ACT Budget 2017 - HCCA Initial Response

During the election campaign in 2016 Health featured strongly. The ACT Labor released a range of election commitments as part of their Ten Year Health Plan. This included significant infrastructure investment with the design and construction of the SPIRE centre, a new, expanded emergency department, an extension of the women and children’s hospital, more walk in centres and funding for a new building for Winnunga Nimmityjah Aboriginal Health Service. This budget starts to bring this vision into reality.

People will notice that there are delays in the state of many of the commitments, such as SPIRE, and these will not see services delivered before 2020. This is for a number of reasons.

ACT Health has started a process of planning for health services for the next ten years. This process is called theTerritory Wide Health Services Plan. This will include the development of models of care (the way care is delivered) as well as looking at planning for the workforce we will need to deliver the care. Technology – through the Digital Health Strategy – will also be considered. And all of these feed into the design of the new buildings. To bring the infrastructure projects forward without doing this planning is putting the cart before the horse. That is not to say the system is working well currently.

We know that there are significant pressure on our public hospital system. Canberra Hospital is one of the busiest Emergency Departments in the country. Calvary continues to experience increase in the number of people presenting there. And the Outpatients Departments are busier than ever.

There is a vast amount of work underway to address thedata issues that ACT Health has been experiencing with the territory wide data Review announced by the Minister in March 2017. This is not due to conclude until early 2018. It is extremely difficult to effectively plan for the future if you do not have confidence in the data you have. And the other major activity is the completion of theUniversity of Canberra Public Hospital, the rehabilitation centre that will provide sub-acute inpatient care for older people, people who have had neurological events like strokes, and longer term mental health rehabilitation. These people will stay at the centre for their treatment and care. It will also provide a range of day programs – where consumers will attend each day but stay at home. This has to be a major focus for the Government. The opening of this centre will free up much needed clinical spaces at Canberra Hospital and Calvary that can then be used for other services.

As mentioned above, there are a number of elements that need further explanation including consideration of workforce issues and the eHealth agenda.

Workforce is a critical element of a safe and efficient health system. There are a range of initiatives that demonstrate investment in the ACT workforce, such as the University of Canberra Clinical School and the additional nursing positions. The existing ACT Workforce Plan is for 2013-2018 and there is a need to have in place strategies to address the attraction, education, recruitment and retention beyond that date, to reflect the timing of the budget initiatives. We need staff for the new services.

The eHealthy Futures that was announced in the 2010-11 budget has experienced delays. This was first announced in 2009 when the ACT Government allocated $90.2 million over four years for eHealth initiatives. It was it described as an "unprecedented level of investment" by the then Minister for Health, Katy Gallagher MLA. The intention of this commitment was to ensure our health system was better positioned to meet the needs of the ACT community at the time and into the next decade. The Budget this year says it will be complete by June 2018. There needs to be some fresh thinking on how technology can improve the quality, safety and efficiency of services .We know it is difficult but it is worth the investment to help people have better experiences and outcomes of care and improve the connection between our very fragmented health system.

A couple of highlight include:

Mobile dental clinics: The community's most vulnerable people suffer the poorest dental health. So two new mobile dental clinics should help. The larger of the two will visit schools in more disadvantaged areas. A smaller one will visit disadvantaged adults in shelters and halfway houses. Turning room and power supplies are among the challenges still to be sorted. The government will spend $2,173,000 over the next four years.

Nurse navigator positions: We are very interested in the announcement of twelve nurse navigator positions. Queensland Health introduced the role in 2015. The nurse navigator roles are clinical roles held by experienced nurses with expert clinical knowledge and in-depth understanding of the health system. Their focus is to support patients with complex health care needs to identity their needs and facilitate access to services. They support and coordinate patients across their entire journey rather than focusing on just a specific disease or condition.

HCCA has been funded in 2017-8 ($100,000) to undertake work to develop a model of patient care navigators. It will be important for us to with ACT Health in this. We are particularly interested to develop the navigator role to help educate patients about self-management of their health needs which supports people to feel empowered to make decisions on their own health care.

While the government has invested in health care services, accounting for a third of the budget, ACTCOSShas called for greater ambition to deliver on the community’s expectation for a practical plan to drive back gathering inequality. Susan Helyar said “we are disappointed that, while the Budget checks off a number of election promises, we are still not meeting the community’s expectations about action for those who face sustained long term cost of living pressures especially those who can’t find affordable and accessible housing.” Their Media Release is available online. ACTCOSS commissioned research into cost of living pressures over the past three years which revealed a persistent and widening gap between income and living costs for individuals and households living on low incomes in the ACT. 

The Budget was well received by the ACT P&C Council. Their media release is available online. The Youth Coalition welcomes elements of the budget but remains concerned that the Government does not have a plan to address education inequity and recognition of the skills, knowledge and expertise of community services in supporting students who are at risk of disengaging from school.

An update on SHOUT. Our members will be interested to learn of the ACT Government commitment to SHOUT. SHOUT supports many community groups and the government wants that to continue. The government also wants to see SHOUT with a sustainable operating model.  The government's solution is

• to await the review's findings and 

• to give $70,000 to ensure SHOUT keeps ticking over.

Pending the review's findings, SHOUT may receive recurrent funding in the 2018-19 budget. 

The Budget Papers are online:http://apps.treasury.act.gov.au/budget/budget-2017-2018/budget-papers.

The Government’s glossy overview of the health budget is available here:http://apps.treasury.act.gov.au/budget/budget-2017-2018/better-care-when-you-need-it  The Budget Papers for Heath Directorate are available herehttp://apps.treasury.act.gov.au/__data/assets/pdf_file/0007/1069369/C-Budget-Statements.pdf.

The Government is to be commended for their commitment to funding the health service to meet the needs of the community. Thirty one percent of the budget has been allocated for health services. This is $1.6 billion. The challenge for the Government is ensuring that the election commitments complement the health services planning that is currently underway within ACT Health.

We will continue to analyse the budget and share our thoughts with members via our newsletter.

Darlene Cox

Executive Director

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

Blacktown Hospital Tour

On Monday 15 February Darlene Cox, Kerry Snell and I drove to Sydney to visit the new Blacktown Hospital expansion. Peter Rophail the transition manager for Western Sydney Local Health District organised and provided the tour just two days before the new building was to be handed over. This meant there was lots of activity throughout the building. We are very thankful of the time Peter gave us for the tour.

Blacktown Clinical Services Building

  

Co Design

The project won a gold medal, in the co-design category at the APAC Forum - Asia Pacific’s premier healthcare conference. Western Sydney Local Health District identified that there was a need for strong community engagement in the planning of the hospital. They were wanting the people of Blacktown to own it. Throughout the planning hundreds of consumers where involved through the many methods such as master planning, user groups, focus groups, and getting out to the community and talking to people about what they want.

Consumer engagement was difficult at the beginning as there was not a strong culture of community involvement. Once models were developed to better involve consumers things improved. They learnt by trailing approaches. They were clear about the need for consumer input and were open to making change along the way. For example, while they started out with a single consumer representative on a user group through the process they found that it was better if there was two or three consumers involved in one user group.

How did consumers influence the design?

·         Adequate number of free parking spots for patients undergoing cancer treatment

·         A significant proportion of their inpatient rooms have a carer zone so that carers can stay overnight with adult patients

·         Attractive images on the ceiling for patients in radiation therapy

·         Provision of easily accessible interpreter services for non -English speaking patients

·         Toilets to accommodate patients with intravenous drip stands

·         Consumer was on the panel that selected the 25 large print photographs for the walls throughout the hospital

Core Values

The project included core values that whenever a decision was made the team would referred to the core values and how it supported them. These values are:

·         Mutual Respect

·         Accountability

·         Integrity

·         Teamwork

·         Trust

·         Quality

·         Consumer involvement

Wayfinding 

Furniture Colour for Wayfinding

The new clinical service building uses colour for wayfinding. This is cleverly integrated into the build. This was in response to consumer feedback. One of the consumers said: “a hospital space does not need to be white and sterile”. Every room and every ward had their own colour to improve way finding. The intent is to assist with orientation to wards and inpatient rooms. Their research informed this design decision and it will help patients and visitors to find their rooms. We really liked this approach. The only thing that could be improved is placing a coloured tile next to the sign with the room number. These wayfinding methods are proven to improve the experience for the consumer and it will be good to see how it goes when the building is open.

The Hospital also related all its wayfinding colours to the external colouring of the building, this brightened up the whole space and again made it feel less clinical.

Community Arts Program 

Blacktown Hospital engaged a Canberra based art company called Health Arts Research Centre to improve community engagement in the design, selection and creation of art within the building. This includes an 80 m mosaic, with 13 different works designed by community groups such as Indian elderly and Arabic community groups. There is also involvement from local aboriginal artists Leanne Tobin, who designed The Call Of Home, which is a suspended sculpture of more than 80 unique hand blown glass eels.

The art project also included a photo completion where people could submit their own photos with a chance to be displayed throughout the hospital. The selection panel was a consumer, art specialist and the General Manger. You can find further information on the Arts & Cultural Program here.

The Call Of Home by Leanne Tobin to be
installed in the foyer of the Blacktown Hospital

Example of the large scale photos in public areas

Hospital Street

Layout

The main entrance into the new Blacktown clinical services building comes into a long open corridor called Hospital Street. A lot of contemporary health facilities include a hospital street. This layout makes the environment feel less clinical and more welcoming. It is also very effective way to connect the existing hospital with the new building.

Main Reception

The volunteers will be located at the main reception desk, to better include them within the hospital. This decision was made after feedback form volunteers that they wanted to feel part of a team and be more involved in assisting patients and families.

Off the main reception was lifts and clearly mark stars to the outpatients and inpatient spaces, making for easy wayfinding.

Inpatient Unit

The design includes an additional 180 beds for acute inpatients. These inpatient beds included 65 single bed rooms, three four bedded rooms and the rest being two bedded rooms. The bathrooms where out bound with double doors. All inpatient rooms had glass windows for better line of sight. This was one of the design principles of to see and be seen.

Convertible couch to bed

Eight rooms per ward provided a carers zone where family and carers could stay the night on a couch that converted into a bed and the two bedded room had reclining chairs that converted into beds to sleep on. This meant visiting hours where revised to allow for flexibility. This was feedback from the multicultural community.

Even though the outbound bathrooms reduced light the room it still felt very bright and welcoming.

Patient entertainer system included internet, free to air TV and their Electronic Medical Records (EMR). The TV is on an arm located above the bed, and could recode clinical information such as observations.

Inpatient Single Bed Room

This was to improve line of sight, with the ability to draw a curtain across for privacy.

The design of the nurse station is very open and a significant move away from the fortress we see in most wards. It will invite communication.

Nurses station in the inpatient areas

Nurses station in the inpatient wards

The floor design is to help with dementia and cognitive decline. This is done by guiding people through the space with visual cues as marked out on the floor to help with wayfinding.

QR Code

Defects Liability for the Building

There was throughout the building QR codes that could be used by NSW Health to note any issues with the building before handover. This meant that you could simply use the QR Code in each room to log any issues with the room and it would go on their data base.

Computers on Wheels (COWs)

We went to have a look at a medical ward in the older clinical tower with a 28 bed ward that included six COWs per ward with fourteen charging bays through the ward. The inclusion of an Electronic Medical Record was a key success to the integration and use of COWs. Other new builds that we have previously visited have had issues with COWs and where not used to the full extent.

Computer on Wheels

Paper light

Blacktown Hospital is one of the first hospitals in NSW to go paper light. What this means is that the use of paper documentation for inpatients is reduced and more information is logged electronically, such as the Electronic Medical Records. Currently the inpatient unit at Blacktown is using one page per person per a day, this is expected to reduce even further with the introduction of a closed loop medication system which is coming in August.

The tour provided some fantastic information on new hospital design and how the community is involved in the planning of their hospital. We have taken lots away from the tour and again would like to thank Peter Rophail for the tour and providing use with so much great information.

Nick Wales

Project Officer

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