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How can health reform help Aboriginal and Islander health: a practical vision

A vision for Aboriginal and Islander health reform in Queensland was recently launched at Qld Parliament House, with the support of the Minister for Aboriginal and Torres Strait Island Partnerships, Curtis Pitt.

In the article below, Selwyn Button, CEO of the Qld Aboriginal & Islander Health Council, explains some of the background to A Blueprint for Aboriginal and Islander Health Reform in Queensland, including the national health reform agenda’s blind spots around Indigenous health.

Button also outlines the key elements of the document, including a call for the National Health Performance Authority to have a specific focus on Indigenous health, and for governance mechanisms to oversee the local impact of national reform upon Aboriginal and Torres Strait Islander people.

The document also calls for the community controlled sector to develop better ways of working together and ensuring the sector’s capacity to respond collectively to health reform implementation.

The document clearly has Queensland as its focus, but it may also have some useful leads for other jurisdictions.

***

 

How can we ensure that health reform promotes Aboriginal and Islander health?

Selwyn Button writes:

The Blueprint has been a culmination of activities that have taken place over the last 12 months in the community controlled health services sector in Qld, and represents a significant shift in the mindsets of community controlled organisations nationally.

Firstly, it must be mentioned that the Blueprint was developed not only from community controlled desire, but also necessity, as there remains very little detail about how national health reform policy changes will ultimately affect the health and well being of Aboriginal and Torres Strait Islander people.

Rather than waiting for someone else to come up with the solutions, the Qld community controlled sector, through its membership and participating communities, provided direct input to QAIHC about what these should look like.

Importantly, this reform document was not intended to just position the sector as the major provider of health care to Aboriginal and Torres Strait Islander people, and continue beating the drum to say ‘we are the only ones that can do it and we should be charged with supporting our own people’.

Instead, it provides some workable options in light of proposed reform changes and attempts to offer some real solutions to supporting reform across the whole health care system to adapt and support improved healthcare for Aboriginal and Torres Strait Islander people.

The overall focus is not another ‘Close the Gap’ branded agenda, as these have been done to death with minimal impact. Rather, it focuses on where real healthcare gains can and need to be made, and that is through reforming the mainstream healthcare system to better meet the needs of Aboriginal and Torres Strait Islander people.

The Blueprint focuses on 7 Key Reform Components, all of which have been identified through active member and community consultation processes across the state, including discussions and conversations with State and Federal MPs.

The 7 Reform Components focus on consolidation of efforts that have existed in the sector for some time, whilst also seeking to influence major change in the mainstream health care system and are as follows –

  1. Implementation of the QAIHC Comprehensive Primary Health Care Model
  2. Establishment of an Aboriginal and Torre Strait Islander specific monitoring function within the National Health Performance Authority
  3. Establishment of three Regional Institutes for Indigenous Health in Qld
  4. Establishment of a Qld Aboriginal and Islander Health Reform Council
  5. Transfer to community control in remote and discrete communities
  6. Funding Reform
  7. Enhanced community controlled sector self-regulation

Component 1

It is well documented and widely researched that the best gains in health improvements for Aboriginal and Torres Strait Islander people occur when provided with good quality comprehensive primary health care through community controlled services.

Over recent times, QAIHC has worked directly with its members in refining the model of comprehensive primary health care that becomes a consistent framework to support services knowledge and understanding of what this means and how we can go about providing services to our people in the best way.

This work has now become a focal point across all community controlled services in Qld and also supports our branding of what you should expect in terms of level of service in a community controlled clinic that differentiates us from the rest of the healthcare system, and leads to better outcomes.

Through developing and marketing this brand, the sector is then able to support the implementation of this model across other providers of healthcare, who may aspire to the core values of good comprehensive primary health care but are not getting the outcomes being achieved in a community controlled environment.  The QAIHC CPHC Model becomes the cornerstone of the quality of service provided from community controlled and we can support others to aspire to the same level of outcomes through the implementation of our model.

Component 2

The National Health Performance Authority will have overall responsibility for monitoring performance of new Medicare Locals and Local Hospital Networks, whilst providing new investments to support healthcare improvements at a national level.

The creation of an Indigenous specific function within the Authority would support this new entity, and engage in the conversation about monitoring, reporting and providing advice on improvements for Aboriginal and Torres Strait Islander people.

It would also focus upon ensuring that all health providers are making efforts to support improvements in health outcomes for Aboriginal and Torres Strait Islander people through a consistent set of performance indicators that commonly impact upon the health of our people.

This function of the Authority would become the ‘watchdog’ on behalf of governments and community to ensure investments were being utilised well and contributing towards the broader close the gap agenda through all aspects of healthcare provision, including community controlled services. Whilst the NHPA is still in its infancy, this would be the opportune time to set up this new function.

Component 3

Establishment of Institutes for Indigenous Health across the state further support access and integration across all healthcare providers for Aboriginal and Torres Strait Islander people.

A major function of the Institutes is about ensuring that Aboriginal and Torres Strait Islander people get access to the required care they need in an appropriate and timely manner, irrespective of who the provider may be.

The role of the Institutes are about knowing and understanding the social and demographic trends of Aboriginal and Torres Strait Islander people across a geographically defined area and determining what is the most appropriate response to those needs.

This function is extremely important given the current circumstances where Divisions of General Practices and Hospital Districts are now evolving into new and more independent business entities with a focus on transitioning into Medicare Locals where service provision is not the priority, and Local Hospital Networks are to focus on reducing access block and hospital waiting lists.

Amongst these priorities, Aboriginal and Torres Strait Islander peoples needs will not be a major focus, and importantly the establishment of Institutes will continue to work with current and emerging entities that have a variety of foci to support the ongoing needs of Aboriginal and Torres Strait Islander patients whilst ensuring that they are not lost in the large healthcare system.

The Institute for Urban Indigenous Health is already functioning in South East Qld, and through its regional profiling and identification of service gaps for Indigenous clients, it has been able to attract significant new investments into the community controlled and private practice space to support the needs of the urban Aboriginal and Torres Strait Islander population.

Component 4

Presently in each State and Territory across the country, there are existing Aboriginal and Torres Strait Islander Health Partnership governance arrangements that include State and Federal Health departments, community controlled sector representatives and private practice reps.

The overall purpose and intent of these governance mechanisms is to support continued improvement in health outcomes for Aboriginal and Torres Strait Islander people through strategic policy direction setting, monitoring of outcomes for improvement, resource investment and allocation and other major priorities.

At this point there is no real governance to oversight the implementation of the National Health Reform initiatives and how they impact locally upon the needs of Aboriginal and Torres Strait Islander people.

In Queensland this can happen quite smoothly through the transition of the current Partnership priorities into the role of a Health Reform Council, which has mandated responsibility to oversight these new reform arrangements and provide advice on how best to implement them to support improved outcomes for Aboriginal and Torres Strait Islander people.

The Reform Council would also provide a direct connection for the performance and monitoring function within the NHPA to ensure that there was state input into a national process in order to contextualise how it might best work within a jurisdictional context.

Discussions have commenced at the Qld Partnership level in order to effect this change with support from all parties participating, although the role of state base organisations is still not clearly defined in the national reform process, which hinders the amount of influence this can have at this point.

Component 5

Transfer to Community Control in remote and discrete communities across Qld has been underway since 2003, with commitments from both state and federal governments to support the process.

The intent of this reform component is about community controlled organisations taking greater responsibility for delivery of primary health care services in remote and discrete communities, allowing government run services to focus upon secondary and tertiary needs.

Although there has been strong intent about making this shift for some time, there has never been any policy commitment from both governments to effect the change.

Consequently QAIHC developed a ‘Pathways to Community Control Policy Framework’ that outlines the aspirations of the sector in transferring government services to community controlled to initiate the conversation about what a joint-policy framework might look like in Qld.  This reform component is not a new concept, as transferring of services has already happened and continues to occur in remote parts of South Australia and the Northern Territory, with the NT releasing a joint policy statement in 2009 across all partners.

Importantly, transfer to community control is also viewed by our sector as a reform process specifically for remote and discrete communities as we believe that this will enable better outcomes to be achieved in supporting the health of our people, particularly in areas where there are limited providers and where communities themselves are seeking to take greater responsibility for the design, development and delivery of health services to their own people.

Component 6

In 2010, Dwyer et al released the Overburden Report,which highlighted the complexity of funding arrangements for community controlled services across the country.

The research indicated that from the 21 organisations interviewed for the research, there was an average of 22 funding contracts and separate reporting requirements for these services, which placed a massive burden upon the services’ ability to provide good quality care for people in their communities.

Funding reform is about supporting greater flexibility in resourcing and investment for community controlled services to ensure that they remain focussed upon their core business of delivering health care.

Additionally, funding reform is about recognising that community controlled services provide a range of activities that focus more broadly upon the social determinants of health and seek to ensure that services are being resourced more appropriately to support this work which fundamentally has the greatest impact upon health outcomes for out people.

Component 7

Community Controlled Sector Self-Regulation is about recognising the need to fundamentally change the way we interact and support each other within the sector.

It is not about closed shops or masking the real problems existing in services, but about working together and ensuring there are consistent approaches in the way we do business to support enhanced service delivery for our people wherever they may be.

Self-regulation is about recognising that individual community controlled services cannot operate effectively on their own and need to establish better networks and closer working relationships with surrounding services to ensure we can strengthen the capacity of not one but all services in regional areas.

Sector self-regulation is also about the change management approach required internally within the sector to ensure that we are ready to adapt with the upcoming health reform changes and are well positioned to respond to reform as it happens in a collective way.

To achieve this, QAIHC has commenced work on the development of stronger regional service arrangements across the state to create stronger regional entities that focus on supporting services across a range of functions that have traditionally impacted upon our services, including –

·        Corporate governance

·        Models of comprehensive primary health care

·        Clinical governance

·        Information management

·        Workforce development

To this end, the Blueprint provides a robust overview of how the community controlled sector in Qld believes that the mainstream healthcare system requires some shifts to better support the needs of Aboriginal and Torres Strait Islander people.

As previously indicated, many of the reform components are presently occurring, so we are not waiting for a green light to progress with the business that we think will make a significant difference to the health of our people, but continuing to seize the opportunities as they arise to implement the reform pieces to our puzzle that will hopefully continue to come together over the coming years.

Whilst there are significant changes occurring in the healthcare system, the opportunity is here to influence and implement some real and sustainable changes to the mainstream system that better support our own mob.

Community controlled services have now been in operations across the country for 40 years and have evolved to become extremely sophisticated entities with the ability to produce high level influential strategic policy initiatives, whilst still providing the best quality care for Aboriginal and Torres Strait Islander people.

Hopefully now all levels of government will recognise that what we have achieved and what we continue to do, can and will ultimately improve health outcomes for not only our own people, but can also make a significant contribution towards improving the health of all Australians.

Then we might have some decent conversations that start by saying: ‘how do we improve the health of all Australians, where community controlled health professionals play a key role in leading those discussions?’

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