The Albanese government released its employment white paper last week.

It presented the document as a major piece of work, comparable to white papers from past eras.

It outlined the government's ambition to fix major problems in our labour market, and it contained a new definition of "full employment."

But was it ground-breaking? Will it lead to cultural change?

The scourge of involuntary unemployment

Let's start with some positives.

The government says the concept of "full employment," as the Reserve Bank defines it these days, is inadequate.

It says what the RBA considers full employment has co-existed with a large amount of "involuntary unemployment" in the economy, and it wants to change that.

This is important.

The debate about involuntary unemployment stretches back more than 80 years and it's really interesting to see the government resurrecting it.

I'll show you what I mean.

In 1936, British economist John Maynard Keynes published an influential book called The General Theory of Employment, Interest and Money.

It inspired a wave of "full employment" policies that washed across the democratic world in the 1940s and 50s.

Keynes showed, in that book, that the traditional way of thinking about unemployment was ignorant and damaging.

He said orthodox economists assumed there were only two types of unemployment: frictional and voluntary unemployment.

But there was actually a third type — involuntary unemployment — that described the reality of millions of people who wanted to work but couldn't get work because there wasn't enough demand for their labour.

He said "full employment" would only exist when involuntary unemployment disappeared (leaving only frictional and voluntary unemployment).

And his book opened peoples' eyes.

It inspired policymakers in countries like Australia to deliberately stimulate economic activity to create enough demand for labour so involuntary unemployment would collapse as a category.

See the graph below.

It shows what happened to Australia's unemployment rate in that post-war era of full employment policy.

Full employment and unemployment average

Now, fast forward to today.

The government's Employment White Paper is clearly drawing on some of that thinking.

It says the modern definition of "full employment" used by the RBA is far too narrow, and our conversations about full employment have to admit the reality of involuntary unemployment and high levels of under-utilisation of Australian workers in the modern era.

It's also revived some wisdom from older conceptions of full employment by reminding us that genuine full employment has qualitative aspects too.

What does that mean?

It means the quality of a job is also important for people, and jobs should pay fair wages and be reasonably located. And if someone's unemployed, it should never take them so long to find a job that it starts to demoralise them.

Those qualitative aspects of full employment were emphasised by William Beveridge in 1944, in his landmark work "Full Employment in a Free Society", which I wrote about a few months ago.

According to Beveridge, if full employment meant anything it meant an abundance of jobs that paid decent wages, where unemployed people don't languish in unemployment, and where labour markets slightly favour workers, not employers.

So, the Albanese government is drawing our attention back to the scourge of involuntary unemployment, and it's emphasising the qualitative aspects of abundant work, to say that that's what full employment really is.

So that's all really interesting.

A bit of courage, but not too much

Strangely, after building the case for a "new" definition of full employment, the government's white paper feels like it melts away.

It doesn't promise to use a muscular set of policies to drive involuntary unemployment out of the system quickly.

Instead, it uses a lot of words (the paper has 264 pages) to explain something meek, which is: it doesn't actually want to be too disruptive.

So, the paper says the Reserve Bank will continue to use its too-narrow concept of full employment to make decisions about monetary policy, but the government will try very hard to remove supply-side barriers to employment to help structural unemployment decline over time.

That way, it says, if things go according to plan, the RBA should eventually be able to sustain a much lower level of unemployment than it has for decades, with much lower rates of labour under-utilisation.

Does that sound revolutionary to you?

It doesn't to me. It sounds like the same ambition successive governments have had for 30 years, ever since the Reserve Bank began targeting inflation in the early 1990s.

And in a moment of cognitive dissonance, the white paper even criticises the outcomes of that familiar policy approach.

"Despite its many successes, the Australian economy has rarely achieved full employment for extended periods and there have been prolonged periods when the available labour force was under-utilised to a much greater extent than it is today," it says.

So, it's hard to avoid the feeling that this white paper is slightly confused, or is saying a lot about not very much.

But then, maybe that's unfair.

Maybe it does have a big ambition but it's obscured by verbiage. Or maybe it's deliberately obtuse, and we'll have to wait to see what type of legislation the government tries to pass through parliament before we understand what its ultimate agenda is.

Would it survive a change of government?

So where does it leave us?

Would it be easier to be enthusiastic about the white paper if its vision was clearer and its ambition bolder?

On that score, it does compare unfavourably to the 1945 White Paper on Full Employment.

That 1945 paper was much smaller (it only contained 131 paragraphs), was written in the simplest language, and it had a major impact.

It declared its intentions from the start: it wanted to change Australia.

When John Dedman, the minister for Post-War Reconstruction, presented the paper to parliament on 30 May 1945, he didn't mince his words:

"I believe that this white paper constitutes a charter for a new social order.

"The old order of the inter-war years had as its prime objective rigid adherence to a certain financial policy. If this entailed 30 per cent unemployment and dwindling world trade, then, according to the pundits of that day, these were necessary evils.

"What a miserable social structure they built on their own false foundation."

He explained clearly how the white paper was structured:

"First, it sets forth boldly and unequivocally the government's intention to secure full employment for the people of Australia after the war.

"Secondly, it outlines the method by which the government proposes to achieve this aim.

"Thirdly, it examines the special problems which will face the Australian economy in the transition from war to peace."

And he said Commonwealth and State governments had to accept responsibility for stimulating spending on goods and services to the extent necessary to sustain full employment, because the welfare of everyone depended on it:

"The policy of full employment is the government's positive contribution to the security of the individual. Full employment spells opportunity, and opportunity opens the way for achievement [...]

"This white paper is an affirmation by the government of Australia that it intends to pursue that policy with the utmost energy and determination."

Clear and digestible. There was no guessing what the policy was or what the government planned for the country.

And when the government lost power four years later (for a variety of reasons), that full employment policy was popular enough to survive the change.

In fact, the victorious Liberal Prime Minister, Robert Menzies, adopted it as his own and pursued full employment for the next 16 years.

Can we see that happening with this white paper?

The special commission of inquiry that opened in November 2022, is examining unsolved deaths suspected of being LGBTIQ hate crimes in NSW between 1970 and 2010.

Justice John Sackar, who is presiding over the inquiry has described police conduct as "unprofessional" for failing to produce documents in time.

He was due to submit his final report by August 30, 2023, but the deadline has been extended to December 15, after police delayed providing documents and the discovery of new forensic evidence.

Today Counsel Assisting Peter Gray SC, said the inquiry had partly been extended after NSW Police submitted more than 50 new witnesses should be spoken to before any findings are made.

Mr Gray said the 50 individuals have been asked to provide statements, but nearly half have not responded.

He said that since at least 2016, "serious ongoing difficulties in locating documentary records and exhibits in unsolved cases" has been well known within the police force.

This is making it difficult to reinvestigate unsolved homicides.

Mr Gray referred to a police internal document submitted to the inquiry, dated 2018, which outlined the task officers were facing.

"One internal police document in recent years estimated that if the unsolved homicide team continued to review cases at its then current rate, it would take 900 years for existing cases to be reviewed," he said.

"I note in passing that even as late as last week, in mid-September, yet more belated documentary production was still being made by the NSW Police Force.

"That production of material last week, was in response to a summons issued in August 2022, more than a year ago."

Mr Gray told the inquiry NSW Police represents itself to the community as having a "competent and adequately resourced team to deal with unsolved homicides".

He noted it was common for a coroner to refer matters to the unsolved homicide team.

"It is assumed that, when doing so, the coroner and relatives of a deceased person expect ... the matter will be considered by the unsolved homicide team within a reasonable time, and not a period of time that can be measured in centuries."

A number of high-ranking officers have been questioned at the inquiry about incomplete records, lost exhibits, and investigative failures into unsolved LGBTQI deaths

we have reached out to @Dirt_Owl@hexbear.net for comment

The Institute of Public Affairs (IPA) has been accused of tprying to indoctrinate school children by distributing a classroom lesson plan that teaches students how to mount arguments against the proposed Indigenous Voice to Parliament.

The conservative think tank has paid for multiple Facebook and Instagram ads promoting high school education materials it says gives teachers "the tools you need to walk your class through both sides of the referendum".

The ads link to a free, 34-page teacher guide and workbook the IPA has written for year 9 to 12 students in English, Australian History, Civics and Indigenous studies.

While the lesson plan promises to teach students about all sides of the debate, the main written exercise asks them to present the "No" case.

It asks students to refute a series of statements supporting the Voice using an almost 1,000-word summary of various "No" arguments.

Students are then asked to rank the arguments in order of persuasiveness and then "respectfully discuss with your peers".

They are not asked to repeat the exercise from the "Yes" perspective.

Students are also asked to complete a true/false quiz that includes the statements, "Anyone who votes No in the Voice Referendum must be racist" and "There are no acceptable arguments for voting No in the Voice Referendum".

The Australian Education Union (AEU), which reviewed the materials, described the lesson plan as a "shallow attempt to inflict their conservative views on students in schools".

"We will fiercely oppose any such moves by private and political organisations that seek to indoctrinate students," AEU federal president Correna Haythorpe said.

"This move by the IPA can only be viewed as a cynical attempt to influence and interfere in Australia's democratic processes via the education system."

The AEU has pledged its support for the Voice but has not told its members how to vote in the referendum.

The IPA's deputy executive director Daniel Wild rejected the criticism, saying: "you would expect the AEU to say that".

"It is on the record as explicitly supporting the Voice to Parliament, which completely undermines the AEU's capacity to provide students and teachers with a balanced view on this critical matter," he said in a statement.

"The AEU is not the sole arbiter of truth, and it is deeply concerning that they are seeking to prevent open and balanced analysis occurring in classrooms ahead of this vital referendum."

The Melbourne-based IPA told ABC Investigations that it "does not support or oppose the Voice to Parliament", despite listing itself in the lesson plan as a resource for students looking for more information about the "No" position.

"Teachers in the classroom are in the best position to determine what materials to use in class, not union lobby groups which are explicitly campaigning for a Yes vote," Mr Wild said.

The teaching resource was developed as part of the IPA's "Class Action" campaign, which has produced a range of lesson plans and other teaching materials it says complement compulsory high school humanities subjects.

On its website, Class Action argues Australia's National Curriculum "carries undertones of Critical Race Theory … a reframing of Western Civilisation through the lens of guilt, and a reduced academic rigour .. where social sensitivity is given primacy over critical thinking".

"The IPA's Class Action research program was established to consider the values of Western Civilisation, and to contribute to a flourishing future of Australian society that knows its roots and can humbly acknowledge its imperfections without erasing its proud achievements," Mr Wild said.

The IPA approached multiple state-based history teacher associations in the past six months and asked for them to share the Class Action lesson plans with members.

Some state associations told ABC Investigations they agreed to alert members to the resource kits, but did not actively encourage or promote their use. They said they were unaware of any teachers using the lesson plans.

"Since Class Action material packages research specifically for use in classrooms it is natural we have let teachers know through multiple channels, including their professional associations," Mr Wild said.

In response to ABC Investigations' questions about whether any teachers had used its Voice to Parliament lesson plan, the IPA said: "according to our analytics, approximately 3,000 Australians have accessed the resources supplied by Class Action in the past month."

Education and history experts who independently examined the document raised concerns about its accuracy, effectiveness as a teaching tool, framing of Indigenous issues, and its lack of balance.

Monash University History Professor Bain Attwood, who supports the Voice, described the document as an "act of bad faith" from the IPA.

He said the resource was "egregious" for presenting itself as impartial.

"What it's clearly trying to do is essentially persuade those who read [it] that the arguments against the proposal are more persuasive and more convincing," he said.

"There's not sufficient material in the resource to help students make sense of and critically evaluate the arguments."

Claire Golledge, a lecturer in secondary education at the University of Sydney who supports the Voice to Parliament, said the exercise format asking students to address individual arguments was a common teaching tool but echoed Professor Attwood's concerns about the lack of balance.

She added there was misinformation in the Vote-No points which were presented without context.

"When you dive into some of the content of those arguments… a lot of those arguments have been credibly challenged by pretty learned experts," Dr Golledge said.

Mr Wild dismissed suggestions the material contains misleading information.

"As the lesson plan makes clear, these are possible No arguments which could be made, and that students are encouraged to critically evaluate," he said.

"One may agree or disagree as they see fit, in conjunction with other materials, as the Class Action lesson plan makes clear."

The IPA says the lesson plan also points to further resources regarding the Yes case, specifically The Uluru Dialogue and Uphold and Recognise.

Professor Attwood, who has published extensively on the history of civil rights in Australia, also took issue with how Indigenous history was framed in the resource.

"It doesn't explain effectively why this referendum is so important from the point of view, at least, of Aboriginal people," he said.

"It doesn't really describe how oppressive and discriminatory this history [through] large swathes of the last 200 years has been."

He said the classroom materials made reference to discriminatory legislation but overall was not an "adequate account of the history of Aboriginal people in this country".

Professor Attwood said if he discovered this lesson plan was being used in his child's classroom he would "immediately contact the principal and make representations that this resource be removed from the school".

Mr Wild denied the materials were designed to persuade.

"Mr Attwood appears to be under the misapprehension that these materials are designed to persuade, when they simply inform teachers of the various arguments regarding the Voice to Parliament," he said.

"The lesson plans are designed to be consistent with the requirements of the National Curriculum, and teachers are free to use these materials should they find them of value."

Victoria's Indigenous truth-telling inquiry is calling on the state government to create an independent watchdog to tackle police complaints, a First Nations-controlled child protection system and to stop detaining children under the age of 16.

During a year-long inquiry, the Yoorrook Justice Commission found evidence of ongoing systemic racism and gross human rights abuses committed against First Peoples in the state of Victoria.

In its most significant proposal yet, the commission has put forward 46 recommendations amounting to a sweeping overhaul of Victoria's child protection and criminal justice systems.

It is the first time in Australian history a government will be forced to respond to a major reform agenda put forward by its own truth-telling commission.

The recommendations range from long-term transformative change — like establishing a dedicated child protection system for First Peoples children, controlled by First People — to urgent asks including raising the age of criminal responsibility to 14.

"This is the first truth-telling commission in Australia, in Victoria, for Victorian First Peoples," Wurundjeri and Ngurai Illum Wurrung woman and Yoorrook Commissioner Sue-Anne Hunter said.

"We are not going to tinker around the edges here." Yoorrook wants an independent police complaints body

Yoorrook's 46 recommendations broadly call for more control — and oversight — of policies that the commission has found are continuing to devastate and disadvantage Aboriginal people in Victoria.

"We are talking about real change," Ms Hunter said.

"We've had over 200 years of a colonial system that needs to change … We're not going to stop until we have self-determination for First Peoples in this state."

Among Yoorrook's recommendations is a call for a new police oversight body — to be led by someone who is not a police officer — with the power to arrest and search Victoria Police officers and investigate police complaints and deaths in custody.

Yoorrook wants the new watchdog to have a dedicated First Peoples-led division to deal with police complaints from Aboriginal people.

The commission also wants recognition of systemic racism embedded at the highest levels of Victoria Police.

It asks that a commitment to understanding and ending racism within the police force be made a mandatory criteria informing the selection and annual review of the police chief commissioner.

It wants criminal offences of poverty, including offending linked with homelessness, disability and mental ill-health to be decriminalised, where appropriate.

Yoorrook is also calling for training for all Victorians working in policing, corrections, youth justice, child protection and some health roles after the commission heard evidence of racial bias and over-policing against First Peoples.

It wants more power given to existing watchdogs, like the Commissioner for Aboriginal Children and Young people.

It is also asking the government to commit to proper monitoring of programs intended to benefit Indigenous Victorians, through an Indigenous-led oversight and accountability commission.

Several of Yoorrook's recommendations — such as bail reform, raising the criminal age of responsibility to 14 and the creation of a new body to handle police complaints — are not new.

The commission has acknowledged progress has been made in some of these areas, including the Victorian government's recently introduced bail reforms and its plan to eventually raise the criminal age of responsibility to 14.

But Yoorrook's recommendations go beyond what has already been proposed by the government.

For example, not only does Yoorrook recommend urgently raising the criminal age to 14, it asks that the government prohibit the detention of children under the age of 16

The recommendations follow Yoorrook's own inquiry into the criminal justice and child protection systems, hearing from more than 80 witnesses including government ministers and First Peoples with lived experience of Victorian state systems.

The 12-month inquiry found unacceptable disparities in outcomes between Indigenous and non-Indigenous people caught up in state systems.

Aboriginal children are 21 times more likely to be in the out-of-home-care system in Victoria.

In the criminal justice system, over the last decade, the rates of Aboriginal men on remand in Victoria increased by nearly 600 per cent.

Twenty of the urgent recommendations relate to reforms of the child-protection system, including addressing the "pre-birth" reports systems, which the commission found were unfairly impacting Aboriginal women.

A "pre-birth" report is a child-protection notification made about a pregnant woman before her child is born.

"In effect, this means an Aboriginal child in our community can be in a pipeline to the justice system before being born," Wergaia/Wamba Wamba Elder and chair of the commission Eleanor Bourke wrote in the forward to Yoorrook's report.

"It is hard to imagine a scenario that more profoundly demonstrates systemic failure."

Yoorrook has recommended a notification scheme for pre-birth reports, including that the pregnant Aboriginal woman is told that she has been subject to a notification and is offered support.

The scheme would also trigger, with the consent of the expectant mother, notification to an Aboriginal community-controlled health and legal service.

These specific recommendations fall within the broader call for the Victorian government to transfer decision-making power, control and resources to First Peoples to give effect to self-determination within the child protection system and criminal justice systems.

In early December last year, during Yoorrook hearings, Premier Daniel Andrews conceded the state's child protection system was "troubling" and "not designed properly".

"We are taking too many First Nations kids away from their families," he said.

"We're going to do something about this … we are absolutely going to do something about this."

Mr Andrews's comments have been referenced by Yoorrook commissioners in its report.

"Premier Andrews said his government would 'waste no time' in delivering on Yoorrook's recommendations," Commissioner Sue-Anne Hunter said.

"I urge the Premier to live up to these words, because our people cannot wait any longer."

Yoorrook's next issues report is expected to examine land injustice, with the commission scheduled to conclude its work with a final report due in 2025.

down with cis

A regional council in New South Wales has pushed back on a bid to remove a book about sex education from its council library.

Yass Valley Deputy Mayor Jasmin Jones moved a motion at the council's meeting on Thursday night to take Melissa Kang and Yumi Stynes's Welcome To Sex off the shelves.

The book — which includes discussion about subjects such as consent, sex positions and other experimentation — rose to prominence after large-scale retailer Big W took it off the shelves, because some staff had been verbally abused by customers.

Cr Jones told the meeting the book's marketing disguised its content.

"It has cute little pictures, cartoon pictures with eyes drawn on them," she said.

"My five-year-old would be attracted to that book."

She also described it as "an arrow to the heart" of families who hold conservative values.

"Our children have the right to cherish their celibacy, to value their virginity, to look forward to committing to a monogamous relationship within the intended partnership of marriage, if they want to," she said.

The motion was defeated 7-2.

In the days prior, the council's chief executive, Chris Berry, said that if it passed, the council might need to seek legal advice about whether it could be removed under state and Commonwealth law.

Cr Jones argued the book's discussion of sexting and sending explicit images meant it fell within provisions to remove books that contain inaccurate or misleading information, given the book is aimed at people under the age of 18.

Yass Valley Council Mayor Allan McGrath said some residents had raised concerns about censorship with him, prior to the meeting.

"Generally, people have the view that a choice of reading matter for children should be a matter for parents, and that's probably a view that I share also," he said.

"If we get into the role of guarding what people are reading, I think it's a bridge too far for local government."

Cr McGrath said he felt the book contained some valuable information for young people.

"In fact, I've been enlightened myself by some of it," he said.

English and creative writing lecturer Dan Dixon from the University of Sydney said discussions about book banning were not unusual in Australia.

"It is something that continues to come up in our national discourse," he said.

Mr Dixon said if the motion had passed, it would have set "a dangerous precedent".

"There's no clear line that then prevents you from doing that with the next book that comes along that doesn't suit your sensibilities," he said

• In short: Only a handful of Australian surgeons offer certain gender-affirming procedures, meaning transgender people are waiting for years or seeking options overseas
• What's next? An application has been made to list gender-affirming surgeries as specific Medicare items, to help address high costs and low availability

For trans woman Abbie Clark, feelings of gender dysphoria have been coming and going since she was a kid.

She didn't initially know what it meant to be trans, but she knew she would rather be a woman than a man.

"When I wanted to transition, I didn't know where to go," the 30-year-old Ballarat woman said.

"I didn't know what service I needed to look at, I didn't know who I needed to talk to."

Ms Clark had surgery on Trans Day of Visibility last year, three years after starting hormone treatment and a year-and-a-half after her consultation with the surgeon.

Transgender Australians are spending years waiting for gender-affirming surgery, which is still required in some states to change birth certificate gender markers.

Gender-affirming surgery refers to a variety of procedures, including mastectomies, breast augmentation, facial feminisation and vocal chord surgery, as well as genital surgery.

Genital surgeries, such as vaginoplasty (creation of a vagina) and phalloplasty (creation of a penis), are known in the trans community as bottom surgeries.

Doctors in the field and trans people say there are only five Australian surgeons regularly performing these procedures.

Ms Clark's out-of-pocket surgery costs were $25,000, which would have been much higher had she not had private health insurance, which covered around $15,000 in hospital expenses.

Medicare contributed about $2,000 to the surgeon's fees.

"A lot of it's considered cosmetic. It's not, because in many cases, it is literally life-changing," Ms Clark said.

Now, for the first time, an application has been made to the commonwealth health department to list gender-affirming procedures on Medicare by the Australian Society of Plastic Surgeons.

Trans people, surgeons and advocates argue a better system of public funding for the surgeries could cut costs for patients and hospitals, as well as address availability concerns.

The president of the Australian Society of Plastic Surgeons, Nicola Dean, said the society made the Medicare application to the Department of Health as part of a collaborative effort with trans organisations and other health professionals to improve access to the surgery.

Dr Dean said this could incentivise more surgeons to join the field and provide better data on how many surgeries were taking place in Australia.

"A lot of it goes on a bit under the radar," she said.

"I think Australia is really quite behind other countries."

A Department of Health spokesperson confirmed it had received an application requesting the Medical Services Advisory Committee (MSAC) consider publicly funding gender-affirmation surgery and consultations under Medicare.

The department is currently considering if the request is suitable to be considered by MSAC.

A spokesperson said some Medicare rebates were already available "if the services are deemed by the treating practitioner to be clinically relevant to the care of their patient".

Surgeons have told the ABC the lack of specific Medicare item numbers for gender-affirming surgeries means costs are unpredictable and not transparent, and some procedures aren't covered.

In 2021, a petition to federal parliament for gender-affirming surgery to be included on Medicare gained nearly 150,000 signatures — the fifth most-signed petition on the Australian parliament website.

Clinical guidelines written by the Royal Children's Hospital Melbourne and endorsed by the Australian Professional Association for Trans Health (AusPATH) advise delaying genital surgery for trans people until adulthood. Surgeons spoken to by the ABC said they would only perform bottom surgeries for people over the age of 18.

Kieran Hart, a surgeon at ACT Urology in Canberra, said he had been swamped with requests for vaginoplasty and orchiectomy (removal of testicles) procedures.

In Dr Hart's first year in 2018, he performed three gender-affirming surgeries. Last year, he did 60.

He has about 150 people booked in for surgery, and 100 for consultations. His waiting list has only recently reopened.

"There's been hundreds who have been trying to get consults while I closed the books for a while," he said. A smiling man in scrubs in a hospital room.

The wait time is around two years, and about 90 per cent of his clients come from interstate.

He said private hospitals doing gender-affirming surgery "almost lose money" because the procedures were not listed on Medicare, meaning surgeons have to use different item numbers that don't quite line up with the procedure.

But Dr Hart said seeing the outcomes for trans women made it some of the most rewarding work a surgeon could do.

"It's just quite remarkable how resilient they are, but also what difference you make to their happiness and mental health," he said.

Advocates point to numerous studies which back the mental health benefits of gender-affirming surgeries for adults.

In a 2014 peer-reviewed study of 188 trans Australians, the 42.5 per cent of respondents who had undergone gender-affirming surgery reported higher levels of physical and mental health than those who had not had surgery. The difficulties in accessing surgery in Australia mean post-surgery survey sample sizes tend to be small.

A peer-reviewed analysis of the 2015 US Transgender Survey, which had 27,715 respondents, found the 13 per cent who had undergone gender-affirming surgeries in the preceding two years experienced a 42 per cent reduction in psychological distress and a 44 per cent reduction in suicidal ideation, compared to those who desired surgery but had not had it.

Not all trans people wish to undergo surgery, and for many of those who do, it is not financially viable — with nearly all surgeries taking place in the private system due to state government policy settings on elective surgery.

For trans men, getting a phalloplasty in Australia is even more difficult, with only two surgeons offering the procedure.

One is Brisbane-based Dr Hans Goossen, whose new patients might expect to wait six to 12 months for an initial consultation.

After completing surgical training in urology and reconstruction, he spent two years overseas learning the skills to do gender-affirming surgeries.

"It's still a relatively new field in Australia," he said.

"Until recently, most patients had to travel overseas."

Bottom surgeries for trans men include metoidioplasty and phalloplasty.

An insured patient might expect to pay $80,000 out-of-pocket, for what is a complicated and lengthy series of three or more operations. This includes costs associated with the surgery, anaesthetic, hospital stay, preparation and recovery.

"I understand people's frustration with the fact that it's currently not available in the public hospital system, and that it costs a lot of money and it's therefore not affordable for everyone," he said.

Dr Goossen wants to see federal or state governments fund a certain amount of surgeries per year, like in New Zealand, reducing the need for patients to spend tens of thousands of dollars on the procedures.

Another surgeon, David Caminer, started regularly performing phalloplasty and vaginoplasty procedures this year at his practices in Sydney and Wollongong.

Dr Caminer said even if the procedures ended up being listed on Medicare, patient costs would still be high due to Medicare not keeping up with inflation.

"The only way to get it cheaper, or for nothing, is to do it through the public hospitals," he said. Review announced into delivery of gender-affirming care in NSW following Four Corners investigation

A clinic at Westmead Children's Hospital has only seen three new patients this year and is struggling to operate in the wake of a string of staff resignations.

He said some private hospitals were religious, and did not permit gender-affirming surgeries to be performed or taught there.

"They won't allow you to do it, because it's not really keeping with their religious belief," he said.

After a religious hospital told Dr Caminer he could not perform a phalloplasty on a patient there, he's struggled to find another hospital with an intensive care unit to do the procedure. The patient has pre-existing health conditions so would require close monitoring.

"There's not that many intensive care units in the private sector," he said.

"It's taking me a lot of time and effort, we're still trying." Official training and support needed, surgeons say

To address the surgeon shortage, Dr Hart said the relevant medical societies and colleges could do more to introduce trainees to gender dysphoria theory and basic gender-affirming procedures.

"The College of Surgeons, we don't have a formalised training pathway for it at this point in time," he said.

"It's not really recognised in the curriculums for the Urological Society or the plastic surgeons' society."

A spokesperson the Royal Australasian College of Surgeons (RACS) said gender-affirming surgery was complex and required multidisciplinary consultation.

"While RACS supports the training of gender-affirmation surgery, it is important to note that the limited number of cases and the highly specialised nature of this field requires specific focus for a limited number of surgeons," they said.

Dr Dean from the Australian Society of Plastic Surgeons said in conjunction with RACS, her organisation provided plastic and reconstructive surgery training which was applicable to gender-affirming surgery, but there should be funding to send surgeons overseas to learn.

"We do have the basics of how to do the genital surgery, but it does need expertise to be built up," she said.

"And I think that it will take quite some time for people to learn off the few Australian surgeons that are doing this surgery."

About one in five patients access their superannuation to pay for surgery at Dr Hart's clinic, he said.

Sav Zwickl, a director with AusPATH, said this could put a financial strain on trans people.

"They spend years saving for surgery, and there's often no option but to access their super and, of course, that has long-term implications down the road for their financial situation," the researcher, who is trans and non-binary, said.

Dr Zwickl said many trans people went to Thailand for surgery, where surgeons were generally "very skilled and experienced in performing gender-affirming surgeries".

"That's a case of a lack of surgeons [in Australia], but also some procedures that people are looking for are not available in Australia at all," they said.

Anne* went to Thailand for her bottom surgery in 2012, after being quoted $30,000 for surgery in Australia.

"Surgery in Thailand was a lot more affordable than what it was in Australia," she said.

"Thailand has been performing these surgeries over there for thousands of trans women for decades."

To fund the surgery and overseas trip, she spent more than two years living in financial hardship.

Previously, Queenslanders wanting to change the sex on their birth certificates had to undergo gender reassignment surgery.

Without surgery, she wouldn't have been able to change her gender marker on her Queensland birth certificate, a requirement that only changed in June.

"I wanted to make sure that all my legal documentation was consistent," she said.

"Without having a birth certificate and official documentation, you're always having to explain yourself."

New South Wales and Western Australia are the only states still requiring gender diverse people to undergo medical procedures to update their birth certificate gender marker.

In WA, a "gender reassignment board" judges applications by trans people to change their gender, although the state is in the process of repealing these laws.

Surgery and the approval of a panel is required to legally change gender in NSW, but a spokesperson for the attorney-general said during the election campaign, Labor had committed to reviewing the legislation in consultation with trans and gender diverse communities.

The spokesperson said work had not yet started on reviewing the legislation.

Post surgery and legal recognition, life's a bit easier

Anne said she had no regrets about her decision to get surgery.

"It stopped the gender dysphoria, the thoughts of self-harm and suicide that I was experiencing," she said.

It's not lost on her that many trans people struggle to access surgery, but she's grateful to have a body she feels more at home in.

"I finally felt complete," Anne said.

Ms Clark can breathe a sigh of relief having overcome the hurdles of surgery.

"I've honestly never been happier, now that it's finally all sorted," she said.

"I occasionally catch places where I've forgotten to change my name, but by and large, it's so simple now."

The national children's commissioner says she has written to the Northern Territory's police minister, calling for an NT Police promotional video of officers chasing and arresting two teenagers to be taken down.

Key points:

• Bodycam vision showing the arrests attracted hundreds of comments
• The majority of users praised police with some calling for dogs to attack the youths
• Police and the NT government have defended the content as showing the reality for police

WARNING: This story contains details some readers may find distressing.

The video, which is overlaid with up-tempo rock music, shows officers and a police dog pursuing one of three teenage boys through bushland outside of Darwin after intercepting a vehicle.

The arrests, made on Wednesday afternoon, came after the three 16-year-old boys allegedly stole two vehicles.

The boys were intercepted using tyre deflation devices in Darwin's rural area and charged with multiple property offences.

After being posted to the Facebook page of the Northern Territory's Police Fire and Emergency Services on Thursday evening, the video had received over 1,100 reactions and 220 comments.

The vast majority of comments praised the actions of police.

But several comments — which were removed after the ABC approached NT Police — included remarks such as "hope the dog had a taste" and "let the dogs take a couple of chunks".

The big four accounting giants racked up billions of dollars in auditing fees in the private sector as the quality of auditing declined, heightening concerns it could trigger another Enron-type corporate collapse.

The infiltration of the big four — EY, Deloitte, KPMG and PwC — in government departments has been well documented. What is less well known is their role in the private sector as auditors sprinkling holy water over company financial accounts, as well as offering consultancy services spanning tax minimisation advice, cyber security, IT and strategy.

Their power extends to the boardrooms of corporate Australia, where hundreds, possibly thousands, of alumni are directors of the most powerful organisations.

Governance and proxy adviser Ownership Matters crunched the numbers for 7.30, using four years of data, to unveil a series of uncomfortable truths about the depth and breadth of the big four across the country's ASX 300 companies.

Until now, the big four accounting firms had built themselves an aura of credibility and trust in government and corporate Australia.

The data reveals that 97 per cent of the external audit work of the ASX 300 companies was done by the big four.

These companies shelled out an estimated $4 billion in auditing and consulting fees to the big four between 2018 and 2022. But the concentration is in the biggest companies, with the top 20 ASX companies accounting for 50 per cent of the fees.

Even more concentrated are the big four banks — CBA, Westpac, National Australia Bank — and Macquarie Group, which spent a combined $832 million over four years, making them the biggest users of the big four's services.

But the real figure is unknown as listed companies only disclose consulting work done by their auditors, not other consultancy work.

And when it comes to servicing the $3.5 trillion superannuation industry, unlisted companies and trusts, the figures could be even more.

Alarmingly, while the big four have been dominating auditing, corporate watchdog ASIC has found the quality of auditing is declining. It is something Professor Allan Fels told 7.30 is a sleeper issue that could trigger a corporate collapse.

"We know that the global financial crisis of 2008 was partly triggered by bad auditing," Professor Fels said. "I have deep fears that something similar could occur to topple the global and the Australian economy in the coming period."

Last year, ASIC's inspection reports found deficiencies in a third of the biggest firms. Separate reviews found negative findings in 50 per cent of Deloitte's auditing cases and 48 per cent of KPMG's.

Accounting professor John Dumay described it as a market failure.

"To me, the value out of the audit is to be able to go to the investor and say, 'we have a good company, we're performing well, the auditors come and have given us a tick in a box, a clean bill of health, you can trust what we've got to say.' That's what an audit is supposed to do," he says.

"When it doesn't do that, because there are deficiencies in the audits themselves, then the system breaks down." People silhouetted against a white and blue KPMG logo.

Auditing plays a crucial role in the integrity of the financial system. Banks, investors, staff, suppliers and superannuation funds all rely on an auditor's independent assessment of financial accounts to ensure they can be trusted to make informed decisions.

When it fails it can be catastrophic. The collapse of Enron torched tens of billions of dollars of shareholder and employee money after it emerged that its financial accounts were a sham and it couldn't pay the bills.

In Australia, there are at least 10 legal actions underway, all alleging substandard auditing and advisory work across the big four firms. The cases include Noumi (formerly called Freedom Food Group) and its auditor Deloitte, the collapsed construction group Hastie Group and sandalwood producer Quintis, all of which misreported their accounts despite their auditors giving their stamp of approval. When the truth came out, shareholders took a drubbing.

Against this backdrop, Labor senator Deborah O'Neill recently reopened a parliamentary inquiry into the auditing industry to investigate the structure, deficient regulation and conflicts.

She will also look at why ASIC decided as part of a restructure it would abandon inspection reports, shrink the audit team and dump its highly regarded chief accountant, Doug Niven.

"It's hard to believe that this relatively new program, which was actually shedding some light on what was going on inside the big four, has been lost in a reshape of ASIC," she says. "I have grave concerns if nobody is watching. That's the perfect conditions in which further degrading of the quality of audit is likely to occur."

Senator O'Neill said conflicts had become the business model of the big four. "What we're observing is a business model where the conflict of interest is the model of business. That's how you grow your business," she told 7.30. "It's a failure of regulatory oversight that's allowed this to fester. And we cannot allow it to continue."

She says the longer an audit firm is inside a company, the more enmeshed relationships become.

It means the independence of the audit firm becomes questionable, which can impact their appetite to stand up to clients if accounting irregularities are suspected. If auditors act in the dual role as consultant, that independence can be further compromised.

Ownership Matters found that non-audit fees as a proportion of audit work for the audit firms was 39 per cent across the ASX300 companies between 2018 and 2022. This is where the big four act in the dual role of independent auditors and consultants, which is fraught with conflicts of interest.

Construction and developing giant Lendlease has had KPMG as its independent auditor for more than 65 years and their head offices are in the same building in Sydney.

They are also embroiled in a tax scandal with whistleblower Tony Watson, a tax lawyer whose career fell apart when he accused his client Lendlease of double dipping on tax, which he believed was wrong.

"I told them that they were stealing from our children, they were stealing from taxpayers," he told 7.30.

He joined law firm Greenwoods & Herbert Smith Freehills in 1985, quickly moving up the ranks to become partner, managing its biggest client, Lendlease.

But things started to unravel when he told a senior executive he disagreed with a tax scheme that related to their retirement village acquisitions. He estimates it boosted profits by up to $300 million, which he says they weren't entitled to.

He says PwC was brought in for advice and backed the scheme. KPMG signed off on the accounts.

Mr Watson alleges in a court case lodged in the Federal Court against his law firm and Lendlease that by 2014 he was dumped from the Lendlease account. He spiralled into depression and while he was on unpaid sick leave, he was terminated.

"I just got a letter from them saying we've decided to terminate you," he tells 7.30

When he recovered from his breakdown, he says, he decided to revisit his concerns about Lendlease and its tax scheme, this time meeting senior Lendlease officials and a partner at PwC as well as writing letters to the company.

In one email, he says Lendlease is "taking an aggressive and wrong view" in its tax deductions. In another, he warns the ATO will not fall for it. He also tipped off the ATO, which is auditing this aspect of the company.

Now he is waiting for the ATO to give its verdict and for his legal action to go through the courts.

In a statement, Lendlease said it "periodically conducted robust audit tender processes," and that its auditor "KPMG had the strongest credentials and commercial insights" after its last tender a decade ago. Last year, it said it would conduct an audit tender process in 2023.

In a statement, it said, "in May 2023, we paused this process with the intent for it to be resumed at a later date". The company said it was confident its tax treatment was consistent with the law.

KPMG said in a statement: "We believe directors are best placed to determine the need for a change of auditors." It said its focus was on "delivering high-quality audits, and a deep understanding of the business is critical to achieving this". It added that "KPMG has comprehensive policies and processes in place to manage potential conflicts".

KPMG said ASIC's inspection reports were disappointing. It said it agreed with some but not all of ASIC's findings and it had launched an audit quality transformation program.

Deloitte said it was committed to delivering the highest quality audit services to clients and it remained focused on doing everything it could to deliver "trusted and expert" audit services for its clients.

ASIC said moving forward, it would combine its annual audit reviews with surveillance of financial reporting and that "targeted reviews of the quality control systems of the largest six firms will also be undertaken from time to time".

It said continuing to provide annual individual reports on the biggest firms "would not provide a meaningful measure of overall audit quality".

PwC declined to comment on Mr Watson's allegations but said: "PwC firms are subject to our global tax code of conduct, which requires tax positions be supported by credible basis in tax law."