A strong budget for healthy communities: ACT Budget 2016

Overall this is a strong health budget that continues to deliver funding to critical services for the ACT.

The commitment to enhancing services for emergency departments and trauma services is much needed. The major announcements are:
- Expanding Intensive Care ($4.6m over four years) to provide one additional bed at Canberra Hospital
- Neonatal Intensive Care ($5.3m over four years) will include two additional neonatal cots. This was always part of the plan with the new hospital bringing on line additional places as the population increased.
- Trauma Services ($5.3m over four years) expanding the major trauma service at Canberra Hospital to provide a specialised model of care.
There is money for more staff with provision made for an additional 39 staff to be hired in the next financial year at Canberra Hospital emergency department, including four new doctors and 24 nurses ($28m over four years). There is also funding for a senior emergency medicine physician at Calvary Public Hospital ($1.9m over 4 years).

Improved palliative care services ($2m over four years) providing an additional paediatric nurse. There will also be an additional palliative care specialist to provide education to treating teams across Canberra Hospital and building capability in palliative care. We are very supportive of both initiatives.

There is an allocation $6m over four years to maintain and expand drug treatment and support services in the ACT. This provides for a range of services including naloxone program, post treatment drug rehabilitation and the Alcohol Tobacco and Other Drug Association the peak body for the sector.

Stroke services at the Canberra and Calvry Public Hospital will receive $5m over four years.  This will employ an additional four specialised staff to provide more timely assessments for clot break-down treatment. This will also allow for improved availability of intra-arterial clot retrieval treatment.

There will be an expansion of outpatient services with the budget allocating $4m over four years. This will include neurology, cardiology, respiratory and sleep services.
Endoscopy services will be expanded by an additional 300 surgeries each year, with a budget cost of $1.2m over four years. This expansion is designed to reduce elective surgery waiting times.

Outreach health services for Aboriginal and Torres Strait Islander peoples will be provided with $1.2m over four years. This is to help deliver appropriate specialised care and support services through outreach services. We are very interested to hear more about this, especially given the ACT Government is in the process of finalising the ACT Aboriginal and Torres Strait Islander Health Plan 2016-2020.

Mental Health has received funding for a range of different programs and services with $43m over four years to be allocated to the staffing and operation of the soon to be open Secure Mental Health Unit. This will allow for the operation of 10 beds that is part of phase one of the Secure Mental Health Unit. There is also an allocation of $2.7m to expand the current bed numbers at the Adult Mental Health Unit from 35 to 37.

Mental health rehabilitation and follow up services will receive $2.9m to establish a Young People’s Mental Health Treatment Team for people experiencing, or at risk of developing mental health illnesses. This will allow for outreach and treatment through intervention. Any additional money for mental health services is welcome but particularly for young people as we know that this is a need.

There is a focus on funding for medical technology that is exciting. Advances in technology have made sequencing an individual’s genome a reality. Genomics is a development in health care that will likely lead to more accurate medical diagnoses and more effective and individualised treatments The Canberra Clinical Genomic Service ($7.3m over four years) will enable more personalised medicine to improve health outcomes. The other exciting aspect to genomics is the potential to reduce unnecessary and ineffective treatment, improving the experience of care of consumers, improve health outcomes and also deliver cost benefits to the health system. The Minister's media release says: "The new genomics program will build on existing research, expertise and achievements of the Centre for Personalised Immunology at the John Curtin School of Medical Research to develop genomics as part of a clinical and diagnostic service in partnership with ACT Pathology." We are pleased that the ACT Government has committed to establishing this Centre and look forward to finding out how consumers will be involved. Involving consumers in research is an important aspect of consumer and community engagement and we are interested in developing a model of participation for this Centre.

The budget includes funding for a feasibility study to assess the benefits of establishing the Australian Pancreas Centre ($200,000 for one year). There is little detail about this but we support the approach. We see that there is value in considering how ACT Health will collaborate with other bodies set up for this such as the Australian Pancreatic Genome Initiative. Pancreatic cancer is relatively uncommon representing about 2% of all new cancer diagnosis but it has high mortality and poor survival rates. It is a disease that can and does devastate families. We welcome consideration of establishing the Australian Pancreas Centre.

There is also $1.3m over four years for the introduction of deep brain stimulation services for people with Parkinson’s disease or other movement disorders. It will be for those people who derive minimal benefit from drug therapy. Deep brain stimulation is a surgical procedure and it has been used in Australia for over a decade. This procedure is offered in other capital cities so this will offer other options for ACT residents.

There are funds set aside for a range of health infrastructure which includes the construction of University Canberra Public Hospital, the much needed sub-acute rehabilitation hospital. There is $360,000 for the business development case of the new Civic Health Centre as the existing Health Centre will be relocated following the sale of 1 Moore St for the ACT Government to derive benefit from the Commonwealth Government Asset Recycling Initiative.

There is $95m for major refurbishment of existing infrastructure to ensure that these buildings meet future health needs for at least the ten years. This includes Canberra and Calvary Public Hospital and also other health facilities around the ACT, including the development of Strategic Asset Management Framework. This is imminently sensible if ageing infrastructure is to be used over the next decade. HCCA has developed a strong model for consumer participation in health infrastructure projects and while it appears that the billion dollar rebuild of the Clinical Services Building at Canberra Hospital is deferred we look forward to continued involvement to improve the existing buildings. The look and feel of health services is important, it builds our confidence in the services. We want health services we can be proud of and will serve our communities well.

The omission from our perspective is the funding for eHealth. Over the past four years there has been funding for Health-e futures, a total of $90m was allocated by the Gallagher Government to build the capability of the public health services for eHealth. There was a small amount included to advance this agenda with $250,000 allocated to determining the feasibility of migrating the Cavalry Hospital ICT infrastructure to the ACT Government network. We are hopeful that the election campaign will bring a renewed focus on eHealth as it is an important enabler of safe, high quality health care.

Darlene Cox
Executive Director

Tour of the Royal Melbourne Hospital

On Friday 12 June Darlene Cox and I went on a tour of the Royal Melbourne Hospital (RMH) in North Melbourne.

We were interested in a tour of the hospital as it is in a similar situation as the Canberra Hospital. The campus is landlocked, meaning roads surround the hospital and there is nowhere to expand on the current campus. Also RMH has undergone and continues to undergo a series of infrastructure upgrades to improve the ageing facility and to accommodate the increasing demand in services.

The RMH has been upgrading older parts of the hospital with various projects completed and include the construction of additional Inpatient Units; Helipad; new buildings and refurbishment of some of the existing building. Some recent upgrades have been the intensive care unit, 300 inpatient beds, as well as upgrades to pathology and medical imaging facilities. The most recent projects are the allied health building and the Emergency Department (ED) refurbishment.

The Community Engagement manager and Director Capital Works, both from Melbourne Health, were our tour guides for the day. We met them both at the main entrance where our tour was to begin.

MAIN ENTRANCE

The main entrance to the hospital was located just off busy Flemington Road. The drop off zone was on street. This is not ideal, however the RMH is completely land locked.

You are greeted at the main foyer with a volunteer’s desk, where they can assist patients and visitors. There seemed to be a very good use of volunteers at the hospital. The main foyer also had a café (café Zouki), bank, florist and gift shop. Even through the space felt cramped with the low roofing it still felt alive and spacious. 

Main entrance to the Royal Melbourne Hospital

EMERGENCY DEPARTMENT

We were very interested in the ED, as it underwent a $53 million redevelopment upgrade in July 2009. It was good to see what was able to be done with a space that could not be extended, only refurbished. It was also useful for the planning of the refurbishment and extension of the existing ED at the Canberra Hospital. 

Triage/administration main desk

The triage/administration desk had cables across the counter rather than glass perspex. Both the patients and the staff preferred the cables over the glass as it was easier to talk to one another and felt less like a compound. The marble front counter was five years old, although you wouldn’t know it. Our tour guide said that the front desk has held up very well to wear and tear over the years. Also the wooden roofing soften both the feel of the waiting room and absorbed a lot of the sound.

The ED has a total of 107 treatment stations, however there was no paediatric stream in the ED as there was an ED at the children’s hospital just down the road. Visitors in ED also had stickers with visitor written on them. This was a great idea, as when in ED it can sometimes feel like as a visitor you are not meant to be there. The sticker provides reassurance.

ED also had write up stations in acute rooms, allowing the wirte up to be done at the bedside. However this is currently only available in ED. There were also smaller write up stations in the corridors of ED, as theses station locations allowed improved line of sight for clinical staff.

Wayfinding through ED was not very clear and we felt there was a need for improvement. It was a bit confusing as to where you were.

ED bedside write up in treatment bay

ED hallway write up station

AMBULATORY CARE (OUTPATIENTS)

RMH has also rolled out a Q flow system similar to the system ACT Health is about to roll out. This was located at outpatients/day services. The system had been in place for about 12 months, there has been very little issues with the system and is making it easier for patients to check in for appointments and go to the sub waiting rooms. These rooms are all colour coded, making it easier to find. Hopefully this is a good sign for the new Q Flow system that ACT Health will be rolling out in the coming months.

Q Flow machine

Outpatient waiting room

Once you got a ticket from the Q Flow system it would tell you to wait in sub wait rooms in outpatients. Each sub wait room was colour coded making it easier to find. We really liked the combination of seating in the waiting rooms. Not only were there the standard single seats you see in all waiting rooms there were also double and single lounge chairs. This meant that if you needed a little more space or had a family member with you the seating arrangement would be able to accommodate this. 

The ambulatory care reception desk also had cables across the counter with some parts covered with glass perspex

NEW HOSPITAL TOWER

The RMH has recently completed a new allied health building that opened in October 2012. It is a three storey building connected to the North Wing of the hospital that provides allied health services for both inpatients and outpatients. This new allied health building is home to rehabilitation services such as speech pathology and a gym. 

Rehabilitation gymnasium

The Gym was bright with floor to ceiling windows surrounding almost the whole room. Although the gym was not massive, it seemed to use the space proved quite well. Also the flooring in the gym was colour coded for different types of exercises, this was incorporated into the design quit well.

The image cover the whole wall as you walk into allied health. The people featured are people who had used the services previously.

Entrance into a speech 
pathology room, with a nice 
use of people on the sign 
who have been using the 
service 

Occupational Therapy 

Entrance

One of the Allied Health sub waiting rooms, with different seating

The new allied health building also incorporated some great signs for services. The inclusion of people in the signs makes it that much easier and relatable. Particularly the sign that has great messages on it such as achieving better health and respecting our community, as you can see in the pictures.

YOU MAKE A DIFFERENCE AWARD

We came across the You Made a Difference Awards on our tour and were interested in what the award meant. The You Made a Difference Awards recognise individuals or teams for making a difference for patients, visitors or staff. We thought this was a great idea as it promotes and shows appreciation to those who most deserve it, as nominations are provided by patients, visitors and staff. Simple things such as this award promotes better care and can be very rewarding to staff and volunteers.

Pictures of past and present winners of the You Make a Difference Award

MUSIC THERAPY

On our tour we came past a group playing some great live music. RMH has been running music therapy almost daily since 1997 with great results. We definitely noticed a positive difference around the live music, everyone seemed more relaxed and had a smile on their face. This is certainly something health services in Canberra need more of. 

The live band playing some great songs with a piano accordion and all

INPATIENT UNIT

The inpatient units were refurbished about 10 years ago. These units where divided into 32 bed pods, there were single bed rooms in this arrangement but unfortunately we could not find out what the ratio was for single bed to multi-bed rooms.  The room layout for both single and multi-bed rooms were a standard layout, similar to the current layout at the Canberra Hospital. There seemed to be limited future proofing done at the time of refurbishment, this includes no bedside write up infrastructure and a large central nursing station with poor line of site to rooms. There was also the constraints of the old building layout. The 32 bed inpatient units were shaped liked a capital T, making it very difficult to design nursing stations that maintain line of site to rooms. In a situation such as this it might had been better to work off a decentralised nurse station model.

There were clocks in each room at the end of the beds with dates and days on them. This was a great idea, as it allowed patents to keep track of what day and date it is. This was in responses to feedback from consumers and carers.

Inpatient clock at the end of patients beds

There were also very informative messages on porters through the hospital such as fall prevention and how you rate your exerances with the health services. What was even better about them was the amount of different languages these signs were in. All in all the hospital provided a lot of information in several different languages.

One of the many posters around the hospital with messages in several different languages and interpreter services

LESSONS LEARNT

We gained a lot from the tour of RMH and it would be worth noting a with a few key points that in the case of RMH need to be kept in mind when planning for both refurbishment and constructing new facilities:

• Always plan for the future, not for what you providing currently. This means including future proofing in design.

• You need evidence base design to work with spatial constraints to gain the best outcomes.

• The use of colour and green spaces are very important.

• Line of site from nursing stations needs better incorporation with the design of inpatient units.

• Incorporating a wide range of languages with all information and clearly mark interpreter services 

• Adaptable seating arrangements in waiting rooms are very important.

• The use of people in signs provides a greater message than just words.

• Volunteers are very valuable and can be used for more than just finding your way around the hospital

HIP Project Officer

Nicholas Wales

Consumer Focus Group on the Emergency Department at Calvary Hospital

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

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

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

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

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

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

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

Kerry Burton
National Access Program
Consumer Coordiantor