Incorporating Health, Aged Care, Housing, Aboriginal Affairs, Youth and Community Services

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1 Department of Human Services

2 Department of Human Services Incorporating Health, Aged Care, Housing, Aboriginal Affairs, Youth and Community Services 555 Collins Street Melbourne Victoria 3000 GPO Box 4057 Melbourne Victoria 3001 DX Telephone (03) Facsimile (03) Internet website Published by the Victorian Government Department of Human Services Melbourne Victoria October 1999 ISSN ( )

3 The Hon John Thwaites MP Minister for Health 555 Collins St Melbourne 3000 The Hon Bronwyn Pike MP Minister for Housing Minister for Aged Care 555 Collins St Melbourne 3000 The Hon Christine Campbell MP Minister for Community Services 555 Collins St Melbourne 3000 The Hon Keith Hamilton MP Minister for Aboriginal Affairs 555 Collins St Melbourne 3000 Dear Ministers In accordance with the Financial Management Act 1994, I am pleased to submit to you the Department of Human Services Annual Report for the year ending 30 June This Annual Report covers a period of the previous Government s administration and reflects the program arrangements and priorities which applied during that time. Yours sincerely, WJ McCann Secretary

4 Contents YEAR IN REVIEW 5 Key Portfolio Achievements In Business Developments 1 Transforming Business Corporate Infrastructure Review 13 Finance Summary 14 SERVING PEOPLE 17 Mission and Key Result Areas 18 Portfolio Functions 20 Organisational Chart 22 Roles and Relationships in Service Planning and Purchasing 23 Purchasing Services 25 Assets and Resources 28 People Management 31 PROGRAM PERFORMANCE 33 Acute Health Services 34 Ambulance Services 42 Aged, Community And Mental Health 46 Disability Services 57 Office Of Housing 64 Public Health & Development 72 Youth And Family Services 78 Aboriginal Affairs Victoria 89 Rural Health 95 Corporate Leadership 101 FINANCIAL REPORT 105 APPENDICES 135 APPENDIX 1: Index of Compliance 136 APPENDIX 2: Staff Profile 139 APPENDIX 3: Application and Operation of Freedom of Information Act APPENDIX 4: Consultancy Registers 143 APPENDIX 5: Extent of Compliance with Building Act APPENDIX 6: Review of Legislation 147 APPENDIX 7: Year 2000 Compliance 149 APPENDIX 8: Major Departmental Publications 150 APPENDIX 9: Corporate Communications Activities 152 APPENDIX 10: Approved Overseas Travel 153 APPENDIX 11: Administration of Acts 155

5 Year In Review Our mission is to ensure that the people of Victoria have access to services that protect and enhance their health and social well-being and to best allocate available resources to meet their needs.

6 Key Portfolio Achievements in The Department of Human Services continued in to implement initiatives aimed at enhancing the efficiency of its operations and strengthening the effectiveness of its service delivery. Key achievements included the positive Australian Health Care Agreement (AHCA) outcome, improvements to the financial position of hospitals, effective management of Year 2000 issues, and the continuing implementation of the Metropolitan Health Care Services Plan. Major sectoral reform in Primary Health and Community Support and in Youth and Family Services was progressed. Business process re-engineering under the innovative Transforming Business 21 (TB21) project, savings and initiatives stemming from the Corporate Infrastructure Review and the strengthening of linkages between the planning and purchasing functions within the Department have made significant advances in developing more effective and streamlined operations. Policy and Strategy Snapshot Influence on National Health Agenda and Outcome of Discussions with Commonwealth The Australian Health Care Agreement (AHCA) was successfully negotiated. The new agreement brings significant benefits to Victorian hospitals compared to prior agreements, and allows much greater flexibility for innovation in the way care is delivered. In force until June 2003, the new agreement reflects explicit recognition by the Commonwealth of demand pressures on public hospitals resulting from demographic change, increased use of technology, and risk sharing in respect of changes to private health insurance coverage. Increased funding as a result of the AHCA and DVA agreements was passed directly to hospitals by way of additional operating funds or additional funds for capital equipment. Total Commonwealth funding under AHCA, including the provision of health services to veterans, increased by $134 million in Together with the State Budget, a total of $268 million additional funding was provided to Victorian public hospitals in As part of a combined funding deal with the Commonwealth, a new agreement for the provision of hospital services to veterans was signed at the same time. This largely guaranteed funding in at a full cost recovery level and therefore generated a significant increase in Commonwealth funding for

7 Sustainability of Hospital Performance and Output Delivery The financial position of the public hospital sector improved. Implementation of the Hospital Financing Strategy ensured that additional State and Commonwealth funding was carefully applied to improve and sustain hospital performance and output delivery. Victorian health care networks and hospitals are operating at Australian benchmark cost efficiency levels. Victorian Rural Health Strategic Directions Rural Health Matters: Victorian Rural Health Strategic Directions was launched in May This strategy brought together the key elements necessary to meet the Government s commitment to the health of rural Victorians. Critical response capability New Commonwealth-State Housing Agreement Negotiated During a new Commonwealth-State Housing Agreement (CSHA) was successfully negotiated, with a total of $1.2 billion funding over a four year period. Year 2000 Contingency Planning The Department played a lead role in coordinating and supporting public hospitals in achieving Year 2000 readiness. At May 1999 the public hospital sector had achieved: ~ 97.6 per cent Year 2000 readiness ~ Remediation of over 41,000 business-critical systems Snapshot Response to the 1998 Gas Crisis The Longford Gas explosion and resulting restriction in gas supply in September 1998 was met with a rapid and comprehensive response by the Department over a sustained period. and industry response, with regional responses coordinated through the regional offices, Health Care Networks and major hospitals, and private sector industry groups. The initial response was to the fire itself, which required activation of the Department s Medical Displan and Disaster Support and Recovery Plan. Once it was evident that resulting limitation on gas availability would have far reaching impact on the community and industry, the Public Health Emergency Plan was also activated. The central coordinating role required in this crisis was unprecedented and involved every part of the Department. The Department secured public access to emergency medical services, and through the commitment of hospital staff, the hospital sector had secure emergency service capacity for the State established within 48 hours. The needs of the most vulnerable people in the community were able to be met through exemptions to the restrictions on gas use that were applied to the general community. A 24 hour operations centre was established at 555 Collins Street and became the nerve centre of the overall Department A Home Health Support Line call centre was also established at 555 Collins Street and was staffed by health professionals and administrative staff. The centre was available to all members of the Victorian population and provided advice on health and related matters, referrals to support agencies and approvals for exemptions from gas restrictions. The Department was also active in providing information via press, media and pamphlet distribution for the general public and industry covering all aspects of activity for a household without hot water, heating, or cooking capacity. In addition, advice was provided to Government about the public health implications of industries unable to operate without gas. The Gas Crisis represented a unique challenge for the Department and the health and community support sectors that was met through a committed, dedicated and innovative response from all sectors, for which the Department wishes to extend its acknowledgement and appreciation. 7

8 Service Sector Reform and Redevelopment Primary Health and Community Support Services Redevelopment Major structural reform in the Primary Health and Community Support (PHACS) sector was significantly progressed in PHACS services responded positively to the Department s plans for reform, with more than thirty proposals for demonstration projects received. Women s Health Plan A draft of the Victorian Women s Health Plan a five year strategy to improve health outcomes for women was completed in Trauma Services Review The Review of Trauma and Emergency Services was released in April 1999 and recommended shifting the focus from individual hospitals to the creation of an integrated State Trauma System. Youth and Family Services Redevelopment This redevelopment represents a significant change in the way targeted services for children, families and young people will be purchased. During , the service redesign and purchasing and performance measurement elements of the redevelopment were completed, paving the way for the first phase of new purchasing arrangements in Aged Residential Care Redevelopment 485 residential aged care places were transferred to the private or charitable/voluntary sectors in stages 1 and 2 of the Transfer Project, with additional funds spent in to upgrade those facilities retained by the State. Suicide Prevention Strategy A range of new initiatives was implemented as part of the Suicide Prevention Strategy. The initiatives included the expansion of crisis assessment and treatment services; additional residential rehabilitation services for young people; and research into men s access to health services and innovative treatment of depression in young people. Rural Ambulance Victoria Rural Ambulance Victoria was created on 1 March 1999 from five former regional ambulance services. Its creation was designed to enhance the efficiency and effectiveness of rural ambulance service delivery. Ambulance Paramedic Education and Training The mainstreaming of ambulance paramedic education and training commenced from 1 July under an agreement with Monash University, Faculty of Medicine, designed to contribute to the professionalisation of the ambulance workforce. In addition, when completed in December 1999, the Centre for Ambulance and Paramedic Studies at Monash University s Peninsula Campus will provide state-of-the-art training facilities. Turning the Tide Strategy Against Drug Abuse Drug Treatment Services were consolidated and expanded in , including additional youth residential and homebased withdrawal services, and additional women s alcohol and drug supported accommodation services. Maternity Services Enhancement Strategy Under the Maternity Services Enhancement Strategy, hospitals received additional funds in to improve the quality and level of post natal domiciliary care and support, to improve antenatal care, and to offer women more choices in models of maternity care available in public hospitals. Working Together Strategy The Working Together Strategy commenced, involving the program areas of Mental Health, Drug Treatment, Child Protection and Juvenile Justice. The aim of the strategy is to improve service responsiveness to clients requiring access to a number of services in these programs. 8

9 Koori Services Improvement Strategy In significant progress was made in implementing the Koori Services Improvement Strategy. The aim of the strategy is to improve the health and well-being of Indigenous people in Victoria by improving access, utilisation and effectiveness of the Department's human services in partnership with the Victorian Koori community. Strengthening Koori Health The Koori Health Reform Strategy was implemented to improve the health of indigenous people in Victoria. Three pilot Koori Health Outcome projects were conducted in three regions in partnership with local Aboriginal communities. Aboriginal Cultural Heritage Progress in included successful completion of a pilot program to identify and document key Aboriginal sites and places in partnership with Aboriginal communities. Redevelopment of Kensington High-Rise Estate Expansion of Supported Housing Supported Housing stock for people who are frail aged or have disabilities was increased by 28 per cent in Refining and Enhancing Statutory Services In , significant enhancements were introduced into the statutory child protection and placement services, and sustained improvements in the quality and consistency of performance were achieved. Major practice improvements included the development and implementation of the Victorian Risk Framework and the Enhanced Client Outcomes initiatives. Service enhancements were also introduced for the juvenile justice system, including the provision of additional resources for court advisory services. Food Safety Significant progress was made during to enhance food safety for all Victorians with the establishment of Food Safety Victoria and associated initiatives, including a targeted communication strategy on food safety in food businesses. Redevelopment of the Kensington high-rise estate commenced with successful relocation of tenants and demolition of the high-rise tower at 72 Derby Street. Implementation of the Segmented Waiting List for Housing Services Victoria became the first State to implement a Segmented Waiting List in , which enables people who are the most vulnerable and have least access to private rental markets to be allocated public housing first. Expansion of Transitional Housing to Assist Homeless People Transitional Housing was expanded by 46 per cent to provide short-medium term accommodation for homeless people which is linked to other support services to help them access the most appropriate long term housing. 9

10 Snapshot Kosovo Refugees The Department of Human Services played a key role late in in the coordination and successful implementation of services to support the 1500 displaced Albanian Kosovars who were offered temporary accommodation in Victoria. As a result of the conflict in the Balkans, the Commonwealth Government offered temporary refuge to 4000 Kosovars in April Nearly 40 per cent were accommodated in Victoria, owing in part to this State s significant population of people of Albanian origin. Pneumococcal Pneumonia Immunisation Victoria took the lead in in providing free vaccines for persons aged 65 years and over, with direct distribution to GPs and nursing homes. Medical and Public Health Research The publication Investing in Health Strategic directions for medical and public health research and development in Victoria was released in December The strategy will guide the allocation of State Government funding to optimise the outcomes to be achieved from research. The Department, through the Aged, Community and Mental Health and the Public Health and Development Divisions, arranged for delivery of an extensive range of health and community services to the three safe havens that were established in Victoria: at Puckapunyal Army Base, Bandiana Base (near Wodonga) and the former Defence site at Portsea. The Department worked in close collaboration with the Commonwealth departments of Immigration and Multicultural Affairs, and Defence, which coordinated the national relief effort. The first 420 Kosovars arrived 15 days after contingency plans had been activated on 16 May; and all 1500 were in residence by 20 June. The Department coordinated the planning of comprehensive health services and an extensive public health program, with the cooperation of the North West Health Care Network (through Northern Hospital), the Peninsula Health Care Network, and Wodonga Regional Health Services. Departmental staff from Hume and Southern Metropolitan regions, and the Acute Health and Youth and Family Services divisions in particular, assisted in the implementation of services. The Austin and Repatriation Medical Centre provided key mental health staff. Major non-government agencies involved in the partnership arrangements included the Red Cross, the Salvation Army, the Victorian Foundation for the Survivors of Torture, and Dental Health Services Victoria. Local government authorities also played a major role, both through maternal and child health staff, and recreation provision (with the YMCA). Adult Multicultural Education Services coordinated education provision, with the cooperation of the YWCA (with the Free Kindergarten Association s Multicultural Resource Centre) in playgroup activities for the many children of pre-school age. Congregate Care Redevelopment Relocation of clients with a disability from Pleasant Creek Training Centre to purpose-built community based accommodation continued in Disability Services Self-Assessment System Launch of The Disability Services Self-Assessment System occurred in April The System, and an accompanying information and training program, assesses the quality of current disability service provision, measures progress and obtains feedback from consumers. Additional Disability Accommodation Places An additional 280 community based accommodation places were created in for those with the highest need, identified through the Disability Services Service Needs Register (SNR). 10

11 Infrastructure Development Implementation of the Metropolitan Health Care Services Plan Major projects completed in included the new Northern hospital in Epping, the new Broadmeadows Health Service incorporating a new Integrated Care Centre; new theatres at Sandringham, upgrade of obstetric services at Box Hill and the upgrade of theatres, wards and radiology area at Williamstown Hospital. Progress on New Hospital Developments The new Latrobe Regional Hospital was commissioned and operated under contracted terms. The preferred bidder for Mildura Base Hospital was announced and construction commenced in May Berwick, Austin and Repatriation Medical Centre and Knox projects were progressed. Housing Stock Acquisition Acquisition of 2,481 properties enabled a substantial increase in Director of Housing owned stock to 70,566 properties. With the inclusion of leased and community owned properties, some 73,300 properties were available for housing assistance at June Responding to Victoria s Cultural Diversity The Department of Human Services is committed to ensuring that all the services which it provides or funds for the people of Victoria are responsive to the needs of our multicultural communities, and are accessible to Victorians from culturally and linguistically diverse backgrounds. A central Multicultural Strategy Unit has been established within the Public Health and Development Division. The Unit provides overall departmental leadership in this area, including responsibility for the development of a broad departmental Cultural Diversity Strategy, and for monitoring the effectiveness of efforts to address the human service needs of Victorians from culturally diverse backgrounds. The Department currently expends between $7 million and $8 million annually on the provision of interpreting and translation services for clients. Major efforts to reform and enhance the provision of language services are underway across the Department and individual program areas of the Department all made significant achievements during These are individually highlighted in the relevant program-specific sections of this Annual Report. Business process transformation Transforming Business 21 Transforming Business 21 is a major strategy to transform the Department s business processes through information and information technology. The strategy will enable the Department, in partnership with its funded service agencies, to transform the business processes which support the delivery of human services in Victoria. On-line Information Stage 1 of the Internet-based Better Health Channel was launched in May The Channel provides 24-hour, online access to information about health, well-being and services and is designed to empower consumers through access to high-quality information relevant to their needs. 11

12 Business Developments The Department made significant progress in on key Department-wide business initiatives that will develop more effective and streamlined operations. Transforming Business 21 Transforming Business 21 was launched in April 1998 by the Secretary. It is the implementation phase of the Department s Information Services Strategy Plan, which identified that information technology offered a range of opportunities to streamline internal business processes and to improve access to and availability of information within the Department and in the community. Six Business Initiatives are progressing the transformation strategy. The initiatives are: Purchasing Client Services. Managing Clients. Managing Information. Managing Resources. Transforming Business 21 is addressing key business practices and capabilities on a range of fronts relating to business processes, information requirements and information technology. Managing Information Technology. Transforming Client Centred Care. It is focussed on: Improving the Department s priority business processes so that available resources can be best allocated to provide the right mix of services, at the right time and in the right places to meet community needs. Defining and delivering the information necessary for decision making and planning for intelligent purchasing of client services. Increasing community access to information about health, well-being and health services. Achievements of Transforming Business 21 during included: The launch of Stage 1 of the Internet-based Better Health Channel. Better Health Channel is a new and exciting step towards empowering consumers through access to highquality information relevant to their need for information about health, well-being and health services. 12

13 Identification of a number of opportunities for immediate actions to improve business processes for the purchasing of client services. These included streamlining funds allocation, expanding purchasing options, better focusing of service purchasing on client outcomes, and simplifying and focusing purchasing planning. Strategies for implementing an integrated case management approach to address the needs of multi service clients were agreed and strategies to improve contracted case management in Juvenile Justice were identified. Undertaking a feasibility study to explore how the Department might encourage electronic service delivery in the human services sector. Completion of a major upgrade to the Department s network and desktop software. Remediation of Year 2000 issues in the Department s own information systems. Implementation of a new Human Resources Management Information System to meet Year 2000 deadlines and to enable employee electronic self-service of routine transactions. Corporate Infrastructure Review Savings of over $18 million over three years arising from the State Government s review of corporate infrastructure in the Department were identified and redirected to the following service delivery initiatives: A targeted strategy to ensure a coherent, high quality service response to children and adolescents with particular health and development needs. Expansion of Personal Alert Victoria (formerly VICPACS) personal response service for frail older people, people with a physical, sensory, intellectual or psychiatric disability, and people who are isolated and vulnerable. Establishment of a Depression and Anxiety Treatment Service (DATS), a new service model which will develop a partnership with primary care services. Business management processes were also strengthened following the Corporate Infrastructure Review with the creation of the Business Development Branch within Corporate Strategy Division. This Branch has amongst its priorities, facilitating and encouraging cross program coordination, the streamlining of the Department s purchasing processes to achieve greater consistency across program areas and strengthen links to planning, and supporting the implementation of key departmental business processes including tendering and contract management, internal service agreements and business transformation. 13

14 Finance Summary In , the Department recorded total operating expenses of $6,147 million. Table 1 records the operating expenses of each Output Group. Table 1 : Total Operating Expenses by Output Group (a) Total Actual Budget Expense $M $M Acute Health Services 2,948 2,918 Ambulance Services Aged Care and Primary Health Services Mental Health Services Public Health Services Disability Services Youth and Family Services Concessions to Pensioners & Beneficiaries Aboriginal Services Housing Assistance Total 6,245 6,147 Table 2 : Output Group Asset Investment Program, (a) Output Group Asset Total Actual Investment Program Budget Expense $M $M Acute Health Ambulance Services 8 8 Aged Care and Primary Health Services Mental Health Public Health and Development 7 7 Disability Services Youth and Family Services Concessions to Pensioners and Beneficiaries 0 0 Aboriginal Affairs 2 1 Housing Assistance (b) Total a) Excludes transfer of assets to Department of Treasury and Finance for disposal. a) This table includes Works in Progress and New Works and Annual Provisions. Annual Provisions funding is provided by Government for the on-going maintenance and upkeep of property, buildings and equipment. It usually includes minor works projects less than $250,000, equipment replacement and project design fees. b) In addition, the Office of Housing made debt repayments of $126 million. Table 2 shows total expenses by each Output Group against the Department s asset investment program of $753 million. The majority of the program for Output Groups in health and community services was funded from current output revenue with the balance of $88 million being funded by a capital injection from Government. The Office of Housing generated funds from internal sources, Commonwealth-State Housing Agreement funding, asset sales and the utilisation of working capital funds. In addition, the Office of Housing made debt repayments of $126 million. 14

15 Tables 3 and 4 summarise the financial operations of the Department of Human Services from to The increase in Government revenue and expenses over this period reflects mainly: Increased funding generated following the finalisation of negotiations with the Commonwealth on the Australian Health Care Agreement and with the Department of Veteran Affairs on the Hospital Services Arrangement for veterans. The approval of additional funding for wage awards, general cost increases, service demand and quality increases, and Y2K remediation. The introduction by the Government of a Capital Assets Charge based on total net assets of the Department and reporting agencies. The increase in assets mainly reflects asset purchases and re-valuations. The reduction in liabilities in mainly reflects the assumption by the Department of Treasury and Finance of the borrowings of the Director of Housing as at 1 July The reduction reflects debt repayments by the Director of Housing. 15

16 Table 3 : Summary of Financial Results, to Summary of Financial Results $000 $000 $000 $000 $000 Total Department Operating Revenue 337, , , , ,853 Revenue from Government 4,521,984 4,872,342 5,123,453 5,413,100 6,196,338 Intra-Government changes, etc (13,977) (20,134) (16,979) (26,020) (4,283) Expenses 4,611,980 5,008,393 5,2201,588 5,502,768 6,193,569 Changes in Net Assets 233, , , , ,339 (before abnormal and extraordinary items) Table 4 : Summary of Financial Positions, to Summary of Financial Positions $000 $000 $000 $000 $000 Total Department Total Assets 7,363,448 7,340,576 7,029,359 7,173,264 7,564,344 Total Liabilities 2,651,607 2,553,436 2,257, , ,932 Total Equity 4,711,841 4,787,140 4,771,942 6,322,278 6,821,412 16

17 Serving People

18 Mission and Key Result Areas The Mission of the Department of Human Services is to ensure that the people of Victoria have access to services that protect and enhance their health and social well-being and to best allocate available resources to meet their needs. Underpinning the Mission are four Key Result Areas (KRAs). To achieve its Mission, the Department s services must: 1. Protect and care for those at risk. 2. Be responsive to client needs. 3. Be accessible. 4. Be focused on performance and efficient management. Program performance is reported in this Annual Report in terms of the Key Result Areas for the Department in These KRAs reflect important organisational values and imperatives over the longer term and provide focus for the Department in determining priorities, setting objectives and developing and implementing strategies and initiatives to improve the delivery of services to our clients. The framework of three year primary goals and associated strategies which guided the Department s operations in is shown overleaf. 18

19 Mission To ensure that the people of Victoria have access to services that protect and enhance their health and social well-being and to best allocate available resources to meet their needs. Key Result Areas Protect and care for those at risk Be responsive to client needs Be accessible Be focussed on performance and efficient management Primary Departmental Goals to Improve services for the most vulnerable sectors of the client population Improve and maintain high quality services and facilities for clients Strengthen population wide interventions and outcome measurement to underpin sectoral strategies Strengthen service integration to better tailor services to clients needs Achieve a more adequate mix and equitable distribution of human services Drive further performance improvement in purchased and directly delivered services Key 3 Year Strategies Deal with the most urgent unmet needs Provide safe and secure facilities for the Department s clients Utilise evidence-based research to underpin responsive service model development and inform resource allocation Implement models of more integrated service purchasing tailored to the life stage or continuing care needs of clients Meet and manage demand for increased services arising from population and technology changes Extend as appropriate the level of contestability and non-government service provision in the human services sector Implement sectoral strategies to address the needs of priority target groups Continuously improve the quality of human service delivery Strengthen early intervention and prevention services to reduce inappropriate and unnecessary use of tertiary services Modify service products to address identified gaps in service provision Develop and maintain the viability of essential human services in local communities Maintain a high level of technical efficiency in hospital service provision. Maintain and strengthen Victoria s leadership in medical research Better utilise technology to improve access to services, particularly in rural areas Enhance electronic service delivery and use of information technology across the human services sector Better utilise capital infrastructure to improve community access to local services Contribute to the reform of Intergovernmental finances and clarify responsibilities Achieve best practice performance measurement within the Victoria Public Sector 19

20 Portfolio Functions In , the Department of Human Services covered the responsibilities of the Ministers or Health, Aged Care, Youth and Community Services, Housing and Aboriginal Affairs. The principal responsibilities of the Department in covered the purchase or provision of: High quality, efficient health care services through the public hospital system, community health centres and ambulance services. A range of public health protection and promotion services and specialist health care evaluation and epidemiology functions. Specialist community-based and inpatient mental health services for children, adolescents, adults and older people and community support and rehabilitation services. Residential and rehabilitation care to older and disabled persons, services to assist return home after hospital treatment, and services to enable these people to continue to live at home. Adequate and affordable housing assistance, targeted to those Victorians most in need of housing. 20

21 A range of general community services for children and families. Other human services programs which concentrate on the provision of services to the vulnerable, including statutory child protection and juvenile justice services. Programs to promote the economic and social development of Aboriginal communities and their cultural heritage. Government concessions designed to ensure that low income groups are not denied reasonable access to essential services. Most services are provided by agencies under funding and service agreements or contracts with the Department. These include Government-related agencies such as public hospitals, health care networks, public nursing homes, local government, community health centres, ambulance services, and a range of non-government organisations providing mainly community services. Housing services are predominantly purchased from external agencies or suppliers under contractual arrangements. The Department also provides some services directly, including intellectual disability case management and accommodation services, child protection and juvenile justice services and some tenancy services. Figure 1 : Regions of the Department of Human Services Loddon Mallee Region Grampians Region Hume Region Gippsland Region Barwon South Western Region Northern Region Eastern Region Western Metropolitan Region Southern Metropolitan Region Established following machinery of government changes in 1996, this broad portfolio created the opportunity for all human services provided or purchased by the Victorian Government to be brought together under the one public administration. The capability was created for the integration of human services delivery and purchasing around the needs of clients and communities and for more effective allocation of resources across these services. The expanded portfolio was restructured during 1996 to more clearly define the role of head office and decentralise local purchasing decisions and contract management to the Department s regional offices. This restructure was designed to focus head office functions on policy development and the setting of service requirements and standards for the purchasing of services by regions. Regions were seen to be best placed to operationalise the integration of services at the community level through their local planning and purchasing functions. Purchasing of hospital services in the metropolitan area remained a head office function, due to the special size and nature of the Department s service agreements with hospital networks and the need for central planning and management of the casemix funding system. 21

22 Organisational Chart The Department delivers its services through an organisational structure based around six functional divisions, three corporate divisions and nine geographic regions. Minister for Youth and Community Services Minister for Health Minister for Aged Care Minister for Housing Minister Responsible for Aboriginal Affairs Secretary CEO, provides advice and support to three Ministers Corporate Strategy Division Corporate Resources Division Portfolio Services Division Business Planning and Analysis Intergovernmental Relations Ambulance Services Export Development Business Development Financial and Administration Services Information Services External Purchasing Support Private Sector Contracts Capital Management Human Resources Secretariat Legal Services Corporate Communications Media Unit Internal Audit Barwon South Western Region Northern Metropolitan Region Acute Health Division Aged Community and Mental Health Division Public Health and Development Division Disability Services Division Youth and Family Services Division Office of Housing Aboriginal Affairs Hospital Services Planning Services Purchasing Entity Ownership Promotion of Quality in Services Policy Development Capital Investment Planning Gippsland Region Purchases a range of aged, community and mental health services which play a key role in improving, restoring and maintaining people s well-being by providing accessible and responsive care in the most appropriate setting. Western Metropolitan Region Focuses on the health of the population rather than treatment of the individual Focuses on the underlying causes of ill health and preventative strategies Grampians Region Provides care and support for people with intellectual, physical, sensory and neurological disabilities and acquired brain Injury Programs work in partnership with families and carers Also supports Rural Health Services Unit Eastern Metropolitan Region Provides a range of community programs and family services to support the key role of the family in society Includes protective and placement and support services for children and young people Southern Metropolitan Region Provides responsive and affordable housing assistance to those most in need Hume Region The Victorian government s central co-ordinating agency for Aboriginal affairs has statutory responsibility for Aboriginal cultural heritage management and protection and the enforcement of legislation Lodden Mallee Region 22

23 Roles and Relationships in Service Planning and Purchasing The role of the Divisions in the Department is to create the framework within which services are delivered while allowing sufficient flexibility for regions to purchase services in a way that encourages local service integration and responsiveness. Divisions are responsible for: Developing, communicating and monitoring policy and service frameworks. Providing service objectives and plans. Determining client eligibility (targeting). Defining outcomes and determining output specifications and structures at Output, Component and Activity levels. Providing Regional Directors with complete budgets specified at output or component levels or as agreed between divisions and regions. Planning and purchasing acute health services. 23

24 Developing purchasing plans and determining prices for other services. Developing elements of tender specification collaboratively with regions. Developing assessment tools to ensure provider performance can be measured/monitored. Providing in a timely manner adequate access to all electronic data systems and other data sets. Figure 2 : Roles and Relationships in the Department of Human Services Service System DEPARTMENT of HUMAN SERVICES Government Divisions Regions Regions and Providers Policy Directions and Strategies Budget Directions and Priorities Statewide Service Planning, Development, Specification and Redevelopment Purchasing Plans and Performance Monitoring Regional Service Agreement Regional Planning Purchasing and Contract Management & Administration Service Delivery Clients Client Service Utilisation and Outcomes Mission Key Result Areas Primary Goals 3 year Strategies Budget In exercising their planning and purchasing functions, Regions are responsible for: Developing a regional plan to inform service provision and purchasing. Developing an understanding of client needs, the service system and the market place which will inform service purchasing. Developing a thorough understanding of the complementary roles of local providers in meeting client needs and identification of potential gaps or opportunities to maximise the use of local infrastructure. Ensuring that services to be purchased contribute to the achievement of the Department s strategic objectives, are consistent with the regional plan and maximise the use of available resources. Ensuring that services to be purchased are packaged in a way that is sensible from the provider market and client perspectives. Developing detailed services specifications that meet the service needs of the region s clients and also the outputs and outcomes determined by the programs. Purchasing services (excluding Acute Health) in accordance with programs purchasing plans and through a flexible budget within defined parameters to tailor responses which best meet the needs of clients. Extending competition and contestability into the process for contracting service delivery as appropriate. Monitoring provider performance to ensure that purchased services meet acceptable quality standards and practice guidelines, and taking corrective action where performance is below target. Monitoring output delivery and ensuring that output targets are being met. Facilitating the development of a sustainable marketplace from which to purchase services. Determining provider budgets and conducting regulatory audits of operational compliance. Identifying and communicating to program divisions and Corporate Strategy Division, opportunities for cross-program service initiatives or redevelopments. Developing strong links between regions for sharing information on new services models and when dealing with agencies that provide statewide services or service to more than one region. 24

25 Purchasing Services In , the Department externally purchased services from over 2,750 provider agencies through funding and service agreements and other contractual arrangements. External purchasing represented approximately $5.2 billion or about 89 per cent of the Department s total output expenditure. The bulk of the value of this external purchasing (80 per cent) was accounted for by approximately 250 acute health and aged care agencies. The Department also provided services directly, representing $365 million or 6 per cent of the Department s expenditure. These services included intellectual disability accommodation, child protection, juvenile justice and some tenancy and mental health services. Areas of the portfolio differed significantly in the balance between external and internally sourced purchasing: Health and Aged Care purchased $4.1 billion of services externally (97 per cent) in

26 Youth and Community Services purchased $808 million of services externally (63 per cent) and $322 million internally (25 per cent), including $216 million for internally delivered Disability Services and $106 million for internally delivered Youth and Family Services. Housing purchased $303 million of services externally (90 per cent) in Figure 3 DHS Current Expenditure by External/Internal Purchasing Internal delivery 6% Corp Support 5% External purchasing 89% Figure 4 Health and Aged Care Output Budget by External/Internal Purchasing Internal delivery <1% Corp Support 3% External purchasing 97% Figure 5 Youth and Community Services Output Budget by External/Internal Purchasing Internal delivery 25% Corp Support 11% External purchasing 64% Figure 6 Housing and Aboriginal Affairs Output Budget by External/Internal Purchasing Internal delivery 8% Corp Support 5% External purchasing 87% 26

27 The bulk of the Department s external purchasing ($4.6 billion or 78 per cent in ) involved service agreements with agencies funded by more than one program. Excluding agreements with pre-schools and child care centres, approximately 50 per cent of all service agreements involve multiple program funding. Programs (excluding Housing) contributed funds totalling $3.2 billion to 15 acute care facilities. While the bulk of these funds were provided by the Acute Health and Aged, Community and Mental Health programs for the purchase of discrete services, the significance of multiple program funding is that it creates opportunities for the streamlining of purchasing. Most service agreements were with Youth and Family Services in but 95 per cent of these were service agreements with pre-school and child care centres. In value terms, 80 per cent of all external purchasing involves Acute Health and Aged, Community and Mental Health. Numerically, responsibility for contract management of service agreements with external agencies was allocated primarily to regions, as shown in the table below, although the agreements managed by Head Office represented the bulk of external funding provided by the Department, since they include agreements with Metropolitan Health Care Networks. Figure 7 Figure 8 Per cent of Service Plans in Agreements, SAMS data currently excludes Housing agreements Chart shows percent of service plans included in Service Agreements Public Health 6% Acute Health 3% YFS 64% Disability 9% ACMH 18% Other <1% Total 3459 Service Plans in 2748 Service Agreements Percent of Value of External Purchasing, Excludes external purchasing by Housing valued at $303m in Public Health 3% Ambulance 2% Acute Health 55% Disability 5% YFS 11% ACMH 23% Aboriginal Affairs 1% Table 5 : Responsibility for Management of Service Agreements by Head Office or Lead Region, Lead Region or Office Number of service agreements, Head Office 99 Gippsland 164 Grampians 176 Barwon-South Western 189 Loddon Mallee 205 Hume 215 Western Metropolitan 256 Northern Metropolitan 394 Eastern Metropolitan 503 Southern Metropolitan 547 Total 2,748 27

28 Assets and Resources The Department holds a large land and building asset portfolio valued at approximately $8.2 billion. Capital assets are used by the Department s directly delivered services and by various external service providers, through lease agreements, in all program areas across Victoria. The Department owns 70,566 properties through the Office of Housing that are utilised for the purposes of public housing. In addition, the Department controls ten institutional residential facilities and approximately 440 community residential facilities which are utilised for the purpose of providing accommodation and support to young offenders, the intellectually disabled and state wards. In , the Department spent approximately $276 million on capital works in health, aged care, and youth and community services, and $477 million in housing capital projects. 28

29 Table 6 : Major projects in the Department s Asset Investment Program, (1) Project Program Project Scope Total End Total Cost Expenditure to Date, as at 30 June, 1999 Sunshine Hospital Acute Enhance current role. Expand general services including 24,400,000 1,804,000 Redevelopment Health paediatric, obstetric, gynaecology, general surgery and general medicine. Ballarat Base Redevelopment Acute Redevelopment of emergency, imaging, intensive care, day 20,500,000 1,176,000 Stage 2 Health surgery, procedures, outpatients, allied health and ancillary services. Royal Women's Acute Service Acute Upgrading of acute clinical services including interim urgent and 19,114,000 5,158,000 Provided at Other Hospitals Health essential needs projects. Royal Children's Acute Service Acute Upgrading of acute clinical services including infrastructure 15,000,000 1,235,000 Provided at Other Hospitals Health projects. Bendigo Health Care Redevelopment Acute This component of the BHCG project includes the 60 bed acute 12,013,700 12,013,700 Health ward, new theatre and day procedures unit, emergency department, medical imaging, pharmacy, allied health and outpatients facilities. Dandenong Acute Clinical Upgrade Acute Upgrading of acute clinical services. Refurbishment, infrastructure 12,000,000 5,134,000 Health upgrade and construction of new acute wards. Inner & Eastern Health Care Aged Care Improve access and physical amenity of aged, extended care and 20,500,000 1,101,000 Network Aged Care Services rehabilitation services in the Inner and Eastern Health Care Network. Redevelop Caulfield General Medical Centre, St Georges and William Angliss hospital and to relocate Manvantara hospital. Queen Elizabeth Centre Ballarat Aged Care Staged funding which will complete rehabilitation, allied health, 8,500,000 1,980,000 Redevelopment palliative care and main front building facility. This stage of the project also allows for the Psychiatry/Aged Care/Acute evaluation management/streams of care component of the project. Queen Elizabeth Centre Ballarat Aged Care / Staged Ballarat Health Service aged care redevelopment at 15,000,000 15,000,000 (QECB) Redevelopment Acute Health QECB site. New facility for 30 bed nursing home and 30 bed rehabilitation ward. Bendigo Health Care Extended Care Aged Care Construction of streams of care and rehabilitation facilities on the 12,036,000 12,036,000 Redevelopment Anne Caudle site. Sunshine Hospital Aged Care Aged Care The development of aged care and rehabilitation facilities including 10,200, ,000 Services a 30 bed rehabilitation ward, a 20 bed geriatric evalutaion and management (GEM) unit, a 20 bed dementia unit and a refurbished and expanded community rehabilitation centre 29

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