2016-05-06
Senator RICE: I want to start with the overall portfolio budget statement for mental health. There appears to be a fall-off in mental health funding. This is program 2.1, where we go from $700 million in 2016-17 to $717 million in 2017-18 to $730 million in 2018-19 and then down to $547 million in 2019-20.
Mr Cormack: It is the transition to the NDIS.
Senator RICE: What exactly is being cut to have that—
Mr Cormack: There has been no cut. There has been a transfer of portfolio responsibility for two programs that are currently in the Health portfolio. They are formally transitioning to the NDIS.
Senator RICE: What are the programs?
Mr Cormack: They are Partners in Recovery and Day to Day Living. They are the two program areas. That is the reason for the drop-off in the expenditure.
Senator RICE: Okay. But there is no increase in funding in the NDIS to account for those?
Mr Cormack: We are simply transferring what is currently in our forward funding profile. It is being transferred, without savings, to the NDIS.
Senator RICE: So the total funding package for those two programs, Partners in Recovery and Day to Day Living, is being transferred to the NDIS.
Mr Cormack: That is right. Yes.
Senator RICE: What happens to the people who are currently accessing Partners in Recovery who are ineligible for the NDIS?
Mr Cormack: At the present time we are working through a transition program where we are providing in-kind contributions. Essentially, we are holding those funds, and they are being distributed through a range of locally based organisations—some through former Medicare Locals and PHNs, and others through other locally based groups. We are working very closely with our colleagues, both in DSS and the NDIA, in a policy perspective to ensure that the transition arrangements and the funding that goes with them are smooth, and that nobody misses out on—
Senator RICE: Those transitional arrangements are not in place at the moment though?
Mr Cormack: They are in place at the moment and they have been—can you just let me finish the question. We are making an in-kind contribution. What we are doing is more or less shadowing the way the scheme will operate in the future. We are merging into the NDIS world. So we are holding the funding, and at that point in the forward estimates you identified, the funding and the programs will then shift to the NDIS, and the current kind of continuity will shift over with the scheme.
Senator RICE: Okay. I could see that for the people who are currently accessing Partners in Recovery will be eligible for the NDIS will be covered. How about the people who are currently accessing Partners in Recovery who will be ineligible for the NDIS?
Ms Cole: You may be aware that there is a Council of Australian Governments' commitment to ensure that people with a disability or in this group that you are talking about, who are currently receiving services, are not disadvantaged in the transition. These program clients found not to be eligible for tier 3, which is the client group that you are really talking about, will continue to receive support consistent with the current arrangements.
Senator RICE: Where is that being funded from?
Ms Cole: There is some residual funding in the Partners in Recovery and Day to Day Living which is being held in the portfolio. There is a process in two years in 2016-17 or 2017-18 to review the transition numbers and to consider whether that residual funding needs to be changed as a result of the trial process.
Senator RICE: So that is not reflected in the budget at the moment? Is the quantum of that residual funding in the budget papers somewhere?
Ms Cole: Yes, it is. Within that overall figure of the mental health funding going forward in the fourth year, when the NDIS is expected to be fully operational, there is a small residual amount of funding left from those two programs within the Health portfolio, but that figure may well be adjusted when we have a clearer indication of the percentages of clients.
Senator RICE: What is that current figure then?
Ms Cole: It is around $13 million.
Senator RICE: Okay. And you may adjust that. Is that your expectation of what would be required?
Mr Cormack: I think there is a very orderly process that we are going through with DSS and with the agency to transition our programs. We are making appropriate adjustments as we transition. If we need to make subsequent transitions that are not catered for within the current budget, then that will be a matter we will bring to the attention of government or DSS, and the agency will bring to the attention of government. But at this stage, we are working on the presumption that there will be sufficient funds to be able to effect the transition. We also have plenty of time to work through issues and bring them to the attention of government.
Senator RICE: What is the total funding for Partners in Recovery per year at the moment?
Mr Cormack: If you want to ask another question, we will get that one for you.
Senator RICE: Okay. Moving on to budget paper No. 3 on page 28, it notes that the national partnership on supporting national mental health reform is ending on 30 June this year.
Mr Cormack: Yes.
Senator RICE: So this is another $50-million-a-year program. Is that also moving over to the NDIS?
Mr Cormack: No. That is an existing National Partnership Agreement that has come to an end; it is not being continued.
Senator RICE: Isn't that a cut over the forwards then?
Mr Cormack: No. There was an agreement struck with the states, a National Partnership Agreement that had a beginning point and an end point. It has come to an end, and the government has decided that it is not going to be extended.
Senator RICE: But, effectively, it is a cut, because effectively it is funding services that people—
Mr Bowles: It is a government decision.
Senator RICE: But it is effectively a cut.
Mr Cormack: It is a government decision not to continue the agreement.
Senator RICE: But in terms of maintaining funding—and we had been told that we are maintaining the same level of funding for mental health—it is effectively a cut. It is a program that is not being continued.
Mr Cormack: There are lots of national partnership agreements. They all have a beginning point and an end point. They do not all get continued. This is one of them—
Senator DI NATALE: There are lots of end points under this government—not many beginning points but lots of end points!
Mr Cormack: These are government decisions.
Senator RICE: Given that 30 June is also the rollover date for the PHNs beginning, do you think it is really the right time to be ending these payments to the states under this program?
Mr Cormack: These are decisions for government. We cannot comment on those sorts of decisions.
Senator RICE: So it is effectively a cut at the same time as we are having a big transition. My expectation is that you will have a lot of people who are currently receiving services who are going to find themselves high and dry.
Mr Cormack: We are talking about one national partnership agreement in the context of quite a few billion dollars in spending in this particular space. As Mr Cormack said, we have a range of national partnership agreements, and, if you go through some of the others, there is a range of them that will finish at the end of this year.
Senator RICE: But in this case, over the forwards, it is $200 million that would have been being spent that is going—$50 million a year.
Mr Cormack: No. That is not—
Senator Nash: No. The NPA has come to its natural end. I would not categorise it as a cut. It has come to its natural end.
Mr Bowles: It was never in the forward estimates.
Senator Nash: When we look at the $2.9 billion that has just been injected into public hospitals, I think it is important—
Senator RICE: I am talking about mental health funding—
Senator Nash: I know you are, but you are talking about what you are categorising—
Senator RICE: As you were trying to tell the committee—
Senator Nash: as cuts, which is incorrect. So I am clarifying that for you. I am also putting it in the context of other government spending that is significant when it comes to health.
Senator RICE: We are clear about where the government is headed with that funding. In terms of the rollover of mental health services into the PHN flexible fund, can you outline, so that we are clear, which programs are being rolled over.
Mr Cormack: I will make a start, and Ms Cole will pick up on that. There are the youth focused programs, which include headspace. There are children focused programs, including beyondblue. Run through the list.
Ms Cole: The list is: mental health rural services program; that is one of them. There is the ATAPS program. There is some new funding for Indigenous mental health and also for Indigenous suicide.
Senator RICE: How much is that funding?
Ms Cole: Indigenous mental health or the suicide funding?
Senator RICE: Both of them.
Ms Cole: Indigenous mental health is about $84 million, but I can get you the exact figure. The suicide funding is about $6.9 million per year, or around that, and again I can get you the exact figure on that one. There is also the headspace funding—
Senator RICE: So that is different from—
Ms Cole: Sorry—I am just going through the list for you. There is 'youth—severe' funding. There is also some funding for community regional suicide prevention programs.
Senator RICE: I have a couple of others that people have told me of: the early psychosis prevention and intervention centres?
Ms Cole: That is 'youth—severe'.
Senator RICE: And the Mental Health Nurse Incentive Program?
Ms Cole: And the Mental Health Nurse Incentive Program.
Senator RICE: Right—so you have left that one out. So that is the full list?
Ms Cole: That is the full amount going into the PHNs.
Senator RICE: The Mental Health Nurse Incentive Program has been successful because it uses credentialled mental health nurses. How are we going to guarantee that those elements of programs that are successful because of those particular criteria are going to continue to have the same quality when they are being rolled out under the PHNs?
Ms Cole: I guess, in a sense, the important thing to note is that, over time, those programs kind of generally move into a broad, flexible pool for the PHNs to address the community needs. So in a sense it is more accurate to say that the PHNs have an obligation to provide services for people who have consistent and severe problems rather than saying the program exists forevermore.
Senator RICE: So you are not going to require the PHNs to continue to engage the credentialed mental health community?
Mr Cormack: The policy basis of this is that the National Mental Health Commission undertook a large-scale consultation process and delivered a report to government. Government then considered that report and outlined in November last year a forward direction in response to that. Part of that forward direction was to recognise that, while there are a number of strengths with the current programmatic approach, what was more appropriate was to have regionally responsive, flexible funding arrangements that would enable PHNs to be able to commission services in response to local needs. The intent was not to simply transfer over programs and forever maintain their existing program boundaries and restrictions, because the commission's report in fact found that those restrictions were problematic. The premise of your question is asking us how we are going to implement something that is contrary to government policy. Government policy suggests to us and requires us to move those funds into a flexible, regionally responsive mental health funding pool, and that is what we are doing.
Senator RICE: If you are shifting programs from ones which have been known to have been delivering very high quality and very effective results, I am interested to know how you are going with ensuring the accountability and ensuring that the PHNs are going to be delivering the same quality of services.
Mr Cormack: The PHNs are responsible for assessing community needs and devising commissioned services in response to community needs. They are required to present to us evidence of their planning, of their needs analysis and of their forward commissioning program. A range of quality indicators will be included within each of those schedules. There are very specific accountabilities for the PHNs to deliver a whole range of quality outcomes across mental health, but I repeat that it is not just simply novating existing Commonwealth programs that have been the subject of significant external criticism and scrutiny and continuing on in a hardwired fashion into the future. That is not the policy intent.
Senator RICE: Have you finalised those accountability measures for the individual PHNs in terms of the oversight and accountability that the department is going to have?
Mr Cormack: We have concluded all of our contractual arrangement with the PHNs, including the provision of funding arrangements for all of the mental health funds for the coming contract period.
Senator RICE: So you finalise the accountability and reporting measurements for that in those contracts?
Mr Cormack: Indeed, it is specified in there.
Senator RICE: My final question is about a program called the Children of Parents with a Mental Illness. My understanding is that funding for the program is ending on 30 June. Is that the case?
Mr Cormack: It has a six-month extension until the end of the year.
Senator RICE: Will it end then or will it be reconsidered?
Mr Cormack: That is a consideration for a future government, but the funding arrangements have been extended to the end of the calendar year.
Senator RICE: By all accounts it seems to be a very successful program. Is there a particular reason why the department has decided to discontinue the funding?
Mr Cormack: It was a decision of government. Like a number of programs—some come to an end, some get renewed, some get modified and some do not continue. This is one that the government has elected to continue for another six months. No doubt they will be seeking advice from the department in the lead up to further consideration of its future past December.
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Senator RICE: When you said it to me, it was $6.9 million.
Ms Cole: There are two components; one has gone into the PHN and then there is a small component which is retained for research. The $6.9 million covers those two components—my apologies.
Senator SIEWERT: So $6.3 million has gone to the PHN—
Ms Cole: Yes.
Senator SIEWERT: of the $17.8 million.
Ms Cole: Ongoing—it is an ongoing amount each year. I believe the money that you may be talking about might be a four-year figure, but we will double-check for you.
Senator SIEWERT: So $6.3 million for the Kimberley?
Mr Cormack: I think we have said we will take it on notice. We will get back to you soon as we can. I do not think you are going to get a clearer or better answer than we can—once we get the material available for you, we will deal with it then. We are not trying to avoid it; we just do not have the information at our fingers now.
Senator SIEWERT: I would have thought you would have the $6.3 million information.
Mr Cormack: We will have it for you, but not right now.
Senator RICE: The answer I was given before was $6.9 million for Indigenous mental health and Indigenous suicide programs, I thought, across the country.
Ms Cole: That is around $84 million for Indigenous mental health, and there is a separate amount of money for Indigenous suicide prevention. Sorry if I was not quite clear on that for you.
Senator SIEWERT: All right. Can you come back after lunch. Thank you.
Mr Cormack: We will come back after lunch, if we can.
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Senator RICE: Do you have an answer for me about the value of the Partners in Recovery funding, and, in fact, the Support for Day to Day Living in the Community program as well.
Ms Cole: I do, Senator. In 2016-17, Day to Day Living is $15 million per year, and in 2016-17, Partners in Recovery is $140 million.
Senator RICE: So that is $155 million, yet we have got $170 million.
Ms Cole: There is growth in those figures.
Senator RICE: Right, but the drop-off in 2018-19 to 2019-20 is $170 million less.
Ms Cole: Because there is growth in those figures, Senator.
Senator RICE: Right, so that is $155 million. Now, that transitional funding, which you said was $13 million—
Ms Cole: That was the residual funding in year 4.
Senator RICE: That is expected to cover the people under both Partners in Recovery and Day to Day Living who are not eligible for the NDIS?
Ms Cole: Yes, senator. But, as we explained earlier in evidence, there is an evaluation process planned when the trials having been running a bit longer and we have a better indication of the percentages of clients who are likely to go.
Senator RICE: I have been told about a quarter of Partners in Recovery clients and about half of Day to Day Living clients will not be eligible for NDIS, which means that, at the moment, your estimation of that $13 million is only about 15 per cent of the funding needed to cover that quarter of the Partners in Recovery clients and that half of the Day to Day Living clients.
Ms Cole: There is that automatic evaluation process that I mentioned. That is already to do. But actually our trial figures for Partners in Recovery, which is the big component, are actually a fair bit higher than that. They are around the 90 per cent mark to date.
Senator RICE: Ninety per cent being covered by NDIS?
Ms Cole: Yes, transitioning into the scheme—around that.