Michael Kakakios Primary Health and Community Partnerships Branch April 2007

1. What is the future of multicultural health? Michael Kakakios Primary Health and Community Partnerships BranchApril 2007

2. Where have we come from? • The period of the 1980’s and 1990’s was a period of rapid growth for multicultural health in NSW • The period since 2000 is more uneven. While there has been growth in the funds available this has not been uniform. The growth has occurred in areas such as the HCIS and statewide multicultural health services

3. Where are we now? • At the Commonwealth level the Australian Government, faced with an ageing population has responded by: • Increasing the immigration intake • Providing incentives for increasing the number of births (5.8% increase since 2004) In response to the criticisms about the way they have handled refugee issues, they have: -beefing up services to refugees -focused more on improving coordination of services and programs

4. Current situation (continued) • At the NSW Government level: • New legislation (Community Relations and Principles of Multiculturalism Act 2000) has enhanced the policy context • The new Act has had a positive impact on a number of key departments. New multicultural units have been established in many key service departments • Better systems for coordinating policy (NSW Government Immigration Settlement Planning Committee) • The NSW State Plan

5. The Future: Work within the relevant NSW policy context

6. Current situation (continued) • At the NSW Health level: • A more complex work environment caused by a surging growth in demand (ageing population, ageing population, financial sustainability, workforce shortages, technology, growing community expectations) • AHS restructure & more pressure to contain the size of the Department. The pressures are not specific to multicultural health however, they are system wide • Still a modest growth in the area of refugee health, mental health • Problems remain however, partly due to the scale of the operation eg interpreters

7. The Current Situation (continued) • NSW Health is a large complex system (Approximately $11billion): • In 2004/05: • there were in NSW 61 million clinical interventionsprovided in the community (24.5 million in the public community health system and 36.2 million GP presentations) • 2.2 million public & private hospital admissions • Approximately 100,000 health workers • Approximately 15% turnover in health staff.

8. The current situation: Multicultural health program in NSW 2005/06 • Total budget for multicultural health program (dedicated to services that target CALD communities) was $43.2 million p.a. • Employed 547 full time equivalent staff • HCIS – 35% of the budget • Recurrent funding for AHS positions 28% of budget • Statewide multicultural services 18% • Non-recurrent projects 18%

9. The current situation: Interpreter usage

10. The current situation: Structure of multicultural health in NSW

11. The future: Where to start? • Action needs to occur at 3 levels simultaneously: • -Political level (political party platforms) • -policy level (develop and implement practical solutions to real problems and risks) • -community level (work with NGOs & local members)

12. Priorities: What to do? At the national Level: • Political agenda • Explore the opportunities becoming available such as the renegotiation of the Medicare agreement • Refine the argument about equity • Bring the health professions on side eg the various health colleges, the AMA etc. • Ensure the Universities produced health professionals who are ready to function in a multicultural context and know how to use interpreters. Once in the system they are difficult to reach. We need to identify the competencies.

13. What to do? (continued) • At the NSW level: • Identify and articulate the opportunities offered by the State Plan & NSW Health Plan for improving the delivery of services to CALD communities • Establish a working relationship with new Minister who represents a very culturally diverse community • Respond to the desire to improve quality, effectiveness, reducing adverse events, contain escalating costs.

14. What to do? (continued) • Have good information on what in particular is going wrong within the health system for CALD communities and how it can be fixed- Solutions need to be practical, flexible and cost effective • Better alignment of the research with the practical realities of people working in the health system. Help health staff to manage the risks! • Be very clear about what new research needs to be undertaken and in whose interest it is being undertaken.

15. Who needs to be involved? • The Minister • Other appropriate agencies such as Anti-discrimination Board, Community Relations Commission, the health colleges, universities etc • The senior staff of the department-always identify your champions and use them to assist you to develop your strategy, refine your pitch, identify best time of approach • Area Health Service executives. They are responsible for large budgets and the direct management of the health services

16. Best approach? • Do not start with an us and them attitude. Remember the public sector employs a large number of highly educated, community spirited people who try to do the right thing within the context of limited budgets and significant constraints • Identify the problem that you want to solve properly and come up with sensible and cost effective solutions. Be solution focused not problem focused • Approach the solution from both points of view ie the consumer and the service provider. They both have needs that must be met

17. Best approach? • Consider the timing of your approach. May –October is not a great time to approach government departments • Work with champions in the organisation • Work on making people look good not bad.Remember everybody wants to be part of a successful outcome.