Thursday, December 17, 2009

LCM response to HCCA comments on staffing

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

What follows is an excerpt from that letter:

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

Thursday, December 3, 2009

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tuesday, December 1, 2009

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

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

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

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

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

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

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

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

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

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

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

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