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Tuesday, 5 December 2017
Page: 9670


Senator McGRATH (QueenslandAssistant Minister to the Prime Minister) (16:28): I present five government responses to committee reports as listed on today's Order of Business. In accordance with the usual practice, I seek leave to incorporate the documents in Hansard.

Leave granted.

The documents read as follows—

Australian Government response to the Senate Community Affairs References Committee report:

Care and management of younger and older Australians living with dementia and behavioural and psychiatric symptoms of dementia (BPSD)

Foreword

In 2017, there are an estimated 365,100 people in Australia living with dementia. This is expected to increase to almost 900,000 by 2050.

The Senate Community Affairs References Committee report Care and management of younger and older Australians living with dementia and behavioural and psychiatric symptoms of dementia (BPSD) provides 18 recommendations on a range of issues affecting people living with dementia in Australia. Since the report was tabled, the Australian Government has taken action through a wide range of initiatives and reforms targeting dementia.

These actions are outlined in this response and underpinned by the National Framework for Action on Dementia 2015-2019 (NFAD). The NFAD was endorsed by the Council of Australian Governments Health Council on 7 August 2015. It outlines Australian, state and territory government priorities across primary, acute and aged care to reduce the risk of dementia and improve the quality of life for people living with dementia and their support networks.

On 29 May 2017, Australia supported the adoption of the World Health Organisation Global Action Plan on the Public Health Response to Dementia 2017-2025 (GAP). The goal of the GAP is to improve the lives of people living with dementia, their carers and families, while decreasing the impact of dementia on them as well as on communities and countries. The GAP includes seven distinct action areas and outlines measurable targets for achievement.

The WHO Global Dementia Observatory provides the monitoring mechanism to track implementation and progress of the GAP and will be a valuable resource for knowledge translation and exchange. Australia is proud to be among the first countries supporting and sharing our data and resources on this platform.

The Australian Government is committed to the provision of quality services for people living with dementia, their families and carers, as well as research into the prevention, diagnosis, treatment and cure of dementia. In the 2014-15 Budget $200 million over five years was allocated to boost Australia' s dementia research capacity and deliver best practice support for people with dementia across the health system. Key priorities of projects funded under this commitment are improving care and interventions for the behavioural and psychological symptoms of dementia and maximising the independence of people living with dementia. Research funding includes a strong knowledge translation component to translate research findings into practice within dementia policy and programs.

Phase one of the re-design of national dementia support programs and services was announced by the Government on 25 January 2016. The co-designed reforms are based on the advice of stakeholders and experts received through the Ministerial Dementia Forums of 2014 and 2015 and KPMG' s nationwide consultation and analysis of dementia programs commissioned by the Government in 2015. Outcomes of the redesign address many of the report' s recommendations.

Importantly, the redesign included the engagement of a single national provider to deliver nationally consistent accredited dementia training and education to the aged care workforce and health care professionals across Australia. Accredited training in best practice care of people with behavioural and psychiatric symptoms of dementia is available free to eligible health professionals and care workers.

Other key elements of service redesign include the establishment of the Severe Behaviour Response Teams (SBRT) and engagement of a single national provider to deliver the Dementia Behaviour Management Advisory Service (DBMAS) across all states and territories. The national DBMAS supports staff and carers in community, residential, acute and primary care settings with information, advice, assessment and short term case management interventions. Family carers, health professionals and aged care providers have access to 24 hour advice and support to improve the quality of life of the person living with dementia. The SBRT supports Commonwealth funded approved residential aged care providers requiring assistance with addressing the needs of people with severe and very severe BPSD.

A mobile workforce of multidisciplinary clinicians also provides locally delivered person-centred interventions, capacity building and resources for carers and organisations to improve skills in the care of people living with dementia in the longer term.

The Ministerial Dementia Forum held in December 2016 focused on redesigning dementia consumer supports to ensure national consistency and regional and remote coverage. The Government is now working with stakeholders on phase two of the redesign of national dementia support programs to develop an improved suite of dementia consumer supports for people living with dementia and their carers across the life-cycle of the disease.

The Government has also supported additional research and service improvement projects at a cost of more than $30 million through three rounds of the Aged Care Service Improvement and Healthy Ageing Grant Fund between 2012 and 2017. Projects address a range of priorities identified through the NFAD including improving dementia diagnosis and care in hospitals and primary care settings, delivering sensory experience interventions, reducing the use of antipsychotic medications in aged care facilities and development of tools and resources to manage and reduce behavioural and psychological symptoms of dementia (BPSD).

In June 2016, the Government committed to establishing Specialist Dementia Care Units (SDCUs) across Australia to support residents with very severe BPSD.

In addition, the Australian Government has provided funding over three years from June 2016 to Dementia Australia (formerly Alzheimer' s Australia) to establish the Dementia Friendly Communities initiative, which is designed to help ordinary Australians better understand dementia. This educative, community awareness raising program aims to give people a greater understanding of dementia and the small things that can be done to make a real difference to people living with the condition. A national dementia-friendly community resource hub will also be developed, to enable communities to network, learn from other initiatives and provide the latest evidence and information on best practice approaches to increasing community awareness and support for people living with dementia.

Aged Care Reforms

The Australian Government is implementing significant reforms to the delivery of aged care services for older people and their carers to ensure that Australia has the best possible system, which is sustainable and affordable. The reforms are consistent with the long term policy direction recommended by the Productivity Commission in its 2011 inquiry into Care for Older Australians.

A number of review processes have also recently been conducted that investigated how aged care services are delivered and the protections for vulnerable older Australians.

On 1 May 2017, the Government announced an independent Review of National Aged Care Quality Regulatory Processes (the Review). The Review was led by Ms Kate Carnell (AO), in conjunction with Professor Ron Paterson (ONZM), and examined Commonwealth aged care accreditation, monitoring, review, investigation, complaints and compliance processes. On 25 October 2017, the Minister for Ageing, the Hon Ken Wyatt AM, MP released the Review report. The Government is considering the Review recommendations.

On 15 June 2017, the Australian Law Reform Commission released its report into elder abuse, recommending tighter regulation and safeguards in relation to the use of restrictive practices in residential aged care. The Review panel considered these recommendations.

The Government recognises that care for older people living with dementia is an integral part of the aged care system.

The Australian Government is committed to the provision of quality services for all older Australians, including for people living with dementia, their families and carers, as well as research into dementia prevention and cure.

Responses to the recommendations have been developed collaboratively by the Department of Health, the Department of Social Services, the Australian Commission on Safety and Quality in Health Care and the National Health and Medical Research Council.

Recommendation 1

The Committee recommends that the Commonwealth create a new Medicare item number that encourages General Practitioners, registered psychologists or other relevant accredited professionals, to undertake longer consultations with a patient and at least one family member or carer where the patient has presented with indications of dementia (para 2.42).

Noted

The Australian Government notes this recommendation.

The second priority area for action under the National Framework for Action on Dementia 2015-2019 (NFAD) is "The need for timely diagnosis". Under this priority, the Government has committed to the following outcome: Australians will have access to skilled and knowledgeable health professionals who can support and provide an accurate and timely diagnosis of dementia.

The Government recognises the important role that can be played by primary care providers in the identification, assessment and management of dementia.

The Government' s view is that rather than creating a new Medicare Benefits Schedule (MBS) item, it would be more appropriate to consider whether current items are effective through the Medicare Benefits Schedule Review and Primary Health Care Advisory Group, and also to improve doctors' awareness of existing MBS items that allow for cognitive screening and care planning.

Whilst there are no specific items for dementia diagnosis and intervention under the Medicare Benefits Schedule (MBS) arrangements, a wide range of existing items may be used for these purposes. These include:

health assessments provided for people aged 75 years and older that can be undertaken annually - MBS items 701-707

comprehensive medical assessments in residential aged care facilities that can be provided annually - MBS items 701, 703, 705 and 707

longer consultations using the standard general practitioner attendance items - Level C attendance item - lasting at least 20 minutes, and the Level D attendance item - lasting at least 40 minutes are available for people of any age with suspected or diagnosed dementia

Chronic Disease Management (CDM) items such as MBS items 721-732. The package of CDM items includes Medicare rebateable items for GP-managed care planning and/or team assisted care planning, items to review care plans and contribute to care plans prepared by other providers including residential aged care services, and a mechanism for GPs to refer patients for Medicare rebateable allied health services

MBS rebates available for professional attendance by specialists and consultant physicians in the practice of geriatric medicine - MBS items 141-149. Some of these services may be to diagnose, treat or monitor patients with dementia and some of these items are for consultations of over 60 minutes and can be undertaken at a hospital or in a patient' s home. One of these MBS items (145 for Consultant Physician or Specialist in Geriatric Medicine, Referred Patient, Initial Comprehensive Assessment and Management - Home Visit) has a rebate of $469.35 as at January 2017.

On 22 April 2015, the Government, announced an MBS Review Taskforce. The Taskforce is undertaking a program of work to review all MBS items to ensure they are contemporary, reflect current clinical practice and allow for the provision of health services that improve health outcomes. Further, it will identify services that are considered unsafe or ineffective.

It is anticipated that the Mental Health Services Clinical Committee will be established to review psychiatry, GP mental health and psychology MBS items.

The Government also established the Primary Health Care Advisory Group, led by Dr Steve Hambleton, former Australian Medical Association President. The Advisory Group investigated options to provide: better care for people with complex and chronic illness; innovative care and funding models; better recognition and treatment of mental health conditions; and greater connection between primary health care and hospital care. Following an extensive national consultation process and review of the evidence, the Advisory Group provided a final report to Government in December 2015.

In response to that report, as announced on 31 March 2016, the Government is providing funding for stage one of the establishment of Health Care Homes in ten Primary Health Networks (PHNs) regions across Australia from 2016-17 through 2019-20. Under this model, eligible patients with chronic and complex health conditions will voluntarily enrol with a participating medical practice known as their Health Care Home. This practice will provide a patient with a ' home base' for the ongoing coordination, management and support of their conditions. The model moves away from current fee-for-service payments for these eligible patients except for routine health issues not related to their chronic illness.

Recommendation 2

The Committee recommends that the Commonwealth consider increasing funding for the Younger Onset Dementia Key Worker Program in order to provide support to all people living with dementia. The increased funding should also ensure that accurate data is collected for evaluation purposes (para 3.39).

Not Supported

The Australian Government does not support this recommendation.

Priority four of the NFAD is "Accessing ongoing care and support".

The Younger Onset Dementia Key Worker Program (YODKWP) is transitioning to the National Disability Insurance Scheme (NDIS). Transitioning to the NDIS will provide the opportunity for Dementia Australia to receive significantly more funding whilst providing services to eligible people with younger onset dementia.

The Government' s priority is to ensure that the NDIS is structured to provide support to those who need it. The NDIS is designed to provide people with disability, their families and carers greater choice and control over the course of their lives, including the flexibility to make decisions about which disability services and supports they use. Evidence suggests that when people with disability are given greater choice and control over their services they achieve better life outcomes.

Access rates for the YODKWP have not been high and performance statistics do not support expansion of the program. An evaluation of this program is currently underway and although initial reports suggest that the program has resulted in some good outcomes so far, it would be inappropriate to expand the program based on preliminary findings without the analysis of longer term, more meaningful data.

The Cognitive Decline Partnership Centre funded by the National Health and Medical Research Council (NHMRC) and industry groups recently conducted an evaluation of current models of key workers for people living with dementia in Australia, including a systematic review of the evidence in Australia and internationally. The key findings from the evaluation supported the role of dementia support workers and identified a need to further explore ways to increase access to the role within consumer directed care. Trialling and aligning the model with Primary Health Networks was also recommended. Key findings are relevant to future policy development.

Recommendation 3

The Committee recommends that each State and Territory develop dementia training facilities similar to the Perc Walkley Dementia Learning Centre in Victoria (para 3.40).

Noted

The Australian Government notes this recommendation.

Priority four of the NFAD is "Accessing ongoing care and support". The related action to which the Government has committed is: Support system wide, organisational and workforce awareness of BPSD together with evidence-based prevention and management strategies, including the provision of dementia friendly environments.

The Government recognises the role that the physical environment and design of the care setting plays on providing high quality care to people living with dementia. Noting environmental design as an emerging priority, the Government is committed to providing flexible funding for a range of different approaches. The Government also notes that the aged care industry and the community share a role in ensuring environments are dementia friendly.

In 2013-14 the jointly funded Commonwealth-Victorian Home and Community Care program provided one-off funding to Dementia Australia Victoria towards establishment of the Perc Walkley Dementia Learning Centre in Victoria. The Perc Walkley Dementia Learning Centre is a dementia learning facility which showcases dementia friendly design. The goal of the Centre is to provide education on how workplaces, homes and public spaces can become dementia friendly. The Centre creates a multi-sensory simulation using light, sound, colour and visual content to create a virtual reality experience at the Centre, which enables aged care and health care workers to be taken into the world of people living with dementia.

The Australian Government funds the Dementia Training Program (DTP) to provide dementia-specific training to aged care, health care and other community providers and their staff in order to improve the care and wellbeing of people living with dementia. The DTP offers an environmental design workshop and consultancy for aged and healthcare services. A consultancy and resources specifically for the design, construction and maintenance of aged care facilities for Aboriginal and Torres Strait Islander peoples is also available. The program provides service managers and their design consultants with the knowledge, resources and tools required to understand the effects of the built environment on the person living with dementia and modify the environment to promote well-being while reducing confusion and depression. The information is provided through education and on-site consultation and is available in each state and territory.

The Government acknowledges the ongoing work of non-government organisations in improving environmental design. For example, Dementia Australia Victoria and HammondCare have both been involved in development of virtual reality dementia training technology which enables anyone to experience planned physical spaces from the perspective of someone living with dementia. The technology assists care staff, designers and builders to understand sensory challenges for a person living with dementia and design environments that are much more welcoming and less confronting.

The Government-funded DBMAS provider notes that environmental factors contribute to over 70 per cent of referred cases. To inform practice, the DBMAS provider can use portable virtual reality technology to educate staff about how sensory challenges contribute to behavioural and psychological symptoms of dementia.

The Government currently funds Dementia Australia New South Wales for a trial of a dementia-specific experiential learning program in hospitals. The program uses a train-the-trainer model to engage hospital staff in simulation exercises to see how life might be experienced by their patients with dementia. The program is an opportunity for staff to reflect on the effect their work practices can have on the behaviour of those they are caring for.

Recommendation 4

The Committee recommends that the Commonwealth encourage relevant professional organisations, such as the Royal Australian College of General Practitioners, to ensure that patients diagnosed with dementia and their carers are informed by health professionals of the dementia supports available and how to access them (para 3.53).

Supported In-Principle

The Australian Government supports this recommendation in principle.

Two priority areas for action under the NFAD is "the need for timely diagnosis" and "accessing care and support post diagnosis".

The Australian Government has delivered multiple initiatives to increase awareness for patients, carers and General Practitioners about the pathways into support and care.

The NHMRC Cognitive Decline Partnership Centre (the Centre) has developed Clinical Practice Guidelines and Principles of Care for People with Dementia (the Guidelines) in consultation with an expert multi-disciplinary Guideline Adaptation Committee convened by the Centre. The Guidelines provide recommendations for the diagnosis and management of dementia and are intended for use by staff working with people living with dementia in the health and aged care sectors. The Guidelines also inform GPs about the key entry points for support services for the person with dementia, including Dementia Australia, My Aged Care, Carers Australia and the Aged Care Assessment Teams.

The Centre has also published Diagnosis, treatment and care for people with dementia: A consumer companion guide to the Clinical Practice Guidelines and Principles of Care for People with Dementia. This consumer version of the Clinical Practice Guidelines includes accessible information about the latest evidence on dementia as well as information about the full range of dementia services and support. It is available from: www.sydney.edu.au/medicine/cdpc/resources/dementia-guidelines.php. The guidelines and the consumer companion have both been promoted to GPs via the Primary Health Networks.

GPs also have access to the HealthPathways program which is a web-based information portal supporting primary care clinicians to plan patient care through the primary, community and acute health care systems. This is designed to be used at the point of care, primarily for General Practitioners but is also available to Hospital Specialists, Nurses, Allied Health and other Health Professionals.

Other activities undertaken by the Department of Health may also assist dementia patients and their carers to be aware of the supports available to them. This includes the establishment of Primary Health Networks (PHNs) which aim to improve the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and improve coordination of care to ensure patients receive the right care in the right place at the right time.

PHNs have undertaken their baseline needs assessments and prepared their 2016-18 Activity Work Plans which have informed their commissioning decisions from 2016-17. While there are no activities specifically devoted to dementia in PHNs' first Activity Work Plans (submitted in May 2016), a number of them give consideration to dementia within broader activities that are focused on aged care including falls prevention, medication management, advanced care planning, palliative and end of life care, and promotion of healthy ageing.

Another important initiative was the launch of My Aged Care in 2013 and its expansion in 2015 to become a true gateway for consumers to have their needs assessed and where appropriate, be referred to government funded aged care services. My Aged Care now includes a central client record to facilitate the collection and sharing of information, holistic needs assessment through a national standardised assessment form, online referral management and web based portals for clients, assessors and service providers.

Prior to the establishment of My Aged Care, there was no central pathway for older people to access information and services. The transition to My Aged Care was a significant shift in how information, assessment and referral to access aged care services took place.

The My Aged Care Regional Assessment Service (RAS) conducts face-to-face home support assessments for clients seeking entry-level support at home, provided under the Commonwealth Home Support Program (CHSP). The Aged Care Assessment Teams (ACATs) conduct face-to-face comprehensive assessments to determine a client' s eligibility for care types under the Aged Care Act 1997, including home care packages, residential care, residential respite care, Transition Care and Short Term Restorative Care.

In June 2017, the Government launched a national awareness campaign promoting the My Aged Care website and national 1800 phone line. The advertising campaign will run in newspapers, magazines, radio, digital and social media. Other public relations activities will also be undertaken, including materials being available in 4,820 GP surgeries across the country.

In addition, carers are able to access further support through the Carer Gateway at https://www.carergateway.gov.au.

Resources are also available to encourage clinicians in hospital settings to provide information on support and referrals for care. In 2014, the Australian Commission on Safety and Quality in Health Care (the Commission) released resources titled A better way to care: safe and high quality care for patients with cognitive impairment (dementia and delirium) in hospitals. This publication emphasises the importance of a comprehensive assessment that includes assessing and addressing the support needs for carers.

The booklet Dementia and Your Legal Rights created by Dementia Australia, contains practical information for people living with dementia, and their families and carers, for when the person with dementia no longer has the mental capacity to make decisions that affect them. This resource could assist GPs to support people living with dementia and their family and carers.

Recommendation 5

The Committee recommends that the Commonwealth facilitate and potentially fund the establishment of dementia-specific respite facilities, including in regional and remote areas (para 3.95).

Noted

The Australian Government notes this recommendation.

Priority four of the NFAD is "Accessing ongoing care and support". The related action to which the Government has committed is:

Provide people with dementia and their carers and families access to appropriate and responsive respite services.

Given its prevalence amongst older people, the Government considers the provision of appropriate care and support of people with dementia, their families and carers to be core business for all providers of aged care (including respite care). To support this, the Government provides a broad range of training and resources in dementia care for the aged care sector, as outlined in other recommendations in this document.

The Government acknowledges the unique respite needs of people living with dementia and their carers, as well as the additional challenges faced by those living in regional and remote areas. Consequently, the Government currently funds a range of programs and initiatives that provide respite support for carers of people living with dementia.

The CHSP provides a range of planned respite services for older people including flexible respite such as in-home respite and host family respite; cottage respite; and centre-based respite. Respite services provided through the CHSP are complemented by other respite services including emergency respite, which can be accessed through the Commonwealth Respite and Carelink Centres (CRCCs), and residential respite (short term stays in aged care homes).

In response to the growing need for planned respite services for frail older clients, the 2016 CHSP Growth Funding Round targeted planned respite services as a priority area across a number of Aged Care Planning Regions for identified client groups. Through this funding round, an additional $115 million has been made available to deliver additional aged care services, including an increased number of planned respite services.

Residential respite is provided across Australia. In 2015-16, of the 2,669 aged care homes that claimed Australian Government residential care subsidies, 2,438 (91 per cent) claimed for delivering residential respite care. This includes 944 (91 per cent) of the 1,042 aged care homes located in regional, remote or very remote areas of Australia.

The Australian Government funds 54 CRCCs nationally to assist carers, including those living in rural and remote locations. CRCCs provide a link to carer support services and assist carers with options to access short-term and emergency respite. Where appropriate, a Centre can help with putting in place regular respite for a carer to reduce the need for unplanned and emergency respite. CRCCs also provide information about carer support services in their local area.

As noted in response to Recommendation 4, My Aged Care is the primary entry point to Australia' s aged care system. My Aged Care provides information about ageing and aged care, and also assesses people' s needs, as well as locating and accessing suitable services, including respite care.

The Department of Social Services (DSS) administers a range of services and programs to specifically support carers. DSS is currently developing and implementing a new Integrated Plan for Carer Support Services which seeks to recognise, support and sustain the vital work of unpaid carers. The first stage of the plan is the implementation of the Carer Gateway, which supports carers to locate and access carer support services. The Carer Gateway can be accessed at https://www.carergateway.gov.au.

The Department of Health is working collaboratively with the DSS to ensure that the support needs of clients and their carers are can considered holistically and in recognition of the importance of supporting the ongoing care relationship.

Recommendation 6

The Committee recommends that the Commonwealth, in consultation with industry, develop guidelines regarding dementia-specific respite facilities that can effectively manage BPSD (para 3.96).

Noted

The Australian Government notes this recommendation.

Priority four of the NFAD is "accessing ongoing care and support". The related action to which the Government has committed is:

Provide people with dementia and their carers and families access to appropriate and responsive respite services.

The Government acknowledges that transitioning from home to respite and back again can be very difficult for a person living with dementia.

As noted in the Foreword, the national DBMAS supports staff and carers in community and residential care services (including respite care), as well as acute and primary care settings. DBMAS provides information, advice, assessment and short term case management interventions to improve the quality of life of the person living with dementia. SBRTs support Commonwealth funded approved residential aged care (including respite care) providers requiring assistance with addressing the needs of people with severe and very severe BPSD.

These services can be provided to support the transition of a person living with dementia to and from respite care. Through both programs, a mobile workforce of multidisciplinary clinicians provides locally delivered person-centred interventions, capacity building and resources for carers and organisations to improve skills in the care of people living with dementia in the longer term.

As previously noted, the Australian Government also funds 54 CRCCs nationally to assist carers, including those living in rural and remote locations. CRCCs provide a link to carer support services and assist carers with options to access short-term and emergency respite. Where appropriate, a Centre can help with putting in place regular respite for a carer to reduce the need for unplanned and emergency respite. CRCCs also provide information about carer support services in their local area.

In 2012, the Dementia Behaviour Management Advisory Service produced guidelines around the management of BPSD. Specifically, the Behaviour Management: A Guide to Good Practice - Managing Behavioural and Psychological Symptoms of Dementia (the Guide) is a comprehensive evidence and practice-based overview of BPSD management principles which enables practical strategies and interventions for assisting care staff and family members in any setting including facilities offering respite care.

Following the release of the Guide in 2012, the Government has also funded additional resources: the Managing BPSD App for Clinicians is a quick reference guide to assist clinicians when they are presented with BPSD and is based on the Guide. This clinicians' app has now also been modified into a Managing BPSD App for Family and Carers to assist family carers in responding to and understanding the behaviours associated with the person' s dementia.

Both apps cover topics such as:

a description of the symptom and how it presents in dementia;

potential causes and/or contributing factors

precautions that can be taken to reduce the chance of some behaviours.

Research on BPSD will increase the evidence base to inform guidelines and implementation strategies for effective management of BPSD across a range of care settings including respite care facilities. One of the objectives of the NHMRC National Institute for Dementia Research (established under the Boosting Dementia Research 2014-15 Budget measure) is to strategically expand dementia research by identifying essential research priorities for Australia across the full spectrum from basic research to research translation. A comprehensive consultation with a diverse range of stakeholders, including researchers, clinicians, consumers and policy makers has been undertaken to identify priority areas for Australian dementia research and translation. An evidence based approach to manage BPSD to support dignity and quality of life of a person with dementia, as well as quality of care and the wellbeing of the carer, emerged as a key priority.

Recommendation 7

The committee recommends that the Commonwealth explore options for improving the provision of respite in rural and remote areas (para 3.97).

Noted

The Australian Government notes this recommendation.

The Australian Government recognises that providers of aged care services located in rural and remote areas face particular challenges in service provision, including issues related to the operation of small services, higher infrastructure and supply costs, and difficulties in attracting and retaining staff.

The Australian Government supports a range of respite options, in both residential, flexible care and home care settings, which carers of people living with dementia in rural and remote areas can access.

Australian Government subsidised aged care facilities are able to provide short-term care in the form of residential respite. Providers of residential respite care do not have a separate allocation of residential respite places. Rather, a portion of each permanent allocation of residential care places is used for the provision of respite care. It is a matter for the provider as to the mix of respite and permanent residential care places delivered within the financial year. The provision of residential respite services depends on the willingness and ability of providers to provide respite care.

In 2015-16, of the 2,669 residential aged care services, 2,438 provided residential respite at some stage in the financial year. Throughout 2015-16, there were 73,335 admissions to residential respite. Providing they are assessed as eligible for respite by an ACAT, people living with dementia are able to access these services.

Respite is also accessible through the Multi-Purpose Services (MPS) Program. The MPS Program is a joint initiative of the Australian and state and territory governments, and provides integrated health and aged care services for small rural and remote communities. MPS have an important role in small or isolated communities and allow services to exist in regions that could not viably support a stand-alone hospital or aged care home. At 30 June 2016, there were 177 MPS services providing 3,592 flexible aged care places. These places can be used to deliver residential care, respite care and home care services.

In addition to residential respite, the National Aboriginal and Torres Strait Islander Flexible Aged Care Program (the Flexible Aged Care Program) funds organisations to provide culturally appropriate aged care to older Aboriginal and Torres Strait Islander people close to home and community. Flexible aged care services funded under this program are located mainly in rural and remote areas, and can deliver a mix of residential and community services, including emergency or planned respite care, in accordance with the needs of the community.

As mentioned in response to Recommendation 5, the Government also funds more than 550 providers to deliver centre-based, cottage and flexible respite services through the CHSP, some of which are in rural and regional areas.

Also previously noted, the Australian Government funds 54 CRCCs nationally to assist carers, including those living in rural and remote locations. CRCCs provide a link to carer support services and assist carers with options to access short-term and emergency respite. Where appropriate, a Centre can help with putting in place regular respite for a carer to reduce the need for unplanned and emergency respite. CRCCs also provide information about carer support services in their local area.  

Recommendation 8

The Committee recommends that the accreditation standards for Residential Aged Care Facilities include requirements for dementia-friendly design principles (para 4.79).

Supported In-Principle

The Australian Government supports this recommendation in-principle.

Priority four of the NFAD is "Accessing ongoing care and support". The Framework notes that a safe, secure and homely environment can reduce confusion and agitation, improve way finding and encourage social interaction.

The Government recognises the role that the physical environment and design of the care setting plays on providing high quality care to people living with dementia.

The Accreditation Standards for residential aged care services include requirements for dementia-friendly design principles. Standard 4: Physical environment and safe systems requires approved providers to ensure care recipients live in a safe and comfortable environment that meets regulatory requirements and ensures the quality of life and welfare of care recipients, staff and visitors.

Further, Expected Outcome 4.4: Living environment, states that approved providers of residential aged care services are expected to be actively working to provide a safe working environment. Assessment of a Residential Aged Care Facility' s compliance against Standard 4 by the Australian Aged Care Quality Agency includes ensuring care recipients can access the environment easily and safely.

The Government has commenced the development of a single set of standards across all aged care services, including residential care. The new standards are being co-designed with industry and consumers, with advice from a Technical Advisory Group. Key objectives of the review are to increase the focus on outcomes for consumers in the standards and better support consumer choice and control.

As previously mentioned, the Government funds a number of initiatives to assist aged care providers to implement dementia-friendly design principles, including through the Dementia Training Program. This includes an environmental design education and consultancy for aged and healthcare services, which provides service managers and their design consultants with the information required to design high quality facilities for people living with dementia. The information is provided through education and on-site consultation.

Recommendation 9

The Committee recommends that the accreditation standards for Residential Aged Care Facilities reflect a better balance between clinical and quality-of-life outcomes (para 4.80).

Noted

The Australian Government notes this recommendation.

One of the key principles underpinning the NFAD is "People with dementia are valued and respected, including their rights to choice, dignity, safety (physical, emotional and psychological) and quality of life."

Consumer focus is one of the fundamental principles underlying the provision of quality care and services, whether the expected outcomes concern clinical care or lifestyle related outcomes. Residential aged care services are assessed against the Accreditation Standards by the Australian Aged Care Quality Agency. The Accreditation Standards contain four Standards and 44 Expected outcomes. The four standards are:

1. Management systems, staffing and organisational development

2. Health and personal care

3. Resident lifestyle

4. Physical environment and safe systems.

The Accreditation Standards were designed to protect and foster quality of care and quality of life of care recipients of aged care homes. They were also designed to support a structured approach to the delivery of quality care to care recipients.

The Accreditation Standards and expected outcomes cover a comprehensive range of care outcomes for consumers, from health and personal care through to considerations of independence, leisure interests, cultural and spiritual life, and the safety of consumers and staff. These care outcomes must be delivered in a way that enhance a consumer' s dignity and rights and promote well-being in a safe and comfortable living environment.

As previously noted, the Government has commenced the development of a Single Aged Care Quality Framework across the aged care sector. The new standards are being co-designed with industry and consumers, with advice from a Technical Advisory Group. In developing a single set of standards the intention is to:

provide consumers with greater consistency in expectations and continuity throughout their aged care journey

provide a greater focus on consumer engagement in line with a consumer directed care model

reinforce the consumer' s right to take risks in the pursuit of quality of life.

Consultation has been conducted on the draft single set of standards. The standards are being refined based on feedback from consumers and the sector. Once revised, the standards will be tested with a small group of providers. This work will be led by the Australian Aged Care Quality Agency. Further work will also be undertaken to develop education and guidance material to support the implementation of the new standards. Any changes to the standards will also involve amendment to the aged care legislation.

In addition to changes to Accreditation Standards, the voluntary National Aged Care Quality Indicator (QI) Program commenced in January 2016 with three clinical indicators (pressure injuries, use of physical restraint and unplanned weight loss) for residential aged care services.

Throughout 2016, the Department of Health worked closely with the National Aged Care Alliance Quality Indicators Reference Group, providers and consumers about next steps for the QI Program. Three tools to measure consumer experience and quality of life were piloted in residential aged care and home care. At the same time, the department also undertook a pilot to measure consumer goal attainment in home care.

In the longer term, information on QIs will be published on the My Aged Care website to give consumers transparent, comparable information about the quality in aged care to assist decision making; and for providers to have robust, valid data to measure and monitor their performance and support continuous quality improvement.

Recommendation 10

The Committee recommends that a phased program of accredited training in dementia and the management of Behavioural and Psychological Symptoms of Dementia (BPSD) be required for all employees of Residential Age Care Facilities (para 5.44).

Supported In-Principle

The Australian Government supports this recommendation in-principle and acknowledges workforce training and education is a shared responsibility between government and industry.

Priority four of the NFAD is "Accessing ongoing care and support". The related action to which the Government has committed is: Provide and promote dementia training and ongoing education for all staff that care for people living with dementia.

The Aged Care Act 1997 requires approved providers of Commonwealth-subsidised residential aged care to meet the Accreditation Standards and ensure that all care recipients are provided with quality care and services. The Accreditation Standards require aged care providers to ensure that staff have the appropriate knowledge and skills to effectively perform their roles. Recognising that many of the levers to influence the workforce rest with employers and providers, the primary responsibility for workforce rests with providers. Aged care providers are best placed to determine and manage their workforce needs. The Government will assist the sector with the development of an aged care workforce strategy.

The Government funds a suite of programs to help embed best practice care of people living with BPSD in the aged care workforce.

On 25 January 2016, the Government announced a new national approach to dementia care and training, in response to the 2015 Analysis of Dementia Programs. The DTP is now funded to provide nationally consistent dementia-specific training to aged and health care providers and their staff in order to improve the care and wellbeing of people living with dementia. The DTP' s training offerings for employees of residential aged care staff include the understanding of changed behaviours and the management of BPSD. Training is delivered across Australia, including in many rural locations.

DTP training for aged care providers and their employees includes:

accredited dementia care vocational level training courses - free to eligible care workers in residential, respite, community care or the wider health services

tailored onsite training to aged care providers who request assistance, including a dementia skills and environment audit, followed by a tailored training package.

As noted previously, the national DBMAS supports staff and carers in community and residential care services, including respite care. DBMAS provides information, advice, assessment and short term case management interventions to improve the quality of life of the person living with dementia. SBRTs support Commonwealth funded approved residential aged care (including respite care) providers requiring assistance with addressing the needs of people with severe and very severe BPSD. In addition to providing person-centred interventions, both programs offer capacity building and resources for carers and organisations to improve skills in the care of people living with dementia in the longer term.  

Recommendation 11

The Committee recommends that the Commonwealth take a proactive stance in highlighting the importance of staff training in dementia care, and develop linkages between care and education providers (para 5.45).

Supported In-Principle

The Australian Government supports this recommendation in-principle.

Priority four of the NFAD is "Accessing ongoing care and support". The related action to which the Government has committed is: Provide and promote dementia training and ongoing education for all staff that care for people living with dementia.

As previously noted, the Australian Government now funds the DTP to provide nationally consistent dementia-specific training to aged and health care providers and their staff in order to improve the care and wellbeing of people living with dementia. In addition to the training for aged care providers and their employees previously noted, the DTA provides Continuing Professional Development training on dementia assessment, diagnosis and management to GPs, nurses, pharmacists, psychologists, specialists, allied health and other relevant professionals as appropriate.

Delivered by a consortium of five universities and Dementia Australia, the DTP has a strong Essential Collaborators Network with members from leading aged care, specialist dementia care, health education and research organisations and actively promotes training for staff in aged, primary and acute care settings.

The DTP engages strongly with aged care and health providers and provides a customised combination of recommended courses, services and resources in response to an audit of the environment and an assessment of staff dementia skills and knowledge.

The DTP learning pathway is designed to enable clients to participate in training options which progress their knowledge from a foundation level to advanced dementia knowledge. The DTP supports choice in learning preferences, depths of engagement, training modality, and accreditation needs. It enables flexible training entry and exit points according to topic, time, and organisational factors.

Recommendation 12

The Committee recommends that the use of antipsychotic medication should be reviewed by the prescribing doctor after the first three months to assess the ongoing need. (para 6.19)

Supported In-Principle

The Australian Government supports this recommendation in-principle.

Under priority four "accessing ongoing care and support", the NFAD notes:

A decision about the use of medicine to treat BPSD is a clinical one made by the prescriber based on individual circumstances... Feedback should be obtained from people with dementia, their carers and families and regular pharmaceutical reviews by pharmacists and prescribers conducted.

As previously noted, the NHMRC Cognitive Decline Partnership Centre (the Centre) has developed Clinical Practice Guidelines and Principles of Care for People with Dementia (the Guidelines) in consultation with an expert multi-disciplinary Guideline Adaptation Committee convened by the Centre. Clinical Practice Guidelines have been shown to improve quality and consistency of care for people with a range of conditions.

The Guidelines advise that, if medication is used to manage BPSD, a range of consultations and medication management techniques should be implemented and:

its use should be reviewed every four to 12 weeks, considering the need for antipsychotics and possible cessation of medication

the review should include regular assessment and recording of changes in cognition and target symptoms.

The Guidelines also advise that, due to the increased risk of serious adverse events, people with mild-to-moderate behavioural and psychological symptoms of dementia should not usually be prescribed antipsychotic medications. In addition, the Guideline Adaptation Committee found that reducing over-prescription of antipsychotics should be prioritised for further research.

The decision to prescribe antipsychotic medicines for a resident of a residential aged care facility is a clinical decision made by the resident' s treating medical practitioner in consultation with the resident and their family or representative and other clinicians. As with any prescribing decision, the treating medical practitioner must balance the potential benefits of treatment against the potential risks, while taking into account the particular clinical circumstances of each resident. This decision is part of the overall care plan that Commonwealth funded aged care providers are required to develop and implement for each resident, which includes a thorough assessment of the resident' s physical and mental health to determine the most appropriate response to meet their care needs.

With respect to subsidy, in Australia there are already strict Pharmaceutical Benefits Scheme (PBS) restrictions, around the prescribing of antipsychotics to ensure they are used appropriately.

Most antipsychotic medicines available under the PBS require the prescriber to obtain and include an authority code on the prescription from the Department of Human Services. Prescribers are required to prescribe in accordance with the PBS restriction criteria and keep evidence of compliance and patient eligibility on patient records. The prescriber must also prescribe in accordance with his/her approved scope of practice under state or territory law, and comply with other State and Territory laws that regulate prescribing.

The independent, statutory Pharmaceutical Benefits Advisory Committee (PBAC) provides recommendations to the Government about PBS listings based on clinical evidence, and takes into account quality use of medicines issues in making its recommendations. As an example, at its November 2015 meeting, the PBAC recommended that an amendment be made to the PBS restriction for risperidone for the indication of behavioural disturbance in patients who have dementia and who have failed to respond to non-pharmacological methods of treatment, to align with the revised TGA indication. This amendment restricts use to moderate to severe dementia of the Alzheimer' s type and limits duration of treatment to 12 weeks based on updated evidence about the efficacy and toxicity of this medicine. Further information is available at http://www.pbs.gov.au/industry/listing/elements/pbac-meetings/psd/2015-11/files/risperidone-psd-november-2015.pdf.

A Post-Market Review of PBS Anti-Dementia Medicines for Alzheimer' s Disease was completed in 2012. The PBAC considered the Review report in December 2012 and accepted the Report' s findings that these medicines are being used in a broader population and for longer periods of time than originally anticipated.

To account for the use of these medicines in a broader population, the PBAC made a number of recommendations including restriction changes to make access to these medicines clinically appropriate for prescribers and patients who respond to treatment. Further information is available on the PBS Post-Market review website at: http://www.pbs.gov.au/info/reviews/anti-dementia-drugs.

In addition, as part of the announcement of the outcomes of the Chemotherapy Review on 30 November 2013, the Prime Minister announced the Government' s intention to review the Authority Required PBS Listings. The Department of Health conducted a Post Market Review of Authority Required PBS Listings, under the Australian Government' s National Medicines Policy framework. The objective of the Review was to improve patient safety and care by reducing administrative burden for health professionals.

The Review built on the PBAC' s consideration of a submission from the Australian Medical Association that recommended the movement of a number of medicines from Authority Required to Authority Required (Streamlined). The PBAC recommended that all Authority Required listings be reviewed to ensure that restrictions appropriately reflect the level of monitoring required to manage the quality use of medicines and the identified risks.

The Review was undertaken in tranches. The PBAC considered the first tranche of PBS Authority Required listings in December 2014 (which included medicines of the highest regulatory burden), the second tranche in March 2015 (which included medicines for psychiatric conditions such as antipsychotics), the third in July 2015, antibiotics and opioids in August 2015 and dermatological listings in December 2015.

The Review of Authority Required PBS listings is now complete. Implementation of PBAC recommendations is being progressed. The final Review report is expected to be published on the pbs.gov.au website in September 2017.

Further information about the Review of PBS Authority Required medicines is available on the PBS Post-Market Review website at:

http://www.pbs.gov.au/info/reviews/authority-required-listings.

The Government has funded two separate projects through the University of Tasmania and the University of New South Wales at a total cost of $4.1 million (2013 to 2016) aimed at reducing the use of sedative and antipsychotic medications in residential aged care facilities (RACFs).

Both projects involved the:

measurement of antipsychotic medication use in participating RACFs

education and training of participating GPs, staff, pharmacists and families on risks related to inappropriate antipsychotic medication use

regular review of individual residents taking antipsychotic medication by the prescribing doctor

Findings from these projects will inform future policy. 

Recommendation 13

The Committee recommends that residential aged care facilities, as part of their existing Aged Care Standards and Accreditation Agency annual audit process, report:

circumstances where an individual has been prescribed antipsychotic medication for more than six months, together with the reasons for and any steps taken to minimise that use; and

general usage patterns of antipsychotic medications in each facility (para 6.20).

Noted

The Australian Government notes this recommendation.

Under priority four "accessing ongoing care and support", the NFAD notes:

It is vital to adopt a collaborative approach to the management of medications for people with dementia as many medicines may induce or worsen BPSD. Feedback should be obtained from people with dementia, their carers and families and regular pharmaceutical reviews by pharmacists and prescribers conducted.

Approved providers of residential aged care must meet the requirements of the Accreditation Standards under the Aged Care Act 1997. Further, each state and territory has legislation covering the use, administration and ordering of medicines. This may include the relevant minimum competency or qualification level required. Providers are required to ensure that all treatments and procedures, including medication, comply with the requirements of their specific state and territory laws (Aged Care Principles 2014; Schedule 1, part 2, item 2.4).

Each provider should consider the needs of their care recipients, the meeting of the Standards and the local legislation governing the use of medicines in determining the staffing skill mix they require and the processes they may use. While state and territory legislation provides the minimum requirement, a provider may need to implement additional steps or a higher skill mix depending on the specific needs of the care recipients in their care.

In considering the ability to meet the needs of care recipients, providers need to ensure that they are cognisant of the steps in medication management. Medication management involves more than the administration of a medicine. It also includes, for example, the monitoring of a care recipient after administration of a medication. It can also involve a decision about administering a medication versus withholding a medication while obtaining further medical advice. Providers need to ensure that they have a system that covers all aspects of medication management and regularly evaluate and review their medication management systems and processes. A resource in this area is the Australian Government' s Guiding principles for medication management in residential aged care facilities, disseminated to all residential aged care homes.

The decision to prescribe antipsychotic medicines for a care recipient is a clinical decision made by the care recipient' s treating medical practitioner in consultation with the resident and/or their representative. As with any prescribing decision, the treating medical practitioner must balance the potential benefits of treatment against the potential risks while taking into account the particular clinical circumstances of each care recipient.

Additionally, the Australian Government supported the development and testing of a standardised medication chart for residential aged care that has been trialled and was fully implemented during 2014-15. The new chart released in 2014 serves as both a prescription for most PBS and Repatriation Pharmaceutical Benefits Scheme (RPBS) medicines as well as a record of medication administration. Testing of the chart has demonstrated improved resident safety and will, over time, provide better aged care sector utilisation data on medicines, including rates of antipsychotic use.

Documents related to the medication chart are available on the Australian Commission on Safety and Quality in Health Care (the Commission) website:

http://www.safetyandquality.gov.au/our-work/medication-safety/nrmc.

The Commission held a national roundtable on reducing inappropriate use of antipsychotics in older people in October 2016. The purpose of the roundtable was to seek expert advice on ways to reduce inappropriate use of antipsychotics in older people with BPSD, and to identify and prioritise strategies for action in the community, residential aged care and acute hospital settings.

The Government has funded two separate projects through the University of Tasmania and the University of New South Wales at a total cost of $4.1 million (2013 to 2016) aimed at reducing the use of sedative and antipsychotic medications in Residential Aged Care facilities (RACFs). Findings from these projects will be used to develop future policy.

Both projects involved the:

measurement of antipsychotic medication use in RACFs

education and training of GPs, staff, pharmacists and families on risks related to inappropriate antipsychotic medication use

promotion of non-drug strategies to manage behavioural and psychological symptoms in people living with dementia.

Recommendation 14

The committee recommends that the Commonwealth develop, in consultation with dementia advocates and service providers, guidelines for the recording and reporting on the use of all forms of restraints in residential facilities (para 6.31).

Noted

The Australian Government notes this recommendation.

The Australian Government has a regulatory framework in place to monitor the quality of care older Australians receive in aged care facilities through accreditation, complaints, quality reporting, compliance and compulsory reporting. As outlined in the response to recommendation 10, the Aged Care Act 1997 requires approved providers of Commonwealth subsidised residential aged care to meet the Accreditation Standards and ensure that all care recipients are provided with quality care and services.

The decision to use restraints in residential aged care facilities is a clinical decision and must be made in consultation with the care recipient and/or their representative, staff and their medical practitioner. Any use of restraint should be included in the resident' s care plan. In making decisions on the application of restrictive practices, care providers must balance a patient' s basic legal and human rights (consistent with the aged care standards) with their duty of care to protect the patient, other residents and staff from harm.

In recognition of the issues facing aged care providers around restraint use the Australian Government has supplied providers with a decision making guide on this issue since 2004. This was updated in 2012 and expanded into the following separate guides for residential and community care:

The Decision-Making-Tool: Supporting a Restraint Free Environment in Residential aged care

The Decision-Making-Tool: Supporting a Restraint Free Environment in Community aged care.

The decision making tools provide staff, managers and carers with information and practical strategies on organisational, environmental, physical and psychosocial considerations that reduce the need to consider restraint as a care option. These toolkits include posters and information sheets which can be photocopied to provide in-house education and an information sheet that has been designed to be photocopied and handed to relatives.

An important avenue in which care recipients and their families can raise concerns about the quality of care provided is the Aged Care Complaints Commissioner, which includes responding to concerns about the use of any form of restraint. The Commissioner takes all complaints seriously and seeks to achieve quality and timely outcomes for care recipients and providers. Where the Department of Health identifies significant failures of an aged care provider to meet their legislative responsibilities compliance action can be taken.

The level of complaints to the Aged Care Complaints Commissioner from residents and/or their families or representatives in relation to the use of restraints is quite low. Analysis of complaints data in 2016 indicates that 1.3 per cent of all complaints are in relation to the use of chemical or physical restraint.

As outlined in the response to Recommendation 9, one of the three quality indicators in the National Aged Care Quality Indicator Program is use of physical restraint.

Recommendation 15

The committee recommends that the Commonwealth collect and report:

the number of residents in aged care and acute care facilities with a diagnosis of dementia;

the number of these residents who are taking, or have taken, antipsychotic medication;

the number of instances where a patient has been prescribed multiple anti-psychotic medications;

the reason the medication was prescribed; and

the average duration of a course of prescribed antipsychotics. (para 6.32)

Noted

The Australian Government notes this recommendation.

Under priority four "accessing ongoing care and support", the NFAD notes:

A decision about the use of medicine to treat BPSD is a clinical one made by the prescriber based on individual circumstances. It is vital to adopt a collaborative approach to the management of medications for people with dementia as many medicines may induce or worsen BPSD.

ACAT assessments and Aged Care Funding Instrument (ACFI) appraisals currently collect data about diagnoses of dementia among clients.

In the Aged Care Assessment Program (ACAP), dementia may be reported among the health conditions recorded in each ACAT assessment. Diagnoses of dementia that may be recorded include Alzheimer' s disease, vascular dementia, and dementia as a symptom of other diseases. From 2016-17, ACATs' transition to use My Aged Care systems enables the availability of this data to the Department of Health at the individual client level.

ACFI appraisals also collect information about diagnosed health conditions, including dementia, for permanent residents in Australian Government-subsidised residential aged care facilities. The ACFI appraisal pack includes a mental and behavioural disorders checklist that allows for the reporting of up to three mental and behavioural diagnoses for each permanent resident. It has previously been reported that over half of all permanent residents with an ACFI appraisal had a diagnosis of dementia .

People admitted to hospital with dementia may have their diagnosis documented as part of the collection of data in Australian hospitals. Dementia may be recorded as a principal or additional diagnosis. However, research has confirmed that dementia is poorly recorded. The Australian Commission on Safety and Quality in Health Care' s resource titled A better way to care: safe and high quality care for patients with cognitive impairment (dementia and delirium) in hospitals emphasises the importance of recognising people with cognitive impairment to reduce increased risks of harm. Uptake of its key strategies may result in increased dementia and delirium coding and therefore a more accurate reflection of dementia rates in hospitals.

Overall access to medicines in residential aged care is through the PBS and RPBS. The Drug Utilisation Sub-Committee (DUSC) considered an analysis of PBS antipsychotics prescription data in February 2013 and produced a report for the Pharmaceutical Benefits Advisory Committee (PBAC) in June 2013. The Public Summary Document detailing the PBAC' s consideration, discussion and recommendation from the DUSC review is publicly available on the PBS website at www.pbs.gov.au/info/industry/listing/elements/pbac-meetings/psd/2013-08/antipsychotics.

The 2013 DUSC reports are available on the PBS website at www.pbs.gov.au/info/industry/listing/participants/public-release-docs/dusc-public-release-documents-by-medicine. In addition, PBAC recommended that DUSC review the whole class of antipsychotic drugs, 24 months after any changes in the pack size or number of repeats. This DUSC review was considered at the November 2016 PBAC meeting. The outcome statement of PBAC' s consideration of the 2016 review can be viewed from the PBS website at www.pbs.gov.au/industry/listing/elements/pbac-meetings/pbac-outcomes/2016-11/dusc-report-2016-11.pdf. The PBAC noted that there was less use of low dose (25 mg) quetiapine indicating a reduction in the inappropriate prescribing of quetiapine for non-psychotic indications, such as sedation. The PBAC requested that DUSC continue to monitor the use of antipsychotics.

In addition, MedicineWise (NPS) is funded by the Government to assist prescribers and patients in the quality use of medicines and provide support for health professionals to assist their clinical management decisions. NPS has developed resources to help residential aged care staff understand and improve the management of medicines. These include Drug Use Evaluation (DUE) toolkits that help promote best practice medicines use in residential aged care homes. Two of these kits relate to sedation and use of antipsychotics.

As discussed in the response to Recommendation 13, a national standardised medication chart for residential aged care services was made available in 2014. Testing of the chart has demonstrated improved resident safety and will, over time, provide better aged care sector utilisation data on medicines, including rates of antipsychotic use.

The Commission held a national roundtable on reducing inappropriate use of antipsychotics in older people on 26 October 2016. The purpose of the roundtable was to seek expert advice on ways to reduce inappropriate use of antipsychotics in older people with BPSD, and to identify and prioritise strategies for action in the community, residential aged care and acute hospital settings.

The Government has funded two separate projects through the University of Tasmania and the University of New South Wales at a total cost of $4.1 million (2013 to 2016) aimed at reducing the use of sedative and antipsychotic medications in Residential Aged Care facilities (RACFs). Findings from these projects will be used to develop future policy.

Both projects involved the:

measurement of antipsychotic medication use in RACFs

education and training of GPs, staff, pharmacists and families on risks related to inappropriate antipsychotic medication use

regular review of individual residents taking antipsychotic medication by the prescribing doctor.

Recommendation 16

The committee recommends that the Commonwealth undertake an information program for doctors and residential aged care facilities regarding the guidelines Responding to Issues of Restraint in Aged Care in Residential Care. (para 6.48)

Supported In-Principle

The Australian Government supports this recommendation in-principle.

One of the key principles underpinning the NFAD is "People with dementia are valued and respected, including their rights to choice, dignity, safety (physical, emotional and psychological) and quality of life."

As mentioned in the response to Recommendation 14, the Australian Government has supplied providers with a decision making guide on this issue since 2004. This was updated in 2012 and expanded into the following separate guides for residential and community care:

The Decision-Making-Tool: Supporting a Restraint Free Environment in Residential aged care

The Decision-Making-Tool: Supporting a Restraint Free Environment in Community aged care.

These toolkits include posters and information sheets which can be photocopied to provide in-house education and an information sheet that has been designed to be photocopied and handed to relatives.

An extensive information program has already been undertaken to support the uptake of the guidelines including:

presentations based on the guidelines were made at the Better Practice Conferences sponsored by the Australian Aged Care Quality Agency held around Australia throughout 2013

the toolkits were distributed to all Australian Government funded residential and home care providers nationally in late 2012. Additional printed copies of the resources are also available on request from National Mail and Marketing. In addition, the toolkits have been placed on the Department of Health' s website and are currently available to download at https://agedcare.health.gov.au/publications-articles/resources-learning-training/decision-making-tool-supporting-a-restraint-free-environment

since October 2012 over 7,560 copies of the toolkit have been distributed to residential aged care providers, and over 5,030 to home care providers from National Mail and Marketing.

As previously noted, the Australian Government funds the DTP to provide dementia-specific training to aged care, health care and other community providers and their staff. All of the training offerings promote the development of knowledge and skills and the creation of environments in which the use of physical and chemical restraints are not required. This includes the identification of strategies to prevent the emergence of BPSD and methods for identifying and minimising triggers of BPSD, which may include staff practices, pain, discomfort, environmental stressors or over stimulation.

DBMAS, SBRT and Dementia Training Australia all support minimal use of restraints including chemical restraints. DBMAS provides best practice guides for managing behavioural and psychological symptoms of dementia and conducts reviews to minimise the use of medication that has a negative impact on a person' s emotional or cognitive state.

Recommendation 17

The Committee recommends that a review of the adequacy of respite facilities for Younger Onset Dementia patients be carried out urgently (para 7.29).

Noted

The Australian Government notes this recommendation.

Priority four of the NFAD is "Accessing ongoing care and support". The related action to which the Government has committed is:

Provide people with dementia and their carers and families access to appropriate and responsive respite services.

People who are experiencing dementia and are under the age of 65 can face different challenges to those faced by older Australians with dementia and the Australian Government acknowledges the unique respite needs of people with younger onset dementia and their carers.

Under the Aged Care Services Improvement Healthy Ageing Grants process 2014 funding was available under priority 2 - responding to existing and emerging challenges including de of markementia care, for initiatives that supported good-practice models of respite care for younger people living with dementia and developed resources that assist organisations to tailor their services to younger people living with dementia.

Two projects were successful in this process:

1. Tailor Made, good practice model for respite services for people with Younger Onset Dementia and their families

2. Making Flexible Respite Care A Practical Reality.

There is no age restriction on residential respite care, so clients with Younger Onset Dementia (YOD) have the same access to respite as other people with an ACAT assessment. YOD clients can also access services from the National Disability Insurance Scheme (NDIS). The NDIS is rolling out nationally over three years (2016-2019) and currently operating in a number of locations across Australia. Findings from the NDIS trial sites coupled with the experience gained during roll-out provides an opportunity to learn, and ensure better outcomes for Australians with disability, their families and carers.

A number of reviews of the NDIS have been commissioned to take place between 2013 and 2017. The reviews will provide information on elements of launch, including performance against aims and objectives and the impact of some policy approaches. In particular, the Evaluation and Review of the NDIS Launch, conducted by the National Institute of Labour Studies, Flinders University and the review of the Lessons Learned from the Trial may provide insights relevant to this recommendation. The Government will reconsider this recommendation upon completion of these reviews.

Currently YOD clients are also able to access respite through other gateways, where there is another diagnosed disability or ailment. For example, the Government funds 109 Mental Health Respite Carer Support organisations across Australia, noting funding is transitioning to the NDIS for this program as care recipients are able to be supported by the NDIS. These services provide flexible respite and support to carers and families of people with mental illness. Carers of people with YOD are able to access these services, provided the care recipient also has a mental illness which is impacting on their ability to function in the community.

In 2013, the Australian Government engaged the University of Wollongong (UoW) to undertake an International Literature Review and a Needs and Feasibility Assessment of Services for People with Younger Onset Dementia. The UoW review and assessment were completed in February 2014, and provided principles of appropriate care and can be used to inform future health care design regarding respite for people living with dementia, their families and their carers. Providers are aware of these principles, and have been encouraged to reference them. The principles are available to the sector online at: http://ahsri.uow.edu.au/chsd/projects/yod/index.html.

Recommendation 18

The Committee recommends that the Commonwealth fund the development of a pilot Younger Onset Dementia specific respite facility at either the Barwon or Hunter area National Disability Insurance Scheme trial sites.( para 7.30)

Noted

The Australian Government notes this recommendation.

Priority four of the NFAD is "Accessing ongoing care and support". The related action to which the Government has committed is:

Provide people with dementia and their carers and families access to appropriate and responsive respite services.

The NDIS provides funding for long-term, individualised care and support that is reasonable and necessary to meet the needs of people with permanent disability, where a person' s disability significantly affects their communication, mobility, self-care or self-management. This includes people with Younger Onset Dementia (YOD).

Under the NDIS people with permanent and significant disability, supported by their families and carers as appropriate, will work to develop their own personal plan for support, based on their goals and aspirations and their individual needs. The scheme will empower people with disability to engage as equal partners in decisions that will affect their lives. This includes having choice over the types of support they want and how these are delivered.

The National Disability Insurance Agency has a Catalogue of Supports that outlines the range of services that can be delivered to participants, provided they are related to the participant' s disability, achievement of outcomes and ultimately their goals.

In addition to support through the NDIS, clients with YOD can also access respite care through the aged care system. As outlined in the response to Recommendation 17, there is no age restriction on residential respite care, so clients with YOD have the same access to respite as other people with an ACAT assessment.

Australian Government Response to the Senate Economics Legislation Committee Report on the Competition and Consumer Amendment (Misuse of Market Power) Bill 2017 November 2017

Recommendation 1:

The committee recommends that the proposed mandatory factors, as drafted in subsection 46(2) of the bill, be removed.

Response

The Australian Government adopted this recommendation by successfully moving parliamentary amendments to remove the 'mandatory factors' from subsection 46(2) (see Hansard, House of Representatives, 27 March 2017, p3264).

Recommendation 2:

The committee recommends that the government undertake a post-implementation review of the reforms to section 46 at least five years after commencement.

Response

The Australian Government supports this recommendation in principle, as it will provide an opportunity to ensure that section 46 is working as intended. The timing of a review will need to take account of the extent to which the courts have had the opportunity to develop jurisprudence on the new provision.

Recommendation 3:

The committee recommends that the bill be passed.

Response

On 14 August 2017, the Senate passed the Competition and Consumer Amendment (Misuse of Market Power) Bill 2017 (see Hansard, pp5568-69).

Dissenting report by Labor Senators Recommendation 1:

That the Senate should not pass the Competition and Consumer Amendment (Misuse of Market Power) Bill 2016.

Response

On 14 August 2017, the Senate passed the Bill (see Hansard, pp5568-69),

Additional comments by Senator Xenophon Recommendation 1:

A ' cost waiver order ' should be introduced into market power abuse litigation cases to improve access to justice.

Response

The Australian Government responded to this recommendation in the Senate on 14 August 2017 (Senator Cormann, Hansard, p5561).

Recommendation 2:

A divestiture order must be made available as a judicial remedy for serious or repeat market power abuse offender cases.

Response

The Australian Government responded to this recommendation in the Senate on 14 August 2017 (Senator Cormann, Hansard, p5556).

Recommendation 3:

As per Draft Harper Review Recommendation 25, to mitigate concerns about over-capture a defence should be introduced so that the primary prohibition would not apply if the conduct in question:

would be a rational business decision or strategy by a corporation that did not have a substantial degree of power in the market; and

the effect or likely effect of the conduct is to benefit the long-term interests of consumers.

The onus of proving that the defence applies should fall on the corporation engaging in the conduct.

Response:

The Government does not support this recommendation as the proposed defence would be broad, and could increase uncertainty about the operation of section 46. The Government also notes that, on 14 August 2017, Senator Xenophon withdrew a proposed amendment to the Competition and Consumer Amendment (Misuse of Market Power) Bill 2017, which sought to introduce the defence, and acknowledged the defence would be unnecessary (Senator Xenophon, Hansard, p5555).

Australian Government response to the Senate Finance and Public Administration References Committee inquiry report: Operation, effectiveness, and consequences of the Public Governance, Performance and Accountability (Location of Corporate Commonwealth Entities) Order 2016

INTRODUCTION

On 8 February 2017, the Senate referred an inquiry into the operation, effectiveness, and consequences of the Public Governance, Performance and Accountability (Location of Corporate Commonwealth Entities) Order 2016 (the Order), to the Senate Finance and Public Administration References Committee (the committee). The committee examined:

a. the process leading to the making of the order

b. the policy of relocating corporate Commonwealth entities with agricultural policy or regulatory responsibilities, including:

i. the identity of corporate Commonwealth entities that could be affected

ii. the policy's effect on the ability of affected entities to perform their functions

iii. economic, environmental and capability implications of the policy

c. the application of this policy to the Australian Pesticides and Veterinary Medicines Authority (APVMA), including:

i. the plan for relocation

ii. the ability of the APVMA to perform its functions from its new location, and any consequent risks to:

A. human and animal health

B. productivity and profitability to the agriculture and fisheries sectors

C. chemical industries

D. Australia's trading reputation

d. any other related matters.

The committee reported on these matters on 9 June 2017. The majority report outlines five recommendations and the Australian Greens' additional comments outline one recommendation. The Australian Government provides the following response.

D ETAILED RESPONSE TO THE RECOMMENDATIONS OF THE MAJORITY REPORT

RECOMMENDATION 1

The committee recommends that the Public Governance, Performance and Accountability (Location of Corporate Commonwealth Entities) Order 2016 be revoked.

The Australian Government does not support the recommendation.

Government policy orders, issued under subsection 22(1) of the Public Governance, Performance and Accountability Act 2013 (PG PA Act), provide a legislative mechanism designed to apply government policies to corporate Commonwealth entities.

The Order was developed and applied to the APVMA to give effect to the government's policy, first outlined in its 2016 election commitment, to establish a Centre of Agricultural Excellence in Armidale by co-locating the APVMA with the University of New England (UNE) and its specialised agricultural research centres (The Coalition's Policy for a Stronger Agriculture Sector)'.

The government is continuing to implement this election commitment; and has provided the APVMA with $25.6 million to help manage its relocation to Armidale.

RECOMMENDATION 2

The committee recommends that the move of the APVMA be paused until the APVMA concludes its review of its business model.

The Australian Government does not support the recommendation.

The APVMA released its relocation strategy (APVMA in Armidale: Relocation Strategy)2 in December 2016. The strategy outlines how the APVMA will implement the government's 2016 election commitment to relocate to Armidale, including how it will manage risks and opportunities. A component of the strategy includes developing a new business model, which is well underway. Once completed, the business model will inform how the APVMA will operate in Armidale; and help shape its relocation from Canberra. While the business model will be an important part of the APVMA operations in the years to come, there is no need to pause the move on account of this work.

RECOMMENDATION 3

The committee recommends that the establishment of the regulatory science course at the University of New England is actively encouraged and supported by the Commonwealth. The establishment of this course should not be contingent on the relocation of the APVMA.

The Australian Government notes the recommendation.

In February 2017, the UNE began offering a Graduate Certificate in Science (Regulatory Science) and a Graduate Diploma in Science (Regulatory Science). A Master of Regulatory Science is also in development.

The UNE has established an Agricultural and Veterinary Chemicals Regulatory Science Industry Advisory Board to provide advice and input to ensure its regulatory science courses meet the needs of both the APVMA and its industry partners. The board held its inaugural meeting on 21 July 2017 and includes members from the UNE, APVMA, Department of Agriculture and Water Resources, Animal Medicines Australia, CropLife Australia, Veterinary Manufacturers and Distributors Association and the National Farmers' Federation. The UNE is also developing partnerships with other government members of the Regulatory Science Network3 to ensure its courses also meet the regulatory science needs of these agencies.

The UNE has advised the Department of Agriculture and Water Resources that a key motivation for students commencing the regulatory science courses is the possibility of future employment with the APVMA in Armidale. The government commends the UNE in developing these courses, which will fill an important gap in the market.

RECOMMENDATION 4

The committee recommends that the Finance Minister apply greater scrutiny to future requests or orders to be made under the Public Governance, Performance and Accountability Act 2013 with a specific focus on consideration being given to the following:

the financial and governance implications on an agency from an order under the Public Governance, Performance and Accountability Act 2013; and

a cost-benefit analysis. In the event that a cost-benefit analysis does not identify a net benefit from the proposed order, the Finance Minister should require the relevant minister to explain the grounds on which the order should be made.

The Australian Government notes the recommendation.

This recommendation does not appear to recognise the policy, that corporate Commonwealth entities with agricultural policy or regulatory responsibilities be located in a regional community and within 10 kilometres by road of a regional university recognised for research and teaching in agricultural science, applied by the Order, had already received formal government consideration and approval. It is not the Finance Minister's role to re-make a government policy already made through due process.

In making an order to apply a policy to a corporate Commonwealth entity under section 22 of the PGPA Act, the Finance Minister must be satisfied that the minister responsible for the policy has consulted the entity on the application of the policy. Such consultation occurred in November 2016.

RECOMMENDATION 5

The committee recommends that a broad inquiry led by representatives from both Houses of Parliament be undertaken into the merits of decentralisation, and the appropriate policy mechanisms for undertaking it.

The Australian Government notes the recommendation.

On 1 June 2017, the House of Representatives established a Select Committee on Regional Development and Decentralisation to inquire and report on best practice approaches to regional

3 The Regulatory Science Network is a group of nine government agencies and departments responsible for the regulation of chemicals and biological agents in Australia (apvma.gov.au/node/15496).

development, the decentralisation of Commonwealth entities, and supporting corporate decentralisation. The Select Committee is due to produce its final report by 28 February 2018.

This inquiry is in addition to the whole-of-government process, announced by the Minister for Regional Development on 19 April 2017, to consider Commonwealth entities that may be suitable for decentralisation. This process is methodical and rigorous, involving a staged approach that includes the Cabinet's consideration of initial criteria and a two-stage business case process.

As there is significant government and parliamentary work underway on decentralisation issues, the government does not see a need to undertake an additional inquiry.

DETAILED RESPONSE TO THE AUSTRALIAN GREENS ADDITIONAL COMMENTS

RECOMMENDATION 1

That the APVMA relocation be scrapped entirely and that the APVMA remain located at its current site in the ACT.

The Australian Government does not support the recommendation.

The Australian Government is committed—consistent with its 2016 election policy—to relocating the APVMA to Armidale to establish a Centre of Agricultural Excellence by co-locating it with the UNE and other specialised agricultural research centres in the region.

This move provides an opportunity to build an efficient and effective regulator; and improve how the APVMA works with its clients, which will increase farmers' access to new chemicals and reduce costs to business.

Australian Government response to the Senate Select Committee on Health First Interim Report

Senate Select Committee on Health First Interim Report

Recommendation 1

The committee recommends that the government should immediately abandon its plan to implement the $7 copayments.

Agreed.

There is no plan to implement the $7.00 co-payment.

Recommendation 2

The committee notes the evidence of the negative implications of the government ' s:

changed hospital funding indexation arrangements that will see public hospitals funded on the basis of population growth and CPI;

cuts to the National Health Reform Agreements and associated National Partnership Agreements; and

lack of commitment to Activity Based Funding.

The evidence points to a significant loss of health services in Australia ' s public hospitals if these changes proceed.

On the basis of the evidence to the committee, the government should restate its commitment to Activity Based Funding and associated reforms.

Support in-principle.

As announced in the Budget 2017-18, the Australian Government will deliver an overall investment of over $10 billion in the Long-Term National Health Plan — based on the four pillars of Guaranteeing Medicare and access to medicines; Supporting our hospitals; Prioritising mental health, preventive health; and sport; and Investing in medical research.

The Commonwealth's contribution to public hospital services has experienced significant growth since the 2014-15 Budget. Between 2014-15 and 2015-16, Commonwealth funding for public hospitals under the NHRA increased from $15.5 billion to $17.2 billion, representing growth of $1.7 billion or 11.1 per cent. Further to this, Commonwealth funding for public hospitals continues to grow over the forward estimates from $18.5 billion in 2016-17 to $22.7 billion in 2020-21, representing growth of $4.2 billion or 22.8 per cent.

Since the release of this interim report, a Council of Australian Governments (COAG) Heads of Agreement on Public Hospital Funding (HoA) was signed on 1 April 2016, which effectively reversed the decision of the 2014-15 Budget to index hospital funding by CPI and population growth from 2017-18. As part of the first wave of reform under the Long-Term National Health Plan, to give effect to the HoA, an Addendum to the National Health Reform Agreement (NHRA) began on 1 July 2017.

The HoA retains important parts of the existing public hospital funding arrangements under the NHRA, including Activity Based Funding (ABF), which provides transparency of the services delivered, and the pricing of hospital services at a National Efficient Price (NEP). The HoA also introduces a national cap on growth in the Commonwealth contribution to public hospital services. This cap, set at 6.5 per cent per annum, demonstrates the Commonwealth's commitment to sustainable growth in hospital funding and will encourage the states and territories to do all they can to reduce costs and improve efficiency.

Recommendation 3

The committee recommends that, based on the evidence before it, and the demonstrated benefits arising from the work of the Australian National Preventive Health Agency (ANPHA) and the National Partnership Agreement on Preventive Health, the government should drop its plans to abolish ANPHA and reinstate the National Partnership Agreement on Preventative Health.

Not Agreed.

Preventive health measures formerly administered by ANPHA were transferred to the Department of Health on 1 July 2014. The Department continues to support the effective delivery of preventive health measures to reduce health related risk factors within the Australian population. It is not possible to fully quantify funding on the Department's prevention activities, as measures can have a broad remit. For example, preventive health can include guidance to clinicians, support for health service provision, support for the work of peak bodies and non-government organisation (NGO) groups, research and monitoring, and intervention and disease management components that cannot be disaggregated. The Commonwealth continues to work with key health stakeholders, including the states and territories.

As announced in the Budget 2017-18, the Australian Government will deliver an overall investment of over $10 billion in the Long-Term National Health Plan (the Plan) — based on the four pillars of Guaranteeing Medicare and access to medicines; Supporting our hospitals; Prioritising mental health, preventive health; and sport; and Investing in medical research. The Plan, increases investment in health, aged care and sport to $94.2 billion in 2017-18. The funding will enable targeted investment, with a focus on high value clinical care, promotion of good health and collaboration with the health sector.

With heart disease, cancer and mental illness accounting for almost half the burden of disease in Australia, the Government is funding initiatives to support healthy lifestyles, prioritising mental health, preventive health and sport. Examples of such initiatives include:

$64.3 million to continue mammograms services for women aged 70 to 74 years under the BreastScreen Program, which complements the BreastScreen Australia services being provided for women aged 59 to 60.

$41.6 million for the Victorian Cytology Service to continue research and quality services for cervical cancer.

$40 million per calendar year to increase sport participation in schools via the Sporting Schools initiative.

$20.3 million for National Sporting Organisations to increase participation in sport.

$20 million for preventive health and research translation projects under the Medical Research Future Fund.

$15.5 million to maintain sporting grounds and services for over 2,000 athletes.

$10.8 million to fight childhood cancer through research and clinical trials.

$10 million to the Heart Foundation for the Prime Minister's Walk for Life Challenge.

$5.9 million to expand the Prostate Cancer Nurse program

$5 million to Royal Australian College of General Practitioners to develop education and training material for GPs to support Australians to achieve a healthy lifestyle through increased physical activity and better nutrition.

Recommendation 4

If the goal of better integration of primary care is to be achieved, the committee recommends that the Primary Health Networks tender must include:

a clear statement of the population health needs to be addressed, including clear outcome measures;

a statement of the population health data expected to be collected or used;

a statement on the outcomes Primary Health Networks will be expected to achieve to improve access to primary care and improve primary care integration for the whole population, in particular for disadvantaged groups; and

a requirement that the integrity of the data collected by Medicare Locals will be preserved

In considering the applications for funding for Primary Health Networks the government should have a mind to the success of Medicare Locals in:

reducing hospitalisations

improving access to after-hours primary care services

reducing rates of chronic disease

reducing smoking rates

increasing immunisation rates

improving access to mental health services

improving access to allied health services

Agreed.

In 2014-15, the Australian Government selected organisations to establish and operate 31 Primary Health Networks (PHNs) through an open competitive funding round. As part of the PHN Invitation to Apply in December 2014, applicants needed to demonstrate their capacity and capability to undertake the role of a PHN, including:

relevant subject matter expertise; and

specific examples of similar activities that demonstrated experience and capacity.

This process clearly articulated that the 31 PHNs, established on 1 July 2015, were to increase the efficiency and effectiveness of primary healthcare services for patients,

particularly those at risk of poor health outcomes; and improve coordination of care to ensure patients receive the right care, in the right place, at the right time.

Under the PHN program, PHNs also have a core set of six priorities, which are: mental health, Aboriginal and Torres Strait Islander health, population health, health workforce, digital health and aged care.

Each PHN has undertaken population health planning, including needs assessments and associated market analyses, as well as stakeholder consultations to identify service gaps, and major health and system capacity issues. This information is used by PHNs to determine their priorities and to develop activity work plans, which describe how the PHN will commission and coordinate services to address those priorities. When this process identifies needs and activities which align with work undertaken by Medicare Locals, PHNs may commission activities to continue to address their community's health needs.

A dedicated data webpage is accessible on the PHN website,

(http ://www.health.gov. au/intemet/main/publishing.nsf/Content/PHN-Home), which provides geographic-level health and demographic data specific to each PHN region.

The PHN program is actively improving the coordination and integration of a wide range of primary health services. PHNs also play an important role in providing education, training and support to general practice, as a key part of strengthening the primary health care system.

The Government provides funding to PHNs to lead mental health and suicide prevention planning at a regional level. Through a new flexible primary mental health care funding pool, PHNs in partnership with relevant services will improve outcomes for people with, or at risk of, mental illness and/or suicide.

To support PHNs in meeting their performance objectives for immunisation, the Department of Health recently engaged NPS Medicine Wise (in collaboration with the National Centre for Immunisation Research and Surveillance) through a competitive process to develop and implement a PHN Immunisation Support Program.

The Program, which commenced in June 2017, will deliver a national and coordinated approach for assisting PHNs in supporting a range of immunisation providers including GPs, nurse immunisers, community health clinics, Aboriginal Medical Services, local councils and pharmacies, in delivering immunisation programs to their patients and communities, consistent with the Australian Immunisation Handbook and National Immunisation Program.

Under the Primary Health Care Development Program, PHNs will continue to .ensure patients in their local communities can access after-hours primary health services and maintain continuity of services. PHNs received funding of $145.5 million from 2015-16 to 2016-17, to implement innovative and locally tailored after-hours solutions based on community need, recognising that all PHN regions are different.

Recommendation 5

The committee expresses its concern that the government ' s decision to abolish 61 Medicare Locals and establish 30 new Primary Health Networks is resulting in loss of frontline services and will see significant cuts to services and programs at the local level that are aimed at improving population health, better integration of primary care services and keeping people out of hospital.

Not Agreed.

Funding for frontline services delivered through the Medicare Local Program has been maintained through PHNs.

Further to this, increased funding has been provided to PI-fNs to support them to take on a larger role in commissioning mental health care services and drug and alcohol treatment services following the Government's response to the National Mental Health Commission's Review of Mental Health Programmes and Services, and the National Ice Taskforce's Final Report.

Recommendation 6

The committee recommends that the government, as a matter of urgency, ensures certainty in regards to the maintenance of the suite of services supplied by Medicare Locals, particularly in areas of rural and remote Australia where access to medical facilities and services is less comprehensive than the level of access in metropolitan areas.

Agreed.

In the establishment of PHNs, service continuity was a priority and PHNs have managed a smooth transition of services from Medicare Locals.

Further information on this recommendation is provided under recommendation 4.

Recommendation 7

The committee recommends that the government must take immediate steps to reinstate funding to indigenous health organisations and ensure that the particular health challenges facing Aboriginal and Torres Strait Islander Australians are effectively analysed and responded to.

Not agreed.

Overall funding levels for Indigenous health are growing. From 2017-18 to 2020-21 the Government will invest $3.6 billion, through the Indigenous Australians' Health Programme, in Indigenous specific health programmes and activities - an increase of over $724 million compared to the previous four years (2012-13 to 2016-17). This does not include funding provided through Medicare and access to pharmaceuticals through the PBS.

To ensure continuity of access to primary health care for Aboriginal and Torres Strait Islander peoples, funding that had been allocated to Medicare Locals prior to 1 July 2015 was transitioned to PHNs established in these regions. These PHNs were funded to deliver primary health care and New Directions: Mothers and Babies services during the transition period.

On 28 January 2016, the Department of Health approached the market with an Invitation to Apply for the continuation of services in the nine regions where PI-INs were still being funded to deliver primary health care and New Directions services. Successful applicants from this process began a transition period to the full delivery of services from 1 January 2017.

Through the 2017-18 Budget, the Government has expanded activity in the key areas of child and maternal health, and chronic disease prevention and management. For example, the Rheumatic Fever Strategy was strengthened and expanded, with funding totalling $18.8 million over four years from 2017-18.

Recommendation 8

The committee recommends that the government should cease its planned merger of the Organ and Tissue Authority and the National Blood Authority.

Agreed.

In December 2015, the Government decided not to proceed with the merger of the National Blood Authority and the Organ and Tissue Authority, as previously announced in the 2014-15 Budget.

Government Senator ' s Dissenting Report

Recommendation 1

That Coalition members of the Committee recommend that the Senate support reforms to improve the sustainability of health expenditure as provided for in the 2014-15 Budget.

Noted.

Australian Government response to the Joint Select Committee on Northern Australia Pivot North - Inquiry into the Development of Northern Australia: Final Report October 2017

OCTOBER 2017

Further developing the north to realise its full potential is in the best interest of the nation as a whole. The north has great promise; however this is limited by factors including its remoteness, challenging weather and a sparse population.

In June 2013 the Coalition released the 2030 Vision for Developing Northern Australia (2030 Vision), which was followed by the release of the Green Paper on Developing Northern Australia in June 2014. Our North, Our Future: White Paper on Developing Northern Australia (the White Paper) was released in June 2015. The White Paper sets out a plan for economic development by facilitating more private investment to the north while developing more opportunities for a range of industries and communities to grow.

The White Paper was informed by the findings of Pivot North: Inquiry into the Development of Northern Australia: Final Report (Pivot North) released by the Joint Select Committee on Northern Australia (JSC), chaired by the Hon Warren Entsch MP. This report identified the important issues facing the north, including trade, industry, water and land rights. The JSC provided valuable input to the White Paper and the Australian Government's response to the development needs of the north. It highlighted the great potential of the north to further develop as a strong economic base for Australia.

The White Paper includes measures to unlock the north's potential across six key areas: simpler land arrangements to support investment; developing the north's water resources; growing the north as a business, trade and investment gateway; investing in infrastructure to lower business and household costs; reducing barriers to employing people; and improving governance.

The White Paper outlines the Australian Government's plan to open the north to world markets and to realise the north's great potential. The Australian Government is determined to take advantage of northern Australia's proximity to the strongly growing Asian region and open the north to both investment and tourism from Asia and surrounding regions.

As outlined in the White Paper, the Australian Government's priorities are to improve the business environment, cut red tape, invest in infrastructure, and strengthen partnerships with the three northern governments and neighbouring nations. Investments in infrastructure include upgrading major roads and water resources and providing concessional loans for major economic infrastructure through the Northern Australia Infrastructure Facility. Upgrading supply chain routes such as transport infrastructure will increase the north's ability to efficiently and reliably produce and get goods to market.

The White Paper acknowledges the need to safeguard Australia's northern environment for future generations and to understand our role as stewards of our unique natural wonders, such as the Great Barrier Reef, to ensure all development is done in a way that protects the outstanding universal value of such special places.

The White Paper, consistent with the 2030 Vision, also looks to establish the north as a world class centre for tropical medical research. As Asia and the tropics grow, the north is in a prime position to develop a research centre to combat diseases and other medical issues that are unique to the tropics.

We are dedicated to the further development of the north but changes are needed to realise its potential. The White Paper, in addressing many of the recommendations of the JSC, establishes the platform needed to build on the potential that is in the north.

Recommendation 1: The Committee recommends that the Australian Government create a Department of Northern Australian Development, and that it be based in northern Australia.

Response: Agreed in part — The Office of Northern Australia opened its head office in Darwin, in December 2015. The headquarters for the Northern Australia Infrastructure Facility is in Cairns and the Cooperative Research Centre on Developing Northern Australia headquarters opened in Townsville on 10July 2017 and will also have a presence in Darwin and WA (location yet to be determined). The White Paper commits to changes to governance arrangements (pp.115-121) including implementing the Northern Australia Strategic Partnership and measures to increase economic activity in northern Australia (pp.55-82). The Australian Government also established the Cabinet position of Minister for Resources and Northern Australia. In addition, a Ministerial Forum on Northern Development has been established. It is chaired by the Minister for Resources and Northern Australia and attended by ministers responsible for economic development from the Northern Territory, Queensland and Western Australia.

Recommendation 2: The Committee recommends that the Australian Government identify key roads and commit to funding their upgrade as a matter of priority, subject to relative benefit assessment by Infrastructure Australia.

Projects to consider would include:

Continued upgrade of National Highways, including the Bruce and Stuart Highways

Hann Highway

Peninsula Development Road (to the tip of Cape York)

Tanami Road

Outback Way

Beef development roads such as the Barkly Stock Route.

Response: Agreed - The Australian Government understands the importance of the land transport network in northern Australia and is therefore committed to improving its safety, efficiency and connectivity. The Australian Government notes the importance of many of the roads identified in the Pivot North Report and has committed significant funding to improve land transport infrastructure in northern Australia.

The Australian Government committed $600 million to the Northern Australia Roads Programme which focusses on inter-jurisdictional links identified in Infrastructure Australia's Northern Australia Audit, infrastructure for a Developing North Report January 2015. A further $100 million has been committed to the Northern Australia Beef Roads Programme, which aims to improve the productivity and resilience of cattle supply chains in northern Australia (pp.95-96).

The Australian Government engaged CSIRO to assess the absolute and relative benefits of more than 80 potential northern Australia road upgrades, including all of those named above for consideration.

Following this assessment, throughout 2016 the Australian Government announced 38 separate projects to be funded under both of the Northern Australia Roads programmes. Key roads to be upgraded include the Hann, Peak Downs, Flinders and Capricorn highways in Queensland; the Barkly Stock Route and the Tablelands, Buntine and Arnhem highways in the Northern Territory; and the Great Northern Highway and Cape Leveque Road in Western Australia.

The Australian Government has committed $100 million to upgrade the Outback Way across Western Australia, Queensland and the Northern Territory. This commitment builds on the $70 million the Australian Government has already invested in the Outback Way through the Infrastructure Investment Programme and the NARP.

In addition to these recent commitments, the Australian Government has committed significant funding to projects in northern Australia in which construction is already underway. This includes its $208.4 million contribution towards the $260 million Cape York Region Package (CYRP). The CYRP includes a range of works to upgrade infrastructure in the Cape York Region including $200 million to continue to seal the Peninsula Development Road.

Further, the Australian Government has also committed up to $6.7 billion towards an $8.5 billion ten-year programme of works on the Bruce Highway (2013-14 to 2022-23), focusing on a range of specific upgrades and safety packages agreed with the Queensland Government as part of the Infrastructure Investment Programme.

Not all projects within the Bruce Highway commitment are within the area defined as northern Australia by the White Paper, however upgrades across the full length of the Bruce Highway will improve access and connectivity into northern Australia.

It remains essential for new or upgraded road construction to consider the north's variable climatic conditions, including rain fall predictions, wet seasons and flood resilient assets. Having operational transport corridors promotes economic activity, increases productivity, attracts investment and helps to minimise social disruptions. The Australian Government continues to work with the northern jurisdictions to identify further priority projects in northern Australia that could inform future investment as funding becomes available.

Recommendation 3: The Committee recommends that the Australian Government, in conjunction with the Queensland and Northern Territory Governments, should fund a cost-benefit analysis of the following projects:

rail line linking Mount Isa and Tennant Creek;

and passing lanes on the Darwin to Alice Springs railway.

Response: Agreed in part—in the White Paper the Australian Government committed $5 million to improve cross jurisdictional freight rail planning with the support of northern jurisdictions (p.91). In addition, Infrastructure Australia's Northern Australia Audit, Infrastructure for a Developing North Report January 2015 continues to be used as a basis for better planning and prioritisation.

The Department of Infrastructure and Regional Development (DIRD) entered into a departmental-level Memorandum of Understanding with Queensland and the Northern Territory Governments to progress strategic and technical studies on the Mount Isa to Tennant Creek corridor. DIRD has committed $1.5 million to this project to assess the viability of freight rail to support broader transport and supply chain corridors from Townsville to Darwin. It is anticipated that the final strategic options paper that provides infrastructure options and key findings will be released in 2017.

The Australian Government continues to work with the northern jurisdictions to identify and select additional proposals beyond the Mount Isa to Tennant Creek Link, including on the rail link to Townsville.

Recommendation 4: The Committee recommends that the Australian Government give priority to the development and funding of water resource proposals that have been scientifically identified as being sustainable and with the strongest cost-benefit case, and consistent with National Water Policy. Projects to be considered could include:

Use of groundwater for expanding horticulture;

Flinders River Weir/O ' Connell Creek Water Storage Project;

Urannah Dam;

Elliot Main Channel;

Nullinga Dam;

Eden Bann and Rookwood Weirs on the Fitzroy River; and

Cloncurry Dam, Cave Hill.

The Committee further recommends that the government proceed with its election proposal to set up the Water Project Development Fund which could be used to assess and plan—and possibly provide seed funding for water management proposals for northern Australia.

Response: Agreed - Through the White Paper the Australian Government has established the National Water Infrastructure Development Fund which is providing support for developing potential infrastructure projects (including dams). It is also enabling detailed information to support decision making by producers, investors and government on water opportunities, including up to $200 million for the north (pp.49-54) over ten years to 2024-25. Applications are now open for Expressions of Interest (E0I) from state and territory governments for water infrastructure construction through the Fund. EOls will be accepted until all funds are committed. The Prime Minister and the Deputy Prime Minister released the Fund's guidelines on 27 October 2016.

Through the Fund the Australian Government is funding 15 northern feasibility studies worth over $25 million; 10 in Queensland, three in Western Australia, one in the Northern Territory and one cross-jurisdictional (NT and WA). These studies include the Nullinga and Urannah Dams (p.53) and the $130 million commitment to the Rookwood Weir mentioned above for consideration.

The Fund is also providing land-use suitability analysis of Ord Stage 3 and water resource assessments commissioned from the CSIRO in the Mitchell River catchment (Qld), the Fitzroy River Basin west Kimberley (WA) and the Darwin region (NT) (p.44).

The National Water Infrastructure Loan Facility has also been implemented which will provide $2 billion in concessional loan funding for water infrastructure that supports the growth of regional economies and communities. Initial applications are being assessed for funding by February 2018. Future assessment dates will be announced in due course.

Recommendation 5: The Committee recommends that the Australian Government conducts a full investigation of the potential and practicality of special economic zones in northern Australia.

Response: Not agreed - The Australian Government does not support special economic zones in northern Australia for the reasons set out in the White Paper (p.60).

Recommendation 6: The Committee recommends that the Australian Government take measures to reduce insurance premiums back to an affordable level, which could include increasing competition in the insurance market in northern Australia. The Australian Government has particular responsibility for the Indian Ocean Territories, but should also conduct negotiations with the Governments of the Northern Territory, Western Australia and Queensland, with a view to allowing the Territory Insurance Office to extend its coverage across northern Australia including the Torres Strait Islands.

Response: Agreed in part — The Australian Government has previously announced reforms to increase competition in the insurance market and established the Northern Australia Insurance Premiums Taskforce (p.75). The Taskforce's key finding is that mitigation is the only sustainable way

of lowering premiums. The Government is carefully considering the findings of the Taskforce and all options available in detail.

The Government has also directed the Australian Competition and Consumer Commission (ACCC) to

monitor prices, costs and profits in the insurance market in northern Australia in relation to home, contents and strata insurance. The inquiry commenced on 1 July 2017 and will continue for three years. The Government will provide the ACCC with $7.9 million to ensure it has the resources to

conduct this inquiry. The Government will closely monitor the findings of the ACCC inquiry, which is an important step in ensuring that all relevant factors impacting affordability including federal and state regulations can be considered.

The Senate Economics References Committee recently inquired into Australia's general insurance industry, including the increase in the cost of home, strata and car insurance, competition in the industry, and legislative and other changes necessary to facilitate a comparison service to improve competition and transparency. The Government is currently considering its response to that inquiry.

Recommendation 7: The Committee recommends that the Australian Government, in conjunction with State and Territory Governments, continue to fund the Great Artesian Basin Sustainability Initiative with a view to completing the capping and piping of all uncapped bores identified under the Great Artesian Basin Coordinating Committee Strategic Management Plan.

Response: Agreed in part — The Australian Government announced a three year extension of the Great Artesian Basin (GAB) Sustainability Initiative in October 2014 (p.49) which concluded on 30 June 2017. On 12 May 2017 the Australian Government announced the Interim Great Artesian Basin Infrastructure Investment Program which will provide $8 million in funding (to be matched by state and territory governments) to continue the delivery of water infrastructure improvements in the Basin to 2018-19. The purpose of the two year program is to enable a seamless transition from the conclusion of the Great Artesian Basin Sustainability Initiative to a new, long term funding model that encourages greater private investment in water infrastructure. The Australian Government has commenced discussions with northern jurisdictions on options for future funding of GAB infrastructure beyond mid-2019.

Recommendation 8: That the impacts of the ongoing change in climate are included in all planning processes, and that the planning process includes the development of adaptation and mitigation policies and strategies for northern Australia.

Response: Agreed in principle — The Australian Government supports the use of best practice planning strategies for development in northern Australia, including the work undertaken by the states and territory. The Australian Government agrees that implications of climate change should be considered as part of that planning in addition to the extreme weather conditions northern Australia is exposed to. For example, the water resource assessments outlined in recommendation four will take into account ongoing impacts of climate variability and change.

The Australian Government released a National Climate Resilience and Adaptation Strategy in December 2015 that sets out how Australia is managing climate risks for the benefit of the community, economy and environment. The strategy identifies a set of principles to guide effective adaptation practice and resilience building, and outlines the government's vision for the future.

The Government is reviewing its climate change policies to take stock of Australia's progress in reducing emissions, and ensure the Government's policies remain effective in achieving Australia's 2030 target and Paris Agreement commitments. The review commenced in early 2017 and will conclude by the end of 2017.

Recommendation 9: The Committee recommends to the Australian Government that it is necessary that where socially significant community centres are placed at risk due to the finite nature of mining activities, consideration be given to appropriate actions to extend mine or like operations and opportunities consistent with best environmental practices and the interests of the region.

Response: Not agreed — The issue of the appropriate time to close or suspend production from a mine is a commercial consideration by the company.

The Australian Government supports world leading best practice for mine closure based on long term planning in partnership with communities and community ownership of post-closure outcomes as a core part of the business of mining.

Community centres are the responsibility of state and territory governments. In developing such facilities the ongoing viability needs to be considered.

Recommendation 10: The Committee recommends that the Australian Government, in conjunction with the Queensland Government, investigate the construction of an abattoir in north Queensland with a view to facilitating private sector investment at the earliest possible date.

Response: Agreed in part —The Australian and Queensland Governments jointly funded a feasibility study into establishing an abattoir in northwest Queensland. The study was published and analysed a number of potential locations in Queensland with Cloncurry being identified as the most suitable for potential investors interested in developing an abattoir facility in this region.

Recommendation 11: The Committee recommends that the Australian Government, in conjunction with the Northern Australia Strategic Partnership, develop a tourism strategy for promoting northern Australia domestically and internationally, highlighting natural assets and Aboriginal and Torres Strait Islander culture.

Response: Noted — Any tourism strategy for northern Australia is best pursued through the framework of the existing national long-term tourism strategy, Tourism 2020, which has been developed and implemented in partnership with the Australian and State and Territory Governments. A separate northern Australia strategy would duplicate efforts and dilute the impact of current tourism marketing and promotion.

Northern Australia's iconic experiences and destinations feature strongly in Tourism Australia's current and recent marketing campaigns. Destinations such as Kakadu, Litchfield, Broome, Darwin, Cairns and Uluru are some of Australia's most iconic and unique regions adding to Australia's diverse and competitive tourism offering. Promotional and marketing strategies for the region should be in line with the Tourism 2020 goal of growing overnight visitor expenditure from $115 billion to $140 billion by 2020. The strategy has broad support within Australia and targets high-yield visitors that will deliver the greatest benefit to the industry and the local economy.

The development of a new product, including through the attraction of investment in tourism infrastructure in northern Australia, should be prioritised to help ensure the region can compete in the highly contested international tourism market. Reliable and cost-effective access to northern Australia via air, sea and land will improve the visitor experience and boost the local economy. Investment in quality tourism products and experiences will also be essential to develop the northern tourism industry.

The White Paper expanded services under the Entrepreneurs' Programme to include eligible northern businesses in the tourism sector (p.66). This was implemented in February 2016. The White Paper also committed to:

An expanded Seasonal Worker Programme (SWP) in northern Australia. Implemented in

2016, the expansion enables Australian employers in the tourism industry in northern Australia to participate in a new pilot under the SWP;

The Pacific Microstates—Northern Australia Worker Pilot Program; a programme providing citizens of Pacific micro-states (Nauru, Tuvalu and Kiribati) with access to a multi-year visa of up to two years. This work can include, as an example, occupations in tourism in northern Australia;

- Other measures to reduce red tape on visa applications for Chinese and Indian visitors

(pp.77-78) and expanding the Working Holiday Maker programme arrangements (pp.112-114).

The Joint Standing Committee on Northern Australia is inquiring into and reporting on Opportunities and methods for, and impediments and challenges to stimulating the tourism industry in northern Australia. The Inquiry has received public submissions. Public hearings have been held in Canberra, Brisbane, Perth, Hamilton Island, Cannonvale, Port Douglas, Cairns, Townsville, Yulara, Alice Springs, Darwin and Broome.

The Australian Government remains committed to working closely with the three northern jurisdictions on developing northern Australia. The Strategic Partnership is an essential mechanism for this collaboration through meetings between the Prime Minister and the First Ministers of Queensland, Northern Territory and Western Australia.

Recommendation 12: The Committee recommends that the Australian Government seek to build upon significant cultural and artistic events, and programs including the promotion of Aboriginal and Torres Strait Islander arts, to increase participation in, and the public profile of, artistic and cultural activities in northern Australia.

Response: Agreed — the Australian Government has a range of programs and policies that encourage excellence in art, support cultural heritage and provide access to arts and culture. The Department of Communications and the Arts delivers $40 million annually through its Indigenous arts and languages programs.

The Indigenous Languages and Arts program supports Aboriginal and Torres Strait Islander communities to revive and maintain languages, and to deliver diverse arts projects that showcase and encourage participation in traditional and contemporary Indigenous artistic expression. The program currently has funding agreements to the value of $10 million with 49 organisations to deliver 67 language and/or arts projects across northern Australia.

The Indigenous Visual Arts Industry Support (IVAIS) program provides operational support to around 80 Indigenous-owned art centres as well as a number of service organisations, art fairs and regional hubs. Together they enable the development, production and marketing of Indigenous visual art. In 2017-18, 72 per cent or $14.9 million of the IVAIS budget is being delivered to organisations in northern Australia.

The Department of Communications and the Arts also provides a range of other funding

opportunities for various cultural and artistic events and programs across northern Australia. These include:

The Regional Arts Fund, supporting sustainable cultural development in regional and remote communities.

The Festivals Australia program, funding a range of high quality, innovative arts projects that grow audiences and encourage partnership and collaboration in arts activities at festivals and events.

The National Collecting Institutions Touring and Outreach and Visions of Australia programs

support access to arts and cultural exhibitions for Australians in regional and remote Australia.

The Community Heritage Grants Program provides funding to assist with the preservation of locally owned, but nationally significant collections. In 2016 it supported organisations in the Northern Territory, far north Queensland and northern Western Australia with training, preservation assessments and the purchase of archival material.

The Australia Council invested in nearly 60 projects by artists and arts organisations in northern Australia in 2015 and 2016 and funds 16 arts organisations working in northern Australia. Regional touring programs Playing Australia, Contemporary Music Touring and the Contemporary Touring Initiative have a particular focus on regional and remote communities.

Recommendation 13: The Committee recommends that the Australian Government commit to facilitating the approval process to enable the reopening of the Christmas Island casino.

Response: Noted — While the Australian Government supports economic and tourism development for Christmas Island, broader government and community consultation would be required prior to any consideration of a proposal to re-establish a casino.

Recommendation 14: The Committee recommends that the Australian Government support the creation of a Cooperative Research Centre for Northern Agriculture. All three universities substantially based in northern Australia should be involved in the CRC.

Response: Agreed — In the White Paper the Australian Government committed to establish an industry-focussed Cooperative Research Centre (CRC) on developing northern Australia, located in the north (pp.67-68). On 21 April 2016 the Australian Government announced Townsville as the location of the CRC's headquarters, although the CRC's work will be across the north. The CRC will support industry-led projects where the north has particular strengths, including in agriculture, food and tropical health and work collaboratively with key academic partners. On 20 February 2017, the Australian Government announced the establishment CRC board. On 10 July 2017, the Chief Executive Officer, Mr Jed Matz commenced in Townsville. The CRC will also have a presence in Darwin and WA (location yet to be determined).

Recommendation 15: The Committee recommends that the Australian Government support the development of a national institute for tropical sports and sports medicine in northern Australia.

Response: Noted — The Australia Sports Commission has developed Australia's Winning Edge, which provides the high performance sports sector with clear performance targets and a framework for collaboration from 2012-2022. The strategy provides for greater levels of accountability, consistent and sustainable success for athletes and teams, and improved governance structures for reporting and monitoring performance. High performance not only fosters a sense of national pride, but also contributes to other government priorities such as participation, economic development, health and education. The Australian Government notes that any new national facility would need to take into account the current investment in, and services offered by, the Australian Institute of Sport as well as existing sports infrastructure in northern Australia.

Recommendation 16: The Committee recommends that the Australian Government allow graduates to have some or all of their Higher Education Loan Program debt written-off in return for living and working in locations deemed remote for a significant period of time, such as five years.

Response: Not supported — While the recommendation fits within the Australian Government's strategy to strengthen and develop northern Australia, a Higher Education Loan Program (HELP) debt write-off scheme would be inconsistent with the Australian Government's current policy on HELP.

The 2014 Review of the Demand Driven Funding System by Dr David Kemp and Mr Andrew Norton concluded that reduced HELP repayments were not a major influence on decisions concerning courses and careers. It is likely that HELP debt remission for graduates in remote Australia will incur a cost to government and would be helping graduates who would live there in any case. This would have little impact, if any, in encouraging others to move and work in northern Australia and is not likely to be an efficient or effective initiative.

Recommendation 17: The Committee recommends that the Australian Government give consideration to locating relevant departmental functions within the Australian Public Service to northern Australia, particularly where new organisations or departments or positions are being created which have no historical connection to other parts of Australia.

Response: Agreed in principle — In the White Paper the Australian Government committed to shift the Office of Northern Australia to the north (p.119). This was completed in December 2015, and in January 2016 the Major Projects Approval Agency (now Major Projects Facilitation Agency) 'single point of entry' Darwin office opened (pp.75-76). The Cairns headquarters for the Northern Australia Infrastructure Facility (pp.67-68) opened in August 2016, and the CRC for Developing Northern Australia (pp.67-68) headquarters opened in Townsville on 10 July 2017, and will have a presence in Darwin and WA (location yet to be determined) and work across the north.

In addition, on 1 September 2017 the Government announced that a new biosecurity hub will be built in Darwin as part of an $8 million joint project by the Australian and Northern Territory Governments to guard against foreign pests and diseases.

These relocations have bought, and will continue to bring, more public servants and other professionals to northern Australia. Additionally there are a number of existing government agencies that have a significant presence in the north, such as the Department of Defence, Department of Immigration and Border Protection, the Department of the Prime Minister and Cabinet, CSIRO, and the Australian Institute of Marine Science.

Recommendation 18: The Committee recommends that the Department of Defence give preference to local firms in northern Australia for the repair and maintenance of material and infrastructure, where it is financially sound.

Response: Agreed in principle — The Australian Government released the 2016 Defence White Paper in February 2016, accompanied by the Integrated Investment Program and Defence Industry Policy Statement. The Integrated Investment Program included around $195 billion in investment in Defence capability over the decade to 2025-26, including a major investment in Defence capability and infrastructure based in northern Australia. This will provide significant opportunities for local industry.

The Defence Industry Policy Statement outlined the Australian Government's commitment to maximising opportunities for the Australian defence industry to meet Australia's defence capability needs and help manage strategic risk over the coming decades. The Statement was founded on four principles:

Australian industry must competitively meet our capability needs.

- Maximise opportunities for Australian industry involvement in our capability programs.

- Strategically plan and develop Australia's industrial base.

- Normalise Australian industry as a fundamental input to capability.

The Australian Government and Defence are focused on building the capability and skills of Australian industry, including in northern Australia to contribute to Defence capability. The size and scale of Defence requirements, including in support of the continuous shipbuilding program, require a national approach harnessing the skills and innovation within industry across Australia.

The Australian Industry Capability Program is where Australian industry can contribute in meeting our defence capability requirements in every materiel project of $20 million and above. The Program has been significantly strengthened by making the requirements on tenderers more explicit. The requirements include:

- maximising Australian industry involvement in the acquisition and sustainment of our Defence capabilities and identify why work proposed to be performed overseas cannot be performed or transitioned to Australian industry;

- growing the skills, knowledge, technology and infrastructure within Australian industry to support enduring Australian industry capability to meet broader Defence needs;

increasing innovation and research and development in Australia, including through Australian industry, academia and other government agency support and collaboration;

- identifying opportunities for increasing Indigenous business involvement in the supply chain

and involve more Indigenous Australians to work in the delivery of that capability; and

promoting defence export opportunities to enhance industry sustainability and international competitiveness.

This new approach was embedded in the Request for Tender for the SEA1180 Offshore Patrol Vessel (OPVs) that Defence released on 30 November 2016. The project will purchase 12 OPVs to provide surveillance, patrol and response operations in Australia's maritime approaches.

The Australian Industry Capability requirements are a core component of the capability need tenderers must respond to that applies across all materiel acquisition and sustainment procurements that meet the threshold. These changes will provide increased opportunities for Australian industry, including companies based in northern Australia, to support Defence.

The Australian Government is also fundamentally transforming the way that Defence engages with Australian industry and the support it provides. A key initiative of the Defence Industry Policy Statement is the Centre for Defence Industry Capability (CDIC), funded by Defence in partnership with Auslndustry. The CDIC engages with and supports industry to do business in the defence market, and to liaise across national and state and territory governments. The CDIC delivers initiatives within three key focus areas:

Industry Development—activities include business advice and funding for sector wide

initiatives.

- Facilitating Innovation connecting business, academia and research organisations with

innovative ideas to Defence.

- Defence Business Competitiveness and Exports — supporting Australian businesses to be

more competitive and internationally successful, including through access to Capability Improvement Grants and export programs.

The CDIC has advisors that can work with local firms in northern Australia to assist them to be best positioned to competitively bid for and win Defence work. A CDIC officer is co-located with the Office of Northern Australia in Darwin.

Under the Australian Government's Defence industry policy and initiatives, companies in northern Australia now have more opportunities than ever to contribute to Defence capability objectives.

The Australian Government has in place a range of measures designed to promote economic growth through procurement. Additional Commonwealth Procurement Rules commenced on 1 March 2017. They require Commonwealth officials to consider the economic benefit of the procurement to the Australian economy and operate within the context of relevant national and international agreements, and the procurements policies to which Australia is a signatory. This includes free trade agreements and the Australia and New Zealand Government Procurement Agreement.

This change requires officials to consider the economic benefit of a procurement to the Australian economy as part of their value for money assessment, for procurements above $4 million for non-construction goods and services and above $7.5 million for construction services.

In general terms, benefits to the Australian economy, including in northern Australia, will result in the better use of Australian resources and increase productivity.

Recommendation 19: The Committee recommends that the Australian Government consider relocating additional defence assets to northern Australia in accordance with the recommendations of the Defence White Paper.

Response: Agreed — the Australian Government will enhance the Defence investment in northern Australia as part of the 2016 Defence White Paper. This investment in national defence infrastructure includes the following northern Australia Air Force bases, Tindal, Curtin, Scherger and Learmonth, the HMAS Coonawarra, and Robertson Barracks.

Recommendation 20: The Committee recommends that the Australian Government improve access to, speed and reliability of high speed broadband in order to support the development of uses of digital communication technologies in northern Australia, such as:

tele-health;

e-learning; and

projects to improve social amenity.

Response: Agreed- The Australian Government has put the rollout of the National Broadband Network (NBN) on track to affordably deliver high-speed broadband to all Australian homes and businesses by 2020. The rollout of the NBN is more progressed in regional areas than in metropolitan areas. At the end of February 2017, when the Interim Satellite Service was decommissioned, almost 65,000 premises were using Sky Muster services. By September 2017, this had increased to 79,000 active users. When the NBN is complete, all Australian homes and businesses will have access to a minimum wholesale download speed of 25 megabits per second.

Approximately two and a half million premises in regional Australia will be receiving a fixed line service. This equates to approximately 70 per cent of premises outside major urban areas. Of the remaining premises, 19 per cent will receive a fixed wireless service, and 11 per cent will receive the Sky Muster satellite service.

The Australian Government is investing more than $2 billion in the Sky Muster service, which will reach parts of Australia that are the most difficult to serve. By 21 September 2017, approximately 79,000 premises had a Sky Muster service installed. The Australian Government is working with NBN Co Limited to design new products using the Sky Muster service to cater for the needs of regional Australia. For example, distance education students can access higher monthly data allowances, comprising 50 gigabytes per student and public interest premises such as eligible health facilities available via a second satellite port in their house. In early October 2017, data allowances increased by 50 per cent for all users.

The Government has introduced legislation into the Parliament to establish a statutory infrastructure provider (SIP) regime. Under this regime, SIPs will have to connect premises to a superfast network on reasonable request, and supply services to retail providers that will allow consumers to receive peak broadband speeds of at least 25 Mbps download and 5 Mbps upload.

SIPs will need to connect premises to fixed-line networks unless this is not reasonable, in which case they will need to connect premises to fixed wireless or satellite networks. SIPs must also support voice services on the fixed-line and fixed wireless networks.

NBN Co will be the SIP in areas it declares ready for services, and after the NBN is complete it will be the default SIP for Australia. Other carriers will be able to be SIPs where appropriate, for example where they have a contract to service a new development.

The Australian Government also notes that the private sector continues to make significant investments in communications infrastructure, both as a complement to the NBN, and on a standalone basis, particularly in the area of mobile communications, transmission, and networks for businesses. Over 99 per cent of people in Australia have access to 3G mobile coverage; and over 98 per cent of people in Australia have access to 4G mobile coverage as a result of competitive, commercial private sector investment. Further significant investment has been announced. NextGen, a Vocus company, has made noteworthy investments in new transmissions through its 2000 kilometre North-West Submarine Cable System. Such investments are important to supporting the delivery of high-speed broadband to people on the move and in their homes and businesses. In December 2009 Telstra laid a fibre-optic cable between Jabiru and Nhulunbuy in the Northern Territory, as part of a $34 million project in partnership with the Northern Territory Government and Rio Tinto.

The Australian Government continues to provide funding for Telehealth services which allow patients to consult with specialist medical practitioners using online video consultations.

Access to broadband will also be important for enabling growth in the tourism industry. This will support tourism operators to optimise digital platforms to better meet visitor needs, such as instant booking/purchasing platforms, payment options in foreign currencies and multilingual information.

Recommendation 21: The Committee recommends that the Australian Government develop a telecommunications and digital technology strategy specifically for northern Australia.

Response: Noted — the Australian Government recognises that communications and connectivity are vital for people living, working and travelling in regional Australia. The ability to connect brings regional Australia closer to the rest of the world and unlocks opportunities for students, farmers, families and business owners. This is why the government is investing more in regional communications than at any other time. This historic-level of investment is already bringing benefits to regional Australians.

As noted above in response to Recommendation 20, the private sector continues to make significant investments in communications infrastructure, both as a complement to the NBN, and on a standalone basis, particularly in the area of mobile communications, transmission, and networks for businesses.

In addition to the government's investment in the NBN, the government acknowledges that mobile phone coverage is an issue of central importance to regional Australians. The government is investing $220 million in the Mobile Black Spot Program to improve mobile coverage along major regional transport routes and in small communities. Using a co investment model, this program has attracted investment from telecommunications carriers, state governments, local governments and businesses. The government's commitment of $160 million for rounds 1 and 2 of the program has leveraged a total co-investment of almost $600 million and will deliver 765 new and upgraded mobile base stations across the country. As part of its commitment, the government has allocated $60 million to address 125 priority locations. There will be an approach to market during 2017 to deliver on this commitment.

Recommendation 22: The Committee recommends that the Australian Government support the development of Aboriginal and Torres Strait Islander employment and businesses through the use of successful public and private sector models of employment and enterprise.

Response: Agreed — The Australian Government's Indigenous Advancement Strategy is focussed on getting people into work and supporting economic development. As part of the reforms to the Remote Jobs and Communities Programme, job seekers will have the opportunity to fulfil their 'work for the dole' requirements through placements in local businesses (p.109). The Community Development Programme (COP) was launched in July 2015 allowing any organisation or business to host CDP job seekers in a Work for the Dole activity.

The Australian Government has also committed up to $100 million to deliver the Vocational Training and Education Centres (including six in northern Australia) for up to 7,500 guaranteed jobs since 2014. In addition the Australian Government, through Tailored Assistance Employment Grants, can provide funding for activities that help Indigenous Australians overcome disadvantage in the labour market and connect them to employment, gain experience that builds work readiness, and contributes to the broader community.

In the White Paper the Australian Government committed to work with northern jurisdictions to agree on Indigenous employment and supply use targets for road projects (and other relevant expenditure) funded through the White Paper (p.110). Following the announcement in 2016 of successful roads projects under the Northern Australia Roads and Beef Roads programmes the work to identify employment and supply use targets for northern jurisdictions is underway. A number of additional measures in the White Paper seek to facilitate and make it easier to do business on Indigenous land, thus supporting enterprise, investment and employment:

The NAIF Investment Mandate includes a mandatory criterion that projects have an Indigenous Engagement Strategy which sets out objectives for Indigenous participation, procurement and employment that reflects the Indigenous population in the region of the proposed project.

Austrade has released a web-based business guide to land tenure arrangements in northern Australia, to encourage engagement and investment in Indigenous land.

A number of communities in the Northern Territory have negotiated township leases in 2017 and are seeing the real-time benefits of economic activity—Mutijulu in Central Australia, Pirlangimpi on the Tiwi Islands and the Binjari housing lease near Katherine. Work continues on the Gunyangara lease in northeast Arnhem Land, at Jabiru in Kakadu National Park and at Yarralin in the Victoria Daly region.

29 Aboriginal Ranger groups in northern Australia are now conducting biosecurity activities across northern Australia in addition to the 40 existing ranger groups that were doing so already.

Recommendation 23: The Committee recommends that large scale extraction of water from river systems and aquifers in northern Australia, which may impact on the environment and the fisheries industry and other activities, should be preceded by thorough scientific investigation.

Response: Agreed — In the White Paper the Australian Government committed to fund thorough water resource assessments in the Mitchell River catchment (Qld), West Kimberley (WA) and Darwin region (NT) (p.44). CSIRO has commenced the $15 million Northern Australia Water Resource Assessment project. Under this project CSIRO is working with state and territory government agencies, scientists, industry, farmers and local and Indigenous communities to assess the three water catchments. This will help state and territory governments develop water resource management plans to govern the sustainable economic and environmental development for these areas.

In addition, as part of the Exploring for the Future Programme, Geoscience Australia is undertaking regional investigations of surface and groundwater systems across northern Australia in collaboration with state and territory government agencies, to underpin future opportunities for irrigated agriculture, mineral and energy development, and community water supply. The programme includes the delivery of pre-competitive data and information to inform decision-making regarding sustainable water management and development planning. The groundwater component of this four year programme totals $30.8 million.

Recommendation 24: The Committee recommends that the numbers of Australian Quarantine and Inspection Service officers be significantly increased in northern Australia.

Response: Agree in principle — Additional resources are being applied in northern Australia to focus on tropical biosecurity risks. Under the Northern Australia and Agricultural Competitiveness White Papers the Department of Agriculture and Water Resources has increased Bio-Security officers (previously known as Australian Quarantine and Inspection Service officers) in northern Australia. The number of staff (including airport and cargo inspection staff) has increased across the north from 110.5 Full Time Equivalents (FTE) as at 30 June 2015 to around 140 FTE currently.

Recommendation 25: The Committee recommends that the Australian Government encourage ongoing bilateral exchange between the northern regions of Australia and neighbouring countries and communities in the Asia—Pacific and Indian Ocean regions.

Response: Agreed — The Australian Government is building international links and northern capacity in tropical research (p.71). It is also linking the north to ASEAN's infrastructure 'connectivity' agency and APEC's Connectivity Blueprint (p.63). The Department of Foreign Affairs and Trade supports the development of the ASEAN Master Plan on Connectivity and the ASEAN Economic Community more broadly through the $57 million (2008-2019) ASEAN- Australia Development Cooperation Program Phase II. This program promotes the cooperation between Australia and ASEAN in areas of agreed regional development priority. The program has evolved to keep pace with economic progress in South East Asia and the maturing nature of the ASEAN-Australia relationship. This program had continued to support regional economic and social development cooperation and capacities.

Recent Free Trade Agreements have been agreed with China, Japan and Korea. This is supporting increased trade that creates more Australia jobs and delivers more opportunities for Australian businesses, including in northern Australia. Furthermore, the Regional Comprehensive Economic Partnership negotiations continue to facilitate and strengthen bi-lateral discussions that have the potential to deliver significant opportunities for Australian businesses.

There is also a tailored programme to build direct business links between the north and Indonesia, Papua New Guinea (PNG) and Timor-Leste (pp.62-63). In Timor-Leste, a business registration and licencing program is being supported to reduce red-tape and improve connectivity, including with northern Australia, and in PNG a partnership has been established to support cocoa farmers to increase productivity and improve business skills.

The White Paper identified the need to share biosecurity expertise with scientists and officials in neighbouring countries including Papua New Guinea and Timor-Leste (p. 73). The Australian Government is also investing $3 million over three years to 2017/18 to trial tropical health and medical research short courses for Indonesian professionals (p.71). Short courses on malaria prevention and treatment for infants, children and pregnant women were delivered in 2016, with further courses in progress for 2017 and 2018.

In addition, the $8.5 million Australian Tropical Medicine Commercialisation Grants Program helps develop pathways to commercialise Australian research on new tropical therapeutics, vaccines and diagnostics for tropical diseases in partnership with international companies. It also provides opportunities to connect Australian research institutes and the global pharmaceutical value chain, including global pharmaceutical companies and philanthropic organisations.

Recommendation 26: The Committee recommends that the Australian Government in conjunction with the Northern Australia Strategic Partnership, design and implement a 20 year strategy for the staged development of capital infrastructure in northern Australia, including:

the upgrade of major arterial roads with a view to provide year round access to most areas in Australia ' s north;

increasing the capacity of ports and airports to facilitate an increase in volumes of traffic and trade; and

the development of water infrastructure to cater for urban and industrial development, particularly in agriculture and the resources sector.

Response to recommendations 26 and 27:

Agreed in part — in the White Paper the Australian Government committed to delivering better analysis, planning and prioritisation of infrastructure to inform decision making and provide greater certainty to investors (pp.86-101); and to work with jurisdictions to develop an infrastructure pipeline for the north (pp.92-93).

The Australian Government has made available key freight route maps identifying nationally significant places for freight, including key container and commodity ports, and the routes that connect them. This ensures strategic planning, operational and investment decisions relating to the Australian freight network can be better informed.

The Australian Government has also committed to measures to better use existing infrastructure (pp.93-95). The Australian Government is working with industry experts to develop a plan for improving aviation and surface transport connections in northern Australia (pp.98-100). In 2017, the Australian Government is providing $10.4 million for 25 aerodrome projects across northern Australia under round 4 of the Remote Airstrips Upgrade Programme with works now underway.

The Australian Government engaged CSIRO to create the Transport Network Strategic Investment Tool (TraNSIT) logistics model that is used to assess the absolute and relative benefit of investment in infrastructure such as rail, roads and ports. TraNSIT is widely used by Australian, state, territory and local governments, and businesses, to guide operation of and investment in northern Australia's infrastructure.

The Australian Government also commissioned Infrastructure Australia's Northern Australia Audit, Infrastructure for a Developing North Report (p.85) which is informing the implementation of White Paper measures. These include the Northern Australia Roads and Beef Roads Programmes, the Northern Australia Infrastructure Facility, the northern component of the National Water Infrastructure Development Fund and the National Water Infrastructure Loan Facility which will support investment in capital infrastructure via concessional loans to state and territory governments. This funding will accelerate the construction of major water infrastructure projects such as dams, weirs, pipelines and managed aquifer recharge projects to provide affordable and secure water supplies to support the growth of regional economies and communities across Australia, including the north.

Recommendation 27: The Committee recommends that the Australian Government identify key ports and commit to funding their upgrade, subject to relative benefit assessment by Infrastructure Australia. Projects to consider may include:

Darwin;

Karumba; and

Wyndham.

Response: Noted - In addition to the response at recommendation 26, the Australian Government has interests in ports for national economic performance, international trade and interstate trade and commerce. The states and territories control planning for port precincts, adjacent land uses and in most cases the connecting transport systems.

The Port of Townsville and the Port of Darwin are two examples of strategically positioned ports. For instance, in accordance with the Sustainable Ports Development Act 2015 (Ports Act) and the Reef 2050 Long-Term Sustainability Plan, the Port of Townsville was identified as a priority port given its proximity to the Great Barrier Reef World Heritage Area and its economic contribution ($10 billion in cargo moved through the port in 2015-2016). Noting also that the $5 billion Northern Australia Infrastructure Facility opened for business on 1 July 2016 and will offer up to $5 billion in concessional finance to encourage and complement private sector investment in infrastructure which can include ports.

Recommendation 28: The Committee recommends that the Australian Government, in consultation with the cattle industry, investigate standover/transfer facilities to accommodate the movement of cattle across Australia.

Response: Agreed in part — The Australian Government is committed to identifying, prioritising and investing in improvements to the northern cattle industry supply chain. The Australian Government undertook extensive consultation with key industry and government stakeholders in Rockhampton, Kununurra and Darwin to identify suitable projects under the $100 million Northern Australia Beef Roads Programme (pp. 95-96). In October 2016 the Australian Government announced 18 projects under the programme. Work is expected to commence on some of these projects in 2017. Further information is available at: http://investment.infrastructure.gov.au/funding/NABeef/

index.aspx.

As outlined in Recommendation 26, the Australian Government commissioned CSIRO to develop the TraNSIT logistics model that has been used to identify and prioritise investment in the northern cattle industry supply chain, based on the absolute and relative benefit of alternative infrastructure investments.

Recommendation 29: The Committee recommends that the Australian Government in conjunction with the Northern Australia Strategic Partnership, design and implement a 20 year strategy for the staged development of horticulture and agriculture in Northern Australia, including:

funding scientific studies on the available water and soil resources on a catchment scale, as well as the environmental implications of horticultural and agricultural developments in each catchment;

identifying infrastructure requirements for horticultural and agricultural development in each region; and

identifying regulatory impediments to horticultural and agricultural development and the best way to overcome these (e.g. land tenure issues and approvals processes).

Response: Agreed in principle — The Australian Government has committed to support analysis necessary for planning and investing in water infrastructure. This includes land-use suitability analysis of Ord Stage 3 (p.53), business case development for Nullinga Dam (p.53) and water resource assessments in the Mitchell River (Old), West Kimberley (WA) and Darwin region (NT) (p.44). The water resource assessments being undertaken by the CSIRO directly address all points in this recommendation. These catchments have been identified as the most prospective for agricultural development in northern Australia.

The $100 million Exploring for the Future programme announced by the Australian Government in May 2016 includes funding for Geoscience Australia to undertake a thorough assessment of groundwater resources and an analysis of the salinity risk for potential agricultural areas in northern Australia and parts of South Australia.

The Cooperative Research Centre (CRC) for Developing Northern Australia, headquartered in Townsville, will focus on agriculture, food and tropical health (pp.67-68).

The 'single point of entry' Major Projects Approval Agency Darwin office provides information and facilitation services to investors navigating regulatory approval processes (pp.75-76).

Austrade has delivered a web-based business guide to tenure in northern Australia. The guide is investor-focussed and provides a general introduction to systems of land tenure and native title in northern Australia (pp.32-33).

The Australian Government also released the Agriculture Competitiveness White Paper in July 2015 which complements many of the initiatives and measures under the Developing Northern Australia White Paper.

Recommendation 30: The Committee recommends that the Australian Government facilitate the creation of a rural investment fund to provide opportunities for investors to participate in rural infrastructure development projects.

Response: Noted — The Australian Government has three significant investment vehicles directly relevant for attracting investors to participate in rural and infrastructure developments.

In the White Paper the Australian Government committed to establish the $5 billion Northern Australia Infrastructure Facility (NAIF). The NAIF opened for business on 1 July 2016 and will offer up to $5 billion in concessional finance to encourage and complement private sector investment in infrastructure (such as rail, water, energy, communications networks, ports and airports) that otherwise would not be built or would not be built for some time. This support for transformative economic infrastructure will be a significant step for the longer term expansion of the economy and population in northern Australia. Investment will be spread across the three northern jurisdictions (pp.86-87).

The Australian Government has also committed to the northern component of the National Water Infrastructure Development Fund (pp.49) and the $2 billion National Water Infrastructure Loan Facility (NWILF) which will support investment in capital infrastructure via concessional loans to state and territory governments. This funding will accelerate the construction of major water infrastructure projects such as dams, weirs, pipelines and managed aquifer recharge projects. It will provide affordable and secure water supplies to support the growth of rural and regional economies and communities across Australia, including the north. In May 2017, the Australian Government announced a newly created Regional Investment Corporation will be established in Orange NSW in 2018 and will administer the $2 billion NWILF as well as the $2 billion farm business concessional loans from 2018-19.

Recommendation 31: The Committee recommends that the Australian Government, as a matter of urgency, engage the Queensland and Western Australian Governments to improve power grids in northern Queensland and in the Pilbara respectively.

Response: Noted — The Australian Government supports the efficient provision and use of energy infrastructure and recognises the private sector is best placed to respond to signals around the need for investment in this sector. The Australian Government works closely with both the Queensland and Western Australian Governments on energy matters. The State's participation in the National Electricity Market, primarily through the Council of Australian Governments (COAG) Energy Council, provides engagement to ensure consumers are able to secure reliable and adequate energy supplies at an efficient cost. The Australian Government notes that the Western Australian Government is also a member of the COAG Energy Council.

Recommendation 32: The Committee recommends that the Australian Government promote the use of renewable energy sources as a solution to the remoteness and isolation from the grid of many homesteads and communities in northern Australia.

Response: Agreed — The Australian Government is supporting the deployment of renewable energy systems in Australia through the Renewable Energy Target and a number of projects specifically supporting the use of renewable energy in off-grid and fringe-of-grid applications, including throughout northern Australia.

The Australian Government notes the Senate Rural and Regional Affairs and Transport References Committee completed an inquiry into the role and contribution of regional capitals to Australia, with a final report tabled on 24 November 2016. This includes the Northern Territory Solar Energy Transformation Program, jointly funded by the Australian Renewable Energy Agency and the Northern Territory Power and Water Corporation. The program will integrate 10 megawatts of solar PV in up to 30 remote communities in the Northern Territory, including one site with energy storage technologies. This will create a platform for greater future use of solar in the Northern Territory. Financing is also available through the Australian Government's Clean Energy Finance Corporation to finance renewable energy solutions across northern Australia.

Recommendation 33: The Committee recommends that the Australian Government, in conjunction with the Northern Australia Strategic Partnership, develop a strategy to promote liveability in Northern Australia using the ' hub-and- spoke ' model to deliver services and promote amenity in regional and remote communities, including in the areas of:

health;

education;

social/community services;

sports; and

arts/culture.

Response: Agreed in principle — the Australian Government notes that while the 'hub and spoke' model of service delivery already exists for a range of government services, there is an opportunity for further refinement of those models to ensure that they are efficient and meet changing consumer needs.

The Australian Government provides funding for Telehealth services which allows patients to consult with specialist medical practitioners using online video consultations.

Across northern Australia, primary health networks (PHNs) have also been established with the key objectives of increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes and improving coordination of care. They have established strong partnerships with local providers to ensure collaboration throughout the region.

The Australian Government is working with the states and territories which are responsible for delivering school education and ensuring access to quality education within their jurisdictions. This ensures that all students, regardless of where they live, have access to high quality education and the same educational opportunities as other students. Further funding is provided to reflect the additional cost of operating smaller schools and schools located in regional, rural and remote areas.

The Australian Government has also commissioned an independent review into regional, rural and remote education to consider key issues, barriers and challenges. This review recommends innovative ways to support these students to succeed whilst at school and during their transition to further study, training and employment. The review will be completed by December 2017.

The Australian Government promotes liveability in regional and remote communities by supporting access to, and participation in arts and cultural activities such as festivals, performances, exhibitions and community projects. Several funded Indigenous art and language centres currently provide an outreach service to multiple outlying communities, and this model is highly successful in some areas, especially in remote Western Australia.

The Australian Government notes the Senate Rural and Regional Affairs and Transport References Committee completed an inquiry into the role and contribution of regional capitals to Australia, with a final report tabled on 24 November 2016.

The Australian Government, Queensland Government and Townsville City Council signed Australia's first City Deal for Townsville on 9 December 2016. The Townsville City Deal is a 15 year commitment between the three levels of government. They will focus on improving the lives of Townsville residents through job creation, economic growth, investment in local infrastructure, a revitalised urban centre, and a more vibrant and liveable city. The Commonwealth and Northern Territory governments have entered into an agreement to work together to create a City Deal for Darwin. The two governments have signed a Memorandum of Understanding, as a step towards a future City Deal for Darwin that will drive investment, jobs and make life better for communities in the region.

Recommendation 34: The Committee recommends that the Australian Government, in conjunction with State and Territory Governments, work to normalise the local government arrangements in mining communities, such as Weipa and Nhulunbuy, to allow these communities to pursue development opportunities free from the control of mining companies. Strategies need to be developed to complete the normalisation process in a number of Pilbara towns where mining companies ' retention of monopoly ownership of utilities and land is hampering growth and economic diversification.

Response: Noted — states and territories are responsible for local government arrangements.

Recommendation 35: The Committee recommends that the Australian Government facilitate the development of the aquaculture industry in Northern Australia by improving the regulatory framework.

Response: Agreed — The Australian Government requested the Productivity Commission to conduct an inquiry into the Regulation of Australian Marine Fisheries and Aquaculture Sectors to identify further opportunities to improve regulation for the aquaculture sector (p.82). The Productivity Commission publically released itsinquiry on 23 May 2017. The Government released its response to the PC report on 23 May 2017 and will continue to work with jurisdictions to develop a collaborative cross-jurisdictional strategy for progressing relevant recommendations. The government continues to progress initiatives to cut red tape for fisheries arising from the White Paper on Developing Northern Australia. These include: moving to single jurisdiction management of northern fisheries; devolving aquaculture management to the states and territories; sharing licensing and compliance services; and extending export approvals to 10 years for low risk fisheries.

Further, the Australian Government is pleased to note the Joint Select Committee on Northern Australia has undertaken an inquiry into opportunities for expanding the aquaculture industry in northern Australia. The Joint Senate Select Committee on Northern Australia report 'Scaling up: Inquiry into opportunities for expanding aquaculture in Northern Australia' was released in February 2016. The Australian Government tabled a response in June 2017 noting that research, revision of existing legislation and provision of financial and technical support were already underway. Potential aquaculture activities in Commonwealth marine reserves are considered when consistent with reserve zoning, management prescriptions and the acceptability of impacts on reserve values. The Australian Government is keen to support further exploration of opportunities for development in Northern Australia, which ensure the waters and land of Northern Australia remain healthy, abundant with native species and a resource for generations to come.

Recommendation 36: The Committee recommends that the Australian Government review fisheries laws to harmonise regulations between jurisdictions, promote the sustainable development of existing commercial, recreational and sporting fisheries and the creation of new fisheries, and provide a secure long-term future for the fishing industry in northern Australia.

Response: Agreed — Discussions on low risk fisheries suitable for long-term (up to 10 year) export approvals have been held with all Commonwealth state and territory fisheries management agencies. These export approvals will be granted as part of the Department of Environment and Energy's business as usual practices. The Australian Government is committed to harmonising regulations between the Commonwealth and northern jurisdictions.

Recommendation 37: The Committee recommends that the Australian Government explore reforms to the taxation system to better promote investment and development in northern Australia.

Response: Agreed in part -As part of the 2016-17 Budget, the Australian Government announced its 10-year Enterprise Tax Plan. The Plan is currently before the Senate and it is the government's policy to legislate the company tax cuts under the Enterprise Tax Plan in full. Under the Plan, a company tax rate of 27.5 per cent will apply to businesses with annual turnover less than $10 million from the 2015-16 income year. For the 2016-17 income year, the Australian Taxation Office has put in place arrangements to ensure that all companies who qualify for the 27.5 per cent in 2016-17 are subject to that rate. The turnover threshold to qualify for the lower tax rate will then be progressively increased to cover all companies by 2023-24. From 2024-25, the corporate tax rate will be reduced in stages to reach 25 per cent in 2026-27. Treasury modelling estimates that a five percentage point cut in the company tax rate will increase business investment by up to 2.9 per cent in the long term and GDP by over 1 per cent. This impact will be felt across Australia, including northern Australia.

Recommendation 38: The Committee recommends that the Australian Government investigate the equity of the current application of the Zone Tax Offset arrangements so that:

the Zones reflect the current distribution of population and rebates are increased to reflect the current cost of living in regional and remote areas; and

the Zone Tax Offset applies only to persons whose principal place of residence is within a zone.

Response: Agreed in part — The Australian Government has made changes to better target the Zone Tax Offset. Eligibility for the Zone Tax Offset has changed to exclude 'fly-in fly-out' and 'drive-in drive-out' workers from claiming the Zone Tax Offset where their normal residence is not within a 'zone' from the 2015-16 incomeyear. This better targets the Zone Tax Offset to taxpayers who genuinely live within the zones.

Recommendation 39: The Committee recommends that the Australian Government review the taxation treatment of FIFO work arrangements to ensure that they are consistent with the goal of promoting the development of regional and remote communities in northern Australia, including:

implementing Recommendations 12 and 13 of the House of Representatives Standing Committee on Regional Australia report Cancer of the Bush or Salvation for Our Cities? relating to changes to the Fringe Benefits Tax Assessment Act 1986; and

Response: Noted — Reforming the Fringe Benefits Tax regime requires careful consideration of how best to achieve a range of objectives, including promoting efficiency while maintaining equity and integrity within a fiscally constrained environment. The Australian Government will consider this recommendation as part of its ongoing work programme of making improvements to the tax system.

reviewing the taxation laws to encourage the construction of permanent dwellings rather than temporary work camps by:

capital depreciation for residential housing developed by mining companies on the same basis as transient worker accommodation; and

the exclusion of transient worker accommodation from within a sixty kilometre radius of existing settlements.

Response: Not agreed — The tax treatment of employer provided temporary housing and residential rental housing is consistent with principles which underpin the rules for depreciating capital assets (that is, an asset is generallyallowed to be depreciated over its useful life, with temporary housing typically having a shorter life).

Recommendation 40: The Committee recommends that the Australian Government pursue, through the Northern Australia Strategic Partnership, the harmonisation and simplification of land tenure arrangements in the jurisdictions across northern Australia. The Committee acknowledges the unique nature of the statutory inalienable freehold title under the Aboriginal Land Rights (Northern Territory) Act 1976 and that it is particular to the Northern Territory. The Committee also acknowledges the limited range of rights in land that are derived from the Native Title Act 1993. The Committee recommends that governments and business work constructively with Aboriginal and Torres Strait Islander people and organisations such as land councils and native title representative bodies or prescribed bodies corporate to maximise the economic development and employment opportunities on Aboriginal land and/or land over which there is native title.

Response: Agreed in principle — The Australian Government is committed to working with Indigenous land owners and native title holders to support them to be able to leverage their rights in land to pursue economic development.

In the White Paper the Australian Government committed to a range of initiatives in support of this, including:

investing in stronger native title corporations to help them meet their aspirations and engage in the mainstream economy ($20.4 million) (pp.23-24);

investing in planning and infrastructure that is needed to improve land administration and support more certain long term tenure arrangements ($17 million) (pp.28-29);

supporting pilot land reform projects ($10.6 million) (pp.18-19);

supporting the efficient resolution of native title claims and efficient native title processes (pp.22-23); and

reinforcing the importance of native title in our economy (pp.19-21; p.25).

Funding has been provided to assist native title holding corporations to generate economic benefit through the effective and sustainable management of their land. In 2016 and 2017, funding of $2.5 million was agreed for 11 projects to date. The Australian Government is supporting eight land tenure reform pilot projects that broaden economic activity on land in the north and demonstrate the benefits of more diverse activity to business, Indigenous communities and other stakeholders. Funding arrangements for these pilots is in place and implementation is underway. The Australian Government is considering additional pilots.

A number of communities in the Northern Territory have negotiated township leases in 2017 and are seeing the real-time benefits of economic activity—Mutijulu in Central Australia, Pirlangimpi on the Tiwi Islands and the Binjari housing lease near Katherine. Work continues on the Gunyangara lease in northeast Arnhem Land, at Jabiru in Kakadu National Park and at Yarralin in the Victoria Daly region.

Further actions for reforming land tenure arrangements are being pursued through the Council of Australian Governments (COAG). On 11 December 2015, COAG agreed to implement the recommendations of the Report of the Investigation into Indigenous Land Administration and Use.

In cooperation with state governments, Austrade has developed a guide for investors to explain land tenure arrangements in northern Australia, including an interactive map to show tenure and native

titles applying in any one geographical location in the north. Austrade will continue to develop this guide and will highlight case studies for investors to demonstrate the processes for engaging with traditional owners.

Austrade appointed in September 2016 a senior manager for northern Australia Delivery (with a cross jurisdictional responsibility to support investment opportunities in Queensland, Northern Territory and Western Australia) to further support the promotion of investment opportunities in the north.

Recommendation 41: The Committee recommends that the Australian Government review the cost and administration of customs, quarantine and immigration services to provide the most cost-effective way of delivering those services, including:

providing customs, quarantine and immigration services at selected regional airports;

reducing visa charges for overseas visitors to encourage inbound tourism; and

reducing the passenger movement charge to reflect the actual cost of providing customs, quarantine and immigration services.

Response: : Agreed in part — On 1 July 2015, the functions of the Department of Immigration and Border Protection and the Australian Customs and Border Protection Service were integrated into a new department. The integration of complementary customs, immigration and border protection functions and capabilities provide greater opportunities for a shared approach to service delivery.

The Australian Government has announced the provision of border control services to facilitate international flights to and from Townsville airport, noting that airports commencing international flights may have an increased transport security obligation requiring a review of their Transport Security Program. International flights to and from Townsville commenced in September 2015.

The Australian Government also announced a number of changes to border fees, charges and taxes as part of the 2015-16 Commonwealth Budget, including simplifying arrangements around import processing charges, changes to licensing arrangements, and the harmonisation of Visa Application Charges.

Recommendation 42: The Committee recommends that the Australian Government pursue, through the Northern Australia Strategic Partnership, the harmonisation of governance and regulation in the jurisdictions across northern Australia, including in the areas of, but not exclusive to:

environmental management;

provision of health services and health industry qualifications;

transport regulations, especially those dealing with heavy vehicle capacity and driver fatigue;

water management; and

Aboriginal and Torres Strait Islander affairs.

Response: Agreed in principle — The Australian Government remains committed to removing red tape where appropriate.

The Australian Government is continuing to work with state and territory governments to reduce unnecessary regulation for environmental approvals of nationally protected matters whilst maintaining high environmental standards. The 'single point of entry' Major Projects Approval

Agency (now Major Projects Facilitation Agency) Darwin office provides information and facilitation services to investors navigating regulatory approval processes (pp.75-76).

Through the National Heavy Vehicle Regulator, the Australian Government is working with jurisdictions in northern Australia to implement targeted and flexible regulatory regimes that facilitate greater use of higher productivity vehicles, whilst delivering better safety outcomes. The Australian Government will also work with jurisdictions in the north to cut red tape associated with cattle supply chains (p.96).

The Australian Government's commitment to water resource assessments will support more certainty over water management in the north (pp.47-48).

The Australian Government is committed to working with Indigenous groups, business and communities to find new ways of using land in the north to promote economic opportunities for all (pp.26-34). The Australian Government will also consult on a more efficient approach to cultural heritage regulation including an option for Commonwealth accreditation of best practice state/territory Indigenous heritage protection regimes (p.79).