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

Seniors Health Roundtable - 11 May 2016, Canberra

The ACT Government has an Active Ageing Framework that sets out the Government’s priorities for active ageing over the next three years. The framework articulates the Government's vision for all senior Canberrans to lead active, healthy and rewarding lives as valued members of our community. One of the guiding principles is the health care is affordable and accessible This means that health services are community based in addition to hospitals.

HCCA had been advocating for a focussed discussion with community members on ways to improve access to health services for older people. We were pleased when the Active Ageing Framework was released and they included an action to convene a round table on health of older people. We participated in the Steering Committee for this round table and our members turned out in force at the event on 11 May 2016.

The round table was opened by Chris Bourke MLA, Minister for Seniors and Veterans.

HCCA President, Dr Sue Andrews, spoke at the round table about the challenges in transitions in care. Her speaking notes are included here.

Theme: Transitions in Care – continuity of care across services

I would also like to acknowledge the traditional owners and custodians of the land on which we meet. I respect their continuing culture and the contribution they make to the life of this city and this region. I pay my respects to their elder past and present.

I am very pleased to be here today. The health of older people is one of the health policy priority areas for HCCA. We also have a very active group of members and consumer representatives who are involved in a consumer reference group who identify and advocate for the health of older people in the ACT and surrounding region.  Much of what I say in these introductory comments is informed by their work.

As health care consumers in many different settings, older people are particularly conscious of the frequency and quality of the transitions in care that they experience as they traverse the health system. As well as a general practitioner or family doctor, they are likely to have several other health care practitioners, often specialising in one organ system, disease or condition. They may receive this care in settings such as GP rooms and other private practitioners’ clinics, in a hospital (private or public), in a rehabilitation facility and in a long term facility such as in aged care.

Healthcare delivery is increasingly complex and multidisciplinary, and where the health care system is complex and often fragmented, good continuity of care across services is not always easy to achieve. When it is not working well people may not adequately understand their health problems and may not know which practitioner to talk to when they do have problems and questions. It is vital that older people are supported to access health literacy programs so they can be well informed and participate as much as possible in managing their own health care.

For consumers the challenges for achieving optimal transitions of care across health services relate to having many practitioners, many settings and many rules (eg about where different clinicians can practice, who has responsibility for different pieces of patient information).

Lack of access to health care can also contribute to disruption of continuity of care. Some older people may miss follow up appointments because they don’t have transport to their GP’s office, or need GP care after hours (sometimes resulting in a call to the ambulance to go to the Emergency Dept). They may not see their specialist because they can’t afford it. And they may not know what actions they need to follow if they have not received information that respects their cultural background or is in a language they cannot understand.

The Australian Safety and Quality Framework for Healthcare, under the principle of consumer centred care, identifies improvements in continuity of care as a key area for action. “Continuity of care for patients must apply within the healthcare team as well as between any team and other health professionals”. (p4)

One of the most important things for consumers is that each health practitioner they see is aware of their medical history, their social circumstances and their treatment plan. Lack of this information can cause considerable anxiety and frustration for patients (and the health practitioner) and can cause delays in appropriate treatment, duplication of investigations and even the provision of inappropriate care. (AQSH Framework p5)

Transitions in care for consumers always need to involve efficient and timely clinical handover. “Clinical handover is the transfer of professional responsibility and accountability for some or all aspects of care for the patient…to another person or professional group…Clinical handovers occur at shift change (in hospital), when patients are transferred between health services or wards, as well as during admission, referral or discharge.” (p5) Millions of clinical handovers occur annually in Australia and this is therefore a high risk area for patient safety with consequences that can be serious.

At all points in the process of transitions in care, communication between practitioners and with consumers and their families and carers is very important. Use of both paper based and electronic medical records are critical for handover and transfer documentation, as is working with patients to make sure they have sufficient information and understanding of their treatment to be able to effectively participate in maintaining the continuity of their own care.

Some of the issues that have been identified for discussion at this afternoon’s roundtable about transitions in care include:

·         High quality transitions in care through careful integration of services;

·         Avoiding gaps in care during critical transitions;

·         Effective communication with the consumer, their family, and other healthcare providers;

·         Complete transfer of information – a patient safety issue;

·         On- going access to health literacy for older people and their families and other care givers;

·         Access to essential services and a single point person to ensure effective coordination and continuity of care;

·         Health assessment processes that ensure consumers are supported to achieve the best health outcomes depending on their situation and condition;

·         Unnecessary or inappropriate transfer of residents of aged care facilities to hospital Emergency Departments; and

·         Availability of community nursing and community health services to enable people to return to their homes with appropriate support after discharge from hospital.

For most of us in this room today these are not new issues. So I look forward to our discussions this afternoon which will I hope focus on some innovative solutions for the healthcare system and improved outcomes for older health care consumers in our community.

Sue Andrews, 

President, Health Care Consumers Association ACT.

Report from a Consumer Rep - Online feedback for users, carers and providers

Below is a report by Consumer Representative Bernard Borg-Caruana on a recent session he attended on online feedback for users, carers and providers.

Online feedback for users, carers and providers

This session provided the challenges of gathering and publishing online feedback and recommended ways of increasing the potential of this avenue for users, carers and providers.

Lisa Trigg of the London School of Economics and Political Science presented on online rating and reviews for care providers.

This is in relation to the MyAgedCare website. The presentation for Aged Care  is where the Australian Government is implementing it. However in the UK it applies to all facilities and similar principles apply.

Aged Care covers:  community care, residential aged care and high care facilities.

How can you measure quality and the consumer experience?

Presentation

1. Why is it important?
2. Policy Context
3. Example
4. Challenges
5. Opportunities

Why is it Important?

Online reviews are the new word of mouth that 54% of adult consumers use before making purchases. 

• Twitter and opinions empower patients.

• We want consumer directed care and empowered consumers

• Gravity of the decision

• Difficulty of moving between providers

• Experience

You can only really assess the service once you have experienced it 

We trust providers.

UK bodies:  CMA + Care Quality Commission (CQC) +  NHS Choices all have a strong interest in this

After engaging constructively with the Competition and Markets Authority (CMA), 2 websites for finding tradespeople, Checkatrade and Trustatrader, and the care home review sites Carehome.co.uk, Care Opinion and Most Recommended Care, have all agreed to improve their practices. These improvements address concerns that were raised following a call for information by the CMA on online reviews and endorsements.

Reviews

The example is often given of Trip Advisor but some excellent lessons from Amazon (particularly regarding Fake Reviews).

Trip Advisor is usually ignored until you’re travelling somewhere where you have no experience: you have to use it.

People go out to dinner and do not review their experience but when selecting a restaurant will look at the star rating.

Some characteristics of aged care settings are “inelastic”:

1. Once you pick a facility you are unlikely to change it; even with bad experiences, a change in care, especially for dementia patients, can be detrimental but social dislocation is a factor for all residents. It is not the same as switching to a new product.

2. The gravity of the decision: How do you know that your loved one would have lived longer or had a happier life at another facility.  This is challenging in retrospect but even more challenging in Prospective decision making.

3. This is not like a diagnosis. You cannot get a second opinion. All care is individual. How can you be sure you have the right care.  

4. Cost of moving—recovering deposits

5. Choice is limited: Availability of services and proximity to the support network.

Residential Aged Care turnover is low and if there is no vacancy. It is unlikely that a consumer will check it out. Could end up with skewed reviews.

Who reviews?

Digital Inclusion reports in Australia and UK equivalent (OFCOM 2013): 

• Older people are less likely to be on the internet entering reviews. They spend less time on the internet and few push information 

• In Australia less than 10% of Indigenous Aboriginal's have IT access outside cities.

Wisdom of crowds – Surowiecki, 2004

Motivations: Some are altruistic and want to help others make better decisions but others think they can help the providers improve service

How do you know you’re getting a trusted reviewer? Some sites publish a number of reviews performed by a reviewer --- may not be useful in aged care as turnover is low.

Fake reviews— are big business – Amazon is suing publishers and providers of fake reviews.

Fake reviews by providers are a big issue and difficult to manage.

Positive reviews of their business and negative reviews for competitors—See Amazon’s experience

One review in the UK described a facility as excellent; 4 reviews over 3 years said 2 average and 2 terrible; NHS assessment, many areas were average and many below par and is always bordering on being closed down.

Accountability

Laws --- ACCC in Australia – false and misleading claims--  

You can also be held responsible for posts or public comments made by others on your social media pages which are false or likely to mislead or deceive consumers.

Businesses using social media channels like Facebook, Twitter and YouTube have a responsibility to ensure content on their pages is accurate, irrespective of who put it there.

Monitor your social media pages 

Barriers

Access to technology

Sufficient knowledge – technical knowledge to assess all aspects of the facility

Some large organisations may get good average reviews but may have a terrible eg chemotherapy unit ie not all services are the same.

Sometimes the people in the home are not in a position to advise you if they are getting the right care eg dementia patients.

Fear of reprisal and retribution – if you see bruising on your parent in a home ---

For effective review system:  the Government MUST look at defamation laws.

What consumers want:

1. Peer discussion; to meet privately with 1-2 people who had experience with a facility.

2. Stories override rating systems. If someone tells you a story, it often trumps the raw statistics and will sway you.

3. Accountability and reliable reviews

4. Reviews are not a substitute for an effective complaints system and need to be kept separate.

5. Advice to consumers:    Never rely on one source.

Difference in UK

Rating is linked to Pricing:  ie if you have 4+ star rating you can charge above $230 but if you have 3 stars you can charge a max of $230,  etc…

References

Digital Inclusion reports in Australia 

UK equivalent (OFCOM 2013: 

Wisdom of crowds – Surowiecki, 2004

Motivation of Reviewers – Sundaram et al 1998

Ubel 2001

Recognition of Reviewers

CMA report 2016 (Competition and Marketing Authority )

https://www.gov.uk/government/news/online-review-sites-commit-to-improve-practices

https://www.gov.uk/government/speeches/alex-chisholm-on-the-role-of-consumer-enforcers-in-a-changing-environment

By Bernard Borg-Caruana

Reflections on the First International Health Care and Social Media Summit 1-2 September 2015

Social Media, Fear and Self Interest and the Khumbaya effect

I am still at that stage in my career where an opportunity to be a conference delegate very exciting. When Darlene Cox our Executive Director let me know about this conference I was pretty pumped. Part of my role along with Darlene and Khalia Lee is to manage our online social media presence, one that is steadily growing. As a fervent science communicator, and someone who just digs humanity and social change generally, I thing social media can do some spectacular things. This conference seemed like the perfect place to discuss how social media can level the playing field and give health consumers a space and the right to shape their health services and be heard. We cannot be ignored, because we are vocal, things go viral quickly and we are demanding for health services to participate in social media, this is our turf, this is not the old paternalistic model of health care, this is about us, our needs, our goals, our social media, we are inviting them to engage and they must respond.

The conference was run by the Mayo Clinic a not-for-profit US service provider that is considered to be leading in using technology, the internet and social media to provide patient centred care. It was run with The Australian Private Hospital Association, which to be honest I had never heard of, but purports to advocate for the needs of private hospital providers. We were a small delegation of around 160 with around 6 of us there as consumers. It was chaired by Norman Swan who increasing frustrates me in the antagonistic way he probes willing speakers to engage, dominates time we audience members tries to ask questions and then haggles those who ask questions. But he was well loved by attendees so perhaps I am overreacting.

A highlight for me was definitely Wendy Sue @seattlemamadoc who had obviously read many books on how to give the perfect ted talk. She spoke eloquently about how social media continues to change how medicine is practice, changing the power dynamic and the importance of consumers in the centre. Stating that social media is a tool that allows consumers to have a louder voice in the health care system, soon she said doctors will have to invited into a consumers health care team not the other way around. Social media is another way that consumers can look to determine quality and credibility of a health care service. This allows personalised medicine rather than paternalistic medicine, where we tell the services was questions we want answered, and how to work with us to meet our needs and provide care.

Another interesting session was about making sure that accurate health information is curated in social media. For example the anti vaccination movement get a lot of their power from social media so how can clinicians engage in this space to make sure accurate public health messages are being spread? They talked about a twitter storm where for 10 minutes a group of clinicians would work to flood social media with accurate information about immunisation. It seems that this could be a really power advocacy tool for the consumer movement too, we could do a twitter storm on person centred care, or quality and safety. What do you think?

Another theme of the conference is how do we create safe online communities? Because we know that people use social media is support groups, for example the endometriosis closed group here in the ACT.

I Reflected lots on social media and stories -  one session we talked about how our brains are hard wired to think in stories. So what is your SoMe story?  My reflection is that consumer stories are crucial to creating systemic change in the health system.

Bupa is everywhere. This is my other reflection. Every event I have attended this year Bupa is there. Certainly something for us as consumers to key an eye on.

Another question I had was how do you use comments on Facebook pages from consumers for quality and safety improvement in your hospitals and use some to include consumers in systemic change of the health system?

My biggest reflection on the conference as a whole was on the tension on wanting to use SoMe to get closer to patients and consumers and listen well and the fear that reputation and discussion is not controlled by medical fraternity.  Is it about providing evidence based care, and controlling dangerous medical misinformation, or fear of loss of personal reputation and fear of the power shift towards the consumer being at the centre and in control of care?

I hate the premise that everyone is controlled by fear and self-interest but that certainly seems to be why people come to the table but I want to know how can we harness the fact that they are at the table at all to create systemic change, to use the khumbaya effect and SoMe to lead and change the world.

Eleanor Kerdo, Policy Officer 

Book review: right of reply

We received the following response to our short review of the book An Insider’s Guide to Getting the Best out of the Health System. Our review was on our Newsletter in February and also on the HCCA blog.

Dear Ms Kerdo,

I read your review of my book with interest, and while I welcome the positive comments you made I was a little perturbed by your criticism of the language in my book, the misrepresentation of what I had written in the section of my book titled: Not Treating Hospital Staff Badly, and the incorrect recording of my current and former professional tiles. 

I would be just as ‘concerned’ as you are if any patient’s health suffered as a ‘consequence’ of merely treating their ‘health team poorly’. However, the behaviour I was referencing were things like patients threatening and racially vilifying staff, and sexually harassing and physically and sexually assaulting staff which goes far beyond treating a health team ‘poorly’. Clearly, patients with life threatening conditions would not be discharged, but some patients with less than life-threatening conditions are simply discharged or are arrested by police. Hospitals are unambiguous about how they will respond to such behaviour:

                             

One of the key findings of my 1996 study: ‘The reasons why patients leave the emergency department without being seen by a doctor’ was because patients didn’t feel safe in the area in which they were asked to wait, in the old emergency department of St. Vincent’s Hospital. This was particularly true for female patients.      

  

I believe that writing a book such as this requires you to take into consideration everyone’s level of understanding, and while the language will be regarded as being a ‘little simplistic’ by some such as yourself, others will still encounter difficulties and these are the very people I hope to reach.

‘Almost 60 per cent of adult Australians have low individual health literacy’, in that they do not understand information about health care (‘Health Literacy: Taking action to improve safety and quality’ Australian Commission on Safety and Quality in Health Care 2014); thus we still have a long way to go, and is why I wrote the book in the way that I have with a plethora of checklists and illustrations

I still work as a registered nurse, while doing some voluntary work as a Patient Advocate and advocate for relatives in matters before the NSW Coroner’s Office. In addition, I worked as a Senior Investigation Officer and Patient Support Officer rather than as a ‘Complaints Officer’ in the NSW Health Care Complaints Commission. These positions having very different functions.

I thank you for the opportunity to respond to your review.

Kate Ryder

Author of ‘An Insider’s Guide to Getting the Best out of the Health System’