fC» Health Commission of Victoria Annual Report 1981/82

VICTORIA

Report

of the

HEALTH COMMISSION OF VICTORIA

for the

Year ended 30 June 1982

Ordered by the Legislative Assembly to be printed

MELBOURNE F D ATKINSON GOVERNMENT PRINTER 1982

No. 59 Enterprise House 555 Collins Street. Melbourne November 1982

The Honourable T.W. Raper Minister of Health Sir The members of the Health Commission of Victoria have pleasure in submitting this, the fourth Annual Report of the Commission, for presentation to Parliament.

Gad Trevaks Chairman

Jack Lewis Evans Full-time member

James Anthony Ryan Full-time member

Miss Mona Menzies Part-time member

Professor Kenneth Hunt Part-time member

Mr. John Waiter Part-time member

Mr. Ernest Tucker Part-time member

Peter Robert Wilkinson Secretary The Division Directors

Dr. Bertram McCioskey Public Health

Mr. Errol Cocks Mental Retardation

Dr. David Race Hospitals

Dr. George Lipton Mental Health

Dr. Richard Scotton Planning

Mr. James Hicks Building and Services

Mr. Tony Clifford Finance

Mr. Pat Daly Personnel

Contents

The Commission's Review ...... 6

Public Heatth Division Services ...... • 20 Mental Heatth Division Services ...... 32 Hosprtals Division Services . . . . . • ...... 36 Mental Retardation Division Services . . . . • . • • • • . 43

The Planning Division Report ...... •...... 47 The Personnel Division Report ...... • ...... 52 The Finance Division Report ...... 56 The Building & Services Division Report . . . • . . . . 64 The Commission's Review of 1981/82

Introduction ...... 7

Commonwea~h-State Funding ...... •..... 7

Hea~h insurance campaigns ...... 10 The regionalisation proposal ...... • 11 Review of Tuberculosis Services ...... • • . 14 Review of School Dental Services . . . . . • • • • • • • • 14 The first year of the Mental Retardation Division ...... 15 Developments wrthin the Planning Division ...... 15 I.Y.D.P.•••••...... •..•.....•.•.•••••••••. 16

Hea~h promotion • ...... 16 Anti-rubella campaigns in industry ...... • 17 Acupuncture concern ...... 17 Legislation ...... 17 Introduction designated categories of social disadvantage, for the financial protection of patients, except through the The past year saw a consolidation of the Commission's private insurance system. services to the community. The manpower and financial constraints imposed during 1980/81 continued The new funding arrangements replaced the special during 1981 /82, but the greatest single influence on the purpose cost-sharing grants for public hospitals, State's heatth services was the term1nat1on of the community health projects and school dental services Commonwealth/State cost-sharing agreement. The by an identified Health Grant unrelated to the costs ramifications of this decision were, and are, so far­ incurred in operating these services. The formula took reaching that the Commission feels bound to explain as its base the actual cost-sharing grants paid in them in detail. 1980/81 and applied predetermined escalation factors of a flat 10 per cent increase in 1981/82 and the actual Commonwealth-State Funding consumer price movement over two years to 1982/83 The single most important event which affected the effectively a further ten per cent in that year. context within which the Commission operates was the These escalation factors fell far short of actual implementation of new funding arrangements by the movements in hospital costs especially those of Commonwealth Government on 1 September 1981. wages and salaries. Statistics produced for the The new arrangements terminated the 50/50 sharing Commission indicate that the actual movement in by Commonweatth and State Governments of the net award wages and salaries between June 1981 and operating costs of public hosp~als which had operated June 1982 was 18.9 per cent. in Victoria since 1 August 1975. The terms ofthe original In addition, the amounts so calculated were not paid to Commonwealth-State agreement were modified in the States: from them were deducted amounts equal to October 1976 and the agreement was subsequently the additional revenue assessed by the Commonwea~h extended for one year beyond its expiry date of 30 June to be received from fees charged in public hospitals 1981, pending the report of the Commission of Inquiry after 1 September 1981: into the Efficiency and Administration of Hospitals (Jamison Commission). (a) at increased rates of The main features of the cost-sharing agreements $80 per day in multi-bed wards (formerly $50). between the Governments, as they operated after 1976, $110 per day in single rooms (formerly $75), were that the States undertook to provide treatment and and accommodation in public hospitals free of charge to all uninsured patients and at agreed fees to privately $20 per outpatient occasion of service (formerly $6 per attendance), and insured patients. In return, the Commonwea~h con­ tributed fifty per cent of the net operating costs of public (b) as the result of charging fees to all patients except hospitals as incorporated in agreed budgets. These to holders of persioner health benefrt cards and arrangements involved the two levels of grovernment in health care cards issued to persons in a reciprocal set of responsibilities for the delivery, pricing disadvantaged categories, it was estimated by the and funding of public hospital services, the detailed Commonwealth that this change would increase operation of which was worked out at periodic meetings paid bed days by ten per cent, from the 1980/81 of Slate and National Standing Committees. actual percentage of 44.6 per cent of all inpatient days to forty-nine per cent of all days. Atthough it was crnical of the incentives incorporated in the cost-sharing formula, the Jamison Commission The Commonwealth estimated that the additional fee recommended that the joint responsibiltty of the revenue to be raised by public hospitals from these Commonweatth and State governments be continued measures would be $106.6 million in a full year. Since and the consultative framework strengthened. the fees to be charged from 1 September 1981 would be The new policy announced by the Commonwealth in collected wnh a lag (estimated at one month) the April1981 and largely implemented in September of that Commonwealth legislation provided !bat whereas in year represented a radical departure from the system 1982/83 the full amount of assessed additional revenue which had operated for nearly six years. In effect, it raising capacity would be deducted, in 1981 /82 the constituted an almost complete withdrawal of deduction from the grant would be only sixty per cent of Commonwealth responsibility for public hospital nine months' revenue at this rate. operations and, with the exception of social security No deduction of revenue capacity was made in the pensioners with PHB entitlements and people in case of communny health and school dental programs.

7 and their component of the health grant was stmply The application of the Commonwealth formula to escalated by the factors already described Victoria is shown in Table 1.

Table 1: Health Grant - Victoria

1981/82 1982/83 (Estimated) $M $M Estimated cost sharing grants for 1980/81 336.5 336.5 Plus escalation allowance - 1981/82 on 1980/81 (1 0 per cent) 33.6 1982/83 on 1980/81 Basic Health Grant 370.1 407.2 Less assessed additional revenue-raising capacity from specified charges - 44.2 106.6

Health Grant 325.9 300.6

After 1982/83, heatth grants are to be escalated by the sharing arrangements, even taking into account the same factors as apply to the States' tax sharing grants additional revenue capacity. that is, the rate of growth in total tax revenue - and The extent to which the Commonweatth has divested the Commonwealth Government has signified its itself of financial responsibility for cost shared systems in intention after 1984/85 of absorbing the health grants Victoria is shown in Table 2, in which the 1982/83 into the general tax sharing grants. The low rate of figures are based on the charges introduced in escalation and the deduction of the full amount of September 1981 . On these figures, the Commonwealth assessed increased revenue means that Victoria's would have reduced its contribution over two years from health grant has been stepped down in 1982/83 to a fifty per cent to thirty-six per cent of the net costs of base level which is far below the amount of $420 million these services and from forty per cent to twenty-seven which would have been forthcoming under the tax per cent of their gross operating costs.

Table 2: Funding of Victorian Public Hospital, Community Health and School Dental Services, 1980/81 to 1982/83 1980/81 1981/82 1982/83 Actual Estimate $M $M $M Gross operating costs 845 965 1105 Revenue 171 236 265

Net operating costs 674 729 840 Commonwealth grants 337 326 301

State share 337 403 539

8 Implementation of the new funding arrangements has more than thirty-five per cent overall, with the daily fee in subjected the Commission and public hospitals to many multi-bed accommodation in public hospitals rising from pressures. In addition, it has for the first time since $80 to $110 (an increase of 37.5 per cent) and other fees August 1975 exposed large numbers of Victorian increasing by slightly smaller percentages. These residents to financial risk as the result of receiving increases were expected to increase revenue by about services in public hospitals. $30 million dollars in 1982/83 and to reduce the contribution from State revenue correspondingly. One effect of the change on the Commission has been intensification of the necessity to hold back the costs of Secondly, the government announced its intention of hospital services. For some years under cost sharing, increasing hospital fees every six months in line with the Commission has been endeavouring to maintain a movements in average weekly earnings. policy of no real growth in resources employed in public Thirdly, it recognised that the financial impact of the new hospitals, although limitations of data about real system was intensified by the fact that actual increases resource levels and cost movements left the actual in revenue were well short of the amounts assessed by state of affairs open to some degree of interpretation. the Commonwealth and hence deducted from the State In the face of the very large wage and salary increases grant In May 1982, the Government submitted a over the past year, the Commission has implemented a detailed submission to the Commonwealth government new establishment and budget system for hospitals requesting a re-assessment of revenue raising capacity which has enabled it effectively to delineate hospital on the grounds that the original assessment had been establishments and to monitor hospitals' adherence to made on wrong assumptions about the base year and them. During 1982/83, hospitals are expected to be had involved projections of hospital activity which had funded only for the actual costs incurred in their not eventuated. approved establishments, and to have increases in The Victorian claim was for an additional $17 million awards funded at approved establishment levels. dollars in 1981/82 and $32 million dollars in 1982/83, On the other side of the ledger, it has been necessary to which were estimated to be the amounts by which the place much greater emphasis on efforts by hospitals to assessments of increased revenue by the Common­ raise revenue. Public hospitals have now been given wealth had exceeded the amounts which should have formal revenue budgets for inpatient and outpatient been assessed as collectable, given the benefit of services which they are expected to meet by rigorous hindsight about several of the important factors. The and efficient billing and collection procedures. The Commonwealth's response, announced at the Commission recognises that the need to expand Premiers' Conference in June 1982, was to forward an inpatient and outpatient billing systems, to implement additional $3.8 million for 1981/82 and no increase in direct collection of fees from patients, and to assess the 1982/83 grant A request for referral to the action in respect to uncollected charges imposed a Commonwealth Grants Commission has not yet been considerable extra workload on public hospitals. To responded to. provide some additional resources for these tasks, the A shortfall in revenue from inpatient fees can be Commission approved additional temporary clerical recovered by raising daily charges, but it would not have positions and the acquisition of computer systems at a been possible to make up, in this way, the large shortfall cost of $1.7 million. in outpatient revenue compared with the Common­ As far as the State Government was concerned, the wealth assessment since it resulted from wildly financial implications of the new system which, on incorrect assumptions about outpatient activities in the the figures shown in the previous table, would result in base year 1980/81. In addition, efficient collection of an increase of $203 million or sixty per cent in the State outpatient revenue is hampered by a great number of share of former cost shared services over two years difficulties, which include physical layouts which are ill­ could not be supported in the existing budgetary adapted to the collection of revenue for individual circumstances. After a 1980/81 allocation to health services rendered and the continuing pressure of staff in services considerably above the budget estimate - outpatient departments of hospitals to provide service almost entirely due to increased wage costs and rather than undertake accounting tasks. shortfalls in hospital revenue - the government With these considerations in mind, the State announced a number of initiatives to operate in government proposes legislation to implement a levy on 1982/83. hospital benefit funds in Victoria at rates designed to In the first place, further increases in hospital fees were raise the amount of revenue which would have been to apply from 1 July 1982. These increases averaged forthcoming from insured patients under the

9 assumptions used in the health grants legislation. Under The Health Insurance Campaigns this legislation, the amounts which hospital benefits funds will be required to pay will be equivalent to forty cents per single membership and eighty cents per Late in 1981 and again in mid-1982, the Commission family membership. conducted publicrty campaigns to encourage people to Patients insured by these funds will be exempted from take out basic hospital and medical insurance. These outpatient fees, which will continue to be charged to were necessary because the changes to the compensable and uninsured patients. The levy is Commonwea~h/State health funding arrangements expected to yield $38 million dollars in 1982/83. The resu~ed in steep increases in public hospital bed Health Commission was involved in the formulation of charges. and uninsured patients ran the risk of incurring debts which, if not collected, would add to hospitals' the legislation but, since it is a taxation measure, it is administered by the Treasurer and not by the Health running costs. Commission, except for the audit of patient declarations Both campaigns were mutti-media and featured a of insured status. "Heatthline" to handle phone enquiries.

Explaining rises in hospital costs _ twice within ten months

10 Regionalisation Proposal permanent head and the Commission to the Minister and Parliament. A draft organisation chart (Figure 1) is shown on page Regionalisation of Victoria's heaRh services was recommended by the Syme-Townsend Committee as the second stage in the Health Commission's Regions development. As a prelude, the Commission released a For effective administration and resource management, discussion paper, "Regionalisation of Health Services in the Commission proposes eight large regions: Victoria", in November 1980. This publication generated Non-Metropolitan: Five regions, as adopted by widespread attention, and subsequent feedback the Department of Education. included more than 150 formal submissions of varying size and complexrty. Metropolitan: Three regions, West, North-East and Southern. Armed with these submissions, plus the resuRs of its own researches, the Commission believes that the time Figure 2 (page 13} shows the proposed regional has now come when it should regionalise its boundaries, and Table 3 (page 11) gives the regions' administrative structure, the aims being: populations. • The improvement of its capacity to respond to Representation government policies and community needs. No formal arrangements for community representation • The promotion of more effective and better co­ have been formulated, although "service development ordinated use of resources. groups" relating to broad programs, on the New Zealand model, are considered to be a promising Structure approach. Successful establishment of regional The Commission's proposal is similar in many respects administration would open up many options to wider to the current re-organisation of the Education community participation. Department in that it is based on the delegation of as many as possible of the Commission's administrative Implementation functions to regional directors. These directors would, in The Commission plans to engage external consultant::; effect, become the line directors of the Commission and to work with Commission staff to formulate a detailed they would remain directly accountable through the and fully costed proposal.

Table 3: Populations of Proposed HeaHh Regions

Populations (June 1981) (Thousands) Non-Metropolitan: Region. 1 ...... ••...... 300.4 2 ...... •...... 167.3 3 ...... •..•...... •...... 217.2 4 ...... •...... 211.5 5 ...... ••...... 191.8

Metropolitan: Region 6 ...... •...... •.. 714.8 7 ...... ••...... 1,099.6 8 .•...... •...... •...... •...... 1,045.8

3,948.4

Source: Estimated resident population in local government areas Victoria, 30 June 1981 and 1976, (preliminary}. Australian Bureau of Statistics, Catalogue No. 3201.2

11 r::i Figure 1 Proposed Regional Organisation

CHAIRMAN HEALTH COMMISSION

Executive: Executive: ADMIN. PROGRAMS

COMMUNITY PARTICIPATION

PROGRAMS Public Environmental Health Hospitals & Special Services Mental Health Mental Retardation Care of the Aged Dental Services .2hildren's Seryices

TECHNICAL SERVICES

Personnel Building & General Services 2 Proposed Health Regions Non-Metropolitan Region 1

2

3

4 s

Region 6

7

8

REGION 3 REGION 2

REGION 4

REGION 5

w- Review of Tuberculosis Services Review of School Dental Services In September 1981, the Health Commission established a Working Party to examine both the present role of the Tuberculosis Branch of the Public Heatth Division and In November 1981. the Commission established an its relationship with other agencies concerned with the internal Working Party to review the present objectives detection and treatment of tuberculosis, and to plan the and performance of the Victorian School Dental future role of the Tuberculosis Branch in the context of Service, which is part of the Dental Heatth Services community requirements. Branch of the Public Health Division. The Working Party was asked to recommend This review was set up in line with the policy of the appropriate future objectives for the School Dental Health Commission of progressively reviewing the Service, and methods of achieving them. range of services for which it has a responsibility. In May 1982, the Working Party presented a report to the The main impetus for the review came, however, from Commission. The final report reflected the two major the substantial changes in recent years in the incidence, tasks tackled in the review. treatment and management of tuberculosis. There was concern not only that the service and its structures were Firstly, it contained a number of specific recommend­ no longer appropriate for current needs, but that the ations which resulted from the internal management allocation of resources to the area of tuberculosis was review of the School Dental Service. These excessive in the present economic climate. recommendations were aimed at improving the efficiency of the Service, and have been formally The Working Party has now presented its report to the Health Commission, which has adopted the report in adopted by the Commission. principle. The Commission is currently seeking the Secondly, the report contained recommendations views of persons and organisations with an interest in which addressed the need to co-ordinate and plan some aspect of the provision of tuberculosis services. A dental services on a long-term basis. A number of final decision on the implementation of the options for possible future directions of the School recommendations contained in the report will be made Dental Service were submitted for the Commission's once these comments have been received. consideration.

The Minister of Health, Mr. Roper, at the May launching of Dental Health Month.

14 The First Year of the Mental Retardation Developments Within The Planning Division Division Last year's report noted the emergence of a fourth line Division, the Mental Retardation Division. In its first year · of operation, an administrative structure was developed to implement policy, primarily that of retaining retarded A major development in the structure of the people in the community, including those people who Commission was the amalgamation ofthe Planning and have entered the community from institutions. Research Division with the Management Services Division to create the Planning Division. Six regional teams (two existing and four new) were developed to aid this process, helped by the allocation The new Division brings together staff and resources of fifty-eight new regional staff positions. The Division engaged in analytical research, the assembly of health­ was thus the only section of the Commission to gain a related data, and the operation of computer systems. significant increase in staff. The principal objectives of the Division are: Other developments included a major administrative • To provide objective, well-documented policy advice restructuring of the Children's Cottages, plans for the and program analyses based on long, medium and sale of St. Nicholas Hospaal (together with the relocation short-term assessments of needs, trends and of its residents in community houses) and the release of resource constraints. the discussion document, "The Protection of • To develop and implement computer-based Intellectually Handicapped Persons", which, among information and management systems and advise other things, recommends a system of guardianship. on electronic data processing strategies.

During .a Commission visit to Su.nbury Training Centre, the Chairman, Dr. Trevaks (right) and Comm1ss1oner Tucker (second "ght) chat with assistant director of nursing, Mr. Michael Cooper (left) and Mr. Errol Cocks, d"ector of the Mental Retardation Division.

15 The International Year of Disabled La Trobe Valley Smoking Control Project Persons The La Trobe Valley Smoking Control Project is the only At the close of 1981, the International Year of Disabled large-scale project of its kind operating in Victoria it was Persons, considerable progress had been made by the initiated at the community level and undertakes a State IYDP Committee in helping people~ all people regional approach to this specific health issue. it to "break down the barriers". receives some funding from the Community Health Program via the Hospitals Division. The identification of the barriers was a necessary primary task of the Committee, and the message from The Program is under the direction of a local Committee disabled people was clear they wanted the freedom to of La Trobe Valley residents plus two advisors from the control their own lives, the right to choose the type of Anti-Cancer Council and the Health Commission. accommodation which best suits their needs, and, A community campaign "Me Smoking? You've got to be above all else, an adequate income to make Joking!" was promoted to coincide with the La Trobe participation in community life a possibility. Valley Festival. Many local personalities and The Committee's recommendations on these and other organisations supported this campaign. The theme was topics are detailed in the book, ''Report on Victorian promoted through posters, showbags and radio and Activities: 1981 International Year of Disabled Persons" television advertisements which featured local sporting (available from the Victorian Government Printer). The personalities who projected a healthy non-smoking report also lists the IYDP projects undertaken during the image. Year, the people and organisations who took part, and, To influence young people, school-based programs happily, the fact that many local government IYDP were developed. The most ambitious to date is the peer­ committees have become reconstituted as permanent leadership program, which involved Year 11 students advisory committees. helping Year 7 students to resist peer group pressure. Also now permanent, the Commission is pleased to advertising and adult influence. This program will be report, are the Consultative Council on Rehabilitation evaluated by the Gippsland Institute of Advanced and the Disabled Persons Information Bureau, both of '::ducation. which were created in response to the Year. A smoking counselling and support program tor The Commission congratulates the State IYDP pregnant women was implemented in response to local Committee and shares its hopes for the improved doctors' concern at the very high incidence of pregnant futures of all disabled people. women who smoke. The Project is beginning to have an impact in schools and on the public generally. This is aided tremendously by local community support - individuals, companies and, in particular, the media

Health Promotion The Commission recognises the importance of preventive medicine and took measures during the year Limited Smoking in Enterprise House to enhance its health promotion services. The Commission feels bound to report that it A major initiative was the reconstitution of the Health implemented an "in house" health promotion measure Promotion Unit and the appointment of a senior health of its own -the restriction on smoking in certain areas education officer. The Unit, which has fourteen health of head office. promotion officers, arranges training programs for These areas lifts, conference rooms and a section of Commission staff and other organisations (including the cafeteria were declared "no smoking", as were advanced colleges) and maintains a resource list of many offices and other work areas where there was other health promotion agencies. consensus by the staff. A feature of the Unit's activity was the design and The restrictions were applauded by most and accepted "launching" of the "Heatthmobile", a caravan to take with understanding by others, to whom "stop smoking" health promotion into the State's market places. Its first courses will be offered. The measure was successful use was during Dental Health Month when the School enough to elicit enquiries from other organisations Dental Service used it to good effect in the Crty Square. contemplating a similar measure.

16 The Commission Chairman, Dr. Trevaks, explains the head office smoking limitations to the media.

Anti-Rubella Campaigns in Industry Acupuncture Concern During April, the Footscray City Council's HeaHh The Commission was informed of certain instances in Department, in co-operation with the Deafness Victoria of harm to patients apparently attributable to the Foundation and the Heanh Commission, conducted a practice of acupuncture. campaign which delivered rubella inoculations to more The information available to the Commission was not than 1000 women working in factories, offices and sufficient to establish whether there is a need for shops. This pilot trial was judged successful on the basis registration procedures or legislative changes to control that the women, many of whom would not have had the practice of acupuncture. However, the Commission natural immunity or have taken it upon themselves to is gathering further information to assess whether or not seek inocl!lation from the normal heatth sources, are the practice is causing serious medical complications now immunised against rubella. The success of this that warrant further action by the Commission. campaign has motivated other Councils to follow the lead given by Footscray City. Legislation 1981/82 The planning, promotion and delivery of future During the year, fourteen Bills introduced by or on behalf campaigns will probably proceed on lines similar to of the Minister of Health were enacted by the those of Footscray, with a request from a Council HeaHh Parliament. The Acts are: Department to the Health Commission for material assistance and to the Deafness Foundation for Alcoholics and Drug-Dependent Persons organisational aid and manpower. (Amendment) Act 1981 The Public Health Division has prepared "informed This Bill was introduced in conjunction with the Drugs, consent" forms in ten different languages, and Poisons and Controlled Substances Bill and the Medical guidelines for medical personnel on selection and Practitioners (Amendment) Bill as part of a legislative interview procedures. package directed at the drug problem in Victoria.

17 The effect of the Alcoholics and Drug-Dependent Environment Protection Act 1970 to reduce the Persons (Amendment) Act is to require any maximum lead content of petrol sold in Victoria from organisation or body conducting an alcohol or drug 0.45 grams per litre to 0.30 grams per litre. service to list the service with the Commission and to The reduced lead level will come into effect on 1 empower the Inspector of Treatment Centres to enter January 1983. the premises of such a service for the purpose of investigating a complaint. Health (Consultative Council on Maternal and A further amendment made to the Alcoholics and Drug­ Perinatal Mortality and Morbidity) Act 1981 Dependent Persons Act 1968 will require a person The object of this Act is to constitute within the ordered by a Court to attend a treatment centre under framework of the Heatth Act 1958 a Consuttative Section 13 to "seek and undergo treatment" at the Council on Maternal and Perinatal Mortality and centre in lieu of "seek treatment". Morbidity to replace the Consuttative Council on Maternal Mortality established under section 29 of the This Act had not been proclaimed as at June 1982. Heatth Commission Act 1977. Cemeteries (Guarantees) Act 1981 The functions of the new Council include the conduct of The object of this legislation is to amend the Cemeteries a perinatal data collection unit. Medical practitioners, Act 1958 to enable the Treasurer of Victoria to mid-wives, and proprietors of hospitals are required to guarantee borrowings by cemetery trusts. make available to the Council prescribed particulars in respect of births and still births in Victoria A minor amendment also made to the Act empowers cemetery trusts to fix fees for the purpose of historical Health (Private Hospitals) Act 1982 research of cemetery records. The main purpose of this Act is to strengthen section 182 of the Heatth Act 1958 following several successful Dietitians Act 1981 appeals in the County Court against decisions of the This Act represents a complete updating of the Health Commission to refuse its approval to plans and Dietrtians Registration Act 1958. specifications tor proposed private hospital develop­ lt establishes a new Board to be known as the Dietitians ments on planning grounds. Board of Victoria and makes a number of other changes The Act also makes some minor amendments to which have become necessary in relation to the sections 179 and 186 of the Principal Act. practice of dietetics in Victoria As at 30 June 1982, this Act had not been proclaimed Hospital Benefits (Levy) Act 1982 This Act imposes a levy on the basic hospital tables of Drugs, Poisons and Controlled Substances Act hospital benefits funds operating in Victoria. 1981 The maximum levy which may be prescribed under the This Act redrafts the existing law regarding the licit and Act is 40 cents per week for each single contribution. illicit use of drugs and other dangerous substances. Under the Act, persons covered by those funds which Among other things, the Act repeals the Poisons Act are subject to the levy (with the exception of persons 1962 and those sections in the Health Act 1958 relating entitled to compensation) are exempted from the to the cuttivation of prohibited plants. lt consolidates in payment of fees for outpatient services at public the one piece of legislation the various provisions hospitals. applicable to the use of drugs by medical practitioners and other authorised persons, and offences involving The act applies from 1 August 1982 to 31 July 1983. the trafficking in, and illicit use of, drugs of dependence Hospitals and Charities (Borrowing Powers) Act and narcotic plants. 1981 Provision is made for the seizure of the assets of This Act amends the Hospitals and Charities Act 1958 persons charged with trafficking offences and for the and enables the Treasurer of Victoria to guarantee the establishment of a Drug Rehabilitation and Research borrowings of incorporated institutions receiving or Fund. entitled to receive a subsidy from the Hospitals and The Act was not in operation as at 30 June 1982. Charities Fund. The Act is intended primarily to enable Government Environment Protection (Lead in Petrol) Act 1982 guarantees to be given for overdrafts and other The object of this legislation is to amend the borrowings by public hospitals.

18 Hospitals Superannuation (Amendment) Act 1982 Optometrists Registration (Amendment) Act 1982 The object of this Act is to facilitate the transfer of the This Act removes the prohibition in the Optometrists Hospitals Superannuation Act 1965 to the administration Registration Act1958 on the use of drugs in conjunction of the Treasurer. with the practice of optometry, increases maximum lt makes several minor but necessary amendments to fines under the Act, removes the requirement that a references in the Principal Act to "Minister". person must be at least 20 years of age in order to be registered, and adjusts the maximum fees which may The Principal Act defines "Minister" as meaning the be fixed on the recommendation of the Optometrists "Minister of Health". Registration Board.

Psychological Practices (Scientology) Act 1982 Hospitals Superannuation (General Amendment) This Act repeals sections 30, 31 and 32 of the Psychological Practices Act 1965. Act 1981 This legislation makes a variety of unrelated These sections, respectively, prohibited the use of a amendments to the Hospitals Superannuation Act galvanometer E-meter or similar instrument except by a 1965. registered psychologist or with the consent of the Victorian Psychological Council, prohibited the These include an extension of the powers of investment teaching, practice or application of scientology for fee or of the Hospitals Superannuation Board, provision for reward, required any person in possession of reviews of contributor's classifications, and for scientological records to deliver such records to the conversion of part of a pension to a lump sum. Attorney-General and empowered the Attorney­ General to issue warrants to search persons or premises for such records. Medical Practitioners (Amendment) Act 1981 This Act makes a number of amendments to the Other Medical Practitioners Act1970 dealing with the conduct Mhough not introduced by the Minister of Health, the of disciplinary proceedings against medical practitioners. Meat Control Act 1981 which amends the Abattoir and Meat Inspection Act 1973 also makes a number of The Act gives the Board power to impose conditions on complementary amendments to the Health Act 1958. the practice of a medical practitioner and removes the restriction which only allows the Board to act after the These amendments, in effect, make it an offence to sell receipt of a complaint. or prepare the flesh of a prohibited animal for human Among other things, the Act repeals the provision consumption. relating to the registration of specialists and empowers A prohibited animal is defined as being a mammal the board to grant registration without the need for a which is not an animal within the meaning of Section 2 of practitioner to personally attend before the Board the Abattoir and Meat Inspection Act 1973.

19 Public Health Division Services

Introduction . . • ...... • . . . . • ...... • . . • . . . 20 Early Childhood Development Program, the allied health professionals and Free Travel to Hospitals. Inspection Services • ...... • . • . . • . . • . . . • . . 20 The Clinical Services Branch is controlled by a deputy Clinical Services ...... • . . • . . • ...... 23 director of the Division. Inspection Services and Occupational Heatth . • . . . . • • . • . . . . • . . . . . • • . . 25 Occupational Health Branches each have assistant Dental Heatth • . . . . • . • . . . . . • . . • . . . . • . . • • . • . . 26 directors, who report to a second deputy director. Similarly, Pre-School Child Development and Fam1ly Pre-School Child Development . . . . • ...... • . 26 Services report to a third deputy director via assistant Family Heatth •....•..•..•...... •• 28 directors. Aboriginal Heatth • ...... • ...... • 30 Three other public health responsibilities, Aboriginal Health, Cemeteries and the la Trobe Valley Health Cemeteries Control ...... • . . . . . 31 Study, report to the Divison Secretary via an executive Senior Division Staff ...... • ...... • 31 officer. Inspection Services Branch Food recalls Introduction There were only two food "scares" of any moment The major organisational change this year was the during the year. The first involved salamis made by a recasting of the Public Health Division into six branches. local manufacturer; the second involved suspected Previously, there were eight. botulism in imported cans of salmon. Both resulted in The six branches, each administered by an executive the product being withdrawn from sale. officer, are Clinical Services, Inspection Services, In the salami episode, more than 250 people became ill Occupational Health, Dental Heatth, Pre-school Child due to salmonella infection. The infection was severe in Development, and Family Health. many cases and more than a few people were Clinical Services is reponsible for the Communicable hospitalised There were no deaths, however. Diseases Centre, the Tuberculosis Service, the Prison Health Service and the Government Medical Officer. Inspection Services controls food standards, the Health Laboratory, the Drugs, Poisons and Proprietary Medicines Unit, eqidemiology, special accommodation houses, past control, district health services, refugee screening, sanitation, water treatment, environmental health, the Plumbers & Gasfitters Board and the Cinematograph Operators Board. Occupational Health embraces industrial audiology, radiology, industrial chemicals and dusts, environmental chemicals, pest control operators, dangerous trades and radioactive materials. Dental Health is an unchanged branch. lt operates the Dental Therapy School and school and pre-school clinics and has responsibilities to handicapped children and children under the care of the Department of Community Welfare Services. Pre-School Child Development is concerned with the control of kindergartens, child minding and day care centres, and with the services provided by visiting J teachers, child development officers and pre-school advisers. Agnes Tan, a microbiologist at Melbourne University's Microbiological Diagnostic Unit, testing salamis for Family Health is responsible for the School Medical Service, infant welfare, family planning, audiology, the salmonella.

20 The salmonella outbreak demonstrated a need for a that the average mercury content remains over the Code of Practice in the production and marketing of statutory limit of 0.5 parts per million. certain foods. Such a Code, including "use by" or similar date markings, was the subject of several meetings A revision of the Regulations on mercury in fish has between representatives of industry and government begun. The new Regulations, when adopted, will make In February and April, more than two million cans of the enforcement of standards easier. North American salmon were withdrawn from sale following two botulism fatalities in Europe. The produce Laboratory analysis detected a number of contra­ from certain small canneries was destroyed; the ventions of various standards. These included remainder was cleared for sale. American and insufficient meat in certain meat-based foods, a Canadian authorities have promised closer supervision prohibited dye in a brand of children's building blocks, a of their canning procedures. "watering down" of an orange fruit juice drink, and more than thirty instances of foreign substances in foods. The Health Laboratory The continuing surveillance of pesticide residues in The Laboratory carried out its seventh survey of flake food indicates that these residues are generally well sold in fish shops. The results, detailed in Table 1, show below statutory limits.

Table 1 - Mercury in Flake - Average figures obtained from various surveys

Time of Survey Number of Average %above %above samples Mercury 0.5 p.p.m. 1.0 p.p.m.

August 1973 38 0.66 34 26 January 1975 24 0.68 54 25 June/July 1976 99 0.47 27 11 Nov/Dec 1976 92 0.57 35 15 Nov 1977-Jan 1978 87 0.65 41 24 September 1979 81 0.84 51 33 Sept/ Oct 1981 178 0.79 51 37

The Victorian Food Standards Commfttee water supplies is giving concern, so much so that a This committee approved several new standards during Health Commission/State Rivers/Board of Works the year. including one for date-marking of food. The committee was formed to investigate water quality. In committee also recommended that salami and other the meantime, when contamination is found in water fermented sausages be identified by batch numbers. supplies, the reticulation authorities are asked to advise The committee spent a good deal of time examining their residents to boil the water. In most cases, these authorities install chlorination plants. NHMRC draft uniform standards. One of them. on labels and advertising, was redrafted, and the revised text is Fluoridation funding was restricted during the year, but under committee consideration. both the Melton and Tongala Waterworks Trusts modernised their existing plants. The proportion of Proprietary Medicines Victorians served by fluoridated supplies remains at Before a pharmaceutical product for human therapeutic seventy-two per cent. use can be sold in Victoria, it must be registered as a proprietary medicine. There were 505 applications The Commission's water treatment section developed made to the Proprietary Medicines Advisory Committee reliable disinfection procedures on behalf of hospitals last year; 381 were registered. Last year, the numbers and other institutions requiring high quality water were 438 and 334 supplies. These procedures became necessary when it was found that Legionnaire's disease organisms Water Supplies and Treatment multiplied readily in certain cooling towers and warm The detection of salmonella organisms in many country water distribution systems.

21 Pest Control Program Night Herons; in animals, from Eastern Grey kangaroos The mosquito control program in northern Victoria in north-eastern Victoria. continued during 1981/82. This program involves General pest control measures were maintained and regular blood sampling of flocks of "sentinel" chickens complaints investigated. Rat infestation of waterfront for the presence of the virus that causes Australian areas was well controlled through surveillance and Encephalitis. With the assistance of the Agriculture baiting. Department, it also involves the trapping and testing of mosquitoes (36,000 last year) for the presence of the arbovirus. Special Accommodation Houses For the second time, the Army's 3 Preventive Medicine The upgrading of the Special Accommodation Houses Company spent two weeks with Commission and Section, together with the improved legislation reported municipal health staff surveying mosquito breeding on last year, has enhanced the quality of care for between Echuca and Nathalia. The 3 Company also residents in this form of accommodation. Section staff made serological collections from forty farms in the now function primarily as advisors to proprietors rather area, taking 605 blood samples from humans and than as inspectors gathering information for court animals. actions. Staff made 363 routine and 205 follow-up visits to Staff continued to check wildlife in an effort to find the premises. There were eight new registrations, 263 animal or bird reservoir of the arbovirus. To date, the renewals, and 155 complaints made. Only five court most consistent indication in birds is from Nankeen appearances were necessary.

Army and Air Force versus the mosquito. From left, Major Geoff Harrison (O.C. 3 Preventive Medicine Company), Captain Bob Fisher (who is chief health surveyor of Camberwe/1) Sergeant Terry Wyatt and Flying Officer Bernie Grealy (5 Squadron, RAAF) and Captain Graha,.;., Marty.

22 Clinical Services Branch

Medical Centre during their community nursing term. Trainees from other medical and paramedical organisations are accommodated whenever possible.

Publicity Community service tapes made and played by Radio 3XY were instrumental in raising young people's awareness of sexually-transmitted diseases. To cope with the response, a phone answering machine was The Communicable Diseases Centre required. Attendances The number of new patients attending the Centre over Another community outreach was the "lecture circuit" the past decade is shown in the following tabulation: - the Centre obliged as many as possible of the numerous schools and groups requesting speakers on 1970 4875 the topic of STD. 1975 8821 1980 11,054 Second Generation S.T.D. 1981 11,854 The main problem of the Centre is no longer gonorrhoea Jan-June 1982 6158 and syphilis but the so-called "second generation" The number of repeat patients for the past two and a half ST.D.'s. Examples of these are non-specific urethritis, years is also tabulated genital herpes, genital warts, trichomoniasis, gardnerella 1980 10,520 vaginalis and candida! infection. 1981 13,806 Non-specific urethritis is almost four times as common Jan-June 1982 8,046 as gonorrhoea, and genital herpes is far more common than syphilis - and appears to be increasing. Notifications To the public, genrtal herpes has become branded the The notifications received at the Centre for syphilis and "incurable" venereal disease, and it causes great gonorrhea over the past decade are shown in Table 2. distress in many patients. As yet, there is no cure.

Education During 1982, medical students from Melbourne Prison Health Services All prisoners entering Pentridge's remand section are University attended a training session at the Centre, screened for illness or injury, and it is policy to take emulating their colleagues at Monash University. histories of such conditions as asthma, bronchitis, heart Although this is a step forward in improving the disease, epilepsy and diabetes. performance of future doctors in this field, the students Doctors at Pentridge conduct daily sick parades and should receive more teaching than is currently attend emergencies, and they visit the high security available. divisions on alternate days or for emergencies. An innovation last year was the regular two-day Emergency cases out of hours are attended by local attendance by student nurses from the Queen Victoria general practitioners. Table 2: Notifications 1970 - 1982

YEAR M.C.D.C. GONORRHOEA TOTAL M.C.D.C. SYPHILIS TOTAL Rest of Rest of

1970 1,673 395 2,068 42 30 72 1975 1,120 531 2,241 67 109 176 1980 1,621 1,100 2,721 47 81 128 1981 1,441 833 2,274 56 111 167 Jan/June 1982 771 25

23 The Pentridge Hospital has twelve beds, but the high NotHicatlons occupancy rate warrants opening another three beds Notifications for 1981 totalled 380 compared with 392 for when staff becomes available. The hospital has an 1980 and 395 for 1979. outpatient service and X-ray and dental facilities. Consultant services, including surgery, gynaecology, neurology and radiology, have been introduced. St. Augustine's Ward at St. Vincent's provides specialist Screenings inpatient services when required. Patients are held here X-ray surveys screened 39,344 people and detected only as long as they require continuous medical fifteen cases of active TB. The Schools B.C.G. Section presence or immediately available consultants. visited 274 schools, screened 97.075 children and detected two cases. From 49,663 attendances at TB Country prisons are visited weekly by local doctors, as clinics, 39,535 X-rays were taken and 123 cases are the Langi Kal Kal and Malmsbury youth training detected. centres. Urgent cases are treated in these doctors' rooms or at nearby base hospitals. Tuberculosis SeiVices Hospital Admissions Services Review There were 316 admissions (225 males) to hospitals A full-scale review of the TB services was carried out and chalets. Discharges numbered 324 (233 males). during the year. Comment on this appears in the There were fourteen admissions and thirteen "Review" section of this Report. discharges at the Repatriation General HospitaL Table 3: Work of the Tuberculosis Branch. X-ray Surveys. 1979 1980 1981 Number screened 39,146 43.501 39,344 Active Tuberculosis 16 29 15 Schools B. C. G. Section. Number visited 247 294 274 Children screened 98,260 103,266 97,075 Cases of Tuberculosis detected 1 2 2 Clinics. Attendances 49,745 51,744 49,653 X-rays taken 35,802 38,235 39,535 Cases of Tuberculosis detected 147 130 123

Table 4: Active Cases of Tuberculosis, 1970 - 1981

YEAR NEW RATE PER RE-ACT- CHRONIC TRANSFERS TOTAL IVATED IN 1970 421 12.11 61 33 515 1971 416 11.78 23 19 458 1972 371 10.42 42 15 428 1973 369 10.25 38 10 417 1974 321 8.21 31 8 360 1975 291 (8)* 7.93 29 3 323 1976 311 (9) 8.30 31 4 4 350 1977 274(21) 7.23 25 7 4 310 1978 293(60) 7.67 23 4 4 324 1979 395(118) 10.27 18 3 9 425 1980 392(11 0) 1008 16 4 9 421 1981 380(93) 9.92 13 6 12 411 * Numbers in brackets refer to refugees. 24 Occupational Health Branch

Lead formulating pesticides, for organochlorine pesticides. As in previous years, the Branch was heavily involved in Five pest control operators had excessive amounts of testing people for lead absorption. Most tests related to dieldrin in their blood, although they had no symptoms of people occupationally exposed to lead. poisoning The Lead Workers (Medical Examination) Regulations 1973 provide for regular testing of people in lead related industries. Under these regulations, 2000 people were Urea Formaldehyde Foam Insulation regularly examined. A diagnosis of lead poisoning was There has been a great deal of publicity given to the made in seven people and a diagnosis of excess lead possible health hazards from formaldehyde released absorption was made in forty-nine people. from this material, and the Occupational Health Branch Lead poisonings occurred in workers from three has spent many hours trying to allay public anxiety factories and excess lead absorption occurred in about it There is a small but unavoidable quantity of workers from eleven factories. These factories covered formaldehyde released during curing, but if the foam is a variety of industries battery recycling, battery subjected to moisture or high temperature, it may break manufacture, can making, chemical manufacture, down and continue to release formaldehyde, to the solder and lead sheet production, and painting. great discomfort of the occupants of houses containing Generally, there has been a gradual improvement in it Investigation of the problem is made difficult because factory conditions. of the uncertainty about the level of formaldehyde to which sensitive individuals may react. Concern about health effects from lead in petrol continues. The Branch tested a number of parents and children, mostly from inner suburban areas. A combined study between the Health Commission and the Solvents Environment Protection Authority to assess the problem The Branch investigated 140 workplaces where of environmental lead in inner suburbs is being planned. solvents were in use. In three, officers found excessive exposure, and Mercury workers suffered some symptoms. Officers of the The Branch carried out 165 analyses of mercury in Branch made recommendations for the improvement of biological samples. Twelve people had absorbed ventilation systems and gave advice on safe handling of excessive amounts of elemental mercury through the solvents. occupational exposure to the metal, but none showed In one workplace, the improper use of solvent led to the signs of poisoning. deaths of two workers. The firm was prosecuted, found guilty of breaching the "Confined Spaces Regulations", Organophosphorus Insecticides and fined. The Branch carried out 559 investigations, and twelve people were found to have had excessive exposure to From our experience. it seems that the small-scale organophosphorus insecticides. Four of these, who had users of solvents, including printing works and paint no symptoms of poisoning, were workers in a flower shops, are still the main areas of concern. nursery where methamidophos is regularly sprayed. Five cases of occupational organophosphorus Pest Control Operators poisoning were reported to the Occupational Health A review of the legislation relating to pest control Branch. All five were poisoned as a result of spraying operators began. wrth the main purpose of the changes mevinphos. One man died after drinking mevinphos recommended to get businesses to improve their which had been stored in a wine bottle. training of operators and handling of chemicals. Surveys among farmers were done at Silvan (twice). A new list of commonly-used insecticides was prepared Geelong, Harcourt, Nar Nar Goon, Thorpdale, as a "guide to approved chemical usage' f:x pest Birregurra, Colac, Werribee, and the Vegetable Growers' control operators. Association Field Day at Frankston. In all, 281 farmers A slate-wide survey was made of all franchise holders in were tested in these surveys. one pest control company. Officers of the Branch took blood tests and investigated the storage and handling of Other Pesticides chemicals. The Health Laboratory analysed 90 blood samples, mostly from pest control operators or workers 25 Dental Health Branch Building Program The modified expansion program continued throughout the year. Concrete platforms for dental vans became Branch Services Review available at Winchelsea. Ocean Grove and Drouin as The operation of the Branch was thoroughly reviewed well as at seven new schools in the metropolitan area. during the year. Comment on this appears in the Two platforms were approved for Ballarat and two for "Review" section of this Report. Doveton. Tenders were let for the construction of fixed clinics at Moreland and Broadmeadows West. Field Operations The shortage of dental attendants limtted field Renovations neared completion at Footscray Dental operations and, on occasions, caused restriction and Clinic and air conditioning was installed at North Fitzroy cancellation of services. All dental therapists had to Clinic. work for considerable periods as nurses. Dental care was given to children on 330,014 Pre-School Child Development Branch occasions. In addition to topical fluoride applications The Pre-School Development Branch oversees a wide and dietary and oral hygiene instruction, over 195,000 range of services now available in Victoria for young fillings were inserted. children. Kindergartens offer 2v2 to 3 hour programs for children in their last year before primary school. Play Vacant dental chairs at the Dental Therapy School Centres provide much the same program in situations continue to be used for field services on a "by where enrolments are limited. Some Toddler Groups appointment" basis. Satisfactory attendances are operate for parents and children of 1 Y2 to 2 years who maintained, mainly from the eastern and southern meet with a pre-school teacher and infant welfare sister suburbs. for discussions and group experiences. State­ subsidised Day Nurseries provide for children from birth Dental Health Education to school age to receive all-day care by trained staff. There was growing emphasis in this area. The resource library was further developed, and regular visits Maintenance funding is provided in the form of subsidy, continued to schools, infant welfare centres, largely tied to salary costs to employers in the industry. kindergartens, etc. The increase in Branch expenditure reflects increases in award salaries during the year. The method of A mobile caravan display spent one week in the City payment of salaries to kindergarten teachers is Square. currently under review Officers of the Commission are examining a~ernatives and their advantages and Dental Cadetships disadvantages to all parties. A computerised program Two dental cadetship holders graduated in 1981 and for subsidy payments was devised and will be began duty as dental officers early in 1982. Six cadets implemented when funds are available. This program continue studies at the University of Melbourne and will will provide more accurate estimates and will speedily be available for work with the Branch after graduation. lt up-date revised estimates in the event of wage is expected that three will graduate in 1982 and three in increases, or other variations, and provide statistics and 1983. information required from time to time. Dental Therapy School Applications for grants for capital works. particularly the The 1982 cadet intake was again thirty. In December establishment of new services. outstripped funds 1981. twenty-seven students graduated and joined field available. While some new projects may be given operations early in 1982. The thirty cadets who began special priority, applications are usually considered in the two-year course in February 1982 are all continuing order of receipt. This means that some projects their studies. dependent on capital funding could not proceed. In addition to State-subsidised services, the Branch is Pre-School Dental Clinics responsible for the registration. supervision and Eighteen municipalities receive subsidies for the inspection of commercial child minding centres and the operation of pre-school dental clinics for the free administration of Federally-funded small-group child treatment of children under the age of six. During the care centres. Consideration is being given by the year. two additional sessions were qpproved for the City Branch to the need for changes to the child-minding of Frankston and reductions of one session each were regulations. Pre-School Advisers are currently accepted by Melbourne and Preston. collecting facts connected with this matter. 26 The National Data Base Collection for Children's Services, which was introduced in 1980, made a second collection in 1981, and a third is planned for 1982. lt is hoped that the Australian Bureau of Statistics will have useful statistics readily available concerning Early Childhood Services throughout Australia. The Pre­ School Child Development Branch continues to administer the collection for Victoria

The Pre-School Advisory Service has continued on a regional basis. During the year, re-allocations were made in line w~h the regional boundaries accepted by the Hea~h Commission. The number of regionally­ based Pre-School Advisers was maintained, but as no additional positions were made available, the work loads increased considerably.

Mr. Paul Mott, director of the Pre-School Child Development Branch.

Table 5: Wort<: of the Pre-School Child Development Branch

1979/80 1980181 1981/82 Enrolments 63,108 59,191 58,551 Total Staff 56 50 50 Capital Grants * 1 -State 700,000 661,522.07 1,074,187 * 2 -Commonwealth Child Care Projects) 578,416 594,475.24 43,729 $32,033,618 $35,867,107 $39,434,779 * 1 - Includes Infant Welfare Centres, Dual Purpose Centres, Day Nurseries. * 2 Includes Commonwealth Child Care Projects, as well as Pre-School Projects. (Note - no further Commonwealth Pre-School payments after 1981/82 for capital)

27 Education has become increasingly important in the work of the Visiting Child Health Nurse, and twenty-one types of group sessions are now available to clients. Family Health Branch Parenting skills is the most popular, and parents are particularly interested in learning more about relation­ ship techniques. There were 561 parent skills group School Medical Service sessions, 154 support group sessions for mothers, and The feature of the year was the pilot program of health 429 play groups. examinations of Preparatory Grade children. which Professional staff and nurses from the Eastern Divide resulted from a desire by many concerned people to and Central Gippsland E.C.D.P's held two camps in have children examined nearer to school entry. February for parents and children, and these provided The program was successful and showed no insur­ an excellent opportunity to teach parenting skills. mountable difficulties. nutrition, budgeting and home management. Consequently, the School Entry Examination will be developed as the standard health check for all children. lt will be conducted by school nurses wnh medical officers available to help. The major role of the school The Early Childhood Development medical officer will be the examination of children who Program may have disabilities or need special education. ECDP's, of which there are seventeen throughout the The nurses, medical officers and sessional paedia­ State, are regionalised networks of specialist resource tricians with the Service have developed closer staff working to promote the health and well-being of associations with Early Childhood Development Pro­ children. They are complementary to the more grams. The paediatricians act as consultants where traditional Pre-School, School Medical and Infant children with developmental disabilities are being \M:llfare services, and they play a co-ordinating role with considered for special programs. all child care services. The School Medical Service continued to provide health Established programs were maintained and new examinations and medical advice for kindergarten and programs introduced according to need. Some typical school-age children. The objectives have been: programs are Systematic Training for Effective 1. Medical examinations of all children enrolled in Parenting (STEP) courses, early intervention to aid kindergarten, and of those in day care and similar young mothers, unmarried mothers, and mothers with programs where there may be a special need for premature or disabled children, nutrition education, and these examinations. audiology, child development and dental screening. 2. Health examinations of school children in Grade 1 by nurses backed up by medical officers, and checks of children causing concern to teachers. 3. Medical examinations of children who may need Allied Health Professionals The allied health professionals dietitians, special education provision, and consunation with occupational therapists, speech pathologists. special teachers and psychologists about these physiotherapists, social workers, psychologists and children. audiologists spend the greater part of their time These activities were restricted by staff vacancies, but a working in E.GDP. programs as therapists, referral great deal was achieved as indicated in Table 6. Over agents and educators. 300,000 children were seen by the Service. DietHians Visiting Child Health Nurse Program The dietitians continued their "Healthy Habit" campaign During 1981/82, Visiting Child Health Nurses maintained aimed at improving the diet of Victorians, and they gave their principle of "one to one" contact with clients in the advice to many individuals and groups concerned client's home. Families in crisis firstly need intensive about nutrition in generaL Education programs were support, but as they become more self-sufficient, the delivered to pre-schools, infant welfare centres and need for frequent visits is reduced. There were 1075 other groups, and slide/tape programs on specific new referrals to nurses during the year. topics were written.

28 Table 6: Work of the School Medical Service 1980 1981 Pre-Schools attended 986 1,159 Primary Schools attended 2,024 2,005 Secondary schools attended 409 550 Special and Special Developmental Schools attended 50 44 Routine/standard examinations. Children examined (complete) in pre-schools 41,891 Routine examination Grade 1 37,540 74,686 79,431 Children reviewed: At time of screening visit in schools and pre-schools 52,063 55,690 Children examined on teacher referral: At time of screening visit to school and pre-school 27,198 25,140 Vision screened: Pre-schools 41,891 Grade 1, 4 and Year 8 179,383 206,982 221,274 Hearing screened: Pre-schools 41,891 Grade 1 37,540 74,686 79,431 *

*This total should be much greater than this, because any child reviewed for hearing or learning problems would also have a hearing test.

Parent contacts: Pre-school 43.828 School 37,175 74,172 81,003 Actions taken: Pre-school 6,090 School 16,490 22,580 Totals Children seen in kindergartens 41,891 Children seen in schools 259,322 301,213

Occupational Therapists Speech Pathologists The occupational therapists made 1690 consultations The main activity of speech pathologists was during the year. Most children were in the 2 5 year­ assessment and management of children with old group. Slow overall development was the condition suspected speech and language problems. Other most encountered (in 29 per cent) followed by the activities included education of teachers, parents and twelve per cent requiring parental support and 10.6 per infant welfare nurses, and a variety of developmental cent with social and emotional problems. programs for specific groups.

29 Physiotherapists Aboriginal HeaHh EC.D.P. physiotherapists made 5670 client contacts. During 1981/82, there were major changes in the There were 1938 clients and 1161 new referrals, most of provision of health services to the Aboriginal community which (54 per cent) came from infant welfare services. following the Report of the Working Party into Aboriginal Ninety per cent of clients were less than six years old, Health. and sixty-five per cent were less than three. Males An Aboriginal Health Resources Consultative Group outnumbered females in all groups. The major problems was established to advise the Minister of Health. This encountered were developmental delay (36 per cent) group has representation from Aboriginal medical and postural problems (28 per cent). services and organisations throughout Victoria. Physiotherapists in the State-wide polio and multiple A network of Aboriginal community-based, community­ sclerosis program treated almost 1000 clients. controlled medical services was established in Victoria Conjointly with their E.C.DP. counterparts, these with funds provided by the Commonwealth. "itinerant" physiotherapists also treated 1158 clients throughout the State, the major problem being slow The Health Commission's Aboriginal Hospital Liaison overall development. Officer Scheme began with sixteen Aboriginal staff in hospitals throughout the State. The new co-ordinator of Social Workers the Liaison Unit is Mr. Kevin Coombs, who was Social work staff recorded 532 consultations with child previously involved in the activities of the 'International service staff about particular cases, and 933 general Year of Disabled Persons' as the representative for liaison and project planning contacts. A great deal of the National Aboriginal Conference. time was spent developing community resources available to families with young children. In this area, a growing number of groups are calling on the social worker's skills in planning programs and activities. Audiology With the continuing co-operation of base hospitals, community health centres and the Education Department, a network of thirty-two audiology clinics operated throughout the State. A large number of these clinics are provided on a visiting basis to those areas not covered by a resident audiologist, thus enabling infants, pre-school and school children to be seen with a minimum of travel. Operating within the limits imposed by staff ceilings, the audiology program refined referral procedures to cater for patient demand. However, an increasing number of "difficult-to-test" patients resulted in a slight decrease in numbers seen during the year. Fewer referrals of infants with a sensori-neural loss of hearing appears to confirm the national trend that severe to profound losses of hearing in this age group are diminishing. Free Travel The free travel scheme, which began in 1955, continues to support pensioners and others of similar means who Mr. Kevin Coombs, co-ordinator of the Aboriginal are required to visit public hospitals for treatment by Health Liaison unit. providing free travel on public transport to and from hospital. Expenditure 1981/82- $272,109 Number of tram tickets issued - 166,324 Number of ra1l vouchers issued - 16,324 30 Cemeteries Control from a Treasury grant, contributions from a number of The condition of Victoria's cemeteries continues to local municipal councils, cemetery trust funds, and a improve with the development of lawn sections and the Treasury-guaranteed bank loan. greater accumulation of funds through the introduction Details of loans guaranteed by the Treasurer are of more realistic fees. Lawn sections are being required by Section 33 of the Health Commission Act established at Cobram, Cranboume, Dandenong, 1977 to be included in the Commission's annual report. Ensay, Grovedale, Kyabram, Omeo, and Violet Town Cemeteries. Traralgon Cemetery Trust - details of cunent The Cemeteries Act was amended to enable the guarantee Treasurer to guarantee loans taken out by cemetery The Loan - $120,000 trusts. This amendment also empowers Trusts to have a Terms and conditions of the Loan: fee approved for searching burial registers. The 1. The loan shall be advanced on or before 30 April Cemeteries Regulations were amended, firstly to allow 1982. the Health Commission to approve, with or without conditions, burials in graves with less than one metre of 2. The term of the loan shall be fifteen years. earth cover, and secondly, to enable burials in the 3. The loan shall bear interest at the rate of 16.0 per Islamic tradition to take place. The Government decided cent per annum. to withhold permission for the construction of 4. The loan and interest !hereon shall be repaid by thirty mausoleums and interments therein pending a full consecutive half-yearly instalments of $10,659.29 review of the situation. on 30 October and 30 April, commencing on 30 Investigations continued into the development of a October 1982. major metropolitan cemetery at Bundoora. The Cheltenham (New) Cemetery was extended and further extensions are in progress at Heathcote, Kyneton, Senior Staff, Public Health Division Lilydale, Quambatook, Templestowe and Traralgon. The Burwood Cemetery was closed to all burials except Director: Dr. Bertram McCioskey those in already purchased gravesites. The former Deputy Director {Clinical Services): Dr. Nicol Sloan Serbian Orthodox Private Cemetery at Elaine was Deputy Director (Inspection Services): Dr. Graham Rouch converted to a public cemetery. Deputy Director (Family Health Services): Dr. Wes Rouch Construction of the Traralgon Crematorium is expected to begin later this year. Funding for this project came Secretary: Mr. John Bennie

31 Mental HeaHh Division Services

Overview ...... 32 • The lack of adequate establishment for certain Works and Services Funding ...... •...... 32 categories of staff, e.g. student nurses. admin­ istrators, allied health professionals, cleaners and Communrty Mental HeaHh Services ...... • . . 32 domestic staff. Continuing Care Services ...... 33 The primary concern of the Division is that of nursing Psychiatric Nurse Education ...... 33 staff - unless there is a substantial increase in student nurses, a serious decrease in nursing manpower will Clinical Services - child and adolescent ...... 33 soon occur. And with service delivery needs increasing, Clinical Services - aduH ...... 34 the regional increase in students cannot be achieved Academic Development ...... 34 within the existing establishment. Administration ...... •...... 34 Works and Services Funding Alcohol, Drug & Forensic Services ...... 34 (Maintenance, Refurbishing and New Construction) Mental Health Legislation ...... 35 Works completed, or substantially completed, during the Mental HeaHh Research ...... • • . . . . . 35 year include the John Cade Admission Unrt at Royal Park Psychiatric Hosprtal, the Travancore Develop­ Senior Division Staff ...... • • ...... • 35 mental Centre, the remodelling of Ward F6 at Mont Park Hospital and the remodelling of Turquoise Ward at Mayday Hills Hospital, Beechworth. New works of reasonably large scope begun during the Overview year included: The use of mental health and alcohol and drug services has marginally increased over the previous year. To the Mont Park Hospital the remodelling of Ward MF1. period ending 30 June 1981, there were 16,400 Royal Park Hospital the remodelling of Bleuler psychiatric inpatient admissions (including 5200 Ward. residents at the beginning of the year) and 2700 Dandenong Psychiatric Centre - extension of inpatient admissions to specific alcohol and drug office accommodation. services. There were approximately 200,000 Mayday Hills Hospital, Beechworth- remodelling of attendances by 31,000 outpatients and 105,000 wards MB and M9. attendances by 3000 day patients. Larundel Hospital internal and external remodelling of Wards B and C. The operating budget for the Division in 1981 /82, including the communtty mental health program, was The level of funding provided in this program continues $120 million. The works and services program for the to be disappointing in view of the extensive need for maintenance and refurbishing of existing facilities and maintenance and refurbishing of facilities throughout new buildings was $7.6 million. the Division's hospitals and clinics. The major difficulties identified by the Mental Health The level of funding provided for ongoing maintenance Division that require urgent attention are: and minor works was disappointingly low in the light of the massive backlog of work. This shortfall in funding is • The continuing inequHable distribution of acute and exacerbated by the difficulty that the Public Works long-term services, particularly in the metropolitan Department has in achieving the level of expenditure area. allocated and in doing work in accordance with the • The lack of suitable alternative community Commission's priorities. accommodation and services for persons with If significant progress is to be achieved in upgrading psychiatric disorders. State psychiatric hospitals. there needs to be a large • The poor standard of buildings and furnishings and increase in the level of allocation provided, and there equipment. needs to be a review of the methods by which the work is carried out so that can be more expeditiously • The impact of staff ceilings and restrictive personnel commenced and completed. management and industrial practices on the Division's abilrty to more utilise resources to develop services, particularly community and Community Mental Health Services The development of more communrty health services outpatient services. has a high priorrty. 32 Many regions now have little, if any. community mental hospital perspective, thereby ensuring that nrnM;:>r·tcrl health services and, in many cases. the viability of staff needs of all psychiatric facilities are taken into existing clinics is under threat because of poor staffing consideration. The reorganisation should also increase and facilities. the capacity of the program to take more students and to enhance the educational content All of the ten nurse The inrtial community mental hea~h program provided for 284 positions. In the 1981 /82 financial year, the education facilities will continue to be used under the funding in the was $5.6 million. and the result overall co-ordination of the Principal Nursing Education was that could not be filled. In an Officers. The three regional schools of nursing are already service. this reduction had a severe Metropolitan and Eastern School impact on the effectiveness of the program. Education centres at need to develop community Royal Park Psychiatric Hospital mental health in the Outer Eastern and Outer Mayday Hills Hospital, Beechworth Western Sectors of the metropolitan area. this is a high Hobson Park Hospital, Traralgon priority for the Division for funding in 1982/83. Central Administration to be located at Royal Park. The Lalor Community Health Centre was officially by the Minister of Heatth on 6 November 1981. Western Region School centre a general community health and Education centres at community psychiatric service to the Shire of Whittlesea. This co-ordinated approach is in line with Lakeside Hospital. Ballarat Commission policy of integrating the delivery of health Aradale Hospital, Ararat services, thereby facilitating development of a more Bendigo Psychiatric Centre comprehensive range of services, a more efficient Brierly Hospital, Warrnambool approach to heatth service delivery and administration, Central Administration to be located at Lakeside. and more effective utilisation of resources. Muriel Yarrington School Education centres at Continuing Care Services Larundel Hospital The Division is developing a policy of continuing care for Mont Park Hospital people with psychiatric disability This policy recognises Central Administration to be located at Mont Park. that a growing proportion of the Division's long-term clientele now lives in the community and not in mental The objective of the reorganisation is to increase. institutions as in the past. lt also recognises the special subject to resources being available, the number of needs of these people for ongo1ng support, students (as at 30 June 1982) to about 600. rehabilitation, and shettered accommodation programs. As part of the re-organisation, an additional nine Nursing The continuing care pol1cy is a corollary of other Education Officers were provided. However. inability to Divisional (and Commission) policies which emphas1se recruit qualified personnel has progress in reg1onalisation, service integration, limited use of obtaining the full benefit of the reorganisation. and maintaining people in the community where possible. lt stresses the need for co-operation between a range of government and non-government service providers. Clinical Services - Child and Adolescent Construction of the new Travancore Developmental Centre was substantially completed and the Psychiatric Nurse Education reorganisation and the of services at the The psychiatric nurse education program was centre is proceeding following a reorganised in 1981 when the existing ten hospital­ reorganisation of the management based schools of nursing were reorganised into three Development of child psychiatric services was regional schools, each under the direction and co­ consolidated at the Austin Hosprral and a new service ordination of a Principal Nurse Education Officer. begun at the Sunshine Hospital. The reorganisation was designed to improve the The development of an adolescent unit at the Parkville planning and co-ordination of the program by adopting Psychiatric Unit also and the recruitment of staff a regional or area perspective rather than an individual to this unit is progress1ng.

33 Clinical Services - Adult ADFS gave priority to establishing the means of Inner Eastern Region Psychiatric Services at prov1ding consultative support to the voluntary sector Willsmere Hospital and to monitoring the work being undertaken in this field. 1982 saw the commencement of changing function for A State association, the Victorian Association for Willsmere Hosprtal. An acute unit of thirty-three beds Training in Alcohol and Drug Dependence (VicTADD) was opened in February in refurbished wards to provide was set up and lls committee includes representation the inpatient component of a regional service to the from training institutes, voluntary agencies and public Inner Eastern Region. In the first four complete months hospitals Its first task was to develop a core tra1ning of operation, there were 113 admissions. program for professional staff working in voluntary agencies The objectives of the Inner Eastern Regional Psychiatnc Services is to be involved as directly with the commun1ty Despite these developments, progress has been as possible. Links wrth local authorities and voluntary impeded in permission to and statutory bodies are evolving and, in particular, with the setting up of a Southern Metropolitan close links have been forged with Camberwell Clinic and Drug Dependence Unit in the St Kilda/South and Box Hill Hospital Consultant Psychiatrist sessions Melbourne reg1on as well as in the relocation of the are now held 1n the community at Doncaster and Smith Street Clinic, which is the only major detoxification Camberwell unrt in Victoria. Discussions have been held with various public Re-organisation of Metropolitan Regional to encourage the development of alcohol and Boundaries drug units within them and the first such proposals are With the opening of the Inner Eastern Regional now under consideration. Psychiatric Services, and the increase in facilities provided Footscray Clinic, catchment Amendments to the Alcohol and Drug Dependent areas for the large hosprtals and Royal Park) Persons Act were (not yet proclaimed) as a were reduced to more manageable proportions. The prelude to a full-scale review of the Act The major producf1on of the new metropolitan directory of amendment is that which requires all alcohol and drug psychiatric services also clarified regional responsibility agencies to be listed in a reg1ster held by the Health for psychogeriatnc assessments and extended care. Comm1ssion. This w1ll allow more effective monitoring as well as further planning 1n this tield. John Cade Admission Unit, Royal Park This unit was opened by the Minister on 12 May 1982. Administration The unit has thirty-two beds, of wh1ch fourteen are The continuing demands for management information dependency. and the devolution of certain administrative work has Considerable difficutly is being experienced in recruiting created a situation where hospital administrations staff to enable the unit to be fully used. At 30 June 1982 cannot now effectively meet the demands being placed only eighteen beds were in use. on them. During the year, a review of the administrative staffing of Academic Development hospitals was undertaken by the D1vis1on in conjuction A new of Director /Professor of Psychiatry for with the Personnel Division and the Public Service Larundel and Austin Hospitals has been negotiated and Board. The resulting proposals were given a high priority is currently under advertisement This will be the first in the Division's 1982/83 manpower estimates. formal major academic appointment to a State The computerisation of hospital payrolls is nearing psychiatric hospital in Victoria. completion and the computerisation of hospital trust accounts and the processing of patients pensions Alcohol, Drug and Forensic Services should be completed in the 1982/83 financial year. The Alcohol. Drug and Forensic Services (ADFS) again There is urgent need for a patient-information encouraged the development of community-based management system. The planning ol a computerised alcohol and drug services. particularly voluntary system should soon be completed, and its installation is agencies and alcohol I drug units in public hospitals. hoped tor by mid-1983. The number of non-government agencies increased, The Division has a large and diverse workforce and with twenty-seven receiving funding through the many facilities throughout the State, and there is an Commission. urgent need for an adequate personnel establishment

34 budget system so that the management of this Mental Health Division prepared a publication giving extensive resource can be more effectively carried out guidelines for research to the year 2000. Such a system would be a logical extension of the This publication selected from the seminar those computer payroll system, and the Division has given a papers and workshop discussions which put forward high priority to the development of this personnel significant areas where psychiatric research was establishment program required or where significant research was already The development of these programs, together w1th developing and needed further impetus. improved staffing at hospitals, should overcome the The Chief Psychiatrist of the Education and Research current difficulties faced in implementing a more Branch, Dr. Graeme Mellsop, left in 1982 to take up decentralised management-decision-making structure the Chair of Psychiatry at Wellington, New Zealand. in the mental hea~h service Mental Health Legislation The Melville Clinic Study A five-year evaluation of the Melville Clinic. a In December 1981, the Consultative Council for the community mental health centre. was completed by the Review of Mental Hea~h Legislation completed 1ts Mental Heatlh Research lnstrtute. report, The Council recommended that the Act be totally rewritten rather than simply amended so t'lat it better The 375-page evaluation, the most thorough matches the Commission's restructuring of the mental examination of a community mental healt'l centre so far health services. made in Australia, was published in mid-1982 and distributed wrthin VICtoria, Australia and overseas. The other major recommendations were the formation of Mental Health Tribunals to routinely review all adm1ssions and to hear appeals by patients against admission or continued stay and the formation of Senior Staff, Mental Health Division Guardianship Boards to provide appropriate control Director Dr. George Lipton over the affairs, if not the person. of a pat1ent who is unable to exercise such control himself. Assistant D:rector (Education & Research): Dr. Warren White Ass1stant Director (Alcohol, Drug & Forensic): Dr. Abe Kessell Mental Health Research Assistant Director (Clinical Or John Grigor Following the international seminar to celebrate the 25th anniversary of the Mental Health Research Institute, the Secretary Mr. Tim Daly

35 Hospitals Division Services

Introduction ...... 36 State where the need is greatest, these officers are links between Aboriginal groups and the institutions Community Heanh Directorate ...... 36 and professional care-givers. Ethnic Heafth Service ...... 36 • Home dialysis training Central Health Interpreter Service ...... 37 In conjunction with the Renal Unit of Prince Henry's Hospital, the Commission established a patient Community Health Resources Group ...... 37 training unit in home dialysis and continuous Patient Transport Services ...... 37 ambulatory peritoneal dialysis. Situated at the Burwood District Community Hospital, the new Apprenticeship Scheme ...... 37 facility will greatly relieve the increasing demand for Relieving Officers ...... 38 hospital care. Safety-in-Hospitals Courses ...... 38 • "Golden Staph" A strenuous effort was. and is, being made to deal Hosprtal Development Section . . . . • . . . . • • . . • . . 38 with the problems of MRSA methicillin resistant Private Acute Hospitals Section ...... 38 staphylococcal aureus the so-called "golden staph" infections. Extra funds were given to hospitals Objectives ...... 38 to maintain staff, equipment and other items and to Legislation ...... 38 improve isolation facilities and aseptic techniques. A committee of specialists continues to gather data. Registrations ...... 39 monitor progress, and advise all levels of the health Standards of Nursing Care ...... 39 system Extended Care Section ...... 39 Three services with State-wide responsibilities were given approval to expand to meet community needs. Discussion Document ...... 39 • Existing neonatal intensive care units received extra Public Education ...... • . 39 staff. Disabled Persons' Information Bureau ...... 40 • The Royal Melbourne Hospital received approval to open the State's third open heart surgery unit to Program of Aids for Disabled ...... 40 complement those at St. Vincents' and the Alfred. New Extended Care Facilities ...... • . . • . . 40 • The Bethlehem Hospital was provided with Staffing ...... • ...... 40 specialist beds to enhance rts service to patients with advanced neurological diseases. Annual Statistics ...... 41 Nursing Section ...... 41 Community Health Directorate Registration and By-laws Section ...... 42 The only new service to begin was the centre at Lalor, which is administered by the Whittlesea Community Advisory Committees ...... 42 Health Centre. Heanh Administration Scholarships ...... 42 This service is the forerunner of integrated community Senior Division Staff ...... 42 health programs it provides both general community health services and community psychiatric services (via the Mental Health Division) This co-ordtnated approach delivers more comprehensive. more efficient Introduction and more effective services. The Hospitals Division has followed the Commission's All other centres and services operated to maximum policy to rationalise services and to implement areas of capacity in providing the particular types of care specialised service. In the latter category, subjects required by thetr communities. receiving attention included: • The needs of Aboriginal communities Ethnic Health Service To increase the access of Aboriginal communities to The Ethnic Health Service, in its first year of operation, health services, fourteen Aboriginal hospital liaison provided multi-lingual health workers to health facilities officers were appointed. Working in areas of the and the community.

36 These workers instigated new developments in health New branch buildings were completed at Avoca and information and education. Activities included the Ferntree Gully, the latter largely paid for by Australian dissemination of information to Vietnamese groups in Safeway Stores Pty. Ltd. as a replacement for an existing hostels, the production of multi-lingual slide-tape property purchased for a supermarket development. No programs on breast cancer and nutrition, assistance to new branches commenced during the year, a health professionals in understanding the cuttural consequence of the development of more exacting factors involved in the treatment of migrant patients, and criteria to assess needs. the development of health promotion programs. Planning for the implementation of certain of the recommendations of the Report on the Mobile Intensive Central Health Interpreter Service Care Ambulance, prepared by Professor Lou Opit, The Central Health Interpreter Service continued to continued. The principal recommendation is the provide highly trained health interpreters to work with introduction of "Advanced Life Support" techniques and ethnic patients and health professionals in the field. equipment into all ambulances. The number of interpreters remains at twenty-two, but The Commission holds the view that helicopters have a the service was able to introduce a limited service in place within the ambulance services. However, their use three additional languages (Polish, Hungarian and is very expensive, and this use should be rationalised. Cambodian) as well as continuing in Arabic (including The logical role of the helicopter ambulance is the Lebanese), Chinese, Croatian, Greek. Italian, Serbian, transport of patients from areas not accessible to Spanish, Turkish and Vietnamese. ground transport and from areas of congested traffic. The Commission began processes that should Community HeaHh Resources Group ultimately lead to the merging of the Melbourne and This group provides consultancy, and support services Peninsula Ambulance Services into a single service for to health professionals in hospitals and community the greater metropoman area. The main objective is to health centres. increase efficiency in the use of resources. During the year, the Group provided assistance in staff The Commission continued to receive advice from its development programs in management, health Ambulance Advisory Committee, which underwent promotion and the establishment of objectives, priorities changes in membership and Terms of Reference, and and evaluation techniques. the various sub-committees and working parties. In addition, the Ambulance Consultant continued to Health promotion continued to be an important aspect provide specialist advice and assistance with a number of the Group's work Advice was offered on how to of projects. develop health education programs and how to promote health education by utilising the community's During the year, the Commission issued a completely many resources. revised Standard List of Ambulance Equipment and arranged bulk purchases of oxygen resuscitators, Assistance was given to specific health promotion oxygen decanting systems, and underground petrol activities and help was given to agencies involved with storage tanks, as well as making the annual audio-visual productions. arrangements for buying ambulances and bulk petrol. The Group continued to develop its central register of The Commission is represented on committees documented health education programs. This register involving ambulance authorities in each State and enables agencies to share their knowledge and Territory dealing with radio communications and expertise. ambulance design and construction. The objective 1s to optimise interstate compatibility in these important Palient Transport Services areas of ambulance work The Hospitals Division oversees the activities of the sixteen regional ambulance services in Victoria, with the Apprenticeship Scheme aim of improving the quality of care and transportation of The State Additional Apprentice Scheme commenced patients. in 1979 as a contribution towards alleviating youth The program to upgrade the standard of ambulance unemployment and meeting the requirements for skilled care by implementation of two-man crewing at regional tradespeople. headquarters stations was extended during the year at For 1981/82, the Hospitals Division was allotted 159 Horsham and Hamilton. positions for apprentices, and these were distributed to

37 seventy-seven general hospitals, hosprtals for the aged, consider how those needs may be met from the and ambulance services. Apprentices engaged resources available. In concert wrth the Building and covered ten trades and the full cost of wages and Services Division, facilities were assessed and, where allowances was met by the State Government appropriate. modifications or improvements recom­ mended. Relieving Officers Relief was provided on fourteen occasions for The Section co-ordinated and monrtored the progress managers' absences, including four periods of long of 106 maJor capital projects during the year. service leave. Government funds of approximately $37.7 million were provided for seventy-seven of these projects. the The regional relieving manager in the North-East remainder being financed from hosprtal resources. The Region provided all the necessary relief in that region. majorrty of these caprtal projects were concerned wrth Relief for radiographers and pharmacists was made upgrading or replacing existing buildings, plant and available on seven occasions for each service. equipment needed to maintain essential hosprtal-based services. Safety-in-Hospitals Courses In addition, the Section was responsible for the co­ An important contribution is made to safety in hospitals ordination of a program of minor works and equipment by the Country Fire Authority's Hospital Staff Training projects. A total of 988 projects, each costing less than Course. $50,000, was approved and allocated Government The course is held annually at the Authorrty's Training funds totalling $12.08 million. These projects were Wing at Fiskville near Ballan. The course covers two selected for funding from submissions made by days. hospitals, geriatric institutions and health-related The Commission encourages hosprtals to nominate charitable organisations throughout the State. In staff to attend the course. Twenty places have been selecting them, priorrty was given to patient safety and allotted each year since 1979, and engineers, care, maintenance and replacement of essential maintenance staff and managers have attended. equipment, and improved efficiency and cost­ effectiveness of services. Hospital Development Section The need for health services and the facilities from Private Acute Hospitals Section which they operate are continually changing in Objective response to changes in population, incidence and The objective of this section is to maintain. and where prevalence of disease, and patterns of treatment and necessary, improve the standards of patient care and care. The Hosprtal Development Section is concerned facilities provided in bush nursing hospitals, private with the rational development and maintenance of hospitals and private nursing homes. lt is a legislative facilrties in public hospitals to enable them to meet these requirement that these premises register annually wrth changing needs. the Commission and that they comply wrth conditions This involves. firstly, identifying the roles that hosprtals determined by the Commission. should play and the range of services they should To achieve and maintain a high standard of patient care provide. The Section is then concerned wrth planning wrthin the private hosprtal sector, section officers co-ordinating and monrtoring the progress of the various conduct regular inspections, investigate complaints and caprtal projects required to ensure that facilrties are accompany inspectors from the Building and Services adequate for those services. These projects include Division on inspections of premises. major and minor building and engineering works, and Since the inception of the Health Commission, the role purchase and installation of equipment of the Section has become that of adviser to the private This year, the Section continued rts systematic program hospital field as new and current operators and directors of visiting hosprtals to discuss their roles wrth thern and of nursing request support and advice in the conduct of to explore how the necessary services and facilities their establishments. may be developed. In the present climate of severe financial constraint, the emphasis was on the Legislation Considerable work was done on a review of Regulations redeployment and recycling of existing resources. relating to private hosprtals to ensure that every factor, At these visits. discussions were undertaken wrth including company ownership, will be taken into commrttees and staff to define each hosprtal's service account when registration is considered. These new population, identify the population's health needs, and Regulations should be in force soon.

38 Following several successful Court appeals against the adequacy. lt also addressed important issues, including Commission's exercise of its planning powers in relation assessment, education. manpower, legislation and to the location of private hospitals, the Health Act was regionalisation. altered to strengthen the role of the Commission in The discussion document was distributed widely in the considering private hospital proposals. field and eighty-six written submissions were received. Now, before a hospital can be established, the In addition, a forum was held during December 1981 Commission must be satisfied that the services when the views of many interested persons were intended to be provided, when added to those already recorded. available in the area, will not result in over-supply. Through this consultation, and with attention to opinions The Act was also altered to ensure that, among other from the field, the Extended Care Working Party things, the character and fitness of an applicant to completed its final report. This document, which operate a private hospital can be taken into account contains twenty-nine specific recommendations, when an application for transfer of registration, either to together wrth a timetable of priorities and costing of another person or to other premises, is considered by implementation, will be released soon. the Commission. Until now, this requirement applied The Commission commended the report as "a valuable only to applications for registration and applications for contribution to the development of an appropriate policy renewaL for the care of aged to disabled persons in the 80s". In Registrations accepting the general direction of the report, the Registrations of private hospitals are renewed annually. Commission noted that the co-operation of other When applications are received, the Commission authorities would be necessary for its full implement­ considers the state of the premises and any special ation. conditions, such as building requirements, that may be a condition of current registration. Public Education it is generally acknowledged that, during the last Two premises were de-registered during the year decade. there had been a marked change in emphasis because they were unable to meet the necessary in care of aged or disabled persons from custodial care conditions. to active rehabilitation and the promotion of health and Standards of Nursing Care independence. There remains a need. however, for There is a need for continued effort to improve the public education to promote an awareness of the standard of nursing care, and inspectors of the Section options and resources available and to bring about endeavour to support nursing staff in this aim. changes in attitudes and values. At present, staff/patient ratios are being maintained as To assist this objective, the Extended Care Section required under the relevant industrial awards. A conducted seminars for self-help groups, for senior shortage of qualified staff applying for employment in crtizens, and, on a regional basis, for local government the private nursing home area is, however, creating bodies whose home help programs. delivered meals problems. This srtuation may be resolved as more and senior citizens' centres make a significant nurses become experienced in Extended Care nursing contribution to the health and well-being of aged and through post-basic courses in public geriatric hospitals. disabled persons living at home. Extended Care Section The 25th Annual Extended Care Conference was held The Health Commission continued to develop services in December 1981. The Conference took as its theme for aged and disabled persons in Victoria through the 'The Barriers to be Broken", following on the motto of the Extended Care Section of the Division. The co­ International Year of Disabled Persons. Overseas and operation of the organisations and personnel providing local speakers contributed to a vigorous conference, the services is greatly appreciated, particularly in view of which was attended by more than 600 people. The 26th the severe financial constraints operating. Conference, hosted by The Queen Elizabeth Geriatric Centre, will be held during November 1982 at the Discussion document on extended care services Ballarat College of Advanced Education and will focus The highlight of the year was the release of the on "Practical Issues in Patient Care". The Health discussion document on extended care services. Commission recognises the invaluable support given to With the assistance of the Commission's Planning the Conference by Monash University Department of Division. the report provided comprehensive statistical Medicine and by Tattersalls in making available information and an analysis of services and their resources to sponsor overseas speakers.

39 Disabled Persons' Information Bureau Program of Aids for Disabled People The Disabled Persons' Information Bureau has The Programs of Aids for Disabled People (P.A.D.P.) has expanded tts service and expertise, and both this been operating for twelve months and approximately Commission faciltty and newly-formed Consu~ative 1500 people were assisted with aids and home Council on Rehabilitation are fortifying the Commission's modifications. Representations were made to the efforts on behalf of younger disabled people. Commonwealth Government to extend the scheme, Information Gathering and the Commission appreciates the efforts of the Gathering information is a major function of the Bureau. issuing authorrties in launching the program in Victoria. This is achieved by receiving newsletters, reports and New Extended Care Facilities news releases, and by attending commtttee and council Rehabilitation and aged care services will be meetings of relevant organisations. strengthened by the development of the two new Information is also being gained by maintaining a close extended care facilities at Bundoora and Eastern working relationship wrth influential people in the Suburbs, where building should soon commence. Both disability field (including the self-help, voluntary agency units will incorporate a day hospital and inpatient and government areas), by visiting centres, groups and accommodation for assessment and rehabilitation. activities, and by participating in seminars and Staffing conferences. All municipal councils/shires are The staff of the Extended Care Section is now at its full contacted for information on their local advisory complement. New staff made orientation and commrttees on the disabled, and directories of their observation visits to the major geriatric centres, services. voluntary organisations and other related facilities. Information Dissemination Routine field visits of Extended Care staff, and the Disseminating information is the Bureau's comple­ associated discussions with professional service mentary function. Primarily, this is done by answering personnel, allow invaluable exchange of information. In direct enquiries, which come to the Bureau at the rate of addition, a series of open forum days at each of the 4500-5000 per year, the great majority by telephone. geriatric centres began and will continue over the next Approximately 140 groups have been listed on the two years. much-sought-after self help group list. Also, lists of Within the Section, the important activities of advice to service provision agencies for the disabled, sheltered clients, discussions with professional personnel, and the workshops and activity centres were assembled. development of heafth services (for example, assisting Similar work needs to be done in other areas such as in the role definition of smaller country hospitals to rehabilitation, mental retardation, transport and ensure their appropriate response to community needs) accommodation. are continuing. Seventy people attended a seminar, "The Self Help Movement", organised by the Bureau in March 1982. This revealed much energy, innovation and co­ operative development in the self help area. A regular newsletter to the disabled field is the Bureau's outstanding need in the dissemination area. The Bureau has advised the Commission on many disability related issues, including attendant care, transport, an access advisory service, and aids supply. National Evaluation of I.Y.D.P. The National Evaluation of the International Year of Disabled Persons assessed that income security and the establishment of a national representative I advocacy structure were the issues of highest priorrty to disabled people. The clear and major achievement of IYDP was substantially increased community awareness of disability, and many initiatives of the Secretariat of the IYDP and its associated committees will need to be continued in a modified form.

40 Table 1: Annual Statistics, Extended Care Services, 1981/82 Senior Citizens' Centres 1980/81 1981/82 New Capital Projects 14 20 New Maintenance Subsidies 15 9 Increased Maintenance Subsidies 57 59 Municipalities assisting Centres 186 188 Centres subsidised (capital & maintenance) 342 348 Membership 53,346 55,130 Municipalities providing M.O.W. 151 161 Centres offering hot meals 132 139 Meals supplied weekly (a) At Centres 11,379 11,735 (b) "On Wheels" 51,766 56,190 Chiropody Centres offering service 171 170 Home Help Services Approved Services 212 212 Approved Private Transport 199 201 Supervisors Employed Full Time 79 78 Part Time 87 100 Honorary 43 28 Home Helps Employed Full Time 74 61 Part Time 1,237 1,156 Casual 2,959 3,263 -- -- 4,270 4,480

Cases Assisted 45,172 53,610 Hours of Assistance 2,347,382 2,449,003 Specific Home Help Service 1980/81 1981/82 Municipalrties participating 187 190 Orientated home helpers 607 644 Cases Assisted 2,381 2.528 Hours of Assistance 198,894 191,961 Commmunity Services Officers for the Aged Subsidies approved to: (a) Municipalrties 62 61* (b) Welfare Commrttees 1 4 Community Services Officer positions 112 116 *Three positions were cancelled in 1981 /82

41 Nursing Section Registrations Nursing Staff Establishments The number of institutions and benevolent societies General hospitals and allied services absorb nearly registered under the Hospitals and Charities Act at 30 e1ghty per cent of State Government health expenditure, June 1982 was 2291. During the year new registrations and the largest single component of that percentage is totalled seventy-five. These, in the main, were nurs1ng. organisations concerned with the health and welfare of the aged, the disabled and children. There were three During 1981/82, the non-expansion policy continued, cancellations of registration due to voluntary wind-up. except to a very limited extent in a number of areas of high priority such as neonatal intensive care and open heart surgery. Advisory Committees The Commission records its appreciation of the Some rationalisation and reclassification of staff invaluable continuing work performed by the members occurred intra and inter hospital, but it was not possible of the following three committees: to expand district nursing services in either country or metropolitan areas, despite the need • The Advisory Committee on Obstetric and Neonatal Equipment Post-graduate Scholarships • The Medical lmaging Advisory Committee. Post-graduate scholarships to the value of $700,000 • The Pathology Advisory Committee. were awarded by the Commission to enable senior nurses to undertake degree courses in Applied Science Heafth Administration Scholarships in Education, Administration or Advanced Clinical The Commission continued to promote the attainment Nursing, as well as in Community Health. of higher qualifications in health service administration by awarding fifty-nine scholarships in five courses: A variety of specialised post-basic and in-service • Certificate of Business Studies (Hospital Admin- courses are conducted in hospitals throughout the State istration) to up-date and improve knowledge. • Bachelor of Health Administration • Master of Health Administration Registration and By-Laws Section • Master of Health Planning Committees of Management • Master of Administration The system of appointing hospital committees ot management by the Governor in Council continued Senior Staff, Hospitals Division smoothly during the year, with 583 persons appointed to Director: Dr David Race fill vacancies. Chief Medical Officer Dr John Wiseman In line with the Government's wishes. procedures are Co-ordinator, Extended Care Services: Dr Tony Moore being developed to open up the committee selection Nursing Advisor Mrs Marion Shaw process and provide for employee representation. Co-ordinator, Hospital Development: Dr Patricia Wilkinson The Commission reported last year that public hospitals Secretary: Mr Vie Feehan and similar institutions with committees appointed by the Governor in Council are ineligible for Common­ wealth subsidies to nursing homes, hostels, sheltered workshops and like facilities. Consequently, there was much activity in establishing and registering new and eligible organisations and in the transfer thereto of assets held for developing such facilities.

Public Hospital By-Laws An internal review of the Commission's model by-laws for public hospitals was completed and a draft document drawn up. Submissions were invited from hospitals and related professional associations. Fifty submissions were received, and, following their review, the Commission's model by-laws for public hospitals will be settled

42 Mental Retardation Division Services

Introduction ...... 43 Establishment of Regional Teams Protection of retarded people ...... 43 Four new regional teams were established in 1981/82 and existing teams were supplemented. New regions Regional teams ...... • . . . . • • ...... • . . 43 include Barwon, Gippsland, Western and Westernport. Community residential program ...... 43 Fifty-eight new regional positions were provided, making a total of 130 regional staff. Desptte setbacks The voluntary sector ...... 43 associated with limits to the Commission's staff ceiling, Client data base • ...... • ...... 44 many of the new staff took up duty in their respective regions. Continuing limitations imposed by staff ceilings St. Nicholas project . . . • . . . . • • ...... • . . . . . 46 mean that a significant proportion of regional positions Vocational and recreational services ...... 46 remain vacant. Vacancies are tilled slowly and Training of direct care staff ...... 46 considerable pressure and frustration is caused to existing staff in trying to meet complex community North Kew Educational Centre ...... 46 demands. Liaison ...... •...... 46 Peter Belleville remembered . • ...... • ...... 46 Future directions ...... ••...... •...... ••. 46 Community Residential Program The Commission's community residential program was Senior Division staff...... 46 accelerated during 1981/82. Unlike the srtuation in 1980/81, the allocation was fully expended. The existence of regional staff and, in particular, the development of improved systems of program monrtoring and control between the Commission and the Public Works Department, contributed greatly to the improved program. To the thirteen houses obtained prior Introduction to 1981 /82 were added eighteen houses purchased. two in the process of construction and two in the The 1981/82 year was a difficult but exciting one for the process of lease, making a total of thirty-five. Each Division. In the lace of greatly increased demands on an house was staffed according to the needs of residents. organisation still in the process of early development, In total, this program will provide accommodation for the goodwill, dedication and enthusiasm of staff has more than 210 mentally retarded people. been remarkable. The Division is streamlining procedures to enhance its Over the year, the central organisation of the Division capacity to handle an expanded community residential was consolidated with the appointment of various staff program next year. and the establishment of a management framework for the Division's successful operation. The Division is now In-service training programs were arranged by the in a better posrtion to tackle the many challenges Division tor staff employed by the voluntary sector in facing it. community residential units.

Protection of Mentally Retarded People In December 1980, a commrttee was established to The Voluntary Sector examine the protection of mentally retarded people and The relationship between the Mental Retardation the preservation of their rights. The Commrttee Division and the voluntary sector continued to be of vital published a discussion paper on guardianship and used importance. The Director addressed a large meeting of this in a tour-month process of public consuttation, representatives from the voluntary sec;tor in April and which included a number of public seminars. The outlined the Commission's broad policies and committee is now revising the discussion paper in the approaches in this area. light of this consuttation and will submit a report to the A number of new regionally-based planning Minister of Health. committees were set up. Many of these committees The Division is examining the need for advocacy have submitted proposals for residential services, which programs for intellectually handicapped people and a have been incorporated into the Commission's budget study is due for completion towards the end of 1982. estimates.

43 The continuing development of broadly-based A major project at Woodbine Private Training Centre representative groups in the voluntary sector is an was conducted with very favourable resuHs. The essential element of the strategy to provide increased restructure of this centre saw the establishment of two community services. group homes. one funded by the Department of Social Five new aduH day training centres were established Security, the other by the EW. Tipping Foundation. In and construction began on a further three centres. The addition, a community residential unit was bought allocation for caprtal grants for day training centres was Agreement has been reached that the new complex will fully expended in 1981 /82. The current system and cater for no more than thirty-two residents. strategy of capital grants in this area is under examination. Funds provided for this program have declined in recent years but perceived need is great, as evidenced by a watting list for funds which is long and represents many millions of dollars. Through careful Client Data Base budget management, subsidies for more additional staff A computerised data base containing information on all positions than originally envisaged were made available known clients of the Division was established. Excluding to those centres with the greatest need. The Statewide approximately 3000 intellectually handicapped persons ratio of one teacher to 5.7 trainees still imposes a attending Education Department facilities, in October restriction on providing adequate staffing levels based 1981 there were 10,171 clients registered with the on need. Division. Tables 1 to 3 provide some descriptive During the year, two day training centres transferred to information on this population. The Division believes that the Education Department as special developmental these numbers are a significant underestimation of schools. those mentally retarded people in need of services.

Tobi1Cra e . 1en ts b)y o··r1g1n Estimated Known Percentage Population M.R.D. of (June 1979) Clients Population 1. METROPOLITAN Inner Urban 258,400 465 0.18 Western 396,130 - 625 0.16 North Western 237 320 609 0.26 Northern 350000 --- 948 0.27 Inner Eastern 411 500 692 0.17 Southern 376,000 887 0.24 Outer Eastern 360,510 909 0.25 Westernport 402,220 862 0.21 TOTAL 2,792,080 5,997 0.21

2.COUNTRY .. Barwon 195,040 369 0.19 Glenelg 98,940 348 0.35 Central Highlands 110,500 287 0.26 Wimmera 56,080 212 0.38 Mallee 77,270 2 0.20 Loddon Campaspe - 140,000 0.32 Goulburn 128,740 r 1 0.21 Upper Murray 77,020 166 0.22 East Gippsland 60,490 209 0.35 Central Gippsland 120,640 127 0.11 TOTAL 1,059,720 2,594 0.24 Ongin Unknown 1,580 STATE TOTAL 3,851,800 10,171 0.26

44 Table 2: Clients in Institutions by Age and Level of Handicap AGE GROUP LEVEL OF Over No HANDICAP 0-5 6-16 17-20 21-40 41-60 60 Information lfOTAL PERCENT Borderline 0 8 5 21 12 8 0 54 1.6% Mild 0 43 46 224 144 63 3 523 15.8% Moderate 2 142 144 591 322 122 8 1331 40.2% Severe 3 121 87 299 149 36 2 697 21.0% Profound 4 74 116 368 33 8 0 603 18.2% Other* 3 30 7 33 3 1 0 77 2.3% No information 0 6 2 14 6 2 0 30 0.9% TOTAL 12 424 407 1550 669 240 13 3315 100% PERCENT 0.4% 12.8% 12.3% 46.8% 20.2% 7.2% 0.4% 100% * "Other" includes: Unspecified Not intellectually handicapped Associated disorder only Not yet seen Average age= 32.7 yrs Table 3: Community-based Clients, by Age and Level of Handicap AGE GROUP LEVEL OF Over No HANDICAP 0-5 6-16 17-20 21-40 41-60 60 Information lfOTAL PERCENT Borderline 6 65 49 229 38 6 12 405 5.9% Mild 39 310 193 878 127 17 30 1594 23.2% Moderate 85 765 298 855 153 29 15 2200 32.1% Severe 30 277 85 203 41 3 5 644 9.4% Profound 19 98 28 38 7 0 0 190 2.8% Other 187 328 64 300 68 11 19 977 14.3% No information 28 205 99 356 75 8 75 846 12.3% TOTAL 394 2048 816 2859 509 74 156 6856 100% PERCENT 5.7% 29.9% 11.9% 41.7% 7.4% 1.1% 2.3% 100% Average age = 22.3 yrs

Mhough further analysis is required for a projection of vocational and recreational services are increasing and needs for future services, particularly residential and intensified by adverse economic conditions and high vocational, some broad conclusions are possible. unemployment. The client data confirms that the residents of Victoria's instrtutions are also ageing and are, on average, about ten years older than retarded The population of intellectually handicapped persons persons in the communrty They also tend to be more living in the communrty, many still with their parents, is handicapped. These factors -the growing community ageing. Wrthin a relatively short time, a large number will need for services and the realrty that more than three­ require residential services. The development of quarters of instrtutional residents have spent in excess communrty-based residential services is still at a very of ten years of their lives in instrtutions - will make any early stage and must be accelerated dramatically if significant movement of persons into the community a needs are to be met. For the same reason, demands for difficu~ and sensrtive process.

45 The Sl Nicholas Project arrangements for voluntary organisations. The Public An historical initiative of the Commission is the project to Policies Unit at the University of Melbourne is co­ sell St. Nicholas Hospital in Carlton and use the operating with the Division to establish mechanisms for proceeds to relocate residents into ordinary housing in the evaluation of services in the field of mental the community. An Implementation Committee with retardation. representation from the Public Service Board, Treasury, Constructive liaison between the Division, the the Public Works Department and the Commission was Education Department, the Department of Community set up to oversee the project. Welfare Services and the CommonweaHh Department This project is the first attempt to effect a major of Social Security continues. redevelopment of resources to provide services which will improve the quality of life of handicapped people and Peter Bellevllle Remembered provide additional services. Implementation of the The many Commission staff who knew Mr. Peter project is progressing carefully and with full consuHation Belleville, assistant secretary of the Mental Retardation with the large number of interested groups associated Division, were saddened by his death in October 1981 with the hospitaL after a long illness. To commemorate his service to the retarded, a new section of the WJ. Christie Day Training Vocational and Recreational Services Centre in Mildura was named "Belleville House". To more clearly describe the need for vocational and recreational services and develop the policies and Future Directions strategies required to meet those needs, the The following are high priority objectives for the next Commission established a small working party under twelve months: the chairmanship of the Division Director. The working • Provision of additional regional teams. party will report in late 1982. • Continued acceleration of the community residential program. Training of Direct Care Staff • Provision of additional vocational and recreational The Commission produced a manpower policy services. discussion document on the training of direct service • Establishment of a Consultative Council on staff in the Mental Retardation Division and the voluntary Intellectual Handicap. sector. lt was widely circulated throughout the field to • Devolution of further responsibility to the regional obtain feedback. Currently, a large proportion of direct level and development of appropriate systems of care staff working in the nine training centres run by the accountability. Division are untrained. • Further examination of guardianship legislation and the need for separate legislation for intellectual North Kew Education Centre, Children's handicap. Cottages, Kew • Further development of a manpower policy The North Kew Education Centre at the Children's encompassing all workers in the area. Cottages was passed over to the Mental Retardation • Development of a plan for the fUture of each training Division in 1982 from the Education Department and is centre. under the authority of the Chief Executive Officer. Addttional changes to the functioning of the Children's Senior Staff, Mental Retardation Division Cottages are occurring, with a movement towards Director: Mr. Errol Cocks creating a number of more autonomous communities Assistant Director (Regional Services): Dr. Erwin von within the centre. Bamburger Assistant Director (lnsautional Services): Mr. Don Liaison Crawford A Liaison Committee has been established between the Assistant Director (Resources Development): Mr. Bill Commission and the Department of Social Security to Myers examine matters of mutual interest, including funding Secretary: Mr. John Mclennan

46 The Planning Division Report

Introduction ...... •...... 47 Health Administration Workforce Study A study was undertaken to measure the size of the Administration workforce study ...... 47 components of the health administration workforce in Hospital planning ...... •...... 47 Victoria The study was linked with a similar exercise Grants Commission ...•.•.•...... 47 being conducted for New South Wales by Professor George Palmer and Ms Ann Stevenson of the School of La Trobe Valley Health Study ...... 47 Hea~h Administration, University of New South Wales. Index of hospital wage movements ...... 49 Resu~s of the study are available on request One Review of migrant hea~h services ...... 49 interesting finding relates to health administrators in Community health ...... 49 central administration, regional offices and treatment institutions in the two States. Mhoug h New South Wales Health manpower •.•...... •...... 49 has quite different organisational arrangements for the Morbidity data collection ...... 50 delivery of health services, the number of administrators per thousand population for the two States is Mental hea~h and mental retardation...... • • 50 approximately equal. Perinatal data collection unit ...... 50 With the possible introduction of regionalisation of health Computer systems ...... • ...... 50 services in Victoria, it is important to continue to monitor Health Management Services ...... 51 the health administration workforce so that there is up­ to-date information about both the number of health Senior Division staff ...... 51 administrators and their location. Hospital Planning Introduction The Division continued its involvement in the processes The Planning Division was established on 1 March 1983 relating to policy formulation and planning of hospital by amalgamation of the Planning and Research and services. Management Services Divisions. The main reason for During the year, a submission was prepared for the amalgamation was the Commission's view that planning of health services for Victoria would be presentation to the Senate Select Committee on Private Hospitals and Nursing Homes. The Division is also facilitated by the integration of other resources engaged predominantly responsible for the quantitative in analysis and assembly of data and management information. In addition, the increasing importance of assessment of applications for new and extended computer-based management systems was con­ private hospital facilities in accordance with the sidered to warrant the application of resources available Commission's guidelines for the estimation of need for hospital services. in a larger administrative unit The Division now consists of three branches, each with Following the changes to Commonwealth/State its own area of expertise, but with a capacity to financial arrangements, which became operative on 1 approach problems in an integraied way. The September 1981, the Division conducted a number of Information Branch is responsible for establishing and investigations related to public hospitals' revenue monitoring data bases and statistics for planning and raising capacity, which is a factor in determining management purposes, for advice on medical record financial allocations by the Commonwealth Govern­ systems, and for analysis of health manpower supply ment under the States (Tax Sharing and Heatth Grants) and future requirements. The Research Branch is Act responsible for research and policy analysis, which Commonwealth Grants Commission have a direct bearing on the planning process and The Commonwea~h Grants Commission was asked to individual health. The Management Systems Branch review the assessments contained in its 1981 Review of provides a consultancy service on management Tax Sharing Entitlements in the light of the systems and is responsible for the development and Commonwealth/State health grants arrangements that implementation of electronic data processing and other have operated since 1 September 1981. systems throughout the Commission and subsidised This Division collected extensive statistical information organisations. on institutional health services required by the Grants The scope of the Division's activities is indicated by an Commission in the course of the review and account of some of the issues in which it has participated in the preparation of health aspects of the participated. submission by the Victorian Government 47 A supplementary submission presented in January monoxide, photochemical oxidants and partic­ 1982 contained further material and an analysis ulate matter) and a series of selected health prepared by Dr. J.S. Deeble of the Australian National indicators: clinical symptoms of respiratory University on the effects of dispersion on hospital usage. disease; the presence or absence of pulmonary The Division also reviewed the factors and methods disease; measurement of pulmonary function; employed by the Commonweanh Grants Commission mortality from lung cancer and other respiratory and the States in assessing heaHh needs. diseases; measurement of incidence of lung cancer. La Trobe Valley HeaHh Study (b) Covering a span of fifteen years, the Study will The La Trobe Valley Health Study continues to be one of examine three cohorts of individuals, randomly the main epidemiological research efforts of the Health selected, from two areas of the La Trobe Valley: Commission. Staff of this Division and of the Public one centered around Traralgon, where the Health Division are closely collaborating. pollution levels are highest, and the other around Substantial progress towards the planning and Warragul, where they are lowest. Each cohort will organisation of the study prior to the start of data be made up of about 5000 individuals divided into collection in the field was achieved in the past twelve four sub-cohorts of equal size: two living in urban months. A pilot study involving four interviewers and and rural areas of highest pollution and two living about 100 households ( 155 individuals) was in urban and rural areas of lowest pollution. The successfully completed in- September 1981 in the number of people examined in the course of the central part of the La Trobe Valley. lt enabled the Study will be approximately 15,000. By means of investigators to verify that the health questionnaire to be a structured interview questionnaire and by administered in the main study was satisfactory and the measuring pulmonary function by spirometry, questions clearly understood by all respondents. In each cohort will be examined twice at an interval addition, the results of this preliminary survey indicated of five years, using the health indicators listed that: above. • The overwhelming majority (98%) of the individuals (c) The resutts of these two examinations will be interviewed are willing to participate in lung function compared to each other, using multiple testing. regression analysis to establish the presence or • Seventy-six per cent of the respondents have been absence of a correlation between exposure to residents of the La Trobe Valley for the past five the highest levels of the five pollutants listed years. (either singly or in combination) and the health • The prevalence of chronic bronchitis among indicators selected. At the same time, mortality respondents is eleven per cent. rates for lung cancer and other respiratory • The prevalence of smokers (32%) is essentially the diseases, and cancer incidence, will be same as that reported in other studies throughout monitored over the fifteen years' duration of the Victoria. Study, comparing rates in the Valley population • The method of data recording is adequate for key with those observed in the State of Victoria as a punching and transfer to computer tape. whole. At a public meeting held in Morwell in March 1982, a La Dr. Guy Lavoipierre at the controls of the lung function measuring equipment being used in the La Trobe Valley Trobe Valley Community Liaison Committee was study. elected to represent the views of the Valley population. The Chairman of the Committee sits as a full member of the LVHS Steering Committee. In June 1982, the Joint Chief Investigators, Drs. Douglas Rankin (Public Heatth Division) and Guy Lavoipierre (Planning Division) submitted a draft final protocol for the study to the Steering Committee. The main features of this draft protocol are: (a) The study will attempt to establish if any association exists between the levels of ambient air pollutants produced by the burning of brown coal (sulphur dioxide, nitrogen dioxide, carbon

48 Index of Hospital Wage and Salary still without special services, and ethnic diversity makes Movements it difficult to ensure that assistance is always available A study was undertaken to identify and quantify when required. movements in award salaries and wages in Victorian In July 1982, the Commonwealth Government hospitals. Labour is the major component of hospital announced its response to A.I.MA recommendations. costs and an index was developed using data from ten in the health sphere, it agreed to continue existing hospitals grouped into four classes (metropolitan funding arrangements for the Ethnic HeaHh and Central teaching; metropolitan other: country base; country Health Interpreter Services for another three years, other). Salary expenditure in the sample hosp~als followed by a further review in 1986. represented 29.4 per cent of salary expenditure in all Victorian public hospitals. Community Health From 1 July 1981, CommonweaHh funding for the Percentage increases in award wages/salaries in Community Health Program ceased As in previous payroll groupings (e.g. nursing; admin/clerical) were years, the Division compiled statistics on the operation calculated for each quarter since the beginning of of the Program during rts preceding year of operation. calendar 1980. For Victoria as a whole, the overall Regional analyses were made of staffing, services and weighted increases were estimated at 15.3 per cent in coverage. the year to 30June 1981 and 19.3 per cent intheyearto 30 June 1982. Reporting systems were further developed through consunations with field staff of community health Review of Migrant Health Services agencies and via the Community Health Information In early 1982, the Australian Institute of Multicultural System (CH IS), which is a computerised data collection Affairs (A.I.MA), undertook an evaluation of the system available for use by any community heatth implementation of recommendations made in the centre and presently used by thirty-four centres of Galbally Report on Migrant Services and Programmes varying sizes and needs throughout the State. it is (1978). As a contribution to the evaluation, the Planning designed to produce statistics, not computerised Division submitted a comprehensive account of medical records, and each centre receives its own services specifically for migrants provided by or through reports direct from Health Computing Services-Victoria the Health Commission of Victoria. These services Limited While CHIS has been designed to provide a include those which received Galbally-funding under standard set of information to enable comparable the Community Health Program. statistics for management and planning to be created Fifteen per cent of Victorian residents were born in non­ throughout the centres, it also provides flexibility in that English-speaking countries, and because both certain areas of the transactions are available for a language and culture may be obstacles to migrant centre to record information of interest to itself. health care, the Commission has expanded services in The Co-ordinating Group, consisting of users and staff ethnic health work and health interpreting. There are of the Commission and Health Computing Services­ now twenty-three ethnic health workers in Victoria, Victoria Limited, are investigating a complete based mainly in community hea~h centres, while restructure of the master file to allow more efficient seventy-six interpreters are either attached to individual access to stored data. This is likely to be implemented in institutions or working from the Central Health 1982/83 Interpreter Service. Both services have sought high Health Manpower working standards through qualification and training of personnel. In addition, the Commission operates certain Assistance has been provided to the Medical Board of public health services exclusively for migrants. These Victoria in the establishment of a computer-based include infant welfare in migrant hostels, and medical medical manpower data base in conjunction with the screening of all migrants and refugees who were not medical register. A summary of manpower statistics for examined before arrival. 1980 is included in the 1980/81 edition of "Health Service Statistics" and more detailed statistics have As the Galbally-funded Ethnic Health Service and been made available to academic researchers. A Central Heanh Interpreter Service had not long been similar data base for dental manpower was established established at the time of the evaluation, no firm for the Dental Board of Victoria. As well as providing conclusions could be drawn about their effectiveness or annual "snapshot" surveys of the medical and dental efficiency. However, the need for such facilities is professions, the data bases enable longitudinal studies unlikely to decline, atthough the predominance of to be carried out using data for a number of years. Staff specific ethnic groups may change. Many localities are on the Division continued to provide advice on medical

49 and nursing manpower issues. In particular, the Division Victorian Perinatal Data Collection Unit is providing research and secretarial support to a small The Consuijative Council on Maternal and Perinatal working party established to conduct a study of the Mortality has been responsible for the collection of nurse workforce. information about maternal and perinatal deaths for twenty years. This year, the Council was established Victorian Morbidity Data Collection under statute, under the new name of the Consultative In 1978, the Commission assumed the responsibility Council on Maternal and Perinatal Mortality and previously carried by the Australian Bureau of Statistics Morbidity with extended responsibility for the collection for the collection of statistics in Victoria on hosprtal of perinatal data for all births in Victoria The Council will admissions, and rt decided to base the collection on the collect statistics through its Victorian Perinatal Data existence of adequate patient records. While hospitals Collection Unit, for which the Division has administrative with qualified medical record staff already had good responsibility quality records, other hospitals were assisted by the Statistics from the Victorian system will be supplied to Section to develop unit records to facilitate the entry of the National Perinatal Statistics Unit, established at patient data to the collection. Public hospitals already Sydney University in 1979, which is responsible for using a computer system contribute to the collection by collating and analysing information about births on a the abstraction of the relevant data items, while other nationwide basis from data provided by the States. The public hospitals have been brought on to the Victorian establishment of a perinatal data collection system has Health Statistics System. Th1s provides data to the been a response both to wide concern about the morbidity collection and provides hospital diagnostic incidence of genetic defects and the need to generate and procedure indexes and statistical tables to the adequate epidemiological data to monitor and analyse Commission. the problem. During the year, more hospitals were brought into the Victoria commenced collecting perinatal data on all collections so that coverage is now almost complete in the public hospital sector. The remaining public births in the State on 1 January 1982 and has joined New South Wales, Queensland and Tasmania in hospitals will be brought into the collection before the contributing non-identified information to the National end of 1982. The next stage will be the inclusion of private hospitals, and the Commission is currently Unit. In addition to contributing data to the National Unit, considering methods of doing this. the Victorian Unit also undertakes more detailed analysis of the Victorian data and will compile a The Information Branch is receiving and processing a comprehensive congenital malformation register. This growing number of requests for data from the morbidity register will need to be supplemented by data sources collection. In general, the information is available to the other than birth information because it is expected that public with certain restrictions that protect privacy Plans only sixty per cent of major congenital malformations tor the regular publication of selected statistics are in will be noticed or recognisable at birth. Unit sources of course of preparation. Procedures for access are being addttional information may include perinatal death established and it is planned to prepare an explanatory certificates (already collected by the Consultative booklet for potential users. Council) and voluntary notifications from medical practitioners and infant welfare sisters. Other uses of the perinatal data include: Mental Health and Mental Retardation During the year, two medical record administrators were • The identification of "at risk" groups of mothers and seconded to the Mental Health Division to design new babies. computer and patient record systems for the State. • Analysis, interpretation and monitoring of trends in Detailed proposals were submitted to the Divisions perinatal diseases. concerned. • Analysis of information for the planning of perinatal health care facilities. Although there are to be separate systems for the two Divisions, they are similar. Each Division will have a computerised information system with a master client index as its core. To this information gained on first Computer Systems contact will be added admission and discharge dates, During the year, the greater part of the available contact and service information and diagnostic coding. resources was directed towards the enhancement ot The data will provide management, planning and the commercial systems to accommodate future cost statistical reports for Commission use. centre reporting requirements within the health industry

50 The implementation of the computer personnel/payroll A prospective change in emphasis by the Commission system was completed for approximately 11,000 staff from cash to accrual accounting has promoted a within hospitals and the Commission. The completion of detailed examination of the current Creditors/General this task provides a foundation for the further Ledger system to accommodate the changes in the development of reporting systems which will provide reporting format. The opportunrty was taken to consider automated assistance to all Divisions of the a complete restructure of the system, and Commission. recommendations will be circulated to users early in Initially, the implementation of the systems was directed 1982/83. towards the public hospital field, where a co-operative Health Management Services effort between hospital managements and the Com­ A wide range of work study projects was undertaken by mission resulted in the reconciliation of staff Health Management Services. Overall, a total of thirty establishments in cost centre sequence. The final individual studies commenced following requests from outcome was a common record of staff establishments eighteen client organisations. Of these, fourteen were for budgetary use by the management of both hospitals successfully completed and a number of others are and the Commission. This task involved the almost finalised. Two workload assessment schemes identification of and definition for some 44,000 positions. were operated on behalf of the Commission. and similar Despite lengthy discussions with most public hospitals, systems for other areas were investigated. considerable effort will still be required in 1982/83 as final minor adjustments are determined by hospitals. Senior Staff, Planning Division Yearly salary budgets are now generated by the Director: Or Richard Scotton computer system and continuously updated to provide Assistant Director (Research): Or John Ross an accurate record of salary movements, levels of staff Assistant Director (Information): Or Neil Powers employed and total salary expenditure. Systems Director: Mr Des O'Callaghan

51 The Personnel Division Report

Introduction ...... 52 • Reorganisation and reclassification of offices within Recruitment ...... • . . • . . . . . • . . . . 52 the Personnel Division. Staffing changes ...... 52 Apart from these organisational exercises, senior staff in the Personnel Division were involved in major Establishment amd Manpower ...... • ...... 53 classification reviews conducted by the Public Service Staffing statistics ...... • ...... 53 Board and Cullen Egan Dell, Management Consu~ants, of all First Division offices and Second Division Industrial relations ...... 54 administrative offices in the Public Service. Human resource development ...... • . . . . . 55 During the year, some important delegations were Personal records ...... • ...... • 55 granted from the Public Service Board to the Division. Senior Division staff...... • . . • . . • ...... • . 55 These effect speedier resolution of reclassifications of minor offices, temporary employment and amendments to advertised duties and qualifications of vacancies. The Introduction delegations were granted by the Board for a trial period. Manpower and financial constraints have continued to No problems arose during the trial period and dominate the activities of the Personnel Division. arrangements are underway for extension of the Since May 1978, the Division has been charged with the delegations, which should resu~ in speedier execution responsibility of providing manpower resources for new of the more routine elements ofthe responsibilities ofthe programs and services initiated by government out of Division. current establishment. In the past three years. it has provided several hundred people tor new programs by Recruitment redeployment of low priority positions to high priority The recruitment of qualified psychiatric nurses and areas. psychiatrists continues to be a major problem for the Commission. Significant reorganisation reviews were undertaken in During the year, a world-wide recruitment drive obtained the following areas: the services of qualified psychiatric staff for some • Provision of fifty-eight positions for mental country instttutions. retardation regionalisation programs. An Australia-wide recruitment exercise to obtain • Occupational Health Branch. qualified and experienced staff for the Mental • Nursing Education Services. Mental Health Division. Retardation Regional Program was also undertaken • Amalgamation of Royal Park and Parkville catering with some success. staff. Recruitment to vacant positions within the Commission • Adolescent Unit at Parkville Psychiatric Unit. has now reached such sophistication that fine tuning is • New nursing structure at Hobson Park Hospital. required to ensure that actual staffing levels are closely • New nursing structure at Travancore Developmental aligned with permitted staffing levels. A priority system Centre. for filling vacancies was introduced whereby Divisions • Review of offices in School Medical area are required to place a priority on vacant offices. These • Review of Aboriginal Health Section priorities are reviewed fortnightly. • Establishment of Internal Audit Section. • Review of Health Laboratory Services. Significant Staff Changes: • Review and reorganisation of offices for the Medical SENIOR PERSONS LEAVING THE COMMISSION. Board. D~ T. Cutler, Psychiatrist Superintendent, Travancore, • Review and reclassification of nursing positions in Mental Health Division. Hospitals, Mental Hea~h and Mental Retardation Divisions, and establishment of office of Principal Mr. A. Grypma, Regional Co-ordinator, inner-Eastern Nursing Adviser to the Health Commission. Region, Mental Retardation Division. • Reorganisation and reclassification of offices in Dr. D. Maginn, Deputy Director, Mental Retardation Cemeteries Section. Division. • Review of senior welfare and training positions in the Dr. P. Stretton, Government Medical Officer, Public Mental Retardation Division. Health Division. • Provision of additional psychologists and social worker positions for Travancore Developmental Dr. A. Verins, Senior Medical Officer (Pathology), Public Centre. Health Division.

52 Mr. D. Webb, Assistant Director of Personnel, Personnel Mr. A Harrison, Administrative Officer, Public Heatth Division Division. Dr. J. Harrison, Assistant Director (Inspection Services), Public HeaHh Division. SENIOR PERSONS COMMENCING WITH THE Ms. B. McRae, Nursing Adviser (Extended Care COMMISSION. Services). Hospitals Division. Mr. J. Bailey, Deputy Director of Personnel (Industrial Ms. P Montgomery, Program Evaluator, Mental Relations). Personnel Division. Retardation Division. Mr. P. Friend, Assistant Accountant, Finance Division. Ms. J. Norton, Manager (Organisation and Classifi-/ cation), Personnel Division. Mr. D. Hassam. Chief Executive Officer, Children's Cottages. Mental Retardation Division. Mr. D. O'Callaghan, Systems Director. Planning Division. Mr. M. Johnson, Co-ordinator of Programs, Mental Ms. B. O'Connell, Principal Projects Officer, Mental Retardation Division. Health Division. Dr. G. Lavoipierre, Medical Research Officer Ms. E. Ots, Supervisor of Treatment Services. Mental Health Division. · (Epidemiology), Planning Division. Mr. G. Ortmann, Hospital Accounting Officer, Finance Dr. N. Powers, Assistant Director (Information), Planning Division. Division. Mr. J. Sandlant, Administrative Officer, Finance Division. Ms. H Pritchard, Assistant Superintendent, Nursing Servtces, Mental Retardation Division. Mr. M. Taliangis. Assistant Director (Industrial Relations). Personnel Division. Mr. H. Reischel, Principal Nursing Education Officer, Larundel, Mental Heatth Division. Mr. P. Trot!, Senior Internal Auditor. Dr. E. F. C. Stamp, Psychiatrist Superintendent, Wtllsmere Hospital, Mental HeaHh Division.

SENIOR PROMOTIONS WITHIN THE COMMISSION. Mr. C. Arnold, Principal Projects Officer, Mental Establishment and Manpower The Division established a Manpower Section in the Retardation Division. latter half of the year with responsibility for collection and Ms. P Bollard, Administrative Officer, Planning Division. retention of essential staffing information used for staff Ms. P La Bonte, Assistant Superintendent, Nursing ceiling administration, manpower planning and Services, Mental Health Division. establishment control. The section has been engaged in evaluation of existing manual systems and has Dr. D. Bornstein, Psychiatrist Superintendent, designed a computerised establishment information Travancore Development Centre, Mental Health system driven by the recently-introduced EDP payroll Division. system. Dr. D. Bradford, Chief Venereologist, Public Heatth The new EDP establishment system will be staged in Division. over the next two years and will provide accurate and Dr. A Faulkes, Senior Medical Officer, Public Health regular reports for staff ceiling administration and Division. manpower planning. Dr. D. Goddard, Senior Medical Officer, Public Health An essential feature of the system will be inclusion of a Division, Occupational Health. computerised vacancy control. This will enable the Dr. J. Grigor, Assistant Director (Clinical Services), Division to accurately monitor all positions that are Mental Health Division. vacant or temporarily occupied. Mr. A Hall, Regional Co-ordinator, Westernport, Mental Retardation Division. Staffing Statistics Ms. 0. Harris, Principal Nursing Education Officer, The number of staff against ceilings employed by the Mental HeaHh Division. Health Commission as at 31 June 1982 was 10,773. 53 This staff is divided among the Divisions as follows: Hosprtals Heatth l Administration~

Mental Retardation

Head Office Mental Health Percentage of Division Number of Staff Total Staff 1981/82 1980/81 Mental Health 6,549 60.80 60.5 Mental Retardation 2,480 23.02 21.91 Public Heatth 1,314 12.20 13.81 Hospitals 81 0.75 0.58 Health Administration 349 3.23 3.2 (Central Administration and Service Divisions) --···--····------TOTAL 10,773 100.00 100.00 Mental Health Division (Head Office) 46* = 0.43% Mental Retardation Division (Head Office) = 60* 0.56% *included in total divisional numbers above.

The total number of staff by occupational category within unions pressed for increased salaries and improved the Commission and its divisions has not changed conditions. In a year of general salary movements, all significantly from that shown in the 1980/81 annual award salaries were increased, most more than once. report Notable features were: In November 1981, the Hosprtal Employees Federation Industrial Relations No. 1 Branch took strike action over salary claims. An The abandonment of wage indexation by the offer based on a market survey was accepted by the Commonwealth Conciliation and Arbitration Com­ union. Although this offer settled the disputes, there was mission in July 1981 meant that both employers and a general reluctance by health unions to embrace the unions had to adjust to a new industrial environment. In market survey approach and a number of claims an atmosphere of general uncertainty over the received subsequently reflected an attempt to see a appropriate wage fixing principles to be applied, and hospital community movement equal to the offer freed of the strictures of wage fixing principles, all heafih accepted by the H.E.F.(1 ). 54 The Royal Australian Nursing Federation imposed bans During the 1982 academic year, there was a significant and held protest meetings about salaries during increase in the number of Commission staff receiving January. Decisions by the Chairman of the Registered study assistance: Nurses Conciliation Board on 12 January and 11 March Full-time study awards with pay: 9 Nursing 1982 led to a settlement of the dispute. Administration, 4 Nursing Education, 1 Social Work, 2 A working party was established by the Public Service Science, 1 Education, 2 Community Health Nursing, 1 Board to review the possible introduction of a 38-hour Accountancy, 1 Master of Science, 1 Master of Public week for Public Servants currently working more than HeaHh. thirty-eight hours. Health Commission Scholarships: 2 Bachelor of Health During the year, the previous government, acting Administration for the 1982 academic year. 1 Bachelor through the Office of Industrial Relations Co-ordination, of Health Administration for one semester of the 1982 took an increasing interest in, and guidance of, industrial academic year, 1 Master of Administration. relations in public funded areas of the health industry. Part-time study leave wrth pay: 10 Post Graduate Since the election of the present government, this trend disciplines being undertaken by 20 officers, 24 Under continued. Graduate disciplines being undertaken by 114 officers. Personal Records Human Resource Development The Public Service Board developed guidelines to A residential weekend management planning seminar provide ready access by staff to their personal records was held during the year to provide senior management held in the Commission. These guidelines were widely wrth the opportunity to review the Commission's circulated throughout the Commission. To date, only a activtties and reach agreement on the focus for the few officers have made requests to examine their future corporate activities. Arising out of this program, personal files. the Commission took a number of initiatives over the sharing of information within the Commission, lt is expected that demands for access to personal files delegations, proposals to develop corporate planning, will increase significantly with the introduction of the and the creation of a network of human resource proposed "freedom of information" legislation. development committees within the Commission. Senior Staff, Personnel Division The Human Resource Development untt makes an Director: Mr. Pat Daly important contribution to the development of super­ Deputy Director (Personnel Services): Mr. Eric Yeatman visory I management skills of nursing administrators in Deputy Director (Human Resources Development): Mr. the Mental Health and Mental Retardation Divisions. Darryl Glasson Initiatives are being taken to develop appropriate Deputy Director (Organisation and Manpower): Mr. programs tor superintendents and managers at Leigh Harry hospitals and clinics in these Divisions. Deputy Director (Industrial Relations): Mr. John Bailey

55 The Finance Division Report

INTRODUCTION ...... •..... 56 HEALTH EXPENDITURE ...... 56 Public Hospitals Program ...... •....• 57 Non-Hospitals Program . • ...... 59 Community Hea~h Program ...... • . 60 Annual Vote Appropriations . • ...... 61 Mental Hospitals Fund • . • . . . . • ...... • 62 Capital Works ...... •...... 63 Government Guaranteed Loans . • ...... 63 SENIOR DIVISION STAFF ...... 63

Introduction volume of transactions involved. In spite of this, it was The Finance Division is responsible to the Commission possible to further develop five major financial reports: for the control and monitoring of all expenditures • The monthly capital works program reports. administered by the Commission. In 1981/82, these • The weekly expenditure and commitment reports. budgets exceeded $1 .5 billion. • The monthly reports on a program basis. The Finance Branch is involved with financial planning, • The half-yearly and annual financial reports. the budgeting of funds and the development of policy. • The monthly expenditure and commitment reports Other budgeting proposals, including all capital works on a Divisional basis. programs and the consolidation of all Estimates. are During the year, the computerisation of all country also Branch concerns. The Branch is a major link mental hospital payroll systems was completed. The between the Commission, the State Treasury and other Commission now has a uniform payroll system for all its government agencies and departments. employees. This system provides a base from which to The Accounts Branch plans, assesses and develops develop a fully-integrated personnel/budget manage­ accounting policies and procedures. lt maintains ment information system with minimal central controls. accounting records, prepares reports to management, performs the Division's electronic data processing, pays HeaHh Expenditure accounts and salaries, and collects revenue. Given the size of the Health Commission and the variety Public Hospitals Program of its functions, the demands on the Branch to produce Non-Hospitals Program timely and accurate management reports are considerable. To assist, the Branch uses two computer Community Health Program networks a Government Computing Service network Annual Vote Appropriations for financial recording and reporting, and a Hospitals Computing Services Ltd. network for payroll processing. Mental Hospitals Fund Both networks must be manually co-ordinated, an Capital Works inherently difficult task made more difficult by the huge Government Guaranteed Loans 56 Table 1: Expenditure by Administration and Line Divisions DIVISION COMMISSION PUBLIC WORKS TOTAL DEPARTMENT $M SM $M 1. HEALTH ADMINISTRATION Votes 23.6 23.6 Works & Services .1 0.3 0.4 Trust Funds 2.0 2.0 25.7 0.3 26.0 2. PUBLIC HEALTH Votes 69.2 69.2 Works & Services 1.2 0.3 1.5 Trust Funds 3.5 3.5 73.9 0.3 74.2 3. HOSPITALS Votes (excludes $521 M contribution to H&C Fund) 40.7 40.7 Works & Services 45.1 45.1 Trust Funds (Includes estimated Public Hospitals revenue S238.3M and Other Institutions $117.9M) 1146.5 1146.5 1232.3 1232.3 4. MENTAL RETARDATION Votes 43.8 43.8 Works & Services 1.6 3.2 4.8 Trust Funds 13.5 13.5 58.9 3.2 62.1 --······ 5. MENTAL HEALTH Votes 121.0 121.0 Works & Services 1.0 7.6 8.6 Trust Funds 122.0 7.6 129.6 TOTAL 1512.8 11.4 1524.2

HeaHh ExpendHure Appropriations and Special Appropriations contained The Commission's expenditure for 1981 /82 is tabulated within various Acts. During 1981 /82, $778.7 million was in Table 1 - Expenditure by Administration and Line spent from the fund under three programs the Public Divisions. it is worth repeating that the total exceeds $1.5 Hospitals Program, the Non-Hospitals Program and the billion. Community Health Program. The largest proportion of the Commission's expenditure Public HospHals Program is recorded through the Hospitals and Charities Fund. The public hospital sector is responsible for sixty per This fund receives most of its income from the Annual cent of all Health Commission expenditure. 57 Table 2: Public Hospitals Recurrent Funding

1979/80 1980/81 1981/82 $M $M $M Gross Operating Costs (G.O.C.) 714.7 803.5 922.6 Revenue 171.6 171.2 236.1 Net Operating Costs 543.1 632.3 686.5 Commonwealth Payments 271.5 316.1 303.5 State Payments 271.6 316.2 383.0 Increase in State n"''m''nr" 44.6 66.8

Table 2 shows the resuHs for years 1979/80 and 1980/81. For 1981/82, the amounts shown are the approved gross operating costs and reported actual revenue received. Major changes were the reduction in Commonwealth The table also clearly shows the effect on the funding of payments and the resunant increase in State payments public hosprtals following the termination of the and revenue collections. Table 3 shows the changes Commonwealth/State Cost Sharing Agreement recorded between 1980/81 and 1981 /82.

Table 3: Changes in Payments and Revenue, 1980/81 to 1981/82. Amount % $M Commonwealth Payments fell by 12.6 4 State Payments increased by 66.8 21 Revenue Collections increased by 64.9 38

In the table of Expenditure by Administration and Line This wage explosion began to affect the liquidity of Divisions (Table 1) estimated public hospital revenue is hospitals when the provision for awards in the Budget shown as $238.3 million. This is the Treasury estimate was fully allocated and there was no automatic release upon which the net operating costs for the year were of additional funds by Treasury to meet increased salary funded. The Public Hospitals Recurrent Funding table costs. Late in April1982, Government policy changed (Table 2) shows the 1981 /82 revenue as $236.1 million, and funds were provided to meet all award increases. which is the reported but as-yet-unaudited actual revenue collections for the year. Revenue Gross Operating Costs (G.O.C.) The new Commonwealth funding arrangements With the introduction in 1981 /82 by the Commonwealth required new procedures to be initiated in patient of new health grant arrangements embracing the user­ classification and fee structure in public hospitals. The pays principle, it was evident that there would be no application of the user-pays principle placed the onus of relaxation of the tight financial constraints of the funding the hospital system back on the State and previous year. consequently forced the Victorian Government to To assist hospital managers in controlling costs, the increase patient fees from 1 September 1981 to raise Commission received the former Treasurer's approval additional funds. to issue interim G.O.C. budgets to hospitals (in July The Commonwealth payments made were based on 1981) for the first time. This Budget was revised when Canberra's assessment of the States' capacity to raise the State Budget was brought down. additional revenue of $80 million in 1981 /82 by raising The full-year cost of wage awards granted in 1981/82 public hospital bed day charges, applying an outpatient amounted to some $98 million compared with $78 charge for each occasion of service, and charging the million in the previous year, an increase of $20 million. average bed day cost of the previous year for

58 compensable patients. Using this crrteria, the State Reporting and MonHoring Budget aimed at a total revenue target for the hospitals The accountability of public hospitals has been a to $255.6 million. concern to the Commission and hospital managements in recent yAars. They generally agreed that, without the means to compare the actual cost of services aqainst a In October 1981, hospitals were requested to supply "standard" cost, cash basis reporting was inadequate. revenue estimates to 30 June 1982 based on Information systems were also inadequate - they September and October experiences. Their estimates could not demonstrate whether programs and goals of $239.9 million were some $15.7 million below the had been set Or, if they had, whether those goals had target imposed by the Commonwealth and confirmed been achieved in the most effective and cost efficient the Commission's view that the Commonwealth had way. over-estimated the extra revenue-raising capacity of Last year's Annual Report mentioned the development Victoria. By early March, the liquidity of many hospitals of an output-related accrual accounting and budgeting had reached a critical level and this was essentially system. 1981 /82 saw the introduction ofthesystem into attributable to the under-funding by the Commission of all public hospitals. award costs and the shortfall in revenue collections. Further revenue estimates of $226.1 million received To help the Commission develop criteria for analysing from hospitals in March 1982, based on five month's budget submissions, forty-two hospttals provided "cost actual experience, shows a shortfall of $29.5 million in centre" and "unit cost" information. When the newly­ the CommonweaHh's assessment. designed Annual Accounts tor 1981 /82 are received from all hospitals, the Commission will use unit cost details as a guide towards more equitable distribution of Despite repeated advice about the serious liquidity resources. problems existing in Victorian hospitals, the The new system does not interfere with the cash Commonwealth deferred its decision on Victoria's claim reporting system, which is still in use. However, the for additional funds of $17 million until late June 1982. Commission's aim is to have total dependence on Against this claim, the Commonwealth approved accrual budgeting together with cash flow monttoring supplementary funding of only $3.8 million, thus forcing and the capacity to compare hospitals on a unit cost the State to finance the difference. basis.

Non-Hospital Programs - Hospitals and Charities Fund Funds amounting of $93.9 million were paid to or on behalf of registered institutions in the Commission's non-hospital programs (see Table 4). Table 4: Funding of Non-hospital Programs Program Gross Cost Revenue Net Cost Grant $M $M $M $M State Nursing Homes 107.5 68.4 39.1 39.1 Charitable Institutions 40.0 19.7 20.3 19.9 Ambulance Services 40.5 24.9 15.6 14.7 District Nursing Societies 8.7 4.8 3.9 3.8 Blood Transfusion Service 7.4 1 7.3 7.3 State Matching Grants for Paramedical Services and Visiting Nurses (other than above Societies) 2.2 2.2 2.2 Central Office Payments 4.3 4.3 4.3 Minor Grants under $1 million 2.8 1.8 2.6 213.4 117.9 95.5 93.9 Payments in 1981 /82 of $93.9 million were $20 million more than the 1980/81 sum of $73.9 million. This $20 million (27.1%) increase is reconciled in Table 5.

59 Table 5: The Increase in Non-hospital Grants $M Salary Awards 17.5 Cost of living increases on non salary items 6.1 Approved expansion of services 2.4 Special increases including prior year adjustments 4.9 30.9 Less increases in revenue 10.9 Grant increase 20.0

Operating budgets from 165 institutions funded under the programs were received. Each budget was assessed for its approved health care components, for it is against these components that grants are made.

Community Health Program In 1981/82, the Commission paid $35.2 million under the Community Health Program against an initial allocation of $34.3 million. Table 6 shows the major elements of this expenditure.

Table 6: Community Health Expenditure, 1981/82 Allocation Payments Increase $M $M $M General 33.7 34.5 0.8 Ethnic Health 0.2 0.2 Translators 0.4 0.5 0.1 Total 34.3 35.2 0.9

The extra sum of $0.9 million paid during the year meet outstanding deficits and cost increases, resutted from a change in Government policy on the particularly in the area of wage awards, to maintain the funding of the Program. In line with the Commonwealth viability of the Program. policy of increasing the 1980/81 expenditure by some The extra funds were absorbed by projects ten per cent, the State provided the Commission with an administered by the Hospitals Division. Projects initial allocation of $34.3 million for the total program in administered by the Public Heatth, Mental Health and the form of a block grant. Mental Retardation Divisions were not able to take advantage of the extra funds due largely to the fact that Under the conditions of the block-funding policy, the public servants staff almost all of their projects. These Commission had no recourse to extra funds for the positions, in addition to taking longer to fill, are also Program to meet any cost increases in wages or other subject to staff ceilings imposed on the Commission in items during the year. 1981 /82. Mhough the Commonwea~h maintained its funding to In Table 7, the 1980/81 payments on the total program the State on the initial basis, the State changed its block­ by the various Divisions are compared with the 1981 /82 funding policy and increased the initial allocation to payments.

60 Table 7: Community Health Payments - by Division 1980/81 1981/82 Payments Payments Increase $M $M $M % Hospitals 19.8 23.1 3.3 16.7 Public Health 5.5 5.9 0.4 7.3 Mental Health 5.1 5.6 0.5 9.8 Mental Retardation 0.5 0.5 Planning 0.1 0.1

Total 31.0 35.2 4.2 13.5

Annual Vote Appropriations Total funds of $246.9 million were appropriated to the Commission under 115 individual vote items in Budget Document No. 4, ''Estimates of the Receipts and Payments of the Consolidated Fund for the Year Ending 30 June 1982". Supplementary funds totalling $11.2 million were approved during the year. Expenditure of $258.1 million is compared in Table 8 with the original allocation of $246.9 million. Table 8: Annual Vote Expenditure Allocation Expenditure Variance $M $M $M % Health Administration 11.4 11.8 0.4 3.5 Public Health 62.2 63.4 1.2 1.9 Hospitals 18.3 18.0 0.3 1.6 Mental Retardation 40.6 43.9 3.3 8.1 Mental Health 114.4 121.0 6.6 5.8 Total Commission 246.9 258.1 11.2 4.5

The major components of these funds were allocated for anticipated wage and cost increases during the year. under: Extra funds needed to maintain existing services had to be sought by way of an application for a Treasurer's Salaries and payments In the nature of Salary Advance for each vote item as appropriate. These included salaries, overtime and penalty rates. and payments in lieu of long service leave. General Expenses These included expenditure on administrative items for Comments on Divisional Variances travelling and subsistence, office requisites, books and Additional funds were sought under each Divisional publications, postal and telephone charges, motor Salaries Vote to cover the cost of wage award increases vehicle expenses, fuel. light and power, incidentals, not included in the original allocation. stores and provisions, and medicines and drugs. The Public Health and Hospitals Division experienced Other services smaller variances due to savings in the areas of the These included the payment of grants, subsidies and School Dental Scheme and Private Hospitals Schools of Nursing. contributions towards the operating costs and expenses of outside organisations. The Mental Retardation and Mental Health Divisions' In line with Treasury practice, these funds were variances were comparatively high due to additional appropriated on the basis of known wage and other funding to cover the reimbursement of pensions to costs. This means that no allocation had any allowance pens1oner pat1ents. 61 Other Vote Items In addrrion to the $246.0 million just mentioned, $539.4 million was appropriated under four other Votes. The expenditures under these Votes form part of the Commission's total expenditures. They are detailed in Table 9.

Table 9: Expenditures from Other Votes Appropriation Expenditure Destination and Program $M $M 501.0 521.0 Contribution to the Hosprtals and Charities Fund. Expenditure from the Fund may be to the Public Hospttals, Non-Hospital or Community Health Programs. 20.1 22.7 Cancer Institute- running expenses. Expenditure on the Cancer Institute forms part of the Public Hospitals Program. 12.1 12.1 Community Health Projects operating costs of Public Health, Mental Health and Mental Retardation Division. For further details, see the Community Health program. 6.2 5.8 Heatherton Hospital running expenses. Expenditure on this hospital forms part of the Public Hospitals Program.

Mental Hospitals Fund This Fund is financed by Special Appropriations under the Tattersalls Consuttations Act No. 6390. A comparison of the expenditure of $13.4 million and the allocation of $13.8 million is shown in Table 10. Table 10: Mental Hospitals Fund Expenditure Allocation Expenditure Variance $M $M $M % Day Training Centres 11.3 11.5 0.2 1.8 Private Training Centres 1.5 1.3 0.2 13.3 Community Residential Untts 0.9 0.5 0.4 44.4 Other 0.1 0.1 13.8 13.4 2.9

Comments on Varlances Private Training Centres Day Training Centres Subsidies were paid to four private residential training centres to cover their approved net operating costs. In Subsidies were paid to day training centres attended by 1981/82, the level of grants was less than forecasted. mentally retarded trainees. The subsidies cover salaries Community Residential Units of approved staff and approved motor vehicle costs. The Mental Retardation Division has an extensive Additional cost of staff appointed in 1981/82 and the program for the establishment of new community effect of award increases on transport staff caused the residential units. As some of these units did not open as variance. planned, a saving resutted.

62 Capital Works The Capital Works allocation of the Health Commission for its general works program for 1981/82 was $70.304 million. of which some $60.250 million was spent. Table 11 shows details of allocations and expenditures of the major segments of this program. Table 11: Capital Works Allocation Expenditure $M $M Hospitals Division: Public Hospitals 39.800 37.028 Public Hospitals Overdraft Increase 8.654 Public Hospitals Overdraft reduction 2.772 Other Projects 6.306 5040 54.760 44.840 Public Health 1.537 1.483 Mental Retardation 4.757 4.756 Mental Health 8.560 8.554 Central Administration and Community Health .690 .617 Total 70.304 60.250

The largest component of the program was expenditure people in residential settings, an allocation of $1.6 million on buildings and equipment at public hospitals and was fully spent in acquiring nineteen group homes other institutions. From an allocation of $48.5 million for throughout Victof1a. public hospitals, $39.8 million was spent. The In addition, grants of $1.1 million were made to Day underspending resulted from the late approval·of the Training Centres on a $41or $1 basis for the provision of public hospitals program, the stopping of four major non-residential facilities for mentally retarded people. projects, and less activity on works in progress than predicted As a consequence, it was not necessary to Within the Mental Health Division, the allocation of $8.6 incur additional overdraft and this resulted in a saving of million was expended. The major programs undertaken $1.3 million in overdraft interest which, together with the by the Division were: underspending, allowed an amount of $2.772 million to $million be repaid against overdrafts. • Re-development of Travancore Centre 1.3 • Provision of new food services at Kew 0.9 Major public hospital project expenditures were • Larundel - ward renovations 0.5 $million • Dandenong - extended office accom­ • The continuation of extension works at the modation 0.3 Austin Hospital. 11.1 • The new 200-bed general hospital at Government Guaranteed Loans Essendon. 9.4 In accordance with Section 688 of the Hospitals and • The re-development of kitchen and Charities Act 1958, the Treasurer approved the cafeteria facilities at Mildura Base borrowing of $7 million on overdraft by the Austin Hospital. 2.4 Hospital and a Contractors Deferred Finance Facility of • The provision of improved pharmacy, $9 million for the Royal Victorian Eye and Ear Hospital medical records, radiology and pathology Senior Staff, Finance Division at Swan Hill Hospital. 1.9 Director: M[ Anthony Clifford In the Mental Retardation area, the allocation of $4.8 Assistant Director (Finance): Mr. Neville Wend! million was fully spent. In line wtth the Commission's Assistant Director (Accounting)·. Mr. Hugh Foenander policy of providing direct services to mentally retarded Principal Finance Office: Mr. John McNair

63 The Building and Services Division Report

Introduction ...... 64 • Technical advice about projects to be included in Services to the Hospitals Division ...... 64 both the Major Capital Works Program and the Minor Works Program. Services to the Public Hea~h Division ...... 64 • The handling of requests for equipment for Services to the Mental Hea~h Division ...... 64 Ambulance Services. Services to the Mental Retardation Division . . . . . 64 Senior Staff of the Division ...... 68 Services to the Public Health Division The building and maintenance requirements of the Public Health Division are arranged through the Public Works Department with proposed works being Introduction technically assessed by the Building and Services The Building and Services Division provides a range of Division. specialist services to the four line Divisions. These services cover all aspects of the procurement and In addition, the Division was involved with technical operation of land, buildings, building services and recommendations about dental equipment and the equipment, and they range from advice on initial procurement of nine double berth caravans. planning and cost estimating to assistance with operation and maintenance. The Division is also responsible for the approval and registration of public buildings and for the inspection of Services to the Mental Health Division those buildings to ensure compliance with the Public The building and equipment requirements for the Building Regulations. Mental Health Division are also provided through the Public Works Department However, the Building and The Division is organised into sections based partly on Services Division provided the following services: professional disciplines and partly on areas of responsibilities. The Divisional sections are Architectural, • Assistance with the planning of mental health Mechanical and Electrical Engineering, Equipment, services, including acute, rehabilitation and long­ Quantity Surveying, Public Buildings and Public Works stay care, community-based residential care and Liaison. community and domiciliary support services. • Technical recommendations about buildings, engineering services and equipment • The development of a "forward look" works and Services to the Hospitals Division services program, a design list for major works, and a priority listing for works to be carried out under • Advice to the State Disaster Plan Medical Working annual provisions. Party, the Limited Care Dialysis Committee, the Regional Dental Advisory Committee, the Organ lmaging Advisory Committee, the Pathology Advisory Committee, the Advisory Committee on Obstetrics and Neo-natal Equipment, and the Ambulance Equipment Sub-Committee. Services to the Mental Retardation • Advice on maintenance of buildings and equipment Division and the efficient operation of engineering systems. The building and equipment requirements for the • The review and approval of documentation for Mental Retardation Division are similarly provided capital works projects at various hospitals. through the Public Works Department The Building and • The preparation of estimates for works proposed for Services Division provided technical assessment, the capital works program. liaison with the PWD, and assistance with maintenance • Involvement in the administration of capital works and operational problems. projects in various hospitals. This involvement also • Reports were made on the condition of buildings at included the direct intervention in the management Janefield, Colac, Sunbury, Sandhurst and Kew. of the Austin Hospital (Stage 2fProject with the aim • Technical advice was given about the group homes of containing the cost of the project program.

64 Table 1: Public Buildings Plans and Specification Approvals Class of Totals Public Buildings {under Public Building Regulations) 83 792 656 220 1751 Tertiary Education Buildings 6 66 124 40 236 Schools 54 391 248 118 811 Pre-School & Infant Welfare Centres 20 102 100 31 253 Child Minding Centres 27 48 5 80 Mentally Retarded Centres 4 16 19 5 44 Elderly Citizens Clubs 22 30 29 8 89 Exhibitions/Seating Plans 21 21 Accommodation Houses 44 48 10 102 Totals 189 1489 1272 437 3387 CODE TO TABLE 1 {a) Sketch Plans for Approval in Principle. {b) Working Drawings for Approval. {c) Electrical Installations. {d) Mechanical Ventilation Installations.

Table 2: Public Buildings, Building Surveying Inspections Building Inspections Day 7042 Night 6 Electrical Inspections Day 2278 Night 2 Mechanical Ventilation Inspections Day 320 Total 9648

65 Table 3: Public Hospital Works Completed Progressing $M $M SPECIAL Cancer Institute - Lift Replacement 0.11 Mercy Maternity - Diesel Generator 0.18 Royal Victorian Eye & Ear - Stage 7 118 Royal Children's- Car Park. Stage 2 0.53 GENERAL Austin - Stage 2 60.00 Austin - Car Park 4.6 Box Hill Children's Ward 0.32 Essendon - New Hospital 23.5 Queen Victoria- Casualty 0.17 Preston Northcote - Replacement PABX 0.13 Prince Henry's - Cardiology 0.16 St. Georges Air conditioning 0.14 St. Vincent's Lifts 0.225 Western General - Wards 3 and 4 0.4 BASE Bendigo Hyett Block - Administration 0.43 Gee long Site Works North Wing 0.2 Hamilton Single and 2 Bed Wards 0.52 Mildura Kitchen 3.06 COUNTRY Ararat - Kitchen Remodelling 0.24 Bacchus Marsh- Kitchen Remodelling 0.16 Daylesford Boilers and Boiler House 0.23 Echuca Services Block 0.48 Frankston Day Theatre and Day Ward 0.44 lnglewood Kitchen 0.1 Kyabram Day Hospital 0.4 Ouyen Remodelling 0.32 Portland Temporary Casualty 0.38 Warracknabeal Boilers and Boiler House 0.48 GERIATRIC CENTRES Eastern Suburbs Preliminary Earthworks 0.12 Lyndoch Warrnambool 1.48 Queen Elizabeth Geriatric - Bulk Stores 0.38 Bundoora Extended Care Centre 5.00 AMBULANCE SERVICES Ambulance Service, Melbourne- Station At Ferntree Gully 0.19

66 Table 4: Major Mental Health Works Mental Health Completed Progressing 1981/82 1982/83 Travancore Redevelopment X Mont Park Remodel Ward F6 X Kew New food service X Ballarat Norwood pharmacy X Bendigo Alter Aquila Ward X Mont Park Storage for pharmacy X Royal Park Fire Protection Stage 1 X Ararat Upgrade electrical sub-mains X Beechworth Alter Turquoise House X Pleasant View Heating pipes X Plenty Fire damage Wards R + C X Mont Park Extend Ward MF1 for outpatients X Royal Park Remodel Bleuler Ward X Dandenong Extend office accommodation X Beechworth Remodel toilets M8 and M9 X Larundel Wards B + C internal remodelling X Larundel Wards A, B + C external remodelling X Beech worth Laundry relocation X Traralgon Restoration of fire damage X Ararat Floor covering to ablutions X Ballarat External Maintenance X Ballarat Reburbish Novar X Plenty Main kitchen car park X Mont Park Service roads X Ballarat Modification to sewerage system X Mont Park Replace valves - pathology X Ararat Exhaust fans - kitchen X Kew Repairs to pipe lagging X Kew Air curtains - laundry X Plenty Floor coverings Wards F + 0 X Plenty External repairs Wards A + B X Table 5: Major Mental Retardation Works Completed Progressing 1981/82 1982/83 Sunbury Remodel toilets Ward F3 X Loddon Campaspe Regional Team Accommodation X Central Regional Team Accommodation X Inner Eastern Regional Team Acccommodation X Western Regional Team Accommodation X Barwon Regional Teram Accommodation X westernport Regional Team Accommodation X Gippsland Regional Team Accommodation X Kew C.C. Improvements to main kitchen X Sandhurst Modification to toilet blocks X Colac Alternative water supply X Sun bury Sewerage of six residential units X various Purchase of 18 houses for community residential units X Moe Construction of community residential unit X

67 Senior Staff, Building and Services Division Director: Mr. James Hicks Deputy Director: Mr. Peter Dwyer Secretary: Mr. Peter Mardling Chief Architect: Mr. Stuart Thornton

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