Minister for Health and Aged Care - speech - 25 October 2023

Read Minister Butler's speech at the National Aboriginal Community Controlled Health Organisation (NACCHO) Conference.

The Hon Mark Butler MP
Minister for Health and Aged Care

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Thank you so much Donella. It is a real honour and privilege to be with you all today. Particularly given it is such a big gathering here over in Perth. It is a great privilege to speak to you, but – more importantly – to listen.

I’d like to thank Donella Mills, Pat Turner and Dawn Casey for your invitation.

In a sector full of incredible people working incredibly hard, Donella, Pat and Dawn have got to be three of the hardest working women in the health sector.

Speaking of hard-working women, as Donella said, I know Malarndirri would love to have been here with me: watching me and keeping an eye on me – but she’s stuck in Canberra fighting the good fight. And it is a bit of a fight in the Senate Estimates over the course of the week.

I also bring the greetings of the Prime Minister and Linda Burney, both of whom know that I'm here today to talk about the importance of this conference generally, but particularly given the timing of what's happened over the last couple of weeks.

I want to begin obviously by acknowledging the traditional custodians of the beautiful land that we’ve flown to, for those of us who have, the Whadjuk people of the Noongar nation and pay my respects to Elders past and present.

I think the boss must’ve come, because Uncle Walter has left. But I want to thank Uncle Walter for his really warm, informative Welcome to Country.

It just reminds me how proud I am to live in a land that is home to the oldest continuously surviving culture on the face of the planet, something I know I consistently remind myself.

I also extend my respect to all First Nations people today who are gathered from every corner of this vast continent.

I was reminded how vast it was in my five and a half hour flight here last night against a bloody terrible headwind from Sydney, but this vast, beautiful continent that that we live in.

I’d like to also acknowledge the emerging leaders. Donella talked about this.

Those young Indigenous people working right around the country in this sector and in so many sectors beyond, who are stepping up and who are stepping forward.

We saw so much of that over the past couple of months.

And I hope those who attended the youth conference on Monday had constructive discussions that will inform future policies. I’m looking forward to staying and hearing a presentation from them over the course of this morning.

I don't think it's just because I'm into the back nine of my own life, and even deeper into the back nine of my career, that I think future leaders, young leaders, give me enormous hope.

Leaders like Jakirah Telfer who’s from my part of Adelaide, the Western Suburbs of Adelaide, who’s just 21 and was one of the coordinators of the Yes23 campaign in South Australia.

Great parents, great grandparents, well known to people in Adelaide.

But this young woman, that Linda Burney's talked about, just lifted with the enormous pressure of that campaign and showed what an extraordinary future she has and an extraordinary contribution she is going to make.

Jakirah’s grandmother was a member of the Stolen Generation and it was from her that Jakirah tells us she learned to “listen deeply”.

Listen deeply.

It is something that we could all stand to do a little more of, frankly at the moment, particularly in government.

I’d also like to acknowledge the great leadership that NACCHO and ACCHOs around the country played in rallying the health sector behind a yes vote.

There were 135 health organisations who signed an open letter published in all of the newspapers of the country advocating a yes vote.

There was no other sector of society that did that and there were hardly any serious health organisations that didn't put their name to that letter.

And we know why.

Because health organisations, no matter what part of the health sector they work in, no matter that profession they might represent, are literally on the front line every day of the yawning gap in health outcomes and life expectancy that Donella just referred to with that graph.

They know it, they live it, they work with it every single day.

The other reason I think why health groups were so willing to sign their name and proudly advocate a yes vote is because health professionals understand, more than anyone else perhaps, the importance of listening, of listening carefully and deeply to the patient.

Because if you're not listening to your patient, you're not going to get to the right solution, you're not going to get to the right outcomes.

I really want to pay tribute to the work that NACCHO did. A few of us did some work as well, to get those organisations signing on to that letter.

It showed a great unity of purpose in one of our most important sectors in our society behind the yes vote.

I know that so many in this room and across the health sector played such an important and leading role over many, many months of sustained effort.

You gave your time and your heart to the campaign.

That took bravery and it took guts, because it carried with it a heavy burden, to answer questions as well as make the case for yes.

And I know how draining it was for many.

It was physically, mentally and emotionally draining.

You have done a great deal of heavy lifting in support, and on behalf, of your communities, as well, while working yourself.

And there will be more to do, as those communities work through the results of the referendum.

I acknowledge that Aboriginal and Torres Strait Islander people have been affected deeply, both by the campaign and particularly by the result.

There is a lot of grief and loss out there.

It is in this room, I’m sure, as well.

And amongst the grief and loss, there is anger.

For some, more than others, perhaps.

But while anger can motivate and it can feel like a salve against the hurt … at the end of the day, it doesn’t heal.

Anger tears apart, it rarely brings together.

In that respect, the theme of this conference is timely:

“Working together, we are stronger.”

Working together, we are stronger.

Because if ever there was a time to come together, to work together, to be stronger together, it is right now.

Campaigning for any change is the art of hope.

I know that many in this room worked their guts out, fuelled by that hope, even against the evidence, sometimes, and against the historical odds.

Because history told us how hard referendum campaigns are to win.

Just 8 out of 44 had been successful.

But still we hoped.

Even when any possibility of bipartisanship between the two major parties was withdrawn and the debate was dragged into bitter and divisive politics.

Still we hoped.

Even when polls told us that the weight of history was likely bear down on this vote, just as it did on the other 44.

Still we hoped.

We hoped, because to do otherwise would be to turn our backs on decades of advocacy, from strong Aboriginal and Torres Strait Islander communities at the grassroots, right through organisations like this, all the way up to the Parliament.

That hope powered us, as it did the tens and tens of thousands of volunteers all around the country who made phone calls, who knocked on their neighbours’ doors, who staffed polling booths and did absolutely everything that they could, to bring about a yes vote.

And millions did vote yes.

But the hard thing about hope – the hardest thing perhaps – is when it is dashed.

What do you do then?

This is a question that I know we are all grappling with.

And I’m not going to pretend that I have the answer.

It would be a foolish politician that came into a room like this and said that they had the answer.

So I don’t know the answer, but I suspect that we will find it by working together … and listening deeply.

In the May Budget, we invested more than $10 million to boost mental health support for First Nations people in the lead up to, and after, the referendum.

That money has hit the ground from NACCHO, through ACCHOs and other partners to ensure that culturally safe mental health, suicide prevention, and social and emotional wellbeing services are available for First Nations people.

We know that levels of distress remain high, and that there is more to do.

So as communities work through the impact of the referendum, both the tenor of the campaign – some of the things that Donella referred to – and its result, we will work with NACCHO and the sector on what additional resources might be needed.

Because governments need to keep listening. Now more than ever.

The Albanese Government, it goes without saying, remains as committed as ever to Closing the Gap.

Before October 14, our priorities were improving health, education, housing and jobs.

And today, our priorities remain improving health, education, housing and jobs.

And we will be looking for other ways that we can embed listening into the business of government.

Because the work of listening to get better outcomes didn’t start with the referendum, and it didn’t end with the referendum.

My predecessor, Greg Hunt, to his credit, began this when he worked with NACCHO and the broader sector to develop the second National Aboriginal and Torres Strait Islander Health Plan.

That Health Plan was, I think, developed in genuine partnership with First Nations health leaders, including many in this room.

As a result, it reflects First Nations priorities and charts a course for improving the health and wellbeing of your communities.

But an official governance mechanism for co-design in the Health Plan was never put in place.

That work will now be expedited, with the creation of a new First Nations health governance group.

The exact governance arrangements will be co-designed with your sector.

In our early discussions, it’s clear that you want this group to provide guidance directly to health ministers as it determines priorities, makes decisions and monitors progress.

You’ve also indicated that you want the group to be able to:

call out systemic discrimination,

point out where red tape is holding the sector back, and

look out for areas where difficult structural reform could actually close the gap.

Accountability will be key.

A shared accountability where government is accountable to community and community is accountable to government.

Because working together means being accountable together.

And that means listening deeply, all the way down to local and regional voices.

We need mechanisms to make this work, and I’d like to hear your ideas on how we put this principle into practice.

Perhaps also it can be something for discussion when we reconvene the Aboriginal and Torres Strait Islander health roundtable.

It was around this time last year, after a long break over COVID, that we brought together all the Health Ministers from the states and territories and the Commonwealth, along with representatives from across the community-controlled and wider health sector, for a roundtable on Aboriginal and Torres Strait Islander health.

The next one isn’t scheduled until October 2024.

I think it needs to be held sooner, which is why I will be asking health ministers to bring that roundtable forward to very early next year, as a first step to holding those meetings annually.

Because there is much for us to discuss.

We’re going to be talking locally and practically, and taking our time to listen deeply as we pursue our shared goal – equity.

That means being clear sighted about all the institutional blocks to equity that First Nations people face in the health system.


The tragic deaths of three women at Doomadgee, who died from complications of rheumatic heart disease, are a clarion call – yet another clarion call - for health systems to work together better.

The coronial inquest called out the systemic failures in the system that contributed to their deaths, and made 19 recommendations for systemic changes to improve healthcare in Doomadgee.

The fact is: these women died from a condition that was largely eradicated in developed countries 50 or 60 years ago.

Doctors working in our major cities, like this one, will likely never see a case of rheumatic heart disease in their entire career.

But in remote Aboriginal communities, as you know so much better than me, you find some of the highest rates of rheumatic heart disease in the world.

Which is why, upon coming to government, we doubled funding to combat rheumatic heart disease. Work is underway, but there is more to do.

The mid-term review of the hospital funding agreement with states - the National Health Reform Agreement - is due to be finalised by the end of this month.

I expect it will make some strong recommendations on improving the health of First Nations’ people, underpinned by a commitment and requirement to work with the community-controlled sector and local communities in the design and the implementation of health services.

I’d like to see all jurisdictions commit to improving access to community-controlled and culturally safe health services for all First Nations Australians.

I am committed to pursuing these critical recommendations as I sit down with my colleagues and nut out the scope of the next Agreement.

Challenges like better healthcare in prisons and custodial settings.

That is something all health ministers heard and recognised at the health roundtable we held in October in Adelaide.

As a first step, my Department has established a taskforce to undertake a review of healthcare in prisons, to ensure we have a picture of the current landscape, and an understanding about what works.


The review will be presented to health ministers and the sector by the middle of next year and will highlight ways that your sector and governments can work together to improve outcomes.

I know that a number of ACCHOs are already delivering healthcare in custodial settings, and my Department will be working closely with NACCHO, at my request, to explore how that might be scaled up, into the future, across the country.

Health Ministers are also keen to look at options to improve the use of health checks for First Nations children and families in the child protection system.

We discussed this, again, at the Health Ministers Meeting only a couple of months ago, in July, after a presentation from Pat Turner.

We need better integration between child protection and health services, as well as an ongoing commitment for the ACCHO sector to be at the forefront of service provision for First Nations families while they are interacting with child protection services.

The model of care embedded in the community-controlled sector is holistic and trauma-informed and exactly what First Nations children need, while they’re in the child protection system.

Health Ministers will reconvene at the next Roundtable, after discussions that we’re having with Child Protection Ministers in every jurisdiction, to agree on the path forward to improving health outcomes for First Nations children in that system.

Another big challenge that can only be faced together is cancer.

Because while death rates for all cancers across Australia are decreasing, pretty sharply, that isn’t the case – as you know – for Aboriginal and Torres Strait Islander people, for whom death rates continue to climb.

Last year, NACCHO recognised that a dedicated Aboriginal and Torres Strait Islander Cancer Plan was needed, one that listened to and was co-designed by the community.

NACCHO has led that work, and I thank them for that, particularly Dawn Casey.

And it is my great pleasure and privilege to launch the first ever Aboriginal and Torres Strait Islander Cancer Plan today, which I think is available here in hard copy and is being published today on our website.

The next step is to rollout a program of activities across the community-controlled sector that includes prevention, screening, early diagnosis and support.

The Albanese Government is proudly funding four years of cancer programs in this sector, with close to $200 million starting this year.

That Plan and its programs are just one part of $970 million in new investments to improve First Nations health that we announced last October and in May.

First Nations communities continue to be impacted heavily by tobacco smoking and nicotine addiction, and I know that many in the sector are concerned that vaping is trapping a whole new generation of kinds into to nicotine addiction.

I read a paper story this morning that says that year 12 students right now are having to do their exams with nicotine patches on them, because they're that addicted to nicotine, through vaping.

Which is why we invested an additional $141.2 million over four years for Indigenous-led activities to prevent smoking but also vaping, through the renowned Tackling Indigenous Smoking program.

Work is also underway, in partnership with NACCHO and Purple House, to roll out the first six sites of up to 30 four-chair dialysis units across Australia, so that loved ones don’t have to travel quite so far, or spend quite so long, away from family and away from Country.

The $32 million provided to NACCHO for prevention and treatment of RHD is also already having an impact.

By October, 15 ACCHOs across W.A., Queensland and the NT had entered into formal arrangements with NACCHO to deliver education, services and frontline support for RHD.

Another 6 ACCHOs are in negotiations to do so, with 32 more having been invited to submit proposals.

NACCHO is also leading the delivery of the First Nations Health Workforce Traineeship Program that we announced at the last election, which will see 500 Indigenous people trained as Aboriginal health workers and practitioners.

This will inject new skills into the workplace, while supporting employers and providing additional opportunities across Indigenous communities.

Already more than 130 students have transitioned into the program, with more students in the pipeline and others scheduled to join next year.

To maximise the impact of this commitment, we are working together, and I’m working with my colleague, the Skills Minister, to fill the gaps in community-controlled RTOs in some parts of the country.

We went to the election promising to deliver new or renovated health clinics and staff housing, in partnership with 18 First Nations health organisations.

Those 26 projects are now well underway.

They build on other programs to repair and improve the aging infrastructure that is used by your sector, in far too many places.

$139 million is already funding 61 projects around the country, and another 70 million dollar grant round opened earlier this month.

All up, these infrastructure upgrades are expected to deliver:

up to 100 new clinics, housing and major refurbishments, along with

up to 230 small scale repair, maintenance and security projects.

It’s clear that we urgently need to expand and repair the infrastructure that underpins your sector, because the work ACCHOs do isn’t just a model for First Nations health, it really is a model for the whole health sector.

I have spoken before, including at last year’s conference in Canberra, about the Government’s commitment to Closing the Gap, and to actually implementing the letter and the spirit of the Coalition of Peak’s Priority Reforms.

Priority Reform number 2, as you know, emphasises the role of the community-controlled sector, and the role of governments in building and supporting and strengthening the sector.

Which is why, when I addressed this conference last year, I directed my Department to review every program that aims to improve health outcomes for Indigenous Australians to ensure that, wherever possible, those services are actually delivered by Indigenous-led organisations.

Transitioning the well renowned Puggy Hunter Scholarship to First Nations control was the first step.

That work of review and transition continues.

We’ve already identified a number of other programs that should be transitioned over time.

It will be a guiding principle as programs come up for renewal and contracts with existing providers, particularly existing non-Indigenous providers, come to an end.

Transitioning services to the community-controlled sector is something that I would like to see all governments and jurisdictions commit to, as part of their responsibilities under the Closing the Gap agreements.

States and territories have a clear role to play her, not just the Commonwealth.

As we look towards the future, and redouble our efforts to close the gap, building and strengthening the community-controlled sector will be critical.

And that means investing in the capacity and capability of the sector.

This needs to be done in the right way, at the right pace.

The community-controlled sector is being asked to do a lot, by your communities and by governments.

We need to work to ensure that the pace of change is sustainable and growing pains are manageable.

In the transition to greater responsibility and a shared accountability, we need to support and empower, rather than have governments just abdicate and delegate.

Indeed, the coronial inquest into the deaths of the Doomadgee women are an all-too-tragic reminder of the need to transition services to community control in the right way: with care, support and a good dose of capacity and capability uplift.

It’s not enough for government to simply say “here, you do this now”.

To that end, I’d like to hear your ideas for how we build capacity and capability as we transition responsibility and more services to the community-controlled sector.

Which is why I come back to my opening: it will be so important for our government to listen; carefully and deeply.

Because listening is the foundation of working together.

And by working together, we will be stronger.

Thank you for inviting me today. I’m going to be here for the next little while to hear the young people present and to share some morning tea with you.

So please come and say hello.

As Donella said, I have been invited to karaoke. It’s not exactly accurate: I forced an invitation to karaoke.

But I’ve got to tell you, listening to me stumble my way through one or two Elvis songs might not be a time that you really want to listen that carefully.

Thanks very much.

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