Monday, June 12, 2017

Health Consumers Queensland Annual Forum 2017

I recently attended the annual forum of Health Consumers Queensland (HCQ). It was held in Townsville, in North Queensland. The theme of the forum was Power and Passion: Culture Change through Consumer Empowerment and Partnerships.

Th team and HCQ will make videos, transcripts, and visual presentations from all sessions available soon.

Over the day I took notes and am posting my thoughts and take away messages in a series of blog posts.

Mark Tucker Evans, Chair, HCQ
The forum opened with a welcome to attendees and acknowledged the Hospital and Health Services (HHS) who supported consumers to attend as well as staff from HSS’s, Primary Health Networks, the Department of Health, a range of non-government organisations and private services. He thanked the consumers and carers on the reference group who developed the program. He reflected that there was a rich and diverse range of participants which would add value to the day. Mark said: "the Forum is about exploring opportunities for meaningful consumer engagement and demonstrations of how it changes culture of organisations and improves the delivery of patient centred care".
Mark also reflected that the Minister launched the Queensland Advancing Health 2026 at the inaugural forum in 2016 and would be at the forum today to give a report on achievement in the past 12 months.

Professor Gracelyn Smallwood – conducted the welcome to country and reflected on 50 years of working in th healh sector, as a nurse including her training and now being involved in training others.

Reflecting on closing the gap she said: “We all have to come together in a collaborative approach, public sector, non-government sector and corporate private sector and then we can move mountains.” Prof Smallwood was also very clear that “A tripartite approach is needed to close the gap. Not paternalism, it’s not about equality, it’s about equity.”

Melissa Fox, Chief Executive Officer
Melissa Fox introduced a short session highlighting the work of the HCQ.  HCQ began in 2008 initially as a Ministerial Advisory Committee. With the funding of the Queensland Government in the past few years they have been able to deepen the work they do in supporting strong consumer participation. The Board and staff of HCQ recognise that the Government has invested heavily in establishing the organisation. They received a three year funding $2.6m in 2015 over three years. Melissa introduced each staff member and they each spent a a few minutes talking about their work, reflecting on highlights and challenges in the past two years since they came a funded organisation.

Jo Sherring, Lin Hinspeter (consumer) – Raising health staff awareness about health literacy issues – impact of a consumer video on staff perceptions of health literacy. Townsville HHS

Jo Sherring is Clinical Lead for Townsville HHS. Lin is a retired nurse and consumer rep. They have been working to raise awareness of the importance of health literacy in the planning and delivery of heath care.

Staff truly believe they are communicating well and that patients have knowledge and understanding but this is not always the case. With this in mind the patient information and Health Literacy group at the Townsville Hospital decided to make a video for patients and their families on te difficulty of understanding medical information.
  • ·        Consumers and carers were given common medical terms and asked to describe what it meant. Words included: triage, NUM, observations, oedemema, consultant, diuretic, titrate, intravenous, handover, multidisciplinary, analgesic, UTI, femur, hypertension, coronary, evidence based, self-care.
  • ·      They were also asked what was it they would like health staff to know and to understand about them to improve their care.

The video has been shown in staff orientation, during Heatlh Literacy week and in staff training.

The key messages were excellent:
  • It’s not our job to know your language. It’s your job to help us understand. Use plain language with everyone people can’t take care of their health if they can’t understanding it. How you provide information to us is important.
  • There are lots of words and includes description and diagnose that is communicated quickly and we don’t; have enough time to process it. And we don’t always know the right questions to ask.
  • Make sure the message you give is the message received. When a person is anxious they do not always here very well and it is easy to misinterpret.

Darlene Cox
Executive Director

Tuesday, June 6, 2017

ACT Budget 2017 - HCCA Initial Response

During the election campaign in 2016 Health featured strongly. The ACT Labor released a range of election commitments as part of their Ten Year Health Plan. This included significant infrastructure investment with the design and construction of the SPIRE centre, a new, expanded emergency department, an extension of the women and children’s hospital, more walk in centres and funding for a new building for Winnunga Nimmityjah Aboriginal Health Service. This budget starts to bring this vision into reality.

People will notice that there are delays in the state of many of the commitments, such as SPIRE, and these will not see services delivered before 2020. This is for a number of reasons.

ACT Health has started a process of planning for health services for the next ten years. This process is called theTerritory Wide Health Services Plan. This will include the development of models of care (the way care is delivered) as well as looking at planning for the workforce we will need to deliver the care. Technology – through the Digital Health Strategy – will also be considered. And all of these feed into the design of the new buildings. To bring the infrastructure projects forward without doing this planning is putting the cart before the horse. That is not to say the system is working well currently.

We know that there are significant pressure on our public hospital system. Canberra Hospital is one of the busiest Emergency Departments in the country. Calvary continues to experience increase in the number of people presenting there. And the Outpatients Departments are busier than ever.

There is a vast amount of work underway to address thedata issues that ACT Health has been experiencing with the territory wide data Review announced by the Minister in March 2017. This is not due to conclude until early 2018. It is extremely difficult to effectively plan for the future if you do not have confidence in the data you have. And the other major activity is the completion of theUniversity of Canberra Public Hospital, the rehabilitation centre that will provide sub-acute inpatient care for older people, people who have had neurological events like strokes, and longer term mental health rehabilitation. These people will stay at the centre for their treatment and care. It will also provide a range of day programs – where consumers will attend each day but stay at home. This has to be a major focus for the Government. The opening of this centre will free up much needed clinical spaces at Canberra Hospital and Calvary that can then be used for other services.

As mentioned above, there are a number of elements that need further explanation including consideration of workforce issues and the eHealth agenda.

Workforce is a critical element of a safe and efficient health system. There are a range of initiatives that demonstrate investment in the ACT workforce, such as the University of Canberra Clinical School and the additional nursing positions. The existing ACT Workforce Plan is for 2013-2018 and there is a need to have in place strategies to address the attraction, education, recruitment and retention beyond that date, to reflect the timing of the budget initiatives. We need staff for the new services.

The eHealthy Futures that was announced in the 2010-11 budget has experienced delays. This was first announced in 2009 when the ACT Government allocated $90.2 million over four years for eHealth initiatives. It was it described as an "unprecedented level of investment" by the then Minister for Health, Katy Gallagher MLA. The intention of this commitment was to ensure our health system was better positioned to meet the needs of the ACT community at the time and into the next decade. The Budget this year says it will be complete by June 2018. There needs to be some fresh thinking on how technology can improve the quality, safety and efficiency of services .We know it is difficult but it is worth the investment to help people have better experiences and outcomes of care and improve the connection between our very fragmented health system.

A couple of highlight include:
Mobile dental clinics: The community's most vulnerable people suffer the poorest dental health. So two new mobile dental clinics should help. The larger of the two will visit schools in more disadvantaged areas. A smaller one will visit disadvantaged adults in shelters and halfway houses. Turning room and power supplies are among the challenges still to be sorted. The government will spend $2,173,000 over the next four years.

Nurse navigator positions: We are very interested in the announcement of twelve nurse navigator positions. Queensland Health introduced the role in 2015. The nurse navigator roles are clinical roles held by experienced nurses with expert clinical knowledge and in-depth understanding of the health system. Their focus is to support patients with complex health care needs to identity their needs and facilitate access to services. They support and coordinate patients across their entire journey rather than focusing on just a specific disease or condition.

HCCA has been funded in 2017-8 ($100,000) to undertake work to develop a model of patient care navigators. It will be important for us to with ACT Health in this. We are particularly interested to develop the navigator role to help educate patients about self-management of their health needs which supports people to feel empowered to make decisions on their own health care.

While the government has invested in health care services, accounting for a third of the budget, ACTCOSShas called for greater ambition to deliver on the community’s expectation for a practical plan to drive back gathering inequality. Susan Helyar said “we are disappointed that, while the Budget checks off a number of election promises, we are still not meeting the community’s expectations about action for those who face sustained long term cost of living pressures especially those who can’t find affordable and accessible housing.” Their Media Release is available online. ACTCOSS commissioned research into cost of living pressures over the past three years which revealed a persistent and widening gap between income and living costs for individuals and households living on low incomes in the ACT. 

The Budget was well received by the ACT P&C Council. Their media release is available online. The Youth Coalition welcomes elements of the budget but remains concerned that the Government does not have a plan to address education inequity and recognition of the skills, knowledge and expertise of community services in supporting students who are at risk of disengaging from school.
An update on SHOUT. Our members will be interested to learn of the ACT Government commitment to SHOUT. SHOUT supports many community groups and the government wants that to continue. The government also wants to see SHOUT with a sustainable operating model.  The government's solution is
• to await the review's findings and 
• to give $70,000 to ensure SHOUT keeps ticking over.
Pending the review's findings, SHOUT may receive recurrent funding in the 2018-19 budget. 

The Government’s glossy overview of the health budget is available here:  The Budget Papers for Heath Directorate are available here

The Government is to be commended for their commitment to funding the health service to meet the needs of the community. Thirty one percent of the budget has been allocated for health services. This is $1.6 billion. The challenge for the Government is ensuring that the election commitments complement the health services planning that is currently underway within ACT Health.

We will continue to analyse the budget and share our thoughts with members via our newsletter.

Darlene Cox
Executive Director

Tuesday, November 22, 2016

Age Friendly Shopping Centres

According to the World Health Organisation, ‘making cities more age-friendly is a necessary and logical response to promote wellbeing and contributions of older urban residents and keep cities thriving’. Where cities are age friendly they tend to be friendlier for all age groups as their direct needs are frequently shared with other groups, particularly people with young children and those with disabilities.

Canberra has been accepted as an age-friendly city. Living up to the WHO ideals should result in a friendlier and more relaxing environment. In shopping centres this is good for business and therefore profits.

These needs include:-
Having appropriate seating at regular intervals. Appropriate seating includes the correct height, and with arms, to enable older shoppers to sit down and get up easily.
Shopping centre seating needs to be user friendly, with seats facing each other to enable interaction between users.
Individual stores which involve customer queues, such as banks, should be encouraged to provide seats on their premises.
Many grandparents today act as baby sitters. Adequate seating near play areas is necessary to attract these customers to centres.
Car parks should be easily accessible to shopping centres, not separated by busy roads, as at the newly built Casey centre. This is a government responsibility but centre managers should have input into such planning. Where access to centres is limited or hazardous, customers are discouraged.
Underground car parks should be appropriately lit, to accommodate older people who often have less efficient eyesight.
In toilets, hooks behind doors, designed to hold handbags etc. should be at a suitable height for older people who tend to be shorter.
Shop keepers, particularly in supermarkets, should be encouraged to store goods purchased by older customers on shelves which are at a height accessible to this group.
In centres which have facilities for entertainment, the interests of the elderly could be taken into consideration.
Safety within centres should be paramount for all shoppers, including the elderly. Where safety is compromised, such as with ‘Wet floor’ signs, older people, for whom falling is a permanent hazard, are automatically discouraged from patronising the centre. The signs have no legal consequence and should be replaced by a non-slip flooring surface.
Moving staircases connecting floors should be appropriate for use by older shoppers. Those recently installed in the Gungahlin shopping centre extension are quite hazardous for older people, particularly for those with trolleys.

Older people form an increasing percent of the population and their needs in shopping centres should be considered, particularly as these are often paralleled by other groups. Attracting customers and providing an environment in which they are relaxed and comfortable is good for shopping centres and is therefore good for business and profits.

Audrey Guy
HCCA Member

Friday, November 11, 2016

Release of Report into the Treatment in Custody of Detainee at the AMC in Canberra

Independent Reviewer, Mr Philip Moss AM, provided the inquiry report to the Minister for Corrections Shane Rattenbury late Monday, 7 November 2016. I would like to acknowledge the important role that the Aboriginal community played in leading the call for scrutiny of the events that led to Mr Freeman's death.

The Government has released the report from the independent Inquiry into the Treatment in Custody of Detainee Steven Freeman. The inquiry considered the management of the custody and care of detainee Steven Freeman at the AMC and whether ACT Corrective Services systems operated effectively. 

It did not examine the circumstances and cause of death of Mr Freeman as that will be addressed by the police investigation and the Coroner. The inquiry examined and made recommendations to improve detainee management arrangements.

It is essential reading for anyone who is concerned about vulnerable people. It is not easy reading. It is distressing to see the points in which services failed this man. 

The report and submissions from key people and organisations, including Winnunga and ACT Health are available online
  • Tensions between ACT Health and ACTCS in relation to the mental health services (12.2.45)
  • The five-month delay in Mr Freeman receiving a dental appointment, despite indicating that he was in pain and that he was unable to eat or sleep due to the pain (12.2.38)
  • At the AMC, all detainees are required to undergo drug testing on induction but Mr Freeman was not tested as he was assaulted soon after arriving and taken to Canberra Hospital. The Inquiry concluded that Mr Freeman probably experienced withdrawal from his multi-substance use while in TCH and on immediate return to the AMC. The Inquiry notes that he did so without support (that is detoxification, medical or therapeutic program) (12.4.4)
  • The Inquiry was told that Steven Freeman originally appeared in court wearing a hospital gown. (This is something Mr Freeman's family was interested in.) The Inquiry concluded that ACT 
  • Health and ACT Correction Services need to ensure detainees transferred from hospital to the courts are provided with clothes and do not appear only wearing hospital garments (10.1.13)
  • The Inquiry concluded that there was inadequate information sharing in relation to Mr Freeman between Justice Health and Canberra Hospital. The Inquiry also concluded that the agencies involved in the care of detainees need to find a way to share relevant detainee related information, yet take into account all legislative, professional and ethical obligations (8.3.8)
  • The Royal Commission into Aboriginal Deaths in Custody (RCIADIC) made recommendations relevant to this case. The Inquiry concludes further that ACTCS and ACT Health work with Winnunga Nimmityjah Aboriginal Health Service to fund and embed its holistic health model for Aboriginal and Torres Strait Islander clients (12.2.61)

Former ACT Chief Minister, Jon Stanhope,  now works are Winnunga. He wrote a submission in his personal capacity. It is compelling reading. He sees this as representing "a worrying failure of leadership".
It is an important matter to monitor.

Darlene Cox
Executive Director

Friday, August 26, 2016

Informed consent and challenges for people from CALD backgrounds

We held a meeting of our Health of Older People Consumer Reference Group on Wednesday . The area of focus was the experiences of care of people from culturally and linguistically diverse (CALD) backgrounds. We have members of the multicultural community participate in discussion and Yelin and Sandra from the HCCA team ran an excellent role play that showed us how difficult it is to make informed decisions about your care when you do not understand the language.
Thank you to our colleagues from the Canberra Multicultural Community Forum and ACT Health for contributing to the session. Your input was very important to increasing our understanding of the issues faced by health consumers from CALD backgrounds.