Senate Select Committee on Health : 29/04/2015 : Health policy, administration and expenditure (2024)

BRENNAN, Ms Lara, Community Services Regional Manager, Roper-Gulf Regional Council

CASTINE, Mr Graham Keith, Chief Executive Officer, Sunrise Health Service Aboriginal Corporation

DOWLING, Ms Carol, Treasurer, Kalano Community Association Incorporated

FLETCHER, Mr Rick, Chief Executive, Kalano Community Association Incorporated

GAZEY, Mr Peter, Health Service Manager, Binjari Health Service

SCRYMGOUR, Ms Marion, Chief Executive Officer, Wurli-Wurlinjang Health Service

Committee met at 11:45

CHAIR ( Senator O'Neill ): Good morning everyone. I declare open this public hearing of the Senate Select Committee on Health. I welcome you all here today. On behalf the committee, I would like to acknowledge the traditional owners of the lands on which we meet and pay my respects to elders both past and present. I also extend that respect to Aboriginal and Torres Strait Islander people present today. This is a public hearing and a Hansard transcript of the proceedings is being made. The hearing is also being broadcast right now through the Parliament House website.

Before the committee starts taking evidence, I remind all witnesses that, in giving evidence to the committee, they are protected by parliamentary privilege. It is unlawful for anyone to threaten or disadvantage a witness on account of evidence given to a committee. Any such action may be treated by the Senate as a contempt. It is also a contempt to give false or misleading evidence to a committee. The committee generally prefers evidence to be given in public, but, under the Senate's resolutions, witnesses have the right to request to be heard in private session. If a witness objects to answering a question, the witness should state the ground upon which the objection is taken and the committee will determine whether it will insist on an answer, having regard to the ground which is claimed. If the committee determines to insist on an answer, a witness may request that the answer be given in camera. Such a request may, of course, also be made at any other time.

I welcome everyone who has joined us today from Katherine as community members but also our witnesses who have come from a range of places to join in. This is a roundtable, so we will move to free-flowing conversation as soon as we can so that we get as broad a picture as possible of what is going on and the wisdom that you have to share with the committee. Firstly, I invite you all to make a very short opening statement of up to about two minutes, just to give us an idea of the flavour of what you do and any particular concerns that you really want to raise with the committee so that we are alert to them. Can I start with Mr Fletcher?

Mr Fletcher : The Kalano Community Association's involvement in the health sector is primarily with health related services in AOD. We manage a rehabilitation centre in Katherine and a transitional after-care facility as well.

CHAIR: Are there any particular issues that you think are important that we should be aware of?

Mr Fletcher : There are issues in relation to funding for the service that we wish to raise with the committee, and also issues around health related services relating to alcohol which we would like to raise in the discussion.

CHAIR: Thank you very much, Mr Fletcher. Ms Dowling?

Ms Dowling : I am here to support our CEO. I also just want to say up-front that at Kalano we support the AMSANT recommendations that have been tabled on the website, as they affect each and every one of us as members of the Aboriginal community, and, along with our alcohol and other drugs program, we might also raise the issue of the lack of funding around drugs, particularly with the onslaught of ice in our communities.

CHAIR: Ms Dowling, you may be aware that we did meet with AMSANT in Darwin just a couple of days ago, and we have a very full submission from them—more than 60 pages.

Ms Dowling : Yes, we have read it online.

CHAIR: Fantastic. Thank you. Ms Scrymgour?

Ms Scrymgour : Wurli-Wurlinjang is an Aboriginal community controlled health service in Katherine town. We provide both clinical—so, acute services—as well as community services to Katherine town. Also, around Katherine you have Aboriginal living areas which are serviced by Kalano. So our scope is within a 45-kilometre radius around Katherine—that is where our scope could go to.

As the chair of the Aboriginal Medical Services Alliance Northern Territory, I second what Carol was saying and the recommendations that have been put forward to the committee. I, like Rick, would like to have some discussions about alcohol and alcohol services. There are some major services—or lack of services—in terms of mental health, so it will be good to talk to Senator McLucas about that. I think that, whilst we provide comprehensive primary health care, mental health is often left off but it is an important part of that. As to child health, Wurli-Wurlinjang is also the auspicing service for the Binjari Health Service, so both Peter and I will talk in sync in terms of some of the issues that are there.

CHAIR: And, for the record, the committee has just been for a site visit to the Binjari Health Service, which was very helpful in informing our understanding of the sorts of challenges and the amazing successes in the work of the organisation. Ms Brennan?

Ms Brennan : Roper Gulf Regional Council has a similar footprint to Sunrise Health Service. So we do the local government council for the area east of Katherine. We are funded by the Northern Territory and federal governments to deliver agency services—services that normally are not provided by a council in other regions of Australia.

CHAIR: Ms Brennan, could I just ask you straight up for a clarification of the amount or relative proportionality of the funding that you receive from state and federal governments?

Ms Brennan : In total, for what I look after, for community services, it is about $4½ million, and that looks after aged care, school nutrition programs, Centrelink, broadcasting, library and creche. So my interest today is in linking health to aged care and child care. Things that I have seen are: we need to increase awareness for the mental health area, which, in aged care, is going to be an increasing burden on our current funding and the resources that we currently have. So we need education and awareness about that, not just for staff but for the whole of the community. Also, my interest today is on alcohol and other drugs, especially the new drugs such as ice. The main thing I would like to talk about today is visits by the department of health and that to remote areas, so when, say, a plane is cancelled or whatever, we do not get that service again for another six weeks. That impacts on our service delivery.

CHAIR: Of the $4½ million that you manage, what percentage is federal government money and what percentage is state government money? Or amounts, if that is easier. Or would you like to take it on notice, Ms Brennan?

Ms Brennan : Can we take that on notice, please.

CHAIR: Absolutely. And could you let us know, as you are looking after community services, what is the budget for the whole area and. Again, could you give us a bit of a breakdown of what goes on in the different departments and how much is federal and how much is state. That would be good.

Ms Brennan : That information is available on our website with our annual reports and things like that.

CHAIR: Thank you. Then we might get a link and we will be able to find out some of that as well.

Mr Gazey : Binjari Health Service looks after the health needs of the Binjari community, situated 15 kilometres from Katherine township. Approximately 300 people reside in the community. The community itself is quite small in infrastructure and in the last 12 years has gone through ups and downs in governance and management. At the moment the Binjari Community Aboriginal Corporation is more the deciding body of what is happening in the community, and they are starting to get more funds coming back. The health service initially was funded through the Binjari Community Government Council and, as has been said, it is now auspiced by Wurli-Wurlinjang.

The main concern that I think needs to be raised is the uniqueness of the area of the Northern Territory, and that as close as 15 kilometres from a town we are dealing with issues that you would normally see 450 kilometres away. The lack of dental services and the availability of follow-on services once problems have been detected and the amount of time it takes to do that follow-up is another of the concerns that I think we will raise. The other is the reduction in funding for preventative or health promotion, which I think is a very important part of delivering to the community.

CHAIR: Mr Gazey, when you said 'issues' you immediately went to speak to dental care and service provision. In terms of issues, do the types of health challenges that you are confronting in that community reflect communities around the rest of the Northern Territory?

Mr Gazey : Yes, I think the issues we would face are relevant to other remote areas across the Territory.

CHAIR: Would you like to indicate what they are?

Mr Gazey : Our anaemia rate is higher—

CHAIR: Yes, exactly. Can you take us through a list of what are those issues that you confront in that community, 15 kilometres from Katherine.

Mr Gazey : Childhood anaemia, diabetes, alcohol, substance abuse, kidney disease, cardiac problems. I think that is probably mostly it. And oral health and ears. With eye health we do not have a big problem. We have good screening at the moment for eye health; we have got visiting optometrists and so they are being followed up. So we do not see that as a major problem for us. It may be elsewhere, though.

CHAIR: We have had some evidence to say that scabies and preventable illnesses that require a high level of antibiotic response are a big problem across the Northern Territory. Is that an issue for you in your community?

Mr Gazey : Yes, we have outbreaks of scabies; we have skin conditions that relate more to housing issues, overcrowding issues, in the communities.

CHAIR: We will have some more questions, but thank you for the clarifications there.'

Mr Castine : Sunrise Health Service is a community-controlled Aboriginal health service which, whilst its headquarters are based in Katherine, the work is to the east of Katherine in the region bounded by in the north-east by Bulman and in the south-east by the Ngukurr communities. I would like to leave with the secretariat a couple of documents—the annual report from last year and the policy document we call The Sunrise Way, which will give a clear idea of the types of programs we run and the cultural interface of the staff of Sunrise working with the Aboriginal community and health workers and so forth.

I have listened to what the other people have said, and the issues facing them very much we are faced with as well. Emerging medical or health issues which require constant attention are things that relate to chronic disease, anaemia, birth weights, men's health in particular, postnatal treatments, getting on top of health checks and diabetes. They are the half-a-dozen or so that are at the top of the list. There are plenty of others.

We receive our recurrent primary health care program funds from the Commonwealth Department of Health and the Northern Territory Department of Health, to the tune of approximately $5 million from the Commonwealth and just on $4 million from the Territory government. That is for our recurrent programs. We have a lot of other money coming in—approximately another $4 million that is from what I call one-off or fenced programs from other minor players. The other biggest player funding-wise, outside of the two governments, is funding we get for population health programs from NTML. Their contribution is quite substantial.

The factors in communities where we work that address health—whilst our outcomes are pretty good and our contact is fairly high, the level of health is sort of plateauing because of some of the things that Peter has mentioned: overcrowded housing, education and jobs, the ability of the community to pay for nutritional food through stores and so forth. Those social determinant factors very much need to be addressed by other arms of the business, I suppose.

I mentioned funding from NTML. They facilitate our ability to address child mental health, chronic disease, social and emotional wellbeing and substance abuse, to a lesser extent. I mention substance abuse in line with what Marion, Peter, Rick and Carol have been talking about. Grog and other substance abuse unfortunately is a detriment to good health, and the funding and material directed to it is very low. In Sunrise's case, we have never had any money for alcohol and other drugs purposes to address those issues. The committee would understand the processes of government funding. We are always nearly there and then the emphasis changes, a new program eventuates and we go back to the bottom of the pile and we have got to build up again. We are hoping that, with all this talk on ice and ganja and so forth, we are not far off the top again, but we address those things we can through mental health programs and so forth and social and emotional.

No-one has mentioned suicide. That is an outcome of a whole range of things, I suppose, but also disempowerment. The people that live in these communities are not really in control of the decision-making process, no matter what the policies talk about and so forth. People have been displaced. We have unfortunately got two or three communities where—I will not say it happens every day—quite often it rears its head, in attempted suicides and so forth, through a whole range of stuff.

So there are all of those sorts of good things and things still to be addressed.

CHAIR: I might just stop you there for the moment, because we have got more conversation to be had. I note for the record that there was much head nodding going on as Mr Castine articulated that sort of rounder vision of things and the interconnectedness that is part of where the problems continue to lie. I note Mr Castine and Mr Gazey have some documents that they would like to provide for the committee. Senator Cameron might move that these be tabled.

Senator CAMERON: I move that.

CHAIR: There being no objection, it is so resolved. I am going to go straight to Senator McLucas for some questions.

Senator McLUCAS: Can we start by just having a broader conversation about mental health services, including the interface with alcohol and other drugs? In terms of the programs that are available and funded in the region for mental health at the moment, can you give me an understanding of what there is and what gaps there are?

Ms Scrymgour : Who wants to start? Graham or me, or will we start from Katherine town and then work out, or do you want to start from the region and come in? We could do it either way, Jan.

Mr Castine : Ladies first.

Ms Scrymgour : I thought you were going to say: 'Age before beauty.'

Mr Castine : The resources that are available, whilst they are expert in their own right, are very scant, and immediate access to those services is not as immediate as you might hope. We have relationships with Royal Melbourne Institute of Technology and Neami, a service, which I think is based in Sydney, which we engaged to bring in mental health. There is limited access to the Northern Territory government mental health services and so forth. Likewise, ready access and on-the-spot access to specialists is fairly scant as well. There is a lot of travel involved with getting clients and patients to come in. Regarding alcohol and other drugs, as distinct from alcohol, whilst the Northern Territory government has a mental health unit here in town and they do what they can to get people out to the areas or communities, it is only two or three visits per community per year. Those visits are coordinated or negotiated with our people so there is a knowledge of who is in the area. But follow-up work, resource-wise, is not ideal. You cannot get the same service out there as you get in a town.

Ms Scrymgour : Just following on from what Graham was saying, you do not even have to be in the bush not to get access to good mental health services. I think that they are wanting, even on the ground in places like Katherine. For Wurli Wurlinjang Health Service, we have now just built our capacity to one full-time psychologist, two mental health specialist nurses and two social and emotional wellbeing workers. They service the Katherine town and those town camps. We are trying to work with the department to try and look at how that resource then works with the department to pick up the capacity that is needed right through the region because a lot of people from the regions come to Katherine and a lot of that transient population will come to Wurli. Most of the patients from both the Katherine West and Katherine East regions come to Wurli. So we will pick up those clients. It is then about servicing those clients. If they go back to their communities, if they return back home, there is that breakdown. The policy and the resources never come together. When Nicola Roxon was health minister there was a fantastic framework, an emotional social wellbeing framework, that Labor brought in. That framework, whilst fantastic and fitting within the parameters of what Aboriginal medical services provide, needed the resources to follow, and that is where we get when we have the problems. It is not just getting the people. It is hard to try and recruit the clinicians that you need to deal with this problem too.

Senator McLUCAS: In terms of federally funded programs, have you got a Partners in Recovery program operating in the Katherine area?

Ms Scrymgour : On the Partners in Recovery program, the disgrace that happened in this region was that nearly $2 million was allocated to a non-government organisation. There was no rhyme or reason why that funding was given to this other NGO that was not in the business of providing health or community services. It was completely separate to any discussion with the health sector. That non-government organisation has since come to Wurli to have some discussions about how we might be able to work together to roll out that program. Again, the approach to the resourcing is just all over the place. There is no working with the organisations on the ground to look at that need and then to fund accordingly for that need.

Senator McLUCAS: In terms of the Partners in Recovery program then, are any services being provided now through the other NGO?

Ms Scrymgour : From what I could gather, that has not got off the ground. They are now talking to us to try to see if we could assist with getting that off the ground, but we have lost nearly 12 months of that funding. They said that they only got that funding 12 month ago, but we have lost nearly 12 months where communities have been screaming for things—particularly when you look at some of the town camps and people with mental health illnesses living in some of the areas that Kalano looks after. On that Partners in Recovery program, a lot of those residents would fit within that stream or the criteria under Partners in Recovery.

Ms Dowling : We have an alcohol rehabilitation facility south of town. We know that most of our clients not only have an alcohol health issue but also come to us with a comorbidity. It is really difficult to address the mental health side of it when we are struggling to deal with the alcohol side of it. Whilst our case managers work extremely hard, it is very difficult when you are dealing with a comorbidity situation.

Senator McLUCAS: Who funds that program?

Mr Fletcher : Our program is funded by the Department of Health under the substance use program. However, it is now shifting to the Department of Prime Minister and Cabinet under the Indigenous Advancement Strategy, which is a concern to us.

Senator McLUCAS: When you say that it is shifting, has it not already shifted?

Mr Fletcher : No, we have a contract until 30 June.

Senator McLUCAS: Then it is going across to PM&C.

Ms Dowling : Yes, the Indigenous Advancement Strategy.

Senator McLUCAS: Are you funded under the Indigenous Advancement Strategy essentially for your recurrent funding?

Mr Fletcher : We will be from 1 July.

Senator McLUCAS: Can I just ask a couple of questions around that? On the money that you would have applied for under the IAS, did you receive the full amount of what you applied for?

Mr Fletcher : No, we did not. We are in negotiation. Our issue that we want to table today is that the service is funded on treatment beds. We are a residential treatment facility. That number of beds is inadequate to treat the number of people who are seeking to access our service. The funding has remained static over the last eight years, bar some CPI increases. It is nowhere near the amount of funding that is needed to address the issue. We work in partnership with the territory government as well, so the federal government funding is for 20 treatment beds and the territory government funds us for an equal number of beds.

However, they continue to experiment with alcohol policy and continue to experiment with the type of client that they refer to our treatment facility. There are gaps in the funding we receive from them to provide continuity of service. The treatment that we provide is inadequate for the demand for our service. At the moment, I would have to say that the federal government are asleep at the wheel on this. Simply, there is not enough funding directed to treat people with alcohol addiction. Very little is done from the government's point of view on the supply issue with alcohol. We know that ice is on the increase and I am hoping that the government will address that at the source before it gets to too much demand. However, we still have this overwhelming demand for alcohol treatment.

Ms Dowling : We have the added issue around the high number of different cultures and languages that we are also working with, because we are a regional hub and we have people coming from even across the borders—from Western Australia and Queensland—who have ended up here as well in seeking help. That puts another burden of pressure on as well.

Senator McLUCAS: Can I ask you a direct question, and you may not be able to answer this one yet: how much did you receive from the federal government for 20 beds last financial year? I think you are still in negotiations around the quantum for the next financial year?

Mr Fletcher : I am not sure of the exact number. It was just over $1 million for those 20 beds, which gives us capacity to treat 80 people in a year. We run an 84-day program. The maximum that we can treat is 80 people. We assess admissions of between 140 and 150 people a year. We keep 15 people on our waiting list and give them bed dates for when a bed is available, so there are no gaps. However, the number of people who are seeking our treatments is far in excess of what we can provide.

Senator McLUCAS: It is almost double what you can provide.

Mr Fletcher : Yes.

Ms Dowling : We are also already having people knocking on the door and seeking help for their ice addiction and other substance abuse addictions as well.

Mr Fletcher : It is getting alarming.

Senator PERIS: On the 20 beds that you get funded for from the federal government, that funding has now gone over to IAS?

Ms Dowling : Yes.

Senator PERIS: Has the Northern Territory's alcohol policy of mandatory rehab added extra pressure on your service delivery?

Mr Fletcher : If I could be frank, the territory government have funded their alcohol mandatory treatment program at the expense of residential treatment beds: they took 12 beds away from us and they gave us 12 beds back on the expectation that they would remain full for the entire year. It has not even got close to that. We have actually wasted treatment beds throughout the last financial year on an experiment that the territory government is still in.

Senator McLUCAS: On that take 12 beds away and put 12 beds back, can you explain that?

Senator PERIS: Can you explain the situation of the NT's mandatory treatment policy?

Mr Fletcher : Our facility is funded for 20 treatment beds from the federal government and 20 treatment beds that we have negotiated with the territory government over the last five years. Those 20 beds that are funded by the territory government are funded under their residential alcohol treatment program. This financial year, they decided to reduce the number of beds funded from their alcohol treatment program and offer us money for 12 beds under the alcohol mandatory treatment program, upon which they would refer people to our service once they had been through the government's process to identify a person under the alcohol mandatory treatment program. The number of people that they expected to refer to us did not meet their target at all, and we see it as being a waste of our time.

CHAIR: Mr Fletcher, if you could also explain for the committee the NT government's recruitment process. In your situation, people would come to you. They were self-referred. Can you explain for the committee the other way that did not work.

Mr Fletcher : The clients that the Territory government are seeking to refer to us are mandated under our alcohol mandatory treatment policy. I do not understand the intricacies of that. I cannot explain that to you.

CHAIR: Are they identified through the court processes?

Ms Scrymgour : Yes. It would be three strikes and you are out. If you were picked up three times by the police—you had to be picked up by the police on the street or you became, under the Police Administration Act, in the custody of the police—rather than being taken to Kalano as such, they set up what they call the mandatory treatment servicing centre at the hospital. A lot of the Aboriginal people who were picked up were taken to the hospital. They would then do an intake in terms of the normal intake that you do when the person was in police custody. When we were having discussions at Wurli with the hospital system, what they found was that, for most of the Aboriginal people who were being taken to the mandatory treatment centre at the hospital, their English was their third or fourth language. The biggest issue under the legislation was that they had to give informed consent as they were going through. A lot of people did not understand the process that the doctors and the nurses were going through, so they could not give their informed consent, and they had to release them.

I suppose the policy did not quite meet the requirements of what the government wanted in terms of trying to get people mandated. When they mandated the beds at Kalano, that then caused was a problem for us, because we run an AOD program. We have clients, and we work with a lot of people in the community, who then wanted to make a decision to voluntarily give up alcohol and go into treatment services. We then could not refer those clients to Kalano because Kalano was then forced into a position that those beds could only be used by mandated clients. We had to send our clients to Darwin and some to Alice Springs, or they ended up back on the streets. We all know that when someone has made a decision to give up drinking we have that window of opportunity. You grab that person and you try and get them into the door and into treatment services. They forced Kalano into this, and it created quite a problem in the region. Despite lobbying by both Kalano and ourselves to try and deal with this, the only money and avenue open was that you either agreed to mandatory treatment or you did not. There are many Aboriginal people in this town, or in the town camps, that have wanted to give up drinking, but there are no places. There is a huge problem in Katherine town, for the region, in terms of trying to find treatment services so that we can get people into those services—and this is for adults let alone kids. If we talk about young people, youth services are simply stretched to the limit, and we do not have the appropriate drug and alcohol services dealing with the youth in this town.

Senator McLUCAS: That conversation has been very valuable. Back to mental health, do you have a PHaMs, Personal Helpers and Mentors, program here?

Ms Scrymgour : Red Cross gets funded for PHaMs.

Senator McLUCAS: What about ATAPS?

Ms Scrymgour : Wurli gets some funding for ATAPS, but it is fraught with some issues. We have been trying to work through with the NTML to try to get ATAPS and access ATAPS in a better way so that the health service can get that funding. But it is there.

Mr Gazey : On the PHaMs program, we have had interaction with the Red Cross through that. The problem we have is that you need to have the diagnosis of the client before they can assist, which is quite hard to get if you do not have the service to be able to get the diagnosis.

Senator McLUCAS: Does that have to be through a psychiatrist?

Mr Gazey : I believe so.

Senator McLUCAS: You do not have a local psychiatrist in town?

CHAIR: There's one.

Mr Gazey : It depends on the month: people come and go with all services in Katherine. Sometimes we have the service and sometimes we don't. It depends on people's movements.

Senator McLUCAS: Thanks for that, it gives me an understanding of what is here and funded. What is the structure, if any, that sits across the top of those services, including NT Mental Health, that is the coordination structure? Is there something that makes everyone know who is going to what service and how we can service a population of people who have mental illness? Is there something that coordinates that?

Mr Castine : Sunrise has a PHaMs program, but only at Ngukurr, which is a community right over in the east of about 1,300 people. We have only just started that program, in this financial year. You are asking about a body that might coordinate stuff. We basically do that ourselves through our clinic and health centre structures and the coordinators, or health workers, who work in that part of the area. I mentioned Royal Melbourne Institute of Technology and a group of mental health workers in Sydney. We contract them to do a range of work. As you might note, when you read The Sunrise Way, for a service like ours, which is regional across a whole range of country and people, it is best that the coordination is left at the level where it is most effective. We try to make sure that happens on site.

Senator McLUCAS: You are probably at a bit of an advantage here, Mr Castine, because there are not so many players in the field, so it makes it easier.

Mr Castine : That might be part of it. The only think I will say about PHaMs and services like it which are funded by various government departments is that not so long ago, when it was favourable to have growth towns and stuff, and Ngukurr was one of those, they targeted that community piecemeal as distinct from the whole Sunrise region. That is a point we have made. I heard IAS mentioned a few times. We have petrol-sniffing programs that are based on locality 1 or locality 2, rather than across the whole Sunrise region. That is a moot point for us, because petrol sniffing and drug abuse are not just at Ngukurr or Beswick or somewhere else: they are right across. Services like mental health services need to be able to be in a position to react when something happens.

CHAIR: Thank you. Ms Brennan?

Ms Brennan : With mental health, I do think that it has been coupled with age and disability care for the last couple of years and generations and that slowly it has been given its own title, with the increased need and identification of mental health issues. I see that, with mental health, we are in the development stage of this program. I do not think that we have referral. We can give a referral—that is what we would do in a normal urban setting, where we have a suite of services—but that clinician is not going to come out for another six weeks. The person that is assessing them, if they come from Melbourne or Sydney, knows that, there, there would be all these other agencies that could provide support to this person. But, as we said, we have this short window to address these needs when the client comes to the door and is willing to take on these services or can be referred by somebody. That is one point. So I see it as being in the development or identification stage. I do not think we actually have a range of services to support mental illness.

Looking at your terms of reference, as to the impact of reduced Commonwealth funding for health promotion: we know that mental illness is impacted a lot by smoking and nutrition—and there are all these things that can help—and also by housing and all these things that we mentioned today. So the reduction in funding for health promotion will impact on that and increase our identified numbers of mental health cases. Then, also, as to the IAS funding, we actually did not receive funding for youth and communities, on which we have programs rolling out in Borroloola, Ngukurr and Numbulwar, which are our larger communities and are where this issue has been identified as impacting on young Indigenous males. So, even though it is used in communities, it is actually a lot to do with mental health or illness, and then the impact of that or the result of that will be deaths of young males by suicide.

Senator McLUCAS: As to the IAS funding, were they programs that the council was previously funded for?

Ms Brennan : We are reapplying. We have been informed that we were not successful, but we have reapplied to the Department of the Prime Minister and Cabinet.

Senator McLUCAS: Were you invited to reapply?

Ms Brennan : I guess we might have been—I am not sure, sorry; that is not my department. But I think we submitted an application.

Senator McLUCAS: Okay. Thanks very much, all of you.

CHAIR: Before I go to Senator Peris, can I just ask you, Ms Brennan, to expand briefly on what you just said about the IAS funding, as to the programs that you were running out, the badging of those programs that no longer meets the IAS requirement, and your certainty, as a clinician and a worker in this area, that a failure to fund these programs will lead to the deaths of young Aboriginal men. Can you just explain that complex set of elements? You have just said it in a couple of sentences, but, when you finish with 'and this will lead to the deaths of young Aboriginal men', I think it needs a bit more.

Ms Brennan : Sure. The statistics for suicide in our region indicate that the people who are most affected are young Indigenous males. In our communities the average age is 16 to 23, so we are looking at a youthful community. With all the impacts in our communities of housing, education, smoking, drugs, alcohol and the lack of employment opportunities, all these things lead to people, when they are bored, turning to recreational use of drugs. Borroloola, for example, is a township, so alcohol is allowed. There is lots of violence—domestic violence. The police are very busy there. We have seen, as a result of this, a high incidence of people turning to the youth and communities program—this is one of our busiest towns for the youth and communities program—and we have seen, in this area, high numbers of male suicides. So there has been the loss of this funding, and I am sure that it has been given to another program, another agency or another organisation to roll out, but then—this was talked about previously—that organisation has to get off the ground again, and there is another year wasted and another two or three lives that have passed in the meantime.

So I think we do a good job there, and I am advocating for programs like youth and communities to continue.

CHAIR: One of the arguments being advanced for why there should be competition between different agencies is we are not getting good value for our money if we just keep giving it to the people who are on the ground with the connections. We should make them fight for this money. They are probably getting too much anyway. We are hearing that. The ideal of competition is creating a context where people who know and have community connections are not counted at all in the process going forward. We have heard here today about a non-government organisation with money sitting in the bank on paper in a competitive tender process looking like they might be the ones to deliver, but ultimately that money is still sitting in the bank and the resources are not going to the people who need it. Is that what it is turning out to be in a nutshell?

Ms Brennan : Yes. It is a business, so you need to be able to start the day you get the funding. We have all been subject to funding rounds, when they stop, when they start, when you get notified and all that sort of stuff. We know that is the way it goes. But, if someone is new to the business, they need start-up time. Whether they promise that during the funding application or whether they have the ability to start as a business on day 1 is something else. We have seen it with RJCP. We have seen it with different fundings that we have had introduced.

CHAIR: And that is not a requirement that they have to prove in that competitive tender process, is it?

Ms Brennan : You do have to demonstrate that you have the capacity, yes.

CHAIR: So you are telling me that they might have been able to demonstrate that they have the capacity in a submission but in reality—

Ms Brennan : things take time.

CHAIR: What kind of lead time are you talking about? This is probably almost nine months now the money has been sitting there.

Ms Brennan : I would say four months. If you have an established organisation that already has a footprint in the community or already is delivering services, it is more likely they will be more successful quickly than getting a new organisation to come in. They have to rent a building, they have to build rapport with clients and stakeholders. You are starting from scratch again.

CHAIR: Which is Mr Castine's comment earlier.

Mr Castine : The discussion is very interesting. Some Commonwealth departments break their funding up into start-up grants and then ongoing, recurrent and operational. If that could be translated into an IAS, that would overcome some of the issues you are talking about.

CHAIR: So what you are saying is the IAS is not using those elements in the requirements for people to put forward a submission. The money is not being broken up into start-up or recurrent; it is just a block load of funding?

Mr Castine : I am saying that is what the Department of Social Services does. I do not think IAS does it. That gives the capacity for these non-Indigenous big national organisations to come in with, as you say, money in the bank from somewhere. We have money in the bank too, but it is tied and cannot be touched for other programs. It gives them a financial advantage of the Indigenous organisations that in the same sense are struggling but certainly have the capacity, the knowledge and the expertise to do the job.

CHAIR: Thank you.

Ms Scrymgour : There has been very little—well, no—feedback to the organisations either. Where we were delivering a program and then that funding was removed, there has been little or no discussion as to the rationale or justification for removing that funding. We are talking about, in a lot of these programs, Aboriginal people. One of the main points under the IAS was jobs for Aboriginal people. If you look across this region and a lot of the funding under the IAS, a lot of Aboriginal people have actually lost their jobs and lost them because the funding which was previously under health transferred across to the IAS process and Prime Minister and Cabinet and because of this furphy that competition is needed in this sector. We are not a job company or a business; we are trying to fix the sickest people on the ground in these communities. We are well established. We have the networks and the staff like Roper-Gulf, like Sunrise, like Katherine West, Kalano and all of us, and yet there have been massive—and we are a major employer. If you were to add the population of Katherine and the number of people who reside in the Katherine region, the majority of those people would be in the health and community services sector. We are a major employer, and that process has actually created a lot of unnecessary division, because we should all be able to work together to try to deal with stuff.

CHAIR: Thank you. Senator Peris.

Senator PERIS: Ms Brennan, how much funding do you ask from the IAS for that program?

Ms Brennan : Youth and communities is not a program that I manage; but, from what I can recall, I think it is about $1 million. It is on our website.

Senator PERIS: What was the outreach? How many youths came through that program?

Ms Brennan : I would have to refer you to the annual report. I am sorry.

Senator PERIS: Okay. So it is all on the annual report document?

Ms Brennan : Yes. It is not something I manage. It is just that, when we talked about IAS, I was like, 'I've got to advocate for youth and communities.'

Senator PERIS: Okay. This is probably a question to Ms Scrymgour in your capacity as the CEO of Wurli-Wurlinjang but also as a former minister. Over the last couple of days we have heard from witnesses talking about people being traumatised through intergenerational trauma. What are the hopes and aspirations? How do they become empowered to be part of society? Given the high level of youth, what is the time line of an Aboriginal person here in Katherine from birth? Where do they end up? How can they be part of society? It is a pretty broad question, but we heard from Dr Brown saying the other that 60 to 70 per cent of presentations at the RDH are Aboriginal and, if you are not investing in the primary health sector, they are all going to end up there. We heard from Mr Gazey today talking about Aboriginal people moving into the RDH, and we all know that is busting at the seams at the moment. What is the snapshot of Aboriginal health and the opportunities? How do we become well people? It is a big question.

Ms Scrymgour : That is a big task!

CHAIR: You're going to answer it in the next five minutes!

Ms Scrymgour : I would like to continue this conversation. I think that, if you look at the Closing the Gap targets and the trajectory of where we were and where we are going, the investment which was started—and I will try not to get too political here, having been in parliament previously—with the Labor government helped to close the gap. It needed a lot of investment, and that is what the Labor government did. There was a lot of investment put into trying to increase the longevity from birth and address, particularly amongst men, the ratio of life span from male to female. There were a lot of resources, and a lot came through with the intervention as well. Good or bad, a lot of that resource found its way into the health and community services sector. There were a number of services that were stretched, so that funding helped.

As I understand it, the last Closing the Gap report showed that the gap was getting wider and we were not doing as well as we could. But, if you take from that data and look at the Northern Territory, that gap is still on track. If we keep the investment there, we will close that gap, but it will take another generation. We need to keep the investment in health, but the biggest investment needs to be made in education. I used to glaze over even when I was in parliament, but we need jobs. I think employment, economic development and all of those things are important ingredients on the ground to make people feel good. If you are working, you feel good. You are earning a living. But, unless we target and we put that same investment into education, we are going to lose another generation. We have to get our kids into school. We have to target education. Ministers say we are back on track and getting kids to school. But the infrastructure in some of those bush schools—and you would have seen them—is appalling. And we expect kids to get up at eight o'clock in the morning, go to school, learn in those dilapidated buildings and then go home to an overcrowded house.

The primary health care sector is complex. You can put as much money as you like into hospitals but if you are not investing in the primary healthcare sector you we are going to be continually pouring money into hospitals. That is not good. You need both. You cannot have one without the other. This region is home to the three biggest AMSs in the Northern Territory—Sunrise Health, Katherine West and Wurli. I like to think we all work together. We are all part of AMSANT and we work together to try and close that gap. But we are battling against the new mantra of 'competition', which has created a lot of problems for our sector. We have put it to the Commonwealth health department, to Commonwealth ministers and also to Senator Scullion that the Aboriginal health sector needs to be exempt from that applying to our sector.

Senator PERIS: Mr Paterson, from AMSANT, made it clear the other day that the whole IAS strategy was disastrous. With regard to removing money from the health bucket and putting it into the IAS, he said: 'Take it all back. Health is health. You can't have mental health here, aged care there and dementia and disability over there. It is all health.'

Ms Scrymgour : We have gone back to the body parts! That is what it is: we are treating the different body parts. We fought for so long to have one agency. I remember when ATSIC was funding health, and being part of the movement that lobbied to get funding away from that. That was not because we wanted to in any way say that the Aboriginal elected arm were not doing their job; they were just not equipped. And why should Aboriginal people not have access to mainstream funding to deal with their health? They have now cut up the body and it is in different parts. With regard to the funding that has gone to the Department of the Prime Minister and Cabinet, decisions are being made on a political whim. I do not say that lightly. There have been funding submissions that have been agreed to that make you shake your head and think, 'Why was that organisation funded and we have been defunded?' There has been a lot of that. That needs to change. Aboriginal people deserve better than the knee-jerk political reactions that happen in Canberra when something needs to happen. We are dealing with the sickest people. We see it coming through our doors every day. And youth suicide rates in the Northern Territory are 10 times the national average. In the Northern Territory young women actually outweigh young men in terms of suicide rates. We are talking about people aged 11. It is disgraceful that we are watching the suicide of 11-year-old kids in the Northern Territory and it does not hit the Richter scale anywhere.

CHAIR: Can I just draw on something you said about living conditions. Much is said about housing and overcrowding in housing. We have just done a brief tour of a site not too far from Katherine which is reflective of communities. We have heard from Senator Paris that people are living in accommodation much worse than what we have seen today. Mr Gazey, could you describe some of the housing we saw? Describe the materials it is made of, the floor surfaces that are in there, the maintenance programs and the amenity. What is going on in in there and why is it a situation in which scabies can live and many other issues as well? Put on the record what it looks like and what it is like living in it—because we only saw it from the outside.

Mr Gazey : The Binjari community is divided into the top camp and the bottom camp. The bottom camp is the lower part, the more original part near the river. The structures down there are tin sheds that are unlined. They have concrete floors. They have power. They have no running water. There is a tap outside. There is a shared ablution block, such as you would find in a caravan park, with showers and toilets—sometimes functioning, sometimes not. It is in the flood zone, so there is no development going on in that area. They are trying to move those people from the bottom area of Binjari up to the top camp, which is the newer area. In the newer area there is Colorbond housing with lined walls and open areas. It is a reasonable set up but, in the 12 years I have been there, only one new house has been built in that top area. At the rate we are going, it is going to take approximately 148 years to move up to the top camp area the 12 families that live in the bottom camp area.

CHAIR: As the director of the medical service there, what capacity do you have to tie that reality to health? How much is that considered in terms of the burden of disease that is being generated by the failure to fund housing? Do those two things talk to each other? Do you as a health worker have a pathway to do something about that?

Mr Gazey : We can advocate for more housing and about the impact that the housing situation has. But it is the conditions in the houses that impact on health. That cannot be denied. The maintenance of those buildings can be addressed. That would be a starting point. If the houses that are there were maintained to a standard, it would improve the conditions. If there were more houses, that is obviously going to improve conditions further. As for health, we do not have any control over housing or the maintenance of those buildings.

CHAIR: Ms Dowling, would you like to make some comments?

Ms Dowling : Kalano is the local Aboriginal community association that provides public housing to the local Aboriginal community. We are starved of money for repairs and maintenance. Our people have entered into a residential tenancy agreements and do pay rent. At times, families struggle, so rent gets left aside and food becomes the priority. We understand that. We do not penalise people like the public housing system might do. We know it affects our health. We have continual conversations with our Aboriginal medical service at Wurli-Wurlinjang—and Dr Bruce Hocking is sitting here. I remember quite clearly the statistics that he gave to us in the community. As I said, our own government seems to have lost interest in providing public housing.

CHAIR: The Territory government?

Ms Dowling : The Territory government, yes. But under the intervention, and still under Stronger Futures, we do not know where we are. We get threatened: 'If you don't do this, then you won't get that. 'To me it is like a land grab again: if you don't sign over your communities for town leasing, you don't get any money for your housing. I mean, what's that about? I am a taxpayer. I am an Australian. I happen to be Aboriginal. For me, that does not fly. But that is what happens. We get penalised for trying to take control of our own lives and to culturally appropriately provide the best services to our community members. That is what we are faced with. What really flew in my face here was the fact that we have not had a new house built in Kalano communities for 20 years or so—

CHAIR: So 12 years is 'a recent development' and 20 years is your reality?

Ms Dowling : but I watched a government employee's Commonwealth owned house being torn down and replaced with a new house—because it had had its 'shelf life'. This is a three bedroom brick house in the town. And yet we are still living in tin houses, as Binjari has indicated as well, that obviously do not have a shelf life. Isn't that hypocrisy?

Ms Brennan : I would also like to advocate for term of reference (d), 'the interaction between elements of the health care system, including between aged care and health care'. I think there are limited resources now, and definitely for the future, for aged care, for respite. And what happens then if respite is required for the whole of the region? Katherine is the hub for aged-care services, for respite. So if we do not have any beds here, people at Rocky Ridge or Red Cross or any of the places that facilitate respite will have to go to hospital, which takes hospital beds from people who might have a medical condition. This is going to be an increasing issue. We are already juggling with different regions for people that need to come in for respite to give their carers respite. While they are having respite, their health improves as well because they have got all the referral systems here and access to all the different services that support aged care—that are not available for mental health but are available for aged care. So I just wanted to mention the increasing issues for aged care in Katherine. Treatment and respite issues are going to increase in this region in the near future and we do not have the infrastructure or the capacity to deliver on that.

CHAIR: Do you know how many beds you currently have?

Ms Brennan : I do not have any beds. I refer people to services, but I get turned down. I cannot get respite for my clients because beds are full.

CHAIR: Do you know how many beds there are that you could refer to in the region or in Katherine?

Ms Brennan : Sorry, I cannot tell you off the top of my head.

CHAIR: We might be able to find that out.

Ms Brennan : The numbers 57 and 27 are in my head, but I do not know which is the correct one.

Ms Dowling : How many are at Rocky Ridge?

Mr Gazey : The total would be 50.

Ms Brennan : So it is 57.

Mr Gazey : We have a client who has been waiting two years for a bed.

CHAIR: That is aged-care permanent places, not respite?

Mr Gazey : Permanent places, yes.

Ms Brennan : Both will become a big issue.

CHAIR: We might be able to clarify those numbers after lunch.

Proceedings suspended from 12:59 to 13:24

CHAIR: I thank Mr Graham Castine, Mr Peter Gazey, Ms Marion Scrymgour and Ms Carol Dowling for staying with us to continue our conversation. Senator Cameron wishes to ask some questions.

Senator CAMERON: I thank everyone for their input this morning. I want to go to one of the wider debates that we have had during this hearing, not just this morning, on employment and socioeconomic issues. I think all the literature says that bad health can be quite clearly a result of low-socioeconomic opportunities. Driving in today, you see a lot of young Indigenous people—teenagers and younger school-age kids—walking around the street. I do not think you would see that in a lot of places around Australia. You would see it in some places, but not too many. How do you view this issue of the socioeconomic factors relating to health?

Mr Castine : In Katherine, in part it is not just Katherinites walking around but youth from the community at large, from regional areas and so forth. That is also indicative of what is not happening out there in the communities they originate from. The lack of meaningful jobs, meaningful employment, is I think part of the key to the answer. Each community can wear five or six per cent unemployment, but when you have got over that and there is nothing on the horizon, I think we have all tried from time to time to look at cultural factors and traditional behaviours or activities and base stuff around that, but it is still not enough for today's younger people. Like it or not—I will put my phone in my pocket—IT is the big ruler, electronic stuff. They are living in a world where, I suppose to put it bluntly, traditional authority is breaking down, caused by a whole range of evolving bright lights and technical things that it would be nice to have and so forth.

People like Roper Gulf and other industries are doing their best to get employment underway, but the economic factors are just not out there. In the Sunrise region, we had a lot of hope about mining activity—whether we like mining or not does not matter, but it is part of the discussion—and then the national/international scene closed those bodies down, so those hopes faded. I have mentioned Ngukuur before, which had two mines on its doorstep. With the infrastructure—bridges over rivers coming along and so forth—there was a lot of hope that this could lead to other activities. Yugal Mangi is the Aboriginal corporation that looks after those sorts of things at Ngukuur. It is back to square one, where it started from. It has to base any employment on things that are not economic. At Ngukurr, there is a lot of vandalism. There is a lot of work going into getting kids into school and so forth. As Marion or someone else said, the buildings are a bit dilapidated and the curriculum does not really suit the occasion and so forth. So there are a whole range of factors that need looking at. Those non-Katherinites that you see walking the street are between a rock and a hard place. They are not fitting in in their home communities, for whatever reason, and they are at a loose end in this town. You probably heard about the temporary policing outside liquor outlets. Those of us who live in the town appreciate the quiet it has brought, but there is a downside to that in that those people have just moved on to another town and carried on with that behaviour, so we have not really addressed the outcome for the individual. The policy of the Northern Territory government seems to be to move people on—out of sight out of mind.

Ms Dowling : Kalano participates in the employment market, so to speak, in that we are partners in a Remote Jobs and Communities Program, a RJCP. If you have ever had a close look at that program, you would know that it is extremely difficult. I have got several university degrees and trust me it is still really difficult to fathom the process—how you get a work activity up for job seekers to participate in. It goes on and on. There is so much approval and accountability after a while you wonder where the transparency has gone.

So we have done away with what was working for many communities in terms of the community development employment program, the CDEP. It has been replaced by the RJCP. I believe the government itself is struggling with it so there are changes being made. So we have to wait until the changes are made and those interpreting that need to understand it so they can explain it to those who are implementing it. It is a vicious circle.

Also if you have ever had to go to Centrelink to sign up for a benefit of any sort you would know that that is extremely difficult. If you have barriers, such as literacy and numeracy problems, you are behind the eight ball. If you throw in two or three other languages before English, then there is another barrier. At the employment level our staff in the RJCP do recognise that people come in with a raft of barriers and they need to try to address them. It can be really difficult.

I have been waiting four months to hear from one interstate agency about a literacy and numeracy program. I hear it is suitable and I want to know if we can buy it to transport it into communities to give our mobs a head start? It has been four months; nothing happens overnight! So you understand that people have to go to Centrelink, then get allocated to the RJCP and then get allocated a case manager—wow!

Senator CAMERON: I think there has been an analysis recently of some of this.

Ms Dowling : The point I am trying to make there is that puts further pressure on families. If young people cannot or do not go down that pathway because it is so difficult then they place further pressures on their family because they do not move out and are still in the house or they go to other family next door or whatever. The pressure does not go away. We have an understanding of the behaviours that poverty and disadvantage bring—and there is a lot of literature about that around the world around Indigenous populations et cetera—and we know what we are seeing and why we are seeing it but we feel powerless to help.

Mr Gazey : None of the people you saw walking around Binjari have jobs they could apply for. There are no jobs in Binjari that are not filled. There is a limited number and those paying positions are filled. Some of those people are on the RJCP and have done some things in the community. Some of them attend training so much that they say they are the most highly trained unemployed people. They are sick of doing the training because there are not jobs when they finish. What needs to change is recognising what skills people have and employing them for those skills. We have people who want to become health practitioners. That is a role in the community they could have except they do not meet the literacy and numeracy standards. They have still got the knowledge of the community and the ability to assist health practitioners, nurses and doctors in those roles without doing the clinical skills, but there is no avenue to employ against that criteria, there is no measure to say, 'This is the job and this is what you've got to do.' It is not recognised, so that could be something to change.

Ms Scrymgour : If I could just touch on what Carol was saying with CDEP—and I suppose I come from the old guard where CDEP was probably a program that had its fair share of problems. The baby should not have been thrown out with the bathwater. If you look at many remote Aboriginal communities, and even places like Katherine, CDEP provided the environment where enterprises could be developed through that program. There are many communities—and I am sure Senator Peris will know which one I am about to talk about—and Maningrida in western Arnhem Land is a community that used effectively the CDEP program and developed and established 25 enterprises. Those 25 enterprises not only employed the majority of the population in Maningrida but also provided enterprises on homelands for people. It was also a program that developed and established the arts industry in western Arnhem Land. Any money that was generated or came out of the CDEP program and those enterprises went back into establishing and sustaining those enterprises. You had enterprise development and people were then able to be employed through CDEP.

The RJCP was always going to be flawed. I was part of the negotiations or discussions when it was being looked at for places like Maningrida. If you go to that community today, there is not one Aboriginal person employed in those social enterprises that were established under CDEP. And the RJCP program has actually broken the back of Bawinanga Aboriginal Corporation, which was the homeland movement centre. That in itself has then meant that the level of crime and the level of dysfunction amongst those families and youth then tripled. You did not need to be a rocket scientist to see that there were going to be problems and continuing problems. I think that government needs to look at and go back to what was working and not be ashamed of saying, 'Let's go back here and let's look at what did work. Let's try and get that happening again.'

I am sure your colleague Warren Snowdon could tell you the backlash that was in the bush when Labor removed CDEP or started chipping away at it. It wasn't because people did not want change; it was because CDEP did provide people with employment. That was the whole problem: people saw that it was work for the dole. It was an employment program. Now with the RJCP, we run—Wurli is probably the only Aboriginal medical service in the Northern Territory that has an agreement with the police and the courts in Katherine where young offenders rather than being sent to jail, we have a 13-week program. We have those young offenders come to us. Part of their entry into that program is that they have to agree to a full health check. We do a full health check. They see the doctors. They then undergo counselling, anger management et cetera. We then try and sign them up with the RJCP and then that is fraught with problems. We cannot get these young people into jobs or into these employment programs and we need to get that other avenue so that they can try and get some employment.

Senator CAMERON: It might seem a bit off the point for a health committee to be looking at these issues, but I think it is clear from the submissions that have been put to us that people not having anything constructive to do during the day and people being in poverty are huge issues. How did you feel when we got an announcement by the government the other day for nearly a quarter of a billion dollars for nannies for people earning a quarter of a million dollars?

Ms Scrymgour : For what—nannies?

Senator CAMERON: Nannies.

Ms Dowling : Yes, they are actually going to pay for night-shift nannies, so you can go to work at night time and somebody will come and look after your children.

Senator CAMERON: But that is just so far out of reality for communities like this, isn't it?

Ms Scrymgour : It is very left-field.

Ms Dowling : Absolutely.

Mr Castine : I have only read a bit of the policy on it, but to get that money the nannies have to be childcare orientated, with all these whitefella skills and so forth. Those nannies out there can look after their kids no worries—and aunties and so forth—and bring them up the right way. I suppose the only thing out of that announcement is that it is for remote areas, but then there are things tied to it: you have to be a shiftworker—maybe CDEP can be shiftwork!—police, emergency services and all that sort of stuff. It is so restrictive.

Senator CAMERON: So it is not really practical. That will have no practical effect on the issues that are faced by your community?

Ms Dowling : I think the figure was $640 million. My first thought was, 'Wow, what could I do with $640 million?'

CHAIR: What could you do with $640 million, Ms Dowling?

Ms Dowling : I have come from an education background; I am a teacher by trade. However, one of my passions has always been the establishment of our alcohol rehabilitation centre. It started on a riverbank in one of our communities by men who woke up and said, 'Hey, we've got to stop this.' So they helped themselves. Now we are helping others—both men and women. But we have a plan to have a family centre, with accommodation out there as well. So we have accommodation to take the wife and the kids and the husband. While the kids go off to school and get an education, the mum is learning how to support dad, who has a disease that is being treated. So it is a whole family picture. We know in community that it is the family that is the essence. If you do not help to fix the family, you are just bandaiding. You fix up that bloke, send him home three or six months later. But he goes back to the same environment and, guess what? It is not long before that bandaid is off.

I know what I could do with $640 million. I could fix up all our houses. We have 104 of them. I could maybe have a bit more energy to engage people into the schools a bit better than what is currently happening. There is a lot of money being spent on attendance officers—the big stick approach. But you see all the children down the street. You go over to Woollies and count how many schoolkids are over there that should be at school. You think, 'Where is the attendance officer? What do they do?' They are all non-Aboriginal people, paid at fairly comfortable AO6 Commonwealth public servant levels.

CHAIR: Did you just say that they are not Aboriginal people?

Ms Dowling : No, not the ones that I know of, anyway.

Ms Scrymgour : They have employed some Aboriginal people in the remote communities.

Ms Dowling : Yes, under RJCP.

Senator PERIS: They are not real jobs.

Ms Dowling : No, that is it. So why have we got one sitting in town when you have got community ones out there? We seem to go round and round. We have to be the one race of people that has had every single policy. We have been done. Every time there is a change of government, whether it is state or federal, we get done with a new one: 'Out that way. No, that one is old; we're doing it this way.' I wonder why we are confused and have mental health problems. Hello?

CHAIR: Senator Cameron?

Ms Dowling : It is probably not employment orientated, but it is in a long stretch, Senator Cameron. I have got a document here that I wanted to share with you, and I am happy to table it.

CHAIR: Thank you. It is so moved by Senator Peris.

Ms Dowling : It is about alcohol management plans—so part of that passion. In the Northern Territory you will see the number of communities and townships that have either worked on or are working on Aboriginal alcohol management plans. But they are all sitting there. We have a Northern Territory government minister's approval for the alcohol management plan here in Katherine. That is something else I do on the side—I chair the committee that oversees the implementation of the plan. There is one Aboriginal community, Titjikala, that Minister Scullion has signed off on. But, if you have a look at the list, it is the towns that get done by NT government. All the rest are under SFNT—we all know what that stands for, yes?

Ms Scrymgour : Stronger Futures.

Ms Dowling : Stronger Futures NT. So there is different legislation that only applies to Aboriginal people in this area. Where does it stop? It just goes on and on and on. Seriously, it is no wonder our people have a lot of mental health issues. You just get to a point where everything is too much. It is easier to drop out, tune out.

CHAIR: Walk away.

Senator CAMERON: Yes. One of the issues that was raised with us by Indigenous women's groups in Sydney was their concern that the faith based groups were getting more and more of the funding and some of their clients did not want to go to faith based groups. I see Mission is one of the big IAS groups up here. Have Mission always been up here?

Ms Scrymgour : Absolutely. I think Mission Australia and the Smith Family should be exempt from having access to any of it. This is the problem. If you look at the IAS funding, the majority of that funding—and I know that Senator Peris said this—has gone to mainstream NGOs. When you look at that list and when you look at the amounts that went to non-government versus our sector—because we got access under FOI and through some sources—the difference was huge. What we have been funded for versus Woolworths, for instance, and all of the AFL codes, the NRL, the Smith Family, Mission Australia, the Catholic dioceses—

Ms Dowling : They got two lots.

Ms Scrymgour : Yes. We were trying to figure out from the list who the 'Northern Territory of Australia' was in terms of the submission. The Northern Territory of Australia was actually the Northern Territory government. It had accessed a fair chunk of that IAS funding as well.

Ms Dowling : There were a lot of sporting groups. There were local shire councils as well.

Ms Scrymgour : The NRL.

Ms Dowling : There was the NRL, ARL, the Brisbane Broncos, surf-lifesaving clubs. I am a local born and bred descendant of traditional owners in Katherine. No, we did not have a lot of the 'care bears' before. They suddenly appeared. It is almost like they are in competition with our Aboriginal organisations and I do not understand. Why would you want to compete? Shouldn't you be coming over across the bridge and giving us a hand in community?

Ms Scrymgour : If you can ask some questions, Senator Cameron, or someone needs to ask questions. Under our funding agreements, all Aboriginal corporations that get funded from the Commonwealth, and particularly through the IAS, if they are incorporated under Northern Territory legislation, have to wind up and transfer to CATSIA, the Commonwealth legislation. Yet Mission Australia, the Smith Family, the Catholic dioceses and all of these other groups can still access this funding and not have to wind up their associations and transfer to Commonwealth legislation, whether it is CATSIA or ASIC's Corporations Law. A lot of people, and Aboriginal people, feel that there are still elements of discrimination happening. So you cannot access Commonwealth funding unless you are under CATSIA.

Senator CAMERON: With the move from the Medicare Locals to the Primary Health Networks, what are the implications in this region of that change?

Ms Scrymgour : Very little. Unlike elsewhere, I think the Medicare Local has been quite effective for us in the Northern Territory. AMSANT, the medical services, had a third of the share in the Medicare Local, and we are also taking that third share into the Primary Health Networks. It has been approved that the Medicare Local will morph into that. There has been minimal disruption, but Medicare Local has actually been quite an effective body for us. It has been problematic. There were some issues we had to work through with the funding agreements and stuff, particular for remote services, but we have managed to work through that and it has been quite an effective body. Particularly for chronic care, supplementary programs, all of the mental health programs that come under it and allied health, it has actually been quite a good forum.

Senator CAMERON: Do you know if the Northern Territory Primary Health Network is going to be funded to the same extent it was? I understand contracts have not been signed—

Ms Scrymgour : No, they have not.

Senator CAMERON: and the discussions have to continue.

Ms Scrymgour : Yes. Those discussions are now commencing. We got the approval to have a Primary Health Network here. Those negotiations are only just commencing, so it will be interesting—because the Medicare Local budget was in excess of $40 million, which was quite substantial for the Northern Territory. We are hoping that that can transfer over. Graham, remind me. I think when we were having our AMSANT meetings this government was saying that any surplus funding would not be transferred across to the Primary Health Networks. That could end up being problematic, particularly for existing contracts. All of us who get some level of funding out of the current NTMLs only have the contracts up to 30 June, and then, hopefully, the other negotiations will take that beyond 1 July.

Senator CAMERON: But it is still unclear.

Ms Scrymgour : Yes, very much unclear.

Senator CAMERON: The other issue that was raised earlier was the education issue. I think the argument that has been put is that, if you can educate the kids, they get educated on health, employment, how to behave and all those issues. What are the implications up here if there is no funding for the Gonski arrangements?

Ms Scrymgour : They are huge. The Territory budget that got released just yesterday shows a further reduction in the level of funding that goes into Northern Territory schools. When is the federal budget?

CHAIR: On 12 May.

Ms Scrymgour : Walking away from Gonski, I think, is going to have a huge impact, particularly in not just our remote schools but our urban schools. In places like Katherine, a lot of our schools have high numbers of Aboriginal kids from the town camp and from Katherine town. It looks like the Northern Territory government has reduced its investment into schools—and I heard that the education union was saying that there was a further reduction; it is probably the worst cut they have ever seen in education services in the Northern Territory.

Senator CAMERON: The issues you have raised are education and health, predominantly, and obviously employment. In education, $534 million has been cut from Indigenous programs out of the last budget. What types of programs were cut up here?

Ms Scrymgour : In the Northern Territory?

Senator CAMERON: Yes.

Ms Scrymgour : There were massive cuts under the Stronger Futures program. There was huge investment that came through under Stronger Futures. A lot of that has been cut—a lot of children's services. If you look in remote communities, all of those women's centres have been cut. The initiatives that came through under Stronger Futures to protect children, to look after children, to build stronger families, have all gone. Some communities are trying to keep it going, but they cannot. Without funding, you cannot keep it going. They are the main ones that I think about. Mental health services have been cut. We get very little. There was some money from the federal government that was earmarked for the Northern Territory for mental health services, separate from the Territory government, and that has been reduced.

Ms Dowling : There has been no growth since about 2007, I don't think, in the AOD sector for us.

Senator CAMERON: The government is saying that the savings in these areas will be earmarked for the medical research fund. Have you got any views?

Ms Scrymgour : Is this the savings from Medicare?

Senator CAMERON: The savings from the cuts in Indigenous areas were going into the medical research fund, according to the budget. As Indigenous leaders, can you understand what the theory behind this is?

Ms Scrymgour : No.

Ms Dowling : No. We have had all the research. We have got some of the best research in the Northern Territory that has been done. It is all there. I thought that is what COAG based its story on as well. But that stuff is out the window as well. We do not know. That is why I said—they wonder why we have got mental health. It just chops and changes so much. As for research, there might not be anybody around to research in the future. That is the worry.

Senator CAMERON: What do you see for the future in a town like Katherine if we continue to have these cuts, no increase in funding in education that has been promised, cuts in health and Indigenous? What is the future, based on that?

Mr Castine : Widening of the gap, I guess.

Ms Scrymgour : That is right. The gap will get wider but what we will see is that incarceration rates will increase—and not just among Aboriginal men. If you look at the court system, the rate of women being locked up is just as great. Suicides will increase. Chronic illnesses—the burden will just start becoming quite a big burden. For services like Wurli, Sunrise, Kalano, Binjari—all of our services—we then collapse under the weight of that. We try and hold that off. You try and work with other providers to try and stop that from happening, but the tsunami will come. That is the problem. If you make that cut and you stop the funding, the tsunami will come. Our health problems will just build and build and build. We run quite an effective chronic disease program, but we should be making sure that that investment is in preventative care, that we are stopping the chronic disease. We are just managing and trying to get that person to live a bit longer, when really we should be stopping it at the early childhood area. That is where there has been a lack of investment—in early childhood. There was a huge focus on early childhood, and mums and bubs, and we have got some funding from the federal government, but the focus has gone off early childhood. The other area that is really quite dire is foetal alcohol, and working with mums and realising the dangers of their drinking and what it is doing to the unborn child and that damage. You can almost predict what the cost of dealing with that child is going to be.

Senator CAMERON: Labor wanted to convene an alcohol summit, and it was not simply on Indigenous alcohol abuse; it was an alcohol summit generally. Many of the community groups supported that, but the government would not go down that path. Given the impact alcohol has on your communities, and the emerging one, ice, how do you deal with this issue?

Ms Scrymgour : As best as we can. You just try and deal with it. I should have introduced Dr Bruce Hocking, who is the director of medical services at Wurli Wurlinjang. We have for the first time at Wurli, in the nearly 30 years this health service has been in this town, had to put Crimsafe on our windows. We have engaged security people to be in the service. The reason is we get these young people who are absolutely wired coming to the health service. They are seeking S8 drugs, because they need to come down as they are withdrawing. As a health service, we do not run a withdrawal service. The main hospital runs that withdrawal service. We have to get that young person from our service to the withdrawal service, but they get quite angry that they cannot just come and see a doctor and say: 'You just give me the Valium or the S8 drug that I need, and then I will just go.' We are obligated by law to try and get them to the withdrawal service, because that is what they will get it. They then run off.

We are seeing the transient population of young people that move between Darwin and Katherine drug seeking, looking for the S8 drugs. That is going to get worse. I think that that population is going to increase. We are seeing a lot of that population moving into the town camps and staying with people under the radar of the police. The Northern Territory government has increased policing in Katherine, but all of those police are standing at the bottle shops and in the pubs and stopping people from buying grog without attending to this other stuff. There is all this other stuff happening, but their attention is diverted to the bottle shop. We try and all work together, but it will just get worse. We all just have to try and work together to try and stop it from getting worse.

It is not all doom and gloom out there either. I think there is some good stuff that the services do, and we do get some good outcomes with what resources we get and the slash and burn that has been done to budgets. We still try and make do, and I think that is the same with Sunrise and Katherine West and Binjari and Kalano. We have to.

Mr Gazey : We were previously funded for Drug Action Week where we could just use that money to target something for the community, relevant to the community—and we did some great things with that. That was just stopped. It means now we have to look at our budget and say, 'Do we do something? Where do we find that money?', when we could easily be spending all that money on dealing with the after-effects—and how we justify then taking that to deal with a potential problem or educating the community beforehand. Since it was allocated to that, it made it easy, because that is what it had to be spent on: the preventative education, doing something before. Now you do not have that money coming in. Ours was a very small budget—other organisations have a lot more, because they have a bigger area—but it was something that was just stopped. It was worthwhile money.

CHAIR: Mr Gazey tabled some documents a little earlier, Senator Cameron, and he has one that might be a useful demonstration of exactly the kind of program that was able to be used. I think it is a picture there. Mr Gazey, could you speak to that. Preventative education in context that was created in context is a good example of this sort of preventative dollar that has now disappeared and what is missing.

Mr Gazey : In 2011 we targeted the effects of alcohol. We tried to let the community know without telling them not to drink, without telling them the effects, as in how many standard drinks you should have. The Binjari Community Aboriginal Corporation gave us permission to use the statistics which showed how many people had died in a certain amount of time in the community, so it was relevant to Binjari only. That time frame was from when I started working there until 2011. Then, for the number of people that died related to alcohol, we had those grave crosses made by people in the community. The young guys came and we collected up cans, we collected up the timber, we cut it all up to make the crosses and painted them, telling them what we were doing for several days before the event. Then we put the gravesites in the main area in the community. For the people that died from causes not related to alcohol at all we were able to purchase the proper floral wreath from the shop, like they would at a proper funeral, so we had them marked out. So the people in the community, without understanding maths, without understanding statistics, were able to see the small number of people that had died from natural causes and the other ones that had died from alcohol-related illness. And it went down really well. There were some people saying: 'You shouldn't do this.' But when they came and we explained what it was about, and that it was not disrespectful, it was just: 'This is your community, this is what is happening here. It is up to you how you are going to manage alcohol, how you are going to address the issues and this is why we worry about it.' You could see how many people were affected.

Senator CAMERON: I know that you have got these big alcohol companies sponsoring football teams, so people see this as being part of life. You have got cricketers and famous former cricketers who have gone: 'The only way you celebrate is through beer or alcohol.' What could these alcohol companies do to try and assist with this problem in these remote and regional communities, if anything?

Ms Scrymgour : I suppose it is like the petrol companies. In a lot of these communities petrol sniffing is still a major issue, and the petrol companies Opal and BP invested their money in terms of coming up with non-sniffable fuels. I think that, given the demand, we are not going to stop people. People are going to drink regardless, and even with having the temporary beat locations on each of the places here, a lot of people have moved to Darwin because they do not have the beat locations in Darwin. So people will move to find the substance. I think that governments have got to look at either a floor price or a volumetric tax on alcohol. There is no two bits about it—you can look at the financials and you look at the health side of it, and at some stage some government has got to be brave enough. I think Labor did with tobacco, and said: 'We will not take any more sponsorship from tobacco companies.' And that was good. I was an ex-smoker, and that was a brave decision to make. Someone has got to be brave enough to say to the alcohol industry that there has to be some tax on this. It is not on every drink; you can look at the ones that they are picking and then increase the taxes on that.

Senator CAMERON: I just noticed that Labour in the UK are putting a tax on payday lenders, and they are using that money for financial education amongst poorer people. I have often wondered why we cannot get some more tax from these alcohol companies and invest it back in these areas and on education and health.

Ms Scrymgour : The Henry review on taxation in Australia actually touched on that, and I think that it has got to happen that way because governments are going to continually chuck money at this end rather than at this end. We are trying to address the demand, but we have got to stop the supply, otherwise it is never going to fix itself.

Senator CAMERON: I do not know if you will ever stop the supply.

Ms Scrymgour : The government can regulate supply in a better way than they currently do.

Mr Gazey : The demand for the substance is there, and even if you—

Ms Scrymgour : And because it is cheap.

Mr Gazey : If you are collecting the tax just on the alcohol to spend on education about alcohol, the abuse of alcohol is only the result of all the other issues. People are seeking it out—so if you give them something else, the alcohol is not the drawcard. We have taken people on camps where we take them away for a few days. The same guys who are the ones drinking come away on camp and they have a ball. They go fishing, they learn health messages and they cook. Nobody says, 'I wish I'd brought the esky with me.' They enjoy the break from it. When they have footy games coming up, they can stop drinking because they have the footy games coming up, admittedly with all the celebrations after. That is not a good, healthy thing, but at least it is beforehand. The target cannot just be education about alcohol; you need to deal with all of the grief, unemployment and low self-esteem. Those things need to be treated and people would not abuse the alcohol as much.

Ms Scrymgour : There is the violence. From a health sector point of view, that is why we had supported, in part, the mandatory treatment. If you could give a family respite for three months, particularly the women and the children, from the violence that is in the house and try to get the man sober, that not only prolongs his life but it gives the woman and the kids some peace and quiet and respite. That is what it is: respite. I have seen communities shut down because of the grief with alcoholism and what it does. I see the dilemma from all sides. I have seen it from a government minister's side and where you struggle. You want to do the right thing.

Senator CAMERON: When we were in Halls Creek, it was quite interesting. We heard the view that, by treating Indigenous people differently, it was discrimination and people had to have the freedom to drink. You look at the results of it and you say, 'What kind of freedom is this? It is not a real freedom, is it?' There are health issues, psychological issues and family breakdowns.

Mr Castine : In that context, there ought to be freedom to have a good life as well—a good and healthy life, and that means a bit of education here and there. Back to your earlier question, Sunrise does not get any money for alcohol stuff. We handle it on an individual basis, I suppose. When alcohol is affecting a patient or a client's life, through the GPs, the health workers and nurses, there is a concerted effort to try to get them to reduce their intake or see better ways. We also run population and public health awareness sessions. We chuck alcohol in with all the other stuff, like petrol sniffing, tobacco and other drugs, as general health awareness. We are managing a piecemeal system. We still have the ability to have people nominated or seek professional help and so forth. There is one of our petrol-sniffing programs called Walk Through Country and it picks up one of the things that Peter just mentioned about taking time out. It is not a program based on a specific community, but it starts to involve the whole family and, to some extent, traditional owners—working together with all the people who are affected by the individual. It is not only youth; older men are involved in it. You take them out of their immediate comfort zone and move them voluntarily through an environment that is away from where they normally go or reside—still in their country—and address those sorts of things in a cultural and traditional sense, involving not only our professional health workers but interested parents, uncles and so forth, getting them involved in addressing the issue. There is a twofold effect from that. In the main, it helps the individual but it also generates an awareness in the broader community that we can address some of these things by ourselves.

You could link that into getting back to CDEP and so forth and the incidents that Marion talked about at Maningrida. We need programs, no matter what they are—whether health, education or economic—that people can manage themselves with the skills they have already got. I often use the example of the big ceremonial events and traditional practices—initiation and so forth. People out there organise all that by themselves. They do not need a whitefella certificate to say, 'I can drive the motor car or go from A to B.' They do it by their own cultural means. They have got the use of electronics and IT and phones and stuff these days, but the messages are still coming through and directed by them, and that is the ownership.

CHAIR: I think Senator Peris wanted to put something on the record.

Senator PERIS: Ms Scrymgour, you were talking previously about the IAS funding and the way that the applications had to be filled out. You mentioned that Aboriginal organisations had to form under ORIC and that non-Indigenous organisations were left alone. Senator McLucas and I raised the question of the process for applications with Senator Scullion during Senate estimates. They informed us that it was correct that Aboriginal organisations had to go over to ORIC, but non-Indigenous organisations were given exemption at the time because they had not been subjected to receiving that funding. Once they had received the funding, then it was at the minister's discretion if they had to go over. So you are quite correct in saying that the process was quite discriminatory.

Ms Scrymgour : Could you imagine them telling Mission Australia or the Smith Family or the Catholic dioceses that they have to chase? They will not. They will give them an exemption. I had a long conversation with Anthony Bevan about this and said that I do not have a problem with the regulations and going under CATSIA, but it limits or takes away choice for Aboriginal organisations and communities. If they want to be under Northern Territory legislation or under the Corporations Act, they should be able to, but you are not. I think we got something from when you had asked that question of Nigel. The problem is that Nigel does not come and tell us. There has been very little conversation with Aboriginal people or communities in relation to these issues. He is the Minister for Indigenous Affairs.

CHAIR: Ms Scrymgour, when you were referring to 'Nigel', you were talking about—

Ms Scrymgour : Sorry, Minister Scullion, I should say.

CHAIR: Just for the Hansard record, so it is clear. I think Senator McLucas might have a last question.

Senator McLUCAS: Just a comment more than anything else. There are two things. That is the value of Senate estimates. If I can say to you and anyone listening that that is what we are here for—to receive your information to ask those informed questions at Senate estimates. So do not hesitate to get in contact with your Labor senator to tell, in this case her, the local on-the-ground stories that we can then pursue at Senate estimates.

The second thing is that we successfully moved in the Senate to have an inquiry into the Indigenous Advancement Strategy. The Senate Finance and Public Administration Committee will be conducting that inquiry. You can go onto their website. Please write a submission to that committee. Do not be daunted by submission writing. A lot of my organisations sometimes say, 'That is too hard.' A letter is sufficient that says: 'My organisation is'—whatever it is—and 'This is what happened to us.' Just tell your story. They are very powerful submissions and they inform a committee's deliberations.

CHAIR: Can I add to that in terms of literacy capacity. The joint speaking and writing of direct testimony from people who want to put their lived experiences on the record is also very powerful for us. These documents do not have to come in under the headings A, B, C and D. The capacity of a narrative to inform the committee and the Australian public about what is really going on on the ground is something that should not be overlooked. Senator Peris wanted to put one more thing on the record.

Senator PERIS: When you look at health, you are scratching the surface if you are not addressing all the other social determinants. Everyone here has spoken about employment. One of the things that was really quite striking in the Kimberley yesterday were the two words 'respected' and 'valued' as Aboriginal people. Mr Castine, you were talking about people managing themselves with skills that they have, and that should be respected. We heard in Darwin the other day that a Gurindji man finally got a job working on the 'purple bus' for dialysis. He speaks four languages and can understand eight languages, which is just incredible. He has a sense of self-worth that he is being paid for the skills that he brings. We know in Halls Creek that there is not one interpreter at the hospital. There are all these languages, and people who speak two or three languages. Ms Dowling, you were rightly asking, as Aboriginal people, when we are going to have that recognition, saying that we should be respected and valued for the skills that we have and can bring to society, whether in health or education as interpreters, as teachers or whatever. And that should be paid, not on an RJCP wage or a Work for the Dole wage. When you are actually earning a real dollar, like our non-Indigenous brothers and sisters, then I think we can look at closing that gap, so to speak. Someone might want to make a comment, but I do respect what you are saying, because it is evident from everyone who has presented.

Ms Scrymgour : Can I put on the record, if you are going to ask some questions, that the minister for health, for all of the community controlled health services, announced our funding about four weeks ago. None of the legal agreements have come out. May is just around the corner. None of us has any indication about those service level agreements. It would be good if you could ask those questions so that we can find out when we are going to get them.

Senator PERIS: Your situation is a bit like that of Danila Dilba's. Right now they do not know what is happening beyond 30 June. You are in the same boat.

Ms Scrymgour : It is like the tobacco program. We have a number of Aboriginal people in our Tackling Tobacco program. We do not know, beyond 30 June, whether we are going to get an extension to that program or whether it ceases. There are whole number of programs that nobody has had any indication about. With our core health funding, we do; we have been told that we will have a three-year agreement. But those have not come out.

Ms Dowling : The service agreements have not arrived, no.

CHAIR: I take this opportunity to thank members of the community who have been here with us for part or the entire duration of this hearing. I would particularly like to thank the witnesses who have given their time and expertise here and put that on record for the people of Katherine and the communities that you serve and look after. Thank you to Mr Gazey for this morning's site visit, and thank you in advance to Ms Scrymgour for the one we are about to undertake at Wurli-Wurlinjang. I also thank Hansard, Broadcasting and the secretariat for the work that they do in making these hearings possible, bringing parliament to the people.

Committee adjourned at 14:24