Senate debates

Wednesday, 3 February 2010

Auditor-General’S Reports

Responses to Senate Resolutions

Photo of Michael ForshawMichael Forshaw (NSW, Australian Labor Party) Share this | | Hansard source

I present responses from the Minister for Health and Ageing, Ms Roxon, and the South Australian Minister for Health, Mr Hill, to a resolution of the Senate of 17 November 2009 concerning renal health services.

The responses read as follows—

The Hon John Hogg

President of the Senate

Parliament House


Dear Senator Hogg

Thank you for your letter of 17 November 2009 to the Premier, Hon Mike Rann MP, about access to renal dialysis. As this matter falls within my portfolio responsibilities, the Premier asked me to respond on his behalf.

I appreciate the opportunity to provide the Senate with information about this issue.

Historically, people from the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands requiring dialysis treatment have been assessed and treated in Alice Springs, as the closest major centre.

The South Australian Government has always, and will continue to pay for the treatment of all South Australian patients from the APY lands who receive renal dialysis in Alice Springs. The cost of their treatment is paid for in full under a long-standing agreement between the South Australian and the Northern Territory Governments. These payments include a contribution towards capital and staffing costs.

South Australian renal dialysis patients who are currently being treated in Alice Springs will continue to receive treatment in the Northern Territory and South Australia will continue to pay for that treatment.

However, since February last year, at the request of the Northern Territory Government, the dialysis services in Alice Springs were ‘closed’ to new patients from South Australia. Newly diagnosed renal dialysis patients residing in the far North will be treated in Port Augusta, Whyalla and Adelaide.

To support the needs of these patients, South Australia has recently boosted its regional renal dialysis services, with a $1.8 million upgrade at Port Augusta Hospital, making it now the largest haemodialysis satellite unit outside of the metropolitan area, treating 35 patients a week.

Additionally, a new $155 000 Renal Dialysis Unit at the Whyalla Hospital has been established, which has two treatment chairs and currently provides dialysis services to eight clients. Until recently, five of the patients were travelling to Port Augusta three times a week to receive dialysis treatment.

I would like to assure the Senate that a key priority for SA Health is closing the 17 year life expectancy gap that exists between Aboriginal and non Aboriginal people. One of SA Health’s four key strategic directions, outlined in the SA Health Strategic Plan 2008 —2010, is to improve the health and wellbeing of Aboriginal people. SA Health is committed to providing access to quality, safe, complete and affordable health care to all South Australians.

Thank you for bringing this matter to the Government’s attention and I trust the above information is of assistance to the Senate.

Yours sincerely

Hon John Hill MP


Date 17.1.10

Senator the Hon John Hogg             

President of the Senate

Parliament House


Dear Mr President

Thank you for your letter of 18 November 2009 regarding the resolution agreed to by the Senate on 17 November 2009, in relation to renal health services in the border regions of Western Australia, South Australia and the Northern Territory.

As Senator Sherry advised the Senate on 25 November, in response to a further motion on this matter by Senator Siewert, dialysis services are predominantly administered by State and Territory Governments. Funding for these services is included with the funding provided by the Australian Government through the Intergovernmental Agreement on Federal Financial Relations. These services are delivered consistent with the terms of the National Healthcare Agreement and under the current arrangements, State and Territory Governments have the authority to determine policy regarding the provision of the services that they operate.

The Government is supporting the Northern Territory Government and the Aboriginal community controlled sector through a range of initiatives directed at Indigenous renal health. Significant funds are provided for renal disease prevention, management and treatment through the Australian Government’s primary care funding, for example, the Medicare Benefits Scheme and the Pharmaceutical Benefits Scheme.

Regarding dialysis services in the Northern Territory, the Government has provided over $10 million. This includes funding of $5.3 million over five years to:

  • increase community-based infrastructure for self-care haemodialysis in remote areas of the Northern Territory;
  • develop renal health promotion and education resources;
  • pilot a mobile dialysis service in the Northern Territory; and
  • increase the capacity of selected Aboriginal Medical Services in the Northern Territory to provide early intervention and better coordinated care to slow the progression of renal disease.

The Government is committed to finding solutions to the dialysis situation in Central

Australia. This includes being flexible in making the facilities supplied through these

initiatives available where they are most needed. For example, on 6 November 2009, the Minister for Indigenous Health, Rural and Regional Health and Regional Services Delivery, the Hon Warren Snowdon MP, agreed to make available a 2 port re-locatable dialysis facility to be used temporarily in Alice Springs until the new 12 port facility becomes available.

Officials from the Northern Territory Government and the Western Australian, South Australian and the Australian Governments are working towards developing a

resolution to the current situation, and on 4 December 2009, an agreement was reached between the three State and Territory Governments to work together to address the needs of current and future renal patients in Central Australia. It has been agreed that the Northern Territory Government would develop a new proposal, in consultation with South Australia and Western Australia, outlining:

  • an agreed model of care;
  • current and projected health needs; and
  • appropriate service development.

I trust that the above information is of assistance.

Yours sincerely


6:03 pm

Photo of Rachel SiewertRachel Siewert (WA, Australian Greens) Share this | | Hansard source

by leave—I move:

That the Senate take note of the documents.

I thank the Senate for the opportunity to respond to these letters. Unfortunately, the letters are very disappointing because they do not provide, firstly, any information additional to what we already know and, secondly, a way forward as to the desperate situation that is still facing many people with end-state kidney disease in Central Australia and particularly in South Australia. The resolution called for a number of things. One of those was federal government leadership on this issue to break the deadlock, which unfortunately has not been shown. I am pleased to say that there has been progress in my home state of Western Australia whereby the Western Australian government has finally reached agreement with the Northern Territory government to provide extra resources so that new patients from Western Australia can once again access renal services and dialysis in Alice Springs. People will remember that new Western Australian and South Australian patients had been denied access to those facilities. Unfortunately, the same cannot be said for patients in South Australia who are still being forced to travel hundreds of kilometres—over 1,500 kilometres in some instances—to Adelaide, Port Augusta or Whyalla. The South Australian government is still refusing to provide additional resources so that those patients in remote Aboriginal communities in South Australia can in fact attend services in Alice Springs. Those communities, and this is similar to the situation of communities in Western Australia, are much closer to Alice Springs than they are to Adelaide, Port Augusta or Whyalla. It is interesting to note the South Australian government’s response that they will not be providing those extra resources and that people will continue to be moved. It is also interesting to note that even today the ABC are reporting that four airstrips on the APY Lands have been closed. In other words, people have to travel out of those communities by road. We have the interesting situation whereby they have to travel out of those communities by road to Western Australia and then fly to Alice Springs before going to Adelaide for treatment. How farcical is that! What lunacy that these patients who could stop in Alice Springs for treatment have to go via Alice Springs to Adelaide.

I remind the Senate that these people more often than not have to basically move permanently out of their communities to Adelaide or to these centres—they are removed from their lands. These people are elders in their communities and they help to hold their communities together. They are taken off their country, removed from connection to that country and, unfortunately, in many cases these people die in the centres they are being relocated to. That is totally unacceptable.

I have been provided with lots of examples, but there is the particular example of an Aboriginal elder from Amata, which the Senate Standing Committee on Community Affairs visited last year. It is on the APY Lands in the north-west of South Australia and it is the second-largest Aboriginal community in South Australia. As the crow flies, it is 20 kilometres from Alice Springs—500 kilometres by road—and 1,430 kilometres from Adelaide. Last year one of the elders in the community, who is the former chairman, in fact, of the Amata Community Council and a current representative on the APY executive board, needed to commence renal dialysis. He is a senior man in the community and a very important member of it. He lived 20 kilometres north of Amata and he would have received treatment in Alice Springs. In fact, if he had been able to receive treatment in Alice Springs he could, from time to time, have returned home—as others do from Alice Springs—where, as I said, he is an important member of the community. It is also very important that people are able to return to their communities to attend important community events, including funerals.

The South Australian government will not help facilitate access by new patients to Alice Springs, because they are refusing to provide additional resources. So this particular patient had little choice but to move to Adelaide and be permanently cut off from his community and from his country. This is not an isolated example; there are many examples of this occurring, and of course there will be many more examples in the future because, as I have articulated in this place many times, there are a growing number of people in central Australia who are suffering from end-stage kidney disease. As has been mentioned in debates in this chamber, existing facilities are totally over committed and even the new facility that will be completed shortly in Alice Springs will be at capacity when it opens.

Clearly, we are not doing enough to address renal health in Australia across the board, and particularly in South Australia. It is important to note that three years ago Australia’s then Chief Medical Officer, Professor John Horvath, convened what was described as a highly productive meeting of clinicians in Alice Springs to consider the challenge of delivering renal services in central Australia. Just after that meeting in 2007 the professor reported that the federal Department of Health and Ageing was then:

…working with the Northern Territory, South Australian and Western Australian health departments to expand and improve current models of service delivery and care for renal patients.

He also wrote:

Patient numbers threaten to overwhelm the capacity of the staff and facilities to deliver services and there is a need to have these services much closer to the communities.

Last month, Australia’s current medical health officer, Professor Jim Bishop, wrote that the federal government was:

... encouraging and supporting the relevant States and Territory to reach swift agreement on a sustainable long-term solution to the delivery of renal dialysis services in Central Australia.

Unfortunately, he dropped the words ‘much closer to the communities’, which, as I have said, is absolutely essential in the provision of these services so that people do not have to move hundreds or thousands of kilometres away from their country. It seems that governments at every level have failed to put the hard yards and resources into solving this issue, and we are now in a situation where we have to make fairly rushed decisions about the provision of services because we do not yet have in place a long-term plan to deal with these issues. I am pleased to say that I am aware that, again, the Western Australian government has been working to provide more beds in the future. I am still critical of the fact that they are not providing those beds in the communities where they are needed and I think they need to take a much more innovative approach to the way those services are provided—such as through renal hubs and by facilitating dialysis in some of the smaller communities and not just the big centres. We believe that it is extraordinarily important that the approach that is taken allows people to remain in their communities or as close as possible to their lands so that they can return to their communities.

It is interesting to note that the South Australian government are completely in conflict with their own policy, because they are saying that they are not going to provide additional resources so that people can be treated in Alice Springs but their own general health policy says that they will deliver ‘more services locally so that country South Australians’ do ‘not have to travel to Adelaide as often for treatment.’ Clearly, this does not extend to those people living on the APY Lands.

For other South Australians it seems to be a different story. In June 2008, the Minister for Health and Ageing told the state’s Rural Doctors Association:

We are ... committed to repatriating services to the country from the city ... We want to ensure that as many people as possible receive treatment closer to home and avoid the need for patients and their support networks to travel to Adelaide

Yet here they are. Their policy on renal dialysis is that people have to travel off country to Adelaide to receive the services. It seems to me that they are contradicting their own policy. The minister noted at the time that the expansion of dialysis services was an important feature of the new state health care plan, and I will acknowledge that they have opened dialysis facilities in Port Augusta. However, even if people are able to access beds at Port Augusta, they still have to travel over 400 kilometres more to get there than to get to Alice Springs. As I said, following the debate that we had in this chamber following our motion there was a meeting on 4 December in South Australia—(Time expired)

Question agreed to.