Four members of the PHAA Victoria Branch
The Victorian Government released its 2022-23 State Budget on 3 May 2022. This week, the PHAA Victoria Branch team has reviewed the Budget papers to compare commitments against recommendations put forward in their Budget submission. Further information on the items included in the Budget papers has also been sought from the Victorian Department of Health.
Given the ongoing public health response to the COVID-19 pandemic, and strong signals about future investments in the public health workforce from within the Department of Health, the Victorian Branch was optimistic that the State Budget would include new and strengthened commitments to public health. Unfortunately, while there are some modest new commitments for the public health workforce and to establish new functions within the nine Local Public Health Units (LPHUs), these commitments do not reflect the long-term vision required to build a more sustainable and equitable public health system.
Here we explore investments made in relation to each recommendation.
1. PHAA’s Budget submission called for investment in the Victorian Public Health Officer Training Scheme, at an estimated $7 million per annum.
The absence of a Victorian Public Health Officer Training Scheme is contributing to problems faced by our fragmented workforce, which is unable to keep up with the scale and breadth of health prevention, protection and promotion work. This has never been clearer than during the two year pandemic response in Victoria, in which the public health workforce was – and remains – under immense pressure. Unfortunately, the Victorian State Government Budget yet again fails to address these shortfalls.
Public health professionals will not benefit from the $70.8 million budgeted to ‘investing in our future health workforce’, as outlined in the Department of Health Budget papers. Rather, the focus is skewed towards acute care, inclusive of a review of clinical placements, expansion of career development opportunities and advanced practice models for allied health, activities to upskill enrolled nurses, and activities to support the retention and growth of the Aboriginal health workforce. Elsewhere, there is funding for midwifery and to recruit new paramedics and emergency department staff.
We were pleased to hear of the Department of Health’s continued support for the Victorian Public Health Medicine Training Scheme, and a review to scope prevention and population health fellowships for medical and non-medical public health professionals (not included in the detailed papers). However, this falls short of the investment required.
The failure to invest in a structured training program for medical and non-medical public health workers was particularly disappointing, considering the:
- Sustained pressure on the public health workforce
- Increased demand to expand the functions of the nine newly created LPHUs and
- Renewed interest in public health career pathways
PHAA will continue to campaign for the implementation of a training scheme for medical and non-medical public health workers in the lead up to the Victorian state election in November 2022.
2. PHAA’s Budget submission called for a commitment to preventive health investment to five per cent of the total annual health expenditure by 2030.
Expenditure records show that the Victorian Government spends approximately 2% of the health budget on public health most years. As a result, Victoria’s total health expenditure continues an unsustainable rise. This is evident through the high need for acute healthcare in Victoria, leading to ambulance ramping, emergency department overload and long elective surgery wait times. The key is to keep people from ending up at hospital in the first place.
Although we are unable to determine the percentage of the health budget committed to public health from the papers provided, the bulk of investment continues to be in acute and subacute care. The approx. $550 million outlined for health advancement and health protection combined is dwarfed by the $14 billion budget for admitted services, $2.1 billion for non-admitted services, $1.2 billion for ambulance emergency services and $2.6 billion for mental health clinical care.
The Budget papers describe positive but small investments in cancer screening, improving health access and outcomes for refugees and asylum seekers, LGBTIQ+ strategy implementation and the design of a new community-based model of care for people with Type 2 diabetes. The Budget also commits to continued funding for the Medically Supervised Injecting Room in North Richmond and expanded outreach in the Melbourne CBD, and maternal and child health services delivered by Aboriginal organisations.
Victoria needs greater investment in prevention to re-orient the health budget towards sustainable, wellbeing-focused spending. This means investing more into those initiatives described above, and into preventing mental health issues and ending family violence. It means strengthening Aboriginal and Torres Strait Islander health and wellbeing initiatives, reducing the impact of harmful products on children, and ensuring all Victorians have access to affordable, healthy food.
PHAA Vic Branch will continue to advocate for the Victorian Government to increase the expenditure on preventive health to 5% of the health Budget, as the state election nears.
3. PHAA’s Budget submission called for a commitment to a five-year funding cycle for the LPHUs and to adequately resource them to assist in the prevention of infectious and chronic disease (estimated to cost $55-70 million per annum).
We welcome this Budget’s investment in LPHUs and the plan to expand their scope beyond COVID-19 to include locally tailored preventative health activities. However, it is extremely concerning that this funding remains limited for the 2022-23 period, with no apparent plans for sustained investment in this vital model of expanded, high-value preventive health initiatives. Without certainty and long-term investment, it will be challenging to attract and retain the public health workforce essential to deliver the vision of these units.
So far, little has been announced about the scope of the units’ preventive activity. We understand that the initial (2022-23) Budget year includes funding to establish the foundations of these expanded services, including Aboriginal and Torres Strait Islander strategy and commissioning, partnership units, and public health intelligence. Further, by June 30, 2022, Primary Care Partnerships will transition under the remit of the LPHUs, which has the potential to support the brokerage of local relationships required for the place-based model of service delivery. However, without certainty and long-term investment, it will be challenging to make and deliver on commitments to community partners.
The PHAA Victoria Branch will continue to advocate that LPHUs are given the accountability and resources required to deliver the Victorian Public Health and Wellbeing Plan. Connecting the LPHUs to the Plan would provide a strategic focus for their work and, through the associated outcomes framework, assist with the monitoring of their impact over time.
Conclusion
The Victorian Government must be bold in its approach to public health reform if it is serious about taking pressure off the healthcare system, and if it wants to create a safer, healthier, and happier community for all. Victorians deserve more investment in their public health workforce development, public health units and the prevention activities that keep them healthy.
The PHAA Victoria Branch will be advocating for these changes and others ahead of the November state election. If you want to get involved, please email phaa.vic@gmail.com and follow us on Twitter at @PhaaVic.
Dr Stephen Carbone, CEO of Prevention United, has written a piece reviewing the Victorian State Budget in the context of mental health. Read it here.