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Health and wellbeing

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The following section is a text version of the infographic.

Health and wellbeing

Maintaining and enhancing the quality of life of clients by improving their physical and mental wellbeing.

In 2017–18:

  • $5.3 billion was spent on health services, including $1.39 billion on hospital services and around $0.20 billion on mental health support
  • 52,125 veterans (27% of veterans) were living with a mental health condition
  • 190,968 DVA health cards were current, including 128,517 Gold Cards and 62,451 White Cards
  • 30.1 million health services were used, equivalent to 162 health services per veteran
  • 106,352 sessions were conducted by the Veterans and Veterans Families Counselling Service
  • 1,301,691 travel for treatment trips were funded through the Booked Car with Driver Scheme
  • 168,970 travel for treatment reimbursement claims were lodged, of which 99 per cent were processed within 28 days
  • 1,104 people enrolled in the Heart Health program
  • Five webinars were attended by over 4,900 health professionals
Program 2.1:
Provide access to general medical consultations and services
Provide access to general and specialist medical and dental services to clients. DVA has arrangements in place with medical and dental practitioners in both the public and private sectors to deliver a comprehensive range of services throughout Australia, provided in hospitals, providers' rooms and clients' homes. To ensure that DVA clients are able to access necessary services, DVA will either pay for clients to travel to the nearest service provider or pay a provider to travel to other locations to provide services to DVA clients.
Program 2.2:
Provide access to hospital services
Provide access to inpatient and outpatient hospital services for DVA clients through arrangements with private hospitals, day procedure centres and mental health hospitals, as well as all public hospitals operated by the state and territory governments.
Program 2.3:
Provide access to pharmaceutical benefits
The Repatriation Pharmaceutical Benefits Scheme provides clients with access to a comprehensive range of pharmaceuticals and wound dressings for the treatment of their health care needs, including items available to the broader Australian community under the Pharmaceutical Benefits Scheme.
Program 2.4:
Provide access to community care and support
Manages community support and residential care programs for clients, including the Veterans' Home Care program and the Community Nursing program, which aim to support people to remain independent in their homes and improve their quality of life and health. The program also provides subsidies and supplements for DVA clients living in residential care facilities.
Program 2.5:
Provide counselling and other health services
Provide a wide range of mental and allied health care services, including counselling and referral services for clients. The program also supports DVA clients with funding for aids and appliances, and travel for treatment.
Program 2.6:
Provide access to health and other care services under DRCA and MRCA
Arranges for the provision of rehabilitation, medical and other related services under DRCA, the MRCA and related legislation. The services include payment for medical treatment, rehabilitation services, attendant care and household services.

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Achievements in 2017–18

More effective relationships

Australian Government partners

As requests for hearing services continued to increase in numbers and complexity in 2017–18, DVA worked closely with the Department of Health, which provides many such services for veterans and their families and the wider population. DVA also worked closely with Health on aged care services, including residential aged care. The departments cooperate to ensure that members of the veteran community are able to understand how to access services through the aged care system, particularly where the services offered by DVA and Health may overlap.

DVA worked with the National Disability Insurance Scheme to identify overlaps in services and ensure that no duplication of services occurs. DVA has provided the National Disability Insurance Agency with information on its health care arrangements to help in the development of similar arrangements through the National Disability Insurance Scheme.

DVA worked with the National Aged Care Advocacy Program and ex-service organisations to improve access to advocacy programs by members of the veteran community who are entering into, or residing in, permanent residential aged care. The advocacy services cover a range of issues, from helping to find a residential aged care facility to ensuring that the resident receives all of the services they clinically require.

On 1 July 2017, the Department of Veterans' Affairs Human Research Ethics Committee merged with the Australian Defence Human Research Ethics Committee to form the Departments of Defence and Veterans’ Affairs Human Research Ethics Committee. The new committee is registered with the National Health and Medical Research Council.

Also in July 2017, DVA and the Australian Institute of Health and Welfare began a four-year research partnership to build understanding of the health, welfare and future needs of Australia’s veterans, with a particular emphasis on contemporary veterans.

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The veteran community

DVA partners with ex-service organisations and other community organisations to deliver programs that promote opportunities for wellbeing and healthy lifestyle actions, with a focus on social connectedness, healthy eating and physical activity. In 2017–18, the Department:

  • partnered with ex-service and community organisations to hold Veterans’ Health Week 2017 — approximately 15,000 people attended 220 health week events
  • contracted community support advisers to provide support to social initiatives and day clubs, focusing on social connection for isolated, frail and aged veterans
  • supported the Men’s Health Peer Education program, through which over 250 volunteers provided health information to members of the veteran community
  • coordinated the National 10,000 Steps Challenge to strengthen social connections and encourage physical activity — 273 teams totalling 1,360 participants enrolled in the challenge
  • delivered Heart Health, a 12-month physical activity and health education program aimed at improving the general wellbeing of participants — 1,104 participants enrolled in the program.

Eligible people often receive advice on DVA entitlements from veterans’ pensions and welfare officers who work, in many cases voluntarily, for ex-service organisations. The Department provides funding to support the work of pensions and welfare officers through the Building Excellence in Support and Training (BEST) annual grants program. As part of a whole-of-government initiative, DVA has a partnership agreement with the Department of Social Services in place that transitioned responsibility for the administration of grants under the program to the Australian Government Community Grants Hub. More information on grants programs is provided in the Management and Accountability section of this annual report.

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Hospitals and day procedure centres

Agreements on the arrangements for the provision of public hospital services to veterans have now been signed with the governments of all states and territories; the final four arrangements were signed in 2017–18. These arrangements will ensure that veterans and eligible members of veterans’ families have access to all public hospital services at over 750 facilities around Australia.

DVA manages contracts with private hospitals and day procedure centres. To ensure that the contracts deliver value for money, the Department annually reviews the prices of the services provided. The 2018 reviews commenced in March 2018 for private hospitals and June 2018 for day procedure centres.

In 2017–18, DVA streamlined its contracting arrangements for private day procedure centres, significantly reducing administrative requirements for both DVA and providers. The new arrangements commenced on 1 October 2017 and mirror closely the changes that were implemented to private hospital arrangements in 2016. The overall objective is to maximise numbers of participating providers to achieve wide access to private hospital services for veterans and members of veterans’ families. All eligible providers can now apply to contract with DVA at any time through a standard service agreement.

DVA also manages contracts for the provision of Veterans’ Medicines Advice and Therapeutics Education Services (Veterans’ MATES) and the patient satisfaction surveys for private hospital overnight admissions. A contract management team undertakes quality checks and relationship meetings to ensure that the providers are meeting DVA’s requirements.

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Transport contractors

All transport contractors must adhere to DVA’s guidelines, which include specific requirements for the contractor and those who drive the vehicle. Most of DVA’s transport contractors have specialised in-house training programs which drivers must undertake before transporting veterans and members of veterans’ families. Such programs may include training modules and videos with DVA content.

DVA works with transport contractors to find ways to improve service and seek feedback from those who use DVA-funded transport. DVA also monitors the journey requests and trips undertaken by the contractors. If the proportion of trips that are unable to be undertaken exceeds DVA’s guidelines, the contract management team takes appropriate steps to improve responsiveness.

In mid-2018, the contract management team extended transport contracts for an additional 12 months.

Rehabilitation Appliances Program providers

Demand is increasing for the products and services of the Rehabilitation Appliances Program, such as mobility and functional support, continence aids, personal response systems, low vision aids, home medical oxygen therapy, continuous positive airway pressure devices and medical grade footwear.

DVA’s contract management team undertakes regular quality and contract compliance audits with the contractors that deliver those products and services, to ensure that DVA’s requirements are being met. The audit process also provides an opportunity for DVA and contractors to raise issues of concern and discuss changes in the industry, including the latest technology or products that may be suitable for veterans and their families. DVA also oversees annual price reviews of more than 35,000 products and services provided through contractual arrangements under the program.

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Improved planning and oversight of health care

Health program performance assurance

DVA developed the Health Programs Performance Assurance Strategy to provide assurance that documented processes and strong controls have been established to support the reliability of DVA’s annual financial statements. The strategy covers five material health programs: Public Hospitals, Private Hospitals, Medical Services, Pharmaceutical, and Residential Care. It includes a two-year approach to reforming assurance processes for health programs, and includes a sign-off on the effectiveness of financial controls at the end of each financial year.

Hospital services

DVA implemented a new quality initiative to identify, analyse and assess all private hospital and day procedure centre episodes for admissions where clinical coding indicates that a sentinel event may have occurred. The process uses the eight sentinel events agreed by the Council of Australian Governments Health Council. Contemporary research shows that while these sentinel events are rare, they are preventable and reflect poor hospital processes. The initiative will allow DVA to seek reimbursement of hospital costs related to such events.

DVA also reviewed the survey used to gauge and report on how veterans and members of veterans’ families experience private hospital admission. A series of workshops were held, in Canberra, Brisbane and Adelaide, with clients who had had one or more overnight private hospital admissions within the previous 12 months. The workshops were very well attended and provided valuable insights that will inform DVA’s development of tools and systems for a new survey.

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Nursing services

The Nursing Approvals and Advisory Centre was established in February 2018 to be a centre of professional excellence for the provision of nursing services to veterans and their families. The centre will drive innovation and service improvement to ensure that veterans receive services of the highest quality, in line with evidence-based best practice, to meet their needs and aspirations.

DVA conducted regular clinical reviews of community nursing providers to:

  • ensure compliance with nursing standards and DVA’s Notes for community nursing providers
  • provide increased support through education and access to specialist nursing services
  • increase the capability of community nursing providers.

Hearing services

DVA developed a communication and awareness-raising strategy for the provision of hearing services to veterans and their families, using key messages drafted to cater for a variety of stakeholders, including hearing services providers and veterans. Messages have been distributed through email communication, articles and fact sheets, and are now being expanded to include social media channels.

Support for carers and volunteers

DVA developed and adopted a revised program model for contracted services delivered under the Carer and Volunteer Support program. In line with Veteran Centric Reform and DVA’s future needs, the revised model delivers improved, more flexible panel arrangements for engaging contractors to meet operational and location specific requirements.

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More efficient service delivery

Planned Support Unit

DVA established the Planned Support Unit to assist veterans with high and complex needs, including long-term accepted conditions, to access appropriate health and social services. The principles of the unit are underpinned by a model of care driven by inclusive, holistic practice.

Veterans’ Home Care services

New contracts for the delivery of Veterans’ Home Care services were awarded in November 2017 through an open tender process. The number of service providers increased from 160 to 185 to ensure adequate coverage across Australia, including in rural and remote areas.

Some existing providers chose not to tender for new contracts. As a result, approximately 2,700 veterans and eligible members of their families were transferred to alternative providers. DVA’s communications strategy ensured that veterans and their families were informed of the changes, and the Department worked with the providers to ensure continuity of services.

The Department also ensured that Veterans’ Home Care services were accessible to rural and remote veterans and their families by funding special arrangements in some locations. DVA made arrangements with service providers to ensure that veterans and their families were not disadvantaged, and resources were quickly and efficiently identified and engaged to cater for each person’s needs.

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Clinical advice services

Contracted medical and health advisers assist DVA in determining the financial and health entitlements of veterans and their family members. The Department is committed to reducing the time taken to process claims by ensuring that there is sufficient medical adviser capacity to help inform decisions.

All advisers are sourced from private companies through an open tender process and are contracted under a standard agreement and fee schedule. These arrangements enable DVA to ensure that the services are equitably managed and targeted to meet the needs of business areas.

Clinical advisers play a critical role in assisting DVA to put veterans and families first through Veteran Centric Reform. To help them understand and enhance their contribution, DVA held several workshops for clinical advisers in 2017–18, explaining the context for Veteran Centric Reform and their role in the delivery of pilots and program initiatives.

Reimbursements for medical expenses privately incurred

DVA improved its business processes for reimbursement of privately incurred medical expenses to reduce the number of claims on hand and the time taken to process such claims. The number of claims on hand was reduced by 66 per cent, from 861 at 30 June 2017 to 297 at 30 June 2018. The proportion of claims processed within the Service Charter time frame of 28 days improved significantly, from 32 per cent at 30 June 2017 to 87 per cent at 30 June 2018.

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New and improved services

Veterans and Veterans Families Counselling Service

The Veterans and Veterans Families Counselling Service (VVCS) is a nationally accredited mental health service which has been providing counselling and mental health support for more than 35 years. Through its 24-hour service delivery system, VVCS provides:

  • counselling for individuals, couples and families
  • proactive, coordinated case management of complex individual needs
  • mental health education for the veteran community.

VVCS also provides initial assessment and referral to mental health support, as a duty of care, to any individual from the veteran community. These services are delivered from 28 VVCS locations and through a network of over 1,300 outreach providers around Australia.

Eligibility for VVCS was expanded in 2017–18 through the expansion of NLHC arrangements. VVCS can now be accessed by:

  • all current and former ADF personnel with at least one day’s continuous full-time service, and their families
  • reservists who are eligible for a non-liability White Card, and their families.

VVCS was expanded to meet the demand of increased eligibility and to build capability to manage veterans and members of veterans’ families who have complex needs or are at risk of suicide. The service established new satellite offices, and expanded its outpost model, whereby VVCS clinicians are co-located in existing serviced offices such as medical centres. Six additional senior clinician roles were established in regional areas to assist in coordinating services.

The VVCS consent form was modified to facilitate communication between VVCS and other DVA areas, and referrals to VVCS if appropriate, when DVA staff receive information relating to the safety of a person that raises a duty of care. As part of a trial of suicide prevention approaches in Townsville, Queensland, led by the Department of Health, VVCS is piloting a community engagement team model. The team, which includes two lived experience peers and a clinician, is expected to enhance the coordination of internal and external services to best meet the needs of veterans and their families.

VVCS also increased its focus on co-designing service delivery with the people who use the services and delivering the most effective intervention for each person. VVCS upgraded its client management system to enhance its understanding of the demand for services and the needs of veterans and their families, while better supporting clinicians to provide the best possible care.

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Mental health webinars

DVA’s professional development webinar series — Mental Health and the Military Experience — aims to assist health professionals to support veterans and their families. Three webinars took place in 2017–18 on the topics of understanding anger in veterans, supporting the families of veterans, and suicide prevention and the veteran community. This builds on the four webinars that took place in 2016–17.

The webinar series has been a success in terms of the high level of engagement of health professionals, positive feedback from external and internal stakeholders, and increased traffic to the At Ease online portal. Further webinars will take place in 2018–19 and 2019–20.

Coordinated Veterans’ Care Mental Health Pilot

The Coordinated Veterans’ Care Mental Health Pilot is built on the Coordinated Veterans’ Care (CVC) Program. The CVC Program is generally open only to DVA Gold Card holders; however, amendments were made to the VEA and MRCA so that White Card holders who might benefit from early clinical intervention could participate in the pilot.

The pilot is designed to support veterans and members of veterans’ families who live in rural and regional areas and have mild to moderate anxiety or depression and a chronic physical condition accompanied by pain, through a team-based model of care led by a GP and supported by a practice nurse. It will also trial the effectiveness of a ‘light touch cognitive behavioural therapy’ digital coaching app in improving mental health resilience and health outcomes.

Initial testing of pilot products and systems, with input from veterans and their families, GPs, nurses and ex-service organisation representatives, was undertaken in the central Queensland region in January 2018. Rollout will commence in 2018–19.

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Drug Review Safety and Pain Management Program

DVA’s Veterans’ Affairs Pharmaceutical Advisory Centre is staffed by pharmacist advisers who are in a unique position to identify high-risk medication use within the veteran community, in particular the overuse or misuse of opioid analgesics and sedative/hypnotic medications.

A new program piloted in 2017–18, the Drug Review Safety and Pain Management Program, enables advisers to make contact with health professionals who prescribe pharmaceuticals for veterans and their family members, providing information, assistance and support in the management of their patients. It also includes the provision of pharmaceutical advice and support to health advisers, delegates and support officers within DVA.

The pilot demonstrated that timely, evidence-based liaison has significant benefits for veterans and their families and for health professionals. The program will be fully implemented in 2018–19.

Veterans’ MATES

Veterans’ MATES is a unique initiative that uses DVA’s health claims data to identify emerging problems with health care and medicine, and deliver targeted support, for veterans and their families. Up to four times each year, the program provides the latest evidence-based information to the veteran, the veteran’s GP and allied health care providers. The activities of the program are underpinned by the principles of Australia’s National Strategy for Quality Use of Medicines.

Online resources

DVA delivers a range of mental health websites and apps through its At Ease portal to increase mental health literacy and encourage veterans to seek help. These online resources are being modernised to enhance the user experience and improve engagement. In 2017–18, the websites and apps helped nearly 60,000 users and received over 340,000 page views.

The Operation Life initiative helps people to understand warning signs and provide information and resources to help keep people safe from suicide. During 2017–18, significant work was undertaken to redesign the Operation Life website and its associated mobile app to better align with contemporary approaches and integrate clinical support.

A major evaluation of the PTSD Coach Australia mobile app was conducted in 2017–18 to provide insight into how serving and former ADF personnel and clinicians use the app, and whether it is meeting their needs. The results will shape a redesign of the app in 2018–19.

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Milestones in research and policy development

Strategic review of the applied research model

A strategic review of DVA’s model for funding applied research was completed in 2017–18. The review highlighted the successes of the Applied Research Program and identified opportunities to better harness the skills and expertise of key research bodies and academics and members of the ex-service community.

Parliamentary inquiry on hearing health and wellbeing

DVA provided input into the Australian Government response to Still waiting to be heard , the report of the House of Representatives Standing Committee on Health, Aged Care and Sport’s inquiry into the hearing health and wellbeing of Australia.

Transition and Wellbeing Research Programme reports

The Transition and Wellbeing Research Programme is the most comprehensive study on the impact of military service on the mental, physical and social health of current and transitioned ADF members and their families. In April 2018, the study released two reports:

  • Mental health prevalence, which discussed the prevalence of mental disorders among ADF members who had transitioned from service between 2010 and 2014, and those who were currently serving
  • Pathways to care, which focused on individuals who were experiencing mental health issues and their experience of care-seeking.

Among other things, the research showed that the transitioned ADF group had significantly higher rates of mental health issues than the serving ADF group, and that about 75 per cent of the transitioned and serving ADF individuals had received assistance for their mental health at some point. DVA is addressing some of the findings through programs to facilitate the transition process for ADF members.

Australian Institute of Health and Welfare research

In January 2018, the first report produced under the new strategic research agreement between DVA and the Australian Institute of Health and Welfare, Incidence of suicide in serving and ex-serving Australian Defence Force personnel: detailed analysis 2001–2015, was published. A working paper on the development of a veteran-centred model will be published in mid-2018.

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Veterans and Veterans Families Counselling Service research

As part of its commitment to continually improve its services, VVCS supported four research projects in 2017–18:

  • the Stepping Out: Attention Reset trial, which is testing whether computer-based attention training can facilitate better outcomes for transitioning ADF personnel
  • the Synergy trial, which is testing an internet-based platform designed to bring together apps and e-mental health tools to empower veterans and their families to manage their mental health
  • the development of a moral injury outcome scale to measure the impact of exposure to potentially morally injurious events
  • the Rapid Exposure Supporting Trauma Recovery (RESTORE) trial, which is investigating whether the intensive delivery of exposure therapy will deliver outcomes comparable to the standard treatment protocol for posttraumatic stress disorder.

Dental and allied health review

In 2015–16, DVA commenced a review of its dental and allied health funding arrangements, looking for opportunities to re-balance the arrangements to ensure that services continue to best meet the current and future needs of the veteran community. The review was undertaken in consultation with clinical experts and representatives of the veteran community and peak provider associations.

The review was completed in 2017–18. Its report was published in May 2018 and informed the development of the 2018–19 Budget measure on improved dental and allied health.

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Priorities for 2018–19

In the year ahead, the Department will:

  • review several of its services and programs to ensure that they are meeting the needs of veterans and their families and to identify opportunities to improve administrative efficiencies—examples include the Rehabilitation Appliances Program, the Repatriation Transport Scheme, the Community Nursing Program and pharmaceutical programs
  • continue to manage noncompliance by health providers, including by strengthening activities with the Department of Health, developing relationships with peak provider bodies, and conducting activities such as the Preventable Re-admissions Quality Initiative for private hospitals
  • implement a system to better record and analyse trends in feedback from people who access services through DVA
  • improve online services by expanding the At Ease portal to focus on wellness and integration within the wider health system, and redeveloping the PTSD Coach Australia app
  • deliver more webinars to strengthen the capabilities of health professionals to deliver quality health care for veterans
  • review its mental and social health programs and establish a national framework to guide the development, delivery and evaluation of such programs in future, including by testing new approaches through
    • the CVC Mental Health Pilot
    • a pilot of improved case management services for at-risk veterans and their families and those transitioning from the ADF who require additional support
    • a trial of psychiatric assistance dogs for veterans with posttraumatic stress disorder
    • a pilot of beyondblue’s The Way Back Support Service for veterans discharging from hospital
  • respond to recommendations of The constant battle: suicide by veterans, including by
    • reviewing its veteran-specific online training programs for health professionals
    • reviewing the service delivery training of departmental staff
    • conducting consultation forums for veterans who are concerned about their use of mefloquine while in service
    • realigning its mental and social health strategies with Defence and whole-of-government strategies to enable a stronger focus on suicide prevention
    • delivering the outcomes of research into homelessness in the veteran community
  • receive the final reports of the Transition and Wellbeing Research Programme
  • begin consultations across government, the veteran community and the research community to co-design a strategic research framework to better understand the future needs of veterans.

The VVCS will:

  • change its name to Open Arms — Veterans and Families Counselling, to increase awareness of its services and expanded eligibility to access them among the veteran community
  • roll out updated and new group programs for current and former ADF personnel in areas such as posttraumatic stress disorder, anxiety, pain management and depression
  • further strengthen the 24-hour support that it provides and its ability to provide support through different channels.
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