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Community Affairs Legislation Committee
17/10/2012
Estimates
HEALTH AND AGEING PORTFOLIO
Australian Institute of Health and Welfare

Australian Institute of Health and Welfare

[09:43]

CHAIR: Welcome.

Senator FIERRAVANTI-WELLS: Mr Kalisch, I am not sure if you got the email about the financial questions we were going to ask of agencies as well, but the same situation applies: please take on notice what you are not able to give me today. I might start with your 2010-11 financial year and actual expenses, including a breakdown.

Mr Kalisch : The actual expenses for the Australian Institute of Health and Welfare—and we have only one program—are provided in our annual report from last year, the 2010-11 annual report. On page 20, the relevant figure is $53,818,000. All of those expenses are characterised as departmental.

Senator FIERRAVANTI-WELLS: And what was your actual figure for 2011-12?

Mr Kalisch : That will be provided in our annual report for 2011-12, which is not yet released. It will probably be available in the coming days. It will go through a process through our board of approval and then go through to the minister.

Senator FIERRAVANTI-WELLS: And you said you have only one program?

Mr Kalisch : Yes.

Senator FIERRAVANTI-WELLS: For 2012-13, what are your budgeted expenses?

Mr Kalisch : The budgeted expenses are all in the PBS that you have been referring to on page 307. The relevant figure for all expenses is $48,848,000.

Senator FIERRAVANTI-WELLS: Over the forward estimates do those figures remain the same?

Mr Kalisch : Yes, we have projected that our external receipts will be constant. One of the challenging things about managing at the IHW is that, of our revenues, only one-third comes through our appropriation. Two-thirds comes through other external fee-for-service activities, which are somewhat volatile.

Senator FIERRAVANTI-WELLS: In relation to variations of your staff numbers, your estimated was 333. What are your current staff numbers?

Mr Kalisch : The latest staff numbers I have are for 30 June and were 357.1. Excluding the inactive staff it was around 330.1. We are expecting a small reduction, probably of the order of about 20 staff, over the financial year.

Senator FIERRAVANTI-WELLS: That is due to?

Mr Kalisch : It would be undertaken through natural attrition. We will not be needing to progress too much. We also are probably reducing a number of our non-ongoing staff as well. Given the volatility of our—

Senator FIERRAVANTI-WELLS: That is as a consequence of the efficiency dividend?

Mr Kalisch : It is a consequence of overall efficiencies. The efficiency dividend itself is very modest for the Institute of Health and Welfare.

Senator FIERRAVANTI-WELLS: What was that figure?

Mr Kalisch : The efficiency dividend is of the order of about $400,000.

Senator SIEWERT: Can I ask whether you have had any involvement with FaHCSIA's Longitudinal Study of Indigenous Children that they have been undertaking over a number of years?

Mr Kalisch : I am not aware that the institute has had any engagement with that in a formal way.

Senator SIEWERT: Have you had any informal engagement?

Mr Kalisch : Not that I am aware of while I have been at the institute. We certainly do engage with FaHCSIA quite extensively around their program of work of Indigenous research and evaluation. As you would be aware the institute also has its Closing the gap Clearinghouse, which is funded by FaHCSIA, which we undertake in conjunction with the Australian Institute of Family Studies. I would anticipate that the Closing the gap Clearinghouse does report some information that uses the data that is coming out of the Longitudinal Study of Indigenous Children.

Senator SIEWERT: Okay. But you have not had any formal engagement with that process?

Mr Kalisch : I am not aware that we are involved with the advisory board or the other processes.

Senator SIEWERT: Could you take on notice to check that?

Mr Kalisch : I will certainly check that.

Senator SIEWERT: Do I take it, therefore, that, if you have had no involvement, you have not been involved in providing advice on survey design?

Mr Kalisch : I am not aware of that, but I will take that on notice.

Senator SIEWERT: Thank you. Has the institute had any involvement in the survey work that FaHCSIA is undertaking in regard to the income management measures, in particular, the child protection income management measures?

Mr Kalisch : Again, not that I am aware of.

Senator SIEWERT: Could you take that on notice. I am particularly interested in the survey work that is being undertaken in Western Australia at this time. If you have had any engagement or been consulted on design of that study, I would appreciate it.

Mr Kalisch : I could certainly let you know that we are involved with some work with FaHCSIA and the other children's services or child protection agencies across the jurisdictions looking at improvements to the national minimum data set that is available for those that are providing and receiving some services. But I am not aware of that specific survey work.

Senator SIEWERT: Just to be clear, that is for the individual states?

Mr Kalisch : Yes. It is the collection of information through administrative purposes of people that receive services in each of the child welfare departments across the states. It is looking at a consistent way of collecting information.

Senator SIEWERT: Which is different?

Mr Kalisch : It is different to the survey dimension that you were talking about.

Senator SIEWERT: I understand that there is a survey being undertaken and obviously I will be asking FaHCSIA more about this tomorrow. I understand that there has been a survey of some nature being undertaken, certainly in Western Australia, of income management measures as they relate to child protection. That is particularly the area that I am interested in.

Mr Kalisch : I will take that on notice and, if we are engaged in any way, I will let you know.

Senator SIEWERT: In terms of the work that you just mentioned about working with the child welfare protection agencies, when is the timeline for that work to be completed? Are you undertaking that or just providing advice?

Mr Kalisch : We are undertaking that work for the jurisdictions and for the Commonwealth.

Senator SIEWERT: When is that expected to be completed?

Mr Kalisch : There are a range of dimensions. We are doing a pilot collection for a new child protection unit record system. A full dress pilot is expected to be carried out in November this year. Alongside the aggregate data collection it is anticipated that the unit record data collection will be fully implemented next year. We are also doing some work to improve the existing five measures reported under the National Standards for out-of-home-care. That commenced in July 2012 for completion in the first half of 2013. We are developing a national minimum data set on treatment and support services. We are also looking at developing ongoing educational outcomes, national data collection, particularly for those children in the child protection system, to look at the way in which they progress through education. So, we are having engagements with states, territories and with ACARA around accessing NAPLAN testing results.

Senator SIEWERT: Thank you. All of those are scheduled to be completed in 2013?

Mr Kalisch : Some completed in 2012 and some going into 2013, but it is certainly a very extensive engagement and body of work.

Senator SIEWERT: That has been commissioned by FaHCSIA?

Mr Kalisch : Some of it comes through FaHCSIA money. A lot of it comes through the Community Services and Disability Ministers' Advisory Council, which the Commonwealth and the states jointly contribute to.

Senator SIEWERT: Is that working in all states, for all states and territories?

Mr Kalisch : Yes, that is working across all states and territories.

Senator SIEWERT: When was that commissioned?

Mr Kalisch : Those pieces of work have been commissioned at different stages. Certainly the unit record collection was commissioned some time ago. Some of the other aspects such as the educational outcomes collection is a more recent feature.

Senator SIEWERT: When was that one commissioned?

Mr Kalisch : I would have to get back to you on that. That is looking to provide a report back to the advisory council late this year.

Senator SIEWERT: Thank you. I apologise, can I go back to the Longitudinal Study of Indigenous Children. You have taken on notice to double check. When you are doing that, could you look at whether you have ever been asked to participate?

Mr Kalisch : I will go back and see as far as our records can tell. I can also engage with Professor Alan Hayes from the Institute of Family Studies.

Senator SIEWERT: Thank you.

Senator FIERRAVANTI-WELLS: I have one question to put on notice in relation to whole of portfolio, Ms Halton, which is a list of all the funds. Is it the 18 funds?

Ms Halton : The flexible funds?

Senator FIERRAVANTI-WELLS: The flexible funds.

Ms Halton : Yes.

Senator FIERRAVANTI-WELLS: If we could have one list of flexible funds and then for each of the outcomes, the funds that are applicable for each of those outcomes. If you could give me a complete list of all of them. Thank you.

Ms Halton : We can get that done now. Someone can do that.

CHAIR: That ends the first session with four minutes to spare. We will take a break now.

Proceedings suspended from 9:55 to 10:09

CHAIR: We will resume and go into question in outcome 1. What we are going to do is, we have a particular request because of timing, for TGA to come on earlier. We have three senators with questions on TGA and we are just waiting for the other two to come. As soon as they arrive, if necessary, Ms Halton, we will move to TGA for focus questions. Until then we will go through the agenda program by program. We are on 1.1.

Senator FURNER: It gives me grave concerns, seeing as it is October Breastscreening Month, to ask this question. Just recently the Queensland Liberal-National Party government has announced a decentralisation of the breast screening arrangements, job cuts in breast screening in Queensland. This has been widely condemned by the AMA Queensland president, and the chief executive of the Queensland Cancer Council has expressed concerns. I am wondering, initially, from the department what concerns you may have over these announcements?

Mr Smyth : At the moment we are monitoring what is occurring in Queensland on the ground through discussions that we have on a regular basis with the program managers of BreastScreen Australia. We do that across the nation. At this point in time we have not seen any disruption to actual services on the ground, but we certainly are taking a keen interest and we are monitoring.

Senator FURNER: I am aware that BreastScreen Australia has around 500 locations throughout the nation.

Mr Smyth : That is correct, there are 500. Some of those are mobile units. Orchid is one of those units in Far North Queensland. Again we are taking, I suppose, a watching brief at this particular point in time to see if there are any changes to BreastScreen Australia rates.

Senator FURNER: I understand half the staff of the BreastScreen Australia office in Queensland have been cut and have lost their jobs as a result of this announcement. No doubt that will have some impact on the overall screening.

Mr Smyth : I could not really answer that question. It is a question for the Queensland government. As I said, as you have pointed, they have made that decision to start to decentralise their arrangements. As I said, we are monitoring the outcomes.

Senator FURNER: I have maybe just a couple of questions on cancer in general. Are breast cancer mortality rates continuing to improve as a result of BreastScreen Australia's screening programs?

Mr Smyth : Since the inception of BreastScreen Australia in 1991 there has been a reduction in mortality of breast cancer in women in the target age group, which is 50 to 69 years of age, by around 25 per cent. What we have seen is the participation rates remaining steady at around 55 per cent. The actual incidence of cancer has increased in that target age group from 229.9 per 100,000 women in 1991 to 274.3 per 100,000 women in 2007, which are the latest figures that we have available for that program. But, overall, a 25 per cent reduction in mortality.

Senator FURNER: I understand that the government has also invested in enabling states and territories to replace analogue mammography machinery with digital mammography systems. Can you give some feedback on that?

Mr Smyth : The government allocated $120 million to upgrade all jurisdictions' analogue equipment to digital. Digital actually has a much better, I suppose, productivity element to it in that the actual films can be looked at immediately and determined whether or not they are clear and provide the information necessary for a clinician to base a decision on. Sometimes under the old analogue systems you might have got a blurred mammogram and that may have necessitated the patient to actually have to come back and undergo rescreening. The digital information also enables you to do that remotely where screening can actually be undertaken in one point and then the reading can be undertaken in another.

Ms Halton : Senator, I think we would not underestimate, particularly for rural and regional women, exactly how important that is. It means that they can get access to a read on their screens as quickly as their city cousins.

We now have instances of people who can receive their results weeks earlier than they would have otherwise if an old-fashioned—if I can describe it in that way—image of them was taken and then sent somewhere else. So this is definitely a huge improvement. That money came out of the health and hospitals fund, by the way.

Senator FURNER: Is it true that you need a centralised management system to make sure that images can be sent quickly and efficiently for reading wherever radiologists are available?

Mr Smyth : I would have to take that question on notice or refer it to my colleagues in the acute care area of the department who are responsible for the implementation of that digital mammography initiative.

Senator FURNER: How much has the Commonwealth invested in digital mammography in Queensland?

Mr Smyth : We can take that on notice and provide it for all states and territories.

CHAIR: We think Queensland is the most important but we might get it for all the states.

Senator FIERRAVANTI-WELLS: I have some questions on population health. Mr Smyth, if you could take on notice the actual expense, including a breakdown of administered and departmental, for the 2010-11 financial year.

Mr Smyth : Yes.

Senator FIERRAVANTI-WELLS: I am looking at the annual report for the 2011-12 financial year, pages 88 to 89 so the actual 602 less 34,000. I am looking at page 51 of the portfolio budget statement, which talks about the average staffing level number for 2011-12 as being 461 and then 401. It then has 1,185 and 1,198. Could you explain that to me. Have I missed something there? There seems to be a big difference or they are different numbers? Do you understand what I mean?

Mr Smyth : I do but I would have to take that on notice.

Senator FIERRAVANTI-WELLS: I would have thought those two numbers would have been very similar to what is in the portfolio budget statement. There seems to be a big difference there. Perhaps I am not reading it correctly.

Ms Halton : There are a few possible things it could be including whether or not there is a TVA element to it.

Senator FIERRAVANTI-WELLS: It seems to be such a big discrepancy. I thought there is obviously an explanation.

Ms Halton : If you look at the annual report at the bottom of page 88 you will see that the TGA is down there. You have average staffing numbers so this by definition must include the TGA staff.

Senator FIERRAVANTI-WELLS: Whereas the 461 is just the population?

Ms Halton : Yes, because it is appropriation, in the portfolio budget statement what you will see there is moneys that are appropriated by governments.

Senator FIERRAVANTI-WELLS: You can see what I am clearly getting at and you can deal with it accordingly.

Ms Halton : That is absolutely fine. As you know, the TGA is cost recovered.

Senator FIERRAVANTI-WELLS: In that case then perhaps if you could give me the 2011-12 DoHA population figure.

Mr Smyth : For the department and associated agencies?

Senator FIERRAVANTI-WELLS: I can assume therefore that in the annual report those figures will likely include the agencies as well?

Mr Smyth : They could well do.

Ms Halton : Let us be clear. When you say agencies, there is a distinction. The TGA is not an agency; it is part of the department. NICNAS staff are part of the department. There is a distinction between separate agencies. We just had AIHW. That is a separate agency. What you see in our annual report are staff that are attached to the department, which includes cost recovered staff.

CHAIR: There is an asterix in the report that identifies all of that.

Ms Halton : There is. To extend the point, I sometimes regret that we give you everything and sometimes I think we should be more circumspect. When we tell you, for example, what we spend on travel, we show you gross expenditure which includes monies that we can and we do cost recover. We do not show you net and that is exactly what this is.

Senator FIERRAVANTI-WELLS: I will stick then to outcome 1 population health and the actual expense including administered and departmental expenses and then the 2012-13 budget expenses in outcome 1 population health. Is this year's budget on track to come out with figures that are in the—

Mr Smyth : We are expecting to spend all of the appropriations this financial year.

Senator FIERRAVANTI-WELLS: So what is left for the remainder of the financial year?

Mr Smyth : It is obviously an estimate at a point in time because I currently have procurement contracts that are across my desk ready to be signed and executed. So it would be at a particular point in time.

Senator FIERRAVANTI-WELLS: So at this point the only realistic estimate can be that you are tracking on budget without necessarily getting into what is left for the remainder of the year?

Ms Halton : That is right.

Senator FIERRAVANTI-WELLS: Are there any changes to the program since the budget?

Mr Smyth : Are you talking across all of outcome 1?

Senator FIERRAVANTI-WELLS: No, I am talking about population health.

Mr Smyth : There has been one change and that is a re-profiling of the national partnership agreement on preventative health. That has been extended out three years.

Senator FIERRAVANTI-WELLS: My favourite agency.

Mr Smyth : The quantum of dollars remains the same over the period but there has been a change in some reward funding to facilitation funding for the states and territories to extend that out for another three years to 2018.

Senator FIERRAVANTI-WELLS: There appear to be small variances in programs. Are there any major variances in the 2011-12 budget?

Mr Smyth : There are no other major variances. I can only speak to the areas I look after, which are 1.1, 1.3 and 1.6.

Senator FIERRAVANTI-WELLS: What I will do is put in my table the amount. The answer could be given here or alternatively it could be taken on notice. I will set that out precisely in the table what it is I would be looking for.

Ms Halton : That is fine.

Senator FIERRAVANTI-WELLS: What are the assessments over the forward estimates for the whole of outcome 1 or will I get those figures in relation to each of the sub programs?

Mr Smyth : I will get to the level of granularity I can based on the resources—

Senator FIERRAVANTI-WELLS: Could you take on notice the expenses for outcome 1 population health including administered and departmental expenses over the forward estimates?

Mr Smyth : Yes.

Senator FIERRAVANTI-WELLS: I will be asking a series of outcome questions and then I will go specifically to 1.1 and 1.2 and ask a series of questions.

CHAIR: My program is I want to complete 1.1 as quickly as we can because we have already had 12 minutes on it. We are then moving to TGA where a number of senators have questions.

Senator FIERRAVANTI-WELLS: Thank you Ms Halton for this. Is there one which actually has the outcome and the funds that are in that particular outcome? Can I have the funds basically divided up outcome by outcome? I notice when I look at the portfolio budget statement it does not necessarily tell me which funds are applicable for that outcome.

Ms Halton : No, but if you go to page 328 of the annual report—

Senator FIERRAVANTI-WELLS: Yes, that is what you have given me. In effect, are these all the funds and all the programs? Is that the case?

Ms Halton : Yes, that is right. Basically, this is the reconciliation. What you can see if you look at page 328 on the left hand side of the column is 1.1 the current program. This is the chronic disease prevention and service improvement fund so this is fund 1, for the sake of this discussion. Fund 1 includes now all the stuff down that page and it shows you which program it was in previously.

Senator FIERRAVANTI-WELLS: For the purposes of working out which funds are applicable in outcome 1 population health, will I have to go through that and correlate it in a different way?

Ms Halton : No, the money you see in 1.1 in the PBS is all of it. Does that make sense?

Senator FIERRAVANTI-WELLS: So the funds are only in relation to specific sub programs?

Ms Halton : All of that money is aggregated under 1.1. In fact, these things no longer exist as separate programs. There are no longer sub programs. There is the one thing. There is now the chronic disease prevention and service improvement fund. That is it.

Senator FIERRAVANTI-WELLS: And it is relevant to 1.1?

Ms Halton : That is correct. I know Senator Moore in the past has asked how does all this work. That is why we stuck down the right-hand side of that table the list of where these things were previously.

Senator FIERRAVANTI-WELLS: A benefit of the table which consolidates all of this will be welcome.

Ms Halton : That is why that is there, so people could kind of follow the money trail. I know you always ask so we thought we had better put it in.

Senator FIERRAVANTI-WELLS: For those sub programs in 1.1, would you take on notice the specific funding in actual program expenses. The figures for 2010, 2011 and 2012 will have to be taken on notice, I take it?

Ms Halton : That is correct. The thing to remember is because things have moved around, year on year they are not necessarily comparable.

Senator FIERRAVANTI-WELLS: I will put those financial questions in 1.1 on notice.

Ms Halton : There will be multiple asterisks on your table is what I am saying.

Senator FIERRAVANTI-WELLS: The portfolio budget statement indicated that there was $65 million to be committed. Would you take on notice the breakdown over the forward estimates of the $251 million allocated for the fund. Is the $250 million included in the total figure for program 1.1 in the portfolio budget statements? Is that in addition or how exactly is it accounted for in the PBS?

Mr Smyth : It is in 1.1.

Senator FIERRAVANTI-WELLS: At the last estimates, 22 applicants had been shortlisted for funding.

Mr Smyth : That is correct.

Senator FIERRAVANTI-WELLS: How many actually received funding agreements?

Mr Smyth : We are still in the process of executing some of those agreements, but all of those that were short-listed will be taking up that funding.

Senator FIERRAVANTI-WELLS: And the total committed from the fund to date?

Mr Smyth : I will take that on notice because, as I said, it relates to where we are up to in the execution of some of those grants.

Senator FIERRAVANTI-WELLS: Could you take on notice the terms of these funding agreements—length, range and amounts provided?

Mr Smyth : Certainly.

Senator FIERRAVANTI-WELLS: What is the timing for the future funding rounds?

Ms Halton : So that we can answer that, we will take that on notice.

Senator FIERRAVANTI-WELLS: How many grants were provided to existing initiatives that were previously receiving funding under existing programs, compared to new initiatives?

Mr Smyth : We have provided an answer to that on notice already, I think, to Senator Di Natale.

Senator FIERRAVANTI-WELLS: Those are my questions in relation to 1.1 and I will put anything more on notice.

CHAIR: That is the end of the questions on 1.1.