As we head into Homelessness Week, we are all acutely aware of the housing crisis in Western Australia.

Recent research from Curtin University shows the depths of this crisis, with increasing numbers of people finding it hard to afford a home and over 40% of people who live in unaffordable housing experiencing poor physical or mental health. The report also tells us that homelessness in WA has risen 8% since 2016 and that the waiting list for social housing has grown to over 20 000. There are 6300 people who are considered to be of the highest priority of needs waiting for a home.

Sometimes we assume that all people experiencing homelessness are street present or “rough sleepers”. In fact, this is often not the case with many people (particularly women) who experience homelessness choosing to stay with family or friends, sleeping in their cars or staying in short term accommodation, which means they are often not visible and also underrepresented in data.

There is no debate that homelessness causes poor health with people who experience homeless experiencing much higher rates of mental health issues, stress and suicide. In addition to this, people who do not have a home tend not to access preventative health care, so their health needs are not addressed early and rapidly become more serious health concerns.

What often happens is that people who experience homelessness seek care at emergency departments of tertiary hospitals and their stay is often longer at these hospitals because there is no safe place for them to go upon discharge. The cost to the health system in treating and accommodating people who experience homelessness is considerable. In a recent study in Western Australia it was identified that over $400 000 was saved in the health system in 12 months by just three patients being placed in appropriate, safe, permanent accommodation. Hospital attendance and hospital admissions reduce significantly once housing needs are met, particularly if those housing needs include wrap around services such as integrated primary health care providers.

Of course we believe that safe, secure and permanent housing should be provided to everyone simply because it’s the right thing to do, for their physical and emotional wellbeing. However, we are aware that often times there needs to be an economic argument as well as a compassionate one, and well-designed social housing using Housing First principles seems to us to tick both boxes.

Photo by Gary Steadman of a reported bag from his LinkedIn post: “Thank you for bringing my living room to my attention.”

Housing First projects argue that housing should be provided first, rather than requiring people to meet a set of criteria before being provided with accommodation. This is a key change in the way homelessness is understood and managed, as it recognises that once someone has a home and appropriate support services nearby, it is much easier to transition into a situation where people may be able to seek work or otherwise make changes that allow less social isolation. Housing First principles make provision of housing a priority, while allowing the clients to access support services without conditions attached. The principles also eliminate the complexity of deciding who is more “worthy” of public housing, and rather just understands that housing is a human right and a health issue.

We are pleased to see some Housing First project progressing in the inner city of Perth and in Mandurah and some funding in the budget for further projects. While these projects are being built, however, we still see many street present people in our neighbourhoods, and this cold, wet weather makes us all acutely aware of how challenging and distressing this must be. We welcome initiatives like the Orange Sky mobile laundry and the Brollie Brigade who provide free mobile hot showers, haircuts and hygiene services, along with Street doctor services. These organisations work tirelessly on the front line of service provision for street present people.

We are still heartbroken though to hear stories of local government rangers removing or threatening to remove the possessions of street present people, as was highlighted recently on LinkedIn or the callous approach some local governments take to move on people who are sleeping in their vehicles or on the streets.

We consider homelessness to be a health issue, as well as a social one, and we welcome the appointment of a Minister for Preventative Health. We hope this preventative health lens takes a wide look at the social determinants of health, including housing, to ensure that housing programs continue to be a high priority for this government.

Bronwyn Ife  |  Systemic Advocacy and Engagement Lead

Media enquiries: 0488 701 839 | info@hconc.org.au

HCCWA welcomes the recent report “Special Treatment: Improving Australians’ access to specialist care” from the Grattan Institute into the cost of specialist appointments.

“The cost of specialist care is a problem for many people, across all areas of health.” according to Clare Mullen, the Health Consumers’ Council WA’s Executive Director in regards to the Grattan Institute‘s report about expensive specialist doctor fees.

“It’s really tough for people to have to make the choice between going on to a public wait list and with no information about how long they might be on that wait list, or trying to find the money to pay for care privately if they do have private health,” she stated in her interview with Nadia Mitsopoulos on ABC News Perth Mornings.

Our Health Advocate Team, who are on the front line of our specialised one-on-one advocacy service, know this all too well; we hear regularly about the prohibitive cost of specialists from people across WA. As Clare Mullen points out in this interview; the emotional and vulnerable nature of healthcare decisions make it crucial for consumers to have trustworthy information. “It’s important that consumers are given access to the information that they can trust to make informed decisions and let’s make healthcare a bit fairer for everyone.”

Health Consumers’ Council WA offer the ONLY free individual health advocacy service in Australia.

Listen to the interview starting at 51:45 here.

Our hybrid health system means that consumers can find themselves caught between choosing to attend an appointment with a private practitioner or waiting for an outpatient appointment in the public system. The lack of transparency around waiting times for public appointments does see people choose to see a private practitioner, but as this report highlights, the cost of these appointments can be well outside the reach of many consumers with one extreme example of an appointment that left a consumer with an out of pocket cost of over $600.

Ideally the health system would have sufficient staff and funding to mean that the toss up between high costs and long waits would not occur .  We are encouraged by the recommendations of the report to identify and train specialists in the fields that are most in need, and also to invest in public clinics in areas where they are most needed.

It is also interesting to note that the report has identified that the current system makes it challenging for GPs to receive advice from specialists about managing specific patients, which therefore leads to a larger than required number of referrals being made to those specialists. The report recommends a secondary consultation system which would reduce referrals to specialists and reduce patient expense and stress at navigating the complexities of the health system. It also has the undeniable benefit of reducing pressure on the specialist system, freeing up time for more patients to be seen. It is these kinds of radically different approaches to the provision of health services that we need to ensure our health system can evolve to manage a growing and aging . Before the state election in March this year the WA Labor government promised a pilot program called “GP Ask” to trial a secondary consultation model, and we look forward to the results of this pilot.

The report refers to the Commonwealth Government’s Medical Costs Finder website which provides some helpful information about how much people can expect to pay for certain procedures. Sadly, very few doctors have voluntarily provided their fees for this website, but the Government has committed to using Medicare data to upgrade the website to give a more accurate picture of the costs a patient can anticipate if undertaking their care in the private system.

The Grattan Institute goes further though and suggests that the government legislate to claw back some extreme fees charged by practitioners. We would be interested to see how this might look and we continue to monitor this situation with great interest.

Bronwyn Ife  |  Systemic Advocacy and Engagement Lead
For media enquiries: 0488 701 839

The State Budget was handed down on 19 June and HCCWA was pleased to be invited to the industry budget briefing and lock in.

Reading the budget documents, it was great to see all health-related election commitments being funded, as these included some important infrastructure promises and some interesting and innovative programs. We are looking forward to the implementation of the GP ASK program, which should reduce unnecessary referrals to specialists, which in turn reduces waiting times for patients. We are also interested to see the WA Virtual Emergency Department expanded and serving more community members. Great preventative programs such as funding for Ngala and the Australian Breastfeeding Association are also welcomed.

Other health items included:

• Improvements to nurse to patient ratios
• Expanding the pharmacist scope of practice to allow greater choice for consumers for access to care for some uncomplicated health conditions
• Additional beds in the Time to Think program, accommodating hospital patients who are waiting for an aged care placement
• Funding to develop the Perth Biomedical manufacturing hub to help grow the local medical research industry
• Funding for the first Dementia Action Plan
• Funding for a Medical Respite Centre for continuing care people experiencing homelessness who need access to the hospital system.

Spending on healthcare for people in regional areas is vital and we welcome the increases to the Patient Assisted Travel Scheme, as well as infrastructure investment in health services in Bunbury, Albany, Geraldton, Kalbarri and Kalgoorlie. Expansion of renal dialysis in Halls Creek and Fitzroy Crossing is also a great step in providing crucial health care close to where people live.

While spending on infrastructure is crucial, there is a wider picture in the health system that needs to be examined. We were hoping to see investment in radically different models of care, as recommended by the Sustainable Health Review. Community Connector and Social Prescribing models are proving to be hugely important at providing services to community members where they live and in keeping people well, connected, and out of hospital. While Silver Chain programs are funded in this budget, there is nothing for new and innovative community connector programs that will be essential in the future of our health system.

While we welcome many cost of living initiatives, such as free public transport to school, we were disappointed that there was nothing in the budget to help WA health consumers and their carers with the high cost of parking at hospitals. Our hospitals are free, but accessing them is not free, we’ve heard from people who have had to take out pay day loans to cover the cost of hospital parking. Subsidising hospital parking would be an excellent initiative to assist people with the escalating cost of living and provide relief for people who are experiencing the acute stress of a sick, hospitalised family member.

Bronwyn Ife  |  Systemic Advocacy and Engagement Lead
For media enquiries: 0488 701 839