Alan Ferguson (SA, Deputy-President) Share this | Link to this | Hansard source

The President has received a letter from Senator Siewert proposing that a definite matter of public importance be submitted to the Senate for discussion, namely:

The need for the Federal Government to respond as soon as possible to address the lack of adequate access to dialysis services in central Australia, the denial of access to services of patients in urgent need, and the commitment of the Government to play a leading role in ‘closing the gap’ on Aboriginal health outcomes.

I call upon those senators who approve of the proposed discussion to rise in their places.

More than the number of senators required by the standing orders having risen in their places—

I understand that informal arrangements have been made to allocate specific times to each of the speakers in today’s debate. With the concurrence of the Senate, I shall ask the clerks to set the clock accordingly.

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

The Australian Greens believe the need for dialysis services in Alice Springs is a matter of extreme urgency and warrants debate here today. We are currently facing a crisis in Central Australia regarding the provision of healthcare services and support for Aboriginal patients requiring renal dialysis. The Northern Territory government has recently announced that, effectively, it is closing its borders to new interstate dialysis patients from the border regions of South Australia and Western Australia, my home state. New patients seeking these services are being turned away because of a serious shortfall in dialysis places, sometimes called ‘beds’ or ‘seats’ in Alice Springs. The Alice Springs renal dialysis unit, the RDU, with 26 dialysis stations, is currently the largest in the Southern Hemisphere, but it is currently 20 per cent over capacity. A new $16.7 million, 12-station renal unit is under construction and is due to open in April 2010—although the latest news is that this date may have been pushed out to June this year or even beyond.

This unit has been designed to be more user-friendly to the large and growing number of Aboriginal patients requiring dialysis, and their families. When it comes on line, which may not be for six months or longer, it should deal with the current unmet need and give us a bit of breathing space. But we know that the level of kidney failure and the need for acute health services in the Aboriginal population continue to grow at an alarming rate. This means we need to think about planning and building the next one, two, three or more renal dialysis units in Central Australia. We need a comprehensive strategy to plan for the future, based on an analysis of the location and scale of this growing demand. We need a better understanding of the factors that lead to higher rates of end-stage kidney failure among Aboriginal Australians and an investment of significant resources into prevention and early intervention. We need to reduce the growing burden of chronic disease on our healthcare system.

This is not a sudden crisis. We have known about and been alarmed about the growing rate of kidney disease in Central Australia for some time. The establishment of the renal dialysis unit in Alice Springs and the current construction of the new unit on Gap Road show that effort is being made to meet this growing demand—and of course we commend this investment—but, unfortunately, too much of this effort has been a struggle to catch up with unmet demand rather than a planned response to the projected need. The Commonwealth government has been aware of the problem of meeting growing demand for renal kidney dialysis for some time. In the 2006-07 annual report of the Department of Health and Ageing, Australia’s Chief Medical Officer at the time, Professor John Horvath, had this to say:

Another area that has been a challenge is the delivery of renal dialysis services to many patient groups, especially in Central Australia. 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. In September 2006, I convened a meeting of all interested clinicians in Central Australia and we had a highly productive roundtable in Alice Springs. As a result, there has been a lot of progress and the Department is 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.

While it is true that we now have a new medical officer, Professor Jim Bishop, I note that Professor Horvath very clearly said that the department was working with the health departments of the Northern Territory, Western Australia and South Australia to undertake this expansion and improvement. I am hoping that during the debate today government senators will be able to give us an update on what efforts are being made and the progress in these efforts.

I note that, when we discussed these issues earlier this week, I was told by various people from the government that this is a state problem—and it needs to be resolved by the state and the Northern Territory—rather than a Commonwealth issue. I have been told that it is not the responsibility of the Commonwealth to try to find an outcome to this problem. I note that this appears to be at odds with the comments in the 2006-07 annual report, which also highlights the fact that the Commonwealth has taken a keen interest. I will note that the Commonwealth contributes resources to fund various aspects of renal disease treatments and dialysis.

It also appears to be at odds with the commitment made by the Rudd government to close the gap on Aboriginal health, disadvantage and life expectancy. It also appears to be at odds with the Prime Minister’s statements in the lead-up to the last election that if the states and territories could not sort their problems with hospitals and health care, then he would step in and take over. It also appears to be at odds with the intent of the current consultation process with Aboriginal communities, which has been unfortunately described to me by some in the Northern Territory as a sort of ‘speed dating’. When communities were asked about their problems, concerns and priority needs, chronic health problems and access to dialysis for their elders come top of the list. I would ask the Senate to consider these points while I am giving some background to this issue and telling some stories for the Northern Territory so that this becomes real to people—the real impact on real people.

I would dearly love an explanation from the federal government about why they do not think this is also their responsibility. This is a responsibility for the federal government, the state governments of Western Australia and South Australia and the Northern Territory government. They could also perhaps explain what the purpose is of closing the gap. Is it to ensure that people do get access to quality healthcare services? For people living in the western desert communities near the WA and Northern Territory border, and for those in communities in the APY Lands near the South Australia-NT border, Alice Springs is very much their regional centre and it has been for a long time. The lines imposed on the map do not reflect the cultural make-up of the region. In many instances they share languages and culture and have close cultural ties. Kiwirrkurra is located just inside the Northern Territory border. It is 2,400 kilometres from Perth—the city in which I live—and there is no road direct from there to Perth.

If you were going to re-do the map, it is highly likely that there would be a circle around Central Australia. The current lines on the map for Central Australia are arbitrary lines, and people in Central Australia and certainly in the western areas of Western Australia do not see Perth as their centre. Nor in South Australia do they see Adelaide as their centre. It does not make sense to be denying people who are chronically ill access to urgently needed medical services on the basis of state lines. If I am taken ill or collapse in the street here in Canberra, I would not expect to be refused service and told to go home to Perth to get those services, yet that is essentially what we are telling Aboriginal Australians.

I would like to tell Patrick Tjungurrayi’s story. He is a renowned member of the Papunya Tula group of artists. Last year, Patrick won Australia’s richest Aboriginal art prize: the $50,000 WA Indigenous art award. Nine years ago, in the year 2000, Patrick and his fellow artists from the western desert region held an auction at a New South Wales gallery which raised $1 million to set up services, including the Kintore dialysis centre and the dialysis training house in Alice Springs, known as ‘the purple house’. I know that a number of my fellow senators in this chamber have visited the purple house on numerous occasions. The Kiwirrkurra painting that was painted by Patrick and others from his home town was bought by Kerry Stokes for $340,000, helping to pay for the Kintore dialysis unit.

Now, nine years later, at the age of 70, Patrick finds himself in urgent need of renal services. He has been denied access to services in Alice Springs. He was initially told to go to Kalgoorlie—again in my home state of Western Australia—to which there is no direct route, but that service was full, so he was then told he would have to go to Perth. Kiwirrkurra is 40 kilometres from the Northern Territory border, 150 kilometres or so from Kintore and 550 kilometres from Alice Springs. It is 2,400 kilometres, as the crow flies, from Perth. There are no road or air links between Kiwirrkurra and Perth—or, in fact, Kalgoorlie. To get to either place he must travel through—you got it!—Alice Springs. Alice Springs is Patrick’s regional centre. He speaks the languages spoken by many of his community who are already in Alice Springs.

Patrick will not go to Perth, because it is a strange place where he knows his family will not be able to visit him. He will probably need to remain on regular dialysis for the rest of his life, meaning that it could effectively be, unfortunately, his permanent home. He fears he will be going away to die alone—far from his land, his family and his community. Because the NT government are now denying ‘outsiders’ access to all renal services, Patrick is unable to access the dialysis unit in Kintore that he helped to fund. The ban was meant to be just about the shortage of dialysis machines, but the NT are now also apparently stopping any access to renal services, including renal check-ups, discussion of treatment options, health management plans and access to simple preparatory operations, like getting a fistula fitted. Patrick had a doctor’s check-up at Kiwirrkurra and was referred to the nephrologist—the kidney doctor—in Alice Springs to have an assessment done, discuss treatment options and get a fistula fitted. That was when the problems started and he was told to go to Kalgoorlie or Perth. Patrick needs access to a renal doctor and a management plan now.

I should have said at the outset that I have permission to tell Patrick’s story. Patrick’s GFR—his test for kidney function—is currently 40. At a reading of 60, you get a management plan. At 30, you fit a fistula and you develop a plan for dialysis. At 15, you should go on dialysis. Before Patrick can access the renal facility near to his home at Kintore, he needs to have a simple operation to fit the fistula and then to undergo his first dialysis in hospital and to stabilise his condition. He can only use the facilities, for which I again note he helped pay, at Kintore or the Purple House in Alice Springs under joint management—that is, under the supervision of the nephrologist from Alice Springs Hospital and a renal nurse. The doctor would have to be satisfied his condition was stable enough and that he was healthy enough to be far away from hospital.

It is possible that there might be other options for treating Patrick. For instance, he might be able to use peritoneal dialysis, which is a tube into the stomach, rather than haemodialysis. Peritoneal dialysis is cheaper and easier and does not require the use of a big dialysis machine. Patients can plug into a smaller box overnight. Peritoneal dialysis as a treatment option is underused in Central Australia. I would ask the question: why? The point here is that we do not know if Patrick would be able to use that sort of treatment because he has not been able to access Alice Springs and he has been denied access to the experts in Alice Springs.

I would like to read a letter that I have received from Papunya Tula about this issue of dialysis. It says:

On behalf of Patrick Tjungurrayi and the Papunya Tula Artists I would like to send you a short message of thanks for helping us highlight the situation surrounding Patrick, and several other renal failure sufferers in central Australia, to the parliament and the general public.

It really seems terribly unjust that someone’s life can be dealt with in such a manner when we all know that Patrick would not consider for a minute a move to Kalgoolie or, worse, to Perth to receive treatment. In other words his fate would be sealed and he would be resigned to a premature death in Kiwirrkura. Patrick is one of the most successful and well known Papunya Tula artists and last year won one of Australia’s most prestigious art awards—the Western Australian Indigenous Art Award. He is a senior Pintupi custodian and a vitally important cultural figure within the Western Desert community.

I have worked at Papunya Tula artists, of which Patrick is a shareholder, for the last fifteen years. In this time I have known no fewer than twelve people who have died as a result of end stage renal failure. Many of these people were senior members of the Kintore and Kiwirrkura community’s and important Australian artists. It was this situation that initially led us to privately fund our own dialysis facilities in Kintore through a fund raising event in Sydney nine years ago that raised over a million dollars. The unit is a shining model of success and is currently an essential component of the dialysis programme for people from the Kintore area by allowing them to continue receiving treatment while on respite visits to their homeland. The tragic irony of this situation is that Patrick was one of the main contributors to the initial fund raiser by overseeing the collaborative painting done by the Kiwirrkura men that went on to raise $300,000.00 and now he is unable to access the facilities resulting from his effort.

I know you are probably aware of the above information, but again, thanks very much for your concern it’s very much appreciated.

(Time expired)

Trish Crossin (NT, Australian Labor Party) Share this | Link to this | Hansard source

I rise to provide a contribution on the matter of urgency that has been moved by the Greens today on dialysis services. I just say at the outset that it is a very important issue. It is a very significant issue and it affects not only Indigenous people in the Northern Territory but mainly Indigenous people in South Australia and Western Australia. However, if you look at the history of provision of access to renal dialysis services in the Northern Territory, there are some elements of Senator Siewert’s contribution that do not give us the complete facts as to why it was necessary for the people of Kintore, through the Papunya Tula artists, to go to Sydney to raise that money for their renal dialysis unit. I think it would be interesting to record in Hansard why there was a need for those people to do that and the fact that the driving force behind it was Peter Toyne, who started that project when he was a member of the opposition in the Labor Party in the Northern Territory. He went on to become the first Minister for Health in the Northern Territory government and continued to work on that project with a lot of support from the Northern Territory government at the time.

There is no doubt that tackling Indigenous health outcomes is a major challenge and has been a major challenge for all political parties right through time. It still continues to be a challenge and this Commonwealth government, the Rudd government, is absolutely committed to closing the gap on Aboriginal health outcomes—so much so that when this Prime Minister had a chance to reshuffle his cabinet in the last year he created the position of Minister for Indigenous Health, Rural and Regional Health and Regional Service Delivery. That position is held by Warren Snowdon who, as a minister in this government, has specific responsibility for Indigenous health. I think that, if that does not show you how much this government has elevated the importance of health improvements and health outcomes, you would be silly to think that it is not high on the agenda of what we are doing as a government.

We have committed a historic $1.6 billion investment in Indigenous health, agreed to through COAG, where all the governments except Tasmania agreed to contribute to the National Partnership Agreement on Closing the Gap on Indigenous Health Outcomes. That is a significant and major investment that will work towards closing the gap in life expectancy within a generation. That is the target and that is what we aim to do. The gap in life expectancy between Indigenous and non-Indigenous Australians is estimated by the Australian Bureau of Statistics to be between nine and 11.5 years.

I have heard people such as Minister Snowdon say that this is a challenge and that it is not easy. There is an admission by us, as a government, that this is going to be an ongoing major focus of work and a major challenge. Last week, with AMSANT’s AGM in the Northern Territory, a number of initiatives were launched by Mr Snowdon and Minister Kon Vatskalis, the Northern Territory Minister for Health, to try and work with Aboriginal community controlled organisations and Aboriginal organisations dedicated to closing this gap and working together. It is an ongoing challenge and it is not easy, but it is something that we have elevated to a cause of national significance.

Chronic disease is the single largest contributor to the current life expectancy gap between Indigenous and non-Indigenous Australians. That is why many of the commitments the government have outlined are an important part of our $105.5 million Indigenous chronic disease package, which was announced on 29 November last year. This four-year package will help our health system and Aboriginal and Torres Strait Islander people to better prevent, detect and manage chronic disease in their communities. It will tackle chronic disease risk factors, improve access to follow-up care and increase the capacity of the primary care workforce with the aim of delivering effective health care to Indigenous Australians.

If I could turn to the matter of the detail before the Senate today—that is, the provision of and access to dialysis services, particularly in Central Australia. Dialysis services are actually administered by state and territory governments. It is not a matter of buck-passing; it is a matter of fact. The Commonwealth does not organise or deliver dialysis services. At the moment, demand for dialysis services in Central Australia exceeds the available resources. It is treating patients not only from the Northern Territory but also from communities just over the border in South Australia and Western Australia. So it is not true to say that people who come to the Alice Springs services at this point in time are just from the Northern Territory. They are not; they are from that catchment area.

The Northern Territory government have implemented protocols to refer new patients, not existing patients, presenting for treatment in Alice Springs who are not residents of the Northern Territory to their state of residence for treatment. That is simply because the facilities and the services are stretched beyond capacity. It has to be made clear that these protocols apply only to new patients who live outside the Northern Territory. The Northern Territory health system is continuing to support up to 30 current South Australian and Western Australian patients in Alice Springs. The Department of Health and Families has advised that this decision was necessary due to delays in establishing the Northern Territory government’s new 12-port renal facility in Alice Springs, which will provide access to increased patient numbers but will not come on line until the middle of next year.

To assist with the current situation in Alice Springs, Minister Snowdon announced, as recently as early November, that the Commonwealth will make a two-port relocatable dialysis facility temporarily available to the Northern Territory government. So the Commonwealth has acted immediately and has provided a two-port relocatable, temporary facility as quickly as it possibly could. This flexible arrangement is intended to ease the pressure on existing facilities until the new 12-port renal facility is operational in Alice Springs.

The Northern Territory government have also begun to address the issue of patients being turned away. They recently led the way to establish a tri-state agreement with South Australia and Western Australia to develop a plan for the management of renal patients from cross-border regions. In fact, my understanding is that Minister Kon Vatskalis is convening a summit with Western Australian and South Australian health department officials in early December. So the discussions will be continued the week after next.

It is not true to say that the Northern Territory government have sat on their hands and done nothing about this, nor is it true to say that the Commonwealth government have done nothing about this. As soon as this problem became a matter of significance, as soon as the Northern Territory health department was made aware that demand from Western Australian and South Australian patients in Alice Springs was going to result in a substantial increase in and drain on Northern Territory health department dollars, action was taken immediately. A two-port renal temporary facility was made available by the Commonwealth and Kon Vatskalis has moved to get discussions with South Australia and Western Australia health officials happening within a three-week time frame. I think that that is an acceptance that there is a problem here. People are trying to act as quickly as possible to get on top of the problem. The summit will focus on concrete proposals to boost dialysis capacity in Central Australia. The Commonwealth are encouraging the three state and territory governments to come to a speedy resolution of these issues.

We understand that access to renal dialysis services in Central Australia is a major issue. It always has been, not just for this government but also for the previous government. That is why at the election we committed $3.5 million to provide extra renal dialysis services in the Northern Territory. With this funding, we will ensure mobile dialysis services are piloted in Central Australia in the first quarter of next year to help improve access for people in remote communities without the need to travel to major centres for treatment. Let us remember that these mobile services mean that, if people are going to treat themselves at home, they have to learn how to use these machines and how to sterilise these machines, and that takes a long period of time. I know that for the people of Arnhem Land it can take them up to eight and 10 months to learn how to self-dialysise. It is not a solution that can happen overnight. We will have renal-ready rooms co-located at community services in places like Maningrida, Lake Nash and Barunga. (Time expired)

Nigel Scullion (NT, Country Liberal Party, Deputy Leader of the Nationals) Share this | Link to this | Hansard source

I note from the previous speaker the attempt to show that the federal government and, particularly, the Northern Territory government and Minister Kon Vatskalis are really making an effort in this area. But, unfortunately, the fact of the matter, which is apparent for all to see, is that this is just another chronic failure by the Northern Territory Labor government and by the Rudd Labor government, under the leadership of the member for Lingiari, Warren Snowdon—ironically, the Minister for Indigenous Health, Rural and Regional Health and Regional Service Delivery.

A report from the Australian Medical Association released last week shows that end-stage renal dialysis is the most common chronic condition amongst Indigenous men checking into hospitals in Queensland, Western Australia, the Northern Territory and South Australia. It also found high levels of psychological stress amongst Indigenous people, with males being twice as likely to be hospitalised as females and twice as likely to be hospitalised as non-Indigenous males.

This relates to a huge range of factors, including illness, disability, deaths, unemployment, alcohol abuse, trouble with the law and, tragically, the old favourite overcrowded housing—and of course we look back at the complete mismanagement of the SIHIP program, which has made a very negative contribution to the health of our first Australians. The AMA said:

However, the AMA still awaits a real and active commitment on the part of governments—

that is, the Northern Territory Labor government and the Rudd Labor government—

to establish genuine, long-term health partnerships with Indigenous people.

After seeing the federal minister for Indigenous health, Warren Snowdon, publicly making a fanfare about the release of this report, I can understand why they would be frustrated about that and why they have said so. The report talked about two things. Senator Crossin amplified, ‘We will release a two-port facility.’ It is actually a mobile facility—and of course that is welcome—which is being set up in Alice Springs. That will no doubt relieve some of the concerns in Alice Springs.

Of course, Kon Vatskalis’s contribution is a summit with concrete proposals. Gee, that makes me feel better already. We need real dialysis units. That is the answer to this problem. We do not need more talkfests. I certainly support what Stephanie Bell says about restructuring governance arrangements and more respect for Indigenous health organisations. I think we should go down that path. But I find these had fairly empty reactions. I say that because of this quote from the Alice Springs Hospital general manager, Vicki Taylor, who said: ‘We have 197 dialysis patients on the books but only the capacity to treat 167.’ Well, I am not sure how you are at maths, Mr Snowdon—I am no rocket scientist at it—but that works out to be about 30 short. So sneaking in a two-bed contribution there is not going to make a single bit of difference. It flies in the face of compassion, of doing the decent thing for our first Australians, to announce that all these things are happening, to say, ‘We recognise all of these are problems and have all these recommendations,’ when the only thing you are going to do is to have a bit of a chat and provide a two-bed relief. That simply is not good enough for our first Australians living in the centre of the Northern Territory.

They have announced a ban and I can understand completely why that would be the case. As Senator Crossin indicated, they are being stretched beyond their capacity. But they are being stretched beyond their capacity because nobody planned. Labor failed to plan; that is why we have this situation. It is not as if February came round and—bang—they had 30 extra people. People know the process—and thank you, Senator Siewert, for explaining how you slowly go through this process. It is tragic, but it is a process that is well understood. We will know, by someone’s medical circumstances, that they are going to need treatment X number of times; that they are going to need a dialysis unit. Once again, we have policy underpinned by a complete and utter failure to understand the challenges—and if they accept that that is wrong then they are in even more trouble—and actually come up with a concrete answer.

I understand that the problem is now so bad that both the Western Australian and South Australian health ministers have agreed to this emergency meeting. It appears the only time you have an emergency meeting is when you get a lot of bad press. They knew about the issue before the bad press but they had to wait until the bad press came round to suddenly have an emergency. Once again the emergency is a political emergency, which seems to be the only time we have any action from the other side.

We have had much press saying that people would rather die in their homelands than travel thousands of kilometres to receive treatment. I would like to couch it a different way: people would like to live on their homelands. I will share with you a very short anecdote. To protect traditional values I will not say the man’s name, but the place is Gumeragi, and many people from the Northern Territory, particularly from Cobourg Peninsula, will remember the old man that was there. I visited him in hospital. At Darwin Hospital they had told him he had four weeks to live, and he desperately wanted to go home. So I made some arrangements. We threw a genset in the back because he needed to have 240-volt power at home to run the equipment. He lived for another year. People do not go back to their homelands to die; they go back to their homelands because on their homelands, on their country, if they have the right equipment they will live—they will live much longer. The rhetoric in the press is that this is a highly emotive issue and people would rather die on their homelands than travel. But they would rather live on their homelands. They would rather get the right treatment where they are.

The staff at Alice Springs Hospital are not bad people; they are wonderful people. You wonder how they feel about saying to people: ‘Sorry. I know you well, but you are going to have to go nearly 2,000 kilometres from your homeland to receive treatment—away from your family, away from the support units—and you will die.’ Aboriginal people will die away from country when they are that old and they are that sick. It is just a fact. It is a fact that has not been recognised. And coming out with a report that glibly talks about all the problems and in effect does nothing should be condemned. This is a very, very important matter and I do not believe it has been dealt with in a way that significantly recognises the problem.

There are a number of other matters in the health area where, between them, this government and the Northern Territory government have fallen incredibly short. I quote from the Sydney Morning Herald on Monday, 16 November, which said:

Trachoma is a disease that starts as conjunctivitis but gradually, with repeated infection, turns the eyelashes inwards so that they scrape the cornea, scarring it, rendering it opaque, causing blindness.

It is actually easily treated with antibiotics. Some of the best work that has been done in this area is in the country I was brought up in, Malawi in Africa. You just treat everybody with antibiotics and it gets fixed. Because it causes blindness it is a horrific thing. Do you know that 25 per cent of children between five and 15 years old have trachoma? Do you know where they live? They live in Katherine, a three-hour drive from Darwin, the capital city of the Northern Territory. I do not even know what to say about that. This government has been in for two years and the Northern Territory government has been in forever—that is what I think—and when you see facts like that you ask: ‘Why can’t you do something about it?’ If we can deal with it in Nepal, if we can deal with it in central Africa, why can’t we deal with that in Katherine?

Chris Evans (WA, Australian Labor Party, Leader of the Government in the Senate) Share this | Link to this | Hansard source

Where were you for the last 11 years?

Nigel Scullion (NT, Country Liberal Party, Deputy Leader of the Nationals) Share this | Link to this | Hansard source

I will take the interjection. Where was I? I can tell you that right now we tragically do not have hold of the wheel on this boat that is spinning out of control, whether you are talking about boat people or the health of Indigenous Australians. Minister, you have failed. It is on your watch and you have failed. Children are going to go blind 300 kilometres from Darwin.

Chris Evans (WA, Australian Labor Party, Leader of the Government in the Senate) Share this | Link to this | Hansard source

They have been for the last 11 years when you were in government.

Nigel Scullion (NT, Country Liberal Party, Deputy Leader of the Nationals) Share this | Link to this | Hansard source

This is no laughing matter, Minister, and you should not interject on such an important matter to Territorians and such an important matter to Australians.

Chris Evans (WA, Australian Labor Party, Leader of the Government in the Senate) Share this | Link to this | Hansard source

Don’t pretend it just happened, mate; it has been going on for years. Where were you for the last 11 years?

Nigel Scullion (NT, Country Liberal Party, Deputy Leader of the Nationals) Share this | Link to this | Hansard source

I can tell you where I was. I was the one who went out to Gumeragi. I have lived amongst these people. I have seen it getting better, but lately it has been getting a lot worse. It is getting a lot worse on your watch and on the watch of the tragic Mr Vatskalis from the Northern Territory. So I am happy to take your interjections, but I am also happy to put on the record exactly who is failing in this regard.

Claire Moore (Queensland, Australian Labor Party) Share this | Link to this | Hansard source

I was really pleased when I saw this matter of public importance on dialysis services for discussion this afternoon because I knew that the people who were going to be involved in this debate shared a common cause and a common interest. I am disappointed with the last speaker, Senator Scullion, who does share this interest. I have worked with him many times in these areas and I understand the deep commitment he has to the people of the Northern Territory, particularly the Indigenous people. When you have a look at the speakers list for this afternoon, the senators it includes share a lot of experience working on a number of senate committees and have had the privilege to visit the areas to which this motion refers—that is, the central and western part of the Northern Territory—and there is a common goodwill. It is important that we have the ability to discuss the issues.

The media has been covering the recent process in the Northern Territory around Alice Springs, but it is not new. I included a similar, but perhaps a little less passionate, discussion about trachoma and the issues around kidney dialysis in a speech I made about 2½ years ago in this chamber. Perhaps it did not have the same degree of emotion, but it did look at what was happening in Aboriginal communities, the issue of renal dialysis and the real need for governments at all levels—state, federal and local—to work together effectively with the local communities to come up with the necessary local responses.

One of the things that a number of us did share was the opportunity to visit what Senator Siewert referred to as the Purple House. I forget the address but everyone knows the house—and Senator Evans has been there as well—because you have such a sense of welcome and achievement when you are able to go there and visit with Sarah, who I am very proud to say is a Queenslander. She is on loan to the Northern Territory for a while; nonetheless, she is a Queensland nurse who is working there on a most inspirational project to do specifically with the issues of renal failure and the necessary care for people in that area.

I think we made that visit 18 months ago and we were talking about these same issues. We acknowledge that within the Aboriginal community, particularly in this part of the world but also, as we heard from Senator Crossin, across many parts of Australia, there is a horrific degree of illness around renal failure. That is on record and that has been processed through many years. I am not saying it is a good thing that we have known about this for a long time, but it is the reality. It is a reality that the issues around lifestyle, life circumstances, lack of treatment and lack of professional advice in those areas because of workforce shortages have all combined to mean that way too many men and women suffer from severe renal failure. Anyone who walks through any of the dialysis areas in any of our hospitals can talk with people who will tell you immediately what impact being linked to machines, being unable to move freely and being unable to react effectively with their families has on their lives. Tragically, there is too high an incidence of this condition in the Aboriginal communities about which we are speaking.

Certainly the focus of this discussion and the focus of a lot of the treatment has been Alice Springs. Years ago they were acknowledging that there needed to be a rapid increase in services being provided there, not only because of the people who currently live in the Northern Territory but also because Alice Springs is the centre for a whole range of regions around that part of Australia. All you have got to do is look at the map to see that it is the focus of transit routes from a whole range of areas that happen to be in Western Australia and in South Australia. Even some parts of western Queensland relate more effectively and more traditionally to Alice Springs as their centre. It is quicker, it is easier and there are distinct cultural links. So the focus has been on people needing to seek services in Alice Springs. That automatically means that there has got to be cooperation between the various state governments. I cannot say that it would be a good thing to draw the maps differently—a number of people would have objections to that—but when it comes to medical services, education and a whole range of other things this government has been saying that we need to have cooperation between the various states to acknowledge commitment, to acknowledge responsibility and to put together a plan to which they are committed and from which they can work into the future to provide effective services.

Clearly that must be a priority in what is happening in Alice Springs, and that has been the reaction of our government through the Minister for Indigenous Health, Rural and Regional Health and Regional Service Delivery, Warren Snowdon, who probably knows this better than anybody in this chamber, because he lives there and knows the Alice Springs community. Minister Snowdon and the governments of the Northern Territory, South Australia and Western Australia acknowledge that they have to work together on this issue and that there is an immediate crisis. We are waiting for some new facilities to be built in Alice Springs, and it would have been better if they had been built more quickly, but in the short time before these new facilities can be brought on line—putting together these beds, the machinery and, most importantly, the personnel who can effectively work these machines is complex and we have heard that you can often have the infrastructure but you do not have the trained professionals, particularly the dedicated nurses who have the skills to work with the people—we have to share resources. Of course, the first decision was that the first clients that need to be serviced are those who are currently receiving the service because, as we know and as Senator Siewert pointed out, once you start on the dialysis program you cannot withdraw. So the current patients need to have the immediate priority. They need to have their times secure and they need to have their work plans and their life plans linked to the process.

Over the last couple of months, in terms of the medical planning process, it has been determined that, as a short-term measure—I know it may not seem short for the people who are involved—new patients who are not residents of the Northern Territory will be referred to their own home states. That is not such a difficult thing to understand. It actually looks at people taking responsibility. The states acknowledge that it is urgent. They are going to get together in the next couple of weeks to ensure that they work effectively on what is going to happen and continue this carry-on process until enough services are available in the Northern Territory. They will take into account the kinds of tragic personal circumstances to which Senator Siewert referred.

Those circumstances will be taken into account. The people who work in this field know the area. They are in pain as much as many of their patients because they do not want to deny service. They want to acknowledge the personal circumstances of each of the patients, to work with them through that process and ensure that they come up with a result that is personal and effective and causes the least disruption—and that is going to be difficult.

In terms of what this government has done, we immediately acknowledged when we came into government the absolute need in this area. And in terms of delivery of primary care in a whole range of areas in chronic disease management we acknowledged, particularly in this part of the world, the chronic need for kidney support. There have been large amounts of money given—Senator Crossin has gone through it—including $5.3 million, which was immediately committed to the Northern Territory government to look specifically at the area of dialysis and support. That money is being spent but it takes time to build the permanent portals.

Nonetheless, other services are being trialled. This is a difficult area, because it is not easy to find the best way. There are special circumstances around letting people have home dialysis—particularly the need for effective water and sanitary services, and knowledge and support locally in the community. That is in train, and more of those services are going to take place, particularly in areas such as Maningrida, Lake Nash and Burunga, which are areas which feed into the area. We are going to have renal ready rooms that will be collocated with the community health centres. It is really important that people can have their service at their own community and not have to travel as much. We are also looking at the drop-in-care dialysis facilities in Alice Springs and Darwin. Once again, they will be making people feel welcome, making people feel secure and letting them access the services locally.

We all know—and I make this statement unashamedly on behalf of all the senators who are taking part in this debate—that there is a need. We are all committed to finding the best way of responding to this need. This government is part of that response. We need to work effectively with the state governments who have primary responsibility in this area. But it is no good just standing here and throwing grenades across the chamber when the important thing is to find out what must be done and how we can work together. And we must look to the future because if we look back at the past we will be talking about who did what since 1935 and people will not be around long enough to talk about what their futures will be. There is a crisis at the moment in looking after the patients. There is a process in train. We must make sure it works.

Judith Adams (WA, Liberal Party) Share this | Link to this | Hansard source

I wish to continue on from my colleague the chair of the Senate Standing Committee on Community Affairs. We have, for the past four years, travelled extensively through the Central Desert region, holding inquiries, whether they be into petrol sniffing or, with the other committee, into regional and remote Indigenous communities.

This motion today is very important in highlighting the problems that are there. The blame game, as has been mentioned, should not be considered because this is about health and people—especially underprivileged people who live in that area where it is impossible to have health services at their doorstep. Patients who have renal disease are very close to their families. Cultural issues come into it but unfortunately, because of the nature of this chronic disease, patients often have to move. And it is not as if they can go home every weekend; that is just not possible. So it is a very difficult thing.

Coming from Western Australia I would like to put forward what the Barnett government is doing in recognising this problem. It has been said that health ministers were going to meet to discuss this, but I have just had word that the Western Australia Country Health Service and health officials from the Northern Territory and South Australia have already met to discuss the shortage of dialysis chairs throughout the central desert region. It should be noted, too, that the Western Australia Country Health Service pays for all the Western Australian patients who receive dialysis interstate—and that includes those who are currently attending dialysis in Alice Springs.

The Western Australia Country Health Service is working on a broader renal plan to expand the number of dialysis chairs in Kalgoorlie because Kalgoorlie is adjacent to the South Australian and Northern Territory borders and often that is the closest place for patients to come to have their dialysis. They are also working with South Australia, who are looking at expanding the number of dialysis chairs, but I have been told that these will probably be located in Adelaide, as services are available at teaching hospitals there. These patients are very sick and when they have to go onto dialysis it is the only option for them, therefore admission to a teaching hospital to start with is very important.

Another meeting of health officials from three states will be held early next month to formulate a plan to expand the services. Also, the Western Australia Joint Planning Forum on Aboriginal Health, which includes representatives from WA Country Health Service, Aboriginal Medical Services, and Divisions of General Practice, meets in Kalgoorlie and is currently looking at the expansion of the Kalgoorlie dialysis unit. The Kimberley dialysis service is also being expanded, with another four dialysis chairs going to Derby. Kununurra are receiving four chairs, and eventually that will be built up to 10 chairs.

Once again, these Western Australian services are utilised by patients coming across the border. So we really do have to work together very closely. The fact that these three health departments are working together is very promising. As we moved around, we did go and visit the Derby Aboriginal Health Service and look at the treatment they were giving their patients. I am delighted that they are going to get another four chairs, because they certainly need it. With the Alice Springs situation, it has been mentioned that perhaps a night shift, if they can get the appropriate staff to run it, would help so that patients can go onto night dialysis. That would be supported by the three states. To go further, we should be working towards peritoneal dialysis and haemodialysis being made available in the regions to reduce load on the facilities in Alice Springs. But, as my colleagues have mentioned, patients and their carers have to be trained in the usage, because they are quite complex. Once again, if you have not got good, clean water and electricity available, of course that is not an option. Another community we visited was Hermannsburg. They have patients who have to travel 170 kilometres into Alice Springs to have their dialysis. The federal government is looking at putting two chairs into Hermannsburg, but they are getting increasingly worried about when their chairs are going to get there. We will have to keep an eye out to see whether that is going to happen.

Mention has been made of the ‘purple house’ in Alice Springs. As a committee we visited that house and saw patients being dialysed. We met with Sarah Brown and her committee who run it. Senator Moore has described Sarah Brown as fascinating. She comes from Queensland. I have never met such a dedicated person. As far as the work she is doing, she has volunteers there to help with the patients, and they run a child-care area to keep their patients and families happy when they have to move to be near their relatives. As I have said, this is a very difficult situation. When you are having dialysis you cannot just up and go home. It just does not work that way. But with the ‘purple house’ and through the arts centre they have raised money to have two chairs at Kintore. So it means that anyone from that community can travel home for weekends and have a holiday. That is really a fantastic service. I am very impressed about the work that is being done with Sarah heading it up. I was invited to go to the centre for rural and remote nurses association conference at Broken Hill last year. Sarah was speaking about the ‘purple house’ at that conference. It was great to catch up with her again and see how much improvement had been made.

The Senate Community Affairs References Committee does a terrific job in working with Indigenous communities. We have certainly been highlighting the fact that dialysis is so important. I am certainly very keen to encourage the Western Australian Country Health Service in all their deliberations and efforts to expand the numbers of those chairs even further. The work that is being done between the three states is very important because a number of the Indigenous communities do not really recognise state borders—and neither should they. For this gentleman that Senator Siewert was speaking about, with the work he has done with the arts, his community is just inside the Western Australian border. It is only 140 kilometres to go to Alice Springs but Kalgoorlie is about 1,800 kilometres away and Perth is probably about 2,000 kilometres away. It is a very difficult situation. He is a new patient. He cannot get to Alice Springs. He can go to Perth. Probably that would be a start. Then he would possibly be able to be relocated back into his community or Alice Springs.

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

Because a man lives 40 kilometres to the wrong side of the border, he has been denied access to dialysis. That is an unacceptable situation in this country. He has been denied access at his nearest centre in the Northern Territory. He would have to fly 2,400 kilometres. He does not see that as a solution. He sees that he would in fact pass away in land that is not in his country. In other words, he is offered no solution to his health problems. That is an unacceptable situation in 2009, in what we call the lucky country. Governments across Australia are committed to closing the gap—the federal government, the Territory government and the state governments involved—and yet here we have patients that have no access to dialysis. As I said, that is unacceptable.

Yes, Senator Adams mentioned the meeting of health ministers that was held last week. One would think they would have discussed access to short-term dialysis to fix this problem while the beds come on in the longer term, but apparently they did not. I heard that from Dr Kim Hames, who is the Minister for Health in Western Australia, on the radio last night. They discussed the longer term provision of dialysis units in Western Australia, South Australia and the NT, I understand. But they did not discuss this short-term crisis. I find that, quite frankly, unbelievable.

I must admit that two weeks ago when I heard the announcement from Minister Snowdon that a temporary unit of two new beds was going to be housed in Alice Springs I thought: ‘Fantastic. That was one of the shortest campaigns we have had to run. We have dealt with this issue of the ban in the Northern Territory because two more beds have been provided and that will get us over the hump until the new beds in Alice Springs have come online.’ But I was sadly mistaken. What Senator Crossin did not articulate in her speech was that the Northern Territory government has not lifted the ban on interstate patients. So the government can crow all that it likes about the fact that it has provided two new beds; it has met some of the unmet need in the Northern Territory, but not for Western Australia and not for South Australia. As of this morning Patrick has still be refused access to renal services in Alice Springs. I will reiterate: that is unacceptable in 2009.

Are we going to stand by and watch patients be denied access to dialysis? No, we should not. If we are genuinely committed to closing the gap, no, we should not. The Commonwealth, as Senator Crossin articulated, has put $1.6 billion into Indigenous health and yet we cannot provide dialysis for patients in Central Australia. That is unacceptable.

What could be done in the short term, as Senator Adams commented, is nocturnal dialysis. This of course is not a long-term option but for the short term isn’t it better than nothing? Isn’t it better than people dying on country without access to the vital services they need to save their lives. Of course it is an option. The Commonwealth has pumped millions and millions and millions of dollars into the Northern Territory intervention to deal with the emergency. Is this not an emergency? Here we are getting caught up, yet again, in arguments between what is a federal, state or territory responsibility. When are we going to get over it? It is not good enough that people will die without this treatment. They have been told to fly over 2,000 kilometres away from their homes and away from their families. It is another form of denial of services. People are being sent to Adelaide. We were just told that the South Australian government is looking at providing more beds in Adelaide. If you live on the APY lands you are being sent to Adelaide. Again: away from your home, away from your family, away from your culture and away from your land. That is not acceptable either. That does not go towards closing the gap.

We believe that the Commonwealth has a fundamental responsibility to show some leadership here. If the states and territories appear incapable of solving this shortfall the Commonwealth needs to show leadership. They have shown leadership before— (Time expired)

Question agreed to.