What's in a name? The UCPH Conundrum

As you might already know, the ACT government is currently conducting preliminary planning for the ACT’s new rehabilitation facility which will be constructed on the University of Canberra campus in 2016-2017. Currently, this facility is referred to as the University of Canberra Public Hospital or UCPH for short.

UCPH will be a sub-acute facility dedicated to rehabilitation and related activities. Sub-acute care is specialised care which aims to improve a person's physical and social functioning and quality of life, often after severe accident or illness, or at end of life. Sub-acute care areas include rehabilitation, palliative care, older person's health and mental health.

UCPH will house physiotherapy and other allied health services, including a rehabilitation gym and hydrotherapy pool, among other features and services.  It will also provide sub-acute mental health services. Acute care services such as surgery will not be delivered at UCPH, nor will it have an intensive care unit or an emergency department. Acute services like these will continue to be provided at Calvary Public Hospital and Canberra Hospital.

At HCCA, we’ve been musing on the name “University of Canberra Public Hospital” and what this implies about the facility. We have had feedback from consumers on the name which consistently says that the word “hospital” is misleading, as it indicates very specific things in the mind of the ordinary consumer.  In particular, people think of hospitals as places you go when are sick and require emergency medical care.

Referring to the new rehabilitation facility at the University of Canberra as a “hospital” has the potential to create confusion in the mind of consumers and may create potentially dangerous situations. A consumer who is unaware that UCPH is a sub-acute facility may present there requiring emergency care, only to be told that they will have to be taken by ambulance to Calvary to be treated. 

Similar facilities in other jurisdictions have side-stepped this problem by appropriately naming the service.  HCCA’s Darlene Cox and Kerry Snell recently visited Victoria on a fact-finding mission about rehabilitation facilities, and they noted that none of the facilities they visited were called “hospitals”. Instead, these services were generally called “centres” (such as the McKellar Centre and the Kingston Centre).  Similarly, other rehabilitation facilities which use the term “hospital” have also included “rehabilitation” in the name (such as Lady Davidson Private Rehabilitation Hospital and Westmead Rehabilitation Hospital).

There doesn’t appear to be any reason why the same principle can’t be applied in the ACT.  A couple of alternative names thrown around by consumers during recent discussions include the University of Canberra Rehabilitation Centre, Rehabilitation Hospital or Rehabilitation and Recovery Centre.

If the ACT government wants to persist with using the name “hospital”, it will require them to undertake a concerted project to educate the ACT community about the difference between different levels of care – primary, acute, sub-acute – and to justify the use of the name “hospital” when in the consumer understanding of the word, UCPH isn’t one.  This seems unlikely to be an effective undertaking, given the longstanding failures around informing the ACT community about other Health Infrastructure Projects. 

In order to find out what consumers think about this issue, we’ve created a short survey. We’d really appreciate it if you could take a couple of minutes to share your views.

The survey closes on 23 August 2013 at 5pm.

Click this link to take the survey.

Expanding Hospital Services in the ACT - ACT Government discussion paper

The ACT Government has released a discussion paper on five options for enhancing hospital services in Canberra.  Each option would deliver an extra 400 beds and range in cost from about $690m to $795 million.  We are pleased to see that the HCCA proposal to include a sub-acute facility has been costed and included as an option (Option E).  Another option (B) is to consolidate services in a 'super hospital' at Woden but the Minister went on the record in early February saying that this is an unlikely option.

The discussion paper is a good start to the conversation and we encourage people to read the paper. This is available in the Community Consultation section of the ACT Health website. 

HCCA is interested to find out more about the type of beds that are being proposed.   We spoke with the ABC this week about this.  A story is available on the ABC website.

A six week consultation period will run from 25 February 2011 – 14 April 2011.  Community consultation fora will be announced soon.
 
This has been a long running issue.  The ACT Legislative Assembly referred to the Standing Committee on Health, Community and Social Services for inquiry and report the proposed four new options for future ownership and management arrangements of Calvary Public Hospital, put forward by the Minister for Health on 19 August 2010.  HCCA appeared before the Committee and made a submission (350 kb Pdf).  The Standing Committee will report to the the Legislative Assembly at the end of March.
 
HCCA is currently considering the discussion paper and will prepare a comprehensive response.  We are interested to hear your views.

Step Up - Step Down: sub-acute care in the ACT

The ACT is currently involved in large scale clinical redesign and health service planning to underpin an ambitious capital works program. The Capital Asset Development Program (CADP) will cost $1B over the next decade. It includes a new women and children’s hospital, neurosurgery operating rooms, refurbishment of existing community health centre and construction of one in Gungahlin and a Cancer Centre of Excellence. HCCA is involved with the health service planning and the CADP, supporting consumer representatives on high level committees holding consultations and providing consumer perspective on documentation.

This development process is seen by HCCA as an opportunity to shape our health system so that it is more consumer centred and overcome a number of longstanding problems. One such problem is inadequate provision of sub-acute care.

Sub-acute care includes rehabilitation, transition care, geriatric evaluation and management and can precede or follow hospital admission. I was pleased to see the NHHRC acknowledge the importance of sub-acute care, describing it as “the glue that connects acute care provided in hospitals with community care provided in peoples homes” (p 146 ). Their Interim Report also states that the limited provision of subacute care represents a significant missing link in the care continuum (p 146 ).

A number of our members have shared their memories of visiting relatives in convalescent hospitals after surgery or illness. This was before the closure of those facilities and the move to community based services. I think we lost something in this process and we are currently working with a group of committed consumers and carers, who consider that aspect of convalescent hospitals are needed to complement the acute services and primary care. As one consumer described it:

“It will all boil down to getting people back on their feet (as it were!) and into their homes with the minimum of trauma.”

Traditionally much attention given to sub-acute facilities has been to ease the burden of bed block. In most cases this has involved moving older patients to transitional care rather than occupying higher acuity (and costly) hospital beds. This was a driver in the establishment of a small public convalescent care unit (nine beds) in the ACT in 2002 post discharge from hospitals consumers were admitted to this unit where they are supported o regain daily living skills through personalised programs. They could stay there for up to two weeks before returning home. Sub acute care facilities such as these can improve the transition process from hospital to home and embed linkage between the acute and community sectors of our health system.

There is further consideration of sub-acute facilties on the ACT at the moment. This discussion is taking palce with regard to the Aged Care and Rehabilitation Services Plan. The plan will be released for consultation in around a month.

We would like to see further exploration of sub-acute care as an extension of primary health care, rather than acute care. The development of the “step-up” concept has been strongly supported by our members, especially those living with chronic conditions. This would enable consumer to receive a high level support in the community to keep them out of hospital. This care could be provided by multidisciplinary teams, including a range of care assistants, and there is potential to work with general practitioners to include them in their supervision of clinical practice.

The NHHRC is to be commended for their call for targets to be set by June 2010 to increase the provision of sub-acute care. This is a good opportunity for consumer movement to articulate what we need from sub-acute care so that it meets our needs for step up and step down. We think the answer lies in reframing sub-acute care as an extension of primary care rather than the traditional model tying it to hospitals.