Thursday, 25 February 2016
Answers to Questions on Notice
Nos 2896, 2897, 2898 and 2899
Under standing order 74(5)(c), I move:
That the Senate take note of the minister's failure to provide the answer, or an explanation, to the Senate.
These questions are very important ones that I put on notice a couple of weeks after the Australian government responded to the Contributing Lives, Thriving Communities review of mental health programs and services. As senators will be aware, the Contributing Lives, Thriving Communities review was a comprehensive review of the mental health system, from the Commonwealth's point of view, right across the country, and their response. There were some major reforms to the way that they were going to provide funding for to deliver services from Commonwealth mental health programs.
Unfortunately, the response to the Mental Health Commission's review was very light on details and on an implementation framework. It did not provide me with the information I need to do my job as the shadow minister for mental health. It was certainly very general in its approach. I think it is only about 26 pages for a review that was more than 1,000 pages and had taken more than a year to complete. The government then took a year to respond to it, having managed to get the response out towards the end of the sitting calendar. The information in the response was really that, 'We will provide you with more information at a later date.' I had the opportunity at estimates to speak with the department and raise some of the questions, but because I had already put these questions on notice and sought this information, I said to the department that I would not necessarily pursue some of that information as I expected to be getting it within the 30-day time frame for answering questions. The time has now elapsed and we have been unable to get greater detail about how the mental health reforms are being rolled out, from the Commonwealth's point of view. To give you an example of that, in the government's response to the Contributing Lives, Thriving Communities review, which was released on 29 November, they said, 'We will be advising funded services in December about what arrangements there are for funding going forward.' A number of services got a letter on Christmas Eve, at about 3 o'clock in the afternoon, to say that they would have to apply for their funding in a funding round whose details would be announced in February. This was for funding that ends on 30 June.
So, where we are at the moment is that we have had a very substantial review completed and we have had the Australian government's—sort of—general response. We have services that do not have any funding certainty, where funding certainty runs out in the next four months. They have not been advised as to what those arrangements will be and what tender processes they will have to embark upon. Some services will be exempt from contestability. Other services have been told that their funding will be contestable. These are services that are providing support to some of the most vulnerable communities in Australia—people with a mental illness, people who depend on continuity of service delivery in order to live their lives as they need to. We have a situation where the services sector does not have any real idea of what is going to happen post 30 June. In our attempts to understand in greater detail exactly what the implementation framework will be, how the Commonwealth is going to be making these decisions, who is going to be involved in contestable tender arrangements and who will not, and how will headspace be handled, all of those questions remain very unclear, not just to me but also to the staff who work in those services and indeed to the people who use the services and their carers.
So, the questions I have asked are ones that you would believe would be fairly straightforward. On the day the minister announced the government's response, we had her saying that no-one would miss out on any care. This was her strategy. Yes, there would be changes—funding streams might be different and money might be devolved out to the PHNs—but no individual would miss out on a service. She went on to say that some people would be able to access individual packages, but, again, when you look at the details of the government's response there is no idea of where the funding would come from for those packages, how those packages would be determined, when they would commence, what the allocation will be over three years or what role the PHNs will have in that. The overall strategy also involves moving people into the stepped-care approach, meaning that they access the right care at the right level for the support they need. So there is a big push on.
On e-mental health or the digital gateway, again, there is no information on how that is to operate and how it will interact with e-mental health digital services that are currently provided. Also, there is no information on how the telephone hotlines would work. There is very little detail on how child mental health services will interact with, say, youth mental health. There is some new money for Aboriginal mental health—about $85 million—but it is not clear where that money is going and how it will be applied. There is a lot of concern from the Aboriginal controlled health organisations that they will have to negotiate any funding with the PHNs in that area. We know how contested that space is. For a long time we have had the Aboriginal-controlled health services establishing their service offerings in mental health, only now to be told they are going to have to go down the road and speak to the PHN about whether you will be eligible for the additional funding. In an area like suicide prevention, again we have 2,500 people a year in this country committing suicide. This is a massive area where reform is needed, and the Labor Party believes targets need to be set to see those numbers come down. Again, the detail in the government's response is very light on, talking about a new way of doing things, but, again, there is no indication on how that will occur.
The questions that I put on notice really went to fleshing out the detail, or the lack of detail, in the government's response. I think all those questions are reasonable and I cannot understand—we did give notice, as is convention, to Senator Nash's office about the outstanding questions—why this information is taking so long to get here. It is either that it is just tardy of the department or that some of these details are yet to be determined, which is even more concerning considering these reforms are due to roll out from 1 July. I have spoken to a number of services, and parts of my questions went to funding and funding certainty, about whether or not they have any certainty in their funding. This is not an insignificant area of primary health care delivery—it looks as though $300 million will be reallocated through the primary health networks starting presumably on 1 July—and there are services that have to advise staff about whether or not they will have a job on 1 July and what that job might be or whether they have to put in arrangements now and go and start negotiating with the PHNs. Again, the actual reform agenda is to give a lot of responsibilities to PHNs. I know that there is some concern about whether or not all of the PHNs will be in a position by 1 July to deal with these new responsibilities. The government's response talks about PHNs being required to complete regional mental health plans, comprehensive needs assessments, service mapping and gap identification, systems to share consumer history and information, the establishment of joint assessment processes and referral pathways, strategies to deal with rural and remote communities and regional specific early intervention strategies to support children. All of this is important work, absolutely, and in terms of having regional approaches to mental health service delivery that is something that the Labor Party supports—but, again, there is no detail on when these need to happen.
Some would argue that these should all be in place before the PHNs get the funding, which then determines the delivery of services, but in the interests of supporting a transition to a new way it could be accepted that these things would be done in conjunction with the first commissioning of services under the PHN model but, again, we do not know whether that will be the case. The role of consumers is very unclear. This is an area where, in my experience in health, consumers have played an essential role in the delivery of services, particularly when reforms are under way. The government's response talks about putting together a consumer participation framework, I think the language is, but it does not talk about when that will happen or how it will happen. There have been no discussions, as I understand it, with consumer organisations about how that work is to be progressed. It is not listed as a priority in the back of the document, which outlines a rough timetable of implementation, and these are all issues that need some more detail on them. That is why I put these questions on notice, so that I could get that information well ahead of these changes kicking in on 1 July. Consumers will want to be involved. One thing that I learnt in mental health in my time in the ACT was that you do not reform a system and then ask consumers how they feel about it, because more often than not their insight into the way they should be delivered should determine some of the decisions that government takes. Again, in this response the role of consumers is very unclear—as is the role of carers, for that matter, who also provide a lot of support.
One other area that I was trying to get further information on in these questions is the role of the NDIS and how the NDIS and the community mental health sector are going to interact with each other. We know that a relatively small proportion of people who live with severe and enduring mental illness will ultimately be accepted into the NDIS. Provision is being made for I think about 50,000 individuals but we know that then there are hundreds of thousands of people who have severe and enduring mental illness who will sit outside this. We also know that some of the programs that support them in the community are being rolled into the NDIS to fund services for the people who get accepted. That is great. For those people who get into the NDIS the service offering will be very positive for them and will support them well, but what does that mean for the people who do not get in who are currently using the programs, including all the carer support programs that are going in? Carers, as we know, do not get access to individual packages through the NDIS, so the programs that they currently use at the moment will not be available. These questions remain unanswered. They are all significant enough issues, during this massive time of reform, for this information to be well known to the government. It should have been well known prior to releasing the government's response.
This is not asking for the evaluation of how the reforms have gone or some assessment of the decision-making process. This would have been information that must have gone to government and cabinet as advice before decisions were taken on whether to support the government's response. I can understand, having been a minister myself, that there are delays for good reason with answering questions on notice, but there are also ways that that can be dealt with—for example, a simple explanation here that it required a lot of work in order to put answers together or that another priority had been identified. That is probably a harder one to argue, but there are ways and means that information could have been provided. Even if only half of them were answered and the others answered at a later date, I would have been more than happy and it would have been reasonable to accept that. But to not be able to give me some of the basic information that I believe must have made its way into a cabinet submission—if it did not then somebody is not doing their job—and have that information provided to me within the 30-day time frame, I think indicates that an explanation is probably unable to be given, which is why the minister was unable to provide that to the Senate today.
This is really important reform. To date, the opposition has offered support for the general direction of the government's reforms. We would like to see them work. We would like to see the PHNs successfully deliver targeted mental health programs to localised communities under local planning that had been developed and delivered by local services. I do not think there can be any criticism of the way that we have approached our response to the government's response, but I think that steps could have been taken to make sure that this information was provided. I would be very surprised if it was not contained in the department's estimates briefs, because that is what happens when you have questions on notice—you make sure that your officials are well briefed at the table in case those matters come up during estimates hearings.
At the estimates hearing I was more than reasonable with the department. The fact that they have not met the time frame and have let their minister down and forced another minister to stand up and say, 'Well, I'm sorry, I can't answer why those questions haven't been given,' is most regrettable, because this is a very important area. I know that there are a lot of people who work in the sector who are ringing my office to ask me whether I have heard things about if and when their funding might be coming up for tender. I think that is completely unacceptable. There are thousands of people that work in this sector, many of them lowly paid, often in casual arrangements with no job certainty in the future, and that is certainly being exacerbated by this reform agenda.
It is not just the staff. Let us spare a moment for the people who use the service—a very vulnerable group who rely on these services. If they asked today whether these services will be running on 1 July, I do not think anyone is in a position to be able to answer them. The sooner this information can be provided—not just to me, although I have a particular avenue through which I can pursue it, but more generally from the department out into the community—I think the better these reforms will go. At the moment the lack of information and some of the confusion about the way the reforms have been rolled out—or if they have been rolled or when they are being rolled out—will compound to make it a quite difficult reform agenda in the second half of this year.
I look forward to the minister representing the Minister for Health being able to come back to the Senate and explain. More than that, I look forward to the questions being answered and, in that spirit, continuing to work in the best interests of people with a mental health condition in this community to make sure that they get the services they need and that the workforce that supports them gets the support that they need to do the job that many of us would be unable to do if it was asked of us.