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Liveability Options in Outer Suburban Melbourne
29 April 2011.
AMA Victoria welcomes the opportunity to express its views to the Inquiry into Liveability Options in Outer Suburban Melbourne. Liveability is a primary concern for all Victorians, and reflects the health and wellbeing of a community. Central to the health of each Victorian is a health system that is accessible, efficient and provides the best possible care.
The Victorian Government must take responsibility for providing quality health care. The need to invest in better health care for Victorians has never been greater. Our health system must meet the challenges of a growing population, demographic changes and the growing threat of chronic disease.
The Government must ensure that patients have access to the right care, in the right place, at the right time. This is equally as important in Melbourne’s outer suburbs as it is in the metropolitan centre, especially in light of the shortage of doctors across Victoria.
Hospital capacity
Victoria’s population is growing rapidly and we need to address the needs of the population now and into the future. Figures compiled by AMA Victoria indicate that the western suburbs is the area of greatest need in Victoria.
The cities of Maribyrnong, Wyndham, Hobson’s Bay and Melton combined are projected to increase population by 152,000 over the next ten years, meaning that an additional 366 hospital beds would be required just to maintain services, let alone address the current shortfalls relative to the rest of the state.
In addition to a shortage of hospital beds and an expanding population in the west, generally people in the western suburbs have a higher rate of health risk factors, higher incidence of chronic disease, and less access to health services. AMA Victoria continues to highlight the need for concentrating on higher-risk population groups.
Aged care alternatives
The Australian Institute of Health and Welfare’s Australia’s Health report shows Australians’ life expectancy is almost 84 for women and 79 for men and continues to rise, with almost four per cent of the population now aged over 80. Victorian local government areas with the highest number of people aged 75 and over include Greater Geelong, Mornington Peninsula and Whitehorse.[1]
Victoria’s public hospitals are already strained under the pressure of our growing population yet older patients are often stuck in hospitals because they are not ready to return home and not sure whether they should enter a residential aged care facility. These choices do not suit a number of patients, meaning that patients spend more time in hospital while the choice becomes clearer. Older patients need to be given more options for care and ensure they have the support needed to assist in their return home.
AMA Victoria supports an alternative to hospital care for older Victorians who are not sick enough to be in hospital but are not ready to return home. Under our proposal, up to eight patients would live in a well-supported share-house or unit. Each patient would have their own private room and access to a shared kitchen, common area and laundry.
The longer older patients remain in hospital, the more difficult it is to readjust to life at home. These ‘step-out’ facilities provide an opportunity for rehabilitations. It can give older Victorians the opportunity to keep their independence and return home if they can.
The facility would be supervised by a General Practitioner (GP) and have one nurse on-site 24 hours a day. Patients would have a range of allied health professionals such as occupational therapists, physiotherapists, counsellors, dieticians to assist recovery, as well as access to a communal gymnasium.
Importantly, patients could be assisted in their transition back to their local community and more hospital beds made available for patients in greater need.
Coordinating care
The fundamental problem for chronic patients is care coordination. Chronic and complex (and frail aged) patients require services from several care agencies, with a complex interaction between public and private agencies, and a fragmentation of care between suppliers. Arguably the GP should be the central coordination point for patient care but the problem is that GPs are scarce and under-resourced for the role.
While fragmentation of services is an issue for patients and their GPs everywhere, the problem is amplified in outer suburban areas. GPs referring patients to mental health or aged care services are sending patients to centres that are in complete isolation of the general practice. Similar issues are raised when GPs refer patients to specialists.
The problem is exacerbated in outer suburban areas as the distance between the various providers is greater. There is a need to provide a coordination role. The Government could fund general practices to employ care coordinators. Approximately 1000 FTE care coordinators would cost only $68.4 million per annum to implement.
Such a program would provide patients with more choice and greater control over decisions about their health care, and improve access to GP coordinated care services. The program is based on the idea of enhancing proven existing arrangements so that they work better for patients – importantly, without the establishment of new bureaucracies and at minimal cost.
Care coordinators would talk with patients and help them to navigate doctors’ referrals and other care needs. Care coordinators would work in the same place as their GP, enabling better patient care.
Electronic discharge summaries
The problems associated with fragmentation of care in Victoria’s health system cannot be solved without improved Information and Communication Technology.
The poor quality of discharge summaries from Victorian public hospitals is an issue raised by our members frequently. GPs must be provided with adequate information about their patients from the hospital. This is particularly relevant for patients and GPs in outer suburban areas.
Discharge summaries play a critical role in ensuring safe and effective continuity of care for patients being discharged from hospital. They are often the only modality of communication between the inpatient and outpatient setting. The transition from GP to hospital and back to community care is being recognised as a key determinant of better patient outcomes. Maintaining continuity of care improves the uptake of preventive care and adherence to treatment plans. This has been shown to:
- Result in fewer emergency department visits;
- Reduce the likelihood of hospitalisations;
- Reduce the incidence of adverse events following hospitalisation; and
- Improve the cost-effectiveness of patient care.
Discharge summaries from Victorian public hospitals often lack important information. If the appropriate details about a patient’s time in hospital are not communicated to the GP or treating specialist, the consequences for future care decisions could be great.
The Government must provide adequate funding to hospitals to improve the frequency and quality of electronic discharge summaries.
Easing planning restrictions
Victoria’s growing and ageing population also highlights the need to improve access to general practice. The government must review car parking requirements for medical practice under the planning codes. Victoria’s doctor shortage affects communities’ access to primary care. Many Victorians in regional areas simply cannot get an appointment to see their GP. Indeed, forecasts show the worst is yet to come. Access to general practice is being obstructed by state planning regulations that require five car parks per full time practitioner.
General practices that want to expand services to the community often are thwarted by these planning regulations. The law should not require doctors to build additional car parking spaces where existing parking supply is sufficient. Such requirements are unnecessary and a barrier to expanded general practice services.
In 2007 an independent advisory committee recommended to the Minister for Planning that parking requirements be lowered for practices employing additional medical practitioners. These recommendations have yet to be implemented.
The ramifications of these laws are wide-reaching. Funding opportunities for GPs, such as the recent Primary Care Infrastructure Grants, are being missed as a result of the requirements. Many GPs have expressed frustration that they were unable to obtain the grant because of the car parking requirements. We strongly urge the government to consider a change in these planning regulations.
Public Transport Zoning
Given the redevelopment of Box Hill Hospital and the significant capacity boost that will come as a result of this, it is timely that the government reconsiders a zone adjustment for Box Hill railway station. Box Hill train station is the closest train station to Box Hill Hospital and the ticket regulations that apply to people travelling there currently impede patients’ access to the hospital.
Box Hill is one station out of zone one. The price in tickets between zones one and two is significant. Box Hill station should be adjusted to a dual zone between zones one and two. Re-zoning the station this way will give patients and staff who use the train greater access via rail to Box Hill Hospital and make travelling by public transport economically more viable.
The redevelopment of Monash Medical Centre raises similar issues. The Government must adjust the zones for Clayton railway station, the closest train station to Monash Medical Centre, so as to remove the barriers for patients accessing hospital services.
Sporting and Recreational Facilities
The Submission to the Growth Areas Authority: Precinct Structure Planning Guidelines by VicSport shows that approximately 2.87 million Victorians participate in sport and active recreation pursuits. Local Government Authorities are finding it difficult to satisfy the demand for sport and recreational facilities due to increased urban development, population growth, and greater demand from a wider variety of sporting organisations that are seeking to increase participation.
AMA Victoria has lobbied the Government to increase funding for obesity prevention programs and encouraged the public to maintain a healthy weight through regular exercise and proper nutrition. It will be harder for Victorians to maintain a healthy weight if sporting and recreational facilities are not available to the public or are not accessible due to their location or overcrowding.
Sustainable Environment
Human health is ultimately dependent on the health of the planet and its ecosystem. The AMA believes that measures which mitigate climate change will also benefit public health. Health systems need to be responsive to a range of health effects associated with both short-term and longer-term impacts of climate change.
Failure to achieve significant reductions in greenhouse gas emissions on a global basis is likely to cause significant public health problems. The Government should pursue effective measures for improved energy efficiency, clean energy production and other emission reduction measures which are likely to contribute to reducing the health impacts of climate change.
Any economic assessment of the costs and benefits of mitigating climate change must incorporate the predicted public health costs of unmitigated climate change. Indeed individuals, businesses and organisations – including in the health and medical field – should be informed about, and take measures to reduce, their greenhouse gas emissions (‘carbon footprint’) by making appropriate changes to consumption patterns.
[1] ABC 2006.
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