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Sebastian Rosenberg. Mental health changes.

Announcing the federal government’s response to the National Mental Health Commission’s review of mental health services today, Prime Minister Malcolm Turnbull emphasised the concept of patient choice.

The commission’s review was the latest in a long line of reports showing that for many Australians needing mental health care, their current choice is between getting no care or getting poor care.

The reforms announced today have the potential to change this appalling situation. But ultimately they should be judged on the outcomes they achieve for patients.

Poor access to care

Mental health is the third-biggest chronic disease in Australia behind cancer and heart disease, affecting 4-5 million people each year.

Access rates to care are low. And once a person has seen their general practitioner or psychologist, if their condition deteriorates, they have few options but to seek care from their local hospital emergency department.

Following deinstitutionalisation 30 years ago, which overturned the practice of sending people with severe mental illness to asylums, Australia largely failed to invest in a genuine system of community mental health care.

The bar for entry into the state-run hospital system rose, so you must be sicker and sicker to qualify for care. Rates of access to state and territory mental health services have not changed in some years. Yet spending has increased by more than 50%.

We are, in fact, over-reliant on hospitalisation and there is waste. An unpublished survey by state governments indicated that more than 40% of all hospital mental health beds were occupied by people who would be better off in other settings if there was anywhere to send them.

Mental illness also has a colossal impact on productivity and economic participation. The OECD estimates the average overall cost of mental health to developed countries is about 4% of GDP. In Australia, this would equate to more than A$60 billion or about A$4,000 a year per individual taxpayer.

Tailored responses

The federal government’s announcements have the potential to address these problems by presenting two key structural changes.

The first is the decision to use the new Primary Health Networks (PHNs) to keep people with mental health problems out of hospital, by building new, integrated and stepped approaches to primary and community mental health care. Under the Abbott government, PHNs replaced Medicare Locals. PHNs’ role is to both plan and commission (fund) primary and community care.

This means having the capacity to respond to all the problems a person might have, including not just their mental illness, but drug and alcohol issues, physical problems, homelessness and other problems. It also means having a range of services available to match the intensity of the person’s needs.

PHNs will be tasked with properly planning to meet the mental health needs of the regions they serve.

Given the size of the PHNs, some may require multiple plans to ensure they understand and can respond to locals’ needs. One of the PHNs in Western Australia covers an area the size of much of Western Europe, so plans will need to cater for diversity within regions.

The second key structural change offered under these reforms is to end the dependency on simplistic fee-based services. The government has recognised that just sending people off for a set number of psychology sessions is an inadequate response, particularly for people with more complex conditions.

The suggestion is that people with less complex problems should access evidence-based mental health therapies and services online.

For others, a continuation of the Better Access program, which subsidises ten sessions with a psychologist or psychiatrist, may be entirely suitable.

For people with more complex problems, however, the government has flagged its intention to permit PHNs to cash out some of their Medicare Benefits Schedule payments into new pooled funding arrangements to meet locally identified needs. PHNs would have the capacity, for instance, to build further on successful programs such as headspace or the Mental Health Nurse Incentive Program.

These reforms suggest that better understanding individual needs can lead the PHN to more intelligently plan individual responses, bringing together clinical care and social supports such as living skills, vocational training and education.

Overcoming barriers

The government’s changes to mental health are not without challenges. It’s unclear whether PHNs will be up to the job, and what support they need to make the scheme work.

The changes don’t appear to be supported with any new funding, yet we know the mental health system is under-funded. Mental illness accounts for 13% of the burden of disease but receives only around 6% of the total health budget. It should be noted that the “cashing out” arrangements are uncapped, opening up the potential for new funding under Medicare.

Most importantly, we need to ensure these changes marry up to commensurate reforms by the states and territories. The fifth national mental health planning process now underway has proven ineffective in joining up mental health approaches between governments. The Commonwealth has pledged new leadership and it is here that it is needed most.

Finally, the Commonwealth must establish a new and robust approach to accountability. Regionalism cannot mean we let myriad programs start and go unevaluated. Instead we need strong and consistent approaches to data collection, providing real information about things that matter.

Rather than reporting on bed numbers, these processes need to reveal the extent to which PHNs are actually working to help people with a mental illness stay out of hospital, recover from their illness, complete their education, resume employment, avoid homelessness and become healthy and productive members of the community. None of this information is currently available.

Prime Minister Turnbull stated that these changes were about trying to make the most of Australia’s mental wealth and human capital. His goal is laudable. But the work starts now.

Sebastian Rosenberg is Senior Lecturer, Brain and Mind Centre, University of Sydney. This article first appeared in The Conversation on 26 November, 2015.

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Travers McLeod. Unusual suspects challenging usual thinking on climate change.

“The greatest trick the devil ever pulled was convincing the world he didn’t exist.”

Twenty years ago Kevin Spacey uttered this famous line about his alter ego, Keyser Söz, in The Usual Suspects. Keyser Söz isn’t climate change, but he might as well be.

Since the film was released an inordinate amount of money has been spent to trick the world that human-induced climate change doesn’t exist.

Recent data from the CSIRO suggests the ‘trick’ is yet to be completely foiled in Australia. Although almost 80 percent of people believe climate change is occurring, every second person routinely changes their mind and there is considerable divergence on whether human activity is a causal factor.

Thankfully, someone who requires no more convincing is Mark Carney, the Canadian Governor of the Bank of England.

“There is a growing international consensus that climate change is unequivocal,” Carney said in September.

“Human drivers are judged extremely likely to have been the dominant cause of global warming since the mid-20th century.”

Carney, like his Chief Economist, Andy Haldane, is what I call an unusual suspect, someone who looks beyond the parapet and leads on an issue when we don’t expect them to.

Think doctors and nurses on children in detention and sporting heroes like David Pocock on marriage equality.

Although we might deem these interventions ‘unusual’ given their infrequency, they can be perfectly natural for the individual speaking out. Often they are based on experience or expertise.

This makes unusual suspects particularly insightful, and especially powerful.

Carney’s incursion into the climate change debate shouldn’t be taken lightly. He also heads up the global Financial Stability Board, established after the Global Financial Crisis.

It was no coincidence Carney gave his speech at Lloyd’s of London.

Insurers know full well the rising cost of weather-related events, aggravated by climate change, from around $10 billion per year in the 1980s to $50 billion today. These losses, Carney conceded, will “pale in significance” to those on the horizon when we consider “broader global impacts on property, migration and political stability, as well as food and water security”.

Carney and Haldane argue the physical, liability and transition risks posed by climate change threaten financial stability.

They are progressives amongst a hitherto conservative central banking set.

Haldane in particular has bemoaned “quarterly capitalism”, which sees public companies over-discounting future income streams by 5-10 percent per year.

He believes “shareholder short-termism may have had material costs for the economy, as well as for individual companies, by constraining investment”.

Haldane is not alone. Larry Fink, Chairman and CEO of BlackRock, wrote to S&P 500 CEOs in April, accusing them of prioritising actions to deliver immediate returns and “underinvesting in innovation, skilled workforces or essential capital expenditures necessary to sustain long-term growth”.

Where are Australia’s unusual suspects in business and finance?

One would find it difficult to locate seminal speeches on climate change and quarterly capitalism by our central bankers or the Business Council of Australia

Much has been made of our tepid growth outlook. Reserve Bank Governor Glenn Stevens challenged the National Reform Summit to ask: “how do we generate more growth? Not temporary, flash in-the-pan growth, but sustainable growth”.

The adjective — sustainable — is key. Focusing on growth at all costs risks missing the wood for the trees. To engineer sustainable growth, one requires a sustainable economy. And that is what Australia lacks most of all.

It is a shame, because sustainability is in Australia’s DNA.

In fact, in 2011, then Treasury Secretary Martin Parkinson told us “the theme of sustainability will need to shape the approach to policy development of this generation”.

Parkinson was and remains spot on: his focus was on how each generation could bequeath to the next a productive base for sustainable wellbeing at least as large as the stock of capital inherited.

How shortsighted it was for one of our best unusual suspects to be dumped by the Abbott government.

His likely reemergence as head of the Department of Prime Minister and Cabinet is timely.

At his alma mater, Princeton, in September, Parkinson echoed Carney by saying company boards and financial market regulators give scant attention to climate change risks. Equally absent was examination of the “knock-on effects to macroeconomic stability of falling demand for carbon-intensive exports”.

Accelerating Australia’s transition to a sustainable economy will require those in business, finance, government and civil society to embrace unusual suspects on climate change and sustainability as the new normal, not the exception. If anyone can do this knitting, it’s Parkinson. Welcome back.

Travers McLeod is Chief Executive of the Centre for Policy Development. This article was first published in the Huffington Post on 26 November 2015.

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Bullying and bugging in East Timor.

The bugging by Australian Security Intelligence Service (ASIS) of an East Timorese cabinet meeting in 2004 will not go away. The event was so outrageous it is not surprising that it continues to resurface. Only a Royal Commission or a Judicial Review can redress some of the damage that has been done to Australia’s reputation, our intelligence agencies and most importantly of all, in our relations with our near neighbour, East Timor.

There have been new revelations and continual cover-ups. As Senator Nick Xenophon has said on the ABC ‘This is a massive scandal”.

I continue to be concerned about the competence of our intelligence services and the inability of all Australian governments to effectively supervise their secret operations. The supervising agency is too small to be effective. My experience is also that the supervisors including parliamentary committees, become part of the ‘intelligence club’. Journalists and so called academics ‘experts’ who report on our intelligence services are also invariably part of the same club.

Our intelligence agencies have greatly expanded resources and powers but it is very hard to assess their competence. The bugging in East Timor, even though eleven years ago, remains a blight.

See link below to ABC interview with Emma Alberici and Senator Nick Xenophon.

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Joanna Thyer. When we are not sure, we are alive.

What do Pope Francis, Thomas Merton and Graham Greene have in common?

Like Pope Francis, Thomas Merton and Graham Greene were individuals whose sheer complexity equipped them to address the often contradictory world we live in, in order to find God in it.

The writer and Trappist monk Thomas Merton, the famous British writer, Graham Greene, and our current pope, Pope Francis, have a lot in common. Merton died in 1968 – from accidental electrocution whilst touring in Thailand, and Greene died peacefully in 1991. Both men were converts to Catholicism. Like Pope Francis, Merton engaged in interfaith dialogue. What these three men have in common, however, is that their works reveal them to be visionaries and mystics with a faith message for the world, a message that does not shy away from naming and engaging with the darkness around us.

Graham Greene led an eclectic life, and embraced and dialogued with the complex world around him. After his conversion to Catholicism in the 1920s, he was commissioned to go to Mexico to report on religious persecution there which resulted in him writing one of his famous novels, The Power and the Glory. He was adept at characterising the flawed broken priest or individual who could still bring Christ to others, despite his brokenness. The internal struggle of the soul to find and receive grace was amongst the issues that consumed him. As he so well depicted in another work, The Heart of the Matter, he understood the paradox of how a person’s conscience and love of God, could also lead them to disaster.

Greene confronted and explored the world of international politics, espionage and the world of corruption, (he worked for MI6 at one stage). He took a stand on moral issues – he allegedly quit the American Academy of Arts and Letters over America’s involvement in the Vietnam War.

A serial adulterer and womaniser, he explored flawed and complex interpersonal relationships in his writing, such as in his famous work, The End of the Affair. He was by his own admission, a man who struggled with his own sins whilst balancing a passionate faith. Able to deepen and challenge his own religious and spiritual beliefs amidst a rich and tumultuous life, his flawed and complex nature both informed his writing, and furthered his faith as a devout Catholic.

Both Merton and Greene struggled with the dynamics of interpersonal relationships and the struggle between the human soul, desire and what God’s direction and actions in a person’s life and the world around them, meant. Merton was also flawed, and allegedly quite headstrong in his inner and outer battles, and in his relationship with his monastic community. Books about Merton have been written saying he was not as ‘holy’ as he seemed and his personal diaries also talk about the love affair he had with a nurse for a while during his time as a monk in the 1960s. Yet these revelations are indications of a multi-faceted individual whose humanity fuelled his wisdom. Like Greene, Merton’s life experience and the wisdom he imparted to the world, enriched his faith. This is an example to all of us.

Like Pope Francis, Merton saw the great wisdom of the Tibetan Buddhist and Hindu traditions, or metaphorically how ‘the sun sets in the East’. Whilst some have critiqued this perceived duality in Merton towards the end of his life, it reveals the depth of his quest to follow where God was leading him. Ironically, only days before his death in Bangkok, Merton had an epiphany whilst reflecting on the beauty of Eastern spiritual experience. In contemplating the ‘dharmahaya’ where ‘everything is emptiness and everything is compassion’ he reflected: “I have now seen and have pierced through the surface and have got beyond the shadow and the disguise”.

In his book Church of Mercy, Pope Francis advises us to read the signs of God in our lives, be guided by the Spirit, and go beyond our comfort zone. Pope Francis’ washing of a female Muslim prisoner’s feet early in his pontificate is a dramatic example of how actions speak louder than words. The subtext of that action could readily be understood as demonstrating how Christ’s love really works. He has not played it safe. He understands the world he is in, and does not separate himself from it. His message is a metaphor for an individual’s spiritual life. He does not want a closed Church, but an open one, and emphasises that “a bruised Church is better than an ill Church”.

Like Pope Francis, Greene and Merton were individuals whose sheer complexity equipped them to address the often contradictory world we live in, in order to find God in it. The lives of such people do not make them saints, yet they do exemplify their status as mystics who contribute to the spiritual development of others.

At a time when religious persecution is rife, when extremists on either side have hijacked and distorted many religious beliefs, in a violent, chaotic and often uncertain world, the lives of people like Pope Francis, Thomas Merton and Graham Greene have a message for us: to embrace the brokenness in the world and in our own lives and find love and God in it. Their message seems to embody what Graham Greene once famously said, “When we are not sure, we are alive”.

Joanna Thyer is a writer, Sydney hospital chaplain, and educator. Her most recent work is 12 Steps to Spiritual Freedom, (Loyola Press, 2014). Source:

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John Thompson. The costly abolition of Medicare Locals

Even when it had no clear policies or plans to replace them, the Abbott government seemed determined to undo many of the initiatives of the previous Labor government. This was certainly the case in relation to primary health care.

In 2008, the then Labor government established the National Health and Hospital Reform Commission(link is external) (NHHRC) to conduct a comprehensive review of Australia’s health system. The review provided the basis for the National Health Reform Agreement (NHRA) signed by the Australian government and the states and territories in August 2011. The reforms set out in the NHRA had three main objectives:

  1. Reforming the fundamentals of our health and hospital system, including funding and governance, to provide a sustainable foundation for providing better services now and in the future.
  2. Changing the way health services are delivered, through better access to high quality integrated care designed around the needs of patients, and a greater focus on prevention, early intervention and the provision of care outside of hospitals.
  3. Providing better care and better access to services for patients, through increased investments to provide better hospitals, improved infrastructure, and more doctors and nurses.

The establishment of 61 Medicare Locals across Australia was one of the key initiatives taken to address these objectives.These regional structures aimed to strengthen the primary care system (and thereby relieve pressure on hospitals and other acute providers) by integrating Commonwealth and state government health planning and service delivery and access.

Medicare Locals were non-profit companies selected after a competitive application process and funded largely by the Commonwealth with $1.8 billion for the period 2011–12 to 2015–16. While the Commonwealth funding deed specified program schedules and reporting requirements, Medicare Locals were provided with considerable scope to arrange their structure, operations and relationships to reflect their local health environment.

To provide this focus on primary care, Medicare Locals were required “to work with the full spectrum of general practice, allied health and community health care providers and improve access to care and drive integration between services.” They established collaboration with health care services and other community organisations in their region to develop strategies to meet the overall primary health care needs of their communities. Considerable effort was made to ensure that general practice had a central role in the work of Medicare Locals – with varying effectiveness.

Medicare Locals worked at a regional level with state and local government in the planning of primary health care services and in the linking of these services with Local Hospital Networks and aged care programs to deliver improved integration and effective transitions for patients across the entire health care system.

The Medicare Locals program was a contentious one, not just because it was a Labor government initiative, but many GPs saw it as a threat to their primacy in their local primary care market and saw the regional health planning activities of the Medicare Locals as an unnecessary additional layer of bureaucracy. This negative view was reinforced by the AMA, the doctors’ union, that lobbied the Coalition Opposition on the basis of the perceived threat to the GP small businesses. For this reason, the Coalition went to the 2013 election with a health policy that included brief mention of Medicare Locals as follows: “We will also review the Medicare Locals structure to ensure that funding is being spent as effectively as possible to support frontline services rather than administration.” However, the then Opposition Leader, Tony Abbott, made a promise that no Medicare Locals would be closed should the Coalition form government.

About a month after coming into office, the new Minister for Health, Peter Dutton, announced a review(link is external) of Medicare Locals to be conducted by Professor John Horvath. The review was aimed at “reducing waste and spending on administration and bureaucracy, so that greater investment can be made in services that directly benefit patients and support health professionals who deliver those services to patients.” Comments from selected “stakeholders” were invited.

Professor Horvath, previously Chief Medical Officer, was assisted in the review by two consulting firms: Ernst & Young provided advice on the current operations of Medicare Locals and future structure and governance options, and Deloitte Touche Tohmatsu (Deloitte), conducted an assessment of their financial performance and compliance to their Deed.

The conduct of the review attracted substantial criticism, particularly for its lack of transparency. A Senate committee subsequently reported(link is external) that it had not been able to obtain much definitive information about the process and methodology used to conduct the review.

More than 270 submissions were received, indicating a high level of interest in the review, but none was made available by the Department of Health or as supporting documents with the review as is the usual case. Horvath advised that he “personally conducted” interviews with key stakeholders but did not identify who they were. A small number of Medicare Locals were asked for input to the review but were restricted in the amount of information they could provide.

It is understood that the Deloitte audit involved what the Department of Health called “a basic review” of the 2012–13 operations of the Medicare Locals functioning at that time, with a more considered audit of six of the 61 Medicare Locals. As most Medicare Locals had only just begun operating (setting up structures, employing staff, developing IT systems, etc.), it is not surprising that their audited financial and other achievements were not substantial, and the auditors were not interested in the future plans of the Medicare Locals.

The review was completed in March 2014 and was highly critical of the performance of the Medicare Locals. Itrecommended(link is external) that the recently established Medicare Local system (one third of the Medicare Locals were only established as from July 2012) be replaced with a system comprising a smaller number of regional organisations called Primary Health Organisations.

The Senate committee referred to above reported: “With limited information available publicly, and no detailed discussion of methodology in the Review report, it is difficult to understand the Review’s recommendations. Similarly, without the transparency that would have been achieved by the publication of the consultancy reports and the 270 submissions, the Review’s assertions that the Medicare Locals are ‘flawed’ cannot be tested.” The Senate Committee also stated that it could not reconcile the positive evidence it heard of the progress and achievements of Medicare Locals with the highly critical and negative findings of Horvath’s review of the work of the Medicare Locals.

Notwithstandinga clear public statement by Tony Abbott that no Medicare Locals would be closed should the Coalition form government, when his government brought down the 2014-15 Budget in May 2014 it was announced that all Medicare Locals would cease operation on 30 June 2015 and a new network of Primary Health Networks(link is external) (PHNs) would be established.

There have been substantial costs incurred in the closure of the 61newly established Medicare Locals, both financial and in terms of disruption or termination of valuable health services. In a relatively short time, boards had been established, staff had been recruited, premises and operating resources were acquired, relationships and collaborations established with local health organisations, and services and programs initiated. On the basis of government commitments, the Medicare Locals had entered into contracts, leases and employment obligations.

The costs of winding up the Medicare Locals have been estimated at between $112 million to $200 million. The Health Department admitted that closing Medicare Locals would cost $112 million but refused a Freedom of Information request for details of this estimate claiming it would not be in the public interest to release these figures because it could jeopardise “its good relationship with Medicare Locals.” However, many Medicare Locals showed no reluctance to publicly announce their wind up costs at the Senate Committee hearing. The Barwon Medicare Local estimated their costs at $2 million; the North Adelaide Medicare Local’s estimated costs were $2.2 million.

Skilled, and often very scarce, staff were lost as they became aware of the uncertainty of their future employment. These staff losses were felt most keenly in non-metropolitan areas where health workers are often difficult to find.

Perhaps more crucially, many highly needed health services that had been recently begun were terminated.Although in their early stage of operation, Medicare Locals had established or funded a range of vital services, made important advances in population health, identified and filled key gaps in services, and begun the critical task of integrating primary care with hospital services. This momentum was lost and many communities lost the gains made. Furthermore, key health staff were lost, a particularly important factor in rural and remote areas.

The Department of Health then announced that the new PHNs would be selected on the basis of a public tender process so that the new organisations could begin operations on 1 July 2015. This tender process was very poorly managed by the Department.

The notice of tender for the PHN Program was issued on 28 November 2014, almost a month after the previously advised scheduled release date. The tender period was very short and conducted over the Christmas–New Year period with tenders to be submitted by 28 January 2015.This was an absurdly short time for major organisational relationships to be established and business structures and financial decisions to be made, particularly as the minister encouraged new private sector interests to participate.

Although broad guidelines were provided to potential tenderers at the start of the process, major decisions and criteria such as the geographic boundaries of the proposed PHNs were drip fed to interested tenderers as the tenders were being prepared.

State government officials advised that there was very little consultation with the key state health agencies to recognise and capitalise on existing health planning and coordination bodies.

Information meetings for prospective tenderers were conducted in each state by Department of Health officials but the information provided was no more than that which already available on the Department’s website. The Department even refused to provide notes of the meetings or lists of attendees (which would have been of assistance to facilitate collaboration in the preparation of tenders).

Horvarth’s review criticised Medicare Locals for focussing too much on service delivery, not entirely coincidentally a concern of GPs and other providers. His report recommended that PHNs “should only provide services where there is demonstrable market failure, significant economies of scale or absence of services”. However, he did not define “market failure” and the Department clearly had difficulty in providing potential tenderers any reasonable clarity on this matter. This certainly made the preparation of submissions very difficult, especially for tenderers in rural and regional areas where Medicare Locals had provided services to meet significant gaps in services.

In summary, the tender process was very deficient. The Senate Committee noted the confusion surrounding the tender process and considered “flaws in the government’s PHN tender process raises doubts regarding any outcome of the tender process.”

It is not surprising that about this time a poll of more than 1100 doctors across Australia conducted by the AMA declared the Minister for Health, Peter Dutton MP, the worst Minister for Health for 35 years.

In April 2015 the Commonwealth government announced that 31 PHNs would be funded as from 1 July 2015. They would be required to establish Clinical Councils involving GPs, and Consumer Advisory Committees. Announcing the successful bidders, the Minister of Health, Sussan Ley, said the new PHNs would replace “Labor’s flawed Medicare Local system,” yet almost all PHNs selected (24 of the 28 PHNs) are either consortia of former Medicare Locals or have a Medicare Local as the lead applicant.

The new PHNs will be responsible for populations and geographic areas that are much larger than those of the Medicare Locals. (For example, one PHN will now be responsible for all of Western Australia except the Perth metropolitan area.) Medicare Locals had an average population of 355,000; PHNs will service an average population of 738,000. Six PHNs will service populations of more than one million. Many health experts doubt the effectiveness and efficiency of such very large organisations, citing the failure of the NSW government’s establishment of mega health services.

The substantial costs of establishing these new organisations are not known and it will be interesting to discover their operating costs when their first financial reports are made.

The concerns of the Senate Committee that the inadequate Horvarth review and the Department’s inept tender process could lead to a poor result appear to be justified. Now, several months after the PHNs were formally established, there has been little progress in developing any useful operations. Many in the health system are of the view that the whole exercise is a very expensive ideological move that, despite very substantial financial resources and lengthy disruption and dislocation, may not achieve the results that the fledgling Medicare Locals were beginning to realise.

John Thompson is an economist with experience in primary health. This article was first published in Australian Policy Online on 23 November 2015.

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Spencer Zifcak. UN Human Rights Council Weighs in on Australia

On 21st of March 2000, an Australian delegation appeared before the UN Committee on the Elimination of all Forms of Racial Discrimination (CERD) in Geneva. The Hon Philip Ruddock, then Minister for Immigration in the Howard Government, led the delegation. The meeting did not go well.

Confronted by exceptionally well-informed and assertive questioning by the Committee’s rapporteur, the Minister became condescending and defensive. His justifications for Australian policies, particularly in relation to Australia’s indigenous peoples, fell apart.

Their health, education and social disadvantages, he implied, were the result of lifestyle choices. Nothing could be done about mandatory sentencing and its disproportionately adverse impact on black Australians because that was the responsibility of the States. As to the position of women, Ruddock replied that ‘if you knew some of the women around me, by blood and other, you would know the empowerment of women is a very significant issue!’ This was hopeless.

The result was that CERD responded with a highly critical evaluation of Australia’s racial discrimination record. It expressed grave concern regarding high rates of indigenous incarceration. It noted the disproportionately discriminatory effect of mandatory sentencing. It remained concerned about dramatic levels of inequality in indigenous peoples’ access to health, education and housing. It was highly critical of the Government’s failure to respond seriously to the Australian Human Rights Commission’s report on the Stolen Generations.[1]

The Government responded by savaging the messenger. It stated that that the Committee’s report was ‘an unbalanced and a wide-ranging attack that intrudes unreasonably into Australia’s domestic affairs’. In his finest diplomatic language, then Foreign Minister, Alexander Downer said that ‘if a UN Committee wants to play politics here in Australia then it will end up with a bloody nose’.
Things do not seem to have improved very much. Reflecting upon Australia’s shellacking before the UN Human Rights Council on November 9th this year, the current Minister for Immigration, Peter Dutton, described the process as ‘a farce’. So, what happened?


Australia was in Geneva for the UN Human Rights Council’s second review of its human rights record, a process known as Universal Periodic Review (UPR). With the agreement of all UN member states, every country submits its human rights performance for review once every four years. Interestingly, given his somewhat dire performance previously, Mr. Ruddock was back again as a member of the Australian delegation. He was more circumspect this time.

Over four hours, more than 100 nations took the opportunity to question and criticise many different aspects of Australia’s performance in protecting human rights. These criticisms were largely consistent with the UN High Commission for Human Rights’ (OHCHR) own analysis of Australia’s actions in responding to the reports of UN Human Rights Treaty Committees in the four years since the last UPR. The Council also benefitted from a fine background document prepared by the Human Rights Law Centre on behalf of more than 200 Australian human rights NGOs.

The OCHCR report contained several very positive comments concerning Australia’s recent record. It warmly welcomed the Parliament’s commitment to recommend a constitutional amendment that recognized Australia’s first peoples. It praised Australia’s concerted efforts to combat people trafficking and trafficking related exploitation. It applauded the introduction of the National Disability Insurance Scheme. It commended Australia’s advocacy for the abolition of the death penalty globally and new legislation that had introduced an offence of torture into the Australian Criminal Code.

Nevertheless, the report noted that UN Treaty Bodies had recommended consistently that the Australian Government do much more to close the inequality gap between Australia’s indigenous and non-indigenous peoples. It reflected concern commonly expressed about the health disparities of children living in rural and remote areas, children in out-of-home care, children with disabilities and in particular about the gap in health status between indigenous and non-indigenous children. It expressed alarm at the levels of violence against women and the sexual abuse of children.

Its principal reservation, however, related to Australia’s treatment of people seeking asylum. The report’s introductory paragraph on the issue read:

The response of Australia to migrant arrivals had set a poor benchmark for its neighbours in the region. The authorities had also engaged in the ‘turn around’ and ‘push-back’ of boats in international waters. Asylum seekers were incarcerated in centres in third countries where they faced conditions that the Special Rapporteur on Torture had reported as amounting to cruel, inhuman and degrading treatment…and which also violated the Convention on the Rights of the Child. Even recognised refugees in urgent need of protection were not permitted to enter Australia which had set up relocation arrangements with countries that might be ill-prepared to offer those refugees any durable solution. Such policies should not be considered a model by any country.”

In the review before the Human Rights Council, the vast majority of countries picked up on the same issues. Mr Dutton was right to criticise North Korea’s intervention which was hypocritical and wayward in the extreme. But one outlier in a hundred does not constitute a farcical dialogue.

France recommended that Australia strengthen measures to eliminate discrimination against indigenous populations. The USA urged Australia to consult indigenous peoples when considering the viability of remote communities. New Zealand asked that Australia address inequalities affecting health, education, employment and income that disproportionately affect indigenous peoples and other minorities. Hungary suggested that Australia should develop, in partnership with indigenous communities, a national strategy to implement the UN Declaration on the Rights of Indigenous Peoples.

Germany strongly condemned Australian refugee policy saying that children, families and other individuals at risk, in particular survivors of torture and trauma, should be removed from immigration detention centres. Sweden urged Australia to ensure that relevant measures should conform fully with international law and human rights, including the principle of non-refoulement and the detention of asylum seekers should only occur when absolutely necessary and for a minimal time.

The USA told Australia to closely monitor the processing of refugees and asylum seekers in offshore detention centres to ensure that their fundamental human rights are respected. Norway insisted that independent judicial review of detention and its conditions should be ensured. Iceland recommended that Australia fully incorporate its international human rights obligations in domestic law by introducing a comprehensive, judicially enforceable Human Rights Act.

There is nothing too farcical here. In fact there was next to nothing in the criticisms made by more than half the nations of the globe that has not previously been identified as deeply problematic by Australia’s Human Rights Commission.

There is no chance of Australia winning a seat on the UN Human Rights Council in 2018-2020 – unless we listen and act.


[1] Readers who wish to follow the history of Australia’s relationship with the UN Human Rights Treaty Body System may wish to have a look at my book Mr Ruddock Goes to Geneva, UNSW Press, 2003.

Spencer Zifcak is Allen Myers Professor of Law and Director of Research at the Academy of Law, Australian Catholic University. He is Immediate Past President of Liberty, Victoria.


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Victoria Rollison. Couples counselling for Labor and Unions

When I saw the news that the Electrical Trades Union invited the Greens’ Adam Bandt to address their National Officers conference, and didn’t invite a speaker from the Labor Party, the lyrics of Gloria Gaynor’s “I Will Survive” came to mind: ‘I’m not that chained up little person still in love with you, and so you felt like dropping in and just expect me to be free, and now I’m saving all my loving for someone who’s loving me’. This is not a lovers’ spat. The ETU has felt unloved by the Labor Party for a long time. In 2010, the union’s members made their displeasure official through a public, conscious uncoupling. As explained on the ETU website ‘our-history’ page: ‘The mood of the ETU membership towards the Labor Party has changed. The members no longer have faith in the Labor Party to listen to and act in the best interests of workers. The argument put forward is that political parties only listen to swinging voters. To that end, in 2010 the ETU membership voted to step away from its affiliation with the ALP and support whichever voice in the Parliament speaks genuinely for the workers’.

Such a statement barely skims the surface of the complicated relationship between the Labor Party and the Australian trade union movement. Whereas some unions are un-affiliated, others are loved up and as cosy as ever, and continue to provide a well-trodden path into the federal Labor caucus. As pointed out by Professor Ray Markey: ‘Only 11 unions account for all federal Labor parliamentarians with union backgrounds, nine of which are affiliated to the party. Almost half of these 39 MPs come from three affiliates: the Shop Distributive and Allied Industries Union (eight), Transport Workers’ Union (five) and Australian Services Union (five)’. And of course, Labor leader Bill Shorten has a well-known union background in the Australian Workers Union.

The question for both Labor and Australian unions is, are they good for each other? Will their relationship continue to be mutually beneficial to both parties, or should they go their separate ways?

There is no simple answer to this question. In recent years, there have been triumphs for the relationship, and inevitable tensions. The triumphs include the union’s campaign against WorkChoices which contributed to Labor’s election win in Kevin-07. Union campaigns were also influential in the election of Queensland Premier, Labor’s Annastacia Palaszczuk. As explained in this interview with Peter Simpson, Queensland state secretary of the ETU union, the ETU, though not an affiliated union, mobilised a grassroots ‘Not 4 Sale’ campaign against public asset sales. Many other unions helped not just with campaign funds, but also with on-the-ground activities such as door knocking and phone calls. In her victory speech, Palaszczuk shared the love by saying: ‘Can I thank the union movement … Because it is the union movement that stands up each and every day and fights for better conditions for workers across this state.’

Still, whereas the good times are good, the bad times are terrible. In working towards Party reform, Labor has slowly been unpicking their strong – some consider stifling – union links. For instance, in an effort to increase the accessibility to the party and the diversity of Labor rank-and-file membership, it is no longer compulsory for applicants to be a member of a trade union. Senator John Faulkner campaigned to reduce union representation at state conferences from half to 20%. Labor’s National President and Shadow Climate Change Minister, Mark Butler, is also pushing to increase rank-and-file decision making and reduce unions’ disproportionate voting rights. Since 2010, Labor has implied they are happy to date other people by describing their relationship with unions as ‘links’ amongst ‘other community organisations’. This is a far more casual relationship than 2002 when Labor described their union relationship status as a ‘partnership’.

Any end to the relationship would be costly for Labor. John Warhurst says Labor ‘depends hugely upon the unions financially, not just through the regular flow of money for daily administration, but for election campaign expenditure and broader pre-election political campaigns…’ But with this money comes an expectation of influence, an influence many non-union Labor rank and file members and supporters see as authoritarian, anti-democratic, sometimes corrupt and with power held by factions and “faceless men”’.

Policy disagreements are also an unavoidable source of tension between Labor and unions. A recent example is the disappointment felt by unions about Labor’s deal with Turnbull’s government accepting the China Free Trade Agreement, albeit with some amendments. ACTU President Ged Kearney was quoted as saying ‘companies would still be able to source workers from overseas without offering jobs to local citizens and residents’ and ‘While we appreciate the efforts of Penny Wong and Bill Shorten to fix a bad deal, the proposed changes simply do not go far enough’.

All of these complications inside Labor and unions’ relationship are amplified by the Liberal Party’s ideological war against unions, and by association, Labor. Speaking about his Royal Commission into Trade Union Governance and Corruption in Parliament on 8 September 2015, former Liberal Prime Minister Tony Abbott claimed the commission was set up ‘because it was absolutely necessary to get to the bottom of rorts, rackets and rip-offs, of corruption and of criminality inside the trade union movement’. This depiction of unions as corrupt and criminal is regularly repeated in news stories, particularly in right-wing partisan press, framing any Labor MP with links to unions as untrustworthy. Overcoming such attacks, and defending their public reputation, is a crucial activity Labor and unions must cooperate in.

If Labor and unions are to remain together, they need to be honest about how each has changed since they first met, and agree to compromise, as any couple who have a long history must do. Unions are operating in a vastly different economy and with a shifting and declining membership base, with ever-changing IR policy challenges to contend with. Labor is often stuck between a positive reform agenda rock and a populist electorally viable hard place, so won’t always be able to accommodate all unions all the time. Of course everyone must acknowledge that Labor can’t be progressively productive, and defend against the right’s attacks on IR policy, without winning elections.

There is so much good about the relationship, I’m sure it’s not something either want to destroy completely. And even if the unlikely decision is made for Labor and unions to cut ties and file for divorce, I would hope they can agree to be cordial for the benefit of the children; for the benefit of everyone who relies on unions and the Labor Party to defend the rights of workers, to deliver socially progressive policies and to maintain economically equitable and sustainable economic growth.

Victoria Rollison is a political blogger. She works in marketing and communications and is researching political narrative at the University of South Australia. She is a member of the ALP in Adelaide.


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Arja Keski-Nummi   Andaman Disaster – Regional Cooperation on Refugees

Too often in Australia we go cap in hand to the region when we have an asylum seeker or refugee problem. When our problems pass, we lose interest in regional cooperation. No wonder the region often see us as fair-weather friends.

But our region faces refugee problems alongside ours. As a good neighbour we should help with the common problems we face. It is in our interest to do so as well as in the interest of regional countries.

On 13 November 2015, the Huffington Post carried a story that “Myanmar’s Rohingya could be the world’s next major refugee crisis”.  The story commented

‘After months of monsoon rains, it is sailing season again in the South Seas of Myanmar. Six months ago, the plight of Myanmar’s Rohingya minority briefly garnered international attention when they were among thousands of starving refugees and migrants abandoned in the Andaman Sea and the Bay of Bengal. Human Rights groups now say a new refugee crisis looms, as members of the Rohingya minority are excluded from the dramatic reforms taking place in their country. Amnesty International recently warned that thousands more people could set sail in the coming months, risking a repeat of the May crisis.’

John Menadue.

See below a post by Arja Keski-Nummi on the earlier Andaman disaster.

The crisis in the Andaman Sea provides an opportunity for the Australian Government through our Foreign Minister Julie Bishop as Co-chair of the Bali Process on People Smuggling, Trafficking and Related Transnational Crime to give the process some teeth and credibility in the region. This is a good opportunity for us to help others just as they have helped us in the past with regard to people movements.

Five countries that are part of the Bali Process are facing a crisis that is drawing negatively the attention of the international community on the region; unprecedented since the Indo Chinese outflows of three decades ago.

Australia should be approaching the other Co-chair, Indonesia, to work with affected countries in examining what can be done to both tackle the people smuggling/trafficking ventures that are preying on vulnerable people in Bangladesh and Myanmar and how best to ensure the safety and security of people who have been affected by such predatory behaviour.  In its 2013 communiqué ministers “underscored the importance of addressing humanitarian and protection needs in managing irregular movement”.

Now is the time to enliven the April 2013 communiqué of the Bali Process Ministerial meeting in which in its penultimate paragraph:

“Ministers recognised that the root cause of irregular movements in the region were complex and multidimensional and encouraged members to continue to work with countries of origin, including through development cooperation, to address where possible underlying factors which made people vulnerable to irregular movement.” 

This communiqué called for greater regional cooperation and work on:

  • People smuggling and trafficking. From the reporting we have seen on this latest humanitarian disaster a people smuggling venture has quickly turned into trafficking.
  • Development of a “protection-sensitive regional approach” – the aspirations of which are to have consistent assessment processes for asylum seekers, and where appropriate and possible harmonised arrangements or the establishment of regional assessment arrangements.
  • Identifying in the region the perceived increase of labour trafficking and how this might be tackled by working with civil society groups and business.
  • Working with countries to address the root causes of such movements

All of these concerns are present in the current situation of the people on the boats in the Andaman Sea.

We should with our Co-chair seek to convene a special high-level ad-hoc group under the Bali Process banner to pull together a practical cooperative action plan that would provide assurances to affected destination countries that the burden is not theirs alone.  This group could comprise the five affected countries, Australia as co-chair and the three international agencies UNHCR, IOM and UNODC.

Such assistance could include:

In Destination Countries:

  • Assistance with initial screening and identification of people with protection concerns or who are victims of trafficking. A multinational task force (comprising nationals of destination countries as well as other Bali Process countries such as Australia and new Zealand) led by UNHCR to undertake that initial screening,
  • Flying in emergency assistance for shelter and medical support with the agreement of affected countries
  • Creation of safe havens pending final determinations –where the burden of costs is shared.
  • Assistance with local integration in certain circumstances through regional social investment projects in housing, health and education services that benefit the indigenous communities as well as new arrivals.
  • Commitments to resettlement of recognised refugees over a period of time.
  • Greater support for return through assistance in innovative new labour creation projects through social investment projects and micro financing schemes.

In Source Countries:

For the Rohingya the solution lies with Myanmar conforming to international norms in relation to the treatment of its citizens.  While Myanmar does not recognize the citizenship of a segment of its population and actively discriminates against them through property, education, movement and marriage laws this situation will continue.  The solutions have to lie in policy changes with the Myanmar government. As Myanmar emerges out of its self-imposed isolation regional institutions such as ASEAN have the opportunity to provide a constructive environment within which Myanmar can address the policy problems of this issue.  Complementary to this an ad hoc group as proposed above could provide practical assistance to ASEAN in mapping out strategies for supporting Myanmar in improving the conditions of Rohingya in Myanmar.

Bangladesh has been a source of labour migration for decades.   Traffickers prey on the vulnerabilities of people desperate for work where there is none. Overpopulation, corruption, lack of opportunities, international demand for cheap labour all play into the hands of traffickers.  There is no easy solution to this cocktail of misery compounded by a lack of political stability in Bangladesh. While the Bangladesh Government has created a legal and administrative infrastructure to combat trafficking – “The Human Trafficking Deterrence and Suppression Act 2012” and the “National Plan of Action for Combating Human Trafficking for 2012 – 2014” and coming out of these instruments established a number of different strategies covering training, awareness and education as well as greater law enforcement measures, the problem remains overwhelming. According to the 2014 US Department of State Trafficking in Person Report, of 215 cases initiated for prosecution in 2013, a total of fourteen people were convicted of trafficking.  There are no reliable figures on how many people were trafficked in this time but conservative estimates put it in the tens of thousands. Given these most recent developments, a Bali ad-hoc group with Bangladesh as an active participant can continue a process of working with Bangladesh in strengthening the strategies it has in place and working with civil society in the country in providing protections and safe haven for people at risk of being trafficked.

Smugglers and Traffickers – the raison d’etre of the Bali Process is to combat People Smuggling and Trafficking. Despite many countries in the region enacting laws against people smuggling and trafficking and the imposition of ever-greater penalties for smuggling and trafficking it remains one of the more lucrative and risk free ventures in the region.  Tackling this through laws and awareness campaigns while important is not enough. These loose coalitions of interest groups and syndicates are like a many-headed hydra quickly adapting and changing techniques and operations to prevailing conditions. Again the issue must be tackled at its source – in this instance most likely Bangladesh. The proposed ad hoc group could start the development of a strategy to support Bangladesh and other countries named in the US State Department TIP reports to strengthen its approaches against traffickers and recruiters and the victim of smugglers and traffickers.

This is a global problem, which will only increase, and we cannot isolate ourselves from it. While for the time being Australia may have stopped the boats – this policy is not sustainable into the longer term. It is in our national and regional security interests to help stabilize populations and to play our part in the region. 

Arja Keski-Nummi was formerly First Assistant Secretary in charge of refugees in the Department of Immigration and Citizenship.

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Victoria Rollison. The Future of Australia’s Trade Unions

A strong trade union movement is crucial to combating growing wealth inequality in the Australian economy.

When asked in 2014 what Australia ‘had done right’ to defend the economy against the chronic wealth inequality experienced in the US, Nobel Prize winning economist Joseph Stiglitz answered: ‘unions’. He explained that Australia has ‘been able to maintain stronger trade unions than the United States. The absence of any protection for workers, any bargaining power, has had adverse effects in the United States. You [Australia] have a minimum wage of around $15 an hour. We [the US] have a minimum wage of $8 an hour. That pulls down our entire wage structure’.

Regardless of their comparative strength to unions in the US, Australian unions cannot afford to be complacent about their long term survival.

Recent data from the Australian Bureau of Statistics, as analysed in The Guardian by Greg Jericho, paint a worrying picture for the Australian trade union movement. Jericho reports that ‘trade union membership in the private sector is now almost one in 10… And in a sign of further strife for the union movement, just one in 20 young workers are in a trade union’. The public sector (39.5%) and education (34.38%) industries have the highest percentage of trade union membership, but as the number of workers in traditionally strong union industries such as manufacturing decline, so too does union membership, particularly amongst male workers. In fact, Jericho points out, whereas men used to be more likely to be union members, women now make up a higher percentage of union members, with 15.9% of female workers members of a union as compared to 14.4% of men. The total percentage of trade union members in the Australian workforce is now 15.1%, and only 13.8% if you include workers in unincorporated enterprises. This compares to 40.5% in 1990.

Commenting on these figures, former ACTU official, Tim Lyons
, says ‘Australian unions have only a few years to change or die’. Lyons is reported as blaming the ‘historic collapse in union membership’ on ‘an outdated approach that does not work across large parts of the workforce’, and admits the blame is shared by him as a ‘former senior ACTU officer’. He says that too often, unions are seen as only being concerned with their position in the political sphere and that ‘Political campaigning can’t ever be an excuse for not organising’. He goes on to argue that ‘The need for new models of membership and worker participation is long overdue’. Offering a potential way forward, Lyons suggests; ‘Strong, growing unions are ones that help give workers some power over their work and therefore their lives. There are no shortage of workplace issues to organise around, with penalty rates being only the most obvious’. Lyons sees unions’ futures in re-evaluating their value to workers and helping workers organise to help themselves, with less emphasis on political campaigning.

Amongst their assessments of the declining membership of Australian unions, Jericho and Lyons comment on some more positive news for unions by citing polling released recently in Essential Media’s Essential Report, October 27 2015. The poll asked ‘How important are unions for Australian working people today?’ and found ‘The majority of respondents regarded unions to be important for Australian working people today (62%), whilst 28% believe that they were not important’.

Ged Kearney, President of the ACTU, responded to the ABS’s declining union membership figures by pointing out that ‘while union membership density is hovering around 15% of workers, more than 60% of Australian workers are employed under conditions that were collectively bargained for’ and ‘Even for workers not covered by collective agreements, they still directly benefit from their broad acceptance. The ubiquitousness of such agreements has led to them becoming the de facto base rate across much of the workforce, rather than the relevant award’.

The challenge for Australian unions is to translate the belief amongst workers of the importance of the role of unions, and the reality of unions’ benefit to wage growth, into a belief that union membership is a valuable investment for workers’ individual job conditions. A strong, united workers’ trade union movement is the best line of defence, as pointed out by Stiglitz, to defend against growing economic wealth inequality.

Victoria Rollison is a political blogger, working in marketing and communications. This article first appeared in ‘Equality, a journal of Australian Fabians’.

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Cavan Hogue. Turkey shoots down Russian aircraft.

Russia supports the (Shia) Assad regime backed by Iran and others while Turkey supports the Sunni backed bySaudi Arabia, the USA and others. The Turks claim the Shia are terrorists while Russia supports them as allies of the Shia, (i.e. Assad) who support Russian strategic interests.. This is an oversimplified picture but it is relevant to the shooting down of a Russian fighter. The Turks claims it was in Turkish airspace which the Russians deny. Turkey probably overreacted but it is perfectly possible that Russians were attacking anti-Assad forces within Turkey or strayed over the border in pursuit of such forces. Either way the Russians are going to deny that they were to blame and the Turks are going to say it was all Russia’s fault.

If left to themselves, Russia and Turkey will almost certainly sort it out with much rhetoric and ittle action but the danger is that NATO will get into the act either by itself or at the urging of Turkey. This would not be a good idea. All this does, however, highlight a basic problem in the whole situation. It is not just the bad guys, ISIS, versus the good guys, everyone else. It is a host of conflicting factions and interests which overlap and vary like the bits of a kaleidascope. The more the parties involved insist on a goodies and baddies analysis the less likely it is that a solution will be found.

Everyone has an interest in opposing ISIS but how do you do this? As has been wisely said, ISIS is not an army or a state but an Ideal. Western countries find it hard to accept that local people see the West as the baddies although a brief foray into history might show them why.

This situation is unlikely to lead to wider conflict.  US increased training of Ukrainians to “combat Russian aggression” is a greater threat. The behaviour of both Russia and the US takes us back to the Cold War but more accurately should be seen as a contest for influence between two great powers. It has nothing to do with morals or political systems. The common fight against ISIS in particular and terrorism in general creates a bond which puts pressure on all parties to work together at least against ISIS. The question is, what happens next? The Coaition of the Willing opened Pandora’s box. Who will put the lid back on it?

Cavan Hogue is former Australian Ambassador to USSR and Russia.

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