessional patient status, this equates to co-payment re-direction of $19.50.
The Australian Nursing and Midwifery Federation
Key points from the ANMF Pre-Budget Submission
The ANMF has a long-held vision of health equity for Aboriginal and Torres Strait Islander peoples. In order to achieve this, the ANMF builds relationships with Aboriginal and Torres Strait Islander nurses, midwives, assistants in nursing, and broader communities, working together to identify and provide opportunities to build capacity and realise potential.
We continue to work towards our vision through our Reconciliation Action Plan, demonstrated by modelling respect for Aboriginal and Torres Strait Islander peoples; promoting understanding of their rights and leading the nursing and midwifery professions in respect and sharing knowledge with Aboriginal and Torres Strait Islander peoples.
The ANMF adopts the principles of reconciliation as part of our core work, and models and encourages promotion of reconciliation throughout the nursing and midwifery professions.
The presence of Aboriginal and Torres Strait Islander health professionals makes a positive difference to service access, experiences, and outcomes for Aboriginal and Torres Strait Islander people. Given they have the worst health outcomes in the country it is essential that strategic and long-term efforts are made to increase the overall number and representation of Aboriginal and Torres Strait Islander nursing and midwifery students and graduates across all jurisdictions.
There is consistent evidence that when Aboriginal and Torres Strait Islander peoples work in the health system, Aboriginal and Torres Strait Islander people are more likely to access services and gain assistance earlier with consequent improvements in health outcomes and reductions in long term health expenditure.
The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) is the national health professional peak body for Aboriginal and Torres Strait Islander nurses and midwives. In the early 1990’s, the ANMF provided significant support for the establishment of the Congress of Aboriginal and Torres Strait Islander Nurses (CATSIN). There is an historical and ongoing close relationship between the ANMF and CATSINaM.
CATSINaM receives triennial grant funding from the Australian Government for their operations. Their role in providing support for Aboriginal and Torres Strait Islander nurses and midwives, nursing and midwifery stakeholders and Governments, and building the current workforce of Aboriginal and Torres Strait Islander nurses and midwives is essential.
Recommendations
The ANMF calls on the Government to:
- Provide increased ongoing funding to CATSINaM to provide leadership for nursing and midwifery organisations to work towards health equality for Aboriginal and Torres Strait Islander peoples and to continue to support and grow the Aboriginal and Torres Strait Islander nursing and midwifery workforce.
- Establish a caucus of Aboriginal and Torres Strait Islander health organisations and representatives to provide regular and ongoing consultation on policies and activities that affect Aboriginal and Torres Strait Islander health and wellbeing.
- Support the increase of the Aboriginal and Torres Strait Islander nursing and midwifery workforce to 5% of the total Australian nursing, midwifery, and assistant in nursing workforce across health and aged care.
- endorse and support the development and implementation of a National Aboriginal and Torres Strait Islander Nursing and Midwifery Workforce Strategy.
- Provide funding and support for the development, implementation, and evaluation of Birthing on Country programs in urban, regional, and remote locations.
- Substantially increase funding to community-controlled, targeted, evidence-based strategies for Aboriginal and Torres Strait Islander healthcare across the life course.
- Endorse and support the implementation and roll-out of nurse- and midwife-led models of care that address Aboriginal and Torres Strait Islander health concerns and challenges.
- Endorse and support the development and implementation of a National Aboriginal and Torres Strait Islander Aged Care Workforce Strategy.
- Fund and support the national uptake of CATSINaM’s cultural safety training at all levels of healthcare service, education, and training to ensure that all healthcare professionals and educators receive best-practice cultural safety training.
- Support the inclusion of cultural safety training into the annual registration and continuing professional development requirements of all healthcare professionals.
- Support the inclusion of measures of cultural safety with all health and aged care service providers into the National Safety and Quality Health Service Standards.
- Support a revitalised nation-wide approach to addressing Aboriginal and Torres Strait Islander health and wellbeing inequalities including greater partnerships with Aboriginal and Torres Strait Islander peak bodies and leaders.
- Make a true and concerted effort to get each of the Closing the Gap targets on track including greater funding.
- Expand the Closing the Gap initiative by adding additional targets linked to incarceration, community violence, disability, aged care, and children in out of home care.
