HCCA response to the ACT Budget 2014

The ACT Government is to be commended for putting people first in this budget.  They have taken the decision to absorb the cuts made by the Federal Government and have crafted a budget that delivers modest expansion of health services.

ACT Budget Papers

The ACT Government have taken the decision to absorb the cuts announced in the recent Federal Budget.  These cuts are by no means small. Treasurer Barr today outlined that more than $500m has been written off the ACT income from 2014-15 until 2017-18. This is due to a downturn in the housing market which will result in less land being sold for development ($250m over four years) and also the Federal Government walking away from the National Health Reform Agreements ($248m over four years).

The Treasurer outlined that the Commonwealth is not only the major employer in the Territory but is also a large consumer of goods and services. The cuts announced in the Federal Budget will see between 6000 and 6500 full time jobs disappear (2.9% of employment in the ACT). This will have flow on effects to the Canberra economy.

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

This budget has allocated funds for more general inpatient beds at both Canberra and Calvary Hospitals (15 beds). The 31 beds announced at Canberra Hospital includes 15 beds that were funded in 2013-14. This is welcome news. We continue to see more people presenting at the Emergency Department requiring admission and Canberra Hospital has been under significant pressure, routinely operating at over 90% capacity. There is also provision for additional staff at Canberra Hospital to support the opening of these beds which is good news, as you can’t open beds without having staff in place.

Hospital in the Home (HITH) which looks at caring for inpatients in their home will also have the service increased by six ‘beds’.

There is also funding to support two new emergency department physicians one for Canberra Hospital and one for Calvary. This is hoped to decrease waiting time in emergency.

The Walk in Centres are a great addition to our health system and provide affordable, appropriate care to consumers. This budget allocates funds for the operation of a new Walk in Centre at the Belconnen Health Centre.

There is also an announcement of about $9m for the expansion of outpatient services including a focus on chronic pain management. People living with persistent and chronic pain are not serviced well by our existing services and this allocation will make a difference.

There is also a modest increase to delivering intensive care at both public hospitals with two more beds at Canberra Hospital and another bed at Calvary Public Hospital. Canberra Hospital is the tertiary referral hospital for Canberra and the Capital Region and this will go some way to meeting the ongoing demand for these important services.

Calvary Health Care ACT will receive ongoing funding of $1.5m for the Birth Centre to continue. This is welcome news as the Birth Centre complements the Canberra Midwifery Program that runs at the Centenary Hospital for Women and Children in Garran.

This follows the launch of the Obesity Management Services, which is a community based service to support people with a BMI of more than 40. An extension of this program is the provision of publically funded bariatric surgery. This amounts to just over $1m over four years and modelling suggests this will enable thirteen people to have the surgery each year. This will make a significant difference to their lives and complement the important work of the Obesity Management Service.

We will see the opening of the Capital Region Cancer Service early in the new financial year. The opening of this services has been delayed due to a burst water pipe, but work has almost finished to rectify this and we see $8.5m made available to deliver services.  Provision has also been made for an expansion of the lymphedema services at Calvary Hospital, with $1.9m funding over four years and new three staff positions to support this.  This service is important in supporting people, mostly women, in overcoming the effects of breast cancer and other conditions affecting the lymphatic system.

Mental Health funding has been maintained with an emphasis on community programs for suicide prevention, and children and youth mental health. Suicide prevention funding will include bereavement counselling for those who have lost someone due to suicide and community awareness campaigns. There has been provision for a modest expansion of service for people with eating disorders. This is an area of need in our community and we welcome the investment in this.

The Funding for the Health Infrastructure Program has been continued and HCCA is excited to see the commitment to the University of Canberra Public Hospital. We look forward to continuing to work with the Government on these projects.

In stressful times it is hard to get the balance right but on this occasion I think the ACT Government has done well in the short term to compensate the Canberra community from the worst effects of the Federal Budget. The big question is how can we sustain this into the future?

Darlene Cox

Executive Director

@darlenecox

New Northside Hospital for Canberra

The ACT Government has released a report identifying the University of Canberra as their preferred site for the construction of the new Northside Hospital.
The ACT Government has indicated that there is a need to enhance public hospital facilities on the north side of Canberra to accommodate the growing health needs of our population over the next 20 years. The ACT Health Capital Asset Development Plan was developed as a blueprint for the redevelopment of the ACT health system.  A discussion paper on options for northside hospital services was issued in February 2011. As a result of that that process, the Government decided to building a stand-alone sub-acute facility in North Canberra. HCCA has been advocating for the establishment of a specialised sub-acute care facility for some time; this is reflected in our submission of November 2010 to the Government Standing Committee on Health, Community and Social Services Inquiry into Public Hospital Options as well as our response to the Government consultation on this matter in 2011.  The HCCA Submission is available online (160kb Pdf)
The HCCA has been very supportive of the decision to build  a sub acute hospital and has not seen a need to replicate The Canberra Hospital in North Canberra.  We have advocated that a sub-acute facility or community hospital, supported by primary health care centres around Canberra, would better meet the needs of the Canberra community. A community hospital with sub-acute and non-acute services will supplement the new enhanced primary health care centres. Planning for these centres is well developed with the new centres in Belconnen and Gunghalin expected to be opened in this year.  
The new Northside Hospital could be designed, built and staffed to provide rehabilitation services for people recovering after an operation (e.g. a hip replacement), an illness (e.g. a heart attack) or an injury (e.g. a fall or car accident). This would improve the potential for recovery as less time would be spent in an acute hospital (ie, Calvary or TCH). It could also include geriatric evaluation and management services, transition care and other step-up or step-down programs.
We have also suggested the facility could house a second secular hospice for the ACT and will participate in consultations with the Government for the review of the Palliative Care Strategy this year. 
The community recognises that people with serious mental illness need access to a range of treatment and support services, connected across the spectrum of care. We believe there is scope to include this in the development of the Hospital at the University of Canberra.  This would complement the successful step up step down facilities currently in place in the community.
A sub-acute facility on the University of Canberra grounds is vital to meet the needs of our community.   
The selection of the site is very important; it needs to be accessible, which means close to major transport routes. One of the failings of the Village Creek Rehabilitation Centre was the site selection.  The services, once you are inside the building, are excellent but being tucked away in a suburban setting has caused difficulty for some consumers and carers when accessing the Centre.  the University of Canberra is located to arterial roads and public transport, has sufficient area for dedicated parking, is close to the Belconnen Town Centre and is within easy travelling distance for people living in Gungahlin and the future Molonglo Valley development
In addition it would create valuable connections with the Faculty of Health Science and provide clinical placements for students in areas including, but not limited to, nursing and midwifery, pharmacy, physiotherapy and psychology.  We agree with the Government that the relationship should assist with staff recruiting and training, and should assist the university in undertaking health research.
The community wants assurance that decisions regarding the planning and design of our health system are taken on sound advice, based on identified clinical need and community needs and sound economic judgement.  We are satisfied with the range of issues the Government has considered in identifying the most appropriate site for the new hospital.
We look forward to being involved in the community discussion on the matter.

Darlene Cox
Executive Director

Budget for 2009 - 2010

Overall, HCCA is pleased to see that the Government has made provisions for services to meet the growing demand, despite the financial crisis. The budget makes provision for further development of the services as set out in Your Health - Our Priority, especially the e-health infrastructure and the design and construction of the community health centre at Belconnen. while we recognise that there is funding to build GP workforce, and funding the in-hours locum service, we are disappointed that there are not more initiatives aimed at improving access to primary health care for older people and will work with the GP Task Force to find ways to overcome this seemingly intractable problem.

We welcome the expenditure for electronic health capacity and infrastructure and consider that it is essential to building a robust and efficient health service for our community.

Enhanced Community Health Centre for Belconnen
HCCA welcomes the Government’s provision of $51.3m for the design and construction of the ECHC at Belconnen. We are very pleased that this has been brought forward, and consider that this offers great potential to develop services for those people in the Belconnen region. We look forward seeing the ACT Government working with the community to identify the services that will best meet the needs of that community. We are also very interested to see how the ECHC will work with the services that will be offered with the West Belconnen Health Cooperative so that they complement each other rather than duplicate services. We also look forward to seeing sufficient flexibility built into the design of the facility to enable other services to be located here over time, such as the ACT Health Equipment Service.

Walk in Centre - The Canberra Hospital
We look forward to working with the Government in the development of the walk in centre for The Canberra Hospital.

Cancer Services
We note the increase in funding for cancer services ($4.2m over four years). Comprehensive cancer services however, need to be provided far sooner than as stated in the documents, to effectively deal with the burden of disease.

Calvary
There is no specific provision for growth in public hospital services on the Bruce campus, while we acknowledge there is uncertainty of who will operate this, we would like to see provision for the development of services to complement those provided across the Territory.

Work Force
There is recognition that people are experiencing difficulty accessing GPs; the budget includes $1.9m to establish an in-hours aged care locum service. we consider that this funding allocation is insufficient in view of the demand we see in residential aged care facilities, older people living independently in the community, people with disabilities and other people with mobility issues.

We are pleased to see the funding of 15 new health assistants. We support the notion of the development of more innovative clinical roles, but we note with some concern there is no specific funding to further increase the role of nurse practitioners. Nurse practitioners have demonstrated their worth as an effective adjunct to traditional roles and we would like to see more funding to increase the number of nurse practitioners in the health workforce.

We welcome the intiatives to build our GP workforce, including the four training positions in general practice for junior doctors and the medical graduate scholarships.

Support for Consumers with Chronic Conditions
We welcome the allocation of $4.2m over 4 years to ensure better support for people with chronic conditions; we call on the government for further support of these programs once they have proven to be effective. We would expect to see considerable increase in funding to enable the roll out to more people in the community.

AMA Report Card on Public Hospitals

There has been considerable interest in the recently released report from the AMA on the state of public hospitals. Their report, Public Hospital Report Card (2008) is available on their website 708kb Pdf. The AMA have recognised that our public hospitals are under pressure and are calling for an immediate $3 billion injection of federal funds.

This has had coverage in major newspapers including the Sydney Morning Herald and the Canberra Times.

The AMA is quite right to draw attention to the bottlenecks occurring in Australian hospitals, but it is a bit behind the game. At the national level the Commonwealth has established a Health and Hospitals Reform Commission to address these problems, and locally the ACT Government is implementing a major capital asset redevelopment plan covering both TCH and Calvary Hospitals

Consumers will welcome additional beds which ensure that they are not caught up for long stays on trolleys in emergency departments when they need to be admitted, but we have been saying for some time that many of the new beds needed could be lower acuity beds at step down facilities, enabling convalescing patients to be discharged earlier form the acute care hospitals.

If the AMA really wants to ensure that taxpayers get best value for our health dollar, they will also be advocating for health care to be provided in the most appropriate setting, which means more primary health care and preventative services, and not just more acute care beds.

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