Senate Community Affairs Legislation Committee, , 6:22:16 to 8:06:49
The committee reviews AHPRA's response to antisemitism, First Nations health outcomes, and suicide prevention initiatives under Closing the Gap.
Topics: First Nations, Closing the Gap, Social cohesion, Bondi attack
Speakers: Justin Untersteiner, Prof Anthony Lawler, Kerrynne Liddle, Gavin Matthews, Malcolm Roberts, Andrew Bragg, Ben Barratt, Blair Comley PSM, Celia Street, Dorinda Cox, Dr Jamie Orchard, Gillian Shaw, Hon Anne Ruston, Interjection, Mehreen Faruqi, Melinda Turner, Michelle Ananda-Rajah, Nick Henderson, Nita Green, Prof Michael Kidd, Prof Steve Wesselingh, Speaker 19, Speaker 45, Speaker 46, Speaker 47
All right. Thank you. Thank you. We are now uh welcoming uh officials and witnesses at outcome one health policy access support and the cross portfolio on indigenous matters. Uh I now call officers from the department of health disability aging in relation to outcome one. Um I also want to welcome the Australian center for disease con control the acting director general uh Mr. Paul McCormack. Um the Australian Commission on Safety, Quality and Health Care, uh Professor Anne Dugen, um the Australian Health Practitioner Regulation Agency, Justin, uh Unsteiner, and the Australian Institute of Health and Welfare, Dr. Zoron um Bolovich, Cancer Australia, Professor Dorothy Keith, uh PSM MD, Chief Executive Officer of the National Health Funding Body, Mr. Shannon White, and Chief Executive Officer of the National Health and Medical Research Council, Professor uh Steve Wesselingh. Uh if any of those folks are here and would like to provide an opening statement, uh I would ask maybe that um they would like to read it out that would make themselves known to the secretariat um and we can arrange that before uh they are fielded for questions. So um I think I'm going to go to Senator Ruston. for you.
>> Uh thank you. So just back to the questions that we asked in our letter. So um in relation to the breakdown around bulk billing incentives um and so do you have them in tabulated form or
I'm just pausing more because it's a question of whether it's outcome one or >> Outcome one.
>> outcome two.
>> You're thinking about the 12 and a half% bulk billing incentive
>> That's fine. I mean, I'm just wondering about the data. I mean, so if it's tomorrow, >> Yeah. Great. Thanks. Thanks. That's super. Thank you. >> Um, okay. Uh, so back to the NH. Um, so is the under this new deal, the Commonwealth commitment, um, for funding for state-run public hospitals to reach a minimum of 42.5% by 2030 and 45% by 2035. Is that commitment no longer?
No, that's still the intention of the Commonwealth. Um, but as was the case in the NAK CAB agreement of 2023. Um, the the glide path was always subject to annual funding caps. Uh, and so the particular [clears throat] CCR that would be reached would depend on overall growth. So the outcome in the agreement had a 12 uh 10.25% 25% cap in the first year. So that's 2627 and 8% caps yearon year after that. And that's on the back of an increase in 2526 which was a 12.3% cap which was part of the one-year rollover when there wasn't an agreement when middle of last year.
>> Y okay. So, I mean, I'm not going to reprosecute the backwards and forwards that we had last estimates, but you know, it strikes me you're either committed to 42.5 and 45% or you're not. It can't be conditional of if circumstances let me get there. That's not a commitment. That's just a wish into the future. So um quite clearly the prime minister's promise of 42.5% and 45% by the respective times um is quite clearly um potentially a broken promise but we won't know until we get to 2030 or 2035. Hopefully cost of providing hospital care will reduce such that he can meet his commitment. Um in the um the funding agreement there was also a an inclusion um they're saying that um over and above the 24.4 billion there was a specific or sorry to make it up to 25 billion there was a specific uh $600 million in further commonwealth investment in the public system. What's the difference between the 24.4 4 billion and the 600 million.
>> So I'll ask Mr to comment but essentially the 24.4 is delivered through the straight the NH ABF funding agreement >> whereas the 600 million are some other elements including first nations funding. So they're not delivered through the activity based funding mechanism of the national health reform agreement. I'll ask Miss to expand.
>> So so the 24.4 4 billion just gets whacked on the NRA in terms of its normal calculated formulas where the caps and limits and all that sort of and the 600 million sort of sits outside of that so it doesn't get caught up any formulas and it's actually specifically dedicated to programs.
>> That's right.
>> Is there a list of the the programs and the processes around that 600 million?
So, Celia Street deputy secretary strategy and first nations group. The 600 million is um divided into three key areas. The 250 million which is for first nations. There's the the the small state uplift for act um NT and um and Tasmania. And then the other element is to support um the enabling functions to enable the reforms to be implemented. And by that I mean for example for the um for the agencies to implement the um the changes to the model.
>> How much is that?
>> So it's around two 200 220 between the the not in the first nations or in the small small state uplift >> just in general.
>> Bit less though isn't it?
>> It's a bit less.
cuz small states is 220.
>> 220.
>> Yeah, small states was 220 million.
>> What? So we've got 130 million. So can you unpack that 130 million for me?
>> So we don't have the specific details in
front of us in terms of what not not specific what but but what it's actually for.
>> Yeah. So so it is to to implement the new funding model. Um
>> so there's a new funding model.
>> Yeah. So the the funding model um so in the past it was the activity based funding. Um it's still activity based funding but it's um yeah so I'll throw
Shaw acting first assistant secretary. Um I I guess a good way to just step back for a moment um there was a midterm review that was undertaken by Rosemary Huxable and out of that review there was a series of um recommendations about significant reforms that could be undertaken as part of the next agreement. So those reforms will be pursued and implemented by this enabling funding. So there's really important reforms around uh pricing also looking at different ways that we could um embed uh further reforms in the in the first nations space. So they enable our um I guess our national bodies such as I hackpa you spoke to professor Michael Pan earlier today um professor an dugen and uh the national health funding body to implement reforms under this new
Um so the 130 million does not go into the states. It's actually going to to support us working with the states in order to implement the
>> support the national bodies in implementing those reforms.
>> And what about the $250 million for indigenous Australians? Does that go to the states and territories or is that ad ministered through the federal
>> So sorry you want me to see that? Uh
yes, there will be an arrangement I guess a partnership arrangement with the states and the commonwealth in co-unding priorities that are co-designed or designed with the sector under that schedule.
>> So is this money just the federal government's contribution? The states and territories will contribute 600 million as well.
>> Yes, that's the intention.
>> Okay, cool. Thank you.
>> 200 million. >> They will match 200 million for the first nation in the first nations.
>> So 250 we've got 200 for them. >> Yes. What about I mean obviously the small states once all are
>> go straight from the commonwealth to
those small makes sense and the 130 million has been spent by the commonwealth. >> Okay. Um so does the NH actually become is it a public document?
>> Um I think uh I guess that's in train. Um and how it technically works senator is the treasury is responsible for publishing all those intergovernment agreements and once finalized they'll be published on treasury website in terms of the heads of of agreement certainly that would be a matter for department of prime minister and cabinet but I do understand from my colleagues over that over there that that's in train as well.
in previous correspondence from with the states and territories the which we've been discussing the prime minister indicated that in order for the commonwealth contributions to increase jurisdictions needed to and I quote reduce growth in hospital activity costs to more sustainable levels. Um, so I'm just wondering what has been negotiated or discussed as part of this agreement in relation to hospital costs and activities that are expected to be reduced under this agreement.
Well, well, Senator, that that's a matter for each state and territory decide what they think the right growth rate is and also what the how they can influence cost drivers. Um, they're the two big components. I mean, that letter you're referring to from memory was sent in um September. The negotiations that moved on from there was essentially comes making uh this offer with the glide path with those caps and the the more there's moderation in either activity growth and but particularly price growth the more they're likely to hit the CCRs of 42.5 and 45. Yeah,
that's all well and good, but the the prime minister said that these economists increased contributions, jurisdictions would need to reduce growth in hospital activity costs to a more sustainable level. What does that mean in substance? What and what and I mean we've gone and negotiated the agreement. The states and territories, we've just whapped out $25 billion worth of taxpayers money on this. That was the requirement for the increase in funding. What did the Commonwealth get for that?
So Senator, the letter that was sent from the prime minister at the time was much longer than that. It's not one sentence in isolation. The context now essentially is a combination of both activity and price growth will determine what the CCR is.
>> Senator Ruston, I am going to shift the call. Uh now we've got a couple of others in the room that do need to ask some questions um before we hit short break. Thank you, Senator Fugi.
>> Um thank you chair. I just have some questions for the NHMRC.
Yeah, it's possible he still thought we were running for 4:15. So, I don't think people have seen him. Is it possible you could hold that off and we will let you know when he arrives?
>> Yeah. come after go first and then we'll come back to you Senator. Thank you Senator R.
chair. Apparently they're printing the name plates now. So apologies to hands
is okay. Um just checking um uh if you had an opening statement that you needed to also table to the committee. No. Excellent. Thank you Senator B. You've got
>> It is. Yeah. Thank you. >> Yeah. Sorry. We had a conversation last year about some of the issues uh of >> Yeah. >> Uh where you're a key organization. So,
um, have you now landed on a definition of anti-semitism?
Uh, >> uh, no, we haven't, Senator Bragg, and I'm happy to give a little bit more context there as well about what we're doing.
>> Well, can you please explain what your definition is then?
>> Sure. So, I mean, first of all, uh, again, just to provide context, I think it's helpful. Uh, from the outset, uh, we play a broad role in the health system. Um uh and so not only do we take people know us for the enforcement activity that we take but we really started the education phase. >> So we play a really critical role in cultural safety and elimination of racism all the way from um the education phase at universities. Um but I think we've explained before uh we have uh codes of conduct for all practitioners. All practitioners are expected to be familiar with those codes of conduct and they held to those codes of conduct. Within the codes of conduct, we have very clear language around our expectations including discrimination um as well. And I'll give you an example. Uh the code of conduct for nurses says to ensure safe and respectful practice, nurses must adopt practices that respect diversity, avoid bias, discrimination, racism uh and challenge belief based on assumptions. What um uh that is then supported by further material, guidance material. on some of that guidance material um includes very specific examples about uh what would uh be seen uh as inconsistent with those code of conducts and we've got examples that relate to anti-semitism uh as well uh that we use and is published on our
it's quite a specific question. I'm wondering why you haven't decided to adopt a clear definition of anti-semitism. I mean, we've just had a religious massacre in Australia, >> uh, where anti-semitism was a key driver. Uh, and so I'm wondering why you haven't adopted one. I think,
>> yeah,
>> it's a reasonable question.
>> No, I I understand and I understand that this is a live discussion at the moment, Senator Bragan, and so I respect the question as well. um uh you know at this stage um what we see in the system is that the vast majority of practitioners do the right thing and they comply with our codes of conduct. Um but in the very few cases where they don't um we do believe that we've got the tools uh to be able to deal with that effectively and we've proven that and in fact in recent times we've made um a number of referrals because of um issues of both Islamophobia and anti-semitism uh in the system. Uh we believe those tools are effective.
>> Are you going to adopt one?
>> Uh so uh right this minute um we are undertaking a significant amount of work to better understand the experience that people are having in the health system and part of that we are considering whether or not we would adopt a definition. And so I'm not saying uh that we have but we and we're not ruling it out.
>> Okay. Because even the government has adopted one based on the special envoys recommendations.
>> Understood. Yeah. And I understand. So
surely even the Labour government have adopted one.
>> Yeah.
>> Surely AR opera would consider doing the same.
>> I um I listened to the special envoy speak at estimates last night. Uh and one of the things uh that I was quite interested and and by the way I should note I've been meeting with the special envoy on a regular basis. I think we've been able to work quite well together. Um and I understand uh that uh they have an intention to release further um support material to talk about how this might look like in practice and adopting in certain organizations. We're really keen to see what that guidance looks like and we're keen to work with special envoy to understand what that could mean for us.
>> Well, we'll see where you get to on answer at this point. >> So, what about the the uh the training materials? What sort of training materials do you have >> uh within the opera organization for anti-mitism?
>> Yeah, sure. So we have undertaken a range of actually let me just again I might step back for a moment to give context here. >> Um so we have and I think we've we've shared this with you before Senator Bragg but I think it's important just to to to note again >> I mean there's no place for racism or discrimination in the health sector. It's a essential service and everybody should feel safe to go and get the care that they need. And likewise practitioners should feel safe practicing in that system as well. And as a CEO, I take that very seriously.
>> Of course, >> everyone would agree with that.
>> Yeah, absolutely. I think we're on the same page there. We've seen in our system uh 225 notifications that relate to either Islamophobia or anti-semitism in our system. Uh and that relates to 112 practitioners. Um about half of those relate to Islamophobia. About half of those relate to anti-semitism. Um we have taken action against 13 of those practitioners now and three with the most significant consequences of referral to a tribunal which can uh the consequences can range anything from a loss of registration through to other sanctions as well.
>> Okay. So sorry just how many uh anti-semitism complaints do you have right now? 113 or something.
>> Uh so uh sorry um in total since uh October 2013. Intificrial
at the moment.
>> Uh we have three before the tribunal.
>> And they're in relation to anti-semitism.
>> Uh and Islamophobia.
>> How many of each?
>> Uh I think two anti-semitism, one islamophobia.
>> Okay.
>> Um what um what I also want to acknowledge though is our notifications don't paint the full picture of the issue that uh people experience in the health system. Um I'm out there talking to Jewish communities and to m Muslim communities as well and I know there is a genuine fear for people uh to engage in essential services including in health and we're very aware of that. We're doing a lot of work uh to address that.
>> I understand that but can I just make the point to you that I mean we are living through a stage in Australian history where we've just had a religious massacre targeted at a particular group of people. I know that there's discrimination in society. All discrimination is apparent. But I'm not asking about any other form of discrimination. I'm asking about anti-semitism because we've had the Bondai Beach atrocity. We have stories of nurses threatening to kill >> Jewish patients. >> Uh we have other things happening which appears to be very targeted at Jewish Australians. So that's why I'm I'm asking about other things.
>> I understand. I I understand.
>> I don't understand the fudging.
>> Yeah. Senator Bragg, if I can just intervene at this point, I think that um that the witness is trying to be very wholesome in their answer. We have had a very um lengthy private briefing already that we've that um we've participated in uh with ARPA. Uh understand that your sentiments and your passion for this area. Um but I would appreciate if um I can listen to the witness's evidence um and that he can give an answer that is fools them. Um and we can move on from >> Thank you.
>> Thank you.
>> Thank you chair. Um look so we've got a dedicated team that uh manages these matters. We currently have 11 that are open at the moment. in terms of the training that uh that you've asked about. Um so we've undertaken a range of different training activities uh that uh but if I to your question I I'll focus on anti-semitism. So they initially we initially undertook uh training uh through the Melbourne Holocaust Museum. Um we have since uh undertaken further training. We have now um partnered with the center for Jewish civilization at me university. uh we are the first non-education organization to partner with the university on rolling out a bespoke training program. That training program has included the people that are managing these complaints as well as executives including myself. I've undertaken the training myself as well. We're now looking at how we can roll that across the whole organization and scheme. And we're also thinking about how we can also think about rolling that training out into the health system more broadly. what can we do to help and and my discussions with the special envoy combating anti-semitism there is a really keen focus on education within the health sector and we want to partner and support that
>> well I'm almost finished here but if you can provide any of the training materials on notice we'd be grateful and can I just ask you um I mean in relation to the two nurses who threatened the >> uh the lives of Jewish people in >> uh New South Wales hospitals. >> I mean, can you give an assurance that those people will never work in the medical system again?
>> Um, I So, I'm not going to preempt the outcome of both a criminal process and a process that's been undertaken in New South Wales at the moment. I think in our previous hearing, Senator Bragg, and again, for the record, I'll just uh share that again. In Australia, we are the national regulator, although there are some differences in New South Wales. New South Wales does have its own uh health complaints commission that uh manages uh the notifications against uh health practitioner. They are the ones responsible for this investigation as well as uh New South Wales uh police as well. And so I can't talk for the outcome of either of those processes, but what I can say is again I share your concerns about that matter. That was very serious and very concerning for all of us. And um at the I think I shared last time the incident occurred uh they action had been taken and they had been removed from the register within a very short period of time to protect the community.
>> So just just finally um I think it's important uh unfortunately there appears to have been reports that people who had survived the Bondi massacre in New South Wales had had their names angllicized.
>> Okay. >> Have you heard about this? Um I I have I heard something very briefly about that.
>> So the apparently a attack victim Rosila Shikberg had had her name changed to Karen Jones.
>> Okay.
>> Uh by uh Liverpool Hospital.
>> So I So Senator I just share I I I heard something very briefly about that. Um uh I'm not sure and I might even through to the chief medical officer who might might have further views on this but my understanding is uh in where there is a major criminal occurrence or crisis when a patient is taken to hospital I understand it's reasonably common practice to give a pseudonym to protect from the particularly from the media. Um so I think it's more of a protection mechanism to stop media calling hospitals shopping around looking for victims of major events and so
>> really
>> uh that's my understanding it is a practice not uh like in major uh activities such as this or not such as this but in major incidents uh and again I think the purpose is not about protecting the identity of a person's religion or culture or background but to protect them from media inquiry which you know I've seen myself how that can play out. I'm not familiar with that process though. Um I'm not sure if uh Mr. K is able to support.
>> I think uh this an issue which we need to raise with New South Wales health senator but uh uh I'm concerned just and what I know about this issue is what I've read in the media as as perhaps you have as well. Uh I think the concern here is about the lack of consent uh for the individual.
>> Yeah. Well, can you just take on notice any more information you can provide about that because I think >> people you know who might have a star of David around their neck might feel worried about entering a hospital in New South Wales at the moment. So any assurance you can provide the clinic clinicians, the doctors, the nurses um the patients I think would be really appreciated at this difficult time.
>> Of course. No, thank you.
>> Thank you. Thank you Senator Bragg, Senator Nander Raja.
>> Thank you chair Mr. Unsteiner. Um we've had two terrorist attacks in the course of 2 months, one on either side of the country. I was wondering if you could even on notice or comment now provide us um with some information on what we're doing with respect to cultural safety for First Nations patients in the healthare system.
>> Yeah, this is a a really um significant focus for us as a scheme. Um and in fact uh changes were introduced into the legislation which embed the importance uh and the uh and the uh the priority of cultural safety elimination of racism for ainal and tourist islander people in our health system. Uh we have a number of measures that we've undertaken um to to support ainal and tourist islander people in the health system. Uh examples include um uh we uh partner with a an important alliance of ainal tourist islander health leaders uh where we meet on a regular basis and they support the policy development out of our organization um to ensure uh that we are making changes to improve safety. Um areas that we're looking at at the moment include things like accredititation. How do we ensure that we're embedding continuous CPD and other requirements for practitioners around cultural safety? Uh that's just one example. Um we have embedded cultural safety into all of our codes of conduct now as well. Uh and in fact we've uh um Mr. Orchard may be able to talk about a prosecution a tribunal referral um that occurred um in recent times off the back of our
>> Yeah. Um Jamie Orchard, general counsel of ARPA. That's correct. It was one of the more serious matters that we referred to the tribunal and it was on the basis of um disparaging comments that had been made publicly in respect of a very respected um Aboriginal practitioner. Um we ran that matter through the tribunal to a very successful um conclusion in so far as we felt that the outcome was appropriate to reflect the serious nature of the conduct and to protect the public going uh forward because that sort of discriminatory comment is a risk to the whole community not just a certain part of it and that was a very successful um prosecution from our point of view.
>> We we've also been looking at how we can address workforce as well. we understand. Um I've spent time out on country and in remote areas. I was up uh I I spent some time in an art show up in NT recently as well. Um and just to see the impact that ainal tourist islander health practitioners have in communities. It's it's really important. And so again, we're doing uh uh work with the ainal tourist islander health practitioner board in thinking about how we can support the states and territories to increase the workforce in a safe way where we can maximize scope of practice as well. And then we're also looking internally. Um we've recently introduced a new u anti-racism policy >> uh that uh where we are recruiting a panel of at arms length ainal and touristra islander people to assess complaints about racism against ainal touristra islander people in our organization and so we take this immensely seriously and uh we are about to launch our next 5year strategy I'm the new CEO we we you know we're looking at the future uh and one of the three pillars is uh remains um cultural safety elimination of racism for ainal and touristra islander Thank you.
>> Thank you. Uh thank you very much for that, Senator Faruqi.
>> Thank you, Chair. I just follow wanted to follow up on some of the responses that you gave to Senator Bragg. >> Um I guess my first question you you said that you have had complaints about Islamophobia as well.
>> Yes.
>> Um so are you also thinking of adopting a definition of Islamophobia?
>> Yeah. So we uh we have set up a a special issues um committee within our organization that is looking at both >> the prevalence at the moment of Islamophobia and anti-semitism. As I said, when we look at what we're seeing in our system, we're seeing uh a rise in both areas, which is really concerning. Y >> the issues are different uh and they're distinct and we're not merging them together, but we recognize that we need to uh place great weight and effort on all fronts. Mhm. >> Uh I have um been I've commenced meetings uh with a special envoy combating Islamophobia um and we have agreed to partner and to do some work together to look at how we can uh both identify issues in the system but then look at how we can address those issues. >> So again I we're not taking anything off the table at the moment whether that be definitions or otherwise. We haven't made a decision to go down that path yet. >> Uh and some of that is making sure that whatever we do there aren't unintended consequences particularly as an independent regulator. um there can be uh um there can be unintended consequences and so that's why I'm very keen to see continue to make sure that we are out there talking to the community understanding what this looks like in practice and so we can make sensible decisions.
>> Yeah, I'm glad to see that you are taking racism seriously. You also mentioned that you were rolling out some anti- anti-semitism training. So, are you rolling out broader anti-racism training because I think that's the crux of it and racism at the end of the day is racism.
>> Yeah, absolutely. I was I was uh Senator Bragg had a particular interest um but we are rolling out much broader training. Uh so for instance because of the current environment we've also had training on Islamophobia for our teams as well and we're we're now looking to expand that more broadly but we're also looking at other training that looks beyond >> Islamophobia um anti-semitism and racism for ainal tourist islander people because we know there are other forms as well and again they are distinct and different but we need to be addressing all of those.
>> Yeah there are some very good um already courses around on anti-racism >> which kind of tackle all kinds of racism. So this exceptionalization I think is a bit of an issue. >> Um yeah, but I'm glad to hear that APA is finally taking this seriously. Thank you. Thanks, Chair.
>> Thank you, Senator Faruqi. Um we are finished a little bit earlier unless you'd like to get started on NHMRC. >> Yes, if you'd like to. Um NHMRC. Yes. I think >> we could spend the next five minutes to >> what if you do your block then we can go to um a break.
So, my questions relate mostly to animal testing. Um, and as far as I can see, there has been no data published since 2023 on the number of grants and the funding awarded by NHMRC that involves animal testing. Why is that the case?
Um I mean I would have to check or take on notice that
>> we can see it published before 2023 but there's nothing for 2024 and nothing for 2025.
>> Um so again as I said I would have to take on notice to check that. Um we are currently doing a review of the uh our guidelines on animal use in scientific research and uh and so it may be that as part of that we've uh issued um quite a lot of information for that review and discussions with the sector. So uh it's possible that it's related to that but I would have to actually take it on notice to uh understand whether we have released any data in the last 24 months.
But surely you would have provided grant funding in the last two years to for animal testing. >> Yes. Yeah. You that is true. You would know that. Yes. Okay. Um do you know what uh uh NHMRC grants were awarded? Okay. You said you for partic in the in the last two years 2024 2025 that involved non-human primates not all animals just non-human primates or would you have to take that on notice? Okay, then I will put some other details like I'd like to know the species, uh the amount of each grant, who got those grants, etc. Do you know which universities in Australia are testing on or are in possession of nonhuman primates for testing and or research?
>> Again, I would have to take that on notice.
>> Okay. How much in federal funding has been awarded to Monache University researchers for experiments that involve primates in cognition experiments in the last 5 years? You would have to take that on notice as well. Um so I guess again details of um a particular project you would have to take that on notice too I'm presuming. Now just coming back to the code, the Australian code for the care and use of animals for scientific purposes clearly requires that animals must not be used in experiments where non-animal alternatives exist. >> That that is right. Yeah. And that is a mandatory requirement.
>> Yes.
>> Yeah. Um so there is this um project that is happening I think at Monach University uh which has approved a stopgo trial in primate primates that lasted several months where marmicetses were kept in tiny cages and forced to undertake at least 30 correct trials daily and was subjected to oxytocin dozing despite there being non-animal alternatives available. So I'm just wondering whether these trials breach that code or have you actually looked into that at all.
>> So the way the code works is that um we license animal ethics committees across the um the country and we work with the states in in that process. Um but the actual approval of an individual research project is um performed by the animal the registered animal ethics committee within an organization such as MES University >> and the process also then goes through the state um animal processes. So we don't um although we oversee the code and as I said we are currently reviewing the code we don't oversee the individual approvals by the animal ethics committees so we would have no visibility of that.
>> Okay so if the code is being breached
said register the the committees. Um the committees work under very strict guidelines and so we do make the assumption that the organizations such as MES University would ensure that those committees are working under those guidelines >> and those committees also report to the state government and we would also assume that the animal welfare activities of the state governments um would be overseeing that process and we do know that the state animal welfare um committees do audit um the animal ethics committees within their states.
>> Mhm. Yeah. I mean the state animal welfare activities are notoriously wful. Um so they would do that. You would have no oversight of any of that unless you are told about it.
>> Unless we're told about it. Yes.
>> Um just last question chair. So in October um last year the Dutch Senate voted to redirect 12.5 million euros annually away from primate experiments [clears throat] um at the biomedical primate research center which was one of Europe's largest facilities. In November last year, the UK government published a formal roadmap replacing animals in science, which was a strategy to phase out many animal tests, including um nonhuman primate use, and it's happened in US as well. So, it seems like the rest of the world is kind of turning its back on very cruel testing on primates. Um, you said you're currently reviewing the Australian code for the care and use of animals in scientific purposes. Are you also going to be looking at turning your back to these very cruel experimentation on nonhuman primates and seize grant funding for research?
>> I I the the review of the code is a broadbased review to to look at all of those issues and as a principle the NHMRC would like to see reduction in all animal use in research. However, we do acknowledge that some animal experiments are necessary and one one of the questions the code the review of the code will be looking at will be the use of primates in um health and medical research. Absolutely. >> Can I just quickly add something? So we we have been working in this area for some time and as an example we are um working with others to try to further develop the ability for as an as an example a drug to be licensed with no animal testing whatsoever. So we are certainly walk in that direction to try and replace animals in health medical research >> um and and certainly replacing primates would be and could be part of that.
>> And when would the code review be What's the timeline?
>> Um, I'm not sure. I'd have to take that
notice as well. >> Thank you. Thanks, Chair.
>> Thank you, Senator Fareri. Um, it now being uh just after 4:00, we will now break for the afternoon break and we will Oh, yeah. I'm happy to just before we head to the afternoon break announce that um opera are able to be released from this hearing today uh after the line of questioning and we will return at 14 uh sorry 4:17 17. Thank you. Uh we are resumeuming after the afternoon break in continuation in outcome one on health policy access support and the cross portfolio on indigenous matters. Um, we now welcome a uh new uh minister to the table. Senator the Honorable Nita Green, Assistant Minister for Northern Australia, Tourism, Pacific Island Affairs, representing the Minister for Health, Disability, and Aging Minister. Do you wish to make an opening statement, Minister?
>> No, thank you, Chair.
>> Thank you very much. Uh, we will, uh, now go to Senator Roberts.
>> Thank you, Chair, and thank you for being here again. Good to see you. Good afternoon. Uh, I'd like to table a document which I've given 10 copies to I won't be discussing that straight away. In the last estimates, I asked the TGA about adivants in singleuse vaccines. The TGA's response on notice number 3215 was the matter had been addressed in 3212, which has not been loaded to the AP's website. Can you please provide those answers today?
>> we'll just get the officials for you, Senator.
So thank you very much for that question So I thank very much for that uh question Senator and uh Anthony Lawler deputy secretary health rights regulation. I I apologize if uh those questions and notice um have not been lodged with you. They were the answers were generated um contemporaneously and and so rather than to uh we had a couple of questions that were related to the same topic and so we tried to to provide them together. Uh I do uh recall conversation that we had on the 3rd of December regarding those matters. Uh and I can I can answer that the that our position as noted in the minutes of the pharmaceutical subcommittee meeting of the 24th of March 20 2015 which you highlighted at the time aligns with the European Pharmicapia monograph on vaccines for human use which generally prohibits antimicrobial preservatives in single dose liquid vaccine preparations unless there is evidence that demonstrates that safety and efficacy are unaffected by that. uh all vaccines registered in Australia undergo a comprehensive assessment for safety, efficacy and quality of product to approval and no new single dose vaccine containing a preservative has been approved since the decision of the pharmaceutical subcommittee meeting of 2015 that was noted in the question.
>> Thank you. Second question TGA also your reply to another question was nothing other than just the usual everything's perfect. It seems you have not actually ever gone back and asked yourself if your approach could in fact be causing serious harm to children. I've tabled a report from the children's health defense which clearly shows aluminium aduants are a leading cause of the autism crisis. The paper draws on supporting evidence from almost 200 papers. I think they're listed in the It was this data that caused the US Health and Human Services Secretary Robert Kennedy Jr. to reduce the vaccine schedule in the United States from 17 to 11 types and actual doses cut in half from 70 to 35. Will you respond to this paper? I mean, you can't respond straight away because this
>> Well, I I I mean, I can certainly respond to the question. Thank you, Representator. I I'm not convinced that I agree with the the characterization that this is why there was a reduction in the um immunization schedule for the US. uh decisions taken by the by the um CDC and the FDA in the US obviously matters to the US administration, but there has been significant um public commentary around the drivers and the potential consequences of the decision to um to adopt the uh the uh vaccination schedule that has been designed based on science and evidence for another country with another epidemiology uh with different demographics, different disease patterns and support of a different health system. Um, as we previously uh mentioned, we we have a process that occurs in Australia uh wherein we uh uh have a uh immunization program that is based on on science and evidence. And I have um the uh representatives from Atagi here uh and I will I will throw to them um shortly. we we we don't uh I think it's safe to say that we we we we don't provide answers to questions on notice stating that everything's perfect. We highlight the scientific basis on which we make determination. Uh we have um provided information uh previously uh on uh aluminium adgivants. Uh we've also indicated that the strong balance of evidence is that they are not associated with autism. We're also aware that uh the um position of the children's health defense, which has a long history of antivax sentiment, um has been to uh make assertion that these linkages do exist um where no evidence to that effect is actually uh verifiable. We'll obviously take the document that you provide with us. We'll assess that. Um, as I previously said, we uh as a contemporary best practice regulator are consistently uh awake to safety signals. Uh, we do not judge a uh a piece of research on the basis of its outcome. We judge it on its rigor and how robust it is from a scientific point of view. So, we will assess uh this piece of work that you have uh provided with us and um and we're happy to uh provide either our support for it or our rebuttal as appropriate. Um I'll throw to a target on the basis of the the comment that you made about um about decisions causing harm to Australian children.
>> Thank you. So Associate Professor Katherine Gibney, co-chair of Atagi. Um so just reinforcing that Iti um continually reviews the the schedule the recommended vaccines in Australia. Um and we're very comfortable with our current schedule. um we see no reason to change our schedule based you know as in reaction to changes in the US by um as recommended [clears throat] by the CDC.
>> Thank you. Next question. Question on notice 3215 asked about a report from the food and drug administration in America center for biologics which stated perfectly clearly 10 pediatric deaths were linked to the co jabs. I asked if you had supporting data in Australia. Your reply referenced reported pediatric deaths after CO jabs and found that quote causality has not been established for those children. How hard did you look? End of quote. How hard did you look? Were the were there autopsies, independent medical board reviewing the medical file for each and deciding no jab did no, the jab did not cause the death. What was the process you engaged?
>> So thanks for that uh question, Senator. Um I will ask Dr. Baskin to uh comment on the process that we've explained previously around our pharmacco vigilance that is uh that is designed and delivers on our um analysis of adverse events including including deaths that occur temporarily following uh following uh temporarily following vaccination. I would just highlight as well that as previously stated um the statement uh regarding the uh identified pediatric deaths following vaccination I mentioned at the time that we'd not been provided with information regarding those deaths. I believe that's still to be the case uh that the claim uh that there had been these deaths that had been causally linked to vaccination um has not to my knowledge been substantiated. Again, if that is if that is uh that is not the case, I'll be I'll be very very prepared to um to correct the record. But if Dr. Daskin would like to comment on on the work that we undertake to respond to uh reported adverse events.
>> Thank you, Professor Lawler, and thank you, Senator, for your question. Um Dr. Daniel Daskam, principal medical adviser in the medicine's regulation division. Um senator, every death that's reported to the TJ following um any vaccination is reviewed to determine whether a regulatory response is necessary based on the weight of available evidence. It's important to note that the TJ does not determine causes of death. Uh this is determined by coroners and treating doctors and as we've explained before and the TJ does has no role in overruling causes of death that are included on a person's death certificate. The causality assessment that's done by the TGA is primarily concerned with the relationship between the vaccine and the adverse event rather than the outcome itself. And it's undertaken as a regulatory process with the intention of appraising risk benefit balance at a population level for that specific vaccine under Australia's regulatory framework.
>> Do you do autopsies?
>> The TJ has no, as I just said, Senator, the TGA has no role in the determination of cause of death for individuals.
>> That was my understanding too. Okay. United States human health and human services 2026 roto virus covid-19 influenza meninja coakal disease hepatitis A hepatitis B were all removed from the schedule Australia still requires roto virus hepatitis B and meninja coakal ACWI is the United States FDA wrong or are you wrong on the risk benefit of those vaccines
>> um Senator my name is Dr. Anat first assistant secretary of the national immunization division. I can't comment on the US but uh as outlined by my colleagues professor Lola and also associate professor Cath Katherine Gibney uh the uh for vaccines to be made available on the national immunization program does require a very high bar. It includes TGA assessment of the safety and efficacy of the vaccine. It also undergoes a target assessment for the clinical effectiveness. It then goes through pharmaceutical benefits advisory committee assessment and then needs to be approved by government for funding. There's also ongoing monitoring uh by Atagi and TGA who constantly assess whether those vaccines are appropriate for the Australian community.
>> Thank you chair. I've got two uh brief
questions left in this very quickly. Yeah, I I I think it's it's really important to note that that one of the great strengths of of of Australia's um regulatory system and and also indeed of a target is that we do make decisions based upon the nature of disease patterns in Australia. Every country will take its own approach to immunization schedules. They rely on the evidence and rely on the demography and the epidemiology in their own areas. um if we were simply to um make decisions based upon what other regulators say then I can almost guarantee that I'll be back at the next estimates answering questions around why we're not making our own sovereign decisions. So I think it's important to note that the vaccination schedule is appropriate to the Australian context because of the evidence upon which it's it relies.
>> Thank thank you. Uh second last question then then I'll go on with the last. How much do these vaccines cost the taxpayers every year? rotovirus, hep and meninja cocoal acwi.
Um Senator I don't have the individual breakdowns of those uh vaccines but what I can tell you uh in uh 2425 we uh the national immunization program which includes a raft of supporting activities that
>> childhood childhood vaccine
>> uh no there's uh this is the full complement of national immunization program vaccines and also other activities like communications and data collection for example uh we spent uh $760 $62.8 million,
>> three quarters of a billion. Is there any chance of getting the breakout for the children's vaccines?
>> Uh I uh it'll be dependent on whether that information is commercial incompetence, but uh I'll take that on notice and get back to you.
>> Thank you.
>> And if I may also, Senator, sorry, just to add um I've mentioned previously that that that the regulator um is involved in balancing the risk and benefit. I I just would highlight that it would be difficult to talk to the cost of vaccines unless we also recognize that these vaccinereventable diseases cause an incredible burden of mortality, morbidity and cost. And in fact in the US RSV is the leading infectious cause of pediatric hospitalization. So the risk benefit is actually uh as important as the cost.
>> Thank you. That's a good point. Professor Lawler, perhaps if you could include in that the the benefits.
>> Certainly Senator.
>> Thank you. Denmark, Sweden, Norway, France and and the Netherlands do not recommend rotovirus vaccines except for high-risisk cases. Vicella vaccine Denmark, Sweden, Norway, Finland, France, Portugal not recommended except high-risisk cases. Hepatitis B not recommended for routine use in Denmark, Norway, Finland, UK, Britain, France, Germany, Netherlands. Surely the default is don't vaccinate unless the need has been established. Can you show me any of these countries where the absence of the vaccination has led to a higher incidence of child harm not infection harm than vaccinated countries?
>> Um Senator uh if I may um as uh my colleague Professor Lula has outlined uh it's uh very difficult uh to compare different uh countries. Um and that's really because uh there's different disease impact uh in each different country um which can be related to public health measures uh that are in place and also uh different diseases that are circulating. Um we also have fun uh different funding mechanisms in Australia. We're very fortunate to be in a country that has a program that provides vaccines uh for free that are recommended by our advisers. So we're very fortunate in that sense. Um so what I'd say Senator is it's uh very difficult to compare uh one country uh to another in terms of how they fund uh or recommend uh their vaccines. But what I will uh will do is throw to associate professor Katherine Gibney who may be able to give you an idea about some of the assessment uh and information that they take into account when they recommend uh vaccines in the Australian context.
>> Thank you. So um certainly a target takes the epidemiology and burden of disease of each of these vaccinereventable diseases into account as we make um as we consider um who to recommend the vaccines for. Uh so establishing a clinical need which isn't just infection. In fact counting numbers of infections is not particularly interesting. It's hospitalizations and severe disease and death that we're particularly interested in or long-term consequences that could be prevented through vaccination. So that's really what we look at when we the first question is is there a need for a vaccine [clears throat] and then we look at the vaccine um considering uh that TGA has already assessed the effectiveness and the safety we further review that in the context of the clinical need and then further to that when we provide advice um to PEAC they look not only at the clinical effectiveness and need but also the cost effectiveness so a target don't assess that but that is assessed for every vaccine before a recommendation is made that it's added to the nick.
>> Well, if you could show me anywhere um where the absence of the vaccination has led to more hospitalizations and more
>> Certainly, we can take that on notice and provide that.
>> Going back to two points you raised, Um Miss Pete, you mentioned Australia assesses the vaccines. >> Do they do actual testing or what is the
>> uh, yes. Uh, I'd have to, uh, throw to, uh, Professor Lawler, uh, about the, uh, assessment, uh, that the vaccines do go through. Uh, but, uh, from my, uh, knowledge, we don't, uh, assess the vaccine. What we do do is, uh, rely on evidence, um, and data uh, to ensure their safety. So, but I'll hand to Professor,
>> where does that evidence? Well, okay. Where does that evidence and data come
from? So, uh, Senator Nick Henderson, first assistant secretary of medicine's regulation division. So, um, we, uh, have a process where we rigorously evaluate submissions provided by sponsors of these vaccines,
>> the drug companies,
>> the pharmaceutical manufacturers who then are
>> submissions from the drug companies.
>> Yeah. which we require a a significant amount of evidence to support our assessments of the safety, efficacy and quality of that of those um vaccines before they are able to be marketed and supplied in Australia.
>> So let me understand this. I go back to March 21 I think it was I asked the previous uh T head of the TGA Professor Scarret or Dr. scared >> what testing was done in this country on the co injections he said none they relied on the FDA at the time he said that it was after the FDA had admitted they did no testing themselves they relied on FISA you're telling me you're doing the same okay
>> next um I might just jump in there um no we we have moved all the co 19 vaccines are now what we call fully registered. So they have been uh assessed on a full suite of evidence to support safety, quality and um efficacy of those vaccines for co 19 vaccines as well. We did have a program in place where we did do batch testing of all vaccines um in the TJ laboratories before they were able to be supplied in Australia.
>> So if I might add to that if I if I may, Senator, um I I know your use of the word testing. uh the role of the regulator um and these regulators uh this regulatory practice is standard uh um worldwide is that uh we undertake a uh an unbiased and objective assessment of the evidence that is presented to us uh particularly >> entity the uh I'm that that was part of the rest of my of my answer senator so I'm going through the process that we follow that while while for the most part that is supplied by the sponsor who is seeking um registration of the product. It does undergo an appropriate assessment by our own uh experts to determine that the uh size of the sample, the controls that are placed um the primary endpoints, the outcomes, the adverse events, all of those elements of the study indicate that the risk benefit analysis is positive. So the process that we undertake is similar to others. Now, as Mr. Henderson's highlighted during co we had a uh provisional registration pathway. This was during a time as you would recall uh when the risk benefit uh of um providing a uh a provisional authorization for that vaccine was high. Since then we have uh undertaken a transition of that uh vaccine through to a um a full market authorization. Um there are other mechanisms for assessing the evidence and obviously in this instance we can also rely on the real world evidence that uh the overwhelming benefit uh the risk to benefit is positive given the uh number of lives saved by the administration of the COVID vaccine when compared to the incidence of adverse events.
>> Mr. Lawler, before I ask my last
question, >> Professor Lawler, sorry, Senator,
>> Professor Lawler, uh, you you said a minute ago on another answer, Australian disease patterns forget the other, forget overseas. Now you're saying they're similar to others. So, our testing is sim assessment is similar to others. You don't do testing.
>> Yeah, I actually said neither of those things, Senator. I certainly didn't say that we should forget other countries. What I said is that we make our own um uh uh vaccine schedules based on the demography, the epidemiology, the disease patterns and so forth of Australia. We certainly have a mind to others. I mean uh just as as an example, the disease patterns in the northern part of the world um circulate to the southern part of the world some six months later. So we certainly have to be mindful of what's going on in the rest of the world. We don't forget what's going on there. What I then said was that there are consistent if not identical approaches to regulatory uh decision-m around the world. Uh there is significant um positive collaboration and work sharing between regulators so that we can know what the appropriate practices are and particularly horizon scanning so that we know uh what's coming up. But I would highlight that the answer that I gave actually went to how we regulated uh during co which was different to other countries. Other countries undertook what's called an emergency use authorization. We undertook a process of provisional registration which was an an abbreviated and expedited process that did not lift from sponsors the requirement to provide appropriate uh evidence particularly real world evidence and then the appropriate uh I guess more wholesome uh transition to full market authorization thereafter.
>> I can only go by what your predecessor said they relied on the FDA. Miss M Dr. Pete, sorry.
>> Yes. Thank you, Senator.
>> Dr. Pete, you said the co the childhood injections are free.
>> Yes.
>> They're actually paid for in 3/4 of a million dollars by the taxpayer.
>> Uh yes, that's correct. Uh Senator, uh what I should have said is is they're provided free to people who are eligible uh for those vaccines. But yes, they are fully funded by the government.
>> Taxpayer.
>> Yes.
>> There's no such thing as government money. It's all taxpayer.
>> Thanks, Chair Robert. >> Chair, can I just make these real senator? I'm not an expert on RSV vaccines or vaccines in general, but I just wanted to say to you that as a parent who's had a baby hospitalized with RSV, this is a program that I I'm so proud that our government has brought this in. And when you're talking about the cost of a vaccine, we do need to consider hospitalizations. You've asked for that data and I hope you'll have a look at that because there is nothing worse than being in a hospital with a little baby who can't breathe. And what's worse would be being in that hospital knowing that it's unnecessary because there's a vaccine available and you're taking up the spot in an ED bed for someone who really needs it. So I just wanted to show I wanted to explain to you that this is having a real impact on families around the country and and that data will help you see I think why that investment is so important.
>> Thank you Minister. I have had many parents come up to me and said they've injected their they saw in front of their eyes their child injected with a childhood vaccine, eyes rolled backwards in their head and died.
>> Yeah. I mean,
>> does One Nation want to see thousands of Australian children die? Is that One Nation's new policy? I'd love to hear that. Go out there and tell [clears throat] the Australian people, Malcolm.
>> Uh, go out there and tell my constituents who come to me and say, "Can you do something about these things?"
>> Hang on a minute. So, so one Nation now endorses the deaths of Australia and
>> Senator Roberts.
>> Wow. >> Wow.
>> You are undermining vaccine. One of the greatest public health interventions the world has ever seen.
Thank you. Uh Senator Little, you have >> Uh thank you. Um unfortunately my first
question is about uh the worsing suicide rates in uh Aboriginal communities. I'd like to ask about the productivity commission's >> If you want to do a segue after this suicide because that's the only sort of Um, you would know the Productivity Commission recently described the worsening suicide rates as alarming given the target is trending in the wrong direction and closing the gap. Can the department explain why its multi-million dollar investments in the social emotional well-being strategy or policy partnership is not coinciding with measurable changes in that target
Matthews, first assistant secretary of mental health and suicide prevention uh division. Hi Senator. Uh look, I think probably the first thing just to check, are you referring to the social emotional well-being program or the policy partners?
>> The policy partnership,
>> right? >> Okay. So the policy partnership exists to provide uh you know it provides advice in a sort of partnership way with with government. So it's been in place for a couple of years. um has played a role in the development of the national ainal tourist islander suicide prevention plan um and obviously sort of refreshed the declaration a range of things around mental health. So it largely exists to sort of influence over time uh what collectively governments are doing at the commonwealth and the state level. It's not a direct deliverer of services as such. I think it's obviously you know the PC has made commentary about increasing rate. I think everybody is concerned about the ongoing increase um if that in that rate. It's obviously multiffactorial of it you know across health and and the broader spectrum. So um you know that is probably the the one of the big things that policy partnership is is providing advice on the PC obviously also has called fairly actively for a you know for governments to consider um a discrete you know section of the productivity commission has suggested that there should be a discrete schedule for a tourist source subvention in the in the national agreement and that's something that the policy partnership has started to provide advice to government on so I think you know So a lot of the work that it's done will influence pieces of work like this um about you know of how we're going to do better to increase that. There has been over the last couple of years increase in some activities and things like culture care connect and programs that have come in to you know to put more resources on the on the ground and increase the efforts around First Nation suicide you know prevention that program is working quite well. So there are some things coming through. They're not necessarily sort of translating as such into a decrease in that rate probably because the broader um you know I guess multiffactorial issues and social determinance uh work that is you know well beyond the health portfolio from a whole government framework I guess in closing the gap but from a mental health and suicide prevention point of view obviously trying to kind of make sure we increase the things that work and look for the evidence and things like culture care connected we've sort of doing some work to evaluate it which is looking really positive. So that'll be things that government will need to consider going forward and they will influence things like the consideration of a new schedule in the national agreement. So they'll be very active in that process.
>> Okay. In terms of um improving access to mental health services, we often hear that um that those things are being worked on and that there's change, but we've got uh 13.3% of indigenous adults reporting they could not access a counselor when needed. And that's a rate that is increasing. Those two things are
>> No. And I think that you know that's obviously access to um services I think generally in the population is obviously you know is a concern. Um that's probably why there is you know obviously from a broader mental health point of view. We are trying to increase services generally not just um you know ainal tourist island services but we do have obviously an increasing network of Medicare mental health clinics and headsp space clinics and we'll have the what's the what was probably previously discussed in this committee as the national intervention service which is now called the Medicare mental health check-in service which will be a tele you know digital and telephone based um cognitive low inensity cognitive behavior therapy service that will come in that people can access all of which have strong first nations cultural competence sort of you know built into that and so we are trying to kind of build and increase the you know the connection points that people can have and particularly those that are either lowcost or free and ensure that they you know are accessible to to first nations people um I think you know we probably have through through my and through the recent sort of commitments we'll probably build towards a network of about 203 headsp space centers and around about 91 92 Medicare mental health clinics and then a large national low inensity um for people with sort of early intervention to access in all of which have uh you know strongly framed access for ainal tourist people to supplement the ainal tourist to specific things like culture care connect so we're going to try and tackle it from a few fronts but yes there are definitely issues
>> I just want to ask often um we see uh health siloed in health um we've got an issue a significant issue across this country about ainal tourist islander children going to So there are multiple points at which we are missing the ability to engage with people on uh mental health >> um and people who are specialists in one area identifying co-orbidities that are associated with an individual presenting. How how much work given that we know that this target has been going backwards since 2022. Um what is new that we've done that the government has done since then given we know that target is tracking wrong
>> uh specifically about connecting with people that are not attending school or getting people to school and connecting in that particular context or
>> given the age of people who are finding themselves harming themselves and in this case suiciding. what what is um what is has been done that is new that responds to the reality these people are younger these people are disengaged uh people aren't picking this up earlier >> they're not intersecting with the places where you might be able to intervene
>> so if you looked at and this is probably from again from a just from a particular mental health point of view things you know if you look from probably from back there culture care connect would be new so there are new programs that have come in at scale that's probably about $20 million a year that started probably around about that time from memory some sort of probably about that period um that that came in that are new and different um there probably some other initiatives sort of that float smaller ones around that and then I think obviously the growth of the centers that I talked about and um the low inensity services will provide you know general access I think you could kind of probably make a reasonable case also that the sort of increased funding and trying to kind of lift the say I'm not sure if my colleagues here but the funding around the ainal community controlled health services is a particular connection point particularly around school attendance in you know particular when you get into regional remote where that can be even more challenging often that is a sort of key interface point um and so increasing resourcing for those um sort of more holistic services that work for it sort of helps because they all you know have social emotional well as you well as you know you know social emotional well-being from an ainal wellbeing point of view is wrapped up into broader health So it sort of tends to the more we can lift all of those services overall then that you know that that increase in funding for that sector over that period is probably in place and then there has been some through the national indigenous Australians agency some increases in funding I think for the social emotional well-being program as well.
>> So I'm wanting to understand um 24.7 million was committed for 2526. Can you tell me I'm interested to understand the breakdown between the funding that's actually committed and the amount that actually gets to frontline community control providers versus administrative overhead versus um that money?
>> So there would not be much you know overhead from a kind of you know departmental point of view. The money I think that probably from the off the top of my head I assume that's probably referring to an extension of funding for Culture Care Connect. that funding runs through to, you know, to Nacho for them to deliver. I would need to go back to the grant of goods and find those sorts of things. Um, for for that um in there would be the predominant aspect of that money. we would probably have to go back and look at that to work it out specifically and it would vary um from service to service as it always does
>> because the what I've got in front of me here talks about 24.7 million over four years for first nation social emotional wellbeing but isn't very specific about the program that
>> no and which document that probably I should check which do
>> the productivity commissions
>> oh okay right so yes we'll chase that that there's quite a few figures and quite a few programs around so knowing where that is if you can do you have a page reference there just out of interest.
>> Yes, that's there's a reference on page seven. There's also
>> Okay, that if it's on page seven and that amount of money, that'll give us enough to be able to chase that back to what that is and we can try and get you as much information that as we can.
>> Thank you. That would be great. Um, thank you. I have a question now that relates to governance bit similar to the issues I raised um last time and it's uh specific to ainal community controlled health services given that's the area I'm here talking about
senator little just um wanting to get a sense of how much time you need in these
another 10 minutes on how long the Keep going. want to rotate. I'll come back. Thank Thank you. Hello. Um, last time we were in here, I was asking questions about uh, YAU Health and Canal as two examples of ainal community controlled health organizations where some issues had been raised about self-reporting and um, management of matters of conflict of interest. I'm wanting to understand um if the department has any or is planning to do anything in addition to that to identify in their due diligence some of those um matters of governance in relation to funding going to those
>> from secretary strategy and first nations group can I clarify the question is that in relation to those particular organizations or more broadly
>> uh no I'm talking generally But I'm raising those two as as examples that I
>> So the so the arrangements continue in terms of the the [clears throat] through through the the grants hub through the but they are monitoring the grant agreements and monitoring the the arrangements we have in place for the funding of those organizations. that's continuing where we do have um where concerns are raised um either directly with the with the hub or with with ourselves or through ministers or through the media. We will we will always respond to those and then that's when we would think about what that what that response should be. Is that um place um in administration? Is it in relation to um the the different things that we can do to try and get them back on track?
>> Right. Okay. It's more into what you're doing to make sure that when there are administrative issues, you're intervening early to ask questions about what's going on and what you're doing with the complaints that are coming in in relation to them.
>> So, so I can assure you when we when we do we we do act on them straight away as as as I said, we do try and what we're trying to do is make sure that the service delivery continues and that we respond to to any concern. Um but in terms of the the general monitoring, anything else to add?
>> Um sorry, Ben Barrett, assistant secretary, First Nations Health Division. Um when we receive um tip offs or you know information through the grants or Nacho or um our other partners um we do take a risk basis based approach to how we move forward with those. So sometimes we will if warranted we'll reach out to the organization and ask them to show cause uh sometimes we'll you know work with Nacho or some of the other affiliates. Uh it really does depend on the nature of the information that we receive.
>> Okay. Want to ask about underspends which is um an underspend against whatever it was people argued in the grant they were going to deliver. So that's um uh less performance against expectations. Um can you tell me in relation to um uh Y in this example YU health um there was an underspend. Can you tell me was um the amount of underspend recovered by department of health or do you simply just let it roll over?
So I think the department as part of its standard uh grant agreements does allow for an automatic rollover up to a certain percentage. Uh I don't have that percentage off the top of my head. I'm sure we can get it for you. Uh and for amounts more than that um organizations can ask to undertake um specific pieces of work or projects with those under spend. So it's on a case by case basis.
Does that mean that option is not available if somebody is in administration? If there are complaints against that organization or is that not a consideration as to whether you give them any whether you allow them to retain those funds?
>> Um I I don't know whether that we have a rule, but I would imagine um if it was less than the threshold, it would automatically be rolled over.
What I'm trying to ask you is if there are issues in an organization that have been raised either publicly because that's how we found out about the last ones or that you have sent stuff. Is there an option at all for the rollover of unspent funds in those organizations? I don't care which organization it is. I just want to know is there a rule that says you won't just let them roll over if there are questions that probably should be examined more closely.
So if an organization um has been placed under grant administration um our trustee would hold that money and so the organization wouldn't actually have access to that money um and we would still handle any uh under spend on a case by case basis.
>> So you're telling me that you protect taxpayer funds by not allowing that roll over to occur in organizations where they're just wanting to ask uh Canal Ainal Health Service, can you provide an update on the audit that was done where that's actually at currently and if there are any findings that are
>> Um the forensic audit is with our internal um investigation branch um still and we we're not able to receive or provide any findings at this time.
>> Okay. When are you expecting that to be
Uh, it's hard to say. It could take um well, it's hard to say. We're not sure
Okay. So, we'll just keep asking about did you do I I sort of asked this last time but um are you getting I'm getting some intel from those areas around uh do uh New South Wales um about people who as a consequence of that particular health service missing appointments um not being able to access a dentist. Are you doing any work at all to understand the health impacts of the governance situation that those organizations found themselves in?
>> Yeah, so with Canel specifically um we understand that there was an average of two GPS on at all times leading up to the grand ad administration being um put in place and uh I think the dental program uh we're not we don't fund the dental program. So while there may have been dips in service, it wouldn't have been due to um anything that we have control over. >> I think they funded themselves actually.
>> Okay. Just got a couple of questions about chronic disease management if um the right people maybe
>> first.
>> Yes, this is all first. This is all indigenous Australians. >> Thank you. Um the data from the close the gap annual compilation report shows a clear decrease in indigenous people accessing chronic disease management plans. Can you give us an idea um have you done any work to understand what's actually happening there because that would signal an inability to capture people early if they're on the pathway
>> so I think that um in relation to the chronic disease management plans um I'd probably be best supported by um people that would probably be here in outcome too in relation to the MDS >> y Um but in so they will be able to tell us in terms of the uptake but I would say in general terms that that not that we wouldn't necessarily um they wouldn't necessarily have that assessment always through a chronic disease management plan or it could be through other consultations and with some of the reforms it might mean that they're using some of the longer consultations rather than some of the management plans but I I'm probably not the best person to talk to that uh we might be better off talking about that under outcome too which isn't until tomorrow but we can we can see what we can see
>> um and also would it be outcome too that I ask a question about the um number of people who actually start a plan and therefore the doctor bills for that plan and then don't continue on that plan?
>> Yes, it would. I'm not sure whether or not the data can be break broken down in that way but I will definitely have put
you on notice that that would be a question that I'll be asking. Um, last couple of questions. Um, I'm interested in the proportion of indigenous children with a medically diagnosed special need. It's jumped from 6.4 to 10.7 according to the CTG annual data report. I'm I'm interested to understand whether that's an increase in um as a consequence of actual need better reporting or um a failure of early
>> So I don't have that analysis and I don't know if we've actually done that analysis yet um Senator so if you're happy for me to take that on notice.
>> Right. Right. So if you can also consider this in that same report because the close the gap report's been out for a little while now. Um can you or have you looked at why it is the proportion of indigenous children assessed as developmentally on track has declined in every jurisdiction except Victoria and Queensland.
>> So I think I'll need to take that one on
the um close the gap annual data compilation report also uh talked about the department uh failing to commence genuine transformative work. How is the work that you're doing consider? Would you reject that from the productivity commission because they say there is no measurement for the implementation of priority reforms?
>> Senator Melinda Turner, first assistant secretary, first nations health division. Uh the department um has a lot of um I guess governance programs in place where um we are looking at um in particular the transition of um of funding to ainal community controlled health organizations and we have a specific group that is um set up um with our sector um to look at programs across the whole department uh and determine what programs transition over to ainal community controlled health organizations. Um so that is one governance group that we have in place. Um the other governance group that we have in place is um the um first nations health governance group. Um that is um a group that's been set up to really hold the the the department to account but for also to hold the sector to account in terms of how we are achieving the closing the gap outcomes and how we are going to uh work more closely together in that genuine partnership to to make that happen. Um, an example of that is the national health reform agreement where um with schedule B um we really we really did work very closely together with states and territories um and um and with the sector on what that schedule will look like um going forward and and how we will address particularly uh racism within within the sector um in hospitals. But again, it's that that real um I think we've we've really uh solidified a few governance groups now that are looking at particular areas under the closing the gap um to give life to the priority reforms. We also has have a closing the gap steering committee which is our internal steering committee um which we have our um our uh SCES executives sit on um and through that steering committee um we we analyze things like our um reconciliation action plan um our workforce um and things like that and that um again looks at the priority reforms and how we're giving life to that across across the department. Um I think it's it's fair to say um we we have made a lot of roads into uh addressing those priority reforms um in particular um our work with the sector but we we still acknowledge we have a fair way to go in terms of um in terms of addressing all
those issues. Can I just add one thing, Senator? That First Nations Governance Group, which I co-chair with Dawn Casey and um Cole Brrisco, um it's been working in the last year on an accountability framework that goes directly to this question. Um, we haven't finalized it yet because we got to a certain point that was almost final, but there was a little bit of twoing and throwing with the sector about whether it was fit for purpose and whether we've got quite the level of sort of the burden of reporting versus the actual holding people accountable. But I'm I'm hoping that we finalize that framework in the probably the first quarter of this year. And that will I think go to the question that the productivity commission is talking about about whether we're systematically monitoring our performance
>> because they're saying your data lacks conceptual logic which is a pretty interesting statement. >> So I think will it satisfy that you
>> Yeah I I think it will. So I think that the timing of the productivity commission work is they're not really informed by that work. >> We've been working on that crisp conceptual basis for the last 12 months. thought we were going to get there three months ago and then there was a slight sort of pivot and change of direction. >> Um, but I'm I'm hopeful that we will get there and and we will certainly engage with the productivity commission once we've done that to see what do you think of this framework now we've done this in a a genuine co-design way with the sector.