Monday, March 26, 2012

Murray Chapman Speaking Series: Dr Tom Calma lecture

Recently I attended a lecture given by Dr Tom Calma as part of the Murray Chapman Speaking Series.  The Speaking Series is an initiative of the Reconciliation Action Plan Committee in honour of the late Murray Chapman, a passionate advocate for reconciliation and the father of one of my close friends.

Dr Calma is involved with indigenous affairs at local, national and international levels, and has been for many years.  He is currently a Social Justice Commissioner with Reconciliation Australia and the National Coordinator to Tackle Indigenous Smoking.

During his speech, Dr Calma discussed indigenous health outcomes, which, on the whole, are significantly worse than those of non-indigenous Australians.  Aboriginal and Torres Strait Islander communities experience higher incidences of infant mortality and deaths in middle adult ages than non-indigenous communities.  A number of “lifestyle” factors contribute to poor health outcomes, such as tobacco and alcohol consumption, obesity, physical inactivity and high cholesterol. 
Dr Calma’s approach to closing the gap on indigenous health issues is informed by a human rights and developmental approach to health.  He reminded the audience that every statistic is a life, and it is important not to lose sight of the individual’s needs in implementing health programs and reforms.  The Close the Gap campaign adopts this human rights based approach to improving indigenous health outcomes, and complements the Federal Government’s Closing the Gap program.

The social determinants of health also play a key role in developing strategies to improve the health of Australia’s indigenous population, with 75% of the indigenous population living in urban areas and 50% of indigenous households surviving on minimum wage. 

In a wealthy and developed nation like Australia, Dr Calma asserted, it is not credible to believe that health crises affecting less than 3% of the population cannot be successfully addressed.  Such success will rely on the continued ability of official programs to engage meaningfully with the Aboriginal and Torres Strait Islander population.

Heather McGowan
Research Assistant

Thursday, March 22, 2012

Forum with health care consumers to discuss the ACT Chronic Disease Strategy

In recognition of the critical importance of effective chronic disease management, the ACT Government Health Directorate is developing a new ACT Chronic Disease Strategy, which will further develop the previous ACT Chronic Disease Strategy 2008-2011.  The strategy will explain how chronic disease care will be managed in the ACT community into the future.   

The prevalence of chronic diseases throughout the world is increasing significantly.  Effective chronic disease management requires working in partnership across a range of sectors, including consumers and community members, all levels of government , the private sector and non-government organisations.  It also means that consumers are supported in learning about the health and community services that are available to us.
So much of chronic disease management happens outside of the system.  We need a broad-based approach to this, including private and public providers of services, as well as services provided by non-government, community-based organisations (eg community transport, home help).  The development of the new ACT Chronic Disease Strategy requires wide consultation, and we are pleased to see that the Government is planning meetings with key stakeholders, consultative fora and a longer timeframe (6 weeks) to consult on the draft Strategy.  

Chronic conditions not only compromise our health and well-being, but can also have a significant impact on our family and friends, our capacity to be active in the community, as well as earning an income. 
Consumers need support to navigate the way through the wriggles and turns, and over the hurdles that occur in our health system.

On 28 February, Health Care Consumers Association hosted one of the first of these consultative fora.  The session was facilitated by Cathie O’Neill, a senior consultant specialising in the healthcare sector and engaged by the ACT Health Directorate to draft the Chronic Disease Strategy.
This post summarises specific areas which consumers wanted felt strongly about and which they wished to see addressed in more detail in the strategy.  

These included:
Chronic disease management outside the ACT Health Directorate (ACT HD):  an explanation of how ACT HD will promote the management of chronic disease within the community in the frequent circumstances when it falls outside the formal ACT HD system.
Advanced care and residential care directives: currently some consumers feel that despite having signed a care directive, their wishes may not always be respected because clinicians fear possible litigation.  
Links between Calvary Hospital and The Canberra Hospital: Ambulatory and outpatients: the strategy must address equity issues between the two hospitals in respect of referral for ambulatory services.  It needs to specify the number of patients at Calvary whose only continuity of care can be provided through referral back to ACT Health at The Canberra Hospital and outline a solution to address this “gap” in the system.
Diabetes: the Diabetes Strategy was still incomplete.  The Diabetes “Buddy” scheme appeared to have faded out.  Consumers wanted to know if there is a strategy to re-establish this excellent initiative?
Community Partners and Support Services: the invaluable services these groups provide need to be highlighted and formally recognised.  Many of these groups are actively supporting ACT HD to deliver its health programs and initiatives, but most lack funding, are under-resourced and much of the assistance they provide is not formally recognised. It is also felt that the HD ACT should do more to assist these Support Groups by advertising their services to the general community.  There is also a need to provide funding to educate GPs about community support services. 
Recognition of, and respect for, complementary medicine:  complementary medicine is extremely important and helpful.  However, services such as meditation, yoga and relaxation are only briefly touched upon in consultation with clinical staff.  This is an area which needs far more prominence and development, concentrating on specific areas of treatment.  
Listening to the patient’s story: getting the message across:  once qualified, clinicians often focus merely on treating a condition, rather than understanding and listening to the patient’s story. This should be used as an education tool right from the start; if medical students could be educated to improve, and understand the importance of, communication skills, this would be hugely beneficial to both patients and the medical profession as a whole.  It is also a low cost, effective solution to an ongoing problem.
Cross-referencing between health services: it is important that those living with a chronic disease are permanently recognised on admission to hospital; eg a system indicating “this is a chronic disease-registered patient”.  Currently, those with chronic conditions are only placed on a chronic disease register once they have been admitted to hospital several times; and they are eventually removed from the register, if they do not present at hospital again within a certain timeframe.  It is important that clinicians always recognise patients with chronic conditions, even when they have been admitted for treatments unrelated to their condition. 
Web-map for linking all relevant services:  there is an urgent need for a web-based effective “one-stop shop”providing details of all services available for those living with chronic conditions.  This discussion highlights the need for a comprehensive and current Health Services Directory that extends beyond services provided by ACT HD; many of the group were unaware of its existence.
Terminology to encompass “chronic disease”: people with chronic disease don’t think of themselves as sick on a day-to-day basis, because they live with the disease all the time; they would consider themselves to be “sick” if they have a flare-up of the condition.  It is also inappropriate to describe people as “sufferers” of a particular condition or disease, because, again, most do not consider themselves to be suffering from day to day.  “Living with a chronic condition” is an appropriate description.
Carers: play a vital role and must be included in the strategy.
Social workers: in many cases, social workers are too focussed on a narrow field.  They are often anxious to get people out of hospital and back home, without taking into account the patient’s family situation and pain management plan.  
Public holidays and weekends: it is important that the strategy explains how access to services will be handled during out of hours.  For example, oxygen services close down and the BOC emergency services are only able to cater for deliveries – they cannot, for example, cope with repairs or spare parts.  This puts consumers at risk.
Cross-border health issues:  the needs of those diagnosed in different health areas must be addressed – ie the strategy must include support for those living in NSW and accessing services in the ACT.
Discharge from hospital to home: it is concerning that many people, especially the elderly, are discharged from hospital without having the necessary support at home to cope with their condition.  A system needed to be implemented whereby patients could be monitored after leaving hospital to ensure they were being properly looked after.  
Secondary prevention:  consumers need quick and efficient access to advice on early prevention of chronic disease.  Currently there is room for efficiencies in this area – early treatment and prevention will offer huge savings.  Access to appropriate, timely treatment is needed – prevention is key.  For example COPD courses should be available for people before they contract the disease, rather than after they have been diagnosed.
Financial courses:  for many people with chronic disease, financial costs for treatment can be the “final straw”, adding yet another mental burden to their already stressful situation.  Mental problems caused by financial stress often exacerbate the physical condition.  Making people aware of their financial entitlements is important; this could be achieved through sponsorship with one or more financial services organisations.
Consistent case management: often you are your own case manager, but this is a complex task when you are dealing with declining health functions.  People need to be empowered and need an advocate.  It is important to have continuity – for example, having one case manager, rather than two or more, is likely to deliver a more effective outcome.
Community based Chronic Care Nurses and Nurse Practitioners: there is a strong need for nurse practitioners to coordinate care with other health professionals and a need for community-based Chronic Care nurses within the ACT.
Homogenous system: currently the system is not homogenous and the strategy must identify a plan to allow all stakeholders to communicate effectively to deliver a seamless and efficient service.  GPs and specialists are central to the strategy’s success.

The group agreed on the Draft Commitment Goals, which state:
“In the ACT we are all working together to ensure any person with a diagnosed chronic condition:
Does not have to repeat their story unnecessarily
Has a management plan, which supports self-management and contains goals for improvement and actions to take for acute or chronic events
Is aware of relevant support options and how to access them
Has their care proactively coordinated and managed
Understands their need for, and adopts, secondary prevention
Receives the best care, in the best place, at the best time
Is supported by a system that is patient-centred, high quality and evidence-informed.”
Consumers will have the opportunity to provide more input to the strategy at “The Future of Chronic Disease Care in the ACT” forum on 16 March. 

Karen Jameson
Policy Officer

Tuesday, March 6, 2012

Palliative Care

The needs for palliative care services in the ACT are increasing, and have been reflected in recent news coverage, such as the ACT Government’s release of a tender for the procurement of a six-bed palliative care sub-acute facility and the opening of the new day hospice in Jamieson. The opening of the day hospice emphasizes the results of current research suggesting that the bulk of end of life care is still delivered in the community and that support should be given to the family and friends who often provide this care.
On 18 February 2012, the ACT Government released a tender for the procurement of a six-bed palliative care subacute facility. The tender is seeking a needs-based palliative care service, providing a Step Up / Step Down facility for adults transitioning from an acute care setting to home, or those needing an admission to a sub-acute facility to prevent a hospital or hospice admission. The successful tenderer will be required to use a palliative care approach in providing these services, based on the definition that “palliative care is care provided for people of all ages who have a life limiting illness, with little or no prospect of cure, and for whom the primary goal is quality of life” (Standards for Providing Quality Palliative Care for all Australians - May 2005). It is intended that the service will complement and work in partnership with the above existing palliative care services to ensure seamless transition between care settings. Submissions to the tender process close on 29 March 2012.
The ACT’s current Palliative Care Strategy expired at the end of 2011 and a review is underway, with completion expected by mid-2012. HCCA held a consultation on 24 February 2012 as part of this review to provide consumer input into the development of the new strategy for Palliative Care for the ACT. Key issues raised by HCCA members included:
·    Improved statistics on palliative care requirements and current service levels would inform better resource provision for palliative care in the ACT region.
·    Consumers need access to more information about palliative care services and the choices available to them, not limited to the Respecting Patient Choices program and Advanced Care Directives.
·    The National Pain Strategy should be linked into the ACT Palliative Care Strategy, and consideration given to more adequate services for pain management at home. Palliative care services should also address consumers living with chronic and acute pain.
·    A greater emphasis on services provided by expert Palliative Care Nurses / Nurse Practitioners could help addressed unmet needs.
·    Palliative care services should address the needs of different groups, including younger people – there are broader needs than just aged care.
·    Consumers should have more choice and access to a range of service providers, without being limited only to services provided by religious organisations.

The work of the review and the new ACT Palliative Care Strategy will help inform the planning and development of Canberra’s new Northside sub-acute hospital, and we hope will lead to improved information, access and provision of palliative care services to health care consumers across the region in the years to come.  HCCA prepared a submission to the ACT Government on the selection of the University of Canberra as the preferred site for building a sub acute facility that will include palliative care.

The Senate Committee on Community Affairs is completing an Inquiry into Palliative Care in Australia.  HCCA has completed a submission and we will put this on our website later this week.

Saturday, March 3, 2012

Development of the ACT Clinical Services Plan

What is the Clinical Services Plan?
The Clinical Services Plan (CSP) will provide a strategic framework for the delivery of Health Directorate clinical services between 2012 and 2017.  It is a strategic level plan which will build on the Clinical Services Plan 2005-2011. 

The CSP will:
·        outline the clinical service framework and service needs to 2017, and a longer term strategic vision to 2022 for ACT public hospitals and community based services;
·        identify broad strategic directions for health service delivery, and guide more detailed planning, models of care and work to be undertaken in the future; and
·        guide the provision of services to meet projected demand during a period of significant infrastructure development across the Health Directorate.

How is the CSP being developed?
A Steering Committee (SC) will oversee the development of the CSP.  Darlene Cox is a member of the Committee, representing HCCA.
A communication and consultation plan has been developed to ensure stakeholders and the broader community have the opportunity to contribute to the strategic directions that will be considered during the planning process.
Initially, senior staff at Canberra Hospital & Health Services, Calvary Hospital and other Health Directorate stakeholders are reviewing the information upon which the plan will be based and provide advice to the Steering Committee.
Health Care Consumers Association has provided informal feedback and will continue to be part of the development process.  We are particularly interested in how this plan will ensure that quality and safety is a driver in the development of health services. 
Once the plan is drafted there will be an opportunity for all staff, the broader community, non-government organisations, regional health services, other government departments, private hospitals, peak bodies and unions to provide feedback.

So far Health Directorate staff have held consultation fora at Calvary Hospital and are planning for meetings with senior staff in Canberra Hospital and Health Services. These consultative meetings will continue through to the end of March.

Clinical technology planning is being undertaken through a Technology Mapping project. A set of Horizon Scanning Clinical Technology Roadmaps have been developed. Customised maps for the Health Directorate will be developed in consultation with clinicians.

A draft Clinical Services Plan will be finalised in April 2012 to enable broader consultation to mid 2012.

 How do you get involved?
·        Email a comment to:;
·        Reading and commenting on the draft Clincal Service Plan when it is released in a couple of months.
HCCA will be preparing a response to the draft Cliniacl Services Plan and we welcome your comments.