By Aisha Dow and Benjamin Preiss
A secret overhaul of the state’s public hospital system is investigating possible forced mergers of local health services and the sharing of surgery waiting lists in what could be a major shake-up of how Victorians access care.
The state has 76 health services compared with 15 local health districts in NSW. Victoria’s system has drawn criticism for being inefficient and uncoordinated, but the prospect of amalgamations has ignited fears smaller hospital services would be targeted, forcing patients to travel further for care.
Victoria has 76 health services, and the system has drawn criticism for being inefficient.Credit: Joe Armao
In response to questions from The Age, the Health Department confirmed a health services plan was being developed to consider the best design and governance for the state’s public hospital system, and to consider how the services can better work together.
“The purpose of the plan is to work with health services to improve equity and access for all Victorians – including maximising opportunities to link primary and acute healthcare services across the state,” a department spokeswoman said.
A leaked presentation obtained by The Age shows that over the past several months, the chief executives and board chairs from Victoria’s health services have been consulted by an expert advisory committee on the plan to improve collaboration between hospital networks.
The presentation document canvasses the possibility of mandatory amalgamations. Other potential changes include formal partnerships between health services, including shared surgery waiting lists, cancer and maternity care, administration services, workforce recruitment and mandatory training.
A senior source privy to the discussions but not authorised to speak publicly said that the reforms could result in the merger of smaller health services into larger ones, similar to NSW or South Australia. There are nine regional and rural health districts in NSW and six in South Australia, compared with 58 in Victoria.
The source said that while there were good principles behind the plan, “I think underneath that there is another layer of work that is going on, which is built very much around financial cost savings”.
They said rural health services were often a town’s major employer and part of its social fabric, providing essential care that would otherwise mean some Victorians would be hours from their nearest service.
An independent expert advisory committee – including former state Labor MP and police minister Bob Cameron, and former chief executive of the Royal Melbourne Hospital Professor Christine Kilpatrick – is leading the health services plan. They are now seeking views from community advisory and consumer groups.
Professor Stephen Duckett has held senior healthcare positions in Australia and Canada.Credit: Elke Meitzel
Some health leaders raised the idea of mandatory amalgamations during consultations, the Health Department confirmed, but there are no predetermined outcomes.
Health economist Professor Stephen Duckett said there was a push to reduce the number of health services in Victoria, mostly by targeting rural services.
But he argued that if the goal was improving efficiency, it would be better to aim for metropolitan services, some of which only manage a single hospital. They could share pathology or orthopaedic services, he suggested.
Duckett said while there wasn’t much political appetite for metropolitan hospital service amalgamations, it could make sense to merge management of the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Royal Children’s Hospital and Royal Women’s Hospital, all located in walking distance from each other on the edge of Melbourne’s CBD.
“How many separate hospital boards do you need in Parkville?” he said. “Even though there’s a huge benefit in the amalgamation of all of them, the politics are such that that is probably unlikely to happen.”
Victorian Ambulance Union secretary Danny Hill said poor co-ordination between Victoria’s many health services often resulted in unnecessary ambulance transfers between hospitals, and long waits when the ambulances arrived, sometimes tying up a town’s only available ambulance crew.
The large number of health services, many with different policies, was a constant source of frustration for paramedics said Hill, who believes things would work better with fewer health services.
Hill said NSW’s system of much larger health districts “by all accounts works much better”. In NSW, hundreds of hospitals have been grouped into just six metropolitan local health districts, nine regional and rural local health districts, and three other networks.
Victorian Ambulance Union secretary Danny Hill is in favour of reform.Credit: Luis Enrique Ascui
However, some Victorians have reported that their local health services have deteriorated following amalgamations.
Earlier this year, Northern Grampians Shire mayor Rob Haswell moved a motion of no confidence in Grampians Health, accusing it of eroding services and shipping healthcare “down the highway” after taking over the Stawell hospital.
Grampians Health was established in November 2021, merging health services in Edenhope, Stawell, Wimmera, and Ballarat.
Haswell said access to health services had improved in his community after he moved his motion. But he stressed it was important that rural communities retained local health services, which were particularly important for ageing patients.
“If all the people over 85 – and most of them have mobility issues – had to travel to Bendigo or Ballarat to be seen, that makes this an unlivable area,” he said.
One chief executive of a rural health service, not authorised to speak publicly, said it was crucial to retain local services rather than allow them to be subsumed by big regional health centres.
“Local communities relate to their local health service,” they said. The rural health boss insisted many small health services already collaborated with larger centres, and mergers should be voluntary rather than just focused on saving money.
Leigh Clarke, the chief executive of the Victorian Healthcare Association, which represents the public healthcare sector, said recent hospital system reforms in Australia and the world have “trended towards” voluntary amalgamation.
She said that amalgamations had potential benefits, including making better use of existing capacity, however, there was also potential for unintended consequences.
“Public health services know their communities best. It’s essential that any potential changes to the structure and governance of Victoria’s health services seek to strengthen, and not compromise, the high standard and access to care that Victorians deserve and expect.”
A draft plan is due to be presented to the department next year.
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