Department of Health & Human Services Policy and funding guidelines 2015 Volume 2: Health operations 2015–16 Chapter 1: Overview, key changes and new initiatives
To receive this publication in an accessible format, please phone 9096 8422 using the National Relay Service 13 36 77 if required, or email
Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. © State of Victoria, Department of Health & Human Services July 2015. Where the term ‘Aboriginal’ is used it refers to both Aboriginal and Torres Strait Islander people. Indigenous is retained when it is part of the title of a report, program or quotation. Available at
Ministers’ foreword...... 9
CHAPTER 1: OVERVIEW, KEY CHANGES AND NEW INITIATIVES...... 11
1.1 Overview...... 12
1.2 Travis Review...... 14
1.3 Accountability framework...... 16 1.3.1 Policy and funding guidelines...... 16 1.3.2 Statement of Priorities...... 16 1.3.3 Health service performance monitoring framework...... 17 1.3.4 Multipurpose service tripartite agreements...... 17 1.3.5 Notification obligations...... 17
1.4 Budget highlights...... 19 1.4.1 Output initiatives...... 20 1.4.2 Asset initiatives...... 22 1.4.3 Elective surgery funding...... 24
1.5 Service performance...... 25 1.5.1 Health service performance measures...... 25 1.5.2 Performance monitoring for community service organisations...... 25
1.6 System improvements and innovation...... 26 1.6.1 Health system innovation...... 26 1.6.2 10-year mental health plan...... 28 1.6.3 Mental Health Act implementation...... 28 1.6.4 Mental health report...... 29 1.6.5 Ice action plan implementation...... 29 1.6.6 Your experience of service (YES) survey...... 29 1.6.7 Telehealth...... 29 1.6.8 Ageing, aged care and supported residential services...... 30 1.6.9 Acute and subacute services...... 31 1.6.10 Specialist clinics access...... 35 1.6.11 Ambulance services...... 36 1.6.12 Community health services...... 36 1.6.13 New consumer participation and experience policy...... 37 1.6.14 Patient experience: Victorian Healthcare Experience Survey...... 37 1.6.15 Meeting the needs of Victoria’s diverse populations...... 38 1.6.16 Victorian Tuberculosis Program...... 38 1.6.17 Implementation of changes to the Assisted Reproductive Treatment Act 2008...... 38 1.6.18 Health Purchasing Victoria...... 39
iii 1.7 The pricing and funding framework for Victorian health services...... 40 1.7.1 Pricing and funding framework...... 40 1.7.2 Commonwealth funding...... 40
1.8 Funding reforms 2015–16...... 42 1.8.1 WIES peer groups...... 42 1.8.2 Pricing for quality...... 42 1.8.3 Specified grant consolidation...... 43 1.8.4 Non-admitted radiotherapy...... 43 1.8.5 Blood products funding...... 44 1.8.6 Updates to the admitted mental health model: towards an activity-based model...... 44 1.8.7 Total parenteral nutrition...... 44 1.8.8 Funding for prisoners...... 44 1.8.9 Funding for patient transport...... 44 1.8.10 Funding for emergency departments...... 45 1.8.11 Funding for interpreters...... 45 1.8.12 Genetics...... 45
1.9 Data and reporting changes...... 46 1.9.1 Revisions to the Victorian hospital admission policy...... 46 1.9.2 Data collection changes...... 46
List of tables
Acronyms and abbreviations
iv Ministers’ foreword
The 2015–16 Victorian Budget provides an extra $2.1 billion over four years for hospitals, ambulances, mental health services and health programs. This massive boost in funding will enable hospitals to increase capacity, treat more patients sooner, and reduce elective surgery waits and waiting times in emergency departments. It will ensure those in need can access mental health services and community care programs. It will help improve ambulance response times, and build and upgrade facilities and equipment, and will support ongoing efforts to improve the overall health and wellbeing of Victorians. The Government is investing an additional $970 million over the next four years to respond to growth in demand for services. This includes $60 million to tackle elective surgery waiting lists in 2015-16 and $200 million for a Hospital Beds Rescue Fund to increase hospital capacity across the state. Victoria is a fast-growing state, and we recognise the importance of meeting not just current, but future, demand for health services. The 2015-16 Budget includes a significant investment in capital projects and new and upgraded equipment right across the state – more than $560 million over the next four years. Our paramedics play a critical role in our health system, treating and transporting patients who need urgent care. The Budget includes $99 million over four years to improve our ambulance service, giving paramedics the support and resources they need to do what they do best – save lives. The Budget also delivers much-needed funding for the clinical mental health system, which is under serious pressure to respond to growing patient demand across Victoria. Additional funding establishes a focus on appropriate community-based care, with $118 million invested in mental health. Increased funding has also been provided for Home and Community Care (HACC) services to enable the continued provision of community care services such as domestic assistance, personal care, home nursing and allied health services for frail older people, younger people with disabilities and their carers. In addition, $26 million has been allocated to progress priorities across government in line with the Victorian Ice Action Plan. Whether it’s through building new facilities, providing extra funding and resources, or promoting better health outcomes in the community, the Andrews Labor Government is investing in the health and wellbeing of all Victorians.
The Hon. Jill Hennessy The Hon. Martin Foley Minister for Health Minister for Housing, Disability and Ageing Minister for Ambulance Services Minister for Mental Health Minister for Equality Minister for Creative Industries
Volume 2: Health Operations 2015–16, Chapter 1 Page 9 Page 10 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
Chapter 1: Overview, key changes and new initiatives
Volume 2: Health Operations 2015–16, Chapter 1 Page 11 Overview, key changes and new initiatives
1.1 Overview
The Victorian Government is responsible for ensuring a wide range of health services are delivered to the Victorian community. The Department of Health & Human Services (‘the department’) plans, develops policy, funds and regulates health service providers and activities that promote and protect the health of Victorians. Through the department, the government funds more than 500 organisations to provide various health services to Victorians including: • acute and subacute healthcare delivered by public hospitals and in community settings • mental health and alcohol and drugs services delivered by public hospitals and community service organisations (CSOs) • residential and community care for older people, support and assistance to enable people to function independently in their own homes, positive ageing programs, and healthy and active living • primary health services delivered by a wide community of health services and others • health promotion and protection through emergency management, public health and related preventative services, education and regulation • emergency transport and ambulance services through Ambulance Victoria. The Department of Health and Human Services policy and funding guidelines 2015: Volume 2, Health operations 2015–16 (‘the guidelines’) represent the system-wide terms and conditions (for funding, administrative and clinical policy) of funding for government-funded healthcare organisations. The guidelines reflect the government and department’s role as a system manager and underpin the agreements at an organisational-level (Statements of Priorities (SoPs) and Service Agreements). The agreements set out the requirements that funded organisations must comply with in addition to their contractual and statutory obligations, outline activity that is required in order to receive funding, and detail expectations of administrative and clinical conduct. The guidelines are relevant for all funded organisations including health services, CSOs and other funded organisations such as Ambulance Victoria. Volume 2 is presented across four chapters. The chapters separate the pricing and funding models from the administrative and clinical conditions of funding. The aim here is to improve the clarity and accessibility of the guidelines. Chapter 1: Overview, key changes and new initiatives provides an overview of the accountability framework for funded organisations and introduces the most significant developments in funding, policy, government priorities and service delivery for the coming year. Chapter 2: Pricing and funding arrangements for Victoria’s health system details the pricing and funding arrangements for public hospital services and for all other outputs provided by the department. Chapter 3: Conditions of funding. In order to receive funding from the Victorian Government, all funded organisations must comply with standards and policies that ensure the delivery of safe, high- quality services and responsible financial management. This chapter details the relevant standards and policies that may apply. Chapter 4: Funding and activity levels provides the tables detailing the modelled budgets for 2015–16 as well as the activity tables that detail the 2015–16 targets for a range of programs across the health system. In addition to these guidelines, funded organisations are expected to comply with all relevant policy documents and guidelines. A list of key policies and guidelines can be found at
Page 12 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
Funded organisations should always refer to the guidelines website for the most recent version of the guidelines, as items may be updated throughout the year. Where these guidelines refer to a statute, regulation or contract, the reference and information provided in these guidelines is descriptive only. In the case of any inconsistencies or ambiguities between these guidelines and any legislation, regulations and contractual obligations with the State of Victoria acting through the department or the Secretary to the department, the legislative, regulatory and contractual obligations will take precedence. Each funded organisation should refer to the relevant statute, regulation or contract in order to ascertain all the details of its legal obligations. If any funded organisation has questions in relation to its legal obligations it should seek independent legal advice. A note on terminology The term ‘funded organisations’ relates to all entities that receive departmental funding to deliver services. Aspects of these guidelines referring to funded organisations are applicable to all department- funded entities. For the purposes of these guidelines, the term ‘health services’ relates to public health services, denominational hospitals, public hospitals and multipurpose services, as defined by the Health Services Act 1988, in regard to services provided within a hospital or a hospital-equivalent setting. Aspects of these guidelines that refer specifically to ‘health services’ are only applicable to these entities. The term ‘community service organisations’ (CSOs) refers to registered community health centres, local government authorities and non-government organisations that are not health services. These guidelines are also relevant for Ambulance Victoria, Health Purchasing Victoria, Ramsay Health Care and the Victorian Institute of Forensic Mental Health. The guidelines specify where aspects of the guidelines are relevant for these organisations.
Volume 2: Health Operations 2015–16, Chapter 1 Page 13 Overview, key changes and new initiatives
1.2 Travis Review
In December 2014 Dr Douglas Travis was appointed to independently review the capacity of Victorian public health services. All public health services provided a response to a comprehensive capacity survey that included beds, emergency departments, operating theatres and other key patient facilities. The ‘Travis Review’ interim report was released in April 2015, providing information on capacity at health service level and recommendations for optimising capacity in the future. Key recommendations include new requirements for reporting of hospital capacity and the development of a strategic statewide service and infrastructure plan to align health service demand with both recurrent and infrastructure funding. All recommendations were accepted in principle by the Minister for Health.
Table 1.1: The Travis Review – Interim report recommendations
Travis review recommendation Recommendation 1 Reporting of hospital capacity on a statewide basis should focus on: • the average time to clear waiting lists – that is, the number of patients on the waiting list divided by the number of patients removed from the waiting list, expressed in months • the percentage of people treated within a clinically appropriate time • the average waiting time from referral to first consultation in outpatient clinics. Recommendation 2 Reporting of capacity measures in Recommendation 1 should also be readily available to the public and detailed to the level of health service and service type. Recommendation 3 Collection and reporting of waiting times for first consultations in outpatient clinics, detailed to the level of health service and type of service, should commence within six months. Recommendation 4 Health services with theatre capacity problems that are unable to be solved in-house should be encouraged and facilitated to form partnerships with neighbouring health services to enhance treatment options for patients. Recommendation 5 The capacity survey should be repeated every four years, using similar methodology, to allow comparison of levels of infrastructure. Recommendation 6 The capacity survey should occur in the spring quarter as this better suits the operational planning cycle of health services. Recommendation 7 A strategic statewide service and infrastructure plan (‘the plan’) should be developed. Recommendation 8 The plan should aim to align health service demand with both recurrent and infrastructure (replacement and new) funding. Recommendation 9 The plan should take a 20-year forward view but have a sharper focus on the first five years. Recommendation 10 The plan should be reviewed every four years. Recommendation 11 The first plan should be completed by the middle of 2017, recognising this is a major undertaking and will require extensive consultation and analysis.
Page 14 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
Travis review recommendation Recommendation 12 An independent expert panel should be appointed to help guide the Department of Health & Human Services in preparation of the plan and provide independent advice to the Minister for Health about the plan. Recommendation 13 The plan should be published. Recommendation 14. Systems should be put in place to encourage and facilitate the expansion of appropriate home-based care supervised from health services. Recommendation 15 Consideration is given to the best value proposals for the Hospital Beds Rescue Fund.
The Travis Review survey circulated to all health services included an invitation to submit proposals under the $200 million (over four years) for the fund. The 2015–16 State Budget included the full commitment to the fund. Allocations of this funding to health services have been included in the health service modelled budgets. The final phase of the Travis Review will identify new opportunities to facilitate innovation and systems improvement to optimise existing and currently funded capacity across Victorian public hospitals. The final report of the Travis Review was provided to the Minister for Health in June 2015.
Volume 2: Health Operations 2015–16, Chapter 1 Page 15 Overview, key changes and new initiatives
1.3 Accountability framework
1.1.1 Policy and funding guidelines These guidelines act as system-wide terms and conditions (for funding and administrative policy) of funding for government-funded organisations. The guidelines reflect the government and department’s role as a system manager. They underpin the contracts at an organisational-level (SoPs and Service Agreements). The guidelines are relevant for all funded organisations including health services (public health services, denominational hospitals, public hospitals, privately owned and multipurpose services), CSOs and other funded organisations, such as Ambulance Victoria. The department monitors all funded organisations’ performance to ensure that funds are directed to appropriate services and that the government’s objectives for the health system are achieved. Data and reports submitted by funded organisations form part of the accountability requirements help the department to perform its monitoring role and contribute to planning and policy development. Chapter 2 of Volume 2: Health operations 2015–16 details the pricing and funding arrangements and Chapter 3 details the state and national policy, legal, reporting and operational obligations of funded organisations. In general terms, funded organisations are expected to: • deliver the volume of services for which departmental funding is provided • deliver quality services consistent with prescribed standards and guidelines • deliver services that are accessible, inclusive and responsive to the diversity of the Victorian community • provide agreed data and reporting to meet accountability and planning requirements • work with the department to develop new approaches to service delivery. Funded organisations should refer to their SoP or Service Agreement for any specific conditions of funding and performance requirements.
1.1.2 Statement of Priorities All health services including Dental Health Services Victoria, Ambulance Victoria and the Victorian Institute of Forensic Mental Health (Forensicare) agree to an SoP, which is the key service delivery and accountability agreement between the government and health services. The SoP outlines the key performance expectations, targets and funding for the year as well as government service priorities. SoPs are an explicit requirement under the Health Services Act 1988 for public health services and represent the Service Agreement requirements under the Act for public hospitals. The SoP for Ambulance Victoria is a requirement of the Ambulance Services Act 1986. The SoP for the Forensicare is a requirement of the Mental Health Act 2014. SoPs are agreed annually between the Minister for Health and boards of major public health services and Ambulance Victoria. SoPs are agreed annually between the Secretary to the department and the boards of subregional, local health services and small rural health services. An SoP is agreed annually between the Minister for Mental Health and Forensicare’s board of directors. SoPs are available online at
Page 16 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
1.1.3 Health service performance monitoring framework The Victorian health service performance monitoring framework describes the mechanisms the department uses to formally monitor the performance of health services and Ambulance Victoria. Health service strategic priorities for the forthcoming year are agreed as part of the annual SoP or, where relevant, the Service Agreement process. There are two key elements of the framework: the performance assessment score (PAS) and the monitoring level. The PAS provides an overall performance score for each health service based on a composite of agreed operational financial and quality targets in the SoP. The department uses the PAS and a range of other risk factors to determine the level of monitoring required for individual health services. Further development of performance monitoring will see Ambulance Victoria monitored against a PAS in 2015–16 for the first time. In 2015–16 the performance monitoring framework will incorporate a number of new and extended directions for high performance. Changes to the framework are described in Chapter 1, section 1.9 ‘Health service performance measures’.
1.1.4 Multipurpose service tripartite agreements The multipurpose services program is a joint initiative of the Australian Government and state/territory governments, and provides integrated health and aged care services for small rural and remote communities. The multipurpose service approach seeks to achieve: • improved access to a mix of health and aged care services that meet community needs • more innovative, flexible and integrated service delivery • flexible use of funding and/or resource infrastructure within integrated service planning • improved quality of care for clients • improved cost-effectiveness and long-term viability of services. Each service operates under an individual tripartite service agreement between the Commonwealth Government Department of Social Services and the department. Tripartite service agreements summarise services to be provided and details of funding and reporting requirements. In accordance with agreement stipulations, multipurpose services are able to pool their funding and expend it flexibly to respond to the specific healthcare needs of the local community. Also in accordance with tripartite service agreements, multipurpose services are required to have a current and comprehensive service plan informed by health planning data, a community needs assessment and extensive community consultation.
1.1.5 Notification obligations
1.1.5.1 Issues of public concern The Health Services Act and Ambulance Services Act specify the functions of health service boards and chief executive officers. Included in these functions is the requirement for boards to ensure that the Minister for Health and the Secretary to the department are advised about significant board decisions and are promptly informed about any issues of public concern or risks that affect or may affect the public health service (Health Services Act s. 65S(2)(i)) (Ambulance Services Act s. 18 (1)(i)). The Act also requires chief executive officers to inform the board, the Secretary and the Minister without delay of any significant issues of public concern or significant risks affecting the health service (Health Services Act s. 65XB(1)(h)) (Ambulance Services Act (s. 21 (1) (h)).
Volume 2: Health Operations 2015–16, Chapter 1 Page 17 Overview, key changes and new initiatives
1.1.5.2 Changes to range or scope of activities Before health services undertake a significant change in the range or scope of services, the planning implications of such a move must be discussed with the department. Metropolitan health services should contact their department performance lead, and rural services should contact the relevant regional officer. The department must provide explicit approval before a health service may significantly alter its services. Health services receiving small rural health service funding are exempt from this arrangement and should refer to the small rural health services guide at
1.1.5.3 Exceptional events There may be circumstances (including industrial action and natural disasters) beyond the reasonable control of health service management that may prevent the health service reaching its targeted throughput. At its discretion, and on a case-by-case basis, the department will consider submissions to adjust the performance scores and adjust funding to health services, irrespective of throughput, for so long as such events continue. Health services are expected to actively mitigate their financial exposure and any decline in throughput during and following such events. See Chapter 2, section 2.17 ‘Prior-year adjustment: activity-based funding reconciliation’ for more details about exceptional circumstances and recall.
Page 18 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
1.4 Budget highlights
The 2015–16 Victorian State Budget is putting the health of Victorian families first, placing additional funding in our hospitals, ambulance and health programs. The Budget builds on previous investments and service reforms, and continues the transition to a more sustainable and innovative system that puts patients first. Investments will not only boost capacity, they will also ensure that all Victorians continue to have access to high-quality treatment and services, irrespective of where they live or their socioeconomic background. Table 1.2 details departmental funding by output categories provided by the 2015–16 Victorian State Budget. A summary of health service modelled budgets for 2015–16 is provided in Volume 2: Health operations, Chapter 4. The 2015–16 State Budget provides $15.852 billion recurrent funding for health, mental health and aged care services. This investment will enable the health system to treat the increasing number of patients and maintain delivery of high-quality services. Funding to deliver preventative health, early intervention programs and community-based care will drive efficiency by leveraging the full scope of the health and mental health systems.
Table 1.2: Victorian State Budget details
Output group 2014–15 budget ($m) 2015–16 budget Percentage increase 2014– ($m) 15 to 2015–16 (a) Acute Health Services (b) 10,275.3 10,967.1 6.7 Ambulance Services (c) 696.5 736.6 5.8 Mental Health (d) 1,260.6 1,309.0 3.8 Ageing Aged and Home Care (e) 1,203.7 1,288.6 7.1 Primary, Community and Dental 462.3 452.3 –2.2 Health (f) Small Rural Services (g) 560.2 578.7 3.3 Public Health (h) 328.8 339.3 3.2 Drugs Services (i) 165.1 181.3 9.8 Total 14,952.5 15,852.9 6.0 Source: 2015–16 Victorian Budget Paper No. 3, p. 222 Notes: ()a Variation between 2014–15 Budget and 2015–16 Budget. ()b The higher 2015–16 Budget reflects funding for the implementation of policy initiatives announced in current and previous budgets as well as indexation. ()c The higher 2015–16 Budget primarily reflects funding provided for government policy commitments. ()d The higher 2015–16 Budget primarily reflects funding provided for government policy commitments. ()e The higher 2015–16 Budget reflects additional funding provided in the 2015–16 Budget for the Social and Community Services Equal Remuneration Order and the ongoing impact of Commonwealth contributions, which had not been agreed at the time of publication of the 2014–15 Budget and indexation. ()f The lower 2015–16 Budget primarily reflects the cessation of the National Partnership Agreement on Treating More Public Dental Patients. ()g The higher 2015–16 Budget primarily reflects funding provided for government policy commitments and indexation. ()h The higher 2015–16 Budget reflects the transfer of funding for biomedical research as a result of the machinery of government changes. This is partially offset by the cessation of the National Partnership Agreement on Preventive Health. ()i The higher 2015–16 Budget reflects funding provided for the Ice action plan, the Social and Community Services Equal Remuneration Order and indexation.
Volume 2: Health Operations 2015–16, Chapter 1 Page 19 Overview, key changes and new initiatives
1.1.6 Output initiatives The 2015–16 Victorian State Budget committed $428.6 million in 2015–16 ($1.490 billion over four years) to new output initiatives that will grow and strengthen the health, mental health and aged care sectors.
1.1.6.1 Acute hospital and ambulance services An additional $372.7 million in 2015–16 ($1.289 billion over four years) has been provided for acute health and ambulance services output initiatives. This investment is jointly funded by the Commonwealth Government under the National Health Reform Agreement (2015–16 to 2016–17) and includes: $248.8 million in 2015–16 ($970 million over four years) to enable Victorian health services to respond to growing patient demand across Victoria; services targeted include emergency department presentations, intensive care, maternity admissions, elective surgery, clinical mental health, specialist clinics, palliative care, chemotherapy, radiotherapy, dialysis, subacute care and Victoria’s contribution to national blood products $50.0 million in 2015–16 ($200 million over four years) to enable additional hospital beds to be opened across Victoria, providing capacity to deliver more hospital services, as recommended by the recent Travis Review of hospital bed and theatre capacity $60.0 million in 2015–16 to boost elective surgery, providing an additional pool of funding to tackle waiting lists and treat more patients sooner $13.6 million in 2015–16 ($57.8 million over four years) to meet ambulance services demand, including supporting timely transfer of ambulance patients at emergency departments and continuing Government funding of clinically necessary ambulance services for eligible Victorians holding a valid pensioner concession or health care card $3.6 million in 2014–15 to support health services to comply with the Victorian Ebola virus disease response plan and an additional $2.8 million of capital investment • $1.3 million over four years to increase the number of peer support coordinators and chaplains available to Victorian paramedics.
1.1.6.2 Mental health and alcohol and drug services The 2015–16 State Budget provides $29.1 million in 2015–16 ($111.8 million over four years, including $4.1 million in 2014–15) for mental health output initiatives including: • $21.2 million in 2015–16 ($88.1 million over four years) to enable clinical mental health services to respond to growing patient demand across Victoria, including intensive mental health clinical support for 80 adults and up to 500 older Victorians and funding to open beds to assist in managing critical demand pressures • $4.2 million in 2015–16 ($8.3 million over two years, starting in 2014–15) to support the National Disability Insurance Scheme trial in the Barwon area of Victoria and ensure services are maintained for clients in the area • $1.4 million in 2015–16 ($5.9 million over four years) to continue promoting suicide prevention for same-sex-attracted and gender-questioning youth through support and counselling services, educational and anti-bullying campaigns • $1.1 million in 2015–16 ($4.4 million over four years) to continue the Royal Children’s Hospital intensive eating disorder day program, which delivers family-based treatment to assist up to 60 families each year $1.2 million in 2015–16 ($5.0 million over four years) to reinstate funding for three mental health community support centres that support people with complex social and mental health issues.
Page 20 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
In addition, the 2015–16 Budget provides an additional $26.0 million for the department’s drugs services output as part of the government’s $45.5 million Ice action plan. Funding for the department includes: an additional $18 million to increase access to drug rehabilitation services, particularly in rural and regional Victoria, with innovative models of non-residential rehabilitation to be established to enable more people to get help sooner $4.7 million to better equip families and communities to identify and support people affected by ice through training and family support services $0.5 million to help grassroots community groups tackle ice use in their local area by helping to conduce forums, promote education and evaluate local strategies to address the increasing harm of ice $0.4 million to develop a best practice training curriculum to better equip workers to deal with ice- affected clients $0.6 million to enhance clinical supervision training for alcohol and drug treatment and mental health workers • $1.8 million to increase the capacity of needle and syringe programs, reducing harm to injecting ice users and the broader community.
1.1.6.3 Ageing, aged and home care The 2015–16 State Budget commits $6.8 million in 2015–16 in additional funding to the HACC program, providing indexation of funding. This program provides support to older Victorians and people with a disability to enable them to remain living in their homes for longer. Support services provided includes care assessments, home nursing and allied health services. The additional funding will enable HACC services to be provided to 317,600 eligible Victorians in 2015–16. In 2015–16 the program will focus on delivering a smooth and effective transition of services for Victorians aged 65 years and older to the Commonwealth Government.
1.1.6.4 Primary, community, public and dental health The 2015–16 Budget commits an additional $17.6 million in 2015–16 ($57.3 million over four years) for primary, community, public and dental health including: $6.3 million in 2015–16 ($25.0 million over four years) to develop a statewide clinical genomic sequencing capability to improve the diagnosis and treatment of genetic diseases $3.75 million in 2015–16 ($10.0 million over four years) for skin cancer prevention grants to increase shading in public areas, supported by an additional $1.25 million for SunSmart education campaigns ($5.0 million over four years) $2.0 million in 2015–16 ($8.4 million over four years) to provide free whooping cough vaccine for all pregnant women from 28 weeks’ gestation and their partners $2.0 million for planning and development of a National Centre for Proton Beam therapy for targeted cancer treatment that offers significant benefits to patients, particularly children $1.0 million in 2015–16 ($4 million over four years) to provide health assessments to farmers and their families and improve their health literacy through a tailored health promotion program $0.9 million in 2015–16 ($3.6 million over four years) to continue the Securing the Future of the Vision Initiative, a program that prevents avoidable blindness and vision loss by raising awareness and health literacy in at-risk populations $0.5 million in 2015–16 ($2.2 million over four years) to continue PRONTO!, a community-based, free, rapid HIV and syphilis testing service in Fitzroy $1.3 million in 2015–16 to continue streamlining pre-approvals processes for multisite clinical trials in Victorian health services to attract more clinical trial activity to Victoria
Volume 2: Health Operations 2015–16, Chapter 1 Page 21 Overview, key changes and new initiatives
$1.0 million in 2015–16 for Victorian Quitline to continue providing information, counselling and other assistance to help people quit smoking • $0.3 million in 2015–16 to evaluate and plan for real-time prescription monitoring, which will reduce ‘prescription shopping’ and minimise harm from drug addiction by giving pharmacists and prescribers access to a patient’s dispensing history. An additional $2.4 million in 2015–16 ($28.7 million over four years) has been provided for the primary, community and dental health output to deliver the government’s election commitment to establish 20 super pharmacies across metropolitan and rural Victoria. These super pharmacies will provide people with an alternative to going to hospital (15 in metropolitan and five regional areas) and will be open for extended hours with a nurse present between 6 and 9 pm to provide face-to-face advice and services.
1.1.7 Asset initiatives
Table 1.3: Funding for asset initiatives
Initiative Description Funding $ million Acute health services Aikenhead biomedical The Aikenhead Centre for Medical Discovery will be Australia’s engineering first research and education centre for biomedical engineering focusing on chronic conditions, such as cardiovascular disease, arthritis, cancer and diabetes, and new technology. The project is planned to be delivered in partnership with the Commonwealth and St. Vincent’s Health. Angliss Hospital An intensive care unit and short stay unit will be established at 20.0 intensive care unit and Angliss Hospital in Ferntree Gully. This will provide 20 beds to short stay unit cater for patients needing urgent care, improving capacity of other hospital clinical services and reducing emergency department treatment times. Ballarat Health Cardiovascular services will be expanded at the Ballarat Base 10.0 cardiovascular services Hospital by building and equipping a new catheterisation laboratory. This will improve the level of critical care, inpatient care and associated ambulatory services for the Ballarat district and Grampians Region. Casey Hospital Casey Hospital will undergo a major expansion, enabling it to 106.3 expansion deliver more services to this fast-growing area. A new acute inpatient tower will be built, as well as four new operating theatres, a new surgery recovery centre, and 96 extra beds including an intensive care unit. Clinical Services This program replaces obsolete information system hardware for 10.0 Hardware Replacement patient-related clinical services. This will allow continued delivery Program of reliable acute clinical support services. Ebola preparedness Health services have been supported to comply with the Victorian 2.8 Ebola virus disease response plan. Designated quarantine health services in the Royal Melbourne Hospital and Royal Children’s Hospital will be upgraded to safely treat Ebola-affected patients. This includes upgrades to pathology infrastructure so that tests can be conducted in a fully contained environment and personal protective equipment can be purchased for ambulance paramedics. Engineering Critical engineering infrastructure in hospitals will be replaced. 25.0 Infrastructure This includes lifts, heating ventilation, air-conditioning systems Replacement Program and electrical equipment. This will enable continuity of health service delivery and compliance with regulatory requirements. Goulburn Valley Health The government will progress planning for the proposed 1.0 redevelopment – redevelopment of the Goulburn Valley Health Shepparton campus planning and to address population growth demand. development
Page 22 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
Initiative Description Funding $ million Health Service Violence A range of infrastructure improvements will be undertaken to 20.0 Prevention Fund make public hospitals and mental health services safer for staff, patients and visitors. Maroondah Breast The Government committed to funding for the first stage of the Cancer Centre Maroondah Breast Cancer Centre, a comprehensive breast cancer centre as part of the Maroondah Hospital precinct in Ringwood East. The centre will bring together breast screening, breast oncology, medical care and support services under one roof. Medical Equipment High-risk medical equipment in metropolitan and rural health 35.0 Replacement Program services will continue to be replaced. This includes equipment supporting acute health services and public health reference laboratories. This will reduce risks for patients and staff and improve service availability through the introduction of technological advances in medical equipment. Monash Children's The government is funding the construction of a new helipad on 3.8 Hospital helipad the roof of the Monash Children’s Hospital. This will provide access to both children’s and adult emergency services across the wider Monash Medical Centre Clayton site for the population of south-east Melbourne, Gippsland and the Mornington Peninsula. Monash Medical Centre A large water retention system will be installed to increase the 7.1 – infrastructure upgrades capacity of the hospital’s current flood management system. This will improve the reliability and sustainability of health services provided at the Monash Medical Centre. Moorabbin Hospital – A range of projects will be undertaken at the Moorabbin Hospital. 16.2 medical imaging and These will include purchasing a medical imaging machine, outpatients expansion purchasing a medical scanner, expanding the number of outpatient specialist consulting suites by 11 rooms and modernising the current 10 consulting rooms. This will significantly improve the volume of patient throughput and patient turnaround times, and improve patient privacy in outpatient services. The Alfred hospital – fire Urgent safety works will be undertaken at The Alfred in Prahran to 4.1 services upgrade comply with firefighting equipment and systems standards. The enhancements to the warning and sprinkler systems, and installation of smoke separation barriers will improve occupant safety and protection of the infrastructure. Victorian Heart Hospital Planning and development of Australia’s first specialist heart 15.0 – planning and early hospital will be accelerated to bring the world’s best works cardiovascular care, research and training to Victoria. Funding in a future budget will deliver the 195-bed standalone cardiac facility at Monash University Clayton, bringing experts to Australia to undertake ground-breaking research and train the next generation of Victorian heart specialists. Werribee Mercy Hospital Acute health services at Werribee Mercy Hospital will be 85.0 – acute expansion expanded through the construction of six additional operating theatres and support services and 64 new inpatient beds, including eight critical care beds. This will increase local access to acute health services and cater for the rapidly growing population of the Wyndham area. Western Women's and Women’s and children’s services in Melbourne’s west will be 200.0 Children's Hospital expanded through the construction of a dedicated five-storey facility at Sunshine Hospital, which will provide 237 beds, 39 special care nursery cots, four theatres and additional clinics. A dedicated women’s and children’s facility will also result in currently occupied space becoming available to accommodate other services. Ambulance services
Volume 2: Health Operations 2015–16, Chapter 1 Page 23 Overview, key changes and new initiatives
Initiative Description Funding $ million Ambulance station New buildings and infrastructure maintenance will be funded to 20.0 upgrades align ambulance stations with contemporary service requirements and expand stations to accommodate staff and equipment. Funding will enable one new station to be built at Wendouree, nine existing stations to be upgraded, and critical maintenance to be provided to several stations in need of urgent repair. Ambulance vehicles and Ambulance Victoria vehicles and equipment will be upgraded. 20.0 equipment This includes five new ambulances capable of managing obese and complex patients. Mental health services Mental health/alcohol Critical minor infrastructure and capital works will be funded in 5.0 and other drugs facilities facilities assisting people with mental health and alcohol and other renewal drug issues. Facilities include inpatient services, community- based services and emergency departments with high volumes of this cohort. The works will address problems relating to aged and poor-quality facilities, contributing towards improved client outcomes. Orygen Youth Mental Funding is provided to progress planning and development to 1.0 Health – planning and Orygen Youth Mental Health, which is a major clinical and development research facility for young people across Victoria with serious mental illness. This will house both the Orygen Youth Mental Health Services Clinical Program and Orygen, the National Centre of Excellence in Youth Mental Health. Public health SunSmart SunSmart will be funded to run skin cancer prevention public 5.0 education campaigns. This aims to inform people about the importance of adopting sun protective behaviours to reduce their risks of skin cancer.
1.1.8 Elective surgery funding Elective surgery boost The 2015–16 Victorian State Budget committed an additional $60 million to boost elective surgery activity, meet increasing levels of demand and treat more elective surgery patients sooner. $5 million of the additional $60 million will be available for public health services to partner with other public and private elective surgery providers to deliver reportable public elective surgery. Bariatric surgery initiative The 2014–15 Victorian State Budget committed $8 million over four years to improve bariatric patient care in Victoria’s health system by consolidating surgery and increasing the number of bariatric procedures undertaken each year statewide. In 2014–15, the three bariatric surgery services (Alfred Health, Austin Health and Western District Health Service) established a formal collaborative relationship to provide high-quality and consistent care to patients in line with the existing Surgery for morbid obesity: Framework for bariatric surgery in Victoria's public hospitals (DHS 2009). In 2015–16, $1.8 million has been allocated to the three bariatric surgery services for the care of additional patients. The department will continue to work with the few remaining health services providing bariatric services to refer new and existing bariatric surgery patients to the three bariatric surgery services including patients awaiting specialist clinic review. Additions to the Elective Surgery Information System (ESIS) for primary procedures and revisions will be monitored by the department to ensure centralisation of services is progressing. Non-participating health services should contact the department prior to establishing any new bariatric surgical services.
Page 24 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
1.5 Service performance
The government is committed to further developing public reporting of health service performance, outcomes and consumer experience. This includes ensuring that reporting measures are fit for purpose and, where appropriate, consistent across jurisdictions. The government has also committed to introduce the Transparency in Government Bill, which will enforce by fixed dates the release of quarterly performance information for public health services and denominational hospitals; quarterly ambulance and fire services response time information; and annual health service SoPs. The department will developed an implementation plan to facilitate the public release of key performance data within legislated time frames
1.1.9 Health service performance measures In 2015–16 the department will extend the directions for health service performance monitoring. High- performing health services: the Victorian health services performance monitoring framework 2015–16 will describe further directions for performance monitoring in quality and safety, patient experience, organisational culture and clinical outcomes. In line with these directions, the framework will also incorporate new indicators into the PAS, Part B of the SoP and the Performance Report for Integrated System Management (PRISM). The framework sets out the business rules for monitoring performance in Victorian health services and Ambulance Victoria, and is available at
1.1.10 Performance monitoring for community service organisations The Performance monitoring framework for funded agencies operates across the department and the Department of Education and Training (DET). The framework has been in place since 2005, providing an overarching set of policies and guidelines to support departmental staff in monitoring funded agencies. Funded agencies are commonly non-government organisations delivering aged care, home and community care, community and dental services, public health services, mental health community support services, alcohol and drug treatment and Aboriginal health services. Health services such as hospitals and Ambulance Victoria are not included. The department is currently reviewing the framework in conjunction with the other participating departments. Sector consultation will form part of this review.
Volume 2: Health Operations 2015–16, Chapter 1 Page 25 Overview, key changes and new initiatives
1.6 System improvements and innovation
1.1.11 Health system innovation The department supports the health sector to deliver better healthcare and patient outcomes in Victoria by building leadership capability, driving best practice and innovation, and facilitating communication and collaboration. During 2015–16 the department will: • continue to work collaboratively with health services and program areas to support a range of redesign initiatives (health services funded as part of the Redesigning Health Care Program will provide reports on progress and outcomes from the improvement work they undertake) • continue to support the Clinicians in Redesign program work collaboratively with health services and program areas to facilitate a range of leadership initiatives in 2015–16 including access to leadership programs • Continue to progress the CarePoint trial - a partnership jointly funded between the Victorian Government and Medibank - to trial a two year integrated care program for insured and uninsured Victorians with chronic and complex conditions • develop a health and medical research strategy for Victoria, establishing research priorities, promoting innovation in the sector and preparing the state for the economic and healthcare opportunities on offer • drive international health engagement to foster innovation, creativity and the exchange of ideas and knowledge to drive continuous improvement and encourage higher benchmarks of performance and productivity. International engagement will also seek to identify opportunities to diversify sources of revenue for Victorian health organisations, increasing their sustainability and capacity.
1.1.11.1 Clinical networks Victoria is committed to the ongoing development and improvement of the health system to support and optimise the health and wellbeing of all Victorians. Clinical networks are a key mechanism for engaging and harnessing clinical leadership to promote system and quality improvement. They also support collaboration across health services to drive innovation in research and clinical practice. Clinical networks bring together health professionals, consumers, carers, peak bodies and other stakeholder organisations to provide leadership for clinical service development across the full spectrum of care. Victoria has clinical networks in the specialty areas of cardiac, emergency care, maternity and newborn, palliative care, paediatric, renal, stroke and cancer.
Table 1.4: Clinical networks 2015–16
Clinical network 2015–16 focus Cancer The Cancer Clinical Network (integrated cancer services – ICS) will: • progress dissemination and implementation of optimal care pathways • support efficient chemotherapy day units through redesign practices aimed at improving access • continue the statewide tumour summits program and continue development of a statewide performance monitoring framework. The ICS will also support work on the next cancer plan.
Page 26 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
Clinical network 2015–16 focus Cardiac The Victorian Cardiac Clinical Network (VCCN) will continue to implement the priorities outlined in Heart health, the department’s five-year cardiac plan, and monitor the outcome of project initiatives funded to support the plan. The network will also provide clinical expertise to support the department in planning for the Victorian Heart Hospital. Clinical Leadership The group will be identifying and developing evidence-based best practice clinical Group in the care of tools and resources that focus on meeting the specific care needs of older people Older People in in hospital and support health services to meet the National Safety and Quality Hospital Health Service (NSQHS) Standards. The projects focus on: • improving partnerships with consumers by involving older people in decisions about their care • recognising and responding to clinical deterioration in older people • identifying and responding to older people at risk of harm • improving medications safety for older people in hospital. Emergency Care The network will continue to implement evidence-based practice improvement projects in emergency departments, for example, management of chronic obstructive pulmonary disease and preventing urinary catheter associated infections. It will also develop programs to improve medication safety patient- centred fact sheets and provide support for adherence of the National Safety and Quality Health Service Standards. Maternity and The Victorian Maternity and Newborn Clinical Network (VMNCN) continues to Newborn expand the clinical and visual content of the neonatal e-handbook. The development of a maternity e-handbook is in progress, with a view to appoint a project officer to oversee development in 2015–16. The network, in conjunction with DET and sudden infant death syndrome (SIDS) and Kids, will continue to progress the development and implementation of Victorian safe infant sleeping guidelines. The network will work closely with the immunisation branch to ensure successful implementation of the parents whopping cough vaccination program, and with the Clinical Councils Unit and health services in response to the upcoming release of the 2012–13 Victorian perinatal services performance indicators. Palliative care The network will continue its work on referral guidelines to specialist palliative care providers and oversight of Victorian end-of-life care pathways coordinating program. The network will also support the department’s development of the next strategic policy direction (End-of-life care framework). Paediatric The Victorian Paediatric Clinical Network (VPCN) will continue work on standardising clinical practice including: • supporting the development of clinical practice guidelines for managing common conditions, and improvement projects to encourage the use of the guidelines in health services • implementing a standardised approach to detecting and responding to clinical deterioration through the Victorian Children’s Tool for Observation and Response (ViCTOR) project, as well as developing further tools and resources to improve clinical practice • continuing a joint project, led by the VCCN to develop a transition model to improve care continuity for young adults with low to moderate acuity congenital cardiac disease. Two sector-wide events are planned: one focused on child and family-centred care in community settings and an event addressing clinical practice improvement in acute care settings. The VPCN will also continue to look for opportunities and practical solutions to improve communication and service integration across the sector including, as appropriate, among private and primary care agencies.
Volume 2: Health Operations 2015–16, Chapter 1 Page 27 Overview, key changes and new initiatives
Clinical network 2015–16 focus Renal The Victorian Renal Health Clinical Network (VRHCN) will continue focusing on prevention and maintenance of renal health, promoting system integration and a collaborative approach to renal service delivery, and reducing unwarranted variation in practice by: • securing support for the ongoing viability of electronic management and assistance for primary care • sustaining the gains achieved by the renal supportive care capacity-building activity • completing the chronic kidney pathway project and implementation plan • completing the key performance indicator audit and implementing any subsequent recommendations for improvement • progressing renal improvement projects on patient education, patient assessment and listing of patients for deceased donor renal transplantation. Stroke The network will continue its focus on evaluating clinical variation by implementing the Stroke and Cardiac Clinical Registries Initiative. This program supports the existing roll out of the Australian Stroke Clinical Registry (AuSCR) and the Victorian Cardiac Outcomes Registry (VCOR). The network will continue existing projects that develop and support stroke services in regional areas via the STROKE education webinar series, the Victorian Stroke Telemedicine Project and supporting the development of regional frameworks for stroke care. The subacute and community sectors will be supported to develop innovative sustainable models of care to improve longer term stroke care.
1.1.12 10-year mental health plan The Victorian Government is committed to develop a 10-year plan for mental health. The plan will provide strategic direction in mental health policy and program development. It will have in its scope health services managed and delivered by specialist services and the community-managed mental health support service system, and other sectors that interface with the specialist system to deliver whole-of-life, person-centred care and support. It will build on the shared commitment in the collaboratively developed Because mental health matters, and articulate a long-term vision for Victoria. The plan will be strongly evidence-based and include clear and achievable targets, measures for success and sequential milestones that flag the way those targets can be achieved over time. This will form the basis for transparent and accountable delivery of the strategic vision. The annual report will provide a platform for reporting on implementation of the 10-year mental health plan.
1.1.13 Mental Health Act implementation The Mental Health Act 2014 commenced on 1 July 2014. The Act provides a legislative framework that supports the ongoing development of recovery-oriented practice in the public mental health service system. Initiatives that will commence in 2015–16 are: • Mental health advocacy. Victoria Legal Aid will deliver the new independent Mental Health Advocacy program commencing early in 2015–16. The program will provide representational advocacy to people on compulsory treatment orders, assist people to understand and exercise their rights and enable them to participate in decisions about their assessment, treatment and recovery. • Second opinion scheme. The Act enables involuntary patients to seek a second opinion at any time about their treatment and whether the criteria for compulsory treatment apply. The department is developing arrangements, in collaboration with stakeholders, to improve access to second psychiatric opinions for eligible patients to commence in 2015–16.
Page 28 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
1.1.14 Mental health report The Victorian Government is committed to developing a mental health services annual report, to be tabled in parliament. The annual report will present current information, using data and analysis from a range of sources, and reflect the lived experience of participants in the system. This commitment is aligned with the government’s commitment to transparency in government. The scope of the report will include clinical and mental health community support services, providing details about numbers of clients receiving treatment or support, waiting times, readmission rates and lengths of stay across acute and community settings. It will also draw on a range of resources including the Chief Psychiatrist report, the Office of the Public Advocate's Community Visitors annual report, future reports from the Mental Health Complaints Commissioner and the Mental Health Tribunal and annual reports from health services. It will be strongly linked to the 10-year plan for mental health, which will provide strategic direction in mental health policy and program development. The annual report will provide a platform for reporting on implementation of the 10-year mental health plan.
1.1.15 Ice action plan implementation In March 2014 the Victorian Government announced the $45.5 million Ice action plan, a cross- government initiative aimed and addressing harms associated with methamphetamine. The Ice action plan includes a number of initiatives addressing drug treatment, prevention and support and worker safety, which will be implemented in 2015–16. These include: • $18 million over four years for non-residential rehabilitation services • $4.7 million over four years for enhanced support for families and communities • $1.8 million over four years for needle and syringe programs • $1.0 million for training for frontline workers. The department will be working with services to inform the development and implementation of a number of the key initiatives. Services will commence operation throughout 2015–16.
1.1.16 Your experience of service (YES) survey Using the national YES survey tool, an annual ‘snapshot’ survey across specialist adult, youth and older persons mental health service settings and selected mental health community support services will be undertaken to better understand the experience of people receiving mental health treatment and support. The survey will be voluntary and anonymous. This information will inform policy and service-level improvement, strengthen agency accountability and transparency for improving consumer experience of service and provide a genuine and meaningful opportunity for consumer involvement in quality improvement. The survey findings will be reported in the State of Victoria’s Mental Health Services Annual Report.
1.1.17 Telehealth Telehealth has the potential to be part of a coordinated, integrated and sustainable service model to support improved service access, provide optimal care to patients and support health service staff to deliver healthcare. Telehealth can be a cost-effective, real-time and convenient alternative to the more traditional face-to- face way of providing healthcare, professional advice and education. It can help remove many of the barriers currently experienced by health consumers and professionals, such as distance, time and cost, which can prevent or delay the delivery of timely and appropriate healthcare services and educational support.
Volume 2: Health Operations 2015–16, Chapter 1 Page 29 Overview, key changes and new initiatives
The department’s Telehealth unit works to identify synergies and opportunities for leverage from projects, as well as ensuring that the projects reflect the overall objectives of the government and department. Uptake of telehealth is increasing, with considerable diversity in projects and initiatives across Victorian rural health services. To support health services to implement telehealth, the department has developed, a number of tools and resources in 2014–15: • Critical success factors: how to establish a successful telehealth service • Web-based investment analysis tool • a medico-legal issues telehealth resource for consideration • an internal database to capture department-funded projects. In 2015–16, in tandem with these resources, the department continues to consider cost-effective mechanisms to address the systemic barriers to telehealth adoption in Victoria. Further work is under development to examine funding mechanisms for telehealth. This includes changes in counting and funding that is being implemented in 2015–16. Further details around telehealth are available on the telehealth website at
1.1.18 Ageing, aged care and supported residential services
1.1.18.1 Public residential aged care reforms A range of initiatives will continue to be rolled out during 2015–16 to support providers of public sector residential aged care services to adapt to an increasingly competitive and market-driven environment associated with the Commonwealth’s aged care regulatory and funding changes including: • the Victorian Healthcare Association’s sector-directed program of activities to support public sector residential aged care reforms (PSRACS) to deliver future-focused, sustainable, high-quality services • advice to rural services in implementing minor capital grants to support alignment with the Commonwealth’s Significant refurbishment guidelines; this aims to ensure that minor capital investments are directed towards upgrades that contribute to the availability of increased accommodation supplements • advice to rural services in their implementation of Better Business Better Care projects to improve sustainable business operations • sector support for the Commonwealth’s national quality indicator program for residential aged care services in 2016. This is underpinned by a licence and state agreement for the Commonwealth to utilise the Victorian PSRACS Quality Indicator Program and associated resources for the national program.
1.1.18.2 Senior programs and participation initiatives In 2015–16 work will continue in respect of improving seniors’ participation, particularly for vulnerable and disadvantaged seniors, and to respond to elder abuse and address prevention. The Tech Savvy Seniors partnership with Telstra will continue to provide free information technology training material for seniors. The Seniors Card program will continue to develop the Age-friendly Partners program, in partnership with local government, traders and businesses.
1.1.18.3 Aged support services In the past the Personal Alert Victoria (PAV) program has been supported by the HACC Response Services, funded through the HACC program. Due to the impending transfer of responsibility for home support services for people aged over sixty-five years to the Commonwealth, the response service has been separated from the HACC program and will be renamed as the PAV Response Service, funded under the Aged Support Services Output.
Page 30 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
1.1.18.4 Home and Community Care The Victorian and Commonwealth governments have committed to implement the National Disability Insurance Scheme (NDIS) from July 2016. As part of this agreement, the transition of HACC services for older people (people aged 65 or older and 50 and older for Aboriginal people) was scheduled to occur from 1 July 2015. The Commonwealth and Victorian governments have been working on the transition; however, arrangements have not as yet been finalised. Discussions are ongoing and both governments are hopeful that a resolution will be reached in the coming months. Existing arrangements will remain in place until further notice. Organisations will be offered an extension of their current departmental Service Agreement to continue providing HACC services from 1 July 2015. A firm transition date will be determined when the agreement is formally endorsed.
1.1.19 Acute and subacute services
1.1.19.1 Cardiac and stroke services The department has commenced development of cardiac services plan in order to support the government's election commitment to build a Victorian heart hospital as a centre of excellence for cardiac care and research. A steering committee has been established to guide development of the plan and articulate the design of the cardiac service system for Victoria. The cardiac services plan will examine options for new and innovative models of care based on the predicted growth of cardiovascular disease, as well as development of new technologies and treatment options. Evidence has emerged of a new and more effective therapy for patients who suffer a significant ischaemic stroke called ‘endovascular clot retrieval’ (ECR). There are now four major studies that clearly show the benefits of endovascular treatment over current standard care that predominantly involves administering thrombolysis. This represents a key service development that will potentially bring improved clinical outcomes for patients who suffer a severe ischaemic stroke, in addition to reducing the burden of disability and ongoing care needs for such patients. The department will take a lead in shaping how this treatment is rolled out across the state, to ensure that we promote the best outcomes at the whole-of-system level. The department will continue to implement the strategic directions outlined in Heart health – improved services and better outcomes for Victorians. Heart health is supported with a funding commitment of $21.9 million over four years to improve access to treatment for heart disease and stroke, especially in rural and regional Victoria. Key initiatives funded to support the strategic direction of heart health include: rapid access to urgent blood-clot-dissolving drugs (thrombolysis) pre-hospital for people experiencing a heart attack in rural and remote areas of Victoria improved access to specialist advice for rural and regional clinicians to manage suspected cardiac and stroke patients improved triage and referral pathways to streamline access to specialist cardiac surgical services new or strengthened models of care to improve management and support for people with chronic heart failure improved cardiac and stroke recovery through new or strengthened models of care for rehabilitation statewide performance monitoring for cardiac and stroke interventions and outcomes measurement.
1.1.19.2 Emergency department care The department continues to support a range of general and hospital-specific initiatives designed to improve and extend access and improve the responsiveness of emergency care being implemented across Victoria. Hospital service improvement initiatives include: optimising alternatives to hospital admission, ensuring provision of earliest definitive treatment, using evidence to reduce variation in care, optimising acute patient flow, and overall system coordination.
Volume 2: Health Operations 2015–16, Chapter 1 Page 31 Overview, key changes and new initiatives
There will be a continuing focus on improving ambulance patient transfers to emergency departments which will build on the significant improvement work undertaken by the sector in 2014–15 to reduce emergency department waiting times and improve ambulance patient transfers to meet the emergency care needs of the community. The department will continue to work closely with Ambulance Victoria and health services to improve the flow of ambulances across the system to ensure a whole of health system approach; and improve coordination between emergency departments and ambulance services. This provides a strong whole of health system foundation to managing emergency department access removing the requirement to maintain the current practice of hospital initiated distribution to manage patient flow. The department is currently reviewing the diversion of ambulance units (hospital initiated bypass) by metropolitan hospitals in order to manage patient flow. The department will work with health services to consider future changes. These changes will seek to bring Victoria in line with other jurisdictions, improve patient access to emergency department care and aim to support Ambulance Victoria to provide a timely emergency response to the community. The department will continue to work with health services and Ambulance Victoria to reduce variation in ambulance patient transfer processes, improve data collection and reporting, clearly define escalation processes for use when delays in ambulance transfers occur, and improve overall system coordination of ambulance arrivals to emergency departments.
1.1.19.3 State trauma system Critically ill patients with multiple injuries require a multidisciplinary, coordinated and integrated system of trauma care. The Victorian State Trauma System’s staged levels of care ensure that trauma patients receive appropriate definitive management including the adult major trauma services provided by The Alfred and the Royal Melbourne Hospital and the paediatric major trauma service provided by the Royal Children’s Hospital. The major trauma services will continue to receive specified funding to provide definitive care to most of the state’s major trauma caseload (either through primary triage or secondary transfer) and to deliver leadership and support to the broader system. A comprehensive review of the major trauma guidelines (including the major trauma advice and interhospital guidelines, major trauma triage guidelines and the specialist major trauma guidelines) was completed in 2013–14, and revised guidelines are now in place. A statewide trauma education program for clinical staff is being developed to support clinical staff who provide early care for major trauma patients outside a major trauma service. The key program elements are a statewide web-based learning management system incorporating electronic learning modules and a trauma literature warehouse. The online learning modules, which are designed to increase awareness of key aspects of the revised guidelines, will be available from mid-2015. Further information regarding the system and its funding is available at
1.1.19.4 Maternity and neonatal services In 2015–16 all health services are required to comply with the Specialist clinics in Victorian public hospitals access policy (2013) and the companion document Specialist clinics in Victorian public hospitals access policy: Ensuring access to maternity care (2014). The policy outlines the government’s expectations of public health services for the delivery of specialist clinics, including specialist clinics providing maternity care. See
Page 32 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
The Victorian Government has committed to provide more maternity choices for women and enhance continuity of care by supporting health services to expand midwifery models of care and, specifically in 2015–16, this will include supporting selected services to enter into a collaborative arrangement with an eligible midwife for private practice rights including birthing. In 2015–16 the maternity and neonatal service system will be expanded, with five additional neonatal intensive care cots being introduced in tertiary services. All health services providing maternity services are required to have an arrangement to regularly review all perinatal deaths. This process will conform to the Perinatal Society of Australia and New Zealand Clinical practice guideline for perinatal mortality (2nd edition, version 2.2, April 2009). Smaller maternity services may choose to combine the functions of the perinatal mortality review committee with another hospital committee or regional mortality review committee (section 2.2.2 (i)). The department is also developing implementation guidance to support public health services interested in implementing a public home birth program. The document will be released in 2015. The department has been consulting on an update of the current neonatal services guidelines. A revised document that aligns more with other jurisdictions six levels of care will be released in 2015. As part of this updated approach the department will explore opportunities to enhance the capability of selected special care nurseries. The Victorian Government has committed to promote the health of Aboriginal and Torres Strait Islander mothers and their children by improving access and choices in birthing services. To progress this commitment, the department is developing statewide Koori Maternity Service guidelines to support public health services and Aboriginal community-controlled health organisations to improve the provision of culturally appropriate maternity care. The guidelines, scheduled for release in 2015, will provide high- level guidance to strengthen clinical governance arrangements, provide responsive models of care and increase access to care. The department will continue to focus on ensuring safe and sustainable maternity services are available in rural and regional Victoria through regional and subregional approaches to planning.
1.1.19.5 Perinatal autopsy service In 2015–16 the perinatal autopsy service will move to a centralised model, with lead health service the Royal Women’s Hospital providing administrative and clinical leadership under an integrated governance arrangement. Where there is uncertainty about the cause of death, the value of perinatal or infant autopsy and pathological examination of the placenta should be communicated and offered to parents (refer to Chapter 2, section 2.2.7 ‘Perinatal autopsy service’). This information also assists the Consultative Council on Obstetric and Paediatric Mortality and Morbidity to undertake its legislative functions.
1.1.19.6 Renal health The department will continue to implement Renal directions – better services and improved kidney health for Victorians. In 2015–16 specific projects will focus on strategies to deliver: • increased patient independence and improved health outcomes through continuing support for home dialysis as the first option for dialysis • improved coordination of care through the development of a renal integrated care pathway encompassing chronic kidney disease, kidney transplantation, dialysis and supportive patient care • improved capacity in primary care to recognise and manage the early signs of kidney disease.
Volume 2: Health Operations 2015–16, Chapter 1 Page 33 Overview, key changes and new initiatives
Funding and organisation of renal services In 2015–16 the department will: • begin reviewing the dialysis funding model • improving access to the full range of treatment options for people with chronic kidney disease by implementing the renal integrated care pathway • amend home dialysis funding reconciliation to be based on the average number of patients across the year rather than the actual number of patients being treated in June each year.
1.1.19.7 End-of-life care and advance care planning The government has committed to providing quality end-of-life care that relieves pain and suffering and provides empowering support to family, friends and carers. The department, working with key consumer, clinical and organisational stakeholders, is developing a number of resources to support the implementation of advance care planning measures. These resources will be made available at
1.1.19.8 Clinical leadership group on the care of older people in hospital and the best care for older people everywhere toolkit The clinical leadership group on the care of older people in hospital is undertaking projects to identify and develop evidence-based best practice clinical tools and resources that focus on meeting the specific care needs of older people in hospital and support health services to meet the National Safety and Quality Health Service (NSQHS) Standards. The projects focus on: • improving partnerships with consumers by involving older people in decisions about their care • recognising and responding to clinical deterioration in older people • identifying and responding to older people at risk of harm • improving medications safety for older people in hospital. Best care for older people everywhere: The toolkit is an evidence-based resource, aimed at improving outcomes for older people in hospital through informing clinical practice and models of care. The department will launch the third iteration of the toolkit and will include e-learning and audio-visual material. It will also showcase examples of how the evidence has been used by Victorian hospitals to improve care. The Better Health Channel will host a suite of fact sheets and four audio-visual info-clips for consumers based on the toolkit.
Page 34 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
1.1.19.9 Credentialling and scope of clinical practice The Credentialling and defining the scope of clinical practice for medical practitioners in Victorian health services policy applies to all senior medical staff (including dentists) and eligible midwives appointed to a Victorian health service. In 2014–15 the department undertook a review of the policy’s implementation and the Partnering for performance framework. The department will be working with senior doctors and health services to implement the findings of the review in 2015–16. Further information is available at
1.1.20 Specialist clinics access Health services are expected to comply with the Specialist clinics in Victorian public hospitals access policy (released in May 2013) by 1 July 2015. The policy and an accompanying implementation guide can be accessed on the department’s specialist clinics program website at
Table 1.5: Health services in scope for the Specialist clinics in Victorian public hospitals: access policy
Health service Albury Wodonga Health Monash Health Alfred Health Northeast Health Wangaratta Austin Health Northern Health Ballarat Health Services Peninsula Health Barwon Health Peter MacCallum Cancer Centre Bendigo Health Care Group South West Healthcare Central Gippsland Health Service St Vincent’s Health Eastern Health The Royal Children’s Hospital Goulburn Valley Health The Royal Victorian Eye and Ear Hospital Latrobe Regional Hospital The Royal Women’s Hospital Melbourne Health West Gippsland Healthcare Group Mercy Public Hospital Inc. Western Health Mildura Base Hospital Wimmera Health Care Group
The department encourages all other health services providing specialist clinic services to work towards meeting the objectives and principles of the policy. In line with health services responsibility for payment of ambulance transport to specialist clinics, health services are responsible for booking and authorising any Ambulance Victoria ambulance transport needed to transport patients to specialist clinics or health independence programs.
Volume 2: Health Operations 2015–16, Chapter 1 Page 35 Overview, key changes and new initiatives
1.1.21 Ambulance services In 2015 the Ambulance Performance and Policy Consultative Committee was established with the aim of improving ambulance service performance and the organisational culture of Ambulance Victoria. Several reform opportunities have been identified by the committee including: • better integration of ambulance services and the broader health system; • better support for paramedics; • a change Ambulance Victoria’s culture to better reflect community expectations; and • improving ambulance call taking and dispatch. The outcomes sought from these opportunities aim to: • shift the culture at Ambulance Victoria so paramedics feel valued and supported • reorientate the system so paramedics primarily use their skills and expertise to help patients experiencing life-threatening and time critical emergencies • improve the call taking and dispatch system so that patient needs can be correctly identified and the right response provided • improve response times to those patients where time makes a difference to their outcomes • reduce congestion at emergency departments • improve community awareness of when to call for an emergency ambulance. The Non-Emergency Patient Transport Regulations (NEPT) 2005 expires on 8 November 2015. These Regulations had recently been updated to reflect the changes in the new Mental Health Act 2014. An initial consultation process with stakeholders has been completed and the draft Regulations are now being prepared. The draft Regulations will be released for public comment prior to finalisation. During 2015–16 the department will trial a range of initiatives aimed at improving the flow and experience of patients requiring planned medically assisted non-emergency transport through the system. This will include a limited public health service pilot of an alternative service delivery approach for planned non- emergency transports to support more timely and effective service provision. Consultation will occur with key stakeholders ahead of any changes. During 2015 the department will release the updated Non-emergency patient transport clinical practice protocols, which capture changes in clinical practice that have occurred since the protocols were first implemented. This will help realise greater efficiencies in the sector. Further changes are planned to align with the forthcoming review of the NEPT Regulations.
1.1.22 Community health services In order to consolidate the initiatives of recent years and further strengthen community health services, the following initiatives will be progressed in 2015–16: • work on the Community Health Practice Indicators and conduct of a client experience survey in community health as part of the Victorian Healthcare Experience Survey (together with ongoing quality of care reporting these initiatives will assist in developing a consolidated performance framework for community health) • ongoing improvements in funding accountability, building on recent improvements to the Community Health Minimum Dataset, and updated community health data reporting guidelines will be released • implementation of new community health guidelines, including the Community Health Integrated Program guidelines, child health and refugee and asylum seeker guidelines, and updating of guidelines for chronic disease management • implementation of the Health care that counts guidelines by community health services in 2015–16.
Page 36 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
1.1.22.1 The Health Literacy Response Framework Project The Health Literacy Response Framework Project is an approach to building capability in services to engage effectively with people at different levels of health literacy. Deakin University, Monash University and the department (HACC, Community Health Program and Health Independence Program) have been working together on a research project supported by an Australian Research Council Linkage Grant. The project is now coming to an end. Its purpose is to develop a response framework that helps health and community services to identify and respond appropriately to the health literacy needs of their local populations. The department is confident that the project will yield useful tools and techniques that will assist clinicians and others involved in the care of people with chronic disease to engage with their patients/clients, give them meaningful and useful information that will help them to be partners in their own care. The high-level aims of the project are to improve health outcomes and reduce health inequalities for people with long-term conditions through: building an understanding of the health literacy of individuals developing service provider responses tailored to the health literacy needs of different individuals building system-wide capacity to respond to individuals’ specific needs for the way information about their conditions is delivered to them finalising a toolkit that can be used widely by a range of primary and specialist clinicians in engaging with their patients/clients on their care.
1.1.23 New consumer participation and experience policy The ‘Doing it with us not for us’: Strategic direction 2010–13 policy and the Cultural responsiveness framework were reviewed in 2014–15. In 2015–16 the department, in partnership with health services, consumers and carers and the community, will be using the policy and framework evaluation findings to develop: • a new policy to lead consumer, carer and community participation across the Victorian health system and enhance responsiveness to our diverse community members • new indicators to measure and inform implementation • tools and resources to help health services partner with consumers, carers and the community to improve the quality and safety of healthcare.
1.1.24 Patient experience: Victorian Healthcare Experience Survey The Victorian Healthcare Experience Survey will be expanded to new setting types in 2015–16. This survey identifies areas where the patient experience can be improved and what aspects of care are enhancing person- and family-centred care. The survey results provide health services with actionable results. The survey is based on the United Kingdom’s National Health Service (NHS) survey and include some questions from the American National Research Corporation. The survey includes the new Australian national core common set of patient experience questions. Four new patient experience surveys are being developed: • for community health service clients (primarily non-general practitioner primary healthcare clients), which will use a tool based on the NHS primary care survey • to capture specialist clinic patient experience data, which will use a tool based on the NHS adult outpatient survey and the Picker Europe paediatric and parent/carer outpatient survey. These four new surveys will be developed with the community and services during 2015–16.
Volume 2: Health Operations 2015–16, Chapter 1 Page 37 Overview, key changes and new initiatives
All surveys are being developed with funded agencies, consumer and carer working groups. They are being cognitively tested with consumers (and, where appropriate, carers), piloted through a sample of the appropriate funded agencies and will include verbatim comments thematically streamed from survey respondents.
1.1.25 Meeting the needs of Victoria’s diverse populations The department supports diversity and reducing health inequalities through accessible and appropriate health service delivery. The department recognises that some groups in Victoria experience poorer health due to a range of social, behavioural and biological factors such as culture, language, migration experience, Aboriginality, sex and gender, gender identity, sexual orientation, age and disability. All these factors can influence health and wellbeing and experiences of healthcare. Services need to be appropriate to meet the needs of a diverse range of populations including women, people with disabilities and refugees. Some examples of departmental initiatives in this area include: • supporting whole-of-government measures to address family violence, encompassing prevention approaches and early intervention responses to family violence through improved identification and referral in healthcare settings • working on a men’s health online training resource for health professionals in partnership with Networking Health Victoria and Andrology Australia • implementing the new departmental Cultural diversity plan to embed consideration of cultural diversity in the planning, development and delivery of programs and services across the health and human services portfolio • working in partnership with the Victorian Refugee Health Network to identify and respond to emerging access issues in refugee and asylum seeker health and wellbeing and supporting Victorian health and human service providers to work with this vulnerable population • the Victorian Women's Health Program, which is aimed at working towards lasting improvements in the health of Victorian women • supporting the new whole-of-government Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Taskforce and Health and Human Services Working Group to respond to emerging health and human services issues for Victoria’s LGBTI communities. Further information is available at
1.1.26 Victorian Tuberculosis Program The department funds Melbourne Health to provide the Victorian Tuberculosis Program. The program is a statewide service based at the Peter Doherty Institute for Infection and Immunity. In the program, public health nurses provide case management to people with active tuberculosis to ensure adherence with treatment, as well as contact-tracing and screening to minimise public health risk of the spread of infection. The department has developed performance measures for Melbourne Health, which are outlined in the Victorian Tuberculosis Program service objectives and scope document.
1.1.27 Implementation of changes to the Assisted Reproductive Treatment Act 2008 Changes to the Assisted Reproductive Treatment Act 2008 began in 2014 and fully come into effect on 29 June 2015. The main purpose of the changes is to enable people conceived from gametes (an egg or sperm) donated before 1 July 1988 to obtain identifying information about their donor where available and with the consent of the donor. Other purposes of the changes include securing access to and preserving donor treatment records and increasing the availability of counselling and support services to a wide array of donor conception stakeholders. Implementation is primarily managed within existing resources with continued additional recurrent funding to the Victorian Assisted Reproductive Treatment Authority to meet the new and changed requirements.
Page 38 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
The Government has committed to giving all donor-conceived people the right to access identifying information about their donors. Further information will be provided about resourcing any new requirements.
1.1.28 Health Purchasing Victoria In 2015–16 the Health Purchasing Victoria budget will be $14.1million. These funds will enable Health Purchasing Victoria to continue delivering its core functions, embed reforms commenced in 2014–15 and deliver further reforms in 2015–16, including strengthening procurement probity compliance across health services, supply chain enhancement and sourcing expansion to drive further efficiencies across the sector.
Volume 2: Health Operations 2015–16, Chapter 1 Page 39 Overview, key changes and new initiatives
1.7 The pricing and funding framework for Victorian health services
1.1.29 Pricing and funding framework The department released the Pricing and funding framework in June 2015. This document describes the department’s framework for making changes to current pricing and funding approaches including the significant changes to occur in 2015–16. The details, including the new prices, health service budget impacts and specific information on new funding approaches, are found in the relevant sections of this document. The pricing framework for 2015–16 can be found at
1.1.30 Commonwealth funding Funding for public health is a combined Commonwealth and state responsibility. However, the Commonwealth Government has implemented successive and substantial cuts to funding for the Victorian health system since 2012–13. In the 2014–15 Commonwealth Budget, the Commonwealth announced significant changes to funding arrangements under the National Health Reform Agreement (NHRA), which will have a major impact on the Victorian health system. This included Commonwealth savings of $1.8 billion nationally over four years from 2014–15 by ceasing the funding guarantees under the NHRA, and revising Commonwealth public hospital indexation funding arrangements from 1 July 2017. NHRA funding will be linked to the level of services delivered by public hospitals as provided under the NHRA until 30 June 2017, after which time it will revert to block funding indexed according to population growth and the consumer price index. The 2014–15 Mid-Year Economic and Fiscal Outlook (MYEFO) released on 15 December 2014 announced further downward revisions to parameters underlying the calculation of national health reform payments to states and territories, resulting in a reduction in funding of $941 million nationally (over four years) based on lower projections of the National Efficient Price. The 2015–16 Commonwealth Budget reported $4,104 million in national health reform payments to Victoria in 2015–16. This is an additional $255.5 million in 2015–16 or 6.6 per cent increase in Commonwealth funding compared with the 2014–15 funding estimate released in the 2015–16 budget papers. This compares with a 6.3 per cent increase nationally. This increase is in line with the Independent Hospital Pricing Authority’s (IHPA) National Efficient Price determination and National Efficient Cost determination, and activity estimates provided by Victoria in March 2015. Forward estimates for 2017–18 and 2018–19 indicate a lower level of funding increase, nationally at 4.1 per cent and 4.3 per cent respectively. In monetary terms this equates to an increase of $201.6 million and $196.1 million, compared with a $255.5 million increase in 2015–16 for Victoria. This is in line with the 2014–15 Commonwealth budget changes to the NHRA, reflecting the introduction of new indexation funding arrangements for public hospital services from 2017–18 onwards. The status of the Commonwealth’s announcement in its 2014–15 Commonwealth Budget on the rationalisation of several health agencies remains unclear, in particular the independent bodies established under the NHRA being consolidated. Despite these short-term funding increases, updated modelling undertaken by officers in the department since the 2015–16 Commonwealth Budget shows that the Commonwealth has cut funding to Victorian public hospital services by an estimated $17.7 billion between 2014–15 and 2025–26. This is largely due to the new public hospital indexation funding arrangements that were announced in the 2014–15 Commonwealth Budget, which will apply from 1 July 2017.
Page 40 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
A new National Partnership Agreement on Adult Public Dental Services ($219.4 million to Victoria over three years) was due to commence on 1 July 2015. However, the 2015–16 Commonwealth Budget only reported $155 million nationally in 2015–16 (estimated $38.5 million to Victoria). This represents an $11.1 million reduction in Commonwealth dental funding to Victoria in 2015–16. The justification for this reduced duration provided by the Commonwealth is to allow for reform work to be undertaken over the next 12 months. Funding arrangements beyond 2015–16 will be subject to negotiations with the states.
Volume 2: Health Operations 2015–16, Chapter 1 Page 41 Overview, key changes and new initiatives
1.8 Funding reforms 2015–16
Ongoing funding reform is required to achieve longer term sustainability and adapt to new challenges. Each year funding models are reformed and updated to improve the functioning of the health system. In line with the Victorian framework for pricing and funding health services, Victoria will maintain a Victorian funding system that adopts appropriate elements of the national approach within current Victorian funding models. Changes will continue to be made to Victorian funding models in 2015–16 to improve their functionality. In addition to the funding reforms outlined below, in 2015–16 a number of regular updates, including rebasings, have been made to account for the most recent cost and activity data. Changes include updates to weighted inlier equivalent separations 22 (WIES22) cost weights, interim subacute non-acute classification (i-SNAC) cost weights and the non-admitted emergency services grant. See Chapter 2 of these guidelines for details.
1.1.31 WIES peer groups Historically the Victorian health funding model has utilised different WIES prices for different types of hospitals (peer groups). Under the 2014–15 model, there are three peer groups with prices that vary significantly and do not necessarily reflect the cost of delivering admitted services across the different peer groups or promote the most efficient and effective outcomes. In order to reduce the variance across peer groups in 2015–16, the number of WIES groups has been reduced from three to two by consolidating major provider and the outer metropolitan and large regional peer groups into one group. The realignment of peer groups is consistent with 2014–15 changes to progress towards reducing the number of peer groups and considers the net change of incorporating specified grants into price. Details of the new peer groups are set out in Chapter 2, section 2.1.5 ‘Pricing’ and Chapter 2, section 2.19 ‘Peer groups for WIES purposes’.
1.1.32 Pricing for quality In 2014–15 Victoria implemented a ‘pricing for quality’ scheme, providing an opportunity to link funding allocations to discrete performance measures that demonstrate a health service’s success in reducing preventable harm and improving the quality of care. The scheme focuses on a small suite of indicators that: • have a strong evidence base and clinical consensus on the characteristics of best practice • have high impact – that is, variation in practice, a gap between best evidence and current practice, high volumes of significant impact • drive policy domains that may not be captured through existing measures • have availability and quality of data. • Victoria is adopting a positive reinforcement approach through rewarding desirable actions. In 2015–16 the scheme will focus on the following clinical areas: • eliminating the intensive care unit central line associated blood stream infection rate • transitions of care – improving processes relating to discharge planning from an inpatient admission, derived from a composite of questions in the Victorian Healthcare Experience Survey. The scheme will enable Victoria to establish a system that is sustainable and drives performance while minimising the cost for Victorians and avoiding an additional reporting burden for health services.
Page 42 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
The introduction of pricing for quality focuses on transparent reinforcement and is a mechanism by which services can stimulate improved performance at the individual, the professional group and the organisational levels that culminate in better patient outcomes.
1.1.33 Specified grant consolidation The following changes to sector-wide specified grants will occur in 2015–16.
Table 1.6: Acute health
2014–15 grant description 2015–16 grant description *GEM admitted private expansion *GEM admitted private *GEM admitted public expansion *GEM admitted public Health Independence Program expansion Health independence program Palliative care admitted private expansion Palliative care admitted private Palliative care admitted public expansion Palliative care admitted public Rehabilitation admitted private expansion Rehabilitation admitted private Rehabilitation admitted public expansion Rehabilitation admitted public **SRHS Health Independence Program expansion **SRHS Health independence program **SHRS Palliative care admitted private expansion **SRHS WIES private **SHRS Palliative care admitted public expansion **SRHS WIES public Notes: *GEM: geriatric evaluation and management **SRHS: small rural health services
1.1.34 Non-admitted radiotherapy In 2015–16 the non-admitted radiotherapy funding unit, being the weighted activity unit (WAU), price will be adjusted in line with increasing Medicare Benefits Schedule (MBS) earnings over recent years across public radiotherapy services. Other funding initiatives for 2015–16 included the following: Radiotherapy services will be shadow funded against the recommended funding model from the Syris review The radiotherapy shared-care arrangement currently in place at Western, Northern and Peninsula Health will be implemented at Monash Health Casey with St John of God Berwick. This will improve radiotherapy access for cancer patients from the Casey, Cardinia and Dandenong regions The department will continue to work with services on quality, efficiency and productivity improvements in line with the implementation of new technologies and commencement of new services, including: – ongoing work to improve MBS billings; – working with services on implementation of new product techniques such as intra-operative radiotherapy; and – supporting and encouraging services to develop regional outreach radiation oncology consulting models. A review of the quality of data reported to the Victorian Radiotherapy Minimum Data Set will be undertaken to reduce variation and improve the consistency of data reported. Funding for allied health services relating to radiotherapy will continue to be allocated separately to radiotherapy hub hospitals in 2015–16, as defined under the IHPA Tier 2 non-admitted services definitions manual.
Volume 2: Health Operations 2015–16, Chapter 1 Page 43 Overview, key changes and new initiatives
1.1.35 Blood products funding In 2015–16 Victoria will further progress blood products funding reform by continuing the process commenced in 2014–15 towards devolved blood budgets to health services. Blood and blood products have historically been provided free of charge to public hospitals in Victoria and the budget centrally held and managed. In 2015–16 the department will introduce financial accountability for blood use by devolving funding responsibility to selected public hospitals that are major users. The department, in conjunction with health services, will monitor this devolution of funding responsibility, to inform future blood and blood product funding policy.
1.1.36 Updates to the admitted mental health model: towards an activity-based model Changes to the Weighted Occupancy target (WOt) model in 2015–16, resulting in development of WOt3, have been guided by discussions with health services that identified specific implementation issues with the current model. In recognition of the changes being made to the model and the need for further monitoring and analysis in keeping with the 2014–15 approach, funding will again not be adjusted for under performance in 2015–16. Performance against the WOt was noted during 2014–15. This information was used to establish minimum occupancy thresholds for WOt3 in 2015–16 to assist health services with monitoring performance.
1.1.37 Total parenteral nutrition Additional funding will be provided to support total parenteral nutrition (TPN) services provided to non- admitted patients who self-administer TPN at home. The additional funding will assist Victoria’s five health services that are funded to provide TPN to transition to a model that better aligns funding with activity. Under the funding model for 2015–16 health services will continue to be funded via a specified grant for TPN services and service event targets will be introduced, based on an indicative price per patient per month. Recall will be applied at the end of 2015–16 for health services whose activity is below target. Ad hoc data and cost reporting may be requested by the department throughout 2015–16 to enable further analysis of activity and costs in order to inform future funding approaches.
1.1.38 Funding for prisoners A new funding model for prisoners will be introduced in 2015–16. The new model will apply to admitted, emergency department and specialist clinic services provided to prisoners treated in Victorian public hospitals. From 1 July 2015, the department will be responsible for funding public hospital services for prisoners, and prisoners will be treated and funded as public patients from this date.
1.1.39 Funding for patient transport Ensuring patients have access to the right service can result in some patients being transported to another health service for their care. Decisions to transport patients are based on clinical factors and it is important that funding approaches support the appropriate decisions being made. Adequately compensating those services with significantly higher than average costs for appropriately transporting patients is therefore considered appropriate. The department will cease the funding adjustment provided to health services in 2014–15 as a result of the new Ambulance Victoria pricing approach.
Page 44 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
In 2015–16 health services that have transport costs (as a proportion of total funding) twice the state average (1.45 per cent) will be considered eligible for additional funding. Health services deemed to be eligible will receive funding equal to 75 per cent of their costs above the threshold. Health services are also be encouraged to consider strategies that will assist in reducing inappropriate costs associated with patient transport.
1.1.40 Funding for emergency departments Patients who attend emergency departments can either be admitted to the hospital they present at, be assessed and then transferred to another facility, or may be treated and discharged home. The funding approach for emergency department activity attempts to mirror this patient flow through two main streams of funding: For those patients who go on to be admitted, health services receive funding through the inpatient price, which includes allowances for the cost of the emergency department care For those patients who present to an emergency department but do not go on to be admitted at that hospital, are funded through a specified grant that comprises two parts, first an availability component, and second, an activity component. In 2015–16 the department will maintain this split funding approach for the different patient pathways (admitted or non-admitted) but will better align the non-admitted and admitted acute funding pools to reflect the activity that is being reported. Improving the specificity of the two funding streams will provide a clearer signal to health services about the efficient level of resources required for admitted and non- admitted emergency care. Further details are provided in Chapter 2, section 2.2.1 ‘Emergency department’.
1.1.41 Funding for interpreters Effective communication is essential for high-quality healthcare. Departmental policy requires health services to provide professional interpreting and translating services for people who speak limited or no English when making significant health decisions. The current funding approach of including all interpreter services funding in WIES is not aligned with the distribution of total costs associated with providing interpreter services From 2015–16, health services with reported 2014–15 interpreter costs that exceed 0.2 per cent of their total funding will receive additional funding from the department in 2015–16 (excluding Dental Health Service Victoria). Health services deemed to be eligible will receive funding equal 75 per cent of the reported costs above 0.2 per cent of total funding.
1.1.42 Genetics Genetic and genomic services are becoming recognised as part of routine clinical practice, and they are expected to deliver significant future improvements in health outcomes. As a result, the demand for this activity has grown considerably and is now consuming significantly more resources. As with all scarce resources, there is a need to ensure they are being used in the most productive way. In 2015–16 the department will change its funding approach for genetic tests, with funding to to the clinical service who order the tests. This change aims to provide clinicians visibility about the level of resources they are consuming and support them to make active decisions about how best to allocate those resources to ensure patients receive the appropriate care. The new arrangements aim to support the more efficient genetic testing by providing greater clinician transparency and accountability for managing these limited resources to ensure clinicians order only those tests that are best for the patient’s circumstance and that the funding model supports the appropriate use of the available resources.
Volume 2: Health Operations 2015–16, Chapter 1 Page 45 Overview, key changes and new initiatives
1.9 Data and reporting changes
1.1.43 Revisions to the Victorian hospital admission policy The Victorian hospital admission policy has been revised for 2015–16 to reflect the following: • The Automatically Admitted Procedure List (AAPL) and the Not Automatically Qualified for Admission List (NAQAL) have been updated to include new Australian Classification of Health Interventions (ACHI) codes and to reflect deleted ACHI codes. This is in response to the introduction of the ninth edition of ACHI on 1 July 2015. • Twelve existing codes relating to the excision of skin lesions have been removed from the AAPL and placed on the NAQAL. These codes are listed on page one in the Victorian hospital admission policy. • Clarification has been provided in the Victorian hospital admission policy fact sheets that transfer from hospital-based care to Hospital in the Home (HITH) does not justify a change of qualification status for newborns. The revised admission policy is in effect as of 1 July 2015. The policy, the related fact sheets and the procedure code lists can be downloaded at
1.1.44 Data collection changes The following sections describe the key data collection changes. For further information about data collection changes, see
1.1.44.1 Victorian Admitted Episodes Dataset (VAED) In 2015–16 there will be an increased focus on data compliance. The penalties for noncompliance have been increased, and the AIMS S1A form will be expected to be completed for sites unable to meet the data transmission deadlines. The final date for receiving VAED for 2015–16 has been brought forward to 24 August 2016.
1.1.44.2 Agency Information Management System (AIMS) The following new forms have been introduced: • palliative care consultancy program activity: this provides the department with data that is uniform across all consultancy programs • mental health establishment organisation overhead full-time equivalent (FTE) and salary: this form will increase the accuracy of the organisational FTE reported against the different settings and align with national reporting requirements • nurse endoscopy activity The diagnostic ancillary services have been removed from the S10 acute non-admitted clinic activity form.
1.1.44.3 Victorian Emergency Minimum Dataset (VEMD) The consistent collection of time points will be a focus for VEMD in 2015–16. These include arrival, triage, treating practitioner and departure dates and times. Penalties for compliance have been increased from $3000 per month to $10,000 per month to improve compliance rates to support the performance reporting timelines. Health services that are implementing or upgrading ED systems are required to be able to report aggregate data on time during any transition phase.
Page 46 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
1.1.44.4 Victorian Ambulance Dataset (VADS) In 2015–16 the department will implement a unit-record minimum dataset for ambulance services provided by Ambulance Victoria, which will be referred to as the Victorian Ambulance Dataset (VADS). VADS builds upon existing data-sharing between the department and Ambulance Victoria and will provide essential data to increase transparency and accountability, enhance forecasting and improve modelling with respect to the use of and demand for Ambulance Victoria’s services. VADS will be implemented in a staged approach, with the first phase incorporating road and air responses and transports and minimal, predominantly demographic, patient information. Other service data will be introduced in future stages.
1.1.44.5 Victorian Integrated Non-Admitted Health (VINAH) dataset There will be a focus on data compliance across all programs reporting to VINAH in 2015–16. For health services that have received specialist clinics stage two funding (which is received once health services become compliant for VINAH specialist clinics), there will be an expectation that specialist clinics data is submitted in line with the due dates, or exemptions are requested. This financial year (2015–16) will be the final year that health services are able to qualify for specialist clinics stage two funding. It is expected that all in-scope health services are submitting timely and accurate specialist clinics VINAH data by the end of the 2015–16 financial year. Subacute programs will continue to be monitored for compliance, with a focus on complete and accurate data.
1.1.44.6 Victorian Perinatal Data Collection (VPDC) Health services where births occur (or where a midwife or medical practitioner is in attendance at a birth not in a health service) are required to report the information set out in the birth report specified by the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) for inclusion in the VPDC. Refer to Chapter 3, section 3.12.3.6 ‘Consultative councils reporting requirements’. The VPDC is a population-based surveillance system to collect and analyse comprehensive information on and in relation to the health of mothers and babies to contribute to improvements in their health. It contains information on obstetric conditions, procedures and outcomes, neonatal morbidity and congenital anomalies relating to every birth in Victoria. The definition of a birth for this purpose means a birth or stillbirth that is required to be registered under the Births, Deaths and Marriages Registration Act 1996. The VDPC manual, including data definitions, business rules and submission guidelines is available at
Volume 2: Health Operations 2015–16, Chapter 1 Page 47 Overview, key changes and new initiatives
Page 48 Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
List of tables
Table 1.1: The Travis Review – Interim report recommendations...... 14 Table 1.2: Victorian State Budget details...... 19 Table 1.3: Funding for asset initiatives...... 22 Table 1.4: Clinical networks 2015–16...... 26 Table 1.5: Health services in scope for the Specialist clinics in Victorian public hospitals: access policy...... 35 Table 1.6: Acute health...... 43
Volume 2: Health Operations 2015–16, Chapter 1 List of tables Overview, key changes and new initiatives
Acronyms and abbreviations
A&EP Aids and Equipment Program AAPL Automatically Admitted Procedure List ABF activity-based funding ABN Australian Business Number ACAS Aged Care Assessment Service ACHA Assistance with Care and Housing for the Aged ACHI Australian Classification of Health Interventions ACS Australian Coding Standard ACSQHC Australian Commission on Safety and Quality in Health Care ADA Australian Dental Association ADIS Alcohol and Drugs Information System AIDS acquired immune deficiency syndrome AIMS Agency Information Management System ALOS average length of stay AN-SNAP Australian National Subacute and Non-Acute Patient ANZICS Australian and New Zealand Intensive Care Society AQL acceptable quality level AR-DRG Australian Refined Diagnosis Related Groups ASD atrial septal defect BBV blood-borne virus BPCLE Best Practice Clinical Learning Environments BPD Better Patient Dataset BPT basic physician training CCCS Community Care Common Standards CCOPMM Consultative Council on Obstetric and Paediatric Mortality and Morbidity CDBS Child Dental Benefits Schedule CEO chief executive officer CHO chief health officer CKD chronic kidney pathway CLABSI central line associated blood stream infection CMBS Commonwealth Medicare Benefit Scheme CMI Client Management Interface CMI/ODS Client Management Interface/Operational Data Store CORE Centre for Outcome and Resource Evaluation CPC community palliative care CSO community service organisation CTN clinical training networks DET Department of Education and Training DFI Dr Foster Intelligence DHHS Department of Health & Human Services DRG diagnosis-related group
Acronyms and abbreviations Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
DTC day therapy centre DuV dental unit of value DWAU dental weighted activity unit EBA enterprise bargaining agreements ECDS Electronic Communications Devices Scheme ECT electroconvulsive treatment ED emergency department eMAP Electronic Management and Assistance for Primary Care ESIS Elective Surgery Information System F1 Financial Data FIM Functional Independence Measure FOBT faecal occult blood test FTE full-time equivalent GEM geriatric evaluation and management GST goods and services tax HACC Home and Community Care HAI healthcare-associated infections HARP Hospital Admission Risk Program HDSS health data standards and systems HEN home enteral nutrition HIP Health Independence Program HIRC Health Innovation and Reform Council HITH Hospital in the Home HIV human immunodeficiency virus HPV Health Purchasing Victoria HSMR hospital standardised mortality ratios ICS Integrated Cancer Services ICT information communication technology ICU intensive care unit IHCS Integrated Hepatitis C Service IHI Individual healthcare identifiers IHPA Independent Hospital Pricing Authority ISCP Individualised Client Support Packages i-SNAC interim-subacute and non-acute classification KMS Koori Maternity Services LGBTI Lesbian, Gay, Bisexual, Transgender and Intersex LOP length of phase LOS length of stay MDS Hospital Minimum Payroll and Workforce Employee Dataset MHCC Mental Health Complaints Commissioner MHCSS mental health community support services MHT Mental Health Tribunal MICA Mobile Intensive Care Ambulance MOU memorandum of understanding
Volume 2: Health Operations 2015–16, Chapter 1 Acronyms and abbreviations Overview, key changes and new initiatives
MPS multipurpose service MSS Membership Subscription Scheme MYEFO Mid-Year Economic and Fiscal Outlook NAESG Non-Admitted Emergency Services Grant NAQAL Not Automatically Qualified for Admission List NATA National Association of Testing Authorities NBCSP National Bowel Cancer Screening Program NDIS National Disability Insurance Scheme NDSS National Diabetes Syringe Scheme NEAT National Emergency Access Target NEC National Efficient Cost NEHTA National E-Health Transition Authority NEP national efficient price NEPT non-emergency patient transport NETS Newborn Emergency Transfer Service NFC Nationally Funded Centres NGO non-government organisation NHIPPC National Health Information and Performance Principal Committee NHRA National Health Reform Agreement NHS National Health Service (United Kingdom) NHT nursing home type NPA national partnership agreement NRCP National Respite for Carers Program NSAP National Standards for Providing Quality Palliative Care NSP needle and syringe program NSQHS National Safety and Quality Health Service NWAU national weighted activity unit OCIO Office of Chief Information Officer OCP Optimal Care Pathways OHS occupational health and safety OHSC Office of the Health Services Commissioner OIS operational infrastructure support PARC prevention and recovery care PAS performance assessment score PAV Personal Alert Victoria PCEHR Personally Controlled Electronic Health Record PCP Primary Care Partnership PDI The Peter Doherty Institute for Infection and Immunity PDRSS Psychiatric Disability Rehabilitation and Support Services PRISM Program Report for Integrated Service Monitoring PSRACS public sector residential aged care service PTC patient treatment coordinator QDC Quarterly Data Collection RACS Royal Australasian College of Surgeons
Acronyms and abbreviations Volume 2: Health Operations 2015–16, Chapter 1 Overview, key changes and new initiatives
REACH REtrieval and Critical Health RRI Reducing Restrictive Interventions RRP Risk-rated premium RUG ADL Resource Utilisation Group – Activity of Daily Living SAMS Service Agreement Management System SAVVI Supporting Accommodation for Vulnerable Victorians Initiative SCTT service coordination tools template SHERP State health emergency response plan SIDS Sudden infant death syndrome SOII Surgical Outcomes Information Initiative SoP Statement(s) of Priority SRHS Small Rural Health Service SRS supported residential services STEMI ST Elevation Myocardial Infarction STI sexually transmissible infections SWEP Statewide equipment program T&D training and development TAC Transport Accident Commission TB tuberculosis TCP Transition Care Program TPN total parenteral nutrition VADS Victorian Ambulance Data Set VAED Victorian Admitted Episodes Dataset VAGO Victorian Auditor-General’s Office VALP Victorian Artificial Limb Program VASM Victorian Audit of Surgical Mortality VCCAMM Victorian Consultative Council on Anaesthetic Mortality and Morbidity VCCN Victorian Cardiac Clinical Network VCDC Victorian Cost Data Collection VCOR Victorian Cardiac Outcomes Registry VCTC Victorian Clinical Training Council VEMD Victorian Emergency Minimum Dataset VFPMS Victorian Forensic Paediatric Medical Services VGPB Victorian Government Purchasing Board VHES Victorian Healthcare Experience Survey VHIA Victorian Hospitals Industrial Association VHIMS Victorian health incident management policy VIC-DRG Victorian-modified diagnosis-related group VICNISS Victorian Healthcare Associated Infection Surveillance System ViCTOR Victorian Children’s Tool for Observation and Response VIFMH Victorian Institute of Forensic Mental Health VINAH Victorian Integrated Non-Admitted Health VMIA Victorian Managed Insurance Authority VMNCN Victorian Maternity and Newborn Clinical Network
Volume 2: Health Operations 2015–16, Chapter 1 Acronyms and abbreviations Overview, key changes and new initiatives
VPCN Victorian Paediatric Clinical Network VPCS Victorian Product Catalogue System VPDC Victorian Perinatal Data Collection VPRS Victorian Paediatric Rehabilitation Service VPTP Victorian Paediatric Training Program VRHCN Victorian Renal Health Clinical Network VRMDS Victorian Radiotherapy Minimum Dataset VRSS Victorian Respiratory Support Service VSCC Victorian Surgical Consultative Council VWA Victorian WorkCover Authority WAU weighted activity unit WBD weighted bed day WIES weighted inlier equivalent separation WOt weighted occupancy target YES Your Experience of Service
Acronyms and abbreviations Volume 2: Health Operations 2015–16, Chapter 1