National Health Reform Briefings – Questions taken on notices – Melbourne

Can you comment on upstream services from ambulances to hospitals, either in terms of the Independent Hospital Pricing Authority or emergency department targets?
Can you outline the workforce strategy to attract and recruit mental health nurses as current mental health nurses will be moving out of the public system due to the Mental Health Nurse Incentive?
People with mental illness who present to emergency departments often have to be transferred to hospitals out of the area or hospitals are forced to discharge in-patients early to create a bed for mental health patients. Have you given consideration to the impact of the four-hour emergency department targets on patients with a mental illness who present at emergency departments?
Mental health reform has a lot of focus on early intervention/psychosis. There is an absence of strategies for long term mental health care. What is the thinking for people with long term mental illness who come in and out of services?
Who will comprise Lead Clinician Groups (LCG)? It is important that Indigenous Health and Allied Health are included in these groups.

Can you comment on upstream services from ambulances to hospitals, either in terms of the Independent Hospital Pricing Authority or emergency department targets?

Ambulance services remain state-based services outside of the National Health Reform Agreement, therefore any ambulance-based service is not subject to the Independent Hospital Pricing Authority in terms of pricing.

Funding for emergency departments will be included in the new Activity Based Funding arrangements, which are aimed at improving access to, and timely delivery of, such hospital-based services. The performance of hospital service delivery systems is still the responsibility of state and territory governments as hospital system managers. The National Partnership Agreement on Improving Public Hospital Services provides specific additional funding to achieve the four hour National Emergency Access Target in public hospital emergency departments.

In terms of how the four hour emergency access target is measured, it commences from the first recorded contact between the patient and emergency department staff. For patients arriving by ambulance, this should coincide with the beginning of triage and/or registration of the patient (whichever occurs first).

It is expected that emergency department staff would make contact with a patient arriving by ambulance as soon after arrival as possible. The period ends with the patient's physical departure from the emergency department, including via ambulance transport.

Can you outline the workforce strategy to attract and recruit mental health nurses as current mental health nurses will be moving out of the public system due to the Mental Health Nurse Incentive?

Support for mental health nurses is available through the Australian Government’s Nursing and Allied Health Scholarship and Support Scheme (NAHSSS) with 60 postgraduate scholarships being available to mental health nurses in 2012, along with opportunities for continuing professional development scholarships.

The Mental Health Nurse Incentive Program (MHNIP) began on 1 July 2007 and 1,060 nurses have been engaged to provide MHNIP services since then. The Australian Institute of Health and Welfare reports that there were 14,640 clinical nurses employed in mental health as their main job in 2009.

An evaluation of the MHNIP will commence in 2011.

People with mental illness who present to emergency departments often have to be transferred to hospitals out of the area or hospitals are forced to discharge in-patients early to create a bed for mental health patients. Have you given consideration to the impact of the four-hour emergency department targets on patients with a mental illness who present at emergency departments?

Consideration of people presenting to emergency departments with a mental illness was included in the Expert Panel deliberations. As a result of the recommendations of the Expert Panel, the National Emergency Access Target will apply to 90% of patients who present to an emergency department, taking into account those who need to remain longer in the emergency department for patient safety and clinical reasons.

The target will be implemented with a staged implementation over four years to allow time for the redesign of hospital processes to improve patient flow.

Mental health reform has a lot of focus on early intervention/psychosis. There is an absence of strategies for long term mental health care. What is the thinking for people with long term mental illness who come in and out of services?

As part of the 2011-12 Federal Budget Delivering National Mental Health Reform package, the Government has committed $549.8 million over five years, including $343.8 million in new funding to establish a new measure: Coordinated Care and Flexible Funding for People with Severe, Persistent Mental Illness and Complex Care Needs. Through this measure, up to 24,000 people experiencing severe, persistent mental illness who have complex care needs, and their families and carers will have one point of contact for coordination of all their clinical and non-clinical care needs.

Regionally based care facilitation services will be established, which will support the coordination of services at a local level by providing a single contact, assessment, navigation and referral point for people with severe and persistent mental illness, and their families and carers. Regions will be determined using Medicare Local boundaries.

Care Facilitators will be responsible for coordinating eligible individuals’ care needs, clinical and non-clinical, to ensure they are being met. Nationally consistent eligibility, assessment and referral processes will be developed and Care Facilitators will use these to develop multidisciplinary service need care plans tailored to the individuals needs. Services will be funded from 1 July 2012.

The Government also will invest in a range of other social and family support services for people severely disadvantaged by mental illness, including:

$19.3 million over five years to provide more Day-to-Day Living program places to help an extra 18,000 people whose mental illness profoundly affects their ability to work and care for themselves,
$154 million over five years to expand the Personal Helpers and Mentors (PHaMS) with an extra 425 new community mental health workers to work one-on-one with people with severe mental illness to support recovery, reduce social isolation and improve vocational outcomes, and
$54.3 million for extra mental health respite services will also give about 1,100 families of people with mental illness great access to flexible respite and support services over the next five years.

The Australian Government will also invest $200 million in a new National Partnership on Mental Health to assist states and territories to improve services, particularly in the priority areas of accommodation support and presentation, admission and discharge planning in emergency departments.

This will particularly benefit people who are frequent users of emergency departments and who need stable accommodation as a cornerstone to keeping well, and breaking the cycle of hospitalisation and homelessness.

Who will comprise Lead Clinician Groups (LCG)? It is important that Indigenous Health and Allied Health are included in these groups.

The National Lead Clinicians Group membership, whilst currently being finalised, is expected to reflect a membership that is cross-sectoral and multi-disciplinary. Members will be expected to have established networks across health care sectors to facilitate ongoing engagement and collaboration.

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