National Review of Community
Transport under the Commonwealth
HACC Program:
Final Report
March 27 th 2014
Prepared for: Department of Social Services
Executive Summary
Introduction
The Review of Community Transport has primarily sought to provide the
Commonwealth with sufficient information about HACC Community Transport to
support the development of more efficient and effective common arrangements for
transport in the Commonwealth Home Support Program (CHSP). HACC Community
Transport within this review included HACC Community Transport (Service Group 7),
HACC Community Transport embedded in other HACC services and HACC-like
transport arrangements.
The review has provided the Commonwealth with information about the current
arrangements for transport that include HACC Community Transport or arrangements
that affect the design and delivery of HACC Community Transport services. This
information was primarily provided through six evidence gathering activities that
included: a literature review; data analysis; National discussions in all States and
Territories and in regional centres; website questionnaires for providers and
client/carer/representatives; jurisdictional mapping and sector consultations. These
activities resulted in the production of five reports producing an evidence base and
accompanying analysis.
The HACC Community Transport Review reports are:

Literature Review

Data Analysis Report

National Discussion Summary Report (developed from 15 individual site reports)

Website Questionnaire Report

Jurisdictional Mapping Report
The evidence and analysis presented in these reports has supported the development
of the fundamental steps detailed in this report. The adoption of the proposed
fundamental steps detailed in this report will support the development of common
arrangements within CHSP Transport and produce greater effectiveness and
efficiencies. These proposals have been developed with sensitivity to the context
within which HACC Community Transport is delivered and included consideration of
the Commonwealth Government’s commitment to reducing unnecessary red tape.
Key Themes arising from Review Activities
Demand
The growth demand for HACC Community Transport will be significant over the next
15 years (+64.9% in the 65+ years population by 2026). The growing demand for
transport will put significant pressure on the entire health and aged care systems and
the plethora of alternate transport programs and arrangements that are focused on
the HACC target population.
The demand for additional HACC Community Transport services is being driven by the
growth of the population 65 years and over and the increasing number of older people
choosing to age in the community (Commonwealth policy supports this choice). Key
factors within this population that impact on the growth in demand for transport
include:

The prevalence and impact of dementia

The increasing support requirements related to the activities of daily living as
people age
ii

The high demand for health services as people age

Reduced access to family carers
These demands will only add to the operational pressures impacting on service
providers which include:

Costs outstripping the growth in Government funding

Uncertainties regarding the future source of funds required to replace vehicles

More State regulation affecting transport operations of community transport
providers leading to increased costs

Ageing and reducing pools of volunteers
The Complex Range of Transport Services
HACC Community Transport (Service Group 7) operates within a complex
environment. This environment includes: embedded transport in other HACC
programs, other Commonwealth Aged Care and Carers programs, alternate State
Transport schemes, Non-Emergency Medical transport services and other
Commonwealth programs that include embedded transport.
Within the HACC program transport is delivered as either a unique service type (which
includes transport reablement activities) or as an enabler of other HACC programs.
Transport is where the client is transported rather than where support worker travels
to the client. HACC service types other than HACC Community Transport (Service
Group 7) identified as having significant embedded transport includes:

Social Support

Respite

Domestic Assistance and Personal Care (particularly in Victoria)

Volunteer Coordination and Linkages – Aged Care (Victoria Only)

Centre-based Day Care (excluding Western Australia)

Case Management and Coordination
The review has also found that transport is embedded in other programs that will
form part of the new CHSP program: Assistance with Care and Housing for the Aged
(ACHA), National Respite for Carers Program (NRCP) and Day Therapy Centres (DTC).
The Commonwealth Home Care Packages (HCP) program also intersects with HACC
Community Transport. HCP providers purchase services from HACC Community
Transport and other transport services and will do so with increasing frequency as the
Home Care Package program is expanded. It is worth noting that HCP clients are
estimated to be using a quantum of transport equivalent to the current HACC
Community Transport (Service Group 7).
In addition to these programs there are other transport programs such as:

Local Government transport schemes

Transport provided by clubs

The COAG Closing the Gap transport scheme

Subsidised Public Transport Schemes

Taxi Transport Subsidy Scheme (all States and Territories)

Fuel Card (Western Australia rural areas)/Cars for Communities (Tasmania)
There is an increasing demand for non-emergency medical transport in the HACC
Community Transport program resulting in a negative impact on the availability of
transport to support other aspects of the activities of daily living. There are multiple
factors impacting on the demand for non-emergency medical related transport in
HACC and more broadly which include:
iii

Reducing or static resources being provided by Health Services for transport

Increased length of life and rapidly increasing population of very old people (85+)
with resultant proportionally higher demand for health services

Increased demand for transport to renal dialysis

Increasing impact of initiatives that are supporting older persons to age in the
community

Increasing incidences of health and specialist services being retracted to larger
population centres

Shortages of General Practitioners (GPs) particularly in regional and rural
Australia
While HACC Community Transport supports eligible older people to access GPs,
Specialist and Health Services there are also other schemes that provide alternate
options to access health services. These transport schemes include:

Patient Assisted transport

Non-Emergency Patient Transport Schemes

Other Health Service Transport arrangements/programs
The significance of these findings is to appreciate that HACC Community Transport
clients are, in many cases, choosing from a menu of transport options and they are
doing so to meet their individual support and social needs. The complex system of
multiple programs, varied eligibility and assessment criteria is leading to duplication
of services, inequity and gaps in service delivery.
Models of HACC Community Transport
The key models and approaches used in the delivery of HACC Community Transport
are:

The Victorian model: is an approach that has been led through a philosophy
enshrined in policies and guidelines. This approach considers transport as an
enabler of other HACC programs rather than a designated service type

The Transport for NSW model: which administers about 70% of HACC Service
Group 7 transport (trips) in NSW through brokered arrangements to a network of
Community Transport providers

Community Transport Services Tasmania: which is the only State-wide single
provider model; the model uses volunteer coordinators and drivers supporting the
transport needs of the HACC target group and the wider needs of transport
disadvantaged people in an integrated and coordinated approach

Community Passenger Networks (CPNs): which operate in South Australia
primarily providing information, coordination, brokered transport services and
transport services as a last resort

Service Clusters: this is the most common approach used in Australia; in this
model the provider delivers a range of HACC services (and/or other Aged Care
services)

Specialist Community Transport Providers delivering a cluster of transport
services to persons who are transport disadvantaged
iv
Carers
Community Transport is accessed by carers who are currently not able to be reported
in HACC Community Transport (Service Group 7) outputs. There is an opportunity to
review this practice and include carers in the CHSP target group.
Commonwealth Funded Aged Care
The key issues, considerations and implications related to the other Commonwealth
funded programs are:

DTC, HACC (all service types other than Service Group 7), ACHA and NRCP have
embedded transport in the programs as an adjunct to or enabler of the service.
As CHSP folds these programs into the overall program there are opportunities to
consider how services may be able to make better use of HACC Community
Transport infrastructure, expertise and services to respond to some of the
embedded transport needs. This should include the relationship of the carer to
CHSP Transport as the National Respite for Carers Programs becomes part of CHSP

The significant growth of Home Care Packages over the next ten years will
challenge the service system but also provide opportunities for HACC Community
Transport service providers to increase capacity and scale. An increase in
capacity and scale may support greater effectiveness and efficiency. In
responding to the community transport needs of Home Care Package clients,
clear policy guidelines will be required

Residential Aged Care clients are likely to have a diminished capacity to use CHSP
Transport into the future. A primary transport service for this cohort is likely to
be non-emergency patient transport
Workforce and Organisation Structure
The structure of the workforce and organisations delivering HACC Community
Transport is an important consideration with regard to appreciating the capacity of
service providers to scale up to meet future demand, the capacity to enact reforms
and the capacity to achieve common arrangements. Organisations responding to the
Website Questionnaire (793 organisations) reported the following workforce structure:

1,367 full-time paid administration/coordination staff and drivers

4,905 part-time paid administration/coordination staff and drivers

9,819 volunteer administration/coordination staff and drivers
It should be noted that these organisations may be only referring to staff deployed in
the delivery of HACC Community Transport not their entire organisation. Some HACC
Community Transport organisations operate with no paid staff at all.
63% of HACC Community Transport is provided by organisations that on average have
one part-time staff member in administration/coordination and one part-time driver.
On average 5.9 volunteers make up the rest of these services workforce.
Client Impacts: related to the current system
Clients of HACC Community Transport may have an array of other transport options
from which they can choose. Client choice and behaviour may dictate which of these
options are chosen; this includes HACC Community Transport. Client choice may also
be limited due to the information available to the client and the confusing eligibility
criteria. The array of transport options and differing client contributions add to the
complication of the system within which HACC Community Transport operates. In
rural and remote locations the options may be significantly limited however this
varies depending on the jurisdiction and/or remoteness.
v
Service Providers Impacts: related to the current system
HACC Community Transport services have developed across jurisdictions according to
State/Territory HACC policies/philosophies, the Territory/State’s geography,
legislative differences and parallel funding arrangements. These dissimilarities have
led to significant operational differences that indicate that developing common
arrangements under the new Commonwealth Home Support Program will need to be
achieved incrementally and with great sensitivity to current State and Regional
arrangements.
Service providers rely on community goodwill and volunteers and therefore providers
will need to be able to embrace and work with these key stakeholders to achieve
service improvements and common arrangements. The small size of the majority of
service providers means that there will be limited resources available for planning,
change management and policy development.
Funders Considerations: related to the current system
The small size of the majority of service providers presents a case for Government to
develop community development positions at a regional level that can work with
service providers and guide change processes. These processes will need to draw on
and secure the ongoing involvement of key stakeholders at a grassroots level.
Overall Implications: related to the current system
There are a number of service improvements and opportunities that will support the
development of common arrangements that would be beneficial to clients, providers
and Government. These improvements and opportunities in the short to medium term
(18 months to 3 years) need to focus on fundamental elements of the program. These
elemental steps are detailed in ‘Towards Common Arrangements’.
Towards Common Arrangements
The review found that was insufficient data available to reasonably determine the
models/options that will best meet the needs/requirements of clients, providers and
Government within CHSP Transport. As a precursor to making these determinations a
fundamental set of measures are proposed. These measures require immediate
attention to ensure that more significant reforms can be achieved as CHSP is
implemented.
Urgency for Action
The urgency for action is also driven by very significant drivers of demand for CHSP
Transport. A key finding of the HACC Community Transport Review is the significant
future demand for additional HACC Community Transport services which is being
driven by the growth of the population 65+ years and by the increasing number of
older people choosing to age in the community.
Fundamental Measures
The fundamental measures proposed to facilitate opportunities for improvements
impacting on clients, service providers and Government in the short to medium term
(18 to 36 months) are as follows:

Clearly define the purpose of Community Transport within the CHSP including
planning for an increased number of clients in the future, particularly clients with
dementia and other special needs and supporting and encouraging a wellness
approach in the CHSP, including transport

Clarify the role of the CHSP Transport in providing non-emergency medical
transport to clients
vi

Consider funding issues such as block funding arrangements, how capital items
are funded, and whether there is scope to introduce a different basis of unit
pricing in CHSP Transport

Define what data should be collected to effectively support, monitor and
evaluate CHSP Transport

Maintain, support and develop the volunteer base

Support and develop coordination functions, potentially across planning regions,
to enable service providers to work together and to assist service providers to
develop their capacity
These measures have been developed with sensitivity to the context within which
HACC Community Transport operates. This includes a mosaic of programs, substantial
reliance on volunteers and community goodwill and a large number of very small
HACC community service providers.
Definition of HACC Community Transport
Any definition for CHSP Transport will build on the main purpose and eligibility of the
CHSP. CHSP will support clients to maintain independent living in the community and
promote healthy ageing.
A definition for CHSP Transport should be written in plain English and include the
following aspects:

Direct and indirect transport service

Embedded transport where transport is an enabler to other service types within
the CHSP

Transport should be accessible to people (carers) escorting CHSP clients where
this support is required

Services that support transport reablement and independence.
The following elements should also be considered in a definition of CHSP transport:

CHSP Transport purposes could include:

social contact and support

local health appointments (e.g. General Practitioner, dentist, allied health)
and health services that maintain/strengthen health status

shopping and banking (activities of daily living)

religious and cultural observances

Possible exclusions: non-emergency medical transport which includes outpatient
services such as oncology, renal dialysis and other hospital based treatments.

Direct and indirect: direct transport services are those where the ride in the
vehicle is provided by a worker or a volunteer. Indirect transport services include
rides provided through vouchers or subsidies1

Independent living in the community.

Transport reablement: services focused on maximising the client’s capacity or
regaining skills related to travel independence

Travel: transport services provided to the client or carer/travel companion where
they are travelling in the vehicle

CHSP Transport should include: non-assisted/assisted transport and planned
(group) and on-demand (individual) services
1
Commonwealth HACC Program Manual, 2012, Commonwealth of Australia, Chapter 3 page 6
vii
Transition Activities
The following section considers implementation and transition steps that may be
considered if the report findings and proposals are adopted.
CHSP Manual
Transition Activities: CHSP Transport definitions, prescribed services and measures
will be detailed in the CHSP Manual including a process/cycle of sector input utilising
the communication and transition support
Communication and transition support
Transition Activities: A number of parallel activities will help facilitate change and
refine CHSP Transport arrangements within this complex and often under resourced
environment, these include:

Recognition from all parties involved in the review that this report represents a
starting place for change and that improvements and actions will be refined and
tested over the next three years

Develop a Coordination and Development function operating within each aged
care planning region to assist the sector to develop the capacity required to
execute the changes, to ensure that changes are sensitive to local operating
conditions and to develop forums for communicating with providers within each
aged care planning region

Establishing ongoing communication with an industry working group to facilitate
the changes such as working with Commonwealth in achieving the changes
required with respect to non-emergency medical transport, broader advocacy and
actions required to reduce the growth demand for CHSP Transport through a wide
range of transport reablement initiatives

Providing participants in the HACC Community Transport Review and other
stakeholders with feedback and information on the outcomes of the review and
ongoing updates on the progress being made
Scope of CHSP Transport
Transition Activities: the transport component of all of these programs will be
reported by providers. This will require new units of measure, data collection and
data analysis/reporting. It may also require this reporting to be a requirement of the
DSS contract with providers. Providers will need to consider their capacity (software,
vehicles and staff) to support the increased scope of services.
Transport Reablement
Transition Activities: New Transport Reablement service definitions will be written to
support the detailing of prescribed Transport Reablement services. Transport
reablement will require new reporting outputs to be developed. These outputs will be
included in new contracts. Providers delivering these reablement services under
current contract with DSS will require adjustments to be made to their contracts.
Additional research is required to identify a broad range of effective reablement
programs and measures.
Carers
Transition Activities: Policies and guidelines relating to the subsidy paid and fee
contribution (if any) for the carer and/or travel escort will need to be developed.
Providers will need to consider their capacity (vehicles and staff) to support the
increased scope of services.
viii
Non-Emergency Medical Transport
Transition Activities:

State and Territory Governments and their respective health services will need to
accept their responsibility to fund the burgeoning need for non-emergency
medical transport for outpatient and specialist appointments for people in the
CHSP target population including the unique issues in rural and remote Australia

State and Territory Governments and their respective health services may be able
to form contracts with existing HACC Community Transport providers to continue
to provide transport that is HACC–like to the client group who are currently
accessing non-emergency medical transport that will be excluded from CHSP
Transport

Commonwealth and State and Territory Governments may be able to consider
new options particularly in rural and remote locations to develop joint or
integrated arrangements to utilise the same infrastructure for CHSP Transport
and non-emergency medical transport for specialist services and outpatients

Commonwealth and the respective State and Territory Governments will need to
address operational issues in other programs and schemes that are resulting in
clients favouring or requiring the support of HACC Community Transport for nonemergency medical transport to access specialists and outpatient services

Providers will need to be given the flexibility to transition clients to alternate
transport schemes or to continue to support existing clients over a number of
years depending on the client’s willingness and capacity to transition. Providers
will need to be funded to continue to support current clients who can’t or won’t
transition to another program during the transition period
Unit Cost
Transition Activities: Undertake research to develop a matrix of costs. Building on this
review quantify the extent of volunteer involvement and community support and the
economic benefits of volunteer and community contributions. The amount of cross
subsidisation should also be considered in appreciating the real costs. These activities
should be undertaken in parallel with the development of a uniform client
contribution schedule and the development of new reporting measures. Future
contracts developed by DSS with providers will be crafted taking into account the
matrix of costs as a benchmark.
Data Collection and Reporting
Transition Activities: Apply the new units of measure to all new contracts developed
for CHSP including programs with an embedded transport component. Incorporate the
new measure into the MDS and require existing contracts to report transport and
where relevant the component of their service that is transport (currently embedded
in the service) using the new standard measure. This process will be aided through
the use of technology. The coordination and development function proposed in this
review will be well positioned to foster the adoption of technology by providers. DSS
through HACC Service Group 82 could consider a grant scheme to support this
proposal.
Supporting the Volunteer Base
Transition Activities: Engage with local communities and organisations (particularly
focusing on under resourced organisations) through the proposed coordination and
development function to create communication, feedback cycles and guidance to
adopt the changes. This activity is calculated to ensure that goodwill is maintained
2
Service types included in Service Group 8 include; building the evidence-base, development and service
interventions and Sector support and development.
ix
and that change occurs in a manner that is sensitive to the grassroots practices and
needs of clients. This engagement and communication will be aided by the proposed
role of the coordination and development function in facilitating coordination and
networking.
Coordination and Networking
Transition Activities: Within planning regions and/or sub regions (as required) develop
transport focused networks and forums. These will be used to maximise the use of
existing infrastructure and to aid the significant changes related to non-emergency
medical transport proposed through this review. It is considered that the use of
alternate travel programs and the capacity of those programs will be subject to
significant variation at a local level, particularly in rural and remote areas. The local
networks, aided by the leadership of the development and coordination function, will
provide a vital link in facilitating change and providing feedback to DSS.
x
Contents
Executive Summary ............................................................. ii
Contents ......................................................................... xi
Tables ............................................................................xii
Figures ...........................................................................xii
1
Introduction .................................................................. 1
1.1
1.2
1.3
1.4
1.5
2
Context ....................................................................... 6
2.1
2.2
2.3
2.4
2.5
2.6
2.7
3
Commonwealth HACC Program ...............................................6
Commonwealth Home Support Program .....................................7
Growing Demand for Community Transport Services .....................7
Commonwealth HACC and other transport services ..................... 11
2.4.1
Aged Care Transport Programs ................................. 11
2.4.2
Other Transport Schemes and Arrangements ................ 12
2.4.3
Non-Emergency Medical Transport ............................ 13
Other Commonwealth Aged Care and Carers Programs ................ 14
Other factors impacting HACC Community Transport .................. 18
2.6.1
Organisational dynamics......................................... 21
2.6.2
Reducing the Demand for Community transport ............ 21
Summary ........................................................................ 22
Towards Common Arrangements .......................................23
3.1
3.2
3.3
3.4
3.5
3.6
4
Acknowledgements ..............................................................1
Authors ............................................................................1
Scope of the National HACC Community Transport Review ..............1
About this Report ................................................................2
Methodology ......................................................................3
1.5.1
Project Plan ..........................................................3
1.5.2
Feedback process ...................................................3
1.5.3
Project activity methodologies ..................................4
The purpose of Community Transport; Definition ....................... 24
The role of the CHSP in non-emergency medical transport ........... 28
Funding and capital ........................................................... 30
Data Collection and Reporting .............................................. 36
Supporting the volunteer base .............................................. 40
Coordination and networking................................................ 42
Transition ...................................................................45
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
CHSP Manual .................................................................... 45
Communication and transition support .................................... 45
Scope of CHSP Transport ..................................................... 46
Transport Reablement ........................................................ 46
Carers ............................................................................ 46
Non-Emergency Medical Transport ......................................... 47
Unit Cost ........................................................................ 48
Data Collection and Reporting .............................................. 48
xi
4.9 Supporting the Volunteer Base .............................................. 48
4.10 Coordination and Networking ............................................... 49
Tables
Table
Table
Table
Table
Table
Table
1:
2:
3:
4:
5:
6:
65+ years Population 2011 and 2026 by Jurisdiction .............................. 8
85+ years Population 2011 and 2026 by Jurisdiction .............................. 8
Home and Community Care Program Estimates .................................. 11
Commonwealth Home Support Program Estimates ............................... 12
Other Commonwealth Aged Care Programs Estimates .......................... 12
Consolidated Findings: Estimates ................................................... 12
Figures
Figure
Figure
Figure
Figure
Figure
Figure
Figure
Figure
1: Project Map .............................................................................. 3
2: Support Arrangements for persons with dementia ............................... 9
3: Hospital separations by age and sex per 1,000 of the population ............ 10
4: Other transport accessed by HACC Community Transport Clients ........... 20
5: What Clients like about HACC Community Transport ........................... 20
6: Cost Elements of HACC Community Transport ................................... 32
7: The average client fees by distance ................................................ 35
8 : Paid and volunteer staff driving and supporting clients ...................... 40
xii
1 Introduction
In 2013 Verso Consulting Pty Ltd was contracted by the Commonwealth Department of
Social Services to review community transport delivered under the Commonwealth
Home and Community Care (HACC) Program.
The National Review of Community Transport under the Commonwealth HACC
Program is one of several reviews that are being undertaken in the context of the
development and implementation of the new Commonwealth Home Support Program
(CHSP). Other reviews include Service Group 2 (Assessment, Client care coordination,
Case management and Counselling/support, information and advocacy (client/carer);
Service Group 5 (Home Modifications, Goods and Equipment, Home Maintenance and
Formal linen service); and Service Group 6 (Meals).
Each review will seek to identify further detail on the current operational
arrangements including the diversity of funding and service delivery models utilised
across Australia, with the aim of determining how these contribute to the objectives
of the new Commonwealth Home Support Program.
The outcomes of the National Review of Community Transport will inform the
development of a more consistent, efficient and effective approach to providing
transport services under the Commonwealth Home Support Program.
1.1 Acknowledgements
Verso Consulting would like to acknowledge the input and expertise from the
Community Transport Review Sub-Group throughout all the phases of the National
Review of Community Transport. We would also like to acknowledge the input and
advice received from the overarching Commonwealth Home Support Program Advisory
Group.
Further to this, Verso acknowledge the members of the Department of Social Services
for their input and assistance as well as the dedication of service providers, clients,
family carers and representatives in providing information during the National
Discussions and Website Questionnaires.
1.2 Authors
The National Review of Community Transport Services under the Commonwealth
HACC Program Report was developed from these research reports and authored by:

Doug Faircloth (Director) Verso Consulting Pty Ltd

Allison Knight (Senior Consultant) Verso Consulting Pty Ltd
The Data Analysis, Website Questionnaire, Jurisdictional Mapping, National Discussion
and Literature Review reports included contributions from multiple members of Verso
Consulting’s team, which included: Doug Faircloth, Sue Faircloth, Allison Knight,
Marita Sealy, Dr Bob Noakes and Germanus Pause.
1.3 Scope of the National HACC Community Transport
Review
The HACC Community Transport Review seeks to identify the delivery of HACC
Community Transport and subsequent service implications to inform the way transport
services operate under the new Commonwealth Home Support Program. Within this
1
remit the Department has sought to appreciate transport delivered under Service
Group 7 and transport delivered as part of other HACC programs whether direct or
indirect. The requirements of the HACC Community Transport Review also included,
seeking information regarding ‘HACC like’ transport services and the interaction with
the Commonwealth Aged Care programs.
1.4 About this Report
This Final Report draws together key themes based on the findings from a number of
data gathering activities within the National Review of Community Transport.
The data gathering activities consist of:

A Literature Review comprising a review of international and Australian
literature covering Transport, wellbeing and reablement; Changing client need
and transport requirements; Existing service models and trends including
responsive practice approaches; Costs associated with community transport;
Utilisation of volunteers; Special needs groups; and Interface with other transport
services

A Data Analysis utilising data from the Master HACC funding from the Portal
Database (HACCTRANS040 Report 3/07/2013), Western Australia and Victoria
indicative data based on a 70:30 split for 2012 to 2013 (DoHA 8/07/13), CASPER
database 2013, HACC − DoHA AC Review of Government Services (ROGS) 2013
data, Minimum Data Set (MDS) Annual Bulletins 2010-11, ABS Census 2011, and
Customised population projections prepared by ABS for DoHA 2008

National Discussions held across Australia between 17th October and 14th
November 2013 to gain input into information gaps identified through the
Literature Review and Data Analysis. Discussions were held in capital cities and
regional centres with Service Providers and Clients/Carers/Representatives.
There were 303 Service Provider participants and 48 Client/Carer/Representative
participants

Website
Questionnaires
were
tailored
to
Service
Providers
and
Clients/Carers/Representatives building on information gaps identified through
the Literature Review and Data Analysis. They were hosted on the
Commonwealth’s Living Longer Living Better website during the period of 17th
October to 14th November 2013. Hard copy questionnaires were also developed
to enhance accessibility for clients and carers. There were 798 Service Provider
responses and 1,930 Client/Carer/Representative responses (900 completed
online, 1,030 completed in hard copy)

Jurisdictional Mapping which consolidated the main findings from the Data
Analysis, National Discussions and Website Questionnaires to illustrate
State/Territory differences and similarities in their provision of HACC Community
Transport services and identify the wide range of other ‘HACC-like’ transport
services available to older people

Verso Consulting also undertook face to face and telephone consultations and
received email submissions from the sector. This Sector contribution included
the input provided by the Community Transport Review Sub-Group members
severally and individually, State Government bodies and other organisations. In
all National Discussions Verso provided contact details and issued an open
invitation for additional inputs to organisations and individuals. Responses
included the provision of documents, reports and emails that supplemented to
face to face and telephone consultations. Records of the consultations were
maintained. These inputs were used to support/clarify the aggregation of
evidence from the other activities and to confirm the veracity of findings
2
1.5 Methodology
1.5.1
Project Plan
The completion of the National Review of Community Transport and its project
activities has been undertaken in line with the project plan (below).
Figure 1: Project Map
1.5.2
Feedback process
Verso Consulting utilises a comprehensive feedback process to ensure that activities
respond to the needs and purpose of the project. We have worked in partnership
with the Department of Social Services and the Community Transport Review SubGroup within a framework of Active Learning©.
Our Active Learning© Model fosters a peer approach to service reviews, and enables
the achievement of service and practice improvements within a spirit of partnership
and shared learning. Active Learning© is a unique consulting method developed by
the Verso Team. It builds on the theories of Action Learning 3 and Action Research4.
Active Learning© is particularly useful to support stakeholder engagement and
collaboration through planning processes with a clear reference to shared principles.
3
Revans, R.W. (1980), Action Learning: New Techniques for Management, Blond & Briggs, London, United
Kingdom
4
Kemmis, S. and McTaggart, R. (eds) (1988), The Action Research Reader, 3rd Edition, Deakin University
Press, Geelong, Australia
3
1.5.3
Project activity methodologies
As each of the project activities had a different purpose, a range of methodologies
have been utilised throughout the National Review of Community Transport. A
summary of each methodology is provided below, although a more comprehensive
description of each activity methodology is included within each activity report.
Literature Review
In order to comprehensively respond to 23 research questions covering the themes
identified in section 1.3 of this report, a Document Register was developed utilising
documents and resources provided by the Department of Social Services and the
Community Transport Review Sub-Group.
Verso Consulting sourced material from international journals to gain an international
perspective on mobility and older people, as well as material from the Victorian
Transport Library.
Grey literature gained through Verso Consulting’s industry experience and research
was also considered.
Data Analysis
A key aspect of the methodology used in the development of the Data Analysis Report
was the identification of the data’s limitations. These limitations include inconsistent
datasets from Western Australia and Victoria due to the continuing provision of HACC
services in those states under a State/Commonwealth partnership, and Northern
Territory information being provided in a consolidated form across all HACC Service
Groups.
The Data Analysis Report utilises a wide range of data sources to gain an indication of
HACC Community Transport services across Australia.
National Discussions
The National Discussions comprised 22 National Discussions at 15 locations across
Australia with Service Providers and Clients/Carers/Representatives in capital cities
and one rural/regional location in all States/Territories (with the exception of the
Australian Capital Territory). The site locations in rural and regional settings provided
additional opportunities to sample distinct regional issues from inland, coastal and
remote Australia.
A range of resources were developed to guide the discussions which focussed on
information gaps identified within the Literature Review and Data Analysis.
Individual Site Reports were developed documenting the National Discussions which
identified key themes for inclusion in the National Discussion Summary Report.
Website Questionnaires
In partnership with the Department of Social Services and the Community Transport
Review
Sub-Group,
questionnaires
for
Service
Providers
and
Clients/Carers/Representatives were developed to respond to key information gaps
identified within the Literature Review and the Data Analysis activities.
The Service Providers and Clients/Carers/Representatives questionnaires were
promoted through a range of activities including the Departments internal HACC
contact databases with emails sent to all HACC and Aged Care Package providers,
industry relationships developed by the Community Transport Review Sub-Group, links
embedded in Participant Packs sent to registered participants attending the HACC
Community Transport National Discussions, and phone calls made by Verso Consulting
to encourage service providers to attend the National Discussion; these calls were also
used to promote the completion of the questionnaires.
In addition to the internet-based Client/Carer/Representative questionnaire, a hard
copy Client/Carer/Representative questionnaire was developed and circulated to a
4
wide range of service providers and client peak organisations as well as all service
providers who registered to attend the National Discussions.
On completion of the questionnaire period, the data was compiled by the Department
of Social Services and sent to Verso Consulting for analysis.
Hard copy
Client/Carer/Representative questionnaires were inputted into the database to
ensure that all responses were analysed.
Jurisdictional Mapping
Multiple data sources were used in the development of the Jurisdictional Mapping
Report. The information and data sources included the Literature Review, Data
Analysis Report, National Discussions, Website Questionnaires, and ABS Census 2011.
A web-search was also conducted around legislation and industry standards and other
community transport programs.
Sector Consultations
Throughout the review processes Verso Consulting also sought input from the sector.
This included the input provided by the Community Transport Review Sub-Group
members severally and individually, State Government bodies and other
organisations. These organisations included but are not limited to: the Council of
Social Service of New South Wales (NCOSS), TransitCare Queensland, LINK Community
Transport (Vic), Community Transport Services Tasmania (CTST) and Transport
Development and Solution Alliance (QLD) who provided Verso Consulting with
additional insights.
5
2 Context
2.1 Commonwealth HACC Program
The Commonwealth HACC Program identifies seven Service Groups to ensure that
older people living in the community are supported. These are:

Service Group 1: Domestic assistance, Personal Care, Social Support, Respite Care
and Other meals services

Service Group 2: Assessment, Client care coordination, Case management and
Counselling/support, information and advocacy (client/carer)

Service Group 3: Nursing care and Allied health care

Service Group 4: Centre-based day care

Service Group 5: Home modifications, Goods and equipment, Home Maintenance
and Formal linen service

Service Group 6: Meals

Service Group 7: Transport

Service Group 8: Building the evidence-base, Development and service
interventions and Sector support and development
The Commonwealth HACC Program provides basic maintenance, support and care
services for frail older people (aged 65+ and Aboriginal or Torres Strait Islander
people aged 50+) to assist them to remain in their homes according to their choice.
The guiding principles5 of the Commonwealth HACC Program are to:

Promote each client’s opportunity to maximise their capacity and quality of life

Provide services tailored to the unique circumstances and cultural preference of
each client, their family and carers

Ensure choice and control are optimised for each client, their carers and families

Emphasise responsive service provision for an agreed time period and with agreed
review points

Support community and civic participation that provide valued roles, a sense of
purpose and personal confidence

Provide appropriate workforce training and development
The aims and objectives6 of the Commonwealth HACC Program are to:

Provide a comprehensive, coordinated and integrated range of basic
maintenance, support and care services for frail older people and their carers

Support these people to be more independent at home and in the community,
thereby enhancing their quality of life and/or preventing or delaying their
admission to long term residential care

Provide flexible, timely services that respond to the needs of these people
As at December 2013, HACC services were provided under the Commonwealth HACC
program in all states and territories, except Victoria and Western Australia. In those
5
6
Commonwealth HACC Program Manual, 2012, Commonwealth of Australia, page 2
Commonwealth HACC Program Manual, 2012, Commonwealth of Australia, page 3
6
states, services are provided through jointly funded state and Commonwealth HACC
programs.
In May 2013, Victoria agreed to transition to the Commonwealth HACC program from
2015 due to agreements encompassing the implementation of National Disability
Insurance Scheme (NDIS).
In August 2013, as part of the negotiations regarding the NDIS, the Western Australian
Government agreed to commence negotiations on implementing a transition of HACC
services for older people to Commonwealth responsibility from 2016-17.
2.2 Commonwealth Home Support Program
The National Review of Community Transport sits within a wider review of a range of
HACC Service Groups including Service Group 2 (Assessment, Client care coordination,
Case management and Counselling/support, information and advocacy (client/carer);
Service Group 5 (Home modifications, Goods and equipment, Home Maintenance and
Formal linen service); and Service Group 6 (Meals). These reviews will inform the
program design for the Commonwealth Home Support Program (CHSP) which will bring
together four distinct programs: the Commonwealth HACC Program, National Respite
for Carers Program (NRCP), Day Therapy Centres (DTC) Program, and Assistance with
Care and Housing for the Aged (ACHA) Program. The new CHSP is due to commence
on 1 July 2015.
2.3 Growing Demand for Community Transport Services
The demand for additional HACC Community Transport services is being driven by the
growth of the population 65+ years (as detailed in table 1 and table 2), and the
increasing number of older people choosing to age in the community and policy that
supports this choice including Home Care Packages. Key factors within this population
that impact on the growth in demand for transport include:

The prevalence and impact of dementia

The increasing support requirements related to the activities of daily living as
people age

The high need for health services as people age

Reduced access to family carers
Other community aged care programs (e.g. home care)
The total number of Commonwealth Home Care Packages is expected to grow
significantly over the next decade, doubling from approximately 67,000 packages
currently to a forecast of 140,000 packages by 2021-22.
This change will place additional demands on the community transport programs and
systems including HACC Community Transport.
Growth of the HACC Target Population
The population of persons 65+ years has been used in Table 1 to capture the majority
of the HACC target population. Table 1 excludes Aboriginal and Torres Strait Islander
people aged 50-64 years, as there is no reliable population projection data to support
proportional growth estimates. The data predicts high growth within the 65+ years
population over the next 15 years of 64.9% with significant increases in all
jurisdictions.
7
Table 1: 65+ years Population 2011 and 2026 by Jurisdiction
Jurisdiction
2011 65+
Population
2026 65+
Population
Estimate
Growth %
NSW
1,037,165
1,653,000
59.3
VIC
765,637
1,250,171
63.3
QLD
584,163
1,009,077
72.7
WA
281,832
539,711
91.5
SA
260,678
392,459
50.6
TAS
82,986
128,357
54.7
ACT
38,653
70,448
82.3
NT
17,538
26,164
49.2
3,068,652
5,059,387
64.9
National
Source: ABS 2011 census and ABS Age Population Projections: 2013 preliminary revision
The population 85+ years; an indicator of high support needs
The 85+ years data has been used in this table to capture the population with the
highest usage of HACC Community Transport, aged care services in general and health
services. The data predicts high growth over the next 15 years of 58.3% with
significant increases in all jurisdictions.
Table 2: 85+ years Population 2011 and 2026 by Jurisdiction
2011 85+
Population
2026 85+
Population
Estimate
Growth %
NSW
139,733
223,800
60.2
VIC
104,994
162,154
54.4
QLD
69,799
113,175
62.1
WA
34,215
62,645
83.1
SA
38,155
51,365
34.6
TAS
10,245
15,083
47.2
ACT
4,829
8,461
75.2
NT
693
1,680
142.4
402,683
638,363
58.3
National
Source: ABS 2011 census and ABS Age Population Projections: 2013 preliminary revision
The prevalence and impact of dementia
The ABS Australian Social Trends December 2012 reported that 80.1% of people
identified as having dementia or Alzheimer’s disease in 2009 said that they needed to
be driven by someone else in a private vehicle or taxi to travel from home. The pie
chart included in this section details the support arrangements of people living with
dementia. The finding is that most people (66%) living with dementia who are 65+
years are living in the community; the balance are living residential aged care (34%).
Current research indicates the prevalence of dementia follows an exponential growth
pattern as age increases. Alzheimer’s Australia report that “Dementia prevalence
rates are relatively low until the age of 70 years and over, where prevalence rates
start to increase rapidly, indicating the increased risk of developing dementia due to
age.”7 A study by the Australian Institute of Health and Welfare found “Among
7
Dementia Across Australia: 2011-2050, Deloitte Access Economics for Alzheimer’s Australia, 2011, p 14
8
Australians aged 65 and over, almost 1 in 10 (9%) had dementia, and among those
aged 85 and over, 3 in 10 (30%) had dementia”8.
The finding is that the prevalence of dementia may be a significant predictor of the
need for HACC Community Transport this is particularly so with the estimated 58.3%
growth of the 85+ years population over the next 15 years.
Figure 2: Support Arrangements for persons with dementia
Sources: Developed from data extracted from the Australian Institute of Health and Welfare 2012.
Dementia in Australia. Cat. no. AGE 70. Canberra: AIHW; Residential aged care in Australia 2010–11 A
statistical overview; AIHW September 2012 and Casper Database 2013
Increasing support requirements
There is increasing support requirements related to the activities of daily living as
people age (which includes support related to dementia). At 70 years of age 23.0% of
people reported in the 2011 census that they need assistance for the core activities;
47.7% of 85+ years population report a need for assistance9. The key finding is that
core activity limitations rise sharply as people age. Therefore there will be increasing
demands for HACC Community Transport to support the activities of daily living due to
the significant increase in the 85+ years population over the next 15 years.
The high demand for health services as people age
The demand for health services rises exponentially as people age as illustrated by the
hospital separations data detailed in figure 3. The finding is that the significant
increased requirement to access health services will drive increasing demand for nonemergency medical transport including transport to General Practitioners (GPs), allied
health services, specialist consultations and outpatient services.
8
9
Australian Institute of Health and Welfare 2012. Dementia in Australia. Cat. no. AGE 70. Canberra: AIHW
ABS 2011 Census of Population & Housing
9
Figure 3: Hospital separations by age and sex per 1,000 of the population
16
Females
14
Males
12
10
8
6
4
2
85+
75 to
84
65 to
74
55 to
64
45 to
54
35 to
44
25 to
34
15 to
24
5 to 14
1 to 4
<1
0
Source: Australian Institute of Health and Welfare 2009. Australian hospital statistics 2007–08. Health
services series no. 33. Cat. no. HSE 71. Canberra: AIHW
Reduced access to family carers
The productivity commission noted that reduced access to family carers will place
added pressure on the formal aged care system into the future. The Data Analysis
Report developed as part of this review demonstrates that as people age they have
reduced access to carers. The significant increase in the 85+ years population and the
reducing availability of carers will result in higher demand for alternate transport
options to support older persons to maintain the activities of daily living.
Summary
The growth demand for HACC Community Transport will be significant over the next
15 years. The growing demand for transport will put significant pressure on the entire
health and aged care systems and the plethora of transport programs and
arrangements detailed in section 2.4 including HACC Community Transport. There is a
high risk that transport responsibilities will be subject to cost shifting across
jurisdictions and Commonwealth departments and programs as demand exerts ever
increasing pressures. The National Discussions provided evidence of these dynamics
with a particular concern regarding the degree to which HACC Community Transport is
supporting non-emergency medical transport at the expense of other essential roles
for HACC Community Transport.
Under the growth pressures, highlighted in the findings of this review, there may be a
failure to produce the optimum results for Government, service providers and clients.
This is particularly so due to the large range of transport programs with different
client contributions, differing goals and different auspice but ostensibly the same
client group. Factors that require careful consideration include how a sector so
dependent on volunteers and services delivered by small community organisations will
be able to respond to this unprecedented demand. These demands will only add to
the operational pressures impacting on service providers which include:

Costs outstripping the growth in Government funding

Uncertainties regarding the future source of funds required to replace vehicles

More regulation affecting transport used by community transport providers
leading to increased costs

Ageing and reducing pools of volunteers
10
These factors suggest that HACC Community Transport will require significant and
robust leadership to manage the competing pressures and risks.
2.4 Commonwealth HACC and other transport services
2.4.1
Aged Care Transport Programs
HACC Community Transport (Service Group 7) operates within a complex
environment. This environment includes: embedded10 transport in other HACC
programs, other Commonwealth Aged Care and Carers programs, alternate State
Transport schemes, Non-Emergency Medical transport services and other
Commonwealth programs that include embedded transport.
To illustrate the complexities and the scope of transport being provided to support
the needs of persons within the HACC target group (the population 65 years and
older) and their carer’s, tables of estimated transport across relevant programs have
been included in this section.
The evidence base for these estimates is detailed in the Jurisdictional Mapping
Report. The estimates are drawn from published data, confidential data and
estimates provided by service providers (Website Questionnaires, National Discussions
and in-depth interviews). The estimates are based on the contracts for 2013-14 for
HACC services and on 2012-13 results for other programs. The lack of definitive data
and the estimated scale of transport being provided to the HACC target population
suggests that there is a need to collect data on transport in a more comprehensive
and definitive manner for future analysis and planning.
Table 3: Home and Community Care Program Estimates
Program
HACC Transport11
HACC Social Support12
HACC Respite 12
HACC Linkages – Aged Care (Vic
Only) 10%13
HACC Centre-based Day Care 12
(excluding WA)
HACC Case Management and
Coordination12
HACC Estimated Transport
HACC
Service
Group
7
Transport
Estimated
Allocation*
100%
Estimated
Transport $
$113,300,000
1
1
2
35.9%
19.6%
10%
$53,500,000
$14,300,000
$3,000,000
4
34.5%
$61,600,000
2
9.7%
$6,100,000
$251,800,000
*Based on estimates drawn from Website Questionnaires, National Discussions and indepth interviews
10
Within this report embedded transport only refers to the provision of transport where the client is being
transported or being provided with a transport service. This does not refer to travel of staff to a client’s
home to provide a service at home.
11
Customised Vic and WA data (70/30 split) prepared for the review by DSS May 2013, HACCTRANS040
Report 3/07/2013 (Master HACC funding from the Portal Database); HACC services received, assistance
type by State/Territory, 2010/2011 MDS annual bulletin. This data includes Victorian Volunteer
Coordination ($11,674,303)
12
Estimates provided by averaging responses from 605 service providers responding to the National Review
of Community Transport website questionnaire
13
Estimate provided through the National Discussion
11
Table 4: Commonwealth Home Support Program Estimates
Program
Assistance with Care and Housing for the Aged
(ACHA)14
National Respite for Carers Program (NRCP)15
including Commonwealth Carer Respite Centres
(CCRC)
Day Therapy Centres (DTC)15
HACC estimated Transport
Total: New Home Support Program Transport
Transport
Estimated
Allocation*
10%
Estimated
Transport $
$600,000
10%
$20,700,000
14%
As Above
$5,400,000
$251,800,000
$278,500,000
*Based on estimates drawn from Website Questionnaires, National Discussions and indepth interviews
Table 5: Other Commonwealth Aged Care Programs Estimates
Program
Home Care Packages, estimated transport
component16
Department of Veterans’ Affairs (DVA) Transport
Repatriation Scheme17
Total Other Commonwealth Programs
Transport
Estimated
Allocation*
10%
Estimated
Transport $
$107,500,000
68.5%**
$103,400,000
$210,900,000
*Based on estimates drawn from in-depth interviews and DVA
Table 6: Consolidated Findings: Estimates
Program
Total New Home Support Program Transport
Total Other Commonwealth Aged Care Programs
Total Commonwealth Transport Funding 65+ years
Estimated
Transport $
$278,500,000
$210,900,000
$489,400,000
**Relates to the transport being provided to persons over 65 years of age.
2.4.2
Other Transport Schemes and Arrangements
There are other HACC-like transport schemes and arrangements operating across
Australia and significant transport support being provided to older persons. These
schemes include initiatives such as:

Local Government transport schemes e.g. the City of Sydney operates a transport
scheme for transport disadvantaged (including the HACC target group) with
annual ratepayer subsidy of $2 million

Volunteer transport schemes that receive no Government funding or that may
receive Local Government or Service Organisation support related to their
vehicles

Transport provided by clubs
14
Estimate Provided through the National discussion
Estimates developed from In-Depth Interviews and National Discussions, using overall program funding
data provided by DSS for years 2012/13
16
Estimate developed from In Depth Interviews and program funding reported through the Aged Care
Services List DoHA June 2012
17
http://www.dva.gov.au/service_providers/Documents/booked_car_scheme_guidelines_taxi_hire _car_
contractors_july2012.pdf ; http://www.dva.gov.au/service_ providers/aged_care_issues /Pages/index.
aspx and DVA Population Distribution (by State, Territory and Region) 2010 Prepared for the ACAR 2010 by
DVA
15
12

The COAG Closing the Gap transport scheme focused on Aboriginal and Torres
Strait Islanders including those within the HACC target Group

Subsidised Public Transport Schemes

Taxi Transport Subsidy Scheme (all States and Territories)

Fuel Card (Western Australia rural areas)/Cars for Communities (Tasmania)
The quantum of the combined services being provided through these initiatives is
unknown. What can be stated is that without these arrangements the demand for
HACC Community Transport would increase exponentially. It is apparent that as the
Department seeks to develop common arrangements for HACC Community Transport
and to identify opportunities for efficiency gains the complex interaction between
HACC Community Transport services and these initiatives needs to be understood.
Within the HACC Community Transport initiatives, some service providers focus on
assisting older people to develop strategies that maximise the use of alternate
arrangements to HACC Community Transport. This type of approach is illustrative of
the way increasing demand for HACC Community Transport may be mitigated where
appropriate.
2.4.3
Non-Emergency Medical Transport
The National Discussions and the findings of the Website Questionnaires identified an
increasing demand for non-emergency medical transport. The rising demand is
reported to have a significant negative impact on the availability of transport to
support other aspects of activities of daily living. The transport needs of persons in
the HACC target group who require renal dialysis or oncology have been an issue
raised across all of the National Discussions. The finding is that persons requiring
these services are likely to be using a significant amount of the available HACC
Community Transport resources.
Findings of the review have suggested that there are multiple factors impacting on
the demand for non-emergency medical transport which include:

Reducing or static resources being provided by Health Services e.g. “we are under
constant pressure to reduce our fleet of vehicles” (Country Health Service
Manager)

Increased length of life and rapidly increasing population of people aged 85+
years with resultant increasing demand for health services

Increased demand for transport to renal dialysis

Increasing impact of initiatives that are supporting older persons to age in the
community

Increasing incidences of health and specialist services being retracted to larger
population centres

Shortages of GPs particularly in regional and rural Australia
While HACC Community Transport supports eligible older people to access GPs,
Specialist and Health Services there are also other schemes that provide alternate
options to access health services. Not all of these schemes are convenient, cost
effective or, in some cases, accessible to the client. These transport schemes include:

Patient Assisted Transport

Non-Emergency Patient Transport Schemes

Other Health Service Transport Initiatives e.g. the renal bus in Darwin
Some service providers reported that the higher costs associated with other schemes
is enough to cause some clients to not receive the medical interventions/supports
they require, with the attendant negative impacts and eventual higher costs within
the health system. Another factor reported by clients is a lack of information about
the services that might be available, lack of appreciation of the differing eligibility
13
requirements and complexities associated with the system (particularly patient
assisted transport).
Some of the transport arrangements detailed in section 2.4.1 and all of those in 2.4.2
may also be being used to access non-emergency health and medical services. This
may be as an alternate or a supplement to HACC Community Transport.
2.5 Other Commonwealth Aged Care and Carers Programs
As already stated HACC Community Transport intersects and interacts with other
Commonwealth funded aged care programs and carers services. These include:

Assistance with Care and Housing for the Aged (ACHA)

National Respite for Carers Program (NRCP) including the Commonwealth Carers
Respite Centres (CCRC)

Day Therapy Centres (DTC)

Home Care Packages

Residential Aged Care
Within this section the review findings relating to each of these services and relevant
implications are discussed, although it should be noted that these programs were not
a key focus of the review. A general discussion regarding carers related to HACC
Community Transport is also contained in this section and precedes the discussion on
programs.
Carers
The review found that carers who accompanied a client were not able to be included
as an output against contracts for the supply of HACC Community Transport. There is
no consistent practice for collecting fees and the use of other cost recovery
mechanisms when it comes to carers. However service providers understand and will
continue to support the essential role of carers in HACC Community Transport.
The review also found that the following issues relating to carers and HACC
Community Transport needed to be considered/appreciated:

To address behavioural needs of clients being transported with dementia there
was a need for an escort; commonly a family carer

Future reporting should include the family carers accompanying clients

Family carers had particularly important inputs when assessments for HACC
Community Transport were being undertaken

The financial needs of carers should to be taken into account when HACC
Community Transport assessments are being conducted
The National Discussions highlighted the increasing number of ageing carers as an
issue that will impact on the availability of carers to support the transport needs of
older people no longer able to drive or access public transport. This issue is also
addressed by the Productivity Commission who stated, “Demographic trends indicate
there will be a decline in the relative availability of informal carers, coinciding with
an increased demand for aged care services” 18. The formal aged care system referred
to will include CHSP Transport.
Literature in a European context19 also highlights factors that are likely to adversely
impact on the supply of carers of the older people in the future. These are:
18
Productivity Commission (2011); Caring for Older Australian’s Chap 2, page XLIV
Daatland. S.O., (1996) ‘Adapting the “Scandinavian Model” of care for elderly people” in Caring for Frail
Elderly People: Policies in Evolution, Social Policy Studies No. 19, Organisation for Economic and Cooperation and Development, Paris, pp.247-260.
19
14

Fewer children per family

An increased incidence of divorce

Different generations being more likely to live alone than in the past

Increased women's labour force participation
These factors are also evident in the Australian context and will lead to a reduced
number of carers being available to support older people ageing in the community
Assistance with Care and Housing for the Aged (ACHA)
Within the ACHA program transport is arranged/provided to support clients to attend
appointments and services. It was noted that skills deficits, personal hygiene and
prompting and support were elements that were taken into account when transport
modes were considered/accessed. Consideration was given to this program in the
review as it will become part of the new CHSP.
National Respite for Carers Program (NRCP)
The National Respite for Carers Program includes the Commonwealth Carers Respite
Centres (CCRC). The review findings demonstrate that across the NRCP and CCRC
programs there is constant use of HACC Community Transport in the delivery of
services. The NRCP may include program responses such as cottage respite, day
respite provided in a residential aged care facility, holiday programs and clusters of
Culturally and Linguistically Diverse (CALD) clients coming together in a single
location; all of these examples include transport. With the primary consideration of
the carer in mind, transport is often provided to the person for whom the carer is
supporting.
Day Therapy Centres (DTC)
The review findings demonstrate that DTC includes transport. DTC’s therapies and
services are offered to clients to assist them to maintain - or recover - a level of
independence that will allow them to remain either in the community or in low level
residential care. Attending the DTC’s often requires access to community transport
either direct or indirect.
Home Care Packages
Current policy documents identify the role of HACC Community Transport within the
Age Care reforms. In the context of consumer directed care it is envisaged that
individual clients will be well placed to purchase transport services from their Home
Care Package budget. As detailed in the HACC Community Transport Literature
Report, the Home Care Program clients are able to ‘purchase’ Commonwealth HACC
services where the services are:

“Not expected to be provided as part of the suite of services under the package
of care. In these cases the client would be expected to pay the fees for the
Commonwealth HACC service and these would be negotiated and charged in
accordance with the fees policy principles set out in the Commonwealth HACC
Program Manual

“Part of the suite of services under the package of care but are being delivered
by a Commonwealth HACC service provider on behalf of the packaged care
provider, for example, respite, social activities and meals provided through a
delivered meal organisation. In these cases the Commonwealth HACC service
provider is able to charge the packaged care provider the full cost for providing
the service”20
In essence, this means that, under a consumer directed approach, clients would be
able to utilise HACC Community Transport services on a fee-for-service basis. As the
number of Home Care Packages will increase over the next decade along with an
20
Commonwealth HACC Program Manual, 2012, Commonwealth of Australia, Section 2, page 8
15
increase in population of persons 70+ years (+68.7%21) there will a significant
opportunity and burden placed on community transport providers (including CHSP
service providers) to increase their services to accommodate demand.
Community consultations conducted by Verso Consulting 22 suggests that Extended
Aged Care in the Home packages (now known as level 3 and 4 Home Care Packages)
have ‘purchased’ access to HACC Community Transport services, however the level of
funding allocated to Community Aged Care Packages (CACP) (level 1 and 2 Home Care
Packages) may result in the client having to make a decision between transport and
other services.
HACC Community Transport service providers also suggest that they are often
providing transport services to clients after they have moved from being a client of
other HACC services to Home Care Packages; from being HACC eligible to being
ineligible. This issue arises because there is often no mechanism to let service
providers know that the client’s status has changed. Service providers report that the
Home Care Package providers are often unable to ‘purchase’ the service at full cost
as there is insufficient funds in the package to do so.
Comments provided by providers to the Website Questionnaire details that “Packaged
Care Clients are a low priority”. The ‘low priority’ is due to the high demand on
existing resources to fulfil core requirements of the HACC program. The practice of
some providers is simply to exclude Home Care Package clients as they are not
eligible for HACC Community Transport and they may potentially disrupt the
arrangements developed to serve the requirements of HACC Community Transport
clients.
Residential Aged Care
The Residential Aged Care Standards state that residents are to be referred to
appropriate health specialists, in accordance with their needs and choices, and are to
be assisted to achieve maximum independence both within and outside of their
residential facility. This implies that the transport to support these choices would be
provided by the facility, however it is not explicitly stated that transport must be
provided. Where transport is provided by a residential facility, it is mainly used for
shopping or organised outings for a group of residents and is often determined by staff
availability.
New South Wales Council of Social Services (NCOSS) state “Strict application of the
HACC eligibility criteria (which does not apply to people living in residential aged care
services) would prevent Commonwealth HACC transport services provision into
residential facilities, thus residents without family support could be severely
disadvantaged in regards to accessing external non-emergency transport”23.
The Website Questionnaire Report details that Residential Aged Care clients are
‘missing out’. Service providers have highlighted that Residential Aged Care clients
are not able to access community transport resulting in reduced ongoing connection
to the community. These remarks should also be tempered with an appreciation that
Residential Aged Care clients are more likely to have a high care assessment and will
increasingly do so into the future; 76.3% of residents of aged care in Australia had a
high care assessment in 2010/11. This figure can be compared to the 1998 figure of
57.8%24 a change of 32%. This rate of change and shift to very high care needs clients
as the primary cohort in Residential Aged Care can be predicted to increase. Factors
that will drive the change include more and greater access to Home Care Packages
and the removal of the high care low care distinction in Residential Aged Care.
21
ABS Preliminary population projections 2013
Annual Aged Care Survey’s conducted by Verso Consulting 2002 to 2013 across up to 30 Aged Care
planning regions and within all States and Territories
23
On the Road, Again: The Transport Needs of People in Residential Aged Care, 2003, NCOSS (Council of
Social Service of NSW), page 47
24
Australian Institute of Health and Welfare 2012. Residential aged care in Australia 2010–11: a statistical
overview. Aged care statistics series no. 36. Cat. no. AGE 68. Canberra: AIHW
22
16
It is likely that the capacity of the majority of clients of Residential Aged Care
facilities to use HACC Community Transport will continue to diminish as the high
support needs of residents continues to increase. Recent consultations undertaken by
Verso Consulting in the Wheatbelt WA (43 community consultations with over eight
hundred community members and service providers) demonstrated that patient
transport was both required and being used by this cohort when transport was
required (mainly health related). It is suggested by service providers of Residential
Aged Care interviewed by Verso Consulting25 that non-emergency patient transport is
the common form of transport required by clients living in Residential Aged Care.
Ambulance Services Victoria26 provides non-emergency patient transport to residents
when:

The resident requires the use of the specialised equipment contained within the
vehicle

The resident requires the skill levels and qualifications of staff on either an
ambulance vehicle or on a non-emergency patient transport vehicle

The resident’s illness or a disability makes it impractical to use any other form of
transport e.g. severe immobility or disorientation
While there are concerns regarding residential care resident’s access to the
community it appears that this is not a prominent issue; it is possibly more an issue of
philosophy.
Summary
The key issues, considerations and implications related to the discussion in this
section of the review are connected to the development of CHSP Transport can be
summarised as:

Community Transport is accessed by carers who are currently not able to be
included in HACC Community Transport (Service Group 7) outputs

DTC, HACC (all service types other than Service Group 7), ACHA and NRCP have
embedded transport in the programs as an adjunct to or enabler of the service.
As CHSP folds these programs into the overall program there are opportunities to
consider how services may be able to make better use of HACC Community
Transport infrastructure, expertise and services to respond to some of the
embedded transport needs. This should include the relationship of the carer to
CHSP Transport as the National Respite for Carers Programs becomes part of CHSP

The significant growth of Home Care Packages over the next ten years will
challenge the service system but also provide opportunities for HACC Community
Transport service providers to increase capacity and scale. An increase in
capacity and scale may support greater effectiveness and efficiency. In
responding to the community transport needs of Home Care Package clients,
clear policy guidelines will be required. These include:

greater clarity in the guidelines regarding the status of Home Care Package
clients

an appreciation what constitutes ‘full cost recovery’

a unit of measure that allows a ‘full cost recovery’ calculation to be
developed

limits on what can be charged as ‘full cost recovery’

the requirements that Home Care Package client needs be treated by
providers with equal priority in response to the Home Care Package client’s
care plan
25
Wheatbelt Integrated Aged Care Solution; WDC (2013), Central East Wheatbelt Aged care Solution: WDC
(2012), Sustainable Aged Care Solution Regional, Rural and Remote Australia: TRACC/DoHA (2010)
26
http://www.health.vic.gov.au/ambulance/nept.htm (accessed 22/01/14)
17


a capacity to report outputs in CHSP Transport for Home Care Package clients

improved communication between Home Care Package providers and CHSP
Transport providers when clients transition to Home Care Packages from CHSP
services
Residential Aged Care clients are likely to have a diminished capacity to use CHSP
Transport into the future. A primary transport service for this cohort is likely to
be non-emergency patient transport
2.6 Other factors impacting HACC Community Transport
Service Provider Considerations
The transport arrangements, programs and the availability of services are further
complicated as a result of State/Territory legislation affecting bus registration, driver
accreditation and organisational registrations.
There are also complexities created by the differing models and program emphases
such as the role of the state Government in supporting community transport services
particularly in NSW and Tasmania. Victoria has a completely different view that
results in transport not being reported as a separate HACC service type, but being
embedded broadly across HACC services.
The key models used in the delivery of HACC Community Transport are:

The Victorian model: is an approach that has been led through a philosophy
enshrined in policies and guidelines. This approach considers transport as an
enabler of other HACC programs rather than a designated service type; this model
principally recognises the transport arrangements through funding for volunteer
coordination and within the unit price of relevant service types. Contextually this
approach sits with the Victorian ‘Active Service Model’27

The Transport for NSW model: which administers about 70% of HACC Service
Group 7 transport (trips) in NSW through brokered arrangements with a network
of Community Transport providers; these service providers commonly receive
other funding to deliver a broader range of transport programs supporting the
needs of transport disadvantaged people, which may include State funding
through Transport for NSW

Community Transport Services Tasmania which is the only State-wide single
provider model; this model is operated over 10 districts within the State using
volunteer coordinators and drivers supporting the transport needs of the HACC
target group and the wider needs of transport disadvantaged people in an
integrated and coordinated approach. Within this model the service provider
considers that they are providing a specialist transport service which in the first
instance matches drivers to vehicles and then supports local client engagement
(through the local coordinators) using the resources available to support their
needs

Community Passenger Networks (CPNs) operate in South Australia primarily
providing: information, coordination, brokered transport services and as a
transport service as a last resort. CPN’s are HACC funded through the Department
of Communities and Social Inclusion. Over 60% of CPN coordinated journeys are
for non-emergency medical transport

Service Clusters (Multi Service Organisations – MSO): this is the most common
approach which is working within and absent of the other models across Australia.
In this model the service provider delivers a range of HACC services that include
direct and indirect transport services and transport as a service type (except
27
The Active Service Model focuses on promoting capacity building and restorative care in community care
service delivery
18
Victoria) or transport embedded within other HACC services. A significant number
of the clustered services operate across program services particularly other
Commonwealth funded Aged Care and Carer services. In this model there is likely
to be cross funding arrangements which impacts on the clarity of specific
operational costs. Within the MSO model the provider may also be delivering
integrated transport services to transport disadvantaged regardless of age

Specialist Community Transport providers delivering a cluster of transport
services to persons who are transport disadvantaged. Typically these services
have a variety of funding sources but deliver services in an integrated manner
(Community Transport Services Tasmania is one such organisation)
In summary the majority of HACC service providers provide a cluster of inter-related
HACC services. The majority of service providers also provide other aged care services
with most of these programs having a transport element embedded within the
provision of the service. A lesser number of service providers also deliver services to
other transport disadvantaged persons such as younger people with a disability or
persons living with mental health conditions.
Within this complex operational environment service providers receive significantly
different funding from the Commonwealth. An exploration of the subsidies by
individual contracts, Planning Region and State was undertaken as part of the HACC
Community Transport Review Data Analysis Report completed within this review. This
exploration demonstrated that the unit price (contract funding divided by contracted
one way trips) varied without discernable explanation across Planning Regions
(whether rural, regional or urban), individual contracts and States. The HACC
Community Transport Review Data Analysis Report draws on all current contract data
for HACC Community Transport and demonstrates variations. The report states that
“There are also significant ranges for unit prices within HACC Regions e.g. NSW Inner
West Region of $5.73 per trip to $31.15 per trip”. The variables that impact on the
differing contract prices are unknown.
The complex program, legislative and operational environment discussed in this
section will have a significant impact on the development of common arrangements
and service improvements for transport in Service Group 7. Operationally service
providers incorporate arrangements such as; drivers, coordination of vehicles
including bookings and scheduling, support required to aid clients using the transport,
travel times and coordination with other service providers across all of their programs
and services in an integrated manner (not just Service Group 7). Therefore common
arrangements and service improvements need to take into account the context within
which Service Group 7 (transport) operates.
The significance of these findings is to appreciate that HACC Community Transport is
only one part of a complex mosaic. Any service improvements and changes to current
arrangements require a comprehensive understanding of the way changes may affect
other elements of the community transport picture. Importantly the maintenance of
the goodwill of service organisations, local Government, local communities and
volunteers is essential. However these complexities do not preclude improvements
being made.
Client considerations
The way the client interacts with these complexities is also important when
considering the context for service improvements and the development of common
arrangements. The following graphs from the Website Questionnaire Report
demonstrate the extent to which clients are likely to be accessing multiple programs
and their key ‘likes’ when considering the options available to them. Appreciating
client choice and behaviour may support better information, improvements to
eligibility assessments and the development of alternate options to HACC Community
Transport (for some clients).
The figure below, taken from the HACC Community Transport Website Questionnaire
Report, details responses to the question “Identify transport other than HACC
19
transport services you access”; 1,235 respondents provided responses detailed in
Figure 4.
Figure 4: Other transport accessed by HACC Community Transport Clients
Source: 1,235 consumer and representative responses to the HACC Community Transport Website
Questionnaire
The second set of data details 1,222 respondents answers to the question “What do
you like most about your HACC transport service?” Respondents ranked their
responses as detailed in the table below. The highest ranked factors for clients were:
social contact with people including friends, access to the community, and one-to-one
services.
Figure 5: What Clients like about HACC Community Transport
Ranking
Subject
1
Social contact with people including friends
2
Access to my community
3
One-to-one service (personalised service)
4
Assistance where and when I need it
5
Door-to-door service
6
Flexibility (meeting my needs)
7
Convenience
8
Reliability
9
Cost/affordability
Source: 1,222 consumer and representative responses to the HACC Community Transport Website
Questionnaire
A case example of a couple in their late eighties living in a regional centre
demonstrates the transport options they accessed over the last 12 months:
20

The husband holds a licence and still drives to meet most of their needs

The wife has taxi vouchers

They access HACC Community Transport when attending hospital clinics together

They have been transported by family

They have been provided with patient transport
The significance of these findings is to appreciate that HACC Community Transport
clients are in many cases choosing from a menu of transport options and they are
doing so to meet their individual support and social needs. The complex system of
multiple programs, varied eligibility and assessment criteria is leading to duplication
of services, inequity and gaps in service delivery.
2.6.1
Organisational dynamics
As detailed in section 2.3 of this report service providers face an increasing demand
for HACC Community Transport, HACC transport embedded in other programs and
other transport focused on older people.
Transport for NSW reports that this creates significant challenges to the sector as the
sector needs to be able to increase its capacity in line with multiple drivers of
demand. Transport for NSW considers that this can be best achieved through using a
community development framework. This approach will provide the leadership and
resourcing required to support community transport service providers which in most
States is dominated by small community-based organisations that rely on community
goodwill and volunteers.
The National Discussions demonstrated that there was a significant need to develop
better coordination and greater sharing of ideas and resources. In a number of
discussions providers highlighted the benefits of HACC development officers and how
the absence of this role had negatively impacted on operations.
2.6.2
Reducing the Demand for Community transport
Particular features of the international literature (detailed in the Literature Review)
are approaches aimed at reducing and delaying demand for community transport
amongst older people. As a result of the emphasis in the literature this theme was
explored through the National Discussions.
Findings from the National Discussions and subsequent consultations with the sector
highlight the following measures:

Measures that create an improved age friendly driving environment for older
drivers (less signage clutter, larger clearer signs, longer slip lanes)

Measures that assist older drivers to maintain their confidence to drive for longer
(developing alternate routes to drive to essential services, strategies regarding
parking, strategies to maximise quieter times of day for travelling)

Alternate transport options such as Voiture Sans Permis (without permit); this
option is used in France to provide alternate vehicles that cannot be used on
major roads but supports older drivers (amongst others) to continue to drive 28

Planning related to the transition from driving to the use of alternate transport
options, this includes travel training to gain confidence and experience in using
public transport

Common legislative and licencing requirements for older drivers across
jurisdictions
28
Information provided in the National Discussions (ACT) by a Service Provider whose parents in rural
France use Voiture Sans Permis. Voiture Sans Permis are vehicles commonly used by older people in France,
and Belgium who are no longer licenced to drive allowing them to maintain transport independence
21

The development of Teleheath29 across regional, rural and remote Australia to
lessen the need for non-emergency medical transport (follow up appointments in
particular have been reduced where Teleheath has been successfully adopted in
rural locations in Western Australia)

The use of more community-based and home-based renal dialysis (where
applicable) to reduce the requirement to travel30
These measures may be able to delay or lessen the need for HACC Community
Transport thus reducing future demand and the associated cost. These measures will
also improve client choice, wellbeing and independence and therefore are worthy of
consideration.
2.7 Summary
Clients
Clients of HACC Community Transport may have an array of other transport options
from which they can choose. Clients choice and behaviour may dictate which of these
options are chosen; this includes HACC Community Transport. Client choice may also
be limited due to the information available to the client and the confusing eligibility
criteria. The array of transport options and differing client contributions add to the
complication of the system within which HACC Community Transport operates. In
rural and remote locations the options may be significantly limited, however this
varies depending on the jurisdiction and/or remoteness. Clients who are financially
and/or socially disadvantaged may consistently access HACC Community Transport
over other options such as a taxi voucher due to no or a negligible fee contribution in
the HACC program.
Service Providers
HACC Community Transport services have developed across jurisdictions according to
State/Territory HACC policies/philosophies, the Territory/State’s geography,
legislative differences and parallel funding arrangements. These dissimilarities have
led to significant operational differences that indicate that developing common
arrangements under the new Commonwealth Home Support Program will need to be
achieved incrementally and with great sensitivity to current State and Regional
arrangements.
Service providers rely on community goodwill and volunteers and therefore service
providers will need to be able to embrace and work with these key stakeholders to
achieve service improvements and common arrangements. The small size of the
majority of service providers means that there will be limited resources available for
planning, change management and policy development.
Funders Considerations
The small size of the majority of service providers presents a case for Government to
develop community development positions at a regional level that can work with
service providers and guide change processes. These processes will need to draw on
and secure the ongoing involvement of key stakeholders at a grassroots level.
Implications
There are a number of service improvements and opportunities to develop common
arrangements that would be beneficial to clients, service providers and Government.
These improvements and opportunities in the short to medium term (18 months to
three years) need to focus on fundamental elements of the program. These
fundamental measures are described in section 3 of this report.
29
Telehealth aims to remove some of the barriers to accessing medical services for Australians who have
difficulty getting to a specialist or live in rural and remote areas. http://www.medicareaustralia.gov.au/
provider/incentives/telehealth/
30
NSW State-wide Renal Services Plan; NSW Ministry of Health, Verso Consulting 2013
22
3 Towards Common Arrangements
As detailed in section 1 of this report; “The HACC Community Transport Review seeks
to identify the delivery of HACC Community Transport and subsequent service
delivery implications to inform the delivery of transport services under the new
Commonwealth Home Support Program”. Within this section of the report
fundamental measures of the HACC Community Transport program are addressed.
These fundamental measures will facilitate opportunity for improvements that will
impact on clients, service providers and Government in the short to medium term (18
to 36 months). The measures have also been designed to promote the development of
a solid evidence base and grassroots stakeholder buy-in to further improve HACC
Community Transport and how transport services will operate within the new
Commonwealth Home Support Program beyond the short to medium term.
Measures to move toward common arrangements
The measures have been developed with sensitivity to the context within which HACC
Community Transport operates. This includes a mosaic of programs, substantial
reliance on volunteers and community goodwill and a large number of very small
HACC community service providers. These measures have emerged from the National
Discussions, in-depth interviews and interaction and feedback with the Community
Transport Review Sub-Group. These measures are also consistent with other evidence
gathered across this review.
Fundamental Measures
The set of measures proposed are as follows:

Clearly define the purpose of Community Transport within the CHSP including
planning for an increased number of clients in the future, particularly clients with
dementia and other special needs and supporting and encouraging a wellness
approach in the CHSP, including transport

Clarify the role of the CHSP in providing non-emergency medical transport to
clients

Consider funding issues such as block funding arrangements, how capital items
are funded, and whether there is scope to introduce a different basis of unit
pricing in CHSP Transport

Define what data should be collected to effectively support, monitor and
evaluate CHSP Transport

Maintain, support and develop the volunteer base

Support and develop coordination functions, potentially across planning regions,
to enable service providers to work together and to assist service providers to
develop their capacity
Urgency for action
Urgent action is required due to the very significant drivers of demand for CHSP
Transport (See section 2.4). A key finding of the HACC Community Transport Review is
the significant demand for additional HACC Community Transport services which is
being driven by the growth of the population 65+ years and by the increasing number
of older people choosing to age in the community.
Key factors within the ageing population that impact on the growth in demand for
transport include:
23

The prevalence and impact of dementia

The increasing support requirements related to the activities of daily living as
people age

The high demand for health services as people age

Reduced access to family carers
The findings highlight that:

From 2011 to 2026 the 65+ years population will increase nationally by 64.9% and
85+ years population by 58.3% resulting significant increased demand for CHSP
Transport

By 2027 the number of people living with dementia in the community will
increase by 71% resulting in more people with high support needs including the
need for escorted, one on one transport

The large increase in the 65+ years and 85+ years population will translate into
significant demand for access to health services. The combination of the
centralising of health services, increased use of outpatient and rehabilitation
services, more specialisation, decreased numbers of General Practitioners in rural
and remote areas, reduced resources being applied to health service transport
options and the higher demand for health services (particularly the rapid growth
in diabetes management and related kidney failure and the need to access renal
dialysis) will lead to a significant growing demand for non-emergency medical
transport

The 85+ years population growth of 58.3% (2011 to 2026) will also result in clients
accessing transport with high support needs; 47.7% of this population report they
have need for assistance due to core activity limitations

The productivity commission reports that there will be reduced access to family
carers putting more pressure on the formal aged care system this will result in
increased demand for Community Transport
These factors in combination will lead to exponential growth demand in CHSP
Transport and highlights the urgent need to develop more effective and efficient
approaches to CHSP Transport.
As stated in the conclusion of section 2.3, a cautionary note details that under the
growth pressures highlighted in the findings of this review there may be a failure to
produce the optimum results for Government, service providers and clients. This is
particularly so due to the large range of transport programs with different client
contributions, differing goals, different auspice but ostensibly the same client group.
One factor that requires careful consideration is how a sector so dependent on
volunteers and services delivered by small community organisations will be able to
respond to this unprecedented demand. These demands will only add to the
operational pressures impacting on service providers which include:

Costs outstripping the growth in Government funding

Uncertainties regarding the future source of funds required to replace vehicles

Increasing regulation affecting transport used by community transport providers
leading to increased costs

Ageing and reducing pools of volunteers
These factors suggest that HACC Community Transport will require significant and
robust leadership to manage the competing pressures and risks.
3.1 The purpose of Community Transport; Definition
HACC Community Transport (Service Group 7) and transport provided in other HACC
services operates with significant differences across jurisdictions.
24
With the establishment of the CHSP from July 2015, there is an opportunity to
develop a National Framework for the provision of CHSP Transport (defined within the
CHSP Manual). This framework must still provide opportunity for, and encourage,
flexible and innovative service delivery that addresses local needs. Fundamental in
the development of this framework is the need to clearly define CHSP Transport.
Current HACC Community Transport Definition
Current HACC Service Group 7 definition can be constructed from the Commonwealth
HACC Program Manual using the overall target group for HACC and by referring to
Chapter 3 services and section 3.2.7 Service Group 7. The HACC MDS User Guide also
provides some further detail of service provision to Service Group 7 (pages 211-212).
The current definition of HACC Community Transport is:
“Assistance with transport can be provided either directly or indirectly. Direct
transport services are those where the ride in the vehicle is provided by a worker or a
volunteer. Indirect transport services include rides provided through vouchers or
subsidies.”31 Direct HACC transport includes transport that is primarily a door to door
service and transport services which require assistance and support to undertake
activities.
Commonwealth HACC transport services facilitate older people (aged 65+) and
Aboriginal and Torres Strait Islander elders (aged 50+) to access transport to maintain
a healthy ageing approach and sustain instrumental activities of daily living (IADL).
A Definition for CHSP Transport
Through the review of HACC Community Transport, a number of factors were
identified as important in a future definition of CHSP Transport. These include:

The significant amount of transport enabling other HACC services such as
Centre-based Day Care, Social Support, Respite, Personal Care, Domestic
Assistance

Transport provided as an enabler of other Commonwealth Aged Care programs
such as the Home Care Package Program, Day Therapy Centres (DTC), The
National Respite for Carers Program (NRCP), and Assistance with Care and
Housing for the Aged (ACHA)

The improved integration and rationalisation of services through the development
of the CHSP (HACC, NRCP, ACHA and DTC) and the opportunity to develop more
efficient, effective and integrated services including transport services

The relationship and interface between Home Care Packages and the new CHSP

The role of people escorting CHSP clients.
Any definition for CHSP Transport will build on the main purpose and eligibility of the
CHSP. CHSP will support clients to maintain independent living in the community and
promote healthy ageing.
A definition for CHSP Transport should be written in plain English and include the
following aspects:

Direct and indirect transport services

Embedded transport where transport is an enabler to other service types within
the CHSP Transport

Transport should be accessible to people (carers) escorting CHSP clients where
this support is required

Services that support transport reablement and independence.
31
Commonwealth HACC Program Manual, 2012, Commonwealth of Australia, Chapter 3 page 6
25
The following elements should also be considered in a definition of CHSP transport:

CHSP Transport purposes could include:

social contact and support

local health appointments (e.g. General Practitioner, dentist, allied health)
and health services that maintain/strengthen health status

shopping and banking (activities of daily living)

religious and cultural observances

Possible exclusions: non-emergency medical transport which could include
outpatient services such as oncology, renal dialysis and other hospital based
treatments.

Direct and indirect: direct transport services are those where the ride in the
vehicle is provided by a worker or a volunteer. Indirect transport services include
rides provided through vouchers or subsidies32

Independent living in the community.

Transport reablement: services focused on maximising the client’s capacity or
regaining skills related to travel independence

Travel: transport services provided to the client or carer/travel companion where
they are travelling in the vehicle

CHSP Transport should include: non-assisted/assisted transport and planned
(group) and on-demand (individual) services
Transport Reablement
Within the CHSP Transport definition, transport reablement is described as a service
within CHSP Transport. A number of terms are used across jurisdictions aimed at
healthy ageing and the maintenance of older person’s functional capacity. These
terms are addressed in this section and are discussed to aid comprehension.
The Wellness Approach is an initiative which explicitly focuses on building client
capacity. HACC clients in this context include both service recipients and their
carers33. The literature identifies that Western Australia, Victoria, Tasmania and
Australian Capital Territory have approaches known as the ‘Wellness Model’, ‘Active
Ageing’ and ‘Positive Ageing’. The Wellness Approach is consistent with broader
health reforms that seek to keep older Australian’s healthier and more active. Within
this approach there is an appreciation of the benefits of building on client’s capacity
or strengths. In the HACC Transport services this approach may include actions such as
exploring all other options rather than providing CHSP Transport when a person can no
longer drive. This exploration may include the use of: mobility aids, public transport,
walking, friends and family and/or the use of other community transport options. In
this approach CHSP Transport Reablement initiatives may be used to help the client
establish new ways of moving about and to gain confidence in doing so.
Transport reablement services within the definition of CHSP Transport would have a
unique funding output covering elements such as:

Public transport travel training/familiarisation or supported access to other
transport services

Driver strategies to support the maintenance of driving (as appropriate)

Information, planning and support to access other transport schemes as
appropriate
32
Commonwealth HACC Program Manual, 2012, Commonwealth of Australia, Chapter 3 page 6
http://www.communitywest.com.au/Wellness/key-principles-and-components-driving-theapproach.html (Accessed 09/01/14)
33
26

Support to plan with family, friends, clubs and churches (circles of support) to
access alternate transport arrangements
In section 2.6.2 findings of the review relating to measures that can reduce the
increasing demand for CHSP Transport were articulated. These strategies support
older persons to maintain their confidence and capacity to drive for longer (where
this is appropriate for the individual) and reduce the need to be transported
particularly in rural areas where access to health services require long distance trips.
Approaches detailed in section 2.6.2 and the initiatives outlined in this section may
have the capacity to stem the growth demand for CHSP Transport with better
outcomes for the CHSP target population. Exploring these initiatives and propagating
transport reablement will produce efficiencies in the CHSP Transport program and at
the same time be more effective.
Measures considered by the sector that require further exploration and consideration
including cross Government/jurisdiction involvement are:

Initiatives such as safe driving programs for older people, transition to non-driver
support and driver/transport education and training, with a view to slowing the
future demand for CHSP Transport

Further research in current practices and programs (including internationally) in
these areas to inform future priorities – either within the CHSP or in other
programs, e.g. transport and education

Ongoing interface between a transport working group and CHSP Transport to aid
broader advocacy and discussion that will be required to achieve positive actions
that require whole of Government support to the initiatives proposed in section
2.6.2
Proposed action towards common arrangements:

Develop a CHSP Transport Definition.

Any definition for CHSP Transport will build on the main purpose and
eligibility of the CHSP. CHSP will support clients to maintain independent
living in the community and promote healthy ageing.
A definition for CHSP Transport should be written in plain English and include the
following aspects:

Direct and indirect transport services

Embedded transport where transport is an enabler to other service types
within the CHSP

Transport should be accessible to people (carers) escorting CHSP clients
where this support is required

Services that support transport reablement and independence.
The following elements should also be considered in a definition of CHSP
transport:

CHSP Transport purposes could include:
- social contact and support
- local health appointments (e.g. General Practitioner, dentist, allied health) and
health services that maintain/strengthen health status
- shopping and banking (activities of daily living)
- religious and cultural observances

Possible exclusions: non-emergency medical transport which could include
outpatient services such as oncology, renal dialysis and other hospital based
treatments.
27

Direct and indirect: direct transport services are those where the ride in the
vehicle is provided by a worker or a volunteer. Indirect transport services
include rides provided through vouchers or subsidies34

Independent living in the community.

Transport reablement: services focused on maximising the client’s capacity or
regaining skills related to travel independence

Travel: transport services provided to the client or carer/travel companion
where they are travelling in the vehicle

CHSP Transport should include: non-assisted/assisted transport and planned
(group) and on-demand (individual) services

Further exploration and research regarding practices that support reablement
and wellness within CHSP Transport
Ongoing DSS interaction with an industry working group to adopt/foster initiatives
that reduce growth demand for CHSP Transport
3.2 The role of the CHSP in non-emergency medical
transport
Review Findings
The HACC Community Transport Review highlights the extensive demand for nonemergency health/medical transport 35 across most jurisdictions. The dominance of
non-emergency medical transport is reducing the availability of HACC Community
Transport to provide other vital services to the HACC population. Evidence to support
this assertion was gathered from multiple sources while completing the review.
The findings of the review highlight the inconsistencies, the extent and impact of
issues relating to the use of HACC Community Transport to support non-emergency
medical transport. Therefore it is proposed that the CHSP Manual should exclude nonemergency medical transport supported by alternate transport arrangements or that
are the jurisdictional responsibility of other levels of Government from CHSP
Transport. In particular this would include programs focused on meeting the needs of
people accessing specialist appointments from rural and remote areas (Patient
Assisted Transport) and schemes such as the taxi voucher scheme and health service
transport schemes.
Key issues include:

Non-emergency medical transport is wanted and needed by the clients who
consider attending medical appointments as an essential activity rather than a
discretionary activity. Through the National Discussions providers reported that
many of their clients considered attending social activities (with the health and
wellbeing benefits) as discretionary

Jurisdictional Mapping Report: Queensland Summary details the State directive
for HACC Community Transport prohibiting the use of HACC Community Transport
for HACC eligible clients accessing oncology or renal dialysis. The PATS scheme in
NT specifically excludes the ongoing treatment of diabetes 36
34
Commonwealth HACC Program Manual, 2012, Commonwealth of Australia, Chapter 3 page 6
Non-emergency medical transport, for the purpose of this discussion refers to transport which could be
considered the responsibility of the state health systems i.e. oncology, renal, dialysis, hospital discharge
etc.
36
Review of Patient Assistance Travel Scheme (July 2013) NT Department of Health; page 29
35
28

National Discussion Report states that ‘across all National Discussions, it was
generally stated that prioritisation was given to medical and health related
appointments. It was perceived by stakeholders that the increase in demand for
non-emergency medical transport impacts on social support and the promotion of
independence’

Western Australian HACC provides non-prescriptive guidelines to service
providers, encouraging them to maintain a balance when delivering HACC
Community Transport of approximately 1/3 rd to support non-emergency medical
transport, 1/3rd to support social support and 1/3rd to support the maintenance of
domestic activities
In section 3.1, elements of a possible future definition for CHSP Transport have been
suggested, including what types of services might be included and/or excluded.
If agreed, this could result in some health related transport visits (e.g. hospital
outpatient services) being excluded from the definition of CHSP transport. Under
these suggested arrangements, clients accessing outpatient or hospital based
treatment services would use taxi voucher schemes, State or local health transport
schemes or the various patient assisted transport schemes instead of CHSP Transport.
The reason the HACC Community Transport program is currently being accessed by
clients to support this need must be appreciated prior to applying exclusions and
these insights will support a transition plan.
The evidence gathered across the review highlights several factors:

HACC Community Transport has a very small fee contribution and therefore is
favoured by many clients

In rural and remote locations there are limited or no taxi services and HACC
Transport may provide the only wheelchair accessible vehicle that is available

Trips in taxis over long distances are cost prohibitive even when using taxi
vouchers

Patient assisted transport schemes are considered by some clients to be overly
complex to use

Vehicles and volunteer drivers are not consistently available to support the
patient assisted transport scheme

Health services are not expanding their programs to meet increasing demand and
therefore in some instances there is simply no other alternative for clients
accessing essential health services
The use of HACC Community Transport to support non-emergency medical transport
highlights flaws in other programs and schemes. Without remedial action related to
other programs it is likely that the CHSP Transport will continue to bear the brunt of
increasing client demand for non-emergency medical transport. It may also be
convenient to some programs to cost shift to CHSP Transport.
Proposed solutions towards common arrangements
The threshold issue of Commonwealth and State and Territory Government’s
responsibilities regarding the delivery of selected non-emergency medical transport
activities must be resolved. The selected activities include transport to access
outpatient services and transport to access specialists (for the CHSP Transport target
populations). Other steps proposed in this section are the suggested options if the
exclusions proposed in this section and section 3.1 are upheld as a result of the
Commonwealth’s and State and Territory deliberations. It is understood that this
exclusion may not come into effect from the commencement of the CHSP on July 1 st
2015.
29
These steps are:

Addressing with the responsible parties the shortfalls in current programs that are
feeding an ever increasing demand within HACC Community Transport. These
include but are not limited to the taxi voucher schemes, patient assisted
transport schemes and various health service schemes

Defining sharply what exclusions may apply e.g. to access renal dialysis,
oncology, rehabilitation, specialist appointments taking into account the primary
purpose of alternate transport schemes

Developing a transition plan to support current HACC Community Transport
clients who are using HACC Community Transport to access specialist, hospital
outpatient services to transition to alternate transport schemes targeted or
accessible for those trip purposes

Considering the capacity of existing service providers to deliver comprehensive
non-emergency medical transport as subcontractors to the responsible fund
holders facilitating a continuation and development of local arrangements in a
HACC-like manner

Giving due consideration to clients and grassroots stakeholders as it is possible
that local communities have raised funds and developed volunteer resources
based on the unmet need for improved access to health services for their
community members. Sensitively maintaining the goodwill of these stakeholders
will be critical to the successful maintenance of volunteer and community
resources regardless of the responsible funding body.
Proposed actions towards common arrangements:

The Commonwealth to continue discussions with State and Territory
Government to resolve what their responsibilities are regarding the delivery
of selected non-emergency medical transport activities
It is suggested that:

CSHP Transport should not include non-emergency medical transport for
outpatient and other hospital based treatment services in the future
If there are to be future changes to service delivery arrangements in this area,
there will be a need to:

Communicate with the sector regarding the proposed changes and receive
feedback regarding the impact and transitional steps

Develop a transition plan to sensitively respond to existing clients receiving
non-emergency medical transport through HACC Community Transport
3.3 Funding and capital
Discussion Funding and Capital
Historically, HACC Community Transport funding has been provided through block
funding arrangements (e.g. based on numbers of trips), although the approach to
planning and allocation of funding has varied between jurisdictions. Under some other
programs (e.g. Home Care Packages and the NDIS), clients can increasingly ‘purchase’
services from an individual budget. During the transport review, some service
providers felt this approach poses a threat to Community Transport. Their concern is
that services purchased from individual budgets would lead to greater uncertainty for
service providers.
The way in which capital (including replacement of vehicles) is funded, was also a key
issue identified during the transport review.
30
Some stakeholders also suggested the need to move to a different basis of unit pricing
over time, e.g. based on the distance or time of each trip (possibly within different
bands/ranges), rather than the total number of client trips undertaken by a service
provider. Some providers highlighted the different costs associated with providing
Community Transport services in metropolitan, rural and remote areas.
There was general consensus that there is a need to maintain a high priority for
Community Transport in future growth funding, e.g. based on trends in the ageing
population, special needs (dementia), and changes in the volunteer base.
In Victoria while there is no direct transport as a service type in HACC, there are a
number of key ideas that could be beneficial when considering funding and capital.
Victorian HACC Providers are able to access Government contract pricing: these
arrangements deliver considerable financial benefit to service providers. The
arrangements cover: Fleet discounts for vehicles, Government insurance contracts
and Government contract fuel prices.
Review findings
The common measure in the HACC Minimum Data Set (MDS) for transport is single oneway trips. This factor is used as a measure of outputs in the contracts that the
Commonwealth forms with service providers. The finding of the review confirms that
this measure is inadequate and does not reflect the practices or business models of
service providers.
Key elements that make up trips include the type of service provided, differing length
of trip, topography/geography, road condition and the time taken.
A further element for consideration with regard to outputs is the cost of trips and the
fees charged or recovered. Ensuring that there is reliable data with regard to costs
will be an important element in contract management and future approaches taken in
regard to competitive tendering. Therefore the findings of the review provide vital
information requiring further analysis and study.
Information gained from the Website Questionnaire Report37 details the average cost
estimated for the most popular trip 0-10Km as $22.78 and the next most popular trip
length 10-20Km as $31.64. Factors included in the costs are detailed in the figure
below.
37
223 respondents to the questionnaire estimated the average costs associated with HACC community
transport for a range of one-way trip distances
31
Figure 6: Cost Elements of HACC Community Transport
Source: 339 service provider responses to the HACC Community Transport Website Questionnaire
The average fees charged nationally for a trip of 0-10Km are $6.60 and the average
national fee achieved for the 10-20Km range is $8.33. It is worth noting that average
subsidies contributed by the Commonwealth as detailed in the HACC Community
Transport Review Data Analysis Report range from $14.29 in South Australia to $25.30
in the Australian Capital Territory. This suggests that within some jurisdictions and
across a number of service providers HACC Community Transport is being crosssubsidised by other programs and/or current arrangements are not financially
sustainable.
A more detailed analysis of unit costing will only be achieved when the unit of
measure and accompanying data collection for CHSP Transport is redeveloped from
single one-way trips to a client/Km based measure. The review found that the sector
is seeking the change in the measure and the change will support better outcomes for
clients.
In-depth consultations demonstrated that in one jurisdiction in 2012/13 costs
increased by 13% while subsidies in the contract increased by 1.7%. This suggests that
the current HACC Community Transport viability cannot be easily assessed on an
‘average’ basis as operating conditions are subject to jurisdictional and other
economic/operational factors. Any future analysis of unit costing will need to
consider these factors.
Sector in-depth consultations suggest that current output targets are not met when
subsidies fail to match real costs; in these cases service providers simply deliver the
trips they can within the funding they have. HACC Triennial Plans demonstrate
anomalies in funding and outputs that may support these assertions. Other findings
from sector in-depth consultations revealed that, when subsidies do not cover the
entire cost of operating the service, some service providers simply hope to use
community grants, fund raising or special capital grants from HACC when the vehicles
need replacing. In Western Australia HACC transport subsidies paid to service
providers are explicitly not intended to cover capital cost or vehicle replacement.
Sector in-depth consultations suggest that embedded transport in other HACC services
is ‘hiding’ the real cost of service delivery; although it is considered that this may
have a positive impact on the primary HACC service being delivered. A negative
impact suggested by the sector includes inefficiency and under-utilised resources. The
National Discussions highlighted the potential for Centre-based Day Care in particular
to have under-utilised vehicles.
32
The wide variety of service provider contract prices detailed in the HACC Community
Transport Data Analysis Report supports a finding that there are no benchmark costs
for HACC Community Transport on which the Commonwealth can base contract
performance management or consider provider bids in competitive tendering.
Findings of the review demonstrate that contract arrangements enable some
providers to depreciate vehicles and/or accumulate funds that allow for the vehicles
to be replaced. Some contracts reflect pricing that allows healthy surpluses to be
generated while other contract funding represent a contribution to the overall costs
by the Commonwealth. The rationale for these differences are not evident within the
findings of this review.
It should be noted that the financial arrangements that underpin HACC Community
Transport are predicated on the ongoing use of volunteers and the goodwill of
communities. It is unknown to what extent communities including Local Government
are relied on to raise capital for vehicle purchases and replacement.
Sector engagement reported that the National Disability Insurance Scheme
(NDIS)/National Disability Insurance Agency (NDIA) is developing a kilometre/unit
price for transport which may support CHSP Transport to develop a similar benchmark
and measure for outputs, contract management and competitive tendering.
Summarised issues
From a big picture perspective the current contract arrangements for HACC
Community Transport are:

Inconsistent from service provider to service provider

Inconsistent across jurisdictions

Representative of a contribution to the overall costs in some instances

Possibly inequitable

Possibly contributing to unsustainable services if current outputs are to be
achieved
The lack of consistent and meaningful data (benchmark costs against a meaningful
measure) including embedded transport in other HACC services has contributed to a
lack of analysis and an inability to manage consistent and equitable contract
arrangements. This lack of data and an inability to set benchmark costs will hamper
future competitive tender arrangements and may contribute to financially
unsustainable CHSP Transport services at a service provider level.
Key Principles that support Funding and Capital
The following steps are fundamental principles necessary to facilitate the
development of effective and efficient CHSP Transport services. The fundamental
principles will ensure:

Service providers are sustainable

Outputs can be measured

Benchmark unit costs for CHSP Transport can be established for use in contract
management and competitive tendering

Equitable arrangements are in place across service providers

Planning/budget allocations can appropriately support the needs of an effective
and efficient CHSP Transport service

Clients contribute to the cost of CHSP Transport
33
Developing a benchmark unit cost
Developing a table of unit benchmark costs is an activity that requires urgent
attention. Sector input suggests that benchmark costs should be devoid of the
benefits derived from using volunteers and alternate funding or in-kind contributions
for vehicles, administration or other infrastructure (e.g. office, office equipment).
This approach would enable the real cost of providing the services to be clearly
defined.
It is intended that by developing benchmark costs devoid of the assistance of
volunteers and other contributions that DSS will be able to assess the business models
of providers against these benchmarks. This assessment will support:

A quantum regarding the beneficial impact of volunteers and alternate funding or
in-kind contributions for vehicles, administration or other infrastructure

Clarity regarding the extent to which volunteers and alternate funding or in-kind
contributions for vehicles, administration or other infrastructure is a key
structural element of CHSP Transport

The value for money propositions that providers are offering when making use of
volunteers and alternate funding or in-kind contributions for vehicles,
administration or other infrastructure when competitively tendering

An appreciation of business cases that are unsustainable/not financially viable

A review of current contracts aiding insight into the extent to which DSS is
purchasing a service or contributing to the cost

Capacity to articulate an economic argument regarding the impact on the
operations of CHSP Transport when jurisdictions develop regulations that have
unintended negative impacts on CHSP Transport (particularly given the reliance
on volunteers)
The development of unit costs devoid of volunteers and alternate funding or in-kind
contributions for vehicles, administration or other infrastructure is not intended to
dissuade providers from incorporating this contribution. In section 3.5 particular
initiatives are outlined in regard to maintaining and fostering volunteerism and
community goodwill.
The benchmark unit cost will be developed within a table format that includes a
matrix of unit costs. It is proposed that the benchmark cost be based on a per KM
client measure (see section 3.4). Elements included in the matrix are proposed as:

Transport Reablement activities including special equipment

Assisted or non-assisted transport (escorted/non escorted)

Mode of vehicle including modified vehicles and other special equipment

Level of support required due to disability to move from the home to the vehicle
and being seated: standby; observe and support as required/needed; full
assistance

Loadings for Regional and Remote areas
Developing a National Fees Policy and Schedule
The contribution made by clients to the cost of CHSP Transport will be an important
element when developing the price arrangements for DSS’s contract with CHSP
Transport Providers. The Website Questionnaire Report reveals that the average fees
charged nationally for a trip of 0-10Km are $6.60 and the average national fee
achieved for the 10-20Km range is $8.33, as detailed in the figure below.
34
Figure 7: The average client fees by distance
Source: 303 service provider responses to the HACC Community Transport Website Questionnaire
Of the 466 responses to the question regarding fee schedules (Website Questionnaire
Report), 365 service providers (representing 78% of respondents) reported that they
have a fee schedule however only 15% stated that fees were means tested. Fees are
more often based on a distance formula; commonly this is within a range (e.g. 0–10
KM). A variety of treatments are apparent regarding fees that include:

A set fee is charged although it is considered as a donation

In Western Australia fees are stipulated within the Statewide HACC fees policy

Fees are voluntary and may be waived if a client is not able to afford the
transport service

There is no consistent practice for collecting fees and the use of other cost
recovery mechanisms (e.g. full cost recovery) when it comes to carers
Through the National Discussion and the in-depth interviews it was detailed that some
providers had developed approaches to fee collection that were more successful than
other providers. This finding is consistent with broader trends 38 in human services
relating to the skills, tools and competencies developed by individuals and
organisations who achieve better outcomes in fee collection.
Developing a consistent and equitable fees policy is an essential element of effective
and efficient CHSP Transport. The proposed key elements of a fees policy are that:

The fees schedule should be developed in a manner that is consistent with and as
a part of the overall CHSP fees policy39

The fees need to be aligned with the reporting measures detailed in section 3.4

The fees policy needs to address the arrangements required for carers and other
persons escorting clients

The collection of fees or the incapacity to collect fees needs to be built into the
business model and contract arrangements developed between individual
providers and DSS to deliver CHSP Transport

Fees make up part of the equation in setting benchmark unit prices
38
Verso Consulting Pty Ltd Practice findings fee collection human services 2002 to 2013
Commonwealth Home Support Program – A fair and consistent national fees policy from 1 July 2015 Fact
Sheet
39
35
Proposed Steps
The proposed steps include:

Develop a new standard set of measures for CHSP Transport rather than the
current measure (single one-way trips) (as detailed in 3.4)

Develop benchmark unit cost matrix based on the new standard reporting
measure. The benchmarks will explicitly detail the elements that make up the
benchmark including the cost of vehicle replacement

The development of a National Fees Policy consistent with the new reporting
measures and the current HACC fees policy; the fees should be developed
understanding how they may impact client choice and behaviour (see section 2.5
of this report)

The identification of leading practice in fee collection to support training and
practice

Develop and support sector transition related to business models and service
development
Proposed action towards common arrangements:

Develop a standard reporting measure for CHSP Transport (see section 3.4)

Develop a National Fee schedule for CHSP Transport

Identify leading practice in fee collection

Review and develop a table of unit prices for CHSP Transport based on full
costs of staff and vehicle replacement/purchase (where applicable to the
service type) including:
- Transport Reablement activities
- Assisted or non-assisted transport (escorted/non escorted)
- Mode of vehicle
- Level of support required due to disability
- Loadings for Regional and Remote

Develop and support sector transition related to business models and service
development
3.4 Data Collection and Reporting
Review Findings
The findings of the review is that the datasets for HACC Community Transport across
the Commonwealth HACC Program and the HACC Programs in West Australia and
Victoria do not currently provide an accurate or comprehensive picture of HACC
Community Transport across Australia. There is limited national data available on unit
pricing, regional variations in service provision, or price variations. Community
Transport in Victoria is embedded in other HACC services, meaning there is no
separate data on the provision of Community Transport in Victoria.
The findings of the review identified a common view that single one-way trips
(detailed in the Minimum Data Set) is an inadequate measure of transport outputs. In
the National Discussions service providers suggested that any future reporting be
aligned to the information required for other program reporting such as NRCP, DVA
and state health departments. A consistent theme across the National Discussions was
the need to develop and utilise technology in the gathering and reporting of HACC
Community Transport. 250 respondents to the Website Questionnaire answered that
36
they utilise information technology to assist with their transport administration.
Common software utilised included: TMA Trips (48 respondents), Alchemy SMS (18),
CareLink+ (12), PJB (5), Gold Care (4), RouteMatch (4), and Xpedite (4).
The most consistent alternate measure proposed is to provide data that relates to
each client by length of trip. This measure was readily available to service providers
responding to the questionnaire who provided information on their costs and trip
length. For ease of administration using trip ranges may be the simplest measure for
the length of trip e.g. 0 – 10 km. However service providers also provided the
following suggestions:

Distance

Distance/Time

Distance/Clients

Client support need/Time

Client support need/Time/Distance/Paid or Volunteer staff/Capped cost

Time

Time/Number of people/Distance

Book log and Volunteer Report
The National Discussion participants suggested that carers be included in the target
group and be reported as an output. Therefore all measures identified in the dot
points above would relate to a client as well as to the carer accompanying the client.
In the case of CHSP service types that are focused on the carer (such as NRCP) then
the use of CHSP Transport for eligible carers in this case would not require/include
the requirement of the carer to accompany the client. The carer in these instances
would be the primary client.
The current measure of single one way trips and the inconsistent national data, limits
planning, impacts on contract management and potentially on the quality of
information used to assess growth funding options. Addressing the serious information
gaps is essential. The HACC Community Transport Review Data Analysis Report
highlights the extent of the issue and the reason that urgent action is required.
The report states “Calculated unit prices by state and territory differ widely. NSW
with a mean unit price of $24.02, Queensland with a mean unit price of $22.72,
Western Australia with a mean unit price of $21.48 and the ACT with a mean unit
price of $25.30, provided services at similar unit costs while South Australia’s mean
unit price of $15.14 and Tasmania’s mean unit price of $13.56 are lower. The
Northern Territory occupies a middle position with a unit price of $18.99. The
differences within the unit pricing could reflect the mix of costing models used, such
as the use of volunteer drivers and staff members, the nature of transport modes, the
distances travelled, the type of transport modes available (including passenger cars, 4
wheel-drive vehicles, people movers and buses as well as special equipment used such
as lifts) or indirect transport such as the use of taxis and taxi vouchers. The dataset
is silent on these underlying elements which influence service and unit costs.”
The level and cost of transport in Victoria, the second most populous State, is
unknown as Victoria does not report HACC Community Transport (Service Group 7).
Victoria however has two unique elements in regard to HACC Community Transport;
volunteer coordination (reported in hours) and a significant and systemic contribution
to transport by Local Government.
Improving Reporting – Reducing Red Tape
In developing this proposed measure consideration has been given to the impact of
changes to current reporting arrangements and the continuing impact of not changing
the reporting. A number of evidence gathering activities were undertaken (including
37
the National Discussions and Website Questionnaires) regarding potential alternate
measures for reporting. The findings of the discussions are detailed as follows:
Future Reporting: National Discussions
The National Discussions considered future reporting in all of the Service Provider
forums. The questions asked in the forums and the key responses included:
Q: What information do you already collect?
A: The data collected includes all the current requirements of the MDS. In NSW
considerable data is collected and reported by some providers to Transport for
NSW. Other providers report considerable variation in the quality and level of data
collected
Q: How should transport be reported in the future? What elements would it cover?
What measure would be used?
A: A wide variety of parameters for reporting were proposed by providers (a
proportion are already collecting this data but not for MDS) – none of the service
providers in attendance40 considered one way single trips as an appropriate
measure for transport
Q: How would you collect this data?
A: A proportion are already collecting this data over multiple domains
Q: Could technology be used (what/how)?
A: Develop and utilise technology in the gathering and reporting of HACC
community transport
Q: What would the purpose of reporting this data achieve?
A: More detailed reporting and information gathering would assist in identifying
gaps, transport trends, future planning, seasonal changes in demand, population
shifts and help in researching health trends. It would also enable better
recognition of the needs of clients, more targeted funding and the ability to plan
realistically for future transport needs
These responses provide insight into the degree to which the sector desires a move
from the current measure towards an approach that would add value and make the
collection and reporting of data a useful activity for the providers and Government.
This theme was repeated in the Website Questionnaire which corroborates the
findings of the National Discussions. None of the 112 provider responses to the
question regarding future reporting supported the current arrangement. Alternate
arrangements are detailed in the discussion in this section ‘review findings’. In-depth
interviews also reinforced the issues with providers universally calling for a change.
An alternate way of considering future reporting is to reflect on the approach used in
Victoria. Transport is not reported under Service Group 7, rather HACC Community
Transport is embedded into the delivery of other HACC services and is purchased by
the particular HACC services as required. The Victorian Government report the cost of
purchasing transport is considered in the overall contract/benchmark price for each
service type where transport enables that service. However there are other factors
unique in Victoria that distorts any analysis of the benefits or drawbacks of this
approach. It therefore considered that using the Victorian approach as an exemplar
for collecting and reporting data is not appropriate. The two issues that distort
analysis are:

The significant funding for community transport provided by Local Government in
Victoria impacting all LGAs in Victoria

The utilisation of volunteer coordination (as a distinct service type) in Victoria
supporting Community Transport provision
40
There were 303 Service Providers who attended the National Discussions
38
Victorian providers in both the Melbourne and Shepparton forums suggested reporting
CHSP Transport as detailed in this section in ‘review findings’ would enable service
providers and clients to receive realistic and equitable allocations of funding and
identify gaps in service provision and community need. They were favouring similar
reporting to other States rather than the continuation of the current approach
favoured by the Victorian Government.
In summary taking into account the Website Questionnaire, the National Discussions
and in-depth interviews there is a need to change reporting and data collection and
there is a desire across the sector to do so, based on the following:

The current measure (single one-way trips) does not provide meaningful data and
cannot measure true outputs

Many providers already collect and report a large range of data not reflected in
the MDS (including kilometres travelled by client)

There are benefits to providers and by extension to clients if the true outputs are
known and better analysis and planning is undertaken by providers and by
Government

By replacing unproductive activities in the current reporting requirements with
productive activities red tape is effectively reduced

By using technology and fostering the further adoption of technology reporting
and data collection can be streamlined
Proposed solutions towards common arrangements
While sector input has proposed a range of measures for CHSP Transport the proposal
in this section suggests that the current ‘minimum’ measure should be replaced with
another measure that is similarly minimalist in its approach. In effect the measure
proposed (km travelled per client) can replace an ineffective measure with an
effective measure. The effective measure will benefit clients as detailed by Victorian
providers …/“clients to receive realistic and equitable allocations of funding and
identify gaps in service provision and community need”. By replacing the current
measure with another simple measure it is calculated that no additional
administrative burden will be placed on providers when the changes are enacted. The
proposed solutions include:

Develop a consistent data collection and reporting approach using kilometres as
the output

Gather the transport data from all services where transport is provided across the
CHSP (HACC, DTC, NRCP and ACHA)

Work with Victoria, Western Australia and the Northern Territory to adopt these
measures to facilitate consistent National Reporting including how the Victorian
volunteer coordination hours will be reported

Use the of development and coordination functions to work with service providers
to adopt technology to reduce the administration in gathering and reporting this
information

Use grant schemes (Service Group 8) to aid the uptake of technology

Support an ongoing dialogue and interface with an industry working group to
focus on further research

Report (as detailed in section 3.1) incidence of service for transport reablement
programs including the following initiatives:

public transport travel training/familiarisation

driver strategies to support the maintenance of driving (as appropriate)

information and support to access other transport schemes as appropriate
39

support to plan with family, friends, clubs, churches (circles of support)
alternate transport arrangements

Proposed action towards common arrangements:

Adopt new MDS reporting from one way trips to kilometres by client/trip

Include carers in the target group for outputs

Apply the new reporting across all CHSP services and programs for the
transport element

Report incidence of service for transport reablement initiatives

Foster the adoption of technology in support of data collection and reporting
including the use of grants
3.5 Supporting the volunteer base
Review Findings
The extensive use of volunteers in Community Transport, across all jurisdictions, is a
major feature of the current service system. The need to attract, support and
develop volunteers will become more important in the future, with potentially a
smaller pool of volunteers available to provide CHSP Transport services. The extensive
use of volunteers is highlighted by the following graph drawn from the HACC
Community Transport Review Website Questionnaire Report.
Figure 8 : Paid and volunteer staff driving and supporting clients
Source: 332 service provider responses to the HACC Community Transport Website Questionnaire
The findings of the review highlight key issues raised regarding the volunteer
workforce which include:

Service providers and client/advocacy agencies consider that it will become
increasingly difficult to recruit and retain volunteers
40

Volunteers are not free; respondents to the website questionnaire detailed that
the three highest costs associated with volunteers were Administration/
Scheduling, Travel reimbursements and Training and Support. The other costs
include: Workplace Health and Safety, Insurance/Police checks, Uniforms, Mobile
Phones, Recruitment and Induction

Men make up a significant part of the volunteer driver workforce

Legislation is increasingly being developed without giving due consideration to
the impact on volunteers delivering Community Transport services

Increasing numbers of clients with high support needs may require more
specialised staff to aid transportation – volunteers may not be as well suited to
this role as trained and dedicated staff
When considering the issues of volunteer recruitment, reward, training and retention
it should be recognised that HACC Community Transport is often being delivered by
small community-based organisations. Organisations responding to the Website
Questionnaire (793 organisations) reported the following workforce structure:

1,367 full-time paid administration/coordination staff and drivers

4,905 part-time paid administration/coordination staff and drivers

9,819 volunteer administration/coordination staff and drivers
It should be noted that these organisations may be only referring to staff deployed in
the delivery of HACC Community Transport not their entire organisation. Some HACC
Community Transport organisations operate with no paid staff at all.
63% of HACC Community Transport is provided by organisations that on average have
one part-time staff member in administration/coordination and one part-time driver.
On average 5.9 volunteers make up the rest of these services workforce. This
information demonstrates that HACC Community Transport relies heavily on
volunteers who make up 61% of the workforce.
The implications of these findings are that volunteers and small organisations are
linked. Changes and service improvements related to supporting volunteers will need
to be executed in a manner that is sensitive to the administrative, leadership,
organisational reason for being and financial resources of the significant number of
small organisations who will make up the backbone of CHSP Transport services.
Proposed solutions towards common arrangements; Managing Change
The review proposes a shift in the emphasis of CHSP Transport from non-emergency
medical transport to the broader remit of social support and engagement and support
to maintain domestic arrangements. The review also proposes the development of
alternate reporting and the delivery of transport reablement. Achieving these changes
in a service system that has such a heavy reliance on volunteers and that includes
small organisations with limited resources will be very difficult without appropriately
targeted resources and leadership.
The strategies and resources proposed in this section will be designed to provide the
additional capacity required to ensure that changes are executed in a timely and
consistent manner by providers. This is particularly important to the 63% of HACC
Community Transport providers whose organisations on average have one part-time
staff member in administration/coordination and one part-time driver. These smaller
organisations will be dependent on volunteers to assist in and support the changes,
therefore the strategies and resources required must be sensitive and designed to
maintain the support and goodwill of the volunteers.
To ensure that appropriate strategies and resources are available the following
initiatives are proposed:

Develop a dedicated coordination and development function such as the nonoutput Transport Development Officer roles in NSW to be located within each
41
Planning Region to support the required changes at an organisational level (This
function may have a broader remit than transport across the CHSP)

The development and coordination function would operate within a community
development and capacity building framework

Prioritise the activities of the dedicated coordination and development function
in the support of small under-resourced agencies in the first instance
Proposed solutions towards common arrangements; Volunteer Support
As outlined in this section the review has found that there is a heavy reliance on
volunteers to administer and deliver HACC Community Transport. The review also
found that volunteers are ageing and that most providers consider that a lack of new
volunteers will be a major threat to the future delivery of CHSP Transport (at current
output levels). Therefore it is proposed that the following initiatives be adopted:

Develop a dedicated coordination and development function such as the nonoutput Transport Development Officer roles in NSW to be located within each
Planning Region to engage with local providers, communities and volunteers,
developing a sensitivity to volunteers including their roles, interest in
volunteering, training and support needs, rewards and an appreciation for what
contributes to the cessation of volunteers

Facilitate practices within CHSP Transport Providers that supports volunteer
recruitment, reward, training and retention

Facilitate grassroots feedback to Government to enable sector development,
common arrangements, service improvement and equity of access for clients

Further investigate service providers that have well-established and successful
volunteer models, document outcomes of the investigation and publish findings to
support volunteer recruitment, reward, training and retention

Work with and draw from State/Territory and Community Based Volunteer
organisations

Clarify and develop guidelines regarding the use of volunteers’ own vehicles, the
volunteers using clients vehicles and minimum training and accreditation
requirements

Proposed action towards common arrangements:

Develop coordination and development function to:
- Facilitate the change process particularly for small volunteer dependant
organisations
- Support and foster leading practice in volunteer, recruitment, training,
retention and reward
- Assist providers to develop connections and the support of volunteer agencies
and community groups

Develop common standards and guidelines across Australia regarding
volunteer vehicles and accreditation
3.6 Coordination and networking
HACC Community Transport interconnects and interacts with a range of other
transport schemes and programs funded by a range of bodies including
Commonwealth and State/Territory governments, local councils, and not-for-profit
42
organisations such as churches, clubs and community groups. HACC Community
Transport and transport contained in other programs to be rolled into the CHSP are
considerable. The embedded HACC transport represents approximately two thirds of
all transport provided in CHSP services however this ‘embedded’ transport is not
reported. The implications are that coordinating with a much wider group than HACC
Community Transport providers and other Community Transport providers will be
essential to deliver and improve services in a coordinated fashion.
Review Findings
The findings of the review demonstrated in many jurisdictions that networking and
coordination operates in an ad hoc fashion with no formal processes or direct access
to services or providers. The findings of the review also highlighted the following
regarding networking and coordination. Networking and coordination could provide
opportunities that:

Will ensure local services are meeting the needs of clients and service gaps and
unmet needs are identified

Will assist in identifying under-utilised vehicles/resources, reduce duplication and
will support the exploration of methods to maximise existing capacity across
service providers (spare seats in existing vehicles). This was of particular
importance in rural and remote areas

Will support better coordination with health services

Will provide a context and opportunity to share best practice and improve the
effectiveness and efficiency of services

Will provide a forum to provide and receive feedback between service providers
and DSS

May provide a framework for the development of local area plans – these plans
may support growth funding targets and service development priorities
Within the National Discussions there were a number of successful networking and
coordination models/arrangements. These include service providers with strong links
with a range of other community transport options including other HACC service
providers, taxis, community transport agencies and public transport depending on the
functional capacity and needs of clients.
Community Passenger Networks (CPNs) in South Australia were particularly
highlighted in relation to successful coordination. CPNs have key roles such as
enquiries and referrals - assisting people to address their transport needs; brokering
transport services - coordinating booking on behalf of the client; providing transport
services - direct volunteer transport as a last resort; changing appointments and
passenger trips – liaising with hospital or clinic staff; and identifying service gaps to
ensure transport services remain responsive. There is a high level of coordination
between local government, CPN and not-for-profit organisations, although it was
commented that coordination is still one of the biggest issues facing responsive
transport delivery in South Australia.
Proposed solutions towards common arrangements
The view consistently expressed by service providers was that better coordination is
feasible if supported by government with more resources supporting a networking
approach and uniformity across both States/Territories and the Commonwealth.
The proposal is to develop a dedicated coordination and development function. This is
consistent with the proposal outlined in section 3.5. It is proposed that this function
would also provide leadership in the development of local networks to achieve the
opportunities highlighted in the review findings in this section of the report.
Coordination would include CHSP Transport providers, other CHSP service providers
with embedded transport arrangements, other Commonwealth funded aged care
providers and health services.
43
It is proposed that this function would operate across each of the Commonwealth
Aged Care Planning Regions providing ‘local’ insights. It is acknowledge that the
population densities and the number of transport services in some rural and remote
planning regions may require approaches that incorporate several planning regions.
Proposed action towards common arrangements:

Develop Coordination and Development functions
networking and coordination with a focus on:
to
facilitate
local
- reducing duplication
- improving efficiencies
- fostering peer support
- redirecting/transitioning clients to alternate non-emergency medical transport
such as PAT schemes and hospital transport schemes
44
4 Transition
The following section considers implementation and transition steps that may be
considered if the report findings and proposals are adopted.
HACC Community Transport provides services under the designation Service Group 7;
however transport is also embedded in the full range of programs that will make up
the CHSP program and embedded transport services are evident in the Home Care
Packages program. From the 1st of July 2015 the CHSP will be implemented providing
the context and opportunity to develop more effective and efficient arrangements for
transport in the CHSP. A number of fundamental measures detailed in this section will
support a move towards common arrangements and more efficient and effective
transport services. In implementing these measures there needs to be consideration
given to the impact on providers, clients, volunteers, communities, other transport
programs and the Commonwealth. Due to the structure of the sector resources,
communication and thoughtful planning will be required to aid successful transitions.
This section addresses these issues.
4.1 CHSP Manual
With the establishment of the CHSP from July 2015, there is an opportunity to
develop a National Framework for the provision of CHSP Transport (defined within the
CHSP Manual). This framework must still provide opportunity for, and encourage,
flexible and innovative service delivery that addresses local needs. The measures,
definitions, services and elements outlined in this review will be used to populate the
framework and will be detailed in the CHSP Manual.
Transition Activities: (Applicable to all the elements detailed in section 4) CHSP
Transport definitions, prescribed services and measures will be detailed in the CHSP
Manual including a process/cycle of sector input utilising the communication and
transition support (section 4.2)
4.2 Communication and transition support
The current HACC Community Transport system operates within a complex
environment with significant jurisdictional differences. A significant number of
providers are very small and highly reliant on volunteers.
The amount of
Commonwealth funding paid to individual HACC Community Transport providers varies
from contract to contract, depending on the scale of the provider’s business, demand
for services and other funding priorities under the program in the region. There are
sometimes quite different business models for Community Transport providers, both
within and between states and territories. The Commonwealth has formed contracts
with service providers to deliver HACC Community Transport with outputs being single
one-way trips; this measure is considered by service providers (through the National
Discussions and in-depth interviews) to be meaningless as it does not measure the
length of trip, the mode of transport or the support needs of the client. The majority
of transport provided in the current HACC program is not reported as transport and is
embedded in other HACC service types. Adding to the challenges the demand for
HACC Community Transport will increase exponentially over the next decade.
Transition Activities: A number of parallel activities will help facilitate change and
refine CHSP Transport arrangements within this complex and often under resourced
environment, these include:
45

Recognition from all parties involved in the review that this report represents a
starting place for change and that improvements and actions will be refined and
tested over the next three years

Development of a Coordination and Development function operating within each
aged care planning region to assist the sector to develop the capacity required to
execute the changes, to ensure that changes are sensitive to local operating
conditions and to develop forums for communicating with providers within each
aged care planning region

Establishment of ongoing communication with an industry working group to
facilitate the changes such as working with the Commonwealth in achieving the
changes required with respect to non-emergency medical transport, broader
advocacy and actions required to reduce the growth demand for CHSP Transport
through a wide range of transport reablement initiatives

Providing participants in the HACC Community Transport Review and other
stakeholders with feedback and information on the outcomes of the review and
ongoing updates on the progress being made
4.3 Scope of CHSP Transport
Transport under the CHSP will include all the current Service Group 7 programs,
transport that is a component of all other CHSP programs (this includes Victoria’s
volunteer coordination) and Home Care Packages.
Transition Activities: the transport component of all of these programs will be
reported by providers. This will require new units of measure, data collection and
data analysis/reporting. It may also require this reporting to be a requirement of the
DSS contract with providers. Providers will need to consider their capacity (software,
vehicles and staff) to support the increased scope of services.
4.4 Transport Reablement
Transport Reablement programs will be recognised as service types.
Transition Activities: New Transport Reablement service definitions will be written to
support the detailing of prescribed Transport Reablement services. Transport
reablement will require new reporting outputs to be developed. These outputs will be
included in new contracts. Providers delivering these reablement services under
current contract with DSS will require adjustments to be made to their contracts.
Additional research is required to identify a broad range of effective reablement
programs and measures.
4.5 Carers
Carers and people escorting clients will be included in the outputs for CHSP
Transport.
Transition Activities: Policies and guidelines relating to the subsidy paid and fee
contribution (if any) for the carer and/or travel escort will need to be developed.
Providers will need to consider their capacity (vehicles and staff) to support the
increased scope of services.
46
4.6 Non-Emergency Medical Transport
As detailed in section 3.2 the threshold issue of State and Territory and the
Commonwealth Government responsibilities in regard to non-emergency medical
transport for outpatient and specialist services needs to be first resolved. If the
recommendations regarding non-emergency medical transport are upheld there will
be multiple impacts and factors that need to be considered including:

Existing clients, particularly those who rely on HACC Community Transport as
their only means of travel or who have developed an affinity and trust in the
HACC Community Transport provider to the point that they are likely to refuse
alternate transport services. As detailed in section 2.5, client choice may include
the low fee regime in HACC Community Transport as a key factor impacting their
reliance on HACC Community Transport. It is also recognised that in some
communities the HACC Community Transport vehicle may be the only wheelchair
accessible vehicle or the only way a client can get to essential non-emergency
medical appointments and that rural and remote clients have very limited or no
choice/alternatives

HACC Community Transport providers who have resources, schedules and
infrastructure committed to delivering services that support non-emergency
medical transport that will be excluded (see 3.2). The current arrangements and
demand may have resulted in the purchase of equipment fit for the task that will
be less suited to a different service mix

Other Transport programs may have lapsed, may not be able to support the
additional volume, and may be cost prohibitive to some clients

Other jurisdictions may not have the resources or they may not be willing to use
the resources to support travel to outpatients and specialist services. The
inappropriate reliance on HACC Community Transport may have become an
entrenched expectation across health and medical services
Transition Activities:

State and Territory Governments and their respective health services will need to
accept their responsibility to fund the burgeoning need for non-emergency
medical transport for outpatient and specialist appointments for people in the
CHSP target population including the unique issues in rural and remote Australia

State and Territory Governments and their respective health services may be able
to form contracts with existing HACC Community Transport providers to continue
to provide transport that is HACC–like to the client group who are currently
accessing non-emergency medical transport that will be excluded from CHSP
Transport

Commonwealth and State and Territory Governments may be able to consider
new options particularly in Rural and Remote locations to develop joint or
integrated arrangements to utilise the same infrastructure for CHSP Transport
and non-emergency medical transport for specialist services and outpatients

Commonwealth and the respective State and Territory Governments will need to
address operational issues in other programs and schemes that are resulting in
clients favouring or requiring the support of HACC Community Transport for nonemergency medical transport to access specialists and outpatient services

Providers will need to be given the flexibility to transition clients to alternate
transport schemes or to continue to support existing clients over a number of
years depending on the client’s willingness and capacity to transition. Providers
will need to be funded to continue to support current clients who can’t or won’t
transition to another program during the transition period
47
4.7 Unit Cost
The Commonwealth does not have a meaningful benchmark to price CHSP Transport,
to analyse the sustainability of the sector, to analyse offers made by providers, to
consider value for money propositions and to plan. Planning activities may include
setting of fees, developing budgets and determining target outputs. Appreciating the
full cost of providing CHSP Transport will also enable the Commonwealth to
appreciate the economic benefit of volunteers and the contribution of local
communities. This ‘appreciation’ will assist the Commonwealth to determine the
resources required to continue to foster volunteerism and to maintain the
contributions of communities. This will be particularly important during the period of
change (the next three to five years).
Transition Activities: Undertake research to develop a matrix of costs (section 3.3).
Building on this review, quantify the extent of volunteer involvement and community
support and the economic benefits. The amount of cross subsidisation should also be
considered in appreciating the real costs. These activities should be undertaken in
parallel with the development of a uniform client contribution schedule and the
development of new reporting measures (section 3.4). Future contracts developed by
DSS with providers will be crafted taking into account the benchmarks.
4.8 Data Collection and Reporting
A new unit of measure for travel services in CHSP Transport based on kilometres
travelled per client is a central proposal of this review. It is also proposed that
transport reablement activities will be measured as an incident of service. The
adoption of a meaningful measure to be used to report direct/indirect and transport
embedded in the delivery of other services in CHSP services will provide the
Commonwealth with meaningful data to manage and develop reliable, consistent and
equitable performance indicators. The unit of measure will also contribute to
meaningful and equitable procurement practices by DSS and a better and more
equitable system for clients.
Transition Activities: Apply the new units of measure to all new contracts developed
for CHSP including programs with an embedded transport component. Incorporate the
new measure into the MDS and require existing contracts to report transport and
where relevant the component of their service that is transport (currently embedded
in the service) using the new standard measure. This process will be aided through
the use of technology. The coordination and development function proposed in this
review will be well positioned to foster the adoption of technology by providers. DSS
through HACC Service Group 841 could consider a grant scheme to support this
proposal.
4.9 Supporting the Volunteer Base
There are two significant factors to be considered with reference to the high reliance
on volunteers. They are:

The large number of small organisations which are heavily reliant on volunteers
to administer HACC Community Transport. These organisations will require
additional support and leadership to successfully adopt the changes required to
transition to CHSP Transport arrangements

Maintaining the economic benefits of volunteers and community goodwill. This is
essential if the current output levels are to be maintained
41
Service types included in Service Group 8 include; building the evidence-base, development and service
interventions and Sector support and development.
48
Transition Activities: Engage with local communities and organisations (particularly
focusing on under resourced organisations) through the proposed coordination and
development function to create communication, feedback cycles and guidance to
adopt the changes. This activity is calculated to ensure that goodwill is maintained
and that change occurs in a manner that is sensitive to the grassroots practices and
needs of clients. This engagement and communication will be aided by the proposed
role of the coordination and development function in facilitating coordination and
networking.
4.10
Coordination and Networking
The National Discussions in particular identified an opportunity to make better use of
existing resources, avoid duplication and maximise the capacity of existing vehicles
through establishing regular forums to coordinate and network.
Transition Activities: Within planning regions and/or sub regions (as required) develop
transport focused networks and forums. These will be used to maximise the use of
existing infrastructure and to aid the significant changes related to non-emergency
medical travel proposed through this review. It is considered that the use of alternate
travel programs and the capacity of those programs will be subject to significant
variation at local level, particularly in rural and remote areas. The local networks,
aided by the leadership of the development and coordination function, will provide a
vital link in facilitating change and providing feedback to DSS.
49