HEALTH MATTERS Victorian Healthcare Association ISSUE 2
[
OCTOBER 2013
] www.vha.org.au
Celebrating 75 Years
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This issue… 3 4 5 6 7 8 9 10 11 12 13 14 16
CHAIRMAN’S MESSAGE Celebrating our past and meeting future challenges CHIEF EXECUTIVE’S MESSAGE Public demand will always drive health system change 2013 ANNUAL AWARDS Finalists celebrate at 75th anniversary dinner
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Congratulations Western District Health Service
2013 AWARD WINNER Congratulations Western District Health Service 2013 AWARD FINALIST Improving health outcomes for young mums and babies 2013 AWARD FINALIST Gipplsand Lakes model used across Victoria 2013 AWARD FINALIST Clients who self-manage have better quality of life 2013 AWARD FINALIST Activity group for people with early onset dementia POLICY UPDATE New projects on elective surgery and aged care ROYAL DISTRICT NURSING SERVICE Translation standard to improve health literacy INNER EAST COMMUNITY HEALTH SERVICE Rewards scheme will inspire healthy living MENTAL HEALTH REFORM Integration, co-location and early intervention are crucial THE VHA CELEBRATES 75 YEARS SINCE INCORPORATION
Cover image: Former VHA Chairs John Smith, Allan Hughes and Patricia Heath AM cut the cake with Victorian Health Minister David Davis and current Chair Tony Graham.
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Rewards scheme will inspire healthy living
For editorial content please contact: SARA BYERS Media and Communications Manager The Victorian Healthcare Association Level 6, 136 Exhibition Street Melbourne, Victoria 3000 Australia Telephone: +61 3 9094 7777 Facsimile: +61 3 9094 7788 Email: vha@vha.org.au www.vha.org.au The VHA would like to thank member agencies and supporters for supplying many of the photos included in this edition. This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior permission from The Victorian Healthcare Association and inquiries concerning reproduction and rights should be addressed to the editor. © The Victorian Healthcare Association Ltd 2011.
The Victorian Healthcare Association (VHA) is the major peak body representing the interests of the public healthcare sector in Victoria. Our members are public hospitals, rural and regional health services, community health services and aged care facilities. Established since 1938, the VHA promotes the improvement of health outcomes for all Victorians, from the perspective of its members.
This publication is printed using eco-clean print processes by Southern Colour (Vic) ISO9001 / ISO14001 & AS/NZS 4801
Chairman’s Message
Celebrating our past and meeting future challenges
ANTHONY GRAHAM VHA CHAIRMAN
This edition of Health Matters celebrates a major milestone in the VHA’s history – our 75th anniversary.
“While our members continually strive to innovate, the VHA works hard to remain a contemporary and influential peak body on their behalf.”
Incorporated in 1938 as the Victorian Hospitals Association, the VHA has continually evolved to remain pertinent to the needs of our members and to the broader health sector. Born in 1938 from the merger of the Country Hospitals’ Association and the Metropolitan Hospitals’ Association, the VHA has fulfilled various roles, including group purchasing, industrial relations, and policy and advocacy. Part II of our historical profile, published in this edition, brings our journey to the present day. Collectively, our members have witnessed – and contributed to – the evolution of Victoria’s healthcare sector over the past three-quarters of a century. Our anniversary provides an opportunity for us to reflect on past achievements, while we anticipate what the future of public healthcare might hold. This theme was discussed and debated at our 2013 annual conference, Celebrating 75 years: meeting the challenges ahead. I congratulate our VHA Award finalists, whose innovative programs are profiled in the following pages. Particular
congratulations go to Western District Health Service, who won both the Annual Award and our inaugural Member’s Choice Award, which was voted for by delegates at the conference. The awards were presented at a special commemorative dinner attended by Victorian Health Minister David Davis, health sector dignitaries, and past VHA chairs. The VHA believes the capacity for innovation in our healthcare sector derives directly from Victoria’s devolved model of governance. Devolved governance allows innovators in local settings to communicate their ideas directly to their executive teams and, ultimately, to their boards of governance. While our members continually strive to innovate, the VHA works hard to remain a contemporary and influential peak body on their behalf. VHA membership has gained strength over the past year, with the return of many metropolitan health services, and the addition of several Medicare Locals and bush nursing organisations to our ranks. Health Matters is also moving with the times. I am proud to present the first online edition and trust that our readers will find the new digital format informative, accessible and more environmentally friendly.
Keynote speakers from the CSIRO: Deputy CEO Craig Roy (left), Professor Lynne Cobiac (centre) and Chairman Simon McKeon (right) with VHA Chairman Anthony Graham and Chief Executive Trevor Carr at the 2013 annual conference.
The Victorian Healthcare Association Issue 2 [OCTOBER 2013] www.vha.org.au
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TREVOR CARR VHA CHIEF EXECUTIVE
Chief Executive’s Message
In his foreword to the Victorian Health Priorities Framework 2012–2022, Health Minister Davis states that “few things matter as much as our health. Being in good health – and getting the care we need when we need it – allows us to live long, fulfilling lives and to participate fully in our community. But we cannot stay healthy without a strong health system”. In celebrating 75 years, we can reflect upon our perpetual efforts to improve the system of public healthcare within Victoria. Real improvement has been achieved, but not without occasional setbacks. A snapshot of the five decades from the 1970s illustrates this point. Funding approaches have moved from deficit funding in the 70s to block funding in the 80s to activity based funding (ABF), which started in the 90s. Throughout the 2000s, the notion of ABF was further refined and expanded, and now in the 2010s we are advancing the discussion and consideration of outcome-based payment systems and funding that follows the client. Recognition of the client as an important partner in health system design, through empowered purchasing choices, is a significant step forward but also a risk to businesses that are driven by volumebased rewards, which are modelled to ensure productive infrastructure.
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Public demand will always drive health system change Nonetheless, the flaw of ABF is that it reinforces the dominant fee-for-service model. Efficient funding allocation and equitable access are difficult to achieve in such a system, and tend to disregard the experience of the individual. The performance of the system is measured by a range of nationally comparable measures and not by ‘bums in beds’ as was the case in the 70s. Industrial relations issues that were virtually non-existent in the 70s now consume significant executive resources. The quality of our infrastructure and services is now routinely subjected to multiple compliance and review processes. In the 70s an 80s, the golden rule of infrastructure design was 4.1 beds:1000 patient population. We now work with a ratio of 2.1 beds:1000 patients, and future innovations will lead to a further reduction in the productive ratio. In the 70s, committees of management were the custodians of our health services. They have evolved into the boards of directors that we have today, which are focussed on the business risks of implementing clinical services for public benefit, and on sustainable strategic and operational plans. Constant change is a given, for there remains much to achieve. Unfortunately, efforts to change the fundamentals of system design and resource allocation carry the risk of outrage from the many vested interests. How often do we see debate over change centred on the protection of custom and culture, rather than what is in the best interest of the public being served? The maintenance of clinical dominion, beds as a blunt measure of system growth, and proprietary ownership of funding, often feature in such debates. Change creates risk. For example, we must ensure that the philosophical shift from ‘cleanliness being next to godliness’ to ‘performance being king’ does not, en-route, result in a collateral loss of the compassion necessary in caring for people
The Victorian Healthcare Association Issue 2 [OCTOBER 2013] www.vha.org.au
at their most vulnerable. It is important that our political leaders clearly acknowledge that our system of universal healthcare is a rationed system. Medicare is a payment system (and only partial payment in most cases). The responsibilities of distribution and design lie with the states, according to the National Health Reform Agreement. The need for co-payments is a form of rationing, as is the misdistribution of services funded through the payment structure. State budgets limit the range and volume of services available, as does the distribution of capital. Our future will be characterised by an older populace, experiencing multiple chronic illnesses. New approaches to system and infrastructure design, workforce utility, and funding models will be necessary to enable an appropriate response to this demand. Our system will feature a more sophisticated use of information technology. Healthcare advice and clinical support will be delivered remotely with the assistance of monitoring devices that relay information in real time. Coproduction will be routine with a web-informed populace because client engagement will require much more than a cursory explanation of the treatment plan. Further workforce change will occur (despite forces of resistance, greater utility will necessitate this) and the focus of governing bodies will move towards data collection to create business intelligence, as the competition for available funds increases. Former VHA Chair, Len Swindon, predicted in 1980 that the pressure to contain costs would increase, relationships with government would become more critical and, partly because of these factors, public scrutiny of hospitals and healthcare in the community would intensify. Much has changed, but nothing has changed! The challenge of managing public expectations is a constant, which will continue to feed change within our system for many years to come.
2013 Annual Awards
Finalists celebrate at 75th anniversary dinner
Victorian Health Minister David Davis (left) and VHA Chairman Tony Graham congratulate winners Rosie Rowe and Usha Naidoo from WDHS.
Finalists from Gippsland Lakes Community Health, Nillumbik Health, the Royal Women’s Hospital, WDHS, and Ovens and King Community Health Service.
The Victorian Healthcare Association Issue 2 [OCTOBER 2013] www.vha.org.au
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2013 Award Winner
Western District Health Service (WDHS) has won the 2013 VHA Annual Award for its telehealth services in oncology, urology and pain management.
Congratulations Western District Health Service Because of these barriers, WDHS patients needing pain management rarely accessed any specialist treatment.
WDHS also won the VHA’s inaugural Member’s Choice Award. These awards recognise an outstanding health service initiative that challenges existing norms in service provision to deliver improved patient outcomes. Award sponsor HardyGroup International presented the winning trophies to WDHS at the VHA’s annual conference on 17 October.
The telehealth program has required participating health services to embrace new models of care. Melbourne Health’s Royal Melbourne Hospital provides pain clinics, while Barwon Health provides oncology and urology clinics. The success of these services has depended on the trust between WDHS nursing staff, specialists and local GPs, who actively sought the pain clinic to overcome a lack of access by their patients. Telehealth has also enabled WDHS to double the number of students on placement within its speech department, and students are now reporting an improved placement experience.
WDHS has been an early adopter of telehealth, establishing three clinical services since August 2012. Its urology and pain management telehealth programs are among the first of their kind in Victoria.
Previously, students were personally supervised by a speech therapist, but evidence showed that the presence of an observer could distort the dynamics of a speech therapy session, and affect the behaviour and performance of participants. One-to-one supervision was also time consuming for WDHS speech pathologist Sue Cameron, who can now remotely supervise two students at a time. Students’ clinical consultations are recorded and available via the web for their university supervisors and peers to access. Through its experience, WDHS has shown that telehealth is sustainable under Medicare and transferable to any rural or regional area with simple technology and infrastructure, and skilled local staff to support the consulting process.
Telehealth has increased patient access and reduced waiting times for these services (see graphs below). It has also saved about 75,000 km in travel by patients and specialists, and up to $48,000 in associated travel costs. Most WDHS telehealth patients are elderly and isolated, with limited access to transport and income. Previously, they had to travel to Melbourne, Ballarat or Geelong (a 500 kilometre return trip) or their specialists had to travel to Hamilton. This was costly, stressful and expensive, sometimes requiring overnight stays which impacted on patients, carers and families.
Speech pathologist Sue Cameron supervises students via telehealth
INCREASED PATIENT ACCESS TO SERVICES AS A RESULT OF TELEHEALTH
NUMBER OF MONTH
NUMBER OF PATIENTS PER MONTH PAIN
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REDUCED WAITING TIMES FOR SERVICE AS A RESULT OF TELEHEALTH
UROLOGY
ONCOLOGY
PAIN
The Victorian Healthcare Association Issue 2 [OCTOBER 2013] www.vha.org.au
UROLOGY
ONCOLOGY
2013 Award Finalist
The Royal Women’s Hospital has introduced a new maternity model of care for expectant mothers aged 13-19. These young women are socially complex and more likely to have poorer birth outcomes, so they require a special kind of support. The Women’s is using a caseload (one-toone) midwifery model to improve the health outcomes for two generations: the mother and her child. Under the caseload model, healthy low-risk women have their own dedicated midwife and a back-up midwife during pregnancy, birth and immediately post birth. Continuity of care and of carer allows a close and supportive relationship between the midwife and the woman, enabling the midwife to personalise the information and care she provides. The model is informed by evidence from the world’s largest clinical trial of caseload maternity care conducted by the Women’s (see separate box). This research showed improved birth outcomes for women and their infants, and an increased level of satisfaction with the pregnancy and birthing experience, compared to standard maternity care. Midwives providing caseload care had higher rates of professional satisfaction and lower rates of burnout than their standard care colleagues. The young women’s program includes the provision of additional social support
Improving health outcomes for young mums and babies services, including a dedicated young women’s care coordinator, a dedicated social worker, careers counselling, contraception services, extensive discharge planning, and parenting and attachment information. Staff are trained to respond to the specific social complexities faced by young mums, including unplanned pregnancy, single motherhood, poor educational opportunities, mental health issues, unemployment and financial hardship. Hospital data from the Women’s in 2011 showed that young women are much more likely to smoke, have a low BMI, be of indigenous background, feed their baby with only artificial formula, have a preterm or low birth weight baby, or a baby admitted to intensive or special care. The Women’s conducted a literature review and analysed models of care in place elsewhere to determine best practice. The antenatal and birth outcomes of previous young maternity patients were also reviewed, and the Women’s consulted widely with staff, external referring organisations and young women themselves in designing the model. The program has been shown to increase both attendance at prenatal check-ups and breastfeeding rates, which lead to better health outcomes for young mums and their babies. Young women have reported a high level of satisfaction with this model and have said they feel more confident as parents.
CLINICAL EVIDENCE From 2007 to 2010 the Women’s conducted the world’s largest clinical trial of one-to-one maternity care for low risk women of all ages. The results, published in the British Journal of Obstetrics & Gynaecology in July 2012, showed that compared to standard maternity care, women receiving caseload midwifery were: • less likely to have a caesarean section – 19.4 per cent versus 24.9 per cent • less likely to have epidural analgesia – 30.5 per cent versus 34.6 per cent • less likely to have an episiotomy – 23.1 per cent versus 29.4 per cent • more likely to have a spontaneous (not induced) vaginal birth – 63.0 per cent versus 55.7 per cent Babies of women receiving caseload midwifery were also less likely to be admitted to special or neonatal intensive care – 4 per cent versus 6.4 per cent. An analysis of birth experiences revealed that women who received a personalised model of care were more positive about their experience of labour and birth. Midwives at the Women’s who worked in the caseload model had higher rates of professional satisfaction and lower rates of burnout than their standard care colleagues. For the first time in Australia, the trial has provided evidence that caseload midwifery is a safe and effective model of care. The evidence from this trial has informed the Women’s decision to introduce one-to-one midwifery care as the standard maternity model for young pregnant women.
A young family who participated in the Women’s new maternity care model.
The Victorian Healthcare Association Issue 2 [OCTOBER 2013] www.vha.org.au
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2013 Award Finalist
Gipplsand Lakes model used across Victoria Under Active Lorikeets in 2012–13, 36 children received 344 hours of occupational therapy and 106 children received 1016 hours of speech pathology. Active Lorikeets also increased the parents’ capacity to develop their children’s communication and fine motor skills:
Allied Health Assistant Allison Ferreira works with a child in Active Lorikeets.
Active Lorikeets is a Gippsland Lakes Community Health (GLCH) program that provides allied healthcare for preschoolers with speech and fine motor difficulties. Active Lorikeets was developed in response to long waiting times for occupational therapy (30.1 days) and speech pathology (33.3 days), and the resulting pressure this placed on families and allied health professionals (AHPs). GLCH also had ongoing difficulties attracting and retaining AHPs – a common problem in rural and remote healthcare settings.
• 63 per cent of parents completed post-evaluation • 78 per cent of these parents reported good to significant improvements in their child’s fine motor skills • 85 per cent were confident to very confident in their ability to assist their child to develop their speech or fine motor skills following completion of the program • 95 per cent were satisfied to highly satisfied with the information provided in the program GLCH has created a resource CD and training package, which includes AHA training manuals, home programs for occupational therapists and speech pathologists, therapy plans, marketing materials, templates and information for parents and kindergartens. Active Lorikeets has been used as a case study by the Victorian Department of Health. GLCH has trained more than 20 other health services in the program and is showcasing its training package at the Victorian Allied Health Assistant conference in November.
A PARENT’S PERSPECTIVE “From the start of kinder for my first son, only his closest friend was able to understand what he was saying. He would even translate words for him to the teachers. By the end of his kinder year, my son’s language and speech had improved to the point where unfamiliar people could understand him. This was from the regular speech therapy and Active Lorikeets program co-existing together. “If anything, l think that my boys have hit prep almost a little more advanced in some areas because of this program. The most significant change is with the boys’ numbers and their speech. This program has improved their speech, communication and therefore socialisation skills. This has resulted in an impact on their self-esteem and readiness for school. My oldest son is now reported as being well above his peer group according to his school report in numbers, and his reading is also higher than the required standard.”
GLCH is the only service offering paediatric allied healthcare in the Gippsland Lakes area. Traditionally, one-to-one services were delivered by AHPs on a first-in-first-served basis. Clients were not prioritised according to care needs, and wait lists were long. Active Lorikeets utilises allied health assistants (AHAs) working under the supervision of AHPs. This has freed up AHPs to deliver more one-to-one therapy in a timely manner. Evaluation has shown that before Active Lorikeets, 16 children received 139 hours of occupational therapy each year, and 91 children received 582 hours of speech pathology. Allied Health Staff who helped design and deliver training throughout Victoria.
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The Victorian Healthcare Association Issue 2 [OCTOBER 2013] www.vha.org.au
2013 Award Finalist
A continence self-management program run by Ovens and King Community Health Service (KCHS) has resulted in a 28 per cent decrease in the number of people waiting for continence nurse assessments and a 29 per cent drop in waiting times. All low and medium priority clients waiting for OKCHS continence services are able to participate in the Dry Up program in their local area. The program was designed by Queensland Health1 and adapted by OKCHS. It is offered to Home and Community Care (HACC) clients in the Shire of Alpine, Benalla Rural City, Mansfield and the Rural City of Wangaratta. Before Dry Up was introduced, all clients were referred to the OKCHS continence nurse advisory service, which had one of the highest client demands of all allied health disciplines across the catchment.
Clients who self-manage have better quality of life Waiting time data from January to June 2011 showed clients were waiting an average of 99 days for continence services, with high priority clients waiting 65 days and low priority clients waiting up to 123 days. Between March and December 2012, a total of 56 clients participated in seven Dry Up programs. Evaluation data (n= 35) showed that 86 per cent of clients did not request assessment or intervention by a continence nurse following the program. Participants also experienced a 12–17 per cent increase in quality of life after completing the program. Ten out of 13 quality of life domains improved, specifically: • clients spent less on continence products • fluid and dietary recommendations were implemented • clients were able to more actively engage in physical and social activities Further data revealed that the use of allied health assistants (AHAs) to deliver
the program achieved a 19 per cent saving in comparative salaries and an 11 per cent saving in comparative total service provision costs. Integrated Aged Care Assessment Service Program Manager Fiona MacPhee said the model could be used in sub-acute, rural allied health, community health and primary care settings with access to a continence nurse, pharmacist, occupational therapist and dietician. She said access to a continence physiotherapist was desirable but not essential. “The program can effectively and safely be delivered by AHAs in community settings. With appropriate investment in AHA training this project would easily be replicated by other teams.” References First Steps in the Management of Urinary Incontinence in Community – Dwelling Older People, The State of Queensland, Queensland Health, 3rd Edition (2010).
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The Victorian Healthcare Association Issue 2 [OCTOBER 2013] www.vha.org.au
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2013 Award Finalist
Activity group for people with early onset dementia
More than 250,000 Australians suffer from dementia, with the number increasing every year. Early onset dementia emerges before a person reaches the age of 65 but can start in their thirties, forties or fifties. Nillumbik Health has for many years run a planned activity group for people with late stage dementia. However, people with early onset dementia found it very confronting to join a group with advanced dementia clients aged in their eighties or nineties. Nillumbik Health has established the Happy Days group to provide regular outings for these younger clients, enabling them to visit shops, museums, cafés, movies and musical shows. The Happy Days program follows a different model to the original centre-based group because people with early dementia are more physically capable and want to remain part of their community. People with early dementia are physically
capable and want to remain part of their community. When diagnosed they may be: • • • •
in full-time employment actively raising a young family financially responsible for a family physically strong and healthy
The Happy Days group was established in 2012 using Nillumbik’s available Home and Community Care (HACC) funding. The group meets weekly and has five participants, with a further four on its waiting list. This small group setting allows a staff member and a volunteer to support individual needs on each outing. The group allows participants to maintain as ‘normal’ a life as possible, while providing much-needed respite for carers. One carer described the group as uplifting: “After my father passed away, and with my mother suffering the onset of Alzheimer’s, it came as a relief to find this group. “It did not take long for my mother to look forward to attending and getting pleasure from the participation and the friendship.
Program manager Sue Ricardo at the VHA Awards.
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The atmosphere and ambience is uplifting. “I don’t know what we would do without it; probably have to put her into permanent aged care, as depressing as those facilities are.” Research conducted by Alzheimer’s Australia shows that family and friends play a very important role in the lives of people with dementia. They provide valuable links to past experiences and enable people with dementia to continue to be valued. All Happy Days activities are negotiated with participants and carers, taking the clients’ interests and backgrounds into account. Alzheimer’s Australia wants to replicate the Nillumbik Health model, which has also been promoted to healthcare organisations at regional network meetings. Nillumbik will also seek further HACC funding this year to run the group twice a week. For further information visit Alzhiemer’s Australia at www.alz.org/alzheimers_disease_early_onset.asp
New projects on elective surgery and aged care
Policy Update
The VHA project will seek to answer the following questions:
ELECTIVE SURGERY ACCESS PROJECT The Victorian Healthcare Association is undertaking a project on elective surgery waiting lists and will release a discussion paper for member input this year.
1. Are the measures used to indicate access to elective surgery the right ones? 2. Are the measures we use dependable and comparable? 3. Are there changes we can make to our health system to improve access to elective surgery? 4. Are there other factors that can reduce access to elective surgery?
Elective surgery is defined as surgery that, in the opinion of the treating clinician, is necessary but for which admission could be delayed for at least 24 hours. There were 35 Victorian public hospitals reporting elective surgery performance data to the Department of Health in December 2012. Some other small rural agencies perform minor elective surgery procedures but do not report this data to the department. However, public hospitals represent only part of the state’s capacity, with 62 per cent of elective surgery admissions occurring in a private hospital in 2011–12. The number of elective surgery admissions in private hospitals is increasing more rapidly than in the public sector. In most public hospitals, emergency and elective surgery use the same resources, so an increase in emergency surgery can result in the disruption of elective services. In 2011–12, 86 per cent of Victoria’s emergency surgery occurred in a public hospital. The media, the public and funding bodies view elective surgery waiting lists as an indicator of access to timely care in the public hospital system. Reports about waiting list length, ‘secret’ waiting lists, delays in surgery, and failure to meet national elective surgery targets (NESTs) erode public confidence in that system. But do these reports tell the full story, or are there other factors affecting access to elective surgery that are not being investigated? Early discussions with the sector suggest that factors including the measures used, and the comparability and integrity of the data behind these measures, influence perceptions about elective surgery wait times.
“Do these reports tell the full story, or are there other factors affecting access to elective surgery that are not being investigated?” The project will build on recent work by the Australian Institute of Health and Welfare and the Royal Australasian College of Surgeons on the national definitions for elective surgery urgency categories, and on elective surgery waiting list management in Victoria. For further information please contact Gaye Britt on 03 9094 7777 or gaye.britt@vha.org.au.
AGED CARE READINESS PROJECT The Victorian Healthcare Association (VHA) has received Department of Health funding to lead a sector-directed program of initiatives to help public providers prepare for the Commonwealth’s Living Longer Living Better regulatory changes. The project will support public health services and incorporated associations operating Public Sector Residential Aged Care Services (PSRACS) to respond and adapt to the risks and opportunities presented by this new regulatory and financial environment.
A steering group will be established and forums will be held across Victoria in the coming months. The project will develop operational checklists, a financial modelling tool and a list of issues requiring policy response from the State Government. For further information please contact 03 9094 7777 or email agedcare@vha.org.au
STATE BUDGET SUBMISSION 2014–15 The 2014–15 Victorian budget will be released on 7 May 2014, six months before the next state election. The proximity of this budget to the election will give added weight to the VHA’s 2014 pre-budget submission. The VHA intends to use this opportunity to achieve positive budgetary outcomes for our members by basing framing the submission around specific, measurable, achievable, results-oriented and timebound recommendations to government. The submission will also inform the VHA’s advocacy program leading up to the state election. A structured engagement process will be conducted to ensure the submission contains specific recommendations that are supported by a strong evidence base gathered from our members. The VHA has held separate member forums for rural and regional health services, community health services and metropolitan hospitals, and Medicare Locals. The VHA policy team will develop a research plan to further refine and gather evidence supporting these issues identified in these forums. This process will involve further engagement with members. At the conclusion of the evidence gathering process, the VHA will prepare a draft submission. For further information please contact Robert Rothnie on 03 9094 7777 or robert.rothnie@vha.org.au
The VHA will work closely with Leading Aged Services Australia (Victoria) in responding to concerns raised by public sector providers over recent months.
The Victorian Healthcare Association Issue 2 [OCTOBER 2013] www.vha.org.au
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Royal District Nursing Service
Translation standard to improve health literacy
Royal District Nursing Service (RDNS) Limited has developed a translation standard to improve the health literacy of older migrants with chronic, complex health problems. The standard was produced in consultation with culturally and linguistically diverse (CALD) community members, to address an identified lack of standardisation in consumer health translated resources. In 2000, RDNS wanted to develop new health information in Macedonian and Italian and found there were no clear guidelines for producing translated materials.
“Health literacy cannot be predicted from education level alone, therefore RDNS staff are encouraged to assess the individual’s learning styles and preferences,” Ms Michael said.
References Aylen T, Michael J, Ogrin R (2013) Development of a translation standard to support the improvement of health literacy and provide consistent high-quality information, Australian Health Review, CSIRO Publishing, vol 3, no4, pp 547–551.
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“Most people like to learn through listening and watching, not through reading or writing. The new information technologies provide RDNS with encouraging learning opportunities that are more visual and interactive than pamphlets.” RDNS is the largest and oldest provider of home nursing and healthcare services in Australia, with approximately 80 per cent of its clients aged over 65.
RDNS Diversity Manager Jaklina Michael.
The RDNS translation standard and accompanying ‘tick’ symbol are now registered trademarks in Australia and New Zealand, allowing their application across different healthcare settings. The quality assurance ‘tick’ denotes resources that comply with a 10-point checklist for ensuring high-quality translations. Already, RDNS has produced over 800 approved resources in more than 35 languages. A paper on the translation standard is published in the current edition of The Australian Health Review.1 One of its authors, RDNS Diversity Manager Jaklina Michael, said better understanding of the impacts of low health literacy would significantly improve the health and wellbeing of older Australians. “There is limited research on health literacy, both here in Australia and internationally, but we do know that low health literacy is particularly prevalent among older people, people from CALD backgrounds, those with limited education, those from low socioeconomic groups and those with chronic disease,” Ms Michael said. More than half of all Australians have inadequate health literacy. Only one-third of people born overseas have sufficient health literacy, compared with 43 per cent of the Australian-born population. A person’s health literacy may be significantly worse than their general literacy skills because of unfamiliar medical vocabulary and concepts.
RDNS nurse Hoa Nguyen with Xiao Seng at a celebrating diversity event.
The World Health Organization presents health literacy as a consumer empowerment strategy.
of Human Services Language Services Policy and from the Centre for Culture, Ethnicity & Health.
Low health literacy is also a key concern of the Australian Commission on Safety and Quality in Health Care.
However, prior to the RDNS standard, there were no clear guidelines on how to produce high-quality health translations.
CALD population groups have lower levels of education and health literacy, and poorer health outcomes, than the Australian-born population.
The RDNS ’tick’ provides quality assurance for healthcare providers, clients and carers, increasing the likelihood that consumers will find translated information relevant and understandable.
The variable quality of translated health information for CALD consumers may be impacting efforts to address these health inequities. Guides for developing culturally appropriate health information are available from the Victorian Department
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This will help consumers make more informed choices about their health and promote better health outcomes for CALD populations.
Inner East Community Health Service
Rewards scheme will inspire healthy living
DR HARRY MAJEWSKI CEO, INNER EAST COMMUNITY HEALTH SERVICE
PHASE 1
Inner East Community Health Service is launching a rewards scheme to encourage healthy living. Unlike retail reward cards that motivate people to shop, the Healthy Australia Club inspires them to become more active. Information about our personal shopping habits is collected every time we use Coles Flybuys or Woolworths Everyday Rewards. This information is used to market to our preferences. Buy a book at amazon.com and they will soon suggest other books you might like to read.
Initially, the Healthy Australia Club is a comprehensive web-enabled database of community activities that are linked to a rewards scheme and to community mentors for hard-to-reach individuals. As the pilot site, the City of Boroondara has supported the project by facilitating the acquisition of local data and helping to attract 130 local community organisations as participants. The website will go live at the end of November. The site is currently being tested with sample activities loaded at www.healthyaustraliaclub.com.au IECHS expects more than 1000 weekly activities will eventually be listed. The system will help organise activities and timetables for small activity providers. It will also offer data services to organisations such as schools and aged care facilities to create healthy activity programs in local areas. PHASE 2 A rewards scheme will encourage Healthy Australia Club members to participate in
activities and will enable the club to track what activities people are choosing. The data will be analysed to build profiles and make personal suggestions to increase individual participation. Due for completion in December, the rewards scheme will operate initially through smartphone apps, and later include a rewards card for non-digital consumers. The rewards scheme is intended to become self-sustaining through the support of local businesses who will, in turn, receive valuable sponsorship and advertising exposure. If the pilot is successful, IECHS intends to expand it across Australia. The program is securely hosted in the cloud to allow national implementation. References D McKenzie Mohr (2011) Fostering sustainable behaviour: an introduction to community based social marketing, New Society Publishers Gabriola Island Canada ISBN 978-0-86571-642-1
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R Craig Lefebre (2010) On social marketing and social change ISBN 1449561934
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For further information visit www.healthyaustraliaclub.com.au
Little data can accumulate into big data, which is primarily used to sell us things. The competitive market place is one where bad ideas fail and good ones prosper, so there is little doubt that rewards schemes are an effective marketing tool. However, social marketing concepts are just starting to emerge in health promotion1,2 and their potential has yet to be unlocked. The Healthy Australia Club project was created in that space by Inner East Community Health Service (IECHS), using postgraduate IT students, pro bono experts and, most recently, integrated health promotion funding from the Victorian Department of Health. The Healthy Australia Club premise is that the community has at its disposal a rich array of healthy activities, and that behavioural change may best be achieved by building on personal preferences.
The Victorian Healthcare Association Issue 2 [OCTOBER 2013] www.vha.org.au
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Integration, co-location and early intervention are crucial
PROFESSOR PATRICK MCGORRY PROFESSOR OF YOUTH MENTAL HEALTH, UNIVERSITY OF MELBOURNE
Mental Health Reform
Mental healthcare in Australia is not properly engineered in relation to the scale of the problem or the pattern of disease onset across the lifespan. The number one roadblock to better care is the failure to integrate the community component of state-funded care with primary care structures, preferring to link it with inpatient and hospital-based services. This is a legacy of the much-vaunted but ultimately disappointing mainstreaming reform of mental health services carried out in the 1990s. These problems cannot be addressed because of the serious fractures between public mental healthcare at the state level and the community-based silos of primary care, specialist office-based psychiatry and psychology, and the ‘non-clinical’ nongovernment organisations (NGO) sector. The limited capacity of publicly-funded community mental healthcare has been progressively eroded since mainstreaming began, as the locus of care shifted to emergency departments and hospital units.
Integration is necessary between primary and secondary care (including private psychiatry, which is far too isolated) and between clinical and non-clinical aspects of care in the community, with hybrid salaried and fee-for-service arrangements within single locations and cultures of care. This is much more important than notional integration between inpatient and shrinking community services at the tertiary level. The solution is for the Federal Government to assume full control over community-based mental healthcare and to require co-location with primary care and related structures. State governments, if they wish, could retain responsibility for acute inpatient care only. This macro reform, which is achievable by a strong Federal Government, acting decisively in spite of pushback from predictable vested stakeholder interests, would pave the way for other critical reforms. Most notably, these reforms must involve re-engineering towards early intervention – especially in young people, sub-acute and longer term residential and housing strategies – and the reduction of stigma. WHY REFORM? Mental health reform is achievable, necessary and has widespread community support. It is achievable because within Australia we have models of early intervention, community-based care that we now know work better and are more economically viable than our current service system.
State governments have demonstrated that they can only formulate and support hospital-focused care, while the community element is a low priority and increasingly isolated and inaccessible to the public. On the other hand, more encouragingly, the Commonwealth has moved from purely funding items of service to directly providing platforms of NGO-based services with salaried and fee-for-service components.
14 The Victorian Healthcare Association Issue 2 [OCTOBER 2013] www.vha.org.au
It is necessary because mental health is expected to continue to grow as a proportion of Australia’s burden of disease and the already creaking acute-hospital model of care simply cannot take any more. It has community support because Australians are becoming increasingly aware of their mental health and are expecting more from a system that regularly lets them down. Mental health reform can benefit all Australians, and all Australians have a role to play in making it happen. HOW YOU CAN HELP Concerned Australians can increase their awareness and understanding of mental health issues, talk more openly with others about mental health problems, lobby their public representatives for improved services or donate money to organisations working for mental health reform. People who work in mental health services can embrace positive changes in their service models and cultures that are based on proven evidence of what works. Policy makers can make long-term, strategic investments to protect and support the mental health of the Australian population as a central strategy for achieving greater economic productivity, more effective health and justice systems, and enhanced inter-generational equity. Professor Patrick McGorry (AO, MD, PhD, FRCP, FRANZCP) is also President of the Australasian Society for Psychiatric Research, Executive Director of Orygen Youth Health and the 2010 Australian of the Year.
Funding, service and boundary changes Significant mental health reform is currently underway at both a state and commonwealth level. Community-based and clinical services are preparing for the next iteration of the mental health system; through retendering for contracts and contributing to the rearrangement of clinical catchment boundaries.
mental health services more closely with the boundaries of Medicare Locals, local governments, PDRSS and Alcohol and Other Drug services.
PSYCHIATRIC DISABILITY SUPPORT SERVICES (PDRSS) REFORM
The existing clinical mental health system has built strong links with communitybased providers, and the proposed changes will mean a reorganisation of these relationships.
The PDRSS system is currently undergoing significant reforms, with agencies retendering to provide services from 2014 onwards. The reformed program will be known as Mental Health Community Support Services (MHCSS) from 1 July 2014, and will promote an area-based response for community psychosocial rehabilitation services across 16 catchments state-wide. Key changes to be expected once the retender process has been completed include: • Individualised client support packages, in-line with those being developed for the National Disability Support Services reform • A single point of entry for intake and assessment services in each catchment, known as preferred service providers, will ensure information for consumers is consistent and organised • All interested service providers have been invited to contribute to the retender, including non-government, private and public providers The Victorian Government is expected to interview all shortlisted providers by the end of November, and notify successful candidates in late December 2013. New contractual service delivery arrangements and responsibilities will take place from 1 July 2014. Further information: www.health.vic.gov.au/mentalhealth/pdrss-reform
MENTAL HEALTH SERVICE CATCHMENTS REVIEW The Victorian Government is reviewing metropolitan Melbourne’s clinical mental health service catchment boundaries. The review aims to align the clinical mental health catchments of child and adolescent, adult, and aged persons’
Better aligned catchment boundaries will offer distinct system-level benefits, including enhanced clarity for consumers, their carers and families.
Further information: docs.health.vic.gov.au/docs/doc/5F81028356E1C1CFC A257BCB0082BC32/$FILE/Clinical%20Catchments%20 Consultation%20Paper_August%202013.pdf
“Better aligned catchment boundaries will offer distinct systemlevel benefits, including enhanced clarity for consumers, their carers and families.” MENTAL HEALTH ACT REFORM In October 2012, the Victorian Government announced its intention to reform the Mental Health Act 1986 (the Act). The Act governs the assessment, detention and compulsory treatment of people with severe mental illness in defined circumstances. The Act contains a series of checks and balances to ensure that compulsory treatment is given only when absolutely necessary, and in the least possible restrictive manner to minimises limitations on patient rights. Proposed changes to the Act include: • establishing a recovery-oriented framework and embedding supported decision-making • minimising the duration of compulsory treatment • increasing safeguards to protect the rights and dignity of people with mental illness • enhancing oversight and encouraging service improvement.
INDEPENDENT HOSPITAL PRICING AUTHORITY (IHPA) AND CLINICAL MENTAL HEALTH Funding for public clinical mental health services is largely based on inputs and negotiated targets for volume and throughput. New activity-based funding (ABF) arrangements were due to be implemented on 1 July 2013, but the Independent Pricing Authority (IHPA) model was not sufficiently developed. Instead, an interim arrangement based on an enhanced Australian Refined Diagnostic Related Group (AR-DRG model has been implemented for admitted inpatients. Victoria will not adopt this model in 2013–14, and instead will prepare for the transition to full ABF by introducing patientcentred pricing using ‘shadow’ weighted occupancy targets. This means targets have been set using 2012–13 funding levels and adjusted for new beds to be opened during 2013–14. Existing funding will be allocated at the beginning of the year, based on an assumption of 100 per cent occupancy (which is known to be inaccurate). Actual occupancy will be monitored throughout the year, but funding will not be adjusted for over- or under-performance in 2013–14. The Department of Health will then use this information to determine appropriate thresholds for 2014–15. An end-of-year process based on actual bed days and cost data analysis will be used to realign funding between admitted and non-admitted (community) settings. This approach will allow Victoria to calculate activity levels in accordance with the IHPA model, to enable Commonwealth funding to flow to health services A national mental health care model encompassing non-admitted mental health has yet to be developed. In the meantime, existing funding arrangements will continue for 2013–14. Further information: docs.health.vic.gov.au/docs/doc/ D80330C08AF585D5CA257B1C007AA94B/$FILE/ Mental%20Health%20Fact%20Sheet%202013%201%20 May%20Final-v05%20.pdf
Further information: www.health.vic.gov.au/ mentalhealth/mhactreform/mhreform.pdf
The Victorian Healthcare Association Issue 2 [OCTOBER 2013] www.vha.org.au
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THE VHA CELEBRATES The Victorian Hospitals Association – incorporated since October 1938 – changed its name to the Victorian Healthcare Association in July 1996. Chairman John Smith said the new name reflected the changing nature of healthcare services and noted that “there is continuing pressure on funding levels available for hospitals and health services at a time of increasing demand and utilisation”. Policy and advocacy issues included the renegotiation of Australian Health Care Agreements and Medicare reform, primary and community health reform to achieve more integrated and coordinated care, and national completion policy. The VHA’s commercial division, VHA Trading, was launched nationally as Hospital Supplies Australia (HSA) in September 1997. A separate trading board was established to govern HSA, which recorded $217 million in revenue and an operating profit of $2.56 million in 1998. In 1999, the VHA represented members’ concerns over the implications of the new goods and services tax (GST) and protested the new cap on fringe benefits tax (FBT). In 2000, the new Victorian Labor Government reviewed healthcare networks and created Metropolitan Health Services – a move that was largely supported by the VHA. In its first budget submission to the new government, the VHA called for increased healthcare funding. The subsequent allocation of an additional $176 million to public hospitals was a starting point in addressing the substantial financial pressures being experienced by the sector. However, there were difficult times ahead for the VHA, with Chair Allan Hughes describing 2001 and 2002 as “unquestionably two of the most difficult and turbulent years in its long history”. In 2001, an independent review of the organisation recommended the sale of HSA, due largely to increased competition posed by the newly-established body Health Procurement Victoria.
Australian Pharmaceutical Industries purchased HSA, and the ‘new’ VHA was shaped around policy, advocacy and member services. “Co-operation is the key to an effective health system that is based on sharing responsibility for healthcare among many providers,” Mr Hughes said.
75 YE
It was hoped 2003 and 2004 would consolidate the VHA as an organisation; however Chief Executive Judy Roseveare recalled these as “difficult years” marred by “dramatic” staff turnover. Current Chief Executive Trevor Carr was appointed in 2006 to advance the ongoing reform of the VHA.
“There is an urgent need to give more attention to the development of co-operative attitudes and for exploitation of the potential synergy between hospitals, health services and health systems.”
A full review of the VHA Constitution led to the abolition of divisional councils and differential voting rights in 2007. This meant all members could vote directly for all elected positions to the board.
A key concern was the implementation of the nurses’ enterprise bargaining agreement (EBA). The VHA argued for the EBA’s implementation costs to be fully funded by government. In response to pressure from VHA members for more nursing staff, DHS allocated 350 new positions in addition to the original 1,300.
Chairman Dr Michael Kennedy described this as “the most significant operational change in the association’s history” and “a deliberate strategy to strengthen member engagement and to advocate more effectively with those whom we seek to influence”.
The VHA had a divisional membership structure, with four separate divisions representing metropolitan, regional, district, and primary/community health. Each division was represented by a council to inform the VHA’s policy directions. In 2003, VHA Chair Michael Walsh noted that “old rivalries within the membership haven’t disappeared” and called on VHA members “to work together for the common good”. “Sometimes we concentrate too much on the divide between rural and metropolitan, or between primary and institutional, rather than on the many characteristics we share. “It is often tempting to run your own race, or to work with like-minded organisations sharing similar interests. From time to time, such tactics are successful. In the long term, however, fragmentation weakens the voice of health service providers.” A major restructure of the Australian Healthcare Association (AHA) in 2003 resulted in the VHA and the Health Services Association NSW sharing responsibility for the AHA’s administrative functions. The AHA retained an executive director in Canberra to focus on national advocacy and policy development.
16 The Victorian Healthcare Association Issue 2 [OCTOBER 2013] www.vha.org.au
The same year, the VHA sold its Albert Park premises and moved to its current CBD location. The organisation undertook new healthcare governance work in the areas of clinical leadership and supervision, risk management in community health, and change management for boards. In 2008, the Australian Taxation Office ruled that Victoria’s community health services (CHSs) would no longer be regarded as public benevolent institutions. The VHA steered CHSs through their transition from being incorporated associations to becoming companies limited by guarantee, and helped to secure amendments to the Health Services Act, which removed significant veto powers held by the Department Secretary. The following year, new relationships were built with key personnel from the newlycreated Department of Health (DH), which had been separated from the Department of Human Services. The VHA advocated for a 10-year health infrastructure and service plan, placing this issue firmly on the 2010 state election agenda. The newly-elected Liberal Government set about realising the VHA’s vision for a 10-year
EARS SINCE INCORPORATION plan, appointing Chief Executive Trevor Carr to the Ministerial Advisory Committee for the development of a Victorian Health Priorities Framework 2012-2022.
within their own jurisdictions. Medicare Locals were established, with several choosing to join the VHA for the benefit of integrating with the sector.
health funding from Victoria between 2012– 2016, following significant pressure from the media, politicians, healthcare providers and the VHA.
At the federal level, A National Health & Hospitals Network for Australia’s Future had been released in March 2010, resulting in the National Health and Hospitals Network Agreement between the Commonwealth and all states except Western Australia.
The VHA introduced a new associate membership category, allowing individuals and groups that were ineligible for full membership to join.
“What we need now is a real debate about the future of federal healthcare funding,” current Chief Executive Trevor Carr said.
This led to the establishment of Local Hospital Networks and Primary Care Organisations, and the VHA saw an opportunity to share its healthcare governance experience nationally. The Australian Centre for Healthcare Governance (ACHG) was established to deliver this important new function. By August 2011, the national health reform agreement was signed, officially recognising the states’ role as health system designers
The board also introduced optional sitting fees for VHA directors, in recognition of their duties, responsibilities and contribution to the organisation.
“National health reform was intended to foster transparency, end the blame game between governments and give hospitals certainty of funding. How far we have moved from those very positive intentions.”
In 2012, the VHA negotiated a two-year phased implementation for the Health Department’s 26 per cent funding cut to integrated health promotion, to soften the impact on community health services.
Now in its 75th year, the VHA has launched a new corporate image and website to reflect its growing reputation as an influential thought leader in contemporary health policy.
The VHA also showed leadership in the federal arena, with the Commonwealth reversing its decision to cut $1.6 billion in
This is Part II of a commemorative article on the VHA. Part I was published in the previous edition of Health Matters.
First State Super CEO Michael Dwyer AM on stage and (seated from left) VHA Chair Tony Graham, Victorian Health Minister David Davis, and VHA Chief Executive Trevor Carr with dignitaries at the annual conference.
The Victorian Healthcare Association Issue 2 [OCTOBER 2013] www.vha.org.au
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An initiative of the Victorian Healthcare Association The ACHG can help you to: • Put in place effective healthcare governance frameworks and processes that equally emphasise corporate and clinical governance responsibilities • Assess board performance and development needs through our online board development and evaluation tool and tailored consultancy services • Develop processes to monitor and redirect organisational performance • Develop a quality and risk management framework that is customised to the activities of your organisation • Develop appropriate quality systems and processes in your organisation • Formulate appropriate strategy to address the population health needs of the community being served • Connect and network with peers, attend knowledge transfer and professional development forums
For membership enquiries, or advice about professional services, please contact:
• Keep up to date with research and policy developments
Alison Brown Governance Consultant
visit www.healthcaregovernance.org.au
The Australian Centre for Healthcare Governance Level 6, 136 Exhibition Street, Melbourne VIC 3000 03 9094 7777 | achg@healthcaregovernance.org.au
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