Wednesday, November 24, 2010

Integrated Cancer Centre Consultation

What do you want from the new ACT Integrated Cancer Centre?
Do you have ideas on how the cancer centre can work well for patients?
What sort of space would be comfortable for patients, carers, families and support groups?
Architects are coming up with plans for the new cancer centre to serve the ACT and surrounding regions and consumers are invited to have their input at this design stage.
It is very important we help the Cancer Centre “get it right” from the start and ensure it develops as a truly patient-centered facility.
Come to a meeting to have your views taken into account!
When: Monday, 29 November 2010
12:30pm-2:30pm

Where: HCCA Office
100 Maitland Street
Hackett ACT 2602

RSVP:02 6230 7800

Saturday, November 20, 2010

HCCA Executive Committee 2010 - 2011


HCCA’s AGM, held on the 12th of November, was a resounding success.  It was great to see so many of our members taking an interest in the governance of the organisation.  Dr Karen Luxford’s after-lunch speech was interesting and enlightening, prompting many insightful questions from the audience. 








 

As part of the organisational business undertaken at the meeting, HCCA elected its new Executive Committee, which is as follows:
President: Adele Stevens
Vice President: Caroline Polak Scowcroft
Treasuerer: Bev McConnell
General Members: Marion Reilly, David Lovegrove and Russell McGowan

Friday, November 12, 2010

ACT Primary Health Care Strategy Consumer Consultation

ACT Health is developing a new ACT Primary Health Care Strategy which will build on the work of the ACT Primary Health Care Strategy 2006-2009 and set the strategic direction for primary health care into the future. The new ACT Primary Health Care Strategy will be a visionary document that reflects the thinking of the ACT community in relation to their needs and priorities for primary health care.

ACT community members, consumers, carers, NGO representatives, GPs and service providers are invited to attend one of the stakeholder forums below to provide input to the development of the draft ACT Primary Health Care Strategy. Further consultation on the draft Strategy will be undertaken in early 2011.


Consumers, Carers and Community Members Forum will be held at the HCCA Offices on Friday 19 November 2010 between 11:00am – 1:00pm.
RSVP by Wednesday 17 November 2010 to 62307800

Thursday, November 11, 2010

National survey of Australians’ perceptions of nurse practitioners in primary care

HCCA is currently undertaking a research project with the Australian Primary Health Care Research Institute (APHCRI) at the Australian National University.   This work is funded by the Department of Health and Ageing

Phase one of the project, involving the focus groups, was successfully completed in October; we are now in the second phase of the project and the national survey of Australians’ perceptions of nurse practitioners in primary care, was launched on 1 November. This survey will close on 30 November 2010.

I am asking for your support in promoting the survey as widely as possible among your members and networks. This includes family and friends.

The survey is available on the Australian Primary Health Care Research Institute website at https://www.surveymonkey.com/s/nursesinprimaryhealthcare and we have placed a prominent link on our website 

Dr Rhian Parker, from APHCRI, spoke on Radio National’s ABC Breakfast on 1 November to mark the launch. In case you missed it, it is available online.

Saturday, November 6, 2010

Conference Workshop 26 October 2010

On Tuesday 26 October 2010 ACT Health staff and consumer representatives from HCCA facilitated  workshop at the National Forum on Quality and Safety in Canberra.


The workshop was run in world cafe style and considered the challenges of collaborative health care for service providers and consumers.   Challenges and successes in four areas were discussed:
  • clinical review
  • consumer feedback
  • policy development and 
  • accreditation of health services 
A summary of the issues participants identified is included in this post.


Clinical Review: The role for consumers


Discussion re consumer representative selection, orientation and training 
Ongoing support for the representative
Discussion re involving consumer reps in clinical review and the Root Cause Analysis process. General discussion points:
o May need to clarify terms, technical aspects
o Adds value - the why and what if person
o Organisation has to be ready for consumer involvement
o Need good consumer rep preparation
o Need good understanding of system issues
o Able to relate the Health Care rights
o Time consumer and reimbursement considerations
o Depends on the type of review
o May not be appropriate for more technical reviews
o Questionable benefit in surgical mortality reviews
o Involve in the team but maybe not interviewing the clinicians involved in the incident
o Some medical staff are not comfortable with consumer representation
o Unclear about the benefit of consumer representation 
o Reminds clinicians of the consumer/human/person aspect of harm
o Transparency
o Ask the questions that may be overlooked by clinicians
Comments regarding the benefits of including the consumer/family/carer side of their experience as part of the review – talking with them.


Policy: How to make collaborative care work for both parties


Consensus: Depends on a variety of factors, including:
Consumer background and role:
Training of consumer reps-  formal vs informal support
need a variety of roles and experience of the consumer
challenge of being on committees –not for all consumers other avenues for input like focus groups or commenting on policies can be used
Issue of renumeration and how this affects the type of input provided eg the difference between type of feedback you get from advocacy organisations and individual consumers  


How the consumers are engaged and the culture of the organisation:
The right questions need to be asked of consumers;  
General agreement that proactive and innovative approaches required to engage with potentially marginalised groups ie holding meetings in their community spaces in partnership with local groups eg social clubs
Victorian document and framework for engagement Doing It With Us, Not For Us talked about as a good approach to consumer participation
Aspects of consumer engagement like consumer advisory committees is mandated in some health services and this was seen as effective
consumer-led consultation being achieved in some areas; 
Resources – clinical staff not necessarily resourced to do consultation and consumer engagement as well as clinical loads, this is a challenge for staff. Use of advocacy and interest groups was suggested as means of addressing this, as they can facilitate feedback
health services do consumer engagement in policy best when they foster a culture of debate and learning where they are open to feedback and different perspectives
Highlight the importance of creating a safe space for consumer feedback, and the role that advocacy organisations play in creating that for consumers ie a place where they can give their raw feedback and the organisation can help to work out the key issues and provide those to health service organisations


What setting and type of policy:
Stages of policy – depends on whether new or re-evaluating as to when to get consumer involved
Use of an evidence based approach can assist when policies are across different areas
In larger geographical areas/ different settings there is a need to simplify frameworks and define where different health services cross over – need to seek out existing policies to avoid duplication and use “reactionary” policies (ie, from incidents, sentinel events) to identify gaps
There needs to be flexibility in systems to allow for things to changes following evaluation and monitoring 
Standardising policies and reducing the number of policy documents wherever possible was seen as a good approach to simplify things for staff and consumers
Importance of good governance structures to support consumer engagement and provide transparent policy decision making 


Consumer Engagement: Summary of key points raised in discussions:
Clear message was the fear of retribution, with immediate consequences, hinders consumers providing feedback, particularly complaints.  How can we give consumers confidence that their complaints will not affect the care they receive?  Is this through training, education, or a middle person?  Participants noted Helen Fernando's session where she explained her activities over a number of years - she's a consumer who talks to people waiting for care and treatment in the paediatrics unit - their concerns are taken to staff and clinical leader immediately so that can be addressed then and there.  This information is then collated, fed back to the clinical director, and also to the consumer association.
The importance of feeding back or marketing the changes that result from consumer feedback was also mentioned - in this way it's possible to let the public know that things are and can be done as a result of them providing feedback, and that it's not "pointless".  
Communication skills and training for staff to actively encourage consumers to provide feedback, softening the terminology from "complaints" in that situation, with a view to making service improvements.  Complaints are focussed
Ideas for getting creative about seeking feedback.  eg. focus groups, conversations with the community, using anecdotal/3rd party information. point of time feedback.
Responding to the demographics make-up of the community - providing feedback forms in other languages, involving community groups to support or interpret for people from other cultures.
Do we acquaint people with their legal rights?
Consumer feedback and engagement to influence the clinical governance framework.
Consumer satisfaction surveys - need to ensure that we're asking the right questions, to get the right information, to fix what we do wrong.


Accreditation: The role of consumers


Consumers have a pivotal role: whether consumers are supportive of providers work is integral to the process.  Consumer reps are important for strategic participation planning/operational planning and implementation:


o Rep on Divisional Quality committees
o Rep on awards – internal – state/territory
o Consumer on accreditation steering group
o Consumer surveyor (ACHS) and helping prepare organisations for survey
o Consumer planning and policy
o Consumer feedback


Developing standards 
o Not needed for compliance standards. 
Monitoring standards 
o Mandated for Mental Health surveyors to have consumer involvement – in depth review 
o Regarding service involvement in survey team – looking at processes, making linkages between services
o Issue 1 – what  type of consumer – educated as individual or group (self serving?), health background? – representing culturally safe practices.
Consumer feedback 
o Continuous improvement – must not be threatening.
o Can use consumer as conduit to listen to feedback then reflect back to management?
o Broad representation
o Define Terms of Reference for consumers – orientation important.
Consumer perspective
o Issue 2 - Confidentiality - Should not be a barrier
o Consumers as advocates for consumers and for organisation eg at survey.


Representative on clinical Board 
o the patient journey/experience provides a  different perspective/ contribution to quality improvement
Quality Forums – education of consumers about activities being undertaken
Focus Groups – useful conversations 

Monday, October 11, 2010

CORPORATISED MEDICINE – A BLESSING OR A BURDEN FOR CONSUMERS?

The Sydney Morning Herald has been running a few articles about corporatised medicine this week.  HCCA has had concerns about this development as it has applied in the ACT, especially after the closure of corporate practices in Wanniassa and North Canberra a couple of years ago, and the forced re-location of their doctors to corporate medical centres in the town centres.

Corporatisation of General Practice is becoming increasingly commonplace in Australia.  In 2006-7, only 8.2% of general practitioners were working solo, while 56.1% worked in practices with five or more doctors, although not all of these could be classed as fully corporate practices in the way this is generally understood.  The attraction of corporate medical clinics, such as those run by Primary Health Care, Sonic Health and Healthscope, seems obvious if you are a GP.  Joining a corporate clinic means that the administrative costs and procedures are dealt with by the company and not the doctor, alleviating an area of concern for many general practitioners.  In addition, generous “sign-on” fees are often offered to entice GPs into selling practices.  However, GPs who “sign-on” with a corporate clinic agree to work a certain number of hours and to sacrifice as much as a half of their billings to the corporation.

As a result of this system, insiders claim that GPs working in corporate clinics are pressured into cramming more patients into consultation hours, reducing time spent with each patient and increasing profits.  The “all-in-one” service approach of many corporate clinics has drawn criticism as well.  Many clinics house various diagnostic services such as pathology and x-ray, meaning that it is financially desirable to have patients take advantage of such services “in-house”. 

For consumers, there are both benefits and disadvantages to this arrangement.  For example, most corporate clinics bulk-bill patients as in a large practice this is financially viable.  In house diagnostic services are also a positive, when they are employed appropriately.  However, these gains may come at the loss of continuity of care for patients, as in a corporate clinic patients do not usually have a regular doctor, but see whichever GP is available at the time.  Also, there has been a disturbing recent trend in some corporate clinics to demand an upfront payment from those presenting for services at a clinic, and this is not refunded even if a disgruntled consumer leaves to seek treatment elsewhere because of long wait times.

The unfair treatment of GPs in this environment where profit is the biggest motivator has garnered media attention in NSW in recent days.  Primary Health Care has been accused of demanding that doctors complete more hours on the end of their contracted time in order to make up their quota.  GPs claim they have been threatened with litigation by the health care giant. 

HCCA stands against this type of corporatised medicine which does little to embrace the new paradigm of patient-centred care being promoted by the Australian Commission on Safety and Quality in Health Care.  In 2008, HCCA supported a rally to try to keep the GP clinic at Wanniassa open, and later appeared at a Legislative Assembly inquiry into GP shortages, noting that centralisation of GP resources into town centre locations did little to make access to GPs any easier.

Details of past HCCA positions on GP clinics and more information about people centred care can be obtained from the HCCA office.   Remember, GPs are people too.  Please let HCCA know if you have had any recent positive or negative experiences with corporatised medicine in Canberra or NSW, and we will feed this back to the Commission in response to its consultation paper on patient-centred care.  There are other potential solutions to the problems that have led to the development of corporate GP clinics.  Better public primary healthcare services through enhanced community health centres incorporating nurse practitioner led walk-in clinics and collective practices such as Super Clinics supported by Commonwealth Government funded infrastructure are two new models we would support in Canberra.  Let’s hope the current reforms in health policy settings will give more support to these options.

Russell McGowan

Thursday, September 23, 2010

Consumer consultation on national health service standards







The Health Care Consumers’ Association Inc and the
Australian Commission on Safety and Quality in Health Care invite you to a consumer consultation on the

National Safety and Quality Health Service Standards

The Commission is seeking comment on the draft National Safety and Quality Health Service Standards to:
  •     Ensure the standards address consumer expectations for safe and high quality services.
  •     Refine the standards and ensure they are meaningful for health services, practitioners implementing safety and quality systems as well as accreditation agencies and surveyors using the standards to assess compliance.
  •     Standardise and streamline processes where possible.
Five Standards were released for consultation in November 2009. The Commission is now seeking comment on the additional five draft Standards before they are piloted in health services and forwarded to Health Ministers for consideration in 2011.

The additional five Standards are:
    Partnering for Consumer Engagement which creates a consumer centred health system by including consumers in the design and delivery of quality health care.
    Blood and Blood Product Safety which sets the standard to ensure that the patients who receive blood and blood products are safe.
    Prevention and Management of Pressure Ulcers which specifies the expected standard to prevent patients developing pressure ulcers and best practice management when pressure ulcers occur.
    Recognising and Responding to Clinical Deterioration in Acute Health Care which describes the systems required by health services responding to patients when their clinical condition deteriorates.
    Preventing Falls and Harm from Falls which describes the standards for reducing the incidence of patient falls in health service organisations.

The draft standards are available online (pdf 714kb).

Date:    Friday 1 October 2010
Time:   10.00am - 3.00pm
Where: Southern Cross Club, woden

Places are limited and RSVP is essential.  Please contact the HCCA office on 02 6230 7800 if you are interested in attending.

Wednesday, September 1, 2010

Interested in Consumer Participation in the Health System?

 
HCCA runs free training  for people interested in becoming consumer representatives.

Dates:  Thursday, September 16, 2010 and
            Thursday, September 23, 2010
 Time:    9:30am-2:30pm at
Where: The HCCA Offices, 10 Maitland St Hackett

Contact the office for more information.

Thursday, June 10, 2010

Would you like to see the nurse?


 Would you be happy to see a nurse instead of a doctor for some of your medical care? Health Care Consumer’s Association, in partnership with the ANU, is asking just that question through an online Nurse Survey being conducted throughout June.

ACT Health estimates that Canberra needs another 74 GPs to satisfy our needs. This means that many Canberrans are not able to see a doctor when they need medical treatment. More than half of the respondents to HCCA’s ACT GP Snapshot Survey, conducted in 2009, had to wait for more than a day to see a doctor for an urgent matter. With this in mind the ACT Government have developed the newly opened Walk in Centre at the Canberra Hospital. This is entirely staffed by nurses. There are nurses working in general practices as well and there are going to be more.

The Federal Government announced in the budget that they will pour $393.3 million into general practices in Australia to employ practice nurses to deliver primary health care. That’s enormous. Yet, we don’t know how consumers feel about this. Are they, or would they be, happy to see a nurse for medical treatment instead of a doctor at their local general practice? That’s what we are trying to find out through our survey. It may be that consumers feel that seeing a nurse is second best, maybe they think it’s a great thing and there should be more of it. We just don’t know. No-one has ever asked the question. Until now.

Last year HCCA conducted a survey which took a snapshot of General Practices in the ACT and it revealed that women with children under 5 and the over 65’s were more likely to see a nurse working in a general practice. HCCA is hoping that these groups in particular will participate in this new survey though it is open to everyone living in and near the ACT.

“We want to flesh out the picture and find out whether people think seeing a nurse instead of a doctor is a good choice in some situations.”

Do the Nurse Survey now. A link can be found at http://www.hcca.org.au/

Darlene Cox was interviewed by Lousie Maher about the survey on the local ABC radio.  Part of the interview can be found on the ABC website.

Tuesday, May 18, 2010

How is consumer feedback used to improve health services in the ACT?

HCCA Health Issues Group:

Are you interested in how consumer feedback is used in the ACT to improve health services?  are you interested in how consumers can provide feedback? 

Thursday June 17 2010, 12.00 –2.00 at the HCCA offices in Hackett

A light lunch will be served at the beginning of the event.  Please contact the office if you can join us.

At this forum we will have two speakers, and time for your questions on:

The work of the Health Services Commissioner from the ACT Human Rights Commission.
Mary Durkin, the Health Services Commissioner will come and talk about the role of office in dealing with complaints about health services and health service providers. Her presentation will cover the types of matters that the Commissioner can investigate, the process for handling complaints, the outcomes that might be achieved, and how complaints can be used to inform system improvements.

and

The work of the Consumer Engagement Team in ACT Health
Robyn Jensen is the team leader for the Consumer Engagement Team. She will speak about:
• the team’s role in managing consumer feedback across ACT Health,
• working with HCCA to provide consumer representatives on ACT Health committees,
• and other ways that they assist ACT Health to engage with consumers.

Note: Out of respect for the access needs of people with chemical sensitivities and people experiencing breathing related allergies and illness, please avoid using perfume, aftershave, essential oils or other highly fragranced products when attending this event.

Wednesday, May 5, 2010

National Health Reform - Consumer Information Session in Canberra

On 29 April 2010 the Hon Mark Butler MP (Parliamentary Secretary for Health) spoke with members of CHF and HCCA at Scarborough House, Woden.  

Photo: Russell McGowan, Mark Butler, Darlene Cox and Carol Bennett at the Consumer Information Session


Mr Butler spoke about the Government's reform agenda announced in the National Health and Hospitals Network for Australia's Future.  He also spoke about the key issues that emerged from the consideration of the context for health reform by the National Health and Hospital Reform Commission (NHHRC) consideration of the health system.  His presentation included a summary of the recommendations arising from the Preventative Health Taskforce, Primary Care Task Force as well as the NHHRC.

The challenges in the Australian health system include:
  • fragmentation of care
  • gaps and poor coordination of services
  • pressure on public hospitals and health professionals
  • unsustainable funding model
  • too much waste and inefficiency, and
  • not enough local clinical engagement
Participants were fortunate in that the timing allowed us to ask Mr Butler about the agreement that had been reached at the Council of Australian Governments (COAG) on 19-20 April 2010. 

The COAG communique is worthwhile reading.  The Communique claims that the reforms will deliver better health and hospitals by:
  • helping patients receive more seamless care across sectors of the health system;
  • improving the quality of care patients receive through high-performance standards and improved engagement of local clinicians; and
  • providing a secure funding base for health and hospitals into the future.
The rhetoric is good and we look forward to further consumer involvement in fleshing out the detail.

One area of interest is the 4 hour targets for the emergency departments.  This target is for consumers to be triaged, admitted, or referred and discharge within 4 hours.  It is in the process of being rolled out in WA and South Australia and will work from triage category 1 - 5 over a progressive period.  This is a signficant improvement.  Mr Butler cited figures that more than 600 000 people wait more than 8 hours at ED each year.  He also pointed to the ACT figures that show taht  only 58% people are seen within clincially recommended time for their triage category.  He compared this with NSW where 78% of people are seen in within the clinically recommended time.

Consumers need to be a little cautious about embracing such targets as we need meaningful performance indicators.  we need to push for indicators for improvement which involve reform to clinical practices to improve outcomes for consumers.  The UK introduced 4 hour targets and the BBC reported that there is a practice of 'fiddling' ED waiting time targets.

There was around 40 minutes for questions from the floor.  Below are a few of the questions and the answers Mr Butler gave:

Q: People with palliative care needs have to go to hospital to get the care they need in terms of pain and sympton relief?  do these announcements deliver more sub-acute care for people needing palliative care?
A: The Sub-acute care funding does not relate to palliative care.
Note: this means that consumers need to continue to advocate for community based palliative care and access to sub-acute care for people who need palliative care.
Q: How will this plan improve health outcomes for women? Is there any dedicated funding for women's health?
A: Women's health is not specifically dealt with in this agreement
Q: There are activity based funding payments on basis of outputs delivered by providers but what about incentives to reward prevention?
A: There will be incentives to jurisdictions to improve prevention
Q: there is lots of talk about consumer centred care but it seems once again we are talking about health economics and health financing.  How does the government plan to engage with consumers to make sure there is nothing about us without us?
A: These reforms will bring the consumer to the centre of each sector and level of care.  this will enable consumers to be at the centre of care as individuals as as communities.  the community based governance will enable community input into how services will be delivered.  The Primary Health Care Organisations will provide more 'patient centred care' (Mr Butler's words) with case management by multidisciplinary team rather than consumers accessing the health silos.
Q: Is there an architecture for governance that enables consumers and the community to have a discussion about how it will hang together in respect of the electronic agenda that has to support all of this?
A:  With respect to e-health, the Prime Minister will make comments about this in the future and it is reflected in the communique to COAG
Note: the Communique says "COAG noted the importance of continuing to work towards a National Individual Electronic Health Record system and agreed to prioritise discussions over the coming months to move towards the implementation phase".

Thursday, April 15, 2010

Consumer Information Session with Parliamentary Secretary for Health, 29 April 2010

The Consumers Health Forum of Australia (CHF) and Health Care Consumers' Association (HCCA) are co-hosting an information session to discuss the Federal Government’s proposed National Health and Hospitals Network with the Hon Mark Butler MP, Parliamentary Secretary for Health.

The consultation forum is planned for Thursday 29 April 2010 (09:00am to 10:30am) in Canberra. The venue is the Department of Health and Ageing Theatrette in Scarborough House, Woden.

We hope that many of our members will be able to attend this important event which will provide an avenue for consumer information and discussion on the hospitals reform debate.

Please register your interest to attend with Lindee Russell, CHF Project Officer by phoning (02) 6273 5444.

Please note that unfortunately funds to support attendance are not available. If you have any special needs please ensure you let us know.

Wednesday, April 14, 2010

Personal Health Records

One of the great potential benefits from consumers in the plan to roll out e-health programs is the improvement in the connection and integration of care. The development of personal held records which can be considered as a is of particular interest to comsumers.  This record would be owned and controlled by the individual consumer and the information it contains could be shared with designated clinicians, providing them with information that would assist them in treating our conditions. The National Health and Hosptial Reform Commission (NHHRC) developed this idea in their final report.

Recommendations 13, 115 and 120 of the NHHRC Final Report are about the need for every Australian to be able to have a personal electronic health record that will at all times be owned and controlled by that person. This is important to support people’s decision making and management of their own health. The Commission called for this by 2012.

Many consumers are already doing this in hard copy or on their computers. Many of the people we speak with you have Chronic Conditions understand that a personal held record is an important tool in managing their own health and making decisions. One of our members had a red A4 folder which he and his wife always travelled with. The folder has details of his diagnosis, medication, hospital visits, doctors and test results. Another consumer has told us about his simple, A4 double sided document that he keeps in this wallet. One of the participants in our recent training for consumer representatives. Julie Derrett spoke with Brian and he shared his story:

Brian has a heart condition and has had numerous visits to the emergency department for his condition. He carries with him a little red book which lists all of his medication history, strength, dosage, date started and reasons for any changes. He also has a letter from his cardiologist which explains his condition and his medical history.
When doctors at the ED ask him what medications he is on, he simply produces the red book. Doctors comment, “I wish all patients did this, it helps so much with diagnosis and misdiagnosis in the ED”
When travelling interstate in a rural area the letter from the cardiologist proved to be invaluable. ED staff in a regional centre were able to contact B’s cardiologist and get advice so that the right medications were administered quickly.
This simple paper based, personally held record has meant that Brian has received timely, well informed advice and treatment when he has attended the emergency department. He thinks that everyone who has a chronic condition should have something like this. If not a small book, then a fold out credit card sized summary document that could be carried in your wallet.
We are interested to collect stories from consumers about personal held health records. We would like to know the information you collect, when do you use it? when have you found it to be of most value? have you changed over time the information you have in the record?

Friday, March 26, 2010

A third hospital for Canberra?

Negotiations are underway between the ACT Government and the Little Company of Mary on the sale of the hospital infrastructure at the Bruce campus.

Today the Chief Minister spoke about the possibility of buidling a new hostpial if the negotations with LCM fall through.


But is a third hospital in the best  interests of consumers?  



We want access to safe, quality and appropriate services but are not convinced that a third hospital will provide that to our community.

We are concerned that building a third hospital and cost of maintaining three hospitals will have a negative impact on money available to community based services. There are not enough health dollars to service the current demand.  



The Government has a large program of works on infrastructure and redesigning health services underway based on moving many services to the community.  We support the move to community based health services.

We call upon the government to commit to a focus on primary health care. We are concerned that having three public hospitals in Canberra will not get us closer to achieving that.

We are supportive of the new nurse led walk in centre that is opening in May.  We are also very supportive of enhanced community health centres such as the new centres planned for Belconnen, Gungahlin and Tuggeranong.  We would hate to see funds diverted from community based services to pay for a third hospital.

Sunday, March 7, 2010

Interested in improving the quality and delivery of health services in the ACT?

Are you interested in improving the quality and delivery of health services in the ACT?
Do you want to drive meaningful change for health consumers?
Why not attend our Consumer Representative Training?








HCCA provides this training workshop to people interested in health in the ACT at no cost to particpants. At the end of this workshop, you will have a better understanding of your rights as a health care consumer, how to effectively contribute your say as a consumer and what opportunities are available for you to make such valuable contribution to our health system.

Areas covered in the workshop include:
-Overview of the Health System
-Consumer Participation in the Health System
-Consumer Representation on Committees/Boards
-Understanding advocacy and the consumer perspective

18 and 25 March 10 - 2.30pm at HCCA offices in ACT Sports House, Hackett. 

For more information contact the HCCA office on 02 6230 7800 or see the training page on the HCCA wesbite

Friday, March 5, 2010

Exciting New Health Services Overseas

Megan Cahill, Executive Director Government Planning and Development, ACT Health spoke to HCCA members about the Ministerial Study Tour of United Kingdom and Scandinavia in August 2009.

Megan spoke about four sites they visited, gave an overview of the services and shared the key learnings from each of the sites. In this post we share three of the sites, the Telemedicine Clinic in Aberdeen Scotland, Hillingdon Hospital (London) Bevan Ward and the Great Ormond St Hospital (GOSH) in London.

Telemedicine Aberdeen, Scotland
Nurses in outlying Shetland and Orkney Islands would beam into ED of hospital nurse make preliminary diagnosis and then use telemedicine to present the person and seek advice about treatment on site or transport to the mainland for care. This system has been operating for 2 years, and they have had the opportunity to test and bed down any problems, refine and improve system.

The Orkney TIA tele-clinic won the Improvement and Innovation Award at the Scottish Health Awards in November 2008 and is a service with the potential for replication in other NHS board areas

Benefits include:


  • technology enhanced timely access to care
  •  useful for triage and management
  • record all the tele-med consults and use this as a teaching tool nursing, allied health and medicine
This requires heavy bandwidth, which is an issue for infrastructure.

From the Annual Report of the Scottish Centre for Telehealth:

In July 2008, the new telemedicine service for patients in Orkney suffering a transient ischaemic attack (TIA) began. Current evidence suggests, and recent guidelines recommend, that patients should be seen by a specialist within 24 hours of a TIA so that secondary prevention treatment can start. Using videoconferencing, patients in Orkney can now see the on-call specialist in Aberdeen within that time because they do not have to travel to the mainland or wait for a visiting specialist.

By the end of March 2009, the Orkney TIA teleclinic had seen a total of 16 patients.

Following their telemedicine consultation, all 16 patients were able to begin the relevant treatment. Thirteen later travelled to Aberdeen for further investigations, treatment or management while three were able to remain in Orkney.

During the year, ENT tele-endoscopy became a routine part of healthcare services in Shetland. A dermatology service in Forth Valley which uses digital photography to triage patients is providing a model example of how telehealth can deliver service redesign.

Hillingdon Hospital (London) Bevan Ward
The Bevan Ward which has been operating since June 2009 and has 24 single rooms designed in three different layouts.

UK have moved to 100% single bed wards with positive implications for cleaning, heating, and implications for clinical outcomes for consumers.

This Ward is a good demonstration on how to achieve the single beds. The critical issues in terms of layout is the placement of ensuite. There are 3 configurations of single bed wards with inboard, outboard, nested layouts.

In developing this staff were given the opportunity to provide input into the design of the hospital and about placement of nurses stations and bed pan room and equipment and will evaluate at 6 months and 12 months.

The participants in the study tour were particular impressed with the touchdown stations staff could do observations on patients in an unobtrusive way. They were also impressed with the absolute commitment to infection control, bare from elbows down, wash hands before and after seeing patients, cleaning devices are placed to follow people's work flow. Each room has a clinical wash hand basin.

They achieved a significant reduction in infection rates.
There is a video online that provides a tour of the ward. It was taken by a consumer organisation that monitors NHS services in the Hillingdon area. It shows the room layout and ensuites, touch-down bases for nurses, infection control strategies, nurse call system, ward kitchen for patients and family, clean utility room and a an enthusiastic opera singer.
The video is available on the Community Voice website at http://www.communityvoicehealth.org.uk/ or for the direct link, follow this link Bevan Ward tour.


Great Ormond St Hospital (GOSH), London
This site is under going a number of phased redevelopments similar to the Canberra Hospital. The hospital is located in Bloomsbury in the middle of London (adjacent to the British Museum and Russell Square) and has considerable physical constraints. The project period will cover Phase 2 of a planned 4 phase re-development of the complex hospital site and Phase 2 needs to be completed by 2011. One of the project objectives is to provide an exemplar sustainable hospital design to influence the future UK hospital build programme estimated to cost $50bn.


The Morgan Stanley Clinical Building is due to open in 2012 at a cost of $520m.


This will include:

· new kidney, neurosciences and heart and lung centres.
· Seven floors of modern inpatient wards for children with acute conditions and chronic illnesses;
· state-of-the-art operating theatres enabling us to carry out more operations on children with complex conditions; and
· enhanced diagnostic and treatment facilities offering faster and more accurate services for patients
· Tele-medicine and tele-education facilities will be installed, enabling peer practitioners around the world to observe surgical interventions and other treatments via video linkup.


Once the Morgan Stanley Clinical Building has been completed they will redevelop and refurbish the Cardiac Wing, aiming for completion by 2014/15.


They are working to replace the inconvenient, cramped, outdated wards with new facilities where parents will have adequate space to sleep alongside their child in comfort, with parent break out spaces. They are also designing the hospital so that children can decide to leave their beds to eat their lunch in a separate room, visit the playroom or a computer.


They demolished an old building using a new implosion technique that meant that doctors conducting neurosurgery 10m away experienced no noticeable vibration.


The website has a video that shows the demolition processes in progress using large technology including track saws, excavators and pulverisers. The demolition focused on minimising disruption to patients, families and staff as well as minimising dust.


They have a focus on prefabricated components as they don't have space to bring in raw materials, assemble on site and then install, so, for example, ensuites were prefabricated and installed.


They have a webcam on the roof and part of patient entertainment system they could go to the webcam and get a panoramic view of London.

The participants in the study tour were particular impressed with the emphasis on the need for strong leadership in developing new models of care and change management process.


The Great Ormond Street Hospital were joint winners of the award for 'Best Environmental Strategy' in the Estates and Facilities Management Class of the Better Building Healthcare Awards last year. More details of how they achieve a reduction in carbon dioxide emissions, use of bio fuels and increasing the use of renewable materials is available online.

A transcript of an interview with Dr Ken Yeang, (Director of Architects Llewelyn Davies Yeang) is also available on the GOSH website.

The are also excellent photo galleries online at the Build Health website.

We are hopeful that ACT Health will embrace similar websites to share the redevelopment process with the Canberra community.
Megan also spoke about the Akershus University Hosptial.  We are currently writing a blog post on this and will post next week.  In the mean time  I can recommend the blog post by Microsoft's health senior director Bill Crounse, MD, on how information technology can improve healthcare delivery and services around the world.  He vistied Noraway in June 08.

Tuesday, March 2, 2010

Are GP Super Clinics the answer to the access problems?

The Federal Government is building 31 GP Super clinics to be set up over the next four years. There will not be one in the ACT. The Commonwealth Government wants to ensure that all Australians have access to affordable, high quality, comprehensive and integrated primary care services which are convenient and accessible and the Super Clinic is seen by many, including the Federal government, as one way to provide this.

On Wednesday (24 Feb 2010) in the National Health Forum Series presented by the Australian Primary Health Care Research Institute at the ANU a panel discussed the Question “Are GP Super clinics the answer to the access problem?”

An overview of the session is available on the APHCRI site. A podcast the second forum in The Australian University's National Health Reform Series, 'Are GP Super Clinics the answer to the access problems?' is available online.

Julie Derrett, HCCA Policy Officer, listened to the podcast and has written this post, sharing some of the points raised by each of the four speakers.
Professor Mark Harris, Executive Director , Centre for Primary Health Care and Equity at the University of NSW and a member of the External Reference Group, National Primary health Care Strategy.

When we look at the big picture of access to GP’s in Australia it doesn’t look too bad particularly when we are talking about episodic care; 80% of Australians see a GP each year and the average number of consultations each year is at least five, and around 80% of those visits are reimbursed totally through Medicare. The situation in rural Australia can be quite different.

After hours availability is very poor when compared to other countries like Australia. The big problems around access are in primary allied health.

Medicare funding is very restricted and about half of the care that people need from allied health providers is not funded at all. This just makes access to allied care unaffordable for many. Co-payments are a big problem with both doctor and allied health care and while state allied health services are free there can be very long waiting times for access.

Will Super Clinics solve this problem of access to allied health services? If they provide access to multi disciplinary care in the one location at an affordable cost, yes they will improve outcomes for many consumers.

The research shows that where multidisciplinary care providers are co-located the quality of care improves, however, size matters. When clinics grow larger than 20 full time equivalent staff the quality of care is more likely to suffer in terms of continuity of care and patient centred care.

Dr Steve Hambleton, Federal Vice president of the Australian Medical Association.

Steve Habmleton believes there has been a significant under investment in both health facilities and doctor training in Australia for decades and that this is why we are talking about an access problem today. He also pointed out that Super Clinics are not a new idea. He went on to list the kinds of services that will be available at the Super Clinics: GP, after hours, dieticians, podiatrists, psychology, visiting specialists, practice nurses, chronic disease management, pharmacy, computerized and provide teaching. This is what Steve’ Hambleton’s Brisbane city practice provides and has done for 21 years. It is a good model and it is good for our patients.

Welcome the investment in the super clinic model, but invite the government to talk to people already on the front line to see where the pressure points. The AMA is very concerned to that super clinics should not be set up in opposition to existing practices.

At public consultation meetings on Super Clinics which Steve Hambleton attended, it was clear that the services were already in place. Are Super Clinics g in the places of most need is the question.

Dr Rashmi Sharma, President of the ACT Division of General Practitice

Dr Sharma pointed out the even though the ACT has a significant GP shortage it did not receive Federal Government funding for a Super Clinic. She was concerned that the clinics could create another tier of primary health care delivery and could further fragment care.

Physical access to clinics was another concern. Concentrating health care facilities in town centres will create barriers for many, especially in Canberra where public transport is very poor.

Dr Sharma was not confident that the bulk billing model of the Super Clinic would be sustainable. In her own quite large practice it certainly isn’t possible, even though they have allied health practitioners and practice nurses providing an income stream.

In a recent survey of Canberra GP’s it was revealed that many consumers were not being referred appropriately because GP’s are often not aware of what services are available. Dr Sharma would expect co-location to overcome some of this awareness problem.

Dr Sharma was not convinced that the new model is any better than what we already have in many existing middle size practices and that it may be better to invest in what we have.

Russell McGowan, Health Care Consumers’ Association of the ACT.

Russell McGowan said, “Super Clinics are no more the answer to our health care needs than supermarkets are to our food needs. They play a role, where they can be useful is where they are physically accessible and where they are open all hours, but they won’t be of value if they crowd out all the alternatives.”

Russell reminded the audience and panel that what consumers are looking for in health care is the triple bottom line – safe, high quality and cost effective health care.

Super clinics can provide a different model and this comprehensive mix of medical and allied health services could be an advantage to some groups who have complex chronic conditions and need the interaction of many health providers to keep them well. Many consumers will still want to see local suburban GP’s because we value some of the things that they do above other considerations. But increasingly consumers will want more from their GPs regardless of location or size. Things like: practice nurses, e records, integration with allied health and after hours access. This will be hard for really small clinics to deliver without additional assistance.

A lot of money will be spent setting up these clinics and we will have to carefully monitor and evaluate to see whether we are getting the best bang for our buck.

The co-op model, like the West Belconnen health Co-op, should be considered seriously. It has the potential to deliver the integrated, accessible and cost effective outcomes that we are seeking from the Government’s expenditure on super clinics, but at a fraction of the cost.

There is more information about the Federal Government Super Clinic program at Super Clinics