Building 15, Canberra Hospital

Our Executive Director, Darlene Cox, had a tour of the new Building 15 at #Canberra Hospital in early December. She took a  few photos to share.

Treatment Room in Building 15 at 

Canberra Hospital and Health Services 

Consult Room in Building 15 at 

Canberra Hospital and Health Services

Consult Room in Building 15 at 

Canberra Hospital and Health Services

Long, wide corridors in Building 15. 

There is good lighting and alcoves to store a range of equipment. 

Gym for exercise physiology. You can also see that patients
are to be escorted by staff members to consult and treating rooms
in Building 15

Good to see bariatric plinths so that people of all sizes can 

safely access the care they need.

Building 15 - the view from the access point of 

the large multi story car park.

Medicare Benefits Schedule Review Consultation :President Report Dr Sue Andrews

On 26 October I attended a Consumer Workshop in Sydney, one of several convened by the Consumers’ Health Forum as part of the government’s consultation process for the Review of the Medicare Benefits Schedule (MBS).

The workshop was attended by a diverse range of consumer advocates and organisations including Breast Cancer Network Australia, Pain Australia, and the Australian Patients Association. 

The Minister for Health, Sussan Ley, gave some introductory comments about why the MBS needs to be reviewed and why consumer and carer input is critical to that process.

Professor Bruce Robinson, Chair of the Review Taskforce, then gave an overview of the Review, key issues in the Consultation Paper which is providing the basis for their call for public submissions.

Professor Robinson also provided an update on progress with the Review. Its first report to Government is due in December 2015.

MBS review activities have been distributed among several groups including Clinical Committees, a Principles and Rules committee and Item-specific working groups.

Of the 30 Clinical Committees, 6 priority areas were launched in October – Obstetrics, ENT, Gastroenterology, Thoracic Surgery, Pathology and Diagnostic Imaging.

The input received so far draws on a wide variety of experiences with the MBS:

•  250 people have submitted feedback online, representing all states and territories.

•  126 clinicians or health professional organisations, 96 consumers or carers, 20 others.

•  Carried out a triage of items,

• Created a preliminary list of obsolete items is being examined further,

• Targeted areas are being moved into evaluation (eg sleep studies, pre-natal testing) and,

•  Several new items have been proposed.

• Referral regulation: Consumers and clinicians have asked to re-evaluate the three month limit on specialist to specialist referrals. This limit can force clinically unnecessary ‘renewal’ consultations.

• Rural Delivery: As rural delivery models and workforce levels evolve, stakeholders have asked for updates to geographic adjustments such as exemptions and cost adjustments.

• Ongoing item reviews: Stakeholders suggest that more frequent ongoing reviews could make the MBS a ‘living document’ improving the quality and relevance of procedures for patients.

The Review has already;

The Rules Committee is considering cross-cutting issues whose implications extend across the Clinical Committees including but not limited to;

Finally, there was some focused discussion around the key themes of the inquiry – unnecessary medical consultations, procedures or tests; application of Medicare rules; information requirements to make decisions about services; and how consumers could be engaged in the review process. 

The final discussion explored how consumers and carers could be better engaged in the Review process. The Review Taskforce have suggested consumers be involved as members of Clinical Committees, through public consultation on draft recommendations and through health consumer organisations. However they don’t have a clear consumer engagement strategy at this stage. Participants discussed other options such as social media and pointed out the importance of meaningful engagement with Aboriginal and/or Torres Strait Islander communities, Culturally and Linguistically Diverse communities, and refugee and migrant communities.

The MBS Review website contains all relevant information about the program, including outcomes of the consumer and stakeholder forums:

http://www.health.gov.au/internet/main/publishing.nsf/content/consultation-mbsreviewtaskforce

Dr Sue Andrews

President, HCCA

Health in Difference Conference Report By Elizabeth Proctor Health Care Consumers’ Consumer Representative & Eleanor Kerdo Policy Officer HCCA

Elizabeth Proctor:

In mid August I was lucky enough to attend the first day of the 9^th National LGBTI Health Conference Health in Difference (and I apologise for the delay in reporting back!). The most striking thing about the conference was how thoughtfully the program and speakers engaged with the overlaps and interactions between healthcare provision and marginalisation of groups. A special focus was placed on how Aboriginal and Torres Strait Islander and culturally and linguistically diverse LGBTI peoples face multiple disadvantages, both when seeking healthcare and more broadly.

The conference speakers shared stories that showed how far we’ve come in LGBTI communities, but also how much work remains – a lesbian mother who in the 1990s snuck into hospital to care for her baby (it took the hospital a week to notice there were two mums taking turns), Bob Brown’s memories of shock therapy and seeking out so many psychiatrists before finding one who gave him the best advice (‘Bob, sounds like you’re gay. Why don’t you try accepting it?’), Muslim-Australian siblings challenging the western notion of ‘coming out’ (instead, invite your loved ones into your life), and lawyers advocating for sex-positive aged care facilities (why aren’t there any double beds?). In a bright spot for aged care, Human Rights Commissioner Gillian Triggs pointed out that the recent change of law for inclusive facilities was almost surprisingly uncontroversial; updating the Sex Discrimination Act so religious aged care facilities were not exempt from LGBTI non-discrimination was met with general acceptance across the community.

Eleanor Kerdo:

On day 2 Eleanor swapped in and attended the ageing and aged care stream. There are lots of organisations working on making aged care facilities (ACF)  and services more LGBTI inclusive, both at a policy and personal level. Silver Rainbow is offering training on inclusive practice to ACF staff, while the Department of Social Services is developing formal standards for LGBTI inclusive aged care. Palliative Care Australia is similarly working on LGBTI specific policy frameworks. On a frontline service level, Switchboard Victoria provides community connections to isolated LGBTI elders through the good old cup of tea, connecting them to new friends who can build their confidence and support them settling into aged care.

Philomena Horsley of Gay and Lesbian Health Victoria (LaTrobe University) presented on LGBTI people’s experiences in end of life care and reflected on the history of end of life care in the LGBTI community. At the height of the 1980s HIV-AIDS epidemic, the LGBTI community was at the centre of an underground end of life care and euthanasia movement to support terminally ill patients with AIDS. At that time a large number of nurses and doctors could see a clear need for those services and took big personal risks to provide care. As conversations about dying with dignity become prevalent again it is timely to reflect on those moments in history that were so compelling to past generations.

Several community groups expressed an interest in HCCA’s Advance Care Planning Project, and Christine is looking forward to working with LGBTI communities in Canberra to help people develop aged care plans that work for them.

Thanks for sending us to this conference we thought it was excellent!

Launch of Capital Health Network

Yesterday I spoke at the launch of the Capital Health Network. The entity was officially launched by Simon Corbell MLA, Minister for Health and Deputy Chief Minister.

The Chair of the Network, Dr Martin Liedvogal, shared the Blue Print with attendees. This document sets out the roadmap for the Network.

My speech is posted here for people to read. As usual, I strayed from the script a little bit...


Health Care Consumers Association is very pleased to work with the Capital Health Network. We are the peak consumer organisation in the ACT and represent the interests of consumers in our very complicated health system.

Consumers and carers need to have a strong voice not only at the Board level but across the operational areas of the Network. We supported a small group of experienced consumer representatives and advocates to provide important perspectives in the development of the blueprint for the Capital Health Network. We worked closely with the staff to develop the foundation documents.

We need to build our understanding of the needs of the community so that services can be developed and supported to meet those needs. The population health planning function of the Network presents us with an opportunity to refine our health system to keep our community as well as possible.

Primary healthcare is essential to a healthy community. There is a new round of reform being led by the Federal Government and this is driven by the desire to control costs in the health system.  But we need to remember that it should not only be about reducing costs in the short term but how we can improve the health of our communities in the long term. The focus of the reform has to be on spending health dollars on what works the best.

There is also reform in workforce. We are at an interesting point where there are many players stepping into the primary care space. General practice-based primary health care is still key but we are seeing the potential for more services delivered by other health practitioners like health coaches, peer workers in mental health and – dare I say it - pharmacists. And we know that private health insurers in this country are also very interested in how they can offer products to support consumers in primary care.

We are also seeing an increased focus on self care and self-management by people with chronic conditions. Health literacy is the key.

Affordability of healthcare is one of the biggest issues for consumers. Out of pocket costs of primary health care are significant. The MBS rebate has not kept pace with the increasing costs and so many consumers face very real decisions about what services to access or which prescription to fill. Cost to see GPs, medical imaging, pathology, prescription and over the counter medications, physiotherapists, and then there's the cost for dental care.

We need to make primary health care more affordable so people can access the care that will benefit us. The stronger our primary health care the less demand for acute services.

There is much work to do but the Capital Health Network does not have to do this alone. There are roles for the ACT Government, the professional bodies, community services, consumer organisations and of course the Network’s membership.

So in closing I would like to congratulate the staff and Board of the Capital Health Network. I would also like to acknowledge the work of the former CEO Leanne Wells, former Board Chair Rashmi Sharma, and also the role that Vlad Alexandric and Angelene True have played in the transition.

Community based solutions can only be developed in partnership. Clearly the Capital Health Network understands this and we look forward to continuing to work with them to meet the challenges the primary health care system faces and improve the health of our communities.

Darlene Cox
Executive Director

Consumer-led Ideas for Better Primary Health Care – CHF Workshop

On the 19^th August, I had the pleasure of attending a workshop on the future of primary health care, organised by the Consumers’ Health Forum of Australia (CHF). The program for the day included an impressive line up of speakers, including the current Commonwealth Minister for Health, who demonstrated energy and commitment to reform.

Proceedings kicked off with presentations from the Chairs of the two connected large scale reviews currently underway: the review of the Medicare Benefits Schedule and the Primary Health Care review. It was encouraging to hear that the two reviews are not being conducted in isolation from one another, with crossover in membership designed to keep watch on changes in one area that may have significant consequences for the other. Both speakers emphasised that their tasks were not about savings, but about better “value” health care (focused on value for the system rather than the individual consumer). Both also commented on the importance of providing and measuring quality care through methods such as increasing use of clinical guidelines. Although there was a significant focus on people with chronic conditions and complex needs, how to deal with conflicting care guidelines for these people was not mentioned.

The focus on costs continued with the presentation from the private health insurance industry representative. The speaker described two programs focused on reducing costs associated with avoidable hospitalisations. The first targeted health fund members with chronic illness and repeated hospital presentations, providing integrated care wrapped around the consumer and GP. Services included phone support, care navigation and flexible funds to be used to improve health literacy and help ensure appropriate care. The second targeted consumers being discharged from hospital, providing three brief follow-ups to reconnect people with their primary health care providers. Both programs were described as having consumers at their heart and clearly have great potential to improve outcomes. It was therefore a bit disappointing to see the “outcomes” box on the evaluation slide describe the result as a reduction in claims rather than an improvement in health.

For me, the contrasting presentation was from the Australian Health and Hospitals Association speaker. She took the approach that incentivising health professionals to engage in what should be good business practice was not a good use of health funds. Reforms need to focus on the rising out-of-pocket costs for consumers as well as the system costs and focus on achieving outcomes rather than rewarding the business of carrying out health care. The business example was taken further with discussion of outdated IT practices hampering progress. This includes problems with data sharing and a lack of interoperability between proprietary health-related software packages.

The main theme of the day therefore turned out to be “how can we squeeze better value out of what we’re already doing?” Costs are an important part of health care but I am bothered when they are wrapped up as “person-centredness” as it can lead to selective care and ignores what matters for consumers. Rewarding outcomes sounds like a smarter move than activity-based incentives, but what happens to the consumers with very complex needs and/or multimorbidity who may not be able to achieve the outcome targets that get doctors the rewards? There is a risk that these consumers may face limited choice of health professionals willing to take them on.

The other theme that emerged was health literacy. I was interested in the conversation regarding health literacy as it seemed to be discussed as the way to ensure people could navigate the health system. Whilst it is true that improving health literacy can help consumers understand the most appropriate health care choices, this does not automatically equate to an ability to navigate the system or make the lowest cost choices. Factors such as complex conditions and location can also play a strong role in where consumers turn for health care. 

Michelle Banfield
Vice President, HCCA