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Effectiveness of state, territory and Commonwealth government policies on regional and remote Indigenous communities

CHAIR —I welcome Debra Malthouse to the table. Information on parliamentary privilege and the protection of witnesses and evidence has previously been provided to you. I now invite you to make a short opening statement. At the conclusion of your remarks I will invite members from the committee to put questions to you.

Ms Malthouse —Wuchopperen Health Service is an Aboriginal community controlled organisation based in Cairns. We have been in operation since 1981 in terms of service delivery. Our client base includes Aboriginal and Torres Strait Islander people from the Cairns region down as far as Innisfail and up as far as Mossman Gorge, and we do some outreach work out as far as Croydon, Dimbulah and Chilligoe.

We provide a comprehensive healthcare service in relation to primary health care as well as social and emotional wellbeing services to families dealing with social and emotional problems which most mainstream organisations call mental health. We tend not to use that term because it has implications for Aboriginal and Torres Strait Islander people in relation to being a bad thing as opposed to the fact that sometimes their issues are around dealing with past history, government polices and things to make their lives today a little bit better. So we tend not to use the term ‘mental health’, although I understand that some of the things you guys are looking at are around mental health. If I tend to use ‘emotional wellbeing’ and ‘social health’ that is what I am referring to, and I appreciate your accepting that from my point of view.

I do not have a statement as such other than that, so I am happy to leave it at that if that is okay with you.

Senator CROSSIN —Can I just go to an area that we probably have not explored in this committee—or maybe we have: antenatal and postnatal provision for women? Do you cover the Cape?

Ms Malthouse —No, we do not do the Cape.

Senator CROSSIN —Just the Cairns area?

Ms Malthouse —The Cairns district. We have a site location in Cairns and one in Atherton. Atherton looks at the tablelands and the rural area, and we in Cairns look after this area. We actually do not go to the Cape.

Senator MOORE —Do you still have a relationship with Mt Isa?

Ms Malthouse —Not any more, no.

Senator MOORE —You have ceased that?

Ms Malthouse —Yes. They have their own service now.

Senator MOORE —That is fantastic.

Senator CROSSIN —So your service is more for urban Indigenous?

Ms Malthouse —And rural in the sense that we do Atherton and the tablelands.

Senator CROSSIN —I was going to ask about remote birthing services, but you would not do that sort of thing?

Ms Malthouse —We do not do anything with that, no. The only time we might have any relationship with women having babies, prenatal and postnatal, is if they actually relocate to Cairns to have their babies. They do sometimes come to Cairns to stay at Mookai Rosie Bi-Bayan, which is the Aboriginal organisation that provides accommodation and support. If they come there they often use our services, seeing our doctors and our nurses.

Senator CROSSIN —Okay. What sort of provision for drug and alcohol rehabilitation is there in this area that your people can access?

Ms Malthouse —We provide a substance misuse program through our social and emotional wellbeing programs. They are by way of counselling and support for individuals and families who have substance misuse problems. We also do some work under the mental health rural and remote program which is funded by OATSIH in the upper tablelands area, out to Croydon and Chillagoe.

Senator CROSSIN —The Queensland government have a fairly good proactive drug and alcohol rehabilitation support service, do they?

Ms Malthouse —We do work with the ATODS. Our substances program actually works with the ATODS workers in Cairns. At the moment we are also working closely with the Gold Coast Drug Council, which has the new Aboriginal and Torres Strait Islander rehabilitation service here in Cairns. The previous one actually closed down and the Commonwealth government funded the Gold Coast Drug Council for it. We are working with them to establish links with the local Aboriginal and Torres Strait Islander community because they are a mainstream organisation which is based on the Gold Coast.

Senator CROSSIN —Thank you. I should probably let Senator Adams ask more questions than me because she has the health background.

Senator ADAMS —Thank you for your brief opening statement. For dialysis care, do you have anything to do with any of the remote people that have to come to Cairns to have their treatment?

Ms Malthouse —No. We do have some clients in the upper tablelands who need to get dialysis, but generally our support is transport. We do not usually do the Cape, but if we have a client in the Atherton Tablelands area who needs to go to the Atherton hospital for dialysis treatment they can organise for us to have our bus pick them up, take them and take them home. Sometimes that is the issue: the transport and getting to the hospitals for the dialysis treatment.

Senator ADAMS —Just on dialysis—it is just the Cairns Base Hospital, is it? Is that where they go, or is there another?

Ms Malthouse —Atherton as well.

Senator ADAMS —Atherton too. And what about for Innisfail and down that way? Do they have a unit?

Ms Malthouse —I do not know. They have an Aboriginal medical service in Innisfail that looks after that area—that is Mamu Health Services.

Senator ADAMS —As far as immunisation programs go—you do all that sort of primary health care?

Ms Malthouse —We provide that through our site in Cairns at Moignard Street and also through our clinic in Atherton.

Senator ADAMS —And what is the take-up with that? Is it fairly successful?

Ms Malthouse —Generally it has been successful. We have difficulty around workforce recruitment, particularly when we have to recruit allied health workers and general practitioners. The difficulty is keeping them because of the amount of money they can get when they are out in private practice.

So we have four FTEs in terms of doctors but only three are permanent, and the rest work part time; they work two days a week. Three fill one position and work two days a week each and, at the other times, they work in their private practice. Our ability to provide the dollars to keep them is quite low, because, while we are commensurate with hourly rates for Queensland Health, we cannot offer the additional packages they can get from Queensland Health and the amount of money they can make in private practice. So in terms of having the doctors on the board, we have the RNs who are endorsed to do immunisation, but we still need to have the doctors available so they can support the RNs and our health workers, and that makes it difficult. We were trying to do some of the work that we need to do around primary health care, particularly comprehensive stuff.

Senator ADAMS —Do you have anything to do with school health?

Ms Malthouse —In Atherton, in particular—Atherton is a smaller community—our clinic runs five days a week. We have one doctor and three health workers and an RN. What they do on a three-monthly basis is to negotiate with the schools, to go and do what they call school screening. Our eye health coordinator goes with them, and our hearing health coordinator from Cairns visits, and they do a whole heap of screening around that. Just recently we have done most of the year 9s at Atherton High School and our hearing health program goes to all the schools when they are invited. So the relationship between the schools, our hearing health and our eye health coordinators is quite good, and they can link with the schools and organise with the schools about when they need to do some programs around screening the children.

Senator ADAMS —With regard to hearing health, could you give us any idea of the percentage of children who have a hearing disability or a problem?

Ms Malthouse —No, I am sorry. I have been in this job only three months so I do not have all the information that I could provide to you. I quickly tried to pick up some information last night that you might be asking about but, no, I cannot give you that information.

Senator ADAMS —Do you have anything to do with the Patient Assisted Travel Scheme?

Ms Malthouse —No.

Senator SIEWERT —Is it possible for us to ask you some questions and, as long as it does not make too much time, provide us with some feedback?

Ms Malthouse —Yes.

Senator SIEWERT —I am interested in the hearing health issues around the level of ON in the year 9s you are testing. What is the percentage of hearing problems you are picking up?

Ms Malthouse —I cannot answer that question but I am happy to provide that information to you later, if that is okay.

Senator SIEWERT —That would be great. Another committee with many common members is carrying out an inquiry into hearing health. It is an area in which we are all getting very interested and passionate. Could you tell us where you get your funding from and how much, if it is possible to get that?

Ms Malthouse —We have an annual budget of around $8 million. Approximately $6 million of that comes from the Commonwealth through OATSIH and the other $2 million comes from the state government, primarily the Department of Communities and some from Queensland Health.

Senator SIEWERT —You have touched on my next question. Is the $6 billion that you get from the Commonwealth in one lot or, as we have discovered in many other health services, are there multiple fundings?

Ms Malthouse —Yes, it is multiple funding. OATSIH might have a budget of around $4 million or $5 million and then they would provide different funding based on the program areas. While they have what they call a global budget—so they will say, ‘This is your budget of $4 million; you can tell us how you are going to use it’—throughout the process when new initiatives come up they generally add to it and then that either goes into part of the global budget or goes specifically to a program. If it is actually a budget initiative then it is often linked to that program, so it is a separate bucket of money because of the way they have to report against it.

Senator SIEWERT —How many budget grants would you be responsible for now or get funding under?

Ms Malthouse —We get funding from the Department of Health and Ageing through OATSIH, and we get funding through the Department of Communities and Queensland Health—

Senator SIEWERT —Yes, I am getting to the projects.

Ms Malthouse —but within those organisations there are projects underneath that.

Senator SIEWERT —I am linking it back to the overburden report, for example, which shows that some organisations can have up to 42 different projects that they are implementing.

Ms Malthouse —OATSIH is not as difficult as the Department of Communities because the department generally has a service agreement for each of the programs, so we might have half-a-dozen programs that have half-a-dozen service agreements that relate to that and then different performance indicators. At this point it is at state level. The Commonwealth, through OATSIH, is not as difficult because, if they do additionally give us dollars and it is about a government initiative, it is generally something that we can actually deal with. More often than not it links back to the overall service agreement anyway whereas the state is a little bit different because there is a different service agreement every time they give us money.

Senator SIEWERT —Thank you. The issue that you were talking about with Senator Adams of not being able to pay your GPs the same amount in terms of packages, how often do you lose doctors or turn over staff?

Ms Malthouse —We have two doctors who have been with us for a number of years but they are overseas trained doctors which also limits us because they have to be supervised. They are not actually qualified to work on their own. They have been with us for almost five years but they need to be supervised by a doctor, so we have to have a doctor who is qualified and who has the requirements to supervise them. While we have those two doctors there we need to find the other person. The problem is that because the other doctors who are qualified also work in private practice we have to do our roster in a way that they are actually there all the time so that there is someone there to supervise the two doctors who are there permanently. When they are not supervised, they are not meant to be seeing clients. That causes difficulty for us. Most of doctors have been with us for a couple of years. The problem is that the ones who have been there permanently who previously worked full time have reduced it to two days, three days or 2½ days because they work in private practice.

Senator SIEWERT —Do you have many allied health professionals in the service as well?

Ms Malthouse —No, we have probably about four. While 75 per cent of our workers are Indigenous, the majority of our workers are Aboriginal and Torres Strait health workers.

Senator SIEWERT —That leads me to my next question which you are touching on which is how many of your workers are Indigenous?

Ms Malthouse —It is 75 per cent. We have a staff of 130 across both of our sites in Atherton and Cairns and 75 per cent of them are Indigenous.

Senator SIEWERT —That is great. Do you have a target for that? You obviously have an active program of ensuring Indigenous workers.

Ms Malthouse —Ideally for us it would be 100 per cent but, unfortunately, if you look at the doctors, the allied health workers that we do have and our RNs, none of them are Indigenous.

Senator SIEWERT —That leads me to the issue around training and support for Indigenous trained health professionals.

Ms Malthouse —We work closely with the peak body for Aboriginal and Torres Strait Islander medical services in Queensland which is QAIHC—the Queensland Aboriginal and Islander Health Council—and they provide a lot of support around training and development. One of the things that are happening in relation to Aboriginal health workers is the need for them to be fully qualified by 2012 to actually enable them to have jobs in AMSs.

Senator SIEWERT —This is the new training.

Ms Malthouse —Yes, so QAIHC works closely with us to ensure that the health workers that we do have are qualified. By 2012 they will need to have minimum qualifications to have a job as a health worker in an Aboriginal medical service.

Senator SIEWERT —We have had concerns raised with us about the changes and some organisations are concerned about some workers not being able to receive the training in time for 2012.

Ms Malthouse —Most of our health workers are already qualified. We have probably only two or three that do not have the qualifications that they require.

Senator MOORE —Ms Malthouse, Wuchopperen are regular visitors to our various committees, talking about health. I know you have been there a limited time, but this is your chance to say what you would like to be able to do in the future for Aboriginal and Torres Strait Islander health in this region, where your organisation has been working for such a long time. If you could have everything that you wanted to provide services in this area, what would you like to be able to do with the health service?

Ms Malthouse —One of the things for us is that we want to be able to provide to our clients a comprehensive primary healthcare service. Unfortunately, we are not able to because the type of approach we would like to take would be a team approach, where we would use a GP, an RN and a health worker to work with the client throughout their journey in receiving health services. Unfortunately, because we are limited with the staffing that we have, we have issues around that. The staffing relates primarily to being able to recruit RNs and GPs because of the fact that they can get better money working outside of AMSs. One of the things I have heard since I have been there is from the doctors, who say that working in an AMS is different from working in private practice because you have clients who have really comprehensive needs and a lot of complex health needs. So, while the organisation might think that the money we are paying them is commensurate with what Queensland Health can pay, they have to work a lot harder and be a lot more up to date on things to work with the family or with the client to meet their health needs.

The other thing that is an issue for us is our ability to house all the staff that we have. When we moved to the site that we are at at the moment, in 1997, we only had 30 staff. We now have 130. We have not been able to secure the funding to have the premises that we require to deliver the services from. Our ideal would be to provide our services from one base. At the moment we have to rent across the town to provide different programs. In order to look at providing a service to our clients holistically, our preference would be to do it from a base where everything could be provided to the client, rather than having to come to Moignard Street for some parts of it and go to another location for other parts and yet another location for other parts. From an Aboriginal and Torres Strait Islander health perspective, we want to be able to work with our clients and their families comprehensively and more holistically. We try to do that. We have our clinical and non-clinical services and what we call our social health programs and our physical health programs, but, unfortunately, because we are not able to co-locate we cannot have the seamless service delivery that we require and we do not have the staffing numbers that we need to actually be able to do it as comprehensively as we would like to.

Senator MOORE —So it is infrastructure that you really need.

Ms Malthouse —At the moment, primarily it is infrastructure. We just do not have the capacity.

Senator MOORE —With the training that JCU is now providing for a range of services, do you have the opportunity to offer workplace placements for people?

Ms Malthouse —Yes. We do that, yes. We get requests for that. We work with universities and medical students. We have one at the moment who is an Aboriginal man. He is in his fifth year.

Senator MOORE —Where is he from?

Ms Malthouse —He comes from JCU. We have just recently, for three weeks, had a medical student from the University of New South Wales. We also have relationships with the dental unit out at JCU. Two of our past dental trainees are now going through dental school. They are Aboriginal young people, a male and female, who are now doing their first year of dental at JCU.

Senator MOORE —Which is all part of the building and training. I am interested to know whether you have any comments about the incidence of foetal alcohol syndrome in this part of the world.

Ms Malthouse —We run the Australian Nurse-Family Partnership that is funded through the Department of Health and Ageing. It is a relatively new program. While it is a nurse led program, we also have what we call family partnership workers. They are Indigenous workers who partner the nurses in working with the young mothers or first-time mothers that the program works with. That program follows the mother and child for two years. I think it is from when they are four months pregnant to the time when the child is two years old. They work with the parents, the family and the extended family to give the child the best chance at life and to help the family deal with when they are new parents. The FAS stuff for us comes up occasionally. We do see a number of children who have had those issues, but I cannot tell you exactly what that might be for us. I know that our Australian Nurse-Family Partnership Program is a key component at this point. It has been in operation for around 18 months.

Senator MOORE —And it is feeding information to national data?

Ms Malthouse —Yes.

Senator MOORE —Thank you.

CHAIR —As there are no further questions, thank you very much, Ms Malthouse. Senator Siewert has already indicated that we will give you some questions on notice. They will be provided through the secretariat. If you have other issues or further information to supply to the committee, or any corrections you may want to make, you can also do that through the secretariat.

Ms Malthouse —Okay. Thank you.

CHAIR —Thank you very much for your evidence today.

Proceedings suspended from 9.35 am to 9.40 am