Sandy Austin Director Health and Aged Care North and Western Metropolitan Region

1. NWMR Health & Wellbeing Implementation Strategy • “…the implications are clear. Without change, our health system will not be able to meet our future needs”. • Victorian Health Priorities Framework 2012-2022 Sandy Austin Director Health and Aged Care North and Western Metropolitan Region

2. Wicked Problems for Health and Wellbeing • The Victorian Health Priorities Framework 2012-2022 states that “the implications are clear. Without change, our health system will not be able to meet our future needs”. • Health and wellbeing issues confronting society include • increasing obesity rates • increasing trends in chronic health conditions e.g. diabetes • ageing populations • rapid population growth • spiralling health care costs • Source:Australian Public Services Commission (2007) Tackling Wicked Problems A Public Policy Perspective, Commonwealth of Australia, Canberra, ACT.

3. Fifth Wave FIRST WAVE Water/Sanitation SECOND WAVE Scientific breakthroughs THIRD WAVE Social security/Medicare FOURTH WAVE Risk factors and lifestyle FIFTH WAVE Complex adaptive system thinking 2011 + 1940 - 1960 1960 - 2000 1830 - 1900 1890 - 1950 Source: Hanlon et al (2011) Making the Case for a ‘Fifth wave’ in public health

4. Fifth Wave • Aspects of this ‘fifth wave’ include • Complex adaptive systems • Reframe our thinking • Rebalance our models • Rebalance our orientation • Iterate and scale up • Source: Hanlon et al (2011) Making the Case for a ‘Fifth wave’ in public health

5. Victorian HealthSystem reform • Primary Health Care Planning – in partnership with the Commonwealth • Mental Health System – recovery focus • Alcohol and Other Drugs – Whole of Govt Strategy and AOD Treatment System Reform • Aged Services – Healthy ageing and Active Service Model • State Health and Wellbeing Plan – Prevention Community Model

6. Victorian Public Health and Wellbeing Plan 2011-2015

7. The goal of the Plan • “Improve the health and wellbeing of all Victorians by engaging communities in prevention, and by strengthening systems for health protection, health promotion and preventive health care across all sectors and levels of government”.

8. Achieving our goals • Two main achievements of the Health and Aged Care NWM Regional Office: • Reoriented ourselves and how we interface with our stakeholders • Broadened and enhanced the authorising environments

9. Prevent progression to established condition Established Conditions At Risk Prevent movement to ‘at risk’ group PUBLIC HEALTH Systemically embedded health inequity reduced Prevent/delay progression to complications AGED SERVICES Improved access to needed supports PRIMARY CARE Better health status in terms of both outcomes from and access to services Well Population Complex Conditions ACUTE 1. We reoriented ourselves and how we interface with our stakeholders NWMR Regional Operating Model

10. Area based approach to system management and population health planning • Improve ability of Health and Aged Care (H&AC) to identify priorities and address service gaps and inequities in local communities. • Build capacity within H&AC programs and NWMR funded agencies through organisational and workforce development. • Increase efficient and effective work practices in H&AC bystreamlining communication with funded agencies i.e. Lead PASA role.

11. Place • A place or area usually ranges from a neighbourhood to a local government area which differs considerably in size and population density. Thus, place-based interventions may use varying definitions or size boundaries for place. • VicHealth (2008) People, Places, Processes Reducing health inequalities through balanced health promotion approaches, Victorian Health Promotion Foundation, Carlton.

12. GOAL D: Building our own workforce and system capacity to influence change Well Population Operating Model Health and Aged Care North and West Metropolitan Region Department of Health • Public health and wellbeing is promoted and protected GOAL A: Improved health and wellbeing of all people within our region We are “Population Health Developers” Prevent movement to ‘at risk’ group • Independence and health for longer • Reduced harm and impact from substance use, mental illness and health conditions At Risk PUBLIC HEALTH Systemically embedded health inequity reduced AGED SERVICES Improved access to needed supports GOAL B: Improved health equity for those most vulnerable / disadvantaged AGED SERVICES Prevent progression to established condition We are “System Integrators” PRIMARY CARE Better health status in terms of both outcomes from and access to services ACUTE ACUTE We are “Health System Managers” • The health system operates with raised efficiency to meet rising expectation and demand Established Conditions INW GOAL C: Integrated health system that is responsive to people’s needs Policy interpretation and development Resource & Performance Regional operations Evidence translation Program implementation Regulation Service system integration • The health system anticipates and responds to independence needs N Prevent/delay progression to complications • Stakeholders inside & outside the health sector make health and wellbeing part of their core business W Complex Conditions Key functions of H&AC Teams

13. Manager Manager Manager Team Leader Team Leader Team Leader Team Leader Team Leader Team Leader Lead PASA Lead PASA Lead PASA Lead PASA Lead PASA Lead PASA Organisational Structure NorthernArea Inner North West Area Western Area We are “System Managers”

14. 2. We broadened and enhanced the authorising environments • Australian Urban Research Infrastructure Network • Support Implementation of Victorian Public Health and Wellbeing Plan • Support Melbourne Metropolitan Strategy • Population Health Short Course • MPHP Evaluation – University of Melbourne • Engaging RMF members to tackle employment, transport, education, secure housing • RMF Regional Directors’ working group to support local government • RMF Integrated Data Working Group • Melbourne University Research 2011-2014: Planning Liveable and Sustainable communities in growth corridors • Support for integrated local area/catchment planning • HACC rolling consultations • Active Ageing in Place - HACC • Local Government Round Table meetings • Support to individual Councils and organisations

15. NWM Regional Management Forum DBI VicRoads CFA NWM Regional 14 Local Councils Management Forum VicPol Chair: Jim Betts, DTF GAA DoT Secretary DoJ Regional Directors DoT Local Council CEOs DHS DH RDA DPCD DSE DEECD

16. WHO Healthy Cities Governance framework (WHO, 1997)

17. Regional Management Forum – Key Outcomes • 1. Identification and commitment to key priorities • Creation of local jobs • Public transport • Education • Secure housing (DoJ priority) • 2. Integrated Data Working Group – AURIN/ANDS Demonstration Projects • 3. Integrated Planning Forums

18. October 2012 Local government elections October 2016 Local government elections June 2013 Council plans June 2017 Council plans October 2013 MPHWPs October 2017 MPHWPs 2018 2011 2012 2013 2014 2015 2016 2017 September 2011 Victorian Public Health and Wellbeing Plan September 2015 Victorian Public Health and Wellbeing Plan November 2010 Victorian government election November 2014 Victorian government election Alignment of State and municipal public health and wellbeing planning

19. Special mention: • Dr. Iain Butterworth for his expert and engaging leadership