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Community Affairs Legislation Committee
23/04/2018

McDONALD, Dr Keith, Chief Executive Officer, South Western Sydney Primary Health Network

PRINCE, Mrs Amy, Director, Planning and Performance, South Western Sydney Primary Health Network

Committee met at 08:59

CHAIR ( Senator Brockman ): I declare open this public hearing and welcome everyone here today to sunny Bankstown! This is the first public hearing of the committee's inquiry into the Social Services Legislation Amendment (Drug Testing Trial) Bill 2018. I thank everyone who's made a submission to this inquiry. This is a public hearing, and a Hansard transcript of the proceedings is being made. The audio of this public hearing is also being broadcast via the internet.

Before the committee starts taking evidence, I remind all present here today that, in giving evidence to the committee, witnesses are protected by parliamentary privilege. It is unlawful for anyone to threaten or disadvantage a witness on account of evidence given to the committee, and such action may be treated by the Senate as a contempt. It is also a contempt to give false or misleading evidence to the committee.

The committee prefers all evidence to be given in public, but, under the Senate's resolutions, witnesses have the right to request to be heard in private session. It is important that witnesses give the committee notice if they intend to ask to give evidence in private. If you are a witness today and you intend to request to give evidence in private, please speak to the secretariat staff. The committee is due to table the report of this inquiry on Monday, 7 May 2018. With this in mind, the committee requests that answers to questions on notice be provided no later than the close of business on Tuesday, 1 May 2018.

We're starting today with representatives from the South Western Sydney Primary Health Network. Can you confirm that information on parliamentary privilege and the protection of witnesses and evidence has been provided to you.

Dr McDonald : Yes.

Mrs Prince : Yes.

CHAIR: Great. I now invite you to make a short opening statement, and at the conclusion of your remarks we will ask you some questions. Please go ahead.

Dr McDonald : Thank you for the opportunity to provide evidence today. South Western Sydney Primary Health Network is one of 31 entities funded by the Australian government's Department of Health and tasked with the key objectives of increasing efficiency and effectiveness of primary health care for the community, particularly those at risk of poor health outcomes, and improving coordination of care to ensure patients receive the right care in the right place at the right time. South Western Sydney PHN is responsible for seven local government areas. That includes Bankstown—pre-amalgamation with Canterbury Council—Liverpool, Fairfield, Campbelltown, Camden, Wingecarribee and Wollondilly. We have a total service population of approximately one million people that is projected to grow over the next 20 years by 45 per cent to 1.35 million.

Drug and alcohol treatment became a focus area for us and other PHNs following the release of the Australian government's response to the National Ice Taskforce's final report back in December 2015, which identified a role for primary health networks in the commissioning of drug and alcohol treatment services based on community need. In early 2016, South Western Sydney PHN undertook a rapid needs-assessment process, investigating local needs in relation to drug and alcohol treatment. The needs assessment involved consultation with the community, local drug and alcohol treatment agencies, GPs and other stakeholders and a review of available data. Throughout that process we also contracted field experts and sought advice from the Network of Alcohol and other Drugs Agencies, or NADA.

From 1 July 2016, South Western Sydney PHN was contracted by the Department of Health to deliver on the drug and alcohol treatment services schedule. This schedule had four requirements for the PHN: (1) to commission services commensurate with community need; (2) to support integration of services; (3) to promote linkages with broader health and support services, including mental health services; and (4) to ensure targeted and culturally appropriate drug and alcohol treatment services for Aboriginal and Torres Strait Islander peoples.

Commencing on 21 October 2016, we released a request for proposal to secure services that would increase the service delivery capacity of the drug and alcohol sector, improve the effectiveness of drug and alcohol treatment services, improve integration of services delivered across these sectors, improve linkages between care providers and ensure culturally appropriate services for Aboriginal and Torres Strait Islander people. The focus of our request for proposal was rehabilitation, withdrawal management, psychosocial counselling and after-care services. We prioritised models of care to those that utilised a day program and which were a community based model, as opposed to residential and inpatient services.

The request for proposal represented an injection of approximately $3 million over two years for drug and alcohol treatment services for South Western Sydney. As a result of our tendering process, we commissioned the following services: a program called headfyrst, led by The Salvation Army, which provides an integrated alcohol and other drugs and mental health comorbidity service for young people aged 12 to 25 and is connected with the headspace services, including the headspace centre here in Bankstown; St Vincent de Paul's Rendu House, which provides after-care services, psychosocial counselling, case management and outreach services; Odyssey House, which provides after-care services, psychosocial counselling and case management; ACON, which provides phone based psychosocial counselling for the LGBTQI community; and Tharawal Aboriginal Medical Service, which provides a comprehensive drug and alcohol treatment team that provides assessment, brief intervention, withdrawal management and after-care services.

In addition, from June 2017, two services were transitioned from Commonwealth management to South Western Sydney PHN. These were the Drug and Alcohol Multicultural Education Centre, or DAMEC, which is funded by us and provides a bilingual drug and alcohol counselling service for consumers and their families; and FYRST, also operated by The Salvation Army, which provides counselling and case management for young people aged 16 to 25. These services are provided to residents of Bankstown, including by outreach.

We also view the role of the general practitioner as critical to supporting patients in the early identification of substance use issues, recovery and providing holistic physical and mental health care for people suffering from substance use issues. Therefore, we also provide education support to GPs in relation to the management of their patients with drug and alcohol concerns. This is achieved through a continuing professional development program of events; fostering GP mentoring opportunities; and the establishment of a phone based GP drug and alcohol support service, which provides GPs with direct, real-time access to local drug and alcohol experts and specialists within the South Western Sydney Local Health District for advice on clinical issues, ranging from screening through to management and referral pathways.

It's our position that substance use and dependency are complex issues in this area and that they obviously require a multisector, multiagency response. Thank you.

CHAIR: Thank you very much. Mrs Prince, do you have anything to add.

Mrs Prince : No, I have nothing further to add.

CHAIR: No worries at all. Senator Watt, do you want to kick things off?

Senator WATT: Sure. Thanks for coming along today, and thanks for the overview of the services that are currently available in this area. You've given us a list of services that sounded like they were primarily commissioned under the auspices of the ice strategy. They were the ones that you tendered for in October 2016 and came online sometime after that. They're basically funded through the ice strategy?

Dr McDonald : That's right. We received a schedule from the Department of Health, which followed on from the ice strategy. But it's more than about ice; it's a drug treatment schedule.

Senator WATT: Sure. Were any of those services already funded by the Commonwealth through some other program, or were they genuinely new services that didn't exist here before? Was it genuinely new Commonwealth funding that didn't exist here before?

Dr McDonald : Our understanding was that some of those services had lapsed contracts, previously from the Department of Health, but we understand that this was new money.

Senator WATT: Right. I'm just conscious that sometimes governments repackage under a new banner, if you like, existing funding that they're providing for services, but it mightn't actually add to the overall number of services that are available. But you're saying that, at least in some instances, the services that arose out of the ice strategy weren't here previously, or had lapsed?

Dr McDonald : That's our understanding.

Senator WATT: Okay. Would you be able to provide us with a bit more detail about that on notice? You've given us a list of the services that are now funded under the ice strategy, and I'd be interested in finding out the dollars attached to each of those services, whether each of them was new funding, whether it was a continuation of previous funding from the Commonwealth under a different banner, or whether it was lapsed funding. I'm just really trying to get a handle on the amount of Commonwealth funding that's already going in here and whether it's new or a continuation or something like that. Could you take that on notice for us.

Dr McDonald : Yes.

Senator WATT: And I'm after the same detail for the additional two services that you said transitioned to the PHN in June 2017.

Dr McDonald : The two transitioned services are a continuation of existing funding.

Senator WATT: They were Commonwealth funded programs that were directly funded by the Commonwealth, but now the Commonwealth money goes to the PHN, who then contracts those services, so that's a continuation.

Dr McDonald : That's right.

Senator WATT: They're services that are now funded under the ice strategy. Is that the full extent of Commonwealth funding for drug and alcohol services in this area?

Dr McDonald : We're only familiar with the funding that's been directed with us; we're not familiar with funding that's across the whole domain.

Senator WATT: Sure. In terms of services that the PHN has any connection with, it's really the services that are funded under the ice strategy that you're aware of that are Commonwealth funded. I just wasn't sure whether there might be other Commonwealth funding coming into the area through the PHN that might not be attached to the ice strategy.

Dr McDonald : Sorry, no, that is the scope of our drug and alcohol services.

Senator WATT: The full scope, okay. I know you won't be aware of this, but at Senate estimates last year the federal Department of Health told us that only six of the 31 PHNs around the country had commissioned residential services under the ice strategy. At that point in time, I think your PHN was not one of those six. Is it still the case that you haven't commissioned any residential services?

Dr McDonald : That's correct.

Senator WATT: Is there a reason for that?

Dr McDonald : In the guidelines, there was encouragement to focus on primary and ambulatory services, and we had to have a good case to justify investing in residential, because the costs per serve are, obviously, higher. And our focus is primary care.

Senator WATT: Do you know what residential rehabilitation services currently exist within your Primary Health Network?

Dr McDonald : We have some information. The main one that we're familiar with is the Odyssey House program, which has multiple centres.

Senator WATT: Including in this PHN?

Dr McDonald : Yes. They're at Eagle Vale and Ingleburn, I believe, which are based in the Campbelltown LGA.

Senator WATT: I know Campbelltown is a little bit away from here, but that still falls within your PHN, does it?

Dr McDonald : It does, yes. We have seven local government areas, including the old Bankstown area, which has now merged with Cantebury. Effectively, we go from Bankstown to Bowral.

Senator WATT: What about within the Canterbury-Bankstown local government area? Are there any residential rehab services in there?

Dr McDonald : Not that we're aware of.

Senator WATT: That's obviously the primary focus of this trial—the Canterbury-Bankstown area. So there's no residential rehab in the local government?

Dr McDonald : I don't believe so, not that we're familiar—

Senator WATT: Where would the closest one be?

Dr McDonald : The closest residential one would be, as I said, at Ingleburn, and then the LHD has its inpatient service at Fairfield.

Senator WATT: Forgive my ignorance: how far is Ingleburn from here?

Dr McDonald : Approximately 20 kilometres.

Senator WATT: Of the other services that you've taken us through that are funded through the ice strategy, do any of them operate in the Canterbury-Bankstown local government area?

Dr McDonald : They do. Several of them are either based here or provide outreach here.

Senator WATT: Along with the question you've taken on notice, I will ask you to provide that detail for us as well, rather than taking up time now.

Dr McDonald : Yes.

Senator WATT: Do you have any data on the level of unmet demand for treatment services in your PHN as a whole and specifically within this local government area?

Dr McDonald : Unmet demand?

Senator WATT: What we were told at the previous Senate inquiry into this legislation is that pretty much all around Australia there are more people looking for drug and alcohol services and assistance than is available. One of our primary concerns here is to see what level of assistance is available in this area and whether there's more demand than the current services can cope with.

Dr McDonald : I think that's a hard measure to collect, in terms of demand. We have some measures of need and we have some measures of current activity for the services that we provide.

Senator WATT: Do you have anything like that available here today?

Dr McDonald : Of the services that we currently contract, in the Bankstown region there have been 81 residents who have accessed our services, and that's 101 consults for 81 residents to date.

Senator WATT: Over what sort of period of time?

Dr McDonald : Since 1 June.

Senator WATT: Since 1 June last year?

Dr McDonald : Yes, this financial year.

Senator SIEWERT: So 1 June?

Dr McDonald : Yes.

Senator WATT: It's since 1 June 2017. Eighty-one residents of the—

Dr McDonald : Bankstown.

Senator WATT: Bankstown local government area have sought assistance from—

Dr McDonald : The services that we commissioned.

Senator WATT: services like St Vinnies and Odyssey et cetera. What was the other number you gave us?

Dr McDonald : That comprised 101 episodes, so some had multiple episodes.

CHAIR: As a follow up to that question, were those 81 having to wait significant periods of time? Was there a clear underservicing or problem with the supply of services?

Dr McDonald : I don't know that we had identification that there was a problem with supply. The capacity—

CHAIR: The capacity was there.

Dr McDonald : Yes, because we commissioned that capacity.

Senator WATT: I realise you're not delivering the services; you've engaged other people to deliver them. Do you keep any data as the funder, if you like, as to waiting times or access issues? Is that something you hold?

Dr McDonald : No we don't. It would be easy enough to ask our providers for some metric of that, but we don't routinely collect that as part of our deliverables.

Senator WATT: I suppose I just wondered whether you might do that so if an issue emerges you can redirect some funding and things like that. But that's not something you hold for present purposes.

Dr McDonald : No.

Senator WATT: I think we have a number of those people appearing today so it might be most efficient if we ask them ourselves. One of the other things we were told in previous inquiries is that there are real issues around whether there is the workforce or trained people who can provide drug and alcohol counselling to the people who will be affected by this trial, that there's a bit of a shortage nationally of the kinds of people you need to provide these sorts of services. Do you have any understanding of whether there are enough trained people to deliver the drug and alcohol services, in this area, that will be required if this trial proceeds?

Dr McDonald : I'll deal with that in two parts. Because our current services commissioned aren't related to what this bill is covering, I suppose, in terms of mandated testing and therapy, we haven't really investigated the evidence around specific requirements it would take. We have commissioned services that demonstrate they have capacity to deliver what is required, in terms of the scale and quality we're looking for, but that is in the scope of what we've commissioned currently. We haven't really investigated what the extra requirements, expectations or evidence are that are spelt out in this bill.

Senator WATT: Has anyone from the federal government, whether it be the Department of Social Security, Health or anyone else, spoken to you about providing additional services to deal with the people who'll be captured in this trial?

Dr McDonald : We had a briefing, probably eight or nine months ago, from the Department of Social Services, but it was more about what the bill involved; it wasn't asking us about what services we would direct towards it.

Senator WATT: Have you turned your minds to what additional services might be needed if this trial goes ahead in this area?

Dr McDonald : Not specifically, other than following the progress of the debate.

Senator SIEWERT: I will pick up from where Senator Watt just left off. In that consultation, government told you about what the bill contained, I presume, from what you said. Was there no discussion then about, 'Have you got enough services in the area to meet expected demand?' And did they outline what they expected that demand to be?

Dr McDonald : It was not specific to Bankstown per se. We understood: 'We have trialled 5,000 people randomly selected over two years,' and the like. It didn't really break down to what we thought the volume in Bankstown might be and, therefore, the impact on existing services.

Senator SIEWERT: At the moment, you are not aware of what assessment of availability of services has been done to meet expected demand?

Dr McDonald : Sorry—could you repeat that?

Senator SIEWERT: You are not aware of any work that has been done to look at whether services are available to meet the expected demand or in fact what that demand will be?

Dr McDonald : No. We've not been involved in that.

Senator SIEWERT: You've not been involved at all?

Dr McDonald : No.

Senator SIEWERT: What survey or analysis has the PHN carried out on the current demand? I've heard what you've said about the services that you've taken on, which were focused on, if I understood the answer correctly, largely the investment in the ice strategy. So what analysis has been done in terms of overall requirements for drug and alcohol services?

Dr McDonald : We maintain what we call a comprehensive needs assessment for the area, of key metrics around epidemiology and demographics. So we do have some measures of need in terms of drug related issues.

Senator SIEWERT: Are you able to give us those?

Dr McDonald : Yes. Do you want that now or on notice?

Senator SIEWERT: If you've got it with you to table, that would be useful, but, if not, could you give us a broader understanding and then provide detail on notice. It's just that it would be useful for us to know now so that we can talk about it with other witnesses as well.

Dr McDonald : We can table the whole needs assessment if you want it.

Senator SIEWERT: That'd be great. That'd be really good.

Dr McDonald : Amy's just pointing out that there is limited LGA-specific data in it. It's for the whole area.

Senator SIEWERT: So that goes outside the trial area?

Dr McDonald : Outside Bankstown—that's right.

Senator SIEWERT: So is there an understanding or breakdown available of the trial area?

Dr McDonald : I don't believe we have that granular detail just for the trial area, no.

Senator SIEWERT: That information would still be useful. Do you know if anybody has done it?

Dr McDonald : Sorry, I don't, no.

Senator SIEWERT: We'll obviously be asking other witnesses, but it would be useful to know if you have an understanding of that.

Dr McDonald : Sorry, no, I can't answer that. I don't know.

Senator SIEWERT: Does the information you have there for the whole area detail what assessment has been done about how services are meeting current demand?

Dr McDonald : 'Current use and trends'—so there is a section there on that.

Senator SIEWERT: I'm obviously trying to get to the current unmet need and then to look at what the expected increase in demand will be with this program coming in.

Dr McDonald : To be honest, I'd have to read back through it to be able to answer that question straightaway.

Senator SIEWERT: But at this stage, would it be fair to conclude that that work hasn't been done?

Dr McDonald : I guess the context for us is that this is a relatively new piece of work, having been told about it in late 2015. This is our first cut, if you like. It is our first measures and analysis. So we fully accept it may not be to the level of granularity that people would like.

Senator SIEWERT: Okay. Can I go to the issue around residential services. I'm also particularly interested in the level of demand versus the supply of services. In your opinion, are residential services currently meeting demand?

Dr McDonald : We don't have a lot of experience with residential services. It has not been our focus through our contracting, so I'm probably not comfortable answering that question because I really don't know the metrics on it.

Senator SIEWERT: The services that you've commissioned, although they're focused on the ice strategy, presumably also offer a range of other drug and alcohol services. Obviously, this particular bill is looking across the spectrum very broadly, beyond ice. So those services are available through those that you've commissioned?

Dr McDonald : Our services were trying to focus on what the local measures of need were. They're not exclusive to methamphetamine treatment. Certainly, in the Bankstown area we know, for example, about cannabinoids. Cannabis is a big issue and so is alcohol, and then meth and then opioids.

Senator SIEWERT: Very shortly, we'll grab the document off you, if that's okay, because it would be very useful for us to have for the day.

Dr McDonald : Sure.

CHAIR: Beyond the commissioning of services, does the PHN have any role in facilitating or assisting general practitioners in assisting people with illicit drug issues?

Dr McDonald : We do a range of things to support general practice, including offering continual professional development training, which includes, in our schedule, drug and alcohol treatment. With the support of the local health district's drug treatment services, we have set up a phone consultancy service. So experts, including a clinical nurse consultant and a part-time GP, can give advice to GPs about their consults related to drug treatment services. We are also sponsoring a GP registrar training position with the drug treatment services, the LHD. Doctors training to become GPs can do a term with drug treatment services so they get more expertise in that region. And, obviously, we maintain a program called HealthPathways, which is an online portal for clinical pathways based on evidence, and the development of drug treatment pathways is included in that, and that's for GPs to access in real time online.

CHAIR: This may not be a question you can answer, but do you have any sense of whether GPs are a frequent first point of contact with the wider health treatment environment for people with illicit drug problems?

Dr McDonald : They certainly would be a first point of contact for a lot of issues, obviously. By definition, that's what GPs do. We have some indication that the identification of drug issues is often underrepresented because of the social stigma and the like, and some people who have a drug issue tend to not maintain a regular GP.

Senator SIEWERT: I'll look at the document, which I now have. What's the process for you once this trial starts? Have you had discussions with government about what the process is in terms of your involvement and the involvement of services you've commissioned in an expected increase in demand? That you haven't had those discussions yet is what I got from your previous answer—

Dr McDonald : That's right.

Senator SIEWERT: What's your understanding and what discussions have you had with government about when and how that takes place, and do you think that you can meet an increase in demand?

Dr McDonald : Our understanding is that the people would be referred for an assessment to a contracted medical officer following a second positive test. We're not clear who those contracted medical officers would be, whether they'd be local GPs or others. I believe as part of that assessment it could be determined whether that be referred for treatment—therapy and the like. It's hard to know, until we know the volumes, what the impact on local services would be.

Senator SIEWERT: If there's been no measure of expected demand, you just don't know?

Dr McDonald : That's right.

CHAIR: Thank you both very much for your participation today.