Victorian public hospital classification review – agreement reached: what does it mean for you?

Members will be aware that the Safe Patient Care Act ¹Victorian Legislation and Parliamentary Documents 2021 Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 Authorised Version No. 011
(the Act) was introduced in 2015 and since its implementation Victorian public hospitals have seen significant increases in patient demand and acuity.

For several years, ANMF members have called for a transparent and evidence-based review methodology to determine the classification of hospital levels in Schedule 1 (medical/surgical wards) and Schedule 3 (emergency departments) to ensure they are responsive to increases in demand. Subsequently, as part of its 2018 election commitments, the Victorian Labor Government agreed to undertake the hospital classification review.

As part of the ongoing review, ANMF (Vic Branch) has been working with the Allan Labor Government and the Department of Health to develop a clear process that reflects Victoria’s busy public health services.

Key to ANMF’s advocacy was ensuring fairness, transparency and accessibility, particularly to enable members to easily understand ‘how and why’ their hospital’s level was determined. After investigating several options, in-principle agreement has been reached on the data and methodology to provide a review of hospital level and emergency department classifications that seeks to:

1. anticipate nursing and midwifery workloads and staffing requirements
2. be transparent, clear and easily applied
3. develop hospital staffing levels that are sensitive to the hospital service profile.

To ensure transparency, the data utilised will be taken from the publicly available Victorian Agency for Health Information (VAHI) hospital performance data ²Victorian Agency for Health Information 2025 Victorian Health Services Performanceand includes:

• Schedule 1 hospital data: utilises the annual data of patient bed days, emergency department (ED) presentations, average daily ICU hours, NICU/SCN admissions, Schedule 1 hospital classification data also includes, where applicable, the Maternity Capability Framework. This data is weighted using the Modified Monash Model (MMM) which accounts for hospital remoteness (see below for ratings list).³Australian Government 2025 Modified Monash Model (MMM) Department of Health, Disability and Ageing
• Schedule 3 hospital data: includes emergency department presentation data only (MMM weighted).

*It is important to note that this review relates specifically to the classification of hospital levels in Schedule 1 and Schedule 3 only and is applied to medical and surgical wards in Schedule 1 and emergency departments in Schedule 3. It is not related to amending specific clauses in the Act, or ratios for clinical areas e.g. Oncology or GEM.

ANMF has secured a commitment from the Allan Labor Government that no hospital will go down a level as a result of this review. Notably relevant ANMF Delegates Conference motions have been achieved through the agreed hospital level data thresholds.

While ANMF insisted on the inclusion of urgent care centre (UCC) presentations in the analysed data, this was not possible as urgent care data is not currently published as part of the VAHI hospital performance quarterly data. However, ANMF has secured a commitment that the department will review current UCC data collection to ensure accuracy and facilitate the publication of UCC presentation data alongside VAHI ED presentations as soon as practicable. UCC data will then be analysed for inclusion in the hospital classification threshold algorithms during a subsequent Hospital Classification Review (HCR) scheduled for 2029.

Regional weighting (MMM) – applied to Schedule 1 and Schedule 3 hospitals: The regional weighting will adjust algorithm weightings for ‘hospital bed days’, ‘emergency department (ED) presentations’, ‘intensive care unit (ICU) average hours of care’ and ‘neonatal intensive care unit/special care nursery (NICU/SCN) babies admitted’ according to the Modified Monash Model (MMM) as follows: MMM1 hospitals: weighting of 1.0 (no adjustment), MMM2 hospitals: weighting of 1.2, MMM3 hospitals: weighting of 1.3, MMM4 hospitals: weighting of 1.4, MMM5 hospitals: weighting of 1.5, MMM6 hospitals: weighting of 1.6. Data are multiplied by the weighting – 1.2 for MMM2 hospitals etc.

Next steps

While agreement on the methodology, data and data thresholds for each level has been reached, there is work to be completed on the implementation process, including how often the process of data analysis and reclassification of health services will occur.

In addition, as with all amendments to the Act, a bill outlining the changes will need to be drafted, tabled, debated and passed by both houses of the Victorian Parliament.

Once the amendments pass and receive Royal Assent, the process of implementation will start.

Hospitals predicted to move

Based on the currently agreed data, the following hospitals are predicted to move up a level once the legislative amendments are in place:

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Table one

1. Hospital results MMM Weighted and relevant to Schedule 1 and Schedule 3 Classifications

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Table two

1. Hospital results MMM Weighted and relevant to Schedule 1 and Schedule 3 Classifications
2. New listing under Schedule 3

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Table three

1. Hospital results MMM Weighted and relevant to Schedule 1 and Schedule 3 Classifications

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Table four

1. Hospital results MMM Weighted and relevant to Schedule 1 and Schedule 3 Classifications

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Table five

1. Hospital results MMM Weighted and relevant to Schedule 1 and Schedule 3 Classifications
2. New listing under Schedule 3

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Table six

1. Hospital results MMM Weighted and relevant to Schedule 1 and Schedule 3 Classifications
2. New listing under Schedule 3

Footnotes