Department of Health and Human Services Policy and Funding Guidelines 2017 - Volume 2

Department of Health and Human Services policy and funding guidelines 2017 Volume 2: Health operations 2017–18 Chapter 1: Overview, key changes and new initiatives To receive this publication in an accessible format, please phone 03 9096 8572 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 and Human Services July 2017. 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. ISSN 2207-8347 (online) Available at . Printed by Impact Digital, Brunswick (1703037) Contents

3 Ministers’ foreword

The Victorian Budget 2017–18 provides an extra $1.67 billion over four years for health, mental health and aged care services. This investment will enable the health system to give Victorian patients the treatment they need sooner, with a massive boost to our frontline hospital services, and yet another boost to elective surgery to drive down waiting lists. The boost will support our hospitals to admit 1.9 million patients, and treat 1.8 million patients in emergency this year, so that more Victorians will get the care they need. Building on the record investment in 2016–17, this budget will also support more than 200,000 patients to get their surgery sooner this year, with $174.3 million provided to support extra operations and cut down elective surgery waiting lists even further. The Victorian Budget 2017–18 will provide $325.7 million over four years for much needed support for mental health and will also invest in forensic mental health services to not only save and improve lives, but to keep Victorians healthy and safe. As part of this funding package, $201.1 million will assist in managing critical demand in the mental health system, making sure more beds are available and that people with a mental illness get the treatment they need. An investment of $10 million will go to Facilities Renewal Grants to assist existing mental health, alcohol and drug services to improve facilities for patients, carers, visitors and staff. A $8.3 million injection for the Ballarat community will see a Prevention and Recovery Centre built, giving local patients more treatment options. Integrated care across Victoria’s congregate crisis accommodation facilities, which include accommodation, health and mental health support, alcohol and drug treatment will be strengthened for the most vulnerable with an investment of $7.3 million. A $428.5 million boost to upgrade hospitals, equipment and other health infrastructure will give doctors and nurses the modern facilities and equipment they require to deliver Victorians better care, sooner. Building on the record $500 million investment announced in November 2016 to improve ambulance response times, a further $26.5 million has been committed to continue this work. Our paramedics, doctors, nurses and hospitals will be supported to better predict and to respond to cases of extreme and unpredictable events such as thunderstorm asthma, with $15.6 million in the budget. A further boost of $12.8 million will support 45,000 more Victorians to be screened for breast, bowel and oral cancers, reaffirming the government’s ambitious target of saving 100,000 lives from cancer over the next ten years. In response to the report targeting zero, the government as part of the most significant reform of our health system in decades will also make an investment of $215 million to overhaul quality and safety in the Victorian health system and drive down avoidable harm. This will build on the 29.8 million provided to support this work in 2016-17. As part of the Government’s response to implementing all recommendations of the Royal Commission into family Violence, the Victorian Budget 2017–18 provides $38.4 million to hospitals to train health workers to identify the signs of family violence and support people who may be experiencing harm to get the help they need. The Victorian Government will double its investment in making hospitals and mental health services safer, as a powerful new campaign makes it clear that violence against healthcare workers is never OK. In addition, the Health Service Violence Prevention Fund has been increased by $20 million, taking our total investment to $40 million.

Volume 2: Health operations 2017–18 Victoria’s world-leading medical researchers, scientists and institutions will also get the support they need to stay at the forefront of medical research with an additional $34.2 million. Joining the five 24-hour Supercare Pharmacies opened in 2016–17, another seven Supercare Pharmacies will open across Victoria, so even more people can get the healthcare and advice they need from pharmacists and nurses late at night. The Victorian Budget 2017–18 will continue to rollout our commitment to public health. A $1.3 million investment to expand the hepatitis B vaccination program will support Victoria’s hepatitis B and C strategies 2016–2020, and allow an additional 10,000 Victorians to be vaccinated. The Victorian Budget 2017–18 is focused on making sure all Victorians, no matter where they live, can get the care they need, when they need it, closer to home.

The Honourable Jill Hennessy MP Martin Foley MP Minister for Health Minister for Housing, Disability and Ageing Minister for Ambulance Services Minister for Mental Health

Volume 2: Health operations 2017–18 Page 5 Overview, key changes and new initiatives

1.1 Overview, key changes and new initiatives

Volume 2: Health operations 2017–18, Chapter 1 Overview, key changes and new initiatives

Introduction to Chapter 1

Chapter 1 of Volume 2: Health operations 2017–18 details the key changes and initiatives in 2017–18. These guidelines articulate the performance and financial framework within which State Government- funded health sector entities operate. They are a reference for funded organisations regarding the parameters that they are expected to work to and within, in order to achieve the outcomes expected by the Victorian Government. The guidelines are divided into five chapters: Chapter 1 sets out the key changes and initiatives in 2017–18 Chapter 2 focuses on the financial framework for providing funding Chapter 3 outlines all the prices and associated cost weights that support the overall financial framework Chapter 4 outlines the conditions and expectations of that funding Chapter 5 includes the modelled budgets for organisations that receive more than $1 million in health funding. Items may be updated throughout the year. Funded organisations should always refer to the policy and funding guidelines website for the most recent version of the documents and guidelines. 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 of Health and Human Services (‘the department’) or the Secretary to the department, the legislative, regulatory and contractual obligations will take precedence. A note on terminology The term ‘funded organisations’ in Volume 2 and all subsequent chapters 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 2017–18, Chapter 1 Page 7 Overview, key changes and new initiatives

1.2 Overview

The Victorian Government is responsible for ensuring that a wide range of health services are delivered to the Victorian community. The Department of Health and 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 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 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 2017: Volume 2, Health operations 2017–18 (‘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, community service organisations and other funded organisations such as Ambulance Victoria. 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 . Hospital circulars provide updates on the changes that affect health services during the year. These are available at . 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.

1.3 Highlights

1.3.1 Targeting zero: Report of the Review of Hospital Safety and Quality Assurance in Victoria Targeting zero: Report of the Review of Hospital Safety and Quality Assurance in Victoria was commissioned by the Minister for Health after a cluster of tragically preventable perinatal deaths was discovered in Victoria during 2013 and 2014. The review was led by Dr Stephen Duckett and sought to identify ways to strengthen the approach of the Department of Health and Human Services (the department) to its governance of safety and quality in Victorian healthcare. There are four key reform themes that emerged in the review: Enhance system leadership and strengthen clinical engagement: with Safer Care Victoria to lead safety and quality improvement across Victorian health services by providing leadership and support via new quality and safety programs, and utilising the experiences of frontline clinicians through revitalised clinical networks, as well as the establishment of the Victorian Clinical Council. Make better use of information and data: with the Victorian Agency for Health Information to provide timely, high-quality information that ensures the health sector and community are better informed about health services, and that health services have access to better information about their performance. Improve sector governance: with a range of new governance initiatives proposed, including the establishment of the Boards Ministerial Advisory Committee, to ensure that boards are independent, skilled and effective. Strengthen departmental oversight: with a range of new programs to enhance the department as system manager in oversighting hospital patient safety and quality performance. In October 2016, the government accepted in principle the 179 recommendations made in Targeting zero, commenced work to implement them and agreed to the establishment of Safer Care Victoria and the Victorian Agency for Health Information. Targeting zero was released, with the government’s response, Better, Safer Care: delivering a world-leading healthcare system. The department established a Targeting zero Implementation Oversight Steering Committee to oversee the implementation of Targeting zero. The committee is made up of representatives from the department, the Department of Premier and Cabinet, the Health Issues Centre, the Victorian Healthcare Association and Victorian health services. The department reports progress on the implementation of the recommendations to the Minister for Health and disseminates a Better, Safer Care update to the sector on a quarterly basis.

Safer Care Victoria and the Victorian Agency for Health Information have now been established as well as the Boards Ministerial Advisory Committee and the Victorian Clinical Council. These entities are working with the department to continue implementing the recommendations made in Targeting zero. The Minister for Health has committed to commence implementation of all recommendations by 2018 and the Victorian Government committed $215 million in the Victorian Budget 2017–18 to deliver Better, Safer Care. This is in addition to the $30 million previously allocated in 2016–17.

1.3.2 Safer Care Victoria Safer Care Victoria is the peak state authority for leading quality and safety improvement in healthcare. Safer Care Victoria was established in January 2017 to oversee and support our health services to provide safe, high-quality care to Victorian patients, every time, everywhere. As well as monitoring the standards of care provided, Safer Care Victoria is partnering with consumers, their families and carers, clinicians, and health services to support the continuous improvement of healthcare.

The agency was established in response to the recommendations within the report, Targeting zero: Supporting the Victorian hospital system to eliminate avoidable harm and strengthen quality of care. In supporting health services to provide the safest and best possible care to patients, Safer Care Victoria is focused on five priority areas: partnering with patients, families and carers partnering with clinicians leadership review and response system improvement and innovation. These five areas reflect the proactive and reactive approaches Safer Care Victoria is taking to its support and oversight of health services. Partnering with patients and their families is a priority because they are best placed to identify good care and opportunities for care improvements. Healthcare is solely provided to serve them. The best healthcare and health outcomes are only possible when consumers and clinicians work closely and respectfully together. Safer Care Victoria will achieve this by: supporting health services to recruit and retain trained consumer advocates; embedding consumers in all healthcare delivery structures to support meaningful co-design of services, supporting timely and high-quality open communication between consumers and health services when things go wrong; connecting consumer advocates across health services; and sharing best-practice across the sector. Partnering with clinicians is a priority because the evidence shows that when clinicians are engaged with the quality improvement agenda, care delivery and care outcomes are better. Work within this area includes: revitalising clinical networks to drive quality and safety; developing and providing guidance for clinicians on best care to reduce variation; measuring and reporting of clinician engagement; using the Victorian Clinical Council and clinical networks to provide advice on health policy and planning; and sharing best practice in quality and safety to clinicians across the system. Leadership is a priority for Safer Care Victoria because the biggest improvements in quality of care are achieved by services with a whole-of-organisation approach to quality improvement and where all staff are engaged and empowered to lead change. Work within this area is focused on developing a suite of workforce engagement and development programs, for all staff. These include leadership development programs tailored to the different types of emerging and existing leaders in our system and their varied career pathways. Safer Care Victoria is also partnering with other government and external agencies to bolster clinical governance training across the system, both at and below board level. The prioritisation of review and response reflects our need to better learn from harm. The evidence shows that 10 per cent of patients admitted to our hospitals suffer an avoidable harm in the course of their care. As well as striving to eliminate avoidable harm, Safer Care Victoria will share local best practice across the system. Work within this area is focused on: establishing new quality and safety reports for boards and clinicians; partnering with the Victorian Agency for Health Information to link existing data sets; strengthening the response to critical incidents and ensuring learnings are shared at a system level; and establishing independent, expert support for case reviews. Safer Care Victoria works closely with other divisions within the Department of Health and Human Services and with other agencies – such as the Health Complaints Commissioner, the Mental Health Complaints Commission, the Victorian Managed Insurance Authority and the Australian Health Practitioner Regulation Agency – to share learnings and facilitate system-wide improvement. The focus on sharing improvement and innovation is recognition that no health service is an island. Learning from each other and working together increases the opportunities for success to reduce harm and unwarranted variation across the state. Safer Care Victoria incorporates Better Care Victoria, which is charged with identifying, testing and implementing innovation. Work is also being undertaken in conjunction with the sector to support continuous improvement in patient care and outcomes by focusing on a number of targeted objectives and providing implementation support to drive change.

Safer Care Victoria is also working with national bodies such as the Australian Commission on Safety and Quality in Health Care and the Independent Hospital Pricing Authority to inform and influence the national agenda in regard to safety and quality in health. Similarly, we are partnering with similar agencies in other jurisdictions to share learnings and work collaboratively on joint priorities.

1.3.3 Better Care Victoria Established in 2015, Better Care Victoria remains a part of the government’s response to the Targeting zero report. In 2017–18 Better Care Victoria’s Innovation Fund will support healthcare provider-led innovation and improvement projects in rural, regional and metropolitan health organisations, and across a broad span of healthcare providers, designed to improve: the accessibility and experience of community-based care and acute healthcare providers access to specialist healthcare providers in rural and regional settings through telehealth technology timely access to outpatient services care options and flexibility for cancer patients the way maternity care is delivered patient access to and care in emergency departments. Better Care Victoria developed a Capability for Innovation and Improvement Strategy 2017–2020 to improve and enable healthcare provider’s capability, with its long-term vision being that ‘innovation and improvement capability is embedded across organisations in the Victorian health sector, enabling the delivery of better patient outcomes’. In 2017–18, Better Care Victoria will also offer a range of activities designed to enhance capability across health organisations aimed at: Health executives to build the skills required to build an innovation and improvement culture in their organisations. Frontline clinical managers to have the leadership capability to drive service redesign and improvement. Early career clinicians to build leadership capability and an understanding of the science of process improvement. Experts in redesign to enhance their skills and knowledge on improvement work to spread across healthcare providers.

1.3.4 Victorian Agency for Health Information The Victorian Agency for Health Information will ensure that trusted and credible information is available to people in the health sector, to make better use of data and evidence in learning, improvement, innovation and health service delivery. The agency was established in January 2017 following the recommendations of Targeting zero, the review of hospital safety and quality assurance in Victoria. The agency is one of many government reforms designed to overhaul quality and safety across the Victorian health system. The Victorian Agency for Health Information has responsibilities that flow across measurement of patient care and outcomes for three key purposes: public reporting, oversight and clinical improvement. The agency is focused on ensuring that everyone has an accurate picture of where the concerns are, and where we are getting it right – so that services are safe, high quality and provide a positive experience. This is done through analysis and sharing of information across the health system. The agency’s priorities are reflected in the following three outcome areas: Enhance the array of new information that will be routinely produced and used by health service boards, senior executives, the department and clinical leaders. This will fulfil their oversight and service improvement responsibilities with a focus on patient pathways, reported outcomes and experiences. Patient and health system outcomes will be measured using existing information systems in new ways.

Expand the volume and type of information Victorians have on safety and quality of care in their local health services. Improve the level of trust stakeholders have in data (in terms of accuracy and reliability) as well as its availability and usefulness to our audiences. These outcome areas will be addressed through a number of deliverables including quarterly safety and quality reports for board, executive, clinical and public audiences. The Victorian Agency for Health Information will also develop and implement strategies to improve information systems in relation to patient-reported experiences and outcomes, incident information and clinical registries. It will reinvigorate the health data integrity program and share information on methods used to measure performance.

1.3.5 Statewide Design, Service and Infrastructure Plan During 2017–18 health service planning will take place in the context of the release of the Statewide Design, Service and Infrastructure Plan for Victoria’s health system. Development of the plan has been guided by a Ministerial Advisory Council with broad representation from the health sector, as well as wider sector and community consultations on specific locality and service-stream planning issues. The Statewide Design, Service and Infrastructure Plan will identify priority actions that will promote optimal design of our health system to achieve the government’s vision set out in Health 2040: advancing health, access and care. The plan provides the framework for how the government will invest in service and infrastructure capacity that will promote better health, better access and better care. The purpose of the plan is to provide clear direction and certainty to clinicians and administrators on the future design and delivery of services to patients. This direction will guide the planning for their own health services, including priority infrastructure investments.

1.3.6 Victoria’s 10-year mental health plan The Victorian Government released Victoria’s 10-year mental health plan in November 2015. It provides a long-term vision to improve mental health services and outcomes for Victorians with a mental illness and support the delivery of world-leading and innovative care by Victorian health services. The plan guides how we can work together as a community, to ensure that all Victorians have the opportunity to experience their best mental health and achieve their full potential. It is a commitment to improving the wellbeing of Victorians with mental illness, their families and carers. It is helping drive a community-wide shift in attitudes. All members of the community and all health services have a responsibility to promote inclusion, support mental wellbeing and combat stigma and discrimination. The plan sets a goal that all Victorians experience their best possible health, including mental health. This goal requires a greater focus on mental health across the whole health system, so that mental healthcare is an equivalent priority with physical healthcare. Health services can contribute to the delivery of this vision through the plan’s four focus areas: Victorians have good mental health and wellbeing Victorians promote mental health for all ages and stages of life Victorians with a mental illness live fulfilling lives of their choosing, with or without symptoms of mental illness the service system is accessible, flexible and responsive to people of all ages, their families and carers and the workforce is supported to deliver this. In support of the plan goals, we must ensure that resources and capacity are directed to the areas of highest demand and greatest unmet need. As part of the Statewide Design, Service and Infrastructure Plan, a specific service plan for clinical mental health has been developed in consultation with the sector. It will focus on the longer-term system and planning reforms necessary to enhance access and effectively use system resources for improved clinical outcomes. It will also consider what changes are necessary to ensure that our commitment to clinical excellence in mental health service delivery is achievable into the future.

The Victorian Budget 2017–18 supports both immediate needs and our longer-term goals through an additional $358 million to enhance health service responses to increased clinical mental health service demand. This funding will make more services available in areas of greatest need, including Melbourne’s rapidly growing western corridor. It will also expand perinatal mental health programs. Additional funding for allied health staff will ensure that Victorians have the support they need from health services, regardless of when they are admitted. The capacity of our health services to provide culturally appropriate care for Aboriginal Victorians will be enhanced through the funding of traineeship positions for Aboriginal Victorians in mental health services. Access to acute services will be strengthened through the establishment of ten Aboriginal-specific therapeutic positions based in Aboriginal community-controlled organisations. An additional $41 million has been provided for forensic mental health treatment and programs, including $17.8 million for the establishment of six community mental health programs to provide assessment and treatment for offenders on a community corrections order and $10.9 million to establish the Mental Health Advice and Response Service to facilitate pre-sentence referrals to mental health treatment and provide clinical advice to magistrates.

1.3.7 Victorian public health and wellbeing plan 2015–2019 Released in September 2015, the Victorian public health and wellbeing plan 2015–2019 establishes an ambitious vision for the state: a Victoria free of the avoidable burden of disease and injury, so that all Victorians can enjoy the highest attainable standards of health, wellbeing and participation at every age. The overall aim is to reduce the inequalities in health and wellbeing. The plan identifies three platforms for change to support population-wide health and wellbeing outcomes: place-based approaches focused on generating system change people-centred approaches and healthy and sustainable environments. The plan also establishes six priority areas for action based on the most significant causes of poor health and wellbeing, those most amenable to prevention, and those that cause the greatest inequalities in outcomes across our population. The priority areas for action are: healthier eating and active living tobacco-free living improving mental health and wellbeing reducing harmful alcohol and drug use preventing violence and injury improving sexual and reproductive health. Key initiatives across the Victorian Government and major government agencies in the first two years of the plan are summarised in Implementing the Victorian public health and wellbeing plan 2015–2019: taking action – the first two years. The Victorian public health and wellbeing outcomes framework provides a new approach to monitoring and reporting on our collective efforts to improve health and wellbeing over the long term. The Outcomes framework provides a comprehensive set of public health and wellbeing outcomes, indicators, targets and measures for our major population health and wellbeing priorities and their determinants. Where data is available, the Outcomes framework also enables assessment of health and wellbeing inequalities. A detailed data dictionary for the Outcomes framework is also available. The first report against the Outcomes framework will be produced in 2018, the third year of the four year public health and wellbeing planning cycle.

1.3.8 Funding to improve ambulance response performance In November 2016 the government announced more than $500 million in extra funding to improve access to ambulance services and ambulance performance. This funding is provided to support Ambulance Victoria to improve statewide Code 1 response performance toward the 85 per cent target for Code 1 cases responded to within 15 minutes. This funding will support: Employing 450 new paramedics over the next three years. Establishing six new ‘super response centres’ supported by more than 200 paramedics to meet growing demand in Melbourne’s suburbs including the west, the outer north-west, the north, the north-east, outer east and south-east. Building new or upgrading 15 branches across the state, in addition to the 20 upgrade projects already underway. Deploying 225 new paramedics in 22 branches across the state, assessed as highest priority and in need of further resources to meet local demand. Purchasing new ambulance vehicles and equipment to support the additional paramedic teams. Creating 12 new services in rural and remote towns with a local paramedic and vehicle, based on a successful model trialled at Wedderburn and Warracknabeal. The government and the Department of Health and Human Services will work with Ambulance Victoria to ensure the successful implementation of these new services and initiatives to improve access to ambulance services for all Victorians.

1.3.9 Strengthening hospital responses to family violence Our health services have a critical role in ensuring that the health needs of a person experiencing violence are met, and that they are safe and have the support they need. The Victorian Government is committed to ensuring that frontline health workers in our hospitals have the support, skills and training they need to identify and help patients experiencing family violence. The government has invested $38.4 million over the next four years through the Victorian Budget 2017– 18 to enhance the role of hospitals as universal service providers to respond to family violence. This funding supports Recommendation 95 from the Royal Commission into Family Violence that requires a whole-of-hospital service model for responding to family violence in public hospitals within three to five years. Whole-of-organisation approaches to identifying and responding to family violence have been found to be effective. The Victorian Government has funded the staged rollout of the Strengthening Hospital Responses to Family Violence initiative from its initial pilot in four health services, to fifteen health services in 2016–17. Over $10 million will be allocated in 2017–18 to lead health services, with a selection of these expected to support other public health services in the state to implement a whole-of-hospital model for responding to family violence.

1.4 Budget highlights

The Victorian Budget 2017–18 is focused on making sure all Victorians – no matter where they live – can get the care they need, when they need it, closer to home. The level of investment for health services in Victoria demonstrates this government’s commitment to the health of all Victorians. The budget invests in infrastructure, health services and equipment to ensure that more appropriate services are provided for Victorians. Table 1.1 details departmental funding by output categories provided by the Victorian Budget 2017–18. A summary of health service modelled budgets for 2017–18 is provided in Volume 2: Health operations, Chapter 5. The Victorian Budget 2017–18 provides $18.123 billion recurrent funding for health, mental health and aged care services. This investment will enable the health system to provide more services and surgeries for Victorian patients, addressing the growing demand for health services across Victoria.

Table 1.1: Victorian Budget 2017–18 details

% increase 2016–17 2017–18 2016–17 to Output group budget ($m) budget ($m) 2017–18 (a) 1.5 Acute Health Services (b) 1.6 1.7 1.8 11,875.0 13,128.2 10.6% 1.9 Ambulance Services (b) 1.10 1.11 1.12 804.1 1,028.7 27.9% 1.13 Mental Health (b) 1.14 1.15 1.16 1,398.0 1,498.9 7.2% 1.17 Ageing, Aged and Home Care (c) 1.18 1.19 1.20 779.6 789.2 1.2% 1.21 Primary, Community and Dental Health (b) 1.22 1.23 1.24 467.5 500.1 7.0% 1.25 Small Rural Services (c) 1.26 1.27 1.28 561.7 558.8 -0.5% 1.29 Public Health (b) 1.30 1.31 1.32 389.8 399.2 2.4% 1.33 Drugs Services (b) 1.34 1.35 1.36 192.5 220.1 14.4% 1.37 Total 1.38 1.39 1.40 16,468.2 18,123.2 10% Source: 2017–18 Victorian Budget Paper No. 3, p. 228 Notes: 1.41 Variation between 2016–17 budget and 2017–18 budget. 1.42 The investment in the 2017–18 budget represents a 10% increase on the funding provided for in the 2016–17 budget, which was also an additional 8.2% on 2015–16 funding.

To support this investment, the Victorian Budget 2017–18 will also provide a $428 million boost in infrastructure upgrades for hospitals, equipment and other health infrastructure to give doctors and nurses the modern facilities and equipment they require to deliver Victorians better care, sooner.

1.42.1 Output initiatives The Victorian Budget 2017–18 committed $759.5 million in 2017–18 ($2.28 billion over five years) to new output initiatives that will grow and strengthen the health, ambulance, mental health and aged care sectors.

1.1.1.1 Acute hospital and ambulance services The Victorian Budget 2017–18 is investing $655.7 million in 2017–18 ($1.93 billion over five years) in health and ambulance services, programs and agencies – across metropolitan Melbourne and rural communities, including: $1.3 billion over four years from 2017–18 to be provided to respond to growing patient demand across Victoria. Additional funding is provided for emergency department presentations, intensive care admissions, maternity admissions, specialist clinics, palliative care services, chemotherapy treatments, radiotherapy treatments and subacute care services. $319.8 million over four years from 2017–18 to provide additional elective surgery funding and support access for more Victorians to elective surgery procedures, respond to demand and reduce waiting times. $215.1 million over five years from 2016–17 to implement the recommendations of Targeting zero: Report of the Review of Hospital Safety and Quality Assurance in Victoria. The Better, Safer Care initiative will enhance system leadership through Safer Care Victoria, strengthen clinical engagement through the Victorian Clinical Council, utilise better information and data through the Victorian Agency for Health Information, and establish the Boards Ministerial Advisory Committee. Departmental oversight of health services will also be strengthened, resulting in higher quality care for patients. $26.5 million over two years from 2017–18 will be provided to Ambulance Victoria to meet demand from a growing population, improving community access to ambulance services through additional paramedics and equipment. Funding will also support the government’s share of increased costs for emergency helicopter services. $16.8 million over two years from 2017–18 to support and expand the function of three key independent bodies to respond to increasing demand, growing community expectations and new legislative obligations for the Victorian Assisted Reproductive Treatment Authority. $11.6 million over four years from 2016–17 to support delivering better, earlier and more integrated care. Through an agreement with the Commonwealth Government, people with multiple chronic and complex conditions will be provided with access to more coordinated care. $10 million for 2017–18 to the Better Care Victoria Innovation Fund, which will continue to invest in public hospital-led improvement and innovation projects to enhance access to services and improve health service quality and performance. The fund will help scale up successful pilot projects, coordinate collaborative projects across health services and advise health services on performance issues. $8.4 million over four years from 2017–18 to fund genomic testing for rare undiagnosed conditions. More genomic testing will be provided to improve the early diagnosis and treatment of rare genetic diseases in adults and children. Testing will be delivered through existing specialist clinics and health services. $3 million over two years from 2017–18 to improve safety and workplace culture through programs that address occupational violence against health workers and workplace bullying and harassment. This funding will support the capacity of the health sector to act and respond appropriately to workplace incidents and implement a trial of independent workplace facilitators to support staff to raise concerns about workplace culture. $2.5 million in 2017–18 to support planning for future statewide health infrastructure investments. Priority asset projects will be developed to support improvements to service capacity and configuration. $2 million in 2017–18 to fund the Victorian Patient Transport Assistance Scheme which will support more rural and regional Victorians required to travel for specialised care with subsidised travel and accommodation.

1.1.1.2 Mental health and alcohol and drug services The Victorian Budget 2017–18 provides $56.7 million in 2017–18 ($257.4 million over four years) for mental health and drug services including: $199.4 million over four years from 2017–18 to address urgent demand for mental health services that will be addressed through the provision of additional inpatient services and additional hours of community care. $41.4 million over four years from 2017–18 to assist the implementation of the Forensic Mental Health Implementation Plan which will support priority service reforms where forensic mental health services will be expanded to increase public safety through new and expanding services including: additional Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 (CMIA) review court support services for forensic mental health clients youth forensic mental health services community forensic mental health services. $9.2 million over four years from 2017–18 for more medical and allied staff in acute admitted settings that will be available on weekends to improve continuity of care and provide additional therapeutic treatment for mental health clients. $3.5 million over two years from 2017–18 to underpin operations of the Forensic Mental Health Implementation Plan and carry out new functions associated with the transfer of the Forensic Leave Panel and recommendations from Targeting zero: Report of the Review of Hospital Safety and Quality Assurance in Victoria. $2.3 million in 2020–21 to support the provision of a new mental health facility for adults to increase the range and number of services available to people with an acute mental illness. This will ensure that people with an acute mental illness in the Grampians Region have access to a flexible, safe and appropriate facility for short-stay periods. $1.6 million in 2017–18 to continue prevention and early detection of perinatal depression that will support new mothers experiencing depression.

1.1.1.3 Ageing, aged and home care The Victorian Budget 2017–18 provides $28.5 million in 2017–18 for ageing, aged and home care. This includes: $25.6 million in 2017–18 to continue to provide high-quality care to vulnerable aged persons, including those with mental health issues in public sector residential aged care. $2.9 million in 2017–18 to support the Home and Community Care Program for Younger People, which provides individuals with a disability with basic community care services such as domestic assistance, personal care, home nursing, allied health services and social support. This program plays a core role in supporting people in their own homes and communities. Additional funding will be allocated to increase the number of places supported under the program in line with demand.

1.1.1.4 Primary, community, public and dental health The Victorian Budget 2017–18 provides $18.6 million in 2017–18 ($63.9 million over five years) for primary, community, public and dental health including: $34.2 million over four years from 2017–18 to assist the Operational Infrastructure Support program that provides financial support to medical research institutes to cover the operational costs of research. This will provide greater certainty to the medical research sector, leverage grant opportunities, and ensure the future growth of health and medical research in Victoria. Under this funding, the Walter and Eliza Hall Institute will be funded for one year to explore expansion opportunities in Victoria and nationally for a National Drug Discovery Centre, which will accelerate the translation of research into new drugs.

$15.6 million over five years from 2016–17 to enhance preparedness, response and community education for extreme weather events such as thunderstorm asthma. Under this funding, prediction of such events will be improved through measures such as increased monitoring and interpretation of pollen data, and research to inform forecasting, modelling and response protocols. The broader health system’s capacity to respond to extreme events will be enhanced through improving system-wide real- time monitoring of relevant data sources such as emergency department demand, and emergency management training for health sector staff, including hospitals. $14.1 million over five years from 2016–17 to deliver on Victoria’s cancer plan 2016–2020, including a range of cancer screening measures. This will improve the health of Victorians by increasing the detection of preventable cancers and reducing the number of late stage cancers diagnosed in Victoria.

1.42.2 Asset initiatives The Victorian Budget 2017–18 is making a significant investment in new and upgraded hospital buildings and equipment with a $498.1 million capital and infrastructure program.

Table 1.2: Funding for asset initiatives

Funding Initiative Description $ million Acute health services 1.43 Austin 1.44 Hot and cold water system infrastructure across the $29.8 Health Austin Hospital campus in Heidelberg will be upgraded to – improve service reliability and minimise risks to patients critical and staff. infrastru cture works (Heidel berg) 1.45 Clinical 1.46 Preventative cybersecurity controls and tools to detect $11.9 technol suspicious cybersecurity events will be implemented ogy across 29 identified Victorian Health Service Networks. refresh This will improve continuity of patient care and safety. – cyber security and network connect ivity (metrop olitan various) 1.47 Deliveri 1.48 Through an agreement with the Commonwealth $1.2 ng Government, people with multiple chronic and complex better, conditions will be provided with access to more earlier coordinated care. and more integrat ed care (statewi de)

Funding Initiative Description $ million 1.49 Engine 1.50 Highest priority engineering infrastructure assets will be $25.0 ering replaced in selected metropolitan and regional hospitals. infrastru This includes lifts, boilers, insulation, communication cture systems and electrical upgrades and will enable replace continuity of health service delivery and compliance with ment regulatory requirements. progra m (statewi de) 1.51 Increasi 1.52 Specialised critical care equipment will be purchased to $2.2 ng operate 11 intensive care or neonatal intensive care beds critical in public hospitals to provide acute health services across care the state. capacit y (statewi de) 1.53 Medical 1.54 High-risk medical equipment in metropolitan and rural $35.0 equipm health services will continue to be replaced. The ent equipment supports operating suites, emergency replace departments, surgical wards, intensive care units, ment neonatal and maternity services, and specialist areas. progra This will improve service availability through the m introduction and upgrade of medical equipment. (statewi de) 1.55 Monash 1.56 The Monash Medical Centre emergency department will $63.2 Medical be refurbished and expanded, to include exclusive areas Centre for children, adults and patients. The expansion will mean – more adult and paediatric beds and will give doctors and expansi nurses the modern facilities they need to deliver the on and highest quality emergency care, more quickly. The upgrad redevelopment will also improve access for ambulances es arriving at emergency, meaning patients will get the vital (Clayto care they need faster, and address traffic and congestion n) concerns making it safer and more efficient. 1.57 Norther 1.58 The current inpatient tower block at the Northern Hospital $162.7 n will be expanded to seven storeys to provide 96 new Hospital inpatient beds, three additional operating theatres, inpatien supporting infrastructure and shell space for future t expansion. This will increase acute health services and expansi cater for the rapidly growing population of Melbourne’s on – north. Stage 2 (Epping ) 1.59 The 1.60 Infrastructure will be upgraded across two sites at The $40.0 Royal Royal Melbourne Hospital to ensure facilities and Melbour associated services remain fit for purpose for patients, ne staff and visitors. Hospital – critical infrastru cture works (Parkvill e)

Funding Initiative Description $ million 1.61 South 1.63 Planning and design will begin on the future $7.5 West redevelopment and expansion of Warrnambool Hospital Health to cater for the growing demand for health services in Care south-west Victoria. This initiative will be funded from the (Warrna existing Regional Health Infrastructure Fund. mbool 1.62 Hospital ) – Stage 2 masterp lan and infrastru cture works 1.64 The 1.65 Planning will commence for a new Footscray Hospital to $50.0 new cater for the growing population of Melbourne’s inner Footscr west. Funding will enable preparation of a business case ay for construction of the new Footscray Hospital, options Hospital for land acquisition of a suitable site if required, and (Footsc urgent infrastructure works at the existing Footscray ray) Hospital. Mental health services and alcohol and drug services 1.66 Forensi 1.67 Planning will commence on the future expansion of $40.0 c forensic mental health beds for people requiring intensive mental mental health treatment in a specialised environment. health Funding will also enable infrastructure works at the bed- Thomas Embling Hospital which builds on other recent based investment to expand adult forensic mental health service capacity. s expansi on (Fairfiel d) 1.68 Forensi $3.9 c mental health implem entation plan – priority service reforms (Fairfiel d) 1.70 Grampi 1.71 A new mental health facility for adults will be built to $6.0 ans increase the range and number of services available to Prevent people with an acute mental illness. This will ensure that ion and people with an acute mental illness in the Grampians Recove region have access to a flexible, safe and appropriate ry Care facility for short stay periods. The initiative will complete a (PARC) statewide network of short-term subacute services that Service commenced in 2007–08. (Ballara t)

Funding Initiative Description $ million 1.72 Region 1.73 Commencement of capital planning and the purchase of $9.7 al drug three new regional sites will be funded to enable resident development of key regional residential drug ial rehabilitation treatment facilities in the Gippsland, Hume rehabilit and Barwon regions. ation service – Stage 2 (region al various) (a)

1.74 Mental 1.75 Infrastructure and capital works in state-owned facilities $10.0 health that assist people with mental health, alcohol and other and drug issues will be funded. These facilities provide bed alcohol based acute and subacute services, community-based and services and services for emergency departments. The other works enable health service innovations to enhance drug access and improve models of care via targeted facilities improvements to ageing and poor quality facilities. renewal (statewi de)(a) Note: (a) Part of whole-of-government Ice Action Plan – Stage 3.

1.76 Quality and safety

The Victorian Government’s response to Targeting zero, Better Safer Care, will continue to be implemented throughout 2017–18. The establishment of Safer Care Victoria and the Victorian Agency for Health Information from January 2017 will ensure that the department and health services are doing everything they can to guarantee quality and safety in Victorian hospitals.

1.76.1 Credentialing and scope of practice In 2017 Safer Care Victoria will release an updated version of the Credentialing and defining scope of clinical practice for medical practitioners. This refreshed policy will both strengthen credentialing processes and provide a consistent approach to deﬁning the scope of clinical practice in Victoria. It will do this by ensuring that medical practitioners are: appropriately qualified, registered and skilled for the practice they undertake supported by regular performance appraisal provided with clear terms of appointment responsible for disclosing personal, legal, or professional impediments to fulfilling the requirements of their role aware of the requirements and capabilities of the health service and aware that these requirements and capabilities may change over time. The revised policy will also outline the responsibilities of the director of medical services, the credentialling and scope of clinical practice committee and the health service board in relation to the appointment and reappointment of medical staff. Further information about the current credentialing policy is available at

1.76.2 Clinical governance Safer Care Victoria’s Delivering high-quality healthcare: Victorian clinical governance framework (June 2017) provides guidance to health service boards, staff and consumers to ensure clinical governance systems are robust and are meeting the Victorian Government’s obligations and standards for providing safe, person-centred care. Health services are required to measure and evaluate compliance with the policy under the framework’s five quality and safety domains: leadership and culture, consumer partnerships, clinical practice, workforce and risk management, with the view to continuously improving the patient experience and standard of care. The new framework enhances the understanding and implementation of effective governance for quality and safety in Victorian health services and aligns with the recommendations set out in Targeting zero: Report of the Review of Hospital Safety and Quality Assurance in Victoria. The new framework provides guidance in fulfilling core clinical governance obligations by clarifying the key requirements and responsibilities of health service board members, staff and consumers. The department and Safer Care Victoria have developed tools, resources and training programs to better support health services to implement the framework. The supporting tools and training programs will continue to be updated and expanded as required. Health services are expected to ensure that all of their staff have relevant training in clinical governance. Links to the policy and accompanying resources can be found at and .

1.76.3 Victorian Healthcare Experience Survey Listening and responding to people’s healthcare experiences is a key measure of healthcare quality and safety. The Victorian Healthcare Experience Survey (VHES) is one of a range of tools to measure experience. In 2017, the new Victorian Agency for Health Information assumed responsibility for planning, implementing and using the VHES program to ensure health service boards, executives, clinicians and Victorians have an accurate picture of where concerns are and where achievements have been made. The Victorian Healthcare Experience Survey is originally based on the United Kingdom’s National Health Service (NHS) survey and includes some questions from the American National Research Corporation. The survey also includes the Australian national core common set of patient experience questions.

1.76.4 Consumer participation and experience Meaningful participation of consumers and carers in healthcare improves healthcare experience and outcomes. To ensure that consumers and carers remain central to healthcare design and delivery, Safer Care Victoria has developed a new partnering in healthcare policy framework, Partnering in healthcare – for better care and outcomes. This framework addresses and expands recommendations made in the evaluation of the department’s Doing it with us not for us: Strategic direction 2010–13 policy, the Cultural responsiveness framework and Targeting zero: Report of the Review of Hospital Safety and Quality Assurance in Victoria. The framework will be progressively implemented in 2017–18. The five key domains of the framework are: person and family centred services, care and outcomes teams, partnerships, knowledge transfer and shared learning participation and shared decision making equity, diversity, inclusion and responsiveness health literacy, information and communication. A digital engagement strategy and co-design methodology with strong consumer and clinician engagement will also be implemented in 2017 to develop: An implementation framework to lead consumer, carer and community participation across the Victorian health system at the direct care, service and system levels. New domains to inform implementation. Tools and resources to help health services partner with consumers, carers and the community to improve the quality and safety of healthcare.

1.76.5 Incident reporting The Victorian Agency for Health Information is committed to developing a data collection and reporting software application which will: Underpin an open and collaborative patient safety learning system and responsive incident monitoring across the system. Collect data on occupational health and safety, clinical incidents and patient feedback. Deliver regular feedback to the sector in a manner that supports local and system health service quality assurance Support the statutory functions of the Office of the Health Services Commissioner and the Mental Health Complaints Commissioner.

1.76.6 Staff safety in Victorian health services All funded organisations are responsible for the safety of their staff, patients and visitors. Funded organisations must have the systems and processes in place to enable them to identify, assess and control occupational health and safety risks in accordance with their obligations under the Occupational Health and Safety Act 2004. The department is committed to working collaboratively with health services to enhance the health, safety and wellbeing of healthcare workers. Fundamental to this work is an emphasis on building positive and respectful workplaces through immediate and long-term actions that focus on addressing systemic issues in relation to bullying and harassment, and occupational violence and aggression. The government will double its investment in making hospitals and mental health services safer, as a powerful new campaign makes it clear that violence against healthcare workers is never OK with the Health Service Violence Prevention Fund being increased by $20 million, taking total investment to $40 million.

1.76.7 Workplace culture A positive workplace culture places the health system, organisations and individuals in a better place to provide safe, high-quality care. Patient safety and standards of care can be significantly compromised by a dysfunctional organisational culture. The department will continue to work with health services in 2017– 18 to address the issues of inappropriate workplace behaviours, including bullying and harassment to create an environment that supports both staff and patient safety in healthcare settings. Initiatives across occupational violence, aggression, bullying, harassment and worker health and wellbeing are aimed at ensuring health services are safe, respectful and healthy places to work. Key actions in 2017–18 will focus on: improving awareness developing a better understanding of the risks by monitoring lead and lag indicators embedding organisational responses that focus on prevention, early intervention and response post incident support and evaluating the effectiveness of strategies to address occupational health and safety risks.

1.1.1 Supporting self-determination – prioritisation of funding to Aboriginal organisations In March 2015, the Premier of Victoria, the Hon. Daniel Andrews, committed to supporting Aboriginal self-determination in Victoria. The department is currently supporting Aboriginal self-determination through prioritising funding to Aboriginal organisations. During 2016, the Aboriginal Health and Wellbeing Branch consulted the Victorian Aboriginal community, Aboriginal organisations and the funded sector in developing the department’s Aboriginal health, wellbeing and safety strategic plan, Aboriginal engagement and partnership framework and the Aboriginal social and emotional wellbeing framework as part of Victoria’s 10-year mental health plan. Overwhelmingly, the government was advised that: The short-term nature of funding to Aboriginal organisations left their programs and workforce vulnerable, with numerous reporting requirements. Aboriginal organisations and community members had limited involvement in the development of programs that affected them. Aboriginal organisations and their communities are best placed to understand the complex needs of their community; they are connected to their communities and can provide culturally appropriate services and programs to Aboriginal communities.

Aboriginal organisations struggled to compete for funding with mainstream organisations to deliver services to the Victorian Aboriginal community due to their comparative organisational capacity and perceived capability. The 10-year Aboriginal health, wellbeing and safety strategic plan, called Korin Korin Balit-Djak is in development, and due to be released mid-2017. This will provide an integrated and holistic approach to improving Aboriginal health, wellbeing and safety in Victoria.

1.77 Victorian health services performance framework

The Victorian Health Services Performance Monitoring Framework (PMF) sets out the Department of Health and Human Services approach to overseeing health services performance in Victoria. It promotes transparency and shared accountability for performance improvement across the system and helps inform future policy and planning strategies. In broad terms, the PMF operates within the legislative framework set out in the Health Services Act 1988 and a number of other contextual elements such as: The vision for the Victorian health system as outlined in Health 2040: advancing health, access and care. The Victorian Government’s commitment to making a real contribution to Victorian’s lives as outlined in the Outcomes framework. Various policy and program requirements including regulation that supports and enhances the wellbeing of Victorians. System and statewide plans that help guide the distribution and design of health services to meet community needs and ensure long-term sustainability of the health system. Accountabilities for service delivery standards as set out in the Statement of Priorities.

1.77.1 Policy and funding guidelines Sitting under the performance framework, 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 (Statement of Priorities 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), community service organisations and other funded organisations, such as Ambulance Victoria and Forensicare. 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. 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 Statement of Priority or Service Agreement for any specific conditions of funding and performance requirements.

1.77.2 Statement of Priorities All health services including Dental Health Services Victoria, Ambulance Victoria and the Victorian Institute of Forensic Mental Health (Forensicare) agree to a Statement of Priorities (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. Statement of Priorities 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

Volume 2: Health operations 2017–18, Chapter 1 Overview, key changes and new initiatives for Ambulance Victoria is a requirement of the Ambulance Services Act 1986. The SoP for Forensicare is a requirement of the Mental Health Act 2014. Statement of Priorities 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. A SoP is agreed annually between the Minister for Mental Health and Forensicare’s board of directors. Statement of Priorities are available online at .

1.77.3 Strategic plans It is a legal requirement that Victorian public health services develop a strategic plan and submit for approval to the Minister for Health. Public hospitals are required by the department to submit their strategic plans for approval. Denominational health services are encouraged to liaise with the department in relation to their strategic plans, in particular the sections which relate to the provision of public health services. The Strategic planning guidelines for Victorian health services (2017) will provide a summary overview of the theory and process involved in developing strategic plans, but also highlight key contextual elements that would need to be considered by health services when developing their upcoming strategic plans.

1.77.4 Multipurpose service tripartite agreements The multipurpose services program is a joint initiative of the Australian Government and state and territory governments. It provides integrated health and aged care services for small rural and remote communities. There are seven multipurpose services, operating campuses across 11 communities in rural and regional areas throughout Victoria. Multipurpose services are often the sole healthcare provider for the local area. Each multipurpose service differs markedly with respect to the range and type of services provided, infrastructure, local socio-demography and extent of geographical isolation. 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 resource infrastructure within integrated service planning safe and improved quality of care for clients improved cost-effectiveness and long-term viability of services. Each multipurpose service operates under an individual tripartite agreement between the Australian Government Department of Health and the department. Tripartite agreements summarise the mix of services, funding and reporting requirements. In accordance with the tripartite agreement, multipurpose services are able to pool their health and aged care funding to expend it flexibly in response to the healthcare needs of the local community. In accordance with tripartite Service Agreements, a mix of services provided by multipurpose services are determined by a current and comprehensive service plan which is informed by health planning data, a community needs assessment and extensive community consultation. There is an expectation that these service plans align with the strategic and service planning framework from their relevant jurisdiction. Multipurpose services will be subject to the same split in HACC program resources between Victoria and the commonwealth as other agencies who receive funds from the HACC program. See Chapter 2, section 2.11.3 ‘Home and Community Care’. Multipurpose services will be included in the department’s new Small Rural Health Service (SRHS) funding model. More information about this model can be found in Chapter 2, section 2.12 ‘Rural health’.

1.77.5 Notification obligations

1.1.1.5 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)).

1.1.1.6 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. All health services should contact their department performance lead. 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 .

1.1.1.7 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 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 2.18 ‘Prior-year adjustment: activity-based funding reconciliation’ for more details about exceptional circumstances and recall.

1.78 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.

1.78.1 Health service performance measures The new performance strategy will employ a new risk-based approach and performance assessment based on an expanded range of performance measures. These include quantitative and qualitative data as well as information from third party reports and cross-agency intelligence. Safer Care Victoria will work with health services to identify key performance indicators for quality and safety across the sector. These will form a core part of performance accountability, combined with the existing measures on finance and access. The development of reports to reflect these will be led by the Victorian Agency for Health Information who will work in partnership with Safer Care Victoria, and the department

1.78.2 Performance monitoring for community service organisations The Funded organisation performance monitoring framework provides an overarching set of new tools and processes to monitor organisations funded by the department. The framework describes an end-to-end process for the Department of Health and Human Services monitoring staff to assess funded organisations’ compliance with the Service Agreement and to respond to identified performance issues that is transparent and informed by evidence. It is risk focused and supports evidence-based decisions. The framework applies to organisations that have a Service Agreement registered on the department's Service Agreement Management System (SAMS). This includes organisations that receive their funding through a SAMS agreement: not-for-profit organisations, for profit organisations, community health services, consortium, universities, local government, public and private hospitals (for their community- based services).

1.78.3 Mental health annual report The Victorian Government tables a mental health services annual report in parliament each year, as part of its commitment to transparency and accountability. The annual report is an important part of an ongoing dialogue with the community, consumers and carers, services and parliament about the government's vision for the continuous improvement of the Victorian mental health service system. The annual report presents data and analysis from a range of sources, and reflects the lived experience of participants in the system. The scope of the report includes clinical and mental health community support services, provision of details about the number of clients receiving treatment or support, readmission rates and lengths of stay across acute and community settings. It provides a mechanism for reporting progress against Victoria's 10-year mental health plan.

1.79 System improvements and innovation

1.79.1 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. In 2017–18, the department will: Implement 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. Invest $10 million through the Better Care Victoria Innovation Fund into sector-led innovation projects and support the development of innovation capability across the state. Better Care Victoria will fund projects that have the potential to significantly improve access to emergency and urgent care; access to outpatient care and quality and safety for patients. These projects will include testing and trialling of new ideas, scaling of proven innovation projects and multi-service collaborative improvement models. Fund local improvement specialists and redesign experts in health services to support innovation and improvement in frontline care. Implement a healthcare provider-led capability and leadership development program through a defined strategy for capability for innovation and improvement, including support for quality and safety improvement The department will commence reforms, once agreed through the Bilateral Agreement between the Commonwealth and Victoria on Coordinated Care, that aim to improve health outcomes and reduce avoidable demand for health services, particularly for people with chronic and complex conditions. This includes supporting the implementation of reforms that aim to better integrate commonwealth and state- funded health services at a local level, and where practical, build on or complement the Commonwealth Government’s Health Care Home model in primary care, being rolled out in the South Eastern Melbourne Primary Health Network region in 2017.

1.1.1.8 National Disability Insurance Scheme and health services The National Disability Insurance Scheme is progressing to full scheme rollout. A number of areas of Victoria will go live in 2017–18, with complete scheme coverage to be in place by 2019. There are currently a number of health-funded activities that may become National Disability Insurance Scheme eligible/funded activities for eligible participants. Health services should note the following updates with regards to the National Disability Insurance Scheme: People accessing health-funded services and equipment may be eligible for the National Disability Insurance Scheme. Health services are expected to identify National Disability Insurance Scheme participants, or those eligible to become participants. They should then access their services and ensure that National Disability Insurance Scheme eligible activity and equipment is billed to the National Disability Insurance Scheme. New National Disability Insurance Scheme-related data elements have been introduced in the VAED and VINAH data sets for 2017–18.

Health services are encouraged to consider registering as National Disability Insurance Scheme service providers. This will enable health services to access additional revenue by billing the National Disability Insurance Scheme for funded activities in relation to eligible clients. In regional areas this will ensure access to certain National Disability Insurance Scheme eligible allied health and nursing interventions for National Disability Insurance Scheme participants where these services may otherwise not be available locally. The department will further assess the impact of the National Disability Insurance Scheme on health service activity and funding during the full scheme rollout and will consider adjustments as required.

1.1.1.9 Non-admitted palliative care Our growing and ageing population, combined with the prevalence of chronic progressive disease and people’s preferences about care, is increasing demand for Victoria’s palliative care services and challenging existing service delivery models. The Victorian Budget 2017–18 allocated non-admitted palliative care growth funding of $6.2 million. This investment will improve access to specialist palliative care advice and enable services to deliver person- centred care according to the person’s preferences, values and goals. It will provide home-based care that is coordinated and responsive to people’s end-of-life and palliative care needs, including improved carer support. This growth funding was strengthened by $5 million in grants to non-admitted palliative care services for equipment that assists in providing in home palliative care. In 2017–18, rural and regional palliative care services will, for the first time, be able to apply for infrastructure funding from the Regional Health Infrastructure Fund. This investment also aims to increase the proportion of home-based deaths for those who choose to die at home, and improve clinical outcomes including pain/symptom management and carer/family support. It will deliver more effective and efficient healthcare outside acute hospital settings. This will reduce unnecessary emergency presentations and acute hospital admissions for community palliative care clients, thereby freeing up hospitals to better respond to acute care demand.

1.1.1.10 Joint planning and action for population health improvement There is significant opportunity for health services, community health services, local government, Primary Care Partnerships and Primary Health Networks to join-up planning and action around local priorities to deliver a concentrated and collective impact on the health and wellbeing of local people and communities. To support this shift, in 2017–18 all five partners will be expected to start reorienting their planning and implementation activities around common priority areas, aligning with the legislated Municipal Public Health and Wellbeing Plans in local catchment areas. It is strongly recommended that increasing healthy eating and active living is prioritised, recognising that action in this area is critical to tackling the widening issue of preventable chronic disease and obesity. All partners will be expected to demonstrate how they have collectively engaged in identifying and acting on local priorities and how they will reorient their future planning processes and activities to coordinate efforts to improve population health in the local area. Ideally, progress will be reported through a single catchment report developed by local partners. For health services and integrated community health services, this will be reported back through health service and Primary Care Partnerships annual reports. For registered community health services, this will be incorporated into annual action plans and reporting processes. And for local government, this will form part of the annual review of Municipal Public Health and Wellbeing Plans. The department will be continuing to work closely with the Victorian Primary Health Alliance throughout 2017–18 to increase collaboration on joint planning and shared accountabilities for health outcomes across Victoria.

1.1.1.11 Integrated care During 2017–18 the department will trial a pooled funding model through a more collaborative governance arrangement between commonwealth and state entities. The initiative will support better integration of commonwealth and state-funded health services at a local level and build on or complement the Commonwealth Government’s Health Care Homes in primary care, being rolled out in the South Eastern Melbourne Primary Health Network region in 2017. The reforms, agreed through the Bilateral Agreement between the Commonwealth Government and the Victoria Government on Coordinated Care, aim to improve health outcomes and reduce avoidable demand for health services, particularly for people with chronic and complex conditions.

1.1.1.12 Clinical networks Victoria’s clinical networks are a key approach for the engagement of clinicians in the promotion of system and quality improvement. The networks also support collaboration across health services, to drive innovation in research and clinical practice. Clinical networks bring together health professionals, consumers, 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 as indicated in Table 1.3. A Mental Health Clinical Network will be developed in 2017–18 and the establishment of further networks in the future. While a cancer clinical network has existed as part of the Integrated Cancer Services to date, there will be a separation of functions in this financial year.

Table 1.3: Clinical networks 2017–18

Clinical network 2017–18 focus Cardiac The Victorian Cardiac Clinical Network will continue to focus on priority initiatives implemented through Heart health, the department’s five-year cardiac plan. Longer-term initiatives will continue as priorities in the 2016 Design, Service and Infrastructure plan for Victoria’s cardiac system. There will be particular emphasis on using best available data through the establishment of a data strategy which will focus on identifying variation and then supporting the delivery of improvement. Work will also continue in the application of Patient Reported Outcomes Measures in Heart Failure and the PROMETHEUS project (Heart Failure tool kit). An evaluation of the work undertaken across the whole Heart health initiative will be undertaken by December 2017. Older people The purpose of the Older People Network is to achieve optimal clinical outcomes and reduce harm for older people in hospital, by providing guidance to the system on appropriate, efficient and effective evidence-based care. The work plan for 2017–18 will include a focus on reviewing available data and linking with existing registries relevant to older people in hospital (such as the Australian and New Zealand Hip Fracture Registry), working with the Chief Nurse and Midwifery Officer on the Delirium project and an ongoing commitment to topics such as end-of life-care, elder abuse and frailty. Building on the success of previous forums, the network is planning the 2017 Forum, Older People with Cancer, in collaboration with representatives from the Integrated Cancer Services and Palliative Care Clinical Network. Critical care The Critical Care Clinical Network will continue to progress the 2016–2017 work plan priorities; consumer experience, clinical dashboard and patient flow, standardise guidelines, Medical Emergency Team (MET)/rapid response, workforce and culture. The network will complete the emergency rapid response quality improvement collaborative and support statewide plans for extra corporeal membrane oxygenation (ECMO), ICU capability framework and the development of a MET database. All activities are focused on improving the outcomes for patients within the critical care environment.

Clinical network 2017–18 focus Emergency care The Emergency Care Network will continue to work with emergency clinicians in emergency departments to reduce variation in clinical practice. For example, work will focus on improving management of patients with bronchiolitis, renal colic, sepsis and rapid rule out of acute coronary syndrome. The network will partner with patients to improve emergency care by, for example, updating patient-centred factsheets. Building staff capability to improve and lead high- quality emergency care continues to be a focus of the network. It will also improve medication safety to support adherence to the National Safety and Quality Health Service Standards. This network will also provide advice on supporting and enhancing Urgent Care Centres. Maternity and The Victorian Maternity and Newborn Clinical Network will continue to expand the clinical newborn content of the neonatal e-handbook in 2017–18. To complement the neonatal e- handbook, the network has developed a maternity e-handbook due to be launched in 2017. Priority focus areas include: induction of labour, care of obese pregnant women and weight management in pregnancy, fetal growth restriction, reduced fetal movements, premature rupture of membranes, prolonged rupture of membranes, hypertensive disorders in pregnancy and diabetes in pregnancy. The network has established two clinical subcommittees to support and enhance the work of both the maternity and neonatal e-handbooks. The Victorian Children’s Tool for Observation and Response (ViCTOR) newborn chart was launched at the annual VMNCN conference which had 400 clincians in attendance. This has been a joint initiative with the Victorian Paediatric Clinical Network. The network supports the development of a Maternity KPI dashboard across the state in partnership with the Victorian Managed Insurance Authority. Palliative care The role of the Palliative Care Clinical Network is to promote consistency of palliative care practice across the state, reflecting levels of service capability and capacity to ensure highest quality palliative care. The network will continue its work on referral and triage guidelines for access to specialist palliative care providers, oversight of the Victorian end-of-life care plans and re-endorsement of statewide endorsed tools and guidelines. The network will also support key activities associated with the statewide end-of-life care framework. Paediatric The Victorian Paediatric Clinical Network will continue work on standardising clinical practice including: Supporting the development of clinical practice guidelines for managing common conditions, and improvement projects. Implementing a standardised approach to detecting and responding to clinical deterioration through the Victorian Children’s Tool for Observation and Response (ViCTOR) project. This includes working with health services to achieve recommendations of the Consultative Council on Obstetric and Paediatric Mortality and Morbidity to use a paediatric monitoring chart, such as the ViCTOR charts and introducing a fluid balance chart. In partnership with the Primary Health Network Alliance, supporting the development of statewide paediatrics Health Pathways with a focus on common Emergency Department avoidable presentations, and supporting the use of the pathways in General Practice. The Victorian Paediatric Clinical Network will also continue to look for opportunities and practical solutions to improve communication and service integration across the sector including transition of care back to the community and transition to adult care.

Clinical network 2017–18 focus Renal The Victorian Renal Clinical Network will continue work on: Advancing patient safety by completing and supporting implementation of guidelines, patient and staff education resources, and minimum elements for dialysis consent form etc. Driving best practice and innovation by ongoing monitoring and support of the renal improvement projects. Measuring clinical performance by ongoing development and monitoring of renal KPIs and undertaking a renal patient experience survey. Providing clinical advice and influence on system-wide service development such as the Organ Donation and Transplantation Strategy and the Renal Reform Strategy. Enhancing workforce development by supporting clinical workforce education and training providing leadership opportunities, hosting webinars, workshops and an annual renal conference. Enhancing clinician and consumer engagement by enabling clinician and consumer participation in renal network activities. Stroke The Stroke Clinical Network will shift its focus from data collection to quality assurance. By the end of 2017 there should be data capture of most stroke cases in Victoria via the Australian Stroke Clinical Registry. The network intends to commence statewide consultation with the sector to examine existing registry data, and develop a prioritised workplan of quality initiatives to address service level gaps. The network will continue to manage and evaluate the existing $1.4 million of projects funded via the Cardiac and Stroke initiative. The initiative supports innovative sustainable models of care to improve longer-term stroke care in the subacute and community sectors. The Stroke Clinical Network will liaise with the department on the development of a stroke services framework, and continue to support stroke services in regional areas via the stroke education webinar series, the Victorian Stroke Telemedicine Project and the implementation of the statewide endovascular clot retrieval service.

1.79.2 Mental health and drugs

1.1.1.1 Mental Health Expert Taskforce The Minister for Mental Health has established a taskforce to draw on the mental health expertise from a broad range of perspectives during implementation of Victoria's 10-year mental health plan. Taskforce members represent the mental health clinical sector, community and non-government organisations and academic and peak organisations. They provide independent advice directly to the minister. Specialist reference groups for workforce, lived experience leadership, Aboriginal social and emotional and innovation have also been established to support the work of the taskforce.

1.1.1.2 Aboriginal social and emotional wellbeing and mental health In 2017–18, $2.7 million ($8.4 million over three years) has been committed for ten Aboriginal-specific clinical and therapeutic position to be established in Aboriginal Community Controlled Health Organisations (ACCHOs). An Aboriginal Mental Health Workforce Training program will also be established to help build a workforce that responds to the needs of Aboriginal Victorians.

1.1.1.3 Ice Action Plan implementation Stage Three of the Ice Action Plan, announced in the Victorian Budget 2017–18, provided an additional $78.4 million to expand drug treatment and support services for ice and other drugs across the state. In total, this means that over $180 million has been invested through the three stages of the Ice Action Plan.

Of the Stage Three investment, $51.2 million will go to funded treatment providers to expand and enhance treatment and rehabilitation services. Components include: $8.7 million to further increase the number of residential rehabilitation beds, with 30 new beds to be established within existing services, providing a short-term boost to capacity. $17 million to provide for stronger access to treatment services for up to 3,800 parents each year to help them meet court requirements and reunify their families. $9.1 million to provide 960 treatment places for people on community correction orders to receive support and get back on their feet. $12.4 million to expand the support available to people when transitioning into or out of treatment services, a critical time when they are at a higher risk of harm. $6 million to expand the current 24/7, 7-day-a-week system of alcohol and drug-specific web and phone- based services and expand support for at risk groups. $4.0 million to strengthen alcohol and other drug treatment data systems. A further $19.7 million of capital funding is also included in the Stage Three Ice Action Plan investment. This funding will support land acquisition for three new regional residential rehabilitation services ($9.7 million) and facilities renewal of both mental health and drugs services ($10 million). The department will be working with services to inform the development and implementation of a number of the key initiatives. Services will commence operation progressively during 2017–18.

1.1.1.4 Implementation of new Victorian Alcohol and Drug Collection The Victorian Alcohol and Drug Collection (VADC) is the new way of collecting and reporting data on activity that takes place within the alcohol and other drug treatment system. The current Alcohol and Drug Information System (ADIS) data collection will progressively be replaced by the VADC during 2017–18. The VADC aims to streamline the current reporting process, with a smaller number of data items to be collected that reflect the current services delivered, as well as simpler processes for reporting that data to the department. The new approach to data collection will allow the sector to develop a better understanding of how clients travel through treatment services. Improving data quality will allow for a more accurate assessment of system performance and client trends. Further information is available at .

1.1.1.5 Transition to new alcohol and other drug treatment system intake and assessment arrangements From 1 July 2017, responsibility for conducting comprehensive assessment and treatment planning for alcohol and other drug treatment system clients will move from intake providers to treatment providers. Catchment-based intake services will continue to deliver intake, triage, screening, brief interventions and bridging support until the client assessment stage. This change will allow alcohol and other drug treatment providers to conduct assessments as the first stage in developing therapeutic relationships with clients. This will improve client experiences by improving engagement and reducing the number of times a person has to tell their story. The department is working closely with the sector to implement these new arrangements, which will improve access to treatment and maximise benefits to clients. These changes are part of a program of work being progressed in response to the Victorian Government's Independent Review of New Arrangements for the Delivery of Mental Health Community Support Services and Drug Treatment Services, conducted by Aspex Consulting in 2015.

The government has consulted with more than 100 alcohol and other drug treatment providers, peer workers, consumers and families help shape these improvements to the alcohol and other drug treatment system. Further information is available at .

1.79.3 Our pathway to change: eliminating bullying and harassment in healthcare In response to the Victorian Auditor-General’s audit into Bullying and Harassment in the Health Sector, released on 23 March 2016, the Minister for Health released the strategy Our pathway to change: eliminating bullying and harassment in healthcare in April 2016. The Bullying and Harassment in Healthcare Advisory Group led by Dr Helen Szoke, Chief Executive, Oxfam Australia, was established to support the implementation of the strategy and make recommendations to the Minister for Health on opportunities to assist health services build a positive workplace culture and prevent, respond and manage inappropriate behaviour including bullying and harassment. Following their final meeting in April 2017, the Minister for Health was presented with the advisory group's final report. The department will continue to work with services to inform the development and implementation of key initiatives during 2017–18. These include the trial of an independent facilitator to provide an independent avenue for support and advice and further development of lead and lag indicators. The department requires that all Victorian public health services undertake the Victorian Public Sector Commission’s People Matter Survey in 2017, including the Wellbeing, Diversity and Inclusion and Sexual Harassment modules. The department will use survey results to compare services and identify services with indicators of poor culture.

1.79.4 Responding to family violence The Strengthening Hospital Responses to Family Violence initiative supports public health services to implement a whole-of-hospital model for responding to family violence. The aim is to increase the competence of hospital staff to better identify and respond to family violence through the use of sensitive inquiry, and improve outcomes for patients who have experienced family violence. The train the trainer style initiative provides mentorship and a step-by-step service model including practical tools for hospitals to adapt to their locality. The Royal Woman’s Hospital and Bendigo Health were engaged to develop an evidence-based service model in 2014. In 2015–16 the publically accessible service model, toolkit and guides were piloted in four health services, and has provided a solid foundation for continual expansion. Funding of $1.235 million in 2016–17 supported rollout to a further ten metropolitan health services and three regional health services across Victoria. Over $10 million will be provided in 2017–18 to identified lead health services to support other public health services across Victoria. The funding will primarily support the cost of recruiting or upskilling implementation project workers and staff trainers. A portion of funding has also been allocated to assist with increases in demand for secondary family violence consultations in those health services who were part of the 2016–17 rollout.

1.79.5 Telehealth Telehealth has the potential to facilitate 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. Such factors can prevent or delay the delivery of timely and appropriate healthcare services and educational support. In 2016–17 the department funded a number of projects to improve access to specialist clinics through the use of telehealth. Continuing on from this initiative another round of project funding will be made available in 2017–18 to increase the uptake of telehealth in Victorian public health services. Health services will be invited to submit expressions of interest for this project funding. To assist in supporting telehealth projects, the department will also continue to provide access to Healthdirect Video Call, a web- based real-time conferencing telehealth solution specifically designed for clinicians and patients. Health services are required to record telehealth activity. Further details are available at .

1.79.6 Cancer service reform In 2017–18 the Victorian Department of Health and Human Services will continue to implement Victoria’s new Cancer plan 2016–2020. This is the first cancer plan developed under the Improving Cancer Outcomes Act 2014, and provides for a four-year program of work for service and system improvement across the domains of primary prevention, screening and early detection, treatment, wellbeing and support and research. The plan will build on and develop Victoria’s ongoing cancer reform program, and in 2017–18 will focus on: Implementation of the nationally agreed Optimal Cancer Care Pathways across Victorian cancer services and service providers. Development of survivorship models to support best practice care for cancer patients and carers following their initial treatment. Working with Victoria’s new Regional Cancer Centres to develop best practice models for regional cancer care, including supporting early diagnosis and more streamlined referral pathways for rural and regional Victorians. Working with Victoria’s Comprehensive Cancer Centre and the Monash Partners Comprehensive Cancer Consortium to strengthen collaboration in cancer research across Victoria. Promote and support access to clinical trials to improve participation rates. Development of a program for monitoring Victorians’ experience of cancer. Victoria’s Integrated Cancer Services will continue to support reform implementation across Victoria (refer to Chapter 4 section 4.2.1.2 ‘Integrated cancer services’).

1.79.7 Elective surgery

1.1.1.6 Elective surgery The Victorian Budget 2017–18 committed $174 million to increase access to elective surgery, meet existing demand and significantly reduce waiting times. There is an expectation that health services will focus on treating long-waiting, complex patients and will continue to treat patients in-turn and within time for their urgency category. This additional investment will provide health services with the resources to address long-waiting and complex patients in a more timely manner. It is also expected that health services will collaborate to utilise system capacity across the state.

1.1.1.7 Elective Surgery Information System All Victorian health services who report to the Elective Surgery Information System must ensure that their patient administration systems are configured to enable health services to meet and retain evidence in compliance with Victoria’s Elective surgery access policy. Health services should also ensure that: They validate the accuracy and integrity of reported data. Training and education programs are in place for staff involved in managing elective patients and waiting lists. All patients requiring elective surgery who are in scope of reporting to the Elective Surgery Waiting List are allocated an appropriate surgical Principal Prescribed Procedure code and are recorded in ESIS.

1.1.1.8 Elective surgery access policy All Victorian health services are expected to comply with Victoria’s Elective surgery access policy (2015). Health services should focus on the following key areas in 2017–18: Patients on the elective surgery waiting lists are where practical, ready and available for surgery. That where a status change is required in the policy to be authorised by the treating specialist medical practitioner or the head of unit, that the appropriate level of authorisation is made and the appropriate records are retained. That health services work where practical, to ensure that the recommended urgency categories as outlined in the policy are followed.

1.79.8 Transfer of care from acute inpatient services A review of the 2014 Transfer of care from acute inpatient services: Guidelines for managing the transfer of care of acute inpatients from Victoria's public health services guidelines was undertaken in 2016–17 to identify and develop supporting materials to assist health services implementing the key objectives of the guidelines: Improving communication between health services, the patient, their family and carer, their general practitioner (GP) and community service providers. Support health services to review their existing discharge and transfer of care practices and to implement more effective transfer of care processes. Promote consistent transfer of care practices across Victorian health services. All health services discharging a patient transferred or re-admitted from another site should provide a copy of the discharge summary to the relevant health service. This enables the transferring site to undertake assessment and review of their practice and determine whether there are local and system learnings. A copy of the discharge summary should also be sent to the patient’s GP within 48 hours after the transfer of care or discharge of the patient. Eight Victorian health services will also be trialling the introduction of the latest technology to seamlessly share patient records with GPs after a hospital stay. Replacing old-fashioned and unreliable faxes that offer poor security, the Electronic Discharge Summaries include details about a patient’s stay in hospital, their diagnosis, tests and procedures performed, prognosis, medications prescribed and recommended follow up. Discharge summaries will be delivered securely and electronically in standardised format to patients’ GPs, preventing errors and ensuring doctors have the most up-to-date information about their patients. This means better and safer patient outcomes, and continuity of care by making it easier and more reliable to transfer information about a patient between hospital doctors and GPs.

1.79.9 Bariatric surgery initiative From 2014–15 to 2016–17 funding was allocated to three designated bariatric surgery services (Alfred Health, Austin Health and Western District Health Service) under the bariatric surgery initiative. Following from this initiative in 2017–18, $2.2 million of funding will be again allocated to these health services. These health services will develop pathways to medical and surgical services for Victorian bariatric patients. A key aim of the Victorian bariatric pathways initiative is to provide better and more timely access to Victorians who live in remote and rural locations. Health services outside of the three designated centres are to support the development of bariatric services by: Working with local clinicians and networks to identify local bariatric resources within their region. Working with designated centres to develop appropriate pathways of care for patients utilising appropriate services (between health services and other providers) in their regions. Assisting with the development of regional bariatric specialist non-surgical services for pre and post- operative patients. Ensuring referrals to the designated bariatric services meet referral criteria. Where medical and surgical services are not appropriate for a patient, obesity care is available in accordance with the Australian clinical practice guidelines1.

1.79.10 Guidelines for the categorisation for clinical urgency of patients being waitlisted for a colonoscopy In 2017–18 the department will release new guidelines to inform for clinical urgency for a colonoscopy. The guidelines also provide advice for referrers, including the information required to complete a referral for colonoscopy in a public hospital. The guidelines are based on a clinical risk stratification for patients and aim to: Improve the quality of referral information and improve decision making by clinicians. Reduce the number of unnecessary colonoscopies. Improve access for patients. When available all Victorian health services who provide endoscopy services will be expected to ensure that clinicians utilise the guidelines and that referrers are provided access to the guidelines and referral information.

1.79.11 Victorian Patient Transport Assistance Scheme The Victorian Patient Transport Assistance Scheme (VPTAS) subsidises the travel and accommodation costs incurred by rural Victorians and an approved escort(s) who have no option but to travel more than 100 kilometres one way or an average of 500 kilometres a week for one or more weeks to receive approved medical specialist services or specialist dental treatment. In January 2016 the latest VPTAS guidelines were published. These included updated eligibility criteria and a new online claim and family support form . In 2016–17 the department undertook its regular biennial review of the VPTAS scheme, which includes review of the existing eligibility criteria. The eligibility criteria reviewed included; block treatment distance travelled, antiretroviral treatment provided by Community Prescribers, clinical trial participants, accommodation and travel subsidy parity with other jurisdictions’ patient travel schemes and the scheme’s accessibility to people receiving changed specialist treatment models of care. These areas of

1 Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children in Australia (2013)

Volume 2: Health operations 2017–18, Chapter 1 Page 39 Overview, key changes and new initiatives focus were based on feedback and focus group consultations with VPTAS consumers, healthcare providers and non-government advocacy groups for consumers and carers who use the VPTAS scheme. Recommendations from the 2016–17 review will be considered by the Victorian Government. Whilst considering these recommendations, the Victorian Government (in the 2017–18 budget) has funded $2 million to VPTAS to ensure the growth in claims received, 8.25 per cent, can be met for rural Victorians travelling for specialist healthcare, as well as the increase in subsidy rates for travel and accommodation. In 2017–18 the current eligibility criteria and subsidy rates include: Private vehicle costs reimbursement rate raised to 21 cents per kilometre. Raising the rate of a patient and an approved escort(s) staying in accommodation to a maximum of $45.00 per night or a maximum of $49.50 per night including GST. Entitlement to two escorts if the travelling patient is a newborn infant (up to six months of age). Entitlement for up to two escorts (parents, guardians or family members) when the patient requires treatment or admission to a hospital over two or more consecutive days for patients over six months of age and under the age of 18 years. Being available to living organ donors from other Australian states or territories who travel to Victoria to participate in a transplant procedure where the recipient is a Victorian resident. This includes travel for donor screening, specialist assessment and transplant procedures. Revised VPTAS feedback: complaints, compliments and review policy.

1.79.12 Ageing, aged care and supported residential services

1.1.1.9 Senior programs and participation initiatives In 2017–18 work will continue to improve seniors' participation, particularly vulnerable and disadvantaged seniors, and to respond to elder abuse and address prevention measures. An integrated model of care in response to elder abuse will be trialled in three health services. A range of new elder abuse prevention initiatives will be introduced, including the establishment of ten local prevention networks. Seven Strengthening Senior Social Inclusion place-based projects will be implemented and the Seniors Card program will continue to develop the Age-friendly Partners Program in partnership with local government, traders and businesses. The Seniors Programs and Participation unit will continue to provide support to the Commissioner for Senior Victorians, including in his role as Ambassador for Elder Abuse Prevention.

1.1.1.10 Home and Community Care Management of the Home and Community Care (HACC) program was split on 1 July 2016 between the Commonwealth Department of Health and the Department of Health and Human Services: Services for older Victorians (people aged 65 and over and aged 50 and over for Aboriginal and Torres Strait Islander people) are now directly funded and managed through the Commonwealth Home Support Programme by the Commonwealth Department of Health. Services for younger Victorians (people aged under 65 and under 50 for Aboriginal and Torres Strait Islander people) will continue to be funded and managed by the Victorian Department of Health and Human Services under the HACC Program for Younger People. Some Home and Community Care clients aged less than 65 will transfer to the National Disability Insurance Scheme as it rolls out in Victoria from 1 July 2016 to 30 June 2019. The Commonwealth Government has committed to a three-year period of stability for funds allocated to services for older people under the Commonwealth Home Support Programme. The Victorian Government has agreed to funds stability for services for younger people, subject to funds transferring to the NDIS. Both governments have agreed to retain the benefits of the current Victorian HACC system as follows:

The department will continue to manage the assessment function until 30 June 2019 and will integrate these services into the My Aged Care system, operating as a Regional Assessment Service. The Victorian and Commonwealth Governments have agreed on a jointly resourced Service Development and Change Management Framework to ensure that service development, planning and change management continue to be coordinated and supported. The significant role of local government in Victoria as service planners and developers, funders and service providers for older people and younger people has been recognised through a trilateral Statement of Intent with local government represented by the Municipal Association of Victoria and the Commonwealth and Victorian Governments. A connected approach to service delivery will continue.

1.1.1.11 Supported Residential Services In 2017–18 a range of community service organisations will continue to receive funding for a variety of initiatives that aim to improve: the viability of pension-level supported residential services the quality of life of the residents using the services (through the Supporting Accommodation for Vulnerable Victorians Initiative).

1.79.13 Acute and subacute services

1.1.1.12 Cardiac and stroke services The Design, service and infrastructure plan for Victoria’s cardiac system (Cardiac Plan), released in May 2016, provides a clear picture of the future of the cardiac system of care across the state. It proposes continuing reform to ensure that people with heart disease achieve the best possible outcomes, with a health system that is efficient and of high quality. The vision of the Cardiac Plan is improved care and outcomes for Victorians with, or at risk of, heart disease, which means person-centred care from early diagnosis of heart disease in the community to end-of-life care. This will be supported through developing new models of clinical engagement that promote collaboration, and through encouraging health service partnerships and relationships based on the needs of patients. The future cardiac system of care will be viewed and supported as a system, rather than a collection of individual agencies. This will support a more area-based service approach to better address the access needs of vulnerable groups and areas of disadvantage. The Cardiac Plan builds on and continues the evolution of the cardiac system outlined in Heart health: improved services and better outcomes for Victorians (Heart health). The Cardiac Plan also recognises the opportunity for system improvement presented by the government’s commitment to build a stand- alone cardiac centre of excellence – the Victorian Heart Hospital. An initial $21.9 million was committed to implement both stroke and Heart health initiatives from 2013–14 to 2016–17. Funding will also continue to be made available to implement the three priority areas for system reform outlined in the Cardiac Plan: better patient access, experience and outcomes a coordinated cardiac system of care effective and innovative cardiac services.

1.1.1.13 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 the provision of earliest definitive treatment

Volume 2: Health operations 2017–18, Chapter 1 Page 41 Overview, key changes and new initiatives using evidence to reduce variation in care optimising acute patient flow overall system coordination. The Victorian Budget 2017–18 committed $173 million to meeting hospital demand. This includes funding to manage the increasing demand so that emergency care patients will benefit through quicker treatment times. The department will remain focused on improving emergency performance across the health system. Key priorities will include working with health services to identify trends and variation in performance across the health services and responding to address the gaps. In particular, working with health services to ensure the timely assessment, treatment and discharge of mental health patients. The healthcare system is often the first place outside of friends and family to which victims of family violence turn, placing health professionals in a central role for their assistance. The emergency department is the most likely place for family violence victims to enter the system as they offer 24-hour service and relative anonymity compared to other health services. Hospitals are uniquely placed to provide women with a safe place to disclose family violence and link them with family violence services. The Royal Women’s Hospital and Bendigo Health have completed phase two of the Strengthening Hospital Responses to Family Violence project. This project aims to build hospital capacity to respond to family violence by increasing the competence and confidence of all hospital staff to identify and respond to patients who have experienced or are at risk of experiencing violence and refer them to appropriate services. This project will be progressively implemented by other health services over the next three to five years.

1.1.1.14 State trauma system Critically ill patients with multiple injuries require a multidisciplinary, coordinated and integrated system of trauma care. The objective of the Victorian State Trauma System is to reduce preventable death and disability and improve patient outcomes by matching the needs of injured patients to an appropriate level of treatment in a safe and timely manner. The Victorian State Trauma System aims to ensure that as many major trauma patients as possible receive their definitive care at a major trauma service, or equivalent for spinal and elderly neurological patients. The major trauma services are The Alfred and The Royal Melbourne Hospital and the paediatric major trauma service is 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 review of the specialist trauma guidelines was completed in 2016–17, and a further six guidelines will be released in 2017–18. They can be viewed at The statewide trauma education program will continue to be delivered in 2017–18. Further information regarding the system and its funding is available at: . Also, through the Better Health Channel, a web-based patient-focused repository of content for Victorians wanting to know about the major trauma process will become available in 2017–18. The emphasis will be on navigating the health system once a patient has been discharged from hospital. While there is a range of content on other websites, such as hospitals, TAC, VicRoads and Department of Veterans’ Affairs, this content is structured in a way that makes logical sense to users and links to these associated websites and in some cases translates the content for end users in another (plain English) way.

1.1.1.15 Maternity and newborn services Safe and high-quality maternity, newborn and early childhood care and support provide the foundation for lifelong health and wellbeing. While overall demand for maternity services is steady, the projections

Volume 2: Health operations 2017–18, Chapter 1 Overview, key changes and new initiatives indicate that growth in public hospital births will be greatest in the metropolitan growth corridors while demand in rural areas will decline. The release of a new Design, service and infrastructure plan for Victoria’s maternity and newborn services is planned in 2017–18 will drive system reform and improved outcomes for women and families and respond to the current and emerging challenges for the system. The priority areas for reform include: an integrated and coordinated system of care better patient access, experience and outcomes an enabled and responsive workforce. Rural maternity and newborn services in particular will continue to be supported throughout 2017–18 by a range of initiatives including: The new Maternity and Newborn Education (MANE) program for all level 2–4 rural health services that is delivered by The Royal Women's Hospital and the Paediatric Infant Perinatal Emergency Retrieval (PIPER). This multidisciplinary training program commenced in 2017 to ensure that smaller rural services have regular access to high-quality training for obstetric emergencies and are aware of best practice guidelines. A new education program for level 1 maternity providers (also provided by The Royal Women’s Hospital) that focuses on the skills and knowledge needed to manage unplanned maternity care and the identification of women that require referral for pregnancy care to a higher level of care. The continued operation of the six regional perinatal mortality and morbidity committees and their facilitation by The Royal Women’s Hospital. A focus on improving regional operating models to support rural services to access specialist advice and referral in a timely way. In 2017–18, the department will work with health services to explore ways to optimise access to local maternity care. In particular, this work will consider how models of care may be expanded or strengthened to promote partnerships with community-based pregnancy care providers including GP shared care practitioners. This work will also ensure women who require specialist advice or tailored care receive this support earlier with a focus on person-centred care and continuity of care. To achieve greater consistency in the monitoring of maternity outcomes in near ‘real time’, the department (in partnership with the Victorian Managed Insurance Agency) has commissioned the development of a set of core maternity indicators which includes a set of key indicators for use by health services and for reporting to boards. Safer Care Victoria is partnering with the VMIA and the department to develop a tool for reporting (a ‘Maternity dashboard’) for services that do not have this capability. From 2017–18 these key clinical quality indicators will be introduced to present real-time information to enable health services to see variation from their expected outcomes. The work on a dashboard aligns with the approach that Safer Care Victoria is undertaking with health services with unexpected outcomes on key indicators in the Victorian perinatal services performance indicators reports. This approach will be consolidated during 2017–18. Performance indicators related to the appropriate management of severe fetal growth restriction and Apgar score at five minutes will continue to be included in the Victorian Performance Framework in 2017–18. In 2017–18, new indicators, focusing on patient experience, newborn care and perineal trauma, will be developed for inclusion in the perinatal services performance indicator set.

1.1.1.16 Maternity care The Victorian Government is committed to providing more maternity choices for women and supporting maternity models that enhance continuity of care. The current funding arrangements allow flexibility for public services to deliver diverse models of maternity care that are responsive to their community’s preferences and care needs and are integrated with other local providers of maternity are such as general practitioners.

In particular, health services should consider the progress that has been made in relation to two models and how they might now be provided at additional sites. The models are as follows: Private midwifery care pilots which have been underway since 2015 at two sites enable women to birth in a public hospital as the private patient of an eligible midwife. Public home birthing programs at Western Health and Casey Hospital (Monash Health) continue to provide care to approximately 90 women annually who are suitable for a planned public homebirth. Health services are encouraged to use the Implementing a public homebirth program: guidance for Victorian health services (2015) to examine if the establishment of a public homebirth program is an option. Koori Maternity Services have supported Aboriginal women in Victoria since 2,000 to have flexible, inclusive and culturally safe maternity care in their community. Victoria’s 14 Koori Maternity Services and public maternity services are now ensuring that 75 per cent of Aboriginal women who give birth in a public hospital have their antenatal care provided through a Koori Maternity Service. There are 14 Koori Maternity Services and 11 are located in Aboriginal community-controlled organisations. Koori Maternity Services partner with public hospitals for the provision of a woman’s intrapartum care. Strong and effective partnerships between Koori Maternity Services and public health services underpins good perinatal outcomes for Aboriginal women and their babies. The key partnerships between Koori Maternity Services and public health services are outlined in Table 1.4.

Table 1.4: Public health services partnering with Koori Maternity Services

Region Koori Maternity Service Key birthing partners North and West Victorian Aboriginal Health Service 1.80 The Royal Women’s Metropolitan Hospital Western Health (Sunshine Hospital) 1.81 Sunshine Hospital (Western Health Northern Health (The Northern Hospital) 1.82 The Northern Hospital (Northern Health) Southern Dandenong and District Aboriginal Cooperative 1.83 Monash Health Metropolitan Peninsula Health (Frankston Hospital) 1.84 Frankston Hospital (Peninsula Health) Barwon South Wathaurong Aboriginal Health Service 1.85 University Hospital West Geelong Gunditjmara Aboriginal Cooperative 1.86 Warrnambool (South West Healthcare) Hume Rumbalara Aboriginal Cooperative 1.87 Goulburn Valley Health Mungabareena Aboriginal Cooperative 1.88 Albury Wodonga Health Gippsland Gippsland and East Gippsland Aboriginal 1.89 Bairnsdale Regional Co-operative Health Service Central Gippsland Aboriginal Health Service 1.90 Central Gippsland Health Service (Sale) Loddon Mallee Mallee District Aboriginal Service 1.91 Mildura Base Hospital Swan Hill Aboriginal Health Service 1.92 Swan Hill District Health Njernda Aboriginal Corporation 1.93 Echuca Regional Health

In 2017–18 the department will work with the Victorian Aboriginal Community Controlled Health Organisation, Koori Maternity Services and partner health services to implement the recently released Koori maternity services guidelines and to use data to target local service improvement activities.

Released in March 2017, the Koori maternity services guidelines assist Aboriginal community-controlled organisations and public health services to continually improve the provision of culturally appropriate pregnancy care. The guidelines have been developed in partnership with the Victorian Aboriginal Community Controlled Health Organisation and the Koori Maternity Services workforce, giving voice to their expertise regarding the provision of culturally safe and high-quality maternity care. The guidelines establish the program objectives and requirements for service delivery. Health services and Aboriginal community-controlled organisations will use the requirements to monitor and report progress against the program objectives. All maternity services are encouraged to also consider how the Koori maternity services guidelines principles can be incorporated into their maternity service models. The guidelines are available at .

1.1.1.17 Accessing newborn care close to home Each year about 6,500 babies (ten per cent of births) require admission to a public health newborn service after their birth. The newborn capability framework introduced in 2016 (Defining levels of care for Victorian newborn services) is a key mechanism to support health services to safely and consistently provide that care as close to the mother’s home as possible. Level 4 and 5 newborn services that can provide care to moderately unwell babies are critically important parts of system, as a step down from intensive care. These services also ensure that more babies can be managed within a region rather than being transferred to a Melbourne service. To support the system and ensure the flow of babies within the newborn service system is optimal, the following will be implemented in 2017–18: Defined transfer protocol for time-critical newborn transfers. Transfer of the cot management system for level 3–6 neonatal cots (Victorian Perinatal Information Centre – VicPIC) to Retrieval and Critical Health (REACH), the adult and paediatric intensive care bed monitoring system managed and hosted by Ambulance Victoria (Adult Retrieval Victoria). Monitoring of delayed discharges from level 6 nurseries to receiving units. Improving the utilisation of existing level 5 services and regional services. The transfer to REACH of time-sensitive information about the capacity of the newborn system will be accompanied by clearer definitions of babies who require level 6 care and greater flexibility in the use of level 6 and level 5 cots. Developed by the Paediatric Infant Perinatal Emergency Retrieval (PIPER), health services and department, the defined transfer protocol for level 6 services will be activated during periods when demand for level 6 maternity or neonatal beds exceeds immediate supply. The practice will support decision-making by PIPER based on pre-agreed principles. These arrangements will bring the neonatal system in line with the long standing statewide adult critical care practices. Level 6 newborn services will be required to establish systems, tools and processes to support the implementation of the defined transfer protocol. This includes having effective internal escalation processes, documented lines of accountability and clear business continuity strategies, particularly in relation to staffing arrangements during the activation period. In 2017–18, PIPER will continue to provide health services with a quarterly report on all maternity and neonatal retrievals and transfers from their health service. These reports are to allow health services to review cases and monitor trends in cases needing retrieval and to consider opportunities to improve care and enhance the safety of their service.

1.1.1.18 Antenatal screening for family violence Findings of the Royal Commission into Family Violence emphasised the central role that universal services play in the earlier identification and response to women experiencing family violence. Pregnancy

Volume 2: Health operations 2017–18, Chapter 1 Page 45 Overview, key changes and new initiatives is a period of increased risk for family violence and, in accordance with recommendation of the Royal Commission into Family Violence, public health services will be required to implement routine screening for family violence in antenatal care (as detailed in Recommendation 96). Screening for domestic violence is recommended as standard maternity care (National Clinical practice guidelines: antenatal care 2014). However, gaining consistency in screening approaches across the range of health and social care providers has important benefits. Screening by health services (including maternity providers) will align with the revised statewide Family Violence Risk Assessment and Risk Management Framework, to be developed in 2017–18. From December 2017, a phased implementation approach will provide health services with the support, training and practice guidance to effectively implement screening and respond to the needs of women and families experiencing family violence. While implementation of standardised screening tools will support consistent practice and referral pathways going forward, health services are required to ensure that current policies, practices, workforce training and staff support processes are in place to identify and provided appropriate care and support (including referral to specialist services) for women and families experiencing family violence. Established in 2015, expansion of the Strengthening Hospitals Response to Family Violence (Strengthening Hospitals) initiative in 2017–18 will continue to support health services identify and respond effectively to family violence.

1.1.1.19 Maternity and newborn capability levels Public health services providing planned maternity and newborn care are required to provide those clinical services in line with their maternity and newborn capability levels that are determined by the department. The maternity and newborn capability levels describe the level of care a health service is able to consistently provide to their community. Defining levels of care for Victorian newborn services (2015) and Capability framework for Victorian maternity and newborn services (2010) describe the minimum requirements (including personnel and other resources, protocols and service arrangements) required to deliver different levels of care. Capability levels are reviewed annually in conjunction with individual services and the levels determined by the department are published on the department’s website. The capability levels for 2017–18 are provided at Chapter 3, Table 3.22 ‘Statewide maternity and newborn capability framework levels’. As changes to capability levels can occur during the year, capability levels will also be published at . Health services are required to have systems in place to support and monitor clinical practices to ensure they are in line with the capability level and that specified capability requirements are continuously met. Planned or unplanned changes to a services maternity and newborn capability (such as planned infrastructure works, unplanned changes to essential workforce) must be escalated to the department and a management plan developed, agreed and communicated. In particular, from 2017–18 rural services that restrict or are unable to provide care at their determined level for short periods (such as a weekend) are required to: Ensure details of the change in service capability and the plan to manage the temporary change in service delivery (transfer of labour care), is formally agreed and documented with local health services or other providers that will be impacted (including Ambulance Victoria and PIPER). Develop and communicate a clear, personalised care plan for women who are likely to deliver over the period with key contacts at both the referring and the receiving hospital(s). Ensure information about how the local community can access care during this period is communicated effectively.

Advise the Department of Health and Human Services in advance of this change by contacting the Manager, Performance, Quality and Governance, Rural Health (in the regional office). Regional office staff will then advise Department of Health and Human Services central office staff of the change and steps taken to action the above requirements. It is expected that over a year, the periods of time that a service cannot meet their capability requirements will be rare and each health service will have plans to ensure service continuity in place. The frequency and duration of service provision outside the determined capability level will be monitored by the department and (along with other factors) will inform decision making about ongoing capability levels for the service.

1.1.1.20 Perinatal mortality and morbidity committees Since 1 July 2015, all health services providing maternity services have been required to have an arrangement to regularly review all perinatal deaths and morbidity. Further, these arrangements are expected to conform to the Perinatal Society of Australia and New Zealand: Clinical practice guideline for perinatal mortality . From 2015, this directive was expanded to require all rural public hospitals providing birthing services participate in one of six regional perinatal morbidity and mortality review committees (or in selected cases to join a ‘proximal’ metropolitan health services’ review committee). The regional committees provide an additional layer of case review for cases of serious harm or death and specifically support smaller rural services and ensure all perinatal deaths have a comprehensive and multidisciplinary case review. From 2017, the committees will also be reviewing selected morbidity cases and time-critical transfers. To build capacity in the sector to undertake multidisciplinary reviews, the department engaged The Royal Women’s Hospital as a facilitator for the six regional perinatal mortality and morbidity committees for the first two years. This additional direct facilitation will conclude in June 2018.

1.1.1.21 Perinatal autopsy service Since 2016–17 all public health services are expected to use the Victorian Perinatal Autopsy Service (VPAS). VPAS commenced in January 2016 under the administration of The Royal Women’s Hospital, and provides perinatal autopsies, associated investigations and advice about perinatal deaths. The service is a collaboration of the three level 6 maternity services. Private health services are also encouraged to use VPAS. 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 2.2.5 ‘Perinatal autopsy service’). The centralisation of expertise, consistency of processes and approaches and critical mass of investigations undertaken by the Victorian Perinatal Autopsy Service contribute to high-quality investigations. Further information is available at .

1.1.1.22 Renal health The department will continue to implement Renal directions: better services and improved kidney health for Victorians. In 2017–18 the department will complete a system design, services and infrastructure plan for renal services. The plan will articulate how Victoria’s renal services should be designed and configured, and how capacity should be developed over the next five years. The new plan will articulate population and patient needs, and identify the necessary actions to support quality, accessible and sustainable services. Further information is available in Chapter 2, section 2.2.3 ‘Renal Services’ and also on the department’s Renal Health website .

1.1.1.23 End-of-life and palliative care framework Victoria’s end-of-life and palliative care framework guides the delivery high-quality end-of-life and palliative care that supports people and their families in Victoria. Demographic patterns and demand forecasts illustrate that current end-of-life and palliative care models will be unable to meet future demand. In responding to people's preferences to be cared for and to die at home the department will work with end of life and palliative care services to re-align models of service delivery and funding approaches to support person-centred care. The framework outlines a foundation for end-of-life and palliative care services to meet people’s needs by: providing clear expectations for people and communities guiding healthcare, human service, social and community sector practices identifying actions to ensure end-of-life and palliative care services are sustainable ensuring Victorians are provided with safe and effective end-of-life care. In 2017–18 health services and non-government community palliative care services will continue to work with the department to implement the framework actions. This will include testing new ways of working together across settings and equipping a range of services to deliver quality end-of-life and palliative care as part of their organisational and clinical practices. In 2017–18 the department will also begin reporting five measures for specialist palliative care services in the program for integrated service monitoring (PRISM). These measures will enable benchmarking amongst Victorian providers, including funded non-government organisations and four community health services. The department will work with health services to develop actions for end-of-life and palliative care which align with the implementation of the Advance Care Planning Strategy so that health services are supported to achieve the national safety and quality standards for end-of-life and advance care planning. Reviewing and strengthening the role of the Palliative Care Clinical Network will also assist in maximising the expertise of palliative care specialists to build capacity across all health and human services to respond to end-of-life care needs. The department will be working with Safer Care Victoria and the clinical networks, to provide clinical practice advice in delivering quality end-of-life care. Palliative care client and carer experience survey In 2017–18 the department will implement an annual palliative care patient and carer experience survey. Results will be reported in quarter 3 of 2017–18. Non-admitted palliative care funding model In 2017–18 the department will continue to explore opportunities to enhance and improve the funding model for non-admitted (home-based) palliative care.

1.1.1.24 Advance care planning Identifying the substitute decision-maker and advance care plans Advance care planning helps to better match the care a person would want with the care they receive. Victorians should have support to develop advance care plans and have their advance care plans identified when accessing health services. The treating team needs to be able to easily identify if the person has a substitute decision maker or advance care plan when a treatment decision needs to be made. Alerts should be integrated into the medical record systems used by the treating team to allow for quick access. This is a mandatory data item for the Victorian Admitted Episode Dataset (VAED) and the Victorian Integrated Non Admitted Health (VINAH) dataset, and from 1 July 2017 becomes a mandatory data item in the Victorian Emergency Management Dataset (VEMD). This will better enable health services to meet their obligations under the Medical Treatment Planning and Decisions Act 2016.

1.1.1.25 Medical Treatment Planning and Decisions Act 2016 The Medical Treatment Planning and Decisions Act 2016 comes into effect on 12 March 2018. The Medical Treatment Planning and Decisions Act creates clear obligations for health practitioners caring for people who do not have decision-making capacity. The Act will ensure that medical decision making is more in line with contemporary views and is more consistent with how people make decisions about their medical treatment and personal autonomy. The Act establishes a single framework for medical treatment decision making for people without decision-making capacity that ensures that people receive medical treatment that is consistent with their preferences and values. Victorians will be able to create a legally binding advance care directive that will allow them to: Make an instructional directive (which will provide specific directives about the treatment a person consents to or refuse). Make a values directive (which will describe a persons’ views and values. A medical treatment decision maker and health practitioners will be required to give effect to a values directive). Appoint a medical treatment decision maker (who will make decisions on behalf of a person when they no longer have decision-making capacity). Appoint a support person (who will assist a person to make decisions for themselves, by collecting and interpreting information or assisting the person to communicate their decisions). Prior to this commencement date, extensive work is being undertaken to provide appropriate materials and education. The department is working closely with the Office of the Public Advocate (OPA) to develop an implementation and communication plan to prepare stakeholders for the commencement of the Act. This will include the development of a range of information and educational material and workshops to support the community, consumers and providers to understand their rights and obligations under the Act. This work is being overseen by an implementation advisory group to guide the development of practical resources to support the Act.

1.1.1.26 Victorian Care of Older People Network and an online resource for older people in hospital The Victorian Care of Older People Network has undertaken a number of 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. The network also supports 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. One page summaries of these projects are available at . The department released the third version of its Best care for older people everywhere: the toolkit, an evidence-based resource aimed at improving outcomes for older people in hospital through informing clinical practice and models of care. Rebadged as Older people in hospital, this resource is now entirely web-based. In addition to the 16 clinical topics relevant to the care of older people in hospital, e-learning, audio-visual material and factsheets for clinicians are included. The topics explicitly align with the NSQHS Standards to assist health services to meet these standards when providing care for older people. The resource is available at .

Information specific to consumers has also been developed. As part of a Get Well Soon campaign a suite of factsheets and four audio-visual info-clips for consumers are jointly housed on the Older people in hospital website and on the Better Health Channel. The resource is available at .

1.93.1 Specialist clinics access Victorian health services are required to develop and implement a plan to ensure that patient level specialist clinics data reported into the Victorian Integrated Non-Admitted Health (VINAH) dataset accurately reflects the status of waiting patients. Health services currently reporting specialist clinics activity only through the Agency Information Management System (AIMS) will progress their capability to report patient level specialist clinics data through the VINAH dataset. Health services are also expected to develop and implement a specialist clinics waiting list management plan to optimise referral management processes and improve patient flow. Health services must ensure patients are seen in turn and within time for their urgency category. Health services will be invited to participate in a specialist clinic collaborative project with Better Care Victoria.

1.1.1.27 Specialist clinics in Victorian public hospitals access policy Health services are expected to comply with the Specialist clinics in Victorian public hospitals: access policy (released in May 2013). The policy and an accompanying implementation guide can be accessed on the department’s specialist clinics program website at . The policy provides business rules and associated timeframes for specialist clinic processes. The key areas covered include: referral management clinical prioritisation managing waiting lists appointment scheduling and booking patient flow and care coordination discharge performance monitoring. The policy applies to the 26 health services currently in scope to report specialist clinics data through the VINAH minimum dataset. All health services providing specialist clinic services should operate in accordance with the objectives and principles of the policy. All health services are expected to continue to improve their AIMS and cost data. 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 where clinically necessary.

1.93.2 Nurse and Midwife to Patient Ratio Improvements Taskforce The government established the Nurse and Midwife to Patient Ratio Improvements Taskforce to provide leadership and strategic policy advice to the Minister for Health on stakeholder submissions for improvements to nurse/midwife-to-patient ratios. Improvement of nurse/midwife-to-patient ratios previously contained within the Nurses and Midwives (Victorian Public Sector) (Single Interest Employers) Enterprise Agreement 2012–2016 has been the subject of enterprise agreement negotiations since ratios were first introduced into Victoria in 2000. With the commencement of the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015, nurse/midwife to patient ratios have been

Volume 2: Health operations 2017–18, Chapter 1 Overview, key changes and new initiatives removed from the agreement and a separate process has been established, outside of the enterprise agreement bargaining process, to further improve ratios. The taskforce will consult with a range of government departments to ensure that potential improvements are accurately costed and modelled prior to recommendations being made to the Minister for Health and Cabinet. The taskforce will operate through until December 2017.

1.93.3 Ambulance services The government established the Ambulance Performance and Policy Consultative Committee in January 2015 to develop policies and make recommendations to improve the performance and culture of Ambulance Victoria. The committee released its final report Victoria’s Ambulance Action Plan: Improving Services, Saving Lives (the Action Plan) on 10 December 2015. The Action Plan sets out a roadmap to transform both the delivery of ambulance services to the Victorian community and the way paramedics are supported throughout their careers. The aims of the Action Plan are to provide the Victorian community with a world-class system for responding to life-threatening medical emergencies, with: a service that achieves some of the world’s best patient outcomes and survival rates, including cardiac arrest, major trauma and stroke patients improved response times for life-threatening emergencies an ambulance service with a renewed culture of continuous improvement and best practice paramedics whose skills are recognised nationally and internationally an ambulance service that provides a modern workplace that supports continuous learning and development an ambulance service that is among the best of its peers for addressing workplace stress a world leader in pre-hospital care research an ambulance service that is a centre of excellence in paramedic training an emergency and health service system that works together to improve the experience for patients an ambulance service that is responsive to community input and feedback. The aims described above are addressed through 48 individual action items. These action items relate to five core themes: providing the right response to patients improving paramedic health, wellbeing and training strengthening partnerships and collaboration with health services improving access to care and patient outcomes in rural communities developing a positive culture that is centred on patients and staff. An Implementation Advisory Group, chaired by the Parliamentary Secretary for Health, has been established (in place of the Ambulance Performance and Policy Consultative Committee) to monitor the implementation of the Action Plan. The Implementation Advisory Group comprises representatives from key stakeholder groups including paramedics, Ambulance Victoria’s Executive, the Board of Ambulance Victoria, the Ambulance Employees Australia – Victoria, government, consumers, and health services. Significant reforms delivered in 2016–17 include: Strengthened call-taking and dispatch arrangements to provide faster responses to patients experiencing life-threatening emergencies and more appropriate care to a wide range of Triple Zero callers whose needs are not urgent. The delivery of a public education campaign to improve awareness of Ambulance Victoria's role and to save Triple Zero for emergencies.

Increasing organisational support for paramedic mental health and wellbeing including addressing violence towards paramedics. Trials of new, innovative and flexible models of care in rural communities based on local demand profiles and community need. Work to better equip the community to act as first responders and provide basic life support to patients in cardiac arrest through the development of an Automated External Defibrillator registry and training of community volunteers. Establishing a Community Advisory Committee to better reflect consumer, carer and community views. Participation in the Victorian Health Experience Survey to better understand the patient experience. In 2017–18 the last of the reforms will continue to be implemented to deliver on the Action Plan. Initiatives will include: Developing legislative and operational arrangements for the national registration of paramedics, including arrangements that enable mutual recognition of qualifications for paramedics. Ongoing advocacy with the commonwealth to enhance the interface between ambulance services and primary and aged care services to support a more person-centred approach to care planning. A review of the hospital transfer time performance target to drive service improvements to reduce the time paramedics spend at hospital Consistent with the aims and core themes of the Action Plan, Ambulance Victoria implemented a number of reforms to its operating and response models in 2016–17 to improve its performance in responding to time-critical and life-threatening emergencies. Through 2017–18 the government and the Department of Health and Human Services will continue to work with Ambulance Victoria to embed these reforms which will improve access to ambulance services for the entire Victorian community.

1.93.4 Community health services Community health services are a fundamental part of Victoria’s health and social care system. To support community health services, the department is progressing initiatives to maximise their role in the provision of high quality, integrated services that respond to the needs of Victorians who are disadvantaged or experience other barriers to care and support. In 2017–18, this will include the development of approaches that provide a greater focus on care delivered in primary and community health settings including: Developing models for integrated care for people with chronic or complex needs whereby groups of providers are tasked to keep people healthy with corresponding flexible funding. Strengthening the role of community health services as a key provider of integrated health and social care for vulnerable people and disadvantaged groups. Under these approaches, community health services will be central to increasing prevention and early intervention by driving integration, supporting vulnerable groups and providing an alternative to hospital attendance for some types of healthcare. Integrated care across the health and social care system is critical for people who are disadvantaged and vulnerable, and who have complex needs. Community health services have experience and expertise in the provision of integrated care as providers of a wide range of health and social care programs funded though diverse sources. The department will be developing and testing new models to meet the needs of vulnerable children and families, which provide for improved coordination and streamlined access to health and social care. Community health services have a strong role in providing locally responsive care. This will be enhanced through the development of place-based approaches that ensure services are planned and designed to be responsive to local need, and close to where people live and work.

Further initiatives in 2017–18 to strengthen community health services and build on recent initiatives include: Implementation of actions to streamline reporting for community health services including: Simplifying and reducing the burden associated with accreditation including actions to address the multiplicity of applicable standards, duplication between standards, and to better integrate accreditation processes with the department’s performance monitoring processes. Making it easier for community health services to report data through reducing manual data collections, addressing inconsistent data formats and the volume of data requested. Improving community health services’ access to data. Strengthen consumer and community engagement by: Using the results of the first client experience survey in community health to improve quality and safety, and conducting the survey in 2017–18. Implementing the Lesbian, Gay, Bisexual, Trans and Gender Diverse and Intersex (LGBTI) project in community health services to develop, pilot and evaluate tools and resources that promote LGBTI inclusive and responsive service planning and practice within community health services. Implementation of guidelines for the care of people with chronic conditions alongside the Community Health Integrated Program guidelines, child health, and refugee and asylum seeker guidelines. Developing a new approach to place-based primary prevention of chronic disease to strengthen the return on investment and deliver a collective impact on health outcomes in local communities.

1.93.5 Meeting the needs of Victoria’s diverse populations The department recognises that there is disparity in the health and wellbeing outcomes for different groups in society. This is due to a range of complex social, historical and environmental factors. Improving the health and wellbeing outcomes of diverse populations including culturally and linguistically diverse (CALD) communities, Aboriginal population, LGBTI, ageing, those with disabilities, and addressing gender issues which impact on people’s health is a priority for the department. Services need to be welcoming, accessible, equitable and responsive to effectively meet the health and wellbeing needs of Victoria’s diverse populations. The department supports a range of initiatives to strengthen the responsiveness of the Victorian health and human services system and improve health and wellbeing outcomes for everyone in the Victorian community. Priorities for the work and expectations of the department for 2017–18 in this area are: Improving Aboriginal health, wellbeing and safety through the direction and initiatives outlined in the new Aboriginal health, wellbeing and safety strategic plan (currently being developed). Helping to develop a fairer Victoria for people with disabilities and making it easier for every person to participate in every part of life, as set out in the new Victorian state disability plan 2017–2020. Better engagement of men in health services, facilitated by new supporting resources such as the Engaging men in healthcare: practice and policy guide and Victoria’s gender equality strategy. Ensuring responsive, non-discriminatory care for lesbian, gay, bisexual, trans and gender diverse, and intersex (LGBTI) Victorians, as part of the government’s LGBTI Equality Agenda. Embedding cultural diversity in the planning, development and delivery of programs and services across the Victorian health and human services system, in line with the department’s Delivering for diversity: cultural diversity plan. Responding effectively to the needs of newly arrived refugees and people seeking asylum, in accordance with agreed eligibility and access policies. Working in collaboration with local settlement support providers to ensure early health assessment and follow-up care for all new arrivals. Maintaining the government’s commitment for women to be at least 50 per cent of new appointments on paid Victorian government boards, and working for board appointments that broadly mirror the diversity in Victoria's communities.

For further information see: Victorian. And proud of it. Victoria’s Multicultural Policy Statement . Delivering for diversity: Department of Health and Human Services Cultural Diversity Plan 2016–19 . Further information on the related Language Service Policy can be found at: . Further information regarding the standard processes and principles for appointing and remunerating board members of, and other appointments to, non-departmental entities in Victoria can be found at: . Further information regarding governance is available at: .

1.93.6 Aboriginal health and wellbeing The government is developing a new Aboriginal health, wellbeing and safety strategic plan 2017–2027 (the Strategic Plan) in partnership with Aboriginal communities. The Strategic Plan will set out what the department will do, together with Aboriginal communities, Aboriginal community organisations, other government departments and service providers, to achieve the Strategic Plan’s vision of ‘self- determining, healthy and safe Aboriginal people and communities’. The Strategic Plan will be guided by the principle of self-determination and will also focus attention on the cultural and social determinants of health, wellbeing and safety across the following five domains:  Aboriginal community leadership  prioritising culture and community  system reform across the health and human services sectors  safe, secure and strong families and individuals  physically, socially and emotionally healthy communities. The department is implementing a policy of prioritised funding to Aboriginal organisations. This policy seeks to strengthen the sustainability of Aboriginal community-controlled organisations. The policy recognises that outcomes for Aboriginal people are greater when led by Aboriginal people and organisations. From 1 July 2017, the following policy will apply to the allocation of all funding targeted to the provision of supports and services to Aboriginal people and communities: Funding for Aboriginal supports and services is to be directed to Aboriginal organisations. Exemptions to this policy require a written justification of why allocation to an Aboriginal organisation is not possible. Exemptions to this policy require the sign off of a Deputy Secretary (including, cc to the Secretary). Aboriginal organisations may sub-contract funding to other organisations. If allocation to an Aboriginal organisation is not deemed possible, the following must be considered by the Deputy Secretary: Whether an auspicing arrangement by a non-Aboriginal agency can be put in place as an interim approach ahead of a transfer to a relevant Aboriginal organisation (a timeframe for the transition needs to be set and the transition process needs to be co-designed with and signed-off by the Aboriginal organisation). Any non-Aboriginal agency allocated funding to support Aboriginal people and communities must demonstrate cultural competence, which is endorsed by the local Aboriginal organisation(s). This auspicing decision will be reviewed in 12 months.

Exemptions authorised by Deputy Secretaries will be monitored and reported to the board annually by the department. This policy will be implemented in two phases. This first phase will commence from 1 July 2017 and will apply to newly funded Aboriginal-specific programs under the allocation of ongoing Aboriginal health and wellbeing funding, currently known as Koolin Balit funding, and will also apply to newly funded Aboriginal-specific programs secured in the Victorian Budget 2017–18. The second phase will progressively apply to remaining Aboriginal-specific funded programs. This will include identifying potential funding for transition and developing a prioritised and planned approach to implementation. Further advice on the second phase will be provided within 2017–18. Implementation will require system reform across the broader cultural and social determinants of health, wellbeing and safety, in consultation with Aboriginal communities. Flexible place-based solutions at the local level that embody the principle of self-determination will be prioritised to focus effort. The policy will be reviewed after implementation. Monitoring of the policy will occur through structures set up as part of the department’s Aboriginal Governance and Accountability Framework. Definition of an Aboriginal organisation An Aboriginal organisation:  guarantees control of the body by Aboriginal people and guarantees that the body will function under the principle of self-determination  is initiated by and for a local Aboriginal community  is based in a local Aboriginal community  is governed by an Aboriginal body which is elected by the local Aboriginal community  delivers holistic and culturally appropriate services and supports to the community which controls it. To improve Aboriginal employment outcomes, health services receiving capital grants funding must have an Aboriginal Employment Plan. Large projects will be required to meet a minimum two per cent aboriginal employment target. More ambitious targets will be looked upon favourably during the tender process.

1.93.7 Quality care for people with a disability All health services are expected to deliver high-quality care that is accessible, welcoming, safe and effective to Victorians with a disability, wherever they are treated. Care for people with a disability must be holistic, and not narrowly focused on their disability. Care must use necessary aids (such as Auslan) to overcome communication difficulties and seek the active participation of the patient, regardless of their disability. Absolutely everyone: state disability plan 2017–2020 identifies the need for a sector-wide approach to reinvigorating disability action plans in all public and community health services focusing on:  holistic care  facilitated pathways through care  preventing discrimination and abuse of patients with a disability. Further information on Absolutely everyone is available from . Guidance on developing disability action plans can be found at .

1.93.8 Gender equality The Victorian Government has outlined its commitment to gender equality in Safe and Strong: A Victorian Gender Equality Strategy. Priorities for the work and expectations of the department for 2017–18 in this area are:  Continuing to address the gender representation in senior leadership positions is a major issue and the government is focused on increasing the number of women in senior leadership positions.  Implementing the Victorian Gender Equality Strategy, including health actions to partner with and listen to women and girls in their healthcare and service provision, continue to provide support for women and girls who have experienced female genital mutilation/cutting, address bullying and harassment and ensure equity and diversity in the workforce through Our pathway to change.  Implementation of the Women’s sexual and reproductive health: key priorities 2017–2020 with a vision for a future where every Victorian woman reaches her optimal sexual and reproductive health.  As well as the commitment for women to be at least 50 per cent of new appointments on paid Victorian government boards, and working for board appointments that broadly mirror the diversity, Victoria’s Gender Equality Strategy recommends a voluntary target for private and not-for-profit boards of at least 40 per cent women. As a principle, having a diversity of board and committee members should be included as part of good governance to reflect the communities served. Further information regarding the standard processes and principles for appointing and remunerating board members of, and other appointments to, non-departmental entities in Victoria can be found at . Further information regarding governance is available at .

1.93.9 Lesbian, gay, bisexual, trans and gender diverse, and intersex health Because any person using a health or community service in Victoria may be same-sex attracted, trans, gender diverse or have an intersex variation, it is important for all services to consider how they can become more inclusive of people who are lesbian, gay, bisexual, trans and gender diverse, and intersex (LGBTI). Services should aim to become more responsive to issues related to sexual orientation, gender identity and intersex variations, and to understand the specific health and wellbeing needs of subgroups within the LGBTI population. To support this policy priority, a LGBTI Taskforce and Commissioner for Gender and Sexuality have been established. The Taskforce’s Health and Human Services Working Group is actively working to support health and human services in this area. The Rainbow eQuality Guide has been developed to assist mainstream health and community service agencies identify and adopt inclusive practices and become more responsive to the health and wellbeing needs of LGBTI individuals and communities. The Community Health Inclusive Practice project is developing, piloting and evaluating evaluation tools and resources that promote LGBTI inclusive and responsive service planning and practice within community health services. Further information is available at .

1.93.10 Newly arrived refugees and people seeking asylum In 2017–18, services will continue to support increased refugee settlement in Victoria in response to the Syrian refugee crisis, with the additional $10.9 million allocated over four years in 2016–17. The funding will continue to support: • Improved health and community services orientation, triage and assessment early in settlement, to be rolled out in settlement services by community health nurses and bicultural workers from the Refugee Health program, and specialists from the Refugee Health Fellow Program in areas of high Syrian and Iraqi refugee settlement. • Improved immunisation coverage for newly arrived Syrian and Iraqi refugees. Enhanced mental health support and psychosocial community education, particularly for children and young people. Increased capacity of the Refugee Minor Program to provide casework and other support for unaccompanied refugee children and young people. Additional language services including interpreter services and translation resources to support effective communication and culturally response service provision. Victoria is committed to providing healthcare access to people seeking asylum living in the community.

1.93.11 Implementation of changes to the Assisted Reproductive Treatment Act 2008 On 23 February 2016, parliament passed the Assisted Reproductive Treatment Amendment Act 2016, which will amend the Assisted Reproductive Treatment Act 2008 to give all donor-conceived people the right to available identifying information about their donors. The legislation will put various protections in place for donors, such as the ability to lodge contact preferences to prevent or manage contact with their donor-conceived offspring (including between these offspring and their non-donor conceived children under 18 years of age), and the requirement that donors be offered counselling where an application is made for information about them. The donor conception registers (the Central Register and the Voluntary Register), will transfer from Births Deaths and Marriages to the Victorian Assisted Reproductive Treatment Authority. The authority will manage all applications for information from the registers and provide a range of linking, counselling and support services in relation to applications. The authority will be supported by an organisation providing specialist search services.

1.93.12 Health Purchasing Victoria Health system procurement reform will focus on enhancing hospital cost containment and improved procurement processes by: Increasing sourcing and contract management efficiency to maximise both financial and non-financial benefits to the sector. Working closely with the sector to improve procurement processes, governance, compliance and probity outcomes. Improving contract delivery and embedding process innovation in Health Purchasing Victoria’s category management. Increasing customer relationship management with health services to ensure a high level of customer service. In 2017–18 Health Purchasing Victoria will continue to support health services as they transition to the new strategic procurement policy framework established by the Heath Purchasing Policies, mandatory from 30 June 2016.

Health Purchasing Victoria will continue to focus on customer engagement to provide accurate information to health services on compliance and probity, contract transition, annual reporting requirements and support stakeholder visibility of core Health Purchasing Victoria activities. Health Purchasing Victoria will finalise its next five-year strategic plan in August 2017. This plan will seek to reposition its organisational approach to strategic sourcing and category management, focusing on improvements to its core function and capability with the goal of maximising sourcing efficiencies. Health Purchasing Victoria will continue to be guided by its vision: ‘advancing affordable, sustainable and safe healthcare for all Victorians’. Health Purchasing Victoria will continue to deliver its core functions and embed reforms in 2017–18.

1.93.13 Clinicians Health Channel The Clinicians Health Channel has been made available free of charge to publicly-funded health services and agencies in Victoria since 2001. The Clinicians Health Channel provides health services with evidence-based resources that improve the health and safety of Victorians. The provision of the Clinicians Health Channel represents a significant saving for health services, who without the service, would be required to purchase evidence-based resources at significant individual cost. The department expanded the Clinicians Health Channel by providing additional evidence-based resources. Additional resources include drug information resources that health services were previously required to purchase to meet health and safety requirements. The expanded Clinicians Health Channel also includes high-value psychiatry, poisons and complementary and alternative medicine resources that were previously purchased individually by health services to increase healthcare.

1.93.14 National Bowel Cancer Screening Program – colonoscopy To support the expansion of the National Bowel Cancer Screening Program (NBCSP), from 2017–18 all Victorian public hospitals providing colonoscopy will be allocated a separate NBCSP WIES target. This was previously only available to NBCSP designated provider health services, but has been expanded to include all public health services providing colonoscopy. This funding is provided in addition to the funding provided for other activity and is paid according to actual activity. National Bowel Cancer Screening Program participants must be coded under funding arrangement code 8 in order to receive additional WIES funding. It is expected that most episodes will be grouped to Vic- DRG8.0 G48B colonoscopy, minor complexity or G46B complex endoscopy, minor complexity. A small number of episodes may group to other DRGs where the patient has required an overnight stay or other circumstances have arisen. The new funding arrangement will improve access for Victorian National Bowel Cancer Screening Program participants to colonoscopy and support Victorian public health services to meet the increase in demand during the expansion of the NBCSP.

1.94 The pricing and funding framework for Victorian health services

1.94.1 Pricing and funding framework The department first released the Pricing and funding framework in June 2016. The accompanying website describes the department’s framework for making changes to current pricing and funding approaches including the significant changes to occur in 2017–18. 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 2017–18 can be found at .

1.94.2 Commonwealth funding

1.1.1.13National Health Reform Agreement Public Hospital funding is a shared responsibility between the commonwealth, state and territory governments. On 1 April 2016, the Council of Australian Governments (COAG) signed a Heads of Agreement which substantially rolls-over existing National Health Reform Agreement arrangements from 2017–18 to 2019–20, and commits to: Delivering reforms designed to improve health outcomes for patients and decrease avoidable demand for public hospital services. Introducing models to integrate quality and safety into hospital funding and pricing and reduce avoidable readmission rates in conjunction with the Australian Commission on Safety and Quality in Health Care and the Independent Hospital Pricing Authority. Cooperative development of a longer-term public hospital agreement for COAG consideration before the end of 2018 and commencement by 1 July 2020. The Heads of Agreement formed the basis of negotiations which led to a time-limited addendum of the National Health Reform Agreement from 1 July 2017 to 30 June 2020. The addendum was signed by Victoria in April 2017. Under the new arrangements, commonwealth funding growth for public hospitals, which was previously unlimited and based on the services provided, will be capped at 6.5 per cent each year and the commonwealth contribution to efficient growth funding will remain at 45 per cent of the efficient growth, rather than moving to the 50 per cent contribution rate from 2017–18 as originally agreed in the National Health Reform Agreement. The addendum does not completely reverse the 2014–15 budget changes (which included commonwealth savings nationally, ceasing the funding guarantees under the National Health Reform Agreement, moving to block funding indexed by population growth and the Consumer Price Index from July 2017) as the maximum funding Victoria could receive from the commonwealth is still significantly less than what Victoria could have received under the original National Health Reform Agreement, for the same period,

1.1.1.14Commonwealth investment in public dental services The Commonwealth Government previously announced it would introduce a new Child and Adult Public Dental Scheme to commence from 1 January 2017. The proposed scheme would have provided $2.1 billion nationally over five years to public dental services. However, legislation to effect this change was

Volume 2: Health operations 2017–18, Chapter 1 Page 59 Overview, key changes and new initiatives not passed by the Commonwealth Parliament. In December 2016, the Commonwealth Government announced that the proposed scheme would not proceed. The commonwealth subsequently announced funding of $242.5 million nationally for a new National Partnership Agreement for the period 1 January 2017 to 30 June 2019. A draft National Partnership Agreement on Public Dental Services for Adults was provided to jurisdictions for comment and is currently under negotiation. The funding offered under the draft agreement represents a 30 per cent reduction from previous commonwealth investment despite activity levels similar to those in previous agreements being maintained.

1.94.3 Funding reforms 2017–18 The department continues to refine and develop its hospital funding models to ensure that the investment made is delivering the best value to all Victorians. Funding models must remain contemporary if Victoria is to continue to deliver better value through high-quality care, delivered in the most effective settings using the most efficient model of care. In 2017–18 the department has further refined existing funding models and will also continue to develop more innovative approaches such as capitation and bundled payments. In line with the Victorian Pricing and Funding Framework, Victoria will maintain a Victorian funding system that adopts and adapts elements of the national approach where it is suitable in the Victorian context. In addition to the funding reforms outlined below, in 2017–18 a number of regular updates, including rebasing, have been made to account for the most recent cost and activity data. Changes include updates to Weighted Inlier Equivalent Separation model (WIES24), Subacute Weighted Inlier Equivalent Separation model (Subacute WIES2) and the non-admitted emergency services grant. See Chapter 2 of these guidelines for more details. The 2017–18 funding reforms will improve system outcome by: encouraging accountability for both health service providers and government remaining simple and transparent supporting efficient and sustainable health service operations. These reforms will not impact patient access or care and will ensure that patients will receive appropriate care in a timely way, and in the most appropriate setting, by the right providers.

1.1.1.15HealthLinks: Chronic Care HealthLinks: Chronic Care (HLCC) is designed to remove funding barriers that may constrain health services from delivering effective and integrated models of care for patients with chronic and complex care needs, at high risk of multiple unplanned admissions. It forms part of the department’s approach to delivering person-centred and integrated care. HealthLinks: Chronic Care commenced in 2016–17 and 10 health services were invited to participate. Implementation is staggered based on health service readiness. The Department of Health and Human Services has developed an algorithm that predicts the amount of acute inpatient (WIES) funding that a defined group of patients at high risk of multiple unplanned admissions will use over 12 months. These patients are enrolled in HLCC. This funding is converted into a capitation-based specified grant and can be used: for all future acute inpatient admissions for the enrolled patient cohort to invest in alternative services that may prevent, or help plan for, some of the predicted inpatient admissions for that cohort, including care beyond the traditional hospital walls.

In 2017–18, the conversion rate for the first 12 months of a patients enrolment in HealthLinks has been calculated as 2.2 WIES per patient/year. Health services may choose to focus their intervention on a subset, or all, of the HLCC-enrolled patients. The specified grant is, however, based on the projected activity-based WIES funding for the predicted average number of enrolled patients. This approach enables the projected WIES to be accurately estimated and ensures that there is adequate funding available to manage a case mix of patients at high risk of multiple unplanned admissions and deliver a mix of services to that eligible patient cohort. This approach, which uses capitation funding, is designed to promote innovative models of care that produce better outcomes for patients at no additional total cost to the public health service system. Over time, it is anticipated that health services will be able to better identify those patients at high risk of multiple unplanned admissions to hospital and deliver a suite of services that will reduce their use of unplanned inpatient care. It is recognised that in delivering this new model, enrolees may consume more planned and community-based care. This shift will not increase the overall cost of the individual patient’s care if their use of unplanned inpatient services can be reduced. The department has contracted the Commonwealth Scientific and Industrial Research Organisation (CSIRO) to work with the department on a cosponsored evaluation of HLCC. The evaluation will assess the impact of the trial at the system level. Participating health services are also evaluating the impact of the interventions at the local level.

1.1.1.16Department of Veterans’ Affairs In March 2017, the Secretary, Department of Veterans’ Affairs, delegates from the Military Rehabilitation and Compensation Commission and Repatriation Commission, and the Minister for Health, Victoria, signed the Hospital Services Arrangement between the Commonwealth of Australia and the Repatriation Commission and the Military Rehabilitation and compensation Commission and the State of Victoria (The Arrangement). The Arrangement implements a uniform national purchasing arrangement for public hospital services provided to eligible veterans. The Arrangement will see the Department of Veterans’ Affairs pay Victoria according to the Independent Hospital Pricing Authority’s funding models with modifications to reflect the contribution that the Department of Veterans’ Affairs makes separately to medical practitioners. As a result of these new funding arrangements, the Department of Veterans’ Affairs will not index the price paid to Victoria in 2017–18. This will significantly reduce the amount of revenue available to distribute to health services. Funding for admitted acute and subacute services will continue to be paid to actuals, whilst the funding for emergency departments, acute non-admitted, Health Independence Program will continue to be provided on a block basis with the available revenue from Department of Veterans’ Affairs allocated based on a health service’s share of the total weighted activity. Further information on eligibility and funding arrangements is available in Chapter 2, section 2.19.3.1 ‘Department of Veterans’ Affairs patients’.

1.1.1.17Admitted subacute – episodic funding model In 2016–17 the department introduced an episodic funding model for rehabilitation and geriatric evaluation and management admitted activity to provide further incentive for system efficiencies through shorter lengths of stay. In 2017–18, the episodic model will be expanded to include palliative care as foreshadowed in 2016–17. Maintenance care will retain bed day funding in 2017–18 with progression to an episodic approach in future years. The funding model will be based on the Australian National Subacute and Non-acute (AN-SNAP) version 4 classification system, using 94 of the classes for admitted activity. The funding model has allocated a cost weight and an inlier and outlier boundary point for the rehabilitation, palliative care and geriatric evaluation and management classes.

Further information on the 2017–18 prices is available in Chapter 3, section 3.1 ‘Price tables’ and information on the technical aspects of the funding model are available in Chapter 2, section 2.3 ‘Subacute inpatient services (Subacute WIES)’.

1.1.1.18Specialist clinics The department has shadowed an activity-based funding model for specialist clinics activity for the past two financial years. In 2017–18, the department will introduce the Weighted Ambulatory Service Event funding model for acute non-admitted specialist clinic activity that is not funded by another Victorian funding model (for example, home renal, radiotherapy, home enteral nutrition). The implementation of the activity-based funding model is intended to encourage health services to improve their data reporting, drive technical efficiency, and delivers greater transparency and accountability for the funding received by services. The funding model will include public and private acute non-admitted specialist clinic activity. Activity will be counted as service events and classified according to the national Tier 2 classification with cost weights calculated based on Victorian cost data. There is a 20 per cent discount for review activity except for maternity. The funding unit is a Weighted Ambulatory Service Events (WASE) and there will be two prices; a public and private price. Health services have been allocated an activity target (WASE) that matches their historical non-admitted specialist clinics funding, and if applicable, their funding provided under the VACS teaching grant. Targets have been calculated based on a health service’s public and private activity split reported in the first three quarters of 2016–17. Further information on the 2017–18 prices is available in Chapter 3, section 3.1 ‘Price tables’ and information on the technical aspects of the funding model are available in Chapter 3, Appendix 3.6 ‘Weighted Ambulatory Service Event technical specifications’.

1.1.1.19Mental health – input-based funding The 2017–18, the department will fund acute admitted mental healthcare on an input basis. Health services will be funded based on their capacity to provide inpatient mental healthcare, with the number of bed days available. Acute adult, child, aged and specialist bed types will receive the same price regardless of the location of the health service. To further support the transition to a single price model, a transition grant will continue to be provided to health services to maintain funding equivalence with 2016–17 allocations. Further review of the funding model for acute mental health admitted care across all patient types will be considered in the future. As the Victorian Cost Data Collection will be used to further understand the costs of mental healthcare, health services should continue to contribute to mental health costing processes within the collection. In 2017–18, admitted extended care and non-admitted acute mental healthcare (such as ambulatory, subacute and residential aged mental health services) will continue via a mixture of input (per day or service hour) and block grants. Further information on the 2017–18 prices is available in Chapter 3, section 3.1 ‘Price tables’.

1.1.1.20 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. In line with COAG commitments, commencing in July 2017, Victoria will progressively introduce funding policies to reflect non-payment for avoidable harm.

Victoria’s 2017–18 approach to pricing for sentinel events involves a staged implementation of the national pricing model for sentinel events. If a sentinel event occurs, and the event is deemed to be avoidable, health services will not receive payment for the episode of care.

1.1.1.21 Admitted acute – Weighted Inlier Equivalent Separation (WIES24) Short stay unit adjustment Admitted activity in short stay units has increased significantly and now exceeds 200,000 separations per annum and continues to grow at a rate much greater than for patients treated in a ward or ward equivalent. Compared to other sameday and oneday medical patients, patients admitted from the emergency department to the short stay unit receive medical observation care and have a shorter length of stay, a lower DRG clinical complexity score, lower reported costs and lower numbers of reported diagnoses and procedures. Under WIES23, the DRG cost weight is based on the combined average cost of care in a short stay unit, together with sameday and overnight care in a ward. The resulting cost weight provides a generous financial incentive for short stay unit patients and a financial disincentive for multiday patients cared for in a ward. In 2017–18, the department will address the inequity arising from the same WIES payment being allocated to different patients receiving different types of care (short stay unit versus ward) and the dilution of the sameday and overnight WIES payments for patients treated in the ward. A new set of WIES24 cost weights will be created for designated DRGs: (i) for care delivered in short stay units based on activity in short stay units only, and (ii) for sameday- and overnight-care delivered in wards based on activity excluding short stay units. Further information on the technical change refer to Chapter 3, Appendix 3.1 ‘Calculating WIES24 for individual patients’. Review of loadings There are currently a range of loadings linked to procedures and patient characteristics in the admitted acute and subacute funding models. These loadings reflect variation in costs within classification classes for specific episodes and have been introduced to support the department’s policy objectives. A loading is considered if its inclusion normalises the cost recovery for the targeted patient cohort when compared to all episodes. If this occurs, the loading is acting to compensate providers for the cohort’s systematically higher costs that are diluted by the broader group of episodes. Notably, these loadings are periodically reviewed to ensure alignment with the department’s policy objectives and reported costs. Loadings used for WIES23 will continue under WIES24, namely: thalassaemia patients Aboriginal and Torres Strait Islander patients an abdominal aortic aneurysm stent an atrial septal defect closure device a cochlear implant device invasive mechanical ventilation. For 2017–18 the department has reviewed the thalassaemia loading for the first time since its introduction in 1997–98. Consequently, the thalassaemia loading has been revised to 0.1089 WIES24 in line the latest available reported costs. There are no other changes to WIES24 (2017–18) loadings but the department will continue to review loadings in future iterations of the WIES funding model.

Australian Refined Diagnosis Related Groups version 8.0 In 2016–17, Victoria adopted the latest available acute admitted patient classification, the Australian Refined Diagnosis Related Groups version 8.0 (AR-DRG8.0). This aligns with the Independent Hospital Pricing Authority approach which applies to the commonwealth contribution under the National Health Reform Agreement in 2016–17. The Australian Consortium for Classification Development, led by the National Centre for Classification in Health (The University of Sydney) in collaboration with Western Sydney University and KPMG, were responsible for the development of Australian Refined Diagnosis Related Groups v8.0 and v9.0. Historically, the AR-DRG classification uses patient diagnoses, procedures and hospital administrative data to determine a patient’s DRG outcome. By contrast AR-DRGv8.0 uses a completely different approach to differentiating patient complexity compared to historical versions of AR-DRGs. Grouping of patients to AR-DRG8.0 now mostly uses patient diagnosis codes. The patient diagnosis codes can significantly influence whether patients are grouped to more complex AR-DRGs and it was anticipated that this change would more accurately measure the true clinical complexity of patients admitted for acute care. Although both AR-DRG v7.0 and v8.0 retain the same number of non-error Adjacent DRGs (i.e. 403), the number of Adjacent DRGs split on complexity has increased from 167 in AR-DRG7.0 (41 per cent) to 315 in AR-DRG8.0 (78 per cent). Only six Adjacent DRGs are now split on administrative variables. The number of diagnosis codes that have the potential to change DRG outcomes has increased from approximately 3,200 in previous DRG versions to approximately 12,500 under v8.0. The principal diagnosis is now also included in the splitting methodology whereas previously it was excluded. To ensure equity and financial sustainability, the department has removed the influence of 44 tenth edition ICD-10-AM diagnosis codes that have been deemed as non-clinically relevant to affecting AR-DRG outcomes under the AR-DRG8.0 episode clinical complexity model. Further information on the technical change refer to Chapter 3, Appendix 3.1 ‘Calculating WIES24 for individual patients’. Endovascular clot retrieval (ECR) Endovascular clot retrieval is a highly specialised procedure. It is a time-critical treatment, with the greatest benefit achieved with early restoration of blood flow. It requires a well-organised system to identify suitable candidates for therapy and rapidly transport them to an ECR-capable centre. The department has guided the development of a statewide approach to ensure that as many Victorians as possible will have access to ECR. Integral to this is concentrating the expertise for delivering the therapy to two centres capable of providing a 24-hour, seven-day service for potential ECR patients from across the state. The Royal Melbourne Hospital (Melbourne Health) and Monash Medical Centre (Monash Health) are the two statewide 24/7 designated ECR centres. Other hospitals currently providing ECR will continue to undertake this service but are not expected to provide a 24-hour service or accept referrals from external hospitals. To be a non-designated ECR provider, the hospital is still required to submit data, be involved in performance monitoring, and have health service executive support. The Alfred, Austin Hospital and St Vincent’s Hospital are non- designated ECR providers. To support the provision of the service, a VIC-DRG8.0 of B02Y Endovascular Clot Retrieval has been created for 2017–18. Further information on the technical change refer to Chapter 3, Appendix 3.1 ‘Calculating WIES24 for individual patients’.

1.1.1.22 Subcutaneous Immunoglobulin therapy Since 1 September 2013 the National Blood Authority has made available immunoglobulin products which can be delivered at home to treat: primary immunodeficiency with antibody deficiency specific antibody deficiency acquired hypogammaglobulinaemia secondary to haematological malignancy secondary hypogammaglobulinamia (including iatrogenic immunodeficiency). There are approximately 2,200 patients who are currently treated with intravenous immunoglobulin and it is estimated that approximately 30 per cent of these patients could be treated with subcutaneous immunoglobulin therapy. In 2017–18, the department will provide seed funding to some hospitals to employ a nurse trainer to educate suitable patients in subcutaneous immunoglobulin therapy self-administration to increase the number of patients accessing subcutaneous immunoglobulin therapy at home. In addition, hospitals will receive an additional $2,000 for each patient enrolled into the subcutaneous program. In 2017–18, the department will also refine a capitation approach to support the provision of subcutaneous immunoglobulin therapy commencing in 2018–19. This capitated funding model will be based on costing and activity data reported to the department in 2017–18.

1.1.1.23 National Bowel Cancer Screening Program – colonoscopy To support the expansion of the National Bowel Cancer Screening Program (NBCSP) from 2017–18, a new WIES target has been created with eligibility expanded to all providers. The new funding arrangement will improve access for Victorian NBCSP participants to colonoscopy and support Victorian public health services to meet the increase in demand during the expansion of the NBCSP. NBCSP participants must be coded under funding arrangement code 8 in order to be counted against this new WIES target. It is expected that most episodes will be grouped to AR-DRGs G48B colonoscopy, minor complexity or G46B complex endoscopy, minor complexity. A small number of episodes may group to other DRGs where the patient has required an overnight stay or other circumstances have arisen. See Chapter 2, section 2.18 ‘Prior-year adjustment: activity-based funding reconciliation’ for more details payment and recall.

1.1.1.24 Dental pricing The recent Victorian Auditor-General's report Access to Public Dental Services in Victoria made a range of recommendations in relation to pricing, funding, performance management and other parameters for State Government-funded services. The department is working with Dental Health Services Victoria to review current Dental Weighted Activity (DWAU) pricing arrangements, with a view to developing options to standardise pricing across the state. The development of standardised pricing will be addressed through a staged approach. The first stage will commence from 1 July 2017, where a new minimum floor price per Dental Weighted Activity Unit (DWAU) will be introduced for all public dental providers. There will be no funding reduction or redistribution for public dental providers currently paid above the minimum DWAU price. Detail of the minimum price will be communicated via the funding agreement between Dental Health Services Victoria and public dental services. The department will continue to work with Dental Health Services Victoria to pursue a common single price and other associated pricing arrangements for implementation in accordance with the Auditor General's recommendations.

1.1.1.25 Prior-year adjustment: activity-based funding reconciliation The National Health Reform Agreement Addendum signed by Premiers in April 2016 significantly changes the Commonwealth Government funding to states between 2017–18 and 2019–20. The agreement imposes a 6.5 per cent funding cap, and provides 45 per cent of efficient growth from 2017– 18 onwards, as opposed to 50 per cent in the original agreement. Funded organisations are cash-flowed during the financial year according to their funding allocations. Where required, adjustments to this funding for over- and under-activity are made in the following financial year according to the policies set out in the prior year adjustment section of this document. In 2017–18, the department will continue to support services by providing additional funding for relevant funding streams at the current rate. The department will also introduce recall and additional funding for non-admitted specialist clinics to improve data reporting, drive technical efficiency, and support greater transparency and accountability for the funding provided to services.

1.1.1.26 High cost, low volume cross border patients The department allocates funding according to the expected activity levels. The department usually estimates its expected revenue for a relevant financial year (commonwealth, state, net cross boarder funding) and also sets aside funding for known commitments to be incurred during the financial year. In general, funded organisations are cash-flowed during the financial year according to their funding allocations. Funded organisations are expected to manage their resident and non-resident demand based on the funding provided. Where required, adjustments to this funding for over- and under-activity are made in the following financial year according to the policies set out in the prior year adjustment section of the Department of Health and Human Services policy and funding guidelines. The prior year adjustment policy does not make adjustments for changes for annual variations in this cohort. In accordance with Clause A91 of the National Health Reform Agreement, cross-border agreements are developed between jurisdictions which experience significant cross-border flows. The department has established agreements with all other states and territories (jurisdictions), based on a standard agreement. These agreements form the basis of the flow of funds between Victoria and other jurisdictions for residents treated from those respective states and territories. Annual reconciliations of cross-border flows occur to determine the liability of each jurisdiction. This revenue/liability is then factored into the available revenue available for redistribution as part of the modelled budget each year. Under these agreements, all financial transactions are to be transacted by the relevant health departments and not through inter-agency transfers (for example, hospital to hospital or state health department to hospital). Under the cross border agreement, there is an exemption for high cost procedure. A high cost procedure is defined as a procedure that is not reasonably funded by the existing classification system and cost weights and are agreed to at a jurisdictional level prospectively on a case-by-case basis. For the avoidance of doubt, this definition excludes experimental procedures. Admitted acute high cost procedures (for example, those funded by WIES) are defined by procedures that are: provided at limited sites nationally have low volume (< 200 separations nationally) and cost significantly more (> $20,000) than the funding provided based on the relevant year’s National Efficient Price Determination . Hospitals may seek an exception from the department for those services classified as high cost procedures and provided to patients who reside in another state or territory. Subject to meeting the definition of a high cost procedure (see high cost procedure section) and complying with the agreed

Volume 2: Health operations 2017–18, Chapter 1 Overview, key changes and new initiatives criteria and process, hospitals may be paid a supplementary payment by the department through the prior year adjustment process to meet the difference between the department’s funding allocation and the actual cost of the procedure paid by the resident’s jurisdiction. Hospitals should advise the department in advance (wherever possible) and care to non-resident patients should not be subject to or impacted by financial arrangements and should be based on to standard clinical protocols. Hospitals may not seek an exemption for Nationally Funded Centre (NFC) procedures as the funding for these procedures are already shared by jurisdictions and set annually by the Australian Health Ministers’ Advisory Council.

1.95 Data and reporting changes

1.95.1 Revisions to the Victorian Admitted Episode Dataset: Criteria for Reporting Changes for 2017–18 include: A new Criterion for Admission has been created for use with patients transferred from an emergency department or an Urgent Care Centre (UCC) to a Short Stay Unit. This criterion excludes patients who are transferred to an assessment unit – these patients must be reported under Criterion for Admission E Day-only Extended Medical Treatment. Following a review of the procedure code lists, seven codes have been transferred from the Not Automatically Qualified for Admissions List (NAQAL) to the Automatically Admitted Procedure List (AAPL). Following a review of the procedure code lists, five codes have been transferred from the AAPL to the NAQAL. The procedure code lists have been updated with new procedure codes introduced with the tenth edition of the Australian Classification of Health Interventions, effective 1 July 2017. Deleted codes have also been removed from the lists. The Victorian Admitted Episode Dataset: Criteria for Reporting policy is in effect as of 1 July 2017. The document, related factsheets and the procedure code lists can be downloaded at .

1.95.2 Data collection changes The following sections describe the key data collection changes. For further information about data collection changes see .

1.1.1.27 Victorian Admitted Episodes Dataset In 2017–18 the focus on data compliance will continue. The Agency Information Management System (AIMS) S1A form must be completed for sites unable to meet the data submission deadlines. The final date for receiving Victorian Admitted Episodes Dataset (VAED) for 2017–18 will be 24 August 2018. The following key changes will apply from 1 July 2017: Add new data item for Preferred Death Place for palliative care episodes. Add Program Identifier for National Disability Insurance Scheme (NDIS) participants. Amend Advance Care Plan Alert reporting guide and make reporting mandatory for all episodes except Care Types 10 and U. Amend Duration of Non-invasive Ventilation (NIV) in ICU definition and reporting guide to make reporting mandatory for public ICUs. Amend Criterion for Admission definition and add code for patient admitted from an emergency department (ED) to ED Short-Stay Unit.

1.1.1.28 Elective Surgery Information System The following key changes to the Elective Surgery Information System (ESIS) will apply from 1 July 2017: Amend Principal Prescribed Procedure (PPP) code list, including removal of PPP 509 Plastics/Aesthetic (cosmetic) procedures.

Amend Reason for Removal code set to include code for patient treated on non-admitted basis.

1.1.1.29 Agency Information Management System The following key changes to the Agency Information Management System (AIMS) will apply from 1 July 2017: Public sector residential aged care services quality indicators – three new sub-measures for the nine or more medicine indicator to be reported from 1 January 2018 for the quarterly data collection. The Urgent Care Centre form has been modified to include information previously collected via a spreadsheet. The S8 Non-admitted Radiotherapy form has been modified to include consultation information only, other sections have been removed. New fields on S10 Non Admitted Clinic Activity form for New and Review acute specialist clinic public service events.

1.1.1.30 Victorian Emergency Minimum Dataset The consistent collection of time points will continue to be a focus for the Victorian Emergency Minimum Dataset (VEMD) in 2017–18. These include arrival, triage, treating practitioner, departure dates and times and the ambulance time stamps for arrivals by both emergency ambulance and non-emergency patient transports. The following key changes will apply from 1 July 2017: Add Given Name and Family Name for Department of Veterans’ Affairs presentations. Add new data item for Advance Care Plan Alert for all presentations. Extend reporting of Ambulance at Destination Date/Time and Ambulance Handover Complete Date/Time to include all ambulance services, not just emergency.

1.1.1.31 Victorian Ambulance Dataset In 2015–16 the department began implementation of a unit-record minimum dataset for ambulance services provided by Ambulance Victoria, known as the Victorian Ambulance Dataset (VADS). The Victorian Ambulance Dataset 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. Implementation of the Victorian Ambulance Dataset is ongoing, and is being managed in a staged approach.

1.1.1.32 Victorian Integrated Non-Admitted Health dataset There will be a focus on data compliance across all programs reporting to the Victorian Integrated Non- Admitted Health dataset (VINAH) in 2017–18. For specialist clinics, the emphasis will be on assisting health services to improve the quality of data to support the public reporting of specialist clinics wait time data of the 2017–18 financial year. Subacute programs will continue to be monitored for compliance, with a focus on complete and accurate data. In 2017–18 two new data elements have been added to VINAH: Episode Special Purpose Flag and the Referral End Reason. There have been amendments to other existing data elements. There have also been minor modifications to some code sets and business rules validations.

1.1.1.33 Victorian Perinatal Data Collection 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 Victorian Perinatal Data Collection (VPDC). Refer to Chapter 4, section 4.12.3.5 ‘Consultative councils reporting requirements’. Under the Public Health and Wellbeing Regulations 2009, VPDC data is to be submitted within 30 days of the birth, unless otherwise specified by the CCOPMM. 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 outcomes. It contains information on obstetric conditions, procedures and complications, 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 . In 2017–18 there will be a continuing data compliance focus to ensure the data is received in a timely manner and that data quality issues are identified as early as possible.

1.1.1.34 Aged Care Assessment Services On 7 March 2016 Victorian Aged Care Assessment Services transitioned to operating in the national My Aged Care gateway. The former ACE database has been decommissioned. Since August 2016, all Aged Care Assessment Services data is being recorded in the My Aged Care portal and key data exported to the national data repository. The department will produce quarterly reports.

1.1.1.28 Home and Community Care Program for Younger People: NDIS reporting Community health services and other organisations funded by the HACC Program for Younger People (HACC-PYP) should use the SigBox system in order to monitor the impact of the NDIS rollout in the three years to June 2019. This is in addition to continuing to participate in the quarterly HACC minimum data set. SigBox is an online data room for the secure exchange of client data between the department and service providers. During NDIS implementation it is being used for the distribution of Provider Reports, and for periodic refreshing of client data. SigBox can be accessed using Google Chrome or Mozilla Firefox from the following link . The Provider Report is produced twice-monthly by the department. Its spreadsheets contain information that is essential to HACC-funded providers during the phase-in period, charting the progress of your clients through NDIS intake and assessment. The department will load Provider Reports into SigBox six months before the phase-in period in your area. Relevant managers should constantly consult these reports during the phase-in period. Requests for additional staff to have access to SigBox should be emailed to and copied to your organisation’s Local Engagement Officer or Program Adviser.

1.1.1.29 Community Health Minimum Data Set The streamlining reporting for the Community Health Services project will continue to be implemented in 2017–18 to address the reporting burden for Community Health Services associated with delivering multiple programs. The project is being undertaken in close consultation with the sector and relevant areas of the department.

Immediate priority actions have been identified for completion by 30 June 2017. As these changes are implemented, Community Health Services should expect a reduction in their reporting burden. The actions will: Align client registration elements for community health, dental health and alcohol and other drug treatment services datasets. Update outdated validations and remove unnecessary validations. Discontinue collection of data which is no longer required. Remove redundant data elements that are not used or could be derived.

List of tables

List of tables Volume 2: Health operations 2017–18, Chapter 1 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 ACCO Aboriginal community-controlled organisations 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 CMIA Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 (Review) CMI/ODS Client Management Interface/Operational Data Store CNS Clinical Nurse Specialists COPD chronic obstructive pulmonary disease CORE Centre for Outcome and Resource Evaluation CPC community palliative care CSO community service organisation

Volume 2: Health operations 2017–18, Chapter 1 Acronyms and abbreviations Overview, key changes and new initiatives

CTN clinical training networks DET Department of Education and Training DFI Dr Foster Intelligence DHHS Department of Health and Human Services DRG diagnosis-related group DTC day therapy centre 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 HACC-PYP HACC Program for Younger People 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

Acronyms and abbreviations Volume 2: Health operations 2017–18, Chapter 1 Overview, key changes and new initiatives

MHCC Mental Health Complaints Commissioner MHCSS mental health community support services MHT Mental Health Tribunal MICA Mobile Intensive Care Ambulance MOU memorandum of understanding 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 the 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

Volume 2: Health operations 2017–18, Chapter 1 Acronyms and abbreviations Overview, key changes and new initiatives

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 REACH Retrieval and Critical Health ROSH risk of significant harm RRAP Risk Reduction Action Plan 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 SDE Secure Data Exchange 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 UCC Urgent Care Centre VADC Victorian Alcohol and Drug Collection 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

Acronyms and abbreviations Volume 2: Health operations 2017–18, Chapter 1 Overview, key changes and new initiatives

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 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 WASE Weighted Ambulatory Service Event WAU weighted activity unit WBD weighted bed day WIES weighted inlier equivalent separation WOT weighted occupancy target YES Your Experience of Service

Volume 2: Health operations 2017–18, Chapter 1 Acronyms and abbreviations