Central Australia Renal Study: the hub-and-spoke model

First posted on 9 July 2012 under Kidney Disease.
This article has been updated and archived.
Tags: cross-border & dialysis

Summary

The final report of the Central Australia Renal Study was released on 27 June 2011.[i]

Its “primary recommendation” called for the delivery of renal services in the cross-border region of Central Australia to be built around a hub-and-spoke model with Alice Springs as the main hub, and remote Aboriginal communities as the spokes.[ii]

The study advocated for the prompt establishment  of some dialysis chairs or self-care options in remote Aboriginal communities, including some on the APY Lands.[iii]

As of 8 July 2012, nurse-supported dialysis was available in three Central Australian remote Aboriginal communities and in the process of being established in another two locations. Four of these communities were located in the Northern Territory and one in Western Australia.[iv]

The Paper Trail

Introduction

Between 2000 and 2009, the number of people from Central Australia receiving kidney dialysis “tripled to more than 200 patients.”[v]

As of June 2011, less than 10% of these people could access dialysis in their home communities, with the vast majority receiving their treatment in Alice Springs or Tennant Creek.[vi]

Data from the APY Lands confirms these regional trends. Between 2001 and 2010, there was a four-fold increase in the number of APY dialysis patients, most of whom relocated permanently to Alice Springs for treatment.[vii]

Central Australia Renal Study

On 7 May 2010, the Federal Minister for Indigenous Health (Hon Warren Snowdon MP) announced a study into “the delivery of treatment for kidney disease” to people from Central Australian remote Aboriginal communities.[viii]

The Minister noted that the study would:

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

A contract to undertake the study was subsequently awarded to the George Institute for Global Health.[x] The value of the contract was in excess of $500,000.[xi]

Click here for more information on the study including its terms of reference.

Final Report

The final report of the Central Australia Renal Study was publicly released on 27 June 2011.[xii]

Among other things, it found that the number of people on dialysis in Central Australia was likely to increase to between 312 and 479 patients by 2020.[xiii]

Click here to access a copy of the final report

Key recommendation

The study’s “primary recommendation” called for “renal services for people in the cross-border region” of Central Australia to be structured around a hub-and-spoke model with:

  • Alice Springs as the main hub, and
  • remote Aboriginal communities as the spokes.[xiv]

The “fundamental premise” of the hub and spoke model was “a structured and sustainable transition” from the provision of treatment in urban facilities in places like Alice Springs, towards an “expansion of community based care”. Accordingly, the model envisaged the establishment of “nurse-supported and self-care options” in a number of remote Aboriginal communities to enable an increasing number of Central Australian dialysis patients to receive their regular, ongoing treatment at home.[xv]

The study identified some particular sites as being “suitable for the first wave” of an expansion in community-based treatment.[xvi] This included the then under-used substance misuse facility in Amata in which, the study suggested, self-care or nurse-supported dialysis might be established by June 2013.[xvii]

The study recognised that the hub-and-spoke model would not make it possible for every patient from a remote Aboriginal community “to obtain treatment closer to home.”[xviii] Accordingly, it called for “supplementary” mobile and respite dialysis services to be provided as well.[xix] The study suggested that, in the case of the APY Lands, these supplementary services might in the first instance be delivered through visits from the Northern Territory Government’s mobile dialysis bus. Such visits might provide, the report continued, “the best opportunity to gain experience of various service approaches for this particular setting,” while long term solutions were being implemented.[xx]

Federal response

On the day the report was released, the Federal Minister for Indigenous Health (Hon Warren Snowdon MP) said:

  • the release of the report would “allow States and Territories … to start the important work of service planning within their jurisdictions”, and
  • that he was looking forward to working with his counterparts in Northern Territory, South Australia and Western Australia “as we together consider the recommendations.”[xxi]

On 14 July 2011, Minister Snowdon discussed the report in an interview for the Paper Tracker radio show. On that occasion, he noted that jurisdictional borders were “artificial constructs” and that, in his view, it would “be better … if the proposed hub-and-spoke model was adopted” because “it makes sense.” The Minister emphasised, however, that “ultimately” this was a matter for State and Territory governments to work through.[xxii]

South Australian response

The Central Australian Renal Study clearly advocated for the prompt establishment of some dialysis chairs or self-care options on the APY Lands as part of the proposed hub-and-spoke model.[xxiii]

To that end, on 7 July 2011, the Australian Senate passed a resolution calling on the Federal Government to assess the possibility of converting the substance misuse facility in Amata into a community-based haemodialysis facility and for the assessment to be completed by the end of 2011.[xxiv]

Three weeks later, this matter was raised in the South Australian Parliament. On that occasion, the Member for Norwood (Mr Steven Marshall MP) asked the South Australian Government if it would “be providing remote dialysis treatment at the Substance Misuse Centre in Amata as recommended in the federal Senate resolution.”[xxv]

In reply, the Minister for Health (Hon John Hill MP) noted that Nganampa Health Council – the primary health service on the APY Lands – had “consistently” advised him that:

a dialysis service on the lands … would not be sustainable for a whole range of reasons to do with staffing and also to do with the technology requirements of running such a service.[xxvi]

Although the Minister went on to talk about the Central Australia Renal Study, he did not comment specifically on the proposed hub-and-spoke model. Instead he focused his comments on one of the supplementary services that the study had identified; namely, the possibility of establishing:

a mobile dialysis service which could provide temporary respite services to people who may have left to live in Alice Springs or elsewhere and who want to go back to their home communities for business for a week or two at a time.[xxvii]

The South Australian Government successfully pursued this option in subsequent months. Their effort saw the Northern Territory Government’s mobile dialysis bus first visit the APY Lands in October 2011. A second APY trip followed shortly afterwards.[xxviii]

The Paper Tracker acknowledges the importance of these visits and the Government’s plans for the mobile bus to make five trips to the APY Lands in 2012.[xxix] That noted, the Paper Tracker does not believe that the successful bus visits remove the need for the South Australian Government to further consider the overarching hub-and-spoke model as proposed in the Central Australia Renal Study.

The Paper Tracker notes that, as of 8 July 2012, nurse-supported dialysis was:

  • available in three Central Australian remote Aboriginal communities (Walungurru,
    Ntaria and Yuendumu); and
  • in the process of being established in another two locations (Lajamanu and Warburton).[xxx]

According to the hub-and-spoke model proposed by the Central Australia Renal Study, each of these locations is a spoke. The Paper Tracker notes that four of these spokes are in the Northern Territory, one is in Western Australia and that no spokes had been established or were in the process of being established in South Australia at this time.

Senate Estimates (2012)

On 17 February 2012, Senator Rachel Siewert (Australian Greens) raised the concept of the hub-and-spoke model with the Federal Department of Health and Ageing during a Senate Estimates hearing.[xxxi]

On that occasion, the Department stated that the Australian, South Australian, Western Australian and Northern Territory governments had not made “a formal statement” on the hub-and-spoke model but that there had “been a lot of discussions and it is strongly supported.”[xxxii]

The Department continued:

effectively it is what is being implemented, particularly in WA where they are building up the capacity in Warburton and the goldfields.[xxxiii]

The Department also advised Senator Siewert that:

  • the Northern Territory Government would be convening a meeting with the South Australian and Western Australian governments “probably in early April [2012]” to progress discussions about the Central Australian Renal Study;
  • the Department would be participating in the meeting as an observer; and
  • it would “ensure” the hub-and-spoke model was discussed at the April meeting.[xxxiv]

At the next Senate Estimates hearing – held on 1 June 2012 – Senator Siewert asked the Department for Health and Ageing for an update on these matters, including the outcomes of the April 2012 meeting.[xxxv]

In reply, the Department advised the Senator that:

  • the April meeting “fell through” and that a subsequent meeting “also was not able to happen”;
  • the Federal Minister for Health and Ageing (Hon Warren Snowdon MP) had “convened a meeting of the relevant State and Territory Ministers “to hear how their action might be going in implementation and to have a discussion about those issues”; and
  • Minister Snowdon’s meeting was due to take place on 14 June 2012.[xxxvi]

Ministerial advice (2012)

On 20 June 2012, the Paper Tracker asked Minister Snowdon:

  • if the scheduled meeting to consider jurisdictional responses to the Central Australia Renal Study, scheduled for 14 June 2012, had gone ahead as planned and, if so, whether all of the relevant jurisdictions had participated;
  • whether the meeting had discussed the hub-and-spoke model;
  • which, if any, of the jurisdictions had confirmed their support for the model;
  • whether he was satisfied with the efforts that the South Australian, Western Australian and Northern Territory governments had taken, to date, “to develop and implement jurisdictional responses to the Central Australia Renal Study’s key findings; and
  • what, if any next steps were identified during the course of the 14 June meeting.[xxxvii]

On 3 July 2012, the Minister’s office advised the Paper Tracker that:

the meeting did go ahead as scheduled … with all jurisdictions (WA/SA/NT and the Commonwealth) participating.[xxxviii]

The Minister’s office further advised that it could not “provide details on discussions that took place” but could confirm that a “follow-up meeting was arranged.” [xxxix]

On the day that this information was received, the Paper Tracker asked the Minister’s office when the follow-up meeting was scheduled to take place.[xl] Within hours, the Minister’s office acknowledged this request and indicated that a response would be forthcoming. As of 8 July 2012, this information had not been provided.[xli]

This article was last updated in July 2012. It 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. 27 June 2011. “Australian Government Responds to Renal Study with $13m Funding,” media release.

[ii] George Institute for Global Health. June 2011, Central Australia Renal Study – Final Report, published by the Australian Department of Health and Ageing, p5.

[iii] See, for example: George Institute for Global Health. June 2011, Central Australia Renal Study – Final Report, published by the Australian Department of Health and Ageing, p77.

[iv] Brown, S. 8 July 2012. Email to J. Nicholls from Western Desert Nganampa Walytja Palyantjaku Tjutaku.

[v] George Institute for Global Health. June 2011, Central Australia Renal Study – Final Report, published by the Australian Department of Health and Ageing, p12.

[vi] George Institute for Global Health. June 2011, Central Australia Renal Study – Final Report, published by the Australian Department of Health and Ageing, p12.

[vii] See: Nganampa Health Council, 2001. Annual Report 2000/2001, p25. Also: 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; UnitingCare Wesley Adelaide. Also: Nicholls, J. March 2010, “Record of meeting between SA Health and UnitingCare Wesley Adelaide held on 15 March 2010.”

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

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

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

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

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

[xiii] George Institute for Global Health. June 2011, Central Australia Renal Study – Final Report, published by the Australian Department of Health and Ageing, p3.

[xiv] George Institute for Global Health. June 2011, Central Australia Renal Study – Final Report, published by the Australian Department of Health and Ageing, p5.

[xv] George Institute for Global Health. June 2011, Central Australia Renal Study – Final Report, published by the Australian Department of Health and Ageing, p5.

[xvi] George Institute for Global Health. June 2011, Central Australia Renal Study – Final Report, published by the Australian Department of Health and Ageing, p5.

[xvii] George Institute for Global Health. June 2011, Central Australia Renal Study – Final Report, published by the Australian Department of Health and Ageing, p53 & 77.

[xviii] George Institute for Global Health. June 2011, Central Australia Renal Study – Final Report, published by the Australian Department of Health and Ageing, p5.

[xix] George Institute for Global Health. June 2011, Central Australia Renal Study – Final Report, published by the Australian Department of Health and Ageing, p5. See also the report’s “Executive Summary”, p9.

[xx] George Institute for Global Health. June 2011, Central Australia Renal Study – Final Report, published by the Australian Department of Health and Ageing, p69.

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

[xxii] This interview was recorded over the phone on 14 July 2011. The interview was conducted in English by J. Nicholls from a studio at Radio Adelaide. A Pitjantjatjara/Yankunytjara interpretation of the Minister’s remarks was inserted into the recording prior to it being aired across the APY Lands on 5NPY Radio.

[xxiii] See, for example: George Institute for Global Health. June 2011, Central Australia Renal Study – Final Report, published by the Australian Department of Health and Ageing, p77.

[xxiv] Siewert, R. 7 July 2011, “Motions: Indigenous Health”. Hansard (proof), Senate, Commonwealth of Australia, p27-28.

[xxv] Marshall, S. 28 July 2011. “Aboriginal Renal Dialysis Services,” Hansard, House of Assmebly, Parliament of South Australia, p4759.

[xxvi] Hill, j. 28 July 2011. “Aboriginal Renal Dialysis Services,” Hansard, House of Assmebly, Parliament of South Australia, p4760.

[xxvii] Hill, J. 28 July 2011. “Aboriginal Renal Dialysis Services,” Hansard, House of Assmebly, Parliament of South Australia, p4760.

[xxviii] Swan, D (SA Health). 17 October 2011. Transcript of evidence presented to the Budget and Finance Committee, Legislative Council, Parliament of Australia, p908.  Note: on this second trip, the bus was based at Marla, just outside the APY Lands and supported five Anangu dialysis patients (see: Swan, D (SA Health). 17 January 2012. Letter to Rev. P. McDonald).

[xxix] Swan, D (SA Health). 17 January 2012. Letter to Rev. P. McDonald. Also: SA Health. 13 June 2012. “Media Statement” provided to J. Nicholls, Uniting Communities.

[xxx] Brown, S. 8 July 2012. Email to J. Nicholls from Western Desert Nganampa Walytja Palyantjaku Tjutaku.

[xxxi] Siewert, R. 17 February 2012. Hansard, Estimates, Community Affairs Legislation Committee, Senate, Parliament of Australia, p95-96.

[xxxii] Powell, L (DoHA). 17 February 2012. Hansard, Estimates, Community Affairs Legislation Committee, Senate, Parliament of Australia, p96.

[xxxiii] Powell, L (DoHA). 17 February 2012. Hansard, Estimates, Community Affairs Legislation Committee, Senate, Parliament of Australia, p96.

[xxxiv] Powell, L (DoHA). 17 February 2012. Hansard, Estimates, Community Affairs Legislation Committee, Senate, Parliament of Australia, p95-96.

[xxxv] Siewert, R (DoHA). 1 June 2012. Hansard (Proof Copy), Estimates, Community Affairs Legislation Committee, Senate, Parliament of Australia, p40.

[xxxvi] Powell, L (DoHA). 1 June 2012. Hansard (Proof Copy), Estimates, Community Affairs Legislation Committee, Senate, Parliament of Australia, p40-41.

[xxxvii] Nicholls, J. 20 June 2012. Email to L. Ivanovski (Office of the Minister for Indigenous Health).

[xxxviii] Ivanovski, L. 3 July 2012 (9.14am). Email to J. Nicholls from the Office of the Minister for Indigenous Health.

[xxxix] Ivanovski, L. 3 July 2012 (9.14am). Email to J. Nicholls from the Office of the Minister for Indigenous Health.

[xl] Nicholls, J. 3 July 2012 (9.54am). Email to L. Ivanovski (Office of the Minister for Indigenous Health).

[xli] Ivanovski, L. 3 July 2012 (3.54pm). Email to J. Nicholls from the Office of the Minister for Indigenous Health. This email message stated in full, “Finding out for you.”

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