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Community Affairs Legislation Committee
29/05/2018
Estimates
HEALTH PORTFOLIO
National Mental Health Commission

National Mental Health Commission

[17:32]

Senator O'NEILL: In a media release, the NMHC states that the federal government's budget demonstrates 'a commitment to making the mental health of our nation a top priority'. Is the government investing enough on mental health services given the significant increase in demand for services?

Senator McKenzie: I think that's an opinion. Chair?

Senator O'NEILL: Is the quantum of money that you're receiving adequate to meet the service need?

Senator McKenzie: I think the senator is asking for opinions of our officials.

CHAIR: She's changing the question on your recommendation, Minister.

Senator McKenzie: Thank you for accepting my recommendation.

Dr Brown : Sorry, could you repeat your question?

Senator O'NEILL: Is there a gap between the services that need to be provided and the allocation of funding from the government, in your view?

Dr Brown : Again, I'm not here to give opinion about government allocation of funds. There is a significant demand for mental health services across Australia. There is also, I guess, an argument for investment in promotion, prevention and early intervention. I think the National Mental Health Commission would like to see the investment maximised because we believe that it really is an investment and that you will get return on that investment over time, but we certainly have been pleased to see the priority that this government places on mental health and to see the increased investment that was in this budget.

Senator O'NEILL: Is there a gap remaining between unmet need and service provision?

Dr Brown : The 2014 report that the National Mental Health Commission completed indicated, I think, that there was substantial investment in mental health services across the nation, across both the Australian government and the states and territories. I think it indicated that we were not necessarily maximising the outcome on the returns on that investment. There is a lot to be gained through better organisation of the existing dollars before we necessarily need to start talking about additional investments.

Senator O'NEILL: The next question I have is really going to that sense of is there a plan? Is there a connected strategic plan, or are we seeing in these budget measures another piecemeal approach to mental health? Do you see the strategy in the budget, or is it still lacking that clarity in terms of what the National Mental Health Commission outlined?

Dr Brown : There are a couple of things I would say in response to that. The 2014 report from the National Mental Health Commission put forward a number of recommendations that gave a structure or a framework in terms of continued investment in mental health. We've since then had the Australian government response to that, and we've seen reforms implemented on the ground as a result of that.

We have also seen all health ministers last year endorse the Fifth National Mental Health and Suicide Prevention Plan. Again, that is not necessarily intended to be a comprehensive plan addressing everything across mental health. It was an agreement by all levels of government on eight particular priority areas. So I think we have a couple of existing documents that do guide the investment of governments.

Senator O'NEILL: Was the National Mental Health Commission asked to do any analysis of the measures in the lead-up to the May budget?

Dr Brown : No.

Senator O'NEILL: Why not?

Dr Brown : You would have to ask the government that question, Senator.

Senator O'NEILL: So with a roadmap laying down eight priorities identified, and the capacity of the National Mental Health Commission, why did the government not use that capacity to actually analyse the measures they were proposing in the budget?

Ms Beauchamp : I think we've answered that question in terms of the consultation that was undertaken. But also we did have the Fifth National Mental Health and Suicide Prevention Plan already, which provides that umbrella. One of the measures was looking at the strengthening of the National Mental Health Commission, just to provide that leadership and advice on mental health reforms and also for reporting on the performance of the mental health system across Australia. I think that has been spoken about as not just being a Commonwealth responsibility but a state and territory responsibility as well. I think that the work going forward, in terms of strengthening the National Mental Health Commission, will provide an updated performance framework for the mental health system across Australia.

Senator O'NEILL: Will the National Mental Health Commission be part of updating that or will its remit the updated?

Ms Beauchamp : The actual measure talks about:

This additional funding will support the Commission to better review and report on the performance of the mental health system in Australia and increase its capacity to provide national leadership in advising on mental health reforms, including expanding its role under the Fifth National Mental Health and Suicide Prevention Plan.

Senator O'NEILL: Were you consulted in a formal way around the extension of the suicide prevention sites?

Dr Brown : No.

Senator O'NEILL: I'm trying to reconcile these two things. You're a really important agency but you are not being consulted about major economic decisions of the government to invest in mental health. There seems to be a gap here between what the minister is doing and the capacity of the National Mental Health Commission to inform the decisions of government with careful analysis.

Dr Brown : I take on board where you're going. I think we need to be mindful that the National Mental Health Commission is a relatively small agency. We do not have the capacity to look at a granular level at each and every measure that government might be investing in. Our remit is to look at the higher-level, broader and overarching approach, not necessarily at specific individual measures.

Senator O'NEILL: Do you think you would have had an instructive contribution to make to a high-level discussion about the extension of the suicide prevention trial sites which you were not asked to consult on?

Dr Brown : Undoubtedly we would have been happy to have made a contribution in discussion with the department, but whether we would have added any additional value over and above the analysis that the department made, I wouldn't necessarily—

Senator O'NEILL: We'll never know, because you weren't asked to the table. Were you consulted on the recent youth funding announcement?

Dr Brown : No.

Senator O'NEILL: How often, then, does the government or the department actually seek advice from the National Mental Health Commission in relation to major mental health announcements and funding decisions?

Dr Brown : Again, we work I guess collaboratively with the department. We don't necessarily expect to be consulted on each particular announcement that the government might be making. But we do seek to work with the sector broadly and with the department in a collaborative way to inform the deliberations.

Senator O'NEILL: What formal arrangement is in place for ongoing consultation with you? Is there any regularity to that?

Dr Brown : We have a regular meeting at officer level.

Senator O'NEILL: How often does that occur?

Dr Brown : Once a month, and we have a periodic meeting with the minister and indeed a twice-yearly meeting with the minister and the Prime Minister.

Senator O'NEILL: Over what period is the periodic meeting with the minister—quarterly? Monthly?

Dr Brown : It approximates quarterly.

CHAIR: Can I just ask a question of clarification at this point, on the role and function of the National Mental Health Commission? My understanding of it is that it's not to advise government on budgetary decisions. Can you just outline your role?

Dr Brown : We have three main functions. The first one is to monitor and report on mental health and suicide prevention systems across the nation. The second is to provide advice to governments and the community on mental health and suicide prevention, and that's a broad advice. And our third function essentially is to act as a catalyst for change to I guess promote mental health reform. So, you're quite right, Senator: we're not specifically set up to provide advice on government budget initiatives.

Senator O'NEILL: In the National Mental Health Commission's view, are the budget measures supportive of the Fifth Mental Health and Suicide Prevention Plan and the National Mental Health Commission's previous recommendations, in whole or in part?

CHAIR: I think we're getting close to asking for an opinion. I'm happy for you to answer that if you see fit, Dr Brown, but—

Dr Brown : I think it's fair to say that in broad terms yes, I think they are supportive of the National Mental Health Commission's previous recommendations and the strategic directions outlined there. And I don't think they're inconsistent with the priorities in the Fifth National Mental Health and Suicide Prevention Plan. Obviously there are specific measures. They're not so broad as to cover all the strategic directions set out in the 2014 report or the eight priorities of the Fifth National Mental Health and Suicide Prevention Plan, but they are certainly not out of alignment with that.

Senator O'NEILL: The title of your work was 'mental health and suicide prevention'. Given that you weren't consulted formally, despite meeting with the minister on a quarterly basis and once—

CHAIR: I think you may be verballing the witness there.

Senator McKenzie: Chair, I'd have to agree with you.

Senator O'NEILL: So, you meet with the officers once a month, you meet with the minister quarterly, and you meet with the minister and the Prime Minister two times a year. Yet, despite that, you were not formally engaged, even though your remit is to advise the government on mental health and suicide prevention, about the extension to the suicide prevention trial site. Is that correct?

Dr Brown : I've indicated that we were not involved in those discussions with the department or the minister around the extension of the suicide prevention trials. We have a broad remit around providing advice, but it doesn't necessarily go to in-depth discussion of every initiative, as I have indicated.

Senator O'NEILL: Without asking for your opinion about whether the government is investing adequately in suicide prevention, what elements of the work outlined by the National Mental Health Commission remain yet unachieved despite the efforts of the government?

Dr Brown : Are you referring to our recommendations from the 2014 report?

Senator O'NEILL: Yes.

Dr Brown : I think there were nine strategic themes in that report; I can't recall them all of the top of my head. One of the areas we are particularly interested in seeing progression in is early childhood. We have seen the measures around education, and there has been a significant investment there. Aboriginal and Torres Strait Islander mental health is another area where we are keen to see further investment. There has been some investment, but we would be keen to see further investment there. Some of the other recommendations were around, for example, taking the approach down to regions through the PHNs and a more person centred stepped care approach. That is happening with the current reforms. There was a recommendation around research. There's a commitment in the Fifth National Mental Health and Suicide Prevention Plan around the National Mental Health Research Strategy. We have also seen investment in this budget in mental health research through the MRFF. We are seeing a lot of what was set out by the commission in 2014 being progressively implemented.

Senator O'NEILL: Would you like to put on the record any areas of concern?

Dr Brown : Not at this particular point in time.

Senator O'NEILL: How do you view the degree of consultation that you are currently being offered by the government? We know its frequency now, but how substantive is it?

Dr Brown : It's fair to say that the relationship between the commission, the department and the minister's office has been strengthening. The government gave a commitment to strengthen the National Mental Health Commission. We've seen increased investment in the funding available. We've had an increase in the staffing resources made available to the commission. With that we've had increased capacity to engage with the department and with the minister's office. I think we're seeing the benefits of that increased collaboration. I hope it will continue to increase as time goes forward.

Senator O'NEILL: Do you expect to be engaged by the government and the department more regularly around the suicide prevention trials?

Dr Brown : I think we expect to be engaged with the government, the minister's office and the department on a range of issues. That would include suicide prevention measures more broadly.

Senator SIEWERT: What involvement will the commission have in progressing the National strategic framework for Aboriginal and Torres Strait Islander peoples' mental health and social and emotional wellbeing?

Dr Brown : We have not been specifically engaged around implementation of the social and emotional wellbeing framework at this point in time. Having said that, one of our priorities in the 2014 report, as I indicated, was around Aboriginal and Torres Strait Islander health, so we are interested in seeing further work in that area. We know that for Aboriginal and Torres Strait Islander people there isn't a clear distinction between social and emotional wellbeing and mental health issues, because of their holistic approach to health. I am co-chairing the PHN Advisory Panel on Mental Health, of which Dr Mark Wenitong is one of the members. He has been emphasising this issue. That panel is due to report to the minister in the next couple of months, and I expect that there will be some commentary in that report about the need to ensure that there is this unified approach in terms of social and emotional wellbeing and mental health initiatives for Aboriginal and Torres Strait Islander people.

Senator SIEWERT: We ran out of time on Friday. I appreciate you don't have the staff available here, but perhaps I can ask you to take on notice what the department's response is and when we can start to see the allocation of some more resources against the framework.

Ms Edwards : For the social and emotional wellbeing framework?

Senator SIEWERT: Yes.

Ms Edwards : I think that belongs to PM&C these days.

Senator SIEWERT: So I should put that on notice to them?

Ms Edwards : Yes. It used to be mine once.

Senator SIEWERT: I'll put that on notice to them. We were talking about health and things on Friday. I have one other area of questioning.

Senator McKenzie: Is this outcome 5 for Indigenous?

Senator SIEWERT: No, not for my next question. We're still on 2.1.

Senator McKenzie: I'm just saying, because we have received correspondence—

Senator WATT: That might have come from me.

Senator McKenzie: Yes. There are other senators who have questions in the same area. Rather than taking it on notice tonight, it might be better that you're aware of that and you ask them tomorrow.

Senator SIEWERT: Yes. I wasn't going on to that, though—but that's very good advice. However, it's PM&C who I need to ask this one of anyway.

Ms Edwards : In relation to the social and emotional wellbeing framework.

Senator SIEWERT: Exactly. I was just taking a chance, because we didn't get up to that point on Friday.

CHAIR: Can I just clarify, Senator Watt. The request you have tomorrow is purely within outcome 5, isn't it?

Senator WATT: Yes. That's my understanding. I think that's what the letter said.

CHAIR: Great.

Ms Edwards : Senator Watt, could I ask exactly what it is you want to ask about, in order to make sure I don't disturb the day of the wrong people?

Senator WATT: Let me see if I can get some more info on that.

Ms Edwards : If possible. Otherwise I can bring the whole show, but obviously they weren't expecting it.

Senator WATT: I'll get some more info.

Senator SIEWERT: I want to go back to a question I think I asked at the estimates before last—in fact, I'm pretty certain it was then—around the telemental health issue and the face-to-face sessions. You took a question on notice.

Ms Beauchamp : Chair, I'm just going to interrupt. Have we have finished with the Mental Health Commission?

Senator SIEWERT: I beg your pardon, yes.

CHAIR: Let's just clarify it from other senators' points of view: is the National Mental Health Commission required anymore?

Senator WATT: Done. No.

CHAIR: Then you are excused, with our gratitude.

Senator WATT: And, in answer to that question you asked, my understanding is that the questions we have tomorrow for outcome 5 relate to sexually transmitted diseases in Indigenous communities.

Ms Edwards : I have a role in that work through the Office of Health Protection, rather than the Indigenous Health Division. With your leave, Senator Watt, I'll make sure the Office of Health Protection people, who know all about STIs, are here, rather than the Indigenous Health Division.

Senator WATT: That would be great. Are you happy for that to be asked in outcome 5, though?

Ms Beauchamp : Yes, because we'll have the Chief Medical Officer here as well.

Prof. Murphy : We are very happy for that to be asked in outcome 5.

Ms Edwards : Thank you for the clarification. They'll be relieved.

Senator SIEWERT: I want to go back to the issue of the telemental health measure and the face-to-face requirements. You took a question on notice. You provided a response on notice and talked about the efficiency of the program, and we've talked a bit about it before that. I've subsequently received quite a bit of feedback saying that there's little evidence to support the idea that the face-to-face requirements, in respect to telemental health, provide better outcomes. I've been told that people do some of their consultations electronically and then drop out when they don't make the face-to-face requirements. Coming from WA, you can appreciate there are long distances involved for people to come down, so they just don't come down. I have subsequently received evidence—papers—around the value of telemental health. Have you had a look at any of the subsequent work? Can I provide you the papers and ask you to respond to the papers on that? I am deeply concerned that that is a good measure that is being undermined because of the requirement for face-to-face.

Senator McKenzie: Providing the department with your papers and getting a full response would be a really good approach.

Senator SIEWERT: I presume that hasn't changed it.

Ms Edwards : Our response to the question on notice is still our view, but if you provide us some additional material we would be happy to respond.

Senator SIEWERT: I have quite a few references here. Minister, if the papers are to your satisfaction in terms of being clinically sufficient, is there a possibility that the government can change the rules on this program to take out the requirement for face-to-face consultations?

Senator McKenzie: The decision to structure the program as we have was based on sound clinical evidence. If there is clinical evidence that that changes then obviously it is within our remit as a government to review it and have a look at that.

Senator SIEWERT: I will provide you with those references. If you could take that notice, that would be really appreciated.

Ms Edwards : Thanks, Senator.

CHAIR: We have had some negative targeted questions to date, but the increase in $338 million.

Ms Edwards : It is $338.1 million.

CHAIR: That is the increase in spending?

Ms Edwards : That is the increase over the longer period in some instances.

CHAIR: What is the total quantum of spending on mental health over the forward estimates?

Ms Edwards : This requires me to do maths again! It is the number we talked about before. It is $4.2 billion annually. That covers mental health programs, MBS mental health related services, PBS prescriptions for mental health, the Australian government's share of public hospital in relation to to mental health, mental health share of private health insurance rebates and research from the NHMRC and the Mental Health Commission. In relation to the mental health program itself, the one that the team runs, it is over $800 million a year, plus the $338 million. And of my trusty budget people will tell me in a moment what the forward estimates.

Ms Beauchamp : I think we went through the forward estimates with Senator O'Neill.

Ms Edwards : We did—in relation to the addition.

Ms Cole : We did. We don't have is four years with the new budget measures in. What we will do is take that on notice.

CHAIR: Is there even a rough global figure on what the spending is projected to be?

Ms Edwards : It is about $3 billion.

Ms Cole : Over the forwards.

CHAIR: I think everyone acknowledges that there is a lot more to do in this space, including in primary research and the delivery of services. But comparing the current profile of spending to previous profiles, to previous governments, would it be correct to say that there has been a significant step forward?

Ms Edwards : We certainly focused on a very broad range of things—on mainstream services targeting to make sure they cater for mental health issues, on making sure mental health specific funding is targeted to things that really work and also research so we make sure we really investigate the causes of mental health problems and the treatments and how we can best roll them out. So it is evolving into a much broader and more multifaceted program, for which I'm sure everybody is supportive, and there's major investment in this budget.

CHAIR: And the resources that this government has put forward for mental health services are significantly more than in previous years with previous governments?

Ms Edwards : It has been increasing greatly.

Ms Beauchamp : From my observations, having been in the Commonwealth for some time, I think this area was traditionally a responsibility of the states and territories, and I think the Commonwealth government has stepped in, in more recent years, with absolutely record funding specifically for mental health services. What was it?

Ms Edwards : $654 million.

Ms Beauchamp : The $654 million, plus the $338 million, is certainly something additional to what we would normally provide in the mainstream services around MBS and PBS, which is in the order of about $4.2 billion per annum. As you say, there's more work to do, but certainly the Commonwealth government has stepped into a traditional state and territory space in this area.

CHAIR: Thank you very much. With that, we will thank those from program 2.1 who have no further involvement this evening, and we will move to program 2.3, Health workforce.

Ms Cole : Chair, Senator O'Neill, who's just stepped out of the room, asked a question about the meeting date of the evaluation steering committee in relation to the suicide prevention trials.

CHAIR: Yes.

Ms Cole : That committee was established in January 2018. You might remember that the ATM was finished for the actual evaluation in February, but the first meeting of the evaluation steering committee was on 1 February. That was a specific question that Senator O'Neill asked us to follow up.

CHAIR: Okay. We will move on from program 2.1 to program 2.3.

[18:01]

Senator SINGH: I just have a couple of questions in relation to the Murray-Darling medical school. Minister, I wanted to ask you, particularly now that the Murray-Darling medical school network has been announced: will you finally tell us whether it was in the secret coalition agreement?

Senator McKenzie: I'm incredibly proud to be the rural health minister that has seen five end-to-end medical schools and provisions across the Murray-Darling region delivering end-to-end training, as recommended. Senator Siewert, you're probably the only other person in this room that was part of this committee in 2012, when it did an inquiry report that actually recommended exactly this type of training as a way of addressing the maldistribution of doctors in the regions.

Senator SINGH: It wasn't a Dorothy, Minister.

Senator McKenzie: No, I just can't stop talking about it.

Senator SINGH: I was asking whether it was part of the secret coalition agreement.

Senator McKenzie: I'm not going to comment on what is in or isn't in the coalition agreement.

Senator SINGH: Why not? Is it cabinet in confidence?

Senator McKenzie: It's an administrative document. We've played this game at the last estimates. I'm happy to play the same game. We won't get any further down the track.

Senator SINGH: No, I just want your reason. What's your reason? Is it cabinet in confidence? Is it budget in confidence?

Senator McKenzie: The reason we've instigated a policy of end-to-end training in the regions is that it has been part of the National Party policy. It was part of recommendations from this committee.

Senator SINGH: That wasn't the question, Minister.

Senator McKenzie: I think we should all actually be incredibly proud. People go out there and say that this committee's Senate inquiry reports don't deliver anything. Well, now you can all champion that they actually have, as a result of our budget a couple of weeks ago.

Senator SINGH: I'm not getting the answer I was asking for, Chair. I'll throw it back to you.

CHAIR: I think we've been there before, so I think you expected that.

Senator RICE: I want to ask some questions about maternity services. Following the end of the National Maternity Services Plan, which I understand finished in June 2016, almost two years ago, I understand that there's a new process underway with a National Strategic Approach to Maternity Services, and that's currently open for consultation.

Senator McKenzie: We will get the appropriate officer to the table as soon as possible.

Prof. Murphy : I think it is outcome 2.4. I don't think it is outcome 2.3.

Senator McKenzie: This is workforce.

Senator RICE: I was told it was under 2.3.

CHAIR: If it's 2.4, let's do it there, because I do have some workforce questions.

Senator McKenzie: It's just that Senator Rice was advised—

CHAIR: Senator Rice has been incorrectly advised. We will be moving to 2.4 relatively soon by the look of it. Can we just clarify who should be answering the question? Do we need to get further—

Ms Beauchamp : 2.4.

CHAIR: I apologise, Senator Rice, for the incorrect information. Are you happy to ask the question in 2.4? We won't release the officers until the issue has been dealt with—just in case.

Senator RICE: All right. Are you going to do the rest of 2.3?

CHAIR: I'm going to ask my questions, because they're very important questions on this very important policy. This is 2.3. I am going to go through a few things in this area. I would like to start with the importance of the strategy of bringing back into the policy mix the underlying principle of getting workers into rural, regional and remote Australia who are actually trained in rural and regional Australia, and the need to develop the system and structures that actually train people in the bush. Can you talk us through the genesis of the package, with a particular focus on that element?

Senator McKenzie: I think the research shows us that there are two factors that will really determine or significantly impact on your decision to practise in the region. Those are: are you of the regions—are you somebody who grew up in rural and regional Australia and have that embedded identity—or, have you undertaken a significant amount of training within your profession at the rural and regional level? There is much data going to that effect. So, in developing this package, what we've sought to do, particularly with the five end-to-end medical schools, is flip the training model, if you like, for medical training in this country. Traditionally, you would be at an urban university and you would enrol in your medical degree and you would pop out to the regions for an amount of time to undertake some of your training. What we've been able to do now is embed them in the regions for the entirety of their medical training, and they may pop back to a capital city to undertake very discrete units of training for the completion of their degree. So, I think we are going to see significant changes in medical graduates who set up practice in the region. David Hallinan has been intimately involved in the development of this package, which really is a comprehensive suite of initiatives—pull and push factors—that we think will deliver 3,000 doctors, 3,000 nurses and allied health professionals to the regions over the next 10 years, which is fantastic.

CHAIR: Do you have anything to add, Mr Hallinan?

Mr Hallinan : In summary, the package does target each stage of the training journey for medical practitioners, from undergraduate through junior doctor training years and then specialist training as general practitioners or other specialists. We've also attempted to improve the funding arrangements with students who have return-of-service obligations of the Commonwealth to work in rural areas, to support better distribution of that workforce and to create some incentive structures to support better qualification of practitioners delivering services in rural Australia.

CHAIR: When you talk about this end-to-end, how does it actually differ from what's happened in the past? The reason I ask this question is that I was in a country town in Western Australia last week that had lost a medical practitioner who worked in the hospital and in a GP setting. Obviously, they were very concerned about how they were going to attract the next generation of medical practitioners. So, can you talk about what's actually changed in the training system to try to improve that kind of nexus?

Mr Hallinan : Sure. The idea of an end-to-end training model is to let students enter their university training on day one in a rural location, and undertake that training throughout university primarily based in a rural location. If not for the entirety, there might be some visits into the city to do anatomy and other things that it might be better to do in the city. But, in effect, you're flipping the model. At the moment we have medical students trained, in large part, in the cities, with perhaps a one- or two-year rotation out into rural locations for clinical training. After they complete their medical degree, there are quite a few rural internships out there, currently. But there are fewer places for junior doctor positions beyond internships, for PGY2 and PGY3—that's probably meaningless—

CHAIR: A little bit meaningless to me!

Mr Hallinan : The second and third year out of university. There are fewer employment options for junior doctors. The package includes some reforms to Medicare arrangements to allow Australian-trained doctors to access Medicare in junior doctor positions for the first time outside of the formal General Practice Training Program, which would then assist with articulation into general practice or other speciality training in rural and regional locations. Fundamentally, the evidence that we've got says the longer we have people in a location the more likely it is that they'll stay. So the underpinnings of the strategy are to try to remove any barriers that would stop people from staying in the regions in which they have trained and therefore support longer term outcomes for the community.

CHAIR: In terms of the problems for those in their second or third year out, was it a structural problem based on the fact that people would go to the bush and tend to stay there, so those junior positions were not available? Were there just not enough positions available in country hospitals?

Mr Hallinan : Regional and rural hospitals are slightly different from major city hospitals in terms of how they operate. Many rural hospitals are actually staffed by general practitioners with some additional skills in the sorts of services delivered in a hospital setting. In order to stay and practise in those communities, the practitioners need to both operate as a general practitioner in a general practice setting but also work in the hospital on a visiting medical officer basis. The existing settings, or the pre-existing settings, for accessing Medicare meant that, for that junior doctor period in particular, an Australian-trained practitioner would likely have to move to the city for their junior doctor training period because there wasn't the ability for them to work in that rural model, where you spend part of your time in a general practice setting and part of your time in a hospital setting. So some of these reforms allow those junior doctors to stay in the rural setting in a general practice setting while also working in the hospital as a longer term option, which we think will then support the development of a national rural generalist pathway that the Rural Health Commissioner has been asked to establish over the coming years.

CHAIR: Can you talk more about how those two things will intersect—that pathway and this package?

Mr Hallinan : The package itself is intended to remove any barriers that would get in the way of the development of the rural generalist pathway, but at this stage it doesn't deliver the rural generalist pathway. That's something that—

CHAIR: So this opens the door to training more doctors and nurses who will hopefully choose to make their careers in the bush. The pathway will then give them the journey along which they can travel?

Mr Hallinan : Yes. They could, yes.

CHAIR: In terms of numbers, it's 3,000 doctors and 3,000 nurses. Does it go to, I guess, nondoctors, nonnurses—allied health workers?

Mr Hallinan : Yes. There's a reform in the package to establish the Workforce Incentive Program. It combines two pre-existing programs, the Practice Nurse Incentive Program and the General Practice Rural Incentive Program, into a single, multidisciplinary Workforce Incentive Program. The reforms under that measure include allowing allied health to be an eligible profession, or set of professions, under the Workforce Incentive Program Arrangements, beyond the existing locations—at this stage, allied health incentives are available in areas of urban allied health workforce shortage, but nowhere else. That's a list of locations that's been identified through the Department of Human Services. This reform will allow allied health eligibility throughout the country, but particularly focusing on rural and remote areas to support better integrated care models in general practice settings throughout rural and regional and remote Australia.

CHAIR: Do you have any detail on how this will work in individual states? From a Western Australian rural point of view, can you give me any idea how this package will impact on the ground in Western Australia? If you can't, I accept that it's early days.

Senator McKenzie: I think a lot of initiatives use the Monash model around rurality, which is a lot more granular and specific than the older model. If you are truly rural, then you will receive incentives that you haven't necessarily been receiving before, and I was going to go to the detail of that. For instance, in WA, communities like Serpentine, et cetera, will be—and there's one that I can't—

Senator DEAN SMITH: Jarrahdale.

Senator RICE: Jarrahdale.

Senator McKenzie: There we go; I have three of you here now, you will between able to interpret for me. But, they'll be now able to receive an incentive, whereas previously they weren't. So, irrespective of your community, we've tailored this package to ensure that all of rural and regional Australia will be able to avail themselves. But, again, state governments will play a key role in that pipeline for the provision of further training places in state public hospitals.

CHAIR: I might be completely off beam here, but does the Curtin Medical School have any particular role in this package?

Mr Hallinan : Yes, it does. The Curtin Medical School through this measure will be established as part of the joint rural school clinical arrangements in WA, with both the other two universities in Western Australia delivering rural undergraduate training as part of their medical degree programs.

CHAIR: How much of that will take place—again, you may not have the detail on this—outside the Perth metro area? Obviously, all the universities are centred in the Perth and the main focus of the medical schools will be in Perth. Is Curtin going to establish an offshoot in a country town, for example?

Mr Hallinan : Yes, I think it will work collaboratively with the other existing sites, the other two universities in Western Australia.

CHAIR: So that will be in the hospitals and in the bush, basically?

Mr Hallinan : It will be, yes—on a distributed clinical training model. At least 25 per cent of their students must spend at least 12 months in rural clinical training through that expansion.

CHAIR: Can you compare that—and obviously Western Australia is very different in terms of population centres; I fully accept that—with what will happen with the Murray-Darling medical school network in New South Wales? How is that going to work—

Senator McKenzie: It's not just in New South Wales.

CHAIR: Oh, sorry.

Senator McKenzie: New South Wales and Victoria.

CHAIR: I'm from WA.

Senator McKenzie: It's all good. East coast.

CHAIR: East coast. The other side.

Senator McKenzie: That's right. The other side. I think it's issues that are fit for purpose. You will remember that Curtin got their CSP medical school places, and it was a significant win for WA to have another medical school set up there. I think this will actually build the capacity within WA in the regions. There will be three different schools operating and collaborating at the same time. In terms of how that compares, I imagine and the research would suggest, that graduates of the Murray-Darling medical school's network will be practising right throughout the country. The research suggests that you don't necessarily go back to where you've studied. You realise that working in the regions isn't a deficit and so you're prepared to go anywhere. For instance, I was at Charles Sturt University in Bathurst at their allied health campus and met a young training dentist from Mitta Mitta. And I said, 'Where are you expecting to practise?' He wanted to go back to Mitta Mitta, which is just outside of Wangaratta in Victoria. So I imagine these graduates will be right around the country.

CHAIR: I think I did ask this question at last estimates, but I will follow-up. You're confident that the research shows that doctors and nurses trained in the Murray-Darling medical school are more likely to stay in the bush no matter where it is?

Senator McKenzie: Absolutely. James Cook University has been running this model a lot. Charles Sturt University does it, not with medical graduates but with a lot of their allied health professionals, and there is very, very strong evidence that between 70 and 80 per cent of the graduates are still in the regions post-graduation, which is a great result. It is what this Senate committee found all those years ago. To be able to deliver on it, I think, is quite profound.

CHAIR: Excellent. Can I have a little bit of detail on the bulk-billing incentives. The description is that they are being 'better targeted'. Can you talk me through exactly how that is going to impact a medical practitioner on the ground—

Senator McKenzie: You won't be able to get it on the Sunshine Coast, but Mr Hallinan can go through the details.

CHAIR: I'd just like to get an understanding of what that better targeting actually means in practice. Again, if you can relate it to Western Australia, I'd love that. If you can't, that's fine.

Mr Hallinan : The package includes updating much of the underpinning rurality models that sit underneath a lot of the programs that we run in the health department for workforce policy measures. That means that we're moving from rurality measures—for instance, for bulk-billing incentives—that were derived out of 1991 population data to current or contemporary models of rurality measures. So we're moving them to the Modified Monash Model bulk-billing incentives from the old RRMA model. That means that locations that, in 1991 would have been identified as rural using 1991 census data, would no longer be identified as rural. For some parts of the country that were identified as urban at that stage, they'll no longer be identified as urban if they are, in fact, a rural setting. So the bulk-billing incentive update takes the old rurality measures and updates them to modern rurality measures. In WA, I think that would mean locations like Ellenbrook or Baldivis would no longer be eligible as rural settings for a rural bulk-billing incentive, and they would instead bill as an urban—

CHAIR: So, basically, areas that have urbanised are being removed. Have areas been added?

Senator McKENZIE: Yes, as I said, we've got a more granular approach than the RRMA, and I think—

CHAIR: So boundaries like—

Senator McKenzie: Areas like the Sunshine Coast and areas of Canberra have been able to access these incentives. We've changed the incentive programs to better target them to areas of need, so those communities that have fewer doctors and health professionals per thousand people actually get the money and the incentive, which is a great step forward.

CHAIR: It is. It's an excellent program.

Senator GRIFF: Professor Murphy, in the February estimates, in relation to mandatory reporting of mental health issues from doctors, you stated that COAG had not reached a final position, although the likely outcome of current deliberations was to remove the mandatory reporting requirements. Can you provide an update on this issue.

Prof. Murphy : COAG has, I think, reached a position at the moment. And the position is that—other than in Western Australia, which will continue its current position where there is no mandatory reporting—the reporting requirements in the other jurisdictions will be softened. If there is still a very serious risk of a practitioner putting patients at risk, there would be still a requirement to report, but the requirements have been softened a bit so that there isn't a concern from junior doctors that any mental health condition that they had in the past might lead to mandatory reporting. Mr Hallinan can perhaps give the exact wording of the COAG agreement.

Mr Hallinan : On 13 April ministers agreed to an exemption for reporting impairment unless, in the treating practitioner's reasonable view, the impairment is such that it would negatively impact the treatment of patients. They agreed to a requirement to report past, present and the risk of future of sexual misconduct, and a requirement to report current and the risk of future instances of intoxication at work and practice outside of accepted standards. There will be a draft bill, I think, tabled in Queensland later in 2018 to give effect to that decision.

Senator GRIFF: So that would also include anyone who has been reported in the past?

Mr Hallinan : In the case of sexual misconduct, it's a requirement to report past, present and the risk of future sexual misconduct, and, in the case of intoxication it's a requirement to report current and the risk of future instances of intoxication at work.

Senator GRIFF: Does reporting in that particular instance also apply to other practitioners registered by AHPRA?

Prof. Murphy : It applies to all registered health practitioners.

Senator GRIFF: I would also like to ask some questions about the $40 million in funding for drug and alcohol professional training with a rehab component that my colleague Rebekha Sharkie negotiated with the government earlier this year. The funding appears in the budget papers, but it does not appear to be new money. Budget paper No. 2 page 125 states, 'Funding for this measure has already been provided for by the Government.' Can the department advise from where the funding for this program will be drawn? Is it being pulled from other programs or some other allocation?

Dr Studdert : Sorry, Senator, we were in the other room and I think we may have missed the nub of your question as we transited in here. I would be happy to try to answer it if you could repeat it.

Senator GRIFF: It's on the $40 million of funding which is allocated against professional training, which is why I'm bringing it up here, and also there is a rehab component there, too. The budget paper indicates that the funding for that measure has already been provided for by the government. So my question is: can you advise from where funding for the program will be drawn? Is it being pulled from another program or department allocation?

Dr Studdert : I think all I can say is that it's not being drawn from within the Health portfolio, and that it was provided for in the budget. We've worked closely with the Department of Social Services on this as part of their measures, but I don't have any visibility of the exact source of that fund.

Senator GRIFF: Can you advise when the program will start?

Dr Studdert : We will start discussions with the stakeholders involved in the coming weeks. My colleague here can say a bit more about that. The intention is that it would start to be rolled out in 2018-19.

Senator GRIFF: Can you advise or confirm how many doctors and allied health addiction specialists will benefit from the program?

Dr Studdert : Again, that's detail that we will work out in consultation with key stakeholders, GPs, primary health networks and service providers on the ground. It would be impossible or inappropriate to even speculate about that detail at this stage.

Senator GRIFF: The same, obviously, with locations for rehab facilities?

Dr Studdert : Exactly.

Senator GRIFF: All right. Thank you.

CHAIR: Senator Smith, did you have a final question before we go to the break?

Senator McKenzie: I can add two more towns from WA.

CHAIR: Please do.

Senator McKenzie: Two Rocks and Yanchep.

CHAIR: That's the northern end of Perth, but fair enough. That's the granularity you're talking about, Minister. Is everybody fine if we release program 2.3? Senator Rice is confident that her questions are going to be answered in 2.4. In that case, we will release program 2.3 with our thanks, and we shall suspend for one hour for dinner.

Proceedings suspended from 18 : 29 to 19 : 30

CHAIR: Okay. We resume with program 2.4, Preventative health and chronic disease support. Senator Rice, who has been waiting very patiently, has the call.

Senator RICE: Yes, finally here. Terrific. I have got some questions to ask about maternity services. I understand the National Maternity Services Plan concluded at the end of June 2016—so, almost two years ago—and that, since then, there's a new process underway to develop a national strategic approach to maternity services. That's correct?

Ms Beauchamp : That's correct.

Senator RICE: And that's currently open for consultation?

Ms Beauchamp : That's correct.

Senator RICE: Yes. Firstly, can you fill me in on how that consultation is going, what stage it's at and how much engagement you've had so far.

Ms Beauchamp : Under the auspices of the COAG Health Council, the officials have got together and asked us to take the lead on the development of the strategic plan. As you've mentioned, there is a consultation process underway, with a number of key stakeholders. I'll hand over to Ms Cole to provide you with all the details of the consultation process.

Ms Cole : Senator, first of all, I might not be able to provide quite as much detail as you'd like, because this process is actually being run by our Chief Nursing and Midwifery Officer, and she's currently on her way back from Howth, but I'll do the best that I can.

So there's an advisory group which has all the major stakeholders on it. There are about 25 different stakeholder groups, including consumers, on that group. It has obstetricians, midwives, general practitioners, academics and consumers from both the public and private sectors. That is the sort of standing consultation arrangement. They also have some nice diversity in terms of rural and regional settings, Aboriginal and Torres Strait Islander communities and all those sorts of things, and they're jointly co-chaired by an obstetrician, Professor David Ellwood; and a midwife, Ms Helen McCarthy. They will be with us, in a sense, throughout the process. Those co-chairs are also involved in the state and territory and Commonwealth discussion around the national strategic approach itself, so that we get those linkages. In addition, there are consultations being done right throughout Australia. I think the next one is actually in Toowoomba. There is also an online submission process, various workshops and focus groups.

Senator RICE: What's the time line for those consultation processes?

Ms Cole : This is where my detail is running out, Senator, so I will have to take that on notice for you.

Senator RICE: Okay. Do you know what the time line for the new strategic approach is?

Ms Cole : The outcomes of that consultation with the group and from the consultations around Australia are going to inform the new strategic approach. Then I think they'll go out for a further round of consultations before they finalise the approach.

Senator RICE: Right.

Ms Cole : So it's a while away.

Senator RICE: It's a while away. But you can't tell me when.

Ms Cole : No, I'm sorry, but I can take that on notice for you.

Senator RICE: Okay. Thank you. In terms of the old National Maternity Services Plan, I understand there was a commitment from the Australian health ministers in 2010 that there was going to be an evaluation of that plan done to inform development of the new national plan. Has that evaluation occurred?

Ms Cole : There was a final report done, but not an evaluation per se.

Senator RICE: Right. Does that mean the new strategy is going to be developed without a formal evaluation of the plan?

Ms Cole : That's right. There were reports, sort of progress reports, and a final report at the end of the previous plan, but not a formal evaluation per se.

Senator RICE: What was the process to decide that there wasn't going to be a formal evaluation, given that the health ministers decided in 2010 that there should be an evaluation of the plan? I would have thought evaluations were good practice.

Ms Cole : I believe that essentially the states and territories and Commonwealth didn't feel that there was much that could be added that wasn't already available in the reporting process that was already under way.

Senator RICE: So there's no independent review—a report of the people who were rolling out the plan? One of the purposes of an evaluation is to get an independent review, an independent look at what has been undertaken.

Ms Cole : I understand what you're saying, but that wasn't undertaken.

Senator RICE: Can you expand on the role and make-up of the strategy project reference group?

Ms Cole : The project reference group consists of senior officials from each jurisdiction. It's chaired by Ms Debra Thoms, who's our Commonwealth Chief Nursing and Midwifery Officer, who is unfortunately overseas at the moment. As I mentioned, the senior officials group, the project reference group, also has the co-chairs from the advisory group to run that context into play. So essentially it's a Commonwealth, state and territory group with the co-chairs from the advisory group also attending to bring that consultation level through.

Senator RICE: Are the any community representatives or consumer representatives on that reference group?

Ms Cole : On the advisory group there are, but not on the project reference group. The role of the chair, the co-chairs, is to bring through those views of all of the members of the advisory group. In addition, the consumers are being consulted on those broader consultations across Australia, and then the second round after the first round.

Senator RICE: They've been consulted with, but you haven't got consumer representation on the overall reference group?

Ms Cole : That's correct. The co-chairs from the advisory group have responsibility to bring forward the views of that whole group, which includes the consumers.

Senator RICE: Was there a particular reason to exclude community representation from that reference group?

Ms Cole : The reference group itself is primarily meant to be where the states and territories discuss and collaborate, and also sometimes disagree, on what the final national plan will look like. Often in these circumstances you'll only have a state and territory and Commonwealth group doing that final consultation. In this case they've actually brought in the two co-chairs to make sure it is informed by community views.

Senator RICE: So they've been channelled by that. Going on to the advisory group and the reference group, are they considering the broad range of issues like funding, work force and such things?

Ms Cole : There is a discussion paper, I believe, on these issues more generally. I expect a huge range of issues in maternity services and strong views will be expressed throughout all the consultation processes.

Senator RICE: Are there terms of reference for the project reference group and the advisory group?

Ms Cole : There are, and I can see whether they can be tabled.

Senator RICE: That would be very useful. So you feel that the scope of the advisory group is broad enough to consider the full range of issues that will be brought up in consultation?

Ms Cole : Whether the final plan incorporates every issue that's brought up is a different issue, but I think that the consultation process is so wide that all of those sorts of issues you mentioned will be canvassed one way or the other.

Senator RICE: Can you comment, either from what was in the old plan or what's being considered for the new plan, on the importance of women being able to access continuity of care when it comes to midwifery services?

Ms Cole : Continuity of care generally is very important for all patients within the health system, particularly over the course of the service where there are many episodes. However, this is not actually an area in which I'm an expert in terms of the clinical needs or clinical benefits. I wonder whether our CMO or deputy CMO might be able to help on that issue?

Prof. Murphy : I can briefly comment because I've had discussions about this advisory group with some of the members. I think a very clear part of their role is to look at providing high-quality access to midwifery care in an integrated framework. There are clearly some issues with community based midwifery care working in isolation at the moment. I think that's one of the key issues that this advisory committee is undertaking to look at. That's what I've been advised, anyway.

Senator RICE: So continuity of care of midwifery services is a key issue to be looked at?

Prof. Murphy : Yes. There's strong representation of midwifery on the advisory group. In fact, I had to reassure the medical members of the advisory group that it wasn't going to be an entirely midwifery based advisory group. So there's a good balance and a very strong midwifery representation, who are putting their case very well, I'm told.

Senator RICE: Given the importance of the continuity of care for midwifery services, are there any plans for mechanisms to encourage, or is it expected to have mechanisms to encourage the states and territories to restructure their maternity services to make sure that women have continuity of care for midwifery services?

Prof. Murphy : That's a big issue. I think only Queensland really has any sort of formal structure where community based midwives are integrated into the public health sector. Some other states and territories have birthing units, but they don't tend to have that same link with community based midwives. That is a big issue because privately practicing midwifery is in a very uncertain situation at the moment because of insurance and all those issues. There is a strong view from some of the obstetric doctors and some of the midwives that the public birthing systems in the states and territories should have a better incorporation of midwives. At the moment, as I said, only Queensland seems to have developed that sort of model. I'm sure the advisory group will be encouraging the other states and territories to look at those models.

Senator RICE: You'd then be looking at whether there were mechanisms, potentially funding mechanisms, to get states and territories to improve their practices?

Prof. Murphy : The states and territories are responsible for those services. The Commonwealth provides its share of money through the National Health Agreements, but ultimately the provision of and the nature of those services are a matter for the states and territories. As I said, Queensland have developed their model. I'm sure there will be encouragement from this group to do some more work in that space.

Senator RICE: The other issue related to that is data collection. I'm interested to know whether there are plans at this stage, going into this review, to be measuring and reporting on women's access to continuity of care.

Prof. Murphy : I'm not aware of that sort of detail. That could be taken on notice to answer for Ms Cole or for Ms Thoms to answer when she comes back.

Ms Edwards : Can I add one thing? The discussion paper that Ms Cole referred to is a consultation paper and is available on our website. It does cover some data and the range of issues that are being considered. It's available on our website.

Senator RICE: And it probably says on the website what the timing of the process is going to be.

Ms Beauchamp : I think the consultation process is due to be completed on 18 June. There are a range of questions that are being asked. To go to your point about continuity of care, it's looking at all the different models of care that apply and making sure that there are improved health outcomes for mothers going through pregnancy and post for the child and the mother as well. I think that absolutely should pick up what the best pathway of care is depending on the individual.

Senator RICE: Some of the midwifery people, given they haven't got that sort of community representation on the project reference group, are concerned that those issues aren't going to end up coming out at the forefront, as they believe they should.

Prof. Murphy : My understanding is that the advisory group is very powerful advice and is providing most of the information. The reference group is coordinating the process, but the advisory group is providing very strong and forthright input into the plan. That was the impression I was given.

Ms Edwards : That's certainly my understanding also. It's a broad range across the whole spectrum, and it is definitely the case that the consultation process is scheduled for May and June with public submissions due on 18 June. Ms Thoms will know more on the timeline, but it also depends a bit on the Commonwealth and state relations meetings and so on. Obviously, this is something that has been commissioned by the Health Ministers' Advisory Council, so it'll go back, through the reference group, to be considered at that high level—we think, later this year, but the exact timing we will take on notice.

Senator RICE: Is it a concern that the previous plan was only meant to be until 2015—it was completed almost two years ago now—and it sounds like it's going to be still quite a lengthy period of time before we have this new strategic approach finalised?

Ms Beauchamp : I think the consultation paper actually refers to the previous plan and the report that Ms Cole referred to and what's been done with it. So that will absolutely feed in to this next plan. It's not as if there's been nothing happening as a response. I think there are annual progress reports provided, and this final report, and the attachment to the consultation paper, from my memory, says what has happened with each of those recommendations. So the advisory group and the consultation process will pick up some of those comments.

Senator URQUHART: I just want to ask some questions around the Local Drug Action Teams. Last year in April, Minister Hunt put out a media release confirming the Local Drug Action Team for Burnie, and, in September last year, then Senator Parry put out a media release confirming a Local Drug Action Team for Devonport. Is a similar service offered in Smithton, in the far north-west of the state?

Dr Studdert : My colleague David Laffan has a detailed list here. So I think he can identify—

Mr Laffan : I'm not exactly familiar with the area that you're talking about, but there are now six Local Drug Action Teams in Tasmania.

Senator URQUHART: Can you just tell me where they are?

Mr Laffan : I can, by electorate. So there's Braddon; three in Lyons; one that crosses over Clark and Lyons—sorry; there are two in Braddon—

Senator URQUHART: Have you got the towns?

Senator McKenzie: Rather than electorates, let's do towns. They're big electorates.

Mr Laffan : There is Burnie Works, which is in Burnie City Council. There is Huon Valley, and the organisation there is Rural Alive and Well. There's a south-east healthy and resilient communities—again, Rural Alive and Well; the Devonport hub committee; the Glenorchy Healthy Active Preventive Program for Youth, and Glenorchy City Council; and one in the Circular Head Aboriginal Corporation—

Senator URQUHART: So there is one in Smithton? That's where Circular Head is.

Senator McKenzie: Local knowledge is important.

Senator URQUHART: Absolutely. Can you provide me with an update on the rollout of these services?

Mr Laffan : Certainly. As you're aware, both the first two rounds were previously announced. The third round of the Local Drug Action Teams was announced on the weekend by the minister—

Senator McKenzie: In Darwin.

Mr Laffan : So broadly, for Australia, there are now 172 Local Drug Action Teams around the country. In that third round, which was announced by the minister on the weekend, an additional 92 LDATs were added to the program.

Senator URQUHART: What about the Tasmanian ones? Can you give me a brief update on them?

Mr Laffan : I can tell you that they are all at various stages. The two that have just been announced in round 3 will have their $10,000 grant for putting together their community action plan and working with the Alcohol and Drug Foundation.

Senator URQUHART: Was that Circular Head one announced in round 3, did you say?

Mr Laffan : Yes, it was.

Senator URQUHART: So that's just been announced. I don't want all the information across Australia; I'm from Tassie. How much funding did each of the sites receive for Tassie?

Mr Laffan : Each of the six local drug action teams have received $10,000.

Senator URQUHART: So it's the same for all of them?

Senator McKenzie: That's to develop their plan. Then, if they require further resources to implement their plan, we've got up to $40,000 for those teams to access.

CHAIR: How many have accessed the $40,000 so far?

Senator McKenzie: A range over rounds 1 and 2. The median amount accessed is around $10,000 to $15,000, because most of these LDATs are groups that are already working in communities. It's about joining up their service delivery.

Senator URQUHART: Is the funding being distributed on a per capita basis?

Mr Laffan : There's roughly the allocation for local drug action teams to be matched to each jurisdiction on a per capita basis, but there is a competitive round for these organisations that apply for this program and so it might not match that when the full rollout's achieved.

Senator URQUHART: So is it correct that $19.2 million has been allocated for the local teams?

Mr Laffan : $19.2 million has been allocated for the program, yes.

Senator URQUHART: How much of that funding has been allocated for Tasmania?

Dr Studdert : Again, it's not allocated on a per capita basis; it's a competitive process. We look to make sure there are opportunities and supports for action teams all across the country and we have a mind to some equitable distribution, but it does have to be on the quality of the proposals.

Senator URQUHART: So the six sites around Tasmania will all be involved in a competitive tender, but they'll also be involved—

Senator McKenzie: No, they've been successful already in competitive tenders at rounds 1, 2 and 3.

Dr Studdert : They're now resourced to go and develop their plan with their communities, and the allocation of funds is then based on what their communities identify as being opportunities and areas of need where they can work.

Senator URQUHART: Have there been any further application from the north-west and west coast of Tasmania for local drug action teams?

Mr Laffan : I don't have any information about local drug action teams that weren't successful in this round.

Senator URQUHART: Can you tell me how many drug and alcohol rehab services are available in Tasmania's north-west and west coast?

Dr Studdert : That's a different funding stream. That's for drug and alcohol treatment services.

CHAIR: I have a couple of questions on LDATs before we move on. You can probably take them on notice. There are 172 local drug action teams so far; is that right?

Mr Laffan : Yes.

CHAIR: Can I have the number in Western Australia but particularly—and I'm happy for you to take this on notice—the number in regional WA.

Mr Laffan : I can tell you that there are 25 local drug action teams in WA. I don't have that broken down by region, but what I can tell you is that, of the 172 LDATS, at least 44 of those are in areas supporting the needs of Aboriginal and Torres Strait Islander people. That is a quarter of those drug action teams.

CHAIR: On notice, can I have the 25 locations for Western Australia. Then I can work out whether they're regional or not.

Mr Laffan : Sure. I do have them, but I think it will take some time to read them.

CHAIR: That's fine. I'm not going to do anything with them tonight. Can you give us a sense of the range of activities that are being undertaken. Are we seeing a lot of variety or are we seeing a lot of similar themes?

Mr Laffan : There are quite a few similar themes across the country, and that's because they're being supported by the alcohol and drug foundations, which have quite a wide range of support tools ensuring that the activities undertaken are evidence based. So we have some activities which are broadly in the community working with people potentially of low-socioeconomic status. Other local drug action teams will be working in mentoring types of programs in local schools. So there is a significant range out there.

CHAIR: So the funding has been focused on providing evidence based models rather than looking to let 1,000 flowers bloom and then get the evidence back from those trials? Or are we doing a bit of both?

Dr Studdert : It is a bit of both. They're supported by the Alcohol and Drug Foundation with its knowledge and evidence base but it is very much tailored to and responsive to local needs and opportunities.

CHAIR: Is part of the process the foundations drawing that information back to what's working on the ground?

Dr Studdert : Absolutely. Yes.

Senator URQUHART: You were finding out how many drug and rehab services were available in the north-west and west coast?

Dr Studdert : We can tell you about details of some of the ones we provide funding to but that would not be a full picture of drug and alcohol treatments services, given a lot of them are funded by the state.

Senator URQUHART: Sure.

Mr Laffan : I don't have the information broken down by region but I do have the information for Tasmania. For rehabilitation projects, there aren't any that are funded specifically by the Commonwealth in Tasmania.

Senator URQUHART: None at all?

Mr Laffan : Certainly not directly, as in managed by the department.

Dr Studdert : I think that's residential rehab, specifically. We have other treatment services.

Senator URQUHART: Tell me what you've got. How many residential rehab beds are available in Tasmania and how many in the North West and West Coast?

Dr Studdert : We don't have that information. Availability of residential rehab beds is not a data set that we maintain.

Senator URQUHART: Is that because you don't fund them?

Dr Studdert : We're not funding any. The data we have here is we're not funding any residential rehab. So our Primary Health Network in Tasmania has distributed some funding for treatment and services. But in their process and assessment of where there was need and where they engaged with the community, they haven't funded residentials specifically but they will have funded other forms of treatment services.

Senator URQUHART: Can I jump back to the Circular Head round 3 that you talked about. I understand that's $10,000.

Dr Studdert : That's their initial funding they get to work with their community to identify other needs, hold forums.

Senator URQUHART: When they identify the other needs, do they then put together a submission?

Mr Laffan : They'll work with the Alcohol and Drug Foundation. They will formulate a plan that is evidence based in conjunction with that organisation and then there will be opportunity in future times to apply for additional grant funding to implement that activity.

Senator URQUHART: When you say 'future times', how often does that come round?

Mr Laffan : They have been, in the past, twice a year, but I don't have in front of me at what point in time the next one will be available. But certainly particularly for the LDATS that have been established as part of round 3, there's a six-month process they work through with the Alcohol and Drug Foundation to finalise what that plan is and then they'd be in a position to seek additional funding.

Senator URQUHART: So they have six months to organise the plan and then they would be in a position to put forward that submission for funding, but you can't tell me when the next round of funding is?

Mr Laffan : I don't have that in front of me.

Senator URQUHART: Do you have it somewhere?

Mr Laffan : I will be able to get you some information about that, yes.

Senator URQUHART: Are you able to get that during the course of the hearing? I'm interested because there are reports of one in 10 people using ice within that Circular Head region. So I'm really interested in the time frame to try and sort of understand just what is going on there.

Dr Studdert : We'll see what we can find out for you and come back to you tomorrow.

Senator URQUHART: That would be great, thank you.

Senator SIEWERT: I should be fairly quick. I wanted to follow up the FASD strategy and the question you took on notice last time, where you said that following the consultation process undertaken in late 2017, you were preparing a draft of the strategic action plan for discussion with state and territories at the first meeting of the National Drug Strategy Committee and Ministerial Drug and Alcohol Forum this year. Has that happened?

Mr Laffan : Yes, it certainly has. We have the draft of the strategic action plan. It was discussed at the National Drug Strategy Committee to go to a working group with the states and territories negotiating the finalisation of what might be put forward to the Ministerial Drug and Alcohol Forum. That Ministerial Drug and Alcohol Forum meets in the middle of next month, and it may note the plan at that point in time. We hope that the strategic action plan is finalised before the end of this year.

Senator SIEWERT: So it has gone to the states and territories working group?

Mr Laffan : Yes, we're working with the states and territories quite closely now in terms of refining that strategic action plan.

Senator SIEWERT: And then it goes back to the ministerial council?

Mr Laffan : Ministers at the Ministerial Drug and Alcohol Forum will have the opportunity to comment on that in the middle of next month. Any views that they express in relation to the strategic action plan will be taken into account and officials will, through the working group, finalise that plan and then provide it forward to the Drug Strategy Committee and subsequently to the Ministerial Drug and Alcohol Forum for consideration.

Dr Studdert : Just to be clear: the Ministerial Drug and Alcohol Forum will meet in the middle of next month, as my colleague said, and then again towards the end of next year. Depending on their consideration and the issues they identify, it could go to them out of session or they could ask for it to come back to them at the later meeting.

Senator SIEWERT: So that's the second one towards the end of the year?

Dr Studdert : Yes.

Senator SIEWERT: The ministerial forum?

Dr Studdert : So it won't be finalised for this one in June, but it will be finalised following that, given the guidance we get from ministers at that forum. As David said, our intention is to finalise it, but we'll obviously need to be directed by ministers.

Senator SIEWERT: Has anybody outside of government had a chance to comment on the draft strategic action plan? Has it gone to any stakeholders or any outside expertise?

Mr Laffan : Certainly the strategic action plan was formulated after quite extensive consultation and feedback from a significant number of people.

Senator SIEWERT: Feedback on a draft or just asking them questions? Seeing the draft strategy and commenting on that is a very different process to being consulted.

Mr Laffan : Sure. No, that hasn't been the subject of further consultation at this time.

Senator SIEWERT: Would that not be appropriate so that those with expertise in the area outside of government get a chance? I can think of a number even in my home state of Western Australia, let alone the rest of Australia—

Dr Studdert : Certainly, there's a lot of expertise.

Senator SIEWERT: Would it not be appropriate to get some feedback from those experts who have literally spent years working on this?

Dr Studdert : As Mr Laffan said, there has already been a lot of input from those experts. I think they would say that we've worked closely—

Senator SIEWERT: With all due respect—

Dr Studdert : But I see your point and we will seek advice from the ministers on that following the meeting.

Senator SIEWERT: You will ask them whether you can actually show the draft to people with expertise in the area? There is a very big difference between asking people what the issues are and consulting with them and letting them actually look at what you're planning to do.

Dr Studdert : I acknowledge that point. We can certainly make the ministerial forum aware of the interest in seeing the draft and get further advice from them at the time.

Senator SIEWERT: Normally it going out for public comment would be useful. But, in the absence of that, at least people with expertise seeing it I would have thought would have been—

Dr Studdert : That's certainly an option—targeted consultation or broader public consultation. As the representative on the National Drug Strategy Committee, which is the senior officials, I can certainly take it on to make ministers aware of that interest.

Senator SIEWERT: Thank you. I look forward to hearing more about it at next estimates.

Senator WATT: I've got some questions about the National Cancer Screening Register. Thanks for joining us. Ms Konti, I don't know if you're the person to direct questions to in the first instance. I remember we talked about this last time. We learnt at previous estimates that the government initially said that the Bowel Cancer Screening Program would move onto the National Cancer Screening Register in March 2017. There have obviously been some delays. Last estimates you told us that it would more likely be in 2019, so a two-year delay. Do you have a more definite target date for us?

Ms Konti : As I think we might have stated at the last estimates, the planning for the bowel cancer screening register transition will recommence once we have finished migrating the state and territory cervical screening registers and have that up and running. That is due to be completed by the end of June this year.

Senator WATT: I remember you saying that essentially you had been put on hold until the cervical cancer register is up and running. That is still the case?

Ms Konti : That is still the case.

Senator WATT: And you have no idea whatsoever about a start date for the bowel cancer screening register?

Ms Konti : It will likely be in the latter half of 2019.

Senator WATT: That would be 2½ years after the government initially said. What do the ongoing delays here mean for Telstra's contract with the government?

Ms Konti : So far, Telstra have been paid less than $11 million under the contract. They will commence being paid full operations for the cervical screening register once that is delivered at the end of June.

Dr Studdert : I think it is safe to say there have been delays in payments to Telstra.

Senator WATT: There have been delays in payments to Telstra?

Dr Studdert : Absolutely.

Senator WATT: Because they are not meeting their milestones and requirements under the contract?

Dr Studdert : Correct.

Senator WATT: Have there been any penalties against Telstra, as opposed to simply not paying them for work they've done?

Ms Konti : The way we are managing the contract is to pay them once the work is complete.

Senator WATT: There are no penalties that they need to pay the department for failing to meet milestones as you might get under a construction contract or something like that?

Ms Konti : Not at this stage?

Ms Beauchamp : At this stage we haven't looked at penalties.

Senator WATT: Is that an option?

Ms Beauchamp : It is certainly an option in the future but we haven't taken that course of action.

Senator WATT: So there is provision in the contract for penalties to be issued?

Ms Konti : Yes.

Senator WATT: Equally, is there provision in the contract for Telstra to impose penalties on the department if they feel that you haven't met your side of the bargain?

Ms Konti : No.

Senator WATT: There is no provision in the contract for that to happen?

Ms Konti : There is provision in the contract for typical dispute resolution and there are health supplied items that are listed in the contract—those kinds of things. If those items are not supplied, that could constitute what is called an excusable event under the contract terms. But there is no provision for penalties.

Senator WATT: Given these delays would the Commonwealth now be within its contractual rights to cancel Telstra's contract as it relates to the Bowel Cancer Screening Program?

Ms Konti : It could consider that course of action. We haven't taken that course of action at this point.

Senator WATT: Have you sought any advice about your ability to terminate the contract?

Dr Studdert : Not at this stage.

Senator WATT: But there is provision under the contract for it to be terminated for the sorts of things that have occurred or not occurred?

Ms Konti : Yes.

Senator WATT: Is there any point where you would actively consider terminating the contract given the ongoing delays?

Dr Studdert : At this stage we are very focused on working with Telstra to deliver what was contracted for. There is still a lot of value to be obtained from establishing a single national cancer screening register and that is the focus of the work and efforts at this stage.

Ms Beauchamp : I think there is also acknowledgement that it was a very complex project. The learnings coming out of the national cancer screening register will absolutely be used in developing the transfer of the national bowel cancer screening register from DHS to the new register. So we will absolutely be able to take some lessons from the current process.

Senator WATT: As I think I have done at previous estimates, I might just remind you of the evidence we received from the department at the Senate inquiry on the legislation required to set up this register. We were told that we had to urgently pass this legislation because the inefficient paper based processes that we have for the National Bowel Cancer Screening Register mean that, for example, when women move interstate their records and capacity to be supported and followed up by a screening register can slip through the cracks. So, given the department's evidence, isn't it the case that this delay is jeopardising people's health and safety?

Dr Studdert : Senator, just to be clear, the Bowel Cancer Screening Register is already a national register. It is run by DHS.

Senator WATT: Yes, but it's paper based.

Dr Studdert : There are paper based elements of it, which could be more efficiently run. So, a woman moving interstate or any Australian moving interstate won't make a difference to that particular part of screening operations. I think the challenge has been around cervical screening, where different jurisdictions have had different registers and there have been challenges for women when they move interstate. Certainly one of the reasons for prioritising the establishment of that part of the national register is to address that inefficiency and risk, and that is now well advanced and underway.

Senator WATT: Just on this point about the existing services that you say cover the gaps, for the moment, I understand that states and territories only have screening results up to 1 December 2017. Is that correct?

Ms Konti : That's correct. Because all of the pathology test results beyond 1 December 2017 for cervical screening tests, or any cervical pathology, are in the National Cancer Screening Register.

Senator WATT: But it isn't up and running yet.

Ms Konti : The National Cancer Screening Register was implemented on 1 December 2017 to support the new screening test. This was part of a planned and phased approach in conjunction with the states and territories to do joint operations of a renewed cervical screening program until such time as the remainder of the functions of the register were available.

Senator WATT: As I understand it—and correct me if I am wrong—while the National Cancer Screening Register has been set up, the screening history function is not yet up and running? That has yet to be—

Dr Studdert : But that has continued to be available from the states and territories. So it is a bit of a hybrid model at this stage, where we're using results and screening histories from the states and territories where they're required based on the pathology that comes in on recent screens.

Senator WATT: But isn't the problem that, if states and territories only have screening results up to 1 December 2017, those state and territory screening systems miss any tests undertaken after 1 December. Given the National Cancer Screening Register isn't yet providing this screening history function, doesn't that mean that labs are now getting screening histories that are several months out of date?

Ms Konti : Laboratories can get screening histories pre 1 December from the state and territory registers. They can also obtain post 1 December screening histories from the National Cancer Screening Register. The process is phone and fax based. The National Cancer Screening Register, in addition to receiving pathology test results since 1 December 2017, is also following up on all of those new tests, from the point of view of high-grade results, cancer results and other kinds of results. So, all of those follow-up functions are being conducted by the National Cancer Screening Register operator staff, which have been in place since 1 December last year.

Senator WATT: Thanks. I will leave it at that in the interests of time.

CHAIR: I have just a couple of final points on this issue. Just to be really clear, to reassure people, there has been no impact on patient services or access to records during this transition phase?

Dr Studdert : Absolutely not.

Ms Konti : No gap in service. That was one of the reasons why we undertook this phased-implementation approach.

CHAIR: Is there anything beyond what you've already described in the terms of the arrangements during the transition phase? I mean, we're dealing with this hybrid model.

Ms Konti : The transition phase is underway right now, and that involves three things. It involves the migration of the state and territory registers over into the National Cancer Screening Register. So far, we have five of the eight states and territories successfully having migrated into that register, along with the Medicare data. One of the state or territory is verifying and reconciling the results of their migration, which is complete, which makes the sixth one. The seventh one is underway, and Victoria is yet to come. That is expected to be finished by 8 June. After that time all of the pathology test results that have been collected by the National Cancer Screening Register since 1 December last year will be matched to participant records and applied to them. Then the services will be complete.

CHAIR: That last part of the puzzle—

Ms Konti : 29 June is the delivery date for that, and we are on track for that.

CHAIR: Excellent. Thank you very much.

Senator DI NATALE: I have some questions about the pill-testing trial that was conducted at the festival in Canberra in April this year. I want to know whether the federal government has any plan to support the introduction of pill-testing services more broader as part of a national harm reduction strategy?

Dr Studdert : There are no plans, no.

Senator DI NATALE: Given that the National Drug Strategy signed off by all health ministers takes a harm minimisation approach—obviously, the three pillars being demand reduction, supply reduction and harm reduction, and harm reduction is described as reducing the adverse health, social and economic consequences of the use of drugs for the user, their families and the wider community—why isn't this consistent with the government's own National Drug Strategy?

Dr Studdert : It is a national strategy and all the state and territory governments, along with the national government, are signed up to it and each jurisdiction will pursue a range of measures on of those pillars, and they will vary across each jurisdiction, depending on priorities and opportunities. At this stage that is not on the national government's planning horizon.

Senator McKenzie: In terms of harm minimisation, in our approach some of the LDATs we were talking about earlier really focus strategies around harm minimisation, not just prevention. So, across the whole suite of government initiatives in this space we do hold true to our support of harm minimisation, obviously.

Senator DI NATALE: I'm interested as to why pill testing doesn't fit within the definition that the government signed on to.

Dr Studdert : I don't think we're saying it doesn't. I think that it is just that it is not something the federal government has a particular role or part to play in.

Senator DI NATALE: Doesn't have a role to play in?

Dr Studdert : The settings in which that occurs are largely under the jurisdiction of state and territory planning authorities.

Senator DI NATALE: I understand the government provided information during its budget lock-up—during the health briefing—that about $40 million was allocated for new drug and alcohol initiatives. Can you outline in detail what these specific measures are?

Dr Studdert : I think you're referring to the measure we talked with Senator Griff about earlier, which was an announcement around funding for education and awareness around treatment services, and some residential rehab and other treatment services.

Senator DI NATALE: What is education awareness?

Mr Laffan : The first part of that measure was in relation to supporting professional development in primary care for treatment of alcohol and drug abuse. The second component of that was in relation to drug rehabilitation services.

Senator DI NATALE: What does the professional development in primary care look like? Is that educating GPs?

Dr Studdert : I think that's something we're still planning with GPs and other primary care providers.

Senator DI NATALE: How much is allocated for that component?

Dr Studdert : $20 million for that element, and then $20 million—

Senator DI NATALE: $20 million for professional development in primary care? What is that?

Dr Studdert : The details are to be worked out. We're consulting with the primary health networks—

Senator DI NATALE: Surely you must have an idea about what that means? Are we talking about methadone treatment? What are we talking about?

Dr Studdert : I think it will be a range of measures—

Senator DI NATALE: Such as—

Dr Studdert : but we haven't finalised any specific details at this stage.

Senator DI NATALE: So you just throw $20 million—

Dr Studdert : No, we're not throwing money anywhere until we have had consultation and come up with a plan for what those—

Senator DI NATALE: You don't allocate $20 million for professional development unless you have an idea about what you're trying to develop.

Mr Laffan : We'll continue to work with stakeholders in relation to both of the elements of that measure and then the final scope of the—

Senator DI NATALE: Why was the allocation made if you didn't have that work done already?

Dr Studdert : I think there was discussion with stakeholders that this was an area of need and an opportunity—

Senator DI NATALE: What was an area of need?

Dr Studdert : Professional development in—

Senator DI NATALE: In what area?

Dr Studdert : For primary care professionals.

Senator DI NATALE: That is so general. Come on; you must have an idea about what you're looking to allocate $20 million for.

Senator McKenzie: I think the officer has answered your question. She said that's—

Senator DI NATALE: No, she hasn't, which is why I'm continuing to ask the question.

Senator McKenzie: She has, actually, Senator Di Natale. She has outlined that that is a piece of work that, on advice of stakeholders, is $20 million, and they'll be preparing a plan of primary care—

Senator DI NATALE: What was the advice from stakeholders? What did the stakeholders ask that the money be spent on?

Dr Studdert : There are opportunities in primary care settings to work with clients that are interested in or in need of primary care services in relation to drug and alcohol harms, and—

CHAIR: Senator Di Natale, are we covering a couple of programs?

Senator DI NATALE: No, we're in 2.4, Preventative Health and Chronic Disease Support.

CHAIR: Okay.

Ms Beauchamp : It's being provided over three years—so we're not rushing to do this. It is absolutely to help frontline workers care for the treatment and support of people with drug abuse and also for residential rehab services.

Senator DI NATALE: I'll get to the rehab in a minute. Half of the $40 million is in professional development. Did you say GPs?

Dr Studdert : It will include GPs.

Ms Beauchamp : Including GPs and allied health professionals.

Senator DI NATALE: But not limited to GPs?

Dr Studdert : Not limited to GPs.

Senator DI NATALE: Drug and alcohol treatment workers?

Dr Studdert : It could include them, yes.

Senator DI NATALE: Could include them?

Dr Studdert : Again, we will consult on the detail and get further information together on where the appropriate targeting and opportunities are.

Senator DI NATALE: So at this stage there's $20 million in some nebulous pool called 'professional development'?

Dr Studdert : I don't think it is nebulous, Senator. We've received advice that there is an opportunity and need in the community from primary care providers and we're looking to respond to that. The detail will be developed.

Senator DI NATALE: I just thought that if GP needed professional development in this space it might be around methadone prescribing—'Can we have some more support, so that we can go on and provide opiate substitution treatment,' or it might be around what the particular responses to detox are. There's a whole bunch of—

Dr Studdert : And I think they're all completely in scope.

Senator DI NATALE: They're all in scope?

Dr Studdert : Absolutely.

Ms Beauchamp : We'll make sure they're not nebulous and that they are well targeted and pick up exactly the sorts of questions that you're raising.

Senator DI NATALE: I want to ask about the drug rehab. What's that going to?

Dr Studdert : Again, there are details to be worked out in consultation with primary health networks and they will respond to areas of need for treatment services.

Senator DI NATALE: So we don't know what areas of drug rehab. Are we talking about therapeutic communities?

Dr Studdert : Absolutely.

Senator DI NATALE: So, again, just drug rehab.

Dr Studdert : And then responding to areas of need.

Senator DI NATALE: So $40 million was allocated to two very broad areas but there is no detail about how that money is going to be spent.

Dr Studdert : With a commitment to work on the detail with stakeholders.

Senator DI NATALE: Is the funding committed to a particular geographic region?

Dr Studdert : The funding for treatment services is committed to South Australia.

Senator DI NATALE: It is committed to South Australia?

Dr Studdert : And the rest of the funding is for primary care professional—

Senator DI NATALE: Why South Australia?

Dr Studdert : That was a decision of government.

Senator DI NATALE: Minister, does this have something to do with a particular arrangement with NXT and Centre Alliance that's related to the welfare testing bill?

Senator McKenzie: I'll have to take that on notice, Senator Di Natale.

Senator DI NATALE: Why South Australia, Minister?

Senator McKenzie: This is area—

Senator DI NATALE: Is there a particular problem with drug use—

Senator McKenzie: Senator Di Natale, you asked me a question; please allow me to answer it.

Senator DI NATALE: I hadn't finished asking the question.

Senator McKenzie: Okay.

Senator DI NATALE: Is there a particular issue in South Australia that warrants funding over and above other states when it comes to drug and alcohol use and abuse?

Senator McKenzie: I'm not sure, Senator Di Natale. I'll consult Minister Hunt and get back to you.

Senator DI NATALE: So just to be clear: is the $20 million for professional development or drug treatment? Which one of those is confined to South Australia?

Dr Studdert : The treatment services.

Senator DI NATALE: So, in this budget, the only additional funding for treatment services is in South Australia?

Dr Studdert : I think that's correct, Senator, yes.

Senator DI NATALE: Where are the trials of drug testing currently engaged in that the government is looking to associate with these welfare measures—what states?

Mr Laffan : Senator, as you are aware, the legislation in relation to the drug-testing trial is before the House at the moment, and it was, I understand, intended that the three locations for that were to be Logan in Queensland, Canterbury Bankstown in New South Wales and Mandurah in WA.

Senator DI NATALE: So South Australia is not one of the states where trials are going to go ahead and yet you've decided to commit $20 million to a place that's not even associated with the trial, based on no evidence that there's a different prevalence or specific problems in South Australia compared with other states?

CHAIR: The minister took the last half of that question—

Senator DI NATALE: No, I'm asking Dr Studdert.

Senator McKenzie: I've taken that on notice.

Senator DI NATALE: I've just asked Dr Studdert.

Dr Studdert : I think that, as you know, there is a range of services that the Commonwealth funds around the country. This is additional funding for South Australia, and I don't think that it will go wanting for appropriate use and allocation to services—

Senator DI NATALE: Did you provide advice to the government that this was necessary in South Australia as compared to other states?

Mr Hehir : No, Senator.

Senator DI NATALE: Do you have access to any information that would allow you to draw the conclusion that South Australia has a problem that doesn't exist in other states?

Dr Studdert : I think as I said, that we hear regularly about jurisdictions—all jurisdictions—having areas of need, and we work proactively through the Primary Health Networks and with our colleagues in the states and territories to address those as best we can, when we can, through the funding sources we have available.

Senator DI NATALE: Perhaps I'll ask you the question in a slightly different way. Does this allocation of funding have any relationship with the welfare-testing bill?

Senator McKenzie: Sorry, Senator Di Natale, can you repeat the question?

Senator DI NATALE: I'm just asking whether the allocation of funds, the $20 million that goes just to South Australia, has any relationship with the welfare-testing bill.

Senator McKenzie: Not to my knowledge.

Senator DI NATALE: Has the department received any applications or requests for funding from other state jurisdictions?

Dr Studdert : We're always, as I said, in consultation with our colleagues through the Primary Health Networks, through the work we're doing with funding services through them, and through our state and territory colleagues. I would have to say that we receive a range of applications. We're not always able to respond to them but we use those to develop our understanding and knowledge of the services out there and where there are areas of need.

Ms Beauchamp : Sorry, Senator, can I also add that this is already on top of what was announced in the 2016-17 budget about the $561 million—

Senator DI NATALE: Sure, I'm aware of that.

Ms Beauchamp : for national treatment services—

Senator DI NATALE: But there was only $40 million of additional money allocated in the 2017-18 budget?

Ms Beauchamp : Yes.

Senator DI NATALE: And, of that $40 million, only half of that was for frontline services?

Dr Studdert : You mean the 2018-19 budget?

Senator DI NATALE: Sorry, the 2018-19 budget—yes, correct.

CHAIR: Sorry, Ms Beauchamp, could you finish your answer? I was actually interested if you still had somewhere you were going with that.

Senator DI NATALE: There was a lot of—

Ms Beauchamp : I think I was saying that this is only a very small part of the overall allocation of Commonwealth dollars to drug and alcohol treatment services. In last year's budget, I think there was $561 million allocated for drug and alcohol treatment services across the country. That was dedicated for treatment services. Much of that went through Primary Health Networks to commission locally based treatment in line with community needs. I think part of that was built on the National Ice Action Strategy. Part of that was for Indigenous-specific services, treatment services—particularly residential rehab services. I guess that this is only an add-on to what's already a significant investment by the Commonwealth around drug and alcohol treatment services.

CHAIR: Thank you. Senator Di Natale?

Senator DI NATALE: Just to be clear, there was $40 million of additional funding in the 2018-19 budget—$20 million to professional development and another $20 million to services, that is, drug rehabilitation services.

Dr Studdert : That's correct.

Senator DI NATALE: And that $20 million, the only additional funding for services in the 2018-19 budget, was allocated to South Australia?

Dr Studdert : That's correct, but noting that we still have another two years of rollout of the National Ice Action Strategy through to mid-2020, in all jurisdictions.

Senator DI NATALE: I've got some questions around drug testing for income support recipients, but I suspect most of those will be dealt with tomorrow. Just a couple of questions that might be relevant—

Dr Studdert : Sorry, I think that would be for the Department of Social Services—

Senator DI NATALE: Yes, I was about to say that I suspect most of that will be for DSS, but—

Dr Studdert : Oh, okay.

Senator DI NATALE: But I think at the last estimates you told me that originally you thought you hadn't had a meeting with ANACAD, and then I think you came back and we got some revised evidence around that.

Dr Studdert : That's correct.

Senator DI NATALE: There's been a Senate inquiry since that time, and the overwhelming—in fact, almost unanimous—body of evidence from that inquiry was that it was a shocking idea. Have you advised against pursuing the trial based on the evidence that was disclosed during the Senate inquiry?

Mr Laffan : We haven't provided any advice to Social Services, and it was the Social Services people who gave advice at that inquiry.

Senator DI NATALE: I might move to something else. Because I've got Senator Smith here, perhaps we'll go to alcohol. I might start with a wonderful piece of writing in the Australian Financial Review dated 4 February 2018.

Senator WATT: What was that? I think that's a cheap shot there!

Senator DI NATALE: Senator Smith states—and I must say it was a very cogent piece:

Australia's alcohol taxation structure is devoid of any consistent set of principles. Its incoherency arises from disparate reforms introduced over many years.

I thought that was absolutely spot on. Senator Smith also noted the health consequences associated with the current alcohol taxation system.

Senator McKenzie: Is this a piece on Modest Members?

Senator DEAN SMITH: One of the 60, I think.

Senator McKenzie: There we go! I hope you subscribe to the others, Senator Di Natale.

Senator DI NATALE: Well, a broken clock is right every now and then. Then he goes on to say:

And with Australia's preventive health sector frequently calling for alcohol tax reform, given the social cost of alcohol misuse on our hospitals and health services, it's clear the current system is failing both our wine producers and our community.

Can I ask whether Senator Smith's wonderful piece of work submitted to the Financial Review is currently being considered and whether the government's doing any work specifically about possible changes to the taxation of alcohol, and specifically the wine equalisation tax?

Senator DEAN SMITH: I didn't put Senator Di Natale up to this, but I'm very curious.

Dr Studdert : Obviously I've missed something very special, but I would have to say that's a question for our Treasury colleagues.

Senator DI NATALE: Have you provided any recommendation in this respect to your Treasury colleagues?

Dr Studdert : No.

Senator DI NATALE: Have you done any work in this regard at all?

Dr Studdert : No.

CHAIR: Senator Di Natale, are you still on this topic?

Senator DI NATALE: I have a couple more.

Senator DEAN SMITH: I hope you take that line of questioning a bit further.

Senator DI NATALE: If I've got time I will.

CHAIR: Please do. We'll just throw the call back to Senator Watt, and then we'll come back to you.

Senator DI NATALE: I have some more alcohol questions.

CHAIR: But I want to point out to members of the committee that we are coming down to the point where we're going to start eating into outcome 3's time, which I'm sure Senator Farrell will be very disappointed with if we do, and we've still got a fair bit to go.

Senator WATT: We have culled questions that we've got for the remainder of outcome 2, but we still do have some.

CHAIR: Okay. Let's get to it.

Senator WATT: Minister, I'm an avid follower of your Twitter account.

Senator McKenzie: Thank you, Senator Watt, and I of yours.

Senator WATT: Thank you. I noticed that you spoke to ABC News on Sunday about World No Tobacco Day. That's this Thursday?

Senator McKenzie: The 31st.

Senator WATT: 31 May?

Senator McKenzie: Yes.

Senator WATT: Why is World No Tobacco Day important?

Senator McKenzie: Because we want to get down smoking rates, obviously. We lead the world in cessation of smoking. State and federal governments over decades have used a range of strategies to really bring down the smoking rates in the Australian population. But, as you'd be aware, our Indigenous Australians still have a very high rate of smoking, upwards of 40 per cent, which isn't good enough. So on the weekend, as part of the start of Reconciliation Week, I was in Alice Springs, and speaking there we had an Indigenous curtain-raiser to the inaugural Sir Douglas Nicholls rounds of the AFL, so there was a great opportunity to really target the messaging to Indigenous communities.

Senator WATT: And I think you launched it.

Senator McKenzie: We had an entire campaign around 'Don't make smokes your story', which is translated into 11 Indigenous languages. We're really targeting that cohort to hopefully bring down smoking rates in that community.

Senator WATT: Why is it so important that we get smoking rates down?

Senator McKenzie: Because cardiovascular disease kills; smoking is obviously a key factor in that. Every 12 minutes in Australia, one person has issues with that. So it's incredibly important for the health and wellbeing of our nation that we decrease—even though it is a legal substance in our community—the dependency on tobacco in the Australian public.

Senator WATT: Am I right that smoking is still the leading preventable cause of death in Australia?

Senator McKenzie: Yes, you're right.

Senator WATT: Particularly in Indigenous communities?

Senator McKenzie: That's right.

Senator WATT: Is the National Party still taking tobacco donations?

Senator McKenzie: As you know, like your party, the donations received are a matter for the party organisation and are publicly disclosed.

Senator WATT: No. Unlike my party, which stopped taking tobacco donations 14 years ago, and unlike the Liberal Party, which stopped taking donations from tobacco five years ago, your party continues to take donations from big tobacco?

Senator McKenzie: As I said, what donations are taken by the National Party are a matter for the party organisation, but I would like to state that—irrespective of who's giving money legally to the party organisation—it in no way deters my determination as the minister responsible to decrease tobacco consumption and smoking rates in this country.

Senator WATT: So you're the Deputy Leader of the National Party and you have no authority over your party about its decision to take donations from tobacco, despite everything you've just told us about how bad tobacco is?

Senator McKenzie: It is bad, and that's why I am committed—as is my department—and that's why we're investing the amount of money we are as a government and that I'm signing the briefs off that that money gets spent. Irrespective of what the political party organisation does or doesn't do with accepting donations from legal entities, it does not deter me in my desire to see smoking rates decrease in this country.

Senator WATT: You've got a phone there, you've got a computer there, you could email or you could text right away?

Senator McKenzie: I could bully my president?

Senator WATT: No, you could just ask them; you don't have to bully them. You could ask them, just like we did and just like the Liberal Party did.

Senator McKenzie: Senator Watt, donations—

Senator WATT: Why don't you exercise leadership?

Senator McKenzie: I'm happy to keep saying it: donations are a matter for the political party and the organisation.

Senator WATT: Which you are the deputy leader of?

CHAIR: This is well outside these estimates hearings parameters—

Senator WATT: No, it's not. It's about tobacco.

Senator McKenzie: Irrespective of the organisation donating to the Nationals, it doesn't deter my desire to see smoking rates decrease in this country.

Senator SINGH: Don't you think it's hypocritical?

Senator McKenzie: I don't feel conflicted, because everything I do is around decreasing smoking rates. I don't think we could do much more. We've launched the third phase of the Don't Make Smokes Your Story campaign on the weekend. We have campaigns going. We have partnerships with bodies like the AFL, with our states. We lead the world. We lead the world in decreasing smoking.

Senator SINGH: We don't deny your goodwill and the programs that you've put in place.

Senator McKenzie: Thank you.

Senator SINGH: But isn't it hypocritical that you are doing that, that you are putting these good programs in place on the one hand, and on the other hand you and your party are taking money from big tobacco?

Senator McKenzie: Well, I'm not taking any money from any cigarette company, Senator Singh. It's a matter of public record who donates to the National Party, and it is a matter for the organisation.

Senator WATT: But—

CHAIR: You've had your chance to ask those questions.

Senator WATT: On Sunday you were out there telling the world, 'I care about smoking. Don't smoke. It's terrible for you,' and on Monday your own party is taking donations from tobacco companies? You don't see any hypocrisy in that?

CHAIR: Please don't answer that question, Minister. Estimates hearings are not an appropriate venue to discuss the activities of the National Party. You've asked the minister—

Senator McKenzie: You can come to my next—

Senator WATT: I would have thought—

CHAIR: You have asked the minister five times; she's answered it very clearly; let's move on.

Senator WATT: Maybe by the next estimates, she could show some leadership and suggest that her party stop taking tobacco donations, just like the Liberal Party has stopped—the Greens maybe never took them—and like we stopped doing a long, long time ago.

Senator DI NATALE: I'm happy if Senator Watt wants to continue that line of questioning!

Senator McKenzie: Rinse, repeat!

Senator DI NATALE: Just some more questions on alcohol. Could you provide us with an update on the status of the funding for the Women Want to Know and Pregnant Pause campaigns around alcohol?

Dr Studdert : I'm just checking if we have that information at hand.

Mr Laffan : I'd need to take questions about those two on notice.

Senator DI NATALE: So you can't tell me if funding for both of those health programs is going to continue beyond 2018-19?

Mr Laffan : I'm not sure if it is. I don't have that information in front of me.

Senator DI NATALE: If you don't mind taking that on notice?

Mr Laffan : Sure.

Senator DI NATALE: Can I ask you about the status of Drinkwise? Obviously you know about Drinkwise—an industry body that provides so-called information to people. Does the government provide any support or funding to Drinkwise?

Mr Laffan : No, we don't.

Dr Studdert : Not at this time.

Senator DI NATALE: Can the department confirm whether any support has been provided for the industry or for Drinkwise to develop its own consumer health information around alcohol and pregnancy to be provided to health professionals?

Mr Laffan : We have not provided any funding to Drinkwise.

Senator DI NATALE: Any other support?

Mr Laffan : No.

Senator DI NATALE: You're not in any discussions with Drinkwise around this?

Dr Studdert : No.

Mr Laffan : No, we aren't.

Senator DI NATALE: So there's no preference given to industry programs that are obviously funded through Drinkwise as opposed to other programs like the two I've just mentioned?

Mr Laffan : Drinkwise are an independent organisation that run their own program.

Senator DI NATALE: Some might argue about that. Can I go to the question of obesity and ask specifically about any measures in the budget that are designed to combat or address obesity.

Dr Studdert : You'll be aware that in the budget there was a package of measures around healthy active beginnings for infants and pregnant women.

Senator DI NATALE: Yes.

Dr Studdert : That did include some measures that relate to healthy weight and physical activity during pregnancy. My colleague can tell you a bit more about those.

Senator DI NATALE: That's specifically about pregnancy, yes?

Dr Studdert : That's one of the areas in the life cycle where we know there is a risk of weight gain.

Senator DI NATALE: Sure. Because we do have limited time, can I ask beyond Healthy Beginnings. Can you list any other—

Dr Studdert : There was also a major package of measure around physical activity promotion, working with the Australian Sports Commission. We continue a range of measures in the food space—health star rating, Healthy Food Partnership, Australian dietary—

Senator DI NATALE: Let's go through those. With the health star rating, what in particular?

Dr Studdert : That's the rollout of the health star rating system on food products in groceries, which I'm sure you are familiar with.

Senator DI NATALE: I'm familiar with it, but what about specifically in this budget? There is just some ongoing funding for the rollout, yes?

Dr Studdert : Yes, but that is a significant commitment that's ongoing with the states and territories.

Senator DI NATALE: Is it still voluntary?

Dr Studdert : It's still voluntary but rapidly being taken up by manufacturers. Over 10,000 products are now carrying that.

Senator DI NATALE: So you've mentioned—

Senator McKenzie: We've got $30 million going to physical activity community infrastructure to overcome some of those barriers. With supporting activity in old Australians, we've got $22 million, nearly $23 million, there.

Senator DI NATALE: What's specifically around that?

Senator McKenzie: That is going to be working with sporting organisations to keep Australians active as they age, similar to FFA's walking soccer program et cetera to keep them physically active. We've also got an amount of money, I think it's $22 million, for community participation grants, which are going to be specifically targeted to inactive cohorts in our communities.

Senator DI NATALE: I might put some more questions around that on notice. I'm good.

Dr Studdert : Could I just add something to the discussions we had with Senator Urquhart about the local drug action teams?

CHAIR: Certainly.

Dr Studdert : I have received clarification that when a local drug action team has developed its plan it can come forward at any point in time to get the rest of the funding. It doesn't have to wait for that six-month cycle.

Senator URQUHART: There's no round.

Dr Studdert : The six months was the period of time we've done between rounds of identifying areas where the local drug action teams will be rolled out, but the follow-up and the funding of those plans, when they're developed, can happen at any time.

Senator URQUHART: So they've got the $10,000 through their plans, and then they have the opportunity at that stage to come forward.

Dr Studdert : Yes, and that can be done at any time when they need it.

Senator URQUHART: Great. Thank you.