New Directions - Services responding to a changing landscape

30 years into the HIV epidemic, Australian service providers and policy-makers face a variety of changes - including biomedical advances that enhance the potential of treatment as prevention; and changes in the profile of new diagnoses each year. In this session at the Positive Services Forum, speakers identified key changes and explored potential responses and strategies for seizing the opportunities these changes present.

In his introduction to this session, AFAO Executive Director Rob Lake reflected on the key factors that will contribute to a successful response. These included:

• 'Keeping what works' and building on existing approaches;
• Effectively communicating the significance of changes in treatment;
• Integrating anti-stigma work into our programs;
• Evaluation and research play a crucial role both in informing our approaches and in supporting our arguments for funding;
• Sharing our learning; and
• These changes offer opportunities for diversifying our funding sources and our partners.

Download Rob's presentation from Slideshare (audio will be available soon)

David Riddell -(Bobby Goldsmith)
David discussed the history and development of BGF and how its operations and processes have evolved.

David explained organisation has a comprehensive database of its 1200 clients that allows complex analysis and reporting about each client's circumstances and needs. Because many long-term donors are retiring and have less capacity to give, most of the organisation's funding now comes from government grants. BGF's database is vital for securing funding in an environment that places increasing importance on detailed reporting.

David described other challenges that the organisation faces, saying that that Australia doesn't have any high-profile individuals living with HIV that can assist with raising the profile of the need for funding services for people living with HIV (for example, Magic Johsnon in the US).

Around 400 of BGF's clients have complex needs and only half of these individuals have external case managers. David explained how BGF provides integrated care because clients don't want to go to other service providers; clients trust BGF and have no interest in  migrating to a mainstream service. This 'quality of relationship' presents a challenge when seeking funding because 'quality' is a hard KPI  to measure and report on. The organisation has to find a way to argue the importance of the quality of relationships over quantity, and why this is so significant for clients.



Chris Carter, (Inner North-West Medicare Local)
Chris presented a brief overview of the history health reform in Australia and some of the key areas. He described a 'clustering approach' to address eHealth reform though a number of new agencies and their functions, including:

Workforce agencies:

•      Health Workforce Australia - trying to improve overall skill level Australia's workforce, including training and capacity development for health services.

•      Australian Health Practitioner Regulation Agency - national body that regulates standards and portability across states and territories.

Preventative health agencies:

•     The Australian National Preventative Health Agency - the integration of preventative health and community education

•     National Health Performance Authority -a  very new body whose role is to set an official price on health services  across states and territories. Chris says it will be looking at setting prices for primary care and chronic disease in the future.

Hospitals:

•     Local Hospital Networks - A clustering of hospitals to share resources and staff. 

For clinicians:

•     National lead clinicians group

Initiatives for consumers include:

•     National Health Services Directory - national repository of health providers accessible on the web
  
•     National GP health phone line for consumers (replaces state and territory call lines)
  
•  PCEHR - 1 July 2012. Staged implementation. It's an opt-in system.
  
•     Medicare locals -  a new structure. There are 63 across country in 3 tranches. These are health organisations with a range of objectives, including identifying needs and gaps at a local level; providing support to all allied health providers, to improve quality standards in health care; and making improvements the patient journey. Aim objectives will be to integrate care or purchase services at the local level.

Chris said that evidence and data from services will be needed and it will be essential for our sector to distinguish what our distinctive versus our core competencies are (quality, compliance). Distinctive competencies of sector are what are going to drive the purchasing decisions and funding  in the future.

Questions from the floor included issues around Medicare Locals: are they ready to engage with organisations yet?

Chris responded that the Medicare Locals  in very different stages of development so their capacity to engage may be limited in some cases at this stage. Chris says he is extreme only to engaging in evidence-based discussions now.

Other questions were raised around PCEHR and hospital involvement and capacity, such as are hospitals ready to implement the system and do they have adequate software/ICT in place?