Health Reform Priorities from Victoria

I want to commence by acknowledging the traditional owners of the land on which we meet, the Koolan nation. I would also like to pay my respects to their elders past and present.

The subject of health reform is one of undoubted national and state significance. Indeed this congress, including its location and the breadth and seniority of the attendance today bears testament to the importance being placed on it.

The Victorian Government sees next week’s COAG meeting as part of an ongoing process of reform in health. This time last year Victoria signed a new Australian Healthcare Agreement with the Commonwealth Government as well as a set of National Partnerships on Indigenous Health, Preventive Health, Workforce, Activity-Based Funding and the development of the sub-acute sector. In addition there are specific funding initiatives and targets set for Emergency Departments and Elective Surgery.

We expect that next week and in the coming months new options will crystallise towards a realignment of arrangements across a range of areas.

At this point in time we have 123 recommendations from the National Health and Hospital Reform Commission, and a similar number in aggregate from the Preventative Task Force and the National Primary Health Care Strategy.

There is no lack of reform options, only a challenge in giving order and priority to them.

The Victorian Government has a set of reform principles for health, some of which I can share with you today.

Reform must build on what we have, address the challenges of the next era, work for people/patients at a tangible level and be tangibly linked to the national goal of becoming the healthiest nation.

With this in mind it is worth sharing our perspective on exactly what we have to build on. The Victorian perspective is that our health system is among the best in the world. By ‘our’ health system here I speak of the Australian health system as it operates in Victoria. The most distinctly Australian aspects are Medicare and PBS, the mix of public and private service provision, and shared funding for state-owned public hospitals.

Some of the most distinctively different ways in which the Australian health system operates in Victoria, compared to other states, is public hospital and health service governance – where Victoria has more formal devolution than other states, and in sub-acute facilities and chronic disease and readmission avoidance programs, where Victoria has been more active over the past 5-10 years, than other jurisdictions.

Victoria has also gone further in setting targets for outcomes such as cancer survival, as part of our Cancer Action Plan. We also have the objective of improving both the patient experience and public confidence in the health system.

So in terms of a start-point we rank our system among the best in the world – possibly in the top 3-5 OECD nations – in terms of longevity of life and in terms of survival rates for cancer and cardiovascular disease. We also acknowledge a set of gaps and weaknesses including indigenous health, population health and weight, dental accessibility and the patient journey and outcomes for those with complex and chronic conditions.

We also have a known set of challenges. The Baby Boomers will soon be reaching retirement age – beginning at the end of 2011. They will bring into their aged years less good health than their predecessors and also greater expectations. By the time all the baby boomers have reached the age of 65 – in another 20 years, the number of senior citizens in this state will have doubled. Planning for this bulge in prospective patients and planning for increasing expectations is among the key challenges.

We must plan for additional facilities and realigned approaches, particularly for chronic conditions and the challenges of co-ordinating care. Part of our collective responses must include increased Workforce planning and development and new era for eHealth information management.

So the Victorian reform perspective is not surprising – build on what we have and what we knows works, combined with what we know has to be done to address the evident challenges forward. The reform priorities then:

• Continued devolution of health service governance;
• Renewed commitment to investment in wellness and prevention
• Renewed commitment to educating and training the next generation of the health workforce
• Realigned arrangements for those with complex and chronic conditions
• If I can elaborate most specifically on those people with complex and chronic conditions.

The Australian health system has not been designed to provide coordinated services for patients across the patient journey. It works well with single treatments and discharges; but it works less well for the ‘frequent flyers’. We also struggle with linkages between hospitals and primary care providers and between the health system and the aged care system.

The NHHRC options for voluntary enrolment of specific categories of patients, and with measures to better co-ordinate local care and transitions between parts of the health and aged care systems warrant detailed consideration.

The area is sometimes described as ‘primary care’ but that is probably pushing the limits of the definition. The area in need of co-ordination covers a wide variety of out-of-hospital service providers including GPs, dentists, allied health workers and hospital outpatient services.

In Victoria, health services are paying a great deal of attention to the task of avoiding readmission of patients with complex and chronic conditions; mostly specifically through our HARP program – the Hospital Admission Risk Program. It has been in operation since 2002. It includes quite proactive management of at-risk patients, providing specialist multidisciplinary service across acute, community settings and in peoples homes, whichever is considered most appropriate. This approach is delivered through a set of partnerships between providers; known in Victoria as our PCPs – Primary Care Partnerships.

Going forward we see a need to review the operation, funding and governance of these types of services and approaches. But we’d expect to build the future on a base of evidence about what works today. We’d expect to advocate devolved health service governance, and a partnership approach to service co-ordination. However we’d expect that there is unlikely to be one-size-fits-all for regional versus metropolitan services. However we would expect to see ‘special and additional services’ for enrolled groups of patients; possibly a much wider group of patients than the reach of our existing HARP approach.

Against these objectives there is also a clear need for better technology to enable health records to be co-ordinated across the patient journey. There is also a case for an expanded scope for casemix style Activity-Based-Funding; and of course workforce realignment and planning.

These are the priorities that we see for today’s discussion, next weeks discussion at COAG and I am sure for the months and years ahead. 

Thank you

Fran Thorn is the Secretary of the Department of Health, Victoria.