Strategic service planning entails predicting future demand and need for services, and developing a range of proposals that would best meet the changing needs of communities. Supply analysis and modelling predicts the likely service system capacity and needs for related infrastructure by considering a range of variables, such as policy objectives, service delivery and network designs, access patterns and the capacity of existing facilities.

Sound strategic service planning across different agencies needs to encompass:

clear governance arrangements, including leadership, lines of authority, and roles and responsibilities

reliable and robust analysis of demand and supply, including sound understanding of the changing demand drivers that contribute to gaps in service supply

integration of state and local government functions that plan and deliver services

a hierarchy of locality plans comprising local, regional and statewide service plans that cover service needs in the short, medium and long terms

mechanisms for information sharing and collaborative efforts on shared outcomes.

This part of the report examines whether the strategic service planning across the audited agencies is integrated, and whether it supports the achievement of high-level government policy objectives for health, liveability and community development, with particular focus on birthing, MCH and funded kindergarten services.

3.1 Conclusion

In areas of rapid population growth, current service planning approaches give only limited assurance to users of birthing, MCH and funded kindergarten services that these services will be delivered where and when they are needed. Unless there are significant changes to these approaches, areas experiencing continuing population growth are unlikely to have full access to MCH and funded kindergarten services when and where needed.

Although there have been issues with strategic service planning for birthing services, DHHS has improved its approach to planning these services, which gives greater assurance that these services will be provided as required.

No agency takes a clear leadership role in the strategic oversight of MCH or funded kindergarten services, including:

identifying if there is sufficient supply of services

ensuring the reliability or completeness of service planning data

gaining a comprehensive understanding of the system-wide demand for services

encouraging or influencing providers to adjust the location and timing of services to meet demand

ensuring MCH and funded kindergarten service planning adequately supports government policy objectives for participation.

There is a clear need to improve the collection of system-wide information on MCH and kindergarten participation and reasons for under-participation. The current systems used to record demand and supply for these services do not reflect their vital importance to communities.

The development of the Child Development Information System (CDIS) for MCH services to allow information sharing across councils is a positive step towards supporting child-centred service planning and provision. There is a similar need for a council-based centralised kindergarten enrolment system.

DHHS has made advances over recent years in its support for service planning by health services, including through the provision of area-based information to support individual health services to plan and deliver birthing services. There is further opportunity for DHHS in its role as the health system manager to improve and strengthen system-wide planning, and to enhance the health system’s capability to better respond to rapid population growth. It is pleasing to note that DHHS has acknowledged and is working on addressing some of these shortcomings.

3.2 Population forecasts

Understanding potential demand for services requires access to reliable data on population projections and robust analyses of future demand patterns.

Errors in forecasting generally increase as the population size decreases, and forecasting is particularly difficult in areas with rapid population growth or decline. Rapid population growth since 2011, due to the magnitude and the volatility of overseas migration, has also brought considerable challenges to population forecasting as the unprecedented conditions are unlikely to be included in standard methods.

We found some good practices in local councils in greenfield growth areas where they use additional information to improve the reliability of projections. Similarly, DELWP has taken actions to improve the state government’s forecasting model by regularly reviewing and updating its methodology.

Ongoing review of the forecasting methodology is a good practice and should be adopted more broadly at both local and state level.

State government entities

Population projections contained in Victoria in Future (VIF), compiled by DELWP using data from ABS, are a key element of planning information. State government entities are required to use VIF projections in their analyses of demand, especially when preparing their annual State Budget submissions.

VIF projections are updated annually and cross-referenced with other sources of data such as building approvals. However, for a number of years, VIF’s population projections have significantly understated the actual pace of population growth, particularly in locations experiencing rapid population increases, partly due to the unprecedented growth in overseas migration.

Underestimates of population growth contribute to the considerable pressure on birthing services to meet rising demand in a timely way. While population forecasts are inherently estimates, continued underestimation suggests a need to review the VIF methodology and assumptions, including how frequently they are updated. Figure 3A illustrates how underestimated population growth affected one health service.

Figure 3A

Planning for growth at Northern Health

In April 2014, Northern Health released a maternity capacity review aimed at better meeting the growing demand in the northern growth corridor. The review noted that, based on the accepted VIF methodology, the actual birth numbers at Northern Health in 2012−13 had reached the forecast birth numbers for 2016–17—three years earlier than predicted. The report stated: ‘It is now accepted that existing planning approaches are not accurately forecasting populations in some locations. This creates enormous pressure on the preparedness of the service system to be responsive.’ To improve forecast reliability, Northern Health undertook scenario modelling based on a combination of existing and alternative methodologies, including using a higher population projection scenario from ABS. This approach was approved during discussions between Northern Health and the then Department of Health.



Source: VAGO, based on information from Northern Health and DHHS.

The underestimations of population growth in VIF projections were noted in a review commissioned by Infrastructure Victoria in 2015. The review also noted that DELWP took a range of actions to improve the robustness and timeliness of VIF population projections. However, there is room for improvement, particularly in the reliability of projections for smaller geographic areas and faster growing areas.

The review recommended that future VIF products provide information at a smaller area level than is currently available. DELWP advised it is considering implementing this recommendation, subject to available resources.

Local government

The councils we examined have engaged private firms to produce their population projections and then tested the robustness of those projections. Local councils have used these alternative forecasts in their applications for state government funding for new early childhood facilities or for the expansion of existing facilities. DET has accepted these forecasts, as VIF projections are not currently available at smaller geographic levels.

We note that both local councils’ and VIF’s projections have underestimated the population growth levels in the past, as a result of unanticipated growth since 2011. Using additional information to conduct regular checks of the population projections can help councils get a better sense of the actual pace of growth.

Hume City Council checks its growth projections by compiling additional information such as service enrolments and attendances, waiting lists, birth notifications, community and service provider surveys, planning permit approvals and new housing lot releases. Better sharing of such local-level information with the state agencies may improve population projections and planning, and delivery of services and infrastructure.

3.3 Strategic planning for birthing services

Health services deliver birthing services. DHHS, in its role as the health system manager, is responsible for policies and plans. It also oversees publicly funded or contracted health services to achieve government’s objectives for the health care sector.

DHHS and health services share service planning activities, which are conducted at the local, area-wide, regional and statewide levels. The effectiveness of strategic service planning can be measured by assessing the extent to which providers deliver birthing services when and where needed.

DHHS is in the process of changing the way it plans the provision of birthing services across Victoria in response to inadequacies in its previous devolved planning approach.

Roles and responsibilities

Figure 3B outlines DHHS’s and local health services’ responsibilities for service planning. As the health system manager, DHHS undertakes strategic planning for statewide services, including taking the lead in planning and funding new and expanded facilities, and in statewide workforce planning.

Figure 3B

Planning for birthing services by health services and DHHS

Agency Statewide planning Area-wide planning New or improved facilities Workforce planning DHHS Statewide system design, and major service streams including maternity services(a) Planning for the northern growth corridor completed. Developing other locality plans. Considers needs, based on each project. Develops statewide needs for health professionals, including specialists. Health service Contributory role Focuses on catchment area, but may contribute to wider area planning. Identifies health service needs. Develops health service workforce needs to support operations.

(a) DHHS began this work in 2016.

Source: VAGO.

The Health Services Act 1988 requires metropolitan and major health services to develop strategic plans with a three- to five-year outlook. These plans provide the strategic context for setting the role and objectives of individual health services, including a description of the current and projected health needs of the local population.

Health services undertake local planning activities to develop services plans, such as predicting local demand and assessing service use patterns, understanding community demographics, assessing current and future capacity and gaps, and developing workforce strategies.

Until recently, DHHS’s service planning activity did not take place within a statewide planning framework that encompasses a comprehensive understanding of the system‑wide demand for and supply of birthing services. Similarly, DHHS submitted infrastructure requests for State Budget funding on a project-by-project basis, rather than presenting its priorities for growth in maternity service capacity within a wider statewide framework of health system needs and priorities.

Demand for birthing services

Between 2005–06 and 2015–16, the number of births in Victorian public hospitals increased by 24 per cent, from 48 387 to 59 760. During this time, there was a 68 per cent increase in the number of births in public hospitals to women residing in the northern growth corridor, covering Whittlesea, Mitchell and Hume.

Figure 3C shows that strong increases in birth numbers also occurred in parts of the inner areas, such as the cities of Melbourne and Port Phillip, as well as some middle-ring councils, such as Moreland.

Figure 3C

The 10 councils with the largest increases in births above the state average, 2005–06 to 2015–16

Source: VAGO, based on data from DHHS.

There are multiple issues arising from the rapid increase in demand for birthing services, including pressures associated with safely meeting that demand.

Some women with ‘normal’ or ‘lower risk’ pregnancies develop complications during labour without warning. Therefore, hospitals with increasing numbers of births are also delivering higher numbers of births with complications.

To meet this increased demand for birthing services safely, health services need to be able to provide timely access to higher-level and specialist services to more women. Higher-level and specialist services include 24-hour obstetric and gynaecological surgery, anaesthetic, paediatric services and physical facilities. Services with these capabilities need to be available in growth areas and have enough capacity to meet demand.

Services with capabilities limited to normal or low-risk pregnancies need to have referral protocols in place to tertiary hospitals, which provide neonatal intensive care services.

A critical system planning issue is the need to ensure that appropriate capacity exists at each of these levels of birthing service. Increasing birthing numbers in both growth corridors and established areas drives the need for additional specialist birthing services.

As shown in Figure 3D, a number of hospitals have met the rising demand for birthing services from women living in the northern growth corridor, including Northern Health taking a greater share over the 10-year period as it gradually builds up its maternity and newborn services.

Figure 3D

Births per hospital to women living in the northern growth corridor, 2005–06 to 2015–16

Source: VAGO, based on data from DHHS.

The Royal Women’s Hospital (RWH) was experiencing a particularly high demand from across the whole state, including from areas of high population growth in northern Melbourne. To protect RWH’s tertiary capability for women with high risks, and make provision for additional maternity services in the northern growth corridor, DHHS began a planning process with RWH and Northern Health, which resulted in an expanded birthing service capacity and antenatal care at Northern Health.

This process also included establishing a clinical referral process that prioritised access to RWH for high-risk pregnancies. As the additional birthing capacity at Northern Health increased, there was a gradual reduction in the overall number of births at RWH to women residing in the northern growth corridor.

In 2015, an independent report—Travis Review: Increasing the capacity of the Victorian public hospital system for better patient outcomes—highlighted that hospitals located in the greenfield growth areas had the largest gaps between demand and supply of hospital beds. The northern growth corridor had the largest gap between demand and supply.

Northern Health advised that, in response to the rising demand, it has implemented a number of initiatives, including reducing women’s length of stay and strengthening domiciliary care availability for women after birth. However, Northern Health believes that there is limited scope to further improve its efficiency in bed management. Northern Health expects that without expanding its capacity and lifting its capability in the near future, it will reach its physical capacity by 2018.

DHHS advised that the Northern Growth Corridor Service Plan is addressing this key capacity issue.

Capability planning

An important part of DHHS’s supply planning for maternity and neonatal care services is to ensure that these services are safe and of high quality through its capability framework. The framework outlines the types of maternity services that a health service can safely provide.

In the past, DHHS’s reliance on health services’ self-assessment of capability contributed to a reactive response to rapid increases in the demand for birthing services.

Capability framework

In 2011, DHHS issued its Capability Framework for Victorian Maternity and Newborn Services (the capability framework), so that health services could conduct a self‑assessment of their capability level to help with their service planning.

The capability framework provides a standard set of capability requirements. These include the staffing levels, infrastructure and equipment required to support locally available services for normal or low-risk births through to the resources required for specialised services dealing with complex high‑risk births.

Under the capability framework, services at level 3 capability provide care to women experiencing normal or low-risk pregnancy, while women with moderate to high-risk pregnancies are cared for by hospitals of level 4 capability or above.

In 2015, DHHS released a revised capability framework for newborn services that introduced stronger compliance and monitoring procedures for assessing the capability levels of all public and private maternity and newborn services.

After the previous framework’s release in 2011, within a devolved governance model, DHHS expected that health service self-assessments against the framework would enable it to map service capability across the state, and to identify hospital-specific and statewide gaps and address them. DHHS did not achieve these objectives.

Our previous audit of the framework in October 2011, Maternity Services: Capacity, found that although the framework was important for statewide planning, DHHS had not articulated how it intended to address identified gaps, or how it would monitor and measure service providers against the framework. To this extent, the framework did not reliably inform statewide planning or improve services.

Due to rapid increases in demand for birthing services, and the emergency nature of some birthing events, some local hospitals in the growth areas that self-assessed at level 3 capability in 2011 had subsequently expanded their services to include women in the moderate risk group.

During the period between 2011 and 2015, DHHS did not, however, regularly review and reassess health services’ capability levels. This means that DHHS did not have a clear view of statewide capability and was not able to identify when health services were operating beyond their current level of safe maternity care. As a result, DHHS was not able to effectively fulfil its system manager role.

A DHHS review in 2016 into safety and quality assurance systems in Victorian public hospitals identified a number of system-level factors that contributed to avoidable baby deaths at a rural hospital. The review also found that health service self‑assessments did not provide DHHS with accurate information about public hospitals’ capabilities to enable it to perform effectively as system manager. If a health service overstated its capability level, DHHS would not necessarily be aware that this health service might be putting patient safety at risk.

The review recommended that DHHS adopt a ‘compliance-oriented’ approach to assessing health services’ capability and supplement these assessments with stronger analysis of health services data, such as numbers of births outside of a health service’s capability.

From 2016–17, DHHS strengthened capability assessment procedures to ensure that it, rather than health services, determines the capability level of public health services that provide maternity and neonatal care. DHHS now conducts annual assessments and reviews key information from services including:

confirming that the health service complies with each requirement of the capability framework

reviewing maternity and newborn service activity data related to service capability

receiving notification of any changes to a service’s capability over the course of the year

ensuring that improvement actions are agreed to as part of the capability reviews that DHHS monitors.

Transparency and consistency in supply projections

Determining supply projection for birthing requires knowledge of projections of maternity bed capacity, theatre requirements for births involving a caesarean section, and workforce requirements.

DHHS’s forecast models for system capacity have been in place for many years, and have undergone several internal and external reviews. A DHHS review in 2016 found that its demand projection model was robust and, in many areas, employed best practice planning approaches at the national level. The review assessed its past projections to have high levels of confidence—for example, the number of bed days projected was within 1 per cent of the actual requirement.

The review also found that, although the overall projection of future capacity was sound, there were opportunities for DHHS to improve capacity projection for individual services. Specifically, there was a need for greater transparency and access by health services to DHHS’s documentation on planning benchmarks to improve consistency in system‑wide planning across individual health services and different health streams.

Forecast models are based on a number of assumptions about inputs and include capacity benchmarks, models of how services are to be delivered—such as in hospital versus at home—and the influences of technological advances. These input assumptions are important in translating the projected demand to capacity requirements.

In the past, DHHS has not always documented changes to the assumptions it uses to underpin the input variables and has not clearly communicated them to health services.

DHHS is preparing to strengthen its system oversight and planning role by introducing a number of initiatives, including a project to review and document the assumptions in the models. This is a positive step towards improving the robustness of supply projections.

New approaches to statewide planning

DHHS recognised the mismatch between the distribution of supply and demand for health services across Victoria and, in mid-2016, it implemented a statewide planning framework to underpin a more strategic approach to service and infrastructure planning. New departmental structures—including a new planning branch and two agencies for overseeing health information and strengthening the quality of care—have been designed to support the new approach to planning.

The new planning framework includes:

an overarching plan —a 20-year statewide service and infrastructure plan, with supporting five-year action plans that DHHS has committed to monitoring quarterly

—a 20-year statewide service and infrastructure plan, with supporting five-year action plans that DHHS has committed to monitoring quarterly service stream plans —a series of individual design, service and infrastructure plans to address issues in specific service streams, such as maternity and newborn, clinical mental health, and surgery and emergency care services

—a series of individual design, service and infrastructure plans to address issues in specific service streams, such as maternity and newborn, clinical mental health, and surgery and emergency care services locality plans—plans that identify long-term local health and associated infrastructure needs that are developed through a collaborative process with health services, local councils and community health providers.

The new planning framework describes an initial set of proposed ‘high-level’ actions over the next two years, and specific commitments planned for later years.

Northern Growth Corridor Service Plan

The approach that DHHS took to developing a locality plan—the Northern Growth Corridor Service Plan—reflected good practice in strategic service planning and provides a planning model that other service providers could use.

The Northern Growth Corridor Service Plan has:

identified service gaps and impediments to service development

adopted integrated land use planning for the area, with the establishment of ‘health precincts’ that align with MCH services, and schools and kindergarten infrastructure

considered the long-term outlook (20 years), and will develop a 10-year and 20-year response

been informed by sound stakeholder consultation processes, involving other health providers such as ancillary health services in the area, local councils, and social and wellbeing service providers.

The plan intends to prioritise and inform subsequent planning by identifying the scope of health services needed, and when and where they are best located. It identifies opportunities for integration with broader council and state‑provided community services to promote better planning for healthier communities in Melbourne’s north. The plan also states that the area needs a new hospital.

3.4 Strategic planning for maternal and child health services

Universal MCH services are integral to the government’s policy objectives for achieving high-quality early childhood outcomes. These services provide an early opportunity to identify children with health or developmental risks.

DET and local councils arrange provision of MCH services through a partnership agreement. Councils plan and deliver the services, with DET providing funding for 50 per cent of the universal service and 100 per cent of the enhanced service. However, neither DET nor councils take a clear leadership role to ensure the adequacy of this planning, including whether current arrangements are meeting policy objectives in areas of rapid population growth.

Since 2015, DET has undertaken research to understand and try to influence participation rates of specific demographics, including CALD and ATSI families at both local government and state levels. Apart from these initiatives, there has been limited analysis of the drivers underpinning demand, participation and system capacity. This compromises statewide information systems that councils need to draw on for local MCH service planning. These gaps mean that there is less assurance that current arrangements are achieving government policy objectives for MCH services.

DET and local governments have recently renewed their partnership agreement, which recognises the need for an increased focus on outcomes and accountability for MCH services by both parties. This is a positive step.

Roles and responsibilities for maternal and child health services

In 2016–17, the state government allocated funding of $266 million over a four-year period for MCH services to fund:

50 per cent of universal MCH services (local governments fund the other 50 per cent)

100 per cent of enhanced MCH services

various additional service costs, including printing of child health monitoring books, conferences and assessment tool licences.

In 2016–17, the state government’s contribution to service provider funding for the universal service was $42.7m, which is matched by local government.

Planning, funding and provision of MCH services occurs through a partnership between the state and councils. A memorandum of understanding between DET and the Municipal Association of Victoria (MAV), established in 2000 on behalf of all councils, formalised the working relationships in the areas of planning, funding and provision of MCH services. The most recent memorandum of understanding covers the period from May 2017 to December 2020.

Figure 3E shows the delineation of roles and responsibilities for MCH planning.

Figure 3E

Responsibilities for planning of MCH services

Agency Statewide service planning Infrastructure planning Workforce

planning DET Partnership approach to developing guidelines and standards, contributes to funding services and supports professional development of MCH workforce. Regional staff play a supporting and advisory role. Limited role—statewide assessments were done in 2009 and in 2016. Local council Implements municipal service improvement plans in line with DET guidelines for a 12-month period. Provides input at land use stage and provides council buildings for service delivery, including relocatables in areas of rapid population growth. Varies between individual councils.

Source: VAGO.

Local councils plan for the provision of MCH services based on the number of birth notifications they receive, the number of children in previous years’ consultations and state population projections.

DET works collaboratively with councils to support the supply and quality of MCH services. DET’s regional staff help local councils to plan and monitor the performance of early childhood services that DET funds, including MCH and kindergarten services.

DET also runs twice-yearly statewide seminars for MCH nurses aimed at developing their capacity to deliver high-quality programs within their local communities.

Demand for maternal and child health services

The numbers of newborn babies and children up to 3.5 years old represent the potential demand for MCH services in a local area. Although MAV introduced initiatives to improve the system for collecting MCH service data in 2014, there are still limitations. This hinders efforts by local government to provide this critical universal service to parents and their babies where and when needed.

Our 2013 audit Performance Reporting Systems in Education found multiple weaknesses in the MCH information system. These weaknesses pose serious questions about the reliability of the information used and reported publicly.

Under the Child Wellbeing and Safety Act 2005, hospitals are required to send birth notifications to the council where the mother resides within 48 hours of a child being born. In most cases, hospitals fax this information to councils. The audited councils advised that there is no systematic check that the birth notifications they received via fax are correctly recorded in the councils’ database in a timely manner, as sometimes faxed notifications are left unattended, or mixed with other communications.

Similarly, there is no systematic check that all families with birth notifications receive their first home consultation. One of the birthing hospitals audited indicated that it does not cross-reference all of its births against evidence that the birth notice has been scanned or faxed to the relevant council. It also does not receive confirmation from corresponding local councils that they have received the notification.

In some cases, families may have incorrectly filled in their home addresses, which results in hospitals sending notifications to the wrong council, causing further delays in providing MCH services for first visits. The extent of this issue is unknown. DET acknowledged that there is an opportunity to improve the process for passing birth notifications between hospitals and councils.

There were also weaknesses in the way MCH services maintained engagement with families with young children when they moved to another council area. To address some of these issues, MAV, with a funding contribution from DET, began developing the CDIS in 2014. This system manages child records within a single, centralised database, making every child enrolled visible to every nurse at the 62 councils on the CDIS. This is a positive step towards supporting child-centred service planning and provision. However, this does not address the issue of MCH services initially engaging with families who move to Victoria from interstate or overseas.

The implementation of the CDIS has had many challenges, as detailed in Figure 3F. In two of the three audited councils, reliable MCH data has not been available for the last 18 months, causing significant frustration for the MCH nurses.

Figure 3F

Implementation of the CDIS for MCH services

In 2014, MAV began developing a new standardised data management system for MCH services. DET contributed $2 million to this project. The new system aimed to: facilitate the sharing of information when families move

enhance engagement opportunities, including sending reminder text messages for upcoming appointments

improve the link to other early childhood data systems through secure transfer of data and referrals

improve statewide performance monitoring and data analysis. The new system was released in late 2015 and, at the time of this audit, 62 of the 79 councils in Victoria were participating. During roll out of the system, various implementation issues have arisen. These included inaccurate reporting due to the loss of data during migration from the old to the new system, the same information being able to be stored in multiple locations, and system navigation difficulties for users wishing to extract information or enter data.

Source: VAGO, based on information from DET.

The implementation issues with the CDIS caused a one-year delay in councils reporting the number of MCH consultations for 2015–16 to DET. The analyses in Figures 3G and 3H use information available up to 2014–15. DET advised that it is working with MAV to resolve the issues in future years.

Figure 3G shows the 10 metropolitan LGAs with the most significant increases in the number of MCH home consultations over the period 2010–11 to 2014–15. Six of the seven greenfield growth areas were represented, as well as a few inner LGAs, such as Melbourne and Moreland. In 2014–15, there were 76 265 home consultation visits across the state, including 56 194 visits in metropolitan Melbourne.

Figure 3G

The 10 metropolitan LGAs with the highest increases in numbers of MCH home consultations between 2010–11 and 2014–2015

Source: VAGO, based on data from DET.

In contrast, Figure 3H shows that in 2014–15 the participation rates from the eight‑month MCH visit onwards in four of the seven growth area LGAs were among the lowest in the state.

While participation in MCH services across Victoria decreases as children get older, the decline in participation in growth areas is more pronounced. This decline is likely to be associated with the particular groups that live in growth areas rather than the fact that they are specifically located in growth areas.

Figure 3H

MCH participation rates in growth area LGAs, 2014–15

Source: VAGO, based on data from DET.

DET’s School Entrant Health Questionnaire (SEHQ) collects a wide range of demographic and health-related information on children attending primary schools and contains more socio-demographic data than is collected through the MCH service. Based on SEHQ data, Figure 3I shows the participation rates of population groups for the 3.5 years MCH check between 2012 and 2016 across Victoria.

Figure 3I

Reported attendance at an MCH centre for the 3.5-year-old check, by population group, 2012–2016

Source: VAGO, based on SEHQ data.

Although overall participation is improving, participation by children from families with a language background other than English remained steady from 2012 to 2014, rose in 2015 but then declined in 2016. The data also shows that the participation rates of children from ATSI families have been rising and exceeded the state’s average for all children in 2015 and 2016.

A range of factors may have contributed to the lower-than-average participation results shown in Figures 3H and 3I, including:

lack of awareness of the services

physical access issues including distance to the services, and operational hours not enabling access by working mothers

lack of acceptance of the services by some cultural groups

lack of infrastructure or service provision in greenfield growth areas.

The Murdoch Children’s Research Institute conducted research in 2012 into the use of MCH services by refugee women and their children, with women reporting that transport accessibility was a factor. The study found that some women could walk to their closest MCH centre, but others had no access to private transport, or found that public transport was difficult to use due to distance from home. Others faced challenges such as managing several young children, including walking toddlers and infants in prams. This research indicates that, in some areas, socio-demographic and transport access issues could exacerbate lower or non-participation rates.

In 2015 and 2016, DET commissioned research to identify statewide opportunities to improve engagement with MCH services by CALD and ATSI groups. Based on the research on ATSI families, DET advised it will begin trialling a new service model in September 2017 that aims to increase ATSI families’ access to and participation in the universal MCH service.

DET advises that it believes the key determinant of lower MCH participation is the socio-economic and demographic characteristics of the communities. DET indicated there is a higher proportion of groups who tend to have lower participation rates in growth areas, and that this contributes to the more pronounced decline in the MCH participation rates shown in Figure 3H. However, DET has not conducted further research to confirm this.

In general, local councils have limited understanding of the major reasons for the lower or non-participation within their areas. This confirms the finding in our 2011 audit Early Childhood Development Services: Access and Quality.

A robust understanding of the drivers of demand and reasons for lower and non‑participation is necessary to inform assessments of MCH service performance. Without comprehensive data, DET and local governments currently have limited knowledge of whether the government’s policy objectives for universal MCH services in areas of rapid population growth are being achieved.

Supply planning for maternal and child health services

The availability of qualified MCH nurses is a key component of supply planning for MCH services. This is potentially more difficult to adjust quickly than is the availability of infrastructure, as MCH services do not require highly specialised facilities. Since councils plan for and employ MCH nurses, DET’s involvement is limited to periodic assessments of demand and supply in the MCH nurse workforce.

DET completed an assessment of the MCH workforce in 2015. This assessment found that Victoria was not experiencing a shortage of MCH nurses overall, but that factors such as the ageing MCH nursing labour force and a growing demand for services due to population growth were likely to result in an inadequate supply of MCH nurses in future years.

Consultations with the audited councils and stakeholders in the sector also indicated that there is a pressing need to systematically plan for the MCH nurse workforce as:

a large proportion are aged over 50 years old—DET estimated in 2014 that over 65 per cent were over 51 years old

the community has high expectations of the quality, training and accreditation of the MCH nursing workforce, which means it currently takes about four or five years to become a qualified MCH nurse.

DET is currently developing responses to the identified future need for increasing numbers of MCH nurses across the state, which is a positive initiative. Since 2004, DET has run a postgraduate scholarship program that aims to encourage eligible nursing professionals to complete the extra qualifications needed to join the MCH workforce. More recently, under the Early Childhood Reform Plan announced in May 2017, DET received $5.2 million from the 2017–18 State Budget, which it will invest in attracting new MCH nurses into the service. These are positive steps. Some councils, including the Moreland City Council, have offered incentives to improve the retention rate of existing MCH nurses.

Overall, there is no sound understanding of the demand for and supply of MCH nurses at the local level. DET regional staff advised that at some locations MCH nurses are experiencing huge workloads due to population growth, while in other councils the nurses’ capacity may not be fully utilised.

In some local councils, the shortage of qualified nurses can have a flow-on effect on the quality of the services provided. In the Moreland City Council, it took an extended time to fill a nurse position for its enhanced MCH service. During this time, the universal MCH service worked with families who were eligible for enhanced MCH services, but without the clinical supervision that would typically be required.

MCH nurses are health professionals and must be considered as part of statewide health workforce planning. DET has not involved DHHS in this project, but has acknowledged that collaboration would improve MCH workforce planning.

Supply planning for MCH services also involves designing appropriate delivery models. Some councils have taken a proactive approach to improve local access and participation. Mitchell Shire Council provides MCH consultations in shopping centres to engage better with harder-to-reach families. Mitchell advised that it is easier for it to connect with local groups than in some other LGAs, due to its smaller population size.

MCH services need centralised oversight to determine how these services can be better delivered in line with changing socio-demographic trends.

3.5 Strategic planning for kindergarten services

High-quality early years education is critically important, and this is reflected in the government’s policies for and commitment to early years services.

Under the current arrangements for service planning, no agency is responsible for ensuring there is an adequate supply of quality funded kindergarten services when and where needed across the state, particularly in areas of rapid population growth.

The collection of system-wide information on kindergarten attendance is another area of concern. The government lacks a sound understanding at the state and local levels of who is accessing kindergarten services and whether eligible children are missing out. As a result, the government is not fulfilling the objectives set out in its policy document Education State 2016, which states that kindergarten provision is at the heart of the government’s vision.

Roles and responsibilities

Various organisations provide kindergarten programs in a range of settings that reflect child, family and community needs, including:

standalone kindergartens

long day care centres

childcare centres

community centres

some schools.

Individual public and private providers deliver kindergarten services through service agreements with DET. The agreements set out relevant legislation, program objectives, service delivery standards, funding responsibilities, performance measures and reporting requirements. Unlike MCH services, there is no formal arrangement in place between councils and DET for the provision of kindergarten services.

Local governments have the lead role for kindergarten infrastructure planning within their areas, in line with their statutory and social responsibility to plan for their local community. Councils that are the sole provider of kindergarten services for their local area also lead the kindergarten service planning for their area. Of the 79 councils in Victoria, 40 are directly involved in providing kindergarten services.

Figure 3J shows the delineation of roles and responsibilities between DET and local government for service planning and infrastructure development for kindergarten services.

Figure 3J

Agency role in planning for kindergarten services

Agency Statewide planning Statewide infrastructure planning Local service planning Local infrastructure planning DET No Yes, when collocating with schools Through partnership with councils Yes, when collocating with schools Local councils No Yes Mostly yes, with some exceptions Yes, able to fully fund kindergarten infrastructure or partly fund along with funding from DET

Source: VAGO.

DET works collaboratively with local government and the kindergarten sector to support the supply and quality of service provision. DET’s performance monitoring has a strong focus on programs that provide vulnerable children with access to kindergarten.

Until recently, there has not been a clear role for DET to plan statewide services or infrastructure, except when a kindergarten is collocated with a school. Some local councils do not provide kindergarten services for a variety of reasons, including financial constraints. When this happens, there is no entity accountable for ensuring the community has universal access to high-quality kindergarten services.

In recent years, the state government made commitments through the Commonwealth Government’s National Partnership Agreement on Universal Access to Early Childhood Education to provide preschool-aged children with universal access to 15 hours of kindergarten per week for 40 weeks of the year before they start school. As a result, it needed to understand whether the kindergarten system could cope with the demand.

In 2011, DET engaged and funded councils to conduct capacity assessment reports to find out what was needed to fulfil the 15-hours guarantee. This required councils to engage with every service in their municipality to understand staff and infrastructure capacity. However, councils have not completed these assessments regularly.

Starting in 2013, DET, in conjunction with MAV and councils, developed and implemented universal access plans, which were completed in 2015. These plans outlined the agreed actions to meet the 15-hours guarantee, and the goals of the National Partnership Agreement on Universal Access to Early Childhood Education, which applied to each council area. Based on the most recent Report on Government Services in 2017, Victoria is one of the best-performing states when assessed on children’s kindergarten participation of 15 hours per week.

Demand for and access to kindergarten services

In 2016–17, the state allocated $582.4 million to early childhood development. This includes kindergarten participation and MCH services across the state. Funding for kindergarten is provided on a per capita basis, and the standard per capita grant for January to June 2017 was $3 390 per child. This represents a significant level of public investment in the kindergarten system.

There is limited information on demand for kindergarten services at an LGA level or at the statewide level, which compromises DET’s and councils’ ability to plan effectively. Many factors lead to weaknesses in the information available on kindergarten service provision:

Not all councils operate a centralised kindergarten enrolment system. Currently 44 of the 79 councils have a system for centralised recording of kindergarten enrolment applications and placements within an LGA.

It is not mandatory for kindergarten service providers to participate in centralised enrolment systems that some councils operate. For example, Moreland Council advised that, of its 32 public and private providers, five do not use its central enrolment system.

There has been no systematic research into under-participation in kindergarten services by particular groups in the community, or in areas experiencing rapid population growth. DET has introduced initiatives to improve kindergarten participation by specific vulnerable groups such as children from ATSI families.

DET can overstate or understate kindergarten participation data because ABS population estimates of specific age groups in small areas and areas experiencing rapid population growth are less accurate. This could result in participation being over 100 per cent, as shown in Figure 3K. Further, the data only captures attendance at a point in time, rather than ongoing attendance.

There is also untapped demand when families of kindergarten-age children do not actively seek kindergarten services for a variety of reasons, including cultural beliefs or practices, or families not knowing about the services available.

A lack of understanding of the demand patterns has compromised DET’s and councils’ ability to proactively plan for kindergarten services. DET is investing $5.5 million through the Early Childhood Reform Plan to expand and improve councils’ central enrolment systems, which may contribute to an improved understanding of service demand.

Measuring participation in kindergarten services

The Kindergarten Information Management (KIM) system is DET’s central system for collecting information on service providers, determining funding needs and monitoring participation. KIM collects a snapshot of attendance details for each child enrolled in August each year, but does not capture ongoing participation. DET uses this data to calculate participation rates—the number of children enrolled compared to the estimated number of four-year-olds—expressed as a percentage, for each LGA and statewide.

In 2015, DET reported that the kindergarten participation rate across the state was 98.1 per cent, up from 96.4 per cent in 2014. Figure 3K shows that in 2015 DET estimated that five out of the seven greenfield growth areas had higher participation rates than the metropolitan average.

Figure 3K

Kindergarten participation rates in growth areas, 2015

Source: VAGO, based on data from DET.

Figure 3K shows that in some LGAs the estimated participation rates exceeded 100 per cent. A council can have a participation rate that is greater than 100 per cent if the actual number of four‑year-olds who reside in the LGA and are enrolled in kindergarten services is greater than the ABS estimate of the number of four-year-olds.

Another source of information on kindergarten participation is the SEHQ, which collects a range of information about children’s health and wellbeing, including whether children have attended kindergarten services before starting primary school. Based on this data source, Figure 3K shows that participation in kindergarten services by children in greenfield growth areas was lower than DET’s estimate in most cases, except for Whittlesea.

Figure 3L shows preschool and kindergarten attendance rates from 2012 to 2016, based on the SEHQ data. It shows that ATSI children and those from a non‑English‑speaking background, who are among the most vulnerable groups of children, have the lowest attendance rates in the state. The numbers for 2015 are the exception and appear at odds with the other years. It also shows that the gap in attendance rates between ATSI and all children has gradually reduced since 2012.

Figure 3L

Children reported to have attended a preschool or kindergarten program, by population group, 2012–2016

Note: The 2016 survey asked a slightly different question on kindergarten attendance—comparison of reported attendance rates in 2016 to previous years should be interpreted with caution.

Source: VAGO, based on SEHQ.

Lower participation by children from a non-English-speaking background is also consistent with findings from the Report on Government Services 2017: Volume B Childcare, Education and Training, which found that representation of children from a non‑English-speaking background in kindergarten was 15.5 per cent, compared with 23.4 per cent in the general population. This indicates that kindergarten services have yet to respond fully to the changing needs of local communities.

Participation results shown in Figures 3K and 3L reflect the weaknesses in KIM and SEHQ datasets and require caution in interpretation. KIM only provides a snapshot

of attendances based on enrolment, not ongoing participation. The SEHQ is a questionnaire completed by parents, but not all schools or parents complete the SEHQ—the completion rate was 84.7 per cent in 2014. The reliability of SEHQ data is also dependent on how accurately parents respond to the relevant questions about kindergarten services. For example, some parents may not consider a kindergarten program in a long day care centre to be kindergarten.

DET advised it makes limited use of SEHQ datasets for calculating participation in kindergarten services.

Supply planning for kindergarten services

Multiple public and private providers deliver kindergarten services. This mixed market creates considerable challenges for both councils and DET in responding adequately to changing demand for services, and further compounds the challenges arising from the lack of a robust understanding of potential demand.

At December 2016, there were 2 312 kindergarten services in Victoria, of which 1 186 (51 per cent) were for sessional kindergarten services, with the remainder delivered in long day care centres. There are six types of service providers, as shown in Figure 3M.

Figure 3M

Share of kindergarten service providers, snapshot at December 2016

Source: VAGO, based on data from DET.

Councils currently do not have ready access to the full range of information that could help their forward planning. For example, councils do not receive SEHQ data that DET collects through schools. SEHQ data could help councils to better understand whether children from the local area attended kindergarten before starting school. This information could reveal untapped demand for kindergarten services in the local areas and could prompt actions to address gaps in service provision.

Figure 3N illustrates how this information helped Moreland City Council with its early years service planning.

Figure 3N

Rising demand for kindergarten services: Moreland City Council

Between 2001 and 2015, births in the City of Moreland increased by 40 per cent. VIF forecasts show that Moreland will be the sixth-highest growth area in Victoria between 2011 and 2031. Coupled with this high growth, Moreland City Council’s service planning has also experienced challenges from the increased diversity in its population and, in some locations, the heightened socio-economic disadvantage of residents. The council became aware in 2009 that only 15 of the 34 Grade Prep children at Fawkner Primary School had attended kindergarten, based on SEHQ results. The other 19 children were either in Australia and did not attend, or were born overseas and did not come to Australia until Prep year. The 2009 Australian Early Development Index data subsequently confirmed the council’s finding that children from Fawkner Primary School had the lowest preschool participation rate in Moreland. Despite the Moreland City Council identifying the problem in 2008–09, it only secured funding of $1.08 million for a new centre in 2013, with a contribution of $0.65 million from DET. The Moreland Council offered enrolments for the new centre from January 2016.



Source: VAGO, based on information from Moreland City Council.

Private providers notify councils of their interest in offering kindergarten services when they apply for a planning permit, but councils do not necessarily know if the proposed service proceeds beyond this stage. This means that councils do not always have complete information to inform planning for kindergarten infrastructure within their local areas. Similarly, DET acknowledged that accurate estimates of required infrastructure investment to respond to population growth are not currently available.

3.6 Future actions

Through consultations with early childhood system stakeholders that began in August 2015, DET has identified opportunities to improve the system, including the planning and provision of MCH and kindergarten services. DET found that the current system is complicated by three levels of government being involved in funding and delivery, with none taking overall responsibility for service provision planning, performance and outcomes for children. From the public’s perspective, the system is confusing and uncoordinated.

Positively, the recent Early Years Compact has formalised the respective roles and responsibilities in early years services, and aims to improve the planning and provision of MCH and kindergarten services. It includes a strategic priority to strengthen place‑based governance and planning to respond to the needs of local communities and Victoria’s changing population.

As part of the implementation of the Early Childhood Reform Plan and its role in the Early Years Compact, DET will take a more active role in estimating demand and supply for statewide kindergarten service delivery and for the long-term provision of kindergarten infrastructure. It will do so in partnership with local government, including working together to better identify local needs.

There is a need for a more integrated and strategically planned system that would deliver the services that families and children need, where and when they need them. We acknowledge that the Early Childhood Reform Plan and the Early Years Compact are positive steps, although still at an early stage. It is important that both initiatives are implemented with a focus on improving outcomes, accountability and quality. This will enable the state to maximise the return on its investments in MCH and kindergarten services.

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