Access and continuing care

The Improving Care for Aboriginal and Torres Strait Islander Patients (ICAP) program was established in 2004 in recognition that Aboriginal Victorians experience poorer health and lower life expectancy than the general community.

Many Aboriginal people are reluctant to attend hospitals and, when they do, may have more acute and complex health issues. In addition, the under-identification of Aboriginal patients continues to hamper policy and service development based on service access and health needs.

The ICAP program is delivered through 41 hospitals in Victoria. A key element to the ICAP program is the employment of Aboriginal hospital liaison officers.

The ICAP program aims to:

• improve accurate identification of all Aboriginal people presenting to Victorian hospitals and area mental health services
• improve access for Aboriginal people to Victorian hospitals and area mental health services
• support Victorian hospitals and area mental health services to provide high quality, holistic and culturally appropriate health care, referrals and wrap-around care for Aboriginal people
• recognise that high quality, culturally safe health care for Aboriginal people is an organisation-wide responsibility and, not just the responsibility of designated Aboriginal liaison officers
• promote partnerships between Victorian hospitals, area mental health services and Aboriginal community-controlled organisations, and other services in the planning and delivery of health care for Aboriginal people.

Changes to the Aboriginal Weighted Inlier Separations (WIES) funding model commenced in 2020-21

These funding changes support the ICAP program.

They also aim to:

• strengthen cultural safety
• provide greater accountability for the funding.
• strengthen the whole of organisation response to cultural safety
• increase Aboriginal hospital liaison officer employment and Aboriginal staffing more broadly
• emphasise the partnerships between Aboriginal communities and hospitals.

These changes require health services to address 8 domains of cultural safety through an annual planning and reporting process:

1. CEO/Executive leadership.
2. Employment of Aboriginal hospital liaison officers.
3. Engagement and partnerships with Aboriginal organisations.
4. Identifying health needs of the Aboriginal population and plans to address.
5. Cultural safety training.
6. Creating a welcoming environment.
7. Improving patient identification.
8. Monitoring and accountability.

The 8 cultural domains align with:

• our Aboriginal and Torres Strait Islander cultural safety framework
• the National Safety and Quality Health Service Standards (NSQHSS)
• the aims of the ICAP and Koori Mental Health Liaison Officer Program (KMHLO) programs.

Management of the program

The Aboriginal Health Branch manages the ICAP program.

The Victorian Aboriginal Community Controlled Health Organisation (VACCHO) supports Aboriginal Hospital Liaison Officers (AHLOs) in their roles and assists relationship development with Aboriginal community-controlled health organisations (ACCHOs).

To demonstrate quality care for Aboriginal patients, health services are required to report progress against 4 key result areas (KRAs) in their annual quality of care reports.

Resources

Hospitals are also encouraged to adopt a quality improvement approach to their ICAP program.

The Aboriginal and Torres Strait Islander patient quality improvement toolkit is a useful resource for hospital staff developed by the Improving the Culture of Hospitals Project. you may also want to refer to the Improving Care for Aboriginal Patients Program (ICAP) Guidelines.

The Victorian Aboriginal Palliative Care Program (VAPCP) aims to create a sustainable and culturally safe palliative care service system to enable Aboriginal people across Victoria to access palliative care services in the setting of their choice.

The Victorian Aboriginal Community Controlled Health Organisation (VACCHO) VAPCP project officer provides state-wide support and advice to palliative care and Aboriginal health services regarding Aboriginal palliative care.

The VAPCP:

• provides education and training
• develops culturally appropriate resources
• collects research and data
• contributes to the national Aboriginal palliative care discussion.

The VAPCP supports the 8 palliative care consortia and local Aboriginal health services to develop regionally based Aboriginal palliative care plans and partnerships.

The long-term outcomes of the VAPCP are to increase:

• Aboriginal health workers’ awareness of palliative care
• the cultural appropriateness of palliative care service delivery
• the number of Aboriginal clients accessing palliative care services.

The National Indigenous Eye Health Survey, published by the University of Melbourne in 2008, found that Aboriginal people over the age of 40 experience blindness at 6 times the rate of other Australians.

In Victoria, this vision loss is predominantly caused by refractive error, cataract or diabetes.

Victorian Aboriginal Eye Health Initiative

In November 2009 we established 3 projects to address Aboriginal eye health.

• a statewide eye health project officer at the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) to:
  • facilitate improved access to eye care for Aboriginal Victorians
  • facilitate community awareness programs around the importance of eye health
  • build the capacity of the Aboriginal health workforce
• a patient pathways coordinator at the Royal Victorian Eye and Ear Hospital to establish referral pathways for Aboriginal patients and to reduce barriers to tertiary care
• the Victorian Aboriginal Spectacle Subsidy Scheme, delivered by the Australian College of Optometry, that allows Aboriginal Victorians to access a specifically designed pair of frames along with prescribed lenses for a patient contribution of $10. This scheme was evaluated in July 2012 in consultation with the Victorian Advisory Council on Koori Health - Eye Health Subcommittee and key stakeholders in eye health. The evaluation report was endorsed by both the VACKH Eye Health Subcommittee VACKH that same year.

Victorian Advisory Council on Koori Health - Eye Health Subcommittee

The Victorian Advisory Council on Koori Health (VACKH) is a 3-party forum between VACCHO, our department and the Commonwealth Department of Health and Ageing. Its aim is to work together to improve the health outcomes for Aboriginal Victorians.

In 2010 the VACKH established its Aboriginal Eye Health Subcommittee to provide expert, technical and policy advice to the VACKH in relation to eye health.

The VACKH Eye Health Subcommittee oversees 3 projects under Victorian Aboriginal Eye Health Initiative described above. The membership of the VACKH Eye Health Subcommittee includes experts in the area of eye health from peak bodies, universities and eye health services.

We provide a secretariat role to the VACKH Eye Health Subcommittee.

Following a review of the Aboriginal Weighted Inlier Equivalent Separations (WIES) loading, the Aboriginal health funding model for public health services was redesigned to strengthen cultural safety and accountability.

From July 2020, there are now 2 discrete Aboriginal funding streams for hospitals. One stream covers the clinical costs of care and the other directly funds cultural safety actions across the health service. More specifically:

• There is a 4 per cent Aboriginal WIES loading. This covers the clinical treatment costs of Aboriginal patients and aligns with the national rate.
• Hospitals in receipt of the Aboriginal WIES loading will also receive a specified grant referred to as the ‘Aboriginal cultural safety fixed grant’. The Aboriginal cultural safety fixed grant provides hospitals with funding to strengthen cultural safety through a whole of organisational response.

The ICAP program continues and is now strengthened through funding changes.

A key component to cultural safety is the employment of Aboriginal hospital liaison officers (AHLOs).

These roles and associated Aboriginal leadership roles play a vital role in supporting the cultural safety of Aboriginal patients and their families within hospitals. However, the funding changes emphasise a whole-of-organisation response to Aboriginal cultural safety and enables greater state-wide transparency and accountability.

Health services receiving the Aboriginal cultural safety fixed grant need to submit an annual cultural safety plan and cultural safety report. For more information read the Aboriginal cultural safety fixed grant requirements.

The Koori Maternity Services (KMS) program(opens in a new window), developed in partnership with the Victorian Aboriginal Community Controlled Health Organisation (VACCHO), provides culturally appropriate maternity care and support for Koori and Torres Strait Islander women at 11 VACCHO sites across Victoria.

The main focus of the program is on increasing access to antenatal care, postnatal support and hospital liaison to improve the health and wellbeing outcomes for Koori and Torres Strait Islander women and babies.

All sites employ an Aboriginal health worker, undertake health promotion, provide support for pregnant Aboriginal women and identify pathways to other services.

9 services also provide antenatal and postnatal care. Supporting relationships with the birth hospital are an important component of the KMS work.

VACCHO provides statewide support and coordination to the services as well as advising the department about service planning and development.