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Where are the risks and opportunities for health in Turnbull’s new ministry?

The new Federal ministry should halt the unending upheaval in Indigenous policy, stop the freeze on Medicare rebates, and ensure the needs of people with disabilities are high on the Cabinet agenda.

These are some suggestions in the analyses below of the Federal ministerial reshuffle’s opportunities and risks for health.

(For more health reaction to the new ministry, see this previous Croakey wrap).

In the post below:

• Dr Tim Senior, a GP and #WonkyHealth columnist, suggests that health ministers Sussan Ley, Fiona Nash and Ken Wyatt have a difficult job ahead as they are likely to be pushed “to make savings, not improve health”.

• Dr Mark J Lock, ARC Discovery Indigenous Research Fellow at the University of Newcastle, urges the Turnbull government to provide stability “in the stormy waters of chaotic government administration”.

He also suggests that an inter-departmental working group should be established between Ministers Briggs, Scullion and Wyatt to produce a whole-of-government response to the issue of how a better built environment contributes to improved Aboriginal health outcomes. (Note from Croakey: Minister Briggs does not mention the word ‘health’ in his first statement).

• Keran Howe, Executive Director, Women with Disabilities Victoria, asks: Why are we witnessing one of the most significant social reforms in the nation’s recent history, the NDIS, with no Cabinet representation?

***

Dr Tim Senior: Action on inequalities and climate policy is unlikely

timSeniorheadshotQ: What is your overall assessment of the reshuffle and its implications for health policy, health care delivery and the community’s health?

I’ve been thinking about the reshuffle in two ways. There’s the soap opera of who got what and who supports whom; and then there are questions of what policy directions we’ll see. In health, with Sussan Ley and Fiona Nash continuing, it looks like there is not going to be any change in health policy. The appointment of Ken Wyatt is interesting. I think we all assume that he will have some responsibility for Aboriginal and Torres Strait Islander Health.

This team has a challenge. Sussan Ley has been consulting with the profession, and I suspect will have heard very consistently of the need to support and fund primary care properly. Fiona Nash will have been hearing the same thing in rural health, and was talking about the importance of prevention at the Public Health conference in Hobart, provoking much commentary about this government cutting all sorts of preventive programs. Ken Wyatt will presumably also have an understanding of what good Aboriginal and Torres Strait Islander health looks like.

The problem for all three is that it mostly looks like they are being pushed to make savings, not improve health.

I don’t think moving Scott Morrison into treasury will change this. He demonstrated as social services minister a willingness to negotiate, but his approach was clearly to save money, and the government continued to try to legislate to have a four-week waiting period before getting any welfare payments, which is a disaster for those children from families without access to big houses and trust funds.

And Scott Morrison has demonstrated as immigration minister he is willing to cause people considerable harm for his policy outcomes. There is the opportunity for Scott Morrison to do things differently, but I don’t see any indication that this will happen. All the talk has been about business and growth. I’ve heard no mention of inequality, and I fear that those who benefit most will be those who are most like Malcolm Turnbull.

A few other thoughts: Christian Porter is an unknown (to me) quantity in social services. His background is law, and he was attorney general in WA, and quit state politics to go federal.

It will be interesting to see what he does – I fear, based on no knowledge, that he will take a law and order approach to welfare, and I hope I am wrong about this. He should stop the four-week wait for young adults for Centrelink, and then start talking about a living wage for everyone, including those on NewStart..

Keeping Greg Hunt on as Minister Against the Environment signals no policy shift (and I do note that Julie Bishop was very quick to say there would be no change to our targets as Malcolm announced he’d won the leadership ballot.) The irony is that we have a PM and Environment Minister who have both argued in the past for a price on carbon pursuing a policy that they both know will achieve very little very expensively as it is currently set up.

Marise Payne as the first female defence minister is worth celebrating, as it does break the stereotype of traditional “female” ministries, such as welfare, health families.

I’ll save my celebrations, though for when we’re diverting money away from building things to kill people to building things to keep them healthy.

And Dutton? WTF!

Q: What is the significance of Ken Wyatt’s new appointment? What advice do you have for him?

Ken Wyatt brings a really important Indigenous perspective into health. I do have a sense of optimism about this, but a lot depends on how much he is listened to and how much support he is given. The first thing he should do is stop the Medicare freeze. This is an ongoing funding cut to Aboriginal Medical Services (and many other practices seeing high numbers of Aboriginal and Torres Strait Islander patients).

A lot of what he needs to do will be undoing the damage caused by the Indigenous Advancement Strategy, and the closure of services for family violence and legal services. He should be constantly talking to colleagues showing how their policies affect Indigenous people all over the country. There’s a risk, however, that he’s just a token, and is set up to fail. I hope not, and I think Ken Wyatt would be appalled if he thought this was happening.

Q: What are the opportunities for the community’s health with the new Ministry of Jamie Briggs? What advice do you have for him?

There is certainly an opportunity to build healthy cities. I think it would be helpful to be clear from the outset what this entails. It would be wonderful to see promotion of wellbeing as one of the principles, with thoughts about public transport, communal areas, parks, public art (and not chosen by George Brandis!). The risk will be that it becomes driven by profit, which will mean development, shopping, casinos, car parks and adverts everywhere. I don’t know enough about Jamie Briggs to know how he sees this.

Q: Any other comments?

I quite like Malcolm Turnbull as he is clearly intelligent and able to argue a case. I don’t see him as a great progressive hope, though, and I’m not expecting anything in the way of policy towards reducing inequalities, or some big change in direction on climate policy.

In the end, he’s a barrister by background, and able to put whatever case he’s paid to argue, no matter what he personally believes. I think it’s these skills he’s drawing on to lead the Liberals currently.

***

Dr Mark Lock: The Turnbull ministry – A lighthouse for the stormy waters of Aboriginal affairs governance?

MarkLockQ: What is your overall assessment of the reshuffle and its implications for health policy, health care delivery and the community’s health?

Each and every Australian government from the 1967 Constitutional Referendum has altered the political and bureaucratic governance structures for Indigenous affairs. The result is changes to national policy and strategy, to administrative processes, lines of management and authority, accountability and reporting requirements, program funding, and inter-governmental structures and processes.

The Turnbull Government should maintain a stable administrative system in the lead-up to the next federal election, in the meantime establishing a process (perhaps an expert review panel and commissioned research) to seek answers to what machinery of government changes would provide generational certainty in the public administration of Indigenous affairs?

The constant political upheavals and subsequent machinery of government changes are directly implicated in the disadvantage of Australia’s First Peoples.

This is made clear in a number of commentaries and articles on the issue. Notably Dr John Gardiner-Garden’s Overview of Indigenous Affairs, Chris Graham’s Crikey blog The PM and Aboriginal Australian-a timeline, Delephene Fraser’s article in The Stringer on the History of government and Aboriginal Affairs prior to 1967 and after, the National Aboriginal Community Controlled Health Organisation’s article on the History of Aboriginal Health from 1967, the Aboriginal and Torres Strait Islander Social Justice Commissioner’s Social Justice Reports of 2004 and 2005, and the Australian Indigenous HealthInfoNet’s Health policy timeline, and Creative Spirits’ article on Aboriginal representative bodies.

Changes in government result in changes to the ‘machinery of government’ through the ‘Administrative Arrangements Orders’. Have a look at the AAO of September 2013 (Department of Prime Minister and Cabinet) and note the 45 pages of legislation administered by different Commonwealth Government Ministers (CGM). Marcia Langton (Indigenous Change Propels Inertia) and Melissa Sweet (Chaos in Indigenous Affairs Policy) note the chaotic inertia of administrative changes in Australian Indigenous Affairs.

Can the Turnbull government, over the next twelve months, be a lighthouse for Aboriginal affairs in the stormy waters of chaotic government administration?

A section of major changes in Indigenous affairs over the last forty-eight years:

  • Turnbull Government announces Ken Wyatt as the first Indigenous frontbencher in federal parliament September 2015.
  • The Abbott government announced the establishment of the Indigenous Advisory Council in September, 2013.
  • In 2010 the Rudd government supported the establishment of the National Congress of Australia’s First Peoples. In 2008 Rudd disbanded the Howard Government’s National Indigenous Council.
  • In 2004 the Howard Liberal/National Coalition Government (1996-2007) abolished (with the support of Labor) the Aboriginal and Torres Strait Islander Commission. It also established the (now disbanded, under Abbott) National Aboriginal and Torres Strait Islander Health Council. The National Indigenous Council was established by Howard Liberal/National Coalition Government in 2004.
  • 1984 the Hawke Labor contracted Louis O’Donoghue to consult widely on the formation of an Aboriginal representative body, leading to the establishment (in 1987) of the Aboriginal and Torres Strait Islander Commission (ATSIC), replacing the Department of Aboriginal Affairs and the Aboriginal Development Commission, and assumed national responsibility for Indigenous health.
  • In 1977 the Fraser government announced the National Aboriginal Conference (NAC) to replace the NACC. The Fraser government (1980) established the Aboriginal Development Commission was established by the Fraser Coalition Government.
  • In 1972 the Whitlam Labor government Department of Aboriginal Affairs replaces the Office of Aboriginal Affairs, and announced the formation of the National Aboriginal Consultative Committee (NACC).
  • In 1967 the Council of Aboriginal Affairs created by the Holt government to act as the federal governments advisory and policy framing unit. In 1968 Harold Holt established the Commonwealth Office of Aboriginal Affairs.

Q: What is the significance of Ken Wyatt’s new appointment? What advice do you have for him?

In 2001 Peter Sutton released the article ‘the politics of suffering: Indigenous policy in Australia since the 1970s’ (followed by a 2009 book on the same topic) in which he noted that a change to an increasingly Indigenous officialdom had not altered the circumstance of Aboriginal people in remote communities.

Sutton highlighted a number of complicating factors in Indigenous affairs policy – the diversity of cultures, the different states of development of Aboriginal organisations, and the different political ideology of governments, and the administrative mentality of bureaucrats. In this context it will be interesting to see how Minister Wyatt navigates the complexity of Liberal ideology and Aboriginal ancestry and following the Liberal Party line. After all, he is only one Liberal politician, bound by the Liberal Party’s rules and policy in Indigenous Affairs.

However, Minister Wyatt has the opportunity to demonstrate leadership in the governance and administration of Aboriginal affairs. If he can work with the members of Parliament to promote a process of stable governance and administration in Aboriginal affairs, he could be heralded as the bedrock upon which the Australian Nation finally moves beyond administrative inertia in addressing Aboriginal health disadvantage.

Minister Wyatt has significant experience in public administration of Aboriginal health, so we can expect a person who knows how to work with bureaucrats. Also, his new-found political position places him in powerful position to argue for stable funding arrangements so that Aboriginal communities are not faced with annual chaotic funding stress.

Minister Wyatt represents a new force in Australian Aboriginal affairs to advance Aboriginal health equity through genuine consultation process with the diversity of Australia’s First Peoples.

Q: What are the opportunities for the community’s health with the new Ministry of Jamie Briggs? What advice do you have for him?

The Ministry of Cities and the Built Environment has a challenge to promote healthy Aboriginal communities through an appropriate built environment. There are several issues in Aboriginal communities such as the lack of adequate housing, health facilities, basic environmental services such as sanitation and clean water supplies, and safer surroundings, as noted in the Lowitja Institute’s report ‘Beyond Bandaids’.

Minister Briggs has the opportunity to consult with a wide range of stakeholders as a necessary step to learning the cultural understanding of what constitutes and appropriate build environment. There should be an inter-departmental working group established between Ministers Briggs, Scullion and Wyatt so as to produce a whole-of-government response to the issue of how a better built environment contributes to improved Aboriginal health outcomes.

***

Keran Howe: What does it mean that we have no minister for people with disabilities in cabinet?

KeranHere we are with the sign off last week to commence NDIS roll out in the two most populated states in the nation. Why are we witnessing one of the most significant social reforms in the nation’s recent history with no Cabinet representation?

Bill Shorten and Jenny Macklin led a strong policy commitment to the NDIS and achieved bilateral support to its roll out in the previous Labor government. With the imminent roll out nationally, this program needs to be driven by a strong government policy presence.

We know that Australia has a dismal record of employment of people with disability, faring only 27th out of 29 OECD countries; we know that women with disabilities are much more likely to experience violence than other women; we know that as parents, myths about our incompetence mean that even perpetrators of violence are sometimes more likely to be granted care of children rather than a mother who has a disability; and our antiquated housing regulations mean we keep building inaccessible housing despite an aging population and the evidence about the benefits of universal design from other more progressive countries.

These facts confirm that disability is a serious social issue. We know that the NDIS is not going to address gender and disability inequality in this country – it will focus only 440,000 of the most severely and profoundly disabled people, leaving a significant cohort of people with disability to make there own way in mainstream services.

Disability must be carried on the cabinet agenda if we are to address the appalling inequality and social exclusion that people with a disability face.

 ***

Other reaction

• CHF: Health Reform Agenda to Maintain Momentum

• AHHA: New approaches to health funding needed

• Report by Adrian Rollins, AMA: “a move replete with symbolic and substantive meaning”

What it means to have Ken Wyatt in Government’s inner circle

CongratsKW2CongratsKW

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