A “radical change” in the organisation of health care for Indigenous Australians was one of the highest priority recommendations from the National Health and Hospitals Reform Commission (at least judging by its prominent position towards the top of the executive summary of the Commission’s final report).
The Commission recommended that all health care funding for Aboriginal and Torres Strait Islander people should be aggregated, and used by a new National Aboriginal and Torres Strait Islander Health Authority to actively purchase and commission the “very best health services”.
By this, the Commission meant services “that are effective, high quality, culturally appropriate and meet the needs of Aboriginal and Torres Strait Islander people, their families and their communities”.
“This also means that we need to invest more than we do now, so that the Authority can ensure that spending actually matches the greater health needs of Aboriginal and Torres Strait Islander people,” the report said.
The Authority would work in a similar way to the Department of Veterans’ Affairs, which sets explicit standards for the quality of care, contracts with whichever health services – public, private, hospitals, GPs, primary health care services – can deliver against these standards. The Commission also noted that the DVA consistently listens to and learns from veterans about how to do better.
The Commission’s report said key groups were broadly supportive of the concept, and cited the Close the Gap Steering Committee for Indigenous Health Equality as commenting that the proposed authority “may catalyse a cultural shift within the health system to support a genuine partnership between government and Indigenous peoples and their representatives”.
After the Commission’s report was released, I didn’t see a great deal of discussion or analysis of this particular proposal around the traps (but would appreciate any pointers if I missed it), although this Crikey article by Stephanie Bell, director of Central Australian Aboriginal Congress, and Professor Judith Dwyer, ex Flinders University, suggested it could have some merits.
So what has happened to the proposal in the 10-months since it was put to the Government? Is there any intention to advance it?
A few weeks ago I put these questions (amongst others) to the office of the Minister for Indigenous Health, Warren Snowdon, as part of research for a feature for the Australian Nursing Journal.
This is the e-mail response that subsequently arrived from the Department of Health and Ageing’s media unit. (I’m running it verbatim, so please bear with the length and read on..)
“The Australian Government is considering the report of the NHHRC and will respond to the recommendations. The Government has already taken action to address some of the issues underpinning the NHHRC’s recommendation to establish a National Aboriginal and Torres Strait Islander Health Authority. The NHHRC were clear that this recommendation was not about the creation of a separate system for Indigenous Australians, but rather about ensuring all health services provide the right care and help to close the gap. In making their recommendation, the NHHRC emphasised the importance of providing adequate funding, delivering quality health care, holding all health services accountable, and developing a genuine partnership between Aboriginal and Torres Strait Islander people and government.
The Council of Australian Governments has made a commitment to focus on health outcomes and ensure high quality and timely access to appropriate care. The $1.6 billion National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes reflects a shared commitment to improving Indigenous peoples’ access to health services by increasing the responsiveness of mainstream providers and strengthening Indigenous specific health service delivery. The National Partnership Agreement is a substantial joint investment in expanding and reforming health services for Indigenous Australians to ensure that the health system meets current and future needs. It includes new Commonwealth funding of $805.5 million over four years to reduce chronic disease risk factors; encourage earlier detection and better management of chronic disease in primary health care services; improve follow up care; and increase the capacity of the primary care workforce to deliver effective health care to Aboriginal and Torres Strait Islander peoples across Australia.
The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, like all the National Partnership Agreements associated with the National Indigenous Reform Agreement, sets out explicit objectives, outcomes, outputs, performance indicators and benchmarks to measure progress towards the Closing the Gap targets. An important feature of the new COAG framework is the focus on achievement of outcomes and public reporting against specified indicators through the COAG Reform Council. In addition, annual national Indigenous Expenditure Reports will provide governments with a better understanding of the level and patterns of expenditure on services to Indigenous Australians.
Furthermore, the Government’s current health reform plan will enable services to be drawn together so they are better integrated, better coordinated, and more responsive to the needs of patients. Primary health care is fundamental to the prevention, early detection and management of chronic diseases and their risk factors which are responsible for the health gap between Indigenous and non-Indigenous Australians. Evidence shows that chronic diseases (including the impact of some risk factors) are responsible for 70% of the health gap: cardiovascular disease, diabetes, mental disorders, and chronic lung disease are major concerns.”
I don’t know about you, but I read all that as a very round about way of saying that the recommendation is going nowhere, and that the Government thinks that there are other ways of producing the outcomes sought by the NHHRC. (Or perhaps it’s just been so focussed on hospitals that it hasn’t had time to think or act more broadly).
It seems my interpretation may not be too far of the mark. John Paterson, Chief Executive Officer of Aboriginal Medical Services Alliance Northern Territory, believes it likely that the recommendation will not be adopted.
“That’s a pity,” he writes in an article in the latest Health Voices, the journal of the Consumers Health Forum.
“We believe such a body would give the strongest possible signal to the process of Closing the Gap of Aboriginal health disadvantage.
“We believe such a health authority should receive all of the current Primary Health Care Funding for Aboriginal people: $550 million recurrent from the Office of Aboriginal and Torres Strait Islander Health, $400 million recurrent from CoAG and the state and territory Aboriginal Primary Health Care funding. This would achieve a total allocation of about $1.2 billion for Aboriginal Primary Health Care services, which would enable an average expenditure across Australia of about $3000 per person for the 470 000 Aboriginal people. “
What do others think?
Does it matter that the Government appears intent on ignoring this recommendation? Is it an opportunity lost?
Update, June 28: Thanks to health reform advocate Fiona Armstrong for this:
I think this section of the NHHN report no. 3 (the red one) might answer your question more directly than Mr Snowdon?
Link here – see p.144 http://www.health.gov.au/internet/yourhealth/publishing.nsf/Content/report-redbook/$File/HRT_report3.pdf and below:
Recommendation 61: Acknowledging that significant additional funding in Aboriginal and Torres Strait Islander health care
will be required to close the gap, we recommend that a dedicated, expert commissioning group be established to lead this investment. This could be achieved by the establishment of a National Aboriginal and Torres Strait Islander Health Authority within the Health portfolio to commission and broker services specifically for Aboriginal and Torres Strait Islander people and their families as a mechanism to focus on health outcomes and ensure high quality and timely access to culturally appropriate care.
Response: The Government does not support this recommendation. The Government will continue to work closely with the Indigenous health sector in an effort to close the gap in indigenous health outcomes. The Government will also continue to work with the Indigenous health sector in the monitoring and evaluation of the progress on the closing the gap measures. The Government also acknowledges that the ACCHS provide an effective model of culturally appropriate primary health care service delivery and will continue to play an important role into the future under the Governments reform to the health care system.
To that end the Government will work with the Indigenous health sector on the implementation of primary health care reform.