EXTRA funding for health care and a commitment to scrap forced amalgamations has brought momentary relief, but with state government health reforms still lacking clarity uncertainty remains as to the impact on the Mansfield District Hospital.
The government’s 179-page Health Services Plan was officially released last Thursday, confirming Victoria’s public hospitals will be grouped under health service networks into 11 regions.
Metropolitan Melbourne will be split into six regions, with Mansfield falling under the jurisdiction of Hume, one of five regional networks that includes Barwon South, the Grampians, Loddon Mallee and Gippsland.
Under the plan, smaller hospitals like the Mansfield District Hospital will then be linked to a major hospital – a “tertiary” - which is anticipated to be Goulburn Valley Health in Shepparton.
The current structure of Victoria’s health system has remained the same for over 20 years and determined to be “no longer fit for purpose”, with 76 independently governed health services, which is more than the whole of Australia combined.
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The state government believes change is necessary to create a more integrated and efficient health service, engaging an independent Expert Advisory Committee to provide recommendations.
These findings are informing the future direction of the state’s health service.
Of the 27 recommendations contained within the committee’s Health Services Plan, the state government has accepted 26 which includes the establishment of local health service networks, rather than forcibly amalgamating hospitals as previously feared.
Member for Eildon Cindy McLeish commended Mansfield and surrounding districts on drawing attention to the issue.
"I'm so proud of how quickly and effectively locals worked together to hold rallies and collect signatures to put pressure on the government to prevent hospital amalgamations," she said.
"It is incredible the government lacked the understanding as to how budget cuts and forced amalgamations would impact local health services and local communities."
In an effort to rebuild eroded trust, Premier Jacinta Allan confirmed amalgamations were not in the best interest of patient care.
Findings recommend continued “local leadership within each network, informed by local community voices” and “in recognition of the importance health services have to communities” that individual identities and brands are retained.
However, the report also states consolidation of health services into networks will deliver a more “equitable, consistent” system.
With the benefits applying not just to patients, but to the health workforce and local communities overall, with consolidation touted as better addressing “the needs of Victorians now and into the next decade”.
As a result, amalgamations have been rebranded as “legislated partnerships”, which ostensibly preserves the independence of hospital boards and chief executives, whilst sharing resources.
Whether this is achievable under wide-spread reform remains a source of community consternation.
Opposition Leader John Pesutto believes this is effectively “amalgamation by stealth”, condemning the lack of detail surrounding “partnerships”.
“Make no mistake, this government has plans to amalgamate health services across the state,” he said.
Leigh Clarke CEO of the Victorian Healthcare Association (VHA) said the three key pillars detailed within the Health Services Plan – establishing Local Health Service Networks, formalising relationships and the creation of a statewide role delineation framework – amounts to a clinical services amalgamation.
Despite retaining hospital boards and chief executives, network-wide consolidation of clinical activity and management ultimately requires the centralisation of administration and resources across health services.
Under the new plan, hospital chief executives will now sit on steering committees within their respective networks advocating for their individual hospitals whilst encouraging collaboration between services and innovation for the region as a whole.
Established during COVID a system like this already exists locally under Hume Health Service Partnerships, with hospitals like the Mansfield District Hospital able to retain autonomy under this model along with the ability to further and actualise local initiatives.
The VHA has expressed uncertainty as to whether hospitals will end up competing for services under the new system.
The association is also unsure as to what governance will look like within the new networks, which have been made accountable to a new Department of Health agency, Hospitals Victoria.
Hospitals Victoria will oversee performance and accountability whilst driving financial sustainability, assisting hospitals to manage budgets and shift to digital technology, allowing each health network the opportunity to focus on goals and targets in their specific region.
Ms Clarke said the VHA noted the creation of this new entity and hoped it would deliver a more collaborative way of working with health services.
“We must not repeat the mistakes of the past few months,” Ms Clarke said of noted community concern at the lack of consultation.
“We call for improved communication and collaboration in the development of health service budgets.
“The Victorian Government also needs to deliver further consultation with the health sector to enable considered implementation of the reform recommendations.”
Ms Clarke is requesting further discussion with all relevant stakeholders – from health service employees to consumers and clinicians - before embarking on any major changes.
With no time frame for the roll-out of the plan and networks yet to be formalised, the government has stated there will be a review three years after implementation, with outcomes assessed at the five-year mark.
The introduction of a connected and standardised Electronic Medical Record to coordinate waitlists, network clinical service planning and make better use of available capacity across the system is seen as a positive, achieving equity of access to care.
Patients will be able to more easily and quickly access specialist care, with referral pathways strengthened.
Addressing workplace shortages with a skilled and mobile workforce also represents a solution for an industry that struggles to attract and retain workers, particularly in rural and regional areas.
However concerns have been raised that additional levels of bureaucracy may reduce the agility of individual health service providers and rather than create efficiencies will hinder local innovation and ability to respond to community needs.
Funding for individual facilities also remains an unknown, with smaller health services subject to budget restraints imposed by a network of health services all vying for a share of the government dollar.
Budget cuts announced earlier in the year already had hospitals bracing to lose more than $1 billion in funding, with cuts predicted to force a critical reduction in frontline services and force smaller health services into mergers.
Shadow Minister for Health and for Ambulance Services, Georgie Crozier said demands had caused enormous concern over the impact on local health care accessibility, jobs and patient outcomes.
After a sustained campaign led by local communities, health services professionals and the state opposition, funding has been reinstated with a $1.5 billion top-up committed over the next year.
However, Ms Crozier is not confident adequate funding will be ongoing, believing the gesture is driven by a government panicking as community sentiment hits an all-time low with a health system in crisis.
She called on the government to provide full details of its $1.5 billion health funding commitment, including the impact on Victoria’s budget position.
The minister believes money will be forthcoming this year, but with the government committed to implementing savings, money will become tight in 2025 and hands will be forced, with services unable to survive unless they voluntarily amalgamate.
Ms Crozier has also questioned the cost of implementing the Health Services Plan, with additional funding required to actualise the recommendations and achieve system-wide reform.
