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Finance and Public Administration Legislation Committee
03/03/2017
Estimates
CROSS-PORTFOLIO INDIGENOUS MATTERS
Department of Health

Department of Health

[14:08]

CHAIR: I welcome Dr Wendy Southern, Deputy Secretary, National Program Delivery Group from the Department of Health and officers to join the office of the Department of the Prime Minister and Cabinet for this session on health issues. Officers called upon for the first time to answer a question should state their name and position for the Hansard record and witnesses should speak clearly into the microphone. Dr Southern, do you have an opening statement?

Dr Southern : No, thank you.

Senator McCARTHY: If I could take you to the issues around the Indigenous Australians Health program, there are two important programs that I would like to examine a little bit more in detail with you. That is around the programs to do with the Northern Territory AIDS and Hepatitis Council and the Queensland AIDS Council. Minister, can you detail the reasoning and justification for the defunding of both of these services?

Senator Scullion: First of all, I will just get some clarification around that question of whether, in fact, they have been defunded or not. Perhaps you can give us an update.

Dr Southern : Their funding terminates at the end of June 2017, so yes.

Senator McCARTHY: Can you explain when, in particular, the Queensland organisation has been funded for 21 years, what the reasons are behind the defunding of both the Northern Territory and Queensland services?

Dr Southern : I will call on my colleague to assist.

Ms Bobbi Campbell : In 2015 the department conducted a review of all Commonwealth funding in sexual health across the nation. We had three specific jurisdictions—New South Wales, Queensland and the Northern Territory—which were the remaining states where Commonwealth funding is provided for sexual health services, which, as you may know, is a Constitutional responsibility of the states and territories. The review essentially looked at various things. It looked at progress reports. It looked at outcomes and evidence and ultimately the review found very limited evidence of outcomes given that the rates of STI and BBV are ever increasing.

We have notified the organisations. New South Wales was the first to be notified and their funding ceased last financial year. This year Queensland and the Northern Territory were notified of the intention to cease funding and for them to seek alternative sources of funding. Their funding will expire on 30 June this year.

Senator McCARTHY: When you suggest that they need to seek alternative funding, where are you proposing that they go?

Ms Bobbi Campbell : The states and territories; our understanding is that both the Queensland AIDS Council and the Northern Territory AIDS Council have been in discussions with their states' health organisations. We understand that particularly in Queensland that Queensland Health, as an announcement yesterday, has looked at additional funding for sexual health in Queensland state. We also understand that they are talking to QAIHC, the Queensland Aboriginal & Islander Health Organisation. QAIHC are also seeking additional support from the state government to continue providing the program to SPiRiTS.

Senator McCARTHY: We are aware that the department is undergoing a desktop evaluation of these programs. Can you explain in detail what that involves?

Ms Bobbi Campbell : The confusion is that the understanding was that we were conducting a desktop evaluation of specific programs. In fact, we conducted an evaluation of all Commonwealth funding in this space, in the space of sexual health. The organisations themselves were also reviewed as part of that overall evaluation of the funding. Those specific programs were reviewed in the sense that we looked at progress reports. We consulted with our state and territory counterparts in the jurisdictions. We have officers in order to understand, essentially, the impact of the programs. We also looked at the available evidence that we have in front of us in terms of the rates of STI and BBV ever increasing and concluded that there was really limited evidence that these programs which we have been funding for, as you say, decades now, have really had any impact. We came to the conclusion that we need a national strategic approach in this space and we really need to look at targeting BBV and STI more specifically and looking at, essentially, how we can have better traction and better inroads in ultimately reducing the rates of BBV and STI.

Senator McCARTHY: I am trying to understand if you have had an evaluation that says you are going to withdraw from these jurisdictions and yet you are also saying that there needs to be a national approach, it does not seem to marry up when you understand that these rates of sexually transmitted diseases are increasing at phenomenal rates. Is that correct? Am I understanding that correctly?

Ms Bobbi Campbell : It is a shared responsibility. It is not just the responsibility of the Commonwealth; it is also the responsibility of the states and territories.

Senator McCARTHY: If the Commonwealth is removing complete responsibility from Queensland and the Northern Territory that is not a shared approach; is that correct?

Ms Bobbi Campbell : We are actually not removing complete responsibility from those states. What we are doing is looking at a nationally consistent focus strategic approach across all jurisdictions, not just Queensland and the Northern Territory.

Senator McCARTHY: So how are you doing that?

Ms Bobbi Campbell : I might ask my colleague.

Senator McCARTHY: What I am trying to understand is how you are doing that if these two organisations, no doubt with no funding, will not be able to continue in their capacity to assist in the reduction of these concerns with STIs and also issues that matter to the LGBTIQ community.

Ms Bobbi Campbell : The national strategy that we are looking at developing will go into those areas. We will be talking to organisations and we are currently talking to an organisation, SAHMRI, to look at new, innovative ways of how we can tackle this issue because doing the same over and over obviously is not having the same impact.

Senator McCARTHY: So you will fund the Queensland and Northern Territory organisations? I am just trying to understand what that relationship is going to be when you say there is going to be a national approach. How can you reassure these two organisations, in particular, who are feeling that come the end of June that is it for them?

Ms Bobbi Campbell : We will be calling these organisations and discussing with these organisations, once we have a strategy and a direction, to talk to them about how they can help and how they can impact in this space. All organisations are always open to providing us with proposals.

Senator McCARTHY: But you are not going to do it with funding, are you? Is that what you are saying?

Ms Bobbi Campbell : We do have funding. We actually have funding that we have committed over the next four or five years in this space. We are looking at innovative projects and innovative grants in order to really target these areas that we need to focus on. It is not that we are completely pulling out; it is that we are looking at a different way of doing something so that we can have maximum impact. These organisations are always welcome to provide proposals. We understand that their funding is ceasing on the 30th. They are welcome to provide a proposal which provides us with some evidence and KPIs with an evaluation strategy and a proposal that essentially will address where we really need to go in this space.

Senator McALLISTER: Can I ask a couple of follow-up questions about your evidence. You indicated that you have set aside an amount of money to pursue sexual health. What is that amount of money?

Ms Bobbi Campbell : We have committed $15 million. That commitment is from 2013-14 and that is from the Indigenous Australians Health program. I will hand over to my colleague, Ms Appleyard, also to talk about the broader population based funding. It is $15 million.

Dr Southern : From 2016-17 out to 2018-19 it is $11.8 million.

Senator McALLISTER: That was previously the funding that was allocated to these state based organisations, or at least the funding that was previously allocated to state based organisations was drawn from that pool?

Dr Southern : That is correct, yes.

Senator McALLISTER: And you are now seeking to provide the funding on different terms?

Dr Southern : Yes.

Senator McALLISTER: Through different providers.

Dr Southern : Yes. As Ms Campbell was saying, we have been funding programs for a long period of time. We are still seeing the infection rates increasing and increasing quite dramatically. What can we do to better target the funds that we have for the outcomes that we are looking at?

Senator McALLISTER: Finally, can I just clarify, you said earlier that you had done a desktop review of the whole suite of investments. Have you done any specific evaluation of the programs that you are defunding?

Ms Bobbi Campbell : As part of the commitments that we have made to these organisations, no, we have not. That is the issue. We need to look at this from a national perspective. In order to do an evaluation we would need to have some contractual commitments within the contracts that we have with the current organisations. We did not have those within those contracts so what we are now doing, essentially, is looking at it from a national strategic approach, looking at how we can best target our funds on a national basis as opposed to a state and territory historical funding basis.

Senator McALLISTER: Did you ask the state based organisations whether they would be willing to partner with you in an evaluation of the program?

Ms Bobbi Campbell : I would have to take that on notice. I am not aware.

Senator McALLISTER: So you have defunded them without a specific evaluation of the programs?

Ms Bobbi Campbell : No, we did not.

Senator McALLISTER: You did not ask?

Ms Bobbi Campbell : No, we did not ask.

Senator McALLISTER: You did not ask. You did not do an evaluation. You defunded.

Senator McCARTHY: Basically what you are saying to the committee is that you acknowledge that rates of STI are increasing at a phenomenal rate. You want to have a national program. You have not evaluated the current situation with the Queensland and Northern Territory centres, nor offered them an opportunity. So, how is that going to close the gap in health for Indigenous Australians, in particular, when you have made a decision based on what appears to be without any thorough thought?

Ms Bobbi Campbell : Just to clarify. We looked at progress reports. As part of their contractual obligations they are required to provide us with progress reports. The progress reports did not provide us with any evidence or outcomes to sustain funding. The evidence is clear that increasing rates of STI and BBV are ongoing and the organisations—

Senator McCARTHY: Are you saying they were not performing? Is that correct? Is that what you mean?

Ms Bobbi Campbell : According to the progress reports they were not performing.

Senator McCARTHY: So you are saying the Queensland and Northern Territory centres were just not up to scratch on this. I think it is important for the committee to understand—that is all—as to how you got to this decision.

Dr Southern : We were looking at the health outcomes that they were achieving for the investment that the Commonwealth was making and on that basis felt that we needed to better target the funding to other mechanisms rather than continuing to fund initiatives that did not seem to be having the sorts of impacts that we were looking for.

Senator McCARTHY: Thank you.

CHAIR: On the same issue, Senator Smith.

Senator SMITH: On the issue of sexual health; in your evidence, Ms Campbell, if I heard you correctly, you talked about STIs as being ever increasing. Did you mean across Indigenous populations or generally?

Ms Bobbi Campbell : I mean across Indigenous populations.

Senator SMITH: You also mentioned, as Senator McCarthy said, that the Commonwealth was looking at a national strategic approach. Of course we know that STIs are important areas of concern because of their long-term impact on reproductive health and of course their social, economic and psychological impacts, but perhaps more significantly, as gateways to HIV infection. I am curious to know, are you familiar with the proposal from Associate Professor James Ward and Professor Frank Bowden in regards to how we might approach this? I do not want to be an alarmist about it, but this is a significant issue amongst Indigenous communities, particularly, of course, young people.

Ms Bobbi Campbell : Yes, we are aware of that. We received that proposal in December of last year, just before Christmas. We have been evaluating that proposal and we have been in discussions with Professor Ward from SAHMRI and we have also been in discussions with the National Aboriginal Community Controlled Health Organisation. We have proposed some clarificatory questions on the proposal and we are in ongoing consultations on that.

Senator SMITH: So you are in ongoing consultations because you find elements of the proposal worthy of discussion with a view to perhaps getting to a position where the proposition could be financially supported by the Commonwealth? Is that why we are having these discussions?

Ms Bobbi Campbell : Yes. That is correct.

Senator SMITH: That is correct.

Ms Bobbi Campbell : We are basically asking them to refine their proposal.

Senator SMITH: Just for the sake of other senators I might just read into the Hansard how they describe the current situation. Their proposal, which I think has been distributed to obviously yourself, myself and others with an interest, says:

Diagnosis rates of STIs, chlamydia, gonorrhoea, infectious syphilis and trichomoniasis, as well as HIV, are at all time highs in Aboriginal communities. Rates of HIV diagnosis are high in all areas, urban, regional and remote. Significant differences occur in epidemiological profile such as greater proportions of HIV diagnosis occur among women, people who inject drugs and heterosexual people than Indigenous and non-Indigenous people. HIV outbreaks are occurring in regional and remote areas where there is a lack of coordination and clinical services to deal with HIV. An ongoing infectious syphilis outbreak involving over 1,100 cases in the north of Australia continues to evolve and spread in remote communities. The most significant burden of STIs occurs in the age group 15 to 25 years. There is evidence that injecting drug use is becoming entrenched in Indigenous communities. While STIs, in their own right, have important effects upon the present and future reproductive health of young Aboriginal people, the ongoing presence of these infections in the community significantly increases the risk of HIV transmission.

I do not say that to be an alarmist but to perhaps put your comments about ever increasing STI infection rates in the context of professionals, that is Associate Professor James Ward and Professor Frank Bowden. I will not labour the point because I have raised it with people in government, but if it is under active consideration then I think that might go a long way in allaying some of the concerns of senators and others about the sexual health of Indigenous people, particularly young Indigenous people in regional and remote areas. Thank you.

Senator SIEWERT: Can I ask about rheumatic heart disease? I would like to know where you are up to in your thinking, because I am sure that you are thinking about where we are going with the funding after this current funding program finishes this year.

Ms Cole : The issue about the ongoing funding for the rheumatic heart strategy is essentially a budget decision to be made by government.

Senator SIEWERT: Why am I getting used to hearing that? Obviously there is a lot of unpacking to do here on that. In terms of budget proposals at the moment, where are you at with your consideration of the current program and then I presume you are providing advice to the minister to put forward through the usual process. Is that correct?

Ms Cole : That pretty much sums up the position.

CHAIR: That is efficient.

Senator SIEWERT: I could just write my own answers. Can you update us on the outcome of the review?

Ms Cole : The review is not currently released. It is under consideration through the budget process; however, it is finished. I am afraid I cannot say much more than that because it has not been publicly released at this stage.

Senator SIEWERT: I know we had similar sorts of discussions in this very room a couple of days ago. Maybe this is something that I should address to you, Minister. You do not have to necessarily hold on to a review of such an important issue before something goes in the budget, do you, unless the review itself, like you said the other day on one of the other issues, canvasses issues around funding?

Senator Scullion: Indeed, I am not actually privy to the review but you have, in fact, answered your own question. There are times where the review actually makes recommendations that are subject to budget processes and that is why that would impact on the decisions by government to release the report or otherwise.

Senator SIEWERT: Is this the case with this review?

Ms Cole : In framing this review we asked the evaluators to look at whether or not the strategy was as effective as it could be, whether there were recommendations about how we could run the register more effectively and so on and so forth. Those kinds of issues are the normal sorts of issues that you would expect to be canvassed in a budget discussion.

Senator SIEWERT: Could you then provide the elements of the review that go to the effectiveness and the outcomes for this particular round?

Ms Cole : I can take that on notice and see what I can do.

Senator SIEWERT: That would be appreciated. In terms of the review itself are the organisations involved in these programs aware of some of the findings? Have they been asked their opinions on the findings?

Ms Cole : I do not believe they have been asked their opinions on the findings but they were asked for suggestions and commentary about the system as it currently runs and how it might be able to be improved.

Senator SIEWERT: Does the review find that the programs were successful and does the department consider there is a need for ongoing funding, which is different to me asking whether you are asking for it and how much you are asking for?

Ms Cole : I will need to take a little guidance from my senior officer here about how to answer this one. Clearly there is a significant and ongoing need in rheumatic heart disease. I think that very few people would disagree with that point of view. The Commonwealth's contribution is significant in making sure that that need is addressed. Whether or not the government wishes to continue in exactly this format is a decision for the budget.

Senator SIEWERT: What arrangements and discussions have you had with the state and territory about this issue and their ongoing commitment?

Ms Cole : The states and territories are aware that the NBA runs out at the end of this year and they were involved in the evaluation process as co-contributors, in a sense, in this strategy. The states and territories, aside from South Australia, have not approached us directly in terms of seeking advice about a possible outcome.

Senator SIEWERT: But South Australia has?

Ms Cole : That is correct.

Senator SIEWERT: Did that include an expression of interest in further ongoing collaboration and involvement?

Ms Cole : From the South Australians?

Senator SIEWERT: Yes.

Ms Cole : Yes.

Senator SIEWERT: So you have not done outreach to the states? They have not approached you? Is it correct that you have not done outreach to them for ongoing commitment other than in the review?

Ms Cole : That is correct.

Senator SIEWERT: Do you plan to do that before the budget?

Ms Cole : I am not really sure. Usually this sort of issue is discussed in the various Commonwealth/State forums such as AHMAC and the health ministers, so that would be the logical forum that we would expect this issue to come up.

Senator SIEWERT: When is the next meeting?

Ms Cole : The next health ministers' meeting is in mid-March, I believe, or late March.

Dr Southern : Late March.

Senator SIEWERT: So there is one before the budget cycle?

Dr Southern : Yes.

Senator SIEWERT: I am in your hands. I have a couple of questions on hearing but I am presuming—

CHAIR: We might go to Senator Dodson and see if we have time to come back to you.

Senator SIEWERT: If we do I would like to ask some questions on hearing.

CHAIR: Thank you. Senator Dodson.

Senator DODSON: I would like to ask a few questions on suicide and then the health implementation plan. In relation to suicide has the membership of the working group arising from the Kimberley suicide roundtable been finalised?

Ms Cole : We have a notional working group, as you may be aware from attending the last meeting of that group. We are considering the suggestions from the members of that group for additional members.

Senator DODSON: When will that be determined?

Ms Cole : Very shortly. The draft minutes from that meeting are out with some of the organisations for comment and coming back for finalisation.

Senator DODSON: The department previously stated that the Country Western Australian Primary Health Network will have a central role in working with the Kimberley Aboriginal groups to address the issue of suicide. Can you detail what role and activity they intend to play?

Ms Cole : The Country WA is essentially the fund holder for the suicide trial in the Kimberley region. My understanding is that the Country WA PHN has been talking recently with the major service provider in the region, CAMHS, around some co-shared project officers for the trial and the Country WA PHN is also providing support to us, the Department of Health, in terms of the secretariat work for that committee.

Senator DODSON: Has the primary health care minimum data set been finalised and distributed to the PHNs?

Ms Cole : Are you talking about the mental health minimum data set?

Senator DODSON: Yes.

Ms Cole : I believe it is currently being trialled through five PHNs—but I will confirm that on notice—and it is likely to be available to all PHNs from about 1 July.

Senator DODSON: Has a grant to establish the national centre of best practice in Aboriginal and Torres Strait Islander suicide prevention been awarded?

Ms Cole : That is part of an approach to market which is very close to finalisation. It is likely to be announced shortly but we are currently in contract negotiations with the successful applicants.

Senator DODSON: 'Shortly' means what?

Ms Cole : You would appreciate that this kind of—

Senator DODSON: 'Shortly' might mean something different to me than it does to you.

Ms Cole : You would appreciate that this kind of announcement is the sort of announcement that ministers often like to make and so, if that is the case, we will be guided by their time frame.

Senator DODSON: So it could be very shortly. Can I go to the implementation plan or the National Aboriginal and Torres Strait Islander Health Plan. Can you give us a brief update on where that plan is up to? I understand that this is a plan from 2013 through to 2023.

Ms Cole : That is right.

Ms Bobbi Campbell : The plan, as you know, has quite a number of deliverables. We have a set of deliverables that are due in 2018 and others which are due towards 2023. At this stage I can announce that we have 13 deliverables that have been completed and we have 84 that have been commenced. There are about nine that have not been commenced but they are dependent on the ones that are in progress at the moment.

Senator DODSON: On Wednesday at the Community Affairs estimates committee Senator Di Natale was told by the health department that there were no funding allocations allocated to the implementation plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023—that is the particular plan that I am talking about now—and all programs were coming through the Indigenous Australian Health program. Is that correct?

Dr Southern : That is correct, yes.

Senator DODSON: Can the department profile the funding allocation of every program that falls under the implementation plan of the National Aboriginal and Torres Strait Islander Health Plan which is funded through the Indigenous Australian Health program?

Dr Southern : We would have to take that on notice and come back to you with that information.

Senator DODSON: How long do you think that might be?

Dr Southern : We will come back to you at the committee's deadline. That will be quite a complicated unpacking of the Indigenous Australian Health program budget, but we will have a go.

Ms Bobbi Campbell : There are also a number of measures that do not hold any requirement for funding, for example, building frameworks or strategies which are generally done internally by the department with consultation from PM&C and, of course, all of our stakeholders.

Senator DODSON: I will come to that in a minute. What steps is the department taking to ensure the Aboriginal community controlled health sector led response to redress the social and cultural determinants of health as specified in the National Aboriginal and Torres Strait Islander Health Plan—what role, if any, has been provided for those Aboriginal controlled health services?

Ms Bobbi Campbell : Quite a central role; we work very closely with NACCHO. We work very, very closely with each of the state affiliates and also we are rolling out a very ambitious set of consultations which commence next Friday in Sydney. We will have a national forum and we will have consultations and forums in each state and territory where Minister Wyatt will be appearing for a presentation. We have also invited each of the state and territory ministers to appear there. We have a fairly long list of invitees to those forums, so we will be not only consulting with the very important community controlled sector but quite broadly and widely across all relevant Indigenous stakeholders also.

Senator DODSON: I sense some of the ministers' impatience about consultations and the outcomes but that is fine. The National Aboriginal and Torres Strait Islander Health Plan was set up to work concurrently with other strategies. Now, one of those strategies—and I am not going to list them all—the National Indigenous Law and Justice Framework has got no funds; so how are they going to work with them?

Ms Bobbi Campbell : That is a good question. Through the Social and Cultural Determinants of Health working group we are reaching out to all departments, including employment and education. We are reaching out through AGD, Infrastructure and PM&C and basically tapping into as many organisations through them as we can to consult. Of course, we are more than happy to have that organisation consulted or reach out to us or likewise reach out to them in order for them to provide input into the work that we are doing at the moment.

Senator DODSON: Does the Health Implementation Plan have some funding?

Ms Bobbi Campbell : It would not have.

Senator DODSON: Has it, itself, got any funding?

Dr Southern : Not through the health programs, no.

Senator DODSON: So how do we close the gap if this plan has no funding associated with it?

Dr Southern : I believe that particular framework is the responsibility of the Attorney-General's Department, but we are working with the Attorney-General's Department about the linkages between what goes on in the justice sector and what goes on in the health sector. We do not have any specific funding in our portfolio for that plan.

Senator DODSON: Minister Nash in 2015 wrote in her foreword that the objectives of the plan was: 'Address the broad changes needed to make health systems more comprehensive, culturally safe and effective.' In response to a question I put on notice last year around the funding for the program which falls under each of these seven domains of the implementation plan there was an answer provided to (g) at SQ 12-00623. Can the department now expand on this by explaining why the deliverables in the social determinants of health are being developed and will they be incorporated in the next iteration of the implementation plan in 2018?

Dr Southern : The short answer to that is yes. There is work underway. When the implementation plan was published it was clear that work on (g), the social and cultural determinants of health, was the piece of work that needed to be done in order to inform the next iteration of the implementation plan in 2018. Ms Campbell has talked about the consultations that will be commencing next Friday in relation to the social and cultural determinants of health and we have, separately within the Department of Health, established an interdepartmental working group which has drawn colleagues from a range of other departments who have contributions to make in terms of dealing with the social and cultural determinants of health. So the Department of the Prime Minister and Cabinet, Education, Employment, Attorney-General's and Infrastructure are there. We have brought that group together to work up proposals that will influence and can become part of the next iteration of the implementation plan along with this range of consultations that we are doing with Minister Wyatt and others around the country.

The other contributors to this work, whom we are working very closely with, include an implementation plan advisory group which comprises a number of people. It includes representatives from NACCHO, from the National Health Leadership Forum and a range of independent experts who are joining us on the advisory group, who, again, are very focused on the social and cultural determinants of health piece of work, recognising that it is the most substantial piece that we need to do for the next iteration of the plan.

Senator DODSON: Can you inform us when the likely anticipated release dates for the reports on the seven domains to the plan and their deliverables is going to be?

Dr Southern : On the progress against the deliverables?

Senator DODSON: Yes.

Ms Bobbi Campbell : The health performance framework will likely be the next report. That health performance framework should be released in May of 2017, so in a few months time.

Senator DODSON: Thank you.

CHAIR: We will go back to Senator Siewert.

Senator SIEWERT: I wanted to ask about ear health, whether it is through the department or I suspect it is a question for the minister. You would be aware that there is a bit of a campaign around making ear health and ear disease a part of the Closing the Gap outcomes. Are you aware of that? I am judging by the nodding of heads that you are.

Dr Southern : Yes.

Senator SIEWERT: What consideration have you given to that?

Dr Southern : There is obviously work underway that I think Minister Scullion and the Prime Minister talked about in the Closing the Gap events a couple of weeks ago in relation to looking at the Closing the Gap targets in the broad and I would defer to my colleagues in the PM&C to talk about that, but in relation to Indigenous hearing, the Department of Health makes quite a substantial investment in initiatives to address hearing. It is in the order of $36 million over the period plus $33 million which is directed through the Northern Territory. We certainly recognise that good hearing sets children up for education and people for employment and education, so it is an absolutely critical and fundamental thing to get right going forward. We are very focused on hearing and making the investment in interventions which will particularly address childhood hearing problems.

Mr Tongue : If I could just add quickly please—

Senator SIEWERT: Yes.

Mr Tongue : Hearing is one of a number of possible areas for targets that have been identified as the announced renewal of the Closing the Gap framework, that the Prime Minister talked about during Closing the Gap week, that goes forward. My new colleague, Professor Anderson, will be leading that work. Certainly I have had conversations with the College of Surgeons who are worried about what they perceive to be increasing rates of severe ear disease in remote communities, despite some of the efforts and expenditure that has gone in over the last 10 years. Until Professor Anderson has done his work in building an overarching framework I would not want to be definitive until all the consultations have happened with all of the parties and the Indigenous leaders and the states and territories.

Senator SIEWERT: Thank you for that answer. Could you provide a list of the programs that have been funded under the $36 million?

Dr Southern : Yes, we certainly can.

Senator SIEWERT: And also is it possible to provide details on the extra $33 million?

Dr Southern : To the Northern Territory?

Senator SIEWERT: To the Northern Territory.

Dr Southern : Yes, we can provide that on notice.

Senator SIEWERT: That would be very much appreciated. In terms of the issue of the consideration of whether this should be included, can I take it to mean that you will not be making a decision until that work has been done?

Mr Tongue : Until that work has been done.

Senator SIEWERT: Will that work be considering the ear disease? We need to deal with OM but we also need to deal with the consequences so we have got that other end as well. Will it look at both?

Mr Tongue : That is the idea because we see the hearing loss then in rates of school attendance and so on. So the process that we are going to engage in will involve a series of discussions with each of the jurisdictions as well as the key Indigenous organisations that are involved in the delivery of health and other programs and also what the evidence is. So, yes, I would anticipate that it will.

Senator SIEWERT: So the issue there is the links through. You have touched on school attendance but then there are the links through to juvenile justice, because I am sure you know the evidence around juvenile justice and adult incarceration.

Mr Tongue : Yes.

Senator SIEWERT: So you will be including that and not just leaving it to the specific health aspects of it?

Mr Tongue : That is right.

Senator SIEWERT: Where are we up to with children's hearing as they are starting preschool or school if not going to preschool?

Dr Southern : Ear checks are part of the MBS item, the 715. They are very much part of that. Then particularly through the Aboriginal medical services it encourages people, particularly children, to have regular ear checks every time they visit their practices. Another thing that we are doing is some work with the Department of Education on a program called Connected Beginnings, which is about a dozen trial sites where we will be working with the Aboriginal medical services who would do outreach into the schools as well and hearing would be part of the health checks and the kind of health literacy approach that they would be taking.

Ms Hefren-Webb : I might just add that we have been in touch with all of the schools involved in the Remote School Attendance strategy to check whether they have an active hearing screening process, and the vast majority have that happening at the beginning of the first year of school.

Senator SIEWERT: The vast majority?

Ms Hefren-Webb : There is probably a couple where it operates a bit differently because of the relationships between the clinics, the school and the locations.

Senator SIEWERT: I really want to follow that up. Can you provide, on notice, where those trials are and a little bit more detail around them because that sounds very positive.

Dr Southern : Yes.

Senator SIEWERT: It is great that they are doing that.

Dr Southern : Yes.

Senator SIEWERT: Then what are they doing about it?

Ms Hefren-Webb : Obviously the hearing services have to take that referral and encourage the parents to attend the centre where there is hearing loss treatment for otitis media, et cetera. So there is follow up happening in relation to the kids.

Senator SIEWERT: That entails a couple of things. It is then addressing the hearing loss from a family perspective. Do all those schools have sound fields in them and are they doing catch-up literacy and numeracy? I know that you know the evidence around hearing loss; your speech, numeracy and literacy is affected from that point. Unless they have catch-up we see dire consequences.

Ms Hefren-Webb : I do not think we have data on whether every single school has hearing loops but, again, every school I have visited has—

Senator SIEWERT: It is not hearing loops. It is a sound field. So most of the kids probably will not end up with aids.

Ms Hefren-Webb : Yes.

Senator SIEWERT: Certainly that is the evidence today so that is why they need sound fields.

Ms Hefren-Webb : We could come back to you with more data.

Senator SIEWERT: If you could come back to us with more data on that and whether they are getting specialised literacy and numeracy programs.

Ms Hefren-Webb : Yes.

Senator SIEWERT: That would be appreciated. Chair, while I have the call, I am not going to ask for more data but you did very kindly provide this additional information. It is great that a little bit of explanation is there but it does not deal with the issue that I raised. As I understand it, you have now confirmed that the series failed and your measures referred to in the question on notice include the CCA stuff but I thought I heard earlier from—it was not Ms Campbell—

Ms Hefren-Webb : Ms Williams.

Senator SIEWERT: Ms Williams, that, in fact, people are not breached during that period so that does not account for the serious breaches and the comments that were made in the question on notice. Could you take that on notice and clarify that for me?

Ms Hefren-Webb : Will do.

Senator SIEWERT: Thank you.

CHAIR: Any further questions for the public health.

Senator McCARTHY: Yes.

CHAIR: Just note that we have five minutes remaining.

Senator McCARTHY: If I could, again, go to Tennant Creek, which is quite an important part of the Northern Territory. I would like to ask a few questions around the Barkly Region Alcohol and Drug Abuse Advisory Group. Is the department aware of the issues confronting the Barkly Region Alcohol and Drug Abuse Advisory Group?

Mr Gibson : Unfortunately the people who could answer the detailed questions about that are not here. I understand the issues at the moment are about compliance, contractual issues and governance issues. Yes, we are aware of the issues.

Senator McCARTHY: And service delivery? Is that included? You said 'contractual issues'.

Mr Gibson : As I said, I think the issues concern governance rather than service delivery. That is my understanding. I will correct that if that is not the case.

Senator Scullion: It would be fair to say—and I know you would be aware to some degree so I do not want to go into the complete details of it—that there are matters that go further than just governance issues around the administration of BRADAAG and the funds.

Senator McCARTHY: Do you want to elaborate?

Senator Scullion: I would have to seek advice. The only reason I would not elaborate is that I am not sure exactly. I understand that there are investigations afoot and I am reluctant for that reason. Perhaps if I could just take that on notice and if there is none afoot I will be able to provide you with all of that detail.

Senator McCARTHY: Thank you. I am certainly aware that the department is going to undertake a review. Can the department step the committee through how they propose to undertake that review?

Ms Hefren-Webb : Is this in relation to Julalikari more generally?

Senator Scullion: No, this is BRADAAG.

Senator McCARTHY: This is the Barkly Region Alcohol and Drug Abuse Advisory Group.

Ms Hefren-Webb : We will need to come back to you with the detail on that.

Senator McCARTHY: Can the department clarify whether you intend on performing a forensic audit? Would you like to take those questions on notice?

Mr Tongue : We will take those on notice.

Senator McCARTHY: I will read them through then. How will you ensure service delivery is maintained while the review is undertaken and will funding be maintained for the region? Was the department monitoring the allocated federal funding granted to the Barkly Region Alcohol and Drug Abuse Advisory Group?

Mr Gibson : We will take all of those on notice.

Senator Scullion: We will take some of those on notice. I have just found the part where I can recall that they were in the process of moving to an ORIC organisation under the requirements for that but the issues at the time ensured that they were required to meet section 93 of the Associations Act of the Northern Territory so it is sort of half in ORIC and half in the territory. I do understand that the Northern Territory Attorney-General and Justice is currently undertaking an investigation into the operational management of BRADAAG and that BRADAAG has reported the alleged financial irregularities to the police and that is being processed.

I am also aware that they now have a different CEO, and you may well be aware of that as well. I understand that BRADAAG, as you know, does a lot of housing and leasing in the area so all of that remains the same. Our area of concern is simply around the allegations of the mismanagement of funds. It should not have an impact on their operations but we will take those matters on notice.

Senator McCARTHY: Thank you.

Mr Gibson : I am advised that alcohol and other drug service delivery funded by the PMC is not affected by issues that are there at the moment.

Senator McCARTHY: Thank you.

CHAIR: Time for one very quick last question, Senator Dodson.

Senator DODSON: A very quick one. Minister Wyatt made a press release the other day on improving health outcomes for Aboriginal and Torres Strait Islander people through appropriate representation on the PHN boards. Can the government expand on the intent to proceed with this objective?

Ms Cole : PHNs are non-profit organisations funded by the government under various contracts and so forth. As they are non-profit organisations with their own constitutions we can only strongly encourage appropriate representation as opposed to demand appropriate representation but a number of the PHNs in recent times, with that encouragement, have increased either their membership or their board representation appropriately.

Senator DODSON: Is that number five? I think it is five Aboriginal controlled representatives on, is it 31 PHNs?

Ms Cole : I will have to get back to you on notice with the specifics on that one.

Senator DODSON: It would be sad to see the minister's best intentions come to no good end.

Senator Scullion: Could I just say, for what it is worth and for the record, it is my belief that the PHNs will not operate at anywhere near the level that they are capable of without Indigenous representation on every one. That is my personal view.

Senator DODSON: Thank you.

CHAIR: Thank you, Senator Dodson.

Senator DODSON: There may be some matters we will put on notice.

CHAIR: Of course. Please feel free to. It being 3 pm that concludes the committee's hearings for additional estimates 2016-17. I would like to thank the minister and officers who have given evidence to the committee today. I would also like to thank Hansard, broadcasting and the secretariat for their assistance. I now declare this meeting of the Senate Finance and Public Administration Legislation Committee adjourned.

Committee adjourned at 15:02