Central Bayside Community Health Service and Bentleigh Bayside Community Health Service provide a broad range of community health services to a large part of Melbourne’s south eastern suburbs, serving a total community of approximately 270,000 persons. Over the past decade in particular services have grown in a somewhat ad hoc manner, due in part to the diverse streams of funding that government, at all levels, has made available in order to target particular problem areas. For instance, the hospital in the home scheme, HITH and the hospital admissions Risk Program, HARP both aim to reduce the usage of acute hospital beds by trying to prevent sub-acute cases progressing to the acute stage, but the funding for each is restricted to activities specified under the relevant regulations pertaining to that program and cannot be diverted to other activities no matter how pertinent they may be from an overall community health perspective. In this climate both CHSs have grown significantly as measured by equivalent full time (EFT) employees. In the past decade Bentleigh grew from 17.8 EFT to 53.0 EFT and Central grew from 60.0 to 122.5 EFT. The time had come for a strategic review of services and UMG was engaged to undertake that review.

The original intention was to undertake a thorough data analysis and services projection exercise which was to inform the intensive but directed consultation process. This approach founded due firstly, to a lack of good quality data; and secondly and most importantly, to the realization that even with good throughput data, there is an irresolvable dilemma in that utilization or usage (e.g. no. of cases, or clients treated for instance) does not necessarily equate to demand or even need in the community health setting. Indeed it is the common experience in this setting that if a new program is commenced it will quickly fill up with clients. In the acute setting however, the assumption that utilization is an adequate proxy measure for demand and need is valid.

A fresh approach was required. UMG turned to a “top-down” approach by examining community wide data and studies such as the Burden of Disease study of Victoria. The approach then taken was to examine underlying causes of particularly prevalent diseases or conditions and project how much “burden” will befall communities (as defined geographically such as the South eastern section of Melbourne) in the future if the pattern proceeds unchecked. Measures such as DALY (Disability Adjusted Life Years) and YLD (Years Lost to Disability) and YLL (Years Life lost) have been devised to quantify “burden”, and these were applied to each CHS’s projected catchment population. Armed with this information the client was able to determine priorities for the usage of future increases in EFT and to put the results in round table forums with their senior management, their boards, their key strategic partners (i.e. the relevant acute hospital network and relevant local government authority) and their community.