Thursday, December 17, 2009

LCM response to HCCA comments on staffing

This week HCCA received a letter from the Little Company of Mary (LCM) in response to our blog post of 2 November 2009.  We will meet with representatives of LCM in January to discuss their position more fully.  In the interim we thought it would be useful to post part of the letter that relates to staffing, as it provides more detail than we initially had.


What follows is an excerpt from that letter:

"In the section Implications for governance and staff conditions you state “nursing staff resources available to provide palliative care in the community appear to be considerably less than when home based palliative care was part of ACT Health”.
  • CHC received seven (7) Full Time Equivalent (FTE) nursing staff when it took on the home-based palliative service. This did not include any provision for clinical nurse consultant, managerial, allied health, medical or administrative support. Following representation to ACT Health in 2003, CHC received additional funding to provide a Clinical Nurse Consultant and administrative support for the home-based palliative care service.
  • Currently, the home-based palliative care service has approximately ten (10) FTE including the Clinical Nurse Consultant position and one (1) FTE of administrative support. Supplementing these staff, and not included in the ten FTE, are management, allied health, medical and administrative support staff located at CHH or working at CHH as an extension of their role at Calvary Hospital.
  • The model of care for home-based palliative care has developed since 2002 to focus on the provision of specialist palliative care services delivered by highly skilled clinicians. Non-specialist palliative care assistance in the home, as required by CHH, is provided by Community Health and also by the volunteer members of the ACT Palliative Care Society."
"Also in the section Implications for governance and staff conditions you state “but with the change of management will be employed by LCM and will be required to sign employment contracts agreeing to work to LCM values”.
  • Staff at CHH and Calvary Public Hospital, whilst ACT public servants, are employed and managed by CHC. Under this arrangement it is already a requirement that staff observe and practice the Calvary values of Hospitality, Healing, Stewardship and Respect. A value based approach to management is considered normal and best practice in health care."
  • "Further, no Clare Holland or home based palliative care employees will “be required” to become Calvary employees should the proposal proceed. If existing staff do not wish to become a Calvary employee (under the proposal) they can elect to remain in public employment with ACT Health.
  • If existing staff do remain with Calvary, and for any reason wish to review that decision at any time in the future, they can return to ACT Health employment with full recognition of length of service etc. All existing entitlements of staff, and their current superannuation  arrangements etc, will be honoured.
  • From the very first announcement of negotiations regarding the possible changes of ownership at Calvary Public Hospital and Clare Holland both parties clearly stated there would be no disadvantage to any staff. This commitment has been honoured to date and any representation to the contrary simply does not reflect the facts of the situation."

Thursday, December 3, 2009

The need for compromise to solve the concerns regarding the sale of Calvary and Clare Holland House



HCCA has spent a great deal of time listening to and considering community views and concerns expressed regarding the possible transfer of ownership, governance and control of Calvary Public Hospital at Bruce to the ACT Government, with the ACT Government to transfer Clare Holland House Hospice to the Little Company of Mary Health Care.  

In summary the HCCA position is:
1. Support the transfer of ownership, governance and control of Calvary Public Hospital at Bruce to the ACT Government;

2. Oppose the transfer of ownership of Clare Holland House (CHH) to the Little Company of Mary Health Care Limited (LCMHC);

3. Oppose the offer of a contract for clinical service at Clare Holland House for a term of not less than 30 years; and


4. Oppose the nexus between the sale of Calvary and Clare Holland House and think that the issues need to be considered separately.
As set out in our submission, we find the arguments for the sale of Calvary very convincing and are fully supportive of the Government owning, funding and governing Calvary Public Hosptial. We consider there will be great benefits for consumers with the integration of the services across both the Canberra and Calvary hospital campuses. This arrangement will provide for more efficient use of public money, reduction in duplication and improved coordination with community based and ambulatory service - all leading to improve outcomes for consumers.

We do not support the sale of Clare Holland House to the Little Company of Mary Health Care.  We have not been convinced that the Government has demonstrated how the quality of care will improve as a result of the change in ownership. 

The provision of a clinical services contract of not less than thirty (30) years is a major concern for HCCA. We do not consider this to be good public policy practice. A contract for the provision of clinical services over such a lengthy period was seen as unrealistic given current and likely future health care reforms. Such a contract could well provide an unreasonable restriction on the ACT Government’s ability to adapt to changing funding and healthcare service models.  An extension of the clinical services contract to not less than thirty years could be seen as excluding other providers from the palliative care sector and creating a private monopoly in ACT palliative care.


We consider that the difficulties in developing and achieving integration of different palliative care services, including home based palliative care, respite care, community based services and integration with residential aged care facilities, need to be addressed.


We are of the view that consumers should be able to access secular palliative care and have the right to refuse pastoral care.  This is made more difficult to achieve when there is a religious provider of public palliative care services.  As once consumer commented recently: "I do not want to be in a place that imposes their ethics and limits my options".

We acknowledge that this is a very difficult position for the Government and the Greens to be in. We share the view that public services are best served in public hands. 

We do not understand why the sale of the two sites are linked in thie proposal and believe that they need to be considered separately on their merits. 


The palliative care approach is highly valued as a response to end-of-life care in the ACT community. However, not all patient groups are adequately served because of limited resource availability particularly for respite places. Before there is any transfer of ownership of the hospice consideration must be given to the establishment of an independent review team made up of individuals with expertise to build a progressive case for additional resources, and to examine the current mix.

We consider that there is a need to treat Clare Holland House separately to the sale of Calvary Public Hosptial as there is a need to reconsider and review the needs of our community in terms of palliative care. 

One aspect of this is the current staffing structure.  The staff complement in the a home based palliative care service is now 8.2 full time equivalents, i.e., 56% of what it was 13 years ago. There have been complaints from some consumers regarding the inadequacy of home based palliative care. LCM has recognised that the service is insufficient for the need and they have been pressing for increased funding for staffing for home based palliative care for some time - pre discussion of the sale.  We would like to see an independent review of palliative care needs and provision in the ACT before we are locked into a longer term arrangement.

It is interesting to reflect on the history of palliative care in the ACT which began as a community initiative with input from a range of people/organisations both secular and religious:
* started in 1985 (a home based palliative care service) run by by Community Nursing, ACT Health. At the same time, the ACT Hospice Palliative Care Society was given a $10,000 donation from the ACT Cancer Society to commence its first volunteer program.
* Following a decade of success of the home based palliative care service and the volunteer program, the ACT Govt agreed to fund a hospice inpatient facility which opened on Acton Peninsular on 1 April 1995. LCM won the tender to manage the hospice for a one year period but the contract was renewed on a regular basis and further tenders have not been advertised over the last 14 years. Home based palliative care continued to be run by Community Nursing.
* In 2002 the specialist palliative care nurses in the home based service run by Community Nursing were transferred went to the management of the LCM. The model of care has been changed from a nursing model under the Community Nursing service to a “support and consultative” model which requires less nursing staff in the specialist palliative care service.

HCCA will continue to put forward the views of our members and networks on this issue and are keen to hear.

The HCCA Executive Committee meets on Wednesday night (9 Dec) and will finalise our position on the Calvary proposal.

Tuesday, December 1, 2009

The Canberra Hospital Car Parking - Shuttle Bus part of the solution

Over the next 10 years the Canberra Hospital campus will be a building site as health services are upgraded and buildings refurbished.  The building work has begun with fences obstructing paths and roads.  Car parking will be difficult over the coming 12 months as the large multi-storey car park is being constructed.

Information is the key to a successful transition period so that TCH campus and building site does not turn into parking chaos for consumers and carers.


The large multi-storey car park was closed last Friday (27 November) and consumers are now required to park in the large open car park adjacent to Hindmarsh Drive.





ACT Health has published a brochure outlining the car parking arrangements.  This is sent to consumers with admission papers and for appointments for outpatients.  This brochure is available on the ACT Health website.

The brochure contains a useful map to show consumers, carers and visitors to TCH where they can park.  This needs to be enlarged and made obvious at various sites around TCH campus.  Currently, oreintation signage is limited.















There are key messages that our community need to know:
Access to TCH will be difficult particularly over the coming 12 months while the car park is being built.  During this time consumers may consider asking a friend or family member to drop them off and pick them up, or using Action buses.
The car parking that is closest to the hospital is limited to 2 hours only.  

We understand that ACT Health has been considering a shuttle bus.  The time is right to introduce this service now to offset the confusion and inconvenience for consumers, and carers. 


A Shuttle bus would overcome many of the issues.  It could operate on a circuit around the hospital grounds for pick ups and drops offs.  It could also operate from Woden Town Centre and the Bus Interchange.
This would pick up and set down passengers every 15 minutes. 

The shuttle bus would benefit a range of uses including; mothers and prams, seniors without disability stickers, visitors and consumers who come to the hospital with a range of needs and physical abilities.  The bus would also improve physical comfort; we don’t want seriously sick consumers their friends and family members struggling to walk from one end of TCH campus in 35 degree temperatures to their cars.

There also needs to be consideration of a transitional lounge where consumers which have been discharged can wait in comfort while their carer, relative or friend collects the car.


It is important that consumers have the support and care of their family and friends while they are in hospital.  Involvement of family and friends is a critical aspect of quality care.  Good signage and information about car parking is an important aspect of this and should not be trivialised.

Wednesday, November 18, 2009

HCCA Executive Committee for 2009-10

Congratulations to the Executive Committee for 2009 - 2010

President: Adele Stevens
Vice President: Caroline Polak-Scowcroft
Secretary: Russell McGowan
Treasurer: Bev McConnell

Committee members: Marion Reilly, Dalane Drexler, Angela Wallace and David Lovegrove

Sunday, November 15, 2009

Annual General Meeting and Planning Workshop









On Tuesday, 10 November HCCA held our Annual General Meeting at the Southern Cross Club, Woden. Adele Stevens, President, reflected on the achievements of the past year:

The past year has been a very successful one for Health Care Consumers’ Association (HCCA) and I have been proud to hold the position of President and work with such a committed and enthusiastic group of health consumers. Over the year, the profile of HCCA has been significantly raised in the community following the hard work of both staff and members on a range of issues. It is not possible in this report to list all the areas where we have made a significant contribution with consumer participation but I would just like to highlight two: first, the GP Taskforce and, second, the Capital Asset Development Program.

Our concerns about the GP shortage were raised with the closure of a GP Practice in Wanniassa. The HCCA Blog detailed our action and response at that time and, with media interest, provided a way for the community to get involved in this issue. Following growing community concern, the ACT Minister for Health set up the GP Taskforce to investigate and make recommendations on ways to improve primary health care services in the ACT. HCCA was a significant contributor to the Task force deliberations. Primary health care was a big issue in the last year and will continue to be an area of major concern for HCCA with our interest and involvement in nurse led walk in clinics and the development of Enhanced Primary Health Care centres in the ACT.


The development of the Capital Asset Development Program (CAPD) following the ACT government’s commitment to spend $1 billion dollars in improving health services over the next 10 years has resulted in a major input from HCCA to this program of capital development. Here are now nine consumer representatives involved with the CAPD program and HCCA has been funded to provide a part time staff member to support these consumer representatives. The exciting program is just beginning and HCCA is pleased with the opportunities for consumer participation provided by the able CAPD team led by Megan Cahill at ACT Health. As the program grows, there will be lots more opportunities for consumer participation in the planning of future ACT health services.

The HCCA Executive Committee has benefited from the contribution of Jude Manning, Chair of our Governance Committee. This year, we endorsed a Governance Framework , and Risk Management Framework. These documents provide useful guidance to the Executive Committee in ensuring the strategic objectives of HCCA are met.

In addition, the HCCA Constitution was revised – a major task long overdue. My sincere thanks to the Working Party who laboured on this over the last year. I am very pleased that we can present the results of that work later in this meeting for your consideration.

Adele's full report in in the Annual Report.

Congratulations to the Executive Committee for 2009 - 2010
President: Adele Stevens
Vice President: Marion Reilly
Secretary: Russell McGowan
Treasurer: Bev McConnell
Committee members Dalane Drexler, Angela Wallace and David Lovegrove

















After the formal meeting members participated in a workshop reflecting on the purpose of HCCA, reasons for involvement and ideas for renewal and growth. This is in the process of being written up and will be posted soon.

Monday, November 2, 2009

Proposed Sale of Clare Holland House

HCCA is opposed to the sale of Clare Holland House (CHH) to Little Company of Mary (LCM). We have a range of concerns relating to the continued integration of palliative care services, implications for governance and staff conditions, and the lack of considered analysis about current and future needs for palliative care in the ACT.

Integration of service:

Concerns have been raised that the proposed sale of Clare Holland House will create a private monopoly in ACT palliative care. At present the service is a tri-partite one, involving ACT Health, LCM, and the Palliative Care Society, which provides checks and balances on the quality of the services provided. What guarantees are there that this balancing mechanism will be maintained if the LCM becomes a monopoly provider of palliative care services?

Implications for governance and staff conditions:

Since home based palliative care management transferred to LCM, nursing staff resources available to provide palliative care in the community appear to be considerably less than when home based palliative care was part of ACT Health. Consumers are expressing concerns about these reductions in available resources while the need for palliative care is growing and the population increasing.

Staff are currently employed by ACT Health, but with the change of management will be employed by the Little Company of Mary and will be required to sign employment contracts agreeing to work to LCM values.

Future needs for palliative care in the ACT:

The palliative care approach is highly valued as a response to end-of-life care in the ACT community. However it is not all patient groups are adequately served because of limited resource availability (e.g. some cancer patients are well cared for but some people with other end of life conditions such as motor neurone are less well catered for; before any transfer of ownership consideration must be given to the establishment of an independent review team made up of individuals with expertise to build a progressive case for additional resources, and to examine the current mix.

Thursday, October 29, 2009

Palliative Care Society meeting of friends and supporters

Last night I attended the information evening of the Palliative Care Society on the proposed sale of Clare Holland House (CHH) to the Little Company of Mary (LCM). It was held at the Ainslie Football Club.
















I counted well over one hundred people, and one organiser gave the figure of 143.

There was overwhelming opposition to the sale of Clare Holland House.

The purpose of the forum was to provide information and a range of perspectives on the proposed sale to encourage friends and supporters of Clare Holland House to share their thoughts with the Council of the Palliative Care Society. The feedback received will provide guidance to the Society on how to respond to the proposal.

The Palliative Care Society is a member of HCCA and a number of HCCA members were part of the audience. We will certainly be considering the feedback we heard last night in responding to the Government’s proposal.

There was a change in the format of the information evening. The Minister for Health, Katy Gallagher and the LCM were invited but the Council decided that, in the interest of open and frank discussion, to withdraw the invitation so that they could provide a forum where friends and supporters could freely discuss matters of concern on the proposed sale.

Shirley Sutton, Patron of the Society, spoke thanked people for attending and provided a history of the home based palliative care and shared with members of her distress at the sale of Clare Holland House.

Peter O’Keeffe, a volunteer with the Society for 10 years, spoke, in a strong and considered way about his concerns about the impact such a decision could have on our community. Peter is a member of the working group PCA set up to research implications of the proposal. He expressed his concern that Clare Holland House seems to have been thrown into the deal as a bargaining chip. Of particular concern is the 30 year exclusive service contract of clinical service to the LCM as part of the proposal. This was a major issue of concerns with those assembled. Peter ended with an impassioned plea to those in the audience to tell others about the issues.

Linda Denham, honorary secretary of the Society spoke on the clinical issues and concerns the staff. There are concerns about loss conditions of employment, and implications for care given the need to have an integrated palliative care as they work across a wide range of areas including radiation oncology, medical oncology, renal, neurology, pediatrics and cardiology. Integration will be more difficult with privatisation of the hospice. Linda also spoke of her concern around the monopoly of services that would result from the sale and the granting of the 30 year service contract.

David Lawrance, President of the Palliative Care Society, opened with comments that the alarm bells have started to ring and that many in our community are worried. He stated that the Society does not have a formal view on hospital sale but strongly oppose the sale of the hospice. He said that they Society considers it to be quite wrong to use CHH as a bargaining chip in negotiations in respect of purchase of the hospital and that they can see no reason for connecting the purchase of CHH and Calvary. David stressed that the current situation works very well and there is no reason to change it.

There was unanimous opposition to the sale and the audience will be supporting the Society in their fight to save Clare Holland House.


HCCA supports the sale of the hospital to the Government but not at the expense of Clare Holland House. We share many of the concerns of the Palliative Care Society. We question the nexus between the sale of the hospital and the hospice and think they are two very different issues to be considered separately.

We have had a number of meetings with consumers and have prepared a paper outlining the issues. We are running a workshop next Thursday to work through these.

Wednesday, October 28, 2009

Health literacy - what does it mean?

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HCCA members and staff have been talking about health literacy in recent weeks. We are thinking about what this means for consumers and the types of supports that could be put in place to improve our health literacy. This is of particular importance at the national level with the current consultations on the National Health and Hospital Reform Commission.


We have pulled together a few definitions that we would like to share and are interested in your feedback.


The Australian Bureau Of Statistics Report on Health Literacy in Australia (2008) is a significant report and we consider it to be critical to health reform in Australia. It defines Health Literacy:

the knowledge and skills required to understand and use information relating to health issues such as drugs and alcohol, disease prevention and treatment, safety and accident prevention, first aid, emergencies, and staying healthy.


A similar definition that we also considered is contained in an online article that talks about the recommendations of Adelaide Thinker in Residence, Professor Ilona Kickbusch, the Healthy Ageing Research Cluster (HARC), to establish the Health Literacy Alliance. Susan Gravier, Co-ordinator of HARC at the University of Adelaide, explains what health literacy is, and how the Health Literacy Alliance aims to help our society.

Health Literacy is not just knowing how to read but knowing how to navigate through life, keeping health in mind and in practice. It's knowing about the body's functions and signs of dysfunction; knowing how to find, interpret and understand information, and how and where to seek further information when required; knowing what constitutes good quality advice, and how to translate this help into action.

Harvard Material on Health Literacy

This Harvard site has a very useful set of guides in plain English as well as lots of information about creating material for adult low literacy groups. The American focus seems to be on the need to cater for people with poor print reading skills. It contains some excellent material for people developing programs and material for the public.


Wikipedia

Studies reveal that up to half of patients cannot understand basic healthcare information. Low health literacy reduces the success of treatment and increases the risk of medical error. Various interventions, such as simplified information and illustrations, avoiding jargon, "teach back" methods and encouraging patients questions, have improved health behaviours in persons with low health literacy.


The University of Queensland has released a response to ABS study:

This research has revealed that nine million Australians — or 60 percent of the population between the ages of 15 and 74 years — don't have the basic knowledge and skills to understand and use information about their own health.


The impact of such a high proportion of Australians without basic health literacy skills should be of major concern to anyone wanting to ensure people and communities are better able to promote their own health and prevent disease.


(Professor Robert Bush, Health Communities Research Centre)

Sunday, October 25, 2009

Consumers have our say on national health reform

Nicola Roxon met with around fifty representatives from the consumer movement on Friday 23 October 2009.

HCCA was well represented with consumer representatives as well as HCCA President, Adele Steven. I attended in my capacity as HCCA Executive Director.

Antonio Russo, Chair of Consumers Health Forum (CHF), welcomed the representatives and the minister. He commented that CHF considered this forum to be unique and powerful opportunity. He went also commented:

  • the final report of the National Health and Hospital Reform Commission accords with CHF strategic plan, and
  • CHF is pleased that the Government is taking health performance seriously and that the Government is backing the rhetoric about health consumers by holding the forum today.
The Minister then spoke, providing a snapshot on the reform commission report and the Commonwealth Government's ambitious agenda of health reform. She pointed to a number of initiatives the government is progressing. These include:

  • $500m in investments for sub-acute care
  • $750m to take pressure off Emergency Departments
  • $1.1b for training doctors, nurses and allied health workers
  • $600m elective surgery waiting list reduction plan
  • 36 GP superclinics with 26 contracts signed
  • MBS and PBS access for NPs and midwives

The report identifies actions that can be taken against three reform goals:

  1. Tackling major access and equity issues that affect health outcomes for people now;
  2. Redesigning our health system so that it is better positioned to respond to emerging challenges; and
  3. Creating an agile and self-improving health system for long-term sustainability.

The Minister spoke about a number of areas: hospitals, primary health care, prevention and areas of special need.

Hospitals:
new access targets, new way of funding, separating emergency and elective care,
strengthen sub-acute care, commonwealth to assume responsibility for outpatient
services
Primary care: commonwealth leadership, more primary care centres, more roads leading to community health services rather than ED in hospitals, voluntary enrolment with a single provider is a contestable idea, better integration, multi disciplinary
teams
Prevention:
10 hear goals and how to engage the whole community, making prevention a focus in
the health system, more information to help better choices

The Minster said:

"whatever we do in the health, it doesn't come cheaply. there are high needs and demands as well as high costs"

Cost of reform has been calculated to be between $2.8 - $5.7b per year and this does not include estimated $3.9b for denticare scheme (through 0.75% increase in medicate levy).

The Minister threw out a number of challenges for consumers including the funding mix and the separation of elective surgery and emergency departments.

The Minister said that the treasury advice on the mix of funding for health care between out of pocket, government funding and private health insurance is about right and recommend maintaining the balance. This is certainly a point of contention with consumers. We pay through our taxes, through private health insurance premiums and then again with out of pocket expenses (co payments).

After the Minster finished her presentation we had an hour for questions and comments from the floor. I will post on the issues raised by consumers later in the week.

http://www.yourhealth.gov.au/

The Minsiter's press release is available online.

Thursday, October 22, 2009

ACT Health Calvary Consultations

I attended two ACT Health consultations on the proposed sale of Calvary on Friday 16 October 2009. The one at Calvary had around 40 people, including a few Calvary staff and other 'minders' and there were around 30 at The Canberra Hospital.

Katy Gallagher responded to many questions and comments. There were a wide range of issues covered.

Questions from the floor included were:

Were there complaints about the performance of Calvary? and is this what has prompted the Government to approach the Little Company of Mary to purchase Calvary Hospital?
How is the Catholic spirit and ethos going to be maintained in a government run hospital? Will the pastoral care team remain as it is?
Why wasn’t consultation started earlier in the process of discussion between Calvary and the Government?
Why are the times for consultation limited to day time? Will the Government consider running forums after hours or on the weekend?
Why is Calvary taking money for the sale when it was built with public money?
What will happen to the hospice f the sale of the hospital does not occur? Will the Government still want to sell it?
How do the Little Company of Mary Sisters feel about the sale of the hospital and Clare Holland House?
Can the costings be trusted? Would the Government consider a cost-benefit analysis?

The responses to questions were largely answered based on the material contained in the Government's information paper and other consultation documents

Tuesday, October 6, 2009

healthdirect

As many of you know healthdirect Australia is a joint initiative of the Australian Government and the governments of the ACT, NSW, NT, Tasmania, SA and WA. healthdirect will be made progressively available to residents of Tasmania and is scheduled to be a fully national service by 2011.

It provides residents with a source of health-related information and advice over the phone and online. It provides a 24-hour telephone health advice line staffed by Registered Nurses to provide health advice.

HCCA has been meeting regularly with an ACT Health representative of the National Health Call Centre Network raising consumer issues regarding this service. The extent to which consumers are shaping the development of this service is somewhat limited at the moment and we have been advocating for more formal arrangements.

We have an ongoing interest in the public reporting of the efficiency and quality of this service.

The NHCCN has made a number of reports available on their website including the Quarterly Report for April ‐ June 2009.

Department of Health (WA) previously published quarterly reports specific to WA however it appears this no longer occurs. The most recent link is to the national report prepared by the National Health Call Centre Network Ltd.

We are interested in what consumers consider to be good indicators of quality in terms of this service.

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Thursday, October 1, 2009

Community Consultation on Government purchase of Calvary Hospital

The Little Company of Mary Health Care has agreed in-principle to sell the hospital to the Government for $77 million. The ACT Government and Little Company of Mary Health Care (LCM) have reached in-principle agreement on the proposed changes and is now in a position to put forward a proposal for community consultation and feedback.

The Government has announced a six week consultation period regarding the ownership and governance of Calvary Public Hospital and Clare Holland House. The consultation period is from 1 October 2009 to 12 November 2009 and will include a number of community forums during October. There also a specific website www.health.act.gov.au/calvaryconsultation which also provides avenues for our community to feed in our views.

The consultation period provides an opportunity for the community to be informed of the proposal and express our views. This is by no means a fete accompli. The Government will hear from staff and community members about concerns and perceived benefits of the deal. This is the time that consumers and carers need to take time to consider the proposal and provide feedback to the Government.

The Government will make a final decision about the sale at the conclusion of the consultation period. If a decision is taken to proceed with the changes, an Appropriation Bill would be introduced into the Legislative Assembly for debate.

HCCA considers that the community will derive benefit by transferring direct responsibility of the public hospital from LCM to the ACT Government. The Government considers that this transfer will provide the opportunity to develop one seamless and integrated public health care system for the ACT and surrounding region, and to maximise efficiencies through a single governance arrangement, with consistency in policy and health program management. Should the Government decide to proceed the implementation will be critical to realising the benefits for our community and improving health outcomes for consumers.

The cumbersome cross‐charging arrangements were highlighted in the 2008 Auditor General's Report and are a direct result of there being no formal commercial separation of the public and private arms of the Calvary operation. This sale of Calvary Public Hospital to the ACT Government can remove this issue. It can also generate efficiencies by reducing duplication of a range of services including human resources and technology and streamline financial, administrative and clinical management within the ACT Health structure.

LCM plans to build a new co‐located private hospital on the Calvary site which forms part of the proposed agreement. This facility would be operated by LCM and replace the current Calvary Private Hospital once constructed.

Written submissions can be provided by:
email calvaryconsultation@act.gov.au or
mail Calvary Consultation, ACT Health Policy Division, GPO Box 825, Canberra ACT 2601

Wednesday, September 30, 2009

Gender and Health

Today I attended a consultation for the National Women's Health Policy. This forum, held in Canberra, is the first of fifteen that will be held around Australia. There were around sixty participants and we worked in table groups to identify priority areas and also detail how we would go about making that happen.

The Commonwealth Government is developing a National Women’s Health Policy which will focus on encouraging specific health services for women and actively promoting participation of women in health decision making and management. I will post more about this in the coming week.

The National Men's Health Policy is currently in development and will focus on reducing the barriers men experience in accessing health services, tackling widespread reticence amongst men to seek treatment, improving male-friendly health services, and raising awareness of preventable health problems that affect men.

In February David Lovegrove, a member of the HCCA Executive Committee, attended a consultative forum at the Hellenic Club. This was one of 18 fora held in states and territories. The consultations have been written up by I have not been able to locate these online. I understand that the national men's Health policy will be finalised later this year.

This drew my mind to the broader the role of gender in our health. Gender is a key determinant of health and the ACT and Commonwealth governments are developing policies that recognise the specific needs of men and women so that programs and services will improve health outcomes.

In 2002 the World Health Organization (WHO) held a seminar on mainstreaming gender equity in health. This is now referred to as the Madrid Statement, (Pdf 208kb). It says:
"To achieve the highest standard of health, health policies have to recognize that women and men, owing to their biological differences and their gender roles, have different needs, obstacles and opportunities."

Gender mainstreaming is the process of consistently incorporating a sensitivity of gender differences in policy, planning, budgeting, and implementation of programmes and projects in order to overcome inequalities between men and women, boys and girls.

The Public Health Association of Australia has a policy on this. Their recommendations and resolutions are important to note in the context of the national health reform on men and women's health.

Friday, September 18, 2009

Consumer experiences of self managing chronic conditions

In August HCCA facilitated a workshop of around 50 consumers on behalf of the ACT Division of General Practice (ACTDGP). This workshop is part of Interprofessional Learning Project currently underway involving ANU and the ACTDGP.

Consumers were asked specifically about what helps them to self management their chronic conditions and what barriers they encounter in their self management. Participants worked in table groups to share their experiences and document their ideas.










A number of speakers also gave presentations to participants.

Russell McGowan (Pictured) talked about the national level reform in chronic conditions and also talked about his involvement with the Consumers Health Forum project on developing resources to support people to self manage their chronic conditions

Judy Stone, told the participants about the Interprofessional Learning programs currently underway in ACT Health

Other speakers included Susan Abbott (ANU), Amanda Plowright (SHOUT), Ann Thomson (RSI and Overuse Injury Association) and Jo Stewart, a peer leader for the Living a Healthy Life with Chronic Conditions workshops.

Enablers

Knowledge of the system and their condition were identified as important enablers for consumers. Working with a doctor who is knowledgeable about the condition, treatment options and available supports was also important. Research, particularly using the internet, was mentioned as were self help courses as a way of gaining knowledge.

Some existing services were identified as significant enablers for managing chronic conditions: Job Access, psychology services, hydro pools and other services sere identified as desirable. Good medical services particularly GP services were also identified as enablers.

Participants identified the need for appropriate design for people with chronic conditions.

Participants repeatedly identified support from others, groups, families, friends, as important enablers for management of chronic conditions.

When communication channels are respectful, informed, inclusive and personable they were seen as enabling the management of chronic conditions. Effective communication between health providers facilitated by good record keeping was also identified.

Participants identified good treatment and plans to treat as important in enabling them to manage a chronic condition. This plan could include lifestyle factors. A multi pronged or holistic approach was mentioned.

Having plenty of money was identified as an enabler to self managing a chronic condition.

Participants identified that a positive attitude and determination are useful enablers.

Barriers

Participants were very vocal about the need for health professionals to interact with them as people first. They want respectful, honest, considered and comprehensive communication about their situation.

Lack of Medical Profession Knowledge about chronic conditions was seen as a barrier to the management of those conditions and the variation between doctors knowledge was raised by participants.

Participants recognized that they needed to be well informed about their chronic conditions, however they were struggling to gather reliable information which would help them to successfully manage their chronic conditions. They were also concerned about the level of general knowledge in the community about chronic conditions.

The shortage of doctors in Canberra both GP’s and specialists was seen as a barrier to managing chronic conditions. This was reflected in many comments about waiting times to see doctors.

Participants identified specific areas of service deficit as a barrier to managing chronic conditions. These included, interpreter services, hydro therapy, rehab gyms, well resourced support groups, advice advocacy services, and service closures.

Carers were recognized by participants as central to their ability to self manage their chronic conditions and when carers were not available self management was threatened.

Participants were acutely aware of the need to provide well designed, accessible public spaces and transport and that when this did not exist it was a barrier to managing chronic conditions.

Poor dental services were identified as a barrier to self management of chronic conditions.

Isolation from community was a concern for participants.

Participants repeatedly highlighted the added costs associated with managing a chronic condition: home help, medication, therapy, tests and medical visits. Loss on income was also mentioned. Several participant also mentioned their concerns around transparency in decision making around the cost of ordering tests and intervention.

Participants were frank about their concerns about their experiences where they perceived a power imbalance in their interactions with the medical profession in managing their chronic conditions.

A report is currently being finalised for ACTDGP and will be available on the HCCA website soon.

Tuesday, September 15, 2009

GP Task Force Final Report


On 15 September 2009, the ACT Minister for Health, tabled the final report of the GP Taskforce in the ACT Legislative Assembly. The report is entitled General Practice and Sustainable Primary Health Care: The Way Forward and is available online (454kb Pdf)

The report presents the outcome of the ACT GP Taskforce’s debate and deliberation following consultation with a broad range of people and organisations

The final report provides the ACT Government with a range of recommendations that supports the provision of general practice and contribute to building a system of sustainable primary
health care for Canberra.

The Report covers issues including

  • Workforce Challenges such as workforce supply and better support for General Practice
  • Development of the non-medical workforce
  • Short and long term sustainability
  • Evolving service models
  • Access to primary care for Residential Aged Care Facilities
  • linking with Government's sustainable transport plan
  • Health Literacy and e-Health
  • Develop easy to read guidelines for the community and the profession on how to access health records


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Tuesday, September 1, 2009

National Primary Health Care Strategy

The Primary Health Care Strategy has been released.


The Key Priority Areas are:

1. improving access and reducing inequity;
2. better management of chronic conditions;
3. increasing the focus on prevention;
4. improving quality, safety, performance and accountability.

Central to achieving this are:
  • patient-centred focus
  • eHealth system and
  • well educated and distributed workforce
The issues for consumers in accessing primary care have been identified and summarised in the document:
For individuals, the primary health care
services they access and the quality of
care that results can depend on where
they live, their particular condition, and
the particular service providers involved,
as much as their clinical needs and
circumstances. Many patients, particularly
those with complex needs, can either be
left to navigate a complex system on their
own or, even when supported by their
general practitioner (GP), be affected by
gaps in information flows and limited
ability to influence care decisions in other
services. (p.9 Strategy)

we will be very interested in following how this reform is implemented and how the community will be involved.
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Monday, August 31, 2009

Building Relationships - broadening our representation

In August HCCA was delighted to conduct training for the Canberra Multicultural Community Forum. The training sessions focused on the health rights, consumer participation and how consumers and advocates can participate in decision making in the ACT health system.
The workshops were valuable and HCCA staff gained important insights from the CMCF participants which we will use to frame responses to health policy. we would like to thank CMCF for their time, enthusiasm and willingness to build a relationship with HCCA.


HCCA President, Dr Adele Stevens, and Vice President, Marion Reilly, attended the first session and shared their experiences and insights as consumer representatives and being involved in an advocacy organisation. Russell McGowan, HCCA Secretary, attended the second session and we engaged in a lively discussion on health reform.


One thing HCCA does for all our training sessions ask consumers what they would like to change about the health system. The responses to this question are below.

What would you like to change about the health system?

Consumer Feedback
Increased representation from inclusive community
Better consultation process with all stakeholders
More efficient uses of resources from a diverse workforce
Overcome the top HEAVY administration in hospitals

Workforce
Better understanding by health professionals about cultural attitudes to health and their expectations for behaviour of clients
Doctors in hospitals who know as much as nurses about wound recovery etc. (they are often unaware of the long term effects of their treatment and they don’t know their patients.

Research
More funding for research into areas affecting consumers such as gluten intolerance

Home and Improve Aged Care support service – have community representative on the HACC committee. Not just restricted to service providers.
Better primary health care – subsidised fees for gym membership?

Navigating the System
More accessible information about services that are available especially for aged people.
More information about assistance for elderly people to let them stay in their own homes

Access
Access to dentists for all
Valet parking for Canberra Hospital!
Better transport to parking at Canberra Hospital
Reduce waiting at Emergency Department

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Thursday, August 20, 2009

Sick Around the Word

Frontline is an online and on air journalism program that looks at critical issues we all face. Last year they worked with a senior reporter from the Washington Post to look at the delivery of health care. The program can be viewed online.

This program, Sick Around the World, looks at how five other capitalist democracies -- the United Kingdom, Japan, Germany, Taiwan and Switzerland -- deliver health care, and what the United States might learn from their successes and their failures.

  • UK - there is the government funded National Health Service (NHS)
  • Japan - everyone must buy health insurance, either through an employer or a community plan
  • Germany - offers universal health care, including medical, dental, mental health, and homeopathy
  • Taiwan - the government collects the money and pays providers but the delivery of health care is left to the market.
  • Switzerland - health reform saw the establishment of a universal health care system that restricted insurance companies from making a profit on basic medical care
This is of particular interest given the current moves to reform the US health system. The Wall Street Journal has been critical of Obama's move to nationalise the health system and has given attention to what they see as the failures of the NHS. Frontline has posted a 10 minute clip from Sick Around the World that profiles the NHS. This is available online.

Saturday, August 1, 2009

HCCA Submission to the GP Task Force

HCCA has made a submission to the GP Task Force. It is available online (290 kb Pdf)

Our community needs primary health care that is accessible, clinically and culturally appropriate, timely and affordable. We based our submission on our research and analysis of consumer experiences and expectations of general practice in the ACT.

We would like thank the hundreds of people who took the time to complete the GP Snapshot online survey and share their experiences and expectations of general practice in the ACT. There is a strong level of interest in the community about access to quality health services.

We would also like to thank the many people in our membership and wider networks who shared their experiences and perspectives with us.

A quick summary:
In our consultations we found that consumers’ experiences of primary health care were varied. Some consumers are very well placed with a regular GP who they can see when the need arises. Other consumers reported that the inadequate supply of GPs presents them with significant difficulties in accessing satisfactory care, including for urgent appointments, referrals, scripts or renewals of prescriptions.

Consumers also reported a level of disruption to their health care with the closure of general practices and move to larger corporate medical centres. The impact of closures of practices on consumers is amplified as many existing GP practices have closed their books to new patients.

One of the strategies consumers have developed to deal with the GP shortage is to have a number of general practices they access. A respondent to the GP Snapshot 2009 said that they had “2-3 GPs because we cannot always get to see the same GP due to difficulties getting an appointment” (Respondent 130).

The extension of “corporate” GP practices with a strong profit emphasis is a cause of dissatisfaction for many health consumers in the ACT; reasons given are reduced geographic access, especially if relying on public transport, no doctor of choice and a ‘production line’ consultation process – a particular concern for consumers with chronic and complex conditions.

The majority (81.2%) of respondents have a regular GP. Respondents were asked to provide reasons for not having a GP. The main reasons given for not having a GP were that the consumers can never get into their preferred GP (17.5%) and that GP Clinics are not taking new patients (16.7%).

The GP Snapshot 2009 was designed to capture a snapshot consumer experiences and expectations of general practice in the ACT.

The survey was developed based on discussions with consumer representatives and members of HCCA. Secretariat to the GP Task Force had seen a draft of the survey before publication. The survey was piloted with a group of HCCA members. It included issues such as whether consumers have regular GPs, waiting times, the quality of the interaction and demographic material and included a number of questions that the GP Task Force had asked practicing GPs.

The survey ran from 15 June - 3 July 2009 and was publicised through HCCA members and networks, and media coverage in The Canberra Times, ABC Canberra and 2CC. There were 635 responses. We think that the number of responses demonstrated a strong interest in the community around this issue.

Our preliminary analysis is included throughout the submission to the GP Task Force. A summary of findings is available online (151kb Pdf). HCCA will continue to analyse the results of the survey and post this to the HCCA blog over time.