State budget submission March 2015

Transcription

1 State budget submission March 2015

2 Introduction The Victorian Healthcare Association was established in 1938 as the peak body representing the Victorian public healthcare sector. Our members include Victorian public hospitals, rural and regional health services, aged care facilities, community health services and Medicare Locals. The Victorian budget will be the first delivered by the Andrews Government, presenting an opportunity to signal its vision for the Victorian health system. Overall the state s health system performs well, offering a strong platform for improvement and innovation to meet the needs of a growing and ageing population in a manner consistent with trends towards consumer centered care. Nonetheless, the budget will be delivered within a broader context of national changes to health funding arrangements, which will result in funding cuts of almost half a billion dollars to Victoria alone. This will be in addition to cuts announced in the Commonwealth s 2013 Mid-Year Economic and Fiscal Outlook and will impact Victoria at a time of increasing population-related pressures and rates of chronic disease. The Commonwealth Government s intention to reform funding arrangements for primary care may, depending on the model adopted, impact on public hospitals capacity to care for vulnerable Victorians who opt to present at emergency departments rather than GPs. The budget will be delivered within a broader context of national changes to health funding arrangements. Sweeping changes will also be made to primary health coordination and service delivery this year, with the Commonwealth s abolition of Medicare Locals and their replacement by six Primary Health Networks across Victoria to take effect from 1 July Both tiers of government must support these new organisations to effectively fulfil their functions and to streamline and improve primary and acute healthcare delivery and outcomes. This budget submission is organised around the themes highlighted in our 2014 state election platform Rethinking our health system 1 which was informed by extensive member engagement. These themes remain highly relevant and we urge the Andrews Government to ensure its first budget is focused on: > > providing more equitable access to health services > > empowering health services to make the best decisions for their community > > ensuring health services are adequately resourced to fulfil their responsibilities 2

3 state Budget submission Sweeping changes will be made to primary health coordination and service delivery this year. 3

4 Our state budget priorities at a glance 1. Providing more equitable access to health services 1. Increase support for preventative health through the Healthy Together Victoria intervention and Integrated Health Promotion program. 2. Build further capacity in primary and community care. 3. Develop in partnership with healthcare providers a Primary Health Strategy that clearly articulates how the primary health sector will work, perform, and link across the system. 4. Demonstrate a commitment to Primary Health Networks by working with the Commonwealth to develop a bilateral approach to priorities and offering a state funding contribution. 5. Enhance access to elective surgery in clinically appropriate times through system reform and investment. 6. Ensure that the $200 million election commitment to enhance capacity in health services is provided on top of usual growth funds and ensure that the Travis Review engages with health services and clinicians about system capacity and reform. 7. Fund an independent evaluation of the new mental health and alcohol and drug service arrangements following their recommissioning in Support the modernisation and interoperability of health information communication technology through the delivery of Victoria s ICT plan and systematic investment. 9. Increase support for telehealth and videoconferencing initiatives so that they can be expanded, particularly in rural and regional areas. 4

5 state Budget submission Empowering health services to make the best decisions for their communities 3. Ensuring health services are adequately resourced to fulfil their responsibilities 10. Support health services to work together to plan, coordinate and tailor their services to meet the needs of their local communities. 11. Ensure that health services have access to data to fully inform service delivery and optimise efficiency and effectiveness. 12. Invest in training and capacity building for health service board members to foster excellence in clinical governance. 13. Enable all health services to choose whether or not to remunerate board members. 14. Retain dedicated funding for health capital and ensure it is allocated transparently and on the basis of a sound business case. 15. Provide a dedicated capital funding program for Victorian Public Sector Residential Aged Care Services. 16. Fund initiatives that reduce the impact of depreciation charges on health services. 17. Ensure that funding accurately reflects the cost of providing care across public health services and registered community health services. 18. Fully recognise the higher cost associated with providing health services in rural areas. 19. Maintain compensation arrangements for health services for all urgent, maternity and paediatric patient transfers and work towards establishing a direct funding relationship between the Department of Health and Human Services and Ambulance Victoria. 20. Deliver additional funding to health services to cover costs arising from the new Easter and Grand Final public holidays. 21. Re-invest productivity savings from public health services into health innovation. 22. Increase funding to promote the recruitment and retention of health professionals in rural areas. 23. Consult with the VHA throughout the development of legislation regarding nurse to patient ratios so that its application does not produce unintended consequences or impose additional unfunded costs for health services. 5

6 1. Provide more equitable access to health services Preventative health and community care Preventative health forms an integral part of the Victorian health system. The Victorian Government s major preventative intervention Healthy Together Victoria and its Integrated Health Promotion program offer Victorians a broad range of community based health promotion and prevention services. The Commonwealth Government s 2014 decision to cancel the National Partnership Agreement on Preventative Health has threatened to impact upon Victoria s jointly-funded health prevention programs. The Andrews Government must secure funding so that Victoria s system wide prevention efforts can continue. Primary and community healthcare is the front line of our health system, providing health and preventative care to Victorians before more costly hospital-based interventions are required. The availability and accessibility of primary and community health services can have a significant impact on presentations at surrounding hospitals because patients who are unable to access primary care services often present at hospitals, even if their healthcare needs are not urgent. Primary and community healthcare is the front line of our health system. The Andrews Government has an opportunity to build further capacity in primary and community care so as to relieve pressures on Victoria s hospital services. This would enable more Victorians to be treated in their communities through flexible and integrated care models. Ideally, this approach would inform a state led Primary Health Strategy developed in partnership with health providers that clearly articulates how the primary health sector will work, perform, and link across the system. Primary Health Networks The replacement of Victoria s 17 Medicare Locals with six Primary Health Networks (PHNs) from 1 July 2015 is an opportunity for the Andrews Government to work in partnership with the Commonwealth in support of greater collaboration between primary and acute service providers across Victoria. This is critical given, in the absence of direct support previously, Medicare Locals have performed inconsistently. 6

7 state Budget submission We recommend a bilateral alignment of planning and service delivery across the state and seek a commitment from the Andrews Government to support PHNs through a state funding contribution for programs that encourage collaboration between Victorian health services and PHNs. Elective surgery National elective surgery targets have proven challenging to meet. 2 In the past governments have commonly responded with one-off targeted investments, or waiting list blitzes, but without strategic and sustained action waiting lists will continue to grow. This requires a systems-based approach that focuses on clinical outcomes rather than a narrow emphasis on flawed indicators like bed numbers or waiting lists. By way of example, community and home-based care may be a clinically appropriate care option that is more cost effective and often preferred by consumers but it would not be reflected in a hospital bed census. 4 Importantly, health performance and capacity measures must be meaningful to both clinicians and the community. The VHA considers that the size of the waiting list alone is in fact a poor indicator of performance and demand and does not reveal whether people are being seen in clinically appropriate times. Accordingly, we recommend more fundamental reform of the elective surgery system, along with investment to improve capacity and access to services. Our 2014 Position Statement Access to Elective Surgery in Victoria provides several recommendations for system reform. They include expanding reporting methods to more accurately reflect waiting times for elective surgery, including the time patients wait for specialist referral and whether they receive treatment within clinically appropriate timeframes. 3 Travis Review Similarly, the VHA is concerned that public and political discussion has relied too heavily on bed numbers as a measure of health service capacity. We refer to the Andrews Government s commitment to invest $200 million to open hospital theatres and beds after a state-wide census of beds and theatre capacity is conducted by Dr Doug Travis. We seek confirmation that this commitment will be reflected in the State Budget as additional funding on top of usual growth funds. We also urge the Andrews Government to ensure that the opportunity is not missed for the Travis Review to engage in a broader discussion with health services and clinicians about system capacity and reform. 7

8 Recommissioning of alcohol and other drugs and community mental health services We applaud the Andrews Government s establishment of an Ice Taskforce as recognition of the need for a coherent and organised response to drug addiction and its effects on Victorian individuals and communities. A key element of the response to drug addiction is treatment and withdrawal services, the basis of which is the Alcohol and Other Drugs (AOD) program. Victorian mental health community support services offer additional support for vulnerable Victorians. In 2014 the previous Victorian Government recommissioned mental health community support services and AOD programs. The new arrangements have a centralised intake and assessment service, replacing an approach where individual service providers carried out client assessments directly. The changes sought to improve access to services, simplify service delivery and introduce area-based approaches to planning and integration with other health and human services. 5 However, we are concerned that the new system has instead hindered the ability for complex and vulnerable clients to easily access integrated care, with our members reporting fewer referrals being made to service providers. The new approach is also a departure from face to face consultation, making a holistic assessment more difficult. The VHA is concerned for the welfare of Victorians who are unable to access services via traditional methods, and who are consequently excluded from the system by a blunt assessment tool or through delays in accessing care. The risk is that many of these clients will require more intensive health and human services, through hospital emergency departments, the justice system, housing and services for the homeless. Against this backdrop, we ask the Andrews Government to fund an independent evaluation of the new mental health and AOD service arrangements. 8

9 state Budget submission Information and communications technology Modernised ICT has the potential to improve the coordination of health services in Victoria, eliminate duplication and waste, reduce the risk of errors and contribute to an improved standard of care. While a Victorian Statewide Health ICT Strategic Framework was developed in 2014, Victoria is not yet fully realising the potential of ICT. Electronic Medical Records (EMR) offer streamlined patient management between health services through a centralised reference of medical, clinical and pharmacological history. There is also potential for EMR to interface with the Personally Controlled Electronic Health Record (PCEHR), for example, when compiling patient information and discharge summaries. A standardised approach to managing patient records across the health sector would generate significant system gains, allowing for greater efficiency in emergency departments and consistency in the treatment of patients in different care settings. However, progress towards the PCEHR has been slow. While many health services see the longer term benefits, there is currently insufficient funding to support implementation. Community health services use government mandated ICT systems that lack the most basic interoperability requirements. Residential aged care services have their own patient management systems which are not linked to general practice systems, resulting in GPs being unable to access required information, particularly when providing after hours care. We urge the Andrews Government to modernise and improve the interoperability of health ICT. This must entail additional resourcing; including for hardware replacement, and a timeline against which investment should occur. This has left health services with little option other than to implement ICT systems that, while relevant to their individual needs, often lack the capability to connect with those used by other health services. In addition, services that are still highly reliant on paper records do not have easy access to patient information held by other health services. 9

10 Telehealth can help to remove many of the barriers currently experienced by health consumers and professionals. 10

11 state Budget submission Telehealth Telehealth and videoconferencing initiatives are improving the ability of Victorians to access high quality, effective care closer to home and at a lower cost to the state. They offer a convenient alternative to the more traditional face to face way of providing healthcare, professional advice and education. Telehealth can help to remove many of the barriers currently experienced by health consumers and professionals such as distance, time and cost and plays an increasingly prominent role in the delivery of specialist healthcare in rural and regional Victoria. Videoconferencing can enhance the assessment and treatment of patients requiring specialist services, such as cystic fibrosis and nephrology clinics, while offering the rural health service advice and support regarding the treatment of a patient. Victoria s approach to the deployment of telehealth has typically been characterised by one-off, time-limited projects with separate funding streams dedicated over the life of the project. These models have most often proven to be unsustainable as the services are seen as add ons to normal business rather than a substitute for existing activity. Consistent with the Andrews Government s pre-election commitment to deliver e-health solutions, 6 we urge the Andrews Government to boost investment in telehealth and support its expansion across Victoria. Summary of recommendations 1. Increase support for preventative health through the Healthy Together Victoria intervention and Integrated Health Promotion program. 2. Build further capacity in primary and community care. 3. develop in partnership with healthcare providers a Primary Health Strategy that clearly articulates how the primary health sector will work, perform, and link across the system. 4. demonstrate a commitment to Primary Health Networks by working with the Commonwealth to develop a bilateral approach to priorities and offering a state funding contribution. 5. enhance access to elective surgery in clinically appropriate times through system reform and investment. 6. ensure that the $200 million election commitment to enhance capacity in health services is provided on top of usual growth funds and ensure that the Travis Review engages with health services and clinicians about system capacity and reform. 7. Fund an independent evaluation of the new mental health and alcohol and drug service arrangements following their recommissioning in Support the modernisation and interoperability of health information communication technology through the delivery of Victoria s ICT plan and systematic investment. 9. Increase support for telehealth and videoconferencing initiatives so that they can be expanded, particularly in rural and regional areas. 11

12 2. Empower health services to make the best decisions for their communities Local service planning The vastness and complexity of the Victorian health system, with multiple funding streams and a diverse array of service providers, creates challenges arising from duplication, service gaps and inefficiencies. We believe that regional and sub-regional health services are best placed to identify local needs and determine how they can be met. Consistent with this principle and Victoria s devolved governance model, the Andrews Government has an opportunity to improve support for local and sub-regional service planning, particularly with the establishment of Primary Health Networks from 1 July Our 2014 election platform sets out a strategy calling for enhanced local decision making structures and clarity around the role of the Department of Health and Human Services. We argue that health services will need enhanced autonomy in order to work effectively with PHNs and respond to the health needs of their communities. 7 Benchmarking To help respond to their communities needs, Victorian health services would benefit from having access to comparable data that shows the delivery of care and its outcomes in any given region across providers. This would assist them to understand differences in service delivery based on specific factors such as access to services, clinical referral decisions, and the health and wellbeing of a population. With this information, a health service is better placed to understand if action should be taken to address an issue affecting care. 12

13 state Budget submission The availability of comparative data has demonstrated clinical benefit. For instance, peer review through benchmarking is an effective strategy for reducing medical practice variation, which in turn has been demonstrated to deliver significant improvements in patient outcomes. 8 Benchmarking enables health services and clinicians to understand potential variation in cost and patient outcomes according to different models of care delivery. Health services would also benefit from information that compares the effects of different models of care for selected procedures. For example, there may be benchmarking of outcomes for hip replacements, such as cost and patient reported outcomes, and inputs such as factors relating to patient complexity, prostheses used, length of hospital stay, and the rehabilitation received. Currently, the Government funds 14 Victorian health services to benchmark hospital standardised mortality rates, hospital readmissions and the relative length of stay through the Doctor Foster Intelligence tools. Information sharing of this nature has been well received, and we would welcome an increase in the number of participating health services and expansion of the benchmarking information into areas affecting patient care. Governance The important role played by directors of Victoria s health service boards cannot be overestimated. They are, on behalf of the Victorian Minister for Health, responsible and accountable for the oversight of high-quality, effective and efficient health services in accordance with government policy and legal obligations. 9 In carrying out these responsibilities, a health service board needs the appropriate mix of skills and experience including: > > health, business, legal and finance expertise > > governance and service quality (clinical governance) experience > > strategic thinking > > knowledge of local health and social needs and community services The Victorian Government has supported individual director training for several years and it is critical that the Andrews Government continues this investment. Attracting Victorians with the right experience to join a health service board is a key issue, particularly within small rural communities. Currently, small rural hospitals and multi-purpose services are not permitted to remunerate board members, 10 impeding their ability to attract appropriately qualified people and undermining the significant role played by their directors. This is despite the fact that rural board directors perform identical duties to their remunerated counterparts in metropolitan and regional Victoria, and oversee similar levels of organisational complexity, albeit on a smaller scale. Accordingly, we ask that the Andrews Government enables all health services to choose whether or not to remunerate board members. We consider the matter of remuneration a decision appropriately made by the board itself. Summary of recommendations 10. Support health services to work together to plan, coordinate and tailor their services to meet the needs of their local communities. 11. ensure that health services have access to data to fully inform service delivery and optimise efficiency and effectiveness. 12. Invest in training and capacity building for board members of health services to foster excellence in clinical and corporate governance. 13. enable all health services to choose whether or not to remunerate board members. 13

14 3. Ensure health services are adequately resourced to fulfil their responsibilities There is scope for new approaches in considering and responding to Victoria s health capital requirements. Health capital Hospitals and community health services must maintain and replace assets as necessary in order to sustain adequate service levels. Funding is also needed to support growth and enable services to deliver effective and efficient services through new technology. Inadequate infrastructure is an impediment to health service efficiency, and in the long-term adds to operational costs. We acknowledge the Andrews Government s election commitments to deliver additional health capital investments including: the $150 million specialist heart hospital; $200 million for a dedicated women s and children s hospital in Sunshine; a $106.3 million expansion for the Casey hospital and $20 million for new intensive care and short stay units at the Angliss hospital. These commitments and past approaches to prioritising and distributing capital have resulted in many necessary improvements to Victoria s health infrastructure. However, there is scope for new approaches in considering and responding to Victoria s health capital requirements, particularly in relation to those capital decisions made through a competitive grants process. Competitive processes are not always responsive to changing needs, are not based on clear priorities of need and have therefore lacked transparency. While the previous Government s additional investment in rural health service capital was welcome, 11 the Andrews Government should consider adopting a new and more transparent approach to allocation, noting that a dedicated capital funding source for rural health services should remain. In the context of aged care, the Commonwealth Government s recent Living Longer Living Better reforms have linked funding to the quality and state of capital stock. That is, significant improvements to the capital stock of public sector residential aged care services (PSRACS) attract a higher rate of Commonwealth funding. As the aged care environment becomes increasingly market-driven, the ability of public providers to sustain themselves financially will depend on the quality and suitability of their infrastructure. Given that Victorian PSRACS 14

15 state Budget submission are not permitted to borrow commercially, it is imperative that the Andrews Government reserves a dedicated capital fund for PSRACS throughout the state to ensure they remain viable and can continue to deliver quality care. This must be considered in light of the Andrews Government s policy to halt the metropolitan reallocation of public sector aged care beds to private providers as many metropolitan PSRACS also require capital improvements. Capital depreciation Victorian health services are also impacted by the imposition of capital depreciation charges which are not adequately recognised in current funding arrangements. Health services must account for depreciation costs from existing revenue, placing a significant burden upon many hospitals, multi-purpose services and community health services. Minor capital grants are allocated by the Department of Health and Human Services but are insufficient. It goes on to say: under the funding model hospital management and boards have limited control over pricing and funding models which are determined by [the Department of Health and Human Services] whilst remaining accountable for the impacts of ageing infrastructure and associated expenditure. The mismatch between the governance and funding models blurs accountability for the financial performance for individual hospitals. 14 We believe that the Andrews Government must look at options to improve funding for the repair and replacement of minor capital (for example, ICT hardware and other equipment) while maintaining state-wide control of major infrastructure replacement. One option is to increase the proportion of the capital assets charge that is distributed directly to health services. The Victorian Auditor-General s Report on Public Hospitals found that the state s annual capital spending was less than depreciation in both the metropolitan and rural sectors in each of the past four years, indicating that assets are being used faster than they are being replaced. 12 Similarly, the Auditor-General s Report on Public Hospitals noted that 33 public hospitals received capital grants of less than 20% of their depreciation expense for the year

16 Funding The VHA is concerned that recurrent funding for health services is not keeping pace with the rising costs associated with providing healthcare to a growing and ageing population. For example, the previous Government s Budget provided community health with funding growth of just two per cent. This was below inflation and failed to recognise rising salaries, operational costs and overheads. While the budget appropriation for acute providers showed a headline funding increase of four and a half per cent, this was predicated on an increase in activity 15 and should not be seen as an increase in real terms. Rural and regional health services often incur higher costs than their metropolitan counterparts, particularly in relation to recruitment and wage costs, and accordingly they must be allocated with funds commensurate with the costs of service delivery. The VHA maintains that both the Weighted Inlier Equivalent Separation (WIES) and the small rural hospital funding model fail to give adequate weighting to account for the actual costs of delivering healthcare in rural settings. Further, a rural health service s revenue challenges are exacerbated by other factors including the reduction in bed day rates paid to public hospitals by private insurers in recent years, declining numbers of patients registered with the Department of Veterans Affairs and volume issues associated with servicing smaller rural communities. Analysis of the annual reports of four rural health services where patient transport costs represent between two and four per cent of operating revenue shows that in the last four years patient transport costs have increased on average by 44 per cent with operating revenue increasing by an average of just 16 per cent over the same period. In the rate structure for urgent patient transport changed and some health services have reported a 10 per cent increase in costs as a consequence. While the Victorian Department of Health and Human Services has compensated health services for most of these costs, it is not yet clear whether this support will continue under the Andrews Government. We ask the Andrews Government to maintain compensation arrangements for urgent patient transport and work towards establishing a direct funding relationship between the Department of Health and Human Services and Ambulance Victoria for all urgent, maternity and paediatric patient transfers. Funding has also failed to adequately account for complexity. The unit price for delivering community-based services to Victorians with chronic and complex conditions is often no longer reflecting the actual cost associated with effectively treating these conditions. Underfunding of case management for clients with chronic conditions and/or complex needs means that these clients may later require more expensive treatment in the hospital or community sector. Another significant pressure for many rural health services is the rising cost of patient transport, representing between two and four per cent of their operating revenue. This cost mostly relates to transfers between hospitals, usually for patients to receive care that cannot be provided at the rural hospital. It is the referring hospital (in most cases the rural health service) which is responsible for bearing the cost of patient transport. 16

17 state Budget submission Public holidays The VHA refers to the Andrews Government s gazettal of Easter Sunday as a Victorian public holiday and its commitment to introduce an additional public holiday on Grand Final Eve. For each public holiday, a Victorian health service will spend an additional per cent of average daily operating costs without increasing productivity or service provision. These costs are largely due to penalty rates for working staff and wages for non-working staff. The loss of productivity from days not worked by non-essential administrative staff, for example, is also of concern. VHA case studies on page 18 illustrate the impact of an extra public holiday on a sample of health services. Our position is that productivity savings cannot be expected without further investment in infrastructure, including ICT. It is relevant to note that ageing and inadequate infrastructure, equipment and ICT raise the cost of delivering services by increasing the cost of repairs and maintenance and through inefficient and/or outdated infrastructure design. Where productivity savings are realised due to government policy, it is imperative that the resulting funds stay within the health portfolio for investment in innovation. We ask the Andrews Government to provide in its budget additional funding for Victorian health services to cover the costs associated with the new public holidays. This must include funds that, at the time of writing, have not yet been confirmed for the Easter Sunday on 5 April Without the delivery of additional funding, health services will have little option other than to redirect funds away from service provision. Productivity savings The Victorian Government has realised productivity savings from Victoria s health sector for many years. These savings may be explicit, such as through the reallocation of existing resources, 16 or implicit. Implicit savings are those discussed above, such as funding not keeping pace with rising demand, or being less than the unavoidable and rising costs of providing health services, such as wages. Without additional funding, health services will have little option other than to redirect funds away from service provision. The impact of productivity savings is felt disproportionately by health services that have higher ratios of non-discretionary costs. Those that have limited capacity to drive further productivity savings must look to reduce expenditure in other areas such as staffing or through a reduction to services. 17

18 Impact of unfunded Victorian Public Holidays Metropolitan health service Small rural health service Small rural health service Metropolitan community health service A metropolitan health service providing acute, emergency, sub-acute and residential aged care services across approximately 700 network-wide beds estimates that for each public holiday, the health service spends an extra $600,000 on operating costs. This represents an extra 46% of the average daily operating cost, at 1.3 million dollars, without an increase in productivity or health service provision. A small rural health service providing acute, emergency, sub-acute and residential aged care services across approximately 200 network-wide beds estimates that for each public holiday, the health service spends an additional $82,000 on operating costs. This represents an extra 42% of the average daily operating cost, at $195,000. A small rural health service providing acute and emergency services across 20 network-wide beds, community health services, and residential aged care services across 90 network-wide beds estimates that for each public holiday, the health service spends an additional $42,000 on operating costs. This represents an extra 62% of the average daily operating cost, at $68,000, without an increase in productivity or health service provision. A metropolitan community health service employing 300 staff estimates it would spend an additional $70,000 to pay for wages on a weekday public holiday. This is equivalent to 400 episodes of care, including mental health and alcohol and other drugs services, at a standard cost of $150 per hour. Income generating services such as public dental and NDIS services would not operate on a public holiday, compounding the financial impost and the reduction in working days and subsequent loss of productivity, placing increased pressure on services to meet performance indicators. 46% average daily operating costs 66% average daily wages 62% average daily operating costs 18

19 state Budget submission Workforce A skilled and effective health workforce is fundamental to delivering quality healthcare to all Victorians. Unfortunately many health services in rural Victoria continue to face multiple workforce challenges, including: > > limited access to a skilled, local workforce of medical clinicians, nurses, midwives and allied health professionals > > recruiting and retaining appropriately skilled staff a chief concern is that varying funding levels prohibit health services from offering positions with longer tenure and therefore offer insufficient incentives to attract staff to rural areas > > an ageing workforce and increasing rates of retirement Health services with staff shortages must rely on locum services at an increased cost. The Victorian maternal and child health nurse workforce is at particular risk in country areas. Health professionals who have had a positive training experience in a rural or regional setting are more likely to work in these communities upon the completion of their training. The VHA calls on the Andrews Government to promote the recruitment and retention of health professionals in rural communities. In particular, health services should be resourced to undertake activities such as mentoring to develop the skills of less experienced clinicians and provide professional support in isolated areas. Rural health services are also ideal settings in which to facilitate extended scope of practice roles for appropriately trained health professionals to increase the breadth of services available to Victorians who reside outside cities and regional centres. Legislating nurse to patient ratios The VHA acknowledges the Andrews Government s pre-election commitment to legislate nurse to patient ratios in Victorian public health services. We ask to be consulted early and throughout the development of the new legislation so that its application introduces no new unfunded costs or unintended consequences for Victorian health services. Summary of recommendations 14. Retain dedicated funding for health capital and ensure it is allocated transparently and on the basis of a sound business case. 15. Provide a dedicated capital funding program for Victorian Public Sector Residential Aged Care Services. 16. Fund initiatives that reduce the impact of depreciation charges on health services. 17. ensure that funding accurately reflects the cost of providing care across public health services and registered community health services. 18. Fully recognise the higher cost associated with providing health services in rural areas. 19. Maintain compensation arrangements for health services for all urgent, maternity and paediatric patient transfers and work towards establishing a direct funding relationship between the Department of Health and Human Services and Ambulance Victoria. 20. deliver additional funding to health services to cover costs arising from the new Easter and Grand Final public holidays. 21. Re-invest productivity savings from public health services into health innovation. 22. Increase funding to promote the recruitment and retention of health professionals in rural areas. 23. Consult with the VHA throughout the development of legislation regarding nurse to patient ratios so that its application does not produce unintended consequences or impose additional unfunded costs for health services. 19

20 The VHA was established in 1938 as the peak body representing the Victorian public healthcare sector. Our members include Victorian public hospitals, rural and regional health services, aged care facilities, community health services and Medicare Locals. State budget submission Authorised by: Acting Chief Executive Tom Symondson Media enquiries: Media and Communications Manager Sara Byers Victorian Healthcare Association Ltd ABN Level 6, 136 Exhibition Street Melbourne Victoria 3000 P / F / E / info@vha.org.au vha.org.au References Introduction 1 Available at Theme 1 2 Steering Committee for the Review of Government Service Provision 2015, Report on Government Services 2015, Volume E: Health, Productivity Commission, Canberra. 3 See: 4 For example, palliative care 5 See: ALP Election Platform, p.45. Theme 2 7 Page 4 of State Election priorities Kenedy, P. Leathley C and Hughes C, Cliical practice variation, MJA 2010, 193(8), p The Victorian health services governance handbook Victorian Department of Health, February 2013, Page 8 10 Appointments to boards of public hospitals, multi-purpose services and early parenting centres Information for applicants Victorian Department of Health, November 2013, Page 6 Theme 3 11 This was done through the introduction of a dedicated and competitive Rural Capital Support Fund. 12 Victorian Auditor-General s Report, November 2013, Public Hospitals: Results of the Audits p Victorian Auditor-General s Report, February 2015, Public Hospitals: Results of the Audits, p Ibid., p See Admitted Service Targets for WIES separations, all hospitals except rural health services, Budget Paper Number 3, p See: Victorian Budget, Service Delivery Budget Paper No.3, p17.