Victorians for which we are responsible.

Department of Health and Human Services strategic planHow to read this plan • Our strategic context outlines the major trends, challenges and opportunities, both ongoing and new, that shape and influence our work. • Our strategic directions explain how we will design, implement and operate our services to respond to these challenges and opportunities. • Our outcomes framework articulates the outcomes for Victorians for which we are responsible and the key results by which we will measure our efforts. • Our priority actions represent the most significant reforms, initiatives and programs we are committed to delivering over the next 18 months that collectively will result in a step change improvement to the outcomes. • Our enabling actions are what we will deliver to enable the successful implementation of our priority actions. strategic directions outcomes framework strategic context 27 priority actions 8 enabling actions 6 Department of Health and Human Services Strategic planAbout the Department of Health and Human Services The department is responsible for developing and delivering policies, programs and services that support the health, wellbeing and safety of all Victorians. We take a broad view of the drivers of good health, the causes of ill health, the social and economic context in which people live, and the incidence and experience of vulnerability. This allows us to place people at the centre of policymaking, service design and delivery. The department provides stewardship of the systems and outcomes in health, human services and sport and recreation. The department leads the delivery of many of the government’s major reforms such as: the prevention of family violence; the transition to the National Disability Insurance Scheme (NDIS) and the subsequent transformation of disability services in Victoria; the implementation of strategies to address the challenges in homelessness services and social housing; building the capability of vulnerable children and families to break the cycle of intergenerational disadvantage; and strengthening the safety and quality of our health services. From 3 July 2017 the department has adopted a new high-level structure to reposition the organisation to drive better outcomes for all Victorians. Our central divisions are now structured on a portfolio basis, leading policy development, service and funding design and system management, as well as providing strengthened whole-of-department functions to support the delivery of the department’s responsibilities. Our new structure also reaffirms our commitment to our four operational divisions, which oversee and coordinate the delivery and funding of services and initiatives across 17 areas of the state. Since the release of our strategic plan last year, three portfolio agencies have been established to ensure a dedicated focus on driving quality and safety improvements across our health services, and to deliver the government’s family violence reform commitments: Safer Care Victoria, the Victorian Agency for Health Information and Family Safety Victoria. The Family Violence Prevention Agency has also been established within our department to drive the focus on preventing family violence. Within and between these new divisions, further refinements to our more detailed structural arrangements will be required so that we continue to be dynamic and responsive to the needs and circumstances of all Victorians. We fund approximately 2,000 organisations to deliver vital health and human services care. We are also a service deliverer in our own right, with many services provided directly to the community through our operational divisions. We partner with other parts of the Victorian public service, federal and local governments, non-government organisations and communities to build community infrastructure capacity, participation and resilience. The combined effort of our department and our partners working together drives positive long-term change for individuals and families, particularly those with multiple and complex needs spanning issues such as mental health, housing, drugs and alcohol, chronic health conditions, family vulnerability and disability. We know that all Victorians will come into contact with health and human services and sport and recreation at some point in their lives and that there are critical links between wellbeing, economic prosperity and social inclusion. We also know that active and engaged Victorians have better long-term health and wellbeing outcomes, and that vibrant, inclusive and cohesive communities are best able to adapt to demographic, social and economic change. By working together, we strive to build stronger functional, policy and service delivery connections to support the health, wellbeing and safety of all Victorians, no matter what their personal circumstances or stage of life. Working together also allows us to leverage our collective resources and relationships to empower patients and clients to be partners in their own care and to recognise the power of self-determining communities.Key facts about our department ~11,200 57% 9,500 3.9 million community sporting facilities Victorians participating Children’s court applications Other legal disputes in direct service delivery indirect 6,800 4,400 42,073 $22 billion $24 billion Public Units Community Units Health assets Housing assets ~18,000 ~66,000 Annual budget 2017-2018 New appointments to paid government boards in the department’s portfolios from March 2015 to December 2016 Number of communicable disease notifications in 2016 Staff across 46 sites Number of funded agencies Capital portfolio Legal matters women Social housing Sport and recreation Total number of health services Total number of drug permits issued in 2016–17 Entities within the department’s portfolios billion $23.2 85 82,814 ~2,000 600+ ~27,300 ~500 8 Department of Health and Human Services Strategic planChildren, Families, Disability and Operations The Children, Families, Disability and Operations Division will provide a dedicated portfolio focus on children, families and disability, leading program management in these portfolios, as well as maintaining oversight and management of operational divisions. Services are delivered directly to Victorians through the four operational divisions. The division is responsible for developing operational policy and funding frameworks for child and family support services and disability services. It leads work to better understand and respond to the needs of our clients and services, and translate evidence of effective service interventions into funded programs. The division works with clients, service providers and other government partners to co‑design more connected end-to-end client journeys to make services easier to navigate, sequence service interventions more effectively, build individual and family capability, focus on child development, and preserve and reunify families wherever possible. It also works to ensure the quality of services, manage critical incidents and assure child safety in a range of government and non-government services. It oversees the translation of policy into operational service delivery to enable healthy, safe and strong communities by addressing the needs of Victorians across the continuum of health and human services care. The division monitors and analyses statewide service delivery performance, provides practice leadership and fosters continuous improvement in service delivery both for internally delivered services and those delivered through funded agencies. The central branches lead and monitor service design, performance and quality improvement, practice and professional development activities, as well as co-ordinating the transition to the National Disability Insurance Scheme (NDIS). The Operations Divisions and Areas play a key role in service delivery, managing relationships with providers, and building the capacity of the system and of communities. The four operations divisions provide strategic oversight, coordinatio
n and delivery of departmental services within their areas. Key functions include: area-based health and human services programs and service delivery; providing child-centred, family focused services to protect children and young people from significant harm; delivering disability services and supports including our ongoing responsibilities to achieve greater inclusion of people with a disability and improve their lives under the State Disability Plan 2017-2020; providing housing assistance, support and planning; and delivering emergency management response, recovery and relief. Health and Wellbeing The Health and Wellbeing division is responsible for policy, strategy and commissioning of services in Victoria’s primary prevention, secondary and tertiary healthcare system. Collocating these activities means services are better connected to a person’s health and wellbeing journey across their entire life course and assists in viewing the health system more holistically from the prevention of ill health to the treatment and care of all Victorians. The division uses primary prevention measures to prevent and reduce the rate of disease across the Victorian population and to reduce inequalities in health and wellbeing between population groups and locations. Recognising the influential role of social and economic forces, as well as biological and environmental factors on health and wellbeing, the division applies population-and place-based approaches to all of its work. The division works with agencies and services to promote wellness and active participation and inclusion of all Victorians in their communities and to prevent and minimise the impact of poor health and wellbeing and disadvantage across Victoria. The department’s structure 10 Department of Health and Human Services Strategic planThe division also advances strategies that enable social and economic participation and opportunities for: women; older Victorians; young people; Aboriginal communities; people from culturally and linguistically diverse backgrounds; lesbian, gay, bisexual, transgender and intersex (LGBTI) people and communities; and Victorians living with mental illness or alcohol and drug issues. It leads the department in progressing Aboriginal self-determination in the design and delivery of services. The division also leads whole-of-government policy and initiatives to promote the social and economic participation and inclusion of Victorians with a disability through the Absolutely Everyone State disability plan 2017–2020 and management of the Victorian Disability Advocacy Program. Leading the department’s work in improving the mental health of Victorians is also the responsibility of this division. Health and Wellbeing oversees the policy, system design, planning and funding of mental health services and support the capability of health and human services to respond to mental ill health. Also being developed within the division is the Family Violence Prevention Agency, which will oversee and coordinate family violence prevention activities within and across government, local government, community agencies and the broader community. The agency will provide a strengthened focus on preventing all forms of violence against women and is an integral part of the government’s broader family violence reform. The Family Violence Prevention Agency, along with the Office of Prevention and Women’s Equality (OPWE), will support gender equality in line with Victoria’s first gender equality strategy – Safe and strong: a Victorian gender equality plan. The division is also the department’s central point of connection with Regional and Metropolitan Partnerships, local government, Children and Youth Area Partnerships, Primary Health Networks and Aboriginal community-controlled organisations, contributing to social cohesion and connectedness through community action and partnerships. It leads the department’s focus on strengthening volunteering in Victoria to increase participation and the sustainability of community organisations and infrastructure. Health and Wellbeing oversees policy, system design and planning, as well as funding and performance of the secondary and tertiary health system (and parts of the primary care system) in Victoria. This includes community health services, public and private hospitals and day procedure centres, emergency and non-emergency patient transport services, residential aged care services, mental health services, public dental services, drug harm reduction, treatment and support services, community care and assessment for people aged under 65 and other non-government healthcare providers. It aims to improve equity of access to services regardless of where the patient lives. The division also has a focus on integrated care for chronic disease patients, recognising the benefits of care coordination and supported navigation to improve health outcomes. The division supports best practice approaches to clinical care through the Victorian Cancer Agency, health and medical research, international health engagement, and policy development. The division is also responsible for our health and medical research strategy, Healthier lives, stronger economy: Victoria’s health and medical research strategy 2016–20, which will create jobs and deliver economic benefits by investing in areas of excellence and addressing areas in need of further development. Working closely with Safer Care Victoria, Family Safety Victoria and the Victorian Agency for Health Information, the division advances safe, quality healthcare and disseminates innovation and improvement efforts across the health system. It also works alongside these organisations to maximise the value and appropriateness of care in our health system.Housing, Infrastructure, Sport and Recreation The Housing, Infrastructure, Sport and Recreation division provides a portfolio focus on housing and sport and recreation, as well as providing best practice leadership for infrastructure planning and project delivery. In this role, the division is responsible for the government’s homelessness and social housing initiatives, recognising that having a home can often provide people with the foundation to stabilise their lives, and participate in education, work and the community. The division also works in partnership with the Health and Wellbeing division, which manages the delivery of the Towards Home package to support rough sleepers and help them into permanent housing. The division is responsible for implementing the Homes for Victorians Strategy, which aims to ensure Victoria has a healthy social housing system through increasing the social housing stock and helping community housing associations grow. The division works in partnership with stakeholders and other agencies to promote active participation and inclusion of all Victorians in their communities including supporting clubs and organisations to grow participation in sport and recreation. In this role, the division implements the recommendations from the Inquiry into Women and Girls in Sport and Active Recreation and delivers ‘Change our Game’ initiatives to increase participation and enhance leadership opportunities in sport for females, including through the new Office for Women in Sport and Recreation. The division provides department-wide expertise and management of infrastructure across health, human services and sport and recreation. It also leads the department’s infrastructure agenda, including critical relationships with agencies such as the Department of Economic Development, Jobs, Transport and Resources to attract investment and leverage jobs growth due to capital investment and our major sporting events. The division also includes the Victorian Health and Human Services Building Authority which will drive the delivery of a multi-billion dollar platform of investment in infrastructure across health, housing, and sport and recreation. The Authority is responsible for providing a sharper focus on delivery and reporting, engaging with the community o
n the government’s significant infrastructure agenda and developing a strategic pipeline of infrastructure projects capable of meeting growing demand across the state. The department’s structure 12 Department of Health and Human Services Strategic planHousing, Infrastructure, Sport and Recreation The Housing, Infrastructure, Sport and Recreation division provides a portfolio focus on housing and sport and recreation, as well as providing best practice leadership for infrastructure planning and project delivery. In this role, the division is responsible for the government’s homelessness and social housing initiatives, recognising that having a home can often provide people with the foundation to stabilise their lives, and participate in education, work and the community. The division also works in partnership with the Health and Wellbeing division, which manages the delivery of the Towards Home package to support rough sleepers and help them into permanent housing. The division is responsible for implementing the Homes for Victorians Strategy, which aims to ensure Victoria has a healthy social housing system through increasing the social housing stock and helping community housing associations grow. The division works in partnership with stakeholders and other agencies to promote active participation and inclusion of all Victorians in their communities including supporting clubs and organisations to grow participation in sport and recreation. In this role, the division implements the recommendations from the Inquiry into Women and Girls in Sport and Active Recreation and delivers ‘Change our Game’ initiatives to increase participation and enhance leadership opportunities in sport for females, including through the new Office for Women in Sport and Recreation. The division provides department-wide expertise and management of infrastructure across health, human services and sport and recreation. It also leads the department’s infrastructure agenda, including critical relationships with agencies such as the Department of Economic Development, Jobs, Transport and Resources to attract investment and leverage jobs growth due to capital investment and our major sporting events. The division also includes the Victorian Health and Human Services Building Authority which will drive the delivery of a multi-billion dollar platform of investment in infrastructure across health, housing, and sport and recreation. The Authority is responsible for providing a sharper focus on delivery and reporting, engaging with the community on the government’s significant infrastructure agenda and developing a strategic pipeline of infrastructure projects capable of meeting growing demand across the state. The department’s structure 12 Department of Health and Human Services Strategic planCorporate Services The Corporate Services division provides integrated strategic, specialist advisory and operational services to the department and supports ministers in their cabinet, parliamentary and other responsibilities. This is an enabling division, delivering centralised finance and human resources services and management of industrial relations. It delivers information services, technology and legal and executive services functions to support the department to achieve its objectives. The division promotes the integrity of the department’s operations and manages systems to maintain transparency and prevent fraud. It supports internal governance frameworks including internal audits, corporate reporting and freedom of information, together with legal advice and services to support policy divisions to deliver the government’s legislative programs. The division works to develop and improve key business systems, services and processes to support the department to deliver its policies, programs and services. Corporate Services also provides human resource, career management and workplace services and leads our work on organisational development, corporate values and cultural change, including the promotion of equality in both recruitment and management of employees. The department is committed to a progressive and dynamic culture in line with our goal of being an employer of choice. Victorian Agency for Health Information The Victorian Agency for Health Information is responsible for providing data and information products that help to stimulate and inform improvements in clinical care across public and private hospitals, strengthen local oversight of health and community services and inform Victorians about safety and quality of care in their local area. Working in partnership with Safer Care Victoria, the agency develops priority measures for safety and quality that will inform sustained efforts to improve Victoria’ s health system and patient outcomes. The department’s structure 14 Department of Health and Human Services Strategic planSafer Care Victoria Safer Care Victoria is the peak state authority for quality and safety improvement in healthcare. Safer Care Victoria oversees and supports health services to provide safe, high-quality care to patients: every time, everywhere. As well as monitoring the standards of care provided, Safer Care Victoria is partnering with consumers and their families, clinicians and health services to support the continuous improvement of healthcare. Family Safety Victoria Family Safety Victoria is a newly established agency with a dedicated focus on delivering family violence reform. The agency is leading the implementation of many of the government’s family violence reforms including: establishing and operationalising 17 Support and Safety Hubs across Victoria; establishing a Central Information Point, which will allow police, courts and government services to track perpetrators and keep victims safe; and establishing and housing the new Centre for Workforce Excellence to build workforce capacity and capability in partnership with the sector. The agency will also work to build the capacity of all workforces with a role in ending family violence and improve information sharing. This will help to keep adults and children who experience family violence safe and provide them with the support they need to recover. Organisational Redesign The Organisational Redesign team is responsible for driving the department’s priorities for how it is organised. Following the announcement of the department’s new portfolios in the 2017–18 State Budget, a new high-level organisational structure has been announced. The Organisational Redesign team will work collaboratively across the department to embed this new structure and its supporting operating model. The team coordinates an effective program for change management and business improvement to realise our four strategic directions of: person-centred services and care; local solutions; earlier and more connected support; and advancing quality, safety and innovation. Children and Families Reform Unit The Children and Families Reform Unit was established to accelerate reforms in our children and families system. It is a time-limited unit that reports directly to the Secretary. Working closely with the Children, Families, Disability and Operations division, it will lead a small number of ambitious reform projects that aim to create a step change improvement to our children and families service system.Our vision and values We have a clear direction, expressed through our vision. Shared core values guide how we deliver on our vision, and an outcomes framework helps us measure our progress. Our vision To achieve the best health, wellbeing and safety of all Victorians so that they can live a life they value. Our values Our values describe what we stand for at the department, how we want to make decisions and how we expect each other to behave. We are respectful • We treat people with fairness, objectivity and courtesy. • We listen and communicate honestly and clearly. • We seek to understand others’ perspectives, experiences and contributions. • We recognise and value people’s diversity, equality and human rights.
We have integrity • We are trustworthy, and we do what we say we will do. • We are professional in all our dealings with others. • We stay true to our values when it’s easy and when it’s difficult. We collaborate • We help each other as colleagues. • We generously share our knowledge, expertise and skills. • We work in partnership with people and organisations to find the best approach. • We are inclusive and seek people’s input and involvement. We care for people, families and communities • We involve people in decisions that affect their lives. • We value our colleagues, and we develop and support them to be resilient and effective. • We have empathy for people and seek to understand their perspectives. • We support and empower people through our work. We are accountable • We each take ownership of the quality and demonstrable impacts of our work. • We ensure that our decisions and actions are evidence-based and outcomes-focused. • We are careful about and transparent in how we use public resources. We are innovative • We are flexible, creative and responsive to changing needs. • We have the courage to take informed risks and try something new. • We are reflective and seek feedback to inform and shape our work. 16 Department of Health and Human Services Strategic planMeasurable, accountable actions will ensure we remain focused on our ambition to support all Victorians to have the best health, wellbeing and safety possible.Our strategic context Effective strategic planning requires organisations to understand the environment that they are operating in and to anticipate and plan for future changes and challenges. Looking across a four year horizon, in Victoria there are a number of significant changes in our environment that shape our priorities. Our population and labour market is growing, meaning there is more demand for the services we fund and provide. Coupled with this, are significant changes to the settlement of the population with the emergence of new growth areas in the west, north, south-east and in inner Melbourne, and in the population’s demographics such as in profiles of age, ethnicity, health and wellbeing. This is causing us to re-think the optimal distribution and configuration of our services and to recognise that the service mix that people need now will be different from what they need in the future. Victorians also have changing expectations and preferences about the services we fund and deliver. Informed by Targeting zero, the review of hospital safety and quality assurance in Victoria and quality and safety reviews in human services, Victorians rightly expect safer, higher quality services. They expect us to learn from the recent tragic events in our health and human services systems through safety failings and deliver the government’s commitment to zero avoidable harm. Victorians also have a growing preference for more personalised services, more choice and greater co-design and shared decision making. Digital media and technology are also changing how people expect to interact and engage with government. Data, analytics and technology are transforming our ability to predict, assess and respond to risks and needs. Victoria is fortunate to have a strong platform of universal health, education and care services that are essential to healthy development and wellbeing. However, our great universal services are not always reaching everyone – and they aren’t always available to meet the needs of everyone who needs them. There are vulnerable populations who miss out – and these include Aboriginal people, people with a disability, people seeking protection on temporary or uncertain visa pathways, LGBTI community members, older Victorians, children in out-of-home care and, sometimes, whole rural communities. When Victorians do come into contact with our services, we and our service delivery partners may not look beyond what is core business to ask: Who else needs to get involved to prevent that injury happening again? Is there an underlying problem here that I can’t help with but that needs to be addressed right now? Could I connect the patient or client with other services that can help? A better understanding of client pathways and trajectories and the correlation between different health and human service needs supports greater emphasis on targeting prevention activities to individuals and places most at risk of poorer health and wellbeing. Engaging individuals and the communities in these places in the evidence and in co-design and shared decision making results in them becoming partners in their own care and ultimately translates to better outcomes and more effective services. While through data and research, health and human service systems around the world are still building the evidence of what works in earlier intervention and prevention, there is an increasing recognition that creating the necessary social conditions to stimulate healthy behaviours, or tackle societal trends, cannot be achieved by a single sector acting alone. Better ways of organising services and supports are needed to break down the artificial barriers within and between service sectors that can get in the way of care that is genuinely coordinated around what people need and want. We also need to better coordinate our services with other government services, including education and justice settings, so the needs of parents and children are met. 20 Department of Health and Human Services Strategic planThe independent review of hospital and quality assurance in Victoria led by Dr Stephen Duckett, Targeting zero, the review of hospital safety and quality assurance in Victoria, taught us that to address avoidable harm we must strengthen devolved governance, better share information, enhance clinical engagement and improve our departmental oversight. Unless we reshape care delivery, harness technology and drive down variations in the safety and quality of care, the changing needs of Victorians will go unmet and unacceptable variations in outcomes will persist. This is the context for our strategic plan. These changes require us to take a longer term view of the possible futures on offer and to be deliberate in the steps we should take to advance our vision. Changes in the needs of Victorians Victoria is the fastest growing state in Australia. Our population growth is a sign of relative prosperity. However, this growth also brings challenges. These include sustaining timely access to services, ensuring that our infrastructure keeps up with the growing population, and supporting regional communities and growth corridors to have the same access to services as those in metropolitan Melbourne. Regions with slower, or in some cases negative, population growth, will still experience a change in the mix of services required, especially as the population ages. As in other parts of Australia and most of the world, Victorians are living longer. Long-term health conditions now represent a substantial proportion of our health expenditure. Rates of chronic disease including cancer, diabetes and heart disease continue to rise and drive demand for healthcare. The services that Victorians will need in the future look different from what they did in the past and to what they will look like now. More than 60 per cent of Victorian adults are overweight or obese, as are approximately 25 per cent of Victorian children. Being overweight or obese is a key risk factor for chronic disease. Chronic diseases are responsible for 85 per cent of Australia’s burden of disease and nine in 10 deaths1. Risk factors for these conditions, including smoking, poor diet, alcohol and recreational drug misuse and physical inactivity, are not shared evenly among the community. They are correlated with poor education, unemployment, poverty and social isolation – what eminent public health researcher Michael Marmot refers to as ‘the causes of the causes’.2 These social determinants of ill health conc
entrate in geographical areas that are associated with patterns of employment and industry restructuring, poorer transport links, low access to social, education or health services, higher rates of crime, and intergenerational transmission of disadvantage. People who are socially isolated are between two and five times more likely than those who have strong social ties to die prematurely. Social networks matter in helping people to recover from illness. This wider social context also drives demand for our targeted social services – social housing, child protection and family services. For some in our community, including people living with disability and rural Victorians, these risk factors can accumulate and reinforce each other. For Aboriginal Victorians, these are all tied up with the intergenerational experience of dispossession, forced removal and enduring racism. In both health and human services care there are familiar patterns in which those people most in need present for help late or not at all. Community attitudes can also be a barrier to people seeking help. For example, a significant minority of Australians believe that family violence is excusable when perpetrators lose control in anger or regret their actions. 1 Australian Institute of Health and Welfare (AIHW) 2014, Australia’s health 2014, Cat. no. AUS 178, viewed 13 June 2017, (http://www.aihw.gov.au/publication-detail/?id=60129547205). 2 World Health Organization 2003, The social determinants of health: the solid facts, 2nd edn, Marmot M, Wilkinson R (eds), viewed 13 June 2017, (http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf).There is a growing body of knowledge about the factors that prompt attitudes and behaviours. Governments around the world are starting to apply this knowledge to the design of health and human services systems, programs and community initiatives to prevent poor health outcomes and violence in the home. This includes recognising that even people experiencing longer term conditions or needs are likely to spend only a small proportion of their time in contact with health and human service professionals. The rest of the time they, their carers and their families manage on their own, and systems need to be designed to support them to better understand their own needs and to be able to manage in these circumstances. Once, health and welfare systems conditioned people to be passive recipients of care. Now, many people want to be more informed and involved with their own care – which they should be – and we need to help them achieve this. Our patients, clients and community members increasingly expect to get services and products that are tailored to their needs and that they will be offered a choice about what, where, when and how they are served. Major advances in technology, along with increasing community expectations, are also bringing about a rapid increase in the pace at which information about our genes is being discovered, gathered, analysed and applied. This brings both challenges and opportunities for healthcare delivery, disease diagnosis, public health infectious disease surveillance and biomedical research in Victoria. The value imperative Shifting citizen expectations are not the only imperative for change. Global healthcare spending is projected to increase by an average of 4.3 per cent per year between 2015 and 20193, creating an urgent need to maximise the value from health and human services expenditure and minimise waste. Over decades, public administrations around the world have moved towards greater accountability for their performance. Increasingly, interest has turned to whether public services are not only efficient but support lasting improvements in the lives of those receiving a service. While Victoria has the most efficient health services in the country, we know there needs to be a concentrated effort on increasing the safety and effectiveness of our health services. The implementation of Targeting zero, the review of hospital safety and quality assurance in Victoria will be pivotal in achieving a safety-led system. We also need to ensure the financial sustainability and viability of health services to deliver safe and appropriate care that meets the needs of the community, particularly in rural communities. We must also make sure the department provides effective oversight of health services across metropolitan, rural and regional services in both the public and private sectors. This will all contribute to achieving the government’s vision for our health system, for Victorians to have better health, better access and better care, as set out in Health 2040. We also need to focus on innovation and generating and capturing the evidence needed to transform services and improve outcomes. It is important to recognise that integral to quality and safety is ensuring understanding of and responsiveness to client diversity, including providing language services effectively, a sense of cultural safety, and freedom from real or perceived bias and discrimination. The creation of Better Care Victoria, Safer Care Victoria and the department’s Office of Professional Practice provide us with opportunities to scale up innovations and spread good practice across Victoria and to take action to address safety and quality issues to reach the Better, Safer Care target of zero avoidable harm. Our strategic context 22 Department of Health and Human Services Strategic planAll levels of government in Australia are working actively to share data with each other, to build the business case for prevention and early intervention, and to evaluate the cost and benefits of our collective services and reforms over time. The Victorian Agency for Health Information has been established to enable the better use of data and information across the health system to improve quality and identify and act on risk. Victoria has developed strong medical, health and human services research capabilities and is the home to world-leading education providers, providing us with the opportunity to translate new knowledge and technologies into education and advances in care. As well as supporting better care, these strengths underpin the importance of the health and human services sector to a strong Victorian economy. The government has identified medical technologies and pharmaceuticals – and, in particular, facilitating greater use of Victorian expertise and innovation across the Asian region and the globe – as one of a number of sectors with high growth potential. Victoria’s Health and medical research strategy 2016–20 aims to embed health and medical research into the Victorian health system, accelerate the translation of research into clinical practice and advance Victoria’s position as the foremost Australian jurisdiction for health and medical research. We will support the Victorian health and medical research sector to deliver excellence as it adapts to evolving and emerging trends such as precision medicine and big data. Victoria’s international health strategy 2016–2020: Partnering for a healthy and prosperous future sets out how we will identify and grow opportunities in health exports and investments to support revenue and jobs growth in our state. The healthcare and social assistance sector is already the largest employer within Victoria, and growing service demand will require ongoing workforce development. The department is also working with the Department of Education and Training and the Department of Economic Development, Jobs, Transport and Resources to expand career pathways into health and human services to meet this demand, with a particular focus on creating pathways for disadvantaged and vulnerable Victorians to improve their social and economic wellbeing. Towards new models of care Growing demand associated with longer term and potentially avoidable health conditions and increasingly entrenched areas of disadvantage require that we invest to meet demand and reorient our system towards prevention, earlier intervention and more connected servi
ces. The Victorian public health and wellbeing plan 2015–2019 outlines the government’s key priorities to improve the health and wellbeing of all Victorians, particularly the most disadvantaged. The plan articulates a vision for a Victoria free of the avoidable burden of disease and injury, identifying areas that government and partners work on together to support healthy living from the early years and throughout life. While Victorian health and human services perform well against many metrics of performance and client satisfaction, there is considerable performance variation across the state. The Royal Commission into Family Violence and consultations on the 10-year mental health plan heard substantial evidence about the difficulties people face navigating a complex and fragmented social services system. This has provided a launching pad for a much broader conversation about people’s experiences and the outcomes delivered across health and human services. The Roadmap for Reform, homelessness and social housing reform, the 10-year mental health plan and Health 2040 have all been shaped by the central themes of the royal commission, which are also 3 Deloitte 2016, Global health care outlook: Battling costs while improving care, viewed 21 May 2017, (https://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/gx-lshc-2016-health-care-outlook.pdf).reflected in the priorities of this strategic plan: the integration and coordination of targeted services, especially when people are most at risk; strong links to universal services for early intervention; and services that are tailored to the unique needs and circumstances of people, their families and communities. Currently, many of our services do not connect in ways that allow them to deal with overlapping problems faced by vulnerable people. For example, chronic health issues, unemployment and homelessness are often linked. Mental healthcare for people without adequate housing is more likely to be ineffective. Out-of-home care that does not include treatment for previous trauma and engagement in education and training will not help young people grow into healthy and secure adults. People in trouble with the law or the court system may need to be diverted to a range of support services to address underling issues and reduce the risk of reoffending. It is also essential that our services consider each person as an individual, as aspects of their diversity or their membership of particular population groups do not define who they are or the services they need. The Royal Commission into Family Violence highlighted that behaviour change programs need to be better linked with parenting, mental health, employment and drug and alcohol services. Helping victims to stabilise their lives and recover from the impact of controlling and violent relationships may require a mix of housing, legal support, employment support, counselling and family supports to rebuild relationships and lives. We have experience that we can draw upon to make it easier for people to access and navigate services, deliver them the right services at the right time, and give people more say in their own care. For example, Victoria has been a leader in clientdirected services in disability. And the joint investment by all Australian governments in the NDIS reflects a commitment to increasing not only the levels of support for people living with a disability but also extending people’s control over the services they use to maintain dignity, independence and achieve what they want from life. New service models are already emerging in trials of the NDIS such as the provision of accommodation and support services. Child and family services and homelessness services are also testing more flexible approaches to funding packages of support that are tailored to people’s individual needs, and Aboriginal community-controlled organisations take whole-of-family approaches as part of advancing Aboriginal self-determination that can be learnt from. In the health sector, new models of care are also being trialled, with the 2017–18 State Budget committing $12.7 million over three years to better connect primary, secondary and acute health services for people with chronic and complex conditions. The 2017–18 State Budget also provided $8.3 million over four years to mainstream genomic sequencing. This means that children and adults with rare conditions and diseases get the genomic sequencing they need, without which they might not get a diagnosis and spend months in hospital undergoing unnecessary tests. The delivery of these new models of care and services depends on people including nurses, social workers, doctors, allied health professionals, administrators, scientists and many others. New models won’t become a reality unless we are able to partner with a workforce with the right numbers, skills, values and behaviours to deliver it, and organisations with the business and operating models that enable them to succeed. Our strategic context 24 Department of Health and Human Services Strategic planCo-design, shared decision making and self-determination Advising government on how services need to change and evidence-based initiatives to fundamentally shift attitudes and behaviours requires us to have a more engaged relationship with the people who rely on our services, as well as carers, service partners and other experts. There is now a body of evidence about highly effective models for collaboration and participative approaches to service design and delivery and social change. Some of these approaches and models have been translated from other industries that now work closely with their customers to ensure products and services make sense for the people they are intended to benefit. Co-design and shared decision making is increasing. We need to learn from the transitions other industries have made and reform programs in other government agencies and overseas to prepare our department, and the broader health and human service systems, for the challenges to come. Our patients and clients must be part of this, with co-design to become a core component of service design and delivery. To advance this in our health system, Safer Care Victoria is establishing a council of patients, families and carers to advise on and inform the agenda for improvement and support authentic co-design of person-centred solutions to healthcare issues. This council will also support the work of Better Care Victoria to drive innovation throughout the health sector. The Victorian Agency for Health Information is leading the way in providing greater access to health performance information to patients and carers, as well as clinicians and health service administrators. The establishment of Family Safety Victoria will also accelerate co-design and shared decision making in our human services system, leveraging the successes and lessons learnt from Safer Care Victoria and the Victorian Agency for Health Information. Within the human services portfolio, co-design and shared decision making will continue to be a feature of system design and reform. Established models include the development of personalised safety plans and use of flexible packages to tailor support and the establishment of Victim Survivor Advisory Council to ensure the voice of victim/survivors is central to the design of the support and safety hubs and other service system reforms. At the community level, there are also opportunities for us to rethink how we involve communities affected by emergencies and victim-survivors of abuse and violence in our work. This is a key part of our response to the Hazelwood Mine Fire Inquiry. Finally, we must play our part in increasing Aboriginal self-determination, recognising that it is vital for improving Aboriginal people’s health and wellbeing. We are already advancing this through empowering Aboriginal community-controlled organisations to take responsibility for and to make decisions about the care of Aboriginal children living in out-of-home care and transferring 1,448 properties
from public housing designated for Aboriginal people to Aboriginal Housing Victoria. However, the nature of our work and the frequency with which we deliver services to Aboriginal Victorians provides more opportunities to advance self-determination across our portfolio.We want to improve the impact of our services and activities on the lives of Victorians.Our strategic directions We have identified four strategic directions over a four year horizon that we will pursue to focus our efforts to deliver measurable outcomes and achieve our vision for the people of Victoria These strategic directions are based on the best available evidence about what will generate an improvement in the impact of our services and activities on the lives of Victorians. These directions inform our three roles of steward (including how we develop and oversee policy), system manager (including how we design funding and regulation) and agent (including how we deliver services, build capacity and influence). Our four strategic directions are described below. Person-centred services and care Before birth and throughout childhood, adolescence and adulthood, all kinds of factors influence a person’s ability to experience a good life. Their safety, family context, educational outcomes, housing, social support, work opportunities and workplaces, gender equality, access to transport and recreational opportunities all have an impact. Person-centred services and care is a way of considering all the influences on a person’s health and wellbeing. Starting in childhood and continuing through life, it is a way of designing services and supports in the wider context of people’s lives. It is a way of enabling people to have a voice and have their own life goals count. Research has found that person-centred care can have a big impact on the quality and efficiency of care – including by helping people to learn more about their health conditions and prompting them to better understand their own needs, be more engaged in their own care and be more motivated and empowered to make changes in their own lives. This has implications for how services are both designed and delivered. For individual patients or clients, it means putting people and their families at the centre of decisions and seeing them as experts, working alongside professionals to give them greater control over their life and the services they receive. Considering the whole person (or family) to understand their physical, cultural and social context helps to identify more quickly if there are additional services or supports that would make a difference to their health, wellbeing and safety. For example, a maternity service might be well placed to identify risks of family violence early and connect a woman to specialist family violence advice before risks escalate. Person-centred approaches tap into people’s intrinsic motivations to help them effect behavioural change by: • enabling people to look after themselves better, including through better access to information, education and resources to help them manage their condition or situation • fostering meaningful relationships that help people to improve their health and wellbeing (this could include peer support networks and community groups) • enabling people to work collaboratively with professionals – person-centred services see the people using health and human services as equal partners in planning, developing and monitoring care. 28 Department of Health and Human Services Strategic planFamily-centred care also lies at the heart of good Aboriginal health and wellbeing service delivery. When self-determined and culturally informed, it empowers Aboriginal people to make the best choices about their health and wellbeing. In turn, more inclusive service models give people access to the support they need at the time it is required. Person-centred services require us to pay more attention to who is accessing our services and their experiences and outcomes. We need to be better at connecting our data in order to have a greater understanding of our service users, and how we can segment them according to need, capability and other characteristics. We need to build shared understandings of how behaviours, attitudes, preferences and needs differ across diverse populations. Particular attention will be paid to responding effectively to gender, gender identity, cultural and linguistic background, faith, refugee status, disability and sexual orientation. Design processes should always focus on whether a service is fit for purpose and safe, and be cognisant of the diversity in the community. Groups of people who have used (or supported other people to use) services should also be engaged in how the whole interaction with services are experienced – and what a positive connection and interaction between a person and a service would involve. Advancing this strategic direction will also involve us improving how we measure the experience and impact of our services, programs and investments on individual patients and clients. Person-centred care still means different things to different people – developing more clarity about person-centred approaches and measuring their impact will help us to learn what works and develop the funding, service and practice models that support effective care. Local solutions Where people live and spend their time affects their health and wellbeing. The conditions in which people are born, grow, live, work and age are intimately linked to place and recognised by the World Health Organization as the major cause of avoidable and inequitable health conditions. There is considerable evidence that accessing services closer to home, and being connected to a community, contributes to wellbeing. Place-based and community-centred approaches to service design and delivery recognise that Victoria is too diverse for a ‘one-size-fits-all’ model to apply everywhere and for everyone. In the future, it will be critical that more people get care in community settings and in their own homes. Existing service configurations and infrastructure, long-term service and infrastructure planning and cultural considerations need to be taken into account as we evolve service models. However, finding local solutions does not mean simply letting ‘a thousand flowers bloom’. Identifying the characteristics of similar communities and building evidence on the key features of effective journeys and service models will create opportunities to spread leading practice while enabling meaningful local flexibility in the way funding rules, regulatory requirements and other mechanisms are applied. Place-based, or community-centred, approaches to advancing health and wellbeing also recognise that community cohesion, volunteering and social capital can all contribute to improving health and wellbeing. Alongside health and human services, urban planners, local governments, transport authorities, legal services, education services, employers, sport and recreation organisations and community groups all contribute to building stronger and healthier communities. The challenge for formal care settingis to better connect with these broader actors to achieve large-scale social change. Place-based approaches are particularly important where location itself is a clear risk factor – for example, in creating adverse environmental health impacts or making it hard to access jobs and services. Some communities face seemingly intractable problems that cannot be solved by government acting alone. There may be a community need, or social challenge, that cannot be addressed by a single actor, where the services or actions required to address the problem are fragmented or disconnected or where there is a need for innovation or new solutions and the problem is of significant enough scale to warrant joint commitment. In these cases, we will adopt a collective impact approach based on rigorous measurement of agreed outcomes and flexibility for local partners to experiment with models and resources. On a range of ind
icators, Victorians living in rural areas are likely to be less healthy than those in the metropolitan area (see Figure 2). Disability pensions Child protection investigations Emotional/behavioural problems in children Mental health clients Unintentional injuries Alcohol and drug treatment clients Avoidable deaths Avoidable deaths – cardiovascular disease Malignant cancers Avoidable hospital admissions 100 110 120 130 140 150 160 170 180 Index (Metro = 100) Figure 2: The health of rural Victorians (2015) On a range of indicators, Victorians living in rural areas are likely to be less healthy than those in the metropolitan area. Source: Measures accessed via Geographical profiles and planning products at (https://www2.health.vic.gov.au/about/reporting-planning-data/gis-and-planning-products/geographical-profiles). Our strategic directions 30 Department of Health and Human Services Strategic planPlace-based approaches may be directed towards improving young people’s pathways into sustainable employment in an area of high youth disengagement and unemployment. They might aim to develop sport and recreation infrastructure and programs to encourage physical activity and social connectedness. Or, a local collaboration may be focused on lifting population health outcomes because there are high rates of obesity or high levels of family violence, or because large numbers of children are missing out on early childhood services. Increasingly, state government agencies are collaborating and coordinating more effectively to respond to local needs. Agencies are using and sharing data more effectively – with each other and with other levels of government and community organisations – to discover which individuals and communities have the greatest needs and to coordinate responses. The Victorian Government has established nine Regional Partnerships across regional Victoria, and six metropolitan partnerships. The objectives of the partnership approach are to reach more deeply into communities to identify common goals and priorities and to give local partnerships a stronger voice and a direct pathway into decision-making processes. Strengthening relationships between Regional Partnerships and other area partnerships is helping to prioritise and mobilise Victorian Government resources to support local collaboration and can help prevent the need for more expensive, tertiary service interventions. Areas of high need and significant disadvantage are prioritised. The Latrobe Health Assembly has been established to provide specialised, independent advice on health priority issues facing the Latrobe Valley community and to drive innovative approaches to health and wellbeing in the Latrobe Health Innovation Zone. It is vital that the voices of service providers, general practitioners, hospitals, carers, young people, parents, patients/clients and community leaders are captured through these partnership arrangements. Primary health networks and disability local area coordinators are also important actors in partnerships. The department is engaging collaboratively with these evolving partnership arrangements to build relationships, share knowledge/data on local need and engage in joint local planning and activity built on an understanding of the social determinants of health and wellbeing. Earlier and more connected support Achieving health and wellbeing throughout people’s lives requires health and human service systems that know and connect with people at every touch point, not just when they are sick or disadvantaged. This means getting in early to prevent or address problems before they become too big or to stop them occurring at all, helping people build resilience to overcome the challenges they face, and designing journeys to make our services easier to navigate for people. This strategic direction is focused on breaking down the barriers in how care is provided within and across sectors – for example, between primary, secondary and acute health services, between health, education and social services, between justice and social services, between paid staff and volunteers, and between specialists and generalists. Our strategic directions 32 Department of Health and Human Services Strategic plan

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