Showing posts with label Consumer Representatives. Show all posts
Showing posts with label Consumer Representatives. Show all posts

Monday, February 8, 2016

Update - University of Canberra Public Hospital

Invitation to the event
On Monday 8 February HCCA staff attended the smoking ceremony and sod turning for the University of Canberra Public Hospital, the new rehabilitation hospital which is being built on the grounds of the University of Canberra

HCCA has been very involved with this project. Our involvement dates back to 2010 when we first proposed a sub-acute hospital to the then Minister for Health, Katy Gallagher.

Since that time we have undertaken plenty of research, reading articles, attending conferences, talking to consumers about their experience, and visiting similar facilities in other places. All of this informs the positions we take when we advocate for design of the building - including car parks - as well as the way care will be delivered. 

Yelin Hung, Darlene Cox and Nick Wales at the site of UCPH.












Consumer representatives have participated in User Groups to date. These are groups that bring together consumers and clinicians to consider planning issues. User groups have been focussed on many aspects of the design, including the main foyer, hydrotherapy, pharmacy, equipment loans, medical imaging inpatient rooms, rehabilitation day services and pathology.

An important aspect of the event was a smoking ceremony, to cleanse and refresh the land before construction begins.
Duncan Smoth from Wiradjuri Echoes conducting the smoking ceremony

Minister for Health, Simon Corbell
Following the smoking ceremony, both Andrew Barr MLA, the Chief Minster and Simon Corbell MLA, the Minister of Health spoke, outlining the role the University of Canberra Public Hospital will play in helping improve access to health services for the ACT. The Chief Minister also stated that health is the Government's number one priority

Finally to mark the official start to construction of the University of Canberra Public Hospital Andrew Barr MLA, Simon Corbell MLA, Meegan Fitzharris MLA, Chris Bourke MLA and Vice Chancellor Professor Stephen Parker turned the first sod on the site. And yes, there were a few jokes about how many Minsiters and Vice Chancellors it takes to turn a sod.

Handshakes all round for the sod turning.


Work is expected to start in the coming weeks, with the fence up around the site on the corner of Aikman and Ginninderra Drives in Bruce. The site is clearly marked with a banner on the whole external fence.

Work is also continuing on the Final Sketch Plan for the hospital with great involvement from consumer representatives. Last week the consumer representatives that will be involved in the User Groups came along to and induction to have a look at the current plans and what will be involved in the User Groups. It’s fantastic to have so much involvement from our members to help improve the design.

The current date for completion and opening of University of Canberra Public Hospital will is early 2018.

There is more information online, including this video.


Darlene Cox
Executive Director

Thursday, November 19, 2015

Medicare Benefits Schedule Review Consultation :President Report Dr Sue Andrews

On 26 October I attended a Consumer Workshop in Sydney, one of several convened by the Consumers’ Health Forum as part of the government’s consultation process for the Review of the Medicare Benefits Schedule (MBS).

The workshop was attended by a diverse range of consumer advocates and organisations including Breast Cancer Network Australia, Pain Australia, and the Australian Patients Association

The Minister for Health, Sussan Ley, gave some introductory comments about why the MBS needs to be reviewed and why consumer and carer input is critical to that process.
Professor Bruce Robinson, Chair of the Review Taskforce, then gave an overview of the Review, key issues in the Consultation Paper which is providing the basis for their call for public submissions.

Professor Robinson also provided an update on progress with the Review. Its first report to Government is due in December 2015.

MBS review activities have been distributed among several groups including Clinical Committees, a Principles and Rules committee and Item-specific working groups.
Of the 30 Clinical Committees, 6 priority areas were launched in October – Obstetrics, ENT, Gastroenterology, Thoracic Surgery, Pathology and Diagnostic Imaging.

The input received so far draws on a wide variety of experiences with the MBS:


  •  250 people have submitted feedback online, representing all states and territories.
  •  126 clinicians or health professional organisations, 96 consumers or carers, 20 others.
  •  Carried out a triage of items,
  • Created a preliminary list of obsolete items is being examined further,
  • Targeted areas are being moved into evaluation (eg sleep studies, pre-natal testing) and,
  •  Several new items have been proposed.
  • Referral regulation: Consumers and clinicians have asked to re-evaluate the three month limit on specialist to specialist referrals. This limit can force clinically unnecessary ‘renewal’ consultations.
  • Rural Delivery: As rural delivery models and workforce levels evolve, stakeholders have asked for updates to geographic adjustments such as exemptions and cost adjustments.
  • Ongoing item reviews: Stakeholders suggest that more frequent ongoing reviews could make the MBS a ‘living document’ improving the quality and relevance of procedures for patients.

The Review has already;



The Rules Committee is considering cross-cutting issues whose implications extend across the Clinical Committees including but not limited to;
Finally, there was some focused discussion around the key themes of the inquiry – unnecessary medical consultations, procedures or tests; application of Medicare rules; information requirements to make decisions about services; and how consumers could be engaged in the review process. 

The final discussion explored how consumers and carers could be better engaged in the Review process. The Review Taskforce have suggested consumers be involved as members of Clinical Committees, through public consultation on draft recommendations and through health consumer organisations. However they don’t have a clear consumer engagement strategy at this stage. Participants discussed other options such as social media and pointed out the importance of meaningful engagement with Aboriginal and/or Torres Strait Islander communities, Culturally and Linguistically Diverse communities, and refugee and migrant communities.

The MBS Review website contains all relevant information about the program, including outcomes of the consumer and stakeholder forums:


Dr Sue Andrews
President, HCCA

Friday, November 6, 2015

Health in Difference Conference Report By Elizabeth Proctor Health Care Consumers’ Consumer Representative & Eleanor Kerdo Policy Officer HCCA


Elizabeth Proctor:
In mid August I was lucky enough to attend the first day of the 9th National LGBTI Health Conference Health in Difference (and I apologise for the delay in reporting back!). The most striking thing about the conference was how thoughtfully the program and speakers engaged with the overlaps and interactions between healthcare provision and marginalisation of groups. A special focus was placed on how Aboriginal and Torres Strait Islander and culturally and linguistically diverse LGBTI peoples face multiple disadvantages, both when seeking healthcare and more broadly.

The conference speakers shared stories that showed how far we’ve come in LGBTI communities, but also how much work remains – a lesbian mother who in the 1990s snuck into hospital to care for her baby (it took the hospital a week to notice there were two mums taking turns), Bob Brown’s memories of shock therapy and seeking out so many psychiatrists before finding one who gave him the best advice (‘Bob, sounds like you’re gay. Why don’t you try accepting it?’), Muslim-Australian siblings challenging the western notion of ‘coming out’ (instead, invite your loved ones into your life), and lawyers advocating for sex-positive aged care facilities (why aren’t there any double beds?). In a bright spot for aged care, Human Rights Commissioner Gillian Triggs pointed out that the recent change of law for inclusive facilities was almost surprisingly uncontroversial; updating the Sex Discrimination Act so religious aged care facilities were not exempt from LGBTI non-discrimination was met with general acceptance across the community.

Eleanor Kerdo:

On day 2 Eleanor swapped in and attended the ageing and aged care stream. There are lots of organisations working on making aged care facilities (ACF)  and services more LGBTI inclusive, both at a policy and personal level. Silver Rainbow is offering training on inclusive practice to ACF staff, while the Department of Social Services is developing formal standards for LGBTI inclusive aged care. Palliative Care Australia is similarly working on LGBTI specific policy frameworks. On a frontline service level, Switchboard Victoria provides community connections to isolated LGBTI elders through the good old cup of tea, connecting them to new friends who can build their confidence and support them settling into aged care.

Philomena Horsley of Gay and Lesbian Health Victoria (LaTrobe University) presented on LGBTI people’s experiences in end of life care and reflected on the history of end of life care in the LGBTI community. At the height of the 1980s HIV-AIDS epidemic, the LGBTI community was at the centre of an underground end of life care and euthanasia movement to support terminally ill patients with AIDS. At that time a large number of nurses and doctors could see a clear need for those services and took big personal risks to provide care. As conversations about dying with dignity become prevalent again it is timely to reflect on those moments in history that were so compelling to past generations.


Several community groups expressed an interest in HCCA’s Advance Care Planning Project, and Christine is looking forward to working with LGBTI communities in Canberra to help people develop aged care plans that work for them.

Thanks for sending us to this conference we thought it was excellent!

Wednesday, November 19, 2014

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

Delegate:  Susan Westwood, Health Care Consumers Representative

Program
What is the drug policy?

Topics
E-cigarettes
Drug driving
New psychoactive substances
Medical Cannabis

What is the Problem?

Preamble

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

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

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

Event Observations

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

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

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

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

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

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

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

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

What is the Problem?

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

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

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

Common Themes from Conference Presenters

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

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

Dr Coral Gartner, University of Queensland

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

Ms Joanne Baumgartner, Health Care Consumers Association

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

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

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

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

Dr Monica Barratt, University of New South Wales

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

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

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

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

Emeritus Prof. Laurence Mather, University of Sydney

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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



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

Monday, November 17, 2014

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



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

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

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

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

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

e-Cigarettes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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


New Psychoactive Substances (NPS) 

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

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

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

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

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

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

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

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

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


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

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

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

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


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

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

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

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

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

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



Quantum Leap 2104 Conference Report -Lisa Harris

The massive white 
Novotel Brighton Beach Sydney
1970s developer’s folly dominating the landscape as you fly into Sydney is the Novotel Brighton, which was the location for  the Quantum Leap conference  ( Sept 9-10). An opportunity for the organisers Australian Healthcare and Hospitals Association (AHHA) and the Australian Council on Healthcare Standards (ACHS) to combine their annual conference with a look at health innovation and research. I was there on behalf of the HCCA along with a couple of hundred other delegates exploring this notion of the Quantum Leap, which, according to ACHS Christine Dennis is the emergence of patient safety into the 1,400 hospitals across Australia.


On day one delegates discussed the big news in first world healthcare - the recent mammoth task of reforming the US health system. So there was a lot of anticipation to hear keynote speaker Prof John McDonough from Harvard University, a key health adviser to the Democrats and co‑developer of Medicaid or Obamacare. The brutal politics of reforming the US health system were laid bare by McDonough. The fundamental hurdle? It just wasn’t part of the US national identity to have equity in the health system. That made it a tough gig and a ‘kinda nutty time’ staring down the republicans, educating for a new system, and most importantly a new set of American values. He talked of the financial imperatives for change - that US health spending was out of control but there was no corresponding benefits to quality, access, cost, equity or mortality. Extraordinary also was the brute fact that medical costs were the highest cause of personal bankruptcy in the US. What really hurt, quipped the affable McDonough, was the fact that the US had ‘Canadian Healthcare Envy’.
Coupled (interestingly) with the fact that all major US health associated sectors wanted change, was the Affordable Care Act. Amongst other changes this guaranteed health insurance to all Americans and immigrants, except of course to those on low incomes in the states that vetoed reform. Interesting was the fact that hospital and physician quality reporting and ranking is an integral part of the US reform package.

In addition the primary aim of the new US system is to improve the patient care experience, as well as a lower per capita cost of care and improving the population health. McDonough closed with the thought provoking comments that perhaps Australia can learn from the US move to transparency and accountability in health insurance and financial incentives for outcomes.

At this point at the conference I quickly realised a few things, in addition to noting that Australia’s largest private hospital provider Ramsay were on the speakers’ agenda.* Firstly, people often confuse the HCCA with the CHF (Consumers Health Forum). Secondly, just who thought it was a good idea to put the giant platters of jam donuts at a health conference!! By far and away my biggest anxiety was the fact that I looked like I was the only health care consumer in this crowd of 250 or more. That probably makes sense as the bulk of the sessions on day-one were ‘process technology’ (my terminology). These presentations talked about the benefits of hospital technologies like SmartWard (electronic lanyards for nurses), Lean Thinking (a kind of brain training for managers) and the companies that make the technology (Cerner). In this context we heard about Australia’s first fully integrated digital hospital St Stephens in QLD’s Hervey Bay, where 30 devices manage everything from patient entertainment, dispensing cabinets and enable real-time nurse location. Their mantra is One record, Multiple Users, Multiple Locations. They made it sound a reality but I wondered how the doctors and nurses adapted to these new ways of doing business?


One of the most powerful conference statements came from Dr Mark Britnell who after 20 years in the NHS now heads KPMG’s Global Health Practice. ‘As individuals we wouldn’t fly if the current random control systems at work in healthcare were adopted by the aviation industry.’ Britnell who performed with the ease of a Ricky Gervais at the podium – ‘Hey guys help me out here’ was the message to the audience when one of his questions drew a blank response. ‘Taxi, Britnell’ was the call when he felt he had delivered a particularly witty response to a query. Notwithstanding slickness his message was both confrontational and common sense. He observed that the siren call of power, not the aim of delivering better care for patients, is often the primary motive for regulating healthcare. Britnell’s bruising experience with NHS bureaucrats and UK politics has led him to some tough conclusions, that the healthcare industry must gain control over quality and become obsessed with outcomes and safety.


One of the best speakers had one of the smallest audiences, Dr Bronwyn King from Epworth Hospital talked with modest charm how she took on the local superannuation industry – who were channelling super money into the tobacco industry - and won. This was a great example of a health professional - who as a cancer specialist was appalled that health industry super funds were divested into big tobacco - became a policy activist.
Consumer engagement didn’t focus strongly at the conference with one panel session dedicated to the issue. An interesting angle might have been to look at the incredibly rapid technological developments in patient safety and hospital practice and compare that to the relatively slow emergence of consumer engagement. What is the role of universities, medical associations and hospital bureaucracies in fostering genuine consumer engagement? Nevertheless, Mary Draper from the Health Issues Centre made the call for an ‘equal partnership’ between consumers and clinicians. My observation that despite displaying lip service to patient communication, fundamentally doctors are trained to be intellectually superior was shot down in flames. The Canadian health system, where consumers are fully engaged in governance arrangements, was once again hailed, this time by the Australian Commission for Standards in Quality Healthcare’s Nicola Dunbar. It led me to thinking that while embedded consumer practice is achievable, selling the practice will be a long road. A brilliant question from the floor to ‘bring back the joy’ in healthcare, or in other words more dopamine and less adrenaline had the audience smiling.


There were some wise words to come out the conference final forum including those from Elizabeth Koff from Sydney Children’s Network, that branding and rebranding in the name of reform is a big issue in Australian healthcare. This was a pervasive theme. The influence of political ideology on health policy and the nature of bi‑partisanship were also keenly debated at conversational level, with Medicare Local staff I spoke to exasperated at the turn of recent events. Are consumers the ‘secret weapon’ to break down the barriers one delegate wondered? With that and a sincere tribute by the chair to the long-time efforts of the HCCA’s Russell McGowan, among other health advocates, it was time to dream of a future of a free and fair system deserved of a wealthy county devoid of funk and day to day circumstance and head back to Canberra.


*Ramsay’s secret to effective consumer participation in its 70 hospitals across Australia lies with external providers assessing patient satisfaction.

By Lisa Harris