APY Lands: investigation of dialysis options

First posted on 31 March 2010 under APY Lands & Kidney Disease.
This article has been updated and archived.
Tags: dialysis & inquiries and reviews

Summary

On 7 May 2010, the Australian Government announced a “joint study” into the delivery of kidney disease treatments to people from remote Aboriginal communities. The study – which focused on Central Australian communities – was carried out by the George Institute for Global Health.[i]

The final report of the study was released on 27 June 2011.[ii]

The Paper Trail

Introduction

In recent years, the number of people from the APY Lands on dialysis has doubled: from 12 patients in April 2005 to at least 24 patients in March 2010.[iii]

As dialysis is not available on the APY Lands, people with end-stage renal disease have to relocate permanently to Adelaide or a major regional centre such as Alice Springs or Port Augusta.

Relocating far from home often comes at great social and cultural cost to the patient, their family and the broader Anangu community. As the Nganampa Health Council noted in August 2004:

Many studies have been done on the social and cultural implications of this relocation and the deleterious health impact such disorientation causes. There is a great deal of evidence that suggests that if Anangu could be dialysed in their home community then their health and well being would be improved.[iv]

However, the Council also observed that “no remote community in Australia” had “successfully set up and run in a sustainable manner a dialysis facility,” noting that there were complex reasons as to why this was so. In addition, the Council pointed out that the State Government’s Renal Services Reference Group did not consider the establishment of a dialysis facility on the APY Lands as “currently supportable”.[v]

Dialysis on the APY Lands: a priority area since 2006

In 2005, the State and Federal Governments and key Anangu organisations established a “peak body” for service planning and provision on the APY Lands.[vi] As part of this process, an Anangu Taskforce “made up of representatives of APY communities and organisations” was also established.[vii]

The Anangu Taskforce – better known as ‘Wiru Palyantjaku’[viii] – held its first meeting on 27 April 2005.[ix]

In mid 2006, the Anangu Taskforce examined eleven “priority areas” that it believed required “immediate action” on the APY Lands. These priority areas included: petrol sniffing, policing, education and kidney disease.[x]

As part of its examination of kidney disease, the Anangu Taskforce called on the State and Federal governments “to seek funding for the provision of dialysis machines” on the APY Lands by 2011.[xi]

Notwithstanding this request, over the course of the next two years, neither the State nor the Federal Government appears to have sought funding for the requested machines or explored in any detail how dialysis could be provided on the APY Lands.[xii]

In August 2008, Mr Jamie Nyaningu – the Chair of Nganampa Health Council’s Board – raised the importance of providing dialysis on the APY Lands at a meeting with the then State Minister for Aboriginal Affairs and Reconciliation (Hon Jay Weatherill MP). On that occasion, the Minister undertook to raise this issue with the State Minister for Health (Hon John Hill MP).[xiii]

Renewed calls for “on the lands” dialysis

In early 2009, the Northern Territory Government announced that it was unable to accept any more dialysis patients from the APY Lands.[xiv]

Click here for more information on this decision and its ongoing consequences

At the time of the Northern Territory’s announcement, 18 dialysis patients from APY communities were already receiving dialysis in Alice Springs. Another two patients were receiving treatment in South Australia.[xv]

As the impact of the Northern Territory Government’s decision became apparent, the possibility of providing dialysis on the APY Lands was frequently raised, often by Anangu.

Coordinator-General’s concerns

In mid 2009, the Australian Parliament created a Coordinator-General for Remote Indigenous Services.[xvi]

Mr Brian Gleeson – the inaugural Coordinator-General – commenced in this role in July 2009.[xvii]

On 30 November 2009, Mr Gleeson presented his first six-monthly report to the Federal Minister for Indigenous Affairs (Hon Jenny Macklin MP).[xviii]

The report drew particular attention to the problem of renal disease in remote Aboriginal communities and the strong desire among patients and communities for treatment to be provided locally “where possible.”[xix]

In his report, Mr Gleeson noted that while “both levels of government” – State and Federal – “argue that providing care for Indigenous people in their communities can be unsafe, expensive and impractical … there are examples of services that are operating successfully.”[xx]

The report continued:

In reality some patients will choose not to receive care if they cannot access it locally, which means they are likely to die prematurely and painfully. Patient wishes and quality of life should be considered when determining the most appropriate approach to care. It should also be borne in mind that the costs associated with treatment provided in regional centres can be considerable and often involve the movement of families.[xxi]

Mr Gleeson called for urgent action on “two key fronts”:

  • “immediate consideration of strategies to boost renal services in Alice Springs” including for people from the APY Lands, and
  • “further consideration … of the costs … and benefits of providing care in priority communities and the merits of co-locating renal services in primary health clinics in these locations.”[xxii]

Western Desert Nganampa Walytja Palyantjaku Tjutaku

Whereas for many years, no remote Aboriginal community in Australia had successfully established and maintained local dialysis services, this is no longer the case.

The Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation is an organisation focused on addressing the renal and dialysis need of people living in ten remote Aboriginal communities and Alice Springs.[xxiii]

The Corporation’s core activities include:

  • delivering renal dialysis care for Aboriginal people in the remote community of Kintore,
  • supporting the health and social needs of people with renal failure who have relocated to Alice Springs for treatment,
  • assisting people on dialysis in Alice Springs to maintain links with family and community through a ‘return to country’ program, and
  • teaching self-care dialysis so that people can return to remote communities (with their own dialysis machines).[xxiv]

On 18 March 2010, the Federal Government congratulated the Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation for its “strong leadership on renal dialysis care.” At the same time, the Government announced annual funding support of $1 million to enable the organisation “to expand renal care to Aboriginal patients from remote areas of Central Australia.”[xxv]

This expansion included establishing a dialysis service in the remote community of Yuendumu and supporting a renal facility at Ntaria (Hermannsburg).[xxvi]

A fresh commitment to examine APY options

In February 2010, the South Australian Government announced that it would examine “how renal dialysis might be offered on the APY Lands in a safe and sustainable way.” The Government also noted that it would be “completely guided” by what the Nganampa Health Council believes “is the best approach.”[xxvii]

On 15 March 2010, the Paper Tracker discussed this announcement with the then Chief Executive of the South Australian Department of Health (Dr Tony Sherbon). On that occasion, Dr Sherbon noted that it would be very difficult and costly to establish and maintain dialysis services on the APY Lands and that any such facility would take many years to establish.[xxviii]

Dr Sherbon also:

  • noted that Nganampa Health Council’s Medical Director (Dr Paul Torzillo) did not support the establishment of dialysis services on the APY Lands, and
  • underscored Minister Hill’s earlier remarks that dialysis services would not be established on the APY Lands without Nganampa Health Council’s support.[xxix]

On 21 March 2010, the Paper Tracker asked SA Health to indicate:

  • when it had begun to explore the possibility of offering dialysis services on the APY Lands, and
  • when it expected the findings of this exploration to be completed and released.[xxx]

On 25 March 2010, SA Health advised the Paper Tracker that:

  • its discussions with Nganampa Health Council about this matter had been “occurring over the last 12 months”,
  • these discussions had become “more focused” in late 2009,
  • the discussions had “now reached the stage of having draft terms of reference prepared”,
  • these terms of reference would soon be discussed with the State Minister for Health, and
  • the Paper Tracker would be provided with “further detail” after the Minister had considered the matter.[xxxi]

Federal study

On 7 May 2010, the Federal Minister for Indigenous Health (Hon Warren Snowdon MP) announced a joint study “into the delivery of treatment for kidney disease among Indigenous people who live in remote communities in Central Australia.”[xxxii]

The Minister noted that the study would:

  • be carried out jointly by the Australian, South Australian, Western Australian and Northern Territory governments,
  • be completed by the end of 2010, and
  • assist in the development of “an integrated service delivery model” that recognises both the “demand for various clinical services” and “the social needs of renal patients … regardless of borders.”[xxxiii]

Following the Minister’s announcement, Health SA advised the Paper Tracker that it would no longer be undertaking a separate examination of “how renal dialysis might be offered on the APY Lands in a safe and sustainable way” (as previously announced in February 2010).[xxxiv]

On 1 June 2010, the Federal Government advised the Paper Tracker that the joint study would:

  • produce “an evidence-based snapshot of the current issues,”
  • “provide key information on the most effective service delivery options and care pathways for … [people] in need of renal services, including dialysis”, and
  • identify issues around [the] distribution of these services.[xxxv]

The advice noted that “senior officials” for the South Australian, Northern Territory, Western Australian and Australian Governments had met in Adelaide on 25 May 2010 “to discuss the Central Australia renal study”:

The meeting was held to discuss the most effective way to work in collaboration with all relevant jurisdictions in progressing this important piece of work.[xxxvi]

Terms of reference

On 4 June 2010, the proposed joint study was examined as part of an Australian Senate Budget Estimates hearing. On that occasion, the Federal Office for Aboriginal and Torres Strait Islander Health reported that the terms of reference for the study would be finalised “quite soon” and “be very broad”:

They will cover workforce issues, technology issues, healthcare access issues, social issues, cultural issues, preferences of patients and their families and their community’s … likely needs[xxxvii]

The Office’s evidence continued:

The consultation will similarly be very broad. It will not be limited to communities. It will include NGOs, service providers, people who receive dialysis and their families, and people who might receive it in the future.”[xxxviii]

On 19 July 2010, the Federal Minister for Indigenous Health (Hon Warren Snowdon MP) released the terms of reference for the joint study.[xxxix]

Minister Snowdon stated that the study would help “determine the most appropriate service delivery models and care pathways” for facilitating “community based renal services.” He also indicated that the process for selecting a consultant to undertake the study had commenced and that the Government expected to make an appointment “shortly.”[xl]

Click here to download a copy of Minister Snowdon’s announcement, including a copy of the terms of reference (file size: 36KB).

Central Australian Renal Services Study

On 13 August 2010, the Northern Territory Department of Health and Families reported that the Central Australian Renal Services Study would be carried out by the Sydney-based George Institute for Global Health under the leadership of Professor Alan Cass.[xli]

The Department noted that:

  • it expected community consultations to begin soon,
  • the researchers were aiming to visit four regions – including the APY Lands – over a four-week period, and
  • “an open stakeholder workshop” would be held in Alice Springs.[xlii]

The value of the contract awarded to the George Institute to undertake the study was in excess of $500,000.[xliii]

In mid September 2010, the George Institute released an information sheet on the study. It stated that the “key outcomes” from the “independent” study would include:

  • “feedback from patients, families and providers about current treatment options”,
  • “comprehensive modelling of projected growth and future need for kidney treatment services for people in the region”, and
  • “recommendations for feasible, sustainable, clinically and culturally appropriate kidney treatment services for people in the Central Australia ‘cross-border’ region in the future.”[xliv]

The information sheet indicated that the study’s recommendations would be provided to:

the Australian, Northern Territory, South Australian and Western Australian Governments for consideration in planning for services for people in the region in the future.[xlv]

Click here to download a copy of the information sheet (file size: 226KB)

On 29 September 2010, two members of the research team attended a Cross Border Renal Dialysis Forum at Umuwa on the APY Lands.[xlvi] The forum was organised by the Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women’s Council. On that occasion about 20 Anangu women spoke publicly about the impact that kidney disease was having on their families and communities.

Click here for a summary of the issues raised at the forum

On 18 November 2010, the Central Australian Renal Services Study team held a “final stakeholder workshop” in Alice Springs. The stated purpose of the workshop was to:

  • “consider and discuss the Study findings and draft recommendations”, and
  • “provide input to inform the final Study report.”[xlvii]

As part of the workshop, Professor Alan Cass reported on the study team’s efforts to predict how many Aboriginal people in Central Australia will require ongoing kidney dialysis over the next decade. At present, around 200 people receive dialysis across the region. Professor Cass noted this number could rise to around 450 by 2020 and, in response to a stakeholder question, commented:

At the moment I think we should plan for the worst scenario.

The Research Team also found that the vast majority of the dialysis patients who took part in the study want to receive their dialysis treatment in Alice Springs if it cannot be provided in their home community.[xlviii]

Releasing the report (updated 2 July 2011)

The study team’s final report was originally due to be completed by 14 December 2010.[xlix] This timeframe was not met.

On 8 February 2011, the study team advised the Paper Tracker that the final report had been provided to the Federal Government on 27 January 2011.[l] However, on 25 February 2011, the Federal Department of Health and Ageing advised a Senate Estimates hearing that the report had not been completed and that the Department was in ongoing discussions with the consultants:

about things that they need to do in order to finalise the report so that it fully addresses the terms of reference.[li]

On 31 March 2011, the Federal Minister for Indigenous Health (Hon Warren Snowdon MP) announced that the report was now not due to be completed until 30 June 2011.[lii]

Later that day, the Minister’s office informed the Paper Tracker that the George Institute had “recently advised” that “extra time” would be required to complete the report to ensure it fully addresses “the Terms of Reference set by participating jurisdictions.”[liii]

The Minister’s office expressed its disappointment at the delay while emphasising “the importance of this study.”[liv]

The advice continued:

The implications for the future delivery of renal services in remote areas are profound.  Ministers in all affected jurisdictions are particularly focused on this process and expect a product that will enable Governments to respond in an informed, evidence-based manner to dialysis and related support issues as they arise.

The George Institute is confident it will deliver a quality product that will inform communities, policy makers and service providers about future renal needs of Aboriginal and Torres Strait islander peoples affected by chronic kidney disease.

The multi-jurisdictional Steering Committee and the Technical Reference Panel are continuing to work closely with the George Institute to ensure the delivery of a robust and a quality outcome for Aboriginal and Torres Strait Islander peoples.

Minister Snowdon looks forward to receiving the final report in the near future, we hope around mid year.[lv]

On 27 June 2011, the report was released.[lvi]

Click here to access a copy of the report.

This article has been archived and will no longer be updated. It will, however, remain accessible online as a source of background information for anyone wishing to undertake further research on this issue. Information included in the article was current at the time it was archived. Keep in mind, however, that Ministerial changes and names of departments, among other things, may have since changed.


[i] Snowdon, W. 7 May 2010. “Joint study to look into the delivery of kidney disease treatment in Central Australia,” media release. Also: Cleary, J. 13 August 2010. Email message distributed by the Northern Territory Department of Health and Families.

[ii] Snowdon, W. 27 June 2011. “Australian Government Responds to Renal Study with $13m Funding,” media release.

[iii] See: Masters, C (Nganampa Health Council). 29 April 2005. Email to Aboriginal Lands Parliamentary Standing Committee, Parliament of South Australia; Gorham, G (NT Dept of Health and Families). 15 March 2010. Email to J. Nicholls; Sherbon, T (SA Health). 30 November 2009. Letter to Rev. P. McDonald; UnitingCare Wesley Adelaide. March 2010, “Record of meeting between SA Health and UnitingCare Wesley Adelaide held on 15 March 2010.”

[iv] Singer, J (Nganampa Health Council). 2 August 2004. Letter to Aboriginal Lands Parliamentary Standing Committee, Parliament of South Australia.

[v] Singer, J (Nganampa Health Council). 2 August 2004. Letter to Aboriginal Lands Parliamentary Standing Committee, Parliament of South Australia. On 25 August 2004, three weeks after the Council made this statement, the South Australian Government similarly acknowledged the profound impact that renal disease was having on Anangu “family relationships and law and culture.” The Government also highlighted the importance of identifying “what would be required to provide safe dialysis on the Lands in order to prevent the continuing loss of elders from family and country.” The Government emphasised the extreme complexity of providing “haemodialysis to Aboriginal people in remote locations” and noted that its  Renal Services Reference Group was “of the view” that “at this point in time that there [are] insufficient resources to provide haemodialysis services in the Lands in a safe, sustainable health strategy” (Holloway, P and Weatherill, J. 25 August 2004. Letter and report to the Aboriginal Lands Parliamentary Standing Committee, Parliament of South Australia, p24).

[vi] Rann, M & Vanstone, A & Abbott, T. 1 April 2005. “New unified approach to help people of the APY Lands,” joint news release.

[vii] Mazel, J. 5 March 2005. Statement to Coroner, paragraph 5 (Exhibit C17). Also: Mazel, J. 6 April 2005, Transcript of evidence given to the Aboriginal Lands Parliamentary Standing Committee, Parliament of South Australia, p294.

[viii] ‘Wiru Palyantjaku ‘ is a Pitjantjatjara/Yankunytjatjara expression that can be translated into English approximately as ‘Better Outcomes’ (See: Mazel, J (DPC-AARD). 31 May 2005. Letter to Aboriginal Lands Parliamentary Standing Committee, Parliament of South Australia.

[ix] Wiru Palyantjaku. 27 April 2005. “Notes from Meeting held at Umuwa.” See also: Tjungungku Kuranyukutu Palyantjaku. 2 May 2005. Minutes of the meeting held in Adelaide, item 4.5, p2.

[x] Wiru Palyjantjaku, 2006, “Priority Areas Workshop,” draft document, p1. Available at:http://www.waru.org/organisations/tkp/workshops/wpwkshpaprilmay2006.pdf. Accessed 25 November 2007.

[xi] Wiru Palyjantjaku, 2006, “Priority Areas Workshop,” draft document, p14. Available at:http://www.waru.org/organisations/tkp/workshops/wpwkshpaprilmay2006.pdf. Accessed 25 November 2007.

[xii] This priority was incorporated into the Action Plan of the combined State, Federal and Anangu peak body (“Tjungukunku Kuranyukutu Palyantjaku” or ‘TKP’) as “examine dialysis options for both on and off the lands.” However, the Paper Tracker has not been able to locate any substantial information in the minutes and Action Plans of TKP to suggest either level of government attempted to secure funding for dialysis machines on the APY Lands or properly examined the option of providing this treatment within an APY community. For example, under “Examine dialysis options for both on and off the lands,” the TKP Action Plan for September 2007 reports (in part): “The SA Government is continuing to explore models and options for renal services. The [Federal] Department of Health and Ageing will continue to work with the SA Government” (see: Tjungukunku Kuranyukutu Palyantjaku. September 2007, “TKP Action Plan: Status-Update Report,” p17).

[xiii] Anangu Pitjantjatjara Yankunytjatjara. 2008, Minutes of the Special General Meeting held at Umuwa on 20 and 21 August 2008, p3.

[xiv] It is difficult to pin down the exact date on which the policy was announced and/or commenced. The South Australian Government has stated that the Northern Territory Government signalled a change in policy in February 2009 (see: Hill, J. 16 October 2009. Letter to A. Mason (NPY Women’s Council.). In contrast, the Northern Territory Government has advised the Paper Tracker that the policy came into effect on 4 March 2009 when the South Australian Government advised it that it “would be organising for the 4 patients known to them in the APY Lands to commence treatment in SA” (see: Gorham, G. 23 November 2009. Email to J. Nicholls). Finally, the Federal Government has reported that the policy began in April 2009. (See: Huntington, K. (Office of the Hon Jenny Macklin MP). 12 August 2009. Letter to Rev. D. Whittaker).

[xv] Gorham, G (NT Dept of Health and Families). 15 March 2010. Email to J. Nicholls. Also: Sherbon, T (SA Health). 30 November 2009. Letter to Rev. P. McDonald.

[xvi] See: Rudd, K. 26 February 2009, Hansard, House of Representatives, Parliament of Australia, p2032. Also: Australian Senate. 25 June 2009, Hansard, (Third Reading) “Coordinator-General for Remote Indigenous Services Bill 2009,” p4309.

[xvii] Gleeson, B. 2009. Coordinator-General for Remote Indigenous Services Six Monthly Report July-November 2009, p113.

[xviii] Gleeson, B. 30 November 2009. Letter to Hon J. Macklin MP.

[xix] Gleeson, B. 2009. Coordinator-General for Remote Indigenous Services Six Monthly Report July-November 2009, p77.

[xx] Gleeson, B. 2009. Coordinator-General for Remote Indigenous Services Six Monthly Report July-November 2009, p77.

[xxi] Gleeson, B. 2009. Coordinator-General for Remote Indigenous Services Six Monthly Report July-November 2009, p77.

[xxii] Gleeson, B. 2009. Coordinator-General for Remote Indigenous Services Six Monthly Report July-November 2009, p77.

[xxiii] Brown, S (WDNWPT). 23 March 2010. Email to J. Nicholls (UCW Adelaide). See also: Rivalland, P. November 2006, ‘It’s more than machines and medicine: they should understand there’s a Yanangu Way’: A short report on the activities of Western Desert Nganampa Walytja Palyantjaku Tjutaku, Western Desert Nganampa Walytja Palyantjaku Tjutaku and Cooperative Research Centre for Aboriginal Health.

[xxiv] Brown, S (WDNWPT). 23 March 2010. Email to J. Nicholls (UCW Adelaide).

[xxv] Roxon, N & Snowdon, W. 18 March 2010. “New funds to support Purple House and expand renal care in Central Australia, ” joint media release.

[xxvi] Roxon, N & Snowdon, W. 18 March 2010. “New funds to support Purple House and expand renal care in Central Australia, ” joint media release.

[xxvii] Hockley, C (Office of the SA Minister for Health). 23 February 2010. Email to Rev. D. Whittaker (Uniting Aboriginal and Islander Christian Congress). See also: South Australian Labor Party. 12 March 2010, “More renal dialysis for patients from the APY Lands,” news release.

[xxviii] UCW Adelaide. March 2010, “Record of meeting between SA Health and UnitingCare Wesley Adelaide held on 15 March 2010”, p2. Available at: https://www.papertracker.com.au/wp-content/uploads/pdfs/SAHealth1.pdf.%20On%2025%20March%202010,

[xxix] UCW Adelaide. March 2010, “Record of meeting between SA Health and UnitingCare Wesley Adelaide held on 15 March 2010”, p2.

[xxx] Nicholls, J. 21 March 2010. Email to T. Sherbon (SA Health).

[xxxi] Sherbon, T (SA Health). 25 March 2010. Email to J. Nicholls.

[xxxii] Snowdon, W. 7 May 2010. “Joint study to look into the delivery of kidney disease treatment in Central Australia,” media release.

[xxxiii] Snowdon, W. 7 May 2010. “Joint study to look into the delivery of kidney disease treatment in Central Australia,” media release.

[xxxiv] Sherbon, T (Health SA). 7 May 2010. Email to J. Nicholls

[xxxv] Plate, A (DoHA). 1 June 2010. Email to J. Nicholls

[xxxvi] Plate, A (DoHA). 1 June 2010. Email to J. Nicholls

[xxxvii] Powell, L. (OATSIH). 4 June 2010. Transcript of evidence given to the Community Affairs Legislation Committee (Budget Estimates), Australian Senate, p52.

[xxxviii] Powell, L. (OATSIH). 4 June 2010. Transcript of evidence given to the Community Affairs Legislation Committee (Budget Estimates), Australian Senate, p52. A fortnight later, the Federal Government noted that the terms of reference for the joint study were “still being negotiated across all states and territories” (see: Plate, A (DoHA). 17 June 2010. Email to J. Nicholls).

[xxxix] Snowdon, W. 19 July 2010. “Agreed Terms of Reference for Central Australia Renal Study.” Media Release and attachment

[xl] Snowdon, W. 19 July 2010. “Agreed Terms of Reference for Central Australia Renal Study.” Media Release and attachment

[xli] Cleary, J. 13 August 2010. Email message distributed by the Northern Territory Department of Health and Families.

[xlii] Cleary, J. 13 August 2010. Email message distributed by the Northern Territory Department of Health and Families.

[xliii] The exact amount was $519,350 (see: Commonwealth of Australia. 2011. Department of Health Ageing – Senate Order 192 (Murray Motion) 2010 Calendar Year 2010, p111.

[xliv] George Institute. September 2010. “Central Australia Renal Services Study,” information sheet.

[xlv] George Institute. September 2010. “Central Australia Renal Services Study,” information sheet.

[xlvi] Namely, Professor Alan Cass and Ms Samantha Togni.

[xlvii] Tongi, S. 4 November 2010. Email to J. Nicholls; also Tongi, S. 16 November 2010. Email to J. Nicholls.

[xlviii] The Paper Tracker’s Jonathan Nicholls attended the forum. The statements published on this webpage concerning information presented at the forum are based on his hand-written notes. While much of the information presented was delivered in the form of PowerPoint presentations, forum participants were not provided with copies of those presentations.

[xlix] During the final stakeholder workshop, Professor Alan Cass stated that the study’s draft report was due to be finished by 26 November 2010 and that its final report would be provided to the Federal Government by 14 December 2010 (Information provided during a “Final Stakeholder Workshop” held at the Crowne Plaza Hotel in Alice Springs on 18 November 2010). See also: Snowdon, W. 7 May 2010. “Joint study to look into the delivery of kidney disease treatment in Central Australia,” media release.

[l] Togni, S. 8 February 2011. Email to J. Nicholls.

[li] See: Commonwealth of Australia. 25 February 2011. Hansard of evidence given at an Additional Estimates hearing of the Senate’s Community Affairs Legislation Committee, p50-51.

[lii] Minister Snowdon made this announcement at the official launch, in Alice Springs, of a mobile renal dialysis bus (see: Snowdon, W and Vatskalis, K. 31 March 2011. Mobile Renal Dialysis Bus Launched”, media release). An advisor to Minister Snowdon subsequently confirmed the new timeframe (see: Plate, A. 31 March 2011. Email to J. Nicholls).

[liii] Plate, A (Office of Minister Snowdon). 31 March 2011. Email to J. Nicholls.

[liv] Plate, A (Office of Minister Snowdon). 31 March 2011. Email to J. Nicholls.

[lv] Plate, A (Office of Minister Snowdon). 31 March 2011. Email to J. Nicholls.

[lvi] Snowdon, W. 27 June 2011. “Australian Government Responds to Renal Study with $13m Funding,” media release.

The Paper Tracker works hard to provide accurate and up-to-date information. We will correct any inaccurate information as soon as it is brought to our attention. Please contact us if you have additional information or can provide us with an update.