Palliative Care Society meeting of friends and supporters

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.

Health literacy - what does it mean?

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HCCA members and staff have been talking about health literacy in recent weeks. We are thinking about what this means for consumers and the types of supports that could be put in place to improve our health literacy. This is of particular importance at the national level with the current consultations on the National Health and Hospital Reform Commission.

We have pulled together a few definitions that we would like to share and are interested in your feedback.

The Australian Bureau Of Statistics Report on Health Literacy in Australia (2008) is a significant report and we consider it to be critical to health reform in Australia. It defines Health Literacy:

the knowledge and skills required to understand and use information relating to health issues such as drugs and alcohol, disease prevention and treatment, safety and accident prevention, first aid, emergencies, and staying healthy.

A similar definition that we also considered is contained in an online article that talks about the recommendations of Adelaide Thinker in Residence, Professor Ilona Kickbusch, the Healthy Ageing Research Cluster (HARC), to establish the Health Literacy Alliance. Susan Gravier, Co-ordinator of HARC at the University of Adelaide, explains what health literacy is, and how the Health Literacy Alliance aims to help our society.

Health Literacy is not just knowing how to read but knowing how to navigate through life, keeping health in mind and in practice. It's knowing about the body's functions and signs of dysfunction; knowing how to find, interpret and understand information, and how and where to seek further information when required; knowing what constitutes good quality advice, and how to translate this help into action.

Harvard Material on Health Literacy

This Harvard site has a very useful set of guides in plain English as well as lots of information about creating material for adult low literacy groups. The American focus seems to be on the need to cater for people with poor print reading skills. It contains some excellent material for people developing programs and material for the public.

Wikipedia

Studies reveal that up to half of patients cannot understand basic healthcare information. Low health literacy reduces the success of treatment and increases the risk of medical error. Various interventions, such as simplified information and illustrations, avoiding jargon, "teach back" methods and encouraging patients questions, have improved health behaviours in persons with low health literacy.

The University of Queensland has released a response to ABS study:

This research has revealed that nine million Australians — or 60 percent of the population between the ages of 15 and 74 years — don't have the basic knowledge and skills to understand and use information about their own health.

The impact of such a high proportion of Australians without basic health literacy skills should be of major concern to anyone wanting to ensure people and communities are better able to promote their own health and prevent disease.

(Professor Robert Bush, Health Communities Research Centre)

Consumers have our say on national health reform

Nicola Roxon met with around fifty representatives from the consumer movement on Friday 23 October 2009.

HCCA was well represented with consumer representatives as well as HCCA President, Adele Steven. I attended in my capacity as HCCA Executive Director.

Antonio Russo, Chair of Consumers Health Forum (CHF), welcomed the representatives and the minister. He commented that CHF considered this forum to be unique and powerful opportunity. He went also commented:

• the final report of the National Health and Hospital Reform Commission accords with CHF strategic plan, and
• CHF is pleased that the Government is taking health performance seriously and that the Government is backing the rhetoric about health consumers by holding the forum today.
  

The Minister then spoke, providing a snapshot on the reform commission report and the Commonwealth Government's ambitious agenda of health reform. She pointed to a number of initiatives the government is progressing. These include:

• $500m in investments for sub-acute care
• $750m to take pressure off Emergency Departments
• $1.1b for training doctors, nurses and allied health workers
• $600m elective surgery waiting list reduction plan
• 36 GP superclinics with 26 contracts signed
• MBS and PBS access for NPs and midwives

The report identifies actions that can be taken against three reform goals:

1. Tackling major access and equity issues that affect health outcomes for people now;
2. Redesigning our health system so that it is better positioned to respond to emerging challenges; and
3. Creating an agile and self-improving health system for long-term sustainability.
   

The Minister spoke about a number of areas: hospitals, primary health care, prevention and areas of special need.

Hospitals:
new access targets, new way of funding, separating emergency and elective care,
strengthen sub-acute care, commonwealth to assume responsibility for outpatient
services
Primary care: commonwealth leadership, more primary care centres, more roads leading to community health services rather than ED in hospitals, voluntary enrolment with a single provider is a contestable idea, better integration, multi disciplinary
teams
Prevention:
10 hear goals and how to engage the whole community, making prevention a focus in
the health system, more information to help better choices

The Minster said:

"whatever we do in the health, it doesn't come cheaply. there are high needs and demands as well as high costs"

Cost of reform has been calculated to be between $2.8 - $5.7b per year and this does not include estimated $3.9b for denticare scheme (through 0.75% increase in medicate levy).

The Minister threw out a number of challenges for consumers including the funding mix and the separation of elective surgery and emergency departments.

The Minister said that the treasury advice on the mix of funding for health care between out of pocket, government funding and private health insurance is about right and recommend maintaining the balance. This is certainly a point of contention with consumers. We pay through our taxes, through private health insurance premiums and then again with out of pocket expenses (co payments).

After the Minster finished her presentation we had an hour for questions and comments from the floor. I will post on the issues raised by consumers later in the week.

http://www.yourhealth.gov.au/

The Minsiter's press release is available online.

ACT Health Calvary Consultations

I attended two ACT Health consultations on the proposed sale of Calvary on Friday 16 October 2009. The one at Calvary had around 40 people, including a few Calvary staff and other 'minders' and there were around 30 at The Canberra Hospital.

Katy Gallagher responded to many questions and comments. There were a wide range of issues covered.

Questions from the floor included were:

Were there complaints about the performance of Calvary? and is this what has prompted the Government to approach the Little Company of Mary to purchase Calvary Hospital?
How is the Catholic spirit and ethos going to be maintained in a government run hospital? Will the pastoral care team remain as it is?
Why wasn’t consultation started earlier in the process of discussion between Calvary and the Government?
Why are the times for consultation limited to day time? Will the Government consider running forums after hours or on the weekend?
Why is Calvary taking money for the sale when it was built with public money?
What will happen to the hospice f the sale of the hospital does not occur? Will the Government still want to sell it?
How do the Little Company of Mary Sisters feel about the sale of the hospital and Clare Holland House?
Can the costings be trusted? Would the Government consider a cost-benefit analysis?

The responses to questions were largely answered based on the material contained in the Government's information paper and other consultation documents

healthdirect

As many of you know healthdirect Australia is a joint initiative of the Australian Government and the governments of the ACT, NSW, NT, Tasmania, SA and WA. healthdirect will be made progressively available to residents of Tasmania and is scheduled to be a fully national service by 2011.

It provides residents with a source of health-related information and advice over the phone and online. It provides a 24-hour telephone health advice line staffed by Registered Nurses to provide health advice.

HCCA has been meeting regularly with an ACT Health representative of the National Health Call Centre Network raising consumer issues regarding this service. The extent to which consumers are shaping the development of this service is somewhat limited at the moment and we have been advocating for more formal arrangements.

We have an ongoing interest in the public reporting of the efficiency and quality of this service.

The NHCCN has made a number of reports available on their website including the Quarterly Report for April ‐ June 2009.

Department of Health (WA) previously published quarterly reports specific to WA however it appears this no longer occurs. The most recent link is to the national report prepared by the National Health Call Centre Network Ltd.

We are interested in what consumers consider to be good indicators of quality in terms of this service.

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Community Consultation on Government purchase of Calvary Hospital

The Little Company of Mary Health Care has agreed in-principle to sell the hospital to the Government for $77 million. The ACT Government and Little Company of Mary Health Care (LCM) have reached in-principle agreement on the proposed changes and is now in a position to put forward a proposal for community consultation and feedback.

The Government has announced a six week consultation period regarding the ownership and governance of Calvary Public Hospital and Clare Holland House. The consultation period is from 1 October 2009 to 12 November 2009 and will include a number of community forums during October. There also a specific website www.health.act.gov.au/calvaryconsultation which also provides avenues for our community to feed in our views.

The consultation period provides an opportunity for the community to be informed of the proposal and express our views. This is by no means a fete accompli. The Government will hear from staff and community members about concerns and perceived benefits of the deal. This is the time that consumers and carers need to take time to consider the proposal and provide feedback to the Government.

The Government will make a final decision about the sale at the conclusion of the consultation period. If a decision is taken to proceed with the changes, an Appropriation Bill would be introduced into the Legislative Assembly for debate.

HCCA considers that the community will derive benefit by transferring direct responsibility of the public hospital from LCM to the ACT Government. The Government considers that this transfer will provide the opportunity to develop one seamless and integrated public health care system for the ACT and surrounding region, and to maximise efficiencies through a single governance arrangement, with consistency in policy and health program management. Should the Government decide to proceed the implementation will be critical to realising the benefits for our community and improving health outcomes for consumers.

The cumbersome cross‐charging arrangements were highlighted in the 2008 Auditor General's Report and are a direct result of there being no formal commercial separation of the public and private arms of the Calvary operation. This sale of Calvary Public Hospital to the ACT Government can remove this issue. It can also generate efficiencies by reducing duplication of a range of services including human resources and technology and streamline financial, administrative and clinical management within the ACT Health structure.

LCM plans to build a new co‐located private hospital on the Calvary site which forms part of the proposed agreement. This facility would be operated by LCM and replace the current Calvary Private Hospital once constructed.

Written submissions can be provided by:
email calvaryconsultation@act.gov.au or
mail Calvary Consultation, ACT Health Policy Division, GPO Box 825, Canberra ACT 2601