So, what do you think of the ACT Budget? Our initial response.

We see a continuation of the modest growth in heath funding to advance the ACT Government’s plan for our city. The Health budget hits $1.5 billion, around a third of the total ACT Budget. The Government is very clear about their commitment to providing health services and they are moving in the right direction.

The fun begins now with the analysis of the 

Budget Papers.

On the whole this is a Business-As-Usual budget. It continues to deliver on the services announced last year, including the continuation of specialists at the Canberra Hospital Emergency Department ($5.7m) and increase in outpatient services for women and children and the Centenary Hospital ($4.3m).

Construction of University of Canberra Public Hospital starts in 2016. This will be a welcome addition to the public hospital system in Canberra. A part of this project is the provision of car parking, often dismissed as a trivial issue. We are very pleased to see that the arrangements have been finalised and made public for parking at the University of Canberra Public Hospital. During the recent consultation on the Reference Design the car parking was not finalised and raised more than a few eyebrows. It is now known that there will be 400 off-site car spaces. There are no dollar amounts included in the budget papers as this is deemed commercial in confidence. (It does make me wonder how contentious funding for car parking must be). It is not clear if the car parking will require user payment.

Some of the good news of this budget is the additional funding for Calvary Hospital. There is a clear vision to have Calvary and Canberra Public Hospitals as part of a networked, integrated health system. There is $5.6m for the upgrade of the Cavalry Public operating theatre and a further $3.7m for upgrading of medical imaging equipment. There will also be additional beds at Calvary. It is important to enhance Calvary so that they can play an increased role in elective surgery into the future.
The draft Clinical Services Plan on the Time to Talk Website from 2012 set this out:

To achieve the most efficient and effective use of resources, it is essential that the ACT’s two public acute hospitals operate as a network with clearly defined roles for each hospital that complement and support integrated service delivery. Roles will be defined by:  the level of acuity of care delivered; and clinical specialty. To explain the acuity of care that a health facility is able to provide, a system of ‘role delineation’ is commonly used in Australian jurisdictions. The Health Directorate has utilised the NSW Health Guide to Role Delineation of Health Services as the basis for delineating the roles of the Territory's hospitals within networked arrangements. p. 26

Prior to the budget the Minister announced an increase in the number of beds in intensive care at Canberra Hospital. Provision has been made for $10.2m over four years. This demonstrates the significant costs of this level of care: intensive care costs an enormous amount of money.

Another big ticket item is the continuation of additional funds to enhance the numbers of people who can access elective surgery. The Government has invested strongly in this area in the past with funding last year to provide surgery for an extra 500 people. They have committed to funding an additional 500 surgeries again for the next two years, at a cost of $7m per year. This will improve waiting times. This funding will stop in 2017-18 unless there is extra funds from the Commonwealth Government.

Care in the Right Place is a new program with funding of $14m over four years. This includes increased access to cancer outpatients services, providing more doctors and establishing a central intake services in the Cancer Centre to streamline access.

This program also makes provision for an expansion of pain management services. This comes on the back of the increase in funding last year where $9m was allocated for this. It is not clear how much is specifically set aside in this budget. People living with persistent and chronic pain are not well served by our existing services and this allocation will make a difference.

Hospital in the Home is also a good initiative and has received additional funds, building on the expansion of this service last financial year. There is $1.4m over four years to increase the number of people who receive care at home as well as come to the day clinic for registrar review.

There is good news for end of life care. There is $2.4m over four years to enhance the provision of hone based palliative care. We know that this is a valued service in the community that is over subscribed. Additional capacity in this area is very welcome. This is in keeping with the ACT Government Palliative Care Services Plan. 

In addition to the increased bed capacity, allocation of resources should also be considered to support a range of other modalities including home based care, day hospice and respite care. p.12

Nick Wales joined me at the
ACT Budget lock up today

Last year the ACT Government took the decision to absorb the cuts announced in the Federal Budget. This year the financial position has been compounded by the Government response to the Mr Fluffy Asbestos and the reduction in GST revenue. This means that we are facing a deficit of $407m.

The Treasurer stressed that unlike other jurisdictions, including the Commonwealth, the ACT Government does not borrow money to fund recurrent operating expenses and that they run a cash surplus every year.  They only borrow for infrastructure projects that add to the asset base of the Territory. And this budget does contain infrastructure spending for the health sector.

This budget has allocated funds for 16 more beds at both Canberra and Calvary Hospitals ($40.6 m). This is in additional to the beds announced in last year’s budget. This is welcome news. We continue to see more people presenting at the Emergency Department requiring admission and Canberra Hospital has been under significant pressure, routinely operating at over 90% capacity.

The ACT Government seems to have prepared a budget that balances the needs of infrastructure and business with the needs of people. One of the concerning elements will be in the out years, when the full effects of the of Commonwealth funding of the national Partnership Agreements takes hold, from 2017-2018. The big question that we need to address is how can we sustain this into the future?

Darlene Cox

Executive Director
@darlenecox

Patient Journey Boards Improving Patient Flows

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

Expanding Hospital Services in the ACT - ACT Government discussion paper

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.

LCM response to HCCA comments on staffing

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

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.

Proposed Sale of Clare Holland House

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

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.

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

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