Re: Victorian Pre-budget submission 2017/18 RANZCP Victorian Branch priority budget consideration

Transcription

1 8 August 2016 Dr Margaret Grigg A/g Director, Mental Health Department of Health and Human Services 50 Lonsdale Street MELBOURNE VIC 3000 By to: Dear Dr Grigg Re: Victorian Pre-budget submission 2017/18 RANZCP Victorian Branch priority budget consideration The Victorian Branch of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) wishes to submit a priority budget funding request for consideration by the Department of Health and Human Services (DHHS) for a specific issue, ahead of a comprehensive RANZCP Victorian Branch pre-budget submission. As articulated in the Victorian Government s Ten Year Mental Health Plan, mental health has a major impact on the Victorian community; each year 1.2 million Victorians will experience mental illness and nearly half of all Victorians (45%) will experience mental illness in their lifetimes (DHHS, 2015). To provide effective mental health service delivery requires a specialised workforce, with psychiatry being a critical element of this workforce. As well as delivering clinical services, psychiatrists provide clinical leadership and governance to mental health services and teach and supervise psychiatry trainees and medical students. Ensuring Victoria s future psychiatrist workforce is of key concern to the RANZCP Victorian Branch, with currently more than 370 trainees on the pathway to RANZCP Fellowship. In this submission, the Victorian Branch wishes to highlight crucial budgetary priorities to ensure support for Victoria s future psychiatrist workforce. The RANZCP is seeking adequate funding to support the three RANZCP Director of Training (DoT) position and to provide full time administrative support for each of these positions. Support and resourcing are also sought for a fourth Specialist International Medical Graduate (SIMG) DoT, also with full time administrative assistance. In the Victorian Branch s view, these initiatives will provide necessary support for trainee psychiatrists as well as help to improve services for mental health care across Victoria and, ultimately, improve the mental health of the Victorian community. Please see the attached submission for details and recommendations for DHHS s consideration. The RANZCP looks forward to receiving your feedback on the submission and its recommendations. 309 La Trobe Street, Melbourne VIC 3000 Australia T F ranzcp@ranzcp.org ABN

2 If you would like to discuss any aspect of the submission further, please contact Jacki Lindsay, Branch Coordinator via or by phone on (03) Yours sincerely Assoc. Prof Richard Newton Victorian Branch Chair

3 Submission to the Victorian Department of Health and Human Services regarding DoT priorities for the Budget August 2016 Improving the mental health of the community

4 RANZCP Victoria Branch submission to the Victorian DHHS regarding DoT priorities for the Budget About the Royal Australian and New Zealand College of Psychiatrists (RANZCP) The RANZCP is the principal organisation representing the medical specialty of psychiatry in Australia and New Zealand, and has responsibility both for the accreditation of training programs and the administration of examinations of medical practitioners for qualification as consultant psychiatrists, leading to admission to Fellowship of the RANZCP. There are 5,500 Fellows of the RANZCP, with almost 1000 Fellows in the Victorian Branch. The Victorian Branch Committee of the RANZCP welcomes the opportunity to provide the Victorian Department of Health and Human Services (DHHS) with its initial views for mental health priorities for the Victorian Government s Budget. As highlighted in the Victorian Government s Ten Year Mental Health Plan, mental health has a major impact on the Victorian community as each year 1.2 million Victorians will experience mental illness and nearly half of all Victorians (45%) will experience mental illness in their lifetimes (DHHS, 2015). Effective mental health service delivery requires a specialised workforce, with psychiatry being a critical element of this workforce. As well as delivering clinical services, psychiatrists provide clinical leadership and governance to mental health services, and teach and supervise psychiatry trainees and medical students. Ensuring Victoria s future psychiatrist workforce is of key concern to the RANZCP Victorian Branch, with currently more than 370 trainees on the pathway to RANZCP Fellowship. In this submission, the Victorian Branch wishes to highlight crucial budgetary priorities to ensure support for Victoria s future psychiatrist workforce. In the Victorian Branch s view, these initiatives will provide necessary support for trainee psychiatrists as well as help to improve services for mental health care across Victoria and, ultimately, improve the mental health of the Victorian community. On this basis, the Victorian Branch makes the following two recommendations for DHHS s consideration: Recommendation One: Increased funding for Director of Training (DoT) positions in Victoria Given that psychiatrist trainees are dispersed across multiple sites and the administrative burden for DoTs has increased significantly in recent years, the Victorian Branch recommends that: the total FTE allocation for the 3 Victorian DoT positions should be increased from the current 1.7 FTE to 3.0 FTE (1.0 FTE position x 3) each of the three DoT positions requires full-time administrative support of 3.0 FTE (1.0 FTE position x 3). Recommendation Two: Creation of DoT-SIMG position The Victorian Branch recommends that the: DoT-IMG position be renamed as Director of Training for SIMGs (DoT-SIMG) DoT-SIMG requires 1.0 EFT with at least 1.0 EFT administrative support, based on current needs, to support Victorian SIMGs. This estimate is based on current numbers, 46 in total, and with consistent average of 8-10 new applicants every year objectives and role of this DoT position can be in line with RANZCP expectations of DoT and will work within similar governance. Submission to the Victorian DHHS regarding priorities for Directors of Training positions for the Budget Page 2 of 6

5 Please see below for details to substantiate these recommendations 1. Directors of Training The RANZCP has three training regions, which are based on geographical regions of Victoria: Western, Northern and Southern. Each region has a DoT. The role of the DoT is to ensure, as far as practicable, that the quality of training and all aspects of the training program run efficiently. Key accountabilities of DoT include: awareness of the functioning of the clinical facilities involved in the program and maintenance of a relationship with them such that modifications can be made if necessary for a trainee s training experience ensuring that training centres take responsibility for trainees development, including the provision of appropriate clinical experience and supervision of the quality of the trainees work and opportunities to make formal presentations of their work in clinical meetings approving each of the trainee s rotations/training experiences ensuring that consultant responsibility is taken for each trainee (that is, that there are clear lines of clinical responsibility from the trainee to the consultant at all times) and that the required level of supervision is provided responsibility for a process of evaluation of the training meeting each trainee at least every six months to review progress with training experiences and tasks. The Victorian Psychiatric Training Committee (VPTC) can liaise with Health Services (employers) in the administration of advertised and selection processes for DoT positions and any support(s). Currently, the required minimum resourcing formula for DoTs to trainees in the RANZCP program (Stages 1, 2 and 3) is: 0.5 FTE DoT time per 20 trainees for training, support, teaching, and remediation (0.4 FTE if there is a separate Masters Formula Education Course. This formula takes no account of geographical size or complexity). 0.4 FTE Administrative assistant staffing per 20 trainees. A minimum even in small programs of 0.3 FTE DoT time 1 and 0.5 FTE Administration time (i.e. this is the minimum administrative staffing needed to run a training base). 2 However, in 2016, an external accreditation review conducted by the Bi-National Committee for Training in compliance with AMC requirements recognised that the above recommended DoT time is manifestly inadequate because of the size and complexity of the RANZCP training regions and that owing to the significantly increased administrative burden, the Offices of the DOTs needed full-time clerical assistance (2015). 1 Refers to all funded DoT/Coordinating sessions 2 This formula takes no account of program geographical size or complexity and more sessions should be allowed for such factors. If the DoT is employed to support SIMGs, these should be added to the trainee numbers. Submission to the Victorian DHHS regarding priorities for Directors of Training positions for the Budget Page 3 of 6

6 RANZCP Recommendation One Given that psychiatrist trainees are dispersed across multiple sites and the administrative burden for DoTs has increased significantly in recent years, the Victorian Branch recommends that: the total FTE allocation for the 3 Victorian DoT positions should be increased from the current 1.7 FTE to 3.0 FTE (1.0 FTE position x 3) each of the three DoT positions requires full-time administrative support of 3.0 FTE (1.0 FTE position x 3). 2. Specialist International Medical Graduate (SIMG) DoT The DoT-IMG position at Goulburn Valley Health (GVH) was funded toward the end of January 2016 to the end of June This role existed a few years in the past and was funded through Eastern Health. However, there has been no DoT-IMG for the last few years in Victoria. The broad objectives for this role are consistent with RANZCP s description of DoT for their trainees and in this case comprise of: supporting SIMGs in applying for assessment of specialist qualifications with RANZCP assisting SIMGs with Substantial Comparability and their supervisors to fulfil their Workplace Based Assessments (WBAs) assisting SIMGs with Partial Comparability to negotiate their training and WBA requirements supporting SIMGs to work better with their services to ensure they have adequate supervision and opportunity as specified by the RANZCP enabling IMG specialists to access support programs that are auspiced through RANZCP assisting in forming networks for SIMGs as they could be isolated due to their location or role. However, due to the limitation of funding and duration for the DoT-IMG, GVH appointed Dr Raju Lakshmana to undertake a scoping exercise to inform the DHHS of the expectation of this role specific to Victoria and to enable them to decide on funding the role accordingly and recurrently. Specialist International Medical Graduates in Victoria The RANZCP uses the term SIMGs as this term recognises the group of IMGs who are trained overseas in the speciality of psychiatry and some or all of their training is recognised by the RANZCP after an assessment process. The candidates who are eligible to enter the Substantial or Partial Comparability specialist pathway are termed as SIMG candidates, the IMGs who are not comparable may choose to enter the Training Pathway and are supported by their Regional DoT as per the flow chart below. Submission to the Victorian DHHS regarding priorities for Directors of Training positions for the Budget Page 4 of 6

7 These SIMGs, therefore, tend to function at senior roles within the health system - usually as a Senior Registrar (Stage III Training) or Consultant Psychiatrist, and may also work in Area of Need positions. This may result in some difficulties in accessing supervision and supports from their peers. Specific challenges for Victoria Victoria has significant numbers of SIMGs. Currently, there are 46 SIMGs, only four are in the Substantial Comparability Pathway, three are in Area of Need positions, most are in the Partially Comparable category. About quarter (10) of them are located regionally or rurally. There are an average of 8-10 new applicants for the SIMG pathway every year in Victoria, the numbers are higher than applications received in Queensland and New South Wales. In the RANZCP s view, there needs to be support for these SIMGs to participate and complete RANZCP requirements in order to attain Fellowship, which in turn provides them with further professional and personal opportunities. Supporting this workforce in career development is also critical to retaining them as Consultant Psychiatrists within Victoria s health system and providing appropriate mental health services to the Victorian community. There are systematically organised and well governed support structures for local trainees of RANZCP through Psychiatry Training Committees but supports to SIMGs are variable in different states (e.g. NSW has integrated them in to their Training Network, Queensland as SIMG Director of Training). Lack of organised support for SIMGs can lead to confusion, disappointment, anger and disillusionment with the RANZCP processes and their employers. The Victorian Branch considers that DHHS leadership in this area is likely to attract more SIMG workforce to Victoria and ultimately retain them as specialists working in the Victorian mental health system for the benefit of all Victorians. Submission to the Victorian DHHS regarding priorities for Directors of Training positions for the Budget Page 5 of 6

8 RANZCP Recommendation Two On the basis of the above, the Victorian Branch recommends that the: DoT-IMG position be renamed as Director of Training for SIMGs (DoT-SIMG) DoT-SIMG requires 1.0 EFT with at least 1.0 EFT administrative support, based on current needs, to support Victorian SIMGs. This estimate is based on current numbers, 46 in total, and with consistent average of 8-10 new applicants every year objectives and role of DoT can be in line with RANZCP expectations of DoT and will work within similar governance (VPTC in case of Victoria). References Report of RANZCP Accreditation Visit of Victoria: Northern Training Program: December Victorian Department of Health and Human Services (2015) Victorian 10 Year Mental Health Plan. Available at: www2.health.vic.gov.au/about/publications/policiesandguidelines/victorias-10-year-mentalhealth-plan. Submission to the Victorian DHHS regarding priorities for Directors of Training positions for the Budget Page 6 of 6