2018 VICTORIAN ELECTION POSITIONS

Transcription

1 2018 VICTORIAN ELECTION POSITIONS

2 VICTORIAN ELECTION POSITIONS

3 CONTENTS A system that needs a reset and a rethink Confronting workforce challenges head-on and giving Victorians the health workforce they need Diffusing innovation: sharing brilliant ideas and driving change across the state Clarify community health s role & funding for future growth Safe healthcare, enabled by world-class digital transformation Funding models that reflect cost of delivering safe & high-quality care Support & incentivise new approaches to manage demand Infrastructure to support safe and high-quality care VICTORIAN ELECTION POSITIONS 3

4 A SYSTEM THAT NEEDS A RESET AND A RETHINK The Victorian health system is under strain. The population is increasing, it is ageing and the prevalence of chronic disease is growing. Hospitals are struggling to manage demand and their budgets are more constrained than ever. Community health services are also constrained by an unsustainable and fragmented funding model and their issues compounded by the lack of a shared vision about their role in the broader health system; they want to do more and they can do more. People working in health are under more pressure than ever. There is burn-out and occupational stress. There are simply not enough staff to deliver the activity required. There is a greater focus than ever on quality and safety and while health professionals support this, systems let them down. Close to the end of the second decade of the 21st century, the majority of Victoria s public health services are still using paper-based records to capture important patient information, notes and data and some hospitals are struggling to get reliable internet access or basic patient administration systems. Health services are great at innovating, they have to be. Many health services can t afford to release time for innovation and when they are funded, new ideas and novel approaches that increase effectiveness and generate efficiencies too often remain funded in pilot phase or don t move beyond the front door of one service; people in other services and their communities miss out. Compounding all of this, health professionals are spending time working with deteriorating or broken equipment rather than on care and many are working in buildings that are outdated and, in some cases, dilapidated. There is no transparent, strategic approach to capital allocations. Our health professionals working in rural, regional and metropolitan hospitals and in community health services are passionate about what they do. They care. And they keep going, no matter what. But there is broad consensus that the system needs to change; that it has to. And this call for change is now urgent. There is no single easy fix, instead the focus needs to be on a range of separate but interlinked areas. We cannot deliver high quality care without a high quality and appropriately trained workforce that is distributed in the right areas across the state. We cannot continue to increase activity and draw on world s best practice without adequate funding. We cannot shift demand from hospitals without properly understanding the role of, and having a clear vision for community health services. And community health services cannot continue to care for and keep some of our most vulnerable people healthy and out of hospital without adequate funding. The safest care cannot be guaranteed without 21st century digital systems and approaches in place and with sub-standard equipment and buildings. The VHA, on behalf of its members, calls for a reset and a rethink. While Victoria s politicians have always prioritised the important issue of health, we now need to confront the challenges faced by the Victorian public health sector, not in a piecemeal fashion but through broad, connected strategies that consider all parts of the health system and its complexities. We need holistic approaches to demand management including a stronger focus on keeping people well. None of this can be done without collaboration and cooperation between large and small hospitals, between community health services and hospitals, with educational institutions and local councils and schools. Without this, the Victorian public health system will not be in a position to sustain its world-class standard and deliver the care the Victorian community deserves into the future. The VHA recommends a focus on seven core areas including workforce, innovation, community health services policy and funding, digital, appropriate funding for hospitals, managing demand, and buildings and equipment, which are based on extensive consultation with VHA members from across metropolitan Melbourne, rural and regional Victoria VICTORIAN ELECTION POSITIONS

5 CONFRONTING WORKFORCE CHALLENGES HEAD-ON AND GIVING VICTORIANS THE HEALTH WORKFORCE THEY NEED Our health workforce is essential to the overall success of the health system and cohesive efforts to improve its effectiveness are central to improving the system s performance to ensure better health outcomes for all Victorians. Our public and community health services are staffed by some of the state s most dedicated and hardworking professionals who regularly go above and beyond to ensure the best possible health outcomes for the community. While Victorians can be confident in the quality of care they receive, the health sector faces significant challenges: an ageing and growing population, increasing prevalence and complexity of chronic disease and increasing community expectations. The impact on the health workforce is increasinglyevident as deteriorating mental and physical wellbeing, including fatigue, occupational stress and burnout continues to escalate, creating ripple effects across the sector. One rural hospital this year reported using its entire overtime funding budget within the first month of the financial year. Placing even more pressure on the workforce are major aged care and disability services reform. Australia s aged care workforce must quadruple by 2050 while the disability workforce will need to grow by 76 per cent in Victoria by Compounding the issue, Victoria is experiencing workforce shortages across a number of health professions including general practice, medical speciality areas, dentistry, nursing, midwifery, mental health, ageing and some key allied health professions 1. In the face of these shortages, health workforce planning and resource allocation is an increasingly-complex and difficult task. Under the current system - particularly in rural and regional areas as well as in specialty services and in metropolitan Melbourne - health services compete for the limited number of staff available resulting in recruitment and retention challenges. 1 Productivity Commission 2005, Australia s Health Workforce, pc.gov.au/inquiries/completed/health-workforce/reportw 2018 VICTORIAN ELECTION POSITIONS 5

6 Ensuring the right distribution of the health workforce is paramount if we are to ensure equity of access and outcomes for Victorians. Not only does this mean having the right skill mix and workforce size required to support the needs of rural and regional communities but ensuring the right distribution of health workers in growth corridors and areas where higher needs groups are growing at a faster rate than the general population. Eastern Health s Box Hill Hospital, Austin Health and Peninsula Health are all at the centre of the fastest growing population of over-65s while Melbourne itself is expected to grow by an additional 160,000 people by Persistent bias towards promoting specialist and subspecialist care, and emerging workforce expectations have resulted in a decline of procedurally-skilled generalists. This is a particular concern for rural communities where the shrinking generalist workforce and difficulty recruiting specialists is already limiting access to high-quality healthcare particularly for obstetrics, anaesthetics, surgery and emergency medicine 2. There is also a lack of incentive for health professionals to transition to rural and regional areas. Health workers face challenges accessing support from other health professionals, continuing their professional development and education opportunities, and often experience social isolation. High turnover in rural areas, and increasingly in metropolitan services, is costly for health services and leads to a lack of continuity of care and poorer health outcomes for Victorians 3. The Department of Health and Human Services recognises many of these issues but it has attempted to address them with a multitude of workforce plans which health services find confusing. Better Care Victoria and Safer Care Victoria both have workforce elements, the Chief Allied Health Advisor has a focus on workforce issues and the Rural and Regional Plan will also focus on workforce. There is not a cohesive approach. 2 Pashen, D et al. 2007, The expanding tole of the rural generalist in Australia: a systematic review, available at: policy_options_10908.pdf 3 Rural communities have higher rates of mortality and chronic disease, have limited access to and lower usage rates of health services, and are more likely to engage in risk behaviours, Australian Institute of Health and Wellbeing, VICTORIAN ELECTION POSITIONS

7 Question How can we ensure an adequate number and equitable distribution of appropriately skilled health professionals across the state to ensure our community receives high quality care close to home? This approach would deliver more job-ready graduates, a suitably qualified workforce to meet demand, and the implementation of strategies to start addressing the long-term retention of health professionals, and ensuring a better distributed and more flexible workforce that meets the needs of all Victorians. Answer To ensure the healthcare needs of Victorian, rural, regional and metropolitan communities, we must tackle the human resources crisis head-on. A single comprehensive state-wide human resources strategy for health that considers innovative ways to address both current and emerging issues must be developed. To be effective the strategy must be co-designed with key sector stakeholders including employers and employees and it will be essential to bring educational institutions, specialist medical colleges, professional associations and registered training organisations into the tent to ensure courses and programs adapt appropriately. The strategy must consider: The changing needs of the health sector, including roles and skill-sets, especially in line with policy reform agendas, to inform curriculum planning HOW MUCH THE DISABILITY WORKFORCE WILL NEED TO GROW BY IN VICTORIA BY % THE AGED CARE WORKFORCE MUST QUADRUPLE BY 2050 ACROSS AUSTRALIA Population trends and projections at a local level and identification of current gaps in the distribution of the workforce Changes in care and support requirements to accommodate identified trends and changing health care needs like rising rates of chronic disease and comorbidities, and the specific health needs of an ageing population The ongoing role of specialist medical colleges, professional associations and registered training organisations in preparing the future workforce to meet the changing needs of health services and patients THE NO. OF AGED CARE WORKFORCE THAT WILL BE REACHING RETIREMENT AGE IN THE NEXT 15 YEARS 1 2 The creation of career pathways and training opportunities that focus on balancing the mix of specialist and generalist clinicians Boosting professional development opportunities for new and existing staff including training and development strategies that incentivise health workers to move into and remain in regional and rural areas and other identified areas of need. WORKFORCE SHORTAGES GENERAL PRACTICE, MEDICAL SPECIALITY AREAS, DENTISTRY, NURSING, MIDWIFERY, MENTAL HEALTH, AGEING AND SOME KEY ALLIED HEALTH PROFESSIONS VICTORIAN ELECTION POSITIONS 7

8 DIFFUSING INNOVATION: SHARING BRILLIANT IDEAS AND DRIVING CHANGE ACROSS THE STATE Two years ago, there was no protocol in place at Alpine Health for people presenting with chest pain. Today, thanks to the ingenuity of team members at this small multi-purpose service in north eastern Victoria, an innovative new approach to care which has been dubbed the Hume Algorithm is saving lives. Innovation in health care plays a major role in driving the system forward to provide better outcomes for patients. Employees within hospitals and, community health services are designing system changes as diverse as the Hume Algorithm, to a new model of care that has resulted in people living with dementia living medication free, to using big data to improve access to outpatient clinics for sick children. These creative solutions usually take place organically, with health services leading the way in developing innovative practices in response to pressures such as managing demand, reducing costs, finding better ways to manage people with chronic disease, improving quality and safety and empowering patients, their families and carers. The Victorian Government has encouraged services to implement these projects through funding and awards programs including the Victorian Public Healthcare Awards. These awards showcase examples of excellence, dedication and innovation in public health care that are making a real difference to the lives of Victorians. And while health sector professionals don t innovate for the sake of awards, such recognition plays an important role in driving a culture of innovation and serves to highlight that healthcare is rich in evidencebased innovation. Despite this, these innovative ideas, projects and programs frequently don t move beyond pilot phase or the single service in which they were developed. Opportunities to share ways of working more efficiently, effectively and for improved patient outcomes are lost. The diffusion of innovations continues to be a major challenge for the sector 4 even though the majority of health projects are measurable and the benefits tangible, practical, scalable and transferable. The absence of innovation diffusion is frequently due to a lack of strategic, formal mechanisms. There is a missed opportunity to share and replicate solutions that may solve problems of accessibility, quality and the cost of delivering public healthcare services. Healthcare innovation also faces the additional challenge of funding for further development and ongoing costs. Many initiatives are only funded for the short term and that funding is often modest. An over-enthusiasm for pilots presents several issues for health services wanting to embed new models of care, ways of working and/or technologies into how they do business. Grants for innovative programs aren t incentivised to be replicated across the sector and scalability isn t necessarily considered. For example, a successful project focused on infection control delivered in a large metropolitan hospital is likely to be applicable to a smaller rural service, however, the smaller service may not be able to replicate the program without support due to the cost, required resourcing or scale of the project. The health sector is also stifled in its ability to identify innovation as core business, given the constant pressure to deliver more services to our growing and ageing population. Innovation can be the first thing to go in the context of tighter budgets and community expectations. This is a symptom of health services needing to balance limited resources with prioritising long term strategic investments in trialling new ways of doing things. Question How can government play a stronger role to foster sharing across the sector of successful programs and projects that have driven innovative system change, and support roll-out across other services? Answer While the sector has an important role to play to drive innovation and thinking outside the square, to help solve some of the issues facing the healthcare system, the government too must ensure the sector is supported to implement change and prioritise innovation so that it may adapt to increasing pressures. 4 Berwick, D 2003, Disseminating innovations in health care, The Journal of the American Medical Association, vol. 289, pp VICTORIAN ELECTION POSITIONS

9 Enabling this will require: Expanding timelines for programs and pilots to enable capacity for measurement, evaluation, scalability and sharing. Reliable and robust data is a critical part of evaluating the efficacy of any project or program. Health services need certainty to collect robust data so that there is confidence in the outcome measures to enable other health services to confidently engage with the program Significant additional ongoing funding of innovative programs, which include a requirement to develop plans for potential replication including capacity to scale A framework to enable rapid transition of pilot programs that have proven effective into long-term embedded initiatives that receive ongoing funding Supporting the establishment of a community of practice where health professionals can come together to share details of projects and learn from one another. This also presents opportunities to engage beyond the health sector with other industries in ideas-creation and implementation with invitations extended to those driving relevant successful initiatives from other states or overseas Establishing a web-based health innovation engagement platform to share outcomes and project plans and to support a community of practice. This would be a space where health services can share ideas, and support each other. RESTORING QUALITY OF LIFE FOR PEOPLE WITH DEMENTIA Wattle Crescent, Rural Northwest Health s secure dementia unit in Victoria s Wimmera Mallee region, was not a place that people were rushing to go to. Family members did not enjoy visiting, and employees didn t enjoy working in the unit in which they said they would never like to live themselves and residents were managed through a medication based model. Knowing something had to give, Rural Northwest Health s aged care team set out on a journey to change the lives of people in their care, designing the ABLE (abilities, background, leadership, environment) person-centred model of care. Built on the Montessori principles of self-directed activity, hands-on learning and collaborative play, ABLE focuses on building the ability of residents, educating staff in new approaches to care, engaging with and involving the local community, and changing the physical environment to feel less like a hospital and more like a home. Importantly, each resident s individual skills and interests are a core focus of ABLE. The impact of the new care model on the lives of residents has been substantial with ABLE eliminating psychotropic medication use, reducing behavioral and psychological symptoms of dementia, improving staff confidence and satisfaction, and improving family satisfaction. Residents have reconnected with simple daily tasks like drying dishes, helping make beds, setting dining tables, gardening, polishing shoes, and making tea and coffee. We must embolden and enable our staff to respond to the needs of the community. The Hon. Jill Hennessey, Minister for Health and Ambulance Services, VICTORIAN ELECTION POSITIONS 9

10 CLARIFY COMMUNITY HEALTH S ROLE & FUNDING FOR FUTURE GROWTH Victoria s community health services deliver primary health, human services and community-based support to meet local community need. Embedded in local communities, these health services have a unique understanding of the communities they serve, informing their ability to develop localised responses to social and health issues. In Victoria there are 86 community health services - 31 independently managed, registered community health centres and 55 community health services that are part of rural or metropolitan health services. This sector is unique in Australia and provides an incredibly-valuable community platform, however, it is one that has not received the attention it deserves from government, and has been gradually weakened over recent decades by enforced competition and funding cuts. Community health services pride themselves on being accessible to all Victorians, including to some of the State s most vulnerable and isolated people who may have nowhere else to turn. They also play the crucial role of filling gaps left by the broader health system, and bridge the gap between acute and primary care sectors. But there is a lack of clarity among the broader health sector regarding the role of community health services and their capability and potential. Community health services are well placed to release pressure from across the system but are constrained in the current environment. They are burdened with an unsustainable, inefficient, unnecessarily-complex and fragmented funding model. With a standard two per cent increase applied annually that does not account for the true cost of delivering care, community health service budgets are buckling. Community health services are also required to report across an inordinate number of funding lines to various areas of government resulting in gross inefficiency. And they are required to demonstrate compliance with multiple accreditation standards; it is not uncommon for a single community health service to have to meet compliance for seven different standards, which all come at a cost. Partnerships between hospitals and community health services are based on the relationships and initiative of individuals rather than facilitated and supported by government. In fact, hospitals that do partner with community health services to manage demand and ensure patients are receiving the right care, in the right place at the right time, are penalised financially for doing so where it results in fewer people presenting at hospital. These constraints are not in the best interests of Victorians accessing and relying upon community health services, they also restrict the services ability to be responsive and flexible in delivering equitable and timely access to care. Question How can we build on the great work of community health services and leverage these services to support and release pressure from the broader health system? Answer Removing constraints will support a co-designed community health service framework which emphasises community health s crucial role providing services to vulnerable communities and supporting people with chronic and complex conditions who are poorly served by the current system. This would support the sector to clearly articulate a shared understanding and vision for community health, and formalise their role in the broader healthcare system. The VHA calls for: Development of a clear community health service framework that clearly articulates their role within the broader health system Delineation of the roles and responsibilities of hospitals and community health services, particularly in managing system demand and development of a funding framework that encourages collaboration between hospitals and community health Creation of a simpler and more sustainable community health funding model and formula, ensuring appropriate, ongoing funding for community health services that considers the real costs of care. A formal framework must be accompanied by additional funding to enable the community health sector to grow in line with population growth. The VHA calls for an expansion of this platform to meet the needs of the Victorian community today and into the future VICTORIAN ELECTION POSITIONS

11 JOINING FORCES TO PROVIDE CARE IN THE RIGHT PLACE AT THE RIGHT TIME A new collaborative approach to caring for people with back pain and related disorders has seen hundreds of patients removed from hospital outpatient waiting lists and improved outcomes for patients. Experts from The Royal Melbourne Hospital and community health services, Merri Health and cohealth, have joined forces to ensure people with back pain and injury receive timely access to the right care in the right place through the establishment of back pain assessment and management clinics. Low back pain is the most prevalent musculoskeletal condition in Australia, with four out of five Australians experiencing an episode in their lifetime and places considerable demand on specialist surgical outpatient clinics, which may not be the most appropriate referral choice. The clinics, established through Department of Health and Human Services workforce innovation grants, see experts triage, assess and refer patients to the most appropriate care setting. With appropriate diversion of patients to community care for non-invasive management and timely identification of patients with red flag conditions fast tracked to specialist surgical care. The partnership has resulted in shorter wait times and improved clinical outcomes and significantly reduced demand on hospital resources VICTORIAN ELECTION POSITIONS 11

12 SAFE HEALTHCARE, ENABLED BY WORLD-CLASS DIGITAL TRANSFORMATION When health professionals have access to complete and accurate information, patients receive higherquality, more timely and safer care. They also receive access to more innovative care with electronic access to data ensuring Victorian institutions are invited to participate in global clinical trials of new treatments and approaches to care. Electronic medical records (EMR) provide a comprehensive health picture of a patient and vastly improve the ability to diagnose, manage risk factors, reduce or prevent errors and improve outcomes. They are widely cited as being pivotal to improved clinical decision making, optimisation of clinical pathways In 2013, the Health Sector ICT Review Panel recommended funding for building EMR capability that incorporates healthcare identifiers at all health service providers (private sector investments in healthcare identifiers should be further encouraged). While a few Victorian hospitals are fully digital, with world-class EMRs underpinning the safety and quality of their operations, most are far behind the evolution of digitally-enhanced care and patient management. The majority, experiencing significant budgetary issues, cannot afford to fund ICT upgrades and new systems, even with partial government funding support. Over time, a lack of long-term planning and government investment has left the sector with legacy ICT systems that often don t communicate with each other or allow easy access to linked datasets. This forces clinicians, patients and staff into inefficient and, at times, unsafe processes. Victoria has fallen behind, nationally and internationally and is out of touch with world s best practice. and better efficiencies including reducing length of stay 5. Similarly, accurate communication of health information is a vital aspect of safe and effective healthcare and key to reducing avoidable harm. A unique patient identifier is considered an essential component, not just to make our system more efficient, but to ensure it is safe. Targeting zero: supporting the Victorian hospital system to eliminate avoidable harm and strengthen quality of care 6, identified the clear need to expedite the implementation of a state-wide EMR and unique patient identifier. This is a way to improve the quality of care and the system s information flow to ensure care deficiencies are identified and improved upon. While this creates headaches for hospitals and their staff, there is a real impact on patients attending hospitals and community health services. The haphazard and disconnected approach to ICT and the lack of integration between health services places patients at risk. For example, if someone from rural Victoria falls unwell during a holiday in Melbourne and needs to be taken to a metropolitan emergency department, that hospital has no way of accessing their patient history from their regular hospital or GP. This risks medication errors like duplicated treatments and lack of access to vital diagnostic information. 5 Electronic medical record benefits: a literature review, Victorian Government, Targeting Zero, Report of the Review of Hospital Safety and Quality Assurance in Victoria, October 2016, Victorian Government VICTORIAN ELECTION POSITIONS

13 The lack of a state-wide unique patient identifier means that two hospitals - even those that are physically linked - must often rely on paper case notes, carried by hand or delivered by fax machine, to jointly manage a single patient. Patients are regularly asked to repeat their histories and stories because systems do not talk to each other, placing a sometimes-traumatic burden on people when they are at their most vulnerable. Even for patients who are not being asked to repeat challenging histories, that patient information can t be easily and safely transferred between services heightens the risk of errors and is completely out of step with community expectations. Question How can we harness advances in digital healthcare, giving clinicians rapid access to real-time clinical data, to achieve the best possible outcomes for Victorians? Answer The need to invest in digital systems and infrastructure across all of the state s public health and community services has been ignored for too long. It s time to show leadership and address the patchwork of Victoria s digital health capability with a coordinated approach to major digital systems. The VHA recommends: Commitment to a prioritised state-wide, longterm health ICT infrastructure strategy with clear prioritisation, strategic appraisal of the state s health ICT needs, realistic funding, and a plan to guide investment. This must include an audit of the current situation and specific upgrade requirements Full commitment to a progressive and structured roll-out of an EMR across the state -- ICT capability is incredibly varied across the public health sector, so the decisions about where and when to direct this roll-out must be transparent and based on an understanding of each health service s existing capability and readiness for an EMR, and the patient flows between different services -- Capital investment to procure appropriate systems is one part of the equation. The commitment must entail a comprehensive change management process that allows staff, in particular clinicians, to be trained as new systems are implemented -- The ongoing licencing and recurrent operational costs associated with operating an EMR must be included to ensure new systems don t come with unmanageable costs for services that cannot afford them, and to ensure a world class system is maintained. Commit to link hospital systems across the state. A unique patient identifier will allow any public hospital to view relevant clinical information about a patient, regardless of whether they have been admitted to that service for the first time. This will improve the quality and safety of care, and deliver information about how people access different hospitals across rural, regional and metropolitan Victoria, enabling better service planning into the future. Electronic patient records are expected to transform the capacity of the system to study and improve safety and quality of care. Targeting Zero: Supporting the Victorian hospital system to eliminate avoidable harm and strengthen quality of care, Victorian Government, VICTORIAN ELECTION POSITIONS 13

14 FUNDING MODELS THAT REFLECT COST OF DELIVERING SAFE & HIGH-QUALITY CARE Funding challenges are not new to Victoria s public health system. Our public hospitals have been driving financial efficiencies for decades and, as a result, deliver some of the most efficient care in Australia dollar-for-dollar. While an excellent outcome for the Victorian taxpayer, it has made it increasingly difficult to cut costs without reducing services or placing patients at risk. Added to this, costs are increasing faster than ever: There is a greater demand for services than ever before with clinical costs expanding along with a growing, ageing and more complex population The price of power has skyrocketed, a trend which is likely to continue as energy policy adapts The health workforce is large and the cost of paying increases to enterprise bargaining agreements is not fully covered by the government, leaving hospitals to search for the remainder to ensure their staff are appropriately remunerated A year on year productivity decrease has meant that hospitals have consistently had to make cuts to their budgets. There is now little to no low hanging fruit remaining; services are being cut and quality of care is being impacted Initiatives focused on critical issues such as tackling occupational violence, improving quality and safety systems, or training employees and graduates need to be implemented and funded. Hospitals are also focused on delivering new and safer approaches to treatment and care, in line with world s best practice and community expectation. But these approaches are generally more costly. Laparoscopic surgery, for example, where operations are performed through a series of small incisions, is far less invasive and results in better outcomes for the patient but requires additional surgical staff and more expensive equipment than traditional open surgery. But these costs are not included in the price paid to hospitals. Recurrent funding to health care providers to cover these increasing costs has not kept pace with inflation. Where there have been funding increases, they often come with the requirement to increase activity. Hospital budgets are under more strain than ever. Adding to the funding burden, in recent years there has been a pattern of delays by government in setting hospital budgets and statements of priorities, as well as last-minute changes to important components of hospital funding policy without consultation. This means hospitals are often starting the fiscal year behind the pace. Even small changes to funding models can have a large impact on the ground, and in some cases can mean important health services cannot be delivered. Question How can we ensure the funding model is accurate and fair and allows hospitals to focus on what they do best, caring for people? Answer Increasing funding to match costs and demand is essential: Ensure health service funding meets the cost of rising demands, wage growth, health inflation and increases in the cost of delivering care at or above the rate of inflation The Weighted Inlier Equivalent Separation (WIES) price and other key funding lines must be increased to allow hospitals to deliver on their commitments, to follow world s best practice in treatment and training and to make sure essential healthcare services continue to be available to all Victorians Bring publication of the annual Policy and funding guidelines forward to allow hospitals to build an accurate budget with contemporary information and policies to guide them. A target date of 1 June will allow hospitals to agree to their budgets and operational plans well in advance of the commencement of the financial year. Ensure hospitals are part of the discussion relating to changes Fully fund public hospitals to cover wage increases for staff with the advent of new EBAs Remove the requirement for an annual arbitrary productivity decrease VICTORIAN ELECTION POSITIONS

15 Victorian health services deliver some of the most efficient care in Australia dollar-for-dollar SUPPORT & INCENTIVISE NEW APPROACHES TO MANAGE DEMAND Victoria is a popular destination for interstate and international migrants and our population is growing at 2.4 per cent per year 7. The population is ageing; more than 15 per cent of Victorians are over the age of 65. This number is likely to triple by Ageing is already a game-changer for health services; it is estimated that people aged over 65 use three times more hospital services than people under 65. This ageing population, combined with a simultaneous rise in the number of people living with chronic diseases, has major implications for health care services. Chronic diseases are the leading cause of illness and disability in those aged 65 years and over 9. Hospitals and community health services around the state are reporting a surge in demand driven by these factors, compounded by barriers to accessing primary health services including a lack of access to general practitioners and the cost of accessing primary health. Outpatient clinics are busy, the demand for beds is high, and emergency department presentations continue to rise. These pressures are not new, but the level of demand for hospital services is approaching critical levels; growth in demand is one of the health system s biggest strategic challenges. Question How can hospitals and community health services respond to ever-increasing demand while maintaining high quality and accessible services? Answer The Victorian Government has approached the issue of managing demand and planning services by committing to developing regional and sub-regional plans, involving public hospitals and relevant community partners. The Australian Demographic Statistics, Mar 2017, Australian Bureau of Statistics 2017, mediareleasesbycatalogue/ca1999baeaa1a86aca a47?opendocument 8 Victoria in Future 2016, Victorian Government, data/assets/pdf_file/0014/14036/victoria-in-future-2016-final-web. pdf, cited 14/11/ Prevalence of comorbidity of chronic diseases in Australia, Caughhey et al, articles/ / , cited 14/11/ VICTORIAN ELECTION POSITIONS 15

16 VHA supports this approach as joint planning exercises are essential, however, more needs to be done. Hospitals are not always the best place to be delivering care, particularly for people with multiple chronic diseases who may need checkups and help with condition management. The existing HealthLinks program is a good example of how hospitals can be given latitude to transfer healthcare into community settings. The VHA recommends this approach be rolled out state-wide based on the right place, right time, right care premise, focusing on shifting the point of care from hospitals to appropriate community settings, in particular community health services Rather than relying on each hospital to negotiate individual relationships to facilitate referrals and the potential transfer of patients for elective surgery procedures, the VHA recommends a more systematic approach to service planning and patient care. Smaller rural and peri-urban hospitals should be viewed as a core partner in helping manage demand for larger hospital services. Ensuring these arrangements are robust and can t be unilaterally changed or withdrawn is important for continuity of care. Provide incentives for hospitals and community health services to participate in local preventative and health promotion initiatives instead of the current approach that penalises organisations that shift demand Drive regional prevention and health promotion solutions and approaches, drawing on data to identify specific regional issues. Support hospitals, community health services, schools, local government and non-government organisations delivering health and social services to work together to enable regionally-specific responses Increase funding and support for outreach services in community health services to help keep vulnerable Victorians healthy and out of hospital. HOLISTIC APPROACH TO DEMAND MANAGEMENT There are unique opportunities to manage demand holistically in a way that is mutually beneficial to several hospitals. For example, many large metropolitan hospitals are oversubscribed, with waiting lists for elective surgery far exceeding their capacity to manage those patients. In some cases, bilateral contracts between large and smaller hospitals have been agreed, resulting in additional elective surgery provided by smaller rural hospitals. These arrangements are ad-hoc and rely on individuals proactively identifying opportunities and building relationships. When there is not enough excess capacity to allow patients to be treated in the smaller hospitals or if the larger hospital is at risk of over-reaching its WIES target, there is a risk that those services are cut. This approach to demand management could be improved by providing predictable funding for both the small and the large services. We need smarter support to drive social determinants of health before people get entrenched in multiple layers of disadvantage and ultimately become big users of the health system. The Honourable Martin Foley, Minister for Mental Health, VICTORIAN ELECTION POSITIONS

17 INFRASTRUCTURE TO SUPPORT SAFE AND HIGH-QUALITY CARE The Victorian Government plays a key role in driving strategic investments into public health and community health capital and equipment, resulting in equipment upgrades, building renovations, rebuilds and new projects that respond to community need. Many of our state s health facilities are outdated which impacts on both their ability to design modern workflows and care, and to attract and retain staff in a competitive environment; staff want to work in fresh, modern and safe environments. The quality of equipment and infrastructure has a direct impact on the community s perceptions about quality of care. In addition to physical infrastructure, equipment in many health services is outdated and, in some cases, bordering on unsafe. With little to no spare cash, public health services rely heavily on government to fund infrastructure and equipment upgrades and organisations are constrained to borrow to fund infrastructure. It is clearly not feasible to rebuild every facility, but the capital infrastructure and equipment we rely on must be managed in a way that facilitates high quality and safe healthcare delivery. While there have been numerous attempts in recent years to publish and remain faithful to a transparent Victorian capital investment strategy, there is a lack of transparency around how capital funding is allocated. There is a lack of strategic coordination for infrastructure funding that considers demand management, modelling and planning, resulting in unclear prioritisation and health services competing against each other for capital grants. There is also a lack of clarity around the principles, criteria and timelines for major capital works and upgrades and no incentives provided to health services to maintain their facilities. In fact, when budgetary issues hit, as they do most years, maintenance budgets can be the first thing cut. Medical equipment in hospitals and community health services must be kept up-to-date to ensure it is safe and compliant. Funding to upgrade equipment in community health services is almost non-existent. Funding for grants to upgrade equipment in hospitals has remained static for years, despite booming demand for hospital services dictating that equipment be replaced and renewed. On top of a stagnant pool of money available to replace medical equipment is a set of rules that inadvertently disadvantage hospitals. The Medical Equipment Replacement Program requires that each grant application to replace equipment must reach a cost threshold of $300,000 and not exceed $3 million, which effectively rules out many smaller purchases or those focused on optimising equipment. It makes it difficult for hospitals which need to upgrade equipment that may just be over the $3 million threshold. They then need to make a major capital bid, in competition with much larger infrastructure bids, for what may be an essential piece of equipment. Question How can we ensure a coordinated, flexible and equitable approach to infrastructure and equipment funding to ensure the best outcomes for people working in the system and those accessing services, no matter their size, scale or location? Answer The Victorian Government must continue to play a central and strategic role in major capital builds. There are several changes to policy and planning that would greatly enhance the ability of public and community health services to improve their physical environments and ensure equipment is safe and optimised. A transparent and needs-based strategy to guide investment in public hospitals. The Victorian health capital plan must be forward-looking and enunciate where, when and why our hospitals will receive much-needed investment The Regional Health Infrastructure Fund has been a significant success, however, despite being intended to last four years the lion s share of the $200 million fund has already been allocated in less than two, highlighting the overwhelming demand for rural capital. The VHA notes the success of the fund, however, recommends that it be reinvigorated with an additional $200 million investment With the ongoing budgetary pressures, including sky-rocketing electricity and gas prices, improving the energy efficiency of public hospitals should be a priority for investment. The greener government buildings fund is due to be fully expended and has resulted in real improvements to the efficiency of key hospital buildings. In many cases, the original investment will be repaid by reduced utilities bills 2018 VICTORIAN ELECTION POSITIONS 17

18 within a short time. The VHA recommends the fund receive further investment, with a significant portion ring-fenced for public hospitals and community health services The $300,000 threshold for accessing the medical equipment replacement fund unintentionally discriminates against smaller hospitals. A small change in guidelines would dramatically improve how hospitals can access funding for vital equipment replacement. Rather than specifying each grant can only be used to replace a single piece of equipment, hospitals must be allowed to bundle their applications to the fund, effectively allowing an application to replace several pieces of equipment from the same unit, a maternity suite bundle or an operating theatre bundle, for example. Alternatively, the threshold could be lowered for all rural, local and sub-regional hospitals, which would immediately facilitate improved access and replacement of equipment in smaller agencies A targeted, ongoing strategy to fund community health infrastructure development based on projected population growth and service demand projections to ensure facilities provide safe and appropriate environment for clients and staff. We re always on a precipice with our equipment and it never feels quite comfortable. Metropolitan health service executive, VICTORIAN ELECTION POSITIONS

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20 The Victorian Healthcare Association is the not-for-profit peak body supporting Victoria s public and community health services to deliver quality care. Members of the VHA established in 1938 include public hospitals, community health services and aged care providers VICTORIAN ELECTION POSITIONS Authorised by: Victorian Healthcare Association Chief Executive Officer Tom Symondson Victorian Healthcare Association Ltd ABN Level 6, 136 Exhibition Street Melbourne Victoria 3000 P / F / E / info@vha.org.au vha.org.au