Strategic Directions 2016-2021

NACCHO is the Peak national body for Aboriginal health in Australia.

NACCHO has a membership of over 140 Aboriginal Community Controlled Health Services (ACCHS). These organisations have over 45 years of cultural experience, knowledge and capability in the delivery of comprehensive primary health care. The services are delivered through fixed, outreach and mobile clinics in urban, rural and remote settings across Australia.

NACCHO’s vision is:

Aboriginal people enjoy quality of life through whole-of-community self-determination and individual spiritual, cultural, physical, social
and emotional well-being. Aboriginal health in Aboriginal hands.

Our members continue to demonstrate that they are the leading provider of culturally appropriate, comprehensive, primary health
care to Aboriginal people across the nation, exceeding Government or private providers. The definition of “health” adopted by NACCHO
and members is in accordance with that described in the 1989 National Aboriginal Health Strategy.

Aboriginal Health means not just the physical wellbeing of an individual, but refers to the social, emotional and cultural wellbeing of the
whole community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total
well-being of their community. It is a whole of life view and includes the cyclical concept of life-death-life.

Over the next 5 years it is anticipated that our population will grow to 721,000 people, a growth rate of 2.2% per year. There is a
need to successfully advocate for targeted additional resources that support high quality health services.

NACCHO provides informed advice and guidance to the Australian Government on policy and budget matters that will contribute to the quality of life for Aboriginal people.

This Strategic Directions document describes five key strategies over the next five years to achieve this quality improvement. Within each strategy, a number of specific actions are detailed, as are key performance indicators. The strategies and actions recognise Aboriginal cultural diversity across remote, rural, regional and metropolitan Australia.

The selection of these strategies and actions arose through consultation with the NACCHO Board of Directors, member organisations, State and Territory Peaks, funding bodies, NACCHO staff and others with specific expertise in Aboriginal Health.

Actions

  • Better demonstrate linkages between the Aboriginal community controlled health sector and achievement of continued improvement in
    Aboriginal health
  • Champion and support the expansion of Aboriginal community controlled health services to properly meet the health needs of Aboriginal people
  • Build NACCHO’s internal capacity and establish effective partnership arrangements in research and policy
  • Develop and maintain effective working relationships/partnerships with the relevant external stakeholders
  • Achieve preferred provider status of the ACCHs with the Department of Health regarding the provision of integrated, comprehensive primary health care for Aboriginal people.

KPIs

  • Achievement of a National Framework Agreement with the Commonwealth government
  • Recognition of preferred provider status with the Department of Health
  • Extent of NACCHO representation on key national advisory groups and committees
  • Recognition of NACCHO as the leader on Aboriginal health and well-being in government policy frameworks and key documents.

Actions

  • Identify and develop holistic health models and practices for whole of life perspectives for the patient journey
  • Ensure central role for ACCHSs in national initiatives that enable improved service integration, access to and quality of care at local levels
  • Develop a cultural framework for adoption and use in the non Aboriginal specific health service sector
  • Enhance NACCHO’s capacity in applied research with a focus on models of care and CQI.

KPIs

  • Achievement of increased capacity of State and Territory Peaks to support members CQI.
  • Engagement of NACCHO in national initiatives such as Patient Controlled Electronic Health Records, Primary Health Networks, integrated care, telecommunications, nationally funded health research
  • A National Aboriginal Research Accord established to engage with community and determine how community wants to be engaged in research
  • Develop a NACCHO Health Status Reporting mechanism.

Actions

  • Evidence based research for financial reform of the Sector including access to mainstream funding
  • Develop and implement strategies for sustainable future funding of ACCHSs
  • Improve communication and enhance accountability to and from members
  • Advocate for the recognition of the Aboriginal Community Controlled model of care as preferred providers in tendering and commissioning
  • Facilitate development of leadership opportunities and succession planning.

KPIs

  • Extent of support for leadership training, succession planning and mentoring
  • Conduct an annual satisfaction survey of all members
  • Establishment of functional Medical Advisory Group and a Policy Officer’s Forum
  • Undertake an annual Board performance review
  • Development of more sustainable funding models.

Actions

  • Ensure the principles of community control are retained at all levels of governance
  • Clarify roles of NACCHO, State and Territory Peaks, regional bodies and ACCHSs to ensure better collaboration, optimal effectiveness and community control
  • Development of a new NACCHO constitution to meet future requirements in a changing landscape
  • Implement strategies to promote a strong skills based NACCHO Board
  • Better engage State and Territory Peak CEOs in NACCHO Board input
  • Improve advice and guidance to members on appropriate governance requirements.

KPIs

  • Changed Constitution to clarify roles of NACCHO and Affiliates and the opportunity to include skills based Directors
  • Board members have completed an appropriate corporate governance course
  • Revitalize the National Principles and Guidelines for Good Governance
  • Establishment of a NACCHO Board State and Territory Peaks CEOs Committee.

Actions

  • Lead development of a National Strategy on the Social Determinants of Aboriginal Health that identify key evidence based policies and programs to address factors such as education, income inequality, alcohol and other drugs, employment and public housing
  • Enhance NACCHO’s role as a national voice on the above platform
  • Improve NACCHO’s capacity to undertake national service mapping of the community controlled sector throughout Australia to identify areas with high levels of preventable admissions and deaths and inadequate services
  • In collaboration with State and Territory Peaks, more strongly advocate on behalf of disadvantaged communities who are seeking to introduce community controlled health organisations
  • With the Department of Health, develop health system reforms in those areas which impact on ACCHs
  • Head the development of a national data health repository for policy and planning purposes and to inform advocacy

KPIs

  • NACCHO produces Aboriginal Health report cards
  • An Australian Government/NACCHO co-design strategy is in place
  • Evidence of continued growth in the Community Controlled sector
  • National service mapping of comparative community disadvantage is in place
  • Endeavours to achieve bipartisan support on the NACCHO Strategy have been made

NACCHO’s four Strategic Challenges

The Aboriginal Community Controlled Health Sector faced four major strategic challenges during 2014-2015.

1. The Australian Government and some State Governments accelerated and extended their related policies of ‘commissioning’ and creating ‘markets’ of contracted service providers.

At the Commonwealth Government level, this challenge was most evident in three major nation- wide changes to funding for Aboriginal Health Programmes, namely:

  • The decision was taken to abolish the unsatisfactory Medicare Locals and replace them on 1 July 2015 with geographically much larger Primary Health Networks, responsible for “commissioning” wide-ranging primary health care service delivery from “service providers”. Primary Health Networks (PHNs) are designed to be led by private, for-profit General Practitioners (GPs) and a key objective is to reduce avoidable hospital admissions and thereby drive down the overall costs to the Budget bottom-line of medical care. In calling for consortia to submit tenders for approval as PHNs, the then Minister for Health, Hon Peter Dutton MP, did not make any provision for Aboriginal or ACCHO Sector representation on PHN Boards, their Clinical Councils or their Community Advisory Committees. A serious concern which NACCHO vigorously advocated against was the automatic transfer of scores of millions of dollars in Aboriginal and Torres Strait Islander “health programme grant funds” from Medicare Locals to Primary Health Networks for PHNs to distribute without any public guidelines to protect probity, ensure fairness, and encourage value for money or consultation with the ACCHO Sector.
  • The decision was taken to use a nation-wide, open, competitive “commissioning” process to allocate grants under the five Programmes of the Indigenous Advancement Strategy (IAS), which includes the “Safety and Wellbeing Programme”, Social and Emotional Wellbeing, mental health and substance misuse (AOD). This process was authorised by the Minister for Indigenous Affairs, Senator Nigel Scullion. The resulting round of applications was widely condemned and was the subject of an Inquiry by the Senate Standing Committees on Finance and Public Administration. The Minister committed in August 2014 that the IAS “will look to channel funds through the organisations that can best work closely with Indigenous people, families and communities, particularly those organisations that employ Indigenous people and understand what needs to be done to improve outcomes for Indigenous people.” But in announcing the “winners” of the IAS commissioning round, in May 2015, Minister Scullion advised that in total only “46 per cent of funded organisations are Indigenous and 55 per cent of funds under the IAS round is going to Indigenous organisations.”

ACCHOs fared especially unfavorably. From the NACCHO member survey, ACCHOs applied for 186 programmes. Of these 186 programmes, 83 were for new funding and 103 were for continuity of existing funding. 67 funding applications for new programmes were unsuccessful, that is, 80% of the 83 new programme funding applications were rejected. Of the remaining 103 programmes that had previously been funded, 68 programmes had their funding continued and 16 other programmes were continued but with funding cuts, which is a success rate of 81.5%. 19 existing programmes were defunded – 18.5%. With 80% of new programme applications being rejected and 81.5% of existing programmes receiving either full or partial refunding, it seems fair to suggest that innovation was not a high priority.

NACCHO made representations to the Senate Standing Committees against the policy dictate from the IAS that Aboriginal organisations receiving grants in excess of $0.5M had to be incorporated under the Commonwealth Aboriginal and Torres Strait Islander Act 2006 to be regulated by the O ce of the Registrar of Indigenous Corporations – which is in no way comparable to the independent statutory regulator ASIC (Australian Securities and Investments Commission) under the superior mainstream legislation, the Corporations Act (Cth) 2001.

NACCHO also advocated that the components of the “Safety and Wellbeing Programme” should not have been included in the IAS and NACCHO consistently advocated for these components to be returned to the Commonwealth Department of Health.

  • In the 2014-2015 Budget introduced in May 2014, the Government announced the establishment of a new “Indigenous Australians’ Health Programme” (IAHP). The IAHP continued to evolve, slowly, during 2014/2015 – eventually new Programme Guidelines were promulgated in July 2015. The original IAHP Programme Guidelines and their July 2015 update both announced that the Department of Health would introduce a “new funding allocation methodology”. By 30 June 2015, no approach had been made to NACCHO to work on this new funding allocation methodology. There are serious questions about the criteria for allocating new grant monies under the IAHP between regions and the weightings given to each of the criteria, and the proportions of the $3.1 billion allocated from 2014-2015 to 2017-2018. [Source: Original Programme Guidelines]

A satisfactory outcome to the ‘‘commissioning’’ and the apparent free-for-all ‘‘service provider’’ challenges is necessary for the sustainability of the ACCHO Sector and its expansion to contribute further to Closing the Gap.

2. Applying data analysis to support the competitive positioning of ACCHOs.

NACCHO realised that one of the effective ways to deal with new and often inexperienced, ‘entrants into the new regional and local ‘service provider markets’ – and with existing competitors in the private sector and mainstream public sector – was to make much better use of data analysis.

Reports, publications, ‘’dashboard’’ graphics and geo-coded maps could be developed and produced using both publicly available information as well as de-identified service performance information from ACCHOs on a local and a regional scale.

The NACCHO Board commissioned the development of a comprehensive Health Information Strategic Plan to provide a programme of action that NACCHO could implement to support Member ACCHOs to apply data analytics to strengthen their positioning for capturing resources in their own ‘‘markets’’. A complementary review of NACCHO’s own ICT infrastructure and capability was set up by the Chief Executive O cer. In early May 2015, a national “ICT/IM Workshop” was convened by NACCHO in Canberra of representatives from jurisdictional A liates and selected ACCHOs, which was helpful in building a broad understanding of optional positioning strategies and tactics.

The NACCHO Board of Directors met on 13 May 2015 and endorsed the directions recommended for the NACCHO Health Information Strategic Plan.

3. Improving the patient journey and therefore health outcomes by applying CQI practices to practical partnerships between the public sector and the ACCHO sector.

The decision of the Commonwealth Department of Health to invest specifically in “CQI” – continuous quality improvement –opened up new possibilities to address the challenges of inter-sectoral patient journey coordination.

The Department’s injection of additional new grant funds into ACCHOs to enable them to develop their own, “local CQI Action Plans” by 31 December 2015 was a welcome initiative. So, too, was the decision to fund capacity building in state-based Affiliates to provide guidance, support and assistance to ACCHOs for their CQI Action Plans.

NACCHO contributed to the development of a “National CQI Primary Health Care Framework” which addressed the three sectors – ACCHOs, private General Practices, and public hospitals and community health facilities. One of NACCHO’s value-add contributions was in the area of inter-sectoral patient coordination.

In 2014 the Australian Health Ministers’ Advisory Council (AHMAC) “Aboriginal and Torres Strait Islander Health Performance Framework” provided compelling evidence of breakdowns in referral pathways, coordinated care arrangements, and patient handovers between the public hospital sector and the ACCHO Sector.

NACCHO’s solutions to rectify these breakdowns continued into 2015/2016, building on shared patient electronic health records and the potential to leverage o Aboriginal and Torres Strait Islander “Partnership Forums” established under jurisdictional multi-party Framework Agreements.

4. Protecting the integrity of the ACCHO “Brand” through Governance support.

Through its national level advocacy programme, NACCHO became aware early in the 2015 calendar year that successive public revelations of governance inadequacies in a number of ACCHOs and other Aboriginal corporations in areas of substance misuse, training and child protection had begun to impact negatively on the ‘‘brand’’ of Aboriginal Community Controlled Health Organisations.

Significant political figures made it clear that the Sector had a window of opportunity to reform its own governance or reforms would be imposed externally. Some of the statements emanating from the Minister for Aboriginal Affairs confirmed this understanding.

Accordingly, the NACCHO Chairperson and Board began a review and reform program of NACCHO itself, starting with its own Constitution, Governance Charter, and governance and meeting practices.

Concurrently, they addressed the strategic challenge of ‘’self-regulation”, that is, of NACCHO and state-based Affiliates taking the lead in pro-actively sorting out governance and financial management problems in ACCHOs to reduce the risk of the Department of Health imposing often non-Indigenous and always expensive consultant administrators to take over from elected Boards.

NACCHO also developed a template model ACCHO Constitution that addressed the principal causes of governance failure; and a complementary template Charter of Corporate Governance.

Confidence in the integrity of the governance systems of ACCHOs is a logical determining consideration for funding decisions by agencies entrusted with a ‘commissioning’ responsibility by the Australian and State Governments.