1996-1997
Programme Summaries: The Year Ahead
The 1996-97 Portfolio Budget Statements, informs Senators and Members of Parliament of the proposed allocation of resources to portfolios outcomes and their objectives and targets including the agencies within the Health and Family Services portfolio.
Summaries:
- Overall portfolio directions
- Programme 1: Public Health
- Programme 2: Health Care and Access
- Programme 3: Aboriginal and Torres Strait Islander Health
- Programme 4: Family and Children's Services
- Programme 5: Aged and Community Care
- Programme 6: Disability Programmes
- Programme 7: Corporate Leadership and Management
Overall portfolio directions
In the 1996-97 year, the portfolio will progress and implement the policy and programme directions of the new Government and implement the structural reforms and financial savings included in the Budget.
The 1996-97 Budget underpins the implementation of the new Government's policy emphases for the portfolio: seeking a better balance between public and private sector involvement in the health sector through incentives for people to take out private health insurance; emphasising the Commonwealth's leadership role in public health; addressing the rural medical workforce crisis; recognising the important role of carers; and enhancing the quality and reach of health services to Aboriginal and Torres Strait Islander communities.
In achieving savings, the Government's overarching emphasis has been on maintaining its Medicare, private health insurance, public health and other policy commitments while at the same time achieving structural reform designed to make the portfolio's programmes and outlays sustainable over the medium term. Such structural reforms have been put in place across the whole range of portfolio programmes, including elements of Medicare Benefits, the Pharmaceutical Benefits Schedule, aged care services, disability services and children's services.
In many of these areas, structural reform has meant a change of approach to service provision, with an emphasis on increasing choice for consumers and freeing up relevant industries while constraining costs. In parallel, the reform agenda of the Council of Australian Governments is likely to see a change in the role of the Commonwealth, with direct service provision becoming more commonly the preserve of the States and Territories, while the Commonwealth's role will lie more in the setting of directions, agreeing methods to measure and report on outcomes and providing leadership in the sector as a whole. In addition, the budget contains measures which pursue micro-economic reforms within the Commonwealth's own programmes, such as the Commonwealth Rehabilitation Services and the Australian Hearing Services.
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Programme 1: Public Health
This Programme aims to improve the general level of Australia's health by reducing the incidence of preventable early death, morbidity, injury and disability.
The Programme includes activities aimed at understanding and controlling the determinants of disease, promoting good health and reducing the public exposure to risks encountered as a part of lifestyle or in the environment. The Programme also includes regulation and research activities directed to protecting and promoting health.
The Public Health Programme provides national leadership, co-ordination and resource support for:
- public health strategies in priority areas;
- strengthening the infrastructure and capacity of the national public health system; and
- health and medical research.
The Partnership offers long-term collaboration between the Commonwealth and the States to improve the skills of the public health workforce; develop the national public health information base; develop a national research strategy; and harmonise and modernise public health legislative and regulatory frameworks.
The Partnership can also provide a framework for better co-ordination and integration of national public health strategies. Strategies for national health priority areas will be continued, with the Commonwealth assuming a greater role in national leadership and devolving administration of programmes to the States and Territories. These include immunisation against communicable diseases; the prevention of injury, cardiovascular disease, cancers, chronic respiratory disorders, and diabetes; women's health; and nutrition.
Within the context of the National Public Health Partnership, bilateral Public Health Agreements between the Commonwealth and the States and Territories are being explored as part of the COAG process for the reform of Health and Community Services.
Depending on COAG's decisions, a single Agreement with each State and Territory would effectively replace several current Commonwealth grant programmes. These Agreements would focus on priority areas, targets and outcomes, while at the same time providing the States and territories with genuine flexibility to allocate resources to local public health priorities. If these Agreements proceed it is expected that they will become operational in 1997-98, with 1996-97 as a transition year.
Health regulation will be managed more cohesively and strategically. There will be continued focus on the development of a common international approach to regulatory requirements with regulatory agencies in countries which have comparable standards in therapeutic goods, chemicals and food.
The programme will provide high quality advice to governments and the community on health issues.
A high level of national health and medical research will be maintained, with a continuing focus on better understanding of the health needs of the Australian population, and investigation of determinants of disease and ill health. This will support an improved capacity to base health policy, and government funding decisions, on sound scientific evidence.
The Department's health research work is complemented by the work of the Australian Institute of Health and Welfare, through the provision of information and analysis on the health and welfare of Australians.
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Programme 2: Health Care and Access
Health care financing is complicated by the mixture of public and private funding and service provision in Australia and the close involvement of both Commonwealth and State governments.
In common with other countries, Australia faces growth pressures in health funding from ageing of the population, technological change, increasing patient expectations and supply side factors. Notwithstanding those growth pressures, Australia's total national spending on health is at about the middle of the OECD range.
The emphasis in 1996-97 will be on:
- working with the States to develop outcome measures and to improve the quality and efficiency of services; and
- continuing to seek efficiency in the areas financed by the Commonwealth to ensure that services remain affordable for patients and the nation.
The key strategies include:
- while meeting the Government's commitment to Medicare, addressing some of the major cost pressures by slowing the general increase in doctor numbers, reviewing schedule fees and increasing some charges (this includes the restructure of pathology and radiology benefits in co-operation with those professional disciplines);
- working via the Council of Australian Governments process to develop improved arrangements for the provision of services;
- implementing reform of the private insurance arrangements to ensure consumer satisfaction while creating an environment where the key players (insurance funds, hospitals and doctors) have the capacity to develop arrangements that consumers regard as providing value for money;
- development of benchmarking to encourage improved efficiency and quality; and
- reform of general practice to ensure its long-term viability as the cornerstone of access to health care services.
Programme 3: Aboriginal and Torres Strait Islander Health
The aim of this Programme is to improve health outcomes for the Aboriginal and Torres Strait Islander peoples by working, in partnership with communities, their health services and other stakeholders, to improve access to culturally appropriate high quality health care, especially comprehensive primary health care.
It will take a generation to improve the health status of Aboriginal and Torres Strait Islander peoples to that enjoyed by other Australians. Accordingly, it is essential that the measures being developed and implemented this year are seen in the context of medium and long term strategies to achieve sustainable health gains.
The longer term strategies involve providing uniform access to comprehensive primary health care services founded on population based health measures, with strong links to secondary and tertiary services, to States, Territories and the Aboriginal and Torres Strait Islander Commission (ATSIC) and planning of environmental health improvements. Implementation of these strategies will require coordinated planning, improvements in data systems, accountability of services and workforce development. The development of innovative service models to improve service provision in remote areas is also required.
Accordingly, during 1996-97 the Commonwealth will continue to take a leadership role in developing partnerships with the States and Territories to improve coordination and cooperation in the planning and delivery of health services. The programme will concentrate on formal agreements, specific disease interventions, support for health services, and better coordinated planning processes.
A joint health planning framework will be developed with States, Territories, ATSIC and community stakeholders, which will embrace mainstream health care provision, services developed specifically for Aboriginal and Torres Strait Islander people and linkages with infrastructure and environmental health initiatives. Planning will aim both to improve existing services and to identify the need for new services. Specific agreements outlining the roles and responsibilities of each party (including the recently established Aboriginal and Torres Strait Islander Health Council) have been developed in each State and Territory, as have forums at the state and territory level.
Key bodies include the recently established Aboriginal and Torres Strait Islander Health Council at the Commonwealth level, and forums at the state and territory level. Sub-committees will develop strategies in relation to remote area issues, substance abuse, and workforce needs.
To support the planning, accountability and evaluation of health service delivery, specific performance indicators and a new data management system will be developed. Funding agreements for Aboriginal and Torres Strait Islander health and substance abuse services will place more responsibility on them for the achievement of specific outcomes, while recognising their accountability to their own communities. New funding models will also be developed as new services are developed to implement the Government's commitment to providing services to 35 additional remote communities..
Strategies will be developed to assist Aboriginal communities to access medical services provided by doctors, nurses and trained Aboriginal health workers, and to gain greater access to specialised services.
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Programme 4: Family and Children's Services
During 1996-97, the Family and Children's Services Programme will continue to work towards the Government's commitment to integrate child care policy and family policy more closely in supporting families in their caring role.
The strategies of the Children's Services Sub-Programme reflect the Government's commitment to the best possible care for children through the provision of high quality, affordable, accessible care, subject to growth of the cost of the Programme being sustainable.
A National Planning Framework will be developed in consultation with other levels of government and industry. These consultations will also focus on means of holding the real growth of the Programme's costs consistent with the underlying increase in workforce participation of women and parents. The budget contains a number of measures designed for this purpose, including a freeze on benefit levels, tighter targeting and limits on weekly hours of care for subsidy purposes.
Other changes in subsidy arrangements will see assistance paid directly to families, with operational subsidies remaining for family day care, occasional care, outside school hours care and multi-functional services. As a result, the child care industry is expected to become more competitive.
Under the auspices of the Council of Australian Governments (COAG) Review of Child Care, the Sub-Programme will continue to work with State and Territory Governments to clarify roles and responsibilities of different levels of government to improve outcomes for families and give value for money for taxpayers and users of children's services. A reform strategy is being developed which would involve agreement by Commonwealth and States to a national framework for children's services, setting down national objectives, nationally agreed programme outcomes and performance monitoring.
Following agreement to the national framework, bilateral agreements between the Commonwealth and each State and Territory will be prepared to cover implementation and administrative arrangements.
The Family Services Sub-Programme will progress the Supported Accommodation Assistance Programme (SAAP) reform objectives related to improved independence and self reliance of people who are homeless, while exploring how SAAP services might be better integrated with other Commonwealth and State family support and related services.
It will also work strategically with key stakeholders to develop a leadership role for the Commonwealth in child abuse prevention, youth homelessness, family support, domestic violence, and support for older homeless people and people at risk of homelessness.
The core business of the Australian Institute of Family Studies is conducting research and disseminating research outputs to inform policy and programme development and service delivery, so as to promote the effective functioning and well being of families in Australia. Development and implementation of core activities are informed by dialogue with all levels of government as well as with service agencies. In the course of its work on specific research projects the Institute collaborates with a range of government departments as well as with other research agencies.
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Programme 5: Aged and Community Care
In 1996-97 the Aged and Community Care Programme will focus on:
- implementing the Residential Aged Care Structural Reform Package;
- concluding new Home and Community Care (HACC) agreements with the States and Territories;
- developing a National Aged Care Strategy as a basis for the States and Territories assuming responsibility for the direct administration of all aged care services; and
- implementing the National Carer Action Plan.
The National Aged Care Strategy will provide a strategic framework to address key issues such as the nature, purpose and extent of flexibility in service arrangements and will form a basis on which bilateral agreements can be developed with individual States and Territories. It will also need to address the Commonwealth's strategic interest in ensuring optimal outcomes for consumers and maintenance of overall access and quality of care while taking advantage of the strengths of competitive federalism in driving the development of best practice and improving standards.
The new HACC agreements with the States are an important first step in the reform process. They will bring to fruition the results of a number of reviews of the programme over recent years and lead into the Government's COAG reform process for aged care. HACC services will continue to grow at 6 per cent per annum in real terms, but with some cost containment from broader application of user charges.
The coming year will be one of transition with many detailed implementation issues to be addressed on structural reform. In line with the Government's commitment to work in partnership with industry, consultation will occur with a broad range of groups across the aged care sector on these issues. Work in relation to COAG will involve close dealings with the States and Territories, provide opportunities for consultations between governments and stakeholders at state and national levels and require close attention to inter-relations between aged care and other programmes such as housing, disability assistance, acute care and mental health.
Priority will also be given to implementing a National Respite for Carers Programme and a Healthy Seniors initiative. The former will enhance the capacity of carers to undertake their demanding role while the latter will identify and pursue innovative approaches to the ongoing good health of older Australians.
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Programme 6: Disability Programmes
The 1996-97 year will be a significant one for the Disability Services Programme, as specialist disability services are reshaped in the context of reforms to the mainstream specialist labour market programmes and broader reforms in health and community services. Budget measures to reform the delivery of employment support services to people with a disability will improve efficiency through competition and improve outcomes through performance based public funding. Changes to funding arrangements will ensure that funds are used efficiently, without any drop in quality or effectiveness of services.
Discussions will proceed with State and Territory governments in the context of the Access and Participation by People with a Disability Sub-Programme to develop a new Commonwealth-State Disability Agreement that will clarify the roles and responsibilities of each tier of government and, consistent with the Council of Australian Governments principles for health and community services, set priorities and performance standards for the purchase of specialist disability support services.
At the same time, the Sub-Programme will progress changes to internal arrangements which more clearly separate the role of purchaser from the role of providing services.
New funding arrangements will increase the transparency of costs of delivery of services to people with a disability and improve accountability for outcomes, while allowing more informed decisions on the effective use of funds.
Budget measures will assist the Commonwealth Rehabilitation Service, the Australian Government Health Service and the Australian Hearing Services to enhance quality of service and consumer choice through the provision of direct services to eligible consumers on a more competitive basis, and increasingly at "arm's length" from government. These measures will also ensure the more complex needs of children and special needs consumers, such as indigenous, rural and remote clients, are met. Work will be undertaken to determine the best long term operating structures for these services, with a view to full contestability of services within two years.
Reforms in each area will be introduced in collaboration with key stakeholders and with a primary focus on the interests of people with a disability and their families, as well as ensuring viable private sector involvement where appropriate.
Programme 7: Corporate Leadership and Management
Delivery of this Programme is the joint responsibility of Executive Services (the Executive, Portfolio Strategies Group, and Audit and Fraud Control Branch), Corporate Services and Information Services. The Programme is responsible for providing corporate leadership and management support to the Department in responding to the Government's commitment to the reform of health and related community services to better focus on people and outcomes.
The Programme will oversight the management of the major change agenda for the Department including the COAG reforms, budget measures, and micro-economic reform. Implementing change while meeting ongoing programme responsibilities is a key challenge.
The Programme will provide leadership in developing the portfolio position on the Commonwealth-State reforms, and assist the Ministers in the development of Government policy and its negotiation and implementation with the States and Territories.
The micro-economic reform agenda requires more systematic approaches to competition. Market testing principles will be applied both to internal operations such as information and corporate services, and to the future operations of the business units and statutory authorities in the portfolio.
A high priority will be ensuring the availability of nationally consistent data to support evidence-based health policy and to facilitate outcomes monitoring and reporting for health and community services. Establishment of appropriate information databases will be achieved through collaborative arrangements with State and Territory governments, the National Health and Medical Research Council, Health Insurance Commission, Australian Institute of Health and Welfare, Australian Institute of Family Studies and other organisations. Emerging technologies and new business processes such as electronic commerce, Internet and Intranet will be investigated and opportunities for achieving productivity gains and more cost-effective information and communication services will be identified.
More sophisticated workforce planning will be developed to ensure our mix of professional skills and analytical expertise supports the Government's priorities and the development of strong partnerships with the States and other stakeholders. Support will also be provided to the Department in responding to the significant challenges of a new industrial relations framework with simplified conditions of service for staff (subject to the passage of appropriate legislation) and the shift towards accrual accounting and budgeting. To facilitate the transitional arrangements for staff resulting from the reform agenda in health and related community services, a strong support framework will be developed.
On the international front, the Programme will seek to promote the reform and modernisation of the World Health Organisation through proactive participation in its governing bodies. The Programme will also work with other portfolio agencies and the private sector to promote greater international trade in both onshore and offshore Australian health services.
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