Tuesday, July 28, 2009

National health reform

The Prime Minister officially launched the report of the National Health and Hospitals Reform Commission at the Australian National University on Monday 27 July 2009. The full report is available online on the NHHRC website.

The report contains three main reform goals:
  • Tackling major access and equity issues that affect health outcomes for people now
  • Redesigning our health system so that it is better positioned to respond to emerging challenges
  • Creating an agile and self-improving health system for longer-term sustainability.

A few points of interest include:
  • The Commonwealth should assume responsibility for all primary health care policy and funding. (States would continue to be owners and managers of public health services. Non government organisations and the private sector would continue to be providers of services).
  • There is a strong to build a regional network focus in primary health care to provide better access to front line care through our GPs and related community care services. A part of this will be the development of Primary Health Care Organisations to improve population health planning and regional delivery of primary health care services, integrating closely with general practice. (It will be interesting to see how the Divisions of General Practice position themselves to take on this role.)
  • Voluntary enrolment with a single primary health care service is recommended for youngfamilies, Aboriginal and Torres Strait Islander people and people with chronic and complex conditions (including people with a disability or long-term mental illness)
  • A new universal scheme for access to basic dental services, ‘Denticare Australia’ which would provide for prevention, restoration and provision of dentures paid through either a private health insurance plan or through public dental services.
  • A national e-health system be implemented with a personal electronic health record owned and controlled by the individual as a central measure
  • Funding for residential aged care providers will be able to make arrangements with primary health care providers to provide visiting sessional and on-call medical care

HCCA will be assisting the Consumers Health Forum in preparing a more detailed analysis of the recommendations and findings of the NHHRC Final Report and will let members know once this is complete.

In the interim, we are interested in your thoughts.

Wednesday, July 22, 2009

Melton Health

Staff from HCCA were very impressed following a tour of the Melton Health Centre on the north west fringe of Melbourne last Wednesday (15 July). Melton Health is one of the sites of Djerriwarrh Health Services.

Melton Health represents a new benchmark for Integrated Primary Health Centres that are proposed in the ACT and also provides excellent ideas for consumer-centred design and refurbishment of Village Creek Centre for the Aged Care and Rehabilitation Services (Read FAQ online 55kb Pdf).

Melton Health is a SuperClinic and was established 3 years ago. Melton Health offers an extensive range of same day medical services, specialist clinics, pathology and radiology services to cater for the health and well being of a rapidly expanding community. It provides around 50,000 occasions of service per year and has greater capacity to provide up to 90,000 service provisions in the future. The figures have shown growth each year but whilst there has been an 8% growth in population, there has been a far greater growth is users of the Centre.

Services were decided on by using population, Emergency Dept, and Health Dept statistics. The highest demand services were chosen and other services were not provided if there was not a critical mass to support them. A Community Advisory Group provided input into what services were provided and the structure of these services. Community consultations were held. The Community was also involved in creating artworks for the Centre, including a large mural at the entrance.

The Centre provides a vast array of services within the one highly functional and attractive environment.

The services provided include:

Urgent Care, Renal Dialysis, Oncology, Haematology, Gastroenterology, Chronic Disease Management, Day Rehabilitation, Orthopaedic Clinic, Endocrinology and Diabetes Clinic, Chest Pain Clinic, Respiratory Clinic, Nephrology Clinic, Dermatology Program, Stomal Therapy, antenatal clinic and classes, Infant Settling and Feeding Clinic, Paediatric Clinic, and an Audiology Clinic.

The centre is open from 9am – 10.30 pm, 7 days a week. Most services are by referral, a few are self- referral.

Particularly noticeable was the absence of consumers waiting to be seen which according to the Executive Officer, David Grace, is due in part to the innovative electronic queueing system by Q-matic. The system allows nine out of ten consumers to be seen straight away by a Clinician, who is prompted upon their arrival by the system. They kiosk can scan the bar code on the consumer’s referral letter which then notifies the clinician that that consumer has arrived. David Grace believed that at first they had underestimated just how effective the queueing system would be. We think this has great potential in assisting consumers in our ongoing quest to tell our stories once and get to the right place and will be raising this for consideration in the Capital Asset Development Program and design and refurbishment of Village Creek.

The Urgent Care Stream is a walk- in service with no appointment required. It’s provided on a non on-going, one off basis where consumers are referred back to their GP for further treatment when required. Interestingly, the local area is similar to the ACT, in that there is a shortage of GP’s. Typically, consumers wait 3- 4 days to see their GP. Since the opening of the Melton Health Clinic, there has been a statistically significant reduction in Emergency Department presentations. The Urgent Care service is both Nurse Practitioner and GP led, with lots of part- time staff working side by side. Discharge summaries are provided in a written format whilst all other medical records are electronic. They are working toward discharge summaries being electronic but at present encrypting taking too long. David reported that they would have two or three code blue emergencies a month and 20% of patients referred to hospital go by ambulance.

The Ambulatory Care Stream is similar to an outpatient clinic except with a Multidisciplinary approach. At a planned appointment, consumers can get back to back appointments with a number of staff. Some staff work across the multidisciplinary team whilst others are part of a specific team. Most doctors are contracted but some are salaried or casual. 5% of doctors rent a room and have their own practice. Recruitment of staff had not been a problem as many professionals wanted to be part of the new and effective system.

The Reception area used glass surfaces and fixtures so as consumers could see the activity going on beyond the waiting area. Each module was secure with Clinicians using swipe cards to let consumers in and out. The secure doors are glass and add to the sense that you are in a welcoming environment rather than an institution.

Electronic records were kept using an electronic system which allowed for both handwritten and computer generated documents to be captured. Eyesoft is the electronic patient master system that sits above all others across the Djerriwarrh community to allow all clinicians to access all records. David Grace mentioned that no consumers have had an issue with privacy and confidentiality of records and so far all have consented to electronic records.

Some other features were pathology, ultrasound and x-ray, and dermatology facilities on site. Group meeting rooms were also provided for educational purposes. The paediatric consultation rooms were of a generous size to allow for the whole family to fit comfortably including an activity table for children.

We were very impressed with building and the sense of being built around consumer needs and also taking into account the needs of staff. HCCA would like to thank David Grace for his time in showing us the Melton Health facility.

Tuesday, July 21, 2009

Workshop: What do consumers need to effectively self-manage chronic conditions?

How patients and health professionals can learn from each other and share information about managing and self managing chronic conditions is one of the key areas of investigation by a collaborative research partnership that has recently been formed in the ACT. This research partnership is between the University of New South Wales, ANU College of Medicine, ACT Health and the ACT Division of General Practice.

While we know that self- management is important for those with chronic conditions, what information and support is needed to make it easier for both patients and health professionals to work together?

Darlene Cox, Executive Director of the Health Care Consumers Association says, “each person has their own unique experience of their condition and illness, which they manage on a daily basis”. But what would make this easier?

What works, what doesn’t work is the topic for conversation that Health Care Consumers' Association and the ACT Division of General Practice would like find out from people in the ACT at a seminar on August 11th. “This is an exciting opportunity for us to meet and hear from people in the ACT and share ideas and experiences of how they manage their chronic conditions”, she said.

To find out more about this seminar or to book a place, contact Health Care Consumers’ Association on ph 6290 1660.

Monday, July 20, 2009

Patient Centredness

A new essay by Don Berwick on the role of patient centredness as a dimension of quality in healthcare was published yesterday in the journal Health Affairs.

Abstract:“Patient-centeredness” is a dimension of health care quality in its own right, not just because of its connection with other desired aims, like safety and effectiveness. Its proper incorporation into new health care designs will involve some radical, unfamiliar, and disruptive shifts in control and power, out of the hands of those who give care and into the hands of those who receive it. Such a consumerist view of the quality of care, itself, has important differences from the more classical, professionally dominated definitions of “quality.”

Key issues discussed:
In Berwick's essay he argues that imposing a clinician view of what is best for a patient is a form of violence against patients. His proposed definition of “patient-centered care” is this: The experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one’s person, circumstances, and relationships in health care.

He goes on to propose that these principles should be applied to include the experience of family and loved ones of their choosing, becoming “patient- and family-centered care.” In this view, a patient- and family-centred health care system would be radically and uncomfortably different from the health systems we experience today.

Characteristics might include:

  • Hospitals would have no restrictions on visitingPatients would determine what they eat and wear in hospital
  • Patients and family members would participate in clinical rounds
  • Patients and families would participate in the design of health care processes and services
  • Medical records would belong to patients
  • Shared decision-making technologies would be used universally
  • Appointment schedules would conform to queuing theory designs rather than clinician convenience
  • Patients physically capable of self-care would have the option to do it

Read the article online

Donald M. Berwick, What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist A seasoned clinician and expert fears the loss of his humanity if he should become a patient. Health Affairs, July/August 2009; 28(4): w555-w565.

Russell McGowan

Sunday, July 19, 2009

Thursday, July 16, 2009

CHF Members Forum

HCCA staff attended a CHF planning forum on 16 July 09 in Melbourne. Antonio Russo, Chair of CHF, opened the forum and outlined the purpose of the morning and then introduced the governing committee and CHF staff.

CHF is currently developing their Strategic Plan for 2009 - 2014 to be launched at their AGM. This forum was designed to draw ideas and priorities from the membership to inform the development of this Strategic Plan. Around 60 people from member organisations were in attendance.

The national health reform agenda will feature strongly in the development of the plan. CHF members expressed a desire for CHF to continue to provide a consumer voice in the reform agenda.
What follows is a summary of the session.

In recognition of the importance of the national reform agenda CHF invited the Hon Robert Knowles, Commissioner of the recently concluded National Health and Hospital Reform Commission (and Chair of Mental Health Council of Australia and former Victorian Minster for Health) to speak to the members about the work of the NHHRC.

The NHHRC was established by the Minister for Health (Nicola Roxon) in Feb 08 and has now completed their work and submitted final report to the Government. Their task was to take a helicopter view of health system to identify gaps and emerging trends and recommend changes to ensure the system could continue to meet the needs of the community and overcome the glaring inequities that are currently embedded. Their focus was very much on those who are dependent and need to access to the health system. IN their work they recognised that there is a need for formal consumer advocacy as well as the need to empower individual consumers to interact with the system and articulate their needs.

The tensions between tight timeframe and meaning participation were commented on. The Commission was established in February 08 and by April 08 they had prepared Beyond the Blame Game to feed into the Australian Health Care Agreements. This report outlined key principles to underpin a good health system and any changes that would be made. They then undertook a national tour of consultations with consumers and community people who use and depend on health system, staff at the front line and managers and policy people employed by government. They also commissioned reports from a range of experts. They submitted their interim report to reflect what they had heard from the community. In essence they found that Australia has a good comprehensive health system but there are gaps and inequalities in the system:

  • oral health: 40% of Australians cannot access basic preventative and restorative oral health services mostly because of costs
  • sub acute services are inadequate
  • there is not consistent provision of primary health care across Australian
  • provision of mental health services is patchy and in need of improvement
  • rural and remote have difficulty in accessing basic services
  • aboriginal health outcomes are appalling
The health system deals with people requiring acute episodes of care very well but does not necessarily deliver good care for those with complex and chronic conditions who require a continuum of care.
  • There are significant changes occurring such as increased demand of services and this holds considerable implications for workforce
  • tsunami of complex conditions and chronic have impact on health demands challenge for way services are structured and funded

The final report has been submitted to Government who are currently considering the report. It is anticipated that their final report will be made public after the Government has had the opportunity to consider their recommendations and prepare a broad response when it is released.
consistent with interim report

The next session was an opportunity for members to present their ideas on the direction and strategic priorities for CHF.

The issues raised by CHF members include:

  • the need for education in the bureaucracy about how to engage with consumers
  • need to define consumers and consumer representatives
  • how do we define and shape family centred care? and the need to define a child?
  • lack of education in the bureaucracy about how to engage with consumers
  • convene regular forums for state peak consumer organisations
  • patient centred health care - consumers need to be defining what this means and advocate for that,
  • build in discussion and action about what climate change means for health
  • shift towards consumer centred systems rather than a consumer representative on a committee
  • consumer participation at local, state and national levels
  • involvement of consumers in health and medical research

The forum was an excellent opportunity for HCCA to engage with other State based consumer organisations and staff connected with the Health Consumers Queensland, Health Consumer Alliance of South Australia, Health Consumer Council of Western Australia and the Health Issues Centre.

These organisations have recognised the need for us to further build our relationships and we will be looking for opportunities to discuss issues that we all face and learn from each other. This is an excellent way of building and sustaining the consumer movement.