With the Victorian government’s decision to abolish VicHealth and fold it into the Department of Health, clinics and doctors are likely now to come under greater pressure from tighter budgets and increased demand for frontline services. Many will seek to expand.
Critics have attacked the decision, saying it will result in less investment in preventative health, a sicker population, and bigger future hospital costs.
This merger is part of the Victorian government’s public service cuts to over 1,000 jobs driven by the state’s chronic budget deficits. VicHealth has an annual budget of $45 million. That amounts to just 0.13% of the $33.6 billion the state government is forecast to spend on health this financial year. VicHealth is one of 29 public entities, government boards, or committees that the government intends to either abolish, merge, or shift into government departments. The government claims all these measures, including reducing its use of consultants and office space freed up by public servants working from home, will save the budget more than $4 billion over the next four years.
But back to VicHealth. The Victorian Health Promotion Foundation, an independent entity trading as VicHealth, was established in 1987 with a legislated budget to help rid sport of tobacco advertising. Its work now focuses on public health campaigns to prevent chronic disease caused by poor diet, inactivity, and obesity.
Hospitals, clinics and doctors have been key partners in implementing VicHealth’s prevention strategies.
The recommendation to abolish it was contained in the Silver Review tabled in parliament, which dedicated just one paragraph explaining its recommendation to get rid of VicHealth.
“VicHealth was established to promote health and prevent chronic disease in Victoria through research, policy development, and community-based health initiatives – including Cancer Council Victoria programs and the QUIT helpline. This is important work but does not need to be conducted independently of a department; it can be absorbed into DH work without compromising service quality,” the report said.
What will happen with the closure? First, it has to be said that hospitals and clinics already carry the burden of treating chronic disease. Without VicHealth’s dedicated prevention strategies, the health system in hospitals and clinics may become more reactive than proactive. That would increase the patient loads for GPs and specialists in clinics dealing with lifestyle-related illnesses such as diabetes, cardiovascular disease, and obesity.
If this merger with the Department of Health goes ahead, it might well see clinics with financial capacity or strong community demand seek to expand.
If VicHealth can no longer fund community-level disease prevention programs (e.g. smoking cessation, healthy eating, mental health), clinics might need to step in directly to provide similar services.
And without VicHealth’s independent campaigns, clinics that can afford it might expand their facilities, staff, or outreach programs to handle the higher patient load. More to the point, it can give these expanded clinics a competitive advantage to differentiate themselves with integrated prevention and treatment services that build their business by attracting more patients and funding streams. Some expanded clinics could also secure grants or partnerships from the Department of Health.
Right now, however, the debate is on about what happens with VicHealth. Five former chairs of VicHealth have written to Premier Jacinta Allan, Treasurer Jaclyn Symes, and Health Minister Mary-Anne Thomas urging them to reconsider their plan.
However, whatever happens with VicHealth, the funding pressures from the Victorian state budget are likely to ensure there will be continued discussion in some clinics about expanding.
