Wednesday, April 23, 2008

Consumer Bites - Issue 8 out now

The next Issue of Consumer Bites is now available.

  • There are new committee vacancies that many of you will be interested in, including two new positions at Calvary; one on their accreditation team and the other providing consumer input to the Simply Better program.
  • There are reports for three committees, including the AIP Steering Committee and Pharmacists Board.
  • There is also a report on a workshop I attended recently on improving the Australian Health Care Agreements.

Monday, April 21, 2008

ABC Talkback: The hospital experience

ABC Life Matters talk back on hospital experiences last Friday. They explore the experience of being in hospital - or more specifically what it's like to be a patient.

One of our members drew it to my attention. The MAGGIE project at John Hunter Hospital We (which has influenced the ACT Health Access Improvement Project) was discussed as well as the need for our health system to deliver care in more appropriate settings and not be limited to hospital.

It's easy to download and listen to on your computer. We have downloaded this at the office and can give you a copy of you would like to listen.


Sunday, April 20, 2008

Australia 2020 Summit

Like many of you I have been paying some attention to the reports of the 2020 summit over the weekend. I have a strong interest in education as well as what the participants come up to for the long term vision of health.

There seems to be an understanding of the social determinants of health and I have heard reference to many factors that are fundamental to good health including the need for
"good housing, nutritious food, a safe and clean environment and modern health services" .

The background paper is available on the Australia 2020 website. (The pdf is 314kb.)

There are plenty of places on the web where you can find out what has been discussed:
ABC reports:
The 2020 summit's health group outlines its top-seven big ideas, including a health version of Facebook and a ratings system for food. The stream's co-chair, Queensland Institute of Medical Research director Professor Michael Good, tells Prime Minister Kevin Rudd they are also proposing a national preventative health strategy funded by taxes on junk food, cigarettes and alcohol. But one delegate believes the group has neglected the need to close the Indigenous life expectancy gap.

There are also web-casts. I watched the plenary of Kevin Rudd speaking to the group. He held my interest and commented on issues that we have been arguing for. He said:

The challenge of public health policy is to deal with the immediate and the long term at the same time. What happens in the ED tonight, in acute hospital beds tomorrow, the clogging up of the system by people who need to be in aged care beds. This all needs to be fixed.

It certainly sounds promising.

CHF prepared a submission for the 2020 summit. It is available on their website.
Our overall vision is one where consumers are partners in their own health care and are included in all discussions and debates around health policy and programs and in all committees involved in the implementation and monitoring of projects and programs. This partnership is premised on availability of and access to well-communicated information that enables consumers to make informed decisions and to navigate the health system to get the best health outcomes.

Friday, April 18, 2008

Improving the Australian Health Care Agreements

In March, Russell McGowan and I attended a workshop on how to improve the Australian Health Care Agreements. This workshop was run by the Australian Health Care Reform Alliance. HCCA is a member of this Alliance.

The Australian Health Care Agreements (referred to as the ‘the AHCAs’ elegantly pronounced ‘Ackas’) are bilateral five-year agreements between the Australian Government and each state and territory. They a way of transferring funds from the Commonwealth to the states and territories to provide free public hospital services to the Australian community.

John Deeble, Emeritus Fellow at ANU, provided an historical overview of the AHCAs. The AHCAs have been in place since 1974. In this time major changes have occurred in the community that have led to an increased demand in the public hospital system. He spoke of the increase in demand for public hospital services. For example, in 2005-6 public hospital admissions increased by 190 000. Prue Power, CEO of the Australian Heathcare and Hospitals Association said that there has been a 25% increase in the admission rate in public hospitals in the last ten years.

When the AHCAs were first negotiated health care was provided to patients in hospital. Now there are many types of care that are provided in a range of community settings, including in the patient’s own home, or community clinics or outpatient clinics. Our population is aging. Currently, there are 1.9 million Australians aged 70 and over, comprising 9.3 per cent of the population. Within 40 years the number of people aged over 65 will almost triple, from 2.8 million today to around 7.2 million in 2047, or from around 13 per cent of the population today to over 25 per cent. Technology has made spectacular advance resulting in a range of effective, less invasive procedures.

There was strong support at the workshop for the scope of the AHCAs to be broadened to a ‘whole of system’ approach to include community based health services in addition to these services performed in public hospitals.

John Deeble gave an overview of who uses the public hospitals. In very general terms he divided admissions into three categories:

  • 50% admission through the emergency Department
  • 25% serous and acute episodes that are life threatening
  • 25% related to chronic illness.

There was agreement by many of the participant that chronic disease management was an area that could be targeted within the funding agreements. If the AHCAs are to be scoped then there is a great opportunity to have funding tied to health promotion and health prevention aspects in the continuum of care.

There is a significant need for health reform. We currently have a silo funding of hospitals, caged care and primary care. This series of disconnected programs and fragmentation has resulted in poor coordination of services for consumers. It has a negative impact on continuity and integration of care. (And of course there are issues with transferring patient information as a result.)

There is room to consider alternate models of health funding. One idea that was put forward is the potential to have perpetual agreements between the Commonwealth and states and territories. These could then be supplemented by particular project funding to promote innovation in practice. There can be five year review points.

Many of these matters will be considered by the National Health and Hospitals Reform Commission. The Commission is calling for submissions to help design
Australia’s future health system. Submissions are due by 30 May. HCCA will be working to complete a submission for consideration. We welcome your thoughts.

Queensland Health has put together a interesting paper on the health care agreements. They provide useful background but also explain why the AHCAs are inadequate in the way in which they fund the states and territiories. A pdf of this report is available online ...

Sunday, April 13, 2008

What is del.icio.us?

On the right hand side of the page (underneath the HCCA logo) you will see a section that has links to websites that we think may provide you with useful information. Included here is a link to del.icio.us.

What is del.icio.us?
del.icio.us is a social bookmarking website -- the primary use of del.icio.us is to store your bookmarks online, which allows you to access the same bookmarks from any computer and add bookmarks from anywhere, too. On del.icio.us, you can use tags to organize and remember your bookmarks, which is a much more flexible system than folders.

We have started a list for HCCA bookmarks.

If there are websites that you find useful, we would love to know about them and add them to the list we have.

Saturday, April 12, 2008

Access Improvement Project Update

The Access Improvement Team release Updates each quarter in pdf format. I will update the link regularly so that you can keep informed of the objectives and achieves.

In our recent Consumer Reps Forum there was discussion regarding how projects are identified by ACT Health to become projects. We have asked Bernadette Brady from the AIP Team to provide us with information about this. I post to the blog with the response.

Thursday, April 10, 2008

ACT Health policies and plans register

While searching the ACT Health website I almost fell into the following website which may be of interest to you: it is an alphabetical, searchable register of ACT Health's policies, plans, strategies and guidelines. http://health.act.gov.au/c/health?a=da&did=10107160

Wednesday, April 9, 2008

Issue 7 of Consumer Bites

The next issue of Consumer Bites is now available.
Of particular note is the report by Janne Graham on TCH Clinical Review Committee. This is an excellent example of how we can report issues of consumer interest to our networks even though the committee we sit on may be privileged. Janne write the report and cleared it with the Chair of the committee before publication.
The Clinical Review Committee operates under qualified privilege. The WA Department of Health has an good overview of what this means. http://www.safetyandquality.health.wa.gov.au/clinical_incid_man/qualified_priv.cfm

In 2006 the ACT Legisltaive Assembly amended the Health Act 1993 and passed the Health Legislation Amendment Bill 2006 to address a number of issues in relation to quality assurance and clinical privileges committees.

On this the Minister said: The need to use information about health care to improve patient care is now well recognised. However, many health care professionals fear that the information they contribute to those activities might unfairly be used for purposes other than for which it was intended. As a result, some health care professionals have been reluctant to contribute sensitive information to health professionals and committees involved in health outcomes and activities care safety and quality improvement activities. Quality assurance legislation seeks to provide for the confidentiality and protection of certain information generated by or for the purposes of health care quality improvement committees. ( Excerpt from ACT Hansard entry from when Minister for Health, Katy Gallagher tabled the bill in 2006.)

Tuesday, April 8, 2008

Summary of COAG Meeting of 26 March 2008 Communiqué

Tony Greville has provided a summary of the Communiqué COAG released after their recent meeting on 26 March 2008:

On health and hospitals, the Commonwealth agreed to commit an immediate allocation of $1 billion to relieve pressure for 2008-09 on public hospitals. This is an increase in Commonwealth funding for public hospitals for 2008-09 of 10.2 per cent.

COAG agreed:

  • that the new Australian Health Agreements should move to setting a long-term share of Commonwealth funding for the public hospital system and incorporate a review of the indexation formulas for future years; to be signed in December 2008 with a commencement date for the new funding arrangements of 1 July 2009
  • that jurisdictions, as appropriate, move to a more nationally-consistent approach to activity-based funding for services provided in public hospitals – but one which also reflects the Community Service Obligations required for the maintenance of small and regional hospital services
  • to the introduction of a national registration and accreditation system for health professionals and steps to address health workforce skills shortages.

To the implementation of health reform in three stages:

  • the first stage involves immediate action on Health Workforce Registration and transitional arrangements for the current healthcare agreement- the Intergovernmental Agreement on the Health Workforce, to implement the registration proposal, has been signed;
  • the second stage involves COAG consideration at the December 2008 meeting of the new Australian Health Care Agreement (AHCA) as part of the broader SPP Financial Framework. There will also be potential NP payments for medium-term health reform from July 2009; and
  • in the third stage, when the National Health and Hospitals Reform Commission (NHHRC) report of June 2009 is available, COAG will consider additional longer term health reform to be implemented either as updates to the National Healthcare Agreement or as new NP agreements over time.

COAG also agreed key health reform priorities for further work ahead of consideration of proposals by COAG no later than October 2008.

Friday, April 4, 2008

Should we increase spending on preventative medicine?

On 3 April Yesterday Life Matters interviewed Jeremy Sammut from the Centre For Independent Studies . He's been studying reports of the outcomes of public health campaigns and has concluded that there's a big difference between knowing what to do and doing it.

The CIS has written an article on six social policy myths. One of the myths they challenge is that higher spending on preventive medicine will reduce health costs in the future.
They argue that:
"prevention is better than the cure, but only when it works".
What do you think?

Thursday, April 3, 2008

ACT Health Organisational Chart

At last week's consumer representatives forum we spoke about the structure of ACT Health. Ross O'Donohue is the new head of Health Policy. Megan Cahill, who spoke to HCCA about health service planning, is the head of Health Planning and Government Relations.

The ACT Health organisational chart may help you. (It is a pdf at 143 kb.)

Wednesday, April 2, 2008

Personal Health Records


There has been recent attention in the media given to the development of commercial personal health record software packages. Russell McGowan has prepared a summary of some issues raised by these developments which may be of interest to other HCCA members as we look at developing a position on the development of electronic health records and/or other e-health issues in the ACT.

In a rapidly changing environment, the failure of Health Connect to make much of an impact on the establishment of a shared electronic health record for the benefit of consumers in Australia has been disappointing, but there are alternative approaches emerging that warrant closer inspection.

I have drawn the following inferences from recent articles I have read on the marketing of software packages offering us software to assist with compiling our own personal health records which may be populated electronically (at least in part) by records compiled by clinicians:

  • Several major software companies are currently peddling Personal Health Record (PHR) products, including Google and Microsoft. On the surface, these provide an interesting approach to an opt in patient controlled EHR system.
  • If one is nervous about giving health information to a PHR provider, an alternative is to maintain one's own records. There are software tools that one can use on one's own computer to help keep records organized, or one can store files in other formats, such as paper or on discs.
  • One has the right to obtain a copy of one's health records from one's health care providers and health insurers, and this is something that is generally a good idea. Placing this into a PHR can help provide safer and better quality co-ordinated care.

However, there are some potential drawbacks:

  • The pressure to make a profit can place commercial PHRs in conflict with consumers over privacy
  • Use of a PHR by a consumer on an office computer or other employer-owned Internet access device may also affect the privileged status of health information.
  • Not all PHRs have the same levels of privacy protection. Some PHRs are covered under the US federal Health Insurance Portability and Accountability Act. (HIPAA), but many are not. Australia doesn't seem to have any equivalent to the HIPAA. that establishes a baseline for health privacy here

The HIPAA rules establish minimum privacy and security standards for covered entities. A covered entity is a health care provider, health insurer, or clearinghouse. Records in PHRs that are covered under HIPAA have built-in standards for privacy and security, including standards governing disclosure, access, correction, and other privacy elements. The basic idea is that if a health care provider (hospital, physician, pharmacist, etc.) or a health plan maintains a health care record, the record is protected under HIPAA. Maybe we need such an Act here as well.

In my view healthcare consumers in Australia need to become more proactive in developing options for different groups within the community who want to be more in control of health information about their health status to ensure that they continue to get the best quality care available without removing the right to privacy of community members who are less concerned about this and more concerned about leakage of information about their health status that may negatively impact on them in some way. Activist healthcare consumers with complex chronic conditions are at one end of the spectrum, and privacy and human rights activists at the other. Allowing the needs of either group to totally over-ride those of the other is not acceptable, so some form of compromise approach needs to be developed if the vast majority of members of the Australian community are to benefit.

I vote for trialling an opt-in PHR in Australia and empowering a representative steering group of consumers, clinicians and health system adminstrators to monitor its application.

Russell McGowan