Victorian AOD sector reform: Back to the future

Transcription

1 Victorian AOD sector reform: Back to the future Victorian Alcohol and Drug Association Brad Pearce 2014 ATDC Conference

2 Who is VAADA? The peak body for funded alcohol and other drug (AOD) services in Victoria Membership comprises health and community organisations, as well as individuals who have an interest in prevention, treatment, rehabilitation or research that minimises the harms associated with AOD use Our vision: A Victorian community in which the harms associated with alcohol and other drug use are reduced and well being is promoted Guiding Principles: 1. VAADA works within a harm minimisation and evidence informed framework 2. We will undertake our work with compassion and integrity, respect and inclusion (supports diversity and cultural inclusion) 3. We will promote stability, integration and coherence across the AOD Sector 4. We are committed to collaboration to achieve the best possible outcomes for individuals, families and communities.

3 The last 15 years in Victoria Today s presentation Our system: current environment with significant reviews and reform New priority areas & system design Consultations But are we being heard? Looking forward: consumers, families, the Victorian community & this is relevant for you because?..

4 Mid Late 1990 s Turning the Tide (1997) was the Victorian Government s response to the recommendations of the Premier s Drug Advisory Council This framework initiated the final phase of the redevelopment of specialist drug treatment services which commenced in 1994 with the closure of large government run institutions Initiatives would significantly add to the existing network of services by filling the gaps in service provision, particularly in regional and rural locations It aimed to inform the public debate by presenting up-to-date facts and current issues that should provide a basis for ongoing discussion and action in our community

5 The strategy promoted: - Strengthening of community based approaches - Development of Youth AOD services - Competitive tendering - Training for health professionals The State Government emphasised four principles on which health and community services were to be based: - Put people first rather than institutions or systems - Ensure a fairer distribution of limited resources - Obtain value for taxpayers funds - Provide a better health status and outcome for all Victorians

6 What happened? Victorian Auditor General (March 2011) Fragmented system Equity of access Quality of data collected Funding model Performance management ORT barriers 32 reviews and evaluations Limited actioning of findings and recommendations - Recurring themes: Service integration Workforce qualifications/training, career pathways Unit pricing Design of ORT system

7 Key ingredients of the current reforms Election of the current Liberal government in late 2010 A Minister that is engaged, understands community consultation and had a clear sense of what government needs to achieve Reforms align with the Victorian Health Priorities Framework ( ) Service Sector Reform: A roadmap for community and human services reform (Peter Shergold) - Promotes diversity, but strength is size Services Connect (housing, disability, child protection, youth and families) WOVG AOD strategy An AOD sector that has for a long time called for change

8 Current system: What's really going on? 8 Department of Health regions Over 20 different funded treatment types 105 funded agencies Approximately 30,000 clients in treatment system 53, 574 closed treatment episodes ( ) Alcohol most common principal drug of concern in closed episodes 45% Counselling most common type of treatment -54% of closed episodes 14, 000 pharmacotherapy clients (2012)

9 New system priority areas 1. A simpler system: centralised access, fewer treatment streams, simplified funding model 2. Integrated services: local area planning, links with other systems, holistic provision 3. A strong, capable workforce: learning and professional development, promoting leadership 4. Quality service provision: principles, tools and mechanisms to enhance quality 5. Accountability for outcomes: from outputs to outcomes, a new performance framework 6. Information management: increased capabilities with long term technology solutions

10 How will the reforms impact? Stage 1: Adult non residential services Competitive process Partnerships, consortiums, mergers Recovery oriented Shift from outputs outcomes Redeveloped catchments Consultations with the sector Reduction in treatment types Centralised intake & assessment Activity based funding model Workforce strategy

11 Consultations The language is very much geared towards co-design and co-development In many ways it was a strategy to encourage the sector to engage and feel comfortable but it seems many are unsure of our role in decision making VAADA functions as the peak - Advisory groups on all new treatment types - Principles of treatment - Facilitated discussions with various groups - Exploring how national projects intersect with state reforms - Surveys gauging implications of change - Transition program activities How have the voices of service users and families/significant others been heard

12 Centralised intake and assessment The new treatment types Central state wide access point and local catchment based intake and assessment units Counselling Face-to-face, online and telephone. Classified as standard or complex Care and recovery coordination In each catchment and can assist the person throughout their treatment journey if required Withdrawal Consolidates home-based, outpatient, rural and residential into resi and nonresi Residential rehabilitation Therapeutic communities. Second stage of recommissioning. Will look at flexible models that vary in terms of intensity, service mix and length of stay. Pharmacotherapy Development of five area based networks

13 Intake and Assessment Centralised intake and assessment function Regional hubs to become key in each catchment Common screening and assessment tool Adapted to various target groups (Aboriginal, forensic, youth, pregnancy) Self help online screening and support Bed vacancy register This new approach will require services to respond differently

14 Activity based funding model Funding capped for voluntary clients in each catchment Some capacity for extra funding for forensic clients 20% flexibility across funded activities Loading for forensic clients (15%) and Aboriginal clients (30%) Catchment based planning function - $48,000 per year

15 All prices are intended to cover direct costs, fixed costs and overheads. Drug Treatment Activity Unit (DTAU) Price (2013/14) $ 644 Product: DTAUs Per Unit Of Activity (Weighting): Price: Equation: DTAU x Weighting = Product price Intake & Referral Phone Contact (Completed Referral) Intake & Referral - Face To Face (Completed Referral) Intake & Referral - Via Internet (Completed Referral) Comprehensive Assessment & Initial Treatment Plan (Comprehensive Assessment & Initial Treatment Plan) Care & Recovery Coordination (Course Of Coordination) Counselling Standard (Course Of Counselling) Counselling Complex (Course Of Counselling) Withdrawal - Non Residential - Standard (Course of Withdrawal) Withdrawal - Non Residential - Complex (Course of Withdrawal) $ $ $ $ $ $ $ $ $

16 Pharmacotherapy Community based prescribers and dispensers 5 specialist clinics 6% of GPs prescribe. Of these, very few hold vast majority of permits Recent policy changes allowing non trained GPs to prescribe bupe/naloxone combination to up to 5 patients First stream to undergo reform Five area based networks Redeveloped training program for GPs and pharmacists

17 Workforce Strategy Objectives: 1. People recruitment and retention 2. Place geographic distribution 3. Environment positive, leadership, culture of collaboration 4. Performance competently skilled Challenges and opportunities: - Attracting a qualified workforce - Workforce development - Career pathways - Peer workforce - Harnessing new technologies Current examples: - Change Agent Network - Workforce Study

18 Other activities supporting the changes Developmental projects: Performance management framework Demand modelling Client management systems Data collection and reporting Stage 2: Youth and adult residential services

19 Selection of preferred providers Call for submissions late 2013 Call for High Level Delivery Plans March 2014 Approved providers to be determined mid May Funding and service agreements negotiated New system to begin August 1 st Challenges related to transition. Namely: Available timelines Staffing changes Client records Ceasing of business Establishment and infrastructure

20 Considerations for Implementation VAADA supported gradual change, but complete reform was opted for It s essential to manage such significant changes effectively Some other important contextual considerations - Community Mental Health System - Medicare Locals - Corrections Victoria sentencing reforms Do competitive processes have long term impacts on relationships? Does reform ensure a client centred approach to service delivery? Will the focus on consortia address fragmentation? Does activity based funding address gaming of the system? Can diverse data collection programs address planning needs? Will this process ensure we are not being set up for the next major reform?

21 Further Information Brad Pearce Phone: (03) Web: Thank You