Tuesday, March 31, 2009

Paternalism harms rather than helps blacks

Just giving them dole money without restriction was disastrous too. Cutting off the dole altogether and just providing soup kitchens is the one thing that might work

The Sunrise Health Service covers 112,000 square kilometres of the Northern Territory east of Katherine and is at the frontline in dealing with the health parts of the intervention. All but one community within its area are subject to the intervention's measures, including welfare quarantining.

Sunrise has compared data collected before and since the intervention and the results are dispiriting. Anaemia is an iron deficiency that leads to poor growth and development, and as such is an indicator for the general health of children. Since the intervention, anaemia rates in the area have jumped significantly. In the six months to December 2006, 20 per cent of children were anaemic. A year later the figure had increased to 36 per cent, and by June last year it had reached 55 per cent, where it stayed in the last six months of 2008. Now, more than half the area's children face big threats to their physical and mental development. In two years, 18 months of which was under the intervention, the anaemia rate nearly trebled.

There is also a worrying rise in low birth weight among babies. In the six months leading up to the intervention, 9 per cent of children had low birth weights. This rose to 12 per cent in December 2007, and to 18 per cent six months later. By the end of last year, it was 19 per cent, double the figure at the start of the intervention.

Since compulsory income management of welfare payments began in the region in late 2007, there have been documented instances when it affected people's capacity to buy food. This included diabetics, who with no local store access were unable to access food for weeks at a time. Their response to this situation was to sleep until food became available.

Income management has not reduced alcohol or drug consumption - indeed, alcohol restrictions on prescribed communities has merely shifted the problems to larger towns or bush camps. And it has not stopped "humbug" or the conversion of Basic Card purchases into cash for grog. There is also no evidence that it has increased the consumption of fresh food among Aboriginal families, which is vital to fighting anaemia.

There was strong agreement about the need to protect women and children from violence and to improve the socioeconomic position of Aboriginal families between those who designed and welcomed the intervention and those who questioned its methods. The key criticism from those of us asking questions was why all the evidence of what is known to work to make communities safer and to improve education and health was ignored in favour of expensive, untried, top-down, heavy-handed policy approaches.

On Friday, the Government is expected to endorse the Declaration on the Rights of Indigenous People, along with the national apology to the stolen generations, another symbolic shift from the Howard government's indigenous policy. But there are still striking similarities between the practical approaches of the former government and the present. Nowhere is that clearer than the continuation of the suspension of the Racial Discrimination Act, the right to appeal to the Social Security Appeals Tribunal and the right to seek redress under the Northern Territory anti-discrimination legislation.

The suspension of the right to seek redress have left those people subject to welfare quarantining with no avenues of complaint if they feel unfairly treated. And there are more reasons to be concerned about continuation of the intervention without reflection on what is working and what is not.

While the Minister for Indigenous Affairs, Jenny Macklin, has said she is relying on conversations with some people about the need to continue without reviewing the policy, the evidence on the ground - like that from Sunrise - suggests it is time for the Government to seriously rethink the mechanisms it is using in the Northern Territory, especially around welfare quarantining.

There are two challenges for the Government over its indigenous policy. The first is to make it compliant with the standards it supports in the Declaration on the Rights of Indigenous People. The second is to make real its promise that it will be led by the evidence of what works rather than ideologies that don't. Both challenges will lead to more positive steps to addressing the socioeconomic disparity experienced by Aboriginal communities and the issues of protecting women and children that has been the justification of the intervention.


Melbourne public hospital lied over waiting lists

THE Royal Women's Hospital has been systematically lying about its surgery waiting list for almost a decade, says a damning report that has forced the Government to overhaul Victoria's hospital funding system. Health Minister Daniel Andrews yesterday apologised to patients who waited months longer for surgery than the Women's has claimed since the late 1990s. He said an independent audit — commissioned after The Age earlier this month revealed the hospital had incorrectly reported data to the Government — confirmed the creation of a "second waiting list" that was disguising the hospital's real performance.

About 180 patients waiting for semi-urgent surgery every year waited an average of 95 days longer than the hospital was reporting, the audit found. This occurred in the context of inadequate scrutiny at the executive level. The finding comes after The Age revealed allegations last May that hospitals were manipulating data to meet benchmarks for bonus funding. Mr Andrews consistently denied the practice was taking place and refused to investigate.

In response to the audit's finding, Mr Andrews yesterday announced that:

* A long-standing $40 million bonus funding pool used to reward hospital performance would be scrapped.

* Six hospitals would be audited without warning every year.

* Patients would be notified in writing if their waiting-list status changed, so they could challenge any discrepancies.

Mr Andrews said he was furious about the audit results and put all Victorian hospital boards on notice that data manipulation was unacceptable. "Health services are accountable for their data and there is an expectation that they record and report it accurately," he said.

The audit of the Royal Women's Hospital found that although staff spoke of "two waiting lists" in front of senior and executive management, executives claimed they knew nothing of it. A "data-entry instruction sheet" revealed that when patients neared a benchmark for how long they should wait, they were put on a secret list, which effectively stopped the clock.

The Government rewards most hospitals with bonus funding if they meet performance benchmarks, but the Royal Women's is not on this list. Mr Andrews said it had previously been on the list and that data manipulation appeared to be a long-standing practice potentially motivated by the incentives. He said he had appointed a delegate to the board of the Royal Women's to ensure the fraud was eliminated. The secretary of the Department of Human Services had received the report and would take legal advice on what action could be taken against those involved, he said.

Royal Women's chief executive Dale Fisher said she had ordered a clinical review to establish whether patient care was affected by the list rorting. She said that, "on the face of it", there was no effect on patients because the list manipulation did not change the booking date of an operation, only the report of the patient's waiting time. "The people got treated at the next available opportunity," she said.

But Ms Fisher admitted it might have hurt the hospital's gynaecological department. "That's one of the disappointing things … that it did compromise our view of demand in gynaecology," she said. "We could have strategically allocated more resources." She said "appropriate disciplinary action" would be taken against staff involved in the practice. This could range from counselling to sacking — but no one had yet lost their job.

Ms Fisher defended her management of the hospital, saying there was no reason the executive team would have spotted the practice, because it was designed to "iron out" the kinds of peaks and troughs that drew management attention. "I am pleased that we found the problem and fixed the problem," she said.

But Ms Fisher said she may never have realised the seriousness of the issue if it was not for a report in The Age this month about waiting-list fraud in unnamed hospitals — a month after she knew about the list problem at her own hospital. "When I found this … I viewed it as a management problem that we needed to fix. The level of seriousness was raised as a result of that article … It was the issue of possible fraud (that) raised the level of seriousness." The hospital will centralise training of staff to get greater control over data reporting, and its internal auditors have been asked "to make sure we're not missing anything else".

The Victorian president of the Australian Medical Association, Doug Travis, welcomed the decision to scrap the bonus pool, saying it would allow hospitals to focus on patient care. "There has been a culture in Victorian hospitals to hit your (key performance indicators) no matter what," he said. "Our community needs to be assured that hospital funds and resources are directed where they are needed."

Shadow health minister Helen Shardey said the Government's response was inadequate because six random audits a year would allow a major hospital to go three years without being audited. "There should be an immediate independent audit of all hospital waiting lists," she said.


Military not ready for war as fighter jets, choppers and submarines unfit for frontline

BILLIONS of dollars of fighter jets, warships and military equipment cannot be used in their current state because they would be too vulnerable to enemy fire. A critical lack of upgraded weaponry has left the Australian Defence Force unable to deploy most of its frontline fighters or warships at short notice against any enemy with modern air defence systems or anti-ship missiles.

An investigation by The Australian reveals much of the ADF's most powerful weaponry is awaiting upgrades or promised replacements and is useful only for training purposes or deployment on operations where there is little or no risk of high-level conflict. As such, the ADF, which receives $22 billion in taxpayer funds each year, cannot conduct any high-level operations without substantial support from coalition forces such as the US.

Former Defence official Allan Behm said: "I think the public would be absolutely astonished and gobsmacked to think we spend so much on defence every year and yet we can't send much of it into harm's way because it won't work or it will not survive in a contest."

Defence experts say none of the RAAF's soon-to-be-retired F-111 strike bombers nor the majority of the 71 F/A-18 Hornet fighters can be used against modern air defences because they lack sufficient electronic protection.

Similarly, they say the navy's eight Anzac frigates cannot be sent into a hotly contested war zone because of a lack of defensive weaponry, while the four other frigates, the FFGs, are still unavailable after a bungled and delayed $1.5 billion upgrade.

Experts say the problem reflects a litany of delayed equipment upgrades as well as a Defence Department mindset that focuses more heavily on future purchases than on current operations. They say the proper balance between current and future defence needs has been lost. Daniel Cotterill, former chief of staff for Defence Minister Joel Fitzgibbon, told The Australian: "There is a bias within Defence towards investing in the future force rather than giving government the fully functioning options they really need today."

The Government is in the final stages of preparing a Defence white paper that will outline a multi-billion-dollar shopping list of new planes, ships and hi-tech weaponry. But the ADF is in a parlous state of readiness for serious conflict.

A deficiency in anti-submarine warfare capabilities means the navy would be unlikely to risk sending surface ships into zones where enemy subs were present. Andrew Davies, an analyst with the Australian Strategic Policy Institute, said: "Our ability to actively search for submarines is very limited to short-range technologies and we have little or no ability to successfully fire a weapon at a modern submarine." Only half of the six-boat Collins-Class submarine fleet is available and a shortage of crew would make it impossible to sustain operations for long.

The army cannot deploy any of its 33 Blackhawk helicopters into warzones, including Afghanistan, because they remain vulnerable to shoulder-launched missiles. It is also considered unlikely to deploy its M113 armoured personnel carriers because, despite receiving a $500 million upgrade, the M113s are considered vulnerable to large improvised explosive devices, such as those used by the Taliban in Afghanistan.

Experts say the Government needs to pressure the ADF to make its existing equipment more operationally effective rather than wait for future replacements.


Keystone Keelty should be fired

FEDERAL Police Commissioner Mick Keelty can duck an issue better than George Bush dodges flying shoes. According to Keelty, the security at an airport where a man was bludgeoned to death last week - in full public view and for many minutes - was "acceptable". You wouldn't use that line at the Comedy Festival. The crime shocked the nation, but the arrogant Keelty seemed pretty relaxed about it.

He has now caught the attention of a few people who want him sacked, a call I have been making for more than a year. Keelty's Keystone moments are too many to mention.

Last year he called for undemocratic restrictions on the reporting of terror-related cases, evidence that he does not appreciate the instruments of the democracy he is paid to protect.

Later, AFP officers were reported to have called the panicking family of Melbourne backpacker Britt Lapthorne, missing in Croatia, aggressively instructing them on how they should behave.

They should "tone down" their language, "ignore the media" and "think of the bigger picture". The dignified parents of the doomed Lapthorne wouldn't have said to Keelty's men what most would.

Young Scott Rush will be shot dead in Indonesia soon for trying to import heroin from Indonesia to Australia. But Scott's dad had a lawyer call a mate attached to the AFP to see if the boy could be stopped at the airport. Instead, the AFP passed on Scott's details to their Indonesian counterparts and he strolled beneath the sign that read "Departures" and on to his grim fate.

Under Keelty, the AFP made fools of themselves - and Australia - by pursuing a suburban doctor, Muhamed Haneef, who someone clearly believed to be a terrorist.

Upwards of $7.5 million was wasted as the AFP had 250 officers on the case, assisted by 225 Queensland police, 97 interstate coppers, six Customs staff, six translators, four officers from other forces and two British police.

If Haneef is a terrorist, and 600 investigators missed their man, Keelty should be sacked. If he is a harmless doctor and we spent all that money trying to prove otherwise, Keelty should be sacked. Keelty should be sacked.


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