1. society
2. gay life

National LGBTI Health Alliance lesbian, gay, bisexual, transgender, and intersex people and other sexuality and gender diverse (LGBTI) people and communities PO Box 51 Newtown NSW 2042 (02) 8568 1120 Executive Director: Rebecca Reynolds 1 April 2015 Committee Secretary Senate Standing Committees on Community Affairs PO Box 6100 Parliament House Canberra ACT 2600 Sent via email to community.affairs.sen@aph.gov.au Dear Committee Secretary RE: The impact on service quality, efficiency and sustainability of recent Commonwealth community service tendering processes by the Department of Social Services The National LGBTI Health Alliance appreciates this opportunity to share our concerns about the impact on service quality, efficiency and sustainability of recent Commonwealth community service tendering processes by the Department of Social Services (DSS). About the National LGBTI Health Alliance The Alliance is the national peak health organisation for organisations and individuals from across Australia that work together to improve the health and wellbeing of lesbian, gay, bisexual, transgender, and intersex people and other sexuality and gender diverse (LGBTI) people. We support measures that contribute to improved health and wellbeing for all LGBTI people in Australia. Formed in 2007, the Alliance has 89 Member Organisations that include the major providers of services for LGBTI people in each state and territory across Australia. The Alliance provides a representative national voice to: develop policy and to support LGBTI health issues; seek increased commitment to services for LGBTI people; develop the capacities of LGBTI organisations; and support evidence-­‐based decision-­‐making through improved data collection covering sexuality, gender identity, and intersex characteristics. Concerns regarding DSS tendering processes The Alliance and our member organisations have had adverse experiences with distinct aspects of DSS tendering processes for Commonwealth community service funding. Several organisations agreed that the post-­‐award funding process during the grant period seemed convenient and accessible. For example, the Gay and Lesbian Welfare Association (GLWA) Convenor Robert Collins shared the comments of GLWA Treasurer Bill Rayment, whom Rob consulted for advice of any problems or concerns they may have had in complying with the terms of our QLife grant with the Federal Government. Bill reported a smooth and manageable process: From my viewpoint, I think it has actually gone really well. We have had a reasonable level of transparency in terms of signing a contract between ourselves and the Alliance and the financial aspects of claiming monthly monies etc has been straight forward. Page 1 of 7
It is important to note that Bill’s positive comments focused on the experience of engaging with the Alliance during the actual funding period and not on the application or renewal processes. As one of the Alliance’s local partners in our national QLife project, Bill’s positive experience highlights the benefits that smaller organisations can achieve from working with national peak bodies such as the Alliance. Bill’s feedback also illustrates the potential of the Alliance to reach communities across Australia through the competitive funding and tendering we receive. Although Bill’s experience of QLife funding at one of the Alliance’s local partner organisations has been a positive one, the Alliance and several other local partner organisations had concerns about other aspects of the tendering process. In the case of QLife, the delayed Commonwealth funding receipt process following the formal announcement of the funding decision meant that the Alliance faced pressure to sign an agreement that involved five state-­‐based organisations within only four weeks. This time period was too limited for some of the partners with minimal to no core funding for operational and administrative functions. As a result of pressure on the Alliance from the Commonwealth Government, the Alliance was placed in the unfortunate position of having to put pressure on potential partner organisations with disparate organisational cultures and resources. In some cases, these local partners would have needed several months to achieve meaningful collaboration, develop Memoranda of Understanding (MOUs), consult with their members, gain approval from their volunteer Board of Directors, and build the partnership relationship adequately prior to signing the formal agreement. The demand for rapid turnaround at the onset of the tendering process has had an ongoing, adverse impact on the resources of QLife partner organisations. The Commonwealth Government has previously communicated to the Alliance that equal partnerships are a priority and noted that the community sector does not typically function with the same consistency and professionalism as private organisations. However, this claim displays limited awareness of key structural distinctions between the community and private sectors. Community sector organisations cannot be compared meaningfully to private companies, as private companies typically have national structures enshrined in formal articles of incorporation and standardised company policies based on relevant legal requirements. In contrast, community sector organisations are typically unincorporated, may or may not have deductible gift recipient (DGR) status, and may or may not have core funding for operational and administrative functions. Indeed, many of our member organisations remain entirely unfunded. In addition, community sector organisations often need time to consult with members and submit proposals for review by volunteer Board members. The positive impacts of community sector interventions can be difficult to identify until after the funding period has concluded and associated reporting deadlines have passed. Thus the reliance on short-­‐term funding makes it difficult to document the success of community sector interventions. The Alliance receives Secretariat funding for core administrative functions that support all of our national projects, members, and community engagement efforts to remain operational. Although we are pleased that the Commonwealth has granted the Alliance 6 months of interim Secretariat funding, this limited time period provides only a few months of ‘breathing room’. The short span of our known funding allocation means that we are currently unable to plan any collaboration beyond December 31st. This limitation means we are unable to continue the long-­‐term sector development work that has been pivotal to our success. We also note that our members have reported tensions that result when state-­‐based organisations that receive federal funding are subject to the same tendering processes as national organisations. Yet national organisations are more likely than state-­‐based organisations to possess core funding that can enable their timely completion of operational and administrative tasks required for successful progression through Commonwealth tendering processes. Page 2 of 7
One of our state-­‐based member organisation, The Gender Centre, expressed serious concerns about Commonwealth tendering processes. As Executive Director Phinn Borg noted, “the Gender Centre has been providing services to trans and gender diverse populations across NSW for over thirty years. The Gender Centre is a Specialist Homelessness and Health related service providing supported transitional housing and health related services to trans and gender diverse populations of NSW.” These populations continue to encounter discrimination, insufficient knowledge of their basic needs, and inadequate service delivery at organisations that receive Commonwealth funding for services to the population at large. Phinn described the diverse services that The Gender Centre provides “to build the capacity of trans and gender diverse populations of NSW to make informed choices through the provision of a wide range of services, activities, information and resources. The wide range of services provided by the Gender Centre include: ·∙ Counselling (including drug and alcohol counselling service); ·∙ Outreach (including night outreach, court, cell and gaol outreach); ·∙ Crisis accommodation program; ·∙ Transitional accommodation program; ·∙ Homelessness prevention and early-­‐intervention program; ·∙ Tenancy support program; ·∙ Case Management (including to residents, community clients and inmates) ·∙ Aged and ageing support care services; ·∙ Resource development service (library, kits and fact sheets, magazine, website); ·∙ Transgender anti-­‐violence project; ·∙ Training and support for clients, service providers, partners and loved ones; ·∙ Training to employers with staff members transitioning in the workforce ·∙ Social events and workshops; ·∙ Support groups for men, women, youth, over 55s, parents of Transgender youth and Queer-­‐
identified people: ·∙ Safe Space Project: ·∙ Greater Western Suburbs Case Management service supporting clients living in Penrith, Richmond, Windsor, and the Blue Mountains ·∙ Rural & Regional Support Outreach Services: The Gender Centre established a memorandum of understanding with Dubbo Sexual Health Clinic to provide specialised, on site face to face outreach services to transgender and gender diverse people in the Dubbo, Bathurst, and Orange region on a regular basis. Please note all services provided by the centre are state wide.” Phinn raised concerns that uncertainty regarding continued funding places a great deal of stress on current staff and the lack of additional Commonwealth funding means that current staff are often stretched beyond capacity. Service demands also far outweigh current state-­‐based funding allocations, with limited access to Commonwealth funding that could address these gaps. For example, the Gender Centre’s current funding agreement states that the Centre is required to deliver services to 87 clients within the year in relation to Homelessness. As Phinn explained, “the reality is that the Centre has ‘no turn away’ policies and aims to support all transgender and gender diverse people in the state of NSW; this means the staff deliver services to well beyond 87 individual clients. However, they do so within the funding boundary’s allocated to the initial 87 clients.” Unfortunately, access to Commonwealth funding for the Centre’s many programs has been challenging. Phinn identified the following problems: Page 3 of 7
·∙ Funding is for 18 and over on the homelessness side, there is a massive gap as there is no support allocation for families with transgender children or young people under the age of 18 who do not wish to access an LGBTI homogeneous service. ·∙ Funding does not meet the client demand experienced by the Gender Centre this means there is a lot of time spent looking for alternate income streams such as small grants. ·∙ Health Funding does not meet client demand. Currently, the Centre has one counsellor providing face-­‐to-­‐face counselling services to over 270 clients. The Over 55 position, which is currently funded by the DSS Division of Ageing and Aged Care, requires a commitment to ongoing funding from a duty of care perspective. As Phinn explained: The transgender community has an increasing ageing population, generic aged care service providers are still struggling with understanding the unique needs of this ageing population, and transgender people are still cautious about accessing main stream services the value of the Gender Centre’s ages care specialist is that she helps facilitate bridging the divide between the needs of trans clients and the provision of those services by generic aged care facilities. She is able to advocate on behalf of aged trans people to access the supports to remain in their family home, or in circumstances where it is necessary she is able to help ageing trans people and their families find suitable accommodation in high care facilities. The role of the over 55 support staff has also been to help clients navigate the complexities of advanced care planning. This is included accessing legal support for the preparation of Wills, advanced care directives, enduring guardianship and enduring power of attorney. This is particularly significant as many of our ageing trans clients do not have immediate next of kin or family members they trust and as such they need support to ensure that their wishes for their future care is given full consideration and is protected. Many ageing trans people are socially isolated, the social support component of the over 55’s role means that ongoing opportunities for a regular support group to be convened is maintained. This support group not only meets psycho-­‐social needs but also provides opportunity for education and information about issues that are relevant to this ageing population. Funding for the over 55 position is due to finish next year. Funding required to sustain the over 55 position is $95,000 per annum, which includes wages, super, annual leave loading, travel, printing, and rent. The following case example illustrates the pivotal role of the over 55 support worker: A transgender lady, aged 78, came to be referred to the over 55 support worker. She was living in her own home, but had multiple admissions to hospital due to falls, and injury due to poor care capacity. The Over 55 worker initially met with therapists and paramedical support providers including ENABLE to discuss what measures could be undertaken to allow the client to remain in her own home. During this time respite care in an aged care facility was also sourced. The over 55 worker was integral to finding a suitable aged care facility that would support the transgender woman to not only receive the specialised care she needed in relation to her transgender identity and associated physical care, but also with respect to her religious beliefs (as she was a deeply Christian woman). Page 4 of 7
The Over 55 worker was able to support the transgender woman client into a denominational service that suited all of her needs. When it became evident that the option of remaining in her own home could not be fulfilled as her declining health placed her at significant risk, the over 55 worker again became her best advocate to assist not only the transgender client but also her family with the grieving and acceptance process that arises when placing a very loved family member in a nursing care facility. Over the following months the Over 55 worker continued to provide support to the client as her health deteriorated. The cultural connections of being linked to a representative from her own community was an important part of her daily life as she missed the connection of chatting to other people who understood transgender people and their experiences. The work undertaken by the over 55 worker meant that when the lady passed away earlier this year she did so in a safe place surrounded by family who accepted and valued her, including a son whom she had been estranged from for a number of years due to her gender diversity. The worker attended the funeral and was able to continue to provide positive support about the value, significance and joy her client had experienced living in her true gender. If Commonwealth funding for this position were discontinued, the loss of expertise would be severely detrimental. Although the Gender Centre’s case workers would be able to continue running the over 55 support group and to provide some basic casework services, they would not have the skills, common knowledge or nursing qualifications that are quintessential to this role. The inability to make future client bookings and the limited time to establish transitional service plans under the existing Commonwealth tendering process places clients at significant risk for negative medical and mental health outcomes. Unfortunately, the Alliance has received numerous reports from member organisations regarding the lack of transparency in Commonwealth tendering processes. While competitive funding and tendering given to the Alliance has allowed us to provide financial support to marginalised communities, pockets of federal funding given directly to small organisations often require unrealistic operational and administrative burdens for which these organisations are not sufficiently funded. Several member organisations reported the limitations that existing tendering processes place on opportunities for genuine collaboration or community participation in funding decisions. Unsuccessful tender applicants have reported frustration with the lack of timely notification and reported their limited awareness of possible mechanisms for feedback or appeal. Disruptions to service delivery as a result of contractual changes can place people engaging with services at substantial safety risk. In addition, service providers often receive Commonwealth funding for projects targeted to meet the needs of DSS priority populations, despite those service providers having limited to no demonstrated prior experience or sensitivity regarding the unique needs and concerns of those populations. Commonwealth tendering processes do not typically involve a vetting process during which the Department can investigate whether a service actually possesses the skills, knowledge, and/or community contacts to deliver optimal services to these priority populations. For example, when general service providers receive funding to provide services for older LGBTI people, these service providers rarely engage in consultation, collaboration, or partnership with LGBTI organisations. The Alliance receives frequent requests for very basic level information from service providers either applying for LGBTI-­‐specific Commonwealth funding or commencing projects that have been awarded LGBTI-­‐specific Commonwealth funding. The rudimentary nature of the questions most frequently asked by these service providers reveals their inadequacy in providing the services for which they have sought and/or received Commonwealth funding. Community engagement typically does not occur until after successful funding allocation, if at all, which means that some project proposals are developed and even Page 5 of 7
implemented without any consideration for the actual needs and concerns of those whom these projects purport to help. In addition, we have heard complaints from some LGBTI constituents that some funding allocations have been made without any Commonwealth review regarding whether an LGBTI service provider has sufficient knowledge and skills to provide services to all of the distinct (but sometimes overlapping) populations within ‘LGBTI’, thus leading to nominally inclusive programs that do not adequately include all populations within LGBTI. Only minimal Commonwealth funding has been allocated to address the unique needs of individual populations within ‘LGBTI’. In some rural and remote areas, our members have expressed concerns about the lack of funding for LGBTI-­‐related medical and mental health services outside of HIV-­‐specific contexts. Although advocacy by funded community organisations is often the only way for LGBTI people to receive adequate service delivery from service providers, Commonwealth tendering processes have historically devalued these services or classified them as irrelevant to direct service delivery. The health disparities that can result from Commonwealth tendering processes extend beyond DSS. Earlier this year, the Commonwealth-­‐funded National Health and Medical Research Council (NHMRC) announced $5.5 million in funding over 5 years for research at Murdoch Children's Research Institute on "disorders of sex development" (sic). This pathologising language and perspective on people with intersex variations was specifically implicated in the ongoing involuntary and coerced medical interventions to which people with intersex characteristics are subjected in Australia. As noted in the Senate Report on the Involuntary or coerced sterliisation of intersex people in Australia, a shift in approach is needed to avoid continued human rights violations within medical settings. We are concerned that, as of 2015, the Commonwealth tendering process for NHMRC funding did not consider the health disparities and human rights implications of Commonwealth funding decisions. We are deeply concerned by the contrast between this $5.5 million in Commonwealth funding and the total lack of Commonwealth funding for our member organisations Androgen Insensitivity Syndrome Support Group Australia (AISSGA) and Organisation Intersex International (OII) Australia. These two organisations are the only national intersex organisations that provide support and education-­‐-­‐ particularly to help people who experience trauma as a result of unwanted medical interventions that are likely to be directly or indirectly perpetuated by this NHMRC funding. Despite the increasing evidence of disproportionately negative health outcomes among LGBTI populations, the Alliance understands that the NHMRC has historically declined to fund community sector organisations focused on LGBTI populations. The contrast between this lack of community funding and the substantial funding granted to researchers who study these populations in non-­‐consultative and often disrespectful ways means that Commonwealth funding decisions can exacerbate existing social exclusions, marginalisation, and medical mistreatment. RECOMMENDATIONS To our knowledge, this is the first time DSS has consulted the community sector on the tendering process. We commend the Department for taking this important step to improve these processes through community consultation. To address the above concerns with the Commonwealth community service tendering processes by the Department of Social Services, we make five key recommendations: Recommendation 1: That the Commonwealth screen all proposed projects focused on DSS priority populations covered by federal anti-­‐discrimination protections for potential human rights and health disparities that could result from tendering decisions. This vetting process should involve direct consultation with community members about proposed projects that are likely to affect their lives. Page 6 of 7
Recommendation 2: That Commonwealth tendering processes require funding recipients to share funding with community-­‐based organisations and engage in direct consultation with community members targeted by a specific project. Commonwealth funding agreements should require co-­‐funding between professionals and community organisations targeted by their projects whenever possible. Recommendation 3: That the Commonwealth provide transparent communication of relevant funding dates and processes for all tendering applicants, with at least three months’ advance notification regarding funding renewal or discontinuation decisions. This three-­‐month notification requirement is consistent with current employment awards in the community sector, which require employers to provide three months’ notice to staff. This three-­‐month period will aid community organisations in the process of making safe and secure transitions into their next phase of operation. Recommendation 4: That Commonwealth community sector funding at the national level move to five-­‐
year contract lengths, as the current two to three year lengths are not appropriate or sufficient to build organisational or sector capacity, nor sufficient to sustain ongoing individual collaborations with government, community members, or community sector organisations. Recommendation 5: That DSS engage in ongoing community consultation regarding tendering processes. Ongoing community consultation will ensure that funding allocations can accurately reflect the needs of priority populations and provide appropriate and genuinely beneficial interventions. Conclusion Based on the Alliance’s direct experience and consultation with our members across Australia, we advise the Department of Social Services to implement the above five recommendations. The Australian Government has made impressive strides to reduce discrimination faced by LGBTI populations, including the addition of sexual orientation, relationship status, gender identity (including gender history, gender expression, and gender-­‐associated characteristics), and intersex status to the Sex Discrimination Act 1984 (the Act). The Act prohibits both direct and indirect discrimination in the administration of Commonwealth laws and programs, including discretionary decisions by government officials made under laws or programs. Given the concerns we have raised, we do not feel that current Commonwealth tendering processes are in line with the spirit of this legislation. As Australia’s national peak body on LGBTI health, we thank you for this opportunity to raise concerns about Commonwealth tendering processes. We encourage you to contact the Alliance’s Manager of Research and Policy, Dr Gávi Ansara, to discuss the issues identified in this submission. He can be reached by email at gavi.ansara@lgbtihealth.org.au or by phone at (02) 8568 1110. Yours sincerely Rebecca Reynolds EXECUTIVE DIRECTOR Page 7 of 7