COAG Indigenous Reform Agenda 6 targets for Closing the Gap

1. Council of Australian Governments (COAG)CLOSING THE GAPGP NSW WorkshopGayle AndersonState ManagerNSW Office Department of Health & Ageing5 August 2009

2. COAG Indigenous Reform Agenda6 targets for Closing the Gap • To close the gap in life expectancy within a generation • To halve the gap in mortality rates for Indigenous children under five within a decade • To ensure all Indigenous four years olds in remote communities have access to early childhood education within five years • To halve the gap in reading, writing and numeracy achievements for Indigenous children within a decade • To halve the gap for Indigenous students in year 12 attainment or equivalent attainment rates by 2020 • To halve the gap in employment outcomes between Indigenous and non-Indigenous Australians within a decade.

3. COAG Indigenous Reform National Partnership Agreements • Indigenous health • Indigenous economic participation • Remote Indigenous housing • Indigenous early childhood development • Remote service delivery

4. THE INDIGENOUS HEALTH NATIONAL PARTNERSHIP AGREEMENT2009- 2013 ($1.6 BILLION OVER 4 YEARS)

5. The Indigenous Health NPA (IHNP)five priority areas • Tackling smoking • Primary health care services that can deliver • Fixing the gaps and improving the patient journey • Providing a healthy transition to adulthood; and • Making Indigenous health everyone’s business. Funding of approximately $1.6 billion over 4 years: • Commonwealth: $805.5 million • States and Territories: $771 million The Commonwealth will contribute to the first three and state and territory governments will contribute to all five priorities.

6. IHNPCommonwealth and State/Territory components by year($1.6 billion over 4 years)

7. Indigenous Health National PartnershipCOMMONWEALTH GOVERNMENTMEASURES

8. The Commonwealth’s component –Indigenous Chronic Disease Package • The package provides $805.5 million over four years from 2009–10 • The initiatives are designed as a complementary package of measures to improve access to health services for Aboriginal and Torres Strait Islander people • The package has three broad strategies targeted towards closing the life expectancy gap between Indigenous and non-Indigenous Australians

9. Three broad strategies • Tackling chronic disease risk factors • Improving chronic disease management and follow-up care • Workforce expansion and support

10. (A) Tackling chronic disease risk factors • Measures in this area will address risk factors including smoking, poor nutrition and lack of exercise, and deliver community education initiatives to reduce the prevalence of these risk factors in Aboriginal and Torres Strait Islander populations. • National and local Indigenous tobacco campaigns, a new tobacco control workforce, a health promotion workforce, lifestyle modification programs and improved access to quit smoking services will be provided.

11. (B) Improving chronic disease management and follow-up care • Measures in this area will deliver a comprehensive chronic disease management program that provides improved uptake of health checks and follow-up care in a coordinated, accessible and systematic manner. • Incentives will be provided to encourage general practices to improve the coordination of health care for Indigenous Australians, and promote best practice management of patients with chronic disease. • Greater support will also be provided for Indigenous Australians to actively participate in their own health care, in addition to improved access to affordable medicines, multidisciplinary follow up care and specialist services for Indigenous Australians with a chronic disease.

12. (C) Workforce expansion and support • Measures include promotional activities to increase recruitment to the Indigenous health workforce; • additional staff such as tobacco workers, healthy lifestyle workers and Indigenous Outreach Workers, health professionals, practice managers and project managers; and • 50 additional nursing scholarships, 38 registrar training posts and nurse clinical placements. • Indigenous specific clinical practice guidelines will also be developed to assist health professionals in tackling the key conditions that contribute to the gap in life expectancy.

13. Specific measures involvingGeneral Practice, Divisions and SBO

14. Additional Workforce in DGPs • Indigenous Health Project Officers • In DGPs to improve the capacity of General Practice • Indigenous Outreach Workers - encourage Indigenous Australians to access mainstream health care options and to utilise general practice

15. Indigenous Health Project Officers 80 Project Officers nationally Lead role in Division on Indigenous health - coordinating and supporting the various Closing the Gap measures - improve the capacity to deliver a wider range of culturally appropriate services - establish and maintain linkages

16. Indigenous Health Project Officers Location of Project Officers • Sites currently being finalised • Allocation primarily based on size of indigenous population in Division’s area • Very small population = no project officer

17. Indigenous Outreach Workers 80 IOWs nationally in DGP 80 IOWs nationally to AMSs Support indigenous access to health services

18. Indigenous Outreach Workers Location of IOWs • Priority communities – based on chronic disease factors, capacity • Advice from NSW Aboriginal Health Forum • Staged rollout – around 50% in 09/10 • Supported by Project Officer

19. IOWs POTENTIAL ROLE OF INDIGENOUS OUTREACH WORKERS • encourage and support people to access health services in a culturally safe environment. • pro-actively support and guide people on their journey through the primary health care system. • may not have any formal qualifications. • strong links into the local community, • good communication

20. IOWs The IOW will have a non-clinical role. Activities may include: • assisting with first contact with the primary health care services; • identifying those who may require a health check • reminders of appointments and escorting people to appointments; • assisting people to fill prescriptions; • assisting people to attend specialist care services; • providing information to people about how to access available services, particularly in relation to chronic disease (ie tobacco programs, health and wellbeing programs); and • assisting people who do not have a Medicare card to get one.

21. AMS Workforce 80 IOWs in AMSs • Complementary strategy to IOWs in General Practice Practice Managers in AMSs

22. IOW Education/training - skills and knowledge • during their first six months • Certificate level II training

23. Chronic Disease Management Program • the CDM Program aims to encourage general practice to provide better health care for Indigenous Australians, including best practice management of chronic disease • Components • PIP Indigenous Health Incentive • Care coordination and Supplementary services • Increased access to specialist care • Commences May 2010

24. Chronic Disease Management Program PIP Indigenous Health Incentive • Sign-on Payment • Patient Registration Payment • Outcomes Payment

25. Chronic Disease Management Program Care Coordination • Coordinators role - support patients care plan - arranging services required, - assisting the patient to attend appointments, - transferring and updating of medical records, and - ensuring regular reviews • Positions likely to be nurses or Aboriginal Health Workers.

26. Chronic Disease Management Program Care Coordinators • Commences after PIP incentive in place –post May 2010 • Small numbers in year 1 • Targeted at chronic disease patients from PIP registered practices

27. Chronic Disease Management Program Supplementary Services • Allied health • Local transport • SBO fundholding • Commences May 2010

28. Chronic Disease Management Program • Changes to the MBS to allow 10 rather than 5 follow up services by a practice nurse or Aboriginal Health Worker per patient per calendar year, to an Indigenous patient who has received an Indigenous Health Assessment

29. Chronic Disease Management Program Specialists • Urban outreach services and follow up care • Rural – expand MSOAP (patients receiving services not required to be registered under PIP)

30. Pharmaceutical Benefits Scheme PBS Medicine Co-payments • assistance to Indigenous patients to improve access to Pharmaceutical Benefits Schedule (PBS) medicines, including assistance towards the cost of co-payments • available to patients receiving treatment at Indigenous health services and at general practices participating in the Indigenous chronic disease initiative proposed for implementation under the Practice Incentives Program

31. Other measures Lifestyle change and self-management for chronic disease • Healthy lifestyle workers • Train workers to deliver in self-management programs • Referral from health checks

32. Other measures Practice Support Guidelines • a comprehensive chronic disease management tool will be developed for use by health care professionals in the prevention and primary care management • existing mainstream guidelines for the management of chronic disease do not adequately address health management needs specific to Indigenous people • clinical practice and decision support guidelines specific for the Indigenous context will be collated and presented in a single management tool to further support better access to evidence-based care