Health Care Consumers' Association Inc

New Northside Hospital for Canberra

2012-01-20T12:50:00.003+11:00

The ACT Government has released a report identifying the University of Canberra as their preferred site for the construction of the new Northside Hospital.
The ACT Government has indicated that there is a need to enhance public hospital facilities on the north side of Canberra to accommodate the growing health needs of our population over the next 20 years. The ACT Health Capital Asset Development Plan was developed as a blueprint for the redevelopment of the ACT health system. A discussion paper on options for northside hospital services was issued in February 2011. As a result of that that process, the Government decided to building a stand-alone sub-acute facility in North Canberra. HCCA has been advocating for the establishment of a specialised sub-acute care facility for some time; this is reflected in our submission of November 2010 to the Government Standing Committee on Health, Community and Social Services Inquiry into Public Hospital Options as well as our response to the Government consultation on this matter in 2011. The HCCA Submission is available online (160kb Pdf)
The HCCA has been very supportive of the decision to build a sub acute hospital and has not seen a need to replicate The Canberra Hospital in North Canberra. We have advocated that a sub-acute facility or community hospital, supported by primary health care centres around Canberra, would better meet the needs of the Canberra community. A community hospital with sub-acute and non-acute services will supplement the new enhanced primary health care centres. Planning for these centres is well developed with the new centres in Belconnen and Gunghalin expected to be opened in this year.
The new Northside Hospital could be designed, built and staffed to provide rehabilitation services for people recovering after an operation (e.g. a hip replacement), an illness (e.g. a heart attack) or an injury (e.g. a fall or car accident). This would improve the potential for recovery as less time would be spent in an acute hospital (ie, Calvary or TCH). It could also include geriatric evaluation and management services, transition care and other step-up or step-down programs.
We have also suggested the facility could house a second secular hospice for the ACT and will participate in consultations with the Government for the review of the Palliative Care Strategy this year.
The community recognises that people with serious mental illness need access to a range of treatment and support services, connected across the spectrum of care. We believe there is scope to include this in the development of the Hospital at the University of Canberra. This would complement the successful step up step down facilities currently in place in the community.
A sub-acute facility on the University of Canberra grounds is vital to meet the needs of our community.
The selection of the site is very important; it needs to be accessible, which means close to major transport routes. One of the failings of the Village Creek Rehabilitation Centre was the site selection. The services, once you are inside the building, are excellent but being tucked away in a suburban setting has caused difficulty for some consumers and carers when accessing the Centre. the University of Canberra is located to arterial roads and public transport, has sufficient area for dedicated parking, is close to the Belconnen Town Centre and is within easy travelling distance for people living in Gungahlin and the future Molonglo Valley development
In addition it would create valuable connections with the Faculty of Health Science and provide clinical placements for students in areas including, but not limited to, nursing and midwifery, pharmacy, physiotherapy and psychology. We agree with the Government that the relationship should assist with staff recruiting and training, and should assist the university in undertaking health research.
The community wants assurance that decisions regarding the planning and design of our health system are taken on sound advice, based on identified clinical need and community needs and sound economic judgement. We are satisfied with the range of issues the Government has considered in identifying the most appropriate site for the new hospital.
We look forward to being involved in the community discussion on the matter.

Darlene Cox
Executive Director

Consumer Representative Training Course

2012-01-20T10:19:00.004+11:00

Are you, or a member of your family, a patient, carer or user of health care services? Then you are a health care consumer

Do you want a better understanding of the Health System in the ACT?

Are you interested in learning new skills to help yourself and others?

Have you thought about getting involved in a Health Directorate Committee?

Do you have questions or feedback about the health system?

This course will answer your questions and provide you with the necessary skills to help you to make a really valuable contribution to the health system.

We invite you to come along, learn some new skills and meet other health care consumers in a friendly atmosphere over the two day course.

After completing the course (you must attend both days), you will receive a certificate of participation, which enables you to nominate as a consumer representative on a Health Directorate Committee.

Course Date: Friday 23 & 30 March 2012: 10am-2pm

HCCA Meeting Room, Sports House, 100 Maitland Street,

Hackett ACT 2602

This course is free and morning tea and lunch will be provided. Please tell us of any dietary requirements. Transport assistance may be available. Please ask for details.

To find out more and to register for course (you must attend both sessions) please contact us: Tel: 6230 7800: email adminofficer@hcca.org.au

Consumer Representative Training Courses are held 3 times a year.

If you miss this one, please ask about the June and September courses.

HCCA Representation at IAPO Congress on Patient Centred Care

2011-12-21T12:15:00.007+11:00

Opportunity to attend the IAPO 5th Global Patients Congress

The HCCA Executive Committee has decided to support an experienced consumer representative to attend the 5th Global Patients Congress ‘Achieving Patient-Centred Healthcare: Indicators of Progress and Success’ on the 17-19 March 2012 in London. Workshop highlights include sessions on ‘Is access to medicines and treatments patient-centred?’, ‘Effective advocacy’ and ‘The role of the World Health Organization (WHO) in defining global healthcare standards’. Discover more about what the workshops will offer.

The Executive Committee has agreed to pay up to $3400 on registration, accommodation, airfare and transfers.

If you are interested you will need to fill out a nomination form, available on the HCCA website, and address the selection criteria.

The criteria are:

i) Proven ability to report back on meetings and share with consumer networks

ii) Represent the organisation at a high level

iii) Has an understanding of the issues to be discussed and can contribute to further understanding of the issues

iv) Cost effectiveness for the organisation

v) That participation in the event will develop the candidate’s experience and skills in representing HCCA at high level meetings

vi) Preference will be given to people who have not received financial support from HCCA to attend an event in the same calendar year

Nominations will be assessed by a panel comprising the President, Treasurer, Chair of the Consumer Representatives Steering Committee, Executive Director and another HCCA member.

Nominations close on Friday 13 January.

We will announce the successful representative by the last week of January.

Pharmaceutical Benefit Scheme Policy: State of Play in 2011 and Future Issues

2011-11-16T10:05:00.000+11:00

On Wednesday 19 October I attended the presentation given by Emeritus Professor Lloyd Sansom at the University of Canberra along with Russell McGowan, Olivia Macdonald and Denis Strangman (ACT Cancer Services Consumer Reference Group).

Professor Sansom’s presentation included a brief history from when the Pharmaceutical Benefits Scheme PBS began, covering the period 1944 to the present. In 1946 legislation was amended to include the PBS. In 1946 the decision was that cost was not a consideration if it adds benefits and that no-one was barred from being an eligible user. He also drew comparisons between the Australian system and those in place in Canada and the US.

Following are a few of the numbers and statistics Professor Sansom shared with us during his detailed presentation:
• PBS represents $8.4billion per annum of government spending
• the current trend for the growth rate of PBS expenditure exceeds GDP. It is worth noting that the percentage of spending in Australia is 9% of GDP and in the USA it’s 18%
• total cost of PBS is $365 per person per annum (based on information sourced from DoHA, Department of Veteran’s Affairs and Medicare Australia)
• special arrangements have been put in place for indigenous groups
• among the top drugs in use are Atorvastatin and Rosuvastatin (both of which are statins used in the treatment of high blood pressure) and Clopidogrel.

Professor Sansom gave an outline of the Therapeutic Goods Administration’s (TGA) decision making and assessment process, how it is based on clinical control data and has a duration window of seventeen (17) weeks for a drug to be assessed and if applicable legislation changed. He also stated that the process involved in the decision making came down to the three fundamental questions of:
• can a drug work?
• does a drug work?, and
• is it worth it?

The method for assessment is based on the ICER (Incremental Cost Effectiveness Ratio):
Cost new – Cost comparator
Outcomes new – Outcomes comparator

On the question of ‘Is the PBS affordable?’, Professor Sansom talked about the National Medicine’s Policy.

Of interest to consumers is that drug companies are now being pushed to ensure they seek patient feedback when making some assessments. Prof Sansom gave an example of this for a medication prescribed for patients with difficulty walking.

Professor Sansom noted that tensions exist between optimal health outcomes and cost. Is the consumer getting value for money? He also acknowledged the absence of an accurate method of measuring the effectiveness of the PBS in the long term due to the high level of complexity that exists between the measurement tools used.

In response to the question ‘have we got our system right in this country?’. In a nutshell, Professor Sansom’s view is that considering the constraints imposed - we do.

A recent ‘consumer jury’ verdict on end of life revealed that people value end of life and are willing to prolong life in order to end it on their own terms – mainly to reach key life milestones like seeing their children marry or provide them with grandchildren.

Professor Sansom ended up by speaking briefly about the role of the media and how a misleading announcement with the headline ‘patients denied cancer drug’ imparted a wrong impression. The actual reason for the drug being denied public subsidy was due to it being no more effective than one already on the market except that the new one had unnecessary laxative qualities which the committee didn’t think they should impose on consumers unnecessarily.

Kerry Burton
NAP Consumer Coordinator

Consumer Focus Group on the Emergency Department at Calvary Hospital

2011-11-16T09:46:00.002+11:00

In September, HCCA convened a focus group of consumers on their experiences of the Emergency Department at Calvary Hospital. This was done in conjunction with the ACT Health Directorate’s Emergency Care Network Coordinator and the Project Lead of the ED Redesign Project Calvary Health Care. The focus group was attended by five people from within the HCCA membership who had recent experiences in the Emergency Department at Calvary.

The aim of bringing these people together was to gather information from them as consumers about their Emergency Department experiences and what they deemed ‘worked well’ and ‘didn’t work well’. The information gathered at this session has been fed back into Calvary’s Emergency Department Redesign Program and will potentially assist Calvary Health Care towards improving the care provided to patients who present at Calvary’s Emergency Department.

The Redesign Team are using the Picker Institute Dimensions of Care as their framework in which they analyse comments. NSW Health have developed this model also. A useful overview of these dimensions is available on their website. The consumer comments their comments and the issues raised have been aligned to the Patient–Centred Dimensions of Care model. It provided an interesting insight into the quality of services delivered in the ED.

What did consumers say?
Overall the feedback was positive. However there were a number of instances where the experiences highlighted areas where improvements could be made.

Positive experiences included:
- the level of priority given to a male patient who presented with a shoulder injury, was seen by a doctor then transferred directly to TCH. This patient was advised by doctors at TCH that had Calvary not acted so swiftly there was potential for him to have lost his arm. Spectrum: Access, Coordination
- Patients felt that when staff knew the patient, respect was increased. Spectrum: Respect

Negative experiences included:
- a patient who was ‘appalled’ by her treatment. On arrival by ambulance at 16:00hrs with a shoulder injury, she was initially ‘very impressed’ at being transferred directly onto a bed in a treatment area but then waited until 23:00hrs to be assessed by a doctor. She felt the lack of communication and the length of the delay in being seen was unacceptable. Spectrum: Access, Communication, Comfort, Respect
- concerns about staff not hearing patients who were repeatedly asked about allergies, however at no point was anything documented. Spectrum: Access, Communication, Comfort, Respect
- shift-handovers where discussions took place in a loud voice and in front of other patients - no privacy leading to the patient suffering a deal of embarrassment. Spectrum: Communication, Comfort, Respect.
- an elderly patient waited several hours to be admitted after arriving by ambulance in the early morning. During this time a faulty ‘alarm’ rang continuously in both the ED and the upstairs area. Spectrum: Comfort, Access
- a patient presented with chest pain and was taken to a bed immediately where she was surrounded by doctors and nurses who all appeared confused about what medication was being given to her and why. None of them communicated to her who these people were or who was responsible for looking after her. She then overheard one of the people ‘whispering to another to get an ambulance’ to transfer her to TCH. She was questioned by staff as to ‘who removed a tube?’ but felt too sick to know or respond. The patient was then told upon discharge at TCH that she should not have been transferred to TCH in the first place. Spectrum: Emotional Support, Coordination, Information, Respect.
- criticism regarding the availability of interpreters available at Calvary. Spectrum: Respect for Patient Values, preferences.
- Pain management team not aware of treatment regime for patient. No consultation with GP regarding patient medications and needs whilst an in-patient. Information the patient provided was disregarded leaving the patient feeling she wasn’t being listened to. Spectrum: Coordination, Information, Respect.
- a patient who was misdiagnosed twice and sent home. When they returned a third time was diagnosed with shingles. This patient spent six weeks in a ward then six weeks in rehab. Spectrum: Access, Comfort, Coordinate, Respect, Transition
- Patient perceptions generally are that they are scared as to how their presentation will be perceived by the staff, patients idea of an emergency is interpreted differently by hospital staff. Spectrum: Access to care, Emotional support, Respect.

Where to from here?
Focus group participant feedback is being reviewed by the Calvary team along with other responses from patient interviews, surveys and patient satisfaction reports, enabling the gathering of key themes and areas of improvement. This information will then be documented in a brief report which will form part of the larger ED Redesign Project Paper. During this time the participants are being kept informed by receiving copies of the Calvary Emergency Department Newsletter and a copy of the Patient Perspective report once it’s completed.

Kerry Burton
National Access Program
Consumer Coordiantor

HCCA Annual General Meeting 2011

2011-11-13T10:12:00.001+11:00

HCCA’s AGM, held on the 10th of November, was a wonderful event. It was good to see so many of our members attending. I often attend medical and nursing conferences and the professions themselves on the noise they make at break times and dinners when they all get together. I think consumers can certainly be proud of our "number of words spoken per minute" rate. I know I was not alone is being able to catch up with so many people for a chat.

Mary Durkin spoke to us after lunch on the role of the Health Services Commission in bringing about improvements in our health system. We all learnt more about the work of the Commission and received useful insight into some of the issues relating to monitoring the performance of clinicians with te new registration arrangemetns under the Australian Health Processional Regulation Authority.

Adele Stevens gave her President's Report. The full report is available ion the Annual Report but the speech she gave at the AGM is on the HCCA blog.

Russell McGowan spoken about the work HCCA is doing with the International Association of Patients Organisations (IAPO).

As part of the organisational business undertaken at the meeting, HCCA elected its new Executive Committee, and the Executive Committee for the next year is:
President: Adele Stevens (term ends 2012)
Vice President: Russell McGowan (term ends 2012)
Treasuerer: Bev McConnell (term ends 2012)
General Members: Caroline Polak Scowcroft, Therese Findlay, Sharon Eacott (terms end 2013)
Marion Reilly and David Lovegrove. (terms end 2012)

I look forward to working with the new Committee in the coming year.

Darlene Cox
Executive Director

HCCA President's Speech at the AGM

2011-11-12T07:05:00.000+11:00

I am proud to be presenting my third report as President of the Health Care Consumers’ Association and I can report that this year of my presidency has been as just as productive as the first two.

The Annual Report includes my full report but today I want to share with you just a few highlights.

Over the past year, our work at the local level has been influenced by health reform at the federal level, including the development of the Local Area Health Network and the Medicare Local. In addition, we have become more involved in research partnerships, such as the project examining consumer perceptions of nurse practitioners in primary health care, for which we received a grant from the Department of Health and Ageing. I am particularly pleased with our move to increasing consumer involvement in research and we will continue to work with our University Partners over the coming years.

Integral to the important work of HCCA are the committed and hardworking consumer representatives, who tirelessly devote their time and energy to providing consumer input on a range of significant health matters.

This year, HCCA has

supported 43 consumer representatives,
managed 31 new appointments on ACT Health committees and
has consumer representation on about 109 health committees across the Territory, including ACT Health, Calvary Health Care ACT, community organisations and also at the national level.
In addition to committee representation, we trained 30 new consumer representatives in the last financial year.

We continue to experience high numbers of requests for consumer representation from the Health Directorate. We know our colleagues at the Mental Health Consumers Network are experiencing a similar situation. We welcome this acknowledgment of the value of consumers at the table. This will continue to grow with the implementation of the national health services standards, in which partnering with consumers is a core standard.

A sign of our increasing role as the peak consumer organisation in the ACT has been the increase over the last year in the number of our organisational members. These are listed in the Annual Report. Working together with other community, health and consumer organisations is an increasingly important part of our work at HCCA.

Consumer representation in the Capital Asset Development Program has also grown over the last year. This is an important and exciting area of work for consumer organisations to be involved in. I have been working on the development of a new model of patient centred care for the community health service. It has been a challenging yet rewarding experience. We will see the fruits of this Community Health Centre development in the coming year with the opening of the new Gungahlin Community Health Centre in 2012.

This year HCCA Consumer Representatives have attended a myriad of events, including the regular E-Health Consumer Reference, consumer reps forums and Health Issues Group meetings. We have convened meetings on topics such as Respecting Patient Choices, Advanced Care Directives, Primary Health Care Strategy and Patient Centred Care.

We are working hard to ensure that consumer participation is not limited to consumer representation on committees. We are working with ACT Health staff to convene round tables and consultative fora on health service plans, medication safety, workforce development, dental health, e-health and the development and implementation of the national health reform agenda.

From a financial perspective, I am pleased to report that HCCA continues to operate within a sound financial base. I will leave Russell McGowan to provide more detail when he presents the financial report on behalf of our Treasurer, Bev McConnell who is unable to join us today.

Pivotal to the effectiveness and success of our organisation are the people within it – our members, our consumer representatives, our staff and my Executive Committee colleagues. Our members put in many hours of thought and preparation for meetings as well as participating in HCCA calendar of events and activities.

Firstly, I would like to thank all our consumer representatives and those members who participate in the workshops and fora we hold. Our membership is our strength and our effectiveness in advocating for improved health services can be attributed to your involvement. The Consumer Representatives Program is truly the cornerstone of HCCA and I am proud to note that this program goes from strength to strength as evidenced by the commitment and dedication of our representatives.

I also want to thank my fellow Executive Committee Members for their support and hard work over the past 12 months. I would especially like to extend my very best wishes to Marion Reilly; and I’m so pleased that she is able to join us today.

Finally, my sincere thanks go to the staff of HCCA and particularly, our Executive Director, Darlene Cox. HCCA has been particularly fortunate in obtaining talented and committed staff that play a vital role in achieving the objectives of our organisation. My thanks to Darlene and all of our staff for the great job you have done over the last year.

I end my report with a tribute to Val Lee, who passed away in January. Val was a dedicated and experienced consumer representative who worked tirelessly to improve the health system, throughout her long battle with cancer. Val continued to attend her full day of meetings for the Canberra Integrated Cancer Centre User Groups until just days before she passed away.

I’m pleased to have been able to share this with so many or you. Thank you for coming today and I look forward to another productive year.

Adele Stevens
President.

The Great Healthcare Challenge 2011: Achieving Patient-Centred Outcomes

2011-11-03T16:28:00.001+11:00

Karen Jameson attended this 3-day conference which was held at the Sofitel Hotel in Melbourne from 11-14 October. The event was sponsored by the Australasian Association for Quality in Health Care (AAQHC), the AustralianCouncil on Healthcare Standards, the Australian Healthcare and HospitalsAssociation and the Royal Australasian College of Medical Administrators(RACMA).

The conference brought together an impressive group of clinicians, executives and academics in the Australian health system. The theme “achieving patient-centred outcomes” reflected the challenges of delivering integrated healthcare in the current reform environment, including governance; information management and e-health; clinical leadership; appropriateness of care; safety and quality and the need for patient-centred outcomes.

A range of local and international speakers presented an innovative program of plenary sessions and workshops which explored the major issues affecting healthcare quality and safety. A comprehensive trade exhibition, showcased the most up-to-date products, technology and information on health and health care innovation and development. There was also an impressive poster display highlighting specific issues relating to patient-centred care.

End of Life Care

2011-11-03T16:23:00.000+11:00

Jeanne Arthur, HCCA consumer rep, attended an End of Life Care workshop in Sydney on 19 October, presented by Les Storey, FRCN, FHEA, RN, MScm.

Les Storey, who is from the UK, has extensive qualifications and experience in the development of strategies for end of life care. His presentation included information about the National End of Life Programme in the UK.

Despite losing his hearing aids, Les engaged the twenty or so attendees at the workshop quickly and with humour. Most of the attendees at the workshop were from New South Wales. Most were engaged in working with older and dying people.

The workshop began with some searching questions – When do we start talking about end of life? Where do we want to die? How comfortable do we feel about talking about death? Answers to these questions included “As soon as possible”; “Give as much choice as possible”; “Not very comfortable”.

Les discussed the End of Life Care Strategy, Preferred Priorities for Care. This program teaches trainees to be honest and open and to identify possible triggers for discussion, ask questions, record the answers, share information and evaluate the process. It aims to minimise the instances of people leaving hospital with false hopes of recovery from terminal illnesses and address the problem of out of hours care for dying people.

The Preferred Priorities for Care key questions are:

In relation to your health what has been happening to you?
What are your preferences and priorities for future care?
Where would you like to be cared for in the future?

Preferred Priorities for Care focuses on people’s wishes concerning their end of life care and not only their wishes in respect of death itself. Sometimes this may be a compromise between what is desirable and what is actually possible, but it is important to have the conversation, to identify issues and resolve them insofar as it is possible, keeping in mind that the preferred priorities may change as circumstances change

Advance Care Planning is a voluntary discussion which asks participants to look to the future, taking into account the best interests of the dying person. It can help in situations where people lose capacity and it aims to improve the quality of death by reducing inappropriate hospital admissions and unwanted clinical interventions.

Les also spoke about the Liverpool Care Plan, which is an integrated care pathway that is used at the bedside to drive up sustained quality of the dying in the last hours and days of life.

Adverse Events and Safety of Health Services

2011-10-26T12:33:00.004+11:00

There has been considerable coverage of the documents released regarding adverse events at the Canberra Hospital.

There is no doubt that these incidents are a cause for concern and it is life changing for those people affected.

As a community we need to be alert to the risks inherent in health care but not alarmed. Overall we have a safe public health system in Canberra but it is not as safe as it could be.

There are robust clinical review processes in place in the ACT Health Directorate and HCCA has consumer representatives involved in consideration of these errors at a number of levels, clinical review committees, clinical audit committee and the overarching safety and quality committee.

Clinical review is a process which enables us to identify and understand the underlying causes of adverse or near miss clinical events, for the purpose of improving the quality and safety of health care. The documents that have been released relate to that process.

It is good that there are review processes in place – but what we do have concerns around the successful implementation of the findings of the reviews and how the changes are monitored. Mistakes continue to be made such as surgery on the wrong side of the body, medication errors. This indicates that the checking procedures are still not adequate.

These committees are underpinned by a quality improvement framework. A safe health system needs to have a strong reporting culture. This is not aimed at naming, blaming and shaming but rather identifying and reporting adverse events and near misses so that they can be analysed and issues identified so that improvements can be made and sustained.

If we didn’t have this system of reporting to discover when things go wrong then we wouldn’t be able to make the system safer.

Quality and safety of health care is everybody’s business. Everyone has a role to play in improving the quality and safety of our services and that includes consumers. Consumers need to be constantly vigilant and be active participants in our own health care and that of our family.

The 10 tips for safer health care is a useful guide.

There is an American fact sheet that also is useful to Help Prevent Medical Errors

By being active and informed consumers we can reduce the risk of harm in the health system

Darlene Cox

Executive Director

Elective Surgery Report Card released

2011-09-24T08:42:00.000+10:00

ACT Chief Minister Katy Gallagher has released a new ACT Surgery Report Card as part of her ongoing commitment to open government and increased transparency. The report card is attached for your information and reference.

The ACT Government has made significant progress on elective surgery, with more people than ever having operations, reduced waiting times and fewer people on the waiting list. The volume of surgery has increased and there has been a reduction in the number of people waiting for surgery longer than clinically recommended time period. There was a 16% increase above last financial year's performance which means 11,336 people from the ACT and NSW had their operations in 2010-11. They also outsourced about 150 surgeries to the private sector in an attempt to improve access for consumers.

The Government deserves to be commended for this work.

The health care is a complex system and it is not as simple as completing more surgery. Surgery is one part of the health system and capacity for surgery is dependent on operating theatre access, surgeons, nurses, anaesthetists. Surgery is also dependent on having wards for recovery and rehabilitation programs. For example, someone having primary joint replacement (ie, knee or hip) requires a place in rehabilitation program to recover and regain full movement. If there are not places available in the rehab programs then surgery cannot be done. From the consumer perspective we want to have a coordinated approach to surgical admissions so that we have the best opportunity to have treatment and recover.

Kerry Burton is working with HCCA on the National Access Program. Kerry is interested in collecting consumer stories on elective surgery. Kerry can be contacted at the HCCA office Monday to Thursday.

Patient Journey Boards Improving Patient Flows

2011-09-23T12:46:00.000+10:00

I visited Calvary Public Hospital on Tuesday to learn more about their Patient Journey Board and the Patient Flow Unit.  This is to have a more coordinated approach to the way in which patients move through the hospital.  It is a large magnetic whiteboard that is near the nurses’ station.  It contains de-identified information about the patients and it means that the commonly asked questions are answered at a glance: When is the patient going home? Has the patient been referred to Allied Health? What is the status of the referral? It means that not only the treating team can see this information but so can the patient and their family.

The manual whiteboard is a common method for tracking patients and their care planning is a manual whiteboard within the clinical space.  This approach has been used for some time on other hospitals and Calvary have adapted it to their facility.  Flinders Medical Centre in Adelaide is using this approach also.  A poster of their work is available online.

Sir Charlies Gardiner Hospital in WA has also undertaken this work.  A slideshow of their approach is available online and will give you an idea of what they have done to improve patient flow through the hospital.

The Department of Health and Human Services in Tasmania, as part of their broader eHealth strategy, was interested in identifying ways to improve the quality of patient care while also increasing organisational efficiency in their hospitals.  One way they did this was by replacing the manual magnetic whiteboard which tracked patients’ admission and care during their stay in hospital with an electronic clinical portal.  There is a short video online that provides an overview of this.

The Access Improvement Service unit within Queensland Health, in conjunction with the University of Southern Queensland (USQ), is conducting an evaluation project to measure the benefits of the electronic patient journey board (EPJB) across a range of clinical settings. The study will be conducted across 12 hospitals and their 32 medical, surgical, and maternity wards. The key areas for evaluation centre on how the EPJB can:
•           make the in-hospital patient journey visible to the whole multidisciplinary team
•           improve communication between multidisciplinary team members
•           facilitate making investigation and care plans more visible, to streamline the patient journey
•           improve the coordination of discharge planning.
More information is available in the newsletter (pp. 5-6)

Patient flow is an issue of great importance to consumers and we will continue to look at ways this is improving in the ACT health system.

Darlene Cox
Executive Director

Food and Culture: The Impact on Health and Ageing

2011-09-19T10:26:00.000+10:00

On 8 September HCCA staff attended the workshop Food and Culture: The Impact on Health and Ageing at the Theo Notaras Multicultural Centre. This event was hosted by the Canberra Multicultural Community Forum. The purpose of this workshop was to explore the issues and challenges in providing a range of food from different cultures in hospitals, nursing homes and aged care services.

The Minister for Multicultural Affairs, Ms Joy Burch MLA, opened the session and welcomed the diversity of cultures and food in the ACT. Following her presentation, a variety of speakers from different fields gave their insight about food and its significance in people’s cultures and the impact on their health. The keynote speaker was Jane Kellet, a Lecturer in Nutrition and Dietetics at University of Canberra. She talked about current research on malnutrition in elderly people in hospitals and residential care. Garry Wright, the Food Services Manager and Kim Crawley, The Nutrition Manager from The Canberra Hospital talked about the changes they are making in their everyday menu planning to cater the diversity of patients admitted every day. Penny Jackson, the Manager for Nutrition Services from Red Cross also gave a good insight about Meals on Wheels services and the changes they are going through. Terry Swarner, a consumer rperesetnative with HCCA, explained Food as a Clinical Issue, the history of clinical food, the standards of nutrition and to close the session he left us with a good prescription providing a healthy hint to have an apple everyday to keep the doctor away; Terry provided an apple to all attendees. Different individuals from Canberra multicultural communities spoke about what food means in their culture and their personal experiences in hospital, Meals on Wheels and aged care homes, suggesting what changes can be made.

The forum closed with an interesting panel discussion where questions were answered. All agreed that communication was an important factor to get the message across to the right people for changes to happen.

Yelin Hung

HCCA Office Manager

President's speech reflecting on consumer representation in the last year.

2011-09-02T01:10:00.002+10:00

On 1 September 2011 the ACT Minister for Health hosted a reception at the Legislative Assembly to thank consumer representatives for their contribution to the development of health services. Adele Stevens, HCCA President, gave the following speech at the event.

2011 marks my third year as a President of the Health Care Consumers’ Association (HCCA) of the ACT, and I am proud to say that the third year of my tenure has been just as productive as the first two. Integral to the important work of HCCA are the committed and hardworking consumer representatives, who tirelessly devote their time and energy to providing consumer input on a range of significant health matters. It is great to see that their contribution is being honoured today.

This year, HCCA has supported 34 consumer representatives on 67 health committees across the Territory and all divisions of ACT Health. In addition to this representation on committees, we have trained 22 new consumer representatives in March and May/June and are expecting a further 15 participants for our September training. As we have 34 consumer reps on 67 committees, this means that on average each rep is on about 2 – 3 committees. My experience as a rep demonstrates this.

I am a consumer rep on 3 committees - I have been one of the consumer representatives on the Clinical Audit Committee for a number of years now. This is a very important committee as it examines when things go wrong in the ACT Health service and looks at ways to prevent these mistakes happening again.

Secondly, following this, I joined the Respecting Patient Choices committee as their only consumer rep. This is an area of health care which I am passionate about. I am one of the growing number of older people who are worried about being kept alive with no quality of life by a health system which has gone mad with technology to prolong life. The Respecting Patient Choices program provides a way for us to register our end of life wishes and for these instructions to be available to health care professional should I arrive at hospital and am not able to make my wishes known. I am pleased to say that that ACT Health has doubled the funding to this program in the last year. The cost of the program is minuscule compared to the money we waste in intensive care keeping old people alive who have made clear that they do not want to keep living without a good prospect of a decent quality of life.

Third, in the last year, I have joined a committee, under the Capital Asset Development Program, overseeing the redevelopment of the Community Health Centres in the ACT. This is an exciting project with a new model of patient centred care for the community service. This means integrating all the different patient records into a single patient record, which means merging our e-health records that are in separate services – eg dental, mental health, continuing care in community – into one record per patient - a challenging task to achieve by the time the new centres are due to open next year.

Health Care Consumers is an organisation which is committed to supporting the improvement of our health record with e-health technology, and the joint work of both of us, HCCA and ACT Health on the e-health consumer reference group is an good example of an innovative way both HCCA and ACT Health are working together to advance electronic health care services to improve health care.

But let us move on from the consumers representation program, to some of the other work we do. In addition to their role as consumer representatives on specific committees, members regularly attend events organised by HCCA which aim to deliver consumer input on a variety of health issues. This year HCCA Consumer Representatives have attended a myriad of events, including the regular e-Health Consumer Reference and Health Issues Groups and Capital Asset Development Program Representatives meetings.

The growth in acceptance of the place of consumers at the table continues and this year we continue to experience high numbers of requests for consumer representation. We know our colleagues at the Mental Health Consumers’ Network share our experience.

We are receiving an increasing number of phone calls from the public seeking guidance and support on how to navigate the system. We are working hard to ensure that consumer participation is not limited to consumer representation on committees. We are committed to working with ACT Health staff to convene round tables and consultative fora on health service plans, medication safety, workforce development, e-health and the development and implementation of the national health reform agenda.

The e-health consumer reference group has developed over this year. We are the only jurisdiction in Australia to have a dedicated reference group of this type. We would like to acknowledge the support of the ACT Health Directorate for their continuing involvement in this committee. I would also like to thank Russell McGowan for his energy and vision in chairing this group.

The Consumer Representatives Program is truly the cornerstone of HCCA. I am proud to note that this program goes from strength to strength as evidenced by the commitment and dedication of our representatives.

Adele Stevens

President

Dying with Dignity

2011-08-23T14:23:00.001+10:00

Last week I attended a presentation about end-of-life rights, delivered by Neil Francis, President and CEO of Dying with Dignity Victoria. The session was held the Weston Club and was organised by Dying with Dignity in the ACT.

In the last two decades, surveys have consistently shown that the majority of Australians believe that terminally ill individuals should have a right to seek and obtain assistance to end their life with dignity. Today that majority is around 85%.

Neil began by explaining the aims of the organisation. These are:

to promote legislation that gives freedom of choice to individuals and acknowledges the human right of terminally and incurably ill people with profound suffering to die with dignity;
to carry out a continuing public education policy to achieve such legislation; and
to educate the public in the need for Living Wills and Advance Directives and to provide counselling and other assistance to people about their end of life rights.

In short, their aim is to change the law so that medically assisted dying is permitted at the request of competent, incurably ill people who wish to avoid pointless suffering and degeneration, and to control their own dying.

Much of Neil’s presentation was based on the experiences of countries and states where voluntary euthanasia has been decriminalised for some years, including Oregon, Washington, The Netherlands, Belgium and Switzerland. The legislation varies between these countries. In Switzerland, passive assisted suicide has been legal since 1942, and it has the most open rules, which allow someone to give another person the means to kill themselves, provided the helper does not personally benefit from the death. The overwhelming view from all these countries is that voluntary euthanasia works well for its citizens; giving people the right to choose, and to talk openly about the option of voluntary euthanasia promoted peace, serenity and reassurance.

The Dying with Dignity website provides further information about voluntary euthanasia, including links to other Australian and international websites about the topic.

YourLastRight.com is a national alliance of Australian state and territory dying-with-dignity and voluntary euthanasia societies.

Karen Jameson

HCCA Policy Officer

Independent Evaluation of the Nurse-led ACT Health Walk-in Centre

2011-08-18T16:15:00.002+10:00

HCCA welcomes the release of the independent evaluation of the Walk In Centre by the ACT Government today. The evalution was completed by the compiled by representatives of the Australian Primary Health Care Research Institute and The Australian National University

HCCA has consistently supported the concept of Walk-in Centres which involve the development of a community based primary care level that is complements the options already provided by general practice and the hospital emergency departments. We believe the walk-in centre provides an additional community health care service that will improve health outcomes for the ACT community.

The report contains valuable consumer feedback and analysis of interviews with key stakeholders. On the whole, feedback is positive, with over 80% of patients surveyed saying they would use the Walk-in Centre again and would recommend it to family and friends. Consumers are pleased to have a service that is community-based and safe.

ACT Govt is today engaging in a 6-week public consultation period on the report and we will be discussing the report with our members and encouraging their feedback, which we will incorporate in HCCA’s response.

Success of this centre supports proposals to create other walk-in centres in the City, Tuggeranong and Gunghalin. This is an exciting opportunity to provide a range of options for consumers who require care for minor illnesses and injuries.

We look forward to further discussions with ACT Government in the development of these centres.

Darlene Cox
Executive Director

Consumers and Clinical Governance

2011-08-01T12:36:00.004+10:00

Peggy Brown addressing the
ACT Clinical Senate, June 2011

Russell McGowan, Kate Moore, Janne Graham and Darlene Cox attended the inaugural ACT Clinical Senate on 28 June 2011.
The Clinical Senate is a new group in the governance structure of the ACT Government Health Directorate whose role is to provide a forum for advice to the Director General on matters relating to:

The coordination and development of clinical planning
Clinical and resource decision making
Other relevant clinical issues in health service delivery in the ACT
Issues of concern to the Chief Executive

It will provide a mechanism for increased participation and advice from nurses, medical practitioners, allied health professionals and consumers on clinical issues. It is in its infancy but promises to be a valuable forum if it evolves along the lines of the clinical senates in Western Australia, South Australia and Queensland.

The focus for the evening was on clinical governance. The evening was facilitated by Chris Baggoley. Speakers included Peggy Brown (Director General), Lee Martin (Deputy Director General), Dr Frank Bowden and Janne Graham.
Janne's notes are included here.

Janne Graham speaking at the
ACT Clinical Senate, June 2011

CONSUMERS AND CLINICAL GOVERNANCE

I’ve probably seen at close hand more reorganisations of ACT Health than any of you. Nevertheless, I am feeling very positive about this one where the emphasis across all services is safety and quality.

Safety for us means managing avoidable risk and sharing information about inherent risk so that community members, patients and families can make appropriate decisions for themselves and actively participate in their care. There is ample evidence now that where consumers and carers have the opportunity to be involved we can contribute to our safety.

Quality for us means that both the consumer experience and the health outcome will be as good as it can be.

Great news that the elective surgery waiting times are reducing (even if Canberra Times can only make it a page two story) but whatever the wait there are people with lives they are trying to live while on that waiting list. How are they being supported with care and information during that wait? As an example a health service moving towards excellence will be accepting its share of responsibility for these less tangible aspects of the patient journey.

RESPONSIBILITY

It seems to me that the new structure enables this broader attention. It enables effectiveness and efficiency to move in tandem.

We are looking for clinicians to focus, not only on your own practice at the bedside or on the operating table, but in sharing in ensuring better systems.

For example, for you to give the right injectable at the bedside you need to know there is a system in place which ensures the right product and the right time etc.
Discharge of a patient not only results in a free bed but may, when not planned well, have significant ramifications for other parts of the health service, the community sector, the family and patient themselves.

Hence, you share responsibility for the system (and the shared benefit).

We look to you to play a leadership role, to support those who work in the team and to you. In turn, we expect you to be supported as you accept responsibility.

We know what it is like to have ideas and possible solutions to problems and not to be heard. Good governance, we believe will give all of us a better opportunity to take responsibility for a better service.

TRANSPARENCY

We know as individual consumers and as an organized movement which hears the stories that there are inherent risks in health care. With you we are contributing to some of the initiatives which avoid risk and near misses. We know that “to err is human” so we want a culture which moves from blame to becoming an active learning organisation where error is identified and acknowledged and where the lessons learned are documented, acted on and applied. We think that the Clinical Senate can play an important role in developing and promoting this culture.

We believe that there is a strong case for proactively reporting error, for an open process of peer review and of community reporting. The community hears the bad stories and unfortunately these often influence confidence more than the good ones. Leaders who support a more open culture of questioning and reflection will develop a more confident workforce, and a more supportive community.

ACCOUNTABILITY

I recently toured Weipa Bauxite mine. Boy! Are there some potentially risky activities there! Expensive too! One tyre on one of their machines costs somewhere between the value of my house and yours and there may be up to a dozen tyres on one vehicle. The drivers know quite clearly that they are accountable for those tyres. Damage may not be caused by them, it may be inherent in the structure or some demand outside their control but they must know the condition of each tyre each time they take over a vehicle and each time they hand it over.

We think of accountability not as a set of reports but of a genuine closing of the loop whether it is in the handover of an individual patient, following through on recommendations for change, Evaluating when introducing new procedures .. and so

CONCLUSION

We have great expectations that the new governance arrangements, as they are worked through will enable clinicians to

take responsibility and be supported,
to further a reflective learning culture and
to be accountable to each other and the community for their contribution to excellent health care.

I believe that an active engaged clinical senate, adequately resourced can provide powerful and effective leadership to this journey towards clinical excellence.

Janne Graham
Member, HCCA

Reflections on Patient Centred Care

2011-07-27T14:22:00.003+10:00

In the last few months it seems that many health services in Australian have caught up with the concept of patient centred care and we hear the term bandied about all over the place. Over the last three weeks I have seen six different onion charts that represent patient centred care. (I will endeavour to post links to these over time.)

Consumer organisations have been talking about these principles for decades. The medical profession have been considering the benefits of this approach for over a decade. I certainly remember a clinician commenting to me in 2001 that they thought patient centre care would evolve to become part of the way clinicians think, just as evidence-based medicine has become the accepted norm.

Health services in are adopting the concept as a key driver for service delivery in terms of improving outcomes for consumers as well as improving efficiency and effectiveness of health services. The attention of the needs and preferences of consumers is certainly welcomed and consumer organisations are well placed to work with consumers, health services and our communities to achieve the objective of patient centred care. Here in Australia we are a little behind the UK and the US in terms of establishing indicators for what constitutes patient and family centred care. Very few services report against patient experience indicators ... but that will change.

The Australian Commission on Safety and Quality in Health Care (ACSQHC) has released their paper on Patient Centred Care and consumer centred care features in the Health Care Services Standards that are currently before AHMAC for consideration.

What is patient centered care?

Providing care that is easy for patients to get when they need it. Making sure that healthcare staff respect and respond to patient choices, needs and values. Forming partnerships between patients, their family, carers and healthcare providers. ACSQHC
providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions The Kings Fund
one aspect of health care quality, as important as care being safe, clinically effective, timely and equitable The Kings Fund
the essence of patient-centred healthcare is that the healthcare system is designed and delivered to address the healthcare needs and preferences of patients so that healthcare is appropriate and cost-effective International Alliance of Patients' Organizations (IAPO)
the essential theme is the importance of delivering healthcare in a manner that works best for patients. In a patient-centered approach to health care, providers partner with patients and their family members to identify and satisfy the full range of patient needs and preferences. Planetree
The Seven Attributes of Patient-Centered Care Superb access to care, patient engagement in care, clinical information systems that support high-quality care, practice-based learning, and quality improvement, care coordination, integrated and comprehensive team care, routine patient feedback to doctors, publicly available information The Commonwealth Fund
Five Principles of patient centred care: Respect, choice and empowerment, patient involvement in health policy, access and support, information. (IAPO)

Based on these sites we constructed a word cloud using wordle.

definitions of patient centred care based on web pages from IAPO, Kings Fund, Planetree, Commonwealth Fund NSW Clinical Excellence Commission and ACSQHC

In the US the Affordable Care Act has Patient-Centered Outcomes Research Institute (PCORI) which was created by US Congress through the 2010 Patient Protection and Affordable Care Act as an independent, non-profit research organization to help patients and those who care for them make informed health decisions. PCORI will commission research that is responsive to the values and interests of patients and will provide patients and their caregivers with reliable, evidence-based information for the health care choices they face.

One of the first things PCORI is doing is developing a definition of patient centred care so that there is shared understanding. They are currently Seeking Public for Input on Definition of Patient-Centered Outcomes Research. This consultation period ends on 2 September. Individuals and organisations are invited to provide feedback on five questions through PCORI's website, pcori.org. they will refine their working definition based on the input they receive.

The working definition says "Patient-Centered Outcomes Research helps people make informed health care decisions and allows their voice to be heard in assessing the value of health care options." It answers four patient-focused questions:

"Given my personal characteristics, conditions and preferences, what should I expect will happen to me?"
"What are my options and what are the benefits and harms of those options?"
"What can I do to improve the outcomes that are most important to me?"
"How can the health care system improve my chances of achieving the outcomes I prefer?"

The need for a shared understanding is very strong and we can safely anticipate more converations between clinicians, policy makers and consumers around what we mean when we say patient centred care.

Darlene Cox
Executive Director

Consumers Reforming Health

2011-07-22T12:39:00.004+10:00

Earlier this week I was fortunate enough to attend the inaugural Consumers Reforming Health Conference hosted by the Health Issues Centre in Melbourne.

It was my first experience of such an event on such a scale - there were over 400 participants from a variety of health related fields, including consumers, health professionals and academics.

The sessions were jam-packed with information on a range of topics such as consumer engagement in mental health, the history and future of the consumer movement in Australia and the myriad benefits of patient-centred care for consumers, family/friends/carers and health service staff.

While the accomplished speakers presented a cross-section of current developments in the area of consumer engagement in health, it was easy to see the key themes underpinning each presentation.

One of the key themes I picked out and one which was expanded upon across the course of the conference concerns the future of consumer engagement in this country. The Australian consumer movement is strong, coherently structured and operates in the mainstream with regard to policy development. However, as Hans Lofgren of Deakin University argued, the increasing official recognition of the importance of consumer engagement may belie the realities of the movement's impact on policy-making. It really highlighted for me the fact that as consumers we must be continually pushing for recognition and engagement - we cannot afford to rest on our laurels, despite our achievements.

The importance of patient-centred care was also strongly asserted by speakers, demonstrating the benefits for patients and their loved ones, but also for staff. Susan Frampton, President of Planetree in the USA, presented patient-centred care in the form of a "business case", outlining the countless emotional, social, health and economic advantages to employing a patient-centred care model.

Overall, the conference emphasised the importance of viewing consumers as equal partners with clinicians in the provision of health care services. The "equal partner" rhetoric was utilised by Beth Wilson, the Victorian Health Services Commissioner, in her opening address and was echoed throughout the conference. Much was made of the unique knowledge and insight consumers can possess about their own health condition, and how they must be valued as an integral part of the care team.

The conference closed with remarks from a panel which comprised Tony McBride (the Australian Health Care Reform Alliance), Dr Jocelyn Cornwell (King's Fund UK), Andrew Hayne (COAG Reform Council), Stephen Murby (CHF), Phillip Bain (Northern Division of General Practice) and HCCA's own Russell McGowan. The panel reflected on the future of consumer involvement in health care policy and touched on the role of the internet and other information technology in further democratising the system and empowering consumers.

The Consumers Reforming Health Conference really enthused me and made me positive for the future. It was so encouraging to see so many consumers and health professionals enthusiastic about promoting consumer engagement within our health system.

Heather McGowan
Consumer Representatives Program

Reflections on Consumer Engagement in Health

2011-07-19T21:57:00.005+10:00

I am attending the Consumers Reforming Heath Conference in Melbourne. I commend the staff and the Board of the Health Issues Centre for their work in providing us with the opportunities to come together and reflect on some of the achievements of consumer participation in the local, national and international settings.

The last session of the day was a panel of people pondering the gains the consumer movement has made in the past decade. The panel was chaired by Mary Draper, Chair of the Health Issues Centre. The responses of the panel were very insightful, based on their experiences of health systems and relationships with other consumers. There was a lovely mix of international (UK, US and Canada) perspectives as well as Chairs of national (CHF) and state based, peak consumer organisation (Qld, WA).

Susan Frampton President of Planetree
Jocelyn Cornwell, The King's Fund
Sue Robins, Consumer from Canada
Steven Murby, Consumers Heath Forum
Anne McKenzie, Chair, Health Consumers Council WA
Mark Tucker-Evans, Chair, Health Consumers Queensland

I have done my best to reflect in this post what each of the speakers said but please leave a comment if you think it needs adjusting.

Jocelyn Cornwell spoke about the development of the National Service Frameworks as one of the strongest advances for consumers in the UK. The National Service frameworks and strategies set clear quality requirements for care. These are based on the best available evidence of what treatments and services work most effectively for consumers. These were influenced by patient organisations in particular those focussing on heart disease, stroke, mental health and cancer.

Jocelyn also sited the effective consumer involvement in research and in particular the work of Involve. Involve is a national advisory group which supports greater public involvement in NHS, public health and social care research. INVOLVE is funded by the National Institute for Health Research. Anne McKenzie (HCC) has had a long standing commitment to involving consumers in research and is very supportive of Australia moving in the direction of the UK in this way, reflecting that the UK is a decade ahead of Australia in the way in which they involve consumers in research. This is certainly a challenge for the consumer movement in the coming decade.

Susan Frampton saw the increase in access to clinical information through the internet as a gain for consumers generally. Access to better information has the potential to better inform consumers and assist us to make more informed decisions about our health care by Susan doesn't think we have yet realised the power this provides for us as health care consumers. The US is further ahead if Australia in terms of the public reporting of clinical and patient satisfaction data but Australia, with the myhospitals website, has certainly started on this path. In the coming decade we will see this information used by consumers to make decisions about where we receive health care and as a tool to leverage improvements in quality of care at hospitals

Sue Robins told a very powerful story of visiting a specialist with her son and the respect, the attention and listening the doctor gave to them This specialist worked in a collaborative way and showed old fashioned kindness. In this day of everyone being "crazy busy" and with the specialisation of disease and development of technology it is less likely consumers and our families will experience this care. Sue referred to the fee for service model in Canada and reflected on how that does not always enable time for conversations and shares the view that many of us in Australia hold that the fee for service model can work against quality care. I am following with great interest the development of activity based funding and quietly wondering whether it will be the saviour that some have told me it will be.

Steven Murby thought that we had achieved the tick-a-box stage of consumer engagement and that we ask more, are told more but we are not in the feedback loop of systemic improvement.

Anne McKenzie reflected on the activitist beginnings of the consumer movement and thought we had two clear successes. The first is the establishment of the health services commissioners who can investigate consumer complaints. There is now the acknowledgement of the right consumers have to complain. This is one of the rights that have been preserved in the national Charter of Health Care Rights. My view is that one of the challenges of the coming decade is to embed that right (and the other six in the charter) into practice at the bedside and in the consulting rooms. The other gain that Anne shared was the establishment and funding of consumer organisations in most of the states and territories. Tasmania and Northern Territory to not yet have such organisations. I share Anne's view that it is these organisations that will drive meaningful engagement in the next decade.

Mark Tucker Evans built on the points of the previous speakers regarding the growth and development of consumer organisations at the state and territory level, consumer access to better information and the embedding of the charter of health rights. Mark also reflected on his disappointment (and he is not alone in this) of the watering down of the commitment to patients cntred care which came through so clearly in the National Health and Hosptial Reform Commission's final report. This material is available online and I think it is important that we go back to it over the coming years along with the report of the Preventative Health Task Force.

So for the next ten years the panel pointed to the following:

let's embrace the digital revolution and look to see how it can build relationships between consumers, with our treating teams, to increase our understanding of our health (Jocelyn)
let's have a different conversation based on what do we want our health for? This will empower consumers to set the agenda and engage us in our own health (Susan)
it would be wonderful for doctors to engage in reflective practice (Sue)
we need to pay attention to the politicisation of our health system by stealth and look at how the cabinet is now making decisions about approvals for the medicines listed on the PBS (Steven)
let's move from rhetoric to action and make sure that the people on the floor know about it and embrace consumer participation. Let's develop action plans that bring into practice the frameworks and overarching strategies. (Anne)
let's have a cross sectoral approach and make sure that aged care, disability, community care are part of the health system as well as primary care and acute services. (Mark)

Thanks to the panel for such insights, it was a very valuable session.

Darlene Cox
Executive Director

HCCA Vacancy: Consumer Coordinator

2011-07-08T12:49:00.001+10:00

HCCA is seeking a Consumer Coordinator with excellent communication and coordination skills to work with consumers and community organisations on improving access to public health services through the National Access Program.

HCCA is involved with health service planning and redesign of clinical services provided by the ACT Government Health Directorate. We do this by supporting consumer representatives on operational and decision making committees, holding consultations with consumers, and providing consumer input into policies, plans and decision making fora.

If you are committed to improving health services and advocating for consumer interests we would like to hear from you.

The hours and days are negotiable, up to 25hrs per week. Award level will depend on the skills and experience of the successful applicant. This is a 12 month contract with possibility of extension. Other conditions of employment will be based on the Social, Community, Home Care and Disability Services Award.

HCCA promotes a healthy work-life balance and is committed to offering employees a supportive family friendly working environment.

Applications, addressing the selection criteria, close on Friday 22 July 2011.

Contact the HCCA office for more information.

More information about the National Access Program is included on our blog

Dental Health Forum

2011-06-14T15:15:00.004+10:00

Community Dental Health Program

Health Care Consumers’ Association (HCCA) hosted a Dental Forum at the HCCA offices in Hackett on 7 June.

Karen Jameson, Karen Macdoanld,
Sanja Fokus and Suzanne Eastwood
at the HCCA Dental Forum.

Sanja Fokas (Regional Manager) and Karen Macdonald (IT Manager) from the Division of Surgery and Oral Health Community Dental Health Program, ACT Health, engaged with consumers for a workshop. The session was faciliattied by HCCA staff member

Karen gave a detailed presentation about the services provided under the Dental Health Program and Sanja spoke about the achievements and successes of the Program. The presentations were well received and provided a useful overview of the dental services available and how to access them.

The workshop sessions which followed, gave consumers the opportunity to talk about their own experiences and give feedback about the services, providing Sanja and Karen with valuable information and ideas about how to improve dental services and also to make them aware of any shortcomings within the system.

Attendees were asked to comment specifically on the following questions:
1. Is it easy to find information about the Dental Health Program, including contact details?
2. Are you aware of the services that are available at the Dental Health Program?
3. If you have attended the Dental Health Program were you satisfied with the service received?

Health Directorate Staff presenting
at the HCCA Dental Forum

The questions highlighted a number of concerns:

Communication
Consumers felt the Dental Health Program needed to be far more widely publicised. Many people said they were unaware of the services provided under the Dental Program and did not know how to access them. They were also unclear about waiting times and eligibility. Consumers felt the Dental Program needed to be far more widely publicised. They suggested displaying posters in waiting rooms in GP surgeries, hospitals and allied health services; publicising the Program through the school system by providing information to teachers who could pass this on to parents; liaison with disability support agencies, CIT, community housing and St Vincent de Paul; publicising the services via Facebook.

Preventative Care
Consumers were keen that the Program should focus strongly on preventative treatment. It was important to make consumers aware of dental hygiene and that thorough teeth cleaning formed part of every routine dental check. Sanja said there were currently two hygienists in the Civic Clinic and hygienists would also be on the staff at the new Belconnen Clinic. She said ACT Health were keen to emulate the Canadian model of preventative dental care, which was the best in the world.

Including dental hygiene and care on the pre-school curriculum was suggested as a means of teaching children how to look after their teeth and gums, which was likely to reduce oral health problems in adult life.

Aged Care Facilities
Concerns were raised about the lack of dental care in aged care facilities. COTA had been lobbying for a mobile clinic and Sanja said ACT Health was investing in a mobile unit, which would make regular visits to nursing homes.

Priority for the poor and homeless
Consumers felt it was important that priority be given to the poor and homeless community. The Salvation Army referred clients to the Dental Program – last year 51 clients were referred by the Salvos. Consumers felt communication with similar organisations would be very beneficial.

Record-keeping and contact with clients
Concerns were raised about how the Dental Program monitored its waiting lists, client contact details and appointment times.

It was felt that it was important that the Dental Program should be fully integrated within ACTPAS (the ACT Health, Patient Administration System).

Sanja Fokas and Karen Macdonald welcomed the opportunity to talk to consumers and undertook to use their feedback to help to improve the Community Dental Health Program in the ACT.

Copies of the presentations will be sent to those attending the workshop.

HCCA and the Community Dental Health Program look forward to hosting another Dental Forum in the next six months to talk about developments in the Program and discuss lessons learned from this session.

What is the National Access Program?

2011-06-08T12:52:00.001+10:00

The ACT Government is currently involved in large scale clinical redesign and health service planning to underpin an ambitious capital works program. This is a significant body of work for and has great potential to bring about structural changes to clinical practice, and to improve efficiencies as well as health outcomes for consumers. HCCA is committed to working with the Government to provide independent, effective consumer input in the developing solutions to intractable.

In April 2010 the Council of Australian Governments agreed to sign the National Health and Hospitals Network Agreement. The reforms outlined in the Agreement are designed to drive major improvements in service delivery and better health for patients, whilst equipping the health and hospital system to serve the Australian community into the future.

The agreed reform program will change health funding. This funding will be linked to health performance targets, known as the National Access Targets.

They are:

• the 4 hour access target - 95% of all clinically appropriate presentations to emergency departments will have been assessed, treated and either admitted, transferred or discharged within 4 hours of arriving at the emergency department.

• the elective surgery access target – 95% of all people accessing elective surgery should be admitted for surgery within clinically recommended times.

To meet these targets, ACT Health has established the National Access Program to develop and implement the required structures and processes within hospitals in the ACT. The goals of this program of work are to support the delivery of safe and effective care for patients, regardless of the hour of the day, aiming to have the right person in the right place at the right time to meet these targets.

HCCA has received funding for a Consumer Coordiator to work with policy makers and clinicians to ensure consumer perspectives are included in this work.

ACT Walk-in Centre

2011-06-06T15:49:00.001+10:00

The Walk in Centre celebrated its first anniversary a few weeks ago.

13,420 people have presented to the Walk-in Centre over the last 12 months, seeing on average 40 patients per day and over 250 a week. Of this, nurses at the clinic have treated around 10,000 people.

There has been media around the perception that the walk in centre has increased the presentations to the Emergency Department at The Canberra Hospital. Of this the Minister said:

Around 20 per cent are referred to general practice, and the numbers referred to the emergency department are changing as the walk-in centre develops and matures. It has been hanging around six to seven per cent. I understand in the last few months it has been about 3½ per cent.

HCCA spoke to the ABC about this issue recently. There are details on the ABC website including an interview Darlene Cox did with ABC Canberra presenter, Alex Sloane.

There was discussion in Budget estimates in May about the cost per patient. The Minister responded:

The advice I have is at the end of March the average cost was around $120 per patient. Obviously, as they are seeing more patients, their costs are coming down. In comparison, the cost of treatment of someone in the emergency department is in the order of $400. I think it is a useful measure to have a look at cost, but if we provided that as the only way of working out whether anything is a success, we would not do a lot things in the health system, I can tell you.

The Hansard for Budget Estimates for 18 May 2011 is available on line as a pdf.

HCCA is very supportive of extending the walk in Centre model to the Community Health Centres in town centres. This is an aspiration of the Government. The Government is building capacity for walk-in centres in the Belconnen, Tuggeranong and Gungahlin Community Health Centres.

Expanding Hospital Services in the ACT - ACT Government discussion paper

2011-03-02T10:18:00.002+11:00

The ACT Government has released a discussion paper on five options for enhancing hospital services in Canberra. Each option would deliver an extra 400 beds and range in cost from about $690m to $795 million. We are pleased to see that the HCCA proposal to include a sub-acute facility has been costed and included as an option (Option E). Another option (B) is to consolidate services in a 'super hospital' at Woden but the Minister went on the record in early February saying that this is an unlikely option.

The discussion paper is a good start to the conversation and we encourage people to read the paper. This is available in the Community Consultation section of the ACT Health website.

HCCA is interested to find out more about the type of beds that are being proposed. We spoke with the ABC this week about this. A story is available on the ABC website.

A six week consultation period will run from 25 February 2011 – 14 April 2011. Community consultation fora will be announced soon.

This has been a long running issue. The ACT Legislative Assembly referred to the Standing Committee on Health, Community and Social Services for inquiry and report the proposed four new options for future ownership and management arrangements of Calvary Public Hospital, put forward by the Minister for Health on 19 August 2010. HCCA appeared before the Committee and made a submission (350 kb Pdf). The Standing Committee will report to the the Legislative Assembly at the end of March.

HCCA is currently considering the discussion paper and will prepare a comprehensive response. We are interested to hear your views.

A wish list for Canberra's Integrated Cancer Centre

2011-03-01T14:16:00.002+11:00

This post has been adapted from a piece that Val Lee and Denis Strangman wrote together in November 2010. At the time they served as HCCA cancer consumer representatives on official ACT advisory committees associated with the planning for the new Centre.

The architects are about to get their heads down and come up with plans for a new cancer centre to serve the ACT and surrounding regions. Some preliminary sketches have been drawn up and planning meetings have been held. It is very important that the Centre "gets it right" from the start and develops as a truly patient-centred facility.

The proposed location will be between the current radiation oncology area at Canberra Hospital, the emerging under-cover parking station, and behind the existing Psychiatric Services Unit, which will eventually have its own new building.

In an endeavour to identify the wishes of the Canberra community, particularly those who have used the cancer services recently and may do so in the future (which could include one in three of the population who might be affected by cancer), the Health Care Consumers Association of the ACT held a public meeting on 29 November.

At this early stage of the design we have a basic wish list in mind.

First – the centre must be patient friendly and be designed around the convenience of the patient, particularly those who are visiting it in an unwell situation.

Second - it must be a pleasant environment, for the benefit of the patients and the staff. Canberra has an inherent difficulty in attracting skilled medical and radiation oncology staff, so the working environment needs to be a whole lot better than other cancer centres that are competing with us. We can’t bribe the weather bureau to falsify Canberra’s winter temperatures so we have to counter the pull of the sun and the surf by superior and generous working conditions.

Third – patients should not be asked to walk long distances to get from where they register to where they are treated. We understand that one key objective is to make it an “integrated” centre but it has to work around a fixed given and that is the bunkers where the Linac radiation therapy machines are located in their protected shells. These are fixed and cannot be moved.

Fourth – the patient information area must be close to where most patients and their carers will come for their consultations. The opportunity could be taken to integrate the patient education function with this facility so that there is a combined access to the disease-specific technical information and the relaxation and meditation resources which many patients specifically seek.

Fifth – patients must be capable of easily meeting with allied health staff and the cancer care co-ordinators. This is an expanding area within cancer services and the objective should be that eventually all cancer patients will be allocated to a care co-ordinator who can be a point of contact as they travel the cancer journey. At the present time some of those with the more intransigent cancers, such as brain tumours, are lacking access to care coordinators covering their cancer. Social workers should not be hidden away in some broom cupboard out of sight but should be easily reachable by patients. That area of assistance needs to be better resourced.

Sixth – the opportunity needs to be taken to reap the advantages of the E-health revolution. Because of our low population base the oncologists in Canberra need to be “generalists” and they do a fine job but much of the expertise of their more experienced colleagues is found interstate. Telemedicine facilities need to be an integral part of the design so that the Canberra staff can act as agents of disease-specific specialists located elsewhere, even on occasion in another country. Patients and their carers should be able to participate in these consultations.

Seventh – “quiet spaces” need to be built into the design where a patient and their carer can retire to and reflect on any challenging information which might have been given to them in a consultation. On occasion they might want a social worker, care coordinator, or pastoral care worker to be easily available.

Eighth – a small café should be integrated into the design, which is easily accessible by patients and their carers either from the chemotherapy or radiation oncology treatment areas. Some kind of call system spanning waiting rooms, the proposed cafe and the patient information area should be developed so that patients do not feel trapped into remaining fixed in a waiting room fearful that they will miss their “call”. These are mostly ambulatory out-patients. Perhaps they could be issued with location tags which tell the staff the general area where they are waiting.

Ninth – particular care needs to be taken for those patients whose immune system is compromised because of procedures they are undergoing, which might involve specific forms of access and isolation.

Tenth – because pathology results are an integral part of the cancer process and often determine a patient’s ability to receive chemotherapy, blood samples should be taken within the Centre, if at all possible.

The project managers and the architects for the new cancer centre are working to a tight schedule but the last thing anyone wants is a $28 million centre which looks new but has inherent design flaws which add unnecessary stress to the patient and their carers. The diagnosis of cancer and its treatment can be very stressful. Let’s do what we can to reduce stress levels for these people.

Sadly Val Lee died in January 2011. Val was a breast cancer survivor who provided peer support through Bosom Buddies for newly diagnosed breast cancer patients. Val certainly left her mark in the consumer movement and was a source of great comfort to many women when they needed a shoulder.

Denis is a former caregiver and provides peer support to newly diagnosed brain tumour patients and their carers by answering the national Freecall number provided by Brain Tumour Alliance Australia Inc. He continues to advocate for consumer and carer interest in the development of the Cancer Centre.

Job Vacancy - Administration Officer

2011-02-11T13:50:00.005+11:00

If you are an experienced administration officer, looking for a varied role in a small, enthusiastic and motivated team, we would like to hear from you.

The Health Care Consumers’ Association (HCCA) is seeking an Administration Officer with excellent administrative and organisational skills. The successful candidate will have experience in managing an executive diary and be able to effectively prioritise competing workloads. The role involves daily contact with internal and external stakeholders. Written and oral communication skills and attention to detail are essential. Knowledge of Microsoft Office is required. Other tasks include setting up meetings, organising functions, compiling and sending out newsletters, website editing (training will be provided) and a variety of other tasks as required.
Hours and days negotiable up to 30 hours per week. This is a 12 month contract with possibility of extension. Other conditions of employment will be based on the Social, Community, Home Care and Disability Services Industry Award 2010.

HCCA promotes a healthy work/life balance and is committed to offering employees a supportive family friendly working environment.

The selection documentation is available online at http://www.hcca.org.au/cms/media/selectiondocumentation.pdfApplications, addressing the selection criteria, close on Monday 28 February 2011 and be addressed to:

Executive Director, HCCA
100 Maitland St
Hackett ACT 2602

ACT Auditor-General’s Report into Waiting Lists for Elective Surgery and Medical Treatment

2011-02-07T14:28:00.002+11:00

On 17 January, the ACT Auditor-General submitted the Performance Audit Report titled ‘Waiting Lists for Elective Surgery and Medical Treatment’ to the Legislative Assembly.

Russell McGowan was interviewed by ABC News on the recommendations included in the recently released report on waiting lists by the ACT Auditor General. This news story is available online.

Australian Hospital Statistics for 2008-09 showed that elective surgery waiting times had worsened in the ACT. Allegations had been made about possible manipulation or mismanagement of the elective surgery waiting list and that some patients had been downgraded to lower categories.

The objective of the audit was to provide an independent opinion to the Legislative Assembly on whether:

information on waiting lists published by ACT Health was complete, reliable and timely;
ACT Health effectively managed the elective surgery policy and related systems and procedures to promote clinically appropriate, consistent and equitable treatment of patients in public hospitals; and
access to medical services (non-surgical) was effectively managed and timely.

The Report found waiting lists had not improved despite extra funding from the Federal and ACT governments. The Performance of ACT Health in the management of elective surgery waiting lists in the recent years was below other jurisdictions, and no improvement had been recorded for most key performance indicators over time.

The Audit acknowledged that management of the waiting lists for elective surgery and medical treatments was a complex process that could be influenced by practices of various parties within the system, including doctors, and by a number of factors, some of which were outside the control of ACT Health.

It also noted that Canberra’s public hospitals provide emergency and elective surgery to ACT residents and those in surrounding areas. As most emergency surgery was conducted at TCH, the pressure of delivering emergency surgery also impacted on the delivery of elective surgery.

The Audit found that, overall, elective surgery waiting lists were administered in the ACT within a sound framework of policies, guidelines and procedures. However, ACT Health’s implementation and monitoring processes were not managed well to deliver the intended outcomes.

From consumer perspective, the findings of the report are obviously concerning and disappointing. Obviously, it is unacceptable that some patients have not been added to waiting lists for months because of a communication failure between clinical staff and the hospital booking office, as indicated in the report.

HCCA has long advocated for a single patient administration system across The Canberra Hospital and Calvary, integrating the two hospitals’ databases to better manage waiting lists across the ACT. We welcome the fact that ACT Health is working on this and keenly await its implementation in October next year.

The Audit’s findings are timely. The ACT Health Elective Surgery Access Policy, referred to in the audit, is currently under development. HCCA recently commented on the draft policy and this Audit gives ACT Health the opportunity to further improve its policy for the benefit of consumers as well as clinical staff. The Audit is relevant for inclusion in the ACT Health Patient & Family Centred Care Discussion Paper 2011, which is also under development.

The ACT Government’s response has been positive: it has accepted the majority of all 11 recommendations and HCCA will be closely monitoring its progress in implementing them.

A full copy of the Performance Audit Report Waiting Lists for Elective Surgery and Medical Treatment, is available online (1.18Mb, 95 page document).

Karen Jameson

Policy Officer

Integrated Cancer Centre Consultation

2010-11-24T13:33:00.001+11:00

What do you want from the new ACT Integrated Cancer Centre?

Do you have ideas on how the cancer centre can work well for patients?

What sort of space would be comfortable for patients, carers, families and support groups?

Architects are coming up with plans for the new cancer centre to serve the ACT and surrounding regions and consumers are invited to have their input at this design stage.

It is very important we help the Cancer Centre “get it right” from the start and ensure it develops as a truly patient-centered facility.

Come to a meeting to have your views taken into account!

When: Monday, 29 November 2010

12:30pm-2:30pm

Where: HCCA Office

100 Maitland Street

Hackett ACT 2602

RSVP:02 6230 7800

HCCA Executive Committee 2010 - 2011

2010-11-20T13:35:00.005+11:00

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

As part of the organisational business undertaken at the meeting, HCCA elected its new Executive Committee, which is as follows:

President: Adele Stevens

Vice President: Caroline Polak Scowcroft

Treasuerer: Bev McConnell

General Members: Marion Reilly, David Lovegrove and Russell McGowan

ACT Primary Health Care Strategy Consumer Consultation

2010-11-12T09:52:00.002+11:00

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

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

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

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

2010-11-11T09:35:00.002+11:00

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

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

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

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

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

Conference Workshop 26 October 2010

2010-11-06T14:50:00.003+11:00

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

The workshop was run in world cafe style and considered the challenges of collaborative health care for service providers and consumers. Challenges and successes in four areas were discussed:

clinical review
consumer feedback
policy development and
accreditation of health services

A summary of the issues participants identified is included in this post.

Clinical Review: The role for consumers

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

Policy: How to make collaborative care work for both parties

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

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

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

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

Accreditation: The role of consumers

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

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

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

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

CORPORATISED MEDICINE – A BLESSING OR A BURDEN FOR CONSUMERS?

2010-10-11T09:29:00.001+11:00

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

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

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

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

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

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

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

Russell McGowan

Consumer consultation on national health service standards

2010-09-23T08:34:00.003+10:00

The Health Care Consumers’ Association Inc and the

Australian Commission on Safety and Quality in Health Care invite you to a consumer consultation on the

National Safety and Quality Health Service Standards

The Commission is seeking comment on the draft National Safety and Quality Health Service Standards to:

Ensure the standards address consumer expectations for safe and high quality services.
Refine the standards and ensure they are meaningful for health services, practitioners implementing safety and quality systems as well as accreditation agencies and surveyors using the standards to assess compliance.
Standardise and streamline processes where possible.

Five Standards were released for consultation in November 2009. The Commission is now seeking comment on the additional five draft Standards before they are piloted in health services and forwarded to Health Ministers for consideration in 2011.

The additional five Standards are:

Partnering for Consumer Engagement which creates a consumer centred health system by including consumers in the design and delivery of quality health care.

Blood and Blood Product Safety which sets the standard to ensure that the patients who receive blood and blood products are safe.

Prevention and Management of Pressure Ulcers which specifies the expected standard to prevent patients developing pressure ulcers and best practice management when pressure ulcers occur.

Recognising and Responding to Clinical Deterioration in Acute Health Care which describes the systems required by health services responding to patients when their clinical condition deteriorates.

Preventing Falls and Harm from Falls which describes the standards for reducing the incidence of patient falls in health service organisations.

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

Date: Friday 1 October 2010

Time: 10.00am - 3.00pm

Where: Southern Cross Club, woden

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

Interested in Consumer Participation in the Health System?

2010-09-01T10:46:00.001+10:00

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

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

Contact the office for more information.

Would you like to see the nurse?

2010-06-10T14:47:00.002+10:00

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

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

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

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

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

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

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

Consumer information session on e-health

2010-05-20T14:57:00.001+10:00

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

2010-05-18T11:47:00.001+10:00

HCCA Health Issues Group:

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

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

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

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

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

and

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

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

National Health Reform - Consumer Information Session in Canberra

2010-05-05T14:01:00.002+10:00

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

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

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

The challenges in the Australian health system include:

fragmentation of care
gaps and poor coordination of services
pressure on public hospitals and health professionals
unsustainable funding model
too much waste and inefficiency, and
not enough local clinical engagement

Participants were fortunate in that the timing allowed us to ask Mr Butler about the agreement that had been reached at the Council of Australian Governments (COAG) on 19-20 April 2010.

The COAG communique is worthwhile reading. The Communique claims that the reforms will deliver better health and hospitals by:

helping patients receive more seamless care across sectors of the health system;
improving the quality of care patients receive through high-performance standards and improved engagement of local clinicians; and
providing a secure funding base for health and hospitals into the future.

The rhetoric is good and we look forward to further consumer involvement in fleshing out the detail.

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

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

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

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

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

2010-04-15T09:56:00.001+10:00

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

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

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

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

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

Personal Health Records

2010-04-14T08:48:00.002+10:00

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

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

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

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

We are interested to collect stories from consumers about personal held health records. We would like to know the information you collect, when do you use it? when have you found it to be of most value? have you changed over time the information you have in the record?

A third hospital for Canberra?

2010-03-26T13:59:00.001+11:00

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.

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

2010-03-07T09:49:00.005+11:00

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

Exciting New Health Services Overseas

2010-03-05T14:55:00.023+11:00

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.

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

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

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

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

They achieved a significant reduction in infection rates.

There is a video online that provides a tour of the ward. It was taken by a consumer organisation that monitors NHS services in the Hillingdon area. It shows the room layout and ensuites, touch-down bases for nurses, infection control strategies, nurse call system, ward kitchen for patients and family, clean utility room and a an enthusiastic opera singer.

The video is available on the Community Voice website at http://www.communityvoicehealth.org.uk/ or for the direct link, follow this link Bevan Ward tour.

Great Ormond St Hospital (GOSH), London

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

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

This will include:

· new kidney, neurosciences and heart and lung centres.

· Seven floors of modern inpatient wards for children with acute conditions and chronic illnesses;

· state-of-the-art operating theatres enabling us to carry out more operations on children with complex conditions; and

· enhanced diagnostic and treatment facilities offering faster and more accurate services for patients

· Tele-medicine and tele-education facilities will be installed, enabling peer practitioners around the world to observe surgical interventions and other treatments via video linkup.

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

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

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

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

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

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

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

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

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

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

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

Are GP Super Clinics the answer to the access problems?

2010-03-02T17:12:00.007+11:00

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

Draft ACT Women's Health Plan

2010-02-23T10:36:00.006+11:00

If you would like to hear about the Draft ACT Women's Health Plan and have an input into our response to it please come to our round table on Mon 1 March. between 2 and 4. Here is your formal invitation.

INVITATION

HCCA is hosting a round table to discuss the Draft ACT Women’s Health Plan - Improving women’s access to health care services and information 2009 – 2014, which has just been released for public consultation.

This is an opportunity to share your thoughts and help each other to strengthen our individual responses to the draft plan.

The consultation period ends on 29 March.
When: Mon 1 March | 2 – 4pm
Where: HCCA New Offices in ACT Sports House
100 Maitland St Hackett (The old Hackett Primary School site)
RSVP to: Julie Derrett | HCCA Policy Officer

E-health Discussion on ABC Radio National

2010-02-23T10:32:00.001+11:00

Electronic control of records and administration in health is coming into its own. We will all be hearing a lot about it in the very near future. This broadcast on the ABC's Radio National provides great background information and a very lively discussion. Click on the link below to listen.

http://www.abc.net.au/rn/australiatalks/stories/2010/2809035.htm

BEDSIDE INTERNET AND LAPTOP COMPUTER HIRE A GREAT IDEA FOR OUR PUBLIC HOSPITALS

2010-02-08T15:25:00.003+11:00

Consumers would like to have internet terminals available for all users in the main foyer areas of ACT Health facilities, bedside internet access and laptop hire similar to TV hire while in hospital. This was one of the innovative ideas to come from a focus group run by Urbis for ACT Heath. The focus group was exploring what consumers want from retail outlets and services located in public health facilities.

Consumers were united in the view that they didn’t want to end up with an airport retail experience. Where shops dominate and the hospital is hidden behind the shop fronts, but people attending the hospital in particular, do need better retail facilities. Our hospital’s are like islands in a sea of car parks and if you need something while visiting the hospital you have to travel to get it. So consumers want a florist, a gift shop, a mini supermarket, banking, post, library and appropriate clothing retail facilities.

There were lots of improvements suggested for food outlets including different types of services for different traffic flow needs for example, a 24 hour restaurant or café area. Consumers wanted healthy and dietary specific choices available for people with diabetes and coeliac’s disease as well as vegetarian choices.

Pre-packed lunch boxes and an express lane were proposed. Consumers also wanted a quiet and cosy area to retreat to for coffee or a meal, and while we are at it how about 24 hr kiosk or café service in the ED area?

Car parking, childcare, applying universal design principles to ensure good access to facilities for all users and the provision of personal services like massage, beauticians and podiatrists were all discussed at the focus group.

If you have ideas on what shops and retail services are needed in our public health facilities now is the time to put your views forward. Email HCCA’s Olivia Macdonald oliviam@hcca.org.au and she will ensure that your ideas are passed on to Urbis.

HCCA is moving

2010-01-13T11:06:00.000+11:00

The offices of the Health Care Consumers' Association are relocating to Hackett.

We will be closing our Pearce office at 12.00pm on Friday 15 January 2010 and our office will reopen at on Wednesday 20 January 2010 in Hackett.

Our new address is:

ACT Sports House
100 Maitland St
HACKETT ACT 2602

Phone: 02 6230 7800
Fax: 02 6230 7833

Our email addresses, website and blog addresses will remain unchanged.

The new offices are close to the Hackett Shops. There is ample parking and good access on Action Buses Route 2 http://www.action.act.gov.au/Routes_25_May/Route_2.html

Google map of new location

As our email server will be moving with us it means that email will be interrupted for a few days. We anticipate that the email will have resumed by Tuesday 19 January 2010.

During this time, please address urgent enquiries to our gmail email address adminhcca@gmail.com .

LCM response to HCCA comments on staffing

2009-12-17T13:44:00.020+11:00

This week HCCA received a letter from the Little Company of Mary (LCM) in response to our blog post of 2 November 2009. We will meet with representatives of LCM in January to discuss their position more fully. In the interim we thought it would be useful to post part of the letter that relates to staffing, as it provides more detail than we initially had.

What follows is an excerpt from that letter:

"In the section Implications for governance and staff conditions you state “nursing staff resources available to provide palliative care in the community appear to be considerably less than when home based palliative care was part of ACT Health”.

CHC received seven (7) Full Time Equivalent (FTE) nursing staff when it took on the home-based palliative service. This did not include any provision for clinical nurse consultant, managerial, allied health, medical or administrative support. Following representation to ACT Health in 2003, CHC received additional funding to provide a Clinical Nurse Consultant and administrative support for the home-based palliative care service.
Currently, the home-based palliative care service has approximately ten (10) FTE including the Clinical Nurse Consultant position and one (1) FTE of administrative support. Supplementing these staff, and not included in the ten FTE, are management, allied health, medical and administrative support staff located at CHH or working at CHH as an extension of their role at Calvary Hospital.
The model of care for home-based palliative care has developed since 2002 to focus on the provision of specialist palliative care services delivered by highly skilled clinicians. Non-specialist palliative care assistance in the home, as required by CHH, is provided by Community Health and also by the volunteer members of the ACT Palliative Care Society."

"Also in the section Implications for governance and staff conditions you state “but with the change of management will be employed by LCM and will be required to sign employment contracts agreeing to work to LCM values”.

Staff at CHH and Calvary Public Hospital, whilst ACT public servants, are employed and managed by CHC. Under this arrangement it is already a requirement that staff observe and practice the Calvary values of Hospitality, Healing, Stewardship and Respect. A value based approach to management is considered normal and best practice in health care."

"Further, no Clare Holland or home based palliative care employees will “be required” to become Calvary employees should the proposal proceed. If existing staff do not wish to become a Calvary employee (under the proposal) they can elect to remain in public employment with ACT Health.
If existing staff do remain with Calvary, and for any reason wish to review that decision at any time in the future, they can return to ACT Health employment with full recognition of length of service etc. All existing entitlements of staff, and their current superannuation arrangements etc, will be honoured.
From the very first announcement of negotiations regarding the possible changes of ownership at Calvary Public Hospital and Clare Holland both parties clearly stated there would be no disadvantage to any staff. This commitment has been honoured to date and any representation to the contrary simply does not reflect the facts of the situation."

The need for compromise to solve the concerns regarding the sale of Calvary and Clare Holland House

2009-12-03T16:48:00.007+11:00

HCCA has spent a great deal of time listening to and considering community views and concerns expressed regarding the possible transfer of ownership, governance and control of Calvary Public Hospital at Bruce to the ACT Government, with the ACT Government to transfer Clare Holland House Hospice to the Little Company of Mary Health Care.

In summary the HCCA position is:

1. Support the transfer of ownership, governance and control of Calvary Public Hospital at Bruce to the ACT Government;

2. Oppose the transfer of ownership of Clare Holland House (CHH) to the Little Company of Mary Health Care Limited (LCMHC);

3. Oppose the offer of a contract for clinical service at Clare Holland House for a term of not less than 30 years; and

4. Oppose the nexus between the sale of Calvary and Clare Holland House and think that the issues need to be considered separately.

As set out in our submission, we find the arguments for the sale of Calvary very convincing and are fully supportive of the Government owning, funding and governing Calvary Public Hosptial. We consider there will be great benefits for consumers with the integration of the services across both the Canberra and Calvary hospital campuses. This arrangement will provide for more efficient use of public money, reduction in duplication and improved coordination with community based and ambulatory service - all leading to improve outcomes for consumers.

We do not support the sale of Clare Holland House to the Little Company of Mary Health Care. We have not been convinced that the Government has demonstrated how the quality of care will improve as a result of the change in ownership.

The provision of a clinical services contract of not less than thirty (30) years is a major concern for HCCA. We do not consider this to be good public policy practice. A contract for the provision of clinical services over such a lengthy period was seen as unrealistic given current and likely future health care reforms. Such a contract could well provide an unreasonable restriction on the ACT Government’s ability to adapt to changing funding and healthcare service models. An extension of the clinical services contract to not less than thirty years could be seen as excluding other providers from the palliative care sector and creating a private monopoly in ACT palliative care.

We consider that the difficulties in developing and achieving integration of different palliative care services, including home based palliative care, respite care, community based services and integration with residential aged care facilities, need to be addressed.

We are of the view that consumers should be able to access secular palliative care and have the right to refuse pastoral care. This is made more difficult to achieve when there is a religious provider of public palliative care services. As once consumer commented recently: "I do not want to be in a place that imposes their ethics and limits my options".

We acknowledge that this is a very difficult position for the Government and the Greens to be in. We share the view that public services are best served in public hands.

We do not understand why the sale of the two sites are linked in thie proposal and believe that they need to be considered separately on their merits.

The palliative care approach is highly valued as a response to end-of-life care in the ACT community. However, not all patient groups are adequately served because of limited resource availability particularly for respite places. Before there is any transfer of ownership of the hospice consideration must be given to the establishment of an independent review team made up of individuals with expertise to build a progressive case for additional resources, and to examine the current mix.

We consider that there is a need to treat Clare Holland House separately to the sale of Calvary Public Hosptial as there is a need to reconsider and review the needs of our community in terms of palliative care.

One aspect of this is the current staffing structure. The staff complement in the a home based palliative care service is now 8.2 full time equivalents, i.e., 56% of what it was 13 years ago. There have been complaints from some consumers regarding the inadequacy of home based palliative care. LCM has recognised that the service is insufficient for the need and they have been pressing for increased funding for staffing for home based palliative care for some time - pre discussion of the sale. We would like to see an independent review of palliative care needs and provision in the ACT before we are locked into a longer term arrangement.

It is interesting to reflect on the history of palliative care in the ACT which began as a community initiative with input from a range of people/organisations both secular and religious:
* started in 1985 (a home based palliative care service) run by by Community Nursing, ACT Health. At the same time, the ACT Hospice Palliative Care Society was given a $10,000 donation from the ACT Cancer Society to commence its first volunteer program.
* Following a decade of success of the home based palliative care service and the volunteer program, the ACT Govt agreed to fund a hospice inpatient facility which opened on Acton Peninsular on 1 April 1995. LCM won the tender to manage the hospice for a one year period but the contract was renewed on a regular basis and further tenders have not been advertised over the last 14 years. Home based palliative care continued to be run by Community Nursing.
* In 2002 the specialist palliative care nurses in the home based service run by Community Nursing were transferred went to the management of the LCM. The model of care has been changed from a nursing model under the Community Nursing service to a “support and consultative” model which requires less nursing staff in the specialist palliative care service.

HCCA will continue to put forward the views of our members and networks on this issue and are keen to hear.

The HCCA Executive Committee meets on Wednesday night (9 Dec) and will finalise our position on the Calvary proposal.

The Canberra Hospital Car Parking - Shuttle Bus part of the solution

2009-12-01T12:24:00.002+11:00

Over the next 10 years the Canberra Hospital campus will be a building site as health services are upgraded and buildings refurbished. The building work has begun with fences obstructing paths and roads. Car parking will be difficult over the coming 12 months as the large multi-storey car park is being constructed.

Information is the key to a successful transition period so that TCH campus and building site does not turn into parking chaos for consumers and carers.

The large multi-storey car park was closed last Friday (27 November) and consumers are now required to park in the large open car park adjacent to Hindmarsh Drive.

ACT Health has published a brochure outlining the car parking arrangements. This is sent to consumers with admission papers and for appointments for outpatients. This brochure is available on the ACT Health website.

The brochure contains a useful map to show consumers, carers and visitors to TCH where they can park. This needs to be enlarged and made obvious at various sites around TCH campus. Currently, oreintation signage is limited.

There are key messages that our community need to know:
Access to TCH will be difficult particularly over the coming 12 months while the car park is being built. During this time consumers may consider asking a friend or family member to drop them off and pick them up, or using Action buses.
The car parking that is closest to the hospital is limited to 2 hours only.

We understand that ACT Health has been considering a shuttle bus. The time is right to introduce this service now to offset the confusion and inconvenience for consumers, and carers.

A Shuttle bus would overcome many of the issues. It could operate on a circuit around the hospital grounds for pick ups and drops offs. It could also operate from Woden Town Centre and the Bus Interchange.
This would pick up and set down passengers every 15 minutes.

The shuttle bus would benefit a range of uses including; mothers and prams, seniors without disability stickers, visitors and consumers who come to the hospital with a range of needs and physical abilities. The bus would also improve physical comfort; we don’t want seriously sick consumers their friends and family members struggling to walk from one end of TCH campus in 35 degree temperatures to their cars.

There also needs to be consideration of a transitional lounge where consumers which have been discharged can wait in comfort while their carer, relative or friend collects the car.

It is important that consumers have the support and care of their family and friends while they are in hospital. Involvement of family and friends is a critical aspect of quality care. Good signage and information about car parking is an important aspect of this and should not be trivialised.

HCCA Executive Committee for 2009-10

2009-11-18T12:50:00.003+11:00

Congratulations to the Executive Committee for 2009 - 2010

President: Adele Stevens

Vice President: Caroline Polak-Scowcroft

Secretary: Russell McGowan

Treasurer: Bev McConnell

Committee members: Marion Reilly, Dalane Drexler, Angela Wallace and David Lovegrove

Annual General Meeting and Planning Workshop

2009-11-15T09:05:00.004+11:00

On Tuesday, 10 November HCCA held our Annual General Meeting at the Southern Cross Club, Woden. Adele Stevens, President, reflected on the achievements of the past year:

The past year has been a very successful one for Health Care Consumers’ Association (HCCA) and I have been proud to hold the position of President and work with such a committed and enthusiastic group of health consumers. Over the year, the profile of HCCA has been significantly raised in the community following the hard work of both staff and members on a range of issues. It is not possible in this report to list all the areas where we have made a significant contribution with consumer participation but I would just like to highlight two: first, the GP Taskforce and, second, the Capital Asset Development Program.

Our concerns about the GP shortage were raised with the closure of a GP Practice in Wanniassa. The HCCA Blog detailed our action and response at that time and, with media interest, provided a way for the community to get involved in this issue. Following growing community concern, the ACT Minister for Health set up the GP Taskforce to investigate and make recommendations on ways to improve primary health care services in the ACT. HCCA was a significant contributor to the Task force deliberations. Primary health care was a big issue in the last year and will continue to be an area of major concern for HCCA with our interest and involvement in nurse led walk in clinics and the development of Enhanced Primary Health Care centres in the ACT.

The development of the Capital Asset Development Program (CAPD) following the ACT government’s commitment to spend $1 billion dollars in improving health services over the next 10 years has resulted in a major input from HCCA to this program of capital development. Here are now nine consumer representatives involved with the CAPD program and HCCA has been funded to provide a part time staff member to support these consumer representatives. The exciting program is just beginning and HCCA is pleased with the opportunities for consumer participation provided by the able CAPD team led by Megan Cahill at ACT Health. As the program grows, there will be lots more opportunities for consumer participation in the planning of future ACT health services.

The HCCA Executive Committee has benefited from the contribution of Jude Manning, Chair of our Governance Committee. This year, we endorsed a Governance Framework , and Risk Management Framework. These documents provide useful guidance to the Executive Committee in ensuring the strategic objectives of HCCA are met.

In addition, the HCCA Constitution was revised – a major task long overdue. My sincere thanks to the Working Party who laboured on this over the last year. I am very pleased that we can present the results of that work later in this meeting for your consideration.

Adele's full report in in the Annual Report.

Congratulations to the Executive Committee for 2009 - 2010

President: Adele Stevens

Vice President: Marion Reilly

Secretary: Russell McGowan

Treasurer: Bev McConnell

Committee members Dalane Drexler, Angela Wallace and David Lovegrove

After the formal meeting members participated in a workshop reflecting on the purpose of HCCA, reasons for involvement and ideas for renewal and growth. This is in the process of being written up and will be posted soon.

Proposed Sale of Clare Holland House

2009-11-02T14:24:00.004+11:00

HCCA is opposed to the sale of Clare Holland House (CHH) to Little Company of Mary (LCM). We have a range of concerns relating to the continued integration of palliative care services, implications for governance and staff conditions, and the lack of considered analysis about current and future needs for palliative care in the ACT.

Integration of service:

Concerns have been raised that the proposed sale of Clare Holland House will create a private monopoly in ACT palliative care. At present the service is a tri-partite one, involving ACT Health, LCM, and the Palliative Care Society, which provides checks and balances on the quality of the services provided. What guarantees are there that this balancing mechanism will be maintained if the LCM becomes a monopoly provider of palliative care services?

Implications for governance and staff conditions:

Since home based palliative care management transferred to LCM, nursing staff resources available to provide palliative care in the community appear to be considerably less than when home based palliative care was part of ACT Health. Consumers are expressing concerns about these reductions in available resources while the need for palliative care is growing and the population increasing.

Staff are currently employed by ACT Health, but with the change of management will be employed by the Little Company of Mary and will be required to sign employment contracts agreeing to work to LCM values.

Future needs for palliative care in the ACT:

The palliative care approach is highly valued as a response to end-of-life care in the ACT community. However it is not all patient groups are adequately served because of limited resource availability (e.g. some cancer patients are well cared for but some people with other end of life conditions such as motor neurone are less well catered for; before any transfer of ownership consideration must be given to the establishment of an independent review team made up of individuals with expertise to build a progressive case for additional resources, and to examine the current mix.

Palliative Care Society meeting of friends and supporters

2009-10-29T11:19:00.010+11:00

Last night I attended the information evening of the Palliative Care Society on the proposed sale of Clare Holland House (CHH) to the Little Company of Mary (LCM). It was held at the Ainslie Football Club.

I counted well over one hundred people, and one organiser gave the figure of 143.

There was overwhelming opposition to the sale of Clare Holland House.

The purpose of the forum was to provide information and a range of perspectives on the proposed sale to encourage friends and supporters of Clare Holland House to share their thoughts with the Council of the Palliative Care Society. The feedback received will provide guidance to the Society on how to respond to the proposal.

The Palliative Care Society is a member of HCCA and a number of HCCA members were part of the audience. We will certainly be considering the feedback we heard last night in responding to the Government’s proposal.

There was a change in the format of the information evening. The Minister for Health, Katy Gallagher and the LCM were invited but the Council decided that, in the interest of open and frank discussion, to withdraw the invitation so that they could provide a forum where friends and supporters could freely discuss matters of concern on the proposed sale.

Shirley Sutton, Patron of the Society, spoke thanked people for attending and provided a history of the home based palliative care and shared with members of her distress at the sale of Clare Holland House.

Peter O’Keeffe, a volunteer with the Society for 10 years, spoke, in a strong and considered way about his concerns about the impact such a decision could have on our community. Peter is a member of the working group PCA set up to research implications of the proposal. He expressed his concern that Clare Holland House seems to have been thrown into the deal as a bargaining chip. Of particular concern is the 30 year exclusive service contract of clinical service to the LCM as part of the proposal. This was a major issue of concerns with those assembled. Peter ended with an impassioned plea to those in the audience to tell others about the issues.

Linda Denham, honorary secretary of the Society spoke on the clinical issues and concerns the staff. There are concerns about loss conditions of employment, and implications for care given the need to have an integrated palliative care as they work across a wide range of areas including radiation oncology, medical oncology, renal, neurology, pediatrics and cardiology. Integration will be more difficult with privatisation of the hospice. Linda also spoke of her concern around the monopoly of services that would result from the sale and the granting of the 30 year service contract.

David Lawrance, President of the Palliative Care Society, opened with comments that the alarm bells have started to ring and that many in our community are worried. He stated that the Society does not have a formal view on hospital sale but strongly oppose the sale of the hospice. He said that they Society considers it to be quite wrong to use CHH as a bargaining chip in negotiations in respect of purchase of the hospital and that they can see no reason for connecting the purchase of CHH and Calvary. David stressed that the current situation works very well and there is no reason to change it.

There was unanimous opposition to the sale and the audience will be supporting the Society in their fight to save Clare Holland House.

HCCA supports the sale of the hospital to the Government but not at the expense of Clare Holland House. We share many of the concerns of the Palliative Care Society. We question the nexus between the sale of the hospital and the hospice and think they are two very different issues to be considered separately.

We have had a number of meetings with consumers and have prepared a paper outlining the issues. We are running a workshop next Thursday to work through these.