Monday, August 10, 2015

Snapshot of ACT Senate Estimates and Appropriation Bill, Health Implications

Hello Everyone!

I thought I would provide you of a little snapshot of the Legislative Assembly for the ACT, Select Committee on Estimates 2015-2016 ’s report on the Appropriation Bill 2015-2016.

It sounds a bit dry but is as noted by the chair of the committee an inquiry process that ‘is one of the key scrutiny mechanisms enabling the Assembly to assess each year how the Government intends to spend taxpayers’ money and whether it is achieving stated outcomes.’

The committee looked at all kinds of ACT Government spending and the two volume detailed report can be found at

In the first volume there was 132 references to health, including mental health, justice health, health infrastructure, preventative health in child and breast and cervical cancer screening. I have selected some key points and recommendations from volume one around health and health services in the ACT that may be of interest. They are all reworded or directly quoted from Report 1 Volume 1.

Cross Boarder Health Care Provision
·         An acknowledgment that ‘a quarter or more’ of patients come from across the NSW border for health care. The NSW Government is likely to compensate the ACT Government on a population basis. It was also stated that people travelling from NSW to ACT for care often require acute care as these services are not available to them in NSW.

·         The Committee recommended that the ACT Government continue to work with all First Ministers and the Commonwealth Government to ensure sustainable health funding for State and Territory governments so they can continue to deliver high quality health services to the community.

Community Consultation

·         The Committee recommended that any decision-making by the ACT Government around community access to health services be undertaken with proper community consultation
·         A Committee recommendation that ACT Government consider an improved way of communicating how health services and health outcomes are delivered to the community.

Postcode Health Care

·         The Committee discussed the number of people presenting at Calvary and Canberra Hospital Emergency Departments. The Deputy Director-General of Canberra Hospital and Health Services stated,  “We are working with Medicare Local to try and get a better sense of that and work out what the patterns are and what, if anything, can be done with them. But, of course, it is individual choice there and if people have confidence in Canberra Hospital and prefer to present there rather than Calvary hospital, then that is their choice.”

·         Additionally, the Committee followed up concerns about the possible use of postcodes to determine where patients would be allowed to access maternity and other health services. The Minister advised that: “These issues warrant consideration but no decision has been made in relation to them and nor would it be without engagement, discussion and consultation with the broader community.”

·         The Committee noted that, whilst the ACT Government has not decided to implement a postcode-based approach to hospital choice, it has not ruled it out. The Committee also agreed that the ACT Government should ensure all its health services are being utilised effectively.

Training and Hospital Culture

·         The Committee sought information on training culture in ACT hospitals and was advised by the Minister that: “It is the case, as we know, that there have been a number of issues raised nationally when it comes to the training of junior medical specialists. Junior medical specialists undertake training in our hospitals to become consultant specialists in their own right. We have seen, for example, the recent reporting from Four Corners about poor behaviour on the part of certain specialists in hospitals interstate when it comes to the training environment they provide for junior medical officers. We have seen similar concerns raised here in the ACT. The maternity services concerns are a good example of that where there was significant discord and what I would characterise as not healthy relationships at that time between trainees and the senior medical staff involved in the training.”

·         The minster then announced “So today, Ms Fitzharris, that I have instructed my director-general to commence an immediate review of the training culture inside the Canberra Hospital to make sure that respectful and professional relationships are being sustained and maintained, and that our existing policies and programs are being effectively implemented—and, if they are not, to look at what we can do to make sure that they are.

·         The Committee further heard from the Director-General that the review of training culture would be started immediately and would be an independent external review. The review is to be conducted over three or four weeks and will be ‘fast, deep and responsive’, with recommendations to be made ‘to ensure that the training culture remains a positive one, productive and develops the clinical and professional skills that we need to see in our future clinical leaders.

Elective Surgery

·         The Committee discussed concerns raised by community members around the cancellation of non-elective surgeries, particularly where people had turned up and been prepped for surgery and then sent home, in some cases multiple times. The Committee noted that there is no information available publicly that indicates targets and achievements for the timeliness of non-elective surgery and the number of people waiting.

Adolescent Mental Health

·         The Committee recommended that a whole-of-government inquiry be carried out, and the findings presented to the Legislative Assembly by March 2016, on the inpatient and outpatient services, support programs and care models for adolescents facing mental health issues.

These recommendations and review of health service provision in the ACT is useful to remember as health consumer advocates and are worth keeping a watching brief on as they directly affect our care.

Eleanor Kerdo, Policy Officer

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