Change and challenge have become the hallmarks of the Government health industry. The pressures on the public system continue to mount.

Our population is aging, a fact which is now beginning to have a very clear impact on the health system. In addition to the growing demands for health services from our aging population, the number of individuals with private health insurance continues to decline.

In short, the demands being placed on the system are increasing faster than the State Government’s capacity to identify funds to meet them.

In addition to the increased pressures on the system from these sources the industry must also confront issues such as the growth in the costs of medical technology and the rising difficulties in recruiting and retaining particular elements of our workforce.

And yet, even though the system is indisputably under enormous pressure, innovation and reform continue to be implemented to the benefit of the people of Western Australia.

At the 1996 election, the Coalition Government provided a policy framework for health built on the principles of Equity and Improved Access, Sensitivity to Community Needs, A Comprehensive Approach to Improving Health for all Western Australians, Better Infrastructure and Coordinated Development, Ensuring Quality and Justice.

These principles are reflected in a number of achievements over the past year.

The increased emphasis in 1996 on all State Government agencies moving towards output-based management following Treasury guidelines, led to a comprehensive review of the Health Department’s funding programs. This review coincided with the developmental work already underway to shift the focus in the health system to a multi-dimensional and health-related program model. Next year, a single health funding program will operate through 10 output groups or sub-programs , each with a focus on a group of related health conditions. Not only does the new program structure represent a new focus on outputs, it also represents a shift from the institutions of service delivery to the specific needs of our patients.

To enhance the efficacy of resource allocation to service providers, the Health Department’s Operations Division has completed work on a budget reform strategy which has been developed with the involvement of teaching, metropolitan and rural health services. The budget reform strategy will initially concentrate on developing a better understanding of acute admitted patients, which currently comprise seventy per-cent of hospital budgets. Reform in this area will involve the application of costing benchmarks which will eventually encompass all services provided by the public hospital sector to allow purchasers and providers alike to better target funding toward specific health conditions for health gain.

In respect to our facilities and infrastructure, the Department commenced a statewide condition audit of all hospitals. The information derived from this audit will enable us to develop a comprehensive understanding of the condition of the capital assets we have and will enable us to plan for the replacement or redundancy and will assist us in addressing any issues relating to deferred maintenance.

The maintenance and development of the health workforce continues to challenge the Department as it does health administrators world wide. There continues to be significant shortages in particular areas of our nursing workforce. While targeted campaigns by the Heath Department, hospitals and tertiary institutions will improve this situation, it is essential that we continue our efforts to make nursing a more attractive career choice both for school leavers and for trained nurses who have left the system for any reason.

While Western Australia leads the nation in our recruitment and retention of doctors for rural and remote areas, our capacity to maintain this position was threatened when the State had to address the proposed restriction by the Commonwealth of the allocation of Medicare provider numbers to medical practitioners during this year. Given Western Australia’s unique population and demographic situation, this could have an enormous adverse impact on rural areas of the State. The Department will continue to support the Minister for Health in challenging this policy.

This year also heralded one of significant change for mental health services with the implementation of the recommendations of the State Mental Health Plan and the passage through Parliament of the new Mental Health Act 1996. In addition to bringing a long awaited clinical focus to mental health services, these initiatives will also strengthen quality and accountability measures in this area through the establishment of the Mental Health Review Board and the Council of Official Visitors.

The accountability of the system and the rights of patients were further reinforced with the opening of the Office of Health Review in 1996. The Office, established under the Health Services (Conciliation and Review) Act 1995 is independent of the health system and provides a readily accessible and impartial means of having complaints about the provision of health services reviewed, conciliated and dealt with, in confidence.

For the future, a number of new initiaitives appeared on the horizon during this year. In particular, innovations such as Telehealth herald a new era for health service delivery in Western Australia and promise to greatly improve the efficiency and complexity of services which can be provided to rural and remote areas.

The State Telehealth Strategic Plan provides the framework for the health system to explore new opportunities offered by telecommunications, interactive multimedia technology and information technology to enhance and transform the quality, efficiency and effectiveness of health service delivery, management and administration and to address some of the problems we have with access and equity in the provision of health services to rural and remote communities.

The significant national and international interest in this initiative became clear when in February 1997, a Telehealth Expo was held by the Health Department to demonstrate the integrated video, voice, data, and image technologies which support the clinical needs as identified in the HDWA Telehealth Strategic Plan. Attendance at the three day Expo was far greater than anticipated with large numbers of visitors traveling from the eastern states to view some of the newest technology in this area and to examine first hand the potential for innovation and improvement to service delivery provided by this initiative.

The coming year holds further challenges for the Department and the health system generally with the creation of the Metropolitan Health Services Board and the implications this has for the better coordination and management of the bulk of our health services.

This past year has been challenging and at times difficult, particularly as we face the issues arising from the funds we have available to meet the constantly increasing demands and costs of the system. However, the commitment of the people who work in both the Health Department and the wider health system remain strong and dedicated to providing the highest quality of care to all Western Australians.

Alan Bansemer
COMMISSIONER OF HEALTH