Danila Dilba Health Service

2017–2018 Our name, our Our Vision people, our region That Aboriginal and Torres Strait Our full name, Danila Dilba Biluru Butji Islander peoples’ health, well-being Contents Binnilutlum, was given by the Larrakia and quality of life equals that of people, the traditional owners of the non-Indigenous Australians. Chairperson’s report 2 land where Darwin and Palmerston Chief Executive Officer’s report 4 are situated. In the Larrakia language, Board of Directors 6 Danila Dilba means ‘dilly bag used to Our Purpose collect bush medicines’ and Biluru Butji Our purpose is to improve 1.Health for Life 10 Binnilutlum means ‘blackfella (Aboriginal the physical, mental, spiritual, people) getting better from sickness’. 1.1 Introduction 11 cultural and social wellbeing of Aboriginal and Torres Strait Islander the Biluru community in the 1.2 Why an Aboriginal community controlled health service? 13 people from around Australia have Yilli Rreung (Greater Darwin) 1.3 Comprehensive primary health care 15 visited Larrakia country for generations. area. We achieve this through 1.4 Care across the life course 16 Some of the visitors stayed and we innovative comprehensive are now blessed with a rich cultural primary health care programs, 2. Outreach, education, engagement & partnership 32 diversity. community services and advocacy. 2.1 Health promotion and education 33 When we describe ourselves in the Our work is based on principles 2.2 Counselling and social support 36 2015–2016 Annual Report, we use the of equity, access, empowerment, words Biluru, Aboriginal, Torres Strait self-determination and collaboration. 2.3 Events and outreach 39 Islander and Indigenous. 2.4 Health research partnerships 41 Our Values 2.5 Research for advocacy 43 Our logo • Respect 3. About Danila Dilba 44 • Trust, honesty and integrity 3.1 Overview 45 • Fairness, transparency and 3.2 Our services 46 accountability 3.3 Continuous Quality Improvement (CQI) 54 • High professional standards, 3.4 Organisational development 57 ethics and quality 3.5 Our people 59

Our logo was designed by 4. Financial Reports 69 Larrakia elder Reverend Wally Fejo. The story of the logo is: the fish being in a school are excited when jumping around and convey to us our exciting, healthy life. The turtle going back to lay her eggs represents the people. The stick represents a hunting tool on how to find her eggs. The overall Danila Dilba Biluru Butji Binnilutlum circle is like looking inside a dilly bag from Health Service Aboriginal Corporation above. The snake brings the threat of ABN 57 024 747 460 / ICN 1276 danger to our wellbeing and reminds us that we should always sustain ourselves and be on guard for our health. This year we were greatly assisted again by our Audit and Risk Management Chairperson’s report Committee, which provides independent advice to the Board on risk, 2017-18 was another exceptional year for Danila Dilba, with control and compliance and financial responsibilities. the addition of two clinics, further strengthening of our Board and Our staff staff, and great work in outreach and community engagement. The Danila Dilba Board values the great work of our staff and supports Danila Dilba’s Board has leadership responsibility for a big community professional development of all staff. We especially encourage our Aboriginal and owned and controlled organisation that now manages seven primary Torres Strait Islander staff to step up to take on training and career development. health care clinics across the Greater Darwin region. Aboriginal Health Practitioners (AHPs) have a vital role in primary health care This year we opened our new clinic at Rapid Creek and welcomed and this year, we initiated four AHP traineeships, an important step in ‘growing the Bagot Community Clinic under DDHS management. The Bagot our own’ skilled clinicians. Four trainees were employed from a strong field of Community Health Centre has served Bagot, Kulaluk and Minmarama nearly 40 applicants. Park communities for some 40 years. We are confident that by working I am pleased to report that the DDHS Human Resources Strategy and together we can build up this service for long-term sustainability and a Indigenous Employment and Career Pathways Strategy have been very secure future. successful, increasing Indigenous staffing at all levels. The outcomes reflect a The Board growing Indigenous professional staff in our organisation. In 2017-18, Indigenous staff were: I thank the directors for their hard work this year. As well as directors’ general responsibilities, everyone contributed to building up the Board’s • 65% of our leadership team (CEO, General Managers, all Clinic Managers), and capacity and skills, including: • 63% of non-GP clinicians and community/social and clinical support staff • attending an executive masterclass for healthcare boards on (AHPs, RNs, clinical administration, community services and client support). Responsibilities for Leading Quality and Safety, Our vision is to ensure continuing leadership by a well-qualified, skilled • corporate governance training with the Australian Institute of Indigenous management team. The Board approved creation of a new identified Company Directors, and position of Deputy CEO as part of long term succession planning, aiming to • five day directors’ course with the Australian Institute of Company make an appointment to this position in 2018-19. Directors, undertaken by two Board members. Community An independent review in 2017 found our Board is performing well As this Annual Report shows, Danila Dilba works to support our community – and improved in every area compared with the previous review in 2015. getting involved in community events, outreach and health education for The review of our CEO, Olga Havnen, also ranked her highly on each all ages, with active social media on Facebook, YouTube videos and regular measure of her performance. quarterly newsletters.

There were changes to the Board this year. Former Chair, Braiden Abala, Special thanks go to our Community Services team and manager Joseph Knuth. former Larrakia Officer, Phyllis Mitchell and Independent director, Priscilla DDHS now provides regular breakfasts for the homeless and people sleeping Atkins (formerly, Collins), retired this year. On behalf of the Board and rough, with support from Orange Sky who provide an additional portable staff, I thank the former Chair and retiring Board members for their clothes washing service. commitment and service to Danila Dilba. On behalf of the Board, I also acknowledge and thank our staff who Continuing Directors were myself (Chairperson), Nicole Butler volunteered their time to work with the ‘breakfast team’ and with the (Deputy Chair), Vanessa Harris, Mark Munnich, and independent Youth Support Team working with young people in detention. non-member director David Pugh.

We welcome new directors Timmy Duggan, Shannon Daly, Malcolm Hauser, and Larrakia Officer, Wayne Kurnoth. Our new independent non-member director Dr Bronwyn Rossingh, brings valuable high-level financial expertise to the Board. Mrs Carol Stanislaus Director / Chairperson

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2017-18 was a year of solid growth, expansion Advocacy for children and families and consolidation for Danila Dilba. Since the 2016 Four Corners TV program on Aboriginal youth in detention in Darwin, Danila Dilba has been active in advocacy for This year we expanded our clinical services with the addition of children in the NT Child Protection and Youth Justice systems. two clinics – a new DDHS clinic at Rapid Creek, and the inclusion of the Bagot Community Clinic under Danila Dilba management. As the Royal Commission that followed has shown, there is a hugely disproportionate level of contact with Aboriginal families and We now operate seven clinics in the Greater Darwin region and children in both systems, and far too many Aboriginal children taken have achieved substantial growth in the number of clients, shown into out of home care. DDHS is now hosting a project to develop by a 20% increase in the number of episodes of care to more Aboriginal-led and managed out of home care and family support than 55,000 this year. services in the NT. Investing in our people We made submissions to the Royal Commission and following Danila Dilba continues to grow our workforce and invest heavily its recommendations, have advocated for legislative change and in our staff and their professional development. We aim to make partnered with peak bodies to call for a tripartite Commonwealth- Danila Dilba an employer of choice, both to attract talented staff Territory-NGO forum to lead the strategic response. and to increase professionalism and capability of staff at every level of the organisation. In May-June 2018, Danila Dilba was delegated on behalf of AMSANT1 to conduct extensive community consultations to hear Investment in training and development has shown enormous about community experiences of the current systems and ideas returns this year. Most importantly, we now have a much more stable about proposed changes to the legislation. workforce to provide the continuity of care for our clients that is essential to their well-being and health. In addition, our more stable Although we have only a small dedicated team of policy and workforce means we are less reliant on agency and short-term staff, research workers, Danila Dilba has been recognised and has generating savings of about $400,000 per year. achieved a solid reputation for high quality, well informed research and the capacity to influence and drive long overdue changes in Australian Nurse Family Partnerships these areas. One of the great success stories this year was the Australian Nurse Family Partnership Program (ANFPP). This home visiting service Finally, I warmly thank and acknowledge all of our Danila Dilba strengthens families and gives first time mothers the nursing and staff for embracing yet another year of change and for your social support they need until their child is two years old. commitment to our shared goal – to achieve a dynamic health service that respects Aboriginal cultures, is committed to the ANFPP only began to take clients in January 2018, and after three world’s best practice, and has a passion to make a difference moves, settled in its permanent home at Malak in April this year. to the well-being of Aboriginal people. Despite these hurdles, in the first year, the program has received 50 referrals, closing the year with 27 active clients and 13 babies!

Our ANFPP home visiting team of Home Nurse Visitors and Family Support workers is unique. It is made up entirely of Indigenous women and is the only all-Indigenous ANFPP team in Australia. Early intervention to support healthy parenting and stronger families is critically important to our community and Danila Dilba is looking for ways to expand and strengthen Aboriginal-led child and Olga Havnen family services. Chief Executive Officer

1 Aboriginal Medical Services Alliance Northern Territory (AMSANT)

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Directors Directors

Carol Stanislaus Nicole Butler Shannon Daly (nee Grant) Timmy Duggan Vanessa Harris Malcolm Hauser (Chairperson) (Deputy Chairperson) Shannon is employed by the Timmy is currently Healthy Vanessa is the Executive Malcolm is a Senior Project Carol is a Tiwi woman, born Nicole is a Larrakia/Wadjigan Top End Health Service as Living Manager at the National Officer of the Northern Officer in the Minerals and and raised in Darwin. She (Top End) and Eastern Arrernte the Consumer and Cultural Heart Foundation, NT Division. Territory Mental Health Energy Branch of the Northern has worked in a variety of (Central Australia) woman. Consultant at Royal Darwin Timmy has had a long and Coalition. She holds a Bachelor Land Council. He has a Indigenous positions in alcohol Nicole is a qualified social Hospital. Shannon has 13 years’ varied career, starting as a of Health Science, majoring background in environmental and other drugs, tourism, worker, having completed a experience as an Aboriginal professional basketball player in Management, from Flinders and resource management and local government and justice Bachelor of Social Work at the Health Practitioner (AHP, with the Cairns Taipans. He has University. Vanessa’s career has has worked with the Northern throughout the Northern Royal Melbourne Institute of previously AHW), educator worked variously as a health included employment with the Territory Government as an Territory and holds a Bachelor Technology (RMIT), graduating and lecturer, having completed promotions officer, as youth Commonwealth Government Assistant Mining Officer. He of Applied Science in Aboriginal with Honours. She has defined her AHP training through trainer with the Council for Office of Aboriginal and Torres has also worked with the Community Management and her career in child and family Danila Dilba in 2001. Shannon Aboriginal Alcohol Program Strait Islander Health (OATSIH), Commonwealth Department Development. Carol currently welfare, with experience in has worked in various roles Services (CAAPS), and as the Katherine West Health of Health on a Senate Inquiry works with the Department of child protection, out-of- that gave her an opportunity youth worker and mentor Board, an Aboriginal Community into the Hearing Health of Prime Minister and Cabinet. home care, residential care to see Aboriginal Health for Indigenous youth at Malak Controlled Health service, the Australia. services, youth at risk (street through different lenses. Re-engagement Centre and Cooperative Research Centre work-outreach), secure care She is passionate about the Diversity Dimensions. Timmy for Aboriginal Health and the and juvenile justice. She has AHP’s vital role in providing is the founder of the Hoops Lowitja Institute. undertaken research in care culturally safe and competent 4 Health program. He received and protection, and program care to Aboriginal people and the Top End NAIDOC Person and policy development in is committed to growing the of the Year Award in 2012 and Victoria and now in the profession and engaging the has many other awards and Northern Territory. Nicole profession at various tiers achievements. is currently Assistant Children’s within Health. She is a team Commissioner with the player who values respect, Office of the Children’s professional support, impartiality Commissioner, Northern and ethical practice. Her Territory. strengths are in evidence- based strategic thinking, critical thinking, innovation and practicality.

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Wayne Kurnoth Mark Munnich Since 2014, the Danila David Pugh Bronwyn Rossingh (Larrakia Officer) Mark Munnich is a Gunggandji Directors appointed Dilba constitution (non-member) (non-member) until 2019 AGM Wayne is a Larrakia man of and Yawuru man, born and has allowed for the David is the CEO of NT Bronwyn has been working • Nicole Butler the Fejo family group. He is raised in Darwin. Mark holds appointment of non- Anglicare and has over and living in the NT for over currently employed as the a Bachelor of Laws and is Deputy Chairperson 35 years’ experience in 20 years. She has a strong member directors Aboriginal and Torres Strait currently undertaking his • Vanessa Harris leadership roles within background in accounting and Islander union organiser for Graduate Diploma in Legal who can bring special NGOs. He holds a Master governance. She is a Fellow • Mark Munnich United Voice, supporting Practice. Mark is employed as expertise or experience of Business degree. He was of the Certified Practising members with workplace issues a Law Clerk with the Solicitor • Timmy Duggan to add to the skills of the previously the CEO of Accountants of Australia and workers’ rights across the for the Northern Territory St Luke’s Anglicare in Bendigo, and has a PhD in accounting. Northern Territory. Previously, in the Attorney-General’s Directors appointed elected directors. Non- Victoria, has served on a Bronwyn has worked he worked as a boiler maker/ Department (AGD) and he until 2020 AGM member directors are number of government extensively in remote welder for 17 years in the is a former Indigenous Fellow • Carol Stanislaus independent – they and advisory councils and has Aboriginal communities shipbuilding, construction with the Office of the High Chairperson their family members may worked in Milingimbi and in the Northern Territory and oil and gas industries. In Commissioner for Human Nhulunbuy. David is a member and Western Australia in 2018, Wayne won the ACTU Rights with the United Nations. • Wayne Kurnoth not have financial or other of the Anglicare Australia the areas of financial Organiser of the Year award. Mark is also a former staff Larrakia Officer interests in Danila Dilba. Board, the Children and management, governance, member of DDHS. • Malcolm Hauser Their specialist skills may Families Tripartite Forum community engagement, and the NT Government enterprise development, • Shannon Daly (nee Grant) include areas such as community development, NGO Consultative financial capability and well- Committee. being, education and pathway Independent non- health, finance, law or development. Bronwyn is member directors accounting. In 2017-18, passionate about supporting • David Pugh the non-member directors the vision of Aboriginal term expires December 2019 were David Pugh and communities and organisations. • Bronwyn Rossingh Bronwyn Rossingh. term expires March 2021

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In 1991, after some 15 years of lobbying and agitation by Aboriginal community members, Danila Dilba Health Service was established to serve the health needs of Biluru (Aboriginal and Torres Strait Islander people) Health in the Yilli Rreung (greater Darwin) region.

Since then, we have grown in size and capacity from one building and seven staff, Burden of disease and seven clinics and 170 staff. However, FOR LIFE Burden of disease is a measure of the the themes of empowerment, self health impact of disease over a given management and building our capacity year—both through dying from, and living to deliver high quality health services and with, disease and injuries. improve the health of our community remain as important as ever. • The NT overall has substantially higher burden of disease than other jurisdictions,

Aboriginal and Torres Strait • Lower socio-economic groups have a higher burden of disease than people Islander health with higher incomes, Despite improvements on some measures, • Socio-economic group accounts for there are still huge disparities between 21% of differences in burden of disease Aboriginal and non-Aboriginal health. In in Australia. the Northern Territory, life expectancy is 16-17 years less for Aboriginal people, and Years of life lost (YLL) because of dying the burden of disease for the Aboriginal younger is one way to measure burden population is nearly 3.6 times the national of disease. 1 average. Over 2004-2013, The leading causes that contribute to the • the YLL rate for the NT Aboriginal gap in years of life lost are: population aged 30-44 years was 8 times higher than the non-Aboriginal • cardiovascular disease, population 30-44 years • cancer, Danila Dilba • The NT Aboriginal total YLL rate was • diabetes and 3.4 times the NT non-Aboriginal rate. was built by a 2 • kidney disease. • YLL rate in the NT Aboriginal population community that was 58% higher than the national empowered itself to Aboriginal average. Sources: Australian Institute of Health and Welfare establish, manage and (AIHW), Australia’s Health 2018; Zhao et al, 2016, deliver health services NT Burden of Disease Study 2004-2013 to its own people.

1 Zhao et al, NT Burden of Disease Study, 2016 p.4 2 Zhao et al, NT Burden of Disease Study, 2016 p.20

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1.2 Why an Aboriginal community controlled health service? Social determinants of health Social determinants - the The major factors that contribute to ‘causes of the causes’ As an Aboriginal community controlled health service, Danila Dilba has poor health outcomes are called the social The World Health Organisation describes an important role to address health inequality by making high quality health determinants of health. These include the social determinants of health as “the services available to our community, and by delivering comprehensive primary living conditions, education opportunities, conditions in which people are born, grow, health care that is easy to access and culturally respectful and safe. employment, working conditions and income, live, work and age”, the circumstances access to transport and health care, and that are mostly responsible for unfair and Our vision is to see Aboriginal and Torres In 2017-18, Danila Dilba opened a new community and social support. avoidable differences in health, between Strait Islander peoples’ health, well-being and clinic in Rapid Creek, and agreed to manage nations and within countries. quality of life achieve equality with that of the Bagot Community clinic starting with Social determinants are ‘the causes of non-Indigenous Australians. a twelve month trial, increasing access to These are the underlying issues that the causes’ of poor health. primary health care to our clients and cause or contribute to other health risk We take a holistic approach to health and community. This year saw an increase of Socio-economic disadvantage contributes factors like low birthweight or unhealthy well-being that is not only about medical more than 1,000 regular clients, and Danila as much as half of the difference in life behaviours such as smoking, poor nutrition services, but includes prevention, health 3 Dilba provided 55,712 ‘episodes of care’. expectancy and more than one-third or harmful drinking. For example, people promotion and education, and supporting with low income may not be able to afford (34%) of the overall difference in health our clients to manage their health. (the ‘health gap’) between Indigenous and to eat well or go to a doctor; people non-Indigenous Australians.4 who have not had much education may not have ‘health literacy’; people who are About Danila Dilba Other factors that contribute to the health unemployed or live in poor housing may gap are: be highly stressed. What makes us different is our focus Regular clients on clients and their care, starting from • differences in health risk factors — such The higher a person’s socioeconomic birth and looking after our clients’ 2016-17 2017-18 position, the healthier they tend to be. as higher rates of smoking, risky alcohol needs as their lives and health changes. Female 3811 4405 People in the lowest socio-economic level consumption, not enough exercise; Male 3047 3510 have the poorest health. In other words Our approach is ‘person-focused’, rather Total 6858 7915 • poor access to appropriate health – the people who are the poorest are than ‘program focused’ or ‘disease focused’. generally the sickest, and this is largely services—Indigenous Australians report The core of our philosophy and approach Danila Dilba’s regular clients have increased by 15% in due to factors beyond their control. greater difficulty in accessing affordable can be summed up as: the past 12 months. ‘Regular clients’ are the people who 5 health services that are nearby. Sources: World Health Organisation, http://www. have used our services at least three times in the past who.int/social_determinants/sdh_definition/en/; • Know our community two years. Australian Institute of Health and Welfare (AIHW), Australia’s Health 2018 • Know our clients Episodes of care* • Know our clients’ health • Care for our clients’ health across 2016-17 2017-18 their lifetime. Female 27,423 32,856 Knowing our community, clients and their Male 18,592 22,856 health means we can plan ahead and prepare Total 46,015 55,712 3 Georges et al, “Progress in closing the gap in life expectancy for the future. For example, we know that at birth for Aboriginal people in the Northern Territory”, This table shows the number of episodes of care provided 1967–2012 MJA 2017; 207 (1): 25-30 the Darwin population is unlikely to increase, to clients. Each episode may be with more than one staff 4 Household income is the largest individual contributor to but there will be increase in the Aboriginal member if related to the same issue. The 20% increase in the overall gap (14%), followed by employment status (12%), population and the proportion of older the last year reflects a significant increase in new clients. Australian Institute of Health and Welfare, Australia’s Health 2018, p.307 and pp 339-352 Aboriginal people. Among our older clients, a 5 Australian Institute of Health and Welfare, Australia’s high proportion have chronic disease issues *New counting rules implemented in 2016/7 allow only Health 2018, p.307 such as diabetes. Knowing our clients’ health one episode of care per client per day. means we can plan for their future care needs and services.

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2017-2022 Annual health checks 1.3 Comprehensive Strategic Priority 4 Annual health checks are a valuable tool This year DDHS implemented a new, Achieving continuous to help us know about our clients’ health. streamlined health check template that greatly primary health care improvement and A Danila Dilba health check is comprehensive simplifies the process and is designed so that integration of and can identify childhood developmental it asks fewer questions that are not relevant Comprehensive primary health care is a holistic approach to services problems, risk factors for disease or to particular clients. This helps the team doing health. It includes accessible and culturally appropriate medical actual disease. the health check and improves the process so services and treatment, but more than that, it tackles illness prevention, we can gather better health data. health education and promotion to empower individuals and engage the broader community to improve and manage health and well-being. 80 80 80 2023 Target 74% Working this way means working in inter- With the addition of the new clinic at 70 2023 Target 69% 70 70 2023 Target 63% disciplinary teams and integrating services Rapid Creek, and management of the Bagot 60 60 60 61% in one location wherever possible – so that Community Clinic, Danila Dilba now operates 57% 57% 56% 55% 50 50 50 services are easily accessible and meet the seven clinics across Darwin and Palmerston. 45% 47% 47% full range of our clients’ health needs at Our clinics are all managed by senior 40 40 40 42% 41% 38% every stage of life. Aboriginal staff. 30 30 34% 30 The key elements of our service model are: 20 20 20 Danila Dilba service model • provide services close to where people live 10 10 10 Accessible health services are critical • integrated services – a ‘one stop shop’ 0 0 0 to good health care. The service model • permanent staff allocated to each clinic to we developed and have implemented in

2014-15 2015-16 2016-17 2017-18 2014-15 2015-16 2016-17 2017-18 2014-15 2015-16 2016-17 2017-18 build team stability and improve continuity the past two years is designed to provide of care for our clients 0-4 years – completed 15-54 years – completed 55 plus years – completed integrated services – that is, a full range of • Child Health Check • Adult Health Check • Adult Health Check needed services such as Aboriginal Health • cultural safety (within past 12 months) (within past 2 years) (within past 2 years) Practitioners (AHPs), general practice, • extended hours counselling, specialist clinics, antenatal and • ‘SQI’ – safety, quality improvement child health, all in one place and in a Delivering good quality health care and Danila Dilba knows our client’s health, culturally safe environment. • data collection – informs what we do health services means so that we can work with people to and how we do it. • building our clients’ trust improve health, by completing a health check annually. Overall the percentage of • working in partnership with others (other our regular clients who have had a health organisations, health providers, researchers) check in the previous year has increased, • building relationships, and with a big improvement in the over 55 • striving to meet or exceed national targets. age group in the past year.

Danila Dilba Staff at the Larrakia Family Day.

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1.4 Care across the life course 2017-2022 Strategic Priority 1

Care across the life course means ensuring that our clients Improving health Pregnancy and birth weight receive the kind of information, services and health care they and wellbeing 90 90 90 need for the best health outcomes at every stage of life – across the 90% 88% 88% 86% starting even before birth. life course 80 80 80

70 70 70 69%* National Start of life target 60% 60 60 60 60%*

55% Antenatal care for women, starting A healthy birthweight is a good start to life, 50 50 53% 52% 50 early in their pregnancy, is important for and especially important for future health. 40 National 40 40 their own and for their baby’s health. Ideally, Babies born with low birthweight (less than 39% 40% target 37%

Danila Dilba links pregnant women with their 2500 grams) have higher risks of health 30 30 30 health professionals (midwife and GP) as early problems in early childhood 20 20 20 as possible when pregnancy is confirmed. and are at greater risk than Women who 10 10 10 healthy weight babies of Women who have their first antenatal visit have their first 0 0 0 developing chronic disease before 13 weeks are better able to prepare antenatal visit as adults – such as diabetes, for the birth physically and emotionally, and before 13 weeks 2014-15 2015-16 2016-17 2017-18 2014-15 2015-16 2016-17 2017-18 2014-15 2015-16 2016-17 2017-18 cardiovascular disease, health staff are better able to support the are better able to high blood pressure, and First antenatal vist early Smoking in pregnancy Babies born with prepare for the • before 13 weeks • • normal birthweight mother with her health and make sure the kidney disease. birth physically * meets the national target (between 2500-3500gms) pregnancy is going well. and emotionally DDHS met the national target for first antenatal visit before 13 weeks (60% of clients) in 2016-17 and 2017-18. There has been some improvement in rates of smoking during pregnancy in the past year (52%), however the national target is 37%.

Pap smear screening

2014-15 2015-16 2016-17 2017-18 Had screen in last 2 years 802 33% 858 35% 1108 45% 1185 43% Had screen in last 3 years 1008 41% 1073 43% 1294 53% 1443 52% Had screen in last 5 years 1260 51% 1279 52% 1411 57% 1602 58% Total no. of eligible women 2448 2479 2455 2784

Pap smear tests for women are important to prevent cervical cancer. More eligible women are having women’s health checks and pap smears.

Joyce Farrow-Thomas and baby Jaxon May with trainee Aboriginal Health Practitioner Kiara Peacock.

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New directions in maternity care “You can really see the changes in the client Danila Dilba has adapted and consolidated throughout pregnancy, while ANFPP for first when you have an Aboriginal team coming special services and maternity care to support time mothers provides wrap around nursing through. They’re really happy, they’re really women in pregnancy and help their babies and social support. Our diabetes educator confident and they’re open to having you to get a healthy start in life. monitors and provides education to pregnant within their home and working with you women with existing or gestational diabetes, and their family.” The DDHS Maternal Service has implemented working with 37 clients in the past year. ANFPP workers Colleen Voss, Katarina Keeler, the Midwifery Model of Care, incorporating Kay Gehan, Karen Geer. The program can work with other family midwives in the primary health care team, These programs work together to support members too, with the mothers’ consent, and in 2017-2018 Danila Dilba also began mothers and their babies during their Australian Nurse Family bringing fathers, siblings and other family the Australian Nurse Family Partnership pregnancy and into early childhood. Partnerships (ANFPP) on the journey. Program (ANFPP). In 2018 Danila Dilba implemented Nurse Since starting the first clients in January 2018, The Midwifery Model of Care ensures Family Partnerships, a new home visiting the team has grown and moved to a newly continuity of care by the same midwife social support service funded under the refurbished location attached to Malak clinic. Australian Government’s ANFP program. It is a friendly and welcoming space, and is The service is for first time mums having an geographically closer to most clients. Midwifery Model of Care Aboriginal and/or Torres Strait Islander baby, The team attended a national ANFPP supporting new mothers to improve their and In 2016, Danila Dilba adopted the Midwifery conference in June in Brisbane and was their baby’s health. Clients receive continuity of Model of Care – a ‘shared care’ model where very well received. After only six months of care through regular home visits from a Nurse clients receive most of their pregnancy care operation, ANFPP is going from strength to Home Visitor and a Family Partnership Worker with their midwife, reviewed by a GP strength with about 80% of Danila Dilba’s from 16 weeks into the pregnancy until the when needed. current pregnant and new mother clients baby is two years old. using the service. When pregnancy is confirmed, clients are Our ANFPP workers are all Aboriginal and linked with the midwife who will lead their View Video: Client Umima Torres Strait Islander women, the only team care until and after birth, ensuring good post- Austral (left) and https://youtu.be/6GmxWg6_2cE natal care. The model’s great strength is the midwife Tennille in Australia to have an all-Indigenous visiting Macdonald team. “I’m a strong believer in Aboriginal health continuity of care and the relationship the holding baby boy Beau Dukes. in Aboriginal hands and I believe our team can client develops with their midwife. ANFPP client deliver really great health outcomes to our mob. Tamara Noakes (left) with Nurse “The positive is when the client walks in, like today, We really tailor the care to the needs of our Home Visitor and says, ‘I need my midwife, Tennille’, reflects “They are coming to those meetings with the community,” says Nurse Katarina Keeler. Katarina Keeler. nurse / midwife, Elle Crighton. “Then I just think consultant, working, planning and having high the program is working, because they are referring risk reviews within Danila Dilba, and getting good outcomes,” Elle said. “We are reducing to the midwife as their midwife. They’ve got that Client profile: Tamara Noakes relationship and the client doesn’t have to tell our ‘prem’ births and our birthweights are their story every time they come.” looking good.” Tamara is an ANFPP client who first engaged with source of information in the ANFPP staff – “having the program at a home meeting. She has enjoyed the one place to go to and you know that those mothers Pregnancy care The midwives work collaboratively with the the support of the program, and the relaxed, have experienced it” – was one of the most valuable Family Nurse Partnership (ANFPP) teams Pregnancy care includes glucose tolerance casual approach of going to a park or having a aspects of the program for Tamara. that support first time mothers until their testing, which has shown excellent results coffee whilst being informed about pregnancy, baby is two years old (see next page). The chance to meet other new mothers was one in early detection of diabetes in pregnancy, healthy eating and exercise. of the best aspects of the program, “getting out to followed up by early intervention from Midwifery services have now been expanded Tamara has enjoyed getting to know the staff and meet new mums and speaking to other young women our Diabetes Educator. The midwives also to Malak, Knuckey Street, the Bagot clinic found the information about breastfeeding who have had other experiences so you don’t feel so coordinate monthly High Risk Pregnancy and the new clinic at Rapid Creek. This especially helpful. alone,” she said. “It is scary being a new Mum because Clinics with a visiting obstetric specialist. means more services, closer to our clients. you don’t know what to expect – children don’t These are very well attended and clients do Our midwives currently have 100 clients New mothers can get many mixed messages and come with manuals!” not have to attend hospital for this service. across the Darwin and Palmerston region. advice about what to do, so having a trusted

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In 2017-18 there was an increase in referrals of 27% and a 96% attendance rate at paediatric clinics.

This year DDHS partnered with PATCHES Paediatrics, which specialises in diagnosis of FASD, with the aim of facilitating development of a FASD multidisciplinary assessment clinic to enhance our current service and ensure much needed local access to this service.

In 2017, the Child Health program that had been based at the Palmerston clinic was integrated into other Danila Dilba clinics.

This change has resulted in a noticeable increase in the number of 0-5 year health Deadly Choices team leader Tracey Thompson at a health education session with students at Moulden Park Primary School. checks, but we still need to see more children Clontarf Academy students at Dripstone Middle School. under 5 returning to keep their health checks up to date. We expect to see this improve Comprehensive Health Check data is Children and youth through staff training and more family-friendly critical to early detection and prevention clinics closer to where our clients live. of illness and provides essential information Care of children is a high priority in Our goal is to reduce anaemia by: about our clients and their health. Health whole of life care and at Danila Dilba we • treating mothers’ anaemia in pregnancy checks also provide a great vehicle for encourage families and the community to outreach and health education. see our services as a key source of friendly • education about diet, and help and support. • managing anaemia and faltering growth in children by follow up reminders and For children in their first five years, supporting parents to engage in care. Child health Danila Dilba follows the NT Health Under Immunisation 5 Kids (HU5K) model for health checks and 100 100 100 100 100 immunisation schedules, to identify problems The rate of children in the NT who are 97% 96% 96% 96% 80 80 84% 80 82% 80 80 early and address them. Some key issues 81% 80% up to date with immunisations is high, but 76% 76% 77% 72% 69% that we monitor carefully are testing 68% 67% difficulties in recording and tracking mean 60 60 60 60 64% 60 for anaemia and continually improving this is not always reflected in DDHS data. 60% 60% 60% 60% immunisation rates. We are exploring a research partnership 40 40 40 40 40 to trial a reminder program for upcoming Anaemia in children 20 20 20 20 20 immunisations to help carers keep up to date. Overall the rate of testing for children 0 0 0 0 0 under five is 59% and of those, 89 % of Paediatric care

regular clients are not anaemic (suffering DDHS supports weekly paediatric clinics for 2014-15 2015-16 2016-17 2017-18 2014-15 2015-16 2016-17 2017-18 2014-15 2015-16 2016-17 2017-18 2014-15 2015-16 2016-17 2017-18 2014-15 2015-16 2016-17 2017-18 iron deficiency). Rates of anaemia are higher children and adolescents at Palmerston clinic Children growing well Children without Children immunised Children immunised Children immunised in children under two years, when brain and a monthly clinic at Bagot clinic with the • under 5 years • anaemia 6 months • 6-11 months • 12 -23 months • 24-71 months development is critical, so active Top End Health Service (TEHS). These mainly to 5 years management is especially important. focus on assessing learning and behaviour problems. The TEHS Child Development This table shows key indicators for children (current clients) who are being seen at Danila Dilba clinics. The majority of children under five years are growing well. While child team also consults at Palmerston. immunisation rates appear lower this year, the data shown may not accurately show the actual rate. Children can receive their immunisation from other providers or services and our records may not be updated. To be safe, we check the immunisation register before giving a child immunisation.

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School based health checks Danila Dilba began school-based health Early intervention checks from the Palmerston clinic in 2010, While evidence based health checks are initially working with the Clontarf Academy valuable in early detection of preventable in schools where the academy was located. chronic disease, they are also important in providing information about the causes of Since then, the Palmerston clinic has reviewed chronic illness. and refined the service and expanded to additional middle and senior schools. As Through delivering this service we have found well as Clontarf Academy, the program also that children and young people learn about works with the Stars Foundation, which aims and become more interested in their health to improve health and education outcomes through their early years. Students get to Menzies School of Health Research Indigenous Reference Group Members for Indigenous girls. In 2018, the service Back Row - Katherine Couthard, Sian Graham, Adeliesja Goodrum, Leona Holloway (DDHS), identify their health concerns early on and Sumaria Corpus (DDHS) and Heather D’Antoine Front Row - Ashley Tipungwuti, Frances Turner, expanded further to include Humpty Doo learn about preventative measures that could Marlenna James, Maxine Fry, Eyvette Hawthorne and Vanya Webster. Primary School. help them avoid costly medication or long- term treatment in later life. The approach of the program is to engage Youth diabetes and build rapport with Indigenous children Many schools have requested health checks Educating young people about taking care Through this clinic, our and adolescents in a familiar environment and for students, but at this stage our capacity is Danila Dilba of their health is a high priority for Danila Diabetes Educator provides encourage them to access primary health limited to the Palmerston Middle and Senior has started Dilba, and especially for young Aboriginal culturally appropriate care at an early age. The team, made up of schools and Humpty Doo Primary School. a monthly and Torres Strait Islander clients who education and advocates clinical and non-clinical staff, attend the school We hope to expand this service in coming multidisciplinary develop type 2 diabetes early in life. for clients to ensure they and carry out culturally and age appropriate years to support more young people to build clinic at receive the best treatment Palmerston to primary health checks. This year oral health, a lifelong interest in their health. The Menzies School of Health Research for their diabetes. support young delivered by DDHS Oral Health Therapist, in Darwin reports that incidence of type people who Jess Hallewell, was added to the program. 2 diabetes in young Indigenous people is As well as initiating the have diabetes growing rapidly across Northern Australia. specialist clinic, Danila and help them This illness is quite difficult to manage Dilba is supporting and to manage and can have further long term health working with Menzies their care. consequences over time. and other community controlled Aboriginal health This service Danila Dilba has started a monthly organisations (ACCHOs) in helps children multidisciplinary clinic at Palmerston to a major research project to and young support young people who have diabetes and • gather research information about type 2 people learn help them manage their care, including case diabetes in young Aboriginal people across about, and management and group work with families. northern Australia, become more The Youth Diabetes clinic is a result of close • develop effective education and prevention interested in collaboration between our Diabetes Educator, materials, their health Sumaria Corpus, the Royal Darwin Hospital through their • learn about and develop best practice (RDH) paediatrician and the Menzies School early years. models of care for young Indigenous of Health endocrinologist. Together we people who have this condition. advocated for a specialist clinic at Danila Dilba to overcome barriers to access care and to meet the increasing demand.

L-R: Trainee Aboriginal Health Practitioner Darren Braun with Phoenix Joe Pool, Tyrelle Berryman, and Registered Nurse Michael Dornan.

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DDHS staff member Karina Kassman with client Iesha Poyner-Gambley.

Chronic disease self management group at Jingili Water Gardens. Cultural safety Cultural safety means being treated with respect and dignity and made Chronic disease care and management to feel welcome, safe and secure. A significant proportion of Danila Clinic in central Darwin. Chronic disease Dilba’s clients suffer from chronic care coordination became a core part of Our clients have the right to health care disease and have complex care needs. each clinic’s primary health care team. The that respects their cultural needs and Among our regular clients over 15 years, benefits from these changes continued this wishes, including the right to choose DDHS staff Nathan Jones-Cubillo and nearly one quarter have diabetes and 12 % year with increased capacity for outreach whether to see a male or female doctor Joseph Fitz talking Quit strategies. have cardiovascular disease. Nearly half of and home visits, better engagement with or health practitioner, and to professional Aboriginal our clients over 55 years have diabetes. local partner services, improved continuity interpreters if help with language is needed. staff are well of care and improved access as more represented as a Care coordination services provide intensive Danila Dilba is strongly committed to services are closer to where clients live. vital part of our support for these clients, incorporating allied ensuring that our services are culturally clinical teams health support services, specialist attention, Care Coordinated clients at 30 June 2018 appropriate and make our clients feel outreach workers and general clinical services comfortable. Our clinics are designed to according to our clients’ needs. Malak 40 feel friendly and welcoming, with Aboriginal Palmerston 56 staff well represented as a vital part of our As part of implementing our new integrated Knuckey St 62 clinical teams – including clinic managers, service model in 2016-17 we changed our Bagot Clinic 31 reception staff and Aboriginal Health approach to chronic disease care, which was Rapid Creek 16 Practitioners and nurses. previously centralised at the Knuckey Street Total clients 205 In addition to general clinics in various Chronic illness regular clients locations, Danila Dilba also has a Men’s % Number Clinic and the Gumileybirra Women’s Adrianne Fejo (right) updating client information for Health Service which provide more specific Iesha Poyner-Gambley at Malak Clinic. Percentage of clients 15 years plus with Cardiovascular Disease 12% 684 focus on the different needs of male and Percentage of clients 15 years plus with Diabetes 22% 1265 female clients. Total regular clients over 15 years of age 5707

Percentage of clients 55 plus with Diabetes 49% 613 Total regular clients over 55 years of age 1296

This table shows the percentage of regular Danila Dilba clients over 15 with specific chronic conditions as a percentage of regular clients. Diabetes is more common as people get older. Regular clients are clients who have used our services at least three times in the past two years. Karina Lalara, greeting Harry Barriya at Darwin Clinic.

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Chronic disease management plans Care Coordination One of the most important parts of chronic The plans also include goals that the client disease care is to educate, support and sets for their own care as they learn how to Care Coordinator, Maida Stewart, is empower our clients in their own care. manage and take responsibility for managing based at the new Rapid Creek clinic, their health. working with clients to manage some Chronic Disease Management Plans are of the complexities around their team-based care plans that the GP, nurse and In early 2018 we implemented a more client- chronic conditions. Aboriginal Health Practitioner prepare with focussed care plan template. While we have clients who have a chronic disease. The plans the same number of clients on a management One of the service’s main aims is to aim to work with clients to provide long-term plan at any time, there has been a better help clients to manage their health to Maida Stewart, Care Coordinator. care and help prevent complications that can flow-through of clients. stay well and out of hospital. occur when people have chronic diseases. “It’s all about getting their health back A Danila Dilba social worker was able on track again, giving people assistance as secure a ground floor unit for the client Chronic Disease Care Plan well as giving them the tools to be able and working with occupational therapists, 70 70 70 to do that,” she explained. the team arranged medical equipment 70% 70% 70% 66% 60 63% 63% 64% 60 63% 63% 60 and medical aids, and organised 61% 61% 61% Care Coordinators work with clients modifications to the home. 50 50 50 who not only have complex health issues, but quite often complex social issues “Changes like these actually made a really 40 40 40 big difference for their health and also for as well: 30 30 30 their life in general. It made their life so “Things like housing or homelessness. much easier,” Maida said. 20 20 20 [Helping] people where their education 10 10 10 is limited, where English isn’t their first A number of the Care Coordination 0 0 language and who may have difficulty in clients also take part in Danila Dilba’s 0 trying to navigate the healthcare system, weekly self management exercise 2014-15 2015-16 2016-17 2017-18 2014-15 2015-16 2016-17 2017-18 2014-15 2015-16 2016-17 2017-18 such as the hospital system, or any of those and hydrotherapy programs under tertiary care systems that can be really, the supervision of physiotherapist Clients with Chronic Clients with Type 2 Clients with Type 2 • Heart Disease on a • Diabetes on a plan • Diabetes and Chronic really hard for people to find their way Phillipa Cotter. This gives our clients an management plan Heart Disease on a plan around and to be able to understand opportunity to get out and about and how things work.” socialise, while exercising safely. Diabetes

80 80 80 These tables show two As an example of how clients may be Care coordination is funded by the measures (sugar control Australian Government Department 70 70 70 assisted, the Care Coordination team 71% and blood pressure) of Health through the NT Primary worked with a client living in a second 60 39% 45% 48% 60 60 65% that tell us how well 47% 61% floor unit who had mobility issues that Health Network. 58% clients with diabetes 50 53% 53% 54% 50 made it very difficult for them to walk 50 are. Despite an increase up and down the stairs. 40 40 40 in the number of Danila Dilba clients diagnosed 30 30 30 with diabetes, the 20 20 20 proportion of clients with good sugar and 10 10 10 blood pressure control 0 0 0 remains steady. 2014-15 2015-16 2016-17 2017-18 2014-15 2015-16 2016-17 2017-18 2014-15 2015-16 2016-17 2017-18

Clients with Diabetes Clients with Diabetes Clients with Diabetes also • with good sugar control • with good blood pressure • with a kidney function test

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Chronic Disease Self Management exercise group Every Wednesday, Danila Dilba runs an For client Josephine Clarke, it provides exercise group at Jingili Water Gardens for support to help her to be a role model to people who have a range of chronic illnesses. others and has great benefits for her mental health. Membership of the group is not limited to chronic disease sufferers and others can come The regular program includes a walk for along if they are assessed as being physically cardiovascular fitness, and strengthening, The Chronic Disease Self Management able to take part. Physiotherapist, Phillipa balance and flexibility exercises tailored to the exercise group at Cotter assesses clients and runs the exercise group. At the end of the session the group Jingili Water Gardens. program, working out what exercises suit each enjoys a healthy lunch prepared by the Danila client and helping them to go at their own Dilba Chronic Disease Self Management team. Pulmonary Rehab trial a Danila Dilba first pace at the right intensity. Visiting speakers also provide In late 2017 Danila Dilba became the The trial of 20 participants “It’s the number “ For a lot Phillipa points out that one of the benefits of health education and first Aboriginal Medical Service to trial ran over 10 weeks. The aim one treatment “For a lot of people, it makes of people, the group is that information, such as a renal home-based pulmonary rehabilitation – is to help clients improve at for lung them realise their health conditions don’t have it makes dietician who came to promote a national first. the everyday tasks important disease, but to stop them doing regular exercise.” them realise kidney health and advise on the for them; the main exercise almost no one their health Pulmonary rehab is an effective treatment for best foods for kidney health. is usually walking. Clients takes it up” The clients enjoy the group and look forward people with chronic obstructive lung disease. conditions in the trial took a short in taking part. It provides a social outing for Danila Dilba is proud to support It combines education with a personalised don’t have exercise test and were set an individual people who normally can’t get out and about, this group which is helping exercise program and support to improve to stop them program. They were helped to understand and some great friendships have developed. people with chronic illness and clients’ fitness and wellbeing, contributing to doing regular their condition and how to manage it, and older people to gain a new lease better quality of life, longer life expectancy, “We care for each other, watch for each other exercise.” supported to keep up their program by on life through exercise and and fewer hospitalisations. and contact each other if we need to,” said home visits or phone calls. social interaction. regular client Delma Holt. “We love it, we Despite this, the rate of taking up and One client (5%) fully completed their all enjoy it and it’s great to be in the outdoors completing a pulmonary rehab program is Keep up keeping strong! program and there were other important instead of watching four walls.” low at less than 10% for both Indigenous and Video Link: https://youtu.be/B08xHVVJlNo outcomes in improvement of health and non-Indigenous clients. fitness of the other participants. “It’s the number one treatment for lung disease, “Even if people didn’t take up the full program, but almost no one takes it up” said Danila there were still beneficial outcomes for many Dilba physiotherapist, Philippa Cotter. of the people who took part in the trial,” “We want people to get it, or at least be able Client profile: Josephine Clarke Philippa said. to offer it to them. Some decline the full rehab Josephine has been a client for 18 years and program but will come along to the Wednesday “Me going and seeing someone, checking regularly attends the Chronic Disease Self group – which is a good outcome because it is their medications, checking they are following a Management group at Jingili. Clients appreciate improving their physical activity levels.” program – that supports all the primary health that Danila Dilba keeps this program going and stuff that we do. Giving them education around hope it will continue for a long time. The home-based approach helps to lung disease – they might not take it up this overcome some of the barriers that “We really look forward to it because it’s something that gives us joy, and we laugh and time but they might take it up next time. discourage people from attending a hospital talk while we exercise. It’s helping me to stay strong in my belief that I can look after my or centre-based program, like lack of “It shows it can be done,” physio Philippa health and try to be an example to the younger generation,“ Josephine said. transport, inconvenient timing or distrust Cotter said. “It’s still a work in progress, but “It helps us to take care of our self and be positive in our state of mind. It’s too easy to of unfamiliar services. it’s looking really promising.” get disappointed about our health which we can get over by learning to self manage, Philippa is pictured on the far right in the and just being here with the others is a boost to our mental health as well.” photo of the exercise group above.

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Client profile: Linda Pulmonary Rehab Linda is a Kamillaroi woman who has been In Sydney, Linda had attended the Royal with Danila Dilba for four years and has Prince Alfred (RPA) Hospital for specialist been working with physiotherapist, Philippa physio care, but the service was not ‘one- Cotter on a physiotherapy program, and on-one’. “They have a huge auditorium self-physiotherapy exercises. with all the machines, with all the bells and whistles. Even though I was at the RPA, I think Building relationships is crucial to help I’ve really got more benefit out of being in clients to take control of their own health, Darwin and meeting up with Philippa,” Residential Care Service staff: Onika Paolucci, Aboriginal Health Practitioner, Dr Saidah Haron, and for Linda, “the relationship is the she said. General Practitioner, Christina Dizon, GP Registrar, Selena Brown, medical student. important thing, because it’s a one on one, no judgement, individually tailored to your “I’ve learnt more because it is relaxed. I feel specific illness.” that Philippa really cares about myself, almost Residential care in later life as much as I do. It’s a teamwork thing. As For over ten years, Danila Dilba clinical reviews, and discuss current Linda took part in the first Pulmonary “One day individuals we have to take control of our staff have been visiting nursing homes to medical-social issues, Rehab trial at Danila Dilba and found we are own lives. If you’ve got somebody there, or the provide ongoing patient care for clients establishing whether the it really helped her. “Going out of the going to be AMS there with all these services, it’s a gift who are physically unable to travel client is up to date with their surgery, doing it in nature with one on one old as well. really isn’t it?” into our clinics. current health plan. The team collaboration – I really feel I’ve got a mentor How are we actively manage the patients, going to be who understands my overall health.” For these clients, this service is about more not only looking at patients cared for? than medical care: it provides a vital link to listed in the doctors’ list, but support their overall wellbeing. other patients as well, so their health Integrated specialist and allied health services Visiting doctor Saidah Haron, explains, doesn’t slip. Clients are referred by the “They need advocates to attend their needs. family, the hospital or themselves. The service model introduced at Danila The table below shows the number of It’s unlikely they would come into the clinic. Dilba in 2016-17 has enabled expansion of clients who saw a specialist or allied health Working in nursing homes involves a special Who is going to care for them, if not us?” specialist medical and allied health clinics so professional this year and over the previous kind of care and patience, and our staff are that more of these services are more easily three years, and demonstrates how the Our teams visit Regis Tiwi nursing home in gifted in providing holistic care that aids accessed and available to our clients. Locating location of services at DDHS under the Tiwi, Juninga Centre in Coconut Grove and clients’ physical health and overall wellbeing. more of these special services at Danila Dilba new service model has improved our Terrace Gardens in Palmerston on a weekly This means providing care that is respectful improves the quality of care for clients and clients’ access to these services. basis. The teams include General Practitioners and overcomes some of the isolation felt better management, especially for complex and Aboriginal Health Practitioners, by patients in nursing homes. The Nursing conditions. sometimes accompanied by trainee Home Care visiting program gives these AHPs and GP Registrars. clients a sense of being listened to, cared Integrated specialist and allied health services for and understood. At each nursing home, the team attends 2014-15 2015-16 2016-17 2017-18 to a doctors’ ‘to do’ list, as well as providing As Dr. Haron observed, “One day we are going to be old as well. How are we going to be Diabetes Educator 862 1032 1504 1476 ongoing management care for clients. All cared for? If you are in a nursing home, how are Obstetrician and Gynaecologist 122 86 106 105 patients are listed and reviewed regularly, including current health plans and advanced you going to want to be treated yourself?” Optometrist 253 112 81 152 care plans (what the patient wishes for Paediatrician 89 251 274 449 their care in the future). They provide health Physiotherapist 239 243 335 411 checks, dementia screening, medication Specialist Medical Practitioner 357 320 339 308 Total 1922 2044 2639 2901

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2 2017-2022 2.1 Health promotion Strategic Priority 3 and education Strengthen Outreach, education, partnerships and Our Community Services teams are active in getting out relationships engagement & to engage with people where they live and get together – to explain the services available through Danila Dilba and advise and educate to improve health, well-being and quality of life.

Much of our work in health promotion, In 2017–18, Deadly Choices provided PARTNERSHIP community education and outreach is done health education through schools to 200 in partnership with other Indigenous and students and took part in nine health non-Indigenous people and organisations. promotion events and expos, reaching We also work with health bodies and 775 individuals. researchers to advance Indigenous health research and in public advocacy. Children and youth As part of our vision to promote healthy All health promotion falls under the Deadly choices across the full range of people’s lives, Choices banner, and all Community Services Deadly Choices targets education to young staff are involved in promoting DDHS and people. The goal is to help them develop individual program services. the strength and knowledge to make their own positive choices about health and ‘Deadly Choices’ wellbeing. We partner with the Clontarf Foundation to deliver the program at Deadly Choices is a health promotion and Dripstone and Nightcliff Middle Schools, education program to help people of all and also work with youth at the Don Dale ages make positive, informed decisions about Youth Detention Centre and at Malak their health and wellbeing. Deadly Choices is Re-engagement Centre. delivered by all community services staff as part of their programs.

Clontarf Academy students undertaking the Deadly Community Choices program get their health checks at the Rapid outreach, health Creek Clinic. promotion and education complement our clinical services and are a vital part of Danila Dilba’s role as a community health service.

Danila Dilba Health Service ANNUAL REPORT 2017–2018 page 33 2. OUTREACH, EDUCATION, ENGAGEMENT & PARTNERSHIP

The main focus is leadership, to encourage A short video about the effects of passive and support the students as potential future smoking was also developed in partnership Alcohol and Other Drugs (AOD) AOD homeless outreach leaders. The program tackles smoking, harmful with the Palmerston Girls Academy. These The Alcohol and Other Drugs (AOD) The AOD team works in partnership substances, nutrition, physical activity and videos have gained strong engagement from service operates from our clinics and with Darwin City Council’s Safer City relationships. Comprehensive health checks the youth audience, with Make a Choice in the community, following up clients who Program to engage with homeless people are included, as early indications of illness receiving 4,800 views on Facebook. DDHS have engaged with the clinic service and who are affected by alcohol or other drugs, such as diabetes can be picked up, and contributed to a Menzies School of Health need more support to reduce or stop offering brief interventions about the effects students are learning from the program that Research project to gather information about their substance use. of substance misuse and linking people changes in diet and exercise can prevent far social media and deciding to quit smoking. to services that support their immediate The AOD clinic stream is available at most greater problems down the track. The insights gained will inform our population needs. Working with the homeless can be clinics, with Bagot and Men’s Clinic on an focused approach to Tackling Indigenous particularly difficult as they have no fixed In high schools, this healthy life program runs on-call basis. Clinic clients are referred by Smoking. address, but many can be followed up at St for 10 weeks. In 2018 a six-week program for our doctors, clinicians or by self-referral for Vincent De Paul’s Ozanam House in Stuart primary schools (Moulden and Manunda) has A key performance outcome for TIS is to a confidential talk with an AOD worker Park which provides a drop-in centre for been very successful and schools are signing encourage other organisations to put smoking about their options. people who are living rough. The AOD team up for coming school terms. policies in place and take up a smoke free attend Ozanam House regularly, providing culture. National TIS Coordinator, Professor The TIS team also links with this service, information sessions and motivational Tom Calma, suggests Board members take providing information sessions at CAAPS Tackling Indigenous Smoking (TIS) interviewing to disengaged clients. up the challenge to champion a smoke free (Council for Aboriginal Alcohol Program Services), FORWAARD and Stringy Bark The Tackling Indigenous Smoking (TIS) organisation. Funding for the TIS Program In 2018 we also began a Rehabilitation Centres and facilitating Program shifted focus this year to has been extended until 2022. regular weekly breakfast weekly Quit groups at these facilities. population health, promotion and education, outside the Darwin Clinic as opposed to clinic-based practice. that now draws about 70 homeless people. We particularly target young people, The homeless are the An Orange Sky van is pregnant women and mothers. Clients who most vulnerable to health now also there, providing want to quit are now referred to the Alcohol issues but the least likely additional shower and and Other Drugs (AOD) team but can to go to a clinic: through laundry facilities.The choose to work with a male or female TIS this outreach, more are homeless are the most worker for information or help to develop engaging and accessing vulnerable to health strategies for quitting. Our clinicians are medical services. issues but the least likely also upskilling to provide smoking cessation to go to a clinic: through information to clinic clients. DDHS Community Services and this outreach, more are Orange Sky volunteers at the Darwin Clinic weekly breakfast. As part of the Deadly Choices program, engaging and accessing the TIS team works with young people in medical services. partnership with Clontarf Academy at schools Senior Tackling Indigenous Smoking Officer, Jenon Batty, AOD Aftercare: in Darwin and Palmerston and with the Stars is pictured at Close the Gap Day 2018. Foundation at Sanderson Middle School and The Department of Health has approached Palmerston Girls Academy. With the Danila The TIS team takes part in health DDHS to take on an AOD Aftercare Dilba media team, we produced Make a promotion at community events. program for people leaving rehabilitation, Choice, a video by local performer Warlu Using 3D models that demonstrate previously run by St Vincent De Paul. AOD Harris, rapping about his own journey to the impact of smoking on lungs, the Aftercare is managed under the Senior quit smoking. team delivers health messages about Program Officer AOD, and at the end of smoking and the benefits of quitting. this year we were recruiting two Indigenous Danila Dilba Alcohol and Other Drugs team outreach workers to join the team. with the Darwin Safer City Patrol.

Scan the code or see the Make a Choice video Scan the code or see the video online at online at https://youtu.be/_Xq8nkSttUM https://youtu.be/Jy1DhnL64OY

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2.2 Counselling and social support Bringing Them Home Danila Dilba’s Bringing Them Home Members say seniors’ group was established more than “It’s really Emotional and Social Well Being (ESWB) the most valuable ten years ago to support members of the aspects are “caring beautiful. The Community Services ESWB Program NT PHN Mental Health Stolen Generation. and uplifting” It’s the includes a range of funded programs that and AOD service: support and best thing This group of 15-30 older women meets work under the scope of therapeutic This service is part of the companionship that ever fortnightly, providing a social support services. ESWB counselling service In the six months of the group. happened and provides services to network and addressing the social isolation to me.” Our ESWB team of six includes two from January to “I needed an outlet. clients who have higher that many members feel. It offers a healing psychologists, two mental health social June 2018 there I needed somewhere mental health needs environment, where members come workers and two social workers who work was a significant to go,” “I was coupled with substance to enjoy sharing stories, culture and said Caroline Spicer. from strengths-based and trauma-informed increase in recommended to join a group, and I did, misuse issues. knowledge in a safe space. approaches. Our clinicians have varied clients accessing and it was the best thing I ever did. Have “Not a lot of people know those stories,” backgrounds and experience and between Royal Commission counselling a good laugh, have a good feed. It’s really “It’s good that them, have specialties in play therapy, Support Service services, with said member Evonne Payne. beautiful. I really love it. It’s the best thing we can share that experience, and we’re on narrative therapy, cognitive behaviour therapy, a total of 914 that ever happened to me.” Funding for the Royal individuals the same level.” mindfulness, art therapy, drama-movement, Commission Support drum beat and dance therapies, motivational referred over Service for people the year. Shelley Hampton, a member of our interviewing and group therapy. affected by the Royal ESWB team has been with the group In 2017-18, for the first time we implemented Commission into the for nine years. She says members “pretty a male-female ratio at all clinics (except Bagot Protection and Detention much run the group – what they like to community clinic) so clients can choose a of Youth in the Northern do, where they want to go.” They choose male or female if they have a preference. Territory ended in June 2018. The Royal activities, excursions, art and educational Commission Support Service worked closely activities that interest them. Counselling Members of the Bringing Them Home Group visiting the with Relationships Australia (also funded to Royal Flying Doctor Tourist Facility in Darwin. Counselling services are now provided provide these services) to provide cultural at each Danila Dilba clinic, making these connection activities to a number of young services more accessible to our clients. In the people who had or were at risk of contact six months from January to June 2018 there with the justice system. Funding for the was a significant increase in clients accessing national Royal Commission into Institutional this service, with a total of 914 individuals Responses to Child Sexual Abuse has been referred for counselling over the year. extended until December 2018. The ESWB program takes a holistic approach Bringing Them Home to client care, giving counsellors direct access to clinical professionals to ensure clients Bringing Them Home is an ESWB group receive complete wraparound services that supports senior women who were tailored to their individual needs. part of the Stolen Generation and have experienced the intergenerational impact of this Government policy (see story opposite).

Members of the Bringing Them Home Group (from left) Yvonne Payne, Florence Nicholls, Alma Cadell and Caroline Spicer.

Video link https://youtu.be/I4FkcyET41Y

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Youth Social Support Program 2.3 Events and outreach The Youth Social Support Program supports “A lot of the young people have been let down youth in the Don Dale Youth Detention by adults their whole life. We’re about bringing Throughout the year our Community Centre and other young people at risk. them up and enabling and empowering them,” Services teams engage in events such as Delsey said. This program was reactivated in 2016 at • NAIDOC week the request of Territory Families, following This year activities included Yarning Circle, • School health expos and sports days ABC TV’s Four Corners revelations about Drumbeat, Geese Theatre, and ‘Hoops’, led • Closing the Gap Day mistreatment of young people at Don Dale. by Timmy Duggan, a former NBL player with • Health promotion events. the Cairns Taipans and currently a member of This program has a dual role as independent L-R: NT Government Alcohol and Other Drugs Service, Bill Ivory and Danila Dilba the Danila Dilba Board, who has made a huge Amongst special events this year was the staff, Tracey Thompson, Joseph Knuth, Jenon Batty and Joseph Fitz attending advocate to Centre management (and the contribution to our work at Don Dale. Our celebration of the Tenth Anniversary of the Close the Gap Day hosted by Stuart Park Pharmacy. NT Government) on issues such as living team also worked with the NAAJA Healing National Apology to the Stolen Generation, conditions and treatment of detainees, Project and Relationships Australia to provide hosted by Larrakia Nation. NACCHO Ochre Day Men’s and working closely with the young people Health Conference 2017 outdoor cultural engagement activities. through educational programs and Rugby League World Cup Danila Dilba hosted the 2017 National support activities. An unstructured program that had great In November 2017, the World Cup game Aboriginal Community Controlled Health success was Saturday cooking with Danila between Australia and Samoa offered a great Organisation (NACCHO) Ochre Day Men’s An important part of the program is to “Cooking sessions with the Dilba volunteers. opportunity to inspire our community and Health Conference. This national two-day prepare young people for release, working kids had them working together, developing staff. Members of the Kangaroos Australian conference is an opportunity for men to with them to identify goals and develop a skills, learning how to cook. That has been Rugby League team visited our Malak Clinic come together, network, share ideas and personal plan. This fills an important gap: really positive!” “That’s the thing that’s been missing here for and the Malak Re-engagement Centre for get involved in discussions and workshops. a long time – once they walk out they’re left youth at risk – a visit that was inspiring for Twenty-one guest speakers, including the to their own devices and the support hasn’t youth and staff. At the World Cup game, Hon. Ken Wyatt, national Minister for been there in the past,” said Senior Youth An important part of the players James Maloney and Steve Renouf Indigenous Health, renowned broadcaster Engagement Officer, Delsey Tamiano. program is to prepare young joined DDHS staff to engage with some Charlie King, and Associate-Professor James people for release, working 250 people. Ward gave moving insights into issues of The team’s experienced Aboriginal and with them to identify goals Indigenous men’s health. Torres Strait Islander youth workers have Disaster relief and develop a personal plan. For Danila Dilba, a highlight was the Jaydon worked hard over time to build rapport, In the wake of Cyclone Marcus in Darwin, Adams Memorial Award to staff member strong relationships and trust. Danila Dilba staff assisted with distribution of Nathan Jones-Cubillo for his outstanding vouchers donated by the Salvation Army to contribution to the health and wellbeing of families at Palmerston Indigenous Village our community, both within and outside and Knuckey Lagoon Community. of his work.

Senior Youth Engagement Officer, Delsey Tamiano and ‘Kangaroos’ Cameron Munster and Felise Kaufusi with Danila Nathan Jones-Cubillo, receiving the Jaydon Adams Memorial Oration Award, with Youth Engagement Officer, Jahmayne Coolwell. Dilba Medical Receptionist Carmel Rantanen at Malak Clinic. Mark Adams (left) and Lizzie Adams, CEO of Goolburri Aboriginal Health Service.

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2.4 Health research partnerships Danila Dilba’s vision is to achieve equality in health, wellbeing and quality of life between Indigenous and non-Indigenous Australians. Working strategically with other organisations to support research in Indigenous health and advocate on behalf of our people are essential to achieving our vision.

Danila Dilba’s Research Working Group Northern regularly reviews requests for our support Territory in Telethon Kids Institute researcher, Dr Rob and participation in research. In practice, general, and we Hand, with Danila Dilba Health Service CEO Olga Havnen, Darwin Clinic General Manager, these do make demands on staff time and are partnering with Malcolm Darling, and Indigenous Outreach resources and present some risks, such as lack AMSANT to help Worker/Recalls Officer, Margaret O’Brien. of adequate funding for the project (and so address them. poor or ineffective participation) and risks to our effective service delivery. In 2017-18 we also worked with AMSANT to promote These challenges are faced by the Aboriginal Indigenous data sovereignty – that is, the right community controlled health sector in the of Indigenous peoples to govern the creation, NT Government Alcohol and Other Drugs (AOD) Services and NT Police with Danila Dilba staff at collection, ownership and application of data.1 our information and education stall at Bagot Community on World No Tobacco Day. 1 Kukutai, T. and Taylor, J., eds. 2016. Indigenous Data Sovereignty: Towards an Agenda (Research monograph 38). ANU Press Partnerships in health research Research projects and partnerships 2017-18

Penicillin Levels for Rheumatic Heart Disease (RHD) Study – investigation of penicillin levels in Rheumatic Heart Disease prevention with the eventual goal of developing an alternative Telethon Kids Institute method of delivery rather than needles. This nine month project was supported by a research nurse and Indigenous Outreach Worker and enrolled over 20 participants. From this study we identified the potential of a peer support model to improve adherence for young people and a partnership ethics application is in process. Danila Dilba Health Service staff at the NAIDOC March in Darwin, July 2017. Employment of a part time facilitator to develop locally accessible PATCHES Paediatrics Foetal Alcohol Spectrum Disorder training and assessment clinics. This project is ongoing as we aim to build local service partnerships.

Aboriginal Medical Services Participated in AMSANT research into the career pathways of Alliance NT (AMSANT) Aboriginal clinicians in health services to support our work in developing career pathways in DDHS for all Aboriginal staff.

National Aboriginal IPAC project (Integrating Pharmacists within Aboriginal Community Controlled Community Controlled Health Services to improve Chronic Disease Health Organisation Management) and pharmacists will engage with participants over (NACCHO) and James twelve months to support their use of medicines while the impact Cook University on their chronic disease is researched. If improvements in health are established, this research will support funding for ongoing services.

South Australian Health and Dr James Ward engaged us to undertake the second GOANNA Danila Dilba staff attending National Homelessness Week DDHS Community Services and Malak Re-engagement Medical Research Institute survey of knowledge, risk, sexual health attitudes and health service events hosted by Somerville Community Services at Centre staff couch surfing in National Youth Week, access for sexually transmitted infections and blood borne viruses Mindil Beach, August 2017. April 2018. (SAHMRI) among young Indigenous people.

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Menzies School of Health Research 2.5 Research for advocacy In 2017-18, Danila Dilba also supported several research projects of the Menzies School of Health Research: The main focus in this area in 2017-18 was again on youth justice and child protection related • expansion of the PANDORA diabetes • a research project, ‘Social media to the Royal Commission into the Protection and in pregnancy study into youth diabetes. Indigenous tobacco control’ which Detention of Young People in the NT. Policy and Strategies Team We will participate in a service delivery utilised Danila Dilba’s social media L to R: Natalie Whyte, Tess Kelly and Joy Mclaughlin. case study and identify Northern channel and audience and produced The Commission’s final report, Tripartite forum Australia cases in the hope that more insights into the influence of social released in November 2017, made With APONT and AMSANT, Danila Dilba information about the prevalence of media on the decision to quit 228 recommendations for reform of the advocated for the establishment of a tripartite youth diabetes will improve funding to smoking. (To see more click on Northern Territory youth justice and child forum to provide high level leadership primary health care. link or scan QR code.) care and protection systems. and direction to the strategic response to the Royal Commission. Comprising • the Territory Kidney Care project (https://academic.oup.com/heapro/ Working in cooperation with Northern representatives of the Australian Government, to support clinicians to improve advance-article/doi/10.1093/heapro/ Territory peak bodies APONT (Aboriginal Northern Territory Government and non- identification and management of day018/4973719) Peak Organisations NT) and AMSANT government sector, the Children and Families people who are at risk of end stage (Aboriginal Medical Services Alliance Tripartite Forum has a particular focus on kidney disease (ESKD). Northern Territory), Danila Dilba has areas that cross both Commonwealth and continued to advocate for wholesale Northern Territory responsibilities to facilitate reform to the overarching legislation and joined up planning and resourcing. Danila for evidence-based solutions to improve Dilba CEO, Olga Havnen, is a representative outcomes for young people and their families. on the Tripartite Forum. Ongoing or completed projects Community consultations supported by DDHS in 2017-18 include: Support for families In May-June 2018, Danila Dilba (on behalf On behalf of APO NT, Danila Dilba is hosting • Sleep disorders in people with MJD • SAHMRI NIMAC study (Novel of AMSANT) conducted a series of the Top End Out of Home Care Project, (Machado-Joseph Disease) Interventions for Methamphetamines users community consultations with Aboriginal led by Natalie Whyte, on secondment from in Aboriginal Communities) to develop communities in the NT’s major population • Evaluation of DDHS contraception clinic Territory Families. Recognising the high and trial community solutions to reduce centres (Katherine, Tennant Creek, Alice service model proportion of Aboriginal children in the child methamphetamine use. Springs, Darwin), and in three remote • ‘Me and My Kidney’ – consumer feedback protection system, this project is developing communities in East Arnhem. The workshops on renal services a strategy to establish Aboriginal-led and The following projects are provided information about the outcomes under consideration: managed out of home care and family • Traumatic Brian Injury project supported of the Royal Commission and gathered support services. by DDHS is now completed • University of NSW – Family Violence study information about community members’ • Lighthouse Project, evaluation of culturally • Menzies School of Health Research – views on the proposed reforms and their DDHS is also leading a project on early safe care in hospital – DDHS staff trial reminder program for childhood experience of the child protection system. intervention family support services for presented at a Lighthouse conference immunisations Serious concerns about the current system Aboriginal families who are identified as at were raised and these were incorporated in Brisbane • Pneumococcal vaccine in pregnancy to risk by Territory Families, or who self-identify into a report on the consultation outcomes • PANDORA – long term outcomes for prevent chest infection in babies. as needing support in their parenting. to Territory Families called Listening and women with diabetes in pregnancy Hearing are Two Different Things. • SISTAQUIT (Supporting Indigenous smokers to assist quitting) project on (https://ddhs.org.au/resources/listening- smoking cessation in pregnancy and-hearing-are-two-different-things).

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3 2017-2022 3.1 Overview Strategic Priority 2 Building organisational 2017-18 was a year of successful capacity and ABOUT consolidation and expansion. strength Danila Dilba now employs 170 staff and Good staff retention means operates seven clinics in the Greater Darwin a stable workforce. For clients this area, including a new clinic opened this year means high quality, reliable services and at Rapid Creek and the Bagot Community continuity of care from people they know. DANILA DILBA Clinic, now auspiced under DDHS Stability in our workforce is also highly cost management. effective, reducing expenditure on casual or agency staff by as much as $400,000 per year. These clinics strengthen delivery of our new service design, which is built around access We also ‘grow our own’ by investing in all to a full range of integrated health services, our staff and their professional development, close to where our clients live. especially encouraging Indigenous clinicians and managers. DDHS spent approximately $139,000 in learning and development Building our organisation training this year, a 55% increase in spending Our new strategic plan, ‘Keeping well, on this area two years ago. getting stronger’, was completed in 2017 and implementation was well under way This year we initiated Aboriginal Health this year. This theme refers not only to our Practitioner traineeships and appointed four clients – it also sums up our approach to trainees from a competitive field of nearly continuous improvement and organisational 40 applicants. We have also improved training development. opportunities by introducing on-line training modules and partnering with PwC Indigenous ‘Building organisational capacity and strength’ Consulting to provide mentoring and career is one of the four strategic priorities and planning to our staff. includes outcomes in: • Effective governance and management Indigenous employment • Financial sustainability and leadership A growing • Investment in our people The new Human Resources Strategy and our and dynamic • Strong evidence base – good data Indigenous Employment and Career Pathways collection to inform service and system Initiative have been very successful so far, health service improvements. increasing Indigenous staffing at all levels. committed In 2017-18, Indigenous staff made up to the world’s Investing in our people • 65% of our leadership team (CEO, General Managers, all Clinic Managers), and Danila Dilba aims to be an ‘employer of best practice • 63% of non-GP clinicians and community/ choice’ – to attract and keep talented staff social and clinical support staff (AHPs, RNs, and support our staff to achieve their clinical administration, community services career goals. and client support).

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3.2 Our services

Clinics Men’s Clinic Danila Dilba now operates seven clinics in the Greater Darwin area. Over the past year, the Men’s Clinic has This strengthens our service model by providing more clinics with a range continued to provide a culturally safe place of integrated services close to where our clients live. for men to receive primary health care, including chronic disease management that looks at ‘whole of client’ health needs. Darwin Clinic The staff also provide support for men The Darwin Clinic in Knuckey St has a long engaged in community alcohol and other history, and over the past year we have drugs rehabilitation. refreshed and updated the premises. This included a new roof, new waiting room chairs Our services have been expanded and water proofing the central courtyard to throughout the year with the addition of make the area more comfortable. tele-health facilities that enable consultation Men’s Clinic with a psychiatrist in NSW for psychiatric 42 McLachlan St, Darwin Although there is not a large resident assessments. This has improved the Men’s population in the city and surrounding Clinic ability to assess and diagnose men suburbs, the clinic is used by regular clients, with social and work-related disability visitors to Darwin, working people and and consequently improve homeless people. Our clients told us in the their access to services. consumer survey that providing services to Darwin Clinic all of these groups is important to them. 32-34 Knuckey St, Darwin Access to these facilities has also given the male We started negotiations with Orange GPs and GP registrars A new clinic manager was appointed and Sky, a mobile laundry and shower service, working at the Men’s with greater service stability, we have seen to jointly provide facilities for our monthly Clinic an opportunity to improved uptake, particularly of social and breakfasts for homeless people. This is an learn and build their skills emotional wellbeing counselling and the addition to our long-standing morning service by working with these monthly legal service (see story p. 52). of showers, tea and coffee and news. This specialists. aims to create a supportive environment The mobile clinic continues to operate and encourage homeless clients to attend Staff at the Men’s Clinic from Knuckey St and supports clients living to their health needs, including chronic have also been active in in town communities and the homeless disease management, when they visit. community promotions to engage with services. In mid-2017 the and presented at the mobile clinic took the lead in response to NACCHO Ochre Day an increased incidence of syphilis in Darwin, Men’s Health Conference helping to follow up people who had about the work that contact with the infection and provide they do. education and support with their L to R: Men’s Clinic Coordinator David Adams, Dr. Nathan Zweck and treatment. Customer Service Officer, Wesley Carolin outside the Men’s Clinic.

L to R: Dr Mostafa Zaman with Mobile Outreach Workers Karly AhFat and Lyall Braun.

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Rapid Creek Clinic Malak Clinic. This year saw the establishment of a In its second year of operation it is no new, fully refurbished Danila Dilba clinic surprise to us that Malak clinic is now one at Rapid Creek. of our busiest clinics.

The clinic opened its doors in early February The team endured renovations this year, while and the opening was celebrated by our continuing to provide services. The resulting Chairperson, Carol Stanislaus, on 16 February. extension of space is now the home base for Jeanine McLennan gave the Welcome to the Australian Nurse Family Partnership Program Country and spoke about the history of (ANFPP) team, while additional clinic rooms and Danila Dilba and contribution of past office space accommodate the Care Coordinator Board members. and outreach worker and visiting midwife and counselling services. The addition of the Safety Rapid Creek Clinic Manager Fran Baird said, Rapid Creek Clinic and Community Liaison Officer to the team helps Malak Clinic “Rapid Creek clinic is now business as usual ensure people’s safety and supports people 3/1 Malak Place, Malak with clients wanting to attend from other Rapid Creek Business Village, to give us feedback to improve services. clinics. Rapid Creek is also working on Saturday Shop 35, 48 Trower Rd, Millner mornings with clients attending those services.” Malak Clinic has signed up as a Health Care Homes As it is close to Nightcliff Renal Unit, Danila site as part of a national trial of funding team-based Rapid Creek clinic is part of the new service Dilba’s preventive specialist renal service was care for chronic disease in block payments rather model to bring comprehensive primary relocated from the Darwin clinic. We know than fee for service. This aims to provide seamless health care close to where our clients live. that many people on dialysis do not have care for people with chronic disease and give our The clinic has welcomed 79 clients who good access to quality primary health care, service more flexibility in how we provide care. are new to DDHS as well as clients who and we aim to engage with them from At the end of the year, initial work to identify clients previously used other clinics. Rapid Creek clinic. with chronic disease had begun, with the trial due to commence when IT issues have been resolved.. Fran leads a team of four doctors, two AHPs The clinic also has a community room (one is a care coordinator), a registered equipped with an industrial kitchen and nurse, an outreach worker, two medical shower facilities which will be used by various receptionists and a safety and community groups such as our diabetes group, fitness Staff Profile: Nathan Jones-Cubillo, liaison officer. DDHS visiting services and seniors’ groups. Malak Clinic Manager include social and emotional wellbeing and tobacco and AOD counselling. The service ‘See a video of the opening at https://www. Nathan’s career began with a placement at Danila moved on to progress her career working in CQI has expanded to include a midwife, dental youtube.com/watch?v=JupuBZYSWso’ Dilba for his studies in Aboriginal Health, but quickly at Danila Dilba, Nathan was offered a six month therapist and diabetes educator. progressed to a traineeship as an Aboriginal Health contract as Malak Clinic Manager. Practitioner (AHP) at the Men’s Clinic in the “Working at Danila Dilba has given me the most Darwin CBD. opportunity and supported me all the way. It’s probably His first mentor was Malcolm Darling, who was the most supported job I’ve ever had,” he said. once an AHP himself, and is now the Darwin General Manager. Nathan appreciates the great team at Malak clinic. “I was lucky enough to have the support of the staff After completing his qualification as an Aboriginal that I was working with. They were always helpful.” Health Practitioner, Nathan started work at the He particularly likes working with Aboriginal people, Malak Clinic, where he was supported by then helping his mob. For any potential or new employees Clinic Manager, Sharni Cardona. at Danila Dilba, Nathan said, “If you are nervous about starting a new job, come to Danila Dilba and by the end Nathan trained in the managerial work and acted as of the week you’ll be feeling good about where you are.” Clinic Manager in Sharni’s absence. When Sharni

Community members and DDHS staff with NT Health Minister Hon. DDHS staff Tracey Thompson, Mathews David and Fiona Tyson cooking up a storm Natasha Fyles (left) at the opening of Rapid Creek Clinic. at the Deadly Choices Healthy Food Steak Sizzle at the Rapid Creek opening.

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Palmerston Clinic Bagot Community Clinic Extended hours The Palmerston clinic was refurbished Partnership The extended hours service trialed in this year, with fresh paint and new decals, In early 2017, Danila Dilba was approached 2016-17 was continued in 2017-18, adding light and brightness to the clinic, by the Bagot Community and AMSANT to with some minor changes, and has been and bringing it to the same standard as auspice its clinic. expanded to the new Rapid Creek Clinic. our other clinics. This request followed extensive community Extended hours received strong support in Throughout 2018 Palmerston Clinic has consultations about the clinic, which although last year’s consumer survey and is especially maintained strong relationships and high providing a vital service was not sustainable. important for clients who find it difficult to levels of engagement with our local boys’ attend a clinic during regular work hours. The proposal required financial investment and girls’ academies, ensuring we provide Palmerston Clinic Palmerston Clinic remains open until 7.30 and presented some risks, but the DDHS quality and culturally safe health checks and 1/7 Rolyat St, Palmerston pm, Monday-Thursday, and Saturday morning continuing health education for young Board saw an opportunity under our service opening has been extended to the Rapid people in our region. design to help Bagot clinic realise its potential Creek clinic to join Palmerston and Malak and thrive in the DDHS clinic family. This year clinics in operating half days on Saturdays. Palmerston Clinic has expanded the school- Bagot clinic was accredited as an AGPAL based health check service to primary (Australian General Practice Accreditation) school students in the area. DDHS oral clinic for three years. Safety and Community health therapist, Jessica Hallewell, also Liaison Officers developed and delivered ‘hand and oral “Bagot is grateful to Danila Dilba Health In December 2017, Danila Dilba introduced hygiene’ education to classes at Humpty Doo Service for responding to our call for assistance Safety and Community Liaison Officers to our Primary School and at other school health to keep the Bagot Clinic open and operational,” clinics, creating five full time positions for local expos and community events. said Bagot Community Inc. President, Helen Fejo-Frith. staff to replace the previous arrangement of contracting a third party security firm. “Community know the clinic staff and the clinic Three of the successful candidates required staff know the community and that’s important additional training and were supported by for us to feel safe and comfortable,” Gumileybirra Clinic Helen said. Danila Dilba to gain their Certificate II in 4/7 Rolyat St, Palmerston “It remains a key service provider and resource Security Operations. for Bagot Community.” The Safety and Community Liaison Officers’ role is to ensure the safety and security of Gumileybirra clients, visitors and staff at DDHS clinics Gumileybirra has a long history and premises. As community liaison officers, of providing a welcoming place for they offer a friendlier interface for our women and is still the one stop clinic clients and foster and promote positive for women’s health. relationships and engagement. They also assist clinic administration staff and The Gumileybirra clinic focuses on occasionally provide assistance with women’s health and is the home base transport. (See Alain Kiza staff profile, p.64.) for our midwives who work collaboratively with GPs and obstetricians to provide the Midwifery Collaborative Model of Care. Women with diabetes in pregnancy and high risk pregnancies receive extra care. A contraception clinic is run by staff Bagot Clinic Oral health therapist, Jessica Hallewell teaching the who have advanced training and 133 Bagot Rd, Ludmilla hand hygiene method to students at the Rosebery Middle School Health Expo. experience in this area.

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Pharmacy Danila Dilba Health Service’s Pharmacy Service helps ensure quality use of medicines and supports clients to understand their prescribed medicines and follow their management plan.

Danila Dilba subsidises the cost of medications for our clients under the oversight of our Medicines Review Committee. We work closely with three contracted pharmacies and in September 2017 a competitive tender process awarded a further three year contract

to these three pharmacies. Aboriginal Health Practitioner trainee, Sarah Quong, in the pharmacy room at Palmerston Clinic. The total expenditure on medications in 2017-18 was $332,385, a cost lower than the Home medication review visits previous year due to a fee reduction by one of our contracted pharmacies. Sixty-two home medication reviews (HMRs) were completed in 2017-18. An HMR checks NT Legal Aid Commission lawyers In 2018, DDHS was selected as a trial site Shelley Landmark and May Mooka. that the client is taking the right medicines in Legal ‘health’ checks 1 for the ‘IPAC’ project. This large project the right way, asks the client about side effects As part of our overall approach to • employment will look at whether including a pharmacist and makes sure that medicines are stored holistic care, Danila Dilba works with 2 • fines and debts in the primary health care team leads to safely. This year, QUMAX funding enabled us the NT Legal Aid Commission to offer improvements in the quality of the care and to include an Aboriginal Health Practitioner • mobile phone contracts clients a visiting Legal Aid service at the client’s health. Participation in the trial will in HMR visits. some of our clinics. • hire purchase contracts provide funding for an additional pharmacy • scams and fraud – fake letters, position from mid-late 2018 and we hope Prescriptions issued under Our clinicians and counselors often learn Closing the Gap program phone calls and social media to also employ an Indigenous outreach that clients have worries about legal worker to assist clients. issues and we encourage our clients to • discrimination. 2014-15 2015-16 2016-17 2017-18 ask at the clinic for a referral or come and Continuous quality improvement (CQI) CTG 22927 25470 27700 31323 For criminal or family talk to the Legal Aid team. Total law matters, they can There’s Two CQI audits were conducted this year: 32048 33548 39108 45066 “We work along with doctors and clinicians, also link clients to always • A follow up drug use evaluation of proton % CTG 72% 76% 71% 70% which is the really important aspect of services that can help. options, pump inhibitors (PPIs) with further review this service – it truly helps people link in it’s always scheduled for mid-2018, The legal aid team is The Closing the Gap prescription program with other services,” said Legal Aid lawyer, worth available at the Darwin • an audit to identify problems in continuity (CTG) improves access to medicines for Shelly Landmark. “There’s always options, talking to Clinic in Knuckey St for of care for DDHS clients on discharge Indigenous clients who live with chronic illness. it’s always worth talking to someone, that’s someone from hospital. The audit recommended that Clients registered by DDHS are eligible for what I tell people.” half hour appointments every fortnight, and the hospital pharmacy be asked to send further reductions in prices of medicines beyond standard Pharmaceutical Benefit The team can advocate or advise clients monthly at the Palmerston and discharge medication lists to Danila Dilba’s Scheme (PBS) rates. In many cases there is on civil law matters like: Malak clinics. The client can be pharmacist for follow up. A further audit will be conducted at the end of 2018. no cost to the client for their medicines. • problems with Centrelink and other referred for a further four hours government departments of free legal advice if needed. 1 Integrating Pharmacists within Aboriginal Community Controlled Health Services to improve Chronic Disease Management (IPAC). • issues with housing, rent, repairs and 2 Quality Use of Medicines Maximised for Aboriginal and Torres Strait Islander People (QUMAX) – a collaboration between maintenance NACCHO and the Pharmacy Guild of Australia to improve quality use of medicines for clients of Aboriginal Community Health Services. It is funded by the Commonwealth Department of Health.

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2017-2022 3.3 C ontinuous Quality Strategic Priority 4 Health Systems Incident reporting and management Achieving continuous A small Health Systems Team has worked The Audit and Risk Management Committee Improvement (CQI) improvement and collaboratively this year to introduce have given valuable input and recommendations integration of processes that support our service design to the DDHS Board regarding organisational risk Service design to improve health care requires good systems, programs and and improved quality of care. Amongst the in clinical and Work Health Safety areas. Board services changes that have been introduced are: Members and the Executive Officer completed both to support the client’s journey through care and to achieve culture the Executive Masterclass: Responsibilities for consistent staff practice. Listening to our clients about what works • Changes to our health and practice Leading Quality and Safety delivered by the for them, learning from mistakes and reviewing our services helps management system, Communicare, to Australian Council on Healthcare Standards, improve templates and provide a simpler us to achieve continuous quality improvement. which focusses on approaches being taken by health check process across different Boards that oversee health facilities to actively The Clinical Safety and Quality Committee An external review of our data quality life stages, focuses on improvement and monitoring the framework was conducted this year and support and drive continuous improvements detail of client feedback, safety and quality, reported our approach to data collection • Simplified management plans that in health care to reduce risks of harm. and works closely with the DDHS Board’s and use as ‘optimal’. give clinic teams better tools to work In 2017-18, Audit and Risk Management Committee. with clients. • Several staff completed the NT Anti- A Clinical Safety and Quality Committee Client feedback One of the important and effective Discrimination Committee Train the work plan and new safety assessment codes A client feedback survey, including face to improvement plans was the Syphilis Trainer program. help the committee monitor incident trends face interviews, was conducted this year and Outbreak Action Plan, commenced in early and manage risks. demonstrated strong satisfaction with the • Staff received ongoing training on internal 2017 in response to the spread of the service, with a few areas for improvement incident reporting systems, resulting in infection across Northern Australia. Steady Data collection in some clinics. A trial of real time client improved staff input. progress to understand the outbreak in The CQI Officer leads implementation of feedback using ‘smiley face’ scores on an Darwin and develop a planned response • Several staff completed Certificate IV in change and improvement action plans across electronic stand was also conducted, with with the Mobile Clinic team meant Danila Work Health Safety. All clinics now have the organisation. The process of ‘telling the analysis of this trial in progress at the end of Dilba was well prepared when additional WHS representatives and fire wardens. story with data’ – making small planned the year. Although the effectiveness of this Commonwealth funding to respond to the • 38 clinical incidents were reported and all changes and checking it works through tool as a measure of client feedback is yet to outbreak became available in 2018. were investigated and closed. In the previous good data collection – leads to sustainable be established, clinic staff report that kids year 81 incidents were reported. improvement. This year whole of service love to play with the devices. Health Systems also hosted two student clinical action improvement plans focused on interns who undertook small projects this • 71 WHS incidents were reported, compared Accreditation and review immunisation, halting the syphilis outbreak, year. In collaboration with AMSANT, Danila with 99 in the previous year. 61 were closed rheumatic heart disease treatment adherence Australian General Practice Accreditation Dilba hosted a GP Registrar to assist our and 10 remained under investigation or subject and reducing childhood anaemia. Education (AGPAL) was achieved in all clinics this year, work in understanding childhood anaemia. to action. No compensation claims resulting and training are integral to maintaining quality including Bagot Community clinic, while the from any form of injury (physical or emotional) data collection and to continuous quality new clinic at Rapid Creek is preparing for were made. improvement. an October assessment. This year we • 20 complaints were made (an increase from reviewed services at Bagot Clinic, the nine last year). The data and performance indicator trends Midwifery Model of Care, our client recall we collect inform the Board’s Audit and Risk and reminder processes, and our Managing Clinical incidents Total WHS incidents Total Management Committee about the quality Difficult Behavior manual. Adverse reaction/event 1 Complaints Total and safety of our clinical and cultural practice. Blood or bodily fluid exposure 2 Physical injury 8 Appointments 0 Documentation error 5 Property 26 Other 3 Immunisation error 12 Transport 7 Privacy & confidentiality 0 Medication error 3 Verbal abuse to staff 22 Client eligibility 1 Needle-stick injury 3 Emotional wellbeing 3 Staff conduct 6 Other 8 Adverse or critical event 1 Service delivery 7 Pharmacy error 4 Other 4 External 3 Total 38 Total 71 Total 20

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Our Organisation 2017-2022 Governance Strategic Priority 2 Community 3.4 Organisational development Financial sustainability: Build the financial Danila Dilba is committed to improving the health and sustainability of the Members organisation to wellbeing of our community and clients, and to building our support the growth own capacity and strengths in providing high quality, and development Board accessible health services. of services In 2017-18, the focus of organisational Our Medicare optimisation Office of the Chief Executive development was on: plan ensures that our internal • Implementing the 2017-22 Strategic Plan processes and billing practice optimise Chief Executive the income we are eligible to earn through Executive Strategy, Marketing and • Consolidating the new service design Officer Officer Research and Communications Medicare billed services. The plan is reviewed Policy commenced 2016-17 regularly and we have developed tools that • Securing financial security and staff stability help ensure that DDHS receives proper Clinical Services payment for the work our clinical staff do Clinical Director • Consolidating good governance and continual policy development to support our chronic disease focus and service design. • Implementing our new Human Health Systems Communicare Medicare Registrar Education Research Resources Strategy Program and Training DDHS Medicare staff support staff to bill • Expanding information and communication correctly and ensure billing compliance for team care in accordance with our policy Darwin technology Darwin Malak Men’s Bagot Rapid Mobile and Medicare legislation. Registering clients General Manager Clinic Clinic Clinic Clinic Creek Clinic • Continuing to develop relationships with Clinic for practice incentive payments also earns other organisations, health providers, income and enables us to constantly audit Palmerston community organisations and peak bodies. GP Clinic Gumileybirra Australian client contact information and improve General Manager Women’s Nurse Family Health Partnership Program data quality. Income from delivery of Manager Deadly Choices Social and Medicare income Community Services Emotional Wellbeing health services The further significant increase of 17.5% 2013-14 $ 2,665,879.00 in income generated by Medicare and Alcohol Tackling Youth 2014-15 $ 2,987,578.00 and Other Indigenous Engagement the Practice Incentive Program reflects an 2015-16 $ 3,280,200.00 Drugs Smoking increase in uptake of our services, better 2016-17 $ 4,067,364.00 service delivery and improved billing 2017-18 $ 4,780,198.00 Corporate Services efficiency through staff training and better Deputy CEO Office Services Audit monitoring and auditing processes in 2017-18. Compliance Increased Medicare income reflects a higher number of Danila Dilba reinvests this income to open Health Checks, Chronic Disease Plans, primary health new clinics, expand and improve services care follow up and registration of eligible clients under the Finance Finance and Payroll Accounts and Closing the Gap pharmaceutical co-payment program. Budget payments and facilities, and build our capacity as a professional community organisation. Senior Executive Officer - Workforce HR Strategy Coordinators

Information ICT System Communication Support Technology (ICT)

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2017-2022 Innovation and new media Strategic Priority 2 3.5 Our people Investment in Danila Dilba is evolving to adapt to New media and ICT outreach our people: new technologies and the new media Reaching out to our clients and the wider To deliver high quality health services to our community, Support the cultural environment. This year we have made major community in the social media landscape competence and Danila Dilba is committed to developing a capable, professional changes in internal communications and presents new challenges. This year we well qualified and stable workforce. development of information and communications technology redeveloped our website to a more modern our staff (ICT) and external and social media responsive platform that works effectively on We aim to attract and retain talented and As an Aboriginal community communication. different devices. The website now includes committed staff and empower them to reach organisation, we aim to a searchable resources section and a their full potential and achieve great things for maximise employment ICT developments “Our people media area with videos and our clients and community. and retention of a strong embody what In 2017-18, we expanded our video image galleries. ‘Our online Aboriginal and Torres As Danila Dilba’s Senior Executive Officer, we stand conferencing capability to all clinics and community Strait Islander workforce Danila Dilba also expanded Sulal Mathai, explains, “Our people embody for as an the Corporate Office. This facility aims to of clients and and build a strong our social media presence what we stand for as an organisation: through organisation… reduce staff travel time between clinics. supporters learning culture that through Facebook and them, their attributes, skills and capabilities, their attributes, has more promotes professional Video conferencing has been used effectively YouTube to build an online our clients really see what Danila Dilba is skills and than doubled development for all of in tele-health and expanded our capacity community of clients and contributing to the community.” capabilities” in the last our staff. to deliver specialist services in our clinics, supporters that has more than especially where it is difficult to access 12 months’ doubled in the last twelve Staff gender ratio IndigenousIndigenous staffstaff Administrative staff ratio specialists locally. The Men’s Clinic engaged a months. This provides an NSW psychiatrist for 23 video consultations effective platform for health promotion 19% during the year. We are trialling training for and keeps our clients informed about 27% GP registrars using this technology. the services we provide. 37% 73% 63% An additional ICT worker was recruited We plan to build on these gains in the 81% this year to support the expansion of our coming year by providing more effective services. Our IT team has successfully set up communications, including development of a the new Rapid Creek clinic and migrated the Frontline resource portal to provide health education • Female Indigenous • Bagot Community clinic into Danila Dilba’s to our clients and the wider community. Male • Non Indigenous •Non frontline • •Does not include 31 GPs Communicare clinical management system. and GP Registrars This system enables seamless integration and We also plan to expand IT services for clients private sharing of client records within DDHS, by developing a WiFi guest network that will so clients can attend any Danila Dilba clinic. offer free internet access to clients in our clinics. This will open the door to interacting Human Resource Strategy In the upcoming year an ICT review will be with clients in real time whilst they are at In line with the Strategic plan 2017-2022, carried out by an external service provider to our clinics, providing information on health Danila Dilba developed a new Human Resource Strategy look at ways we can enhance our ICT service promotion and our services. built around three pillars, which we implemented this year. delivery even further.

Talent Management Attract, recruit and retain the best people using fair, equitable and transparent processes.

Encourage pride and motivation through staff Engagement communication and feedback, recognising and rewarding performance, learning and development.

Learning and development Support staff to build a meaningful career and create their professional path.

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Talent management Indigenous and non-indigenous staff by roles Indigenous and non-indigenous staff by roles Recruitment and retention initiatives senior positions. All Clinic Managers Indigenous Danila Dilba’s goal is to become an employer and General Managers are now Indigenous, • Non Indigenous 1 of choice. We have become more active in making up 65% of the Executive CEO • 0 the labour market to become better known Leadership team. 3 Clinical Executive - Clinical Director, General Managers and establish relationships with potential 1 0 candidates. Internal recruitment Corporate Executive - Deputy CEO, HR, Finance, IT, Communications 4 11 Managers/Team Leaders This year we partnered with Employment Positions 17 3 Office, a recruitment and consultancy Applications received 30 0 General Practitioners firm. We are developing and showcasing Positions Filled 13 23 0 Registrars a stronger public profile, emphasising the 8 strengths and benefits of working with us and 10 DDHS aims to contribute to our staff Aboriginal and Torres Strait Islander Health Practitioners 0 our commitment to supporting all our staff to members’ ability to develop leadership and develop their career pathways. We published Registered Nurses / Midwives 8 career pathways by making the knowledge, 17 feature stories of successful staff career skills, experience, and job requirements Clinical admin/Health systems 15 8 pathways in print and digital media and also of each position within the organisation initiated social media recruitment through Community services/client support workers 30 transparent. 4 LinkedIn, YouTube and Facebook. 0 Other professionals (includes counsellors, psychologists, oral health therapist, pharmacist) Our Career Pathways project, funded by 8 3 External recruitment the Northern Territory government under Trainees 0 an Aboriginal workforce grant, is still under 0 Positions advertised 75 Strategy, research and policy development. Consultation with leadership 3 Positions Filled 62 and managers began in August 2017 and staff Finance, HR, IT, Communications 5 5 Applications received 535 consultations were organised in September 0 5 10 15 20 25 Average no. of applications per position 7.13 2017. Chris Hancock, an independent consultant, is working with our HR team. In 2017-18, Indigenous staff made up • 65% of our leadership team (CEO, General Managers, all Clinic Managers), and When the project is completed it will enable Indigenous employment and • 63% of non-GP clinicians and community/social and clinical support staff our staff to map out a career pathway, utilising career pathways (AHPs, RNs, clinical administration, community services and client support). training to achieve their personal aspirations. Our Indigenous Employment and Career We expect to complete this project in Pathways plan has been successful in November 2018. increasing Indigenous staffing at all levels of the organisation. Mentoring

DDHS has been promoting managerial / A Mentoring and Coaching program has research positions internally as part of been developed in partnership with PwC’s our Indigenous staff career development. Indigenous Consulting so that Indigenous Leadership development is a strong focus employees can be partnered with a mentor of Danila Dilba’s business and talent from an external organisation who can management approach and includes provide guidance on how to reach their identifying and offering further education career goals. and support to potential candidates. Ten Indigenous staff members were offered All managerial positions were advertised the mentoring program. On completion, the internally first which has assisted in the coaching program provides a more in-depth appointment of more Indigenous staff to goal setting and planning exercise which is aimed at the managerial level. Mentoring our colleagues: at left, CQI Officer and experienced Clinic Manager, Sharni Cardona, and Clinic Manager, Rosemary Blake at Darwin Clinic.

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Build a meaningful career and create We have Learning and development your own path seen a At Danila Dilba, personal development and Online learning significant a strong learning culture are central to our From September 2017, Danila Dilba has reduction in strategies for strengthening staff, offering contracted Aboriginal Medical Service staff turnover career development and providing high Education 24/7 (AMSED) to provide from 36% in quality services. E-Learning Continuing Professional 2015-16 to Development. The 70 licenses for use by In 2017-18, DDHS increased the learning and 22% in 2017-18. registered health professionals were secured development budget and will continue to do for a one year trial and based on the usage of so in 2018-19. Danila Dilba staff at a business planning meeting. the platform, Danila Dilba will continue this Over the past year Danila Dilba has continued investment in future. Engagement to develop a continuous learning environment Staff can engage with 65 learning modules, for all our staff, including: Staff satisfaction including 43 addressing client care, Danila Dilba conducts an annual staff We received positive feedback and to • a monthly training calendar 12 around all staff, three administration satisfaction survey and uses the outcomes to maintain the momentum, continued to • an online learning platform and general interest, and nine from the develop action plans in consultation with staff. engage staff in the staff survey action Fair Work Ombudsman. • support from our full time Education plan in 2018. Engagement at Danila Dilba The 2017 annual Danila Dilba staff survey and Training Officer has increased, with 90% of our people In 2017-18, 277 modules were completed, the reflected high levels of staff satisfaction and positively engaged. equivalent of 384.5 continuing professional engagement and was followed by an action Learning and development expenditure development (CPD) hours for our clinicians. plan, You Said, We Listened, Let’s Act Together We have seen a significant reduction in 150,000 completed in November 2017. staff turnover from 36% in 2015-16 to 22% This platform provided staff with ready in 2017-18. Absenteeism has also been access to mandatory CPD and other relevant In December 2017 – January 2018, we 120,000 reduced with the average absence rate per learning activities related to service delivery conducted a ‘pulse check’ – a shorter version employee (on sick leave or unexplained and client care. All AMSED modules meet of the detailed staff survey. 147 staff members 90,000 $138,816.48 Australian Health Practitioner Regulation

absence) at 3.47 days per year. $125,683.00 completed the ‘pulse survey’, a response rate Agency (AHPRA) criteria for continuing of 94% – the highest response rate since the 60,000 professional development for nurses, staff survey was established. In 2016, 84% of $90,028.00 midwives and Aboriginal Health Practitioners. staff participated. 30,000 Over time, DDHS has established 0 relationships with local institutions such as 2015-16 2016-17 2017-18 Flinders University, Charles Darwin University, Proud to work Would recommend DDHS has an Danila Dilba Batchelor Institute and Fox Education at DDHS working at DDHS outstanding future engagement profile and Consultancy that enable us to access 1% 2% 4% CPD Activity (Quarterly) 1% 1% 6% 2% and utilise developed resources including 200 structured course and training materials that 6% 6% 8% 183 meet our training needs. These relationships 33% 14% 150 also offer access to a pool of experts in 58% 34% 53% 38% 50% many fields. 40% 125 100 43% 90 70 50 61.5 277 modules used Strongly agree Strongly agree Strongly agree 50 47 Highly engaged 35 384.5 CPD hours • Agree • Agree • Agree • Moderately engaged • Neither disagree or agree • Neither disagree or agree • Neither disagree or agree • Passive 0 67 active employees Q3 2017 Q4 2017 Q1 2018 Q2 2018 • Disagree • Disagree • Disagree • Disengaged • Strongly disagree • Strongly disagree • Strongly disagree • Modules CPD Hours • • • • •

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Staff profile – leadership, Sharni Cardona Growing our own Staff Profile: Clinic Manager Aboriginal Health Darren Braun, AHP Trainee Sharni started with Danila DIlba as a Management Practitioner Traineeships registered nurse in the Darwin Clinic. which has In November 2017, DDHS created As one of nearly 40 been very four trainee positions for Aboriginal and applicants, Darren Braun She quickly showed potential and was helpful for Torres Strait Islander Primary Health Care was happy to be accepted as one of the offered the role of acting clinic manager her career and learning. As a senior Practitioners (AHP’s). four new Danila Dilba Aboriginal Health for several months before being appointed staff member, Sharni continues to support Practitioner trainees. to a permanent role and has now been a These are full time paid positions which and mentor two up and coming clinic clinic manager for five years. require the trainee to complete a “So far, the traineeship has been very challenging,” managers, meeting with them weekly to Certificate IV qualification in Aboriginal and/ talk about their management decisions Darren said. When the Malak Clinic opened in 2016, or Torres Strait Islander Primary Health and any other concerns they have. “What I enjoy about it most is the face to face Sharni was appointed manager. Then, after Care Practice at Batchelor Institute. Trainees In the future, Sharni hopes to move into contact with clients. Getting them to take care of mentoring the current Malak manager receive on the job clinical training outside Executive Management in Danila Dilba their health and (me) taking care of their health, Nathan, Sharni moved to work in of formal training blocks to consolidate or possibly become a doctor. sending out positive messages to stay healthy. Continuous Quality Improvement in knowledge, skills and experience in the the Corporate Office. “I find that it’s unlike anywhere else that health sector. “It’s very important to build that relationship with I’ve worked,” Sharni said. “I find the working each client and maintain that engagement and Sharni values the help she has been given From 38 applications, 16 candidates were by DDHS for training and development environment within Danila Dilba is very relationship and keep building on it.” easy going but professional at the same interviewed and four were selected. and the ability to move quite quickly in Batchelor Institute has identified our AHP “Danila Dilba is very supportive time. The staff are great to deal with and Darren’s goal is to qualify as a registered nurse her career. trainees as amongst the highest performing with education and training needs, especially very supportive. I also find the clients very (RN), specialising in sexual health. interesting and it helps, because part of my students in the course – a reflection of the if it’s to do with your role,” she said. Sharni “One of the things that I’ve learnt is the prevention goal in life is to help my own people.” time and dedication our clinic staff have has completed a Diploma of Practice invested to support them. Our four trainees and education around it. If we can get the expect to complete their qualifications by prevention awareness and education out there the end of 2019. about safe sex and condoms and talk about it, we can make a difference.”

Staff Profile : Alain Kiza Mushamuka AHP trainee Safety and Community Liaison Officer Staff profile: Sarah Quong, Sarah recently finished school and completed “I like helping my mob Alain, who is originally from the Congo, “Danila Dilba is Certificate II and III in Community Services. and telling them to not first came to Danila Dilba as a security most different from be shame about their officer employed by an outside agency. all jobs I have been working on. It is based She was working with the Community Services team at Danila Dilba when the AHP traineeship health – we’re here to on helping the community, helping the people,” When the new Safety and Community came up. help them and fix their Alain said. “They are very, very friendly, they Liaison Officer positions were created this issues,” she says. are helpful. Everyone is engaged, talking to “It’s a big achievement for me because I’m 18, year, Alain applied and was successful. each other, helping each other.” just out of school. It’s a really good opportunity Sarah sees clients with health conditions like Safety and Community Liaison Officers are I have been given and I don’t take it for granted,” diabetes and rheumatic heart disease nearly Alain enjoys working with clients. “These are really big problems with now located at each clinic. It is an important “For me, I appreciate it. Many of them she says. Clinic staff give the trainees a lot of every day. our mob and we are trying to help them get it role that works as part of the clinic team to call me brother. I have made good encouragement and help them if they are under control.” ensure the safety of clients and staff. Alain is relationships with the clients. There is good struggling in their course. based at the Darwin Clinic in Knuckey Street communication. Because they appreciate me “It was a bit rough at the start, but once I started When she graduates, Sarah wants to work and has undertaken further training in risk and I appreciate them, we are connecting to get into my studies and going out on the floor with her own community at Warramyunga, and management and dealing with challenging with each other.” doing practical stuff, it’s going pretty well”. in the long term aims to become a midwife. behavior since joining Danila Dilba.

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Training Staff profile: cultural diversity In-service training Student placements Dr Saidah Haron: GP Rapid Creek Clinic The monthly training calendar offers clinical As a major Indigenous primary health care ‘Dr. Saidah’ joined Danila Dilba in 2007 staff a range of learning opportunities, organisation in the Northern Territory, we as a GP Registrar and has stayed with us ranging from AMSED certificate courses, facilitate student placements and this year since she qualified as a GP 10 years ago. management of chronic disease, frontline accepted 16 medical student placements ‘de-escalation’ training, and lifestyle and from Flinders University NT and three For most of that time Dr Saidah was at nutrition. nursing placements through Charles Palmerston Clinic, but joined the team at Darwin University. the new Rapid Creek clinic in April 2018. DDHS also employs a full time Education and Pursuing her interest in women’s health, As a Muslim woman of Malaysian Training Officer who assists staff to identify DDHS partnered with the NT Government she has a diploma in Obstetrics and background, Dr Saidah has found Danila development opportunities and coordinates Department of Education to offer structured works closely with the midwife at Dilba very welcoming towards staff of training, in addition to identifying potential work placements for Indigenous students. Rapid Creek, and she is also part of the culturally diverse background. “Danila opportunities (and risks) to the organisation Under this program three students Residential Aged Care team. Dilba was accepting of that when I came that can be addressed through training. completed Certificate II in Community on board, and they haven’t changed in the Services. Over 10 years, Dr Saidah has come to past ten years.” During 2017/18, Danila Dilba provided 60 know many of the staff well and developed hours of in-house training to all clinical staff, DDHS staff pursuing/completed formal strong ties: “We’ve got the bonding, we’ve got “I was myself coming from different including five hours’ training or professional qualifications in 2017/18 the friendship, we know each other, we know ‘everything’, different from everyone – development within work hours. the history of the last ten years.” different religion, culture, background, # of staff everything. They are still accepting me, and We have also organised PART (‘Predict, Cert II in Security Operations 3 Similarly, some of her long-term clients see more people from different backgrounds are Assess and Respond To’) training for our her as a part of family and have followed coming in. Danila Dilba is really welcoming new frontline staff members to address Cert III in Community Services 1 her from Palmerston to Rapid Creek. for diversity, definitely.” challenging/aggressive client behaviours and Cert III in Health Services Assistance 7 assist staff to identify and respond to such Cert IV ATSI PHCP 4 challenges. Cert IV in Health Administration 3 GP Registrar to General Practitioner Danila Dilba GPs also provide guidance in Cert IV Leadership and Management 1 small group sessions that cover 20 topics External training and Cert IV in Payroll Administration 1 Danila Dilba’s most significant education professional development 2017-18 commitment in 2017-18 continued to be in over the registrar term. Certificate IV in Work Health and Safety 2 hosting GP Registrars, that is, doctors training General Practice Registrars (GPRs) are an Administrative 5 Dip. Clinic Management 3 to be General Practitioners (GPs). important part of our current and future Clinical 17 Dip. of Leadership and Management 2 In 2017-18, 14 GP Registrars were placed medical workforce. Over the past three years Leadership 3 Dip. of Human Resources Management 1 at Danila Dilba for training terms ranging a number of our registrars, after successfully Professional development 66 Graduate Certificate in Nursing 1 from six to 12 months. These placements are completing their qualification as GPs, Work Health and Safety 3 Certified Practitioner in Human Resources 1 coordinated by Northern Territory General have chosen to stay with Danila Dilba Mandatory 180 Total 30 Practice Education Ltd (NTGPE), the regional Health Service. training provider for GPs in the Northern GP Registrars transition to GPs Cultural Awareness training Territory. 15 Cultural Awareness training is mandatory We maintain a flexible learning program 14 12 13 for all new staff. In 2017-18 Danila Dilba for GP Registrars which enables Danila organised training exclusively for staff Dilba Health Service to meet both legal 9 10 members at our premises and 52 staff requirements and staff expectations. Weekly members attended the awareness training. registrar learning sessions provide varying 6

content given by a range of facilitators. 3 3 2 2 0 2015-16 2016-17 2017-18

page 66 Danila Dilba Health Service ANNUAL REPORT 2017–2018 Danila Dilba Health Service ANNUAL REPORT 2017–2018 page 67 Nathan Jones-Cubillo, Cultural competency project Acting Manager Malak Clinic, was Danila Dilba has been granted funding of honoured by being awarded the Jaydon $94,340 from Northern Territory General Adams Memorial Oration award at the Practice Education (NTGPE) to enable NACCHO 2017 OCHRE Day National Danila Dilba to design and develop a Conference held in Darwin. Cultural Competency Framework, including competency levels for staff and in house cultural training content that NTGPE will be 4 Staff excellence able to trial as a model for other Aboriginal Danila Dilba staff continue to excel in their health services in the Northern Territory. chosen pathways. We are proud of our staff, The project will commence with focus FINANCIAL many of whom received formal or additional groups for staff and key external stakeholders qualifications, won awards and built successful early in 2018-19, with the aim of achieving career pathways this year. a trial model by March 2019. REPORTS The following staff members received awards at the Danila Dilba annual event Software and system in December 2017: innovations • Employee of the Year - Onika Paolucci Paperless Onboarding Hugo Smits and Danila Dilba implemented paperless • Hall of Fame – David Adams onboarding in January 2018 to provide a • New Arrival – Leona Holloway seamless onboarding experience to new staff members. This process offers a smooth • Team of the Year award – HR Team and productive start to employment that • Shining Stars – 10 staff members who provides easy access to Danila Dilba policies completed their formal qualifications. from commencement of the employment contract.

Grants New Work Partnership Agreements Employer of Choice grant We have replaced the SharePoint Work Danila Dilba was awarded an Employer of partnership agreement platform with Action Choice grant of $25,000 under Aboriginal HRM HR Software as the new platform for workforce grants initiated by the Northern Work Partnership Agreements (WPAs). The Territory Department of Trade, Business new platform enables easy access to staff to and Innovation, for new initiatives in Human plan and progress their career development Resources such as development of career and maximise their learning opportunities in pathways and introduction of our online the workplace. learning system. HR Systems integration Aboriginal and Torres Strait Islander Danila Dilba uses two Human Resource Mentoring systems, Action HRM for recruitment, The NT Department of Trade, Business and onboarding and Work Partnership Innovation also supported an Aboriginal and Agreements, and HR3 for employee database, Torres Strait Islander Mentoring service in payroll and leave management processes. In partnership with PwC Indigenous Consulting 2017 we integrated these systems to create (PIC) and this opportunity was offered to a unified service for staff across the two selected DDHS staff members. platforms.

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Directors and Directors Meetings Distributions paid to members Qualifications, experience and The following persons were members of the Danila Dilba Health Service Management Committee during the year special responsibilities of directors for the year ended 30 June 2017 and up to the date of this report There were no distributions made to members Carol Stanislaus (Chairperson) is a Tiwi woman, during the year nor were there unpaid or declared born and raised in Darwin. She has worked in Current Meetings distributions to members outstanding at year end. a variety of Indigenous positions in alcohol and Directors Position Attended Term Expires other drugs, tourism, local government and Ms Carol Stanislaus Chairperson 7 Nov 2020 Environmental regulations justice throughout the Northern Territory and Ms Nicole Butler Deputy Chairperson 6 Nov 2019 holds a Bachelor of Applied Science in Aboriginal The corporation’s operations are not regulated by Community Management and Development. Ms Vanessa Harris Ordinary Member 4 Nov 2019 any significant environmental regulation under a law Carol currently works with the Department of Mr Mark Munnich Ordinary Member 5 Nov 2019 of the Commonwealth or of a State or Territory. Prime Minister and Cabinet. Mr Timothy Duggan Ordinary Member 1 Nov 2019 Proceedings on behalf of the Nicole Butler (Deputy Chairperson) is a Larrakia/Wadjigan (Top End) and Eastern Arrernte Mr Malcolm Hauser Ordinary Member 3 Nov 2020 corporation (Central Australia) woman. Nicole is a qualified Mr Wayne Kurnoth Larrakia Member 3 Nov 2020 There were no applications for leave to bring social worker, having completed a Bachelor of Mr David Pugh Independent Director / Non Member 7 31 Dec 2019 proceedings made during the year under section Social Work at the Royal Melbourne Institute of 169-5 of the Corporations (Aboriginal and Torres Technology (RMIT), graduating with Honours. She Ms Bronwyn Rossingh Independent Director / Non Member 3 22 Feb 2021 Strait Islander) Act 2006 (CATSI Act). has defined her career in child and family welfare, with experience in child protection, out-of-home Non-Current Meetings Auditors independence declaration care, residential care services, youth at risk Directors Position Attended Date Ceased (street work-outreach), secure care and juvenile The Auditors Independence Declaration for the Mr Braiden Abala Previous Chairperson 2 10 Nov 2017 justice. She has undertaken research in care and year ended 30 June 2018 has been received and protection, and program and policy development Ms Phylllis Mitchell Previous Larrakia Member 3 10 Nov 2017 can be found on page 73 of the report. in Victoria and now in the Northern Territory. Ms Priscilla Collins Independent Director / Non Member 3 31 Dec 2017 Nicole is currently Assistant Children’s Significant events after the balance Commissioner with the Office of the Children’s Ms Kristy Nichols Previous Ordinary Member 3 10 Nov 2017 sheet date Commissioner, Northern Territory.

Eight General Meetings were held during the financial year, and the Annual General Meeting No matters or circumstances have arisen since Shannon Daley (nee Grant) is employed by was held on 11 November 2017. the end of the financial year which significantly the Top End Health Service as the Consumer affected or may significantly affect the operations and Cultural Consultant at Royal Darwin of the corporation, the results of those operations, Hospital. Shannon has 13 years experience as Principal activities Review of operations or the status of the affairs of the corporation in an Aboriginal Health Practitioner (AHP, previously future financial years. AHW), educator and lecturer, having completed During the financial year the principal activities of The surplus for the year of the entity was $699,991. her AHP training through Danila Dilba in 2001. Danila Dilba Health Service consisted of: The Corporation is in a sound position with Shannon has worked in various roles that gave - Primary Health continued growth. The Corporations new service Likely developments her an opportunity to see Aboriginal Health - Community Programs delivery model and the growth of the new clinics The Corporation expects to maintain the present through different lenses. She is passionate about - Care Coordination that opened in Rapid Creek (2018), Palmerston and status and level of operations and hence there the AHP’s vital role in providing culturally safe - Pharmacy Malak (2016) have illustrated a positive outcome. are no likely developments in the corporation’s and competent care to Aboriginal people and is - Health Systems A quality approach has supported a better operations. committed to growing the profession and engaging - Youth Justice Advocacy and Programs integration of healthcare services at all sites to the profession at various tiers within Health. She provide effective and holistic care plans. is a team player who values respect, professional Danila Dilba also provides for visiting specialist support, impartiality and ethical practice. Her services as outlined within the Annual Report. Significant changes in the strengths are in evidence-based strategic thinking, Peripheral integrated services to the core business state of affairs critical thinking, innovation and practicality. included corporate, finance, human services, marketing, client transport and information There were no significant changes to the technology. The Board undertook training provided corporation’s state of affairs during the year. by the Australian Institute of Company Directors, Governance Institute of Australia and completed a Chief Executive Officer review process.

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Timothy Duggan Mark Munnich Timmy is currently Healthy Living Manager at the Mark Munnich is a Gunggandji and Yawuru man, National Heart Foundation, NT Division. Timmy born and raised in Darwin. Mark holds a Bachelor has had a long and varied career, starting as a of Laws and is currently undertaking his Graduate professional basketball player with the Cairns Diploma in Legal Practice. Mark is employed as a Taipans. He has worked variously as a health Law Clerk with the Solicitor for the Northern Territory promotions officer, as youth trainer with the Council in the Attorney-General’s Department (AGD) and for Aboriginal Alcohol Program Services (CAAPS), he is a former Indigenous Fellow with the Office of and as youth worker and mentor for Indigenous the High Commissioner for Human Rights with the youth at Malak Re-engagement Centre and Diversity United Nations. Mark is also a former staff member Dimensions. Timmy is the founder of the Hoops 4 of DDHS. Health program. He received the Top End NAIDOC David Pugh (non-member) Person of the Year Award in 2012 and has many other awards and achievements. David is the CEO of NT Anglicare and has over 35 years’ experience in leadership roles within Vanessa Harris NGOs. He holds a Master of Business degree. Vanessa is the Executive Officer of the Northern He was previously the CEO of St Luke’s Anglicare Territory Mental Health Coalition. She holds in Bendigo, Victoria, has served on a number of a Bachelor of Health Science, majoring in government advisory councils and has worked in Management, from Flinders University. Vanessa’s Milingimby and Nhulunbuy. David is a member of the career has included employment with the Anglicare Australia Board, the Children and Families Commonwealth Government, Office of Aboriginal Tripartite Forum and the NT Government NGO and Torres Strait Islander Health (OATSIH), the Consultative Committee. Katherine West Health Board, an Aboriginal Bronwyn Rossingh (non-member) Community Controlled Health service, and the Cooperative Research Centre for Aboriginal Health Bronwyn has been working and living in the NT and the Lowitja Institute. for over 20 years. She has a strong background in accounting and governance. She is a Fellow of Malcolm Hauser the Certified Practising Accountants of Australia Malcolm is a Senior Project Officer in the Minerals and has a PhD in accounting. Bronwyn has worked and Energy Branch of the Northern Land Council. extensively in remote Aboriginal communities in He has a background in environmental and resource the Northern Territory and Western Australia in management and has worked with the Northern the areas of financial management, governance, Territory Government as an Assistant Mining Officer. community engagement, enterprise development, He has also worked with the Commonwealth financial capability and well-being, education and Department of Health on a Senate Inquiry into the pathway development. Bronwyn is passionate about Hearing Health of Australia. supporting the vision of Aboriginal communities and organisations. Wayne Kurnoth (Larrakia Officer) Wayne is a Larrakia man of the Fejo family group. This report is made in accordance with a resolution He is currently employed as the Aboriginal and of directors on 31 August 2018. Torres Strait Islander union organiser for United Voice, supporting members with workplace issues and workers’ rights across the Northern Territory. Previously, he worked as a boiler maker/welder for 17 years in the shipbuilding, construction and oil and gas industries. In 2018, Wayne won the ACTU Mrs Carol Stanislaus Organiser of the Year award. Director / Chairperson

Mrs Nicole Butler Deputy Chairperson 31 August 2018 Darwin page 72 Danila Dilba Health Service ANNUAL REPORT 2017–2018 Danila Dilba Health Service ANNUAL REPORT 2017–2018 page 73 Contents Statement of Profit or Loss and Other Comprehensive Income

General Information Statement of Profit or Loss Notes 2018 2017 The Danila Dilba Biluru Butji Binnilutlum and Other Comprehensive Income 75 Health Service Aboriginal Corporation was Revenue established as an incorporated association Grant income 2-4 19,946,835 15,668,453 in June 1991 under the Commonwealth of Statement of Financial Position 76 Australia Aboriginal Councils and Associations Prior year unspent funds brought forward - - Act 1976 (Now the Corporations Aboriginal Medicare receipts 5 4,805,121 4,085,383 and Torres Strait Islander Act 2006). Danila Statement of Changes in Equity 77 Sundry income 6 782,442 671,303 Dilba Biluru Butji Binnilutlum Health Service Aboriginal Corporation operates as a provider Total Revenue 25,534,398 20,425,139 of primary health care to Aboriginal people Statement of Cash Flows 78 of the greater Darwin area of the Northern Territory of Australia. Expenditure Notes to the Financial Statements 79 The principal place of business is: Administration 7 1,765,135 1,386,023 28-30 Knuckey Street Bad and doubtful debts 9 2,049 - Darwin, Northern Territory 0800, Australia Directors’ Declaration 96 Telephone Number: +61 8 8942 5400 Employee expenses 8 18,130,129 14,967,624 Motor vehicle 11 518,361 432,007 Operational 12 4,224,517 3,382,420 Independent Auditor’s Report Operations and to the Members of Danila Dilba Principal Activities Rental property 13 10,609 - Biluru Butji Binnilutlum Health Travel and accommodation 14 183,607 174,246 Service Aboriginal Corporation 97 As an Aboriginal community controlled health organisation, Danila Dilba Biluru Assets written off 15 - - Butji Binnilutlum Health Service Aboriginal Total Expenditure 24,834,407 20,342,320 Corporation aims to provide a holistic comprehensive primary health care service that focuses on empowering and building the Surplus/(Deficit) before income tax 699,991 82,819 community’s capacity to determine its own health needs. This means ‘Aboriginal health Income tax expense - - staying in Aboriginal hands’. Surplus/(Deficit) for the year 699,991 82,819 Main services, programs and projects Other comprehensive income - - conducted through the year: Total Comprehensive Income 699,991 82,819 • Clinical Services • Men’s Health and Well Being • Women & Children’s Health and Well Being • Community Outreach • Eye and Ear Health • Sexual Health • Youth Services • Counselling and Support Services

The above statement of profit or loss and other comprehensive income should be read in conjunction with the accompanying notes

page 74 Danila Dilba Health Service ANNUAL REPORT 2017–2018 Danila Dilba Health Service ANNUAL REPORT 2017–2018 page 75 Statement of Financial Position Statement of Changes in Equity

Notes 2018 2017 Retained Earnings

Current Assets Balance at 30 June 2016 2,395,919 Cash and cash equivalents 16 275,079 1,857,310 Surplus/(Deficit) for the year 82,819 Trade and other receivables 18 262,905 791,720 Transfer (to)/from reserves - Other current assets 17 160,612 67,658 Balance at 30 June 2017 2,478,738 Total Current Assets 698,596 2,716,688 Adjustment to adopt the National Standard Chart of Accounts (16,010) Restated Balance at 30 June 2017 2,462,728

Non-Current Assets Surplus/(Deficit) for the year 699,992 Property plant and equipment 19 11,055,249 8,026,856 Balance at 30 June 2018 3,162,720 Total Non-Current Assets 11,055,249 8,026,856 Total Assets 11,753,845 10,743,544 Land Revaluation Reserve Balance at 30 June 2016 5,000,000 Asset revaluation (450,000) Current Liabilities Balance at 30 June 2017 4,550,000 Accrued expenses 20 1 5 7 , 6 1 4 140,548 Asset revaluation - Trade and other payables 8 9 2 , 8 9 0 320,692 Balance at 30 June 2018 4,550,000 Employee provisions 22 1,323,545 1,094,484 Other current liabilities 23 1,102,362 1,838,452 Total Current Liabilities 3,476,411 3,394,176 Asset Replacement Reserve Balance at 30 June 2016 189,252

Non-Current Liabilities Transfer to retained earnings - Balance at 30 June 2017 189,252 Employee provisions 22 1 5 1 , 4 9 1 131,377 Transfer to retained earnings - Loan Payable 24 223,971 - Total Non-Current Liabilities 375,462 131,377 Balance at 30 June 2018 189,252 Total Liabilities 3,851,873 3,525,553 Net Assets 7,901,972 7,217,991 Total Accumulated Funds Balance at 30 June 2016 7,585,172

Accumulated Funds Surplus/(Deficit) for the year 82,819 Decrease in land revaluation reserve (450,000) Retained earnings 3,162,720 2,478,739 Balance at 30 June 2017 7,217,991 Asset replacement reserve 189,252 189,252 Land revaluation reserve 4,550,000 4,550,000 Surplus/(Deficit) for the year 699,991 Opening balance adjustment (16,010) Total Accumulated Funds 7,901,972 7,217,991 Balance at 30 June 2018 7,901,972

The above statement of financial position should be read in conjunction with the accompanying notes The above statement of changes in equity should be read in conjunction with the accompanying notes

page 76 Danila Dilba Health Service ANNUAL REPORT 2017–2018 Danila Dilba Health Service ANNUAL REPORT 2017–2018 page 77 Statement of Cash Flows Notes to the Financial Statements

AASB 16 Leases Notes 2018 2017 Note 1: Statement of Significant This standard is applicable to annual reporting Cash Flow from Operating Activities Accounting Policies periods beginning on or after 1 January 2019. The standard replaces AASB 117 ‘Leases’ and for lessees Grant income 20,548,007 15,180,413 The principal accounting policies adopted by Danila Dilba Biluru Butji Binnilutlum Health Service Aboriginal will eliminate the classifications of operating leases Medicare income 4,805,121 4,085,383 Corporation in the preparation of the financial report and finance leases. Subject to exceptions, a ‘right- Interest received 11,178 12,471 are set out below. of-use’ asset will be capitalised in the statement of financial position, measured at the present value of Other income 698,908 966,814 a. Basis of preparation the unavoidable future lease payments to be made Payments to suppliers (8,293,528) (5,119,862) over the lease term. The exceptions relate to short- The financial statements are general purpose financial term leases of 12 months or less and leases of Payments to employees (15,847,176) (13,200,467) statements that have been prepared in accordance low-value assets (such as personal computers and Net Cash Inflow/(Outflow) from Operating Activities 27 1,922,511 1,924,752 with Australian Accounting Standards (including small office furniture) where an accounting policy Australian Accounting Interpretations) and the choice exists whereby either a ‘right-of-use’ asset is Corporations (Aboriginal and Torres Strait Islander) recognised or lease payments are expensed to profit Cash Flows from Investment Activities Act 2006. The Corporation is a not-for-profit entity or loss as incurred. A liability corresponding to the for reporting purposes under Australian accounting capitalised lease will also be recognised, adjusted Proceeds from sale of assets - - standards. for lease prepayments, lease incentives received, Payments for property plant and equipment (3,504,742) (777,395) initial direct costs incurred and an estimate of any New Accounting Standards future restoration, removal or dismantling costs. The Net Cash Inflows/(Outflow) from Investing Activities (3,504,742) (777,395) Several new standards, amendments to standards corporation will adopt this standard from 1 July 2019 or interpretations have been promulgated by the but the impact of its adoption is yet to be assessed Australian Accounting Standards Board but are by the corporation. Net Increase/(Decrease) in Cash and Cash Equivalents (1,582,231) 1,147,357 effective for future reporting periods. The following Cash and cash equivalents at the beginning of the financial year 1,857,310 709,953 standards will need to be considered by the AASB 1058 Income of Not-for-Profit Entities Cash and cash equivalents at the end of the financial year 16 275,079 1,857,310 corporation; This standard is applicable to annual reporting periods beginning on or after 1 January 2019.The standard AASB 15 Revenue from Contracts replaces the current income recognition requirements with Customers in AASB 1004: Contributions. The new standard This standard is applicable for Not-for Profit entities is applicable to transactions that do not arise from on annual reporting periods beginning on or after enforceable contracts with customers involving 1 January 2019. The standard provides a single performance obligations, as such transactions are standard for revenue recognition. The core principle accounted for in accordance with AASB 15. AASB of the standard is that an entity will recognise 1058 requires the Corporation to recognise; revenue to depict the transfer of promised goods • Income immediately in profit or loss for the excess or services to customers in an amount that reflects of the initial carrying amount of an asset over the the consideration to which the entity expects to be related contributions of the corporation, increases in entitled in exchange for those goods or services. liabilities, decreases in assets and revenue; The standard will require: contracts (either written, verbal or implied) to be identified, together with the • Liabilities for the excess of the initial carrying separate performance obligations within the contract; amount of a financial asset (received in a transfer determine the transaction price, adjusted for the to enable the corporation to acquire or construct time value of money excluding credit risk; allocation a non-financial asset that is to be controlled by the of the transaction price to the separate performance corporation) over any related amounts recognised obligations on a basis of relative stand-alone selling in accordance with the relative standards. The price of each distinct good or service, or estimation liabilities must be amortised to profit or loss as approach if no distinct observable prices exist; and income when the corporation satisfies its obligations recognition of revenue when each performance under the transfer; and obligation is satisfied. Credit risk will be presented • Volunteer services or a class of volunteer services separately as an expense rather than adjusted to as an accounting policy choice if the fair value of revenue. The corporation will adopt this standard from those services can be measured reliably, whether or 1 July 2019 but the impact of its adoption is yet to be not the services would have been purchased if they assessed by the corporation. The above statement of cash flows should be read in conjunction with the accompanying notes had not been donated.

page 78 Danila Dilba Health Service ANNUAL REPORT 2017–2018 Danila Dilba Health Service ANNUAL REPORT 2017–2018 page 79 The corporation will adopt this standard from 1 July c. Employee benefits g. Goods and Services Tax a straight line basis so as to write off the net cost 2019 but the impact of its adoption is yet to be or other revalued amount of each asset over its assessed by the corporation. Provision is made for the Corporation’s liability for Revenue, expenses and assets are recognised net of expected useful life. The following estimated useful employee benefits arising from services rendered by the amount of goods and services tax (GST), except: lives are used in the calculation of the depreciation: Currency the employees at the end of the reporting period. • where the amount of GST incurred is not Employee benefits that are expected to be settled The financial report is presented in Australian dollars recoverable from the taxation authority, it is within one year have been measured at the amounts 2018 2017 and rounded to the nearest dollar. recognised as part of the cost of acquisition of an expected to be paid when the liability is settled. asset or as part of an item of expense; or Buildings 20 years 20 years Historical cost convention Non-current employee benefits payable later than Plant and Equipment 3 - 5 years 3 - 5 years one year have been measured at the present value • for receivables and payables which are recognised These financial statements, except for the cash of the estimated cash outflows to be made for those inclusive of GST. The net amount of GST Motor Vehicles 5 years 5 years flow information, have been prepared on an accrual benefits. In determining the liability, consideration recoverable from, or payable to, the taxation basis and are based on historical costs, modified Clinical Software 3 years 3 years is given to employee wage increases and the authority is included as part of receivables or where applicable, by the measurement at fair value probability that the employee may not satisfy vesting payables. of selected non-current assets, financial assets and requirements. Those cash outflows are discounted Policy treatment of revaluation financial liabilities. Cash flows are included in the Statement of Cash using market yields on corporate bonds rates with Flows on a gross basis. The GST component of An item of property, plant and equipment is The financial statements were authorised for issue on terms to maturity that match the expected timing of Cash Flows arising from investing and financing derecognised upon disposal or when there is no 31 August 2018 by the directors of the corporation. cash flows attributable to employee benefits. activities, which is recoverable from, or payable to, future economic benefit to the Corporation. Gains the taxation authority, is classified as operating and losses between carrying amount and the Critical accounting estimates d. Material estimates or judgements cash flows. disposal proceeds are taken to profit and loss. The preparation of financial statements in conformity In the preparation of the financial statements, with Australian Accounting Standards requires the management has made judgements, estimates and h. Trade and other receivables j. Impairment of assets use of certain critical accounting estimates. It also assumptions that affect the amounts reported for requires management to exercise its judgement Trade receivables are initially recognised at fair value. The corporation values the recoverable amount assets and liabilities as at the balance sheet date and in the process of applying Danila Dilba Biluru Butji Trade receivables are generally due for settlement of plant and equipment at the equivalent to its the amounts reported for revenues and expenses Binnilutlum Health Service Aboriginal Corporation’s within 30 days. depreciated replacement cost. Impairment exists during the year. Actual results may differ from these when the carrying value of an asset exceeds its (Danila Dilba Health Services) accounting policies. The collectability of debtors is reviewed on an estimates. Estimates and underlying assumptions estimated recoverable amount. are reviewed on an ongoing basis. Management ongoing basis. Debts which are known to be b. Revenue recognition policy have adopted a revaluation methodology with further uncollectible are written off by reducing the carrying Impairment losses are recognised in the income Revenue recognition for grant and donation income revaluation modelling to be reviewed in the upcoming amount directly at year end. A provision for statement unless the asset has previously been received is carried out on the following basis: financial year. impairment of trade receivables is raised when there revalued, when the impairment loss will be treated is objective evidence that the organisation will not as a revaluation decrement. i. it is probable that grant funding will be used for the e. Superannuation be able to collect all amounts due according to the designated purpose; original terms of the receivables. k. Financial Instruments Employee’s superannuation entitlements are ii. control has been obtained over the grant income; principally provided through the Australian Other receivables are recognised at amortised cost, Recognition Retirement Fund. Danila Dilba Biluru Butji Binnilutlum less any provision for impairment. iii. the grant income is measurable. Financial assets and liabilities are recognised and Health Service Aboriginal Corporation pays 9.5% derecognised upon trade date. Grant income that meets the above revenue of an employee’s salary as per the compulsory i. Property, plant and equipment recognition criteria is recorded as income in the year superannuation guarantee levy. When financial assets are recognised initially, they are of receipt. A liability is recognised when there is a Land measured at fair value. In the case of assets not at present obligation to repay unspent grant funds. The Land assets are valued at fair value, and are fair value through profit and loss, directly attributable 2018 2017 Directors have determined that a present obligation measured on the basis market value, being the transaction costs are taken into account. arises where the funding agreement specifically Full Time Equivalent revalued amount at the date of the revaluation. The Financial assets are derecognised when the states that unspent grant funds must be repaid and Employees as at 30 June 156.5 137.3 last independent valuation was done 27 February contractual rights to the cash flow from the financial the Corporation has not received permission from the 2017 by Colliers International Pty Ltd. Independent assets expire or the asset is transferred to another funding body to carry forward unspent grant funds revaluations are conducted every 3 to 5 years in f. Income tax entity. In the case of transfer to another entity, it is to the next reporting period. All other project related order to keep values current. Each year a desk top necessary that the risks and rewards of ownership income is fully recognised in the year of receipt. The income of Danila Dilba Biluru Butji Binnilutlum audit will also be done to ensure any unexpected are also transferred. Due to the level of complexity in reconciling Medicare Health Service Aboriginal Corporation is exempt from increases or decreases in value are not overlooked. income tax pursuant to the provisions of Section claims to actual Medicare receipts, Medicare income Plant and equipment is stated at cost less Financial assets is only recognised when received. 50-5 of the Income Tax Assessment Act, 1997. accumulated depreciation and any accumulated Financial assets are classified as either financial impairment losses. Depreciation is provided on assets at amortised cost or available-for-sale property, plant and equipment. Land is not a financial assets. depreciating asset. Depreciation is calculated on

page 80 Danila Dilba Health Service ANNUAL REPORT 2017–2018 Danila Dilba Health Service ANNUAL REPORT 2017–2018 page 81 Financial assets at amortised cost m. Cash and cash equivalents 2018 2017 Trade and other receivables, which generally have Cash and cash equivalents includes cash on hand, 30 day terms, are recognised initially at fair value and Note 2: deposits held at call with financial institutions, other Australian Government Financial Assistance subsequently measured at amortised cost using the short-term, highly liquid investments with original Department of Health 12,922,270 10,058,092 effective interest rate method, less an allowance for maturities of three months or less that are readily impairment. convertible to known amounts of cash and which Department of Social Services 2 8 4 , 8 2 0 492,000 Collectability of trade and other receivables is are subject to an insignificant risk of changes in Dept. of Prime Minister & Cabinet 894,424 885,646 reviewed on an ongoing basis. Individual debts that value. Where accounts at financial institutions are 14,101,514 11,435,738 are known to be uncollectable are written when overdrawn, balances are shown in current liabilities identified. An impairment provision is recognised on the balance sheet. when there is objective evidence that the Corporation Note 3: Northern Territory Government Financial Assistance will not be able to collect the receivable. n. Commitments Primary Health Network 2,383,987 1,770,973 Commitments are recognised when the Corporation Financial liabilities has a legal or constructive obligation, as a result of Northern Territory Government 1,265,914 651,131 The classification of financial liabilities depends on past events, for which it is probable that an outflow Dept. Children & Families 687,651 628,162 the purpose for which the liabilities were entered into. of economic benefits will result and that outflow can Danila Dilba Biluru Butji Binnilutlum Health Service be reliably measured. Commitments recognised 4,337,552 3,050,266 Aboriginal Corporation classifies its financial liabilities represent the best estimate of the amounts required in the following categories: to settle the obligation at reporting date. Note 4: Other Financial Assistance • financial liabilities at fair value through profit or loss; and o. Operating leases Northern Territory General Practice Education Ltd 1 , 3 6 1 , 4 9 7 1,134,045 • other liabilities. Lease payments for operating leases, where Other Grants 146,272 48,404 substantially all the risks and benefits remain with 1,507,769 1,182,449 Other financial liabilities the lessor, are recognised as an expense in the Total Grant Income 19,946,835 15,668,453 Other financial liabilities, including payables, are income statement on a straight-line basis over initially measured at fair value, net of any transaction the lease term. costs. Other financial liabilities are subsequently Note 5: measured at amortised cost using the effective p. Nature and purpose of reserves Medicare Receipts interest rate method, with interest expense Commonwealth Government Medicare Receipts 4,805,121 4,085,383 recognised on an effective yield basis. Land Revaluation Reserve The Land Revaluation Reserve is to record 4,805,121 4,085,383 Impairment increments and decrements in the fair value of land. Financial assets are assessed for impairment at Note 6: each balance date. Asset Replacement Reserve Sundry Income The Asset Replacement Reserve is to record funds If there is objective evidence that an impairment Bank Interest 11,178 12,471 set aside for the replacement of capital assets. loss has been incurred for financial assets held at Reimbursements 242,101 384,506 amortised cost or available-for-sale financial assets, Rent Income 82,417 28,700 the amount of the impairment loss is measured as the difference between the asset’s carrying amount Qumax 94,484 113,593 and the present value of estimated future cash flows NACCHO 66,535 - discounted at the asset’s original effective interest rate. The carrying amount is reduced by way of an Other Sundry Income 285,727 132,033 allowance account. The loss is recognised in the 782,442 671,303 profit or loss.

l. Trade and other payables

Liabilities for trade creditors and other amounts are carried at cost, which is the fair value of the consideration to be paid in the future for goods and services received, whether or not billed to the Corporation.

page 82 Danila Dilba Health Service ANNUAL REPORT 2017–2018 Danila Dilba Health Service ANNUAL REPORT 2017–2018 page 83 2018 2017 2018 2017

Note 7: Note 10: Administration Expenses Depreciation Accounting Fees 29,800 38,315 Buildings 2 4 4 , 4 7 9 148,539 Advertising - 5,983 Plant and Equipment 203,322 172,862 Bank Charges 10,684 - Motor Vehicles - - Board Governance Expense 86,479 - Clinical Software 28,547 22,138 Business Planning Report and Evaluation 82,602 - 476,348 343,539 Depreciation 476,348 343,539 Note 11: Information Technology Service 378,653 437,356 Motor vehicle Expenses Insurance 155,161 90,904 Fuel and Oil 74,351 78,959 Interest Expense 7,641 - Lease Expense 411,295 332,525 Lease – Plant and Equipment 64,075 37,456 Repairs and Maintenance 29,173 18,809 Legal Service 65,670 166,966 Registration 3,542 1,714 Membership Fees 64,279 29,532 518,361 432,007 Postage 32,632 26,736 Note 12: Stationery 78,303 28,493 Operation Expenses Telephone 176,789 117,506 Advertising and Promotions 218,273 46,180 Other 56,019 63,237 Agency Staff 92,848 23,393 1,765,135 1,386,023 Cleaning 480,009 332,243 Client Services 254,667 162,367 Note 8: Employee Benefits Expenses Consultants 300,122 317,444 Fringe Benefit Tax (10,272) 9,886 Consumables - 70,550 Salaries 16,185,546 13,331,647 Dental Supplies 3,566 3,322 Superannuation 1,426,776 1,167,000 GP Locums 49,822 55,005 Work Cover 225,143 168,368 Health and Safety 70,879 - Staff Training 138,816 125,683 Library Services - 8,819 Other 164,119 175,322 Medical Supplies 508,122 592,501 18,130,128 14,977,906 Minor Equipment Purchases 269,005 89,972 NACCHO Expenditure 66,595 - Note 9: Project Expenditure - 337,453 Bad and Doubtful Debts Expense Publications and Resources 85,479 - Bad Debts 2,049 - QUMAX Expenditure 94,484 - 2,049 - Rent Expenditure 1,104,073 809,191 Repairs and Maintenance 208,267 154,521 Security 253,230 208,998 Utilities 156,813 134,673 Other 8,263 25,505 4,224,517 3,372,137

page 84 Danila Dilba Health Service ANNUAL REPORT 2017–2018 Danila Dilba Health Service ANNUAL REPORT 2017–2018 page 85 2018 2017 (b) Impaired receivables

Note 13: As at 30 June 2018, current receivables with a nominal value of $138,798 (2017: $38,324) Rental Property were past due but not impaired. These relate to a number of customers for whom there is no history of default. Rental Property 10,609 - 10,609 - Note 14: 2018 2017 Travel Note 19: Travel and Accommodation 183,607 174,246 Property Plant and Equipment 183,607 174,246 Clinical Software – at Cost 444,479 388,308 Note 15: Accumulated Amortisation and Impairment (383,432) (354,885) Assets Written Off Written Down Value 61,047 33,423 Assets Written Off - - Land – at Fair Value 5,150,000 5,150,000 - - Buildings 6,698,378 3,882,684 Note 16: Cash and Cash Equivalents Accumulated Depreciation and Impairment (1,485,428) (1,451,365) Cash at Bank 273,179 1,855,410 Written Down Value 10,362,950 7,581,319 Cash on Hand 1,900 1,900 Plant and Equipment - at Cost 1,981,658 1,583,501 275,079 1,857,310 Accumulated Depreciation and Impairment (1,379,566) (1,171,387) Note 17: Written Down Value 602,092 412,114 Other Current Assets Website Work in Progress - at Cost 29,160 - Bond Paid 81,991 54,160 Accumulated Depreciation and Impairment - - Prepayments 58,862 - Witten Down Value 29,160 - Other 19,758 13,498 Total Written Down Value 11,055,249 8,026,856 160,611 67,658 Note 18: A Land Revaluation was conducted on 27 February 2017 by an Independent Valuer - Trade and other Receivables Colliers International. 32 and 36 Knuckey Street were revalued with no change in value to 36 Knuckey and a decrease in value of $450,000 for 32 Knuckey Street. Land assets are Trade Debtors 229,950 60,810 valued at fair value, and are measured on the basis market value, being the revalued amount Other Debtors – Grants and Medicare 32,955 730,910 at the date of the revaluation. No items of Property, Plant and Equipment are expected to 262,905 791,720 be sold or disposed of within the next 12 months

(a) Trade receivables and allowances for doubtful debts

Trade receivables are non-interest bearing and are generally on 30 day terms and are expected to be settled within 12 months. The ageing of trade receivables is detailed below:

2018 2017 Gross Allow. Gross Allow. Not Past Due 124,107 - 753,396 - Past Due 0-30 Days 70,785 - 5,500 - Past Due 31-60 Days 2,046 - 17,760 - Past Due 61-90 Days - - 150 - Past Due 90 Days & Over 65,967 - 14,914 - 262,905 - 791,720 -

page 86 Danila Dilba Health Service ANNUAL REPORT 2017–2018 Danila Dilba Health Service ANNUAL REPORT 2017–2018 page 87 Year Ended 30 June 2018 Land & Plant & Work in Clinical 2018 2017 Property Equipment Progress Software Total Opening Net Book Amount 7 , 5 8 1 , 3 1 9 412,114 - 33,423 8,026,856 Note 23: Other Liabilities Additions 3,026,110 393,300 - 56,171 3,475,581 Tax Payable 442,734 536,252 Disposals - - - - - Unspent Grant Funds 59,931 720,454 Work in Progress - - 29,160 - 29,160 Grants Funds Received in Advance 613,718 502,823 Depreciation (244,479) (203,322) - (28,547) (476,348) Closing Book Amount 10,362,950 602,092 29,160 61,047 11,055,249 Employee Liabilities ( 1 4 , 0 2 1 ) 78,923 1,102,362 1,838,452

Year Ended 30 June 2017 Land & Plant & Work in Clinical Property Equipment Progress Software Total Note 24: Loan Payable Terms and Repayment Schedule Opening Net Book Amount 7,503,524 512,311 - 27,165 8,043,000 as at 30 June 2018 Additions 676,334 72,665 - 28,396 777,395 Opening Balance 28 February 2018 241,000 - Disposals - - - - - Current 17,029 - Depreciation (148,539) (172,862) - (22,138) (343,539) Non-current 223,971 - (450,000) Revaluation (450,000) - - - Closing Balance 30 June 2018 223,971 - Closing Book Amount 7,581,319 412,114 - 33,423 8,026,856

The loan is secured against the Fit-Out Works completed. This loan is repayable in instalments over 5 years. Interest is charged on the principal sum at a rate of 7% nominal interest per annum (interest paid 2018: $6,832) compounding monthly until the expiry date of the lease or the date 2018 2017 on which the principal and all interest is paid in full.

Note 20: Note 25: Accrued Expenses Operating Leases Accrued Employee Benefits and On-costs 127,814 110,865 Vehicle Operating Leases Accrued Expenses 29,800 29,683 Payable Within 12 Months 332,868 215,185 157,614 140,548 Accrued expenses are expected to be settled within 12 months. Payable 12 Months – 5 Years 423,812 187,498 756,680 402,683 Note 21: Contingencies There are no contingent liabilities or assets in the current year. The motor vehicle lease commitments are non-cancellable operating leases contracted for with a two or three year term. No capital commitments exist with regards to the lease commitments at Note 22: year end. The lease payments are constant throughout the term of the lease. Provisions Current Premises Operating Lease Employee Benefits Payable Within 12 Months 1,276,793 932,172 Annual Leave 9 6 9 , 9 5 6 810,087 Payable 12 Months – 5 Years 3,108,600 2,315,909 Long Service Leave 353,589 284,397 4,385,393 3,248,081 1,323,545 1,094,484 Non-Current Premises lease commitments are non-cancellable leases contracted for between three year and ten Employee Benefits year terms in general. No capital commitments exist with regards to the lease commitments at year Long Service Leave 1 5 1 , 4 9 1 131,377 end. Lease payments are constant throughout the term of the lease. 151,491 131,377 Total Provisions 1,475,036 1,225,861

page 88 Danila Dilba Health Service ANNUAL REPORT 2017–2018 Danila Dilba Health Service ANNUAL REPORT 2017–2018 page 89 2018 2017 Market Risk Interest Rate Risk Market risk is the risk that changes in market Interest rate risk is the risk that the fair value Note 26: prices, such as interest rates and equity prices or future cash flows of a financial instrument will Reconciliation of Operating Result will affect the Corporation’s income or the value fluctuate because of changes in interest rates. to Net Cash Inflow From Operating Activities of its holding of financial instruments. Exposure to The Corporation manages its interest rate risk Operating Result 699,991 82,819 market risk is closely monitored by management by maintaining floating rate cash and fixed and carried out within guidelines set by the Board. rate debt. Depreciation and Impairment 476,348 343,539 The Corporation does not have any material Assets Written Off - - market risk exposure. Gain on Disposal of Assets - - Total 1,176,339 426,358 Sensitivity Analysis At balance date, the Corporation had the following assets exposed to variable interest rate risk: Changes in Assets and Liabilities (Increase)/Decrease In Trade and other Receivables 528,815 (483,406) 2018 2017

(Increase)/Decrease In other Current Assets (92,953) 109,198 Financial Assets $ $ Increase/(Decrease) In Unexpended Grants (549,628) 1,223,277 Cash At Bank 273,179 1,855,410 Increase/(Decrease) In Trade and other Payables, including accruals 573,254 (28,736) Total Financial Assets 273,179 1,855,410

Increase/(Decrease) In Employee Provisions 249,175 228,154 There are no financial liabilities exposed to variable interest rate risk. Increase/(Decrease) In Other Liabilities 37,508 449,907 The table below details the interest rate sensitivity analysis of the Corporation at balance date, Total Change in Assets and Liabilities 746,171 1,498,394 holding all variables constant. A 100 basis point change is deemed to be a possible change and Net Cash Generated From/(used) in Operating Activities 1,922,510 1,924,752 is used when reporting interest rate risk.

Effect on P&L Effect on Equity Effect on P&L Effect on Equity Note 27: Financial Risk Management 2018 2018 2017 2017 $ $ $ $ The main risks the Corporation is exposed to exposure to credit risk, excluding the value of Base Points + 1% 2,732 2,732 18,554 18,554 through its financial instruments are liquidity risk, any collateral or other security, is limited to the credit risk, market risk, interest rate risk, and total carrying value of financial assets, net of any Base Points - 1% (2,732) (2,732) (18,554) (18,554) concentration of credit risk. provisions for impairment of those assets, as disclosed in the balance and notes to the financial The table below reflects the undiscounted contractual settlement terms for the financial Liquidity Risk statements. instruments of a fixed period of maturity, as well as management’s expectations of the Liquidity risk is the risk that the Corporation will The Corporation has a concentration of credit settlement period for all financial instruments. not be able to meet its obligations as and when risk where all the Corporations cash is held with they fall due. The Corporation manages its liquidity 30 June 2018 Within 1 – 5 Over Total the one banking institution, Westpac Banking 1 year years 5 years Carrying risk by monitoring cash flows and also through its Corporation. Financial Assets are monitored budget management process. Due to the nature of Financial Assets – $ $ $ $ regularly with zero financial assets past due nor Cash Flow Realisable its business, the Corporation is able to estimate its impaired at balance date. Further there have Cash and Cash Equivalents 275,079 - - 275,079 income and expected expenditure on a seasonal been no credit terms renegotiated. Management basis based on grant funding release timeframes. have investigated further banking options where Trade and other Receivables 262,905 - - 262,905 a second banking institution will be negotiated Credit Risk Other Current Assets 160,611 - - 160,611 during 2018 financial year to allow for decreased Credit risk is the risk of financial loss to the credit risk and business interruption risks that may Total 698,595 - - 698,595 Corporation if a customer or counterparty to a occur due to locational regions. Management have financial instrument fails to meet its contractual established business continuity plans, policies and Financial Liabilities obligations. Exposure to credit risk is monitored by procedures to mitigate operational banking risks. Due for Payment management on an ongoing basis. The maximum Accrued Expenses 127,184 - - 127,184 Trade and other Payables 892,890 - - 892,890 Other Liabilities - - - - Loan 57,265 205,200 - 262,465 Total 1,077,169 205,200 - 1,283,169

page 90 Danila Dilba Health Service ANNUAL REPORT 2017–2018 Danila Dilba Health Service ANNUAL REPORT 2017–2018 page 91 Within 1 – 5 Over Total ii. Valuation Techniques Year Ended 30 June 2017 1 year years 5 years Carrying A valuation technique that is appropriate in the a valuation technique, priority is given to those Financial Assets – $ $ $ $ circumstances and for which sufficient data is techniques that maximise the use of observable Cash Flow Realisable available to measure fair value. The availability of inputs and minimise the use of unobservable Cash and Cash Equivalents 1,857,310 - - 1,857,310 sufficient and relevant data primarily depends on inputs. Inputs that are developed using market the specific characteristics of the asset or liability data (such as publicly available information on Trade and other Receivables 791,720 - - 791,720 being measured. The valuation techniques selected actual transactions) and reflect the assumptions Other Current Assets 67,658 - - 67,658 are consistent with one or more of the following that buyers and sellers would generally use valuation approaches: when pricing the asset or liability are considered Total 2,716,688 - - 2,716,688 observable, whereas inputs for which market - Market Approach: valuation techniques that use data is not available and therefore are developed Financial Liabilities prices and other relevant information generated Due for Payment using the best information available about such by market transactions for identical or similar assumptions are considered unobservable. Accrued Expenses 110,865 - - 110,865 assets or liabilities The Corporation has adopted the market approach Trade and other Payables 320,692 - - 320,692 - Income Approach: valuation techniques that which determines the appraisal value of an asset convert estimated future cash flows or income Other Liabilities 1,302,200 - - 1,302,200 based on the selling price of similar items using and expenses into a discounted present value Total 1,733,757 - - 1,733,757 direct comparison, analysed on a rate per square - Cost Approach: valuation techniques that reflect metre of site area. Management acknowledge and the current replacement costs of an asset at its support the requirement for the selected Valuer to Fair Value i. Fair Value Hierarchy current service capacity remain independent from the Corporation. The carrying amount of assets and liabilities is AASB 13: Fair Value Measurement requires the Each valuation technique requires inputs that The following table provides the fair values of the equal to their net fair value. The following methods disclosure of fair value information by level of the reflect the assumptions that buyers and sellers company’s assets measured and recognised as and assumptions have been applied: fair value hierarchy, which categorises fair value would use when pricing the asset or liability, a recurring basis after initial recognition and their measurements into one of three possible levels Recognised financial instruments including assumptions about risks. When selecting categorisation within the fair value hierarchy: based on the lowest level that an input that is Cash, cash equivalents and interest bearing significant to the measurement can be categorised deposits: The carrying amount approximates fair into as follows: Freehold Land Level 1 Level 2 Level 3 Total value because of their short-term to maturity. Level 1 32 Knuckey St - 3,050,000 - 3,050,000 Receivables and Creditors: the carrying amount Measurements based on quoted prices approximates fair value due to their short term to 36 Knuckey St - 2,100,000 - 2,100,000 (unadjusted) in active markets for identical assets maturity. or liabilities that the entity can access at the Total at Fair Value - 5,150,000 - 5,150,000 Note 28: measurement date. Recurring Fair Value Measurements Level 2 The fair value measurement amounts of freehold land include office buildings in Darwin in close The following assets are measured at fair value Measurements based on inputs other than quoted proximity to the CBD. on a recurring basis using the market approach prices included in Level 1 that are observable for method after initial recognition: the asset or liability, either directly or indirectly. Note 29: -freehold land Key Management Personnel Compensation Level 3 No liabilities are measured at fair value on a Measurements based on unobservable inputs for The aggregate compensation made to directors recurring basis or any assets or liabilities at fair the asset or liability. and other members of key management personnel value on a non-recurring basis. is set out below. The fair values of assets and liabilities that are not traded in an active market are determined using one or more valuation techniques. These 2018 2017 valuation techniques maximise, to the extent Key Management Personnel Compensation possible, the use of observable market data. If all significant inputs required to measure fair value are Short Term Employee Benefits 1,429,503 1,852,771 observable, the asset or liability is included in level Post-Employment Benefits 9,659 58,154 2. If one or more significant inputs are not based on observable market data, the asset or liability is Total 1,439,162 1,910,925 included in level 3.

page 92 Danila Dilba Health Service ANNUAL REPORT 2017–2018 Danila Dilba Health Service ANNUAL REPORT 2017–2018 page 93 Note 30: Note 31: Note 35: Related Parties Economic Dependency Statement of Unspent Grants Received during the Year During the financial year ended 30 June 2018, The management of grant funded projects by no loans or other related party transactions were Danila Dilba Health Service is dependent on 2018 2017 made to any Board member or key management continued funding from the Commonwealth personnel. In 2017/18, no Board members were and Northern Territory Governments. Dept. of Health paid sitting fees (2016/17:$nil). No sitting fees Australian Nurse Family Partnership - 301,916 were paid from grant funds. Note 32: Events Occurring after Capital Funding Palmerston Clinic - 22,450 Balance Sheet Date Capital Funding Darwin Clinic - 204,250 The directors are not aware of any significant Indigenous Sexual Health 573,718 - events since the end of the reporting period. 573,718 528,616

Note 33: Northern Territory Government Auditors’ Remuneration General Practice Education - 60,000 2018 2017 Mobile Clinic - - Amounts Received or Due and Receivable by Primary Health Network SEWB - 191,838 the auditors of Danila Dilba Health Service Primary Health Network Choosing Wisely 20,890 - Audit or Review Service 29,800 29,683 Territory Families Safe, Respected and 40,000 - Other Services - 8,632 Free Violence Prevention Total 29,800 38,315 60,890 251,838

Prime Minister and Cabinet Note 34: Statement of Funding Sources Alcohol and Other Drugs - 277,011 Emotional and Social Wellbeing - 165,812 2018 2017 NAIDOC Palmerston 29,972 - Department of Health 12,922,270 10,058,092 29,972 442,823 Department of Social Services 284,820 492,000 South Australian Health and Medical Dept. Children and Families 687,651 628,162 Research Institute Ltd Northern Territory Government 1 , 2 6 5 , 9 1 4 651,131 SAHMRI Goanna Survey 9,069 - Dept. Prime Minister & Cabinet 894,424 885,646 9,069 - Northern Territory General Practice Education Ltd 1,361,497 1,134,045 Primary Health Network Northern Territory Ltd. 2,383,987 1,770,973 Gross Total of Unspent Project Funds 673,649 1,223,277 Other Grants 146,272 48,404 Unspent Grants received during the year vary from Unexpended Grants shown as a liability in the Medicare 4,805,121 4,085,383 Statement of Financial Position depending on whether the grant is ‘Reciprocal’ and whether a present Bank Interest 11,178 12,471 obligation to repay the funds exists at balance date. Reimbursements 242,101 687,854 Sundry Income 529,163 274,326 25,534,398 20,728,487

page 94 Danila Dilba Health Service ANNUAL REPORT 2017–2018 Danila Dilba Health Service ANNUAL REPORT 2017–2018 page 95 Directors’ Declaration

The members of the Governing Committee of Danila Dilba Biluru Butji Binnilutlum Health Service Aboriginal Corporation, hereby state that in their opinion: 1. the financial statements and notes are in accordance with the Corporations (Aboriginal and Torres Strait Islander) Regulations 2007 (CATSI Regulations), including: a. compliance with the accounting standards; and b. providing a true and fair view of the financial position and performance of the Corporation and the Consolidated group; and 2. there are reasonable grounds to believe that the Corporation will be able to pay its debts when they become due and payable.

Made in accordance with a resolution of the Directors on 2 November 2017.

Mrs Carol Stanislaus Mrs Nicole Butler Chairperson Deputy Chairperson

page 96 Danila Dilba Health Service ANNUAL REPORT 2017–2018 Danila Dilba Health Service Regular clients

Northern suburbs North- % eastern 15 suburbs 18%

AIRPORT Palmerston and surrounds 30%

Fannie Bay Darwin city to Berrimah 7% 19%

Rural areas 4%

Rest of NT Outside % of NT 5 1%

GPO Box 2125, Darwin NT 0801 Malak Clinic [email protected] 3/1 Malak Place, Malak www.ddhs.org.au (08) 8920 9500

Corporate Services Men’s Clinic 1st Floor, 28 Knuckey St, Darwin 42 McLachlan St, Darwin (08) 8942 5400 (08) 8942 5495

Community Services Gumileybirra Women’s Health Service Ground Floor, 28 Knuckey St, Darwin (08) 8942 5400 4/7 Rolyat St, Palmerston (08) 8931 5700 Bagot Community Clinic Palmerston Health 133 Bagot Rd, Ludmilla (08) 8942 5380 1/7 Rolyat St, Palmerston (08) 8931 5711 Darwin Clinic Rapid Creek Clinic 32-34 Knuckey St, Darwin (08) 8942 5444 Rapid Creek Business Village, Shop 35, 48 Trower Rd, Millner (08) 8942 5350

page 98 Danila Dilba Health Service ANNUAL REPORT 2017–2018 Danila Dilba Health Service ANNUAL REPORT 2017–2018 page 99