Tuesday, June 2, 2015

So, what do you think of the ACT Budget? Our initial response.

We see a continuation of the modest growth in heath funding to advance the ACT Government’s plan for our city. The Health budget hits $1.5 billion, around a third of the total ACT Budget. The Government is very clear about their commitment to providing health services and they are moving in the right direction.
The fun begins now with the analysis of the 
Budget Papers.
On the whole this is a Business-As-Usual budget. It continues to deliver on the services announced last year, including the continuation of specialists at the Canberra Hospital Emergency Department ($5.7m) and increase in outpatient services for women and children and the Centenary Hospital ($4.3m).
Construction of University of Canberra Public Hospital starts in 2016. This will be a welcome addition to the public hospital system in Canberra. A part of this project is the provision of car parking, often dismissed as a trivial issue. We are very pleased to see that the arrangements have been finalised and made public for parking at the University of Canberra Public Hospital. During the recent consultation on the Reference Design the car parking was not finalised and raised more than a few eyebrows. It is now known that there will be 400 off-site car spaces. There are no dollar amounts included in the budget papers as this is deemed commercial in confidence. (It does make me wonder how contentious funding for car parking must be). It is not clear if the car parking will require user payment.
Some of the good news of this budget is the additional funding for Calvary Hospital. There is a clear vision to have Calvary and Canberra Public Hospitals as part of a networked, integrated health system. There is $5.6m for the upgrade of the Cavalry Public operating theatre and a further $3.7m for upgrading of medical imaging equipment. There will also be additional beds at Calvary. It is important to enhance Calvary so that they can play an increased role in elective surgery into the future.
The draft Clinical Services Plan on the Time to Talk Website from 2012 set this out:
To achieve the most efficient and effective use of resources, it is essential that the ACT’s two public acute hospitals operate as a network with clearly defined roles for each hospital that complement and support integrated service delivery. Roles will be defined by:  the level of acuity of care delivered; and clinical specialty. To explain the acuity of care that a health facility is able to provide, a system of ‘role delineation’ is commonly used in Australian jurisdictions. The Health Directorate has utilised the NSW Health Guide to Role Delineation of Health Services as the basis for delineating the roles of the Territory's hospitals within networked arrangements. p. 26
Prior to the budget the Minister announced an increase in the number of beds in intensive care at Canberra Hospital. Provision has been made for $10.2m over four years. This demonstrates the significant costs of this level of care: intensive care costs an enormous amount of money.
Another big ticket item is the continuation of additional funds to enhance the numbers of people who can access elective surgery. The Government has invested strongly in this area in the past with funding last year to provide surgery for an extra 500 people. They have committed to funding an additional 500 surgeries again for the next two years, at a cost of $7m per year. This will improve waiting times. This funding will stop in 2017-18 unless there is extra funds from the Commonwealth Government.
Care in the Right Place is a new program with funding of $14m over four years. This includes increased access to cancer outpatients services, providing more doctors and establishing a central intake services in the Cancer Centre to streamline access.
This program also makes provision for an expansion of pain management services. This comes on the back of the increase in funding last year where $9m was allocated for this. It is not clear how much is specifically set aside in this budget. People living with persistent and chronic pain are not well served by our existing services and this allocation will make a difference.
Hospital in the Home is also a good initiative and has received additional funds, building on the expansion of this service last financial year. There is $1.4m over four years to increase the number of people who receive care at home as well as come to the day clinic for registrar review.
There is good news for end of life care. There is $2.4m over four years to enhance the provision of hone based palliative care. We know that this is a valued service in the community that is over subscribed. Additional capacity in this area is very welcome. This is in keeping with the ACT Government Palliative Care Services Plan
In addition to the increased bed capacity, allocation of resources should also be considered to support a range of other modalities including home based care, day hospice and respite care. p.12
Nick Wales joined me at the
ACT Budget lock up today
Last year the ACT Government took the decision to absorb the cuts announced in the Federal Budget. This year the financial position has been compounded by the Government response to the Mr Fluffy Asbestos and the reduction in GST revenue. This means that we are facing a deficit of $407m.
The Treasurer stressed that unlike other jurisdictions, including the Commonwealth, the ACT Government does not borrow money to fund recurrent operating expenses and that they run a cash surplus every year.  They only borrow for infrastructure projects that add to the asset base of the Territory. And this budget does contain infrastructure spending for the health sector.
This budget has allocated funds for 16 more beds at both Canberra and Calvary Hospitals ($40.6 m). This is in additional to the beds announced in last year’s budget. This is welcome news. We continue to see more people presenting at the Emergency Department requiring admission and Canberra Hospital has been under significant pressure, routinely operating at over 90% capacity.
The ACT Government seems to have prepared a budget that balances the needs of infrastructure and business with the needs of people. One of the concerning elements will be in the out years, when the full effects of the of Commonwealth funding of the national Partnership Agreements takes hold, from 2017-2018. The big question that we need to address is how can we sustain this into the future?

Darlene Cox
Executive Director