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.