Funding (Public/Private)


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Initiative Title: Funding (Public/Private)
Category: Infrastructure Initiatives
Description:

Premise

Our Australian community relies too heavily on unnecessary Hospital treatment.  Consequently, our current Hospital-centric health care model has become unsustainable and unaffordable.  An alternative is the considered introduction of  community-driven health care services that fill the many gaps in our current health care system; gaps not able to be effectively addressed by our hospital system.  It is possible “to get ahead of the game” by individuals taking greater responsibility for their own well-being and health care issues, especially those that are (in the main) self-inflicted and thereby self-correctable and self-managable.  The proposed Manly Community-driven Health Care Facility (McHCF) would become part of new health care model – a hub of health care services positioned between our current Hospitals (Triage) and the emergent of the innovative “Home Hospital” (ie. private homes empowered with health care enabled technologies serviced from a Community-driven Health Care hub, such as McHCF).

The McHCF would have self-funded permanent accommodation (for a mix of affordable Aged Care, Disability and Health Carer residents) and temporary housing (for addiction rehabilitation, mental health, hospice and Men’s & Women’s Refuge residents).   Each being supported and funded by Not-For-Profit organisations from the private sector.   On-site would also be public/private funded non-resident health care services (doctors, dentists, physios, podiatrists, personal-trainers, well-being specialists, health food outlets, etc.) whose services would also extend into private homes, in much the same way their services are delivered to the on-site permanent and temporary residents.  The mix of well with unwell is a proven approach to community members caring and supporting one another, thereby avoiding the need to call upon hospital services. leaving hospitals focus upon patients needing their specialist services and equipment only. 

 

With the imminent closure of Manly Hospital in October 2018, the Manly Community has had the long held expectation that the site be used to fill the many community Health Care gaps identified across the Northern Beaches area.  The site and existing buildings are all owned and managed by the NSW Government (Health Dept).  We are fortunate that our current NSW State Premier (Gladys Berejiklian) was born at Manly Hospital and also worked in our Corso shopping area.  She has made it clear on numerous occasions that it will be our local Manly Community who ultimately determines the future of the site.   To this end, the Manly Community forum has made their community expectations well known to our respective Government representatives (Federal, State and Local Council) over the past 10 years after we accepted that The Manly Hospital site was not suited to supporting a new proposed level 5 Hospital, now about to open at Frenches Forest.   The Manly Hospital site has long been identified as ideal for filling our many urgent health care gaps:-

  • Aged Care
  • Affordable Housing
  • Youth & Adult Palliative Care
  • Addiction Rehabilitation (Obesity, Smoking, Drug, Alcohol, Gambling, etc.)
  • Residential Health Care Workers, Students, Nursers, Teachers, Researchers
  • Community Health Care Support Services, Education and Administration

A key condition of the community take-up from NSW Health is that funding of the site’s health care services not add to the NSW Government long term debit and that a viable funding model be devised that is sustainable and viably achieve this conditional goal.  A Memeorandum of Understanding (MOU) to this effect will be put in place as part of its operational principles and continuance.

The four key objectives of an onsite Community-directed Health Care facility is to :-

  • Fill existing gaps in Health Care services across the Manly Community and those arising from having our nearest public hospital some 15 kilometres away (in Frenches Forest)
  • Take the pressure off our current Hospital system, especially the new Frenches Forest and existing Mona Vale Hospitals
  • Accommodate a diversification of compatible health care providers, with healthy and not-so-Health residents all prepared to collaborate and care for one another (when able to)
  • Extend the available Health Care facilities available at the site into the broader community, drawing upon the greatest Australia asset (the private home) and through the innovations made possible through advances in modern technology progressively make these “Home Hospitals”.

There are many facets to the establishment of an effective Community-directed Health Care facility (one of which is funding – how the McHCF will fund it:-

  • Community Environment – conducive to Health Care and needs of our disadvantaged
  • Buildings (new & existing) & Infrastructure
  • Care Capabilities (Compatibility of Residential, Volunteer and Commercial)
  • Technology, Innovation and Health Reform (especially regulatory controls)
  • Transport and Communication
  • Ecological & Environmental 
  • Regulation, Governance and Administration
  • Funding

 

Funding (Public/Private)

It has always been envisaged that an all-inclusive Funding Model be considered that includes both public and private funding (as for the new Frenches Forest Hospital), but much more Community-directed.  

  1. Multi-faceted Public Funding:-
  • Federal Government
  • NSW State Government
  • Northern Beaches Council
  • Manly Community Services, Volunteers and Residents
     
  1. Multi-faceted Private Funding
  • Not-for Profit Organisations
  • Local Business, Investors, Philanthropic, Crowdfunding and For-Profit Organisations

Funding Scenario (for Aged Care)

Once the range of integrated Health Care capabilities are fully defined and shown to be viably accommodated onsite, a complete Funding Model can be shaped via the likes of Expressions of Interest (EOI), RFI, RFP, RFT, etc.  In the meantime, one priority Community Care capability that is well defined and able to be accommodated within the context of existing but fully renovated onsite buildings, is Aged Care.  By taking Aged Care as a typical Health Care service scenario (for low-medium income elderly residents), it is possible to illustrate how an all-inclusive, multi-faceted Funding Model might be implemented. 

The Federal Government has devised its own Aged Care Funding Instrument (ACFI) for assessing the relative care needs of residents and is the mechanism for allocating the government subsidy to Aged Care providers for delivering of Health Care to residents.  Currently ACFI is reviewing its principles for Aged Care Services, using those devised by Not-for-profit Aged Care providers.  The ACFI would form the foundation to the development of an associated Funding Model for a Manly Community-directed Aged Care facility (MCACF).  In addition to the ACFI (for care providers and our elderly residents) funding is needed for the refurbishment, establishment and running an Aged Care facility on the Manly Hospital site.  

An initial high level assessment of the current onsite buildings, has identified up to 10 of the main existing buildings could be re-usable for Aged Care, especially those with wide access lifts and corridors where patient care is already being delivered.   Pro-active planning for such a re-use strategy would facilitate the quick-start-up, low-cost delivery of a much needed Aged Care facility and serve as the foundation to any additional onsite Community-directed Health Care facilities on the site.  How might this initial re-use strategy be funded?

Organisations like Oceania Healthcare (a NZ based company) and Arvida have had great success focusing upon “care beds”.  Whereas groups like Summerset and Metlife Care focus more on “independent “independent units” in the provision of aged care.  The most affordable and more suited style for low income elderly is the “care bed” model.  This style of aged care accommodation is also more suited to the potential re-use of the many existing Manly Hospital buildings earmarked for re-use, redesign and refurbishment.  As shifts occur to circumvent the problems caused by increased housing prices in Sydney and Manly in particular, key areas such as Manly are finding severe shortages in not only affordable housing but also general Health and medical services.   Key investors, like the Bennet family offices with backers like AMB Capital Partners and other wealthy individuals specialising in this sectors are all keens lookers for opportunities such as a Manly Community-directed Health Care facility, as are medical centre businesses (such as Cornerstone Health).    

Our past-Premier (Mike Baird) has already made provisions for seed funding a Northern Area Health Services Steering committee, which has been extended our latest state member – James Griffin. 

A newly formed Project Steering Advisory Committee (PSAC) has been established since the election of James Griffin as our NSW State Representative.  Being the current Owner responsible for the Hospital site and its current buildings, naturally the NSW Government (and Health Minister Brad Hazzard) will play a pivotal role in shaping the before mentioned multi-faceted Public/Private Funding Model; working in conjunction with the PSCA.     

Public Funding Opportunities

  1. Federal Government Funding
    1. Dept. of Health
      1. Funding State Health Initiatives (with Australian-wide implications, eg eHealth, Hospital systems, NDIS, Medicare & Centrelink, etc.)
    2. Dept. of Family and Community Services
      1. Funding Health Care Community services
  2. NSW State Government Funding
    1. NSW Health Dept.
      1. Funding existing Building renovation – fit for Private/Community Investment
    2. NSW Land & Housing Corporation
      1. Funding infrastructure for Affordable Housing Innovation
    3. NSW Finance and Innovation
      1. The eventual site Owner/Custodian  
  3. Local Council and Community Funding
    1. Northern Beaches Council
  4. Residential Accommodation and Care Funding
    1. Community Residents

Private Funding Opportunities

  1. Not-for-Profit Provider Funding
    1. Housing Pathways
  2. Local Business and For-Profit Organisational Funding
  3. Residential Accommodation Funding from the local Community
  4. Crowdfunding (traditional, equity-based, reward-based)

Evolution of a Broader Funding Model

It is further envisaged that the initial funding approach for site development be leveraged across a broader Funding Model for the vertical integration of additional compatible Health Care capabilities. To better appreciate how this might be achieved, it is important to consider some of the underlying principles of innovative Community-directed Health Care service engagement, like:-

  • Vertical integration, Compatibility, Synergetics, Diversity and Inclusiveness – of residents, backers, community & providers engagement
  • Management and Policy Reform – Regulation, Governance and Administration
  • Effectiveness & Productivity – Technology, Science and Disruption 
Contact Name: Darryl Dobe
Contact Email Address: darryl@yourselfhelper.com
Start Date: 20-Jun-2017
End Date: 21-Dec-2018
Signup: I would like to signup as a Volunteer for this Special Project Initiative

Volunteers already signed up for this Special Project Initiative (if any)

  1. Darryl Dobe   darryl@yourselfhelper.com

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