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 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