1 The National Health Plan for Young Australians An action plan to protect and promote the health of children and young people Copyright 1997 ISBN X This work is copyright. It may be reproduced in whole or in part for study or training purposes subject to the inclusion of an acknowledgement of the source and no commercial usage or sale. Reproduction for other purposes than those indicated above, requires the written permission of the Australian Government Publishing Service, GPO Box 84, Canberra ACT Commonwealth Department of Health and Family Services Publication Number 2029 FOREWORD The National Health Plan for Young Australians has been prepared by the AHMAC Working Party on Child and Youth Health to address the seven key action areas identified in The Health of Young Australians, the national health policy for children and young people. The Plan details a series of interrelated strategies designed to maintain and enhance the capacity of governments to respond effectively to the multi-faceted and ever changing needs of children and young people. The Australian Health Ministers Conference unanimously endorsed the Plan in July 1996 and referred it to individual jurisdictions for implementation in accordance with local needs, priorities and resource availability. Australian Health Ministers July 1996 CONTENTS Introduction 5 Scope of Plan 7 Key Action Areas Healthy, Supportive Environments Customer - Focussed and Participative Health Services A Balanced Approach Addressing Inequities Co-ordination and Collaboration Research, Information and Monitoring Workforce and Training 24 Accountability 26 INTRODUCTION
2 INTRODUCTION The Health of Young Australians, the national health policy for children and young people was endorsed by all the Australian Health Ministers in June Major concerns about the health of young Australians were identified in the Policy and this National Health Plan for Young Australians details strategies to address those concerns through collaborative national endeavours over a five year period. This Plan needs to be read in conjunction with The Health of Young Australians. The Health of Young Australians emphasised the crucial roles that families and communities play in providing the emotional and material support essential to the well-being and healthy development of children and young people. It reaffirmed the need for support for parents and carers in providing an optimum environment for their children's development, particularly where a young Australian has a disability or is at risk of developing long term health problems. The Health of Young Australians also drew attention to the impact of poverty, family dysfunction, racial discrimination, geographical isolation and other environmental factors on the long term health of children and young people. It asserted that much of the ill-health and injury that occurs among children and young people can be prevented and that positive, co-ordinated action from all levels of government and the private and non-government sectors is needed to ensure that all young Australians continue to have the opportunity to enjoy good health. The Policy stressed the critical role the developmental years play in establishing the foundations, skills and attitudes for optimum health throughout life and the need for positive investments in the health of young Australians in order to achieve optimal health outcomes on an ongoing basis for all Australians. This Plan details a series of proposals for co-operative national initiatives that will contribute significantly to health promotion and health care during childhood, adolescence and the later teens. The development of the Plan reflects the outcomes from consultations in the last two years with consumers, State and Territory and Commonwealth governments. As such it represents both a joint understanding and a national consensus on strategies to develop and improve health care for young Australians that will complement and build upon existing Commonwealth, State and Territory provisions for young Australians. The Plan encompasses a five year period with specific activities and outcomes nominated for each year. It proposes that regular reporting be introduced on the health of young Australians and that the impact of the Plan on their health status be evaluated towards the end of the period. The evaluation should take account of differing consumer needs and health system responses in individual States and Territories. The Plan is not necessarily about committing the community to spending additional resources on health services on a long term basis. Its aim is to promote the best use of limited resources by achieving the right balance in resource allocation and enhancing the focus on client outcomes in health and related activities. The Plan also aims to promote intersectoral collaboration between different portfolios in recognition that the health and well-being of children and young people is often affected by decisions taken outside the health portfolio. Strategies in the Plan are designed to complement, and build on, the extensive range of health related activities already being undertaken by Commonwealth, State and Territory Governments. They are intended to accommodate differing but complementary roles and responsibilities within government and between the government, private and non-government sectors. As needs, priorities and levels of development vary between the States and Territories the focus and pace of change will also vary and will relate in part to the level of resources that can be made available to assist in the reform process. The National Health Plan for Young Australians and The Health of Young Australians were prepared by the AHMAC Working Party on Child and Youth Health. SCOPE OF THE PLAN This Plan relates to the health and well-being of young Australians 0-24 years of age. It is designed to address and promote the aim and principles set out in The Health of Young Australians and the priorities in the
3 Health Goals and Targets for Australian Children and Youth. The Plan concerns health care in all its phases, from public health and health promotion through to the general, acute and co-ordinated streams of personal care and treatment services. Differing organisational structures, funding mechanisms or portfolio responsibilities should not be regarded as constraints on the scope of action. The Plan recognises the continuity of development throughout the years of childhood, adolescence, the later teens and, in some cases, new family formation. It affirms that successful progress through each stage is in itself a major health outcome. Further, health care that is compatible with client needs at each and every stage of this development is seen as a pre-requisite for good practice in health care for young Australians. The Plan addresses fundamental issues in the planning and delivery of health and related services for young Australians. It nominates priorities for immediate action including: improving access to effective health care for disadvantaged young Australians and their families; a national information and community awareness strategy; and intersectoral action at Commonwealth, State and Territory levels to promote healthy, supportive environments for young Australians and their families and other care givers. All the strategies in the Plan are underpinned by the following themes in the Policy: the crucial need to invest in the health of young Australians in order to promote and maintain high quality health outcomes for all Australians, both now and in the future; the importance of families as the primary and ongoing source of care and support for most young Australians; the unique needs of young Australians as they move from the vulnerability and dependency of infancy towards the independence and personal responsibilities of adulthood; the significant contribution of childhood and the teen years to the development of lifestyles and health profiles in adulthood; the need to focus on client involvement and health outcomes in service planning and provision; the acknowledgment that health and related care is provided in various contexts, including many outside the health system; and the significance of multi-disciplinary and intersectoral approaches in promoting effective health care. The Plan provides for the development and regular collection of measures of the performance of health services for young Australians in line with national targets and other indicators of health. It also provides for reporting by the Commonwealth, States and Territories on progress towards enhancing the health of young Australians through the co-operative national endeavours set out in this Plan. This reporting will include a particular emphasis on identifying and responding to the health needs of young Australians with, or at risk of developing, serious health problems. These include those who are living in poverty, in dysfunctional families, are homeless, or are located in rural or remote areas as well as those with disabilities, mental health problems or chronic illness. Particular attention will be paid to Aboriginal and Torres Strait Islander young Australians. These strategies are not to be viewed as discrete activities but rather as co-ordinated and mutually supportive elements of the ongoing national commitment to promote, maintain and improve the health of all Australian children and young people. They are designed to take account of recommendations, priorities and
4 developments in related national policies, strategies and research, including the Health Goals and Targets for Australian Children and Youth, National Aboriginal Health Strategy, National Health Advancement Program, National Mental Health Policy, National Rural Health Strategy, National Child Protection Strategy, National Immunisation Strategy and Our Children, Our Future - Australia's National Program of Action in response to the World Declaration on the Survival, Protection and Development of Children, together with relevant national initiatives in health promotion, and work by the National Health and Medical Research Council. The Plan recognises, and is compatible with, broader health system reform agendas, including the process being pursued by Commonwealth, State and Territory Heads of Government which seeks to ensure both improved health gains for consumers and cost effectiveness for governments through reforms in the way health and community services are organised and funded. The Plan is intended to be introduced with effect from 1 July 1996 and will terminate in respect of all parties at the end of a five year period, on 30 June An evaluation of the Plan and of progress in implementing strategies will be conducted in the fourth year of the Plan. KEY ACTION AREAS 1. Healthy, Supportive Environments Objective Awareness in the community and at all levels of government of the health needs of young Australians which is reflected in policies, programs and services that impact on their health. Good health depends upon a broad range of social, economic and other environmental factors, many of which are beyond the direct influence of the health system. Approximately one third of young Australians under 16 years of age live in very poor households, more than under 25 years of age are homeless, cases of child abuse were reported in and the rate of detention for young Australians years of age was 58.8 per in If positive and timely investments are not made during the critical years of childhood, adolescence and early adulthood, many young Australians are likely to carry physical and/or emotional effects into adulthood. Concerted and sustained action is needed to ensure that decision makers at all levels are informed about, and responsive to, the health needs of young Australians. Achieving optimal health outcomes for young Australians requires co-operative action between sectors at all levels of government, and between government and non-government and private sectors. Strategies Within the life of the Plan, the Commonwealth, State and Territory health authorities, each within their own jurisdictions, will: 1.1 Take a leadership role in promoting intersectoral action to improve and maintain the health of young Australians. Areas to be focused on include: physical environments particularly housing, water, sanitation, air quality and community safety; the health and safety needs of young Australians, in home, work educational, and recreational environments; family functioning and support; protection of young Australians from neglect and abuse; income maintenance for both families and individual young people; and health, education and training, justice, employment, media and community services. Years Action as appropriate in each jurisdiction Years 1, 3, 5 - Reporting. 1.2 In partnership with relevant agencies, develop intersectoral approaches to address the health impacts on young Australians of physical, social, environmental and economic factors. Year 2 Developmental phase
5 Years 3-5 Implementation Reporting 1.3 Advocate for administrative arrangements and where necessary, legislative processes, to ensure: protection from exploitation, neglect, abuse and violence; confidentiality of personal health and related information; informed consent as a health consumer; and product safety and environmental safety. The need for portability of decisions between States and Territories in matters relating to child protection will need to be addressed as part of this work. Years 1-2 Years 3-4 Year 5 Scoping exercise followed by plan development Negotiations on changes to administrative arrangements Legislative changes where appropriate - Reporting 2. Customer-Focussed and Participative Health Services Objective Health services that have both a customer focus and a commitment to the participation of young people and families in decisions about health and health care at all levels. A strong commitment is needed to address problems of service availability and quality of care issues raised during the public consultation processes. Ongoing consumer involvement is essential to ensure that services are responsive to community needs and expectations. Consumers need to be resourced and supported so they can participate with professionals in determining needs and developing strategies to meet those needs. In turn, planning, monitoring, evaluation and decision-making processes must be regularly reviewed to ensure ongoing and effective consumer participation. Strategies Within the life of the Plan, the Commonwealth, States and Territories, each within their own jurisdictions, will: 2.1 Develop strategies in consultation with consumers, health service providers, community and professional organisations to continuously improve responses to the health needs of children and young people. These strategies will build on existing quality monitoring processes in health facilities and ensure the development of these processes as a priority in community services. This will be achieved by: establishing service standards and other benchmarks as appropriate, in agreed priority areas; developing, in collaboration with consumers, clinicians and allied health workers, performance indicators to monitor the structure and scope of services, the processes for service delivery and service outcomes; monitoring client needs, outcomes and satisfaction; and nationwide reporting on a range of agreed priority indicators (e.g. access to care, use of services, immunisation rates, surgical outcomes, complaint data, nature and extent of consumer participation, satisfaction ratings). Year 2 Years 3-5 Development work Implementation Reporting 2.2 Enter into new arrangements for providing health and related services designed to enhance service
6 availability and effectiveness by: examining service utilisation and the impact of existing funding arrangements involving medical practitioners, specialists and other health and related workers, with particular reference to the Medicare Benefits Schedule, and recommending changes where necessary; working towards more equitable distributions of child and youth health workers across metropolitan areas and between urban and rural areas; and increasing the skills of health and related personnel as they relate to the needs of young Australians, and of their families and other care givers. Year 1 Years 2-5 Development phase Implementation Reporting 2.3 Develop a national communication and public awareness strategy to address the information, skills, and consumer needs identified in the Policy. The strategy should draw upon results from both clinical and population based research and involve significant public input and national, State, Territory and local components. Its aim should be to: firmly place health issues relating to young Australians on the public agenda; provide information to assist children, young people and families to make informed decisions about healthy lifestyles and usage of health services; and enhance the knowledge of The Health of Young Australians, its principles and action areas among those who work with young Australians and their families. Years 1, 2 Scoping and planning work Years 3-5 Implementation 3. A Balanced Approach Objective A balanced approach at all levels of government to health planning and service delivery for young Australians. Good health does not happen automatically. Ongoing positive investments are needed to for an infant to grow and develop into a competent, participating adult member of the community. A balanced approach within health systems requires ongoing review of resource allocation to ensure that the particular needs of young Australians are recognised, that the available resources are used effectively and efficiently and that a sufficient level of investment continues to be made to ensure the maintenance and promotion of the health of all young Australians. Children and young people need access to a range and balance of primary, secondary and tertiary health care. This may require shifts in resources or new funding arrangements in some instances. Furthermore, there needs to be a balance of investment between public health interventions (aimed at protecting and promoting the health of young Australians) and personal care and treatment services (aimed at tackling health problems once they have occurred). Strategies Within the life of the Plan, the Commonwealth, States and Territories will: 3.1 Ensure that investments in the health of young Australians are a high priority and that the level of investment is determined not only by current needs but also is designed to ensure long term health gains. Years 1,3,5 Reporting
7 3.2 Ensure that health systems and services are responsive to current and future needs of their populations, including children and young people, by undertaking a process of systemic change which focuses on improved outcomes and increased efficiency and effectiveness. This will include: examining the impact of current and future levels of investment in the health of young Australians; ensuring that there is adequate funding for health promotion and prevention activities as well as appropriate medical technologies and therapies; identifying those elements of care where inpatient settings deliver best quality and the most cost effective outcomes for consumers, and those elements where community based care offers enhanced outcomes and equal or better value for money; developing strategies to promote greater equity in client access and outcomes including, where appropriate, informing processes for the allocation of resources between hospital and community based care, between urban and rural/remote areas and, as well, shifting resources within metropolitan areas; improving inter-agency cooperation, organisational and service delivery arrangements, particularly at the local level; and developing mechanisms to inform health workers and consumers about practice guidelines, service availability and effectiveness. Entering into new funding arrangements to support these reforms. Year 1 - Planning Years Implementation 3.3 Develop and implement specific strategies on a collaborative basis to achieve each of the Health Goals and Targets for Australian Children and Youth and other nationally agreed health targets relating to young Australians. Years Implementation 4. Addressing Inequities Objective Availability of, and access to, the range of health services appropriate to the needs of all young Australians. Among young Australians, inequities in health status and access to appropriate care are influenced by factors such as location, income and other resources, cultural and social background, physical and/or mental health problems and disabilities. Commonwealth, State and Territory governments are currently working together to ameliorate inequities through initiatives such as the National Mental Health Plan, the National Rural Health Strategy and the National Aboriginal Health Strategy and the national commitment to improved outcomes in the delivery of services to Aboriginal and Torres Strait Islander peoples. Endeavours are required to ensure that the needs of young Australians are addressed within these, and other national agendas that impact on health and health care needs. These endeavours will need to focus on both existing and possible new services and other health promotion initiatives, including activities outside the health system. Strategies Within the life of the Plan, the Commonwealth, States and Territories, each within its own jurisdiction, will: 4.1 Expand and enhance the range of health care responses targeting children and young people with demonstrated inequities in health status including, where necessary, developing new administrative
8 arrangements such as funding provisions consistent with broader national reform agendas. Years Implementation Within the life of the Plan, States and Territories, each within its own jurisdiction, will: 4.2 Incorporate proven models of service delivery into, and develop new service models within, existing service systems in order to enhance responsiveness to the needs of disadvantaged young Australians, particularly Aboriginal and Torres Strait Islander people, those with mental health problems and those living in rural and remote areas. Years Implementation Within the life of the Plan, the Commonwealth, States and Territories, each within its own jurisdiction, will: 4.3 Work co-operatively with key stakeholders associated with the National Rural Health Strategy, the National Mental Health Policy, the National Aboriginal Health Strategy and other national initiatives to ensure that the health needs of young Australians are identified and addressed within related national health policies. Year 1 - Develop processes Years Implementation Within the life of the Plan, the Commonwealth, States and Territories will: 4.4 Undertake a collaborative exercise to audit, analyse and identify barriers encountered by socio-economically disadvantaged children, young people and their families or other caregivers which limit or prevent access to health care and the achievement of optimum health outcomes. This will include: the use of existing reports and, if necessary, further investigations, to identify the impact on health of associated costs such as transport, child care, accommodation, respite care, medical, pharmaceutical and other health care goods and equipment; and research on access issues, including the range, location a convenience of services. Following completion of this exercise, jurisdictions will develop action plans to reduce inequities identified. Year 2 Collaborative exercise Years 3-5 Implementation Reporting 5. Co-ordination and Collaboration Objective Co-operative strategies within the health sector and between health and other sectors to improve the health of children and young people. The Plan is committed to enhancing the accessibility and effectiveness of services through initiatives to promote continuity of care across services, facilitate greater co-ordination and collaboration between individual service providers, between health and related services and between health and other sectors. Strategies
9 Within the life of the Plan, the Commonwealth, States and Territories will: 5.1 Determine the co-ordination and continuity of care required to improve health outcomes for young Australians and their families, especially those with complex care needs by: reporting on suitable models and levels of co-ordination; and advising on strategies for addressing issues relating to the maintenance of care across key entry/exit points, such as the management and timing of transitions within and between paediatric, adolescent and adult care. Year 1 Investigate and report 5.2 Develop and test the effectiveness of models of care based on the findings of the report from 5.1 with regard to: new funding and administrative arrangements involving public and private health care providers at regional and local levels; means of integrating services for children and young people that encourage co- operation and linkages between providers working with the same client groups; transition care provisions for young Australians with ongoing care needs; means of service provision that address the health related care needs of young Australians who are chronically ill or have physical, emotional or mental disabilities; and meeting the particular service needs of young people who are parents. Year 2 Years Development - Implementation Reporting 5.3 Develop and implement national guidelines, in consultation with consumers, professional organisations and service providers, for service delivery through: determining priority areas; and initiating a program of guideline development which reflects agreed priorities, is evidence based, contributes to improved health outcomes and includes provisions for consumer input, information sharing and regular review and updating. Years Development -Reporting 5.4 Build on current initiatives and develop new approaches in health promotion for priority health issues. Years 3-5 Development and implementation Reporting
10 6. Research, Information and Monitoring Objective Research, data collection and monitoring focussed on the health of children and young people. Mechanisms need to be developed to collect and process data to monitor health outcomes for young Australians. Measures are required for the health indicators identified in Health Goals and Targets for Australian Children and Youth and other nationally agreed health targets relating to children and young people. Research and information needs include the development and evaluation of population based, cost effective approaches to enhancing health outcomes for use in implementing and evaluating strategies in this Plan. Strategies: Within the life of the Plan, the Commonwealth, States and Territories will 6.1 Develop a national research agenda to underpin the Plan by establishing a group comprising researchers and policy makers to: prepare a plan to address the research needs identified in The Health of Young Australians; pursue priority issues within established research programs; and develop strategies for targeted research. Year 1 - Develop agenda Years Implement research plan Years 1, 3, 5 Reporting 6.2 Undertake a national survey on the health status of children and young people. Years 3, 4 Year 2 - Planning work Conduct survey and publish results. 6.3 Develop a national information strategy for measuring and reporting on the health of young Australians which will include: addressing data issues relating to the health of children and young people, in co-operation with the Australian Institute of Health and Welfare as part of the National Health Information Plan; development and regular collection of a national minimum data set; and development of health indicators and health outcome measures to provide effective monitoring of the health of young Australians and of services provided commencing with data relating to national health targets. Years 2-5 Year 1 Major developmental phase and preliminary data collection work Regular data collection and reporting. 6.4 Progress health service delivery measurement, including Casemix development, to ensure the needs of young Australians are met in both in-patient and non-in-patient settings. Years 1-2 Years 3-5 Development work Ongoing work - Reporting 6.5 Develop mechanisms to facilitate effective distribution of data, research findings and other information
11 relevant to the implementation of this Plan. Years Development and implementation; - Reporting 6.6 Develop measures of performance and collect information to monitor this Plan. Years 1,3,5 Year 1 Develop measures Collection and reporting 7. Workforce and Training Objective A workforce with the skills and knowledge to work effectively in the maintenance and enhancement of the health of young Australians. A strong commitment is needed to enhance the availability and skills of personnel who are involved in health and related work with young Australians and their families and other caregivers. In particular, training programs need to recognise the changing care needs of children and young people at different ages and stages of development and the need to train and support personnel working in differing models of care, especially those with an inter-disciplinary focus. Workforce and training strategies need to reflect and facilitate the overall reform process in this Plan. Strategies: Within the life of the Plan, the Commonwealth, in consultation with States and Territories, will: 7.1 Work towards addressing both the initial and continuing training needs set out in The Health of Young Australians by participating in: joint activities with professional bodies and consumers; development of nationally endorsed competency measures for workers in health and related industries that recognise the specific skills in health care required for work with young Australians; and current national agendas for training and workforce reform in the health and community services sectors, including work being undertaken by the National Community Services and Health Industry Training Advisory Board, the Australian Medical Workforce Advisory Committee and the development of Trans-Tasman mutual recognition of skills and qualifications. Year 1 - Scoping exercise, establishment of participative mechanisms; Years Relevant initiatives; 7.2 Examine the implications of, and develop appropriate responses to, workforce issues arising out of the implementation of The Health of Young Australians, including: consumer involvement; examination of the nature, type and mix of workforce required; and mechanisms for ensuring that workers are able to achieve and maintain service standards and other benchmarks.
12 Year 3 Development and review phases Reporting 7.3 Examine the implications of, and develop appropriate responses to, training issues arising out of the implementation of The Health of Young Australians, including structural and funding changes needed to align training programs with the contemporary health needs of young Australians. Year 3 Development and review phases - Reporting ACCOUNTABILITY Commonwealth, State and Territory governments will each need to establish and maintain a specific focus relating to the health of children and young people within their jurisdictions to promote co-ordination within health systems and between health and other agencies in implementing this Plan. The Commonwealth, States and Territories will each establish participative mechanisms involving stakeholders and consumers to provide feedback on implementing strategies, advise on subsequent years' activities and contribute to evaluation of the effectiveness of the Plan. Commonwealth, State and Territory representatives will meet annually in a national forum to workshop national issues relating to both the health needs of young Australians and the implementation of the Plan. The forum will meet in a different State or Territory each year and the Chair will rotate between the States, Territories and Commonwealth. A national body such as an AHMAC Sub-Committee should be established, for five years in the first instance, to oversee the implementation, monitoring and evaluation of the Plan. The national body will also: monitor the impact of other national policies and programs relating to the health of young Australians; report, using information supplied by each jurisdiction, to Health Ministers at the end of the first, third and fifth years of the Plan on progress towards achieving the strategies set out in this Plan for each action area; and be responsible for the collation and publication of a national report concerning the health of young Australians and progress towards implementing this Plan at the end of the first, third and final years. The national body will have the following features: each jurisdiction will provide a representative; the overall composition will include members from both clinical and/or policy backgrounds relating to both children and young people; the Chair will rotate between jurisdictions and will be a non-voting position, the jurisdiction providing the Chair having a further representative with full voting rights during the time the Chair is located in that jurisdiction; and the Commonwealth will undertake the secretariat work for the national body and the management of national project work. The impact of the Plan will be independently evaluated during the fourth year, in line with an evaluation strategy developed during the second year. The evaluation report will be submitted to Health Ministers in the fifth and final year of the Plan together with proposals for where ongoing action might be needed in the future.