Introduction by Croakey: Health and environmental groups have welcomed the Victorian Government’s announcement that native forest logging will end this year – a “long overdue” move that researchers say is “a clarion call for other Australian states still doggedly logging their precious forests”.
“Today is a day for celebrating. At last, Victoria’s government has acted for the future. Preserving our native forests is worth much more in carbon storage, water production and tourism than they ever were as woodchips,” Professor David Lindenmayer and Dr Chris Taylor wrote for The Conversation.
Health and community sector groups have generally welcomed today’s 2023-24 Victorian state budget, which boosts overall funding for Victoria’s public health system, but highlighted failure to invest enough in prevention, housing and employment support and warned that big public sector cuts will bite.
The community health sector, which had launched a #StopTheCutsVictoria campaign amid fears of significant cuts, breathed a sigh of relief at a Budget that delivered most of its pain in increased payroll and property taxes via a ‘COVID Debt Levy.’
The Victorian Labor Government today said its Budget was aimed at building “a fairer, more equal state for every Victorian”, with significant investments in First Nations Treaty and truth processes, a welcomed boost for Aboriginal legal services, and new support for young people living in out of home care.
Treasurer Tim Pallas’ big ticket items were major cuts to the public sector and new taxes on payroll and property, designed to “pay off our COVID credit card”, with the State having borrowed $31.5 billion during the pandemic, when it had some of the longest and toughest lockdowns worldwide.
Introducing a ten-year COVID Debt Levy with two components, Pallas said “some did better out of the pandemic than others”, noting that business profits were up 24 percent over the past three years compared to the previous three, and land values were up 84 percent in the past ten years.
It was “only fair that those that did well contribute to the repayment effort”, he said.
Announcing the public sector cuts, Pallis said they would restore the public service back towards pre-pandemic levels, while not affecting frontline workers, but the Victorian Council of Social Service (VCOSS) warned that would have a ripple effect on community services.
VCOSS CEO Emma King also issued a warning to landlords that “under no circumstances” should they pass on their land tax increases to their tenants.
The Climate and Health Alliance said the end of native forest logging would be good for climate and health, while Environment Victoria hailed the move as “monumental”, and welcomed the delivery of election commitments to phase out coal by 2035, but said Victoria needs to speed up work to break its “gas addiction”.
The Budget papers are here, and see below for responses from: Victorian Health Association, cohealth, First Peoples’ Assembly of Victoria, Victorian Aboriginal Legal Services (VALS), VCOSS, Australian Nursing and Midwifery Federation (Victorian Branch), Community Health First, AMES Australia, Mental Health Victoria, Council to Homeless Persons, Environment Victoria, Council of the Ageing and Senior Victorians, the Royal Australian College of GPs, and Jesuit Social Services. We will add more as they are released.
Public health system funding up in tough times
Victorian Healthcare Association (VHA)
VHA CEO Leigh Clarke said that, in tough economic times, the Victorian Government is “investing in Victorians’ access to free, high-quality care in our public health system”.
“We’re pleased to see the State Government increasing its overall funding for Victoria’s public health system, particularly as we transition out of the emergency phase of the COVID-19 funding arrangements with the Commonwealth Government,’ she said.
“The recent federal budget showed Commonwealth funding for Victorian hospitals will decrease by 10 per cent in 2023-24 before increasing during the following years to match expected population growth, so we’re navigating our way through a difficult period.”
“Our public health system remains under enormous pressure with severe workforce shortages and rising demand, especially for more complex care. We’re still catching up on elective surgery and other delayed care from the pandemic lockdown periods. This “catch up” work is likely to go on for many years.”
The VHA praised the Victorian Government’s investment in expanding Victoria’s Virtual Emergency Department – an innovative model created by public hospitals and Ambulance Victoria to speed up emergency response times.
“It’s great to see investment in new models of care that are clearly working. Victoria’s Virtual Emergency Department is taking pressure off our ambulance service and busy emergency departments,” Clarke said.
“This is exactly the sort of innovation we need to back if we want to modernise our health system to keep up with the new challenges we’re facing.”
The VHA also welcomed a top up to the Metropolitan Health Infrastructure Fund, which pays for essential upgrades and maintenance for public hospitals and community health services.
However, it continued to call for a more strategic and predictable approach to support all health services with maintaining their buildings and critical infrastructure.
Clarke said: “We support the Victorian Government building new hospitals in future, but this should not come at the expense of maintaining our existing health services to operate safely and effectively here and now.”
“These funds pay for things like fire and emergency systems, lifts and accessible toilets, as well as vital infrastructure such as ventilators.”
Recognises need to protect healthcare system
cohealth, one of Victoria’s largest community health services, has commended the Victorian Government for maintaining its commitment to health service funding in delivering this year’s “difficult” budget.
“We recognise the difficult decisions that have been made in the face of soaring debt, and we’re relieved that the Victorian Government has chosen to protect our healthcare system from budget repair measures,” said CEO Nicole Bartholomeusz.
“A good healthcare system is the bedrock of a community in which all members can flourish and participate, and this budget recognises that. It’s particularly pleasing to see the continued investment in services that support vulnerable people in our community,” she said.
cohealth said that it was pleased that community health funding would be maintained at current levels but hopes that future budgets will provide a funding increase.
It said health spending in the Budget is primarily focused on the Victorian Government’s election commitments, including investment in hospital infrastructure.
“We still have much work to do to reorient our health system towards keeping people well while they are in the community, rather than waiting for them to become sick before stepping in.”
“As the Government has long posited, hospitals should be the place for very unwell people, but most of our healthcare delivery happens in the community, close to where people live and work, and should focus on keeping people out of hospital.”
Bartholomeusz says she was pleased to see ongoing funding for the roll-out of mental health and wellbeing local services, alcohol and drug outreach services and gave special mention to the extension of the Homelessness to a Home program funding.
“For people who have experienced years of chronic homelessness, Homelessness to a Home has provided a stable home and the wraparound support they need to make a fresh start, and we applaud the Government for extending funding to this vital program,” she said.
cohealth also welcomed the State Government’s extension of funding for Homeless Outreach Mental Health Service program (HOMHS) for another four years, a program which provides individualised wrap-around support for people experiencing homelessness who have a severe and long-term mental illness.
Challenging road ahead after “mixed bag” budget
Victorian Council of Social Service (VCOSS)
VCOSS says Victoria has delivered “a lean and challenging budget, signalling tough times for many people”.
VCOSS CEO Emma King said the budget has dramatically curbed spending in key areas, such as employment support. The Community Connectors program, which links vulnerable Victorians to health and social supports, has been cut entirely. A series of low-income electricity concessions have also been scrapped.
“This budget certainly lacks the big spending investments of recent years,” King said.
VCOSS said new revenue measures to repay COVID-era debts have been squarely targeted at businesses, investors and higher-income earners, with lower-income and more vulnerable Victorians spared the pain.
However, so-called “efficiency dividends” facing government departments will have flow-on effects for social service bodies.
King said many now face the tough challenge of keeping staff and delivering critical services with less money. “That will prove impossible for some,” she said.
VCOSS highlighted a number of positive measures:
- Aboriginal care
There’s an historic $140m investment in out-of-home care services, which will empower Aboriginal people and community-led organisations to take the lead in delivering key family supports.
More than $100m has been allocated to expand the delivery of Housing First models to address homelessness.
- Flood recovery
$347.5m this year to support genuine and long-term recovery for flood-affected communities (including mental health supports).
- Engaging young people
Including more than $5m to assist teenagers to stay connected to school (currently about 10,000 Victorian school students drop out each year) and $1.9m for an Engaging At-Risk Youth Program, to promote school engagement or re-engagement for African and Pasifika young people.
- Disability advocacy
Boost funding for disability advocacy will be maintained for a further year.
- Early intervention
More than $670m will be spent on health and social inclusion measures, under the government’s broad-ranging Early Intervention Investment Fund.
“These are some of the bright spots in a tough budget,” King said.
VCOSS said the budget includes $20 million to increase baseline community sector funding by 3.3 per cent.
“While this is less than what’s required to keep pace with surging costs and increasing demand, it’s a critical and welcome down payment on further support. VCOSS remains hopeful of greater commitments in the near future.”
Strong funding for key Treaty processes
First Peoples’ Assembly of Victoria
The First Peoples’ Assembly of Victoria has welcomed the $138 million investment in the Treaty process over four years in the Budget, with $82 million allocated directly to the Assembly.
Assembly Co-Chair and proud Nira illim bulluk man of the Taungurung Nation, Marcus Stewart, said that the Budget investment in the Treaty process shows the Victorian Government understands that while state-wide Treaty negotiations are expected to begin soon, the Treaty process requires a long-term commitment to ensure better outcomes for First Peoples.
“Treaty will restore our freedom and power as First Peoples to make the decisions that affect our mob, our culture and our Country. Having laid the foundations for Treaty-making, Treaty is now within our reach, but it must be done properly to make sure it delivers on its promise of improving our people’s lives,” Stewart said.
“For Treaty to begin to undo the damage of over 230 years of colonisation, the process must be set up for success, and all mob must have the chance to be part of Treaty-making.
“This investment will further build the power of the Assembly and ensure it has the resources to reach out to Aboriginal and Torres Strait Islander people in every corner of the state and invite them to get involved in the journey to Treaty.”
The Assembly is currently holding its elections for its second term, after which it expects to begin statewide Treaty negotiations with the Victorian Government. In its first term, the Assembly secured agreement on the three key pieces of Treaty architecture.
The search for the independent ‘umpires’ in Treaty Negotiations, the Treaty Authority Members, will begin shortly. The Self-Determination Fund will help Traditional Owner groups become Treaty ready and enter negotiations with the Victorian Government on a level playing field.
Through the Fund, Traditional Owner groups will be able to seek the resources required to ensure they meet the standards set out in the Treaty Negotiation Framework, or ‘ground rules’ for Treaty-making in Victoria.
Boost for Aboriginal legal services
Victorian Aboriginal Legal Service
The Victorian Aboriginal Legal Service said it “needs to be able to help our communities when and where they need it” and that a key part of its vision is “our Aboriginal Justice Hubs, our plan to expand our local office network, because we’re at our best when our communities can self-determine the services they need”.
“Today, the Victorian Government announced a significant investment in our Aboriginal Justice Hubs, committing $7.1 million over the next 2 years to help us open hubs in Aboriginal communities across Victoria,” it said.
VALS said investing in Aboriginal legal services is vital to address the overrepresentation of Aboriginal and Torres Strait Islander people in the legal system, amid continuing racism revealed in recent hearings of the Yoorrook Justice Commission.
In the last year we have opened new offices in Warrnambool and Bendigo, thanks to funding from the Victorian Government. These offices have already allowed us to help many more Aboriginal and Torres Strait Islander people in these communities and contribute to great outcomes for them and their families.
We look forward to working with the Victorian Government on delivering our hubs and committing to recurrent funding for our full Aboriginal Justice Hubs model so that we are always able to help our communities when and where they need it.
VALS CEO Nerita Waight said:
“It is good to see the Victorian Government investing in Aboriginal legal services in a significant way. Helping our people engage with the legal system must be a prerequisite for the transformational change that is being sought through the Treaty process.”
“This funding will mean more VALS offices in communities across Victoria. It will mean there will be more of our lawyers and community support staff to help our people when and where they need it.”
“We want to build VALS so that we can support all of our people who want our support. We are not there yet, but this is an important investment to kickstart the expansion of our Aboriginal Justice Hubs.”
“I thank the Attorney-General, Jaclyn Symes, for her commitment to helping find this funding for VALS as well her passion for Aboriginal justice issues.”
Delivers on nursing, midwifery workforce promises
Australian Nursing and Midwifery Federation (Victorian Branch)
The ANMF (Victoria) said the Budget delivers on all of the Victorian Government’s 2022 election commitments to Victorian nurses and midwives to retain and increase the workforce and improve staffing levels in emergency departments, intensive care, high dependency and coronary care units and maternity services during this term.
It continues to progress the implementation of the Mental Health Royal Commission recommendations and the public aged care building program and increases maternal and child health appointment times for new parents and their babies and young children, it said.
Secretary Lisa Fitzpatrick said: “This budget delivers the funding for extra nurses and midwives in specific clinical areas and the government’s recruitment and retention initiatives election commitments. A strong focus on both workforce and infrastructure investment will assist the public health system meet the growing demand.”
“The Andrews Government budget also provides continued funding for the Victorian virtual emergency department, priority primary care centres, GP respiratory clinics and an important recognition that we’re not back to business as usual and the COVID-19 pandemic is still with us.”
The health budget will invest $167 million for targeted and staged initiatives proposed by ANMF members:
- New postnatal night shift ratios in Level 4, 5 and 6 services under the Safer Care Maternity Capability Framework. Implementation to start in 2024. (currently 1:6 and will move to 1:4)
- A two-year trial of a registered nurse on every shift at each postnatal and antenatal ward at three maternity services. This trial will run from July 2023 to 2025.
- Level 1 hospital ED resuscitation bays will be 1:1 on the morning shift (currently 1:3).
- The formalisation of 1:1 intensive care initiative for all shifts in level 1 and level 2 ICUs.
- Liaison nurse in addition to prescribed ratios in levels 1 and 2 ICUs.
- Night duty in charge in stand-alone high-dependency units and coronary care units.
Fitzpatrick said the Victorian health budget also provides funding for the $5000 graduate nurse and midwife bonus. This two-part bonus will be paid to nurses and midwives who graduate in 2022, 2023 and 2024 if they work in the public health system for two years. This builds on the 2023 and 2024 $3,000 per annum and then $7,500 retention bonus paid to undergraduate nurses and midwives who choose to work in the public sector following their graduation for a period of two years.
She said the Government has also listened to ANMF maternal and child health members with an $86 million investment to increase their key ages and stages appointment time length with new parents and their babies and young children from 30 minutes to 45 minutes. New early parenting centre will be established in Northcote and an Aboriginal-led centre in Frankston.
ANMF said it is pleased to see special attention and $152 million for 20 women’s health clinics, an Aboriginal-led clinic and mobile health clinic, nine new women’s sexual and reproductive health hubs, an inquiry into women’s pain management and 10,800 additional laparoscopy surgeries which were all election commitments.
A $162 million to rebuild public aged care facilities in Cohuna, Maffra and Numurkah reaffirms the Andrews Government election commitment since 2014 to retain beds in this sector.
The budget also provides $776 million to continue the work to deliver the implementation of the mental health royal commission recommendations with $156 million for 98 new mental health beds across Victoria, $77 million for 50 new Mental Health and Wellbeing Locals.
“The steady and measured pace of the mental health reforms includes a continued focus on alcohol and other drugs services, health-based rather than punitive interventions for drug and alcohol addiction, and growing and retaining a mental health nursing workforce,” Ms Fitzpatrick said.
Good start to addressing state’s health crisis
Community Health First
Community Health First, an initiative led by the 24 registered independent community health services in Victoria, welcomed the Budget, saying it “delivers substantial investment to support the growing health needs of Victorians amidst a challenging economic environment”.
“This budget responds to the extreme sustained demand on Victoria’s health system, with a funding injection of $4.9 billion to build and upgrade hospitals, boost primary care services and support the health workforce,” it said.
Community Health First said it celebrates the continuation of funding to increase access to health services in community-based settings, particularly funding for GP Respiratory Clinics “which will ensure that Victorians can access urgent care outside of our overcrowded emergency departments as we head into flu season”.
Additionally, funding of $32 million in incentives for doctors who enrol in the GP training program will provide a much-needed boost to the GP workforce in Victoria and cover the shortfall in income for doctors leaving the hospital system to enter general practice, it said.
However, while this investment is necessary to address the pressures facing our hospitals and primary care services, Community Health First warned that “to ensure sustainability of our health system in the long run we need to see increased investment into preventative care initiatives”.
“This budget is a good start to addressing Victoria’s health system crisis, but we know there is further work to be done to support the services that keep Victorians healthy and out of hospitals and ambulances in the first place,” spokesperson Anna Robinson said.
“We look forward to further discussions with Government about the future of our health system and the vision we share for a system where all Victorians can access care early on and close to home, before their issues worsen.”
“We know that investing in primary and preventative care reduces presentations in our emergency departments and ambulance services. According to a report by the Australian Institute of Health and Welfare (AIHW), potentially preventable hospitalisations in Australia by age groups and small geographic areas, 38% of illness, diseases, and early deaths can be prevented. This same report also found that 1 in 10 hospital admission days are preventable.
“Victoria’s registered independent community health services play a crucial role in keeping our state healthy and supported, helping communities thrive and keeping Victorians out of hospital,” Robinson said.
“Community Health First will continue to advocate for increased and sustained primary and preventative healthcare for Victorians and the community health services that provide these vital services.”
Welcome support for mental health and wellbeing
Mental Health Victoria
Mental Health Victoria welcomed the Budget and the additional $520 million it will invest into the state’s mental health and wellbeing system.
“Against the backdrop of a challenging fiscal environment, this Budget represents a commitment by the Government to provide stability in the sector while ongoing reforms continue to mature,” it said.
“We’re in a time of tremendous change and growth. These additional commitments enable the sector to keep delivering for Victorians whilst undergoing the transformative change set out in the Royal Commission’s final report,” said CEO Marcelle Mogg.
MHV particularly welcomed confirmation of an additional year of funding for the Mental Health and Wellbeing Hubs, which were established during COVID-19 restrictions, and which have been servicing Victorian communities ahead of the roll out of Mental Health and Wellbeing Locals. 19 Hubs will continue to operate throughout 2023/24 whilst Locals procurement continues – a position for which MHV said it had long advocated.
“MHV is calling for a comprehensive approach to transition planning, as we move from legacy programs and establish new and diverse models of care across the sector. There is more to do to deliver on this promise, but there are some thoughtful decisions in this Budget which give us hope that the Government is listening and is prepared to work collaboratively with the sector in the challenges ahead.”
- $41 million allocated over two years to improve access and equity of service provision. It understood part of this will go towards targeted services provided by MHV members including Eating Disorders Victoria, Anxiety Recovery Centre Victoria, Perinatal Anxiety and Depression Australia, and The Compassionate Friends Victoria.
- $157 million to be spent to operationalise 72 new beds, across Royal Melbourne, Bendigo Health, Western Health and the Alfred, as well as continue the 24 current Hospital in the Home beds state-wide.
- an additional $48 million will be invested into new entities, including $16.2 million into the establishment of the Mental Health and Wellbeing Commission, and $8.5 million for the Victorian Collaborative Centre.
However, it said several key levers of reform remain untouched by the Budget, most notably workforce reforms and significant capital investments.
“The next iteration of the Mental Health Workforce Strategy may signal future investments, but without action on workforce development now, the Government will be hard-pressed to meet their own election commitment to double the mental health workforce by 2031.”
“This Budget doesn’t diminish the challenges ahead, but it gives us a foundation from which to continue building the mental health and wellbeing system all Victorians deserve.”
Royal Australian College of GPs
The Royal Australian College of General Practitioners (RACGP) has welcomed key measures in the Victorian Budget but reiterated calls for the Government to act on payroll tax obligations on tenant GPs.
Today’s Budget includes several promising elements including $32 million to encourage new trainee GPs into the general practice workforce and $29 million to keep operating Priority Primary Care Centres and GP Respiratory Clinics for urgent but non-emergency patient care.
RACGP Victoria Chair Dr Anita Munoz welcomed the measures.
“More must be done to boost the GP workforce, and this is a step in the right direction,” she said.
“We have enough medical students; the key is encouraging them to take up a career in general practice, particularly outside of major cities. I can tell you from personal experience that being a GP is an incredibly rewarding career and one that I would highly recommend to future doctors. You are valued by your community and see your patients through different stages of their life. The skills and expertise you develop make such a difference to so many people’s lives and no two days are the same.
“I hope that the $32 million investment announced today will encourage more future doctors into general practice. The college will keep working constructively with the Government to devise new measures to boost the GP workforce so that all patients, irrespective of where they live, have access to high-quality general practice care. That will ease pressure on the entire healthcare system and ensure that no communities are left behind.”
Dr Munoz once again called on the Government to not apply payroll tax on the medical services provided to Victorian patients by tenant GPs.
“The ‘Sick Tax’ could spell the end of accessible general practice care,” she said.
“Increasing the payroll tax threshold to $900,000 from 1 July 2024 is a welcome measure; however, when it comes to payroll tax on practices the Government must go much further. Practices across Victoria already pay payroll tax on employees such as nurses and receptionists. However, a sweeping extension of payroll tax following a New South Wales tribunal ruling in 2021 represents a huge increased tax burden that will send some practices to the wall. That ruling determined that what we call tenant GPs, who pay a percentage of their earnings to a clinic rather than being paid a fixed wage as an employee, count as employees for payroll tax purposes.
“Unless the Government exempts practices from this new interpretation of the existing tax obligation, clinics across Victoria will have little choice but to either pass the cost on to patients by charging more or face the prospect of shutting up shop. So, the RACGP will keep working with the Government to make this exemption a reality and secure the future of general practice care across the state.”
The RACGP has been advocating for a fair go for practices for more than a year after a new interpretation of payroll tax law in the NSW tribunal ruling. The ruling disrupts established business models for practices, which now face the unenviable choice of charging patients more or closing.
Support for women welcome
Migrant and refugee settlement agency AMES Australia has welcomed the Budget’s provisions to support for vulnerable women.
“We know that women from diverse communities can be among the most vulnerable in terms of missing out on health care and also as victims of domestic violence. So it is pleasing to see more resources put into these areas,” AMES Australia CEO Cath Scarth said.
AMES said the budget includes funding for women’s health, with $63 million for 20 new health clinics, with the government saying it will spend $77 million on providing support to victims of domestic violence.
There is also a $23 million initiative aimed at eliminating “period poverty” will provide free pads and tampons to women at up to 700 locations across the state.
The government will also fund thousands of extra laparoscopies to help treat endometriosis, which affects one in nin