A National Health and Hospitals Network for Australia's ... - yourHealth

A National Health and Hospitals 

Network for Australia’s Future 

Delivering the Reforms

A National Health and Hospitals Network for Australia’s Future Delivering the Reforms 

ISBN: 978-1-74241-272-6 

Online ISBN: 978-1-74241-273-3 

Publications Approval Number 6803 

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(c) Commonwealth of Australia 2010 

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Contents 

Foreword..................................................................................................................................................3 

Introduction.............................................................................................................................................4 

Reforming Australia’s health system to deliver better health and better hospitals................................6 

Governance and funding.......................................................................................................................12 

Stream 1 — Hospitals............................................................................................................................16 

Stream 2 — GP and Primary Health Care.............................................................................................22 

Stream 3 — Aged Care..........................................................................................................................26 

Stream 4 — Mental Health....................................................................................................................32 

Stream 5 — National Standards and Performance..............................................................................36 

Stream 6 — Workforce..........................................................................................................................40 

Stream 7 — Prevention..........................................................................................................................43 

Stream 8 — eHealth..............................................................................................................................46 

Stakeholder engagement......................................................................................................................50 

Further work ..........................................................................................................................................52 

Abbreviations.........................................................................................................................................54 

Contents 

1

2 A National Health and Hospitals Network for Australia’s Future – Delivering the Reforms

Foreword 

Prime Minister and the Minister for Health and Ageing 

The provision of an affordable and accessible health system is vital for a fair and just Australia. 

Our country must act now to ensure our health system can cope with the demands of the future. 

Demand for health services is increasing as our population is ageing and more people are living with 

chronic disease. 

That is why we are implementing far-reaching health reform. 

The Government has worked for two years to deliver a package of health reforms. Patients, doctors and 

nurses were consulted across the length and breadth of the country. 

And now the Commonwealth Government and seven states and territories have agreed to a fundamental 

shift for delivering vital services and for our federation. 

The establishment of the National Health and Hospitals Network will be the most significant reform to our 

health system since the introduction of Medicare. 

Our hospital system will be funded nationally and run locally. The Commonwealth will take on 60% of the 

efficient cost, with hospitals managed by Local Hospital Networks. 

The Commonwealth will take 100% funding and policy responsibility for GP, primary care and aged care 

services. Medicare Locals will be established to coordinate services in local areas. 

The accessibility, performance and safety and quality of services will be measured and reported on – and 

this information will be used to drive improvements across the system. 

Reaching agreement at COAG was a significant achievement – and we now need this change to have 

an impact at the bedsides, operating theatres and GP practices across the country. It is vital that the 

implementation of the reforms is carefully planned and well executed. 

New funding for emergency departments, elective surgery, sub-acute beds and upgrades to GP clinics will 

start to flow immediately. In other cases – such as establishing Medicare Locals and implementing national 

clinical standards – the implementation of reforms will take a lot of hard work that we are starting now. 

Many Australians will want to know how these reforms will be progressed, when changes will happen and 

how they can provide input. This document provides just that - outlining our program of implementation for 

this massive program of reform. 

We’re going to need the expertise and enthusiasm of the almost one million people who work in the health 

system – and the many millions of patients who rely on it every year. 

The delivery of these reforms will ensure that these patients receive high quality, better coordinated and 

sustainable health care in the decades ahead. 

Julia Gillard 

Prime Minister 

Nicola Roxon 

Minister for Health and Ageing 

Foreword 

3

Introduction 

The most far-reaching reforms to the health system since Medicare were ushered in by the recent decision of 

the Council of Australian Governments (COAG, excluding Western Australia). 

Under these reforms, the National Health and Hospitals Network (NHHN) will create a single national unified 

health system which is nationally funded and locally run to ensure all Australians have access to affordable and 

high quality health care. 

The Commonwealth will become the dominant funder of hospital services and have full policy and funding 

responsibility for general practice (GP), primary health care and aged care. 

The Commonwealth will leverage its funding responsibility to deliver more coordination, control and 

accountability at a local level. Central to these reforms is a focus on prevention, improved health outcomes for 

Australians and better availability and delivery of their care. 

A national performance, funding and reporting framework will be implemented to make the system more 

transparent and drive improvements across all aspects of the health care system. 

Implementing these reforms will be a complex task over a number of years that will require a high degree of 

collaboration within the Commonwealth and states and territories, and between all jurisdictions and the many 

groups across the Australian community who have an interest or involvement in our health system. 

Implementation of the reforms has already commenced and will be driven across eight streams. These are: 

• Hospitals 

• Primary Health Care 

• Aged Care 

• Mental Health 

• National Standards and Performance 

• Workforce 

• Prevention 

• eHealth 

The purpose of this publication is to provide an outline of the implementation process for the delivery of 

these major reforms. It includes high level implementation roadmaps, major milestones and timelines. 

Detailed implementation planning is well advanced on the 56 major areas of work that are distributed across 

these eight streams. Each of these areas of work will include arrangements for stakeholder engagement. 

These reforms are wide-ranging and have implications for all Australians and many specific interest groups 

within our community. While this document includes a guide to some of the opportunities that will be 

available for stakeholders to be involved in throughout the implementation process, it is important to note 

this is a starting point only and a specific framework for stakeholder engagement will be further developed. 

The Australian Government and state and territory governments are agreed that stakeholder engagement 

and consultation will be a critical factor in successfully implementing these reforms in a way that ensures 

the improved outcomes for all Australians that they are designed to achieve. This will be actively pursued 

throughout the entire process. 

Implementation will also be built around close cooperation between the Australian Government and state and 

territory governments. The historic agreement reached at COAG in April 2010 is an agreement to work together 

to deliver an improved health and hospital system for all. COAG will provide overall leadership for the reforms 

in consultation with Health Ministers and Treasurers. Health Ministers will provide advice to COAG on health 

policy aspects and take the leadership role in the practical implementation of the National Health and Hospitals 

Network. Treasurers will provide advice to COAG on the very significant financial aspects of this reform. 


All signatories to the National Health and Hospitals Network Agreement have affirmed that the implementation 

of this reform will be underpinned by the following principles: 

• an effective health system that meets the health needs of the community requires coordination between 

hospital care, GP and primary health care and aged care to minimise service duplication and fragmentation; 

• Australians should be able to access transparent and nationally comparable performance data and 

information on hospitals, GPs and primary care, aged care services and other health services; 

• governments should continue to support diversity and innovation in the health system, as a crucial 

mechanism to achieve better outcomes; 

• these reforms should be delivered with no net increase in bureaucracy across Commonwealth and state and 

territory governments, as a proportion of the ongoing health workforce; 

• all Australians should have equitable access to high quality health care, including those living in regional and 

remote areas; and 

• Australia’s health system should promote social inclusion and reduce disadvantage, especially for Indigenous 

Australians. 

These principles will guide and inform activities and decisions taken during the implementation process. 

Good implementation is flexible and adaptable, with changes being made when circumstances require it, or 

when new situations are encountered. It is expected that some of the approaches and timeframes set out in 

this publication will be revised in response to new information or changed circumstances, when these become 

apparent as implementation takes place, including through consultation with stakeholders. That is as it 

should be. 

The implementation timetable has already begun with a number of key activities commencing in 2009–10: 

• New funding to states and territories to improve emergency department waiting times and increase numbers 

of elective surgery procedures began to flow in June 2010; 

• Legislation to establish the Australian Commission on Safety and Quality in Health Care as a permanent 

body responsible for new national clinical standards and strengthened clinical governance was introduced to 

Parliament on 23 June 2010; 

• Legislation to implement changes to federal financial arrangements to give effect to reforms to the financing 

of health and hospital services, including the dedication of a portion of Goods and Services Tax (GST) 

revenue to health care, was also introduced to Parliament on 23 June 2010; 

• In eHealth, the Healthcare Identifiers Act 2010 and the Healthcare Identifiers (Consequential Amendments) 

2010 were passed on 24 June 2010 to establish the Healthcare Identifiers Service. The Service will assign 

unique identifiers to individuals, healthcare providers and healthcare organisations to improve safety and 

quality of patient care; and 

• On 25 June 2010, applications opened for Primary Care Infrastructure Grants of up to $500,000 each to 

upgrade facilities in general practices, primary care and community health services, and Aboriginal Medical 

Services. Application details are available on the Department of Health and Ageing’s tenders and grants 

website (www.health.gov.au/tenders). Applications close on 20 August 2010. 

The Government will closely monitor progress against the milestones for these reforms and will provide regular 

updates on progress. Reporting on the implementation program will be a key activity – anyone interested in 

receiving regular updates on program can register at www.yourhealth.gov.au. 

Introduction 

5

Reforming Australia’s health system to deliver 

better health and better hospitals 

Overview 

The new National Health and Hospitals Network Agreement combines reforms to the financing of the 

Australian health and hospital system with major changes to the governance arrangements between the 

Commonwealth and the states and territories to deliver better health and hospital services. The changes to the 

funding arrangements will provide a secure funding base for health and hospital services in the future. The new 

governance arrangements will improve the responsiveness of the system to local needs, enhance the quality of 

services, and allow greater transparency. 

New financial arrangements — funded nationally 

Under the National Health and Hospitals Network, the Commonwealth will become the majority funder of the 

Australian public hospital system. The Commonwealth will fund: 

• 60 per cent of the national efficient price of every public hospital service provided to public patients; 

• 60 per cent of recurrent expenditure on research and training functions undertaken in public hospitals 

currently funded by states and territories; 

• 60 per cent of block funding paid against a COAG-agreed funding model, including for agreed functions and 

services and community service obligations required to support small regional and rural public hospitals; 

• 60 per cent of capital expenditure, on a ‘user cost of capital’ basis where possible; and 

• over time, up to 100 per cent of the national efficient price of ‘primary health care equivalent’ outpatient 

services provided to public patients. 

The Commonwealth will also take on full policy and funding responsibility for primary health care and aged 

care, including the Home and Community Care program (currently other than in Victoria) — see Streams 2 

and 3. 

The Commonwealth will fund its increased responsibilities through a combination of: 

• funding sourced from the current National Healthcare Specific Purpose Payment (SPP); 

• the Commonwealth retaining an agreed amount of GST to be dedicated to health and hospital services; and 

• from 2014–15, an additional top-up payment to be paid by the Commonwealth, reflecting its greater 

responsibility for financing growth in health costs. 

The Commonwealth has guaranteed that the top-up payments will amount to no less than $15.6 billion 

between 2014–15 and 2019–20. If the amount required to fund the Commonwealth’s hospital and primary 

care commitments is less than $15.6 billion, then the residual funds will be paid into the National Health and 

Hospitals Network Fund for distribution to the states and territories for activities which will reduce demand for 

public hospital services. 

Under the National Health and Hospitals Network Agreement, states and territories are required to meet 

specified financial obligations which complement the Commonwealth financial obligations outlined above 

(including meeting any costs above the Commonwealth’s share of the efficient price of hospital services), 

establish Local Hospital Networks and National Health and Hospitals Network Funding Authorities, provide 

data to the Independent Hospital Pricing Authority, maintain their current level of effort in the delivery of GP 

and primary health care services, and ensure that appropriate levels of health expenditure (including capital 

investment and funding) are maintained until the end of 2013–14. States and territories will also be required to 

meet national standards and targets for emergency department and elective surgery services under a national 

partnership agreement. 


Ensuring the health and hospital system can work effectively 

The Commonwealth Government will make significant investments in the National Health and Hospitals 

Network to deliver better health and better hospitals for all Australians. 

These investments include $3.5 billion to improve access to public hospital services (Stream 1): 

• $800 million in capital and recurrent funding to support access to elective surgery; 

• $750 million in capital and recurrent funding to support implementation of the new 4-hour National 

Access Target; 

• $1.6 billion to deliver more than 1,300 sub-acute care beds; and 

• $200 million in flexible funding which can be applied to emergency departments, elective surgery and/or 

sub‐acute care. 

The distribution of services and funding across states and territories is depicted in Figure 1. 

Figure 1 Distribution of public hospital services and funding across states and territories 

National (total $3,373.6m) 

$1,623.6m sub acute beds (1316). 

$800.0m elective surgery. 

$750.0m emergency depts. 

$200.0m flexible funding 

WA (should they sign) (total $351.6m) 

$166.4m sub acute beds. 




NT (total $48.8m) 





Legend 

Public Hospitals 

WA 

NT 

QLD 

QLD (total $675.7m) 





SA 

NSW 

NSW (total $1,066.2m) 





VIC 

ACT 

ACT (total $67.0m) 





TAS 

SA (total $253.2m) 





VIC (total $822.1m) 





TAS (total $88.9m) 





Source: Department of Health and Ageing . 

http://www.health.gov.au/internet/main/publishing.nsf/Content/hospitals2.htm. 

Reforming Australia’s health system to deliver better health and better hospitals 

7

More broadly, the Commonwealth Government is investing in programs and activities that will ensure the 

system can function effectively, including: 

• $1.2 billion in workforce initiatives — to address current workforce shortages and better equip Australia’s 

health system to meet the growing demand for health services into the future, by training more GPs and 

specialists; supporting nurses working in general practice, aged care and rural areas; and supporting allied 

health professionals working and training in rural areas (Stream 6); 

• $466.7 million investment in the key components of an eHealth system, so that all Australians can have 

access to a personally-controlled electronic health record if they choose to (Stream 8); and 

• reducing the burden of disease caused by the lifestyle risk factors of tobacco use and harmful consumption 

of alcohol, thereby improving quality of life and ensuring the sustainability of the health and hospital system 

(Stream 7). 

Improving the quality of services and increasing transparency 

New governance arrangements will be established to set and monitor prices and safety and quality standards. 

A core element of the National Health and Hospitals Network will be strong national standards and transparent 

reporting that is nationally consistent and locally relevant. For the first time, Australians will be able to 

access transparent and nationally comparable performance data and information on their local hospital and 

health services through the Hospital Performance and Healthy Communities Reports. Two new independent 

authorities will be established by the Commonwealth and states and territories to establish and oversee these 

national standards, the: 

• Australian Commission on Safety and Quality in Health Care (Stream 5); and 

• National Performance Authority (Stream 5). 

At the same time, new institutions will be established to ensure transparency in funding for public hospitals and 

give taxpayers confidence that health dollars are going directly to hospital services. These are the: 

• Independent Hospital Pricing Authority – which will ensure nationally consistent funding based on the 

efficient price for each hospital service, established by the Commonwealth and states and territories as an 

independent statutory authority (Stream 1); and 

• National Health and Hospital Network Funding Authorities in each state and territory — jointly governed 

by the Commonwealth and state or territory, and which will transparently report on the number of services 

provided and paid for. Commonwealth funding will flow automatically through the authorities directly to Local 

Hospital Networks. 

Integrated and responsive services — delivered locally 

To improve responsiveness to the needs of local communities, the governance and management of local health 

and hospital services will be devolved to the local level. New institutions will be established to work together 

to deliver services tailored to the needs of communities and that provide seamless transitions across the full 

spectrum of the health and hospital system, including: 

• Local Hospital Networks will manage and deliver hospital services (Stream 1); 

• Medicare Locals will be established across Australia, to work with the full spectrum of GP, allied health and 

community health providers to provide better services, improve access to care and drive integration across 

GP and primary health care services (Stream 2); and 

• aged care one-stop shops will streamline the front end of the aged care system to ensure older Australians 

can more easily access information and assistance about receiving aged care services (Stream 3). 

System overview 

An overview of the National Health and Hospitals Network is provided in Figure 2. The figure shows the 

linkages between the different reform activities and how they contribute to the new system. Key features of 

the new sytem (eg national funding and local governance) are described above and also in more detail in the 

chapters following. 

Implementation 

The following chapters provide implementation details by stream. Figure 3 below summarises the key 

implementation milestones from those chapters, by stream (eg Hospital) and by element (eg Faster access to 

emergency department care). Further information on each of the milestones is provided in the relevant stream 

chapter, along with other implementation details. 


Figure 2: National Health and Hospitals Network 

NATIONALLY FUNDED 

Sustainable funding 

Setting and monitoring 

prices and standards 

Commonwealth . 

funded enablers 

Financial flows 

LOCALLY RUN 

HOSPITALS 

Commonwealth funds 60% of: the efficient 

price of all public hospital services 

provided to public patients, capital, 

research and training; block funding to 

support necessary services and small rural 

and regional public hospitals. States and 

territories will meet any costs above the 

Commonwealth’s funding contribution 

PRIMARY CARE 

Commonwealth takes full funding and 

policy responsibility for primary care, 

including primary mental health care 

AGED CARE 

Commonwealth takes full funding and 

policy responsibility for aged care 

Dedication of around one-third of the GST to health and hospitals 

Commonwealth provides $15.6 billion additional funding between 2014–15 and 2019–20 

Australian Commission on Safety and Quality in Health Care, . 

Independent Hospital Pricing Authority, National Performance Authority 

Increasing the health workforce 

eHealth 

Commonwealth 

Government 

State . 

Government 

Commonwealth 

Government 

Commonwealth 

Government 

NHHN Funding Authority 

(state) 

* 

Local Hospital 

Networks 

Primary care 

providers 

Medicare . 

Locals 

Aged care 

providers 

One-stop aged 

care shops 

WORKING TOGETHER TO DELIVER INTEGRATED SERVICES LOCALLY 

* Automatic payment 


9

Figure 3: Summary of key National Health and Hospitals Network reform milestones 

Date 2010–11 2011–12 2012–13 2013–14 

Apr- 

Jun 

Jul- 

Sep 

Oct- 

Dec 

Jan- 

Mar 

Apr- 

Jun 

Jul- 

Sep 

Oct- 

Dec 

Jan- 

Mar 

Apr- 

Jun 

Jul- 

Sep 

Oct- 

Dec 

Jan- 

Mar 

Apr- 

Jun 

Jul- 

Sep 

Oct- 

Dec 

Hospitals 

1.1 Faster access to emergency department care 

1.2 More sub-acute beds 

1.3 Improve access to elective surgery 

1.4 Flexible funding pool for emergency departments, elective surgery and sub-acute beds 

1.5 Increase Commonwealth’s share of hospital funding to 60% including GST retention and 

dedication 

1.6 Local Hospital Networks 

GP and Primary Health Care 

2.1 After hours GP telephone advice available from 1 July 2011, and local face-to-face services 

available from 1 July 2013 

2.2 Expand the number of GP Super Clinics and upgrade existing GP and primary health care 

services 

2.3 Medicare Locals boundaries initially resolved by 31 December 2010 with first group of 

Medicare Locals to commence operations mid-2011 

2.4 GPs commence signing up to coordinated care for diabetes arrangements 

2.5 New Practice Nurse Incentive Program implemented 

2.6 COAG determines scope of additional GP and primary health care services to be transferred 

to Commonwealth 

2.7 Funding and policy responsibility for primary health care transferred to the Commonwealth 

including GST retention and dedication 

Aged Care 

3.1 Improve access to primary health care for people in aged care 

3.2 Improve viability of Community Care Providers 

3.3 Consumer directed care 

3.4 Support Long Stay Older Patients (LSOP) 

3.5 Increasing Commonwealth aged care funding 

Transfer funding and policy responsibilities 

GST retention and dedication 

3.6 Aged care one-stop shops 

3.7 Improve aged care providers business practices 

3.8 Supporting consumers 

Strengthened consumer protection for accommodation bonds 

Improved Aged Care Complaints Investigation Scheme 

3.9 Expand Zero Real Interest Loans 

3.10 Release land and accelerate planning approvals for aged care facilities 

3.11 Increased access to care through Multi-Purpose Services in rural and remote areas 

3.12 Productivity Commission report on Caring for Older Australians 

Key milestone: 

Arrow key: preparatory phase implementation phase ongoing delivery 


Mental Health 

4.1 Funding commences for additional youth-friendly mental health services 

4.2 Funding commences for additional early psychosis 

service sites 

4.3 New flexible care packages available for people with severe mental illness 

4.4 Funding commences for extra mental health nurses 

4.5 Work on additional mental health service reform for report back to COAG 

National Standards and Performance 

5.1 Establish the ACSQHC as a permanent body 

5.2 Establish the NPA 

5.3 Establish the IHPA 

5.4 Lead Clinicians Groups 

Workforce 

6.1 Measures to better support the aged care workforce 

6.2 Additional GP training, specialist training program and pre-vocational GP placement 

6.3 Scholarships for allied health clinical placements and allied health worker locum scheme 

6.4 Nursing and allied health locum schemes 

6.5 Enrolled nursing training places and undergraduate nursing scholarships for aged care 

workers 

Prevention 

7.1 Increase tobacco excise 

7.2 Revise anti-smoking campaign 

7.3 Plain packaging of tobacco 

7.4 Community sponsorship program as an alternative to alcohol sponsorship 

7.5 Support community activities to tackle binge drinking 

7.6 Enhanced alcohol telephone counselling and referral services 

7.7 Establish the Australian National Preventive Health Agency 

7.8 Survey of Australia’s health 

eHealth 

8.1 PCEHR governance 

8.2 Consultation 

8.3 Change management 

8.4 Lead implementation sites 

8.5 Analysis and IT architecture 

8.6 National infrastructure established 

8.7 Standards developed 

8.8 Legislative amendment 

8.9 PCEHR available for registration online 

Key milestone: 

Arrow key: preparatory phase implementation phase ongoing delivery 


11

Governance and funding 

Overview 

The establishment of the National Health and Hospitals Network includes significant changes to the basic 

structures of the health system, to make them more responsive to the needs of local communities, adhere to 

higher standards of safety and quality, and to ensure transparency in funding arrangements. 

The new National Health and Hospitals Network will be funded nationally (with the Commonwealth taking 

majority funding responsibility across Australia’s health and hospitals system) and delivered locally (with 

governance and management of local health and hospital services devolved to the local level). These new 

funding and governance arrangements aim to ensure the Network is sustainable and provides efficient and 

safe health services. 

Consistent with the National Health and Hospitals Network Agreement, the Commonwealth will: 

• work closely with states and territories to ensure that Local Hospital Networks, Medicare Locals and aged 

care one-stop shops are aligned, wherever possible - this will maximise support and coordination of care for 

patients as they move through different care types; 

• establish the Australian Commission on Safety and Quality in Health Care, the Independent Hospital Pricing 

Authority and the National Performance Authority as permanent independent authorities; 

• take majority funding responsibility for public hospitals (including services, research, training and capital), and 

full funding and policy responsibility for general practice, primary health care and aged care; and 

• reform Commonwealth-state financial arrangements, including retaining a portion of the GST to dedicate to 

health and hospitals. 

These activities constitute an overarching governance and funding framework which sits across, and is 

fundamental to, all areas of the reforms. Each of the milestones and actions relating to governance and 

funding are documented in the eight specific streams of reforms detailed in the following chapters, but all are 

presented here in a consolidated format to provide an overview of governance and funding reforms. 

Outcome: Efficient and safe health services are available 

to all Australians 

Stream Purpose: 

• To establish a nationally funded health and hospitals system, thereby reducing cost-shifting and ensuring 

efficient and sustainable financing across the entire system. 

• To establish a locally run health and hospitals system, increasing local autonomy and flexibility so that 

services are more responsive to local needs. 

Objectives 

• Use local know-how to drive improvements at the local level by devolving management to local 

professionals. 

• Drive health system performance nationally through clinical engagement and transparent reporting. 

• Increase transparency and sustainability by funding hospitals for the services actually provided using a 

national efficient price, and by funding training, research, capital and block funding of necessary services and 

small rural and regional hospitals. 

• Create incentives to drive efficiency within the health system and to reduce cost-shifting by the 

Commonwealth being the majority funder of the entire system. 


Key Milestones 

1.1 Devolving governance to local communities 

1 

2 

3 

4 

5 

6 

7 

Local Hospital Network boundaries initially resolved bilaterally between First Ministers 

first group of Local Hospital Networks commence operations 

remaining Local Hospital Networks commence operations 

Medicare Local boundaries initially resolved bilaterally between First Ministers 

first group of Medicare Locals to commence operations 

remaining Medicare Locals commence operations 

network of aged care one-stop shops commence 

1.2 Improving health system performance 

8 

introduce legislation to establish the Australian Commission on Safety and Quality in Health Care 

(ACSQHC) as a permanent body 

9 

10 

11 

12 

13 

establish the ACSQHC as a permanent body 

introduce legislation to establish the Independent Hospital Pricing Authority (IHPA) as an 

independent authority 

IHPA established and operational 

introduce legislation to establish the National Performance Authority (NPA) 

NPA established and operational 

1.3 More efficient and transparent funding mechanisms 

14 

15 

16 

17 

18 

19 

Funding Authorities established in each state and territory 

GST retention and dedication to health care commences 

COAG determines scope of additional GP and primary health care services to be transferred to the 

Commonwealth 

funding and policy responsibility for primary health care transferred to the Commonwealth 

funding and policy responsibility for aged care transferred to the Commonwealth 

transfer of HACC management responsibility to the Commonwealth (currently except Victoria) 

20 

commence Commonwealth funding of 60 per cent of public hospitals 

21 

Commonwealth funding of 60 per cent of admitted patient services through activity based funding, 

followed by funding of sub-acute, emergency and outpatient services through activity based funding and, 

over time, will move to funding 100 per cent of primary health care equivalent outpatient services 

22 commence Commonwealth funding of 60 per cent of public hospital research, training and capital 


13

Date 

2010–11 2011–12 2012–13 2013–14 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

1.1 Devolving governance to 

local communities 

LHNs 

1 

2 

3 

Medicare Locals 

Aged care one-stop shops 

4 5 

6 

7 

1.2 Health system 

performance 

ACSQHC 

8 

9 

IHPA 

NPA 

10 

12 

11 

13 

1.3 Funding mechanisms 

NHHN funding authorities 

in each state and territory 

14 

GST retention and 

dedication 

Primary care responsibility 

transfer 

16 

15 

17 

Aged care responsibility 

transfer 

18 

19 

Commonwealth funding of 

public hospitals 

Arrow key: 

20 21 

22 

preparatory phase implementation phase ongoing delivery 


Immediate Actions 

Work area 

1.1 Devolving governance to 

local communities – LHNs, 

Medicare Locals and aged care 

one-stop shops established to 

manage service delivery within 

local communities 

1.2 Health system performance 

– establish the ACSQHC, IHPA and 

NPA as permanent authorities 

Immediate implementation activity 

• Consult with stakeholders throughout. 

• Release potential boundaries of LHNs and Medicare Locals for 

consultation. 

• Determine size and location of LHNs, Medicare Locals and aged 

care one-stop shops. 

• First LHNs, Medicare Locals and aged care one-shop shops 

commence operations from 1 July 2011. 

• Develop terms of reference for all authorities. 

• Develop enabling legislation to establish the organisations as 

permanent independent authorities. 


• Develop the Performance and Accountability Framework. 

1.3 Funding mechanisms • Amend the Intergovernmental Agreement on Federal Financial 

Relations and the Federal Financial Relations Act 2009 to reflect the 

National Health and Hospitals Network Agreement. 

• Align jurisdictional budget data and program specification to COAG 

agreed expenditure categories to achieve consistency across 

jurisdictions. 

• Work closely with states and territories. 

• Develop mechanisms to ensure all states and territories are better 

off and appropriate levels of health expenditure are maintained. 

• New federal financial relations arrangements commence on 

1 July 2011. 

Stream 

Streams 1 (Hospitals), 

2 (Primary Health Care) 

and 4 (Mental Health) 

Streams 1 (Hospitals), 

2 (Primary Health Care) 

and 3 (Aged Care) 

Stream 5 (National 

Standards and 

Performance) 

Key Interdependencies 

National standards established by ACSQHC must be adhered to by hospitals, 

and will be reported on by the NPA. 

Determinations by the Independent Hospital Pricing Authority will include 

consideration of the linkages between safety, quality and funding. 

The Commonwealth taking dominant funding responsibility for all three sectors, 

and policy responsibility for primary health care and aged care will result in 

more efficient investments across the three sectors, reducing cost-shifting and 

providing patients with certainty about who is responsible for the health system. 

Provides the framework for standards and performance underpinning the 

National Health and Hospitals Network. 


15

Stream 1 — Hospitals 

Overview 

The Commonwealth and states and territories have agreed on major reforms to the way hospitals are funded 

and run, to ensure future generations of Australians continue to enjoy universally accessible health care. 

Majority Funding 

In return for a secure funding base for public hospitals into the future, states and territories (except for Western 

Australia) have committed to becoming part of the new National Health and Hospitals Network. 

The Commonwealth will fund: 

• 60 per cent of the efficient price of every public hospital service provided to public patients; 

• 60 per cent of recurrent expenditure on research and training undertaken in public hospitals currently funded 

by states and territories; 

• 60 per cent of capital expenditure, on the basis of a ‘user cost of capital’ approach, to maintain and improve 

public hospital infrastructure; 

• 60 per cent of public hospital funding provided through block grants, including for necessary services and 

small rural and regional hospitals to meet Community Service Obligations; and 

• over time, up to 100 per cent of the efficient price of ‘primary health care equivalent’ outpatient services 

provided to public hospital patients. 

Efficient National Funding 

COAG has agreed to the introduction of activity based funding from 1 July 2012 — ensuring that hospitals 

are paid on the basis of the services they provide. This will provide incentives for hospitals to treat patients 

more efficiently, and will provide incentives for hospitals and governments to ensure patients are treated in the 

most appropriate setting. Commonwealth and state and territory government funding for each service will be 

calculated and paid automatically, through National Health and Hospitals Network Funding Authorities to Local 


The national efficient price will be determined by a new independent umpire, the Independent Hospital Pricing 

Authority (IHPA). In setting the efficient price, the IHPA will take into account the need to ensure reasonable 

access to public hospital services, clinical safety and quality, efficiency and effectiveness and financial 

sustainability of the public hospital system. 

Locally Run 

Responsibility for hospital management will be devolved to Local Hospital Networks, giving communities and 

clinicians a greater say in how their hospitals are run. Local Hospital Networks will be single or small groups of 

public hospitals with a geographic or functional connection, large enough to operate efficiently and to provide 

a reasonable range of hospital services. They will be established by states and territories in line with nationally 

agreed characteristics, and in close consultation with the Commonwealth. Boundaries for these networks will 

be initially resolved bilaterally by First Ministers by 31 December 2010. 

Local Lead Clinicians Groups will provide advice to the Local Hospital Networks on service delivery, optimal 

models of care and methods to improve clinical outcomes – see Stream 5 for further details. 

Local Hospital Networks will work closely with Medicare Locals and aged care one-stop shops to deliver better 

integration and smoother transitions for patients across the entire health and hospital system – see Streams 2 

and 3 (respectively) for further details on Medicare Locals and the one-stop shops. 


More beds and higher performance 

The Commonwealth will invest close to $3.5 billion over four years to address key pressure points in the 

public hospital system and immediately deliver improved services for patients, including more beds, quicker 

emergency department services and better access to elective surgery. This includes: 

• a four hour National Access Target, which means that emergency department patients are admitted, referred 

for treatment or discharged within four hours, where clinically appropriate, to be progressively implemented 

from 1 January 2011; 

• access targets for elective surgery with 95 per cent of public elective surgery patients seen within clinically 

recommended times against COAG agreed targets of 2014 and 2015; 

• an elective surgery National Access Guarantee of free rapid treatment in a public or private hospital if patients 

wait longer than is clinically recommended, with staged implementation commencing from 1 July 2012; and 

• from 1 July 2010 the Commonwealth will invest $1.6 billion to fully fund the capital and recurrent 

costs of 1,316 additional sub-acute care beds to allow patients to access the right type of hospital or 

community care. 

These immediate investments are backed by the Commonwealth’s commitment to become the majority funder 

of public hospitals from 2011–12 and to meet 60 per cent of any additional demand and cost growth from 

2014–15. 

Outcome: Reforming the fundamentals of our hospital 

system for sustainable service delivery 

Stream Purpose: 

• To provide better care and better access to sustainable and safe services for patients now and in the 

future by: 

– Reforming governance and financing arrangements; 

– Linking funding to services provided to patients through activity based funding; 

– Providing better access to high quality integrated care designed around the needs of patients; and 

– Increasing investments in hospitals and infrastructure. 

Objectives 

• Determine and apply the national efficient price of hospital services through activity based funding. 

• Determine and apply a framework to fund 60 per cent of: 

– training; 

– research; 

– capital; and 

– block grants to support necessary services and small rural and regional hospitals. 

• Increase transparency and sustainability by comparing costs and efficiency between hospitals and 

jurisdictions. 

• Decentralise public hospital management to achieve local accountability for treatment outcomes and 

increase responsiveness to patients’ needs. 

• Improve access to timely and safe health services for emergency department patients. 

• Improve sub-acute care with 1,316 new sub-acute care beds and community based services by 2013–14. 

• Ensure patients have their surgery within the clinically recommended times. 

• Retain around one-third of total GST revenue for investment in health and hospitals. 


17

Budget Measures 

Measure 2009–10 2010–11 2011–12 2012–13 2013–14 Total 

Emergency departments 100.0 200.9 150.9 150.7 150.6 753.3 

Elective surgery 75.0 351 144 116.5 116.5 803 

Sub-acute beds 234.3 318.2 447.1 625.9 1625.4 

Flexible funding 125.0 25.2 25.2 25.1 200.4 

Activity based funding 0.1 67.7 38.1 23.7 33.9 163.4 

IHPA 3.8 31.8 28.5 27.7 91.8 

Total 300.1 882.9 708.2 791.6 954.6 3,637.3 

*Note this does not include funding already in the forward estimates 



1.1 Faster access to emergency department care 

1 commence ED capital and flexible funding to states and territories 

2 facilitation funding for 4 hour ED target commences 

3A ED 4 hour target commences for triage category 1 

3B ED 4 hour target commences for triage category 2 

3C ED 4 hour target commences for triage category 3 

4 ED reward payments 


5 commence sub-acute beds and services funding to states and territories 

1.3 Improved access to elective surgery 

6 commence elective surgery capital payments to states and territories 

7 facilitation funding for elective surgery commences 

8 elective surgery reward payments 

9 staged implementation of National Access Guarantee commences 

10 elective surgery targets for category 1 and 2 patients reached, December 2014 

1.4 Flexible funding pool 

11 

commencement of Flexible Funding Pool to support emergency departments, elective surgery and 

sub-acute services 

1.5 Increase the Commonwealth’s share of hospital funding to 60 per cent 

12 Independent Hospital Pricing Authority established and operational 

13 

14 

NHHN Funding Authorities established in each state and territory 


15 Commonwealth funding of 60 per cent of public hospitals 

16 commence Commonwealth funding of 60 per cent of public hospital research, training and capital 

17 

Commonwealth funding of 60 per cent of admitted public hospital services through activity based funding, 

followed by funding of sub-acute, emergency and outpatient services through activity based funding from 

1 July 2012 and, over time, will move to funding 100 per cent of primary health care equivalent outpatient 

services 


18 

Local Hospital Network boundaries initially resolved bilaterally between First Ministers by 

31 December 2010 

19 first group of Local Hospital Networks commence operations 

20 remaining Local Hospital Networks commence operations 


19

Date 2010–11 2011–12 2012–13 2013–14 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

1.1 Faster access to 

emergency department care 


1.3 Improve access to 

elective surgery 

1 

6 

2 3A 3B 4 3C 4 

5 

8 

7 8 

9 

8 10 

1.4 Flexible funding pool for 

emergency departments, 

elective surgery and subacute 

beds 

11 

1.5 Increase 

Commonwealth’s share of 

hospital funding to 60% 

through ABF and block 

funding 

12 

14 

15 

16 

13 

17 


18 19 20 

Arrow key: 



Work area 

1.1 Faster access to emergency 

department care — enable 

hospitals to develop infrastructure 

and processes to meet four-hour 

access targets 

1.2 More sub-acute beds — 

provide sub-acute beds and 

services funding to states and 

territories 


• Develop, approve and review state and territory 

implementation plans. 

• First capital payment to states and territories in June 2010. 

• Facilitation payments provided to states and territories. 

• Development of nationally consistent, clinically safe and 

appropriate definition of the four hour rule. 

• Consult with states and territories in their development of 

sub‐acute implementation plans. 

• Submission and assessment of state and territory implementation 

plans including the allocation of beds across sub-acute care types. 

• Make payments to states and territories. 


Work area 

1.3 Improved access to elective 

surgery — construction of 

dedicated ES or Day Surgery 

facilities, expansion of existing 

facilities or purchase of new 

equipment, meeting National 

Access Guarantee and targets. 

1.4 Flexible funding pool — to 

drive improvements in EDs, 

elective surgery and sub-acute 

care and assist with meeting 

targets. 

1.5 Increase Commonwealth’s 

share of hospital funding to 

60 per cent through ABF and 

block funding 


— establishment of LHNs as 

separate entities under state and 

territory legislation 


• Payments to states and territories for capital projects from 

June 2010. 

• Develop, approve and review implementation plans. 

• Facilitation payments to states and territories. 

• First payment to states and territories in June 2010. 

• Develop, approve and review implementation plans. 

• Development of establishment legislation of the IHPA and NPA for 

commencement before 1 July 2011. 

• Finalise terms of reference for the IHPA. 

• States and territories to collect patient level data using the revised 

admitted acute patient classification system developed under 

the 2008 COAG initiative and provide de-identified data to the 

Commonwealth to support activity based funding implementation. 

• Commence development of activity based and block funding 

models which focus on service activity and performance. 


• States and territories to consult on potential LHN boundaries. 

• Determine size and location of LHNs. Boundaries to be initially 

resolved bilaterally between First Ministers by 31 December 2010. 

• Development and passage of legislation by states and territories. 

• Appointment of Governing Councils by states and territories. 

• Design service level agreements, for agreement between LHNs 

and states and territories. 

• Commence consultations on National Lead Clinicians Group from 

1 July 2010. 

• Local Lead Clinicians Groups established in line with LHNs. 

Stream 

Stream 2 — 

Primary Health Care 

Stream 3 - Aged Care 

Stream 5 — National 

Standards & 

Performance 

Stream 6 — Workforce 

Stream 8 — eHealth 


Local Hospital Networks, Medicare Locals and aged care one-stop shops will 

work closely to ensure integrated transitions between hospitals, primary care and 

aged care. Effective primary and aged care will reduce demand on hospitals. 

Hospitals must adhere to nationally established safety and quality standards, 

which will be reported on transparently by an independent organisation. 

Lead Clinicians Groups will provide clinical support. 

Increasing the workforce available will ensure patients are able to access 

services earlier. 

eHealth will ensure practitioners have better access to information to support 

clinical care and management - this will lead to better outcomes for patients. 

Stream 2 — GP and Primary Health Care 

21


Overview 

The Commonwealth will have clear responsibility for improving services in the community and taking pressure 

off hospitals. Consistent with the National Health and Hospitals Network Agreement the Commonwealth will: 

• take responsibility for funding all GP and primary health care services in Australia; and 

• over time, move to fully fund up to 100 per cent of those hospital outpatient services that are better 

characterised as primary health care. 

Additionally, the Commonwealth will make a major investment in GP and primary health care, to: 

• establish Medicare Locals (independent primary health care organisations) across Australia, to work with the 

full spectrum of GP, allied health and community health care providers to provide better services, improve 

access to care and drive integration between services; 

• ensure that communities will have access to GP advice and services after hours, with the capacity to put 

Australians in contact with a GP service in their community when they need it; 

• transform the way Australians with long-term illness are treated with a $449 million investment in coordinated 

care for Australians living with diabetes; 

• deliver around 23 new GP Super Clinics and around 425 upgrades to general practices, primary care and 

community health services, and Aboriginal Medical Services to improve access to integrated GP and primary 

health care; and 

• invest $390 million to expand and enhance the role of nurses in general practice, to improve patients’ access 

to primary health care and take pressure off GPs. 

Medicare Locals will work closely with Local Hospital Networks and aged care one-stop shops to deliver better 

integration and smoother transitions for patients across the entire health and hospital system – see Streams 1 

and 3 (respectively) for further details on Local Hospital Networks and the one-stop shops. 

Outcome: Australians stay healthier and pressure on 

hospitals is reduced 

Stream Purpose 

• To improve access to GP and primary health care services and provide more integrated and connected care 

for patients across the health and aged care system. 

Objectives 

• Take responsibility for funding all GP and primary health care services in Australia. 

• Provide a range of primary health care services in single convenient locations. 

• Provide more integrated and connected care through the establishment of Medicare Locals. 

• Ensure after-hours access to GP advice and services. 

• Transform the way Australians with long-term illness are treated, starting with investment in coordinated care 

for people with diabetes. 

• Improve access to primary health care through expanding and enhancing the role of practice nurses. 


Budget Measures (Does not include Practice Nurse Incentive Program and improved access 

to primary health care in aged care – see streams 6 (workforce) and 3 (aged care) 

Measure 2009–10 2010–11 2011–12 2012–13 2013–14 Total 

Coordinated Diabetes Care 5.7 13.3 183.2 247.0 449.2 

Improved Primary Health 

Care Infrastructure 

Establishing Medicare Locals 

and Improving Access to 

After Hours Care 

56.7 179.4 119.1 355.2 

14.0 66.6 156.5 179.7 416.8 

Total 76.4 259.3 458.8 426.7 1,221.2 



1A 

national after hours GP telephone advice available 

1B 

2 

2A 

3A 

3B 

3C 

4 

5 

local face-to-face services available 

release guidelines and advertising of round 1 grants 

commence funding successful applicants 

Medicare Locals – boundaries initially resolved 

first group of Medicare Locals to commence operations 

remaining Medicare Locals to commence operations 

GPs commence signing up to coordinated care for diabetes arrangements 

New Practice Nurse Incentive program implemented 

6 

COAG determines scope and arrangements of additional GP and primary health care services to be 

transferred to the Commonwealth 

7 

8 

transfer of funding and policy responsibility for primary health care to the Commonwealth 



23

Date 

Jul-Sep 

2010–11 2011–12 2012–13 2013–14 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

2.1 After hours GP telephone 

advice available from 1 July 2011, 

and local face-to-face services 

available from 1 July 2013 

1A 

1B 

2.2 Expand the number of GP 

Super Clinics and upgrade 

existing GP and primary health 

care services 

2 2A 

2.3 Medicare Locals boundaries 

initially resolved by 31 December 

2010 with first group of Medicare 

Locals to commence operations 

mid-2011 

3A 

3B 

3C 

2.4 GPs commence signing up 

to coordinated care for diabetes 

arrangements 

4 

2.5 New Practice Nurse Incentive 

Program implemented 

5 

2.6 COAG determines scope of 

additional GP and primary health 

care services to be transferred to 

Commonwealth 

6 

2.7 Funding and policy 

responsibility for primary 

health care transferred to the 

Commonwealth 

Arrow key: 

7 

8 



Work area 

2.1 After-hours GP 

telephone advice — national 

after hours telephone based 

GP medical advice from 

July 2011 

2.2 Expand GP Super 

Clinics — advertise grants 

to establish GP Super Clinics 

and to upgrade existing 

primary care services to 

deliver GP Super Clinic-style 

services 


• Consult with stakeholders, starting from May 2010. 

• Present the business case to the the National Health Call Centre 

Network Joint Policy Review Committee in August 2010. 

• Drafted and published guidelines and advertised Round 1 on 

25 June 2010. 

• Assess grant applications, commence negotiations and commence 

finalisation of funding agreements. 

• Conclude negotiations with successful applicants, finalise first round of 

funding agreements and commence projects from January 2011. 


Work area 

2.3 Medicare Locals — first 

group commencing from mid 

2011 

2.4 Coordinated care for 

diabetes — GP practices 

commence signing up to 

coordinated care for diabetes 

arrangements from July 2012 

2.5 Practice Nurses — new 

Practice Nurse program 

commences from January 

2012 

2.6 Scope additional 

services to be transferred 

— determine scope of 

additional GP and primary 

health care services to 

be transferred to the 

Commonwealth by 

December 2010 

2.7 Funding and policy 

responsibility for 

primary health care — 

responsibility transferred to 

the Commonwealth from 

July 2011 


• Begin developing program guidelines for Medicare Locals. 

• Consult with stakeholders starting from June 2010. 

• Determine boundaries for Medicare Locals between First Ministers by 

31 December 2010. 

• Consult with stakeholders starting from May 2010. 

• Engage with Medicare Australia (including developing and agreeing 

Better Business Practice Agreement and ongoing liaison). 

• Develop program policy and implementation arrangements, including 

fund-holding arrangements with Medicare Locals. 

• An advisory group comprising key stakeholders will also be convened 

to consider implementation arrangements. 

• Develop program documentation with relevant stakeholders. 

• Monitor Medicare Australia’s system developments for practice and 

patient registration and payment arrangements. 

• Consult with stakeholders throughout, starting from May 2010. 

• Begin developing program guidelines. 

• Develop evaluation framework. 

• Work on scoping additional services from July 2010. 

• Make recommendations to COAG in December 2010 on community 

health promotion and population health programs including preventive 

care, drug and alcohol, child and maternal health, and communitybased 

palliative care. 

• Undertake stocktakes of existing state-funded primary and community 

health services identified for transfer. 

• Agree on any additional primary and community health services to be 

transferred to the Commonwealth and the transitional arrangements. 

• Develop policies and processes needed to support the transfer to the 

Commonwealth. 

Stream 


Stream 3 — Aged Care 




Primary health care reform will help reduce demand on the hospital system. 

Aged care initiatives are dependent on links with and access to GP and primary 

health care services. 

Access to primary health care depends on initiatives to increase capacity and 

capability in the primary health care workforce. 

eHealth will assist the primary health care system in delivering better health 

outcomes by ensuring health practitioners have access to patent information, 

with patients’ approval. 

Stream 2 – GP and Primary Health Care 

25


Overview 

The Commonwealth will invest $813 million in aged care, including $533 million in additional funding, and will 

direct $280 million to the states to support older people eligible for aged care in public hospitals. 

The Commonwealth will take full policy and funding responsibility for aged care services, including a transfer to 

the Commonwealth of current resourcing for aged care services from the Home and Community Care (HACC) 

program, currently except in Victoria. This will enable the development of a consistent aged care system 

covering basic care at home through to high level care in aged care homes. It will enable the Commonwealth — 

as the majority funder of Australia’s health and hospital system — to drive increased integration between acute 

care, public hospitals, GPs, primary health care and aged care. 

The Commonwealth will invest to increase the capacity of the aged care system through: 

• providing more Zero Real Interest Loans to support the development of 2,500 additional aged care places 

($300 million in loans, at a cost of $145 million); 

• providing capital funding for 286 sub-acute beds or bed-equivalents in Multi-Purpose Services to provide 

integrated health and aged care services ($122 million), and expanding the number of rural communities 

eligible to apply for Multi-Purpose Service funding, creating an additional 300 aged care places in rural and 

remote areas; and 

• working with the states and territories to release more land and accelerate planning approvals, so aged care 

homes become operational more quickly. 

The Commonwealth will invest more to increase services in aged care through: 

• improving access to primary health care services for people in aged care ($99 million); 

• improving the viability of community care providers ($10 million); 

• allocating up to 2,000 time-limited flexible aged care places to states and territories, which will provide 

funding to the states and territories for Long Stay Older Patients in hospitals (providing an estimated $280 

million over the next four years to the states); and 

• providing 1,200 Consumer Directed Care packages, through which care recipients and carers have a greater 

say in how services are provided to them. 

The Commonwealth will also: 

• strengthen consumer protections in aged care and toughen prudential requirements to protect residents’ 

savings ($72 million); 

• help control costs for taxpayers and care recipients by providing funding to help aged care providers improve 

their operations ($7 million); 

• provide $1.6 billion for sub-acute beds which will also support the transition between acute and aged care; 

and 

• deliver a comprehensive package of measures to deliver greater support and professionalisation of our aged 

care workforce (more than $390 million, including $103 million in additional funding). 

The Commonwealth has provided the Productivity Commission with terms of reference for an inquiry into the 

aged care system to set out a path for reform to ensure the sector is equipped to deal with future challenges. 

The Commission is due to provide its final report in April 2011. 


Outcome: Older people and their carers are better 

able to access information and services close to 

where they live 


• To develop a nationally consistent and integrated aged care system that provides improved access to 

appropriate care to meet the needs of older Australians and their families. 

Objectives 

• Increase the capacity of the aged care system through 5,000 places or beds and 1,200 packages of 

care by 2013. 

• Increase primary health care services provided to people in aged care. 

• Strengthen consumer protection in aged care. 

• Easy access to information and assessment for aged care services, through one-stop shops located across 

the country linked with Local Hospital Networks and Medicare Locals. 


Measure 2009–10 2010–11 2011–12 2012–13 2013–14 Total 

Improving access to GP and primary 

health care 

Improving the viability of community 

care providers 

0.2 14.1 14.3 35.3 34.6 98.6 

2.3 2.5 2.6 2.7 10.1 

Supporting Long Stay Older Patients 1.0 1.0 0.4 0.4 2.7 

Reform of roles and responsibilities: 

HACC and related programs 

19.0 5.4 13.8 38.3 

Aged care one-stop shops 23.3 2.6 5.4 5.5 36.8 

Increasing business efficiency 0.6 2.1 2.2 2.2 7.0 

Strengthened consumer protection 

for accommodation bonds 

Strengthening arrangements for 

complaints 

6.3 5.1 5.2 5.3 21.8 

10.1 12.6 13.4 14.5 50.6 

Expansion of zero real interest loans 72.1 72.1 0.4 0.4 145.0 

Expand access to Multi-Purpose 

Services 

50.7 35.5 35.5 0.3 122.0 

Total 0.2 199.5 153.2 114.2 65.9 532.9 

*Note this does not include funding already in the forward estimates. Funding for aged care workforce 

measures is outlined in Stream 6. 


27


1A 

Funding commences for improved access to primary health care for older Australians 

1B 

1C 

First group of Medicare Locals to commence operations 

Remaining Medicare Locals to commence operations 

2 Funding increases for viability supplements 

3 Opportunities in place for care recipients and carers to shape their care 

4 Financial assistance to states to provide care to Long Stay Older Patients 

5A 

5B 

Transfer of aged care funding and policy responsibility to the Commonwealth 

Transfer of HACC management responsibility to the Commonwealth (currently except Victoria) 

6 GST retention and dedication to health care commences 

7 Network of aged care one-stop shops commenced 

8 Aged care providers benchmarking commenced 

9 

10 

Consumer protection for accommodation bonds enhanced 

Improved complaints handling commenced 

11 Zero Real Interest Loans, through two aged care approval rounds 

12 Improved planning approvals 

13 Staged commencement of capital funding for Multi-Purpose Services 

14A Productivity Commission draft report to Government on caring for older Australians, December 2010 

14B Productivity Commission final report to Government on caring for older Australians, April 2011 


Date 

Jul-Sep 

2010–11 2011–12 2012–13 2013–14 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

3.1 Improve access to primary 

health care for people in aged 

care 

3.2 Improve viability of 

Community Care Providers 

3.3 Consumer directed care 

3.4 Support Long Stay Older 

Patients (LSOP) 

1A 1B 1C 

2 

3 

4 

3.5 Increasing Commonwealth 

aged care funding 

Transfer funding and policy 

responsibilities 

GST retention and dedication 

3.6 Aged care one-stop shops 

3.7 Improve aged care providers 

business practices 


Strengthened consumer 

protection for accommodation 

bonds 

Improved Aged Care 

Complaints Investigation 

Scheme 

5A 

6 

7 

8 

9 

10 

5B 

3.9 Expand Zero Real Interest 

Loans 

11 

11 

3.10 Release land and accelerate 

planning approvals for aged care 

facilities 

12 

3.11 Increased access to care 

through Multi-Purpose Services in 

rural and remote areas 

13 

13 

13 

3.12 Productivity Commission 

report on Caring for Older 

Australians 

14A 

14B 

Arrow key: 



29


Work area 

3.1 Improve access to primary 

health care for people in aged 

care 

3.2 Improve viability of 

community care providers 


• Commence funding increase for Aged Care Access Initiative in 

July 2010. 

• Inform GPs and other relevant stakeholders about the Aged Care 

Access Initiative. 

• Commence monitoring of Aged Care Access Initiative through 

Practice Incentives Program. 

• First group of Medicare Locals commence from 1 July 2011. 

• Commence increased viability supplements for community care 

providers in July 2010. 

• Inform consumers and providers of the new arrangements and 

what it means for them. 

3.3 Consumer Directed Care • Commence first round Consumer Directed Packages. 

3.4 Support Long Stay Older 

Patients (LSOP) 

3.5 Increasing Commonwealth 

funding 

• Commence working with states to establish eligibility for funding 

and share of places to be allocated to each state. 

Transfer aged care funding and policy responsibility to 

Commonwealth. 

• Initial transitional arrangements. 

• Stakeholder engagement. 

• Audit of existing arrangements. 

• Program policy definition. 

Commonwealth takes management responsibility for HACC 

(currently except Victoria). 

• Commence discussions with state and territory government 

officials. 

• Develop expanded grant management capability to fund HACC 

service providers nationally. 

3.6 Aged care one-stop shops • Commence consultations with stakeholders. 

• One-stop shops to commence operations from 1 July 2011. 

3.7 Improve aged care providers 

business practices 


– strengthened consumer 

protection for accommodation 

bonds and Improved Aged Care 

Complaints Investigation Scheme 

3.9 Expand Zero Real Interest 

Loans 

3.10 Release land and accelerate 

planning approvals for aged care 

facilities 

• Commence working with care providers to establish 

benchmarking tool and business advisory services. 

• Continue current consultations to inform the development 

of improvements to the aged care Complaints Investigation 

Scheme and prudential framework including prudential 

consultation paper. 

• Commence first round of Expand Zero Real Interest Loans in line 

with Aged Care Assessment Rounds. 

• Commence working with states and territories to improve 

planning approvals. 


Work area 

3.11 Increased access to care 

through Multi-Purpose Services 

in rural and remote areas 

3.12 Productivity Commission 

Report on Caring for Older 

Australians 


• Commence developing guidelines for state and territory 

governments to apply for capital funding. 

• Analyse impact of new geographic boundaries due to increase in 

size of eligible regional and remote communities. 

• Productivity Commission draft report to Government in 

December 2010. 

• Productivity Commission final report to Government in 

April 2011. 

Stream 

Stream 1 — Hospital 

Stream 2 — Primary 

Health Care 



Aged care reforms will allow hospitals to better target care where needed. 

Medicare Locals need to be functioning effectively to support aged care delivery. 

Support for the aged care workforce will enhance capacity in aged care services, 

improve access and quality of care. 


31

Stream 4 — Mental Health 

Overview 

The Commonwealth is committed to ensuring Australia has a sustainable and effective mental health system 

and is determined to improve the system to ensure people with mental illness, their families and carers have 

access to the services they need. 

The National Health and Hospitals Network will mean better planning, management and coordination of local 

services based on local needs, more hospital and sub-acute beds, more doctors and nurses and a strong 

primary care system. These structural reforms will improve services for all Australians, including those with 

mental ill-health, and lay a strong foundation for further reform of the mental health sector. 

In particular, Medicare Locals will improve local integration of Commonwealth and other mental health services 

in primary care. They will work with Local Hospital Networks to improve clinical pathways for people with 

mental health needs. Headspace sites will work with their Medicare Local to ensure strong referral pathways 

and care coordination. 

Services for people with severe mental illness will also be improved by the Government’s $1.6 billion 

investment to expand sub-acute care facilities. Extra community-based residential mental health beds will 

ease transitions from hospital to the community and reduce the need for hospitalisation. 

As part of the National Health and Hospitals Network, the Commonwealth has already agreed to take full 

funding and policy responsibility for primary health care services currently funded by the states and territories. 

This will include responsibility for mental health care services delivered in a primary care setting which target 

the more common mild to moderate disorders such as anxiety and depression. 

The Commonwealth has also been clear that the system needs to do better for people with severe mental 

illness and there is much more work to be done, and at COAG signalled its intention to provide greater policy 

and funding leadership for specialist community mental health services over time. 

Therefore, the Commonwealth is working with the states and territories on the scope for additional mental 

health service system reform to report back to COAG in 2011. This will include looking at the inconsistencies 

and gaps in services and current roles and responsibilities. 

In the meantime the $176 million package of measures as part of the National Health and Hospitals Network – 

including new funding of $123.2 million – is designed to address some gaps in the mental health system now. 

This immediate investment is focused on improving services for disadvantaged groups, including significant 

expansion of early intervention services for young people and tailored coordinated packages of care for the 

most vulnerable in the community: 

• $78.8 million over four years will deliver up to 30 new youth-friendly headspace services and provide extra 

funding for the existing 30 headspace sites. As part of this new investment, sites which are exceptionally 

busy or are in rural or remote areas will receive a funding top-up; core funding for national communication 

and coordination activities will increase; and telephone and web-based services for young people will be 

improved. This expansion is expected to provide support and early intervention services to about 20,000 

more young people each year once all new headspace sites are up and running. 

• $25.5 million over four years will expand the Early Psychosis Prevention and Intervention Centre (EPPIC) 

model in partnership with interested states and territories to new locations as a best practice ‘standard’ of 

care. With state contributions, this will benefit up to 3,500 young people aged between 16 and 25 years and 

their families with improved detection of and earlier treatment and holistic support for early psychosis, which 

will reduce their risk of homelessness and help with study and/or job stability. 

• $13 million over two years will employ 136 extra mental health nurses to help provide coordinated clinical 

care to people with severe mental illness in the community; and 

• $58.5 million over four years will be directed to deliver new packages of coordinated care to better support 

up to 25,000 people with severe mental illness being managed in primary care, to be delivered through 

Access to Allied Psychological Services arrangements. Medicare Locals, once established, will be the 

fundholders for the care packages. 


Outcome: Reducing the impact of mental illness on 

individuals and families 


• To improve access to better integrated and targeted mental health care in the community, particularly for 

young people and people with severe mental illness. 

Objectives 

• 20,000 more young people per year can access youth friendly mental health services. 

• People with severe mental illness are better supported in the community through new flexible care packages 

and 136 more mental health nurses. 

• Early Psychosis Prevention and Intervention Centre (EPPIC) model expanded so more young people and their 

families benefit from improved detection and early treatment of early psychosis. 

• Working with states and territories and key stakeholders to report back to COAG on the scope for additional 

mental health service reform. 


Measure 2009–10 2010–11 2011–12 2012–13 2013–14 Total 

More youth-friendly services 10.8 19.9 23.8 24.3 78.8 

Additional early psychosis service sites 6.5 6.3 6.4 6.4 25.5 

Extra mental health nurses 5.3 7.7 13.0 

Flexible care packages for people with 

severe mental illness 

0.1 -3.0 5.1 2.4 1.3 5.9 

Total 0.1 19.6 39.0 32.6 32.0 123.2 



1 

2 

funding commences for additional youth-friendly mental health services 

funding commences for roll out of additional early psychosis sites 

3 

new flexible care packages become available for people with severe mental illness being managed in 

the community 

4 

5 

funding commences for extra mental health nurses 

report back to COAG on additional mental health service reform 


33

Date (Qtr) 2010–11 2011–12 2012–13 2013–14 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

4.1 Funding commences for 

additional youth friendly mental 

health services 

1 


additional early psychosis 

service sites 

2 

4.3 New flexible care packages 

available for people with severe 

mental illness 

3 

4.4 Funding commences for extra 

mental health nurses 

4 

4.5 Work on additional mental 

health service reform for report 

back to COAG 

Arrow key: 

5 




Work area 

4.1 Funding commences 

for additional youth friendly 

mental health services 


additional early psychosis 

service sites 

4.3 New flexible care 

packages available or 

people with severe mental 

illness 

4.4 Funding commences 

for extra mental health 

nurses 

4.5 Work on additional 

mental health service 

reform for report back to 

COAG in 2011 


• Commence funding for additional and expanded headspace mental 

health services from October 2010. 

• Consultation with consumers, clinical experts and other stakeholders. 

• Consultation with state and territory governments regarding their 

interest in expanded early psychosis services. 


• Implement additional sites for the EPPIC model from April 2011. 


• Provide funding agreements to Divisions of General Practice and 

Medicare Locals (where established) for new Flexible Care Packages. 

• New care packages available for people with severe mental illness 

being managed in the community from April 2011. 

• Commence funding for extra mental health nurses from July 2010. 

• Work with states and territories and key stakeholders on the scope for 

additional mental health service reform to be report to COAG in 2011. 


Stream 






Sub-acute investments will allow hospitals to better target care where needed 

as well as ease the transition between acute care and the community for people 

with mental health needs. 

Effective Medicare Locals will support expanded mental health services and 

better coordinate care. 

Allied health workforce initiatives will improve capacity to deliver care in mental 

health services. 


35

Stream 5 — National Standards and Performance 

Overview 

A core element of the National Health and Hospitals Network will be enhanced national standards and 

transparent reporting that are, for the first time, nationally consistent and locally relevant. 

Strong national standards will drive improved performance across the health and hospital system, with 

funding increasingly linked to performance. 

For the first time, Australians will be able to access transparent and nationally comparable performance data 

and information on their local hospitals and health services — including emergency department and elective 

surgery waiting times, bed occupancy rates and reporting of adverse events and hospital acquired infections. 

Under a new Performance and Accountability Framework, the National Performance Authority (NPA) will 

develop and produce Hospital Performance Reports and Healthy Communities Reports (on primary health 

care performance) which will help Australians make more informed choices about their health services, and 

help ensure the standard of care patients receive continues to improve. The framework will be used over time 

to improve performance across hospital, GP and primary health care services. 

The COAG Reform Council (CRC) will continue to play a key role in enhanced national standards and 

performance. The CRC will provide clear and transparent public reporting about national and jurisdiction level 

performance, and provide independent assessment of whether predetermined performance benchmarks have 

been achieved prior to reward payments being made. 

The Commonwealth and states and territories will permanently establish and expand the role of Australian 

Commission on Safety and Quality in Health Care (ACSQHC). The ACSQHC will play an important role in 

developing, implementing and monitoring National Clinical Safety and Quality Standards which will cover 

safety, quality and appropriateness of clinical care. 

In setting the efficient price of public hospital services, the Independent Hospital Pricing Authority (IHPA) will 

take into account the need to ensure reasonable access to public hospital services; clinical safety and quality; 

efficiency and effectiveness and financial sustainability of the public hospital system. 

Increased transparency will allow ready identification of high-performing hospitals, support sharing of 

innovative practices with other Local Hospital Networks, and help to create continuous improvement within the 

hospital system. 

The establishment of national and local Lead Clinicians Groups will lead to improved clinical engagement. 

National Lead Clinicians Groups will advise on clinical care and standards, as well as help to develop and 

encourage the use of evidence-based clinical guidelines and national standards. They will also identify local 

innovative practices and share these nationally. Local Lead Clinicians Groups will guide the development of 

local implementation of national standards, and provide a focal point for local clinical engagement with the 

health system. 

Local Lead Clinicians Groups will provide advice to the Local Hospital Networks on service delivery, optimal 

models of care and methods to improve clinical outcomes. They will assist in turning national clinical guidance 

into local clinical practice and guiding improved safety and quality outcomes for the Local Hospital Networks. 


Outcome: Improved performance across the health and 

hospital system, with funding linked to performance 


• To develop a culture of continuous improvement and enable Australians to make more informed choices 

about their health services, through linking efficient funding to consistent national standards. 

Objectives 

• Develop new national clinical safety and quality standards for clinical best practice and enhanced safety 

in the health system. This will include developing clinical guidelines for the treatment of key diseases and 

conditions and standards of clinical care. 

• Develop a new performance and accountability framework to drive improved performance across hospitals, 

GPs, primary health care and mental health services. 

• Establish the IHPA to determine the national efficient price of every public hospital service provided to 

public patients. 

• Implement nationally consistent, clear and transparent reporting on performance, including against new, 

higher national standards for emergency department services and elective surgery. 

• Engage with clinicians to encourage effective and efficient clinical practice, especially with regards to how 

services are run and developed, and to ensure patients receive evidence-based care, which would in turn 

result in optimal clinical outcomes. 

• Provide financial incentives to Local Hospital Networks to provide services that meet the new clinical 

standards. 

• Provide the community and clinicians with information on the performance of the health and hospitals 

system. 


Measure 2009–10 2010–11 2011–12 2012–13 2013–14 TOTAL 

ACSQHC 0.7 8.2 12.6 13.7 35.2 

NPA 22.3 23.6 29.4 34.2 109.5 

Lead Clinicians Groups 11.8 15.6 15.4 15.4 58.1 

Total 34.8 47.4 57.4 63.3 202.8 


Stream 5 — National Standards and Performance 

37


1 

introduce legislation to establish the Australian Commission for Safety and Quality in Health Care 

(ACSQHC) as a permanent body 

1A 

2 

2A 

establish the ACSQHC as a permanent body 

introduce legislation to establish the National Performance Authority (NPA) 

NPA established and operational 

3 

introduce legislation to establish the Independent Hospital Pricing Authority (IHPA) as an independent 

authority 

3A 

4 

5 

6 

IHPA established and operational 

National Lead Clinicians Groups established and operational 

first group of local Lead Clinicians Groups commence operations 

remaining local Lead Clinicians Groups commence operations 

Date 

2010–11 2011–12 2012–13 2013–14 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

5.1 Establish the ACSQHC as 

a permanent body 

1 1A 

5.2 Establish the NPA 

2 

2A 

5.3 Establish the IHPA 

3 

3A 

5.4 Lead Clinicians Groups 

4 

5 

6 

Arrow key: 




Work area 

5.1 Establish the 

ACSQHC as a permanent 

body 


• Extend the existing Australian Commission for Safety and Quality in 

Health Care operations from 31 December 2010 to 30 June 2011. 

• Legislation to make ACSQHC a permanent statutory authority introduced 

on 23 June 2010. 

• Consultation with key stakeholders on the expanded role and functions of 

the new ACSQHC. 

5.2 Establish the NPA • Develop the plan for the establishment of the NPA. 

• Consultation with key stakeholders. 

• Commence activities to establish the NPA. 

5.3 Establish the IHPA • Develop the plan for the establishment of the IHPA. 

• Consultation with key stakeholders. 

• Commence activities to establish the IHPA. 

5.4 Lead Clinicians 

Groups 


• Work closely with states and territories in the design and implementation 

of local Lead Clinicians Groups. 

• Develop terms of reference for national and local Lead Clinicians Groups. 

• Develop mechanisms to ensure that improved clinical engagement is 

happening and effective. 

Program 

Streams 1 (Hospital), . 

2 (Primary Health Care) and . 

4 (Mental Health) 



National standards established by ACSQHC must be adhered to by 

hospitals, and will be reported on by the NPA. 

Determinations by the IHPA will include consideration of the linkages 

between safety, quality and funding. 

Close interaction with NEHTA in relation to capture of data and reporting. 


39


Overview 

To address current workforce shortages and better equip Australia’s health system to meet the growing 

demand for health services into the future, the Commonwealth will invest $1.2 billion over the next four years 

in training more GPs and specialists, and better supporting nurses working in general practice, aged care and 

rural areas, and allied health professionals working and training in rural areas. 

The Commonwealth will deliver: 

• 5,500 new GPs or GPs undergoing training over the next decade ($345 million over the first four years) 

including 1,375 more general practitioners (GPs) practising or in training by 2013; 

• 975 places each year for junior doctors to experience a career in general practice during their postgraduate 

training period ($150 million by 2012); 

• 680 more specialist doctors over the next decade ($145 million over the first four years); 

• a comprehensive package of measures to deliver greater support to nurses and other workers in the aged 

care system (more than $390 million, including $103 million in new funding); 

• for the first time, support for up to 7,500 rural nurses and 1,000 rural allied health professionals over the next 

decade to take leave to access professional development courses to keep their skills up to date ($34 million 

over the first four years); and 

• 1,000 extra clinical placement scholarships for allied health students over the next decade ($6 million over 

four years). 

The Commonwealth will also provide $390 million through the Practice Nurse Incentive Program to support 

general practice nurses (see Stream 2). 

These reforms build on the Commonwealth’s commitment to fund 60 per cent of the costs of training 

undertaken in public hospitals, which will make the Commonwealth the majority funder of training for future 

doctors, nurses and allied health professionals. 

Outcome: Enable the health and aged care workforce 

to meet the needs of today and growing demands of 

the future 


• To improve Australians’ access to health and aged care services by expanding the health and aged care 

workforce and providing health professionals with the skills and training opportunities necessary to deliver 

Australia’s future health care needs. 

Objectives 

• 5,500 new GPs practising or in training over the 10 years. 

• 680 more medical specialists in the next 10 years. 

• 975 additional places for junior doctors each year to experience a career in general practice. 

• Support access to professional development for 7,500 rural nurses and 1,000 rural allied health professionals 

over 10 years. 

• Provide 1,000 extra clinical placement scholarships for allied health students over the next 10 years. 

• 600 additional aged care enrolled nurse training places and 300 registered nurse scholarships over four 

years. 

• Incentive payments for aged care workers to upskill. 

• Support development of appropriate service models for nurse practitioners in aged care. 


Budget Measures (Includes Practice Nurse Incentive Program) 

Measure 2009–10 2010–11 2011–12 2012–13 2013–14 Total 

Training for doctors, nurses, and 

allied health professionals 

56.6 109.6 210.2 329.2 705.6 

Rural locum schemes 9.3 8.2 8.2 8.4 34.1 

Nursing careers and nurse 

practitioners 

Workforce support for practice 

nurses 

3.7 11.6 13.3 11 39.6 

3.8 70.7 147.6 168.2 390.3 

Total 73.4 200.1 379.3 516.8 1169.6 



1 

2 

3 

4 

5 

6 

commence support measures for aged care workers 

applications open for GP and specialist training places 

additional training places for GPs and specialists available 

scholarships for allied health placements made available 

nursing and allied health locum schemes commenced 

scholarships for enrolled and undergraduate nurses made available 

Date 

2010–11 2011–12 2012–13 2013–14 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

6.1 Measures to better 

support the aged care 

workforce 

1 

6.2 Additional GP training, 

specialist training program 

and pre-vocational GP 

placement 

2 

3 

3 3 

6.3 Scholarships for allied 

health clinical placements and 

allied health worker locum 

scheme 

4 

6.4 Nursing and allied health 

locum schemes 

6.5 Enrolled nursing training 

places and undergraduate 

nursing scholarships for aged 

care workers 

5 

6 

Arrow key: 



41


Work area 

6.1 Measures to better 

support the aged care 

workforce 

6.2 Additional GP training, 

specialist training program 

and pre-vocational GP 

placement 

6.3 Scholarships for allied 

health clinical placements 

and allied health worker 

locum scheme 

6.4 Nursing and allied 

health locum schemes 

6.5 Enrolled nursing 

training places and 

undergraduate nursing 

scholarships for aged care 

workers 


• Develop guidelines for incentive payments by 1 July 2010. 

• Consult on design and scope of various initiatives with stakeholders 

from July 2010. 

• Roll-out training and scholarship program from December 2010. 

• Consult and negotiate with stakeholders from July 2010 and 

throughout. 

• Commence contractual negotiations with GPET for junior doctor and 

GP training for completion by December 2010. 

• Commence negotiations for the expansion of the specialist training 

program from December 2010. 

• New scholarships available from July 2010. 

• Develop guidelines for the locum schemes by December 2010 ready for 

roll out. 

• Consult on program design with stakeholders from July 2010. 

• Roll-out training and scholarship program from December 2010. 

Stream 





Workforce reform will allow hospitals to better deliver care where needed. 

Workforce reform will allow the primary health system to better deliver care 

where needed. 

Stream 3 — Aged Care Workforce reform will allow the aged care system to better deliver care . 

where needed. 


Workforce reform will allow the mental health system to better deliver care 

where needed. 


Stream 7 — Prevention 

Overview 

A key element of the National Health and Hospitals Network is early intervention and prevention to take 

pressure off other parts of the health system. 

The Commonwealth will tackle the lifestyle related risks that cause chronic disease — targeting smoking and 

binge drinking, in particular. 

To achieve this, the Commonwealth will take further steps towards reducing the adult daily smoking rate 

including: 

• increasing the tobacco excise by 25 per cent above normal CPI adjustments; 

• in a world first, legislating to mandate plain packaging for tobacco products; and 

• implementing the largest ever national public education campaign on smoking. 

The Commonwealth will also invest $25 million in a community sponsorship program to provide an alternative 

to alcohol sponsorship for local community, sporting and cultural organisations, $20 million in additional grants 

for community-led initiatives to change the culture of binge drinking, and $5 million for enhanced telephone 

counselling and referrals. 

These investments build on the $872 million allocated to the COAG endorsed National Partnership Agreement 

on Preventive Health — the largest single commitment to health promotion by an Australian government. 

The National Partnership provides, for the first time, significant investment in programs to tackle the rising 

burden of obesity and its associated risk factors. It funds a comprehensive range of initiatives, including 

interventions supporting people to adopt a healthier lifestyle and public awareness campaigns of the risks of 

chronic disease. 

Outcome: Reduce preventable death and disease by 

addressing the risk factors of tobacco use and harmful 

consumption of alcohol 


• To address the rising prevalence of lifestyle related chronic diseases by re-focusing the health system 

towards prevention so that the burden of preventable health conditions is reduced, supporting a more 

sustainable health system. 

Objective 

• Reduce the adult daily smoking rate in Australia to 10 per cent by 2018 by increasing targeted health 

information and the price of tobacco products. 

• Continue to tackle the culture of binge drinking in Australia. 

• Establish the Australian National Preventive Health Agency. 

• Deliver the most comprehensive study of Australia’s health ever undertaken. 


43

Budget Measures* 

Measure 2009–10 2010–11 2011–12 2012–13 2013–14 Total 

National Binge Drinking 

Strategy expansion 

9.5 11.8 14.3 14.3 50.0 

Plain packaging 1.3 1.0 0.2 0.1 2.6 

Total 10.8 12.8 14.5 14.4 52.6 



1 

tobacco excise increased from 30 April 2010 by 25 per cent 

2 

3 

4 

5 

6 

7 

8 

9 

revised anti-smoking campaign commences 

plain packaging of tobacco products legislation commences 

plain packaging of tobacco products fully introduced 

establish a community sponsorship program as an alternative to alcohol sponsorship 

commence funding round to support community activities to tackle binge drinking 

commence enhanced alcohol telephone counselling and referral services 

establish the Australian National Preventive Health Agency 

conduct survey of Australia’s health 

Date 

2010–11 2011–12 2012–13 2013–14 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

7.1 Increase tobacco excise 

1 

7.2 Revise anti-smoking 

campaign 

2 

7.3 Plain packaging of 

tobacco 

3 4 

7.4 Community sponsorship 

program as an alternative to 

alcohol sponsorship 

5 

7.5 Support community 

activities to tackle binge 

drinking 

6 

7.6 Enhanced alcohol 

telephone counselling and 

referral services 

7 

7.7 Establish the Australian 

National Preventive Health 

Agency 

8 

7.8 Survey of Australia’s 

health 

Arrow key: 

9 




Work area 


7.1 Increase tobacco excise • Tobacco excise was increased by 25 per cent above normal CPI 

adjustments from 30 April 2010. 

• Legislation was passed to make this excise increase permanent in 

June 2010. 

7.2 Revise anti-smoking 

campaign 

7.3 Plain packaging of 

tobacco 

7.4 Community sponsorship 

program as alternative to 

alcohol sponsorship 

7.5 Support community 

activities to tackle binge 

drinking 

7.6 Enhanced alcohol 

telephone counselling and 

referral services 

7.7 Establish the Australian 

National Preventive Health 

Agency 

7.8 Survey of Australia’s 

health 

• Develop materials and approach to targeted anti-smoking social 

marketing campaign from July 2010. 

• Prepare for commencement of targeted anti-smoking social 

marketing campaign from December 2010. 

• Commence development of tobacco plain packaging research, 

design and consultations from 1 July 2010. 

• Plain packaging design completed by 31 March 2011. 

• Plain packaging legislation ready for introduction before 30 June 2011. 

Plain packaging legislation commences 1 January 2012. 

• Plain packaging legislation fully implemented – tobacco products 

packaging must comply with legislation by 1 July 2012. 

• Community consultations on operation of sponsorship fund from 

July 2010. 

• Commence the $25 million community sponsorship program to 

provide an alternative to alcohol sponsorship for local community, 

sporting and cultural organisations from October 2010. 

• Evaluate process of previous rounds of community level initiative 

funding. 

• Commence the $20 million funding rounds to support community 

activities to tackle the culture of binge drinking, particularly among 

young people with first round advertised by October 2010. 

• Commence the $5 million enhanced telephone counselling and 

referral services with development commencing July 2010. 

• Continue to consult with stakeholders. 

• Develop operational framework for the Agency. 

• Establish the Agency by late 2010 (subject to passage of legislation). 

• Consult with key stakeholders on planning and implementation. 

• Plan for general survey of Australia’s health – survey due to 

commence in April 2011 and to be completed in March 2012. 

• Plan for component relating to Aboriginal and Torres Strait Islander 

health – survey due to commence in November 2011 and to be 

completed in October 2012. 

Stream 


Stream 2 — Primary Health 

Care 


Prevention reforms should reduce demand on hospital services. 

Prevention reforms should reduce demand on primary health care services. 


45


Overview 

The Commonwealth will make a landmark $467 million investment over two years in the key components of 

an electronic health record system, so that all Australians have access to a personally controlled electronic 

health record (PCEHR) if they choose to. In order to fully realise the significant benefits of this Commonwealth 

investment, states and territories will also need to continue their planned or expected investments in core 

health information systems. States and territories will also need to provide the complementary investments to 

build their capacity in readiness for connection to this national system. 

This will enable Australians to access their own health care information and permit authorised health care 

providers to access and use this information, when and where it is needed, to provide better coordinated and 

effective care for the individual. Implementation is expected to focus initially on people who have the most 

contact with the health and hospital system. These include people with chronic and complex conditions, older 

Australians, Aboriginal and Torres Strait Islander peoples, and mothers and their new-born children. 

A PCEHR system will enable Australians who choose to have an electronic health record to have more 

confidence in the information available to them and their health care providers. It will help patients experience 

smoother transitions between health care providers, reducing waste and inefficiency, and enable better and 

safer care that is more responsive to patients’ needs. 

Additional privacy safeguards will be established through supporting legislation, regulation, and robust 

governance arrangements. The national eHealth records system will also be designed to incorporate audit 

trails, technology, and data management controls and an appropriate security access framework. These 

features will ensure availability of high-quality information and assist patients to have greater control of their 

health information. 

In addition to the national activities above, it is intended that a number of lead PCEHR implementation sites 

that align with the national work program, will be concurrently funded across different geographic and 

functional parts of the Australian health sector. The purpose of these lead implementation sites will be to: 

• Deploy and test national eHealth infrastructure and standards in real world health care settings; 

• Demonstrate tangible outcomes and benefits from funded eHealth projects; 

• Build stakeholder support and momentum behind the national PCEHR system work program; and 

• Provide a meaningful foundation for further enhancement and roll-out of the national PCEHR system. 

Within the agreed national framework of governance, standards, workforce etc, lead implementations will focus 

on implementing PCEHR components that support sharing of electronic health information. 

This investment builds on the work of the National eHealth Transition Authority (NEHTA), which has among 

its priorities the development of eHealth foundations, the coordination of solutions and processes, and the 

accelerated adoption of eHealth in Australia. 

This investment also builds on the Healthcare Identifier (HI) Service established by legislation in June 2010 

and being operated from 1 July 2010 by Medicare Australia. The HI Service will allocate unique identifiers to 

healthcare recipients, healthcare providers and healthcare organisations to improve safety and accuracy in 

electronic management and communication of health information. Healthcare identifiers are a key building 

block for the PCEHR system. 

Outcome: Australians have access to their own personally 

controlled electronic health record 


• To provide better access to health information enabling better health outcomes through more integrated care 

centred around the needs of patients. 


Objectives 

• Provide every Australian with a PCEHR that is controlled by them. 

• Ensure individuals’ privacy. 

• Improve efficiency in the healthcare system through streamlining access to patient information thereby 

reducing duplication and improving use of scarce resources. 

• Provide continuity of care by enabling access to patient information at the point of care. 

• Improve safety and quality in healthcare. 


Measure 2009–10 2010–11 2011–12 2012–13 2013–14 Total 

Personally controlled electronic 

health records 

185.6 281.2 466.7 



1A 

PCEHR interim governance framework agreed and in place 

1B 

2A 

2B 

3A 

3B 

4A 

4B 

4C 

4D 

5A 

5B 

5C 

5D 

5E 

6 

7 

8 

9 

10 

PCEHR long term governance framework agreed and in place 

stakeholder consultation – state and territory governments 

stakeholder consultation - health care providers and software vendors are informed and engaged in 

development activities 

public consultation – public website established 

public consultation – collect and analyse public views 

change management – work practice analysis 

change management – implement training and awareness activities 

change management – monitor and evaluate training and awareness activities 

change management – revise and implement ongoing awareness and take up strategies based on lessons 

learned 

lead implementation sites – selected (minimum of three) 

lead implementation sites – contracted 

lead implementation sites – operational 

lead implementation sites – initial evaluation 

lead implementation sites – final evaluation 

PCEHR analysis, IT architecture and requirements developed 

PCEHR IT standards developed 

national infrastructure established 

legislative amendment as required 

PCEHR available for registration on-line 


47

Date (Qtr) 

8.1 PCEHR governance 

Jul-Sep 

1A 

2010–11 2011–12 2012–13 2013–14 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

Jan-Mar 

Apr-Jun 

Jul-Sep 

Oct-Dec 

1B 

8.2 Consultation 

2A 2B 3A 

3B 


4A 

4B 

4C 

4D 

8.4 Lead implementation sites 

8.5 Analysis and IT architecture 

8.6 National infrastructure 

established 

8.7 Standards developed 

5A 5B 5C 5D 

5E 

6 

8 

7 

8.8 Legislative amendment 

9 

8.9 PCEHR available for 

registration online 

Arrow key: 


10 



Work area 

8.1 PCEHR governance and 

policy developed 

8.2 Stakeholder 

engagement undertaken 


undertaken 

8.4 Lead implementation 

sites selected and 

established 

8.5 PCEHR analysis, 

architecture and 

requirements developed 

8.6 National infrastructure 

established 

8.7 Make standards and 

security access framework 

available 


• Agree to governance arrangements with governments. 

• Commence privacy impact assessment. 

• Commence alignment with key health reform initiatives. 

• Execute stakeholder engagement and communication plan. 

• Develop change management plan. 

• Clinical education and awareness. 

• Lead implementation sites framework developed. 

• Consult on design and scope of lead implementation sites with 

stakeholders from July 2010. 

• First lead implementation sites selected by November 2010. 

• Consult with stakeholders on requirements and design from July 2010. 

• Commence industry briefing from November 2010. 

• Develop and test technical PCEHR capability. 

• Complete specifications before March 2011. 

• Commence development of PCEHR standards from July 2010. 

8.8 Legislative amendment • Commence privacy impact assessment. 

• Draft legislation prepared and released for public consultation. 

8.9 PCEHR available for 

registration online 

• Commence stakeholder consultations on the design and scope of the 

various initiatives from July 2010. 

• Commence planning for public awareness activities in July 2010. 

Stream 





Stream 5 – National 

Standards and 

Performance 

Stream 6 – Workforce 


eHealth will assist hospitals to improve emergency department services by 

providing a more comprehensive record at the point of care, which will lead to 

efficiencies and greater safety in the acute care sector. 

The availability of the eHealth capability is expected to encourage higher use of 

care plans, which will lead to a reduction in unnecessary hospitalisations and 

better coordination of care across the primary care sector. 

eHealth capability will allow the uptake of more complete health summaries for 

all patients from 2012-13. With more complete information available at the time 

of prescribing, adverse drug events in both aged care and the community will be 

more effectively managed. 

eHealth will support better data capture. 

eHealth will provide better support to the workforce in aged care, general practice 

and for allied health professionals. 


49

Stakeholder engagement 

Overview 

The Government is committed to working with stakeholders in delivering the National Health and Hospitals 

Network. Our commitment to stakeholder engagement and consultation was demonstrated by the more 

than 100 consultations we held across the country testing the recommendations made in the final report 

of the National Health and Hospitals Reform Commission with patients, health professionals and the 

Australian public. 

Reforming the health and hospitals system requires the input of a broad range of stakeholders, able to bring 

forward diverse views and experiences. In coming months and years, we will use new and existing networks 

and mechanisms to consult with health consumers, health professionals, health service providers (public 

and private), peak organisations across the range of health care sectors, health service administrators, 

statutory authorities, and state and territory governments. This section outlines how we will engage with our 

stakeholders. 

Health system consumers 

The changes associated with the National Health and Hospitals Network will affect the experience that patients 

and their families, older Australians, those with diabetes, and carers have with the health system. The voice 

of consumers, care recipients and their families is critical in shaping the changes as they are implemented in 

coming months and years. 

New local institutions will ensure services are joined up on the ground, whilst new national institutions and 

changes to funding and policy responsibilities will ensure that national consistency, high clinical standards and 

safety will be in place across the country. 

New funding made available for the National Health and Hospitals Network will make it easier for Australians 

to access care, with additional investment in hospitals, workforce development, diabetes treatment and 

management, aged care and mental health. New fiscal and regulatory arrangements coupled with education 

campaigns will support Australians to quit smoking, tackling the most significant driver of the burden of 

disease in this country. 

The Government’s approach to these new arrangements will be developed through consultation during the 

transition, implementation and review of these reforms. 

The Government will seek the views of consumers, care recipients and clients of the health system as well as 

their families. This engagement will be achieved through a range of public forums, via peak groups and through 

the internet. We encourage all Australians to visit the health reform website (www.yourhealth.gov.au) to access 

the most up to date information on health reform and opportunities to participate in consultation activities. 

All Australians will benefit from increased information made publicly available through the Hospital 

Performance Reports and the Healthy Communities Reports, to be published by the new National Performance 

Authority after its establishment in July 2011. 

Health practitioners and service providers 

The new National Health and Hospitals Network will result in changes in the way health service providers and 

practitioners engage with the health system. The experience of service providers and practitioners will provide 

valuable input to the implementation process. 

The Government will seek the views of health practitioners through clinician forums, e-newsletters and media 

forums, as well as through peak organisations representing the full range of health practitioners (including 

specialist medical practitioners, GPs, nurses, allied health professionals, and aged care, Indigenous, rural and 

remote and mental health service providers). 

For example, consultations will be held with aged care providers and their representative bodies as well 

as residents, between July 2010 and June 2011 through a combination of discussion papers, submissions 

and meetings. 


For clinicians, the establishment of Lead Clinicians Groups will ensure that local health professionals have a 

say on improving safety and quality in hospitals, planning the most efficient allocation of services within Local 

Hospital Networks, developing innovative solutions that best address the needs of local communities and 

translating national best practice into local delivery of services. 

Health practitioners will be supported in doing their jobs by a new national performance and accountability 

framework, incorporating high standards of safety and quality and performance reporting to ensure 

transparency and to identify best practice as well as areas requiring improvements. 

In developing these national clinical safety and quality standards, the Australian Commission on Safety 

and Quality in Health Care will work with clinicians to identify best practice clinical care and to ensure the 

appropriateness of services being delivered in a particular setting. 

New funding made available to boost the number of health practitioners delivering services will address current 

workforce shortages, provide health practitioners with new training opportunities and reduce the demand 

on the current workforce. Advertising rounds will alert interested individuals to the availability of these new 

opportunities. 

The Government has committed to regular and ongoing engagement with Indigenous health representative 

groups, such as the National Indigenous Health Equality Council and the National Aboriginal Community 

Controlled Health Organisation, to ensure that the new arrangements are effective in addressing the needs 

of Aboriginal and Torres Strait Islander people and communities. Existing forums, such as Aboriginal Health 

Partnership Forums in each jurisdiction, will be key mechanisms for engagement with stakeholders in 

Aboriginal and Torres Strait Islander health. 

This will be in addition to the participation Aboriginal and Torres Strait Islander health stakeholders, including 

from the community controlled health sector and Aboriginal and Torres Strait Islander health professionals, 

in reference groups and other arrangements established to advise on specific initiatives under the Reform 

arrangements. 

The National eHealth Transition Authority will continue its consultations including forums as it develops 

the PCEHR. 

In support of the transition process targeted information and materials will be provided in the coming months – 

to register your interest in receiving further information visit www.yourhealth.gov.au. 

Governments working with you 

Consistent with the National Health and Hospitals Network Agreement, all levels of government will work 

together to deliver the health and aged care reforms. Establishment of high level governance arrangements, in 

addition to a range of Ministerial and Officials forums will ensure ongoing consultative approaches. 

The Australian Government will support the implementation of the reforms with broad media strategies, widescale 

consultation and innovative on-line engagement mechanisms. Current information about engagement 

opportunities is available from www.yourhealth.gov.au. 

State and territory governments have undertaken to consult the local community in the establishment of Local 


Stakeholder engagement 

51

Further work 

At the COAG meeting of 19–20 April 2010, the Commonwealth and states and territories (with the exception of 

Western Australia) committed to undertake further work to consider a number of services, either for transfer to 

the Commonwealth or for strong national reform efforts with current roles and responsibilities. 

For the following services, a recommendation on government arrangements will to be put to COAG in 

December 2010: 

• community health promotion and population health programs including preventive health, in order to 

determine how to maximise the value of the new National Health and Hospitals Network and Australian 

National Preventive Health Agency; 

• drug and alcohol treatment services; 

• child and maternal health services; and 

• community palliative care. 

Mental Health 

COAG agreed (with the exception of Western Australia) to undertake further work on specialist community 

mental health services, particularly for those with severe mental illness, either for transfer to the 

Commonwealth or for strong national reform efforts with current roles and responsibilities as part of an overall 

report to COAG on mental health in 2011. Further work will be undertaken by Tasmania to determine the 

definition and timeframe for the transfer of primary mental health services to the Commonwealth. Specialist 

community mental health services for people with severe mental illness will form part of the overall mental 

health report back to COAG in 2011. 

The Commonwealth considers mental health an important priority for the next 12 months and has identified 

its intention to provide greater policy and funding leadership for specialist community mental health services 

over time. 

The Commonwealth investments in mental health through the National Health and Hospitals Network are 

a down payment towards addressing immediate gaps in the mental health system especially for vulnerable 

groups such as young Australians. This new investment builds on existing efforts and means that, on top of 

the funding for mental health through the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme, 

funding for mental health specific programs (including Indigenous programs) will nearly double over the next 

four years: $1.16 billion over four years from 2010–11 to 2013-14, compared to $516.3 million from 2004–05 

to 2007–08. 

Improving Cancer Care 

COAG noted that cancer remains the leading cause of premature death in Australia, placing a significant 

ongoing burden across the entire Australian community. 

The Commonwealth is strongly committed to preventing cancer where possible and strengthening care for 

cancer patients where it is not. 

The Commonwealth’s comprehensive package of tobacco reforms announced in April 2010, including the 25 

per cent tobacco excise increase, legislation for plain packaging of tobacco products, targeted anti-smoking 

social marketing campaigns and internet advertising legislation, will help reduce rates of smoking-related 

cancer over time. 

Since 2007, the Commonwealth has invested a record $2.3 billion in national infrastructure, medicines, 

screening and research to build a world class cancer care system in Australia. This includes $560 million to 

build a national network of best practice regional cancer centres to help close the gap in outcomes for rural 

and regional cancer patients. The Commonwealth has announced twenty successful regional cancer centre 

projects across Australia under the first and second funding rounds of the nation-building Health and Hospitals 

Fund. The Commonwealth is working with the states and territories and with private providers to ensure these 

important infrastructure projects commence quickly so that rural and regional cancer patients can benefit as 

soon as possible. 


In addition to this significant investment, COAG agreed that more could be done to ensure cancer is diagnosed 

and treated in a consistent way based on best practice. 

COAG agreed that Victoria and the Commonwealth would lead work, under the auspices of Health Ministers, 

to report back to COAG in 2011, on the most effective cancer diagnosis, treatment and referral protocols, to be 

developed with expert clinical input. 

Patient Assisted Travel Schemes 

The Commonwealth and states and territories (with the exception of Western Australia) committed to undertake 

further work around Patient Assisted Travel Schemes, with a view to higher and more consistent national 

standards. 

Abbreviations 

53

Abbreviations 

ABF 

ACSQHC 

COAG 

ED 

EPPIC 

ES 

GP 

HACC 

IHPA 

PCEHR 

LHNs 

NEHTA 

NHHN 

NPA 

Activity Based Funding 

Australian Commission on Safety and Quality in Health Care 

Council of Australian Governments 

Emergency Department 

Early Psychosis Prevention and Intervention Centres 

Elective Surgery 

General Practitioner 

Home and Community Care 

Independent Hospital Pricing Authority 

Personally controlled electronic health record 

Local Hospital Networks 

National eHealth Transition Authority 

National Health and Hospital Network 

National Performance Authority 


Abbreviations 

55


www.yourhealth.gov.au 

All information in this publication is correct as of July 2010 

6804 (1007)

A National Health and Hospitals Network for Australia's ... - yourHealth

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