Dental Health Forum

Community Dental Health Program

Health Care Consumers’ Association (HCCA) hosted a Dental Forum at the HCCA offices in Hackett on 7 June.

Karen Jameson, Karen Macdoanld,
Sanja Fokus and Suzanne Eastwood
at the HCCA Dental Forum.

Sanja Fokas (Regional Manager) and Karen Macdonald (IT Manager) from the Division of Surgery and Oral Health Community Dental Health Program, ACT Health, engaged with consumers for a workshop.  The session was faciliattied by HCCA staff member

Karen gave a detailed presentation about the services provided under the Dental Health Program and Sanja spoke about the achievements and successes of the Program.  The presentations were well received and provided a useful overview of the dental services available and how to access them.

The workshop sessions which followed, gave consumers the opportunity to talk about their own experiences and give feedback about the services, providing Sanja and Karen with valuable information and ideas about how to improve dental services and also to make them aware of any shortcomings within the system.

Attendees were asked to comment specifically on the following questions:
1. Is it easy to find information about the Dental Health Program, including contact details?
2. Are you aware of the services that are available at the Dental Health Program?
3. If you have attended the Dental Health Program were you satisfied with the service received?

Health Directorate Staff presenting
at the HCCA Dental Forum

The questions highlighted a number of concerns:

Communication
Consumers felt the Dental Health Program needed to be far more widely publicised.  Many people said they were unaware of the services provided under the Dental Program and did not know how to access them.  They were also unclear about waiting times and eligibility.  Consumers felt the Dental Program needed to be far more widely publicised.  They suggested displaying posters in waiting rooms in GP surgeries, hospitals and allied health services; publicising the Program through the school system by providing information to teachers who could pass this on to parents; liaison with disability support agencies, CIT, community housing and St Vincent de Paul; publicising the services via Facebook.

Preventative Care
Consumers were keen that the Program should focus strongly on preventative treatment.  It was important to make consumers aware of dental hygiene and that thorough teeth cleaning formed part of every routine dental check. Sanja said there were currently two hygienists in the Civic Clinic and hygienists would also be on the staff at the new Belconnen Clinic.  She said ACT Health were keen to emulate the Canadian model of preventative dental care, which was the best in the world.

Including dental hygiene and care on the pre-school curriculum was suggested as a means of teaching children how to look after their teeth and gums, which was likely to reduce oral health problems in adult life.

Aged Care Facilities
Concerns were raised about the lack of dental care in aged care facilities.  COTA had been lobbying for a mobile clinic and Sanja said ACT Health was investing in a mobile unit, which would make regular visits to nursing homes.

Priority for the poor and homeless
Consumers felt it was important that priority be given to the poor and homeless community.  The Salvation Army referred clients to the Dental Program – last year 51 clients were referred by the Salvos.  Consumers felt communication with similar organisations would be very beneficial.

Record-keeping and contact with clients
Concerns were raised about how the Dental Program monitored its waiting lists, client contact details and appointment times.

It was felt that it was important that the Dental Program should be fully integrated within ACTPAS (the ACT Health, Patient Administration System).

Sanja Fokas and Karen Macdonald welcomed the opportunity to talk to consumers and undertook to use their feedback to help to improve the Community Dental Health Program in the ACT.

Copies of the presentations will be sent to those attending the workshop.

HCCA and the Community Dental Health Program look forward to hosting another Dental Forum in the next six months to talk about developments in the Program and discuss lessons learned from this session.

What is the National Access Program?

The ACT Government is currently involved in large scale clinical redesign and health service planning to underpin an ambitious capital works program. This is a significant body of work for and has great potential to bring about structural changes to clinical practice, and to improve efficiencies as well as health outcomes for consumers. HCCA is committed to working with the Government to provide independent, effective consumer input in the developing solutions to intractable.

In April 2010 the Council of Australian Governments agreed to sign the National Health and Hospitals Network Agreement. The reforms outlined in the Agreement are designed to drive major improvements in service delivery and better health for patients, whilst equipping the health and hospital system to serve the Australian community into the future.

The agreed reform program will change health funding. This funding will be linked to health performance targets, known as the National Access Targets. 

They are:

• the 4 hour access target - 95% of all clinically appropriate presentations to emergency departments will have been assessed, treated and either admitted, transferred or discharged within 4 hours of arriving at the emergency department.

• the elective surgery access target – 95% of all people accessing elective surgery should be admitted for surgery within clinically recommended times.

To meet these targets, ACT Health has established the National Access Program to develop and implement the required structures and processes within hospitals in the ACT. The goals of this program of work are to support the delivery of safe and effective care for patients, regardless of the hour of the day, aiming to have the right person in the right place at the right time to meet these targets.

HCCA has received funding for a Consumer Coordiator to work with policy makers and clinicians to ensure consumer perspectives are included in this work.

ACT Walk-in Centre

The Walk in Centre celebrated its first anniversary a few weeks ago.

13,420 people have presented to the Walk-in Centre over the last 12 months, seeing on average 40 patients per day and over 250 a week. Of this, nurses at the clinic have treated around 10,000 people.

There has been media around the perception that the walk in centre has increased the presentations to the Emergency Department at The Canberra Hospital.  Of this the  Minister said:

Around 20 per cent are referred to general practice, and the numbers referred to the emergency department are changing as the walk-in centre develops and matures. It has been hanging around six to seven per cent. I understand in the last few months it has been about 3½ per cent.

HCCA spoke to the ABC about this issue recently.  There are details on the ABC website including an interview Darlene Cox did with ABC Canberra presenter, Alex Sloane.

There was discussion in Budget estimates in May about the cost per patient.  The Minister responded:

The advice I have is at the end of March the average cost was around $120 per patient. Obviously, as they are seeing more patients, their costs are coming down. In comparison, the cost of treatment of someone in the emergency department is in the order of $400. I think it is a useful measure to have a look at cost, but if we provided that as the only way of working out whether anything is a success, we would not do a lot things in the health system, I can tell you.

The Hansard for Budget Estimates for 18 May 2011 is available on line as a pdf.

HCCA is very supportive of extending the walk in Centre model to the Community Health Centres in town centres. This is an aspiration of the Government.  The Government is building capacity for walk-in centres in the Belconnen, Tuggeranong and Gungahlin Community Health Centres.

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.

A wish list for Canberra's Integrated Cancer Centre

This post has been adapted from a piece that Val Lee and Denis Strangman wrote together in November 2010.  At the time they served as HCCA cancer consumer representatives on official ACT advisory committees associated with the planning for the new Centre.

The architects are about to get their heads down and come up with plans for a new cancer centre to serve the ACT and surrounding regions.  Some preliminary sketches have been drawn up and planning meetings have been held.  It is very important that the Centre "gets it right" from the start and develops as a truly patient-centred facility.

The proposed location will be between the current radiation oncology area at Canberra Hospital, the emerging under-cover parking station, and behind the existing Psychiatric Services Unit, which will eventually have its own new building.

In an endeavour to identify the wishes of the Canberra community, particularly those who have used the cancer services recently and may do so in the future (which could include one in three of the population who might be affected by cancer), the Health Care Consumers Association of the ACT held a public meeting on 29 November. 

At this early stage of the design we have a basic wish list in mind.

First – the centre must be patient friendly and be designed around the convenience of the patient, particularly those who are visiting it in an unwell situation.

Second - it must be a pleasant environment, for the benefit of the patients and the staff. Canberra has an inherent difficulty in attracting skilled medical and radiation oncology staff, so the working environment needs to be a whole lot better than other cancer centres that are competing with us. We can’t bribe the weather bureau to falsify Canberra’s winter temperatures so we have to counter the pull of the sun and the surf by superior and generous working conditions.

Third – patients should not be asked to walk long distances to get from where they register to where they are treated. We understand that one key objective is to make it an “integrated” centre but it has to work around a fixed given and that is the bunkers where the Linac radiation therapy machines are located in their protected shells. These are fixed and cannot be moved.

Fourth – the patient information area must be close to where most patients and their carers will come for their consultations. The opportunity could be taken to integrate the patient education function with this facility so that there is a combined access to the disease-specific technical information and the relaxation and meditation resources which many patients specifically seek.

Fifth – patients must be capable of easily meeting with allied health staff and the cancer care co-ordinators. This is an expanding area within cancer services and the objective should be that eventually all cancer patients will be allocated to a care co-ordinator who can be a point of contact as they travel the cancer journey. At the present time some of those with the more intransigent cancers, such as brain tumours, are lacking access to care coordinators covering their cancer. Social workers should not be hidden away in some broom cupboard out of sight but should be easily reachable by patients. That area of assistance needs to be better resourced.

Sixth – the opportunity needs to be taken to reap the advantages of the E-health revolution. Because of our low population base the oncologists in Canberra need to be “generalists” and they do a fine job but much of the expertise of their more experienced colleagues is found interstate. Telemedicine facilities need to be an integral part of the design so that the Canberra staff can act as agents of disease-specific specialists located elsewhere, even on occasion in another country. Patients and their carers should be able to participate in these consultations.

Seventh – “quiet spaces” need to be built into the design where a patient and their carer can retire to and reflect on any challenging information which might have been given to them in a consultation. On occasion they might want a social worker, care coordinator, or pastoral care worker to be easily available.

Eighth – a small café should be integrated into the design, which is easily accessible by patients and their carers either from the chemotherapy or radiation oncology treatment areas. Some kind of call system spanning waiting rooms, the proposed cafe and the patient information area should be developed so that patients do not feel trapped into remaining fixed in a waiting room fearful that they will miss their “call”. These are mostly ambulatory out-patients. Perhaps they could be issued with location tags which tell the staff the general area where they are waiting.

Ninth – particular care needs to be taken for those patients whose immune system is compromised because of procedures they are undergoing, which might involve specific forms of access and isolation.

Tenth – because pathology results are an integral part of the cancer process and often determine a patient’s ability to receive chemotherapy, blood samples should be taken within the Centre, if at all possible.

The project managers and the architects for the new cancer centre are working to a tight schedule but the last thing anyone wants is a $28 million centre which looks new but has inherent design flaws which add unnecessary stress to the patient and their carers. The diagnosis of cancer and its treatment can be very stressful. Let’s do what we can to reduce stress levels for these people.

Sadly Val Lee died in January 2011. Val was a breast cancer survivor who provided peer support through Bosom Buddies for newly diagnosed breast cancer patients. Val certainly left her mark in the consumer movement and was a source of great comfort to many women when they needed a shoulder.


Denis is a former caregiver and provides peer support to newly diagnosed brain tumour patients and their carers by answering the national Freecall number provided by Brain Tumour Alliance Australia Inc.  He continues to advocate for consumer and carer interest in the development of the Cancer Centre.