Department of Health and Human Services policy and funding guidelines 2018 - Volume 2: Health operations 2018-19 Chapter 1: Overview, key changes ...

 
 
Department of Health
and Human Services
policy and funding
guidelines 2018
Volume 2: Health operations 2018–19
Chapter 1: Overview, key changes and new initiatives
To receive this publication in an accessible format, please phone 03 9096 8572 using
the National Relay Service 13 36 77 if required, or email policy and funding guidelines
.
Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.
© State of Victoria, Department of Health and Human Services August 2018.
Where the term ‘Aboriginal’ is used it refers to both Aboriginal and Torres Strait Islander people.
Indigenous is retained when it is part of the title of a report, program or quotation.
ISSN 2207-8347 (online)
Available on the policy and funding guidelines page .
(1806029)
Contents
Ministers’ foreword ..................................................................................................................................11

CHAPTER 1: OVERVIEW, KEY CHANGES AND NEW INITIATIVES .....................................................15

Introduction to Chapter 1 .........................................................................................................................16

1.1         Overview .....................................................................................................................................17

1.2         Highlights ....................................................................................................................................18
1.2.1       Statewide design, service and infrastructure plan for Victoria’s health system 2017–2037 ........18
1.2.2       Safer Care Victoria .......................................................................................................................18
1.2.3       Better Care Victoria ......................................................................................................................19
1.2.4       Victorian Agency for Health Information ......................................................................................20
1.2.5       Victoria’s 10-year mental health plan ...........................................................................................20
1.2.6       Victorian public health and wellbeing plan 2015–2019 ................................................................21
1.2.7       Funding to improve ambulance response performance...............................................................22
1.2.8       Family violence .............................................................................................................................22
1.2.9       Voluntary Assisted Dying Act .......................................................................................................23

1.3         Budget highlights .......................................................................................................................25
1.3.1       Output initiatives 2018–19 ............................................................................................................25
1.3.2       Asset initiatives.............................................................................................................................27

1.4         Quality and safety ......................................................................................................................30
1.4.1       Safer Care Victoria .......................................................................................................................30
1.4.2       Victorian Healthcare Experience Survey .....................................................................................31
1.4.3       Consumer participation and experience ......................................................................................31
1.4.4       Incident reporting..........................................................................................................................32
1.4.5       Staff safety and workplace culture in Victorian health services ...................................................32
1.4.6       Supporting self-determination – prioritisation of funding to Aboriginal organisations ..................32

1.5         Victorian health services performance framework .................................................................34
1.5.1       Policy and funding guidelines .......................................................................................................34
1.5.2       Statement of Priorities ..................................................................................................................34
1.5.3       Strategic plans..............................................................................................................................35
1.5.4       Multipurpose service tripartite agreements ..................................................................................35
1.5.5       Notification obligations .................................................................................................................36

1.6         Service performance ..................................................................................................................37
1.6.1       Health service performance measures ........................................................................................37
1.6.2       Performance monitoring for community service organisations ....................................................37
1.6.3       Mental health annual report .........................................................................................................37

1.7         System improvements and innovation ....................................................................................38
1.7.1       National Disability Insurance Scheme and health services .........................................................38
1.7.2       Palliative care system improvements ...........................................................................................38
1.7.3       Acute and specialist care .............................................................................................................39

                                                                                                                                                          iii
1.7.4    Mental health and drugs ...............................................................................................................47
1.7.5    Cancer service reform ..................................................................................................................49
1.7.6    Transfer of care from acute inpatient services .............................................................................50
1.7.7    Victorian Patient Transport Assistance Scheme ..........................................................................50
1.7.8    Ageing, aged care and supported residential services ................................................................51
1.7.9    Ambulance services .....................................................................................................................53
1.7.10   Community health services ..........................................................................................................54
1.7.11   Meeting the needs of Victoria’s diverse populations ....................................................................55
1.7.12   Aboriginal health and wellbeing ...................................................................................................56
1.7.13   Quality care for people with a disability ........................................................................................57
1.7.14   Gender equality ............................................................................................................................57
1.7.15   Lesbian, gay, bisexual, trans and gender diverse, and intersex health .......................................58
1.7.16   Newly arrived refugees and people seeking asylum ....................................................................58
1.7.17   Implementation of changes to the Assisted Reproductive Treatment Act 2008 ..........................59
1.7.18   Health Purchasing Victoria ...........................................................................................................59
1.7.19   Clinicians Health Channel ............................................................................................................60

1.8      The pricing and funding framework for Victorian health services .......................................61
1.8.1    Pricing and funding framework .....................................................................................................61
1.8.2    Commonwealth funding ...............................................................................................................61
1.8.3    Funding reforms 2018–19 ............................................................................................................62

1.9      Data and reporting changes ......................................................................................................67
1.9.1    Revisions to the Victorian Admitted Episode Dataset: Criteria for Reporting ..............................67
1.9.2    Data collection changes ...............................................................................................................67

List of tables

Acronyms and abbreviations

iv
Ministers’ foreword
The Victorian Budget 2018-19 provides $2.1 billion to support the 1.96 million patients expected to be
admitted to our hospitals, and the 1.84 million patients to be seen in our emergency departments, this
year.
More than 207,000 Victorians will get the surgery they need sooner, with a $217.6 million elective
surgery blitz to cut down waiting times and lists. This is equivalent to nearly 14,370 hip replacements or
more than 76,000 eye surgeries.
Budget funding will also help meet the growing demand on our health and ambulance services, giving
patients the emergency care they need, when they need it.
Code 1 Ambulance response times are at their best in nine years thanks to the Government’s support for
our paramedics. This Budget provides an extra $58.5 million to ensure more paramedics are on the road,
supported with the equipment they need to continue saving lives.
The Budget is also investing $2.1 million to support research into rare and hard to treat illnesses. This
funding will enable Maddie Riewoldt’s Vision to establish a research centre into bone marrow failure
syndrome. In addition to this research funding we will continue to provide support for Better Care
Victoria’s Innovation Fund to grow innovation and expand the capacity of our hospitals. This budget saw
the investment grow to $25 million.
Last year, Victoria experienced a horror flu season – one of the worst on record – with more than 48,000
confirmed cases of influenza and a record number of people presenting to emergency departments each
day. This budget provides $50 million to help hospitals open more beds, hire more doctors and nurses
and treat more patients. In addition the budget delivers $3.5 million to provide free flu shots for Victorian
children aged six months up to five years, available from May 2018. This is part of the $6.7 million
provided to deliver immunisation programs that tackle meningococcal and influenza.
The Victorian Budget 2018-19 provides support to rural and region Victoria through $5.5 million to
support the Loddon Campaspe and Central Highlands Regional Partnerships deliver key health
prevention projects. In addition $2.1 million has been provided for more rural and regional patients to
access support through the Victorian Patient Transport Assistance Scheme.
Victorians with a mental illness will get the treatment they need, thanks to $705 million in the Victorian
Budget 2018-19 for more mental health support, extra regional rehabilitation facilities and new
emergency department crisis hubs to help Victorians struggling with mental illness.
To address the growing need, $232.4 million will support 89 new and existing acute inpatient beds and
boost the number of treatment hours in community-based services, giving around 12,800 more Victorians
the care they require.
In addition further investment of $100.5 million will provide six emergency department crisis hubs across
the state, to help people with urgent mental health, alcohol and drug issues. These new hubs – located
at Monash Medical Centre, St Vincent’s, the Royal Melbourne, Geelong, Sunshine and Frankston
Hospitals – will take those who are dealing with serious mental health or addiction issues out of
emergency department waiting rooms, and ensure they get specialist care from specialist health
professionals.
In 2016, we lost 624 Victorians to suicide – that’s more than twice as many lives as our state’s road toll.
It’s why this year’s Budget includes $18.7 million to support the development of six new Hospital
Outreach Post-Suicidal Engagement sites. These dedicated facilities will help an extra 3,000 Victorians
every year, and ensure they and their families get the support they need.
An additional $58.9 million will also go toward expanding the Mental Health and Complex Needs Initiative
to assist more people experiencing a mental health crisis. Funding will also establish a Compulsory

Volume 2: Health operations 2018–19                                                                  Page 11
Treatment Scheme for adults with complex needs who pose an unacceptable risk to the safety of others,
and will include a new treatment facility.
We know that the scourge of addiction is hurting our regional communities, so an extra $40.6 million will
fund the construction of three new 30-bed residential treatment facilities in Barwon, Gippsland and
Hume. This will make 90 extra public beds available in regional Victoria, on top of the 100 extra rehab
beds already funded and opened as part of the Drug Rehabilitation Plan. With an extra $6.7 million to
provide treatment for up to 80 people a year at the Grampians residential rehab facility.
This year’s Budget also includes $153.8 million to provide intensive community mental health services
and support for current high-need mental health clients.
To prevent further relapses, Victorians in the early phases of recovery will have more treatment options
and better clinical care with $28.6 million to boost support in existing Preventative and Residential Care
units (PARCs).
Victoria’s mental health workforce will be expanded and new protections will be introduced to prevent
occupational violence, with $32.5 million to keep our state’s dedicated mental health professionals safe
at work.
A further $11.9 million will build a new 20-bed residential facility for young people with a mental illness,
focussing on early intervention and tailored support.
New mums struggling with perinatal depression will also get the support they need, with an extra $6.4
million in perinatal funding. Not only will this boost make sure these mums are getting the help they
need, it will also mean a better start in life for their babies. In addition funding has been provided to
support 10 additional cuddle cots so parents can spend precious time with their stillborn babies or those
lost soon after birth.
An additional $10 million will upgrade existing mental health, alcohol and drug services through the
Facilities Renewal Grants program, while $4 million in funding will help promote mental health and
wellbeing for Aboriginal Victorians.
This year’s Budget provides historic investments to help more Victorians get their lives back on track.
The Victorian Budget 2018-19 invests $1.2 billion in hospital upgrades and equipment to give our
hardworking doctors, nurses and paramedics the world-class facilities they need to keep saving lives.
Even more Victorians will have access to quality healthcare close to home, thanks to a massive new
investment in our state’s hospitals. With a focus on rural and regional Victoria, the Budget’s centrepiece
is a $461.6 million investment to redevelop the Ballarat Base Hospital. The project will create a new
emergency department, a modernised acute mental health facility, an intensive care unit, a women’s and
children’s hub, an expanded critical care ‘hot floor’, and at least an extra 100 inpatient beds.
The Budget also invests $115 million to expand Wonthaggi Hospital, building a new theatre, emergency
department and inpatient rooms, to meet the community’s growing needs. The project will also deliver
345 jobs.
A $50 million boost to the Regional Health Infrastructure Fund will mean more rural and regional
hospitals get the upgrades they need to care for and treat more patients.
The Budget also includes $123.8 million to roll-out electronic medical records across the Royal
Melbourne, Peter Mac and the Royal Women’s hospitals, helping to save lives, and supporting medical
research.
A $29.6 million update of Sunshine Hospital’s emergency department will create a separate space for
children and their families, ensuring our sickest kids get treatment sooner. With funding also delivered to
purchase land for the new Footscray Hospital with a site selection to be made in coming months.
The Victorian Budget 2018-19 provides $69.5 million to support urgent works at the Alfred Hospital to
upgrade fire safety compliance.

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Additional funding of $396 million has been made available to fully fund Australia’s first standalone Heart
Hospital, to provide the very best cardiac care for patients with heart disease, bringing the total
investment to $543 million.
So that our clinicians have everything they need to keep saving lives, $72 million has been made
available for key technology and medical equipment.
This Budget builds on the record investment we’ve made in our hospitals and ambulance services to
make sure every Victorian, no matter where they live, has access to the quality care they deserve.

 The Hon Jill Hennessy MP                               Martin Foley MP
 Minister for Health                                    Minister for Housing, Disability and Ageing
 Minister for Ambulance Services                        Minister for Mental Health

Volume 2: Health operations 2018–19                                                                   Page 13
Page 14   Volume 2: Health operations 2018–19
Overview, key changes and new initiatives

                   Chapter 1: Overview, key changes
                   and new initiatives

Volume 2: Health operations 2018–19, Chapter 1                                   Page 15
Overview, key changes and new initiatives

Introduction to Chapter 1
Chapter 1 of Volume 2: Health operations 2018–19 details the key changes and initiatives in 2018–19.
These guidelines articulate the performance and financial framework within which State Government-
funded health sector entities operate. They are a reference for funded organisations regarding the
parameters that they are expected to work to and within, in order to achieve the outcomes expected by
the Victorian Government.
The guidelines are divided into five chapters:
• Chapter 1 sets out the key changes and initiatives in 2018–19.
• Chapter 2 focuses on the financial framework for providing funding.
• Chapter 3 outlines all the prices and associated cost weights that support the overall financial
  framework.
• Chapter 4 outlines the conditions and expectations of that funding.
• Chapter 5 includes the modelled budgets for organisations that receive more than $1 million in health
  funding.
Items may be updated throughout the year. Funded organisations should always refer to the policy and
funding guidelines website for the most recent version of the documents and guidelines, available at
.
Where these guidelines refer to a statute, Regulation or contract, the reference and information provided
in these guidelines is descriptive only. In the case of any inconsistencies or ambiguities between these
guidelines and any legislation, Regulations and contractual obligations with the State of Victoria acting
through the Department of Health and Human Services (‘the department’) or the Secretary to the
department, the legislative, regulatory and contractual obligations will take precedence.

A note on terminology
The term ‘funded organisations’ in Volume 2 and all subsequent chapters relates to all entities that
receive departmental funding to deliver services. Aspects of these guidelines referring to funded
organisations are applicable to all department-funded entities.
For the purposes of these guidelines, the term ‘health services’ relates to public health services,
denominational hospitals, public hospitals and multipurpose services, as defined by the Health Services
Act 1988, in regard to services provided within a hospital or a hospital-equivalent setting. Aspects of
these guidelines that refer specifically to ‘health services’ are only applicable to these entities.
The term ‘community service organisations’ (CSOs) refers to registered community health centres, local
government authorities and non-government organisations that are not health services.
These guidelines are also relevant for Ambulance Victoria, Health Purchasing Victoria, Ramsay Health
Care and the Victorian Institute of Forensic Mental Health. The guidelines specify where aspects of the
guidelines are relevant for these organisations.

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Overview, key changes and new initiatives

1.1            Overview
The Department of Health and Human Services’ vision is to achieve the best health, wellbeing and safety
of all Victorians, so that they can live a life they value. To achieve these outcomes, the Victorian
Government is responsible for ensuring that a wide range of health services are delivered to the Victorian
community. The department plans, develops policy, funds and regulates health service providers and
activities that promote and protect the health of Victorians.
The Victorian Government funds more than 500 organisations through the department, to provide various
health services to Victorians including:
• Acute and subacute healthcare delivered by public hospitals and in community settings.
• Mental health and alcohol and drugs services delivered by public hospitals and community service
  organisations (CSOs).
• Residential care for older people, support and assistance to enable people to function independently
  in their own homes, positive ageing programs, and healthy and active living.
• Primary health services delivered by a wide community of health services.
• Health promotion and protection through emergency management, public health and related
  preventative services, education and regulation.
• Emergency transport and ambulance services through Ambulance Victoria.
The Department of Health and Human Services policy and funding guidelines 2018: Volume 2, Health
operations 2018–2019 (‘the guidelines’) represent the system-wide terms and conditions (for funding,
administrative and clinical policy) of funding for government-funded healthcare organisations.
The guidelines reflect the government and department’s role as a system manager and underpin the
agreements at an organisational-level (Statement of Priorities (SoPs) and Service Agreements). The
agreements set out the requirements that funded organisations must comply with in addition to their
contractual and statutory obligations, outline activity that is required in order to receive funding, and detail
expectations of administrative and clinical conduct.
The guidelines are relevant for all funded organisations including health services, community service
organisations and other funded organisations such as Ambulance Victoria.
In addition to these guidelines, funded organisations are expected to comply with all relevant policy
documents and guidelines. A list of key policies and guidelines can be found at
.
Hospital circulars provide updates on the changes that affect health services during the year. These are
available at .
Funded organisations should always refer to the guidelines website for the most recent version of the
guidelines, as items may be updated throughout the year.

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Overview, key changes and new initiatives

1.2            Highlights
1.2.1          Statewide design, service and infrastructure plan for
               Victoria’s health system 2017–2037
Victoria’s Statewide design, service and infrastructure plan for Victoria’s health system 2017–2037 was
released in December 2017. The plan articulates a new operating model for locality and service stream
planning guided by the following priorities:
• Building a proactive system that promotes health and anticipates demand.
• Creating a safety and quality-led system.
• Integrating care across the health and social service system.
• Strengthening rural and regional health services.
• Investing in the future – the next generation of healthcare.
The first five-year implementation plan is being supported by additional funding in the Victorian Budget
2018–19, which allocates:
• $2,373.3 million for additional service capacity
• $369.7 million for service reforms and initiatives
• $27 million for research and innovation
• $1,443.9 million for planning or building of health infrastructure.
Under the Statewide design, service and infrastructure plan for Victoria’s health system 2017–2037,
mechanisms for more joined-up planning between health services and with other sectors, including
across government, will be strengthened to support our commissioning framework.
The plan will be updated every five years to reflect changes in clinical practice, demand projections and
future trends. The Statewide design, service and infrastructure plan for Victoria’s health system 2017–
2037 can be accessed at .

Role delineation and capability frameworks
The Statewide design, service and infrastructure plan for Victoria’s health system 2017–2037 also
commits to the progressive development of a system role delineation framework, underpinned by
capability frameworks for specific service streams and volume-outcomes review.
Targeting Zero: Report of the Review of Hospital Safety and Quality Assurance in Victoria (the 2016
Duckett Review) recommended that, for all major areas of hospital clinical practice, the department
develops and monitors compliance against capability frameworks delineating, for each hospital, which
patients and treatments it has the capability to safely care for.
Individual capability frameworks are in place for maternity and newborn services and subacute services.
Work is well underway on the development of a cardiac capability framework. This will more broadly
inform the development of a statewide approach to capability frameworks to provide consistency in how
capability frameworks are to be developed, applied and monitored.
Capability frameworks will also support and inform service stream and locality plans, as well as promote
efficiencies in investment in infrastructure and capacity building across Victoria.

1.2.2          Safer Care Victoria
Safer Care Victoria was established in January 2017. It supports our health services to provide
outstanding healthcare for all Victorians – always.
Safer Care Victoria is focused on the following five priority areas.

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Overview, key changes and new initiatives

Partnering with consumers
Commitment to the involvement of consumers and community stakeholders – and ensuring they have an
equal voice in quality and safety improvement activities – is critical. A key aspect of our work is
supporting a person-centred approach to health service design and to quality and safety improvement
initiatives. This includes health service governance, health service incident responses and patient
complaints, and to develop the capacity for people to fully participate in their care.

Partnering with clinicians
Support, engagement and coordination with clinicians to enable authentic partnership and leadership on
quality and safety improvement is central to providing high-quality care and essential for system-wide
improvement. Our chief clinicians, clinical networks and the Victorian Clinical Council play crucial roles in
bringing clinician and consumer voices to the forefront of Safer Care Victoria’s work. We have a range of
clinical networks, covering specialty areas of healthcare, that work collaboratively to unite practitioners
across the state. Our clinical networks are working to drive reductions in unwarranted variation, establish
and implement clinical practice guidelines, and lead specific improvement programs and projects.

Leadership
Healthy cultures are driven by strong leaders. Leadership for quality and safety across all organisational
levels enables more effective governance to be embedded throughout health services. We are partnering
with the sector to develop a strategy and series of programs to enhance, support and connect senior and
frontline leaders within and across health services and the health system.

Stewardship and support
We are responsible for the oversight of quality and safety in Victorian health services and, in partnership
with the Victorian Agency for Health Information, for monitoring and reviewing data and providing advice
to health services and the department on matters of quality and safety. We support the sector to respond
to system issues including Therapeutic Goods Administration (TGA) alerts. We also engage with national
committees and agencies to drive the quality and safety reform agenda, including revision of health
service accreditation processes. Our legislated consultative councils conduct case reviews, identify
trends and themes, and provide recommendations and advice on how to prevent avoidable harm.

System improvement and innovation
We support the development, implementation and scaling of improvement and innovation programs and
projects. Time-limited quality and safety programs and projects, including those funded by the Better
Care Victoria Innovation Fund, help us deliver on this strategic priority. Information about the innovation
projects can be found at .
For more information see the Safer Care Victoria Strategic Plan 2017–2020 and the Safer Care Victoria
Corporate Plan 2017–18 at .

1.2.3         Better Care Victoria
Better Care Victoria was established in 2015. The initiative supports innovation within our health
services. Better Care Victoria has been administered by Safer Care Victoria since 2017.
In 2018–19, Better Care Victoria’s $10 million Innovation Fund will support healthcare provider-led
innovation and improvement projects in rural, regional and metropolitan health organisations, and across
a broad span of healthcare providers. Dedicated funding is also allocated to support the scaling up of
successful projects from the 2016–17 fund. This includes the scaling of the sepsis project across 11
health services, and the Choosing Wisely initiative.
Better Care Victoria developed a Capability for Innovation and Improvement Strategy 2017–2020 to help
healthcare providers embed innovation and improvement to deliver better patient outcomes.
Better Care Victoria will offer a range of activities in 2018–19, which are designed to enhance capability
across health organisations. The activities are aimed at:

Volume 2: Health operations 2018–19, Chapter 1                                                       Page 19
Overview, key changes and new initiatives

• Health executives: to build the skills required to build an innovation and improvement culture in their
  organisations.
• Frontline clinical managers: to have the leadership capability to drive service redesign and
  improvement.
• Early career clinicians: to build leadership capability and an understanding of the science of process
  improvement.
• Experts in redesign: to enhance their skills and knowledge on improvement work to spread across
  healthcare providers.

1.2.4          Victorian Agency for Health Information
The Victorian Agency for Health Information ensures that trusted and credible information is available to
people in the health sector, to make better use of data and evidence in learning, improvement, innovation
and health service delivery. The agency was established in January 2017 following the recommendations
of Targeting zero: Report of the Review of Hospital Safety and Quality Assurance in Victoria. The agency
is one of many government reforms designed to overhaul quality and safety across the Victorian health
system.
The Victorian Agency for Health Information has responsibilities that flow across measurement of patient
care and outcomes for three key purposes: public reporting, oversight and clinical improvement. The
agency is focused on ensuring that everyone has an accurate picture of where the concerns are, and
where we are getting it right – so that services are safe, high quality and provide a positive experience.
This is done through analysis and sharing of information across the health system.
The agency’s priorities are reflected in the following three outcome areas:
• Enhance the array of new information that will be routinely produced and used by health service
  boards, senior executives, the department and clinical leaders. This will fulfil their oversight and
  service improvement responsibilities with a focus on patient pathways, reported outcomes and
  experiences. Patient and health system outcomes will be measured using existing information
  systems in new ways.
• Expand the volume and type of information Victorians have on safety and quality of care in their local
  health services.
• Improve the level of trust stakeholders have in data (in terms of accuracy and reliability) as well as its
  availability and usefulness to our audiences.
These outcome areas are addressed through a number of deliverables including quarterly safety and
quality reports for board, executive, and clinical audiences. The Victorian Agency for Health Information
will also produce reports for the general public as well as develop and implement strategies to improve
information systems in relation to patient-reported experiences and outcomes, incident information and
clinical registries. It will reinvigorate the health data integrity program and share information on methods
used to measure performance.

1.2.5          Victoria’s 10-year mental health plan
The Victorian Government released Victoria’s 10-year mental health plan in November 2015. The plan
guides how we can work together as a community, to ensure that all Victorians have the opportunity to
experience their best mental health and achieve their full potential. It is helping drive a community-wide
shift in attitudes. All members of the community and all health services have a responsibility to promote
inclusion, support mental wellbeing and combat stigma and discrimination.
It also provides a long-term vision to improve mental health services and outcomes for Victorians with a
mental illness and support the delivery of world-leading and innovative care by Victorian health services.
It is a commitment to improving the wellbeing of Victorians with mental illness, their families and carers.

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Clinical mental health services action plan 2018–2023
The Clinical mental health services action plan 2018–2023 focuses on specialist clinical mental health
services, targeted to people with severe mental illness and delivered primarily by public health services.
The plan provides health services with a clear guide for action over the next five years through stepped,
carefully targeted investment in clinical mental health services. These investments respond to urgent
issues while also introducing fundamental reforms that will make the system more sustainable in the face
of future demand.
There will be a focus on developing a new mental health funding model for specialist community-based
adult mental health services in 2018–19. The new model will link funding to the delivery of services and
will provide different levels of funding depending on the complexity of the consumer needs. The reforms,
and related and revised performance and outcomes monitoring, will improve the transparency and drive
improvements in services performance and consumer outcomes.
In support of the action plan, we must ensure that resources and capacity are directed to the areas of
highest demand and greatest unmet need. The Statewide design, service and infrastructure plan for
Victoria’s health system 2017–2037 underpins service planning for mental health services. This includes
responding to population need, a strong focus on prevention and early intervention, connected to broader
health and social care system and services delivered out of the hospital setting and as close to home
wherever possible.

1.2.6         Victorian public health and wellbeing plan 2015–2019
The Victorian public health and wellbeing plan 2015–2019 was released in September 2015. It
establishes an ambitious vision for the state: a Victoria free of the avoidable burden of disease and
injury, so that all Victorians can enjoy the highest attainable standards of health, wellbeing and
participation at every age. The overall aim of the plan is to reduce the inequalities in health and
wellbeing.
The plan establishes six priority areas for action based on the most significant causes of poor health and
wellbeing, those most amenable to prevention, and those that cause the greatest inequalities in
outcomes across our population. The priority areas for action are:
• healthier eating and active living
• tobacco-free living
• improving mental health and wellbeing
• reducing harmful alcohol and drug use
• preventing violence and injury
• improving sexual and reproductive health.
The plan also identifies three platforms for change to support population-wide health and wellbeing
outcomes:
• place-based approaches
• people-centred approaches
• healthy and sustainable environments.
Key initiatives across the Victorian Government and major government agencies in the first two years of
the plan are summarised in Implementing the Victorian public health and wellbeing plan 2015–2019:
taking action – the first two years. An updated action plan for the final two years of the plan, 2017–2019,
will be available on the department’s website in 2018.
The Victorian public health and wellbeing outcomes framework provides a new approach to monitoring
and reporting on our collective efforts to improve health and wellbeing over the long term. The outcomes
framework provides a comprehensive set of public health and wellbeing outcomes, indicators, targets
and measures for our major population health and wellbeing priorities and their determinants. Where
data is available, the outcomes framework also enables assessment of health and wellbeing inequalities.

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Overview, key changes and new initiatives

A detailed data dictionary for the outcomes framework is also available. The first report against the
Victorian public health and wellbeing outcomes framework will be produced in 2018, the third year of the
four-year public health and wellbeing planning cycle.

1.2.7          Funding to improve ambulance response performance
In November 2016, the government announced more than $500 million in extra funding to improve
access to ambulance services and ambulance performance. This funding is provided to support
Ambulance Victoria to improve statewide Code 1 response performance toward the 85 per cent target for
Code 1 cases responded to within 15 minutes.
This funding will support:
• Employing 450 new paramedics over the next three years.
• Establishing six new ‘super response centres’ supported by more than 200 paramedics to meet
  growing demand in Melbourne’s suburbs including the west, the outer north-west, the north, the north-
  east, outer east and south-east.
• Building new or upgrading 15 branches across the state, in addition to the 20 upgrade projects
  already underway.
• Deploying 225 new paramedics in 22 branches across the state, assessed as highest priority and in
  need of further resources to meet local demand.
• Purchasing new ambulance vehicles and equipment to support the additional paramedic teams.
• Creating 12 new services in rural and remote towns with a local paramedic and vehicle, based on a
  successful model trialled at Wedderburn and Warracknabeal.
The government and the department will work with Ambulance Victoria to ensure the successful
implementation of these new services and initiatives to improve access to ambulance services for all
Victorians.

1.2.8          Family violence
Ending Family Violence: Victoria’s Plan for Change outlines how the government will deliver the Royal
Commission into Family Violence recommendations, to ensure victim survivor safety and build a future
where Victorians live free from family violence. The Victorian Government has committed $1,313 million
to implementing the recommendations of the Royal Commission.

1.2.8.1        Prevention of family violence
The Victorian Government has outlined its commitment to the prevention of family violence in Free from
violence: Victoria’s strategy to prevent family violence and all forms of violence against women. Priorities
for the work and expectations of the department for 2018–19 in this area are structured under the
following five priority areas, which form the pillars of the strategy.

Build prevention structures and systems
This includes the establishment of the Family Violence Prevention Agency, and investment in the
prevention workforce. Prevention practitioners will be embedded to work with the LGBTI community,
seniors and Aboriginal sectors to improve primary prevention practice capacity and capability. Specialist
primary prevention training will enhance prevention knowledge and skills for new and existing prevention
practitioners and contributors.

Research and evaluate
Critical knowledge gaps will be identified for immediate research. A Victorian Family Violence Prevention
Research Alliance will be established. A long-term research agenda for 2019–2021 will be launched by
the Family Violence Research Alliance. New data sets will inform the monitoring, evaluation and the
reporting framework.

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Innovate and inform
New and innovative ideas and approaches to preventing violence, will be underway in a range of settings
and sectors. An innovation fund will be launched to support and drive innovative prevention practices in
local communities. An additional innovation fund will be launched to support Aboriginal-led services
including Aboriginal community-controlled organisations and Indigenous family violence regional action
groups to design and deliver innovative prevention programs.

Scale up and build on what we know works
Prevention programs will commence in a range of settings, including:
• Victorian public sector workplaces
• universities and TAFEs
• local governments
• antenatal and postnatal settings.

Engage and communicate with the community
Phase two of the prevention of family violence behaviour change campaign will commence. Separate
media campaigns tailored to Aboriginal and LGBTI audiences will be launched, and an elder abuse
media campaign. The Victoria Against Violence 16 Days of Activism Campaign 2018 will commence.

1.2.8.2       Strengthening hospital responses to family violence
A total of $38.4 million over four years has been allocated to support public hospitals put in place a
whole-of-hospital service model for responding to family violence within three to five years
(Recommendation 96).
Regionally-based networks of public hospitals and health services are funded to implement the
Strengthening Hospital Responses to Family Violence initiative. Funding will be provided progressively
until 2021. These regional networks, together with statewide lead health services at The Royal Women’s
Hospital and Bendigo Health, are expected to support other health services across the state to
implement the initiative. Twenty-seven health services have now been funded to implement the initiative
and to provide mentoring and support to the remaining 62 public health services in a regional hub-and-
spoke style implementation model. A further $13.9 million will be allocated to these health services in
2018–19 to continue the implementation.

1.2.8.3       Antenatal screening for family violence
All public health services providing planned maternity care will implement routine antenatal screening for
family violence over the next three years, as part of the implementation of the Royal Commission into
Family Violence recommendations.
As part of the staged statewide implementation, seven public hospitals began routine screening for family
violence in December 2017, with more hospitals due to commence routine screening in 2018–19.
Screening for family violence is recommended as part of routine maternity care (Clinical Practice
Guidelines: Pregnancy Care, 2018). However, gaining consistency in screening approaches across the
range of health and social care providers has important benefits. The revision of the statewide Family
Violence Risk Assessment and Risk Management Framework (MARAM) in 2018–19 will ensure that
screening tools support consistent screening practices and referral pathways going forward. Within
hospitals, local implementation of antenatal screening for family violence will be supported by the
Strengthening Hospitals Response to Family Violence initiative.

1.2.9         Voluntary Assisted Dying Act
The Victorian Government believes all Victorians are entitled to quality end-of-life care, which relieves
pain and suffering, and provides compassionate support to family, friends and carers.

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On 29 November 2017, the Victorian Parliament passed the Voluntary Assisted Dying Act 2017. The Act
provides a safe legal framework for people who are suffering and dying to choose the manner and timing
of their death.
The Act commences on 19 June 2019. It allows for an 18-month implementation period, to give health
services time to plan and prepare for voluntary assisted dying. The department is supporting the
implementation and an Implementation Taskforce has been established to provide the necessary
expertise, focus and leadership to oversee the practical implementation of the Act.
The taskforce will coordinate the development of resources, processes and systems needed to ensure
safe and compassionate access to voluntary assisted dying. This includes community information and
consumer guidelines, substance and dosage guidelines, the permit process, clinical guidelines, a training
program and models of care and protocols.
The taskforce will partner and consult with key stakeholders and services to ensure voluntary assisted
dying is safely established within the context of existing care options available to people at the end of life.
The Implementation Taskforce will partner with Safer Care Victoria to establish the Voluntary Assisted
Dying Review Board, which will oversee the operation of the Act. The Voluntary Assisted Dying Review
Board will be established from 1 July 2018.
For further information about voluntary assisted dying visit: .

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1.3             Budget highlights
The Victorian Budget 2018–19 seeks to enhance Victoria’s liveability and support economic growth. The
department plays an important role in contributing to Victoria’s economic growth through the jobs our
services and programs create, especially in the construction sector, and the industries and workforces
we support. The initiatives funded in the Victorian Budget 2018–19 strive to increase the liveability of
Victorians, by providing key services to improve their health and wellbeing as well as essential supports
for vulnerable Victorians.
Table 1.1 details departmental health operations funding by the output categories provided by the
Victorian Budget 2018–19.
A summary of health service modelled budgets for 2018–19 is provided in Volume 2: Health operations
2018–19, Chapter 5.
The Victorian Budget 2018–19 provides $19.4 billion in recurrent funding for acute health, ambulance,
primary health, mental health and aged care services. More Victorians will get the care they need sooner
with a massive funding boost to help our hardworking doctors, nurses and paramedics treat even more
patients.
Funding for ambulance services will help maintain improvements in Code 1 ambulance response times
and maintain the required infrastructure and equipment, so that more paramedics are on the road,
supported with the equipment they need to continue saving lives.
Mental health services will be considerably strengthened in both services and infrastructure, including
more mental health support, extra regional rehabilitation facilities and new emergency department crisis
hubs to help Victorians struggling with mental illness.

Table 1.1: Victorian Budget 2018–19 by output group

                                                                       2017–18     2018–19     % increase
                                                                        budget      budget     2017–18 to
Output group                                                             ($m)        ($m)      2018–19(a)

Acute Health Services                                                   13,128.2    14,106.7          7.5%
Ageing, Aged and Home Care                                                 789.2       804.8          2.0%
Ambulance Services                                                       1,028.7     1,084.3          5.4%
Drugs Services                                                             220.1       259.9         18.1%
Mental Health                                                            1,498.9     1,605.7          7.1%
Primary, Community and Dental Health                                       500.1       559.6         11.9%
Public Health                                                              399.2       369.1        (7.5%)
Small Rural Services                                                       558.8       592.0          5.9%
Total                                                                   18,123.2    19,382.1          6.9%

Source: 2018–19 Victorian Budget Paper No. 3
Notes:
(a) Variation between 2017–18 budget and 2018–19 budget.

1.3.1           Output initiatives 2018–19
The Victorian Budget 2018–19 has allocated $919.8 million in 2018–19 and $2.77 billion over five years
for new output initiatives that will grow and strengthen the health, ambulance, mental health and aged
care sectors.

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1.3.1.1        Acute health and ambulance services
The Victorian Budget 2018–19 is investing $792.9 million in 2018–19 ($2.1 billion over five years) in
health and ambulance services programs across metropolitan Melbourne and in rural communities. This
investment includes:
• $1.6 billion over four years to meet hospital services demand to respond to growing patient demand
  across Victoria. Additional funding is provided for emergency department presentations, critical care
  admissions, maternity admissions, outpatient services, subacute care services, palliative care
  services, chemotherapy treatments and radiotherapy treatments.
• $362.2 million over four years to improve access to elective surgery, to respond to demand, reduce
  waiting times and to maintain the current performance of Victoria’s health service system.
• $50 million (in 2017–18) for a Winter Blitz package to support health services to prepare for the 2018
  winter flu season. As part of this funding, health services will address their local winter demand in a
  range of ways that best suit their community’s needs. For example, putting on more doctors and
  nurses, or opening more beds to treat more patients.
• $55.1 million over four years for an additional 90 paramedics to meet increases in demand for
  ambulance services. A further 39 paramedics and nurses will continue to support Ambulance
  Victoria’s secondary triage service. This, alongside mental health and occupation violence training for
  paramedics and continued service in Nagambie, will ensure recent improvements in ambulance
  response times are maintained.
• $25 million over two years for the Better Care Victoria Innovation Fund to enable continued
  investment in public hospital-led improvement and innovation projects to enhance access to services
  and improve health service quality and performance.
• $6.5 million over four years to respond to people’s end-of-life care choices for the safe and effective
  implementation of the Voluntary Assisted Dying Act 2017. This will include supporting the work of an
  Implementation Taskforce and Secretariat, the establishment and operation of the Voluntary Assisted
  Dying Review Board and the delivery of Voluntary Assisted Dying.
• $2.1 million in 2018–19 to improve access to the Victorian Patient Transport Assistance Scheme to
  provide travel and accommodation subsidies to rural and regional Victorians who are required to
  travel long distances to receive specialist medical care.
• $58,000 over two years to support parents of a stillborn or newborn baby death by providing an
  additional 10 cuddle cots to public maternity services to allow more women and families the
  opportunity to spend time with their baby following stillbirth or early death.

1.3.1.2        Primary, community, public and dental health
The Victorian Budget 2018–19 is investing $12.8 million in 2018–19 ($14.3 million over four years) in
primary, community, public and dental health including:
• $6.1 million to fund free influenza vaccines for Victorian children aged six months to five years in
  2018–19. In addition to administering vaccines, this initiative includes targeted campaigns to increase
  uptake and the effectiveness of the influenza vaccination program.
• $5.5 million in 2018–19 to support a locally-driven approach to target preventable health outcomes
  will be undertaken in the Loddon Campaspe region, which will contribute to reducing the incidence of
  preventable disease. The elements of this approach are: a Heart of Victoria Active Living Census; an
  Active Communities infrastructure program; and health and wellbeing brokers to build capacity and
  health and wellbeing throughout the region. A Prevention Lab brand will be developed to improve the
  health and wellbeing of families in the Central Highlands region and improve healthy eating habits
  and physical activity levels for people of the region.
• $2 million over four years towards the establishment of a Centre of Research Excellence for Bone
  Marrow Biology will be in Melbourne, to help accelerate the work of Maddie Riewoldt’s Vision in
  finding a cure for bone marrow failure syndromes.

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• $700,000 in 2018–19 for child and youth vaccinations, specifically the Meningococcal ACWY
  vaccines will be offered to all year 10 students, and 15-year-olds not in school, during the 2018 school
  year. In addition to school immunisation sessions, local governments will implement strategies to
  increase uptake.

1.3.1.3       Mental Health and drug services
The Victorian Budget 2018–19 is investing $83.7 million in 2018–19 ($583.8 million over four years) in
mental health and drug services including:
• $344.8 million over four years to reorient services towards recovery-focussed community-based
  mental health care that is effectively integrated with other health and community services and that
  provides high quality hospital and crisis care for those who need it. This includes new funding
  packages to increase hours of care for the most unwell consumers of community-based services,
  enhanced crisis responses to help reduce pressure on emergency departments, additional funding to
  expand the Hospital Outreach Post-suicide Engagement Initiative and further investment to
  strengthen the mental health workforce.
• $232.5 million over four years to meet the clinical services demand to address increasing demand for
  mental health services, through the provision of operational funding for 89 newly built and existing
  acute inpatient beds, and increased community-based service hours for approximately 12,800 people
  over four years.
• $6.7 million over four years towards the Grampians residential rehabilitation facility to commence
  operations, providing treatment for up to 80 people a year. This new facility will improve services to
  residents of regional Victoria who would otherwise be required to travel to Melbourne to access
  treatment.
• $6.4 million over four years for a perinatal package to continue support for prevention and early
  detection of perinatal depression for new mothers.
• $100,000 in 2018–19 to develop and deliver a one-hour suicide prevention training program in the
  Great South Coast Region to increase capacity within the community to recognise, and respond to,
  those at risk of suicide. The training will be delivered to representatives from 350 businesses, sporting
  and community groups.

1.3.1.4       Ageing, aged and home care
The Victorian Budget 2018–19 is investing $28.8 million in 2018–19 ($32.6 million over four years) in
ageing, aged and home care, including:
• $26.6 million to support the future provision of public sector residential aged care incorporating the
  provision of high-quality care to vulnerable aged persons, including those with mental health issues.
• $6 million over four years for an elder abuse family counselling and mediation service to continue to
  trial an integrated model of care to respond to suspected elder abuse, offering specialist clinical
  advice and family counselling and mediation services from five locations across Victoria. Community
  awareness events will also be held to increase community understanding of elder abuse as a form of
  family violence.

1.3.2         Asset initiatives
The Victorian Budget 2018–19 includes a $1.3 billion acute health capital, infrastructure and equipment
program incorporating the construction, upgrade and expansion of metropolitan and regional hospitals as
well as essential ambulance services equipment. There is also $110.6 million in capital funding allocated
for mental health facilities.

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