cohealth’s submission to this inquiry by the Victorian Parliament’s Public Affairs and Estimates Committee highlights the impacts of COVID-19 on the communities we work with and the central role community health services have played in COVID-19 responses. We identify key lessons, including the importance of engaging communities and enabling models of care that integrate primary health care, hospital care, social support and public health messaging, and that have local expertise and engagement with community health services.
cohealth welcomes the opportunity to contribute to the Public Affairs and Estimates’ Committee Inquiry into the Victorian Government’s Response to the COVID-19 Pandemic.
The COVID-19 pandemic has confronted Victoria with unprecedented challenges, to health, employment, financial security and social connectedness and wellbeing. These challenges are being felt most acutely by people who were already experiencing disadvantage. COVID-19 has highlighted and exacerbated existing inequalities. Governments at all levels have a clear obligation to ensure that no-one is left behind in responses to the pandemic. We have a critical opportunity to build a fairer and equal society through the recovery policies and actions that are implemented.
cohealth recognises the extraordinary efforts of the Victorian Government, community groups and organisations, business sector and individuals to respond to the threats of COVID-19. We applaud the many supports introduced by governments to mitigate the worst impacts of the pandemic.
At the same time cohealth has observed where there is opportunity for improvement in the system response , from inadequate engagement with community groups to effectively communicate information about the virus, through to the lack of integration of care between COVID-19 testing and health care responses.
This submission will focus on the impacts on the communities cohealth works with. From the learnings from these experiences we hope that enhanced responses can be developed to improve the health and wellbeing of the community and for planning for future crises.
Given the concentration of the covid-19 outbreak in the north and west of Melbourne, cohealth has been central to the COVID-19 pandemic response. As a non–government organisation, cohealth has been able to be extremely agile and rapidly setup a range of services, where they are needed, including the following:
Community health services across the state have played a key role in the health service response. With close connections to, and trusted relationships in, their local communities, as well as existing understanding of the needs of these communities, community health services have been able to make critical contributions to the state-wide COVID-19 response.
The community health sector has a history of rapid mobilisation in response to other disasters, such as the recent bushfires. Community members who face barriers to accessing mainstream services find accessible and welcoming health care and social support services at their local community health centres. However, despite this critical role that the community health sector plays it has not been valued to the same degree as other parts of the health system. As a result, the sector has not seen any real funding increases for many years, despite the increasing community need for services stemming from increasing inequality and hardship.
The effective response of community health services to the COVID-19 has demonstrated the vital role community health services play in providing early intervention and care, effectively reducing the load on hospitals and overall health system cost. The Victorian community health sector is in a unique position to deliver targeted, integrated and person-centred services for vulnerable and disadvantaged Victorians. In doing so, the sector has the potential to address systemic challenges and contribute to the delivery of sustainable healthcare in Victoria. To do this, the community health sector needs to be recognised as a key partner in health system design, planning and operation, with appropriate investment to grow the sector and support this critical work.
On 4 July 2020, nine public housing high rise towers in North Melbourne and Flemington became subject to a Public Health Directive that placed residents into detention in order to prevent the spread of COVID-19. The lockdown came into effect very quickly, without any notice for residents.
Significant attention has been paid to how the hard lockdown of the high-rise housing towers in North Melbourne and Flemington was undertaken. The Victorian Ombudsman is conducting an investigation into the treatment of people and conditions of detention at 33 Alfred Street, North Melbourne.
Key issues were:
cohealth was notified hours before the lockdown and was able to immediately mobilise staff to setup a clinic for residents. cohealth has a trusted relationship with residents and communities built over many years of providing services in the local area. Our involvement during the hard lockdown included:
Learnings from the hard lockdown experience informed the development of an ongoing comprehensive model of place-based integrated primary health care and engagement that has subsequently been rolled out to high-rise housing estates across Melbourne. Developed in partnership with local communities and leaders, key features of this model include:
As a result of adopting this integrated approach that actively engages local communities, COVID-19 outbreaks at other high-rise towers have been prevented and the outbreak in North Melbourne and Flemington has gone from hundreds of COVID-19 cases to now only one case (as at end of September 2020). This model has shown that working with the community can prevent and manage outbreaks, preventing the need for hard lockdowns.
A number of communities face particular challenges during the pandemic, from being able to receive accurate and timely information, to being able to comply with the public health measures designed to reduce the spread of the virus. cohealth acknowledges the proactive approach the government took with some groups, such as providing information in key community languages and swiftly providing accommodation to people sleeping rough.
However, for some other groups the response was slower. As we have seen, people in low paid, insecure work, particularly those not eligible for JobSeeker or JobKeeper payments, for some months had no option but to continue working to receive income. As a result of the fear of loss of all income and long term job loss there have been accounts of people working when symptomatic, not getting tested for COVID-19 or working while waiting for a test result. The introduction of state government payments to support people in these circumstances, such as the Worker Support Payment and the Coronavirus (COVID-19) Test Isolation Payment, is welcome, but could have been introduced earlier.
Effective communication about the risks of COVID-19, public health measures such as physical distancing, masks, hand sanitising, and assistance available for those effected is critical to prevent the spread of COVID-19. Too great a reliance has been placed on distributing these messages via mainstream media, in English, or in a limited number of community languages. Communities for whom these are not the main sources of information did not received targeted and tailored communications until later in the pandemic, and this was often initiated by the communities themselves.
To ensure public health policies consider the needs of, and impacts on, all Victorians, the wide range of communities need to be engaged in both the processes of planning and developing crisis responses, and in the implementation of these responses.
The government engage with diverse communities as active partners in planning for and responding to crises/pandemics.
Health responses to the pandemic at the State level have focussed on the critical areas of testing, tracing, health messaging and preparing and supporting hospitals, and other health providers, to cope with the pandemic.
As the pandemic progressed, it became clear that for those who tested positive there was limited connection to medical care, with GPs not notified of positive test results, or to supports to assist people to self-isolate. This was particularly challenging for people who live alone, or who face barriers to self-isolation (such as low income, living in crowded dwellings, limited information provided in community languages), and was highlighted during the response to the high-rise towers lock down. It became apparent that some people who tested positive were unclear of the requirements to self-isolate, or faced barriers to doing so, while others were not connected to medical care to monitor their symptoms. In normal circumstances the results of medical tests are communicated with the requesting clinician who can then monitor their condition, provide appropriate treatment and make referrals to other medical or social support providers as required. However, positive COVID-19 test results are not generally requested and therefore shared in this manner, preventing the follow up required to monitor patients’ health and wellbeing.
To ensure that all people who test positive for COVID-19 receive care, cohealth, Melbourne Health, the North Western Melbourne Primary Health Network and DHHS partnered to develop an integrated model of primary care, acute hospital care and social support. The pathway is designed to provide safe, high quality care, including community-based care for low risk COVID-19 positive individuals, with escalation mechanisms to higher levels of care if required. This program was piloted in August 2020 and is now being rolled out across Victoria.
In this approach, DHHS provides details of patients who test positive to cohealth. Care Connectors contact patients and undertake a clinical assessment and risk stratification, along with a social and welfare needs assessment. This program has enabled early identification and monitoring of patients who need higher level of health care, including transitions to hospital care when required.
For low risk individuals, information is communicated to the individuals GP, or a referral made to a local GP if they don’t have an existing one, for ongoing health care and monitoring. Medium risk individuals (a very small proportion) are referred to Hospital in the Home and High Risk individuals are referred to hospital.
The pilot program identified that half of the people who have tested positive were provided with social supports to enable isolation. Material needs included evacuation to hotel quarantine where housing was unstable, linking with financial supports and food relief to offset the burden of not working, or assisting people to speak with their employer about not attending work for the necessary time. Care Connectors also provide and clarify vital information about self-isolation processes and requirements, along with mental health support.
In this way, solutions are found for circumstances where people may otherwise have found it difficult to self-isolate, health needs are monitored, and any deterioration is escalated in a timely manner.
Models of care that integrate and coordinate primary health care, hospital care, social support and public health messaging should have local expertise and engagement with community health services across the state.
Recognising the significant health risks faced by people experiencing homelessness from COVID-19, and the potential risks to community health, governments across Australia took rapid action to ensure accommodation was made available for everyone sleeping rough. cohealth applauds the various measures taken by the Victorian Government to provide accommodation and support, including enabling people sleeping rough to move into longer term arrangements such as private rental housing. Many people have been moved from hotel accommodation and into longer term housing as a result. However, for those who remained in hotel accommodation for a longer period of time, this type of accommodation has limitations. Most notably, the lack of cooking facilities and outdoor space make it particularly challenging to remain in these rooms for an extended period of time.
We urge the Victorian Government to build on this work and take action to permanently eliminate homelessness in Victoria through a substantial investment in building social housing and providing wrap around supports for those who need them.
Disturbingly, members of the communities cohealth works with, cohealth staff and the media have all reported increased incidents of racism during COVID-19. These span the spectrum from overt racist attacks to the systemic racism that results in the over policing of particular communities and vital health information not being as available to people with low literacy and from non-English speaking backgrounds as it is to the wider community.
cohealth urges the Victorian government to develop stronger action to prevent and reduce racism in all its forms.
COVID-19 has illuminated the existing inequities in Victoria, and the severe consequences of this for individuals, their families and society more broadly. The health and economic impacts of the pandemic continue to disproportionately effect people facing disadvantage and marginalisation.
The people who are most affected by the disease, and the consequences of the restrictions rightly put in place to limit its spread, are those who are low paid, have insecure work; live in overcrowded, insecure or high-density housing; the elderly; and those with pre-existing complex health conditions. These groups are where the support and investment should be focussed.
cohealth recommends the Victorian Government act to provide a range of financial and practical supports to address the income and housing factors outlined above and therefore reduce the risk of the disease being spread by those who have limited choices. Combined with the Federal Government’s introduction of JobKeeper Payment and the Coronavirus Supplement, these have cushioned the impact. Nevertheless, the gaps in our social protection system have been exacerbated by the pandemic, including:
cohealth would welcome the opportunity to provide more information about this submission. Please contact Nicole Bartholomeusz, Chief Executive of cohealth on firstname.lastname@example.org or Jane Stanley, Advocacy and Policy Manager on email@example.com.