The newly appointed Victorian Health Minister, Jenny Mikakos, has inherited an ambitious agenda after the Labor Party’s success at last week’s state election.
As stated in its pre-election policy platform, Labor’s overarching goal for the Victorian health system is that:
Every Victorian should be able to see a health professional and get the treatment they need, when they need it. Similarly, every Victorian should have access to the services they need to enable them to fully participate in our community.
To support this goal, the election platform focuses on Labor’s record in the health portfolio, reminding Victorians of its initiatives in the ambulance system, public hospitals and in improving childhood vaccination rates. It also highlights its investment into the public hospital system, including in regional areas, and in medical research. Key achievements cited in the policy include the legalisation of medical cannabis and the establishment of Victoria’s first safe injecting room.
In its next term in government, Labor has committed to building on this record with a carefully curated mix of traditional public hospital-focused services and a more broadly focused agenda, reflecting growing awareness of the social, cultural and environmental determinants of health.
A summary of the main commitments made by the incoming Labor government in Victoria in the health portfolio, together with some points of interest arising from these commitments, are below. More analysis of the implications of the Victorian election for the health sector will be included in this week’s Health Wrap.
Jennifer Doggett writes:
Some key points to note:
- Public hospitals remain the central focus of Victorian Government policy and are the first issue addressed in the policy platform. Key commitments in this area include: upgrading infrastructure and building new facilities; decreasing waiting times in hospital EDs and increasing capacity for elective surgery.
- There is some recognition of the health impact of climate change: “Victoria has experienced fires with prolonged periods of smoke haze, intense heat waves, flooding, and the epidemic thunderstorm asthma event in 2016. These natural disasters and extreme events are particularly difficult for older, vulnerable and young Victorians, as well as those who are already struggling with health conditions.” However, there are no policy commitments which explicitly address the health risks of climate change or promote greater sustainability within the health sector.
- It is promising that Indigenous health issues are not treated as simply an isolated policy area but are incorporated into a number of mainstream initiatives, such as the commitment to develop culturally appropriate cancer services and to develop an Aboriginal medical research accord to embed culturally sensitive practices into medical research. Also, there is a commitment to ensure funded service providers understand the impact of colonisation and inter-generational trauma on Indigenous Australians.
- Similarly, there are a number of commitments which reflect an understanding that people can belong to a number of identified communities, such as Indigenous and LQBQTI, and should not have to choose between these identities when accessing care.
- The policy on family violence reflects the growth in awareness of this issue, in particular the statement that family violence is the most significant and preventable contributor to the ill health of Victorian women and the commitment to make sure the health system is equipped to properly identify and respond to family violence.
- Boundaries between federal and state responsibilities for health remain an issue, even though integration and coordination of care across jurisdictions and sectors is a major problem for consumers. For example, the policy platform includes a number of commitments in relation to community services but fails to mention how state-funded services will interact or engage with federal primary health care responsibilities such as general practice and Primary Healthcare Networks (PHNs).
The following is a summary of pre-election commitments of the Victorian Labor Government in health and human services.
Public hospitals
- strengthen hospital networks linking local primary health care providers with specialist aged care, mental health and disability services
- review public health service board composition to ensure they reflect diversity, community engagement and a balance of skills
- seek to appoint local people to rural hospital boards
- increase access to urgent after-hours care across the state
- improve public access to defibrillator programs to save more lives
- cut wait times in Emergency Departments so patients receive quality care when they need it
- prioritise cutting elective surgery waiting lists to help more Victorians get the surgery they need, sooner
Cancer services
- prioritise treatment, research and social support for cancers with high mortality rates and less awareness
- reduce the incidence of cervical cancer by continuing screening programs and increase immunisation rates for human papillomavirus (HPV)
- build on our world leading achievements in skin cancer prevention as a result of which melanoma rates are starting to decline in those under the age of 55
- improve bowel cancer survival by investing in campaigns to increase participation in the National Bowel Cancer Screening Program
- implement culturally appropriate services for Aboriginal Victorians and CALD Victorians.
Ambulance services
- assist those seeking patient transport across Victoria
- ensure rostering models support appropriate service delivery for patients and paramedics, including consideration of minimum crew numbers
- support innovative models of pre-hospital emergency care, such as Ambulance Paramedic Practitioners, across Victoria, including remote and rural areas
- introduce two-officer paramedic crewing as a minimum standard across Victoria
- improve investment in emergency services telecommunications infrastructure.
Medical research, development and innovation
- invest in medical research utilising DNA sequencing technology in the areas of complex diseases
- continue to explore models of translational clinical practice
- continue to improve the availability of and access to high quality research and data
- develop an Aboriginal research accord to recognise and embed culturally sensitive practices and respect in medical research.
Electronic records
- work to implement electronic medical records at public hospital health services and electronically-stored patient records at public hospitals, while making sure patient privacy is protected.
Mental health
- expand access to mental health services as Victoria’s population grows
- reduce risk of future harm and hospital presentation of public mental health patients by investigating the provision of discharge medications free of charge
- make sure mental health funding, programs and services are age appropriate and targeted to specific areas of need, including perinatal mental health, Aboriginal Victorians, teenage eating disorders, asylum seekers, prisoners and members of the LGBTI community
- expand the provision of integrated mainstream and specialist forensic in-patient and community mental health services
- ensure the ongoing development and expansion of clinical community bed-based services with a focus on both short and long-term recovery and rehabilitation
- make sure staff, female and other vulnerable patients in mental health facilities are safe
- make sure regional and rural Victorians can access mental health support services and staff
- make sure all mental health services are high quality, best practice, efficient, carer-friendly and support partnerships and collaboration
- make sure both Federal and State funded mental health services remain available to Victorians who are ineligible for a funded NDIS package.
Community health services
- support and fund community health services and programs
- promote strong connections between community health centres, state-wide prevention programs and health care systems
- make sure wages and conditions of allied health professionals remain on par with colleagues in the public sector
- fund ‘Victorian Centres Against Sexual Assault’ to ensure equal access in the community to survivors of sexual assault
Dental services
- expand the fluoridation in Victoria’s water supply
- provide public dental care in community health centres across Victoria to ensure eligible Victorians have access to emergency and ongoing dental care when they need it
- lobby the Federal Government to significantly improve dental health funding
- increase dental service delivery to Aboriginal Victorians, including through partnerships with Aboriginal Community Controlled Health Organisations.
Immunisation
- support compulsory vaccinations as a requirement for access to childcare
- consider expanding the vaccination program to include other high risk preventable illnesses; and continue to promote and support allergy testing
Smoking
- support initiatives to cut the number of smokers in Victoria, with focus on at-risk communities where smoking rates are higher; and
- support Quit, Cancer Council Victoria and VicHealth in their efforts to reduce smoking and continue to adopt measures to reduce exposure to smoking in the workplace.
Natural disasters
- make sure there are enough places at suitable facilities for vulnerable Victorians during natural disaster emergencies
- continue to develop monitoring systems to track demand and ensure fast responses to large-scale emergencies, such as thunderstorm asthma.
Sexually transmitted infections and blood-borne viruses
- continue to promote Pre-Exposure Prophylaxis (PrEP) to populations at high risk of Human Immunodeficiency Virus (HIV) to work towards eliminating new HIV diagnoses
- investigate Human Papillomavirus (HPV) vaccination programs for men who have sex with men (MSM) through a research trial to monitor and reduce the risk of cancer caused by HPV
- collaborate with drug support services to reduce the spread of blood-borne viruses by injecting drug users and sex workers
- develop strategies to address the sexual health needs of men who have sex with men
- fund targeted communication strategies and community based interventions to increase testing and treatment in communities that have high rates of chronic hepatitis infection.
Women’s health
- support the right of Victorian women to access abortion services
- provide funding to women’s health services and clinics across Victoria specifically increasing
- access to specialist services for women in rural areas
- make sure government health services are sensitive and responsive to the health needs of lesbian, bi-sexual and transgender women
- provide support for those who have experienced female genital mutilation and undertake prevention measures
- provide culturally appropriate services for Aboriginal Victorians and CALD women.
Men’s health
- actively promote men’s health and improve awareness of morbidity, premature death, illnesses and general health among men
- encourage health promotion programs on nutrition and exercise, delivered through workplaces, schools and community health services, with an emphasis on groups at risk
- provide support to community organisations like men’s sheds which provide support for socially isolated men by connecting them with their local communities
- ensure health services are responsive to Aboriginal men, including gay, bi-sexual and transgender Aboriginal Victorians
- ensure health services are sensitive and responsive to the health needs of gay, bi-sexual and transgender men
- develop programs designed to address accidents and suicide.
Reproductive health
- implement the Victorian Sexual and Reproductive Health Plan, working alongside women’s health organisations
- provide reproductive health education services for men and women
- ensure access to Assisted Reproductive Technologies to address infertility;=
- ensure assisted reproductive services are accessible to, and inclusive of, all Victorians, including LGBTI, Aboriginal, culturally diverse and low-income Victorians
- support women’s reproductive choices providing impartial education and counselling services on pregnancy options
- improve the accessibility and affordability of medical and surgical terminations, including at public hospitals, while reducing unwanted pregnancies
- publicly fund pregnancy support and pregnancy loss counselling
- support the removal of GST from all menstrual products to end gender discrimination
- in the taxation system
- stop and seek alternatives to the involuntary sterilisation of women with disabilities
- expand funding and training within Victorian health services to identify, respond to and support patients experiencing family violence with compassion and respect
- promote the use of Long Acting Reversible Contraception (LARC) options to reduce unplanned pregnancies and work with health service providers and the Commonwealth Government to ensure LARC is accessible and affordable
Maternity services
- expand midwifery models of care during pregnancy, child birth and the post-natal period;
- make sure hospitals have appropriate models of care for women at low and high risk of
- complications and refer women for care at tertiary hospitals where necessary;
- make sure maternity and post-birth services in rural and regional Victoria are safe, sustainable and culturally appropriate;
- encourage empathetic and sensitive support and specialist support services for breastfeeding for women when they are in hospital and back at home;
- increase the number of culturally supportive birthing suites for Aboriginal Victorian mothers; and
- consider ways to help more rural and regional mothers, particularly Aboriginal Victorian mothers, accompany their babies when transferred to major metropolitan hospitals
- improve the promotion and provision of perinatal mental health services, including depression screening, prevention and treatment
- strengthen the Maternal and Child Health (MCH) service and MCH Phone Line to improve parents’ access to reliable, evidence-based information and advice from MCH nurses
- expand the Enhanced MCH service to provide additional targeted support to 15 per cent of Victorian families who have children from birth to three years of age, such as families with babies who were born prematurely or with a low birth weight, children with a disability or parents experiencing mental health issues.
Rural and regional health
- support the provision of specialised medical and clinical services in regional areas;
- consider incentives to get more health care professionals in rural and regional communities
- develop an LGBTI health promotion strategy focusing on the special needs of people in rural and regional communities.
Aboriginal Victorians’ health
- work towards closing the life expectancy gap and significantly reduce the mortality rate for children under five
- increase the participation of Aboriginal Victorians in health policy development and service delivery
- develop cultural protocols within the Victorian health system to increase accessibility and responsiveness to Aboriginal Victorians
- work with Aboriginal organisations to improve education, develop targeted prevention and health promotion strategies to address health status inequity
- improve access to mental health and drug and alcohol services, linking Aboriginal organisations with other drug and alcohol service providers
- ensure funded service providers understand the impact of colonisation and inter-generational trauma
- improve referral pathways for Aboriginal Victorians to Aboriginal Community Controlled Organisation drug and alcohol service providers
- develop early intervention strategies with the younger Aboriginal generation to build resilience;
- work with the Aboriginal communities to develop and implement strategies to reduce the incidence of self-harm and suicide
- increase the level of dental services for Aboriginal people including by ensuring all public dental services actively work with Aboriginal communities to improve access to dental care
- deliver incentive-based programs to increase the number of Aboriginal Victorian health professionals
- work with LGBTI and Aboriginal Victorians to support and improve their health and wellbeing.
CALD communities
- ensure continuity of care after a baby is born, with seamless transition from culturally appropriate postnatal to maternal and child health services, with increased specialised support services in the weeks and months following the birth
- make sure all people from CALD communities can receive culturally sensitive health services with appropriately trained staff and translation services
- make sure specialised services are available for people who are isolated, have left war torn areas or who have suffered torture
- improve the sustainability of birthing services and midwifery care in rural and regional Victoria;
- reduce mortality rates and improve health outcomes for Aboriginal parents and babies
- improve health outcomes for lesbian and same sex attracted people and their babies
LGBTI health
- promote and encourage inclusive workplace practices and activities across public sector health services
- promote best-practice inclusive health care, including in reproductive health services
- support transgender transition services
- make sure health services and workers effectively deliver services to the LGBTI community.
Organ donation
- make sure existing Transplantation/Organ Donation Coordinators and Services are adequately resourced and supported to meet demand
- explore options to increase organ donation and transplantation rates, including collaboration with the Federal Government
- support hospitals to better identify potential donors and manage sensitive conversations with a patient’s next of kin.
Supporting Victorians with a disability
- make sure Victorians with a disability have access to a range of specialist services, improved advocacy, opportunities for paid employment and individual choice in their services, including public provision of services where available. Labor recognises that these are key to building the independence and social inclusion of people with a disability
- increase access to all aspects of life and mainstream government services, such as transport, housing, health, justice and education for people with a disability and make sure services are integrated
- work with Federal and local governments, community housing providers and investors to improve accommodation options for people with a disability and their families, including young people
- protect people with disabilities from abuse with a mandatory reporting scheme for abuse and a mandatory disability worker registration and accreditation scheme
- make sure those ineligible for NDIS funding are still supported
- be an effective market steward under the NDIS and work with the NDIA to ensure a provider-of-
- last-resort for people with a disability in thin markets; and for those with complex needs
- continue to support the not-for-profit disability services sector as it transitions to the NDIS; and
- make sure all Victorians with a disability are supported by helping Aboriginal Victorian organisations participate in NDIS service delivery and providing education programs for disability workers about the additional needs of LGBTI people with disabilities.
- promote the use of advance care directives for all public patients
- encourage discussion about advance care directives at various points in the health system
- recognise and support the specific end of life needs of Aboriginal Victorians
- provide support and training to medical professionals to deal effectively with requests for access to voluntary assisted dying.
Drug and alcohol services
- support models of service delivery that reduce the number of alcohol and drug-related hospital admissions
- invest in flexible drug treatment and other support options for all patients including those in transition between withdrawal and rehabilitation services
- ensure patients have access to clinicians specifically trained in alcohol and other drugs
- expand culturally appropriate rehabilitation and withdrawal services for Aboriginal Victorians.
Problem gambling
- strengthen obligations on Electronic Gaming Machine license holders to respond to suspected problem gambling
- work with sporting and other clubs to identify new revenue streams
- work with the Federal Government and other State Governments to address emerging issues arising from the growth of online gambling
- support health professionals, alcohol and drug services and family service to minimise and treat the harm caused by problem gambling
- work to address problem gambling in vulnerable communities, including women, CALD, Aboriginal Victorians, low income, regional and LGBTI Victorians.
Child protection
- address the over-representation of Aboriginal Victorian children in the Out of Home Care System and ensure Aboriginal Victorian children in the system have Aboriginal child placement principles consistently applied and monitored, and remain connected to their culture
- transform residential care so it becomes a short-term intervention for children with complex needs before placing them in a loving family
- expand evidence-based models that achieve positive outcomes for vulnerable families and children, including professional foster care and programs to build family capability
- expand home based care options by recruiting more foster carers, including LGBTI people
- ensure both foster and kinship carers are adequately supported to provide excellence in care and support to Victoria’s vulnerable children
- increase support to children ageing out of the care system to enable strong transitions to independence and explore extending the leaving age to 21 years
- continue to lobby the Federal Government to improve support for children in Out of Home care, such as a dedicated Medicare item number and support to carers including the expansion of the Centrelink grandparents’ helpline
- implement the ‘Roadmap for Reform’ to transform child protection and family services from crisis response to an early intervention and prevention focus
- work to reduce the number of children in residential care and divert them into culturally appropriate home-based placements or return them safely to family
Seniors and older Victorians
- make sure older Victorians are well supported with the services they need in their homes and that services within the community are accessible and feasible
- foster and support initiatives to address social isolation and loneliness among senior Victorians and promote age friendly communities
- oppose the privatisation of Victoria’s public sector residential aged care facilities, including aged care mental health facilities, and believes people should have a choice of private or quality public aged care services
- recognise the current crisis within the non-government aged care system, particularly relating to the current state of the Aged Care Funding Instrument (ACFI); and the exponential decay in care, caused by reduced ACFI funding
- investigate e-health and tele-health solutions to increase access to services for older Victorians;
- improve coordination between hospitals, residential aged care and General Practitioners so older Victorians receive better, fully coordinated care
- lobby the Federal Government to introduce mandatory aged care staff : resident ratios for private aged care facilities to free up public hospital emergency rooms and ambulance services
- consider introducing baseline standards through Worksafe, as well as legislative change through the Occupational Health and Safety legislation, in order to implement minimum ratios for Personal Care Workers to residents in the non-government aged care sector in Victoria
- consider further amendments to the Safe Patient Care Act to ensure residents receive high quality care
- build on the Federal Labor reforms to acknowledge the special needs of LGBTI seniors in accessing appropriate aged care services, free from discrimination
- work with the Federal Government to ensure governance standards in privately owned residential care facilities are maintained and continue to be met through unannounced rigorous accreditation and auditing
- work to make sure older Victorians who cannot be managed in mainstream aged care residential services due to their level of persistent cognitive, emotional or behavioural disturbance, have access to Aged Persons Mental Health nursing homes and hostels
- support the move to amend Federal legislation to provide for mandatory minimum skill mix nursing and care staff ratios so as to guarantee the quality of services in non-governmental religious and charitable and privately owned and operated aged care facilities
Keeping health, human and emergency services workers safe
- work to reduce violence and aggression in all healthcare settings
- help all healthcare workers manage and protect themselves from incidents of
- occupational violence
- ensure greater cooperation between hospitals and police to better protect staff and patients at hospitals
- ensure adequate safety and security measures are in place across public hospital emergency departments
- expand the bullying and harassment prevention strategy across all public-sector health and human services
- support the Nursing and Midwifery Health Program Victoria and the Victorian Doctors Health Program
Supporting unpaid carers
- make sure the health and human services system is alert and responsive to the mental, physical and financial needs of unpaid carers
- make sure services and support are targeted to unpaid carers in their own right
- lobby the Federal Government to improve funding and support for unpaid carers
- promote greater respect within our health and human services system for the contribution of unpaid carers in the day-to-day care of Victorians in need, including those with episodic illness who are often less visible
- ensure young carers get the support they need so their education, mental and physical health does not suffer
- advocate to the Federal Government to reassess the eligibility criteria for Special Disability Trusts for persons with severe mental illness.
Health workforce
- increase the number of medical training places available in metropolitan and regional Victoria;
- improve education and training for workers in disability services
- expand implementation of Nurse Practitioners across specialist public health services
- investigate improving Nurse-Patient Ratios across the public health sector and clinical areas
- investigate new staffing models of care, including the role of nursing assistants across general wards of public hospitals to ensure patients receive high quality care
- explore access to additional graduate entry positions and further career pathways in mental health for nursing and allied health professionals
- support the re-establishment of a nursing undergraduate major in mental health to address workforce supply shortages
- investigate the establishment of a cadetship model and training pathways in mental health for people from diverse backgrounds to achieve qualifications in nursing and allied health
