Thursday, November 27, 2014

Health Issues Group Blog Post: COTA Transport forum by Nicholas Wales

Health Issues Group Blog Post: COTA Transport forum by Nicholas Wales


Jane Thomson from Council on the Ageing (COTA) came out to HCCA on the 13th of November 2014 to present an insight to COTA’s study on how older people in the ACT travel and transport options.

In 2013 COTA ACT conducted research on how older people in the ACT travel. The aim was to find out how older people in the ACT travel and to identify and explore the issues to recognise potential solutions/improvements.

443 people responded to the survey resulting in the following:

       78% of respondents had access to a car.
       60% used buses (31% of those didn’t drive)
       Nearly half said they had difficulty travelling.
       Older age groups & people with mobility/health problems much more likely to have difficulty.
       People weren’t aware of all the transport options
       People felt transport was important for social connection and were afraid of becoming socially isolated

From the survey findings COTA put together A Guide to Getting Around in Canberra, for older Canberra residents which was printed in October. The guide gives an overview of transport options including buses, community transport, flexible transport, taxis, scooters, bikes and walking. It also includes advice about how to use or combine these options, relevant phone numbers and web sites and information about social clubs and recreational opportunities.

COTA also provides free individual and group transport training which is delivered by volunteers. The free individual transport training can be delivered to people in their homes, it has been available since June 2014. This service is help build the skills and confidence by going along on bus trips and provide info on services, social supports and connections. The free group training has been running since July 2014, it provides a presentations to groups of older people on transport options. It covers options, tips and ideas with info on services, supports and connections. For more information on training click here.

Jane then went on to looking at the main transport options in Canberra. She listed driving, buses, community transport, taxis, scooters, bikes and walking as the 7 primary options for travel in Canberra.
Driving:
Driving is a great while you can do it but can be a challenge when you lose the licence. NRMA provides a Safer Driving School which can help seniors assess their skills and retain their licence. Park & Ride can help minimise driving and also avoid parking charges.

Buses:
Buses are a cheap mode of transport (free if you’re over 70), however they are hard to use if you have poor balance and/or mobility. There are also major issues with frequency and reach, especially on weekends, so where possible use the frequent bus network. NXTBUS is better than written or online timetables as it tells you how far the bus is away from your stop or if you have missed it. Accessible buses make it easier to get on and off the bus, however accessible buses only run on some routes.

Community Transport
Community transport is available through the 5 regional Community Services Organisations for eligible residents in their designated areas. The service offers door to door but are not always flexible and/or available, as this service prioritises medical over social travel. The Belconnen Community Services offers whole of Canberra service. There is also a Flexible Bus Service which is available for members of the community with limited access to public transport. Their contact number is 6205 3555

Taxis
The taxi service will take you door to door, however this service is expensive and there can be driver behaviour issues. Fares can be reduced, such as sharing or the taxi subsidy scheme. The ACT Taxi Subsidy Scheme provides financial assistance to ACT residents with a disability or significant mobility restriction that prevents them using public or community transport.

Other options
Scooters and bikes
Scooters are great for short trips. There is lots of advice around – Independent Living Centre, AusScooter, Guardian Mobility and Scooter Safe handbook. Scooters can go on accessible bus, if meet size/type conditions, but you cannot drive them on a main road.
Electric bikes are a great substitute for easy travel, as the electric motor will assist you when needed. Bike hire available through SEE-CHANGE. Electric bikes can use on footpaths, cycle paths and roads

Walking
Walking is great for your health, however poor paths and ramps can be an issue. Fix My Street is an ACT Government initiative, where the public can put in a repair request for a specific location. You can contact them online or phone 13 22 81.

Jane stated that COTA will continue providing transport training and information through volunteer peer-educators. COTA would also like to update the transport Guide, this is depending on feedback and funding.


COTA will continue to lobby for better transport options in Canberra with the help of community involvement.

If you would like any further information on the services and information COTA supplies please contact them on 02 6282 3777 or email contact@cotaact.org.au
You can also visit their website at: http://cotaact.org.au/

HIP Project Officer 
Nicholas Wales


Conference Report SYMPOSIUM ON POPULATION AGEING AND AUSTRALIA’S FUTURE Shine Dome, Canberra, Tuesday 11 November 2014 by Kay Henderson

SYMPOSIUM ON POPULATION AGEING AND AUSTRALIA’S FUTURE Shine Dome, Canberra, Tuesday 11 November 2014


Background

The Symposium was sponsored by the Academy of Social Sciences in Australia (ASSA) in collaboration with the ARC Centre of Excellence in Population Aging Research (CEPAR).  The Symposium was held in conjunction with an Annual Meeting of FSSA that included a book launch and a lecture on income contingent loans by Prof Bruce Chapman, both held after the Symposium closed and each of which I also attended.

Much of the Symposium ranged well beyond health care, with general policy issues also covering social welfare, social and population change and economic issues.  However, health care consistently came up within the context of general discussion.  The Keynote Speech was given by the Age Discrimination Commissioner, Susan Ryan, who spoke on “The Longevity Revolution – Crisis or Opportunity?”   The other speakers at the Symposium were grouped into four “panels”:

  1. Societal Ageing:  What it means and why it matters;
  2. Population Ageing:  Global, Regional and Australian perspectives;
  3. Improving Health and Wellbeing; and
  4. Responses by Government and Families/Individuals.

Within the context of general discussion of the implications of an ageing population, two presentations had particular relevance to issues of health and the funding of health care.  One dealt with the enhancement of “cognitive capabilities” over an individual’s lifespan and the other with the interlinked issues of ageing, entitlement and the funding of health care.

Cognitive Capacities

Prof Kaaren Anstey has the dual titles of Director, Center for Research on Ageing, Health and Wellbeing, and Director, Dementia Collaborative Research Centre – Early Diagnosis and Prevention, ANU.  Her presentation covered what is known (in a preliminary sense) about what happens to people’s cognitive capacities as they age.  The term “cognitive capacities” refers to memory, thinking, reasoning, problem solving, planning and processing speed.

Once, it was thought by psychologists that “intelligence” was innate and relatively fixed throughout life.  Now, researchers view cognitive abilities in a much more fluid and dynamic way.  Environmental and genetic factors come into play, and the trajectory of cognitive abilities through life is not predetermined.

Prof Anstey focused on two elements in cognitive development over a lifespan.  The first, “cognitive reserve”, is the peak cognitive ability that an individual achieves and is a reflection of optimal brain development and education.  The second element is the rate of cognitive decline through adulthood and into old age.

There is growing evidence that the brain is far more plastic than previously realised.  Research on brain development combined with increasing longevity suggests that our perspective on education needs to change.  Participation in education at various points during adulthood may have influences on the brain we have not yet imagined.

There is still much to be learned about the cognitive capacity of the brain, particularly into old age.  Researchers are now examining whether there is a link between cognitive capacity and dementia.

Prof Anstey stressed that bringing all our knowledge together and creating the best possible public policy for cognitive health is likely to promote a genuine increase in the numbers of adults who age well and to reduce the incidence of late-life dementia.

Ageing, Entitlement and Funding

Jane Hall is Professor of Health Economics, Centre for Health Economic Research and Evaluation, UTS Business School.  Her presentation, co-authored with Kees van Gool, examines the phenomenon noted by the OECD that in developed countries health care expenditure increases at a faster rate than national income.  For Australia, health care expenditure is expected in the Commonwealth Government’s “Intergenerational Report” to grow more rapidly than Commonwealth Government spending on aged care and pensions.

Prof Hall noted that the Australian Institute of Health and Welfare regards an increase in the prevalence of chronic disease as Australia’s biggest health problem.  However, Prof Hall also notes that while ageing populations have resulted in a greater incidence of chronic diseases, treatment has changed in such a way for most diseases that patients expect to manage their conditions so as not to have to withdraw from normal life.  There is a substantial variation in health within all age groups.  Interestingly, almost half of the 85+ age group rate their own health as good to excellent.

While ill-health is variable within populations and particular age groups, public funding is designed around three main funding streams – for hospitals, pharmaceuticals and medical services – that are separate and inflexible.  Prof Hall postulates that greater flexibility in service delivery could result in savings in the health care system.  For example, in an internet-connected world many patients may get some health services without physically seeing an expensive doctor.  The last year of life is the most expensive time for health care provision. Half of Australians die in hospitals, which are expensive, while surveys show that most would prefer to die at home.

Prof Hall concluded that ageing per se is not a threat to the sustainability of the Australian health care system.  In particular, it is not a threat to the continued viability of tax-financed universal health care insurance.  Prof Hall maintains that universal coverage and high levels of public insurance must be part of the solution to the policy challenge of healthy ageing.  Because of the wide variation in health status and expenditure, policy reforms that are aimed at the average are likely to miss their target and have sub-optimal health and financial consequences.


Comment

While both presentations were by necessity delivered in very general terms, each highlights issues of relevance to the continued evolution of health status and health care delivery in Australia.  Research into “cognitive capacity” is still at an early stage, and as more is known there may be significant benefits for ageing portions of the population generally.   A move away from health care funding and service provision that is based on “average” needs towards one that targets those within the population who have the most intensive needs would decrease the likelihood that ageing will in itself result in greater public health care expenditure.

For both issues, “Watch this space!”


Prepared by Kay Henderson

Medicare Local: Future Thinking Symposium : “whole system working” Consumer Representative Conference Report Bernard Borg Caruana

Medicare Local: Future Thinking Symposium : “whole system working”Friday 17 October.By Bernard Borg Caruana

Introduction:   Whole of Systems Thinking
‘Whole system working’ is a radical way of thinking about change in complex situations.  To solve some of our most challenging health and wellbeing issues, we will sometimes have to look outside of health for some of the answers. They are beyond the ability of any one agency or individual to fix. To drive better outcomes and get systems such as health working better, we need to think about the connections between the parts – how things fit together.

Format
This was an all day session 9am to 5 pm held at the Canberra Rex.
Sessions were hosted by the ACT, Murrumbidgee ans Southern NSW Medicare Locals and facilitated by Dr Norman Swan.
It was attended by over 100 people

There were 4 plenary sessions which ran in succession:
  • ·         Vision for Primary Healthcare
  • ·         Order from Chaos: whole system primary health planning
  • ·         Whole System Working: Why the Mantra; and
  • ·         Whole of system in Practice.



Some of the presentations can be found at:

Medicare Locals and Health Networks

Medicare Locals will cease to exist as of June 301 2015 and replaced with Health Networks.
The ACT boundaries will not be changed but Murrumbidgee will have one Health Network replacing 6 Medicare Locals covering some 0.5 Million square kilometres.



1.      Vision For Primary Healthcare

A significant theme here that was raised by a number of speakers was the need to write the policy and drag the politicians behind us. We do not need permission to act when it is our health system. We need to galvanise communities and move it forward.

Professor Di O’Halloran had a number of interesting points in her slides regarding the Western Sydney vision for Medicare Locals. She urged us to “Stay true to our values and drive with ideals and health objectives.”


She proposed an approach for working across 3 levels to meet the various needs in Western Sydney. I have attached her Universal Triangle of the work of Medicare Locals


Proessor O’Hallon outlined some Medical Home principles and showed that they were close to the RACGP principles and also suggested some improvements

High priority, high risk groups need new integrated models of care: Patient centred, integrated Mdels of Care  for high priority groups Enrolment, Care Plan


     



Whole System Primary Care Planning

This session outlined the development of The Peninsula Model in the Frankston/Mornington district of Victoria.

Their starting point was:
Problem of short horizons and Services were not aware of one another or did not value one another.

A small team of well placed leaders were able to transform this chaos and bring som collaboration..
The team was 4 people but they were senior people from different organisations, Local Government, Exec Director of the Hospital, Regional Director of the State Department and CEO of the Medicare Local.

Although much was achieved, some factors that can still work against them is the sources of funding dealing with the resource contribution of various entities. Also there is a high cost of collaboration and from Jan to Sept 2014 they had 284 meetings.

However a key message is that “goodwill” is required. Organisations benefit by moving away from their “silos”. Alliances outside the organisation does not detract from the agency’s mission; it enhances or “spices” up the work.



3Whole System Working

I had high expectations regarding the speaker from Canterbury, New Zealand where they seem to be making great progress in integrated care. I had hoped that there would be more discussion regarding their Health pathways but this had been discussed the previous day in a more closed session. (see www.healthpathways.org.nz)

From what I gathered from the presentation, they have achieved a great level of cooperation across professions and providers and consumers. This contrasts heavily with Australia where such cooperation and collaboration is lacking. They are focussed on the “right thing for the patient”.

One of the key messages was “Progress not Perfection”.

Where possible the decision should be made where the clinician and the patient meet rather than applying broad policy.
Enable them NOT tell them what to do.

This presentation was followed by  a panel to discussion regarding integration in practice.
Some principles for implementation from the panel which struck a chord with me include:

·         Highest needs have multiple needs. Allocation of a house is easy; keeping them in the house is much harder

·         The system complicates the provision of support. Make the system easy for complex needs

·         Failures: cultures of some providers and professional cultures do not mix
  •  
  • ·         Go for one size fits most (rather than all).
  • ·         Provide a spectrum of services rather than one size


  • ·         Try different approaches:
  • ·         Top down systems do not always work;
  • ·         It is more effective if you give actors permission to act (actors = professionals and consumers)


These echoed key messages from previous sessions.


4    Whole of system in Practice

The final presentation discussed the Human Services Blueprint in the ACT which integrates: social services, housing, Justice, health and child welfare and is performing a trial in partnership with 50 families in the West Belconnen area for families with complex needs. They are just commencing a trial which will run for 18 months. It seeks to improve economic and social participation. 
By Bernard Borg Caruana

Wednesday, November 19, 2014

7th Annual ACT Tobacco and Other Drug Sector Conference 2014 -Report By Susan Westwood

Delegate:  Susan Westwood, Health Care Consumers Representative

Program
What is the drug policy?

Topics
E-cigarettes
Drug driving
New psychoactive substances
Medical Cannabis

What is the Problem?

Preamble

A lot of theoretical ground on the conference topic was covered by the speakers at this conference, the majority of whom had academic backgrounds.  Many important questions and issues relating to drug policy were raised by the speakers, and by the delegates who had the opportunity to discuss and question some of the key points raised by the speakers at the end of each session.  No definitive answers to the questions raised were given, although some suggestions and viewpoints were expressed.  Mr Ross Bell from the New Zealand Drug Foundation provided an interesting insight into the New Zealand experience, describing a political attempt to decriminalise drugs in the public arena.  But the community turned and lobbied against the idea of decriminalisation, due to a bizarre change of political influences and an emotional advertising campaign.

Drug policy is often subject to personal judgment. Formulating the stance taken on this sometimes confronting and demanding topic may depend on one’s own personal background, experience, age, nationality and perspective.  To some extent, it may be difficult to be totally impartial because many lives in the community have been influenced by family members affected by addictions, mental illness and drug intake. 

My personal experience as a health professional has been focused on saving lives and applying the principles of public health, wellbeing and enjoyment of life.  It goes without saying that the huge diversity of opinions, life experiences and life stages of people throughout the world can offer many interpretations of what form a drug policy should take.  In saying this, I am mindful that the problem is not just confined to ‘recreational drugs’ but that certain legally prescribed drugs can be just as addictive and life‑threatening as illicit drugs.

Event Observations

The Portrait Gallery was a good venue for the meeting; however, our table was placed right next to some heavy sliding doors which were constantly being pushed aside by a facilitator to allow persons to exit the room.  At times, it was very noisy in the foyer and this caused some problems in hearing the speakers.  One person at our table left and sat elsewhere. 

The morning tea, lunch and afternoon tea were very good and much welcomed because it was a long and demanding day.  I had the onset of flu so I welcomed fluid intake and food.  I did notice, though, that there was no choice for persons on special diets, e.g. gluten free, diabetic, etc.

The delegates all had a ticket number and a raffle was held at the beginning of each session, with prizes for the winners.  This was fun and encouraged everyone to get back on time for the next session.

The Role of Narrative, Metaphor and Media in Marihuana and Drug Use

Prof. Alison Ritter reflected on the popular trend to define problems according to narrative and metaphor. She questioned whether the use of specific narratives and metaphors contribute to the problem of interpreting drug policy. She believes that the use of narrative and language are central to those who implement any policy on drugs.  She claims that these policy makers can be viewed as ‘actors’ and that their solutions to the problems do not always relate to the problem at hand.

Prof. Ritter suggested that framing and the use of language can often publicly characterise certain drug usage, e.g. What is the image of a ‘vapor’ as opposed to a ‘smoker’? This leads to the question of how do we conceptualise drug usage and users in our modern society?

Emeritus Prof. Laurence Mather talked about the discourse of pleasure around drug usage and that the opposite is also true in reality.  He said that marihuana is often referred to as that ‘demon weed’ and the media have often portrayed marihuana negatively, for example, as in the 1969 novel Marijuana Girl which tells of a young girl who sells her body in order to buy marihuana.  Similarly, the 1936-39 movie production Reefer Madness, an American propaganda film portrays marihuana habitual usage as a gradual personal descent into crime and eventual madness.

There seems to be no doubt that the power of the media can influence public opinion about alcohol and drug issues and produce a fearful reaction among the public.  The media can instil beliefs, attitudes and fears, and can bias public opinion in many different ways about the drug discourse.

What is the Problem?

I refer here to the following Australian National Drug Strategy objective:

‘The aim of the National Drug Strategy 2010–2015 is to build safe and healthy communities by minimising alcohol, tobacco and other drug-related health, social and economic harms among individuals, families and communities’.
(Collins, D. and Lapsely, H., 2008, The Costs of Tobacco, Alcohol and Illicit Drug Abuse to Australian Society’, in 2004/05, National Drug Strategy Monograph Series no. 64.).

I was interested to observe whether there had been a change to the ‘strategy’ since this report was written and whether our more liberal, humanistic approach to life in 2014 reflects the winds of change in drug reform and strategy.

Common Themes from Conference Presenters

Ms Anke Van Der Sterren, Alcohol Tobacco and Other Drug Association, ACT

Ms Van Der Sterren talked about the health and safety of modern drug usage. She suggested that there is currently insufficient research evidence on the long-term effects of drug usage.  Research outcomes, findings and evidence are often open to interpretation depending upon which ‘slant’ is taken to the research subject.  Pharmaceutical companies, politicians and interest groups all have an investment in the drug issue.  She raised the question of just how applicable the findings are to the ‘coal face’ where health workers are confronted with the everyday reality of the effects of drug usage on users and their families.

Dr Coral Gartner, University of Queensland

Dr Gartner suggested that currently there is no specific legislation or drug policy that is effective in dealing with the drug problem in our society.  She questioned who is affected by current legislation—the policy makers, the enforcement agencies, the criminal system, the list is endless.  This suggests that there is a rather indefinable area in approaching this problem in the A.C.T.

Ms Joanne Baumgartner, Health Care Consumers Association

Ms Baumgartner talked about the social concept of ‘punishment’ and that an authoritative approach has been adopted in society geared towards punishing the drug user and generating negative press.  She suggests that a more libertarian approach to this problem may remove the stigma attached to drug use, as, for example, the legalised use of marihuana in medicine.

Mr David McDonald, Social Research and Evaluation, Australian National University

Mr McDonald posed some interesting questions related to the objective of legislation to reduce costs to the community in respect to injury and ongoing medical support. He questioned the underlying assumptions made by policy makers. For example: What are some of the general and specific deterrents to drug taking? Is it valid to breach human rights?

He also pointed out that, currently, there is a lack of available research in the ACT on, for example, the effects of drug driving.  He said that there is no publicity about drug driving so how does one quantify drug thresholds for, say, drug driving?  Interestingly, synthetic drugs are not detectable in blood or urine analysis.

Dr Monica Barratt, University of New South Wales

Dr Barratt pointed out that there are many cases of teens dying from synthetic drug usage because of lack of legislation in N.S.W and the A.C.T to prohibit easy access to these drugs in drug outlets in shopping centres and so on, and that there are inadequate warning labels on these synthetic products.  Teenagers are unaware that these products are dangerous and can lead to death.
Mr Ross Bell, NZ Drug Foundation

Mr Bell was a straight-talking person who said, in his experience, governments try to control drugs through obsolete laws leading to prohibition. He said that there are many new drug products coming onto the market that produce ‘legal highs’ and that New Zealanders like their drugs.

He discussed the question of prescriptions versus restrictions and suggested it would not make that much difference to recreational drug use in N.Z.  He also highlighted the need for adequate labelling and health warnings on drug products, and the need to restrict retail licenses.

Mr Bell emphasised that any drug reform or regulation needs broad public support and consensus, and referred to a failed recent attempt by the NZ Government to decriminalize drugs.

Emeritus Prof. Laurence Mather, University of Sydney

Prof. Mather reflected on the 1937 AMA findings that concluded that there was no evidence to indicate any benefits from the use of marihuana in medicine. 

He suggested that there are three main fears around legalising marihuana for medical use: (1) political, (2) pharmaceutical and (3) business.  He said that prohibition has not and will not work as a solution.
He strongly suggested based on his experience, that regulation with prescription is necessary to monitor and control recreational marihuana usage.

Similar to popular opinion at the conference, Prof. Mather suggested adequate package labelling, and a ban on both advertising from the outset of legal use, and on all donations to political parties.

He suggested that drug reform is a socially constructed problem that focuses on one substance rather than on the perspective of the drug user as a person and individual.  He questioned the assumptions that underlie policy on drug reform.

Summary
This conference was a very interesting and well-organised event.  I sat next to a health worker from the mental health area of the Canberra Hospital, with whom I established a good rapport very quickly.  She was exceptional in her area of caring and she shared with me a lot of most informative and valuable information about the role of the worker at the forefront of the drug and alcohol scene. 

Although this conference did not provide all the answers to the related problems ‘of drug and alcohol’ in Canberra, it did pose some interesting questions, outlined problems and occasionally suggested some ideas about how to effectively bring about change in the area.

The speakers, coupled with the practical and frank discussion with the companion who sat next to me at my table, provided me with a new perspective on the drug and alcohol scene. Since attending this


conference, I have spent some time researching some of the issues, i.e. legalisation of marihuana, synthetic drugs. I have also had some interesting discussions with members of the community who have provided me with their views on the topic.

This is certainly a most convoluted and complex problem, which was highlighted at this conference.

References:
 Marijuana Girl by NR DeMexico (Soft-Cover Library S-75124, 3rd printing, 1969)

 A novel about a fresh and fetching girl, who at 17 was ‘hooked’ on the drug marihuana— thanks to an older man.
He did not mean to harm her. He was just setting her up for love! But after that drug-induced ecstasy, her pretty feet trod the path of degeneracy.   Here we study every nuance of her disturbing relations with other teenagers, with mature men out for ‘kicks’, with colored jazz musicians! We watch her resorting to every vile device, trading her self, body and soul for the drugs she had to have!!!

Reefer Madness (originally made as Tell Your Children and sometimes titled as The Burning Question, Dope Addict, Doped Youth and Love Madness)

 A 1936–1939 American propaganda exploitation film revolving around the melodramatic events that ensue when high school students are lured by pushers to try marijuana—from a hit-and-run accident, to manslaughter, suicide, attempted rape, and descent into madness due to marijuana addiction. The film was directed by Louis Gasnier and starred a cast composed of mostly unknown bit actors.

Originally financed by a church group under the title Tell Your Children, the film was intended to be shown to parents as a morality tale attempting to teach them about the dangers of cannabis use.  However, soon after the film was shot, it was purchased by producer Dwain Esper, who re-cut the film for distribution on the exploitation film circuit beginning in 1938/39 through the 40s and 50s.

The film was ‘rediscovered’ in the early 1970s and gained new life as satire among advocates of cannabis policy reform. Although finding a popular audience as a cult film, critics have panned it as one of the worst films ever made. Today, it is in the public domain in the United States.



*Please note that this Report is the Intellectual property of Ms Susan Westwood, HCCA Representative.

Tuesday, November 18, 2014

HCCA ANNUAL GENERAL MEETING



HCCA’s Annual General Meeting was held on Thursday 25 September at 3:00pm in the Griffith Community Hall. It was a magnificent event with a very strong turnout and I would like to thank to all attendees for their time and participation.

We are very pleased to introduce our new Executive Committee as elected at our AGM.
 Our Executive Committee members are as follows:
- Dr Sue Andrews – President
- Dr Michelle Banfield - Vice-President
- Hugh Crawford – Treasurer
- Bill Heins - Member (for two year term)
- Fran Parker - Member (for two year term)
- John Didlick -Member (for two year term)
- Marcus Bogie - Member (for two year term)
- Adele Stevens - Member (for one year term)
- Bev McConnell - Member (for one year term)

HCCA would like to thank the outgoing Executive Committee members David Lovegrove for his support for HCCA over many years and contribution to the governance of this organisation.

The AGM was followed by a panel discussion on the politics of health and the role of consumer organisations in ensuring that our health system meets the needs of the community. We were very pleased to hear from two HCCA members, Fiona Tito Wheatland, Russell McGowan and also Adam Stankevicius, the Chief Executive Officer of the Consumers Health Forum.

Fiona Tito Wheatland kicked off the panel discussion looking at how consumers and people alike have differing power and knowledge. Fiona noted that everyone has their own feelings regarding health and health services. An example of this was Fiona’s mother, she did not want to make a fuss so Fiona waited until her mother passed away to make complaints surrounding her health services. It can sometimes be more complicated if you are advocating for someone else, rather than yourself.

Consumers need to be at the core of the health service, but it is always around the needs of the provider. An example Fiona gave was the processes in which nurse administer morphine. Rather than administering morphine when it was best for the patient, nurse were more focused on when it was the best and easies time for them.

They were taking blood test every morning because that’s what they do. The efficient running of their word is more important. This shows how political the health service is. There are some serious issues with aged care.

Fiona stated that doctors and nurses need to response to consumer’s feelings. It is quite difficult to change the way doctors and nurses deal with patients as they are trained in the structure of an apprenticeship, this means the same issues are only passed onto each generation of doctors and nurse, such as keeping a distance. Change will be hard as doctors and nurses will have to give up power and move to a new model.

Fiona finished with saying that patient centred care is still not the main model supported within health services. There is still a lot of work to be done and a need for more consumer input.

Russell McGowan followed Fiona, Russell’s presentation to members was looking at the aspect of ensuring our health system meets community needs. Russell started off with the question “Are we patients or are we consumers?” The answer was we are who we say we are, sometimes we identify our self’s as consumers and sometimes as patients. Consumers are people, we bring that to the table. We are also carers and citizens.

Consumers come in all shapes and sizes, with mixed experiences of life. There are three dimensions to consumers, these are:
  • Active/passive
  • Informed/uninformed
  • Positive/negative

Consumers as participants, Healthcare works best when consumers are active partners in decision making. Consumers are more likely to adopt and maintain healthy behaviours and follow care plans when they feel in control. This means better clinical hand over, better clinical decisions when consulted, improved medication management, minimised wastage, minimisation of duplicated tests and learn from mistakes.

Consumer groups / organisations represent millions of healthcare consumers, when everyone works together its more power full. Consumer groups / organisations cover such a broad spectrum, this includes population groups: older people, women, culturally diverse and Illness and self-help groups which includes diabetes, arthritis, cardiovascular and prostate cancer.

Consumer groups deliver opportunities to build opportunities to work with health care organisations. They also provide support and training to consumers so they can participate in service planning, tap into community views and compile/research into consumer experiences and expectationsRussell finished with the statement that we should see consumers as the solution. We can make a difference, the glass is still only half full.

Adam Stankevicius, the Chief Executive Officer of the Consumers Health Forum, was the final speaker from the panel. Adam started by saying it’s a really interesting time to be in health policy, it could be seen as a blessing or a curse. The current political environment is not focused on health policy, where two of the main political parties very light on health issues.

One of the main issues today is that the things currently shaping health policies are not brought up by the health minister, rather by other ministers. The current Government feels there is no need for a therapeutic goods administration. The current Australian government believes regulation can be through the American system. However this is an issues, as removing red tape and deregulation can have detrimental effects. The regulation should be provided through states and territories, this is a clear sign that Australian is moving towards more of a U.S health system. The importance of having Health Care Consumers’ and Consumers’ Health Forum is to ask and debate these ideas is such a vital part of shaping a better health system for all.

Fiona Tito Wheatland, Russell McGowan and Adam Stankevicius all gave fantastic talks, providing everyone with a different perspectives at different levels of the health system. We would like to thank all three panel member for giving up their time and sharing their valuable views and experience of the health system. 


Nick Wales
Project Officer - HIP 

Monday, November 17, 2014

7th Annual ACT Alcohol Tobacco and Other Drug Sector Conference (ATODA) Conference Report by Kim Novack



7th Annual ACT Alcohol Tobacco and Other Drug Sector Conference (ATODA)
Wednesday 24 September 2014
                                   
 
Summary:

The ATODA conference comprised of approximately 115 delegates from a variety of ACT Heath Service Organisations, which included ten guest speakers. This conference was highly interactive and provided all participants with the opportunity to raise issues around the current solutions in place.   

“What’s the problem represented to be?”  This was a very clever question raised to initiate discussions and various perspectives around the key topics of e-Cigarettes, Drug Driving, New Psychoactive Substances and Medicinal Cannabis.

ATODA discussed the different approaches that are used to address these Drug Policy problems.  Their focus being: understanding that problems are created by the way we implement policy and solutions. There is no right or wrong decision but there will always be ways to improve the systems and solution in place.
The Policy models comprise of:
  1. Policy as an authoritative choice – decision making by authorities, i.e Pharmaceuticals
  2. Policy as structured interaction – governance networks, i.e King Cross violence and re-structuring alcohol licences
  3. Policy as social construction – of target populations, i.e UKDPC and ANCD consensus

The following notes are a summary of the key points raised by each of the guest speakers on their topic of interest. The conclusion to each of the main topics is somewhat confusing as it appears there are more questions than solutions at this stage. Most issues are still facing much uncertainty and debate in moving forward to obtain consensus and approvals through communities, governments and legislation.    

e-Cigarettes

Speaker: Anke van der Sterren
Organisation: Alcohol Tobacco and Other Drug Association ACT (ATODA)
Topic: e Cigarettes and personal vaporisers also called ENDS, ANDS and E Smokes

Anke raised the current debate around the use of e Cigarettes in our community and whether these are safe or safer than Tobacco cigarettes.  

Questions that have been raised with the Health Services sector include:

  1. Safe for vapour users and the people around them?
Yes, better than cigarettes, less smell, nil or limited nicotine, however no real evidence based assessments have occurred regarding the safety of others.

  1. Effective to help smokers quit?
Possible smoking reduction, however no real evidence based assessments have been conducted as yet.

  1. Is this a gateway for young people to use or start smoking?
Young people could get addicted to Vapours. There is also concern that vaporisers will be used with other illicit substances.

  1. Is this a way to re-normalising smoking activity?
This is undecided. No real evidence based assessments have been conducted as yet.

Issues with the Solution: Group Discussion Perspective:
  • Many studies have been conducted however no real evidence has been produced.
  • It is too early at this stage to determine the effects on indoor air quality and biomarkers in vapours.
  • The World Health Organisation (WHO) recently commissioned a report reviewing evidence on E-Cigs, however this was not considered as substantial evidence based results.
  • The “Big Tobacco Company” is cashing in via advertisements and pushing the use of e-Cigs.  Also developing new e-Cigs and false terminology as “real tobacco” is used.
  • Question if this is a middle class problem? Who does this affect? This information needs to be qualified and verified.
  • The cost associated is very expensive
  • The quality of information must be addressed
  • Is this a distraction and are we misdirecting our efforts?
  • Should we focus on the low socio economic majority, to reduce smoking?
  • Should we be focusing on similar campaigns that were used for the HIV and Condom education?
Speaker: Dr Coral Gartner
Organisation: University of Queensland
Topic: Long term Regulatory goals and minimise nicotine use and the black market trade.

Dr Gartner discussed the legal aspects and the current regulation state around the use of e Cigs in Australia.

There are currently multiple laws in place for States and Federal Government. Queensland was the first to propose regulation of e-Cigs and is currently in Legislation review.  

Personal Vaporisers without Nicotine: are legal to obtain, possess and import.
Current State sale provisions:
  • NT, TAS, VIC, ACT = legal
  • QLD = legal however must be inline with the Tobacco Laws
  • WA = possibly illegal, the appeal outcome is pending
  • SA, NSW = possibly illegal.
Personal Vaporisers with Nicotine: are only legal, where there is a therapeutic claim and a medical prescription must be obtained.  

Issues with the Solution: Group Discussion Perspective:
  • How are we regulating cigarettes in the supermarket?
  • If personal vaporisers are not sold in supermarkets should cigarettes be removed from open sales?
  • Cannabis and other drugs could be used in the vaporiser tool which could encourage further illicit drug use.
  • Only high quality safe products are legally sold, how will this be monitored?
  • Taxation – Tobacco has high tax levies, should vaporisers incur the same?  
  • More research is needed to acquire data on the safety for person using and others and is this good for public health?
  • Economic issue – are people in low socio economic status the focus?
  • Safety and Harm – Is this a legitimate harm control tool with a positive reduction in Tobacco use?
  • Social and Community to obtain information and communications about this product.
Drug Driving

Speaker: Professor Maxwell Cameron
Organisation: Monash University
Topic: Accident Research Centre study on random roadside drug testing in Victoria.

Professor Cameron discussed the effectiveness of roadside drug testing (RDT).  

The Accident Research Centre study has shown that increased drug tests and detection have had a positive deterrent effect on Victorian roads. However, this is a very costly exercise. To become cost effective in the long term the testing tools and technology will need to become cheaper to sustain RDT.

Future focus on a targeted approach to test truck drivers is hopeful as the carnage is severe in most cases in truck accidents due to the high use of Methamphetamine.  


Issues with the Solution: Group Discussion Perspective:
  • How effective is RDT?
  • Consider the cost ‘vs’ time?
  • Is the message of reducing driving under the influence of substances being heard?
  • Are fewer drivers being killed due to less impairment from substance abuse?
  • An expensive exercise however worth the investment as RDT is working as a deterrent. 
Speaker: Mr David McDonald
Organisation: Australian National University
Topic: Social Research and Evaluation on Drug Driving

Mr McDonald raised the current debate into whether the drug driving problem is a road safety or drug law enforcement problem, should it be focusing on prevention or targeted and the issues around prosecution of drug driving is quite different to driving under the influence of alcohol.

What are the underlying assumptions?
  • Some drivers could be impaired by the use of drugs
  • Some drivers use drugs and some drive after use
  • RDT will reduce prevalence of drug impaired driving
  • RDT will reduce the increase of road side crashes
  • Currently only testing for Cannabis, MDMA and Methamphetamine
  • It is valid to breach human rights
  • Community awareness and knowledge regarding RDT and road safety
  • Education is needed in the ACT in regards to the consumption and impairment thresholds - when is it safe to drive after taking drugs.
  • High rates and remain high from past ten years on usage and driving under the influence.

What are we seeking to achieve?
  • Can the problem be thought about differently?
  • Costly, different set-ups could be put in place
  • Safety ‘vs’ Prosecution?
  • Publicity for government and police
  • Proof that testing of Drugs is stopping accidents
  • Prescribed limits – The UK Government is trying to come up with quantitative impairment thresholds for 16 Drugs 

Issues with the Solution: Group Discussion Perspective:
  • Does drug testing take away resources from other police resources?
  • Equipment ‘vs’ police man power?
  • What is the best investment for Road Safety?
  • RDT is still very effective and important
  • Threshold of effect is very complicated and not as simple as testing alcohol in breath and blood samples.
  • Focus on the effect not the level in the system needs to be considered.
  • Look at medicated cannabis and how to monitor if users are safe to drive?
  • Current Legislation any impairment under any substance will be prosecuted
  • What about Opiates? Currently not being tested first hand.
  • What are the varied State jurisdictions?
  • What about new psychoactive substances and synthetic cannabis


New Psychoactive Substances (NPS) 

Speaker: Dr Monica Barrat
Organisation: University of NSW
Topic: Drug Policy Modelling Program

Dr Barrat discussed the use of New Psychoactive Substances; Synthetic Cannabis, Methadrone, 2CI and 2CB and Cathinones in relation to the findings in the September 2014 Senate Committee report and EMCDDA which is monitoring drugs and analogues.

What are the underlying assumptions?
  • Users of cannabis will try synthetic
  • It is not encouraging new addiction or new users
  • People use Synthetic Cannabis as it is legal, easier to get, produce an effect they were curious about.
  • A full import ban on NPS is with the Senate at the moment.
  • Illegal and will produce harm to humans – both social and health related harm
  • NPS is similar in effect or structure
  • Key public messages – it is not safe nor legal
  • Some people may think this is safe.
  • Motivation for use
Speaker: Mr Ross Bell
Organisation: New Zealand Drug Foundation
Topic: Legalisation of NPS in NZ

Mr Bell discussed the process in which the NZ government attempted to legalise NPS use and the problem with governments trying to control illegal substance use through Drug Laws and Prohibition.

Mr Bell is fighting for Regulation rather than Prohibition. Prohibition is not working as there are too many new products being created. Prohibition worked when only a dozen substances existed 40 years ago. NZ tried various forms of controls, including;  banning substances quickly, implementing drug laws, adding illicit substances to controlled analogue lists. Nothing worked.

The NZ Government soon ran out of patience. A review of the current Drug Policy Law commenced. New reform recommendations were put in place and a Regulation model, under tight controls was created.

Industry had to prove their drug is not harmful including; labelling, poison centre line, testing regime and prove that their drug is low risk of harm. A licence to sell the product would only be issued if this process was passed successfully. This would enable the legal selling of these New Psychoactive Substances.

Evidence Drug Policy making was passed through Parliament Law. The Law was passed but Regulation had not been written as yet. Then a new Election year proved to cause trouble and the process stopped.  The Media got involved and pursued a negative campaign against legalising NPS. Advertising a picture of a 17 year old boy called Jesse, coughing up blood into a tissue when detoxing after 4 years of synthetic Cannabis use and possibly other drugs, was an influential campaign in changing the community support for legalisation.  The media then created a new campaign which involved the testing of Synthetic Cannabis on animals, at this stage the public didn’t hear that the products will be approved through an intensive process and only sold under an approved license. The public soon changed their mind on the new Drug Law. Parliament then changed the Law and removed all licences.

Issues with the Solution: Group Discussion Perspective:
  • The professionals don’t know how big the problem is and can’t confirm that NPS are safe for long term use.
  • Public eye – Politicians reputation backlash from community
  • Does this reduce organised crime? 
  • Politicians are too afraid to act
  • Regulations – Education is needed
  • Fear in people with propaganda and corruption from media
  • Keeping prohibition Laws in place is not working
Benefits if Law is passed:
·         Controlled – low risk harm and legally tested products
·         Monitored, tested and licensed.
·         If NZ get the model right this could change the world model. Uruguay is next to implement legalisation of NPS, then Colorado and Washington
·         History of improvement in NZ
·         This will not be built overnight
·         Regulation ‘vs’ no Regulation
·         Disconnect between Policy and the Public
Medicinal Cannabis 
Speaker: Professor Laurence Mather
Organisation: Sydney University
Topic: Advocate for the use of medicinal cannabis


Professor Mather discussed the different types of Cannabis and the critical importance for legalisation of Medicinal Cannabis to give much needed relief for cancer patients. Professor Mather suggests that enough extensive testing and evidence has been produced with the evidence showing huge benefits for patients.  

Crude Cannabis – plant produces 400+ recognised chemicals. A mixture of cannabonoids - THC, CBD, CBN with contaminants such as pesticides, mould and other dangerous chemicals. 
Home growing model – Chemical consistency is a problem. Cannabis Hybrids produce over 800+ strains.

Pharmaceutical Cannabis –  pure chemical entity (biosynthetic or synthetic) in the final dose form. Marinol or dronabinol are the synthetic THC substances.

Issues with the Solution: Group Discussion Perspective:
  • Political
  • Unsure/unknown long term effects
  • Money/ Profit for pharmaceutical companies
  • Does this need more research?  


Speaker: Dr Alex Wodak
Organisation: Australian Drug Law Reform Foundation
Topic: Legalisation of medicinal cannabis

Dr Wodak raised the remaining questions that need to be addressed before the legalisation of medicinal cannabis occurs. How and when will this occur and should this be used clinically or conduct further trials? Dr Wodak also believes that the debate will continue for many more years and will require a campaign to educate the community on the beneficial affects for medical purposes.

Obstacles and moving towards supporting medicinal cannabis:
  • Political – both sides support use
  • Strong growing community support – male, female and all ages
  • Now discussed in all 9 jurisdictions
  • Supply – Import, domestic, Dept of Health Supply?

  • Will medicinal Cannabis cause recreational use? Evidence does not support this contention.
  • Is natural cannabis better for medical treatments ‘vs’ synthetic?
  • Regulating cannabis – enough but not too much, purpose is not to over regulate.

Regulation:
·                     Need TGA approval
·                     Requires application which is costly
·                     Establish ‘office of Medicinal cannabis’ to set standards
·                     20 Countries now provide
·                     USA – 23 our of 50 States now provide
·                     Uruguay starts to legalise use in 2014/2015

Issues with the Solution: Group Discussion Perspective:
  • Prohibition prevents the medicinal properties of this drug to be utilised for great benefit especially for Cancer suffers
  • Denial – people are already using this
  • Legal in ACT – decriminalised but can only grow two plants outside – can not grow plants inside as considered hydroponics growing
  • Do we focus on legalising recreational use and leave medicinal for now?
  • Do we follow the Dutch model which has a vast range available to the public, including high and low level THC
  • What about Medicinal use of MDMA and LSD? This will not be addressed until Cannabis is legalised.
  • Recreational ‘vs’ medicinal use – must keep this fight separate and fight for medicinal use first
  • The use of Cannabis for medicinal use may cause further stigma for those that use it for recreational use?  
 By Kim Novack HCCA Member