Alcohol, Tobacco and Other Drugs Association (ATODA) Election Forum

On 11 September I attended the ATODA Election Forum.  It was an interesting forum, with interesting speakers and presentations.  This is a brief outline of issues raised and discussed.  Members of the ACT Legislative Assembly attending were Ms Katy Gallagher (MLA, ACT Chief Minister and Minister for Health), Mr Jeremy Hanson (MLA, ACT Shadow Minister for Health), and Ms Amanda Bresnan (MLA ACT Greens Health Spokesperson)

The session was Chiared by Justice Richard Refshauge

Justice Refshauge spoke about:

• the damaging consequences of secondary harm, particularly its effect on families.

• 95% of work in courts resulted from use of ATOD

• looking closely at evidence was particularly important, in context of policy development, because evidence is not always intuitive

• importance of ATOD education in schools

• problems of alcohol related violence

Implementing evidence based school drug education

Associate Professor Richard Midford (Centre for Indigenous Australian Education and Research at Edith Cowan University)

• young people are a particularly vulnerable group

• education in schools especially effective, because they are a captive audience

• importance of “inoculating” children before they become “attractive”

• it’s cost-effective – prevention far cheaper than cure

• alcohol is by far the biggest problem among 14-15 year olds, followed by tobacco

• 75% of high school children have tried alcohol by age 13

• 41% are current drinkers by age 17

• 7% of 13 year olds drink in a manner causing risk

• research is important, but Australia needs its own research,and not rely on research from USA and UK, which is often not relevant to Australia

• Australia has good reputation in research based on harm minimisation – much of it is exported overseas

• cognitive/group learning methods are good, but teachers must be properly trained too

• important not to focus on changing attitudes, because this isn’t necessarily linked to changes in behaviour

• a Drug and Alcohol Education Program (DEVS) will be rolled out across schools in Victoria from September 2012.  The program for Years 8 and 9, was developed as a partnership between the Department, Edith Cowan University and the Youth Research Centre at Melbourne University and won the Excellence in Prevention and Community Education Award at the National Drug and Alcohol Awards on June 22 

• DEVS is based on thorough research and evidence. It’s a good initiative, because Australia does not do well at setting up ongoing drug school education. The results show it improves students’ knowledge and decision-making, increases communication with parents and reduces risky drinking. Students learn about the effects of drugs and alcohol on the body, the social pressures that encourage alcohol and drug use, and practical skills that help them to avoid drug use and how to remain at low risk of alcohol harm

• DEVS didn’t convince participants to stop drinking, but did lead to a reduction in amount of alcohol consumed and subsequent harm.

Effective policy responses to alcohol and related violence

Mr Tony Brown (NSW Community Campaigner for the reduction of alcohol related violence)

• this presentation focussed on Newcastle

• violence is concentrated around licenced premises

• alcohol related violence had been reduced by 37% in Newcastle as a result of restricting licencing hours

• Proust’s words – “The voyage of discovery lies not in seeking new vistas, but in having new eyes”, highlights the disparity between evidence and what’s actually happening on the ground

• ACT and NSW have a balanced approach to the problem

• most harm resulting from alcohol consumption is unintended injury (eg falling over/hitting head/traffic accidents)

• less than half injuries resulting from alcohol consumption is criminal

• the 2008 Intervention in Newcastle was one of the most successful programs in reducing harm caused by alcohol consumption

• responsible service of alcohol, reducing trading hours and hotel density are key and has overwhelming community support

• the methods the alcohol and hospitality industry have advocated have not worked

• a level playing field -  an apolitical, bipartisan approach needed

Addressing tobacco and disadvantage

Mr Ray Lovett (Australian Institute of Aboriginal and Torres Strait Islander Studies and National Centre for Epidemiology and Population Health, ANU)

• 11% of people in ACT smoke

• various strategies to reduce/quit smoking discussed – group therapy is most effective (2.4 times more likely to quit); individual therapy (1.2 – 1.6 times more likely to quit); similar ratios for telephone and motivational incentives

• screenings by health professionals are good, but not conducted frequently enough

• social marketing and media campaigns effective

• where to focus efforts? – justice system; blue collar sector; unemployed; Aboriginal and Torres Strait Islanders

• every dollar spent on tobacco control delivers an overall saving of $1.30

Q&A Panel Session

What ideas does the panel have to ensure consumer participation is embedded in drug treatment?

Comments included:

• There must be a balance between evidence and reality on the ground.  Consumer voice is important, but there must be a compromise between the solution and meeting consumers’ needs.  Important to listen to consumers and include their views in health policies.

• If consumers are involved, you get a better outcome.  ATOD consumer participation is an area that needs development/encouragement and ATODA is working on this.   Depends on the area – eg consumer participation in surgery is poor.  ATOD, as a unit within health, will improve.

• Training for consumers is vital.  There is an excellent opportunity to build a good model of consumer participation in the ATOD sector through ATODA working with HCCA to build that model.

What is the panels’ views on holding young people in the Watch House?

Comments included:

• Watch House is a last resort.  It’s really a sobering up facility.  Ideally it would be good to have another facility specifically designed for children.  However, this isn’t necessarily easy/practical in such a small jurisdiction.  Agreed young children have range of needs and important to get the model right.

• The correct setting for young people depends on the individual/circumstances/behaviour.  Sometimes, the Watch House is a suitable place.

• Greens support expanding facilities for young people.  Very important to prevent children becoming involved in youth justice system.  Definitely should be separate service for young people.

$4 million was allocated for random roadside drug testing, but there is little evidence to show that it has been effective.  Would the panel support implementing an evidence-based social marketing campaign? And would the panel support a formal evaluation of the program?

Views differed on efficacy of the program. 1 in 60 people in Australia drive while under the influence of drugs and in ACT it is 1 in 40.  Effective marketing of the program is needed.  Currently the program is in its infancy, but doing well.  

There will be an awareness campaign in 2013 and the Road Safety Trust will do an evaluation.  As the police become more familiar with policy and procedures, costs should be reduced.

What are the panel’s views on the second Australia 21 Report?  Does it agree with one of the outcomes of the recent meeting that there is a need for National Summit on the topic and a referral of the issue to the Australian Productivity Commission?

Comments:

Ranged from disagreement with Australia 21and believing there is no need for referral to the Australian Productivity Commission (APC), to welcoming involvement of APC, because, this would remove politics from the process.

What are the panel’s views on flexible payment options for vulnerable people/groups?  What about people who are fined who cannot pay?

Comments:

• Policy work is being done on this.  Issues need to be dealt with other than by handing out financial fines.

• Balance needed here.  Fines and penalties are there for a reason.  Often they achieve their objective as acting as a deterrent.  But agrees there is no point in fining people who cannot pay.

Is there capacity for more young people to have their problems addressed by the health, rather than the justice system?

There was unanimous support from all parties on this one.

Evidence shows outcomes for young people and the community are better if young people avoid the criminal youth justice system.

Policy needs to be tailored to specific needs.  The availability of alternative programs is important.  

Karen Jameson

Policy Officer

Comment on Liberal Health Policy

There is an undeniable and urgent case for the proposed development of the the health services infrastructure in the ACT. This development is essential to meet the projected demands of an expanded population together with an increased proportion of elderly. The Health Care Consumers' Association of the ACT supports the Capital Asset Development Program implemented in the 2008-09 Budget by the present government. The commitment given to this Program by both of the major parties is most welcome.

HCCA has considered the Liberal Party Health Policy and is however concerned that their policy only covers a funding period to 2011-12 and does not detail further funding for the year 2012-13 as the Labor Party policy does. This makes direct comparisons between the costs of the two policies difficult.

It is appears even in the period to 2011-12 the Liberal Party policy provides a lower level of recurrent funding to meet the projected growth for ACT health services of demand and the operation those new facilities scheduled to commence operation during that period. These will include the expanded cancer services and the new neurosurgical operating suite. Using the Treasury costings we estimate the shortage to be in excess of $120m.

Part of the difference can be explained by the number of Liberal Party policy initiatives which only detail expenditure for one or two years, such as the GPs for Canberra Fund, payment for West Belconnen Centre and the suicide prevention strategy. Most of these will require ongoing funding beyond the initial input.

Comment on Liberal Party Health Policy

eYesterday the Liberal Party launched its health policy, promising an extra 80 new hospital beds, 37 new emergency beds and a 'super theatre' at Calvary Hospital for elective surgery. We are yet to read the detail and have received advice from Mr Seselja's office that the health policy will be available on their website by 4pm today.

At this stage we can say that any additional spending on health care is welcomed however we would prefer the expenditure was planned and working towards introducing new models of health care rather than committing to more of the same.

We do not consider that the invective of 'war on waiting lists' is beneficial. We look forward to reviewing the policy to ensure that there is a level of details that moves beyond this.

We ask the Liberal Party to commit to working collaboratively with consumers to achieve a rational and sustainable solution to the growing demand for health services.

As you know, Health Care Consumers' Association has been advocating for more options to ensure that our community received appropriate care in a variety of settings. Hospitals are not always the most appropriate setting for care and we need to provide options for consumers to access primary health care and other community based services.

We support the refurbishment and construction of community health centres. We are also supportive of redefining roles within the health workforce to help meet the increasing demand for services. We are also keen to see progress on the development of systems to support electronic health information, including electronic discharge summaries and electronic prescribing.

Once we have seen the details of the policy we will be able to comment further.

Darlene

ALP health policy for the election

aThe ALP has released its health policy. We have had an opportunity to consider the policy and have come up with the following thoughts:

The ALP Health Policy seems to provide an integrated and comprehensive plan for the development and delivery of health care for 2012, touching most bases and linking existing and recent expenditure and policies.

The standout issues are:

• $250m expenditure on new and expanded heath services over next four years
• Infrastructure of $150m per year, including:
• additional hospital facilities and beds, community health centres, walk-in-centres, and e-health
• staffing for new facilities including, Women’s and Children Hospital and Gungahlin Health Centre
• $20m over next four years to support health workforce – expanded roles of allied health professionals, doctors, nurses and assistants
• $10.3m over next four years to support people living with chronic disease
• $11.3m over next four years to support a healthy future – health promotion, including $6m for children and $0.3m for adolescents and young person
• $35.6m over four years for acute, rehabilitation and community based services for older citizens.

Surprisingly there is no mention of consumer role/input into ACT Health planning, management or evaluation of health services. Given that this government has involved consumers in the planning of health services I would have expected to see an explicit statement of commitment around this.

There is also no explicit reference to engaging consumers at the individual level to be more involved in decision making around their care.

The additional $2m to support the implementation of e-health and smart technology initiatives does not appear until 2012-13 – this seems a long delay. There is certainly a number of things that could happen in this area, especially around electronic discharge and electronic prescribing. We are puzzled by the delay.

We are interested in your thoughts.

Consumer Issues on the Agenda in the ACT

Thank you to the members who took the opportunity to listen to and ask questions of the candidates in the upcoming ACT Election. The event was well attended and a great success from our perspective.

Our election forum brought good news for consumers as all candidates supported a number of the issues HCCA has identified as critical.

All candidates spoke of the need to plan and prepare for our ageing health population. This starts in 2016 and peaks in 2032 when a quarter of our community will be over 65. There was support for the program of infrastructure renewal that is currently underway of Canberra hospital, refurbishment of existing community health centres and building a new facility in Gungahlin. HCCA is advocating for development of community based health services rather than locking up all resources in a hospital-centric system. We want a health system that enables timely access to services in the most appropriate setting, which is not always in hospitals.

All candidates support expanding roles of allied health professionals and nurses however candidates vary in their degree of understanding of what these roles are and how they will contribute to reshaping our health system. We are very keen to see development of roles. There are some concerns expressed by doctors groups around the safety of nurses taking on more primary care roles. We do not consider this to be a barrier as with any medical professional there needs to be checks and balances in place to assure the community the health professionals are competent and working within their defined scope of practice. This includes the recognition of the value of multidisciplinary teams; the new health workforce will not have room for people who are not team players.

The candidates were all supportive of e-health initiatives including electronic health records, electronic prescribing, digital imaging, and electronic discharge summaries.

Most questions were for the Minister and included:

• Use of inert materials in new buildings and refurbishment
• palliative care services at the hospice and community
• Need for health interpreters to work across health and aged careto assist with translation
  
• How to safeguard patient information in electronic health records
• access to dental care and the role of dental hygienists
• more information on the Cancer Centre of excellence
• continuity of care for all maternity services, rather than just the Community Midwifery Program.

ACT Election Health Forum

We are holding a ACT Election Forum for the Canberra Community on health issues on Wednesday 24 September 2008.

There will be an opportunity to have members of the Assembly and candidates answer your questions about our health system.

We encourage you send us your questions in advance so we can ensure these issues are raised in the forum.