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cohealth’s submission to the Victorian Government’s pre-budget process presents four proposals to realise the benefits of community-based care, particularly for those with the most complex needs:
An innovative model of co-location of health and housing services
Investment in community-based psychosocial support for people with serious mental illness
Improving the health of families with complex needs
Providing opportunities for young people and enhance social inclusion
cohealth has a clear vision of healthy communities, healthy people. The Victorian health system is world class, providing excellent, cutting edge care. However, we also know that too many people are not able to access the care they need, particularly those who experience disadvantage. As a result, these groups have poorer health than other Victorians.
Everyone deserves access to the physical and mental health care they require, that best meets their needs, in the places that suit them. Care should be provided as soon as it is needed and integrated with social support to best treat conditions before they require acute, complex care.
Victoria’s health system also faces a range of challenges due to a growing and aging population, rising rates of chronic disease and increasing inequality. Responding to these challenges requires reorienting the health system towards prevention and early intervention and providing more care in the community.
Community health services are in a unique position to deliver health and social care in this way. The sector is well placed to play a more significant role in the health system, through providing integrated and person-centred care for vulnerable and disadvantaged Victorians. The provision of holistic healthcare for our communities is enhanced by the sector’s ability to draw together both state and federal government investment to provide a wide range of health and social support services.
Community health services have extensive experience working with people who face disadvantage and marginalisation and developing service responses to reduce their barriers to accessing care. For some groups this might involve ensuring interpreters are available for all appointments and written materials are translated into community languages; for others this might involve longer appointment times or outreach approaches. With co-located and integrated medical, allied health and social supports, community health services can assist people to navigate an otherwise fragmented system to deliver holistic, integrated care.
Building the capacity of the community health sector will ensure people stay well and prevent avoidable hospital admissions. Research has demonstrated that community-based care has significant clinical benefits, better carer outcomes and reduced healthcare costs.
cohealth presents the following proposals for the 2020-21 Victorian Budget to realise the benefits of community-based care, particularly for those with the most complex needs:
At the same time, widespread improvements in the health and wellbeing of all Victorians will not be achieved unless the circumstances in which people live, work and age that affect their chances of a healthy life are improved. cohealth therefore also urges comprehensive action on addressing the social determinants of health, including increasing affordable housing, reducing socio-economic inequalities and tackling stigma and discrimination.
Population changes and increasing inequality are driving an urgent need to rethink the delivery of health services.
| Our population is growing | Victoria is the fastest growing state in Australia in terms of population and this will continue. |
| We are getting older
|
Victoria’s aging population is growing and is driving significant growth in demand across the health and social services sector.[1] |
| Chronic disease rates are rising
|
More of us have chronic diseases, and the proportion of people who experience multiple chronic diseases and complex needs is increasing.[2]
Higher prevalence of multiple chronic diseases is experienced by people living in communities with lower socioeconomic status.[3] |
| Inequality is getting worse[4] | Health is directly correlated with income, with health status rising as income and wealth rise[5]. As inequality increases, so too will the differences in health outcomes[6], unless radically different approaches are implemented. |
| Homelessness and housing insecurity are rising | Nearly 25,000 Victorians are homeless each night[7], and very few rental properties are affordable to low-income earners. 3,000 new public and community-owned homes per year for 10 years are needed to relieve the pressure.[8] |
| Social isolation in growing | Social isolation and loneliness significantly increase risk for premature mortality and a range of health conditions. It impacts more on those people who are the most vulnerable.[9] |
| Rates of avoidable hospitalisations are rising | A large proportion of hospital admissions could be avoided with appropriate care in primary and community settings |
| People are delaying care due to cost | People on low incomes are significantly more likely to miss or delay care due to cost.[10] |
| Royal Commission into Victoria’s Mental Health System | Too many people with mental ill health are not receiving the care and support they need. The Royal Commission will recommend how to improve the mental health system for Victorians. |
cohealth recognises the significant impact the broader social, economic and environmental structures in which people live – the social determinants of health – have on the health of individuals and communities. The unequal distribution of income in our society, coupled with changing employment opportunities, reduced social expenditure and increase in divisive narratives, means that for many, quality of life is deteriorating. Life is becoming harder for the communities we service, and demand is subsequently growing.
cohealth and Unison[11] have partnered to propose a redevelopment of the high-profile, longstanding community health centre at 365 Hoddle St Collingwood.
The project will establish a ground-breaking community hub centred on the whole person, by co-locating housing and health care at the one site.
It will generate a cutting-edge supportive housing model that will sustain tenancies and increase participation by connecting people to existing services and activities. The new, purpose-built facility will:
The location of this site near to public housing and areas of concentrated disadvantage within the City of Yarra (as measured by SEIFA ranking) makes it critical to the health and social outcomes of the local population. People who access our services are presenting with more complex and more chronic health conditions, overlayed with social vulnerabilities.
Demand is also set to increase – by 2031, it is predicted that 18,000 additional visits will be required across the City of Yarra each year with the resident population estimated to increase by 32%. The increase in population, coupled with the loss of affordable housing options, will only heighten the need for local, affordable health care and housing.
The site at 365 Hoddle St Collingwood is aging, inefficient and is at the end of its lifespan, limiting cohealth’s ability to keep up with community demand. This redevelopment will ensure that cohealth remains at the site beyond the next three years.
The redevelopment also creates an opportunity to contribute to health and housing policy objectives, such as Homes for Victorians, Health 2040 and the Statewide Design, Service and Infrastructure Plan for Victoria’s Health System 2017-2037.
cohealth and Unison have committed to make significant contributions – of $3.5m and $7.5m respectively – to the overall project cost of $40m. A detailed project prospectus is available.
Stage one of progressing this innovative proposal is developing a detailed feasibility study. cohealth and Unison have committed a total of $400,000 towards a feasibility study.
We seek a Victorian government contribution of $600,000 to enable this comprehensive feasibility study to progress.
People with serious mental illness can live well in the community with the right supports. However, too many people with mental illness are unable to access the supports and services they need to stay well in the community and avoid the need for costly hospital admissions. The Royal Commission into Victoria’s Mental Health System Interim Report[12] has clearly identified the shortcomings of the current system.
While the Royal Commission continues to investigate how best to respond to the breadth of mental health issues in the community increased investment in community-based mental health care to address unmet need cannot wait until the Commission’s recommendations are delivered.
cohealth proposes a pilot program to address the needs of the increasing number of people not receiving the psychosocial support they need, address the poorer physical health of people with mental illness and to intervene early before acute, more costly care is required.
Comprehensive mental health care will be integrated into existing multidisciplinary allied health teams in our community health service.
The program will work with people with a severe mental disorder, complex support needs and a psychosocial disability who are not receiving the recovery-based psychosocial support they need to remain well in the community. It will also work with those who have chronic or complex physical health care needs and need psychosocial support.
Through integrated service delivery 5,000 clients per year will benefit from improved mental and physical health outcomes.
Building on our deep connection with local community, the model will provide a place-based, accessible and holistic health response in the community – intervening earlier, responding quicker and providing choice and control. Pressure will be taken off clinical mental health and acute health services, including emergency departments.
Multi-disciplinary teams will provide a same day response, care coordination, step up mental health support and a comprehensive range of mental health supports. These will include individual and group programs, secondary consultation, service coordination, family and carer support, counselling for low prevalence disorders and mental health support to the 60 per cent of people with a chronic health condition who also have a mental health issue. Mental health focussed health management opportunities and health literacy activities will improve the poorer physical health experienced by people with mental illness.
Integration of mental health and physical health in the mainstream community health environment will deliver a more accessible service with improved health outcomes and contribute to the government’s response to the Royal Commission into Victoria’s Mental Health System.
Furthermore, the model can be scaled using the statewide network of Community Health, providing a highly accessible and local place-based response – the right care, at the right time, in the right place.
A detailed proposal is available.
cohealth seeks a state government contribution of $5m per annum for three years.
Community health plays a central role in improving access to primary and social care services, often bridging the gap between different service types to deliver holistic care. Community health also has a wealth of experience and expertise partnering with other health and social care providers to deliver services to people with complex needs. The sector is ideally positioned to improve the health outcomes of priority populations through strengthening the links between health social services and providing more holistic service responses to these groups.
cohealth, in partnership with Urbis, has developed an innovative social investment model to improve the health and social outcomes of children and families experiencing significant disadvantage.
Recognising the importance of the early years in children’s development, this model will provide local, family-orientated integrated health care, case management and capacity building focused on improving health and the family’s access to social support services. The project aims to break the cycles of stress for vulnerable young children by drawing on cohealth’s extensive experience providing holistic, integrated care and wrap around support.
By engaging vulnerable families early and providing tailored, individualised support to each family member – children, youth and parents – the program will:
Positive outcomes at the child, parent, family and system levels will include: improved management of health risks and chronic illness; improved family relationships; increased sense of community belonging; safe and sustained housing; improved connection with education and employment; and reduced contact with acute health services and the child protection and justice systems.
480 families will be supported for up to three years. A seven-year pilot time-frame enables sufficient time to design, deliver and measure the social impact of the program at the family, community and sector levels. The outcomes focused service has been developed so that, once proven, it could be scaled up beyond the initial pilot.
The project will contribute to meeting Community Health Program[13] aims of providing an integrated service platform for people with complex health and social care needs and bridging the gap between hospital-based services and universal services that are often experienced by priority populations.
Modelling indicates a socio-economic return is $1.10 for each $1.00 invested. A detailed proposal is available.
To realise this project, cohealth seeks a state government contribution of $10.6m over seven years.
Enhancing social inclusion and strengthening communities has significant mental health benefits. As such, cohealth collaborates with various communities that can experience exclusion to develop a range of programs aiming to address racism and discrimination and increase employment and social inclusion.
Through creative and cultural engagement Arts Generator supports people who have experienced structural disadvantage explore their sense of self, increase wellbeing and agency, develop life skills, and create connections within and between communities to strengthen social cohesion.
Sisters and Brothers
Sisters and Brothers is a preventative program in collaboration with schools where artist-facilitators work directly with young people in years 6 and 7 to provide a safe means to explore social issues. It incorporates bystander education, confidence and skills building to identify and intervene when racial discrimination is witnessed. The award-winning program uses creative means to unpack difficult issues and channel’s young people’s energy towards to creative, critical and collaborative means of dialogue. The program provides an alternative space in school environments to support students to remain in school, unpack dialogue, and promotes early crime prevention.
Platform
Platform is an entry-level artist development program designed to respond to young people in the City of Wyndham who have been identified as at risk of disengaging from studies, employment and/or presenting with anti-social behaviour. This skills development and capacity building program aims to engage young people interested in working in the music and creative industries to develop skills, record a track and learn essential skills for looking for work. After graduation, participants are work-ready and undertake paid internships (funded through Platform) with various creative arts organisations, with ongoing mentoring and reporting back to project artist mentors.
In this way Platform provides a pathway, under mentorship and support, for at-risk young people into paid work and on-the-job learning and networking within the creative industries.
These projects will contribute to meeting the Government’s aims of delivering community-led crime prevention initiatives and boosting social inclusion and participation among culturally diverse groups.
Over three years Sisters and Brothers will work with 15 schools and 1,500 students. Platform will engage up to 36 young people in paid employment in the creative industries over three years. Detailed program descriptions are available.
Sisters and Brothers and Platform programs receive no core State government funding. To secure their future and ensure these programs continue to provide opportunities for young people, enhance social inclusion and support crime prevention at an early stage, cohealth seeks funding of $250,000 per annum over three years.
Critical to improving health outcomes is addressing the social determinants of health – the circumstances in which people are born, grow, live, work and age – and the structural conditions in a society, which lead to unequal living conditions and affect the chances of living a healthy life[14] – that have the overwhelming influence on health outcomes. cohealth supports a ‘health in all policies’ approach – where governments consider the health impacts of all policy decisions, and proactively work to address the underlying drivers of ill-health, including:
Addressing these issues is essential to improving health outcomes and equity. To do this, cohealth recommends urgent attention be given to addressing the following issues:
[1] The number of people aged over 70 is forecast to increase 95% in the 15 years to 2031. Growth will be concentrated in Melbourne, Brimbank, Hume, Melton and Wyndham. https://nwmphn.org.au/our-community/community-and-population-health-profiles/
[2] More than 90 per cent of people aged over 70 years have two or more chronic conditions https://nwmphn.org.au/our-community/community-and-population-health-profiles/
[3] https://nwmphn.org.au/our-community/community-and-population-health-profiles/
[4] https://www.acoss.org.au/inequality/
[5] http://apo.org.au/node/55699\
[6] https://www.australia21.org.au/wp-content/uploads/2014/06/Final-InequalityinAustraliaRepor-2.pdf
[7] https://vcoss.org.au/analysis/ending-homelessness-it-can-be-done/
[8] https://chp.org.au/electionplatform2018/
[9] https://www.vichealth.vic.gov.au/letter/articles/vh-letter-47-loneliness
[10] https://grattan.edu.au/report/commonwealth-orange-book-2019/
[11] One of the largest housing providers in Victoria
[12] https://rcvmhs.vic.gov.au/interim-report
[13] https://www2.health.vic.gov.au/primary-and-community-health/community-health/community-health-program
Collingwood