This is a long-form analysis of the Victorian Government’s investments in health, mental health, alcohol and other drugs, and oral health. For a quick summary of specific Budget program expenditure in this space click here.
The theme of the Victorian Government’s 2022-23 Budget is ‘Putting Patients First’, and it’s certainly a bonanza for the health system, which has been put to the test during COVID-19.
With ‘pandemic repair’ a key priority, this Budget makes a mammoth investment in measures to grow and develop the health workforce (nurses and midwives, paramedics, allied health staff, Triple-Zero call takers and dispatchers, and other healthcare roles) and provides funding to increase surgical activity across Victoria to record volumes, exceeding pre-pandemic levels by 25 per cent. This is coupled with a significant future-focused infrastructure program.
Running alongside this is substantial funding for mental health, to implement the recommendations of the Royal Commission into Victoria’s Mental Health System. This includes record investment in the mental health workforce – $371.5 million over four years–to continue to build the pipeline of workers required to deliver the reforms.
This is important, welcome investment – supply and capability are fundamental to delivering the Royal Commission reform agenda. These jobs will span all parts of the mental health service system, including mental health and wellbeing services delivered by community sector organisations. However, the local labour market has never been tighter. The sector has noted that finding a workforce to enable the mental health system’s expansion is going to be a significant challenge.
There is a risk that the mental health system’s expansion may exacerbate workforce shortages in intersecting sectors, such as alcohol and other drugs, disability support, homelessness, family violence, child and family services, and aged care. That’s why VCOSS will continue to advocate to government for an overarching strategy to grow, sustain and skill all parts of the community services industry. This must include action to address the key structural barriers to workforce attraction and retention: insecure work and low and unequal pay.
The Mental Health Royal Commission also identified the value of lived experience. Consumer peak bodies (such as VMIAC and Tandem) have highlighted the need to ensure that the record investment in the mental health workforce includes an equitable focus on supporting the growth and development of the lived experience workforce.
Another area identified as missing from an otherwise very positive budget for mental health is prevention. For example, the sector has noted housing as a protective factor (and as central to support and recovery). However, this year’s Budget is silent on this area of significant need. Though the nation-leading Big Housing Build is making a positive investment in 2,000 new supported housing homes for people living with mental illness, the sector says this quantum will not be sufficient to meet demand and is seeking additional growth beyond the current four-year program.
While many of the big attention-grabbing investments in health and mental health are at the pointy end of the health system – for example, hospitals – this Budget does make some excellent investments in community-based health care, including healthcare in the home. (Refer to VCOSS’ list of significant initiatives, such as ‘Better at Home’, here. We are particularly thrilled that the investment in public health and local place-based delivery includes $19.4m over two years for women’s health services, a doubling of their previous budget.)
Victoria’s community health services will be key to delivering many of the 2022-23 Budget commitments. This is a sector that has been on the frontline of Victoria’s response to COVID-19. Government has relied heavily on community health services to provide public health information, primary healthcare and social assistance to people who are socially or economically disadvantaged and have complex care needs or limited access to appropriate healthcare. They stepped up to provide COVID testing and vaccination to Victorians who otherwise faced barriers to accessing essential health information and services.
But – as VCOSS noted in our State Budget Submission – the celebratory stories about community health’s impact have concealed an ugly truth – the sector is struggling with inadequate funding and infrastructure.
While this Budget includes some welcome extensions of funding that will assist community health services to meet local demand (including pent-up demand and new and emerging demand) and provide targeted support to vulnerable and at-risk cohorts and communities, the community health sector needs an increase in core funding for its ‘business as usual’ activities, as well as longer-term funding contracts.
We also continue to call for an increase in core funding for Aboriginal Community Controlled Organisations (ACCOs) – including ACCHOs – to meet rising demand for services, including in the growth corridors of Ballarat, Ararat and the Surf Coast, and to address the sustainability of the Aboriginal Community Controlled sector more broadly. This Budget contains significant funding for health infrastructure – some of this funding should be quarantined to fund the completion of Infrastructure Master Plans across the Aboriginal health sector.
Another area of concern is access to oral health. While the Budget includes some investment to increase the capacity of ‘Smile Squad’ (additional specialist dental treatment), it does not deliver on the more ambitious agenda set out in VCOSS’ budget submission.
There is an urgent need for the Victorian Government to address major backlogs and gaps in the provision of public dental health. The Victorian Oral Health Alliance reports there are 1.5 million Victorian adults eligible for public dental care, but only 175,000 were treated in the year to June 2021 (11.6 per cent, or equivalent to treatment every 8.5 years). In June 2021, the average wait for non-emergency public dental was 22.7 months. There were more than 154,000 people on waiting lists. While the pandemic has exacerbated wait lists, timely access to public dental is a long-standing issue.
This negatively affects quality of life for low-income Victorians, and has direct and indirect impacts on the Victorian economy. For example, poor oral health is associated with other health conditions such as cardiovascular disease, stroke, hepatitis C, and pancreatic and oral cancers, as well as lost productivity.
We need the Victorian Government to invest in a catch-up program in community clinics and set in train longer-term changes to the funding model, to increase access to public dental care for low-income Victorians and support a greater focus on prevention, in line with the Victorian Government’s Early Intervention Investment Framework.
Victoria’s community health services will be key to delivering many of the 2022-23 Budget commitments. This is a sector that has been on the frontline of Victoria’s response to COVID-19.
Another area that presents opportunity for greater investment is the alcohol and other drugs space. The Budget provides welcome funds for a new mental health and alcohol and other drugs residential rehabilitation facility in Mildura, mental health and alcohol and other drugs emergency department hubs in regional Victoria, and an additional $10 million for the Mental Health and Alcohol and Other Drugs Facilities Renewal Fund. However, the Victorian Alcohol and Drug Association (VAADA), has identified an overall cut of $39 million in service funding to 2021-22 revised budget figures for alcohol and other drug treatment and prevention. The sector is concerned this will negatively impact treatment and prevention services that support people experiencing substance dependence.
Additionally, VCOSS notes that VACCHO has been calling for the establishment of Aboriginal community controlled residential AOD detox and rehabilitation facilities. This investment is needed, as an adjunct to the decriminalisation of public drunkenness.
In our State Budget Submission, VCOSS noted that in September 2021 there were 3,599 Victorians waiting for treatment on any given day – a 50 per cent increase in just one year. When people cannot access treatment voluntarily, they risk being pushed into the forensic system. This puts additional pressure on the service system – and is out of step with the Government’s Early Intervention Investment Framework.