Response to the Health Performance Council’s audit of South Australia’s Local Health Networks

Introduction

Delivering services that produce positive outcomes for the health and wellbeing of all South Australians is a critical objective of SA Health. This includes working to address inequities faced by Aboriginal people and reducing the gap in health outcomes between South Australia’s Aboriginal people and the rest of South Australia’s population.

SA Health acknowledges the Health Performance Council’s work to measure and report on institutional racism, with particular focus on disparities for Aboriginal people, in South Australia’s health system. It is recognised that institutional racism can act to create inequality in both service delivery and in outcomes

The Health Performance Council’s audit of publicly available information concludes that there is evidence of institutional racism across the 10 South Australian Local Health Networks.

SA Health notes the seriousness of this conclusion and will consider the recommendations of the Health Performance Council to inform an appropriate response.

It is noted that the Health Performance Council’s analysis relied upon published information only. As such, it has not considered the full breadth of the activities and responses within Local Health Networks. Further, considering the Local Health Networks in isolation from broader health system and state-government strategy and policy produces a significant gap in the Health Performance Council’s analysis.

SA Health will consider its response within this broader context including policy and service responses currently planned within the context of new and emerging state-wide initiatives and national agreements.

An overview of this information, and how it relates to the Health Performance Council’s audit, is outlined below.

Governance reform

Ensuring that decisions about health services are made at the local level is a critical part of delivering health care responsive to the unique needs of local communities. This was recognised in the governance reforms implemented across SA Health, which saw decentralisation of health system decision making through the establishment of Local Health Network Governing Boards and the creation of six Country Local Health Networks. The 10 Local Health Network Governing Boards became formally operational on 1 July 2019.

These new governance arrangements provide the basis for improved engagement and planning at the local level that recognises the diverse needs of local Aboriginal communities. Each of the Local Health Network Governing Boards has a legislative obligation to engage closely with their local communities, through development of both a clinician engagement strategy and a consumer and community engagement strategy. A requirement also exists for all governing boards to have at least one member with expertise, knowledge or experience in relation to Aboriginal Health.

While the Local Health Networks manage local health service delivery, the do not exist in a vacuum: The Health Performance Council’s focus on Local Health Networks as isolated units fails to take into account the leadership provided by the Department for Health and Wellbeing. The Department is responsible for setting the strategic directions for the health system and providing system leadership and planning functions.

The Local Health Networks are required to comply with strategic directions and policies of the Department, including those which relate to Aboriginal Health.

Activities underway in SA Health

There are a range of system-wide initiatives which are driving changes across SA Health. This includes the Aboriginal Workforce Framework 2017-22, which aims to increase the Aboriginal workforce across the public health sector in clinical, non-clinical and leadership roles. This is supported by the Aboriginal Cultural Learning Framework, which provides an approach for improving cultural competency across SA Health’s workforce and includes mandatory engagement for all employees.

A new Aboriginal Health Care Framework is being developed to provide an effective benchmark to measure contributions towards closing the gap on health disparity between Aboriginal and non-Aboriginal people in South Australia. This is occurring through comprehensive consultation with Aboriginal communities, partners and staff.

In line with the objectives of the governance reforms, decisions regarding implementation of the framework in local areas will be made by the Local Health Networks. However, the Framework will provide increased transparency in measurement and reporting of performance.

The 10 Local Health Networks have developed or are in the process of finalising a range of initiatives that address health inequalities for Aboriginal communities. These include:

  • Aboriginal consumer engagement strategies as outlined in the Consumer and Community Engagement Frameworks
  • Delivering services focused on Aboriginal consumers, which consider areas including but not limited to primary health care, family birthing, and trachoma elimination programs
  • Working in partnership with Aboriginal Community-Controlled Health Organisations to ensure services are accessible
  • Providing significant funding to Aboriginal Community-Controlled Health Organisations and other Aboriginal organisations to support the improvement of health outcomes
  • Developing Aboriginal Impact Statements as a requirement for any new policies and service initiatives
  • Reconciliation Action Plans, which reflect the circumstances of each Local Health Network
  • The inclusion of Directors of Aboriginal Health in local executive teams
  • Increasing numbers of Aboriginal through strategies aligned to workforce plans

Given the short time in which the new governance structures have been operational, many of the regional Local Health Networks in particular are still early in their strategic planning and reporting cycle. Therefore while consideration of priorities and actions for Aboriginal health is an important component of these processes, information on many of the initiatives underway or being considered is not publicly available.

The broader context –whole-of-government initiatives and national agreements

Whole-of-South Australian Government initiatives

Local level decision making is complemented and supported by state-wide strategies and initiatives.

SA Health has clear responsibilities for improving the quality and delivery of services to Aboriginal South Australians as part of the South Australian Government Aboriginal Affairs Action Plan 2019-20. The objectives of deliverables under this Action Plan, such as the development and implementation of an Aboriginal Rural Health Workforce Strategy, have clear links with the recommendations of the Health Performance Council. As part of that Strategy, eight students have commenced study with the Aboriginal Health Council SA, and an Aboriginal and Torres Strait Islander Health Practitioners Reference Group has been established.

Progress against the Action Plan, including for all SA Health responsibilities, is publicly reported.

SA Health also participates in whole of Government planning around reconciliation action and will be required to deliver initiatives agreed through this process.

National Agreements

Local level decision making is also complemented and supported by a number of national agreements and initiatives which are applicable across SA Health, rather than being developed and led by the individual Local Health Network Governing Boards.

The South Australian Government entered the National Agreement on Closing the Gap in July 2020. This Agreement was developed in partnership between the Australian Governments and the Coalition of Aboriginal and Torres Strait Islander Peak Organisations. The Agreement has specific socio-economic outcome targets, as well as five key outcomes related to how government operates, including:

  • Shared decision-making
  • Building the community-controlled sector
  • Improving mainstream institutions
  • Aboriginal and Torres Strait Islander-led data

The Agreement signals a major shift in the way Government’s work, by encompassing shared decision-making in the design, implementation, monitoring and evaluation of policies and programs to improve life outcomes for Aboriginal and Torres Strait Islander people. This will have significant implications for policy setting and service responses across the health system as part of whole-of-government implementation strategies.

The second edition of the National Safety and Quality Health Service (NSQHS) Standards, also include a clear action for improving cultural competency. Consideration will need to be given to how a supportive environment and clear processes for exploring the cultural needs of Aboriginal and Torres Strait Islander patients to reach this objective.

The Health Performance Council’s findings will be considered in context of the obligations and activities which will occur under these national agreements, noting that they are in their early stages.