Despite billions of dollars in funding and endless virtue signalling from inner-city lefties for Aboriginal and Torres-Strait Islanders, the state of healthcare services being provided by Governments on Mornington Island is close to third world.

You should get the same government services regardless of skin colour. If the government can’t take care of the basics, why should we allocate more funding?

Transcript

Senator Roberts : Thank you all for attending today. I’d like to ask some questions about Mornington Island, following my questions last year, and then perhaps some general questions. How did the federal government allow the Mornington Islanders’ situation—their health and wellbeing—to slip into one of a Third World country’s?

Ms Rishniw : Mornington Island—I think we provided some answers to questions on notice that we took last time. As you are aware, we work closely with ACCHOs and with the communities. With Mornington Island in particular we worked very closely with the Queensland health and hospital services there, and we are working closely with them to make sure that the services on the island are improved over time.

Senator Roberts : Can you tell me how you are working with the government?

Ms Rishniw : Mr Matthews?

Mr Matthews : There are a number of arrangements. It’s a very broad question when you get to health because you can’t differentiate the health and wellbeing from the broader people, social and environmental aspects around that.

Senator Roberts : I agree.

Mr Matthews : Probably the headline way I would respond to what is happening is through Closing the Gap, which is the framework for the government and states to work in partnership with Aboriginal and Torres Strait Islander people around improving outcomes generally. That agreement was signed and struck around the middle of 2020. It’s been in place about 12 months. Its aim is to reset the relationship. It is looking at a broad range of factors to work with. Rather than doing things to people, it’s the concept of doing things with people and bringing them to the table and then looking at how the overall investment across the range of things, from education, employment and housing through to health and health outcomes, come together around that situation. That is probably the nutshell, the main context of the answer to your question about how that’s going to progress into the future from here. Health is a part, but it isn’t the only part in relation to that question.

Also, when you start to get into the provision of hospital services on Mornington Island, they are delivered by the Queensland government, as are a range of education services and those sorts of things, so it’s not a simple Commonwealth Department of Health question; it’s a very broad question. In that context, it’s about understanding the landscape through the lens of where Closing the Gap is resetting that and also some of the other mechanisms—for example, when Senator Dodson was asking about the development of the voice, that is geared towards empowering and encouraging Aboriginal and Torres Strait Islander people to be more in charge of their future, which will hopefully lead to improved outcomes over time.

Senator Roberts : There were some wonderful points there that I’d like to continue with. First of all I endorse and value your comments about needing an holistic approach. Health is just one part of it. Health is an outcome of the whole way of life, so I understand that. That was a very broad statement, but what are the current initiatives for working with the Queensland government and doing things directly? The Premier of Queensland and the Queensland health minister promised to visit the island last year or early this year. Have they done so?

Mr Matthews : I couldn’t comment on anything about the Queensland government or their ministers and their intentions around that. We don’t have visibility or necessarily monitor or track that, because that’s obviously a matter for the Queensland government.

Senator Roberts : More specifically, how do you work with the Queensland government?

Mr Matthews : From a health point of view—and my colleagues from the National Indigenous Australian Agency may be able to talk more broadly from a broader Aboriginal and Torres Strait Islander affairs perspective—from the Health perspective, there are two mechanisms. We have what are called partnership forums in each jurisdiction, including Queensland. They are regular meetings that usually happen a couple of times a year between Queensland health officials, Commonwealth health officials and officials from the Aboriginal and Torres Strait Islander health sector in Queensland. They’re largely geared towards trying to increase the alignment between the Commonwealth, the state and the Aboriginal and Torres Strait Islander stakeholders, many of whom are delivering services there, to ensure that we are aligning our policy and delivery as far as possible. I’m not talking about Mornington Island specifically, but there are a range of things that will happen through that. Many of the programs we talked about, including things like our syphilis program, will deliver services into Queensland. Over the last two years we have also been looking to increase investment in our Aboriginal and Torres Strait Islander health services, where we’ve increased investment in the Aboriginal community controlled health system by a bit over $160-odd million.

Senator Roberts : Specifically doing what?

Mr Matthews : The investment we’ve lifted into the Aboriginal and Torres Strait Islander health service is really around increasing the primary resourcing that goes to primary health care delivered by Aboriginal and community controlled health services in communities. That is different from Mornington Island, which doesn’t have one; it does have some servicing through the Mount Isa service into the community, but a lot of services are delivered by the Queensland government there. What we’re looking to do is increase the resourcing for primary healthcare services delivered by Aboriginal and Torres Strait Islander organisations because they know their clients well and will put in place a stronger framework around comprehensive primary health care. That is something we’ve been doing across the country, not just in Queensland, and will continue to do over—

Senator Roberts : Is that funding for nurses or doctors or—

Mr Matthews : It’s for both really. It funds the resourcing of the Aboriginal and Torres Strait Islander health clinic and the health clinic will use that for a range of things—it could be used for an Aboriginal health worker, for a doctor, a nurse or other things it may do from a comprehensive healthcare point of view. It is really about the patient coming in and having their needs understood and looking at their broader circumstance and spending an increased amount of time. It’s a little different from a normal visit to a GP. We will bring them in, spend more time with them, look at their other issues and try and provide some of those wraparound supports. That’s how comprehensive primary healthcare works within an Aboriginal community controlled health setting. One of the things we’re doing is increasing our investment in that over time and working with the sector in particular to expand that and look to improve how they service over time as well, which is their intention.

Senator Roberts : How would you characterise not just the quality of the relationship but the actions and behaviours that come from the relationship? Are you a money provider? Are you a resource provider? Are you someone looking over their shoulder in a helpful way that identifies shortfalls in the Queensland government’s approach? Are you advisers to them? How would you describe it?

Mr Matthews : Are you referring to the Queensland government, or to the Aboriginal health services?

Senator Roberts : The Aboriginal health services, with the Queensland government—not just Mornington.

Mr Matthews : I hope the Aboriginal health services wouldn’t characterise us as looking over their shoulder.

Senator Roberts : I mean in the sense that you are working with them.

Mr Matthews : Our intention is very clearly to ensure that we have a partnership approach with Aboriginal health services, which is one of the priority reform areas in the Closing the Gap agreement as well.

Ms Rishniw : Senator, we take the Closing the Gap agreement very seriously. It talks about a partnership with Aboriginal people and Aboriginal services. The money that Mr Matthews outlined goes directly to service delivery by community controlled health organisations. We provide funding—

Senator Roberts : It doesn’t go through the state government?

Ms Rishniw : No, it doesn’t. It goes directly to the sector. It’s deliberately flexible to allow them to address the particular issues around health and providing holistic health services to their community. We work very closely with the National Aboriginal Community Controlled Health Organisation, and all of the services, to make sure that what we are achieving is a collective set of outcomes that everyone has agreed to around improving health and wellbeing for Aboriginal and Torres Strait Islander people.

Senator Roberts : It was wonderful to hear Mr Matthews talking about a holistic approach—not just health but health as an outcome of lifestyle. What about personal accountability? Two or three people in my office and I visited all the Cape York communities. Although the communities are quite different in their needs and their backgrounds, they have some commonalities. Mr Matthews mentioned Closing the Gap. I put it to all the communities that Closing the Gap perpetuates the gap, and they resoundingly said yes. First of all, the underlying intent is to focus on the gap which perpetuates the gap. But putting that aside, there is also what some people call the ‘Aboriginal industry’ and it consist of whites as well as Aboriginals, who are consultants and lawyers et cetera that feed off this and they perpetuate the gap, because without the gap there is no Aboriginal industry. Any comments on that?

Ms Rishniw : I don’t want to speak for Mr Matthews, but our job is to make sure that we can provide comprehensive health care for all Australians. The government invests significantly in the health and wellbeing of Aboriginal and Torres Strait Islander people as First Nations peoples because of the disparity in health outcomes to date, and that is what the closing the gap agreement is about. We have worked tirelessly. The community-controlled health sector has been a major part of the infrastructure of delivering health outcomes for Aboriginal and Torres Strait Islander people for over 50 years now and to suggest in any way that that is not a necessary and evidence based investment—

Senator Roberts : I wasn’t suggesting that—

Ms Rishniw : I just wanted to clarify—because asking Mr Matthews for a comment on that. It is evidence based. It is clear. It is a government commitment.

Senator Roberts : You would agree, I would hope, that personal accountability has a lot to do with managing people’s health?

Ms Rishniw : Everyone, I think, across the country wants the best health care and the best for their family and themselves. Personal accountability is one element. We recognise social determinants of health and a range of historical factors as well.

Senator Roberts : So you’re agreeing with me that personal accountability is important?

Ms Rishniw : I think I said it was one of the factors.

Senator Roberts : It is one of the factors so it has a part to play. What we’ve done in this country, under both Labor and Liberal since 1972—people in the communities have told me we have created a sense of victimhood, not beggars but of victimhood, and that’s the opposite of accountability. What I’m trying to do is to get an understanding of the environment in which you work, because if that accountability is not there—these people in the communities are wonderful. There are a diverse range of them, as you know. But they seem to be held back by the ‘Aboriginal industry,’ maybe not deliberately, maybe subconsciously, but that is what’s happening, and lot of it has been caused by state and federal governments, particularly since 1972.

Mr Matthews : We are probably limited to speak from the health perspective. It is where our responsibility is. Just to repeat Ms Rishniw, it would not right be to characterise the community controlled health sector, that is delivered and run by Aboriginal people for Aboriginal people, in a negative connotation around an ‘Aboriginal industry.’ We fund them because of your point around getting good services delivered by Aboriginal and Torres Strait Islander people to Aboriginal and Torres Strait Islander people. We are talking about the provision of health services. There is clear evidence that it is effective in delivering it because it comes from an empowering place of empowering people to do it—

Senator Roberts : That is what I was after.

Mr Matthews : That is why we are growing the sector strongly, investing in it and trying to work very closely with the sector on the way through. I think if you were listening to Dr de Toca’s evidence around our response to COVID we’ve also centred that 100 per cent with Aboriginal and Torres Strait Islander people and experts for that very reason.

Senator Roberts : What I’m interpreting—it is very welcome if I am interpreting it correctly—is that you’re giving more responsibility to the communities for their health and managing that health?

Mr Matthews : This is always very difficult to verbal, but I would imagine from our colleagues in the community controlled health sector that they would say they are services that are—that their membership is the community and their boards are elected from their community, so they would say they are in and of the community. They would express their view very strongly around that in terms of providing services to their own people.

Senator Roberts : That is welcome news. Is there a plan within your organisation that is part of an overall plan within the government’s—I don’t know what’s Ken Wyatt’s department name title is. The department of Aboriginal and Torres Strait Islander or the—

Mr Matthews : The National Indigenous Australians Agency.

Senator Roberts : Is there a coordinated plan with the National Indigenous Australians Agency?

Mr Matthews : This is something that’s easily googled. If you google ‘national Aboriginal and Torres Strait Islander health plan’, you’ll find the National Aboriginal and Torres Strait Islander Health Plan that was released on 15 December last year, which is now a new 10-year national plan around Aboriginal and Torres Strait Islander health, worked up very extensively by, and predominantly led by, Aboriginal and Torres Strait Islander health experts in the sector around the development of that plan and refreshed to be consistent with Closing the Gap and many of the things we’ve learnt over the last few years. As I said, it was released in the middle of December.

It has at its very heart the concept of how the broader social determinants, linked with health, bring in a dimension around the cultural determinants of health, of how culture plays out for Aboriginal and Torres Strait Islander people and impacts on their health and how health needs to respond to that landscape. So that’s been recently refreshed. If you are looking at where the national plan is, that is probably the prime and most important one to have a look at. I’d encourage you to do that. We can provide the link on notice, if you like, just to refresh. If not, that’s okay. That would be well worth having a look at. I also note that it’s endorsed by the majority of the states and territories. It forms a plan now that is developed in and of through the Aboriginal and Torres Strait Islander sector, agreed by the Commonwealth government and endorsed by the majority of the states and territories.

Senator Roberts : Thank you. That’s welcome news, too, because there are a lot of outstanding people with a lot of potential in those communities who are somehow stymied by an invisible hand. It’s varying from, say, the Lockhart River, where they are really going ahead, to other parts of the country.

CHAIR: Senator Roberts, just quickly, we are very close to time, and I have one question that I would like to ask the officers before we finish up.

Senator Roberts : Last question, then, Chair. Thank you for that notice. Has there been a drop in the death rate from suicides in the last year? What’s the overall trend in suicide, because it’s quite alarming?

Ms Rishniw : I might go to my colleague online, Mr Roddam, who can talk about speak suicide data and prevention activities.

Mr Roddam : Overall, in 2020, there was a 5.4 per cent reduction in suicide for the whole population. Unfortunately, for Aboriginal and Torres Strait Islander people, suicide remained the fifth leading cause of death that year, and Aboriginal and Torres Strait Islander people continue to die by suicide at more than twice the rate of non-Indigenous people—27.9 per 100,000 population compared with 11.8 per 1,000 population.

Senator Roberts : Can you tell me the overall trend? Relative to the rest of Australia, it’s high. Thank you for that. What’s the overall trend? Is it increasing, decreasing, flat—

Mr Roddam : It did increase slightly in 2020. I’m just trying to get the figures for 2020 compared with 2019. I know that it was a little higher, while the whole-of-population rate fell.

Ms Rishniw : Senator, given the time, we can take that on notice and give you the data around the trends. But it also goes to why we are investing heavily in suicide prevention and mental activities across Aboriginal and Torres Strait Islander people. We have a 24/7 crisis line that’s about to be launched—and we’ll start services from 24 February—and a range of other activities that Senator Dodson well knows we’ve been undertaking around suicide prevention.

Senator Roberts : And just like physical health, mental health is an outcome of cultural and social factors. I think those were Mr Matthews’ words.

Ms Rishniw : There are a range of social determinants that impact on an individual’s health across the board.

Senator Roberts : Thank you all for attending.

CHAIR: Thank you very much, Senator Roberts.