Wednesday, December 17, 2008

ACT Walk-in Centres

ACT Health made a presentation to a group of HCCA consumer representatives on the ACT Health Walk-in Centre initiative on Monday 15 December.

The concept of a walk-in centre in ACT has not been fully developed and consumer input is being sought. ACT Health is seeking public comment on Walk-in Centres in the ACT a discussion paper, by 28 February 2009. The Discussion Paper is available at
What is a walk-in centre? This question was asked a number of times on Monday. The answers given were not entirely satisfactory. A team from ACT Health went to the UK to look at a number of the National Health Service models. The ACT centres are likely to have a number of the features that the UK models have. The term walk-in means that consumers walk in off the street, ie there is no need for an appointment.

Features of the UK centres include: the centres are often nurse-led services; they sit between a hospital emergency department and a GP surgery, the types of cases treated will be those that are acute or have minor acuity, for example centres don’t handle breast lumps, rectal exams, childhood vaccinations or provide medical certificates. The centres are not designed to provide ongoing care but operate 365 days a year, 8am to 9pm iare the most common opening hours, busiest times are 12-2 lunchtime and 4-6pm after work. As the centres are part of the NHS they are free, including any GP consultation.

The UK staffing model varies some involving GP’s, many being led by a nurse practitioner or advanced practice nurse – the staffing structure for the ACT has not yet been determined.

It is yet to be decided what aspects of the NHS centres will be incorporated in the ACT centred. The differences in the UK and ACT/Australian health systems, such as the salaried vs. private practice role of GPs, will also impact on the centres services. Allied health and other services to be provided in the ACT such as diagnostic services is also a matter for consideration.
The desirability of including both oncology and mental health services was raised.

It was considered that evaluation should be built in to the development of the centres and this should be done at the beginning.

Members views on the role and services of walk-in centres would be very welcome to inform the HCCA submission to ACT Health in late February 2009.

Tony and Kerry

Tuesday, December 16, 2008

The importance of hand hygiene

We met last week with Carmel Spence, Infection Control Officer from Calvary Hospital. Carmel came to the HCCA office with Erica Webber, the Volunteers Coordinator at Calvary to present Adele Stevens with an award for her work as a consumer representative on the Infection Control Committee.

Health care associated infections are a major and growing issue in the quality and safety of health care. It has been identified by the Australian Commission on Safety and Quality in Health Care as a priority area and the highest priority area to reduce the risk of health care-associated infections is to improve health care worker hand hygiene.

The Daily Telegraph has published a story on the action NSW Health is taking that demonstrates the importance of this. The article is entitled NSW doctors told wash hands or be fired
"Under the first significant commitment by the Government, following Commissioner Peter Garling's inquiry into hospitals, doctors who continually fail to wash their hands will be disciplined, then dismissed."
Hand Hygiene Australia built on the work of recent research and identified the critical times when Hand Hygiene should be performed.

We will organise a time for Carmel to speak with members in 2009 about hand hygiene and infection control in health care settings.

Sunday, December 14, 2008

A year in review: 2008

This year HCCA celebrated our 30th birthday. We are the oldest health consumer organisation in Australia.

Consumers must be meaningfully involved in setting the agenda and priorities of health services if we are to have a health system that is responsive, respectful, accessible and affordable to all. There is a strong health care consumer movement that works to achieve this. We are proud of the role we play and appreciate the strong contribution our members make.

This year we have supported more than 50 active consumer representatives. This year they have spent more than 500 hours at committee meetings, 200 hours travelling to and from meetings and about 300 hours reading papers and preparing for meetings. And this does not include the hour is they spend building and sustaining their networks.

This year we have trained 15 new consumer representatives to add to our pool of committed and experienced reps. We are looking forward to working with them over the coming years.

Each year we survey our reps to help us evaluate our representative program. We are currently analysing the results of this year’s survey. I want to share with you some of the findings as I think it is useful in thinking about the contributions our consumer representatives make to the ACT community.

We asked our reps why consumer participation is important in health care. They responded overwhelmingly that it because it
• improves the quality and safety and quality if services and
• provides a way for consumers to shape the services we use

We asked our reps what we achieve with the consumer representatives program. And they responded that it
• improves the quality of services,
• increases policy makers and service provider's understanding of what health consumers want and
• brings about cultural change

Most of our reps say they feel that their contributions frequently influence the committee. This is an important measure.

We also surveyed ACT Health staff who work with consumer representatives and their responses are very interesting.

The ACT staff who responded said consumer participation is important in health care because it provides a way for consumers to shape the services they use

When asked what HCCA achieves through the reps program 75% of staff increases policy makers’ and service providers’ understanding of what health consumers want.

Kerry Snell will be analysing the results of the survey in January and will report at the first consumer representatives forum for the year. We will also include a summary in Consumer Bites.

I would like to thank the great staff team that we have in the office. We have had a busy and successful year and even managed to have a bit of fun. The HCCA office will be closed between 24 December 2008 and 2 December 2009 inclusive (so that the staff can recharge).

We want to thank you for your contribution this year. It has been a busy year, especially with the service planning processes and the Capital Asset Development Program. I hope you all have a restful summer break and look forward to continuing our work in the new year.

Best wishes


Sunday, December 7, 2008

Nursing and Midwifery Stakeholder Reference Group

I attended the first Stakeholder reference Group for the Department of Health and Ageing on 14 November 08.
Rosemary Bryant explained that the main purpose of the group is to provide a means for two-way exchange of information and advice between the CNMO and key nursing and midwifery experts. Members of the group are representatives of their respective organisations.

Maternity services review
Over 900 submissions have been received. The submissions have been prepared by consumers, health professionals and peak bodies.
The Chief Nurse and Midwifery Officer (CNMO), Rosemary Bryant, commented that there were lots of areas of agreement across the submissions including the importance of continuity of care, support for midwifery led models, and indemnity issues facing midwives. The Department is currently analysing the submissions and writing a report for the Minister of Heath, Nicola Roxon. It is up to the Minister whether this report will be made public. I think that this is a very important document that would contribute significantly to that this become a public document.

There was considerable discussion of membership of the Stakeholder Reference Group. In particular, there was discussion of the need for aged care nursing to be represented. The distinction between community based nursing and residential facilities was drawn.

The place of Community nurses around the table was also raised. This is a significant workforce for consumers, especially vulnerable people. With our work at Health Care Consumers Association we have heard a range of issues from advocates regarding competency standards and scope of practice of community nurses.

One issue that affects the wider consumer movement is that there is not a professional association for community nursing. The ACCNS folded around two years ago. For consumers this means that we need to work across a number of bodies to raise any issues we may have about standards and practice. This includes: the registration Boards, the Nursing Federation, the College of Nursing and Midwifery, deans of nurse education, CRANA and chief nurses in each jurisdiction.

Friday, November 28, 2008

Good Medical Practice

The Australian Medical Council on behalf of all state and territory medical boards - is developing a national code of professional conduct for medical practitioners – Good Medical Practice.

Members of the working team came to meet with members of HCCA in October to discuss the draft code. we have prepared a summary of the issues raised at that discussion and have submitted this to the AMC for consideration.

Our submission is available on our website (146kb Pdf)

Monday, November 24, 2008

Comments on proposals for a national health complaints system

HCCA has lodged a submission on the Consultation Paper on Proposed arrangements for handling complaints, and dealing with performance, health and conduct matters. The development of a national complaints system is a part of the national health workforce registration and accreditation implementation. The emphasis is therefore on the development of national health profession registration boards and related performance and professional standard issues. However, the opportunity is also being taken to produce a single national health complaints system incorporating the complaints systems existing in the States and Territories. In the ACT that system is in the Human Rights Commission and headed by Mary Durkin, Health Services Commissioner. The submission which is summarised here, can be viewed in full at, raises some general issues followed by comments on the some of the specific issues and proposals raised in the Consultation Paper.
HCCA strongly supports the National Registration and Accreditation Scheme for Health Professions which should bring considerable benefits to consumers. The development of a comprehensive health complaints system as part of those national workforce proposals has the potential to provide additional benefits in terms of quality of care and patient safety.
The development of a national system for handling complaints and related performance issues will need concessions and flexibility. An unstated issue is that the system will only deal with complaints relating to individual health professionals. The broader issues of conciliation and systemic and organisational failure in public and private health care are not addressed; there is therefore a need for much of the jurisdictional complaints and health care quality and standards structure to remain and often to be enhanced. The proposal to “build on the best aspects of State and Territory schemes, rather than replicating one existing disciplinary scheme” is supported as a general principle. This does offer an important opportunity to develop a health care complaints system that provides a coordinated linked system that could enable both individual and systemic concerns to be addressed.
As a health consumer body, HCCA, wishes to see a number of principles and features included in the structure and processes of the joint national registration system. These include existing charters, standards and guidelines relating to rights and handling complaints.
The following aspects are critical in a national complaints system: consistency between jurisdictions, streamlined and transparent processes between agencies, coverage of both individual and systemic health care, easy access to the complaints system, simplify the decision making process and provide support and assistance to consumers, boards and tribunals should include a community /consumer voice and regular reporting of complaints outcomes to health authorities and the public.
From the health consumers’ point of view the actual complaint structure is not the critical issue. The issue is the service provided within that structure, which must be responsive to the concerns of consumers, result in improved health outcomes, be free of both professional and bureaucratic conflicts of interest, have a seamless flow of information with other relevant bodies, be transparent, communicate well and be timely in its decision making.
The national complaints system, together with State and Territory systems, has the potential to provide an invaluable national database on a number of aspects of the operation of the Australian healthcare system. These data could provide current, reliable, validated, national information on the safety and quality issues as well as the national health workforce. This data should be reported both to health authorities and made available publicly.
Roles of national and jurisdictional complaints bodies
The Consultation Paper’s lack of clarity in defining the respective roles of the jurisdictional Health Complaints Commissioners (HCCs) and their relationships with the boards is regarded as a major issue. The Paper notes the value of the HCCs and comments that the “contribution of health care complaints bodies to the maintenance and improvement of health services is important and valuable” However, the it then goes on to suggest that the HCC role should simply be that of conciliation. It appears that the new system based on the boards is to address shortcomings of individual, not those due to systemic or organisational failure. ACT health consumers would be concerned if the role of the ACT Health Services Commissioner was reduced to a conciliation role. Currently the ACT Commissioner is able to initiate independent reviews and investigate systemic issues. While accepting the need for coordinated action and consultation with appropriate boards it is important that the Commissioner retain this role.
The lack of clarity does also result in the potential for complex and unresolved complaints “falling into cracks” or the resolution being paralysed.
A keystone of the current ACT health complaints system is its independence from the health bureaucracy and the health registration boards. HCCA sees this independence as an important issue in giving assurance to consumers that the complaint resolution mechanism is independent from the health care professions and the health arm of government.
The ACT experience is that while the contribution from conciliation is important, the wider contribution by investigation of professional competence and standards and systemic issues are also critical contributions. Certainly in the ACT the HCC has developed a reputation for independence and impartiality. If the boards are designated as the only recipients of complaints regarding professional competence there needs to be a careful explanation to consumers and consumer bodies about the rationale, processes and safeguards.
The Consultation paper is available at Further consultation, including national and State based forums will be held in March 2009. Further consumer input is therefore very welcome.

Tuesday, November 18, 2008

Blood culture to change, but not at any price

Russell McGowan recently attended a national seminar, run by the National Blood Authority in Sydney. He has written the following post on a few issues that emerged.

I learnt that blood is not actually free, but comes at a price. That price can be up to $1000 per unit of fresh red cells transfused, and more like $2500 per patient assisted. In fact, the cost of blood accounts for as much as 5% of all health expenditure.Now I have been a frequent user of blood and blood products in the past – at one stage receiving as many as six units a month as my enlarging spleen started to consume all the blood my bone marrow could produce.

Subsequently, I became a heavy user of IVIG, a fractionated derivative of blood plasma, to boost my immune system following my bone marrow transplant. As a result I have followed the evolution of blood service arrangements in this country with some interest. The latest development is that private hospitals in NSW are to be charged for the blood that they use. (see article from The Age, 15 November 2008).

This will be seen by some as exploitation of donors (including my daughters) who give blood freely to help the health system do its job. Fortunately I won’t have to refund the health system for all the blood I have received over the years, but what will it mean for other consumers?Why would a State Government break ranks with its counterparts and start charging for blood? The answer is quite simple – we don’t value what we don’t have to pay for.

Blood is often used inappropriately in health care when other therapies would be more cost effective and probably would produce better outcomes for consumers. So at a time when threats to the blood supply are looming larger than ever before, it makes a lot of sense to set some price signals to help control use of a scarce resource.Surgeons can operate successfully without resorting to blood transfusions – they do it already for Jehova’s Witness patients. Haematologists can learn not to resort to transfusions for anaemia when mere infusion of intravenous iron can achieve an equivalent or better effect.

In the ACT, the TCH blood team has recently attacked wastage of blood in operating theatres where excess units are provided for surgery just in case they are needed, but are left lying around at room temperature for too long in the process and then need to be discarded rather than being used elsewhere. A good start to dealing with an insidious inefficiency.

I am more than happy to discuss these issues with any readers interested in them. In addition there is an opportunity for consumer input to a professional and community forum being conducted by the National Blood Authority here in Canberra in early December.It is to be hoped that blood culture can be changed in the health system to ensure better outcomes for consumers and that politics generated the NSW Government action will not railroad reforms into a dead end siding.

Russell McGowan

Monday, November 17, 2008

Maternity Services Review - Round Table on Workforce

National Maternity Services Review
Round Table Forum on Workforce Standards, Quality and Inter-Professional Collaboration

The Government is undertaking a Review of Maternity Services. I have posted on this already. The Review is led by the Commonwealth Chief Nurse and Midwifery Officer, Ms Rosemary Bryant.

Maternity services in Australia are in need of change. While we generally have safe services there is still room for improvement. This need has been recognised and there have been several inquiries into maternity services in Australian states and territories where consumers have provided feedback. The current review will (I hope) build on previous work to develop a national maternity services plan.

In October I attended a Round Table Forum on workforce issues. The Forum brought together over thirty people including academic and professional leaders in maternity services, representatives from unions (Nursing Federation and the AMA), the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and two consumer representatives.

The discussion was structured around three questions:
  • What are the key professional development needs, including interdisciplinary, of the maternity workforce?
  • How will models of workforce vary in rural and urban settings?
  • Where are the key workforce barriers to integrated models of care?

There are significant issues regarding the maternity services and rural and remote communities. There was consensus that high quality care can be provided in rural and remote areas through outreach services.

The issue of culturally appropriate / sensitive services for women was raised. Indigenous women report not feeling safe in the care of the services and are reluctant to attend. There is a need to further consider the needs of a range other other culturally and linguistically diverse women. Put simply: if women do not trust the services they are not going to use them. The potential for poor outcomes in terms of perinatal and maternal deaths is considerable.

There is pressure on the number of training positions. The Department of Health and Ageing are funding a series of training positions for medical trainees in private settings. There was discussion about the degree to which private obstetric practice can provide these additional training places.

There has been a lapse in the communication between the College of Nursing and Midwives and the College of Obstetricians and Gynaecologists which they hope to rebuild. This can only be a positive move for consumers.

There are many workforce issues around maternity services, including training and shortages, and there has been considerable discussion whether the existing workforce is able to service the existing demand. There is a challenge of balancing workforce issues regarding roles, training and funding with the need to provide more continuity of care for women, and at the same time rationalising of services to fit within the health budget. The “turf” war between medical specialists and midwives places further pressure on the system to plan for and deliver safe and quality maternity services. These tensions and challenges influence the way in which reform of maternity services is framed. There is no better time to re-frame maternity services from a consumer perspective.

I do have some concerns around the level of consumer participation in the review. Representatives at Round Tables such as this goes some way but we need to work with the Department to have more meaningful engagement if we are to develop a national maternity service plan that reflects the needs of women and our babies.

Darlene Cox
(wearing my CHF Consumer Representative hat)

Wednesday, November 12, 2008

AMA Report Card on Public Hospitals

There has been considerable interest in the recently released report from the AMA on the state of public hospitals. Their report, Public Hospital Report Card (2008) is available on their website 708kb Pdf. The AMA have recognised that our public hospitals are under pressure and are calling for an immediate $3 billion injection of federal funds.

This has had coverage in major newspapers including the Sydney Morning Herald and the Canberra Times.

The AMA is quite right to draw attention to the bottlenecks occurring in Australian hospitals, but it is a bit behind the game. At the national level the Commonwealth has established a Health and Hospitals Reform Commission to address these problems, and locally the ACT Government is implementing a major capital asset redevelopment plan covering both TCH and Calvary Hospitals

Consumers will welcome additional beds which ensure that they are not caught up for long stays on trolleys in emergency departments when they need to be admitted, but we have been saying for some time that many of the new beds needed could be lower acuity beds at step down facilities, enabling convalescing patients to be discharged earlier form the acute care hospitals.

If the AMA really wants to ensure that taxpayers get best value for our health dollar, they will also be advocating for health care to be provided in the most appropriate setting, which means more primary health care and preventative services, and not just more acute care beds.

Monday, November 10, 2008

HCCA 2009-10 health budget priorities

HCCA input to ACTCOSS submission for 2009 - 2010 ACT Health Budget
HCCA views and priorities for 2009-2010 reflect a continuation of those proposed last year. While supporting the outlays proposed through the Capital Assets Development Program, HCCA argues that these additional capital assets and infrastructure must be seen as a means to providing the necessary services.
It is also important to ensure that the immediate service needs are met at the same time as the investment in the medium to long term infrastructure is taking place – there must be balance.

Identified Priority Areas - which warrant increased resources and policy emphasis

Primary health care

  • Ensure supply of GPs and nurses to ACT through recruitment and training programs
  • Restructuring of health workforce eg nurse practitioners and allied health assistants
  • Chronic condition management, including support for self-management
  • Community health centres/clinics (Walk-in/Super GP clinics)• Community based services – including allied health services and support
  • Health promotion and illness reduction

Aged and palliative care

  • Develop appropriate housing/residential needs
  • Develop transition facilities/services including convalescence beds
  • Expanded respite care
  • South side hospice
  • Palliative care services and community based services
  • ACT based spinal injury rehabilitation centre and services
  • Improve access to HACC programs and services for residents of aged care facilities

Community infrastructure and supportive care programs

  • Enhancement of aged care services inc equipment loan scheme
  • Dental health
  • NGO support networks

Mental health

Consumer participation in ACT Health

  • Need additional training resources and support to meet increased demand for consumer representatives from government
  • E-health (electronic information, digitised images, individual health) will require more informed consumer representatives and improved consumer health literacy
  • Develop consumer advocates and system “navigators”

Cancer services

Maternity care

Monday, November 3, 2008

Consultations on aged care and rehabilitation issues paper

Outcomes of the Aged Care and Rehabilitation Issues Paper/Options Consultation

Health Care Consumers Association of the ACT Round Table on 20 October 2008 at HCCA office Pearce Community Centre

There was a broad discussion on the underpinnings of the ACT aged care and rehabilitation services, the purpose of the plan, its context, its relationship with other health and broader government plans, coordination mechanisms and the need for monitoring and evaluation. It was throught that a preamble to the Plan should be provided to reflect those broad issues.

  • Development of specific care coordinators that look at the person as a whole – social, housing, physical health. These care coordinators must be able to cross all ACT Government Departments
  • ACT Health to develop an appropriate convalescent facility (not a sub-acute ward) that allows people to appropriately transition back to their own home and or their new living arrangements
  • Develop a spinal rehabilitation unit within the ACT
  • Increased numbers and role for Nurse Practitioners
  • Development of a single HACC funding service
  • Increased palliative care services in the ACT (new facility constructed on the south side). Services should also be able to be accessed in facilities, home or community.

Consumers at the forum also raised the following more specific aspects and issues to be considered in preparing an aged care and rehabilitation services plan.

Scope of Plan
  • The Plan needs to be realistic in terms of the planning period and resources
  • The Plan should be defined in relation to the type and range of services being incorporated in the Plan against the broader context of the other available services; public/private: ACT Health/Commonwealth: ACT/NSW needs and services: aged care services/ community based/acute care/aged residential.
  • The scoping of the Plan must also address both existing financial/funding models and those proposed.
  • How does this Plan fit within the Capital Asset Development Program and broader ACT Government uses for other assets such as closed school sites?

Planning process
  • The planning should take as its starting point existing services and structures, identification of shortcomings and positives
  • Plan should include an implementation strategy and process
  • Plan must be able to proactively interact with other Government agencies eg on local housing issues
  • Plan to identify key performance indicators for monitoring and evaluation; this requires incorporation of appropriate data collection from the start of the Plan (preferably with a starting point baseline)
  • Plan to be evaluated some 12 months prior to end of planning period.

Service philosophy

Plan must look at the person as a whole and must
  • be person centred
  • take into account the social needs of the person (not just physical)
  • take into account the housing options
Plan to incorporate the community location approach rather than locating services adjacent to hospital campus.
Plan to provide for transition facilities and support services such as step down and convalescent facilities.

Identification of needs and issues
Demography including:
  • current and projected demand based on demographic and service data
  • comprehensive data-base of current services and user outcomes
  • existing policies and plans
  • outputs, findings and recommendations from recent and current reviews eg Equipment Loan Scheme
· Identify service gaps, transitions and services
· Consult with consumers, carers, health professionals.

Service Coordination
Discontinuities between the aged care facilities and hospitals are large
Gaps lead to huge personal impact and financial impact for the individual
and the need to support families and carers
There is a distinct lack of flexibility in service providers
Need for transition facilities and services
There needs to be specific care coordinators (see ACT Government Coordination across departments below)
- a navigator model
- cost effective
- may also need to act as an advocate
Plan should outline strategies to enable proactive linkages with other ACT Government Services:
  • must be a whole of government approach that has all departments working together
  • some people don’t want services that are run by non government organisations
  • no out-sourcing of services traditionally provided by ACT health or ACT Government
  • Northside Community Service ‘burnt’ 80k and provided a very poor service
  • There are many services provided by non ACT Health service providers andhow will the plan link to other non government service providers
  • Consider a single phone number to call to ask advice and or to help

Transition services
· There is an Australian Government push to centralise access to community care – this seems counterintuitive
· Identified a preference for government service (see Northside issue)
· There is need to simplify funding and services (i.e. broader entry criteria?)

· Convalescence beds are a critical service that needs to be reinstated
- enables an appropriate level of care
- allows for the individual to practice being at home
- there were 9 beds
- sub acute beds are not appropriate
- this should not take to form of a medi-hotel
- staff must be appropriately trained – i.e. not just certificate IV workers
· Clients who require a nursing home placement but are in the hospital system
- Needs are different from a convalescent facility
- There needs to be transition facility to free up the acute bed and provide the appropriate level of care for the individual
- Currently they are scattered throughout the hospital
- They should all be accommodated in one ward (or facility)
- There are between 20 and 25 people in the predicament
· Step down facility should be investigated as integral part of this service..

· Appropriate housing is a key
- Policy regarding single person single bedroom is poor
- Does not allow for visiting carer
- Can therefore lead to increased hospitalisation
- There is much time spent finding housing for those in need
- This costs far more than modifying housing
- i.e. $1200 per day for a hospital bed versus $20,000 for modifications, equipment and services for a year
- ACT Housing houses must be built with ‘universal design’ (adaptable housing standard AS 4299) at its core
· The Plan must enable ACT Health to engage to achieve a change in the attitude of ACT Housing
- People must have the ability/power to make decisions
- Allow some people to have modification made to their houses early
- Environmental sustainability must play a role also
- All departments must report against this

Identified needs
  • Spinal injury rehabilitation: Plan should incorporate the processes needed to establish a case for ACT based specialised spinal injury and acquired brain injury units that can provide the necessary rehabilitation. Currently acute care is done well at TCH but spinal injury rehab is done in Sydney, which is disruptive stressful and expensive
  • Inability to access an appropriate equipment (loan) scheme
  • Are ‘not wanted’ by NSW health system

Palliative Care
- There will be an increase in palliative care services
- There needs to be a hospice provided on the south side
- The government should set aside land for this now and provide capital for its construction
- People want choice in services and options:
§ Community based (specific hospice)
§ Hospital based
§ Home based, with appropriate services provided to the home
- What are the projections for palliative care?
- Anecdotal evidence suggest that Calvary are not keen for a second hospice
§ Felt that there was very little accountability in the services they provided
- The group was not aware of the turn away statistics but felt that, from their experience, they were likely to be high
- COTA did some research ~ 20 years ago
§ Majority wanted palliative care in the home
· If they had a carer
· If the carer could cope
· If they were not in pain
- There is a respite service available
§ 2 beds only
§ Needs to be enlarged
§ Booked out well in advance
- Look at best practice palliative care strategies from around the world
- Review ACT strategy

Workforce issues
· General Practice
- hard to get GPs in Canberra
- almost impossible to get a GP to go to an aged care facility
§ it is expensive and difficult for them to do
§ when they are at the facility they often get inappropriate referrals (from untrained staff)
· Aged care nursing
- an issue both in aged care facilities and community care
- increased use of nurse practitioners

· Allied health care
- lack of occupational therapists is a particular issue

· How do we use workforce better
§ E.g. OT are unable to achieve the results the could because they cant access services and are doing too much administration
· Aged Care facility workforce
§ Not valued
§ Under paid – nurses are paid ~30% less than ACT health nurses
§ Under trained – many have a Certificate IV, many do not
· Community nursing
§ Highly valued
§ Must be funded
· Some OH&S requirements are silly
§ Using lifting equipment that takes one person in a home requires two people in hospital and or nursing home
§ This can prevent and delay the delivery of essential services
§ Risk framework needs to be looked at and appropriately managed

Aged care residential facilities
· Concerns
- once a client goes into the facility they lose their rights to choice
§ The facility knows what is best for them
§ Cant (always) access HACC services
§ Cant access community transport
§ Often lose the access to the community which increases social isolation that leads to further problems
- Care coordination would be appropriate
§ Facilities may chose not to be involved
§ This would leave their clients out of the loop
- What can be done to influence aged care facilities
- Recognise that many facilities are no longer profitable
§ Many more high care clients than before
§ Churches are now getting out of aged care
§ Maybe there needs to be a change in the model of care
- Is it appropriate for aged care facilities to look after older ‘high care’ clients?
- Staffing in aged care facilities
§ Under trained
§ No nurses
§ Not valued as employees – paid less than ‘someone packing shelves’
- Young people in nursing homes
§ This is in appropriate

- Two tiered system does not work well
- Too many different sources of funding
- Funding is too “specific” – too many criteria that makes it difficult to get funding and then to report on it
- ACT needs to try and influence Australian Government to simplify the system
- Would like to see HACC territory based rather than Australian Government
- Which department should administer HACC?
Other issues
· Refer to consumers and carers separately

· Social sustainability
- Key to keeping fit and healthy
- Remain connected with their community, their friends and their family

· Finance
- Against a brokerage model
§ Felt that this was just anther source of losing money
§ Need to review models that support the community sector

· Chronic Care
- Coordinated approach
- Self-care or self management
- Provide for greater levels of care

The Plan should include an implementation plan with appropriate strategies and a schedule – noting the earlier comment about the need for measurable key performance indicators.

Thursday, October 30, 2008

Maternity Services Review

The Government is undertaking a Review of Maternity Services. The Review is led by the Commonwealth Chief Nurse and Midwifery Officer, Ms Rosemary Bryant.

The Government Review is:
  • canvassing a wide range of issues relevant to maternity services, including antenatal services, birthing options, postnatal services up to six weeks after birth, and peer and social support for women in the perinatal period;
  • ensuring that all interested parties have an opportunity to participate; and
  • informing the development of a National Maternity Services Plan.

The Department of Health And Ageing prepared a discussion paper, Improving Maternity Services in Australia: A Discussion Paper from the Australian Government, which is available online.

Submissions responding to the discussion paper close this week and I know a number of our members are involved in preparing individual submissions as well as contributing to those prepared by other organisations.

We consulted with our members on the discussion paper and have framed our response based on their experiences and perspectives. We have also received input from the Women’s Centre for Health Matters and ACT members of Women With Disabilities Australia and incorporated comments into our submission.

The HCCA submission is available on our website as a pdf (171kb).

We are interested in your comments.

As you know, planning is underway for the construction of a women and children's hospital and a Women's Health Plan is currently being developed. We will be drawing on our submission to the national review to provide input to both of these processes.

Wednesday, October 29, 2008

Rising cost of medicines affect consumers in ACT and Australia

Two recent surveys have reported that increasing financial pressures and costs have reduced consumers’ use of prescribed medicines. The findings of these reports are a matter of concern and need to be addressed through appropriate government action.

The survey by Council on the Ageing–ACT (COTA-ACT) was of 700 older Canberra residents; the second study analysed Pharmaceutical Benefits Scheme (PBS) data from the Department of Health and Ageing to determine the effect of increased consumer payments for medicines on use of the medicines.

The survey “The Seniors Lifestyle and Finance Survey” (1) available on has produced some worrying findings, including health issues. HCCA wishes to thank COTA-ACT for permission to quote from their report.

While the background to the survey was to collect data on lifestyle and financial issues that had been raised anecdotally, there was also a need to clarify whether older Canberrans face the same economic pressures as other Australians and are not all on high retirement incomes with good social support. The survey sought responses on the impact of income and cost pressures on older people in the four principle areas of accommodation, income, health and social and recreational aspects of life.

In general the survey supported the view that older Canberrans were being forced to compromise on critical lifestyle issues because of severe financial constraints.

In the health area rising costs had resulted in 15% ceasing private health insurance with 31% of respondents not having private health insurance. 56% do not have access to bulk billing through their general practitioner. As a consequence of increasing costs 13% have stopped or reduced their medical treatment, with 7% reducing or giving up their medication. Increased food costs have also resulted in 33% of respondents buying less or cheaper food and changing their diets. This included reduced purchases of fruit and vegetables. The medium to long term effect of many of these changes have the potential to be serious.

As well as the direct health issues an important finding with health implications was that older Canberrans had significantly reduced their social and recreational activity, which includes volunteering.

The second survey (2) looked specifically at the impact of the cost to consumers of medicines under the government subsidised PBS. The survey was conducted by researchers from the Universities of WA, SA, Adelaide and Curtin. This survey, using government data on prescribed dispensing of 17 selected categories of medicine, looked at the changes in amount of the medicines dispensed after the consumer contribution (co-payment) was increased in January 2005. The study compared data from 2000 to 2004 with that from 2005 to 2007. Co-payments were increased by 24%, together with increased safety net thresholds in January 2005; there were also subsequent increases in the safety net thresholds in January 2006 and 2007.

The selected categories of medicines included hypnotics, beta-blockers, insulin, anti-Parkinson’s treatments, statins (cholesterol lowering), muscle relaxants, osteoporosis treatments, thyroxine, combination asthma medicines, glaucoma treatments and acid-related upper gastrointestinal disorder treatments.

The findings of the study indicated that the increased cost of medicine to consumers resulted in reduced use by consumers of medicines. The study showed that the amount dispensed of 12 of the 17 medicines decreased after the cost increased. The largest decrease observed was for medicines taken for asymptomatic conditions or for which there were over-the-counter substitutes. The cost of medicines appears to have particularly reduced the medicine use by social security beneficiaries. The findings noted that the increased costs to consumers reduced the volume dispensed of both discretionary and essential medicines. While the increased co-payments may achieve the policy objective of reducing the cost of the PBS this study suggests that there may be longer term health affects for consumers, especially the most socially disadvantaged.


1 COTA-ACT; Finance and Lifestyle Survey, 09-2008
2 Hynd, Anna; et al The impact of co-payment increases on dispensings of government subsidised medicines in Australia: Pharmacoepidemiology and Drug Safety (2008)

Tuesday, October 28, 2008

Commissioner for Health Services and Services for Older People

We were very fortunate to have Mary Durkin, Commissioner for Health Services and Services for Older People, speak at our AGM recently.

The Commissioner provided an overview of the role of the Commission and went on to outline the ways in which our current legislation, the Human Rights Commission Act 2005, enables her to contribute to the safety and quality of health services provided in the ACT.

The Commissioner also spoke about the current move to establish a national Registration and Accreditation Scheme for the health professions. The Committee established to progress this initiative recently released its consultation paper Proposed arrangements for handling complaints and dealing with performance, health and conduct matters. The Commissioner commented that the model proposed is significantly different to the current model of independent health complaints commissions.

HCCA is currently considering the discussion paper for consultation and are seeking your input on this.

The Commissioner's speech is available online and I encourage you to read it.

Thursday, October 23, 2008

Executive Committee for 2008 - 2009

The HCCA Annual General Meeting was held on 22 October 2008.
The Executive Committee for the 2008 - 2009 is:

President: Adele Stevens
Vice President: Marion Reilly
Secretary: Russell McGowan
Treasuer: Bev McConnell
Jude Manning
David Lovegrove
Angela Wallace
Dalane Drexler

The new committee is a great balance of enthusiasm, experience and vision and I am excited at the prospect of working with them this year.

We celebrated the 30th birthday of the organisation. HCCA is the oldest health consumer organisation in Australia.

The occasion marked the end of a very successful and positive term for our outgoing President, Russell McGowan. We have benefited from his guidance, vision and leadership over the last ten years. Russell will continue to contribute to the organisation in our Executive Committee as well as continuing as a consumer representative.

We also took a moment to reflect on the achievements of HCCA and the contribution of members including Kate Moore, Paula Calcino and Russell McGowan.

Darlene Cox, Adele Stevens and Russell McGowan at the HCCA AGM

Thursday, October 16, 2008

Comment on Liberal Health Policy

There is an undeniable and urgent case for the proposed development of the the health services infrastructure in the ACT. This development is essential to meet the projected demands of an expanded population together with an increased proportion of elderly. The Health Care Consumers' Association of the ACT supports the Capital Asset Development Program implemented in the 2008-09 Budget by the present government. The commitment given to this Program by both of the major parties is most welcome.

HCCA has considered the Liberal Party Health Policy and is however concerned that their policy only covers a funding period to 2011-12 and does not detail further funding for the year 2012-13 as the Labor Party policy does. This makes direct comparisons between the costs of the two policies difficult.

It is appears even in the period to 2011-12 the Liberal Party policy provides a lower level of recurrent funding to meet the projected growth for ACT health services of demand and the operation those new facilities scheduled to commence operation during that period. These will include the expanded cancer services and the new neurosurgical operating suite. Using the Treasury costings we estimate the shortage to be in excess of $120m.

Part of the difference can be explained by the number of Liberal Party policy initiatives which only detail expenditure for one or two years, such as the GPs for Canberra Fund, payment for West Belconnen Centre and the suicide prevention strategy. Most of these will require ongoing funding beyond the initial input.

Monday, October 13, 2008

Health Reform discussion papers

The process of developing appropriate reforms of our health system continues. The complex interrelationships of health care, funding, health workforce, commonwealth/states issues just to mention a few major considerations makes untangling and reconstructing our current health system a difficult and complicated task. To assist in preparing a long term health reform plan the National Health and Hospitals Reform Commission (NHRC) invited discussion papers in the key areas of Primary and Community Care, Prevention, Governance, and Public-Private Mix. These papers are now available on the NHHRC website under 'Discussion Papers' at

The papers are:

· Achieving a patient-centred, effective, efficient, robust and sustainable primary and community care sector 2020, Professor Claire Jackson and Adjunct Associate Professor Diana O'Halloran
· New Models of Primary and Community Care to meet the challenges of chronic disease prevention and management
, Mark Harris, Michael Kidd, and Teri Snowdon
· Primary Care Reform Options, Hal Swerissen
· New Models of Primary Care and Community Care with a Focus on Rural and Remote Care, Associate Professor Isabelle Ellis, Ms Debra Jones, Professor Sandra Dunn, and Dr Alison Murray
· Models of primary and community care in 2020, Dr Beres Wenck and Ian Watts
· Primary health care in rural and remote Australia: achieving equity of access and outcomes through national reform, Professor John Humphreys and Professor John Wakerman
· New and emerging nurse-led models of primary health care, Professor Mary Chiarella
· Options for reform of Commonwealth and State governance responsibilities for the Australian health system, Professor Judith Dwyer and Professor Kathy Eager
· A Mixed Public-Private System for 2020, Mary Foley
· Funding Policy Options for Preventative Health Care within Australian Primary Health Care, Professor Doris Young and Professor Jane Gunn
· A vision for primary care: Funding and other System Factors for optimising the primary care contribution to the community's Health, Professor Leonie Segal
· A Preventative Priorities Advisory Committee and Prevention Benefits Schedule for Australia, Associate Professor Anthony Harris
· Financial incentives, personal responsibility and prevention, Professor Anthony Scott

A number of these relatively short discussion papers are worth reading by Canberra health consumers as they provide views and some indication of possible policy directions in areas of interest.


Comment on Liberal Party Health Policy

eYesterday the Liberal Party launched its health policy, promising an extra 80 new hospital beds, 37 new emergency beds and a 'super theatre' at Calvary Hospital for elective surgery. We are yet to read the detail and have received advice from Mr Seselja's office that the health policy will be available on their website by 4pm today.

At this stage we can say that any additional spending on health care is welcomed however we would prefer the expenditure was planned and working towards introducing new models of health care rather than committing to more of the same.

We do not consider that the invective of 'war on waiting lists' is beneficial. We look forward to reviewing the policy to ensure that there is a level of details that moves beyond this.

We ask the Liberal Party to commit to working collaboratively with consumers to achieve a rational and sustainable solution to the growing demand for health services.

As you know, Health Care Consumers' Association has been advocating for more options to ensure that our community received appropriate care in a variety of settings. Hospitals are not always the most appropriate setting for care and we need to provide options for consumers to access primary health care and other community based services.

We support the refurbishment and construction of community health centres. We are also supportive of redefining roles within the health workforce to help meet the increasing demand for services. We are also keen to see progress on the development of systems to support electronic health information, including electronic discharge summaries and electronic prescribing.

Once we have seen the details of the policy we will be able to comment further.


Tuesday, October 7, 2008

Open disclosure is about open communication

Last year I participated on a working group that developed education materials for general practitioners and registrars on open disclosure. This work was completed with the Royal Australian College of General Practice.

I have just received a final copy of the open disclosure education module and the companion workbook. It was a particularly long process (with a 10 month hiatus) but finally the module was launched at the RACGP Annual Scientific Convention on Saturday 4 October by Dr Chris Mitchell, and GP consultant to this reference group, Dr Genevieve Hopkins.

The module and it's companion workbook is available from RACGP publications or can be downloaded from

A copy of the module will be sent to every registrar in Australia.

The RACGP is confident that the module is comprehensive and meets the needs of registrars and new entrants to general practice, who may be new to the complexities of open disclosure.

From my perspective, as the consumer representative on the working group I appreciated the recognition of the importance of open communication between consumers and doctors and I think the materials reflect that. In the ACT the Health department is in the process of implementing open disclosure. While the examples on the modules are specific to general practice the issues around communication are generic enough to prove useful for registrars in hospitals also.


Tuesday, September 30, 2008

ALP health policy for the election

aThe ALP has released its health policy. We have had an opportunity to consider the policy and have come up with the following thoughts:

The ALP Health Policy seems to provide an integrated and comprehensive plan for the development and delivery of health care for 2012, touching most bases and linking existing and recent expenditure and policies.

The standout issues are:
  • $250m expenditure on new and expanded heath services over next four years
  • Infrastructure of $150m per year, including:
  • additional hospital facilities and beds, community health centres, walk-in-centres, and e-health
  • staffing for new facilities including, Women’s and Children Hospital and Gungahlin Health Centre
  • $20m over next four years to support health workforce – expanded roles of allied health professionals, doctors, nurses and assistants
  • $10.3m over next four years to support people living with chronic disease
  • $11.3m over next four years to support a healthy future – health promotion, including $6m for children and $0.3m for adolescents and young person
  • $35.6m over four years for acute, rehabilitation and community based services for older citizens.

Surprisingly there is no mention of consumer role/input into ACT Health planning, management or evaluation of health services. Given that this government has involved consumers in the planning of health services I would have expected to see an explicit statement of commitment around this.

There is also no explicit reference to engaging consumers at the individual level to be more involved in decision making around their care.

The additional $2m to support the implementation of e-health and smart technology initiatives does not appear until 2012-13 – this seems a long delay. There is certainly a number of things that could happen in this area, especially around electronic discharge and electronic prescribing. We are puzzled by the delay.

We are interested in your thoughts.

Sunday, September 28, 2008

ACT Health Strategy for Chronic Conditions

The ACT Health Chronic Disease Strategy 2008 - 2011 is now available online as a Pdf (322kb).

This document sets the direction for chronic disease prevention, detection and management in the ACT for the next three years.

HCCA supported consumer representatives on the Steering Committee and also made submissions during the consultation phase.

Friday, September 26, 2008

Consumer Reps Training Completed for September 2008

Today we finished a very successful training course for consumer representatives. Canberra will be very well serviced by the recent graduates of our training. These people have a vast experience of the health system and will make very effective consumer representatives.

At the consumer representative training today we had the pleasure of listening to Russell McGowan share his story and insight into health following his hears of participation in the health consumer movement. Russell went through his very useful Roolz for Reps. These are tips on how to be effective consumer representatives.

We also discussed the national reform agenda. Members may be interested to read the recent Light on the Hill speech by the Federal Minister for Health, Ms Nicola Roxon, MP.

Well done to your new reps. I look forward to working with you to make our health services healthier!


Thursday, September 25, 2008

Consumer Issues on the Agenda in the ACT

Thank you to the members who took the opportunity to listen to and ask questions of the candidates in the upcoming ACT Election. The event was well attended and a great success from our perspective.

Our election forum brought good news for consumers as all candidates supported a number of the issues HCCA has identified as critical.

All candidates spoke of the need to plan and prepare for our ageing health population. This starts in 2016 and peaks in 2032 when a quarter of our community will be over 65. There was support for the program of infrastructure renewal that is currently underway of Canberra hospital, refurbishment of existing community health centres and building a new facility in Gungahlin. HCCA is advocating for development of community based health services rather than locking up all resources in a hospital-centric system. We want a health system that enables timely access to services in the most appropriate setting, which is not always in hospitals.

All candidates support expanding roles of allied health professionals and nurses however candidates vary in their degree of understanding of what these roles are and how they will contribute to reshaping our health system. We are very keen to see development of roles. There are some concerns expressed by doctors groups around the safety of nurses taking on more primary care roles. We do not consider this to be a barrier as with any medical professional there needs to be checks and balances in place to assure the community the health professionals are competent and working within their defined scope of practice. This includes the recognition of the value of multidisciplinary teams; the new health workforce will not have room for people who are not team players.

The candidates were all supportive of e-health initiatives including electronic health records, electronic prescribing, digital imaging, and electronic discharge summaries.

Most questions were for the Minister and included:
  • Use of inert materials in new buildings and refurbishment
  • palliative care services at the hospice and community
  • Need for health interpreters to work across health and aged careto assist with translation
  • How to safeguard patient information in electronic health records
  • access to dental care and the role of dental hygienists
  • more information on the Cancer Centre of excellence
  • continuity of care for all maternity services, rather than just the Community Midwifery Program.

Wednesday, September 10, 2008

ACT Election Health Forum

We are holding a ACT Election Forum for the Canberra Community on health issues on Wednesday 24 September 2008.

There will be an opportunity to have members of the Assembly and candidates answer your questions about our health system.

We encourage you send us your questions in advance so we can ensure these issues are raised in the forum.

Monday, September 1, 2008

Joint Letter to Primary Health Care Limited

Last week Russell McGowan signed a joint letter to Dr Bateman, on behalf of Health Care Consumers' Association.

The letter acknowledges the contribution Primary Health Care Limited makes to the provision of services to the Canberra community. The letter also expresses our concern at the impact the closure will have on consumers and asks that the company considers making the facility open to other organisations who may be in a position to make use of the site to provide primary health care to the community.

The will be available to read on our website very soon.

We appreciate your comments. Many of you have provided comments and our response has been strengthened by the voices of many consumers on this issue. Thank you for your support.


Friday, August 15, 2008

Inquiry into the Wanniassa Medical Centre closure

The closure and relocation of staff from the Wanniassa Medical Centre to Phillip has prompted a strong community reaction. The community held a public rally and is being supported in its demand for action by the HCCA.

The Standing Committee on Health and Disability of the ACT Legislative Assembly is holding an Inquiry into the closure. HCCA has made a submission to the enquiry, this available on the HCCA website. Russell McGowan was a witness at the Committee’s public hearing on Thursday 14 August. The transcript of that evidence and a copy of all submissions to the Committee can be found on the Assembly’s website.

Our Submission and evidence raised the concerns of many of the Wanniassa health consumers that the relocated service is relatively inaccessible for Wanniassa consumers, particularly those with mobility issues, the choice of doctor is increasingly unrealistic, the quality of service is likely to decline with the need for high levels of throughput and that will especially effect those consumers with chronic and complex conditions.

It has become clear that the Wanniassa community has been seriously disadvantaged by the closure and relocation of staff and facilities. Also there is a need for the ACT Government to work with the Commonwealth to achieve a satisfactory resolution to both the immediate Wanniassa problem and to the longer term problem of corporate medicine replacing the traditional GP practice.

Broader issues were also raised by those giving evidence to the Committee, in particular;

· the tendency of corporate ownership of medical care to place profits before care,

· the expansion of corporate medicine into many areas in Canberra,

· the difficulty in providing community based health care to Wanniassa consumers if the current lessee does not vacate the lease, as has been asserted, and

· the wider impact on a community following withdrawal of services as part of the process of undue concentration of primary health care.

HCCA has argued that the ACT Government needs to move quickly by developing innovative approaches to provide the community with primary health care in Wanniassa. There are many options that the government can put in place to establish and manage the necessary community based primary services. HCCA considers it critical that consumers participate in the development, planning and management of those services.

Thursday, August 14, 2008

Inquiry into the closure of the Wanniassa Medical Centre

We have prepared a submission to the ACT Legislative Assembly Standing Committee on Health and Disability.

We have sought views from our members and drawn on that input in preparing our submission. Many people contacted us to share their perspective on this issue and we thank you for your support.

Our submission is available on our website (90kb Pdf) and available for you to read. We are interested to hear your feedback on this.

The Terms of Reference for the Inquiry are online. In summary the Committee will consider:
  • the circumstances of the closure;
  • the impact on the residents of the Tuggeranong Valley;
  • the nature of the ACT Government's relationship with privately owned general practice in the ACT; and
  • possible options for the future delivery of GP services in the ACT.
The Canberra Times contributes to publish letters to the Editor on this issue.

Sunday, August 10, 2008

Closure of cancer clinic disadvantages consumers

The ACT’s largest private hospital Calvary John James Hospital is planning to close its cancer clinic by the end of September. It is understood that the cancer clinic is financially unsustainable, like the Wanniassa Medical Centre whose imminent closure was announced last week.

There has been considerable coverage in the media with the local ABC and The Canberra Times picking up this story.

The Cancer Unit at Calvary John James, which was open four days a week, treated about 70 patients. While most of the patients would be able to continue private treatment at the Zita Mary Clinic at Calvary Hospital, Bruce; or at National Capital Private Hospital, at Garran, services in the public sector at the Canberra Hospital were already stretched, and it would be difficult for the private patients to be absorbed there.

The commercial imperatives observed by both health funds and private sector health providers cannot be ignored, but should not override the public interest because of their need to provide a return to their shareholders

Russell McGowan has commented on this. He said:

“Vulnerable people will suffer because of the failure by health insurance funds to support key Canberra health services. People may be able to get suitable treatment elsewhere, but having to face these changes will be another impediment for consumers to confront at a time when they are least able to deal with the extra stress”
"Ensuring continuity of care in the one location is an important element in providing the safe, high quality and affordable care that is essential in obtaining optimal outcomes from cancer treatment.”

We would invite you to contact the office with your thoughts on this matter.

We have issues a press release (87kb Pdf) that can be found on our website.

Tuesday, August 5, 2008

Rally to protest the closure of the Wanniassa Medical Centre

Around 300 people participated in this morning's rally to protest against the closure of the Wanniassa Medical Centre. The rally was organised by Annette Ellis MP. Ms Ellis addressed the crowd outlining the concerns she had heard from the local community.

Russell McGowan addressed the crowd and highlighted the concern of the HCCA that this decision was made based on what was best for the shareholders of Primary Healthcare rather than the best interests of the local community and the consumers who attended the surgery.

I took the opportunity to mix with people this morning and had a number of conversations. The themes were very clear
  • profit comes before the welfare of the patient
  • parking at the Phillip Clinic is poor and access for elderly is difficult, the access via bus was mentioned many times and is a source of considerable concern.
  • the closure of the clinic erodes the community. People expressed concern at the effect of the closure on other businesses in the Centre, including the chemist, supermarket and newsagent.
  • One woman commented that if she had to wait for hours to see a "random GP" at the Phillip Clinic she may as well go to the Emergency Department where she will see a random doctor at no direct cost to her.
There has been strong media coverage in this story. Members of the public have posted comments to the Canberra Times website in response to Natasha Rudra's story last Friday.

There is a petition circulating. This will be forwarded to Primary Healthcare on Thursday night so that it arrives on 8 August. Contact the office of Annette Ellis at 205 Anketell Street
Tuggeranong or by calling 62931344

Friday, August 1, 2008

Closure of Wanniassa Medical Centre

The closure of the Wanniassa Medical Centre and consequent relocation of the services and GPs to Phillip is a matter of great concern to residents in the Wanniassa area and is an all too familiar story to Canberra.

We have been contacted by members expressing their concern over the closure of the Wanniassa Medical Clinic. Their views are shared by many others, as you can see with the media coverage.

The issue of continuity of care, especially with people with chronic conditions, is a significant concern.

One of our members commented:

I cannot see that moving a medical centre which caters for a wide range of people in a local area, with nearby shops and with reasonably good public transport to a location in a busy centre without adequate public transport and parking problems on many days is at all 'patient centered'.

Annette Ellis MP for Canberra has issued a press release saying that she considers this to be unacceptable. She also says:

“The Wanniassa Medical Centre has been there for 20 years, it has regular patients who have connections and relationships with their own GPs. The Colbee Court facility is walk-in, no appointments – so if you want a particular doctor you’ll have to turn up and hope. For those who can make the commute to Phillip, their medical relationships with their doctors are not guaranteed because of this move."

The Government’s walk-in clinic offers one solution to this intractable problem but we would also encourage serious consideration of expanding the clinical roles of health care professionals, including the increased use of nurse practitioners and other allied health workers.

The GP clinic is an entry point to our heath system and at the same time operates as a business. Many GPs are in the unenviable position of balancing consumer access to primary health care with meeting their business costs. Inevitably this leads to conflicting priorities. In this case, it appears that many of the consumers using the Wanniassa Medical Centre are the losers.

We need to find a more effective way of ensuring consumers receive safe and appropriate care in primary health care setting.

The HCCA media release is available on our website (34kb Pdf).

We want to hear your views on this issue

Monday, July 28, 2008

Acronyms N - Z

NCDS National Chronic Disease Strategy
NRA National Reform Agenda
PBS Pharmaceutical Benefits Scheme
TAMS Territory and Municipal Services (ACT Government)

Acronyms A - M

ABHI Australian Better Health Initiative
ACTDGP ACT Division of General Practice
ACTPLA ACT Planning and Land Authority (ACT Government)
AIHW Australian Institute of Health and Welfare
CMD Chief Minister’s Department (ACT Government)
COAG Council of Australian Governments
COPD Chronic Obstructive Pulmonary Disease
DALYs Disability Adjusted Life Years
DET Department of Education and Training (ACT Government)
DHCS Disability, Housing and Community Services (ACT Government)
GP General Practitioner
LDA Land Development Agency (ACT Government)
MBS Medicare Benefits Scheme

Thursday, July 24, 2008

SCIPPS - conference presentation

Dr Jun-Hee Jeon from the Australian Primary Health Care Research Institute, Australian National University sent me the link to the slides from her recent conference presentation based on the interim findings from SCIPPS.

The Experience of Chronic Illness: Balancing Life and Illness

pdf (144 kb) of slides from her presentation

Tuesday, July 22, 2008


Serious and Continuing Illness Policy and Practice Study (SCIPPS)

Yesterday HCCA held a forum for a report on the interim findings of SCIPPS. What follows is my summary of the session. I didn't capture all the details but hope this gives you a feeling for the presentation and discussion that followed. The team presented at a conference in June

Professor Nick Glasgow gave an overview of SCIPPS to the participants. He said:
SCIPPS is an NHMRC funded program designed to identify and understand impediments that consumers with chronic conditions have in accessing best practice care, with a view to discern perfect policy solutions to these system impediments to access.

The chronic conditions that have been considered in this study are diabetes, chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD).

The SCIPPS Research team came to HCCA in November 2006 to outline the research project and returned to present interim findings.

Research Fellow, Dr Yun-Hee Jeon presented the findings of the study to date.

Who was involved in the study?
The research team conducted in depth interviews with study participants.
  • 66 participants (52 patients and 14 carers) from ACT and Sydney West Area Health Service
  • participants were aged between 45 – 85, living in ACT or WSAHS with the COPD, CHF and Diabetes and most were older than 65
  • The participants were referred by acute care wards, community health services and GPs
  • significant number from CALD backgrounds
  • most identified as experiencing significant financial disadvantage as a result of their chronic condition
  • most have more than one chronic condition
  • 86% had co-morbidity
  • most visited their GP more than once a month

Participants spoke of the difficulty in balancing life and illness. They reported constant juggling of competing priorities of work, family, illness. The limitations to aspects of daily life as a result of their health included: time, physical, financial, and psycho-social. Isolation was mentioned by the majority of participants as an issue.

Key issues
1. Financial hardship
2. Health literacy
3. Health care encounters – experience and perception of standards of care practice
4. Co morbidity conditions

1. Financial hardship
  • Affordability of treatment : Medication, oxygen, texts and check ups equipment and support devices medical appointments, Accessing allied health care services and other services
  • Affordability of other things: Basic cost of living, Healthy food, exercise, travel, house repair, entertainment
  • Pension concession related issues: Eligibility of pension, health care card and concession card
  • Health funds and insurance: Access to private health care

2. Health Literacy
  • Difference between health care consumers level of knowledge and clinicians perception of their knowledge
  • Experiential learning, learning as it takes place, by trial and error but there must be a safer way to share consumer knowledge and to learn form each other

3. Health care encounters
  • Difficulty they have with health workers
  • Difficult in accessing services
  • Manner in which some professionals
  • Transport was a major problem
  • Waiting for services

Service and system issues identified by consumers and carers:
  • access lack of timely services and
  • workforce shortage
  • fragmentation of services
  • lack of continuity of care
  • health professional behaviour

Patient related issues identified by health professionals included:
Lack of compliance
poor health literacy

Discussion with HCCA members

Patient Centred Care was discussed. Reference was made to the International Alliance of Patients' Organisations (IAPO) Declaration of patient centred health care.

One participant in yesterday's discussion said:
To make patient centred health care we need to take away the authority of the doctor. It is my disease and it is happening to me.
There was considerable discussion on management plans
ED presentations often mean the management plan has failed.
Who never has to go to ED because their care is well managed: luck, disease progressions lifestyle factors.
  • There was agreement that a management plan is an essential tool
Writing these plans is a time to have questions answered, conversations about concerns, write useful things down, prepare advance care plans. This is important to give people a sense of control, ownership and security.
One consumer shared his own experience. He spoke of his Management Plan and Emergency Response Plan. These plans have kept him out of hospital four times in the last 12 months
There is a question of who writes the care plans? How can we reward consumers and staff for contributing to the plan? Financial reward for employees?

Other issues raised were:
  • Disturbed employment pattern exacerbated some of the financial issues. Accessing health care when yo are maintaining a job “being sick is a full time business”
  • What about identifying consumers with disabilities and see how this impacts in patient experience
  • If economic limitations are excluded ( people who can afford access to allied health services) and have higher level of health literacy, do they have a high health status.
  • Respite needs to be appropriate for the carer and the person
  • Earlier intervention, not end stage of chronic disease but vast majority of chronic conditions would benefit from earlier intervention people who are still trying to manage family responsibilities, work commitments etc
  • Need for consumer participation
  • raising people’s confidence to take a lead in their own care
I will post the results of the findings once Dr Jeon has sent them on.

I received an email this morning from Laurann Yen, the Research Manager of SCIPPS. Laurann writes:
Thanks so much for organising for us to speak with the group of interested consumers and consumer organisations- it was really helpful to be able to run our findings past the experts, and there were a number of things we picked up which will both suggest a re-think of our interpretation, such as thinking about balancing not as between two competing priorities, but between a range of different issues and alternatives which present themselves and need dealing with; and of course the suggestions for how the system might act differently for a better outcome. I hope we can come back to HCCA again after we have started to try out some interventions and get the thoughts of the group.
Thank you to everyone who participated on the day.