Something for New Sou' Welshies to think about as the year ends.....

I’m told that once-upon-a-time in regional New South Wales you could find yourself locked up in a secure mental health facility just on the say so of a family member backed up by the word of a GP who hadn’t actually seen or talked to you.
The only hope you had of getting out from under this form of domestic violence (if the trick cyclist on duty didn’t believe you) was to speak with the visiting magistrate.
Now it seems the bad old days are returning:
“You, or anyone in NSW, could be picked up by the police and held in detention for up to one month without any form of judicial review. This could happen at any time, even though you have committed no crime. These are not the latest draconian anti-terror laws nor are they laws targeting asylum seekers. This is a legal framework that is directed at you and me, or it will be if we are unlucky enough to occasionally suffer a severe mental illness…. The act places restrictions on psychiatrists' power. It says that "as soon as practicable" after someone is admitted involuntarily to hospital, their case must be heard by an independent umpire. Until June, the umpire was a magistrate who came to the hospital every week. The magistrate saw every patient who had been detained and psychiatrists had to justify that deprivation of liberty to the magistrate. In June though, the umpire became a lawyer from the Mental Health Review Tribunal and, instead of visiting the hospital, he or she started appearing by audiovisual link. Whereas patients detained in hospital would previously have an automatic review within a week or so, now that would not happen until they had been locked up three or four weeks. The words "as soon as practicable" were suddenly interpreted to mean "within about a month" and many patients would now be involuntarily admitted and eventually released without ever having their detention independently checked.”
Shame, Premier Keneally, Shame!

NSW Health Minister gets a bi-partisan letter from NSW North Coast MPs

The following is a copy of the bi-partisan letter sent to the NSW Health Minister by NSW North Coast MPs Saffin, Georges, Cansdell and Page:

Friday, December 3, 2010.
REF: PE.03.12.10.

The Honourable Carmel Tebbutt MP
NSW Deputy Premier
NSW Minister for Health
Level 30 Governor Macquarie Tower
1 Farrer Place
SYDNEY NSW 2000.

Dear Carmel,

I am writing, with the support of three North Coast-based State MPs, to express our deep disappointment that the NSW Government has excluded the Lismore Base Hospital Stage 3 Redevelopment from a list of priority projects for funding under the Federal Government’s Health and Hospitals Fund Round 3.

We simply cannot reconcile this decision, particularly as this long overdue, $150-million capital works project is so critical to the future wellbeing of a coastal region with one of the fastest growing and ageing populations in Australia.

Lismore Base is a major referral hospital and its importance as the public health service hub for the entire Northern Rivers cannot be understated.

Federal and State governments, regardless of their political colours, and local community leaders, have long recognised the absolute need for this final stage of the hospital’s redevelopment to cope with an estimated 30-per cent increase in patients over the next decade.

This is reflected in the extensive planning done by the North Coast Area Health Service on a proposed new and expanded Emergency Department; upgraded medical imaging; new operating theatres and wards; a new procedures centre, helipad and additional parking.

In 2005-2006, a capital options study was undertaken as part of the planning process, which signalled that capital funds were imminent and construction would start soon after.

We fail to understand how, on any grounds -- be it clinical services need, population demand or time spent waiting in the queue for funding -- any hospital could have been prioritised higher than the Lismore Base Hospital.

All of these major capital improvements, together with an increase of 90 beds and about 70 full-time clinical staff, are also what the people of the Northern Rivers expect and deserve.

At every public forum held in recent years, including a Big Ideas seminar organised by The Northern Star newspaper in Lismore last Sunday, LBH Stage III has been consistently identified as our region’s No. 1 priority.

While we realise that the Health and Hospitals Fund Round 3 is a highly competitive environment, the NSW Government now has made it that much harder for us to argue our strong case for ‘the forgotten corner’ of this State – north of the Central Coast and Port Macquarie.

As Members of Parliament who cover geographic areas beyond Lismore, we too have other priority health projects, but we know that if Lismore Base is not progressed at State level, it will be virtually impossible to get those ones looked at.

The Northern Star has a petition, which calls on you as NSW Health Minister torethink the decision, and further, calls on Federal Minister for Health and Ageing, The Honourable Nicola Roxon MP, to give priority to LBH Stage III, regardless of the current advice coming from NSW Health.

We come from across the political divide to stand unified in representing the interests of several hundred thousand Australians living in our electorates, and we respectfully ask that you act on our bipartisan approach as a matter of urgency.

Yours sincerely,

Janelle Saffin MP

Federal Member for Page.

Thomas George MP

State Member for Lismore.

Don Page MP

State Member for Ballina.

Steve Cansdell MP

State Member for Clarence.

Cc. Federal Minister for Health and Ageing, The Honourable Nicola Roxon MP.

Another attempt to define protections for Australian mental health service consumers

National standards for mental health services 2010
National standards for mental health services 2010 (PDF 699 KB large file)

"This document outlines a set of mental health service standards which can be applied to all mental health services, including government, non-government and private sectors across Australia."

Standard 6.

Consumers

Consumers have the right to comprehensive and integrated mental health care that meets their individual needs and achieves the best possible outcome in terms of their recovery.
(Note: The consumer standard is not assessable, as it contains criteria that are all assessable within the other standards.)

Criteria

6.1 Consumers have the right to be treated with respect and dignity at all times.

6.2 Consumers have the right to receive service free from abuse, exploitation, discrimination, coercion, harassment and neglect.

6.3 Consumers have the right to receive a written statement, together with a verbal explanation, of their rights and responsibilities in a way that is understandable to them as soon as possible after entering the MHS.

6.4 Consumers are continually educated about their rights and responsibilities.

6.5 Consumers have the right to receive the least restrictive treatment appropriate, considering the consumer’s preference, the demands on carers, and the availability of support and safety of those involved.

6.6 A mental health professional responsible for coordinating clinical care is identified and made known to consumers.

6.7 Consumers are partners in the management of all aspects of their treatment, care and recovery planning.

6.8 Informed consent is actively sought from consumers prior to any service or intervention provided or any changes in care delivery are planned, where it is established that the consumer has capacity to give informed consent.

6.9 Consumers are provided with current and accurate information on the care being delivered.

6.10 Consumers have the right to choose from the available range of treatment and support programs appropriate to their needs.

6.11 The right of consumers to involve or not to involve carers and others is recognised and respected by the MHS.

6.12 Consumers have an individual exit plan with information on how to re-enter the service if needed.

6.13 Consumers are actively involved in follow-up arrangements to maintain continuity of care.

6.14 The right of consumers to have access to their own health records is recognised in accordance with relevant Commonwealth and state / territory legislation / guidelines.

6.15 Information about consumers can be accessed by authorised persons only.

6.16 The right of the consumer to have visitors and maintain close relationships with family and friends is recognised and respected by the MHS.

6.17 Consumers are engaged in development, planning, delivery and evaluation of the MHS.

6.18 Training and support is provided for consumers involved in a formal advocacy and / or support role within the MHS.

The concept of a dysfunctional life and the national e-health database

Ever since medical doctors such as John D'Arcy first began to appear on television screens, be heard on radio and be quoted in print commenting on social, economic and political aspects of Australian life it became apparent that medicalisation of the media and everyday life was well underway in Australia.

All behaviour commonly thought of as unacceptable (and even some behaviours previously falling within 'normal' ranges) quickly became defined as some form of deviance, psychopathology or physical illness. Nevermore so than when applied to those without a large measure of social or political power ie., children and the poor, which had previously only suffered under moral labels such as "lazy" and "bad".

If you are under voting age or come from a socio-economic band found at the bottom of the pecking order then it is highly likely that many aspects of your life are now considered to be so dysfunctional that the state must step in to regulate your behaviour - as instanced by the Australian Government's staged national roll out of a scheme quarantining at least half of the fortnightly cash transfer amount received by certain welfare recipients.

That Australia was not alone in experiencing this domination by the world view of health professionals was obvious when one noticed that internationally this phenomena was being debated, including such issues as the cross-over between moral and medical explanations of criminal behaviour, the medicalisation of sleep and fads in diagnosis which saw some previously rare diagnoses cluster in ways that surprised many epidemiologists.

One only has to look at the increased incidence of multiple personality diagnoses (an estimated 10 per cent of the 1991 North American adult population had a DSM-III-R dissociative disorder of some kind) in the years since The Three Faces of Eve was first picked up by the world-wide media to realise that something may be amiss.

Much of this past discussion was confined to the halls of academia and often only broke free of those constraints via humour, instanced in the late 1980's by an early version of The Etiology and Treatment of Childhood which can now found on the Internet and, more recently by George Monbiot's A Modest Proposal for Tackling Youth.

In the current century this medicalisation of the human condition is so entrenched that some in the principal offending professions became a mite uncomfortable and now posit the theory that we are all to blame for this state of affairs:
Originally, the concept of medicalisation was strongly associated with medical dominance, involving the extension of medicine's jurisdiction over erstwhile 'normal' life events and experiences. More recently, however, this view of a docile lay populace, in thrall to expansionist medicine, has been challenged. Thus, as we enter a post-modern era, with increased concerns over risk and a decline in the trust of expert authority, many sociologists argue that the modern day 'consumer' of healthcare plays an active role in bringing about or resisting medicalisation.
However, this concern has not halted the inexorable march forward of this universal redefinition of life.

In 2010 it seems that children are being further defined by the concept of criminal behaviour and in June this impressively titled study was released by the British Home Office; Experimental statistics on victimisation of children aged 10 to 15: Findings from the British Crime Survey for the year ending December 2009, England and Wales.

This study seeks to define the following scenario as a crime in law:
At home, two siblings are playing and one of them deliberately smashes the other's toy.

Now before you start shaking your head or roaring with laughter (because after all everything is so normal and sane in your particular corner of the national garden) think about the ramifications of this penchant for defining so much of the human condition as deviance, dysfunction, congenital defect or criminal activity.

Think about what the Gillard Labor Government's e-health national database of all Australian citizens (privately endorsed by the Federal Coalition Opposition ) may actually permanently contain by way of label or opinion concerning your own health, lifestyle decisions and family dynamics.

These digital records will not only affect how you are viewed today and tomorrow by officialdom in all its many guises, they might also affect how competent the state deems you to be as you enter frail old-age and whether control of your assets/financial affairs are assumed by another.

Scared yet?

Round the online traps....

Unflattering pic of Tony Abbott alongside ABC News article about his
Budget Reply 13th May 2010

IanLoveridge: Missed the budget reply on purpose. I like my new TV and I didn't want to harm it!
Orcisano: Tony Abbot spent at least 35 minute of his budget reply attacking the government and praising the Howard government.
{Twitter 13th May 2010}

"Accused war criminal "Captain Dragan" Vasiljkovic spent the night in police custody last night in a Coffs Harbour police station after 43 days on the run."
{The Australian 13th May 2010}

"Electronic Frontiers Australia and Australian Privacy Foundation asking the company [Google] to clarify its reasons for collecting personal Wi-Fi network data from Australian homes."
{The Sydney Morning Herald 13th May 2010}

"For Australia's sake, we need to ban the bikini"
{En Passant 11th May 2010}

"Health authorities are warning of the dangers of eating slugs as a Sydney man battles a rare form of meningitis."
{ABC News 13th May 2010}

"Freud signed, but added in his own writing, "I can heartily recommend the Gestapo to anyone."
{Jonathon Glover "Bits and Pieces"}

"THERE is good reason why the North Coast Area Health Service (NCAHS) doesn't want the public to read a report by an emergency medicine expert about the state of the Grafton and Maclean emergency departments (EDs).
Alleged shoddy clinical practices by certain GPs, bullying of nursing staff by senior Visiting Medical Officers (VMOs), bad relations with Coffs Harbour hospital's ED and a culture of overspending on unnecessary pathological tests are just a few of many inflammatory findings of the report."
{The Daily Examiner 7th May 2010}

"Six Things You Need to Know About Facebook Connections"
{Electronic Frontier Foundation 4th May 2010}

Google receives takedown request for multiple Blogspots offering "direct links to files containing soundrecordings for other users to download"
{Internet Anti-Piracy 14th April 2010}

"How Many Bad Assumptions Can You Make In A Single Article About Content Creation And Copyright?"
{Techdirt May 2010}

"A MAN has pleaded guilty over an armed siege at a Port Macquarie McDonald's restaurant last year."
{Port Macquarie News 14th April 2010}

A genetic test will be offered Friday at Walgreens drug stores, but the FDA warns that "consumers are putting themselves at risk if they use a test not approved" by the federal agency. The test, offered by Pathway Genomics, already is offered online. So are similar tests from other companies. The FDA has not previously intervened.
{WebMD 12th May 2010}

"Prominent economist Ross Garnaut says China has shown more leadership in tackling climate change than Australia."

{ABC News 13th May 2010}

Babies!

{Slate 7th May 2010}

Phony Tony just didn't wanna know....

As Australia's Opposition Leader 'Phony Tony' Abbott revs up with manufactured outrage over Kevin Rudd's health funding deal with the states, a neighbour sent me this evidence that he doesn't listen to voters, even very polite ones:
Your message To: Abbott, Tony (MP)
Subject: Forthcoming Leaders' Debate March 2010
Sent: Mon, 22 Mar 2010 13:11:23 +1000
was deleted without being read on Thu, 22 Apr 2010 02:18:49 +1000

BBQ Brumby served on a skewer with sauce piquante

If there was an award for questions from the floor after a National Press Club Address, this one should get first prize:

"Mr Brumby, Sue Dunlevy from the Daily Telegraph. You're saying today —  the title of your address is "putting patients first". But it's not something that you're doing in your own hospital system. Victoria's hospitals see fewer emergency and elective surgery patients within the recommended time than hospitals in New South Wales. You spend $123 less per patient than New South Wales. Your hospital system provides fewer beds per thousand people than New South Wales. And your hospital performance has been going backwards for five years. Why should you be regarded as some kind of authority on health? And why should patients in other states have to put up with a second-rate system because someone who can't run his own health system is behaving like a bully?"

You little bewdy, Sue!

And these are some of the bureaucrats that the Australian Health Minister expects to have access to a national personal health infomation data base

Fifty-two per cent of the agencies

we assessed using capability models had not established

effective controls to manage IT risks, information security

and business continuity. Thirty-one per cent of agencies had

not established effective change controls and 33 per cent

had not established effective controls for management of

physical security [Information Systems Audit Report, March 2010]

On 26 March 2010 Computer World reported on Part Two of a West Australia Government Information Systems Audit Report covering 56 government agencies including the WA Health Department:

Ineffective security measures in Western Australian government agencies are failing to protect sensitive staff and taxpayer information, according to an official security audit....

The audit report found that Royal Perth Hospital and the Department of Commerce do not keep accurate records of laptops. It claimed that Perth hospital "could not provide any assurance on the number of its laptops, where they are or who had them" and possessed two conflicting record lists with a disparity of 277 devices....

"All seven agencies lacked comprehensive management, technical and physical controls over their laptops and portable storage devices to minimise the risk of them being lost or stolen and of sensitive information being accessed," the report states.

Six of the seven agencies failed auditor expectations by not enforcing access controls for laptops or portable devices that would help prevent sensitive data leaving the organisation. The WA Police received praise for encrypting all outgoing sensitive information.

The auditor found critical software vulnerablilities across each of the seven agencies due to a lack of patching. WorkCover was the only agency to enable laptop firewalls to protect computers from introducing potential infections from insecure networks into the corporate environment.

The second part of the report, tabled by acting auditor general Glen Clarke, blasted the agencies for poor application and general computer controls.

Out of the 52 agencies investigated, two had stored unsecured credit card data — one via a network "accessible by any user" and the other within an application — in direct violation of the Payment Card Industry (PCI) Data Security Standard.

Auditors were able to access sensitive information through "highly privileged" accounts that were accessed by simple password guessing. One agency allowed users to access accounts with a single character password that did not expire.

Thousands of sensitive records were cracked with the same basic password guessing in "several agencies".

Auditors were able to manipulate staff and contractor paychecks stored on freely accessible folders before they were processed.

Another unnamed agency sent out names and addresses of clients to external contractors, and many were found to lack basic account access controls that stop users from accessing inappropriate sensitive data, or even creating administration accounts without approval.

Boot passwords were scarcely employed by the agencies, leaving laptop hard disks vulnerable to hacking. Contractor service level agreements were found to be not enforced by another agency.

Weak access controls were found in 41 per cent of agencies, followed by poor network security in 23 per cent, polices and procedures, password control, and physical security.

Third world medicine on the NSW North Coast?

Premier Keneally needs to shift her focus from early electioneering and seriously address funding and service delivery failures in NSW North Coast public hospitals.

This report in The Northern Star last week is yet another pitiful example of how this region is being short-changed by the Keneally Government's management of NSW Health:

AN ELDERLY man suffering from asbestosis had to call Triple-0 from his hospital bed in Lismore Base to get help from a nurse.
Eighty-seven-year old World War II veteran Kevin Park called the emergency number after night shift failed to hear the brass bell he was given as a replacement to the electronic call system at the hospital, which is still not operational.
Yesterday a still angry Mr Park said after ringing the bell for 45 minutes, 'desperate times demanded desperate action'.
"This is like the Third World. We are being treated like dogs."
Patients in Lismore Base's surgical ward were issued with brass bells four weeks ago after both the emergency and nurse call systems failed.
North Coast Area Health last night offered the air force veteran from Iluka an apology 'for any distress that may have been caused to Mr Park and his family'.

Federal Election 2010: so you like the idea of local hospital boards?

The Federal Coalition and their leader, Tony Abbott, may not have revealed much in the way of a national health policy for Australia to date, but the mantra they are all chanting as they move about electorates is local hospital boards.

So how does Opposition Leader Abbott see these boards functioning in a health system he describes (in his latest book Battlelines) as not needing "fundamental restructuring or gargantuan amounts of additional funding"?

Well, he sees these "hospital boards with clout" - apparently run by medical professionals, probably unqualified but prominent local business people and some community representatives - having an ability to vary public hospital staff wages in a two-tiered system if necessary (with newer staff being paid less as a budget-saving measure) and an ability "to contract out hospital management to a private operator" as another budget measure.

Possibilities which would more than likely horrify communities on the North Coast and in other NSW rural and regional areas.

Elsewhere Abbott claims; Boards would appoint hospital CEOs and, with the CEO, manage hospital budgets. Government would appoint boards and set hospitals’ funding levels but wouldn’t be able to cut funding when hospitals raise money from private patients or fundraising.

All in all, this sounds like a recipe for health service delivery disaster in the public sector.

Show me the policy, Mr. Abbott!

It would appear that during the faux federal election campaign Opposition Leader Tony Abbott is not taking the forthcoming Leaders' Debate seriously and expects to use it to mount a series of questions rather than give any genuine outline of the health policy the Coalition intends to take into the formal campaign.

This attittude is not always playing well in the regions if the following emailed letter is any indication:

Hon. Tony Abbott MHR
Leader of the Opposition
Parliament House
Canberra ACT

22 March 2010

Dear Sir,

I have read with interest your reported comments on the forthcoming "Leaders' Debate" this week which is intended to address the subject of health care.

I am concerned that these comments appear to indicate that you have no intention of broadly outlining the Coalition health policy you intend to take to the Australian electorate later this year.

As an ordinary voter I would appreciate less politicking and more respect for the general public, who deserve the longest possible time to compare competing policies before going to the polling booths.

Quite frankly even the most pyrotechnic of debating styles will fail to impress my household if all it turns out to be is flash and no substance.

Sincerely,

[Name and address redacted]

Is this an example of Rudd's future local health service delivery? GP Super Clinic causing stress in Grafton

No-one would deny that the 2007 Federal Labor general practice super clinic election promise was very welcome in the Clarence Valley. However, it has been a rather strange affair as reflected in The Daily Examiner letters to the editor columns over recent months, in light of the fact that this proposed clinic is a taxpayer-funded project though a $5 million federal capital grant for land purchase, building design, construction and equipment purchase.

One has to wonder why Rudd, Roxon and Dept of Health & Aging are allowing a private company Ochre Health (30 percent-owned by global investment bank Lazard through Lazard Carnegie & Wylie which in turn is connected with former Labor PM Keating) to set the agenda in this rather highhanded manner. After all, this clinic is supposed to provide another free health service as an adjunct to the public health/hospital system.

Even if it is apparently a joint venture agreement between Ochre and the Commonwealth, the company appears to outlay next to nothing and it will obviously be well-paid for any ongoing state-level service delivery if past contracts of over $1 million per annum are any indication and, the contracts Ochre usually has with its own doctors are based in part on expectations of the patient volume they attract with practitioners turning over to the company 40% of any Medicare bulk billing payment received.

It is understood that the property eventually reverts to Ochre ownership outright, which would mean that the land and building containing this conveyor-belt medical clinic would be able to be sold on for non-medical purposes in 2031 without penalty.
As the only consolation objecting neighbours have concerning this development is that it would provide a permanent super clinic for the local community, I wonder what they will think if any change of business type came to pass.

A brief history 29 January 2009 to 15 March 2010:

Super clinic site

NO doubt that the Valley is in great need of improved medical services.

Sixty-four people submitted written objection to (Clarence Valley) council regarding the location for the proposed (medical) super clinic (in Grafton).

I objected to the location of the super clinic in a residential area. I was one of many who gave a deputation at the site meeting with council's environment, economic and community committee, and the committee meeting on Tuesday. For three weeks I tried to contact Peter Bailey, of Ochre Health, to discuss my concerns. My calls went unanswered and unreturned. It has been very difficult for residents to get answers to their concerns.

At the site meeting citizens/voters were forbidden to ask any questions. At the site meeting Mr Bailey finally admitted that allied health service includes drug and alcohol treatment at the clinic, to be located in a residential area.

However, when asked by a councillor, Mr Bailey would not reveal why the site was the most suitable out of the other 15 sites allegedly considered.

The committee chair, Des Schroder, advised councillors that the developer's traffic study concluded 'no traffic issues'.

The DA reports an increase of an estimated 300 cars at this location, to begin with.

Ochre Health's report states 30,000 patients in year one, building to 60 by year eight. It is obscured to say the least to suggest such a significant increase in pedestrian and vehicle traffic will have no impact on the area, residential or otherwise.

The DA, and council, does not intend to put basic safety initiatives in place such as a pedestrian crossing or refuges at the site. Despite one councillor's concerns about site selection criteria, including river views for clinic staff, the matter will proceed to council vote this week.

This leaves very little time to exercise our democratic rights and speak out against the location of the super clinic as residents and voters of the Clarence Valley.

K VINCENT, Grafton.

- I WAS present at both the on-site meeting and the meeting of the CVC Environment, Economic and Community Committee meeting relating to DA 2010/0009 on Tuesday.

My strong impression was that I was witnessing a fairly elaborate charade with the issue at stake considered a foregone conclusion. It was deeply disappointing to me, as owner of 5 Fitzroy Street, Grafton, to hear Councillor Ian Tiley moving and Councillor Pat Comben seconding a motion that the DA be recommended for approval at the council meeting of Tuesday, March 16. Both councillors gave 'the greater good' as their justification. Surely 'the greater good' is that Grafton has secured the GP Super Clinic, a good not dependent on site chosen. Please note in this respect that 63 submissions made against the DA were objections to the location only (as compared to one submission of support).

Matters of concern:

(A) It is apparently indisputable that the DA could not be approved under the CVC's own existing 5(a) special uses (school/church) public purposes zoning arrangements. However, we are told that under clause 8 of the infrastructure SEPP if there is an inconsistency between the policy and any other environmental planning instrument, the policy prevails. My reading is that the EEC Committee therefore chose to avail themselves of the opportunity to over-ride their own council policy and the interests of affected ratepayers and residents in order to accommodate a large-scale commercial enterprise, something they concede is not generally referred to as a community purpose. Why? Why not adhere to council's own policy and leave it to the applicant/developer to respond? This would guarantee confidence in transparency and accountability. There are definitely other sites where the clinic could be more appropriately located.

(B) The chairman of the EEC Committee stated at the committee meeting of March 9 that there was only one DA relating to the super clinic for consideration at the meeting and that consideration of other sites was therefore irrelevant. Please consider these points. (i) There was, as far as I know, no community consultation re possible sites for construction of clinic. (ii) There was, as far as I know, no public call for expressions of interest. (iii) There was, according to Peter Bayley of Ochre Health Ltd, an understanding between St Mary's Parish (vendor) and Ochre Health (purchaser of site) that no contact with press or community be made until such time as a joint announcement be agreed. (iv) Well before this announcement was made on January 11, 2010, a DA had been lodged on Christmas Eve 2009. (v) The first communication I received came in a letter from Clarence Valley Council dated January 12, 2010 (received January 14) with an initial deadline for submissions of January 28. It is not surprising therefore that no other DA was before the committee. Further, an examination of the preceding points lends credibility to my impression that I have been participating in a charade.

(C) At both site and committee meeting some vital matters were dealt with cursorily or not at all: (a) The first of these is traffic. In my view, a GP Super Clinic means delay, congestion, frustration, an accident waiting to happen. (b) The second is the disregard for council's own policy re buildings and sites of historic interest. I have been in contact with the National Trust of NSW and the matter was considered by their advocacy unit. At present the Trust prefers not to be involved unless a building listed on their Special Register (there are two in this historic precinct) is threatened with demolition. However, they have asked to be kept informed.

- Edited for length.

KAY ALDEN, Grafton.

Doctors to meet and discuss Grafton GP Super Clinic 26 August 2008

Talks over Grafton super clinic continue 4 December 2008

Super clinic for Grafton 29 January 2009

Provider chosen to run GP super clinic 15 July 2009

Super Clinic site a secret 17 November 2009

Site announced for new GP super clinic 13 January 2010

No methadone for super clinic 23 February 2010

GP says support for local doctors needed 24 February 2010

Sth Grafton calls for medical clinic 11 March 2010

Is Tony Abbott failing to read the mood of the electorate?

Another of Opposition Leader Tony Abbott's policy one-liners surfaced over the last few days in relation to health services and he is now proposing the 'return' of local boards to run public hospitals. No real change to the centralised federal and state administrative systems which allocate health funding and no significant increase in that funding - just another layer of bureaucracy added back into the mix in New South Wales and Queensland in particular.

This is what the man (who as former Health Minister resisted calls to increase federal health funding over his five-year tenure and left office with Commonwealth funding running at approximately 42-43% of total health funding) had to say in yesterday's press release, which refined his message to include the possibility of the abolition of NSW and Queensland area health service management leaving each region without a co-ordinated approach to service delivery or forward planning and presumably individual hospitals left to fight for their own piece of the federal-state funding pie.

Community response to this Coalition policy and its lack of detail appears lukewarm to say the least with the state governments highly resistant to the idea and, the Essential Report poll of 1,033 respondents between 9 and 14 February on the question of responsibility for Australia's public hospitals clearly shows that Abbott is not reading the mood of the electorate on the issue of who should be taking responsibility for our hospitals.

Q. Would you support or oppose the Federal Government taking over the responsibility for hospitals from the State Governments?
Total support 58%
Total oppose 10%
Strongly support 26%
Support 32%
Neither support nor oppose 19%
Oppose 7%
Strongly oppose 3%
Don’t know 13%

Over half (58%) of those surveyed support the Federal Government taking over responsibility for hospitals from the State Governments, 10% disapprove, 19% neither support nor oppose and 13% don’t know.
People aged 55 years and over were more likely that those in other age groups to support a Federal Government takeover of hospitals (79%).
People in NSW were more likely than those in any other states to support a hospitals takeover (67%), while people in Western Australia (18%) and South Australia (17%) were more likely to oppose such a move.
Males were more likely than females to support a hospital takeover by the Federal Government (65% v 52%).
Support for a Federal Government takeover of hospitals from the State Government was highest amongst Labor voters (70%), followed by Coalition voters (63%) and then Green voters (54%).

Abbott's foray into the area of industrial relations policy last Friday and his pledge to roll back workplace relations legislation until it reflects the intent of John Howard's much hated Work Choices also appears set to lead the Coalition down a rocky road.

e-Health: something's rotten in the State of Kevin

"The End User Security Reviews clearly found that there are instances in which particular users may share user credentials (whether they be passwords or tokens) to facilitate their obligation to patient care.

In situations such as a hectic Emergency Department or a large onsite trauma situation, the adherence to business processes which promote unique identification and authentication of users of the HI Service may not be practically possible.
The security controls and awareness levels found in these assessments have been varied." {NEHTA - HI Service Security and Access Framework 13/11/09 PUBLIC}

The Medicare smart card and national health information database rolls on.
According to the National e-Health Transition Authority this is its board which is facilitating the progress of this giant collection of the nation's most personal information:

David Gonski AC - NEHTA Chair
Australian public figure and businessman.

Dr David Ashbridge
Chief Executive of the Northern Territory Department of Health and Families.
Mark Cormack
ACT Health Chief Executive.
Dr Peter Flett
Director-General of the Department of Health of WA.
Jane Halton
Secretary of the Australian Department of Health and Ageing.
Prof Debora Picone AM
Director-General of NSW Health.
Mick Reid
Former chief of staff for Federal Health Minister Nicola Roxon, now the Director-General of Queensland Health.

David Roberts
Secretary with the Department of Health & Human Services in Tasmania.
Dr Tony Sherbon
Dr Tony Sherbon is the Chief Executive of the South Australian Department of Health.
Fran Thorn
Secretary of the Victorian Department of Human Services.

Notice the complete absence of anyone from a consumer health lobby group in the key positions of importance?
No, the board is full of former bankers, accountants, bureaucrats, and gawd help us, a couple of individuals who helped drive the North Coast Area Health Service into the dismal state it's in today.
It is only in a list of organisations invited to attend the NEHTA Stakeholder Reference Forum that one consumer health group is invited inside the tent.
I imagine it's no coincidence that this single consumer organisation in that 33 strong group is an organisation which is firmly guided by government, receives funding from the Dept. of Health & Aging, was actively engaged in creating a so-called consumer demand for e-health and remains committed to the database scheme regardless of emerging concerns.
Even this feeble form of consumer protection is not participating in each internal working group.

NEHTA's Stakeholder Reference list:

Jurisdictions

ACT Health Department

Department of Health and Ageing

Northern Territory Department of Health and Community Services

NSW Health

Queensland Department of Health

South Australia Department of Health

Tasmanian Department of Health and Community Services

Victorian Department of Human Services

Western Australia Health Department

Industry Associations and Peak Bodies

Aged Care IT Council

Allied Health Professions Organisation (AHPA)

Australian Association of Pathology Practices (AAPP)

Australian Association of Practice Managers (AAPM)

Australian Commission on Safety and Quality in HealthCare (ACSQH)

Australian General Practice Network (AGPN)

Australian Health Insurance Association (AHIA)

Australian Information Industry Association (AIIA)

Australian Medical Association

Australian Medical Association (AMA)

Coalition of National Nursing Organisations (CONNO)

College of Nursing (CON)

Consumers Health Forum (CHF)

HCF Australia

Health Informatics Society of Australia (HISA) and Coalition for e-health

Medical Software Industry Association (MSIA)

National Coalition of Public Pathology (NCOPP)

Pharmacy Guild of Australia

Private Hospital CIO Forum

Private Hospital CIO Group

Royal Australasian College of Physicians (RACP)

Royal Australasian College of Surgeons (RACS)

Royal Australian and New Zealand College of Radiologists (RANZCR)

Royal Australian College of General Practitioners (RACGP)

Federal election campaign information 2010: Who is funding Australian hospitals?

By now no-one is in doubt that this is an election year across Australia and, if Tony Abbott, Barnaby Joyce, Joe Hockey, Stephen Conroy, Jenny Macklin and Nicola Roxon are any indication, this will be a year filled to the brim with politically motivated misinformation.

Although I (like many others) have come to expect a high degree of doublespeak and obfuscation from those elected to federal and state parliaments, it is not something the electorate should tolerate.

The 2007 federal election campaign demonstrated that NSW North Coast candidates for elected office had not always factored in the possibility that voters would use the Internet to check the 'facts' they presented. At least one of these local candidates had obviously hoped that his face and a soundbite would last longer in voters' minds than the truth - needless to say he was spectacularly unsuccessful in his bid for a parliamentary seat.

Hopefully this year's local candidates will be mindful of that salutary lesson and stick to factual accounts and realisitic promises.

The public hospital system is a constant source of concern and debate on health will likely form part of the election campaigns of all major political parties during the 2010 federal election.
To offset at least some of the inevitable mudslinging, here are excerpts from The state of our public hospitals:June 2009 report (C'wealth Dept of Health & Aging) with regard to beds, funding sources and basic costs.

How many hospitals were there?

At June 2008, Australia had 1,314 hospitals, of which 58 per cent (762) were public.

There were 742 public acute hospitals in Australia, ranging from small remote hospitals with a few beds providing a narrow range of services, to large metropolitan hospitals providing a wide range of specialist services.

How many beds were there?

The number of available beds indicates the availability of hospital services. An available bed is defined as a bed which is immediately available for use by a patient and may include same-day beds, neonatal cots, hospital-in-the-home and overnight beds.

In 2007–08, the total number of available beds nationally was 84,235.
In 2007-08, the number of available public hospital beds was 56,467 (67 per cent). This means there were around 2.5 beds per 1,000 people.
The number of available private hospital beds was 27,768 or about 1.3 beds per 1,000 people.

Who funds hospitals?

Australia spent an estimated $94 billion on all health care in 2006–07 (the latest year for which this figure is available). More than a quarter ($27 billion) was spent on public hospital services. Almost 8 per cent ($7.1 billion) was spent on private hospitals.

The Australian Government funded around 40 per cent of public hospital services expenditure ($10.8 billion) through public hospital funding, rebates for private health insurance, hospital services for veterans and direct expenditure such as payments for blood products, specialised drugs and grants for diagnostic equipment.

State, Territory and Local Governments contributed 53 per cent ($14.3 billion) of public hospital services funding. Private sources contributed 7 per cent ($1.9 billion), these included private health insurance benefits and out-of-pocket payments from patients.

In comparison, more than 70 per cent (nearly $5 billion) of private hospital expenditure came via private health insurers. Of this, over 23 per cent (nearly $1.7 billion) was provided by the Australian Government through health insurance premium rebates and 47 per cent ($3.3 billion) came from premiums paid by contributors and other revenue to insurers. These figures do not include funding provided by the Australian Government through the Medicare Benefits and Pharmaceutical Benefits Schedules or for blood and blood products for patients in private hospitals.

What was the cost of an average patient?

The average cost of a patient treated in a public hospital in 2007–08 was $4,232 (excluding depreciation). This cost covers nursing and medical staff, supplies such as surgical dressings and support services such as meals, cleaning and security.

Salaries for medical and nursing staff represent 50 per cent of admitted patient costs.

Half of all ambulances will arrive within 10 minutes of a 000 call, but on the NSW North Coast.....

Ambulance response times from NSW Health

Half of all ambulances in New South Wales will arrive within 10 minutes of a Triple O call, but on the NSW North Coast 30 out of every 100 people taken to a public hospital will probably wait in that ambulance or on a stretcher in some open hallway for over 30 minutes before being transferred into the care of Accident & Emergency medical staff for treatment according to the last NSW Health Quarterly Hospital Performance Report July-September 2009.
North Coast Area Health Service needs to explain why there is a bottle neck.
Staff cuts beginning to bite perhaps?

Florence Nightingale had feet of clay and nothing much has changed in nursing since then if Calvary Mater is any indictation

By the time I was in my teens it had become apparent that historical figures were not always as presented in popular history tomes considered suitable for high school students.

A case in point is Florence Nightingale, whose admirable drive to establish the nursing profession also hid an individual with almost as many prejudices and erroneous preconceptions as the average person walking the streets of London in Victorian England.

Nothing much has changed over time. The nursing profession is still quick to judge and slow to examine its own assumptions, if hospital patients I have spoken with over the years are to be believed when they complained of the degree of 'labelling' they experienced.

The latest example of this to come to light is this effort by a nurse who should have known better than to mention werewolves at all when being interviewed by The Sydney Morning Herald last Sunday:

There were 91 emergency patients rated as having violent and acute behavioural disturbance at the Calvary Mater Newcastle hospital from August 2008 to July 2009.
Leonie Calver, a clinical research nurse in toxicology, said almost a quarter of the cases (23 per cent) occurred on a night of full moon and this was double the number for other lunar phases.
The patients all had to be sedated and physically restrained to protect themselves and others.
"Some of these patients attacked the staff like animals - biting, spitting and scratching," Ms Calver said.
"One might compare them with the werewolves of the past, who are said to have also appeared during the full moon."
Ms Calver said werewolf mythology included reports of people rubbing "magic ointment" onto their skin or inhaling vapours to induce the shirt-rending transformation from man to beast.
The main ingredients were belladonna and nightshade, she said, both substances that could produce delirium, hallucinations and delusion of bodily metamorphosis.
Ms Calver said it appeared the "modern-day werewolf" preferred alcohol or illicit drugs, as more than 60 per cent of the patients reviewed in the study were under the influence.
"We don't know if its more fun to use drugs and alcohol under a full moon or if their behavioural disturbance is directly influenced by the moon," she said.
"Our findings support the premise that individuals with violent and acute behavioural disturbance are more likely to present to the emergency department during...full moon."

Calvary Mater Hospital should have looked at two things which may have influenced the raw data producing these so-called findings.
One - a full moon means more light in the landscape, which in turn means that vulnerable homeless people have less shadowed urban public space in which to conceal themselves from the predators in our society, so stress levels for some of these marginalised individuals may be higher during this time as a reaction to perceived increased threat levels rather than to a bigger moon in the sky.
Two - full moon during 10 out of the 12 months covered by this particular study fell on or within seven days of at least one type of fortnightly Centrelink payment, which meant that many individuals with long-term substance abuse problems were more likely to have had the cash to purchase alcohol and/or street drugs during a full moon. Those with serious levels of abuse and those self-medicating due to psychiatric disability are also perhaps more likely to turn up at a hospital A&E during the acute intoxication phase.

Not exactly the moon-influenced scenario favoured by the werewolf-loving Catholic hospital in Newcastle, which so foolishly sought a bit of easy publicity for a very limited study which could almost be called bureaucratic time wasting if one was inclined to be unkind.

Less mythology and more empathy required there.

Death took a national half-holiday in Australia in 2007 but not on the NSW North Coast. Make a memo, Premier Rees & Health Minister Tebutt

While you and your ministers are riding your party towards factional ruin, Premier Rees, please spare a thought for the fact that NSW Government health policy is also shuffling our family members off this mortal coil faster than we would like here on the NSW North Coast.
Nationally it seems that for every birth around two minutes later there's a death, but I remember some years where total births and deaths were running neck and neck in places like the Clarence Valley, so I expect that the North Coast has a higher number of older people than many other parts of the state and therefore we might expect some differences to show.
However I have to class it as passing strange that.......
In 2007 when the nation was enjoying longer life expectancy and a decline in the crude death rate with record low numbers for three years in a row, the Clarence Valley's death rate rose to 476 souls out of a population of about 50,542, taking it above the national standardised death rate.
Deaths also rose in the Byron, Coffs Harbour, Richmond Valley, Tweed and Kyogle areas.
That's more people falling off the perch in 6 out of 8 North Coast council areas than had died in the previous year according to this ABS spread sheet.
Not something to be proud of Premier, when your North Coast Area Health Service had been relentlessly cost-cutting and downsizing over those very same years.
From what I can gather, the national death rate is on the increase once again this year and (along with the fact that lower socio-economic status means worse health outcomes and this region certainly has more people per capita on low incomes than the big cities) that doesn't bode well for our local communities.
Now The Daily Examiner tells us that Maclean District Hospital right in the middle of a retiree belt has just lost 6 more beds reducing overall bed numbers to 36 beds:
"The surge model allows beds to be closed during periods of low demand and reopened when needed.
But the doctor said that was not how the system was working last week, the problem being that the staff needed to attend those six beds were not rostered on and therefore the beds could not be used.
"We've always understood that surge beds could be subject to open time to time but on Friday we were told they were gone forever and we should consider ourselves a 36-bed hospital," the doctor said.
While he acknowledged the hospital had a high number of spare beds for a couple of days, he said that was part of the normal turnaround and patient numbers could fluctuate greatly.
Even still, he said the 11 spare beds was an exception and usually the hospital was full.
He said Maclean was an area experiencing significant population growth and the hospital needed more beds, not less, and the real motivation behind the move was to cut staff.
While that may be okay for a large hospital, for a small community hospital it was deadly, he said.
"We're operating on a skeleton crew as it is and it's dangerous. We've already been cut to the bone - we don't have any fat left to cut," he said.
He said he was only speaking out because he was angry cost-cutting was being put before the needs of patients and the community.
"We are there to service the community and how can we do that when we are turning people away?"
Not a great position to be in, Premier, and one that's getting many of us a bit hot under the collar up here on the NSW North Coast and just itching to front a polling booth.

NSW public hospitals once more becoming thought of as a place you go to die?

When I was a nipper a hospital was considered a place you went to die.
By the time I became an adult hospitals had become places where you went to be treated and maybe if you were lucky, cured.
Now as I get even older and read the growing litany of medical errors, I begin to wonder if perceptions are swinging back again and we're once more becoming afraid of hospitals?
Take this old man left on a bedpan for so long in a public hospital that he had to have surgery for the ulcers this disgusting neglect created.
NSW Health Care Commission media releases over the last twelve months don't instill a lot of confidence either. Neither does the growing list of doctors, nurses, pharmacists, psychologists etc. who are either reprimanded, suspended or deregistered in this state.
If you want a real scare - just read this May 2009 Medical Journal of Australia article which looked at the chances of survival if a baby is born in a public hospital:
"After adjusting for the same maternal variables, serious adverse neonatal outcomes showed similar differences between the two hospital groups.
Term babies born in public hospitals were more likely to require high levels of resuscitation, to have an Apgar score < 7 at 5 minutes, and to require admission to a neonatal intensive care facility or special care nursery (Box 3).
Perinatal death was twice as likely for babies born in public hospitals.
Even using a composite for adverse perinatal outcome (patients with at least one adverse outcome), the unadjusted OR was 1.30 (95% CI, 1.28–1.33) for public hospital deliveries.
When the adverse perinatal outcomes were compared individually by method of birth, the differences between public and private hospital sectors persisted for all the adverse outcomes studied (data not shown).
For example, for spontaneous vaginal births, the rate of Apgar score < 7 at 5 minutes was 0.9% in the public group compared with 0.6% in the private group.
The differences for forceps deliveries (1.6% v 1.1%), ventouse deliveries (2.1% v 1.4%), and caesarean sections (1.3% v 0.5%) showed a similar pattern.
The rates of perinatal death were similarly lower in private hospitals for each method of birth: spontaneous vaginal birth (0.2% v 0.1%); forceps delivery (0.5% v 0.2%); ventouse delivery (0.2% v 0.1%); and caesarean section (0.3% v 0.1%)...
Conclusion: For women delivering a single baby at term in Australia, the prevalence of adverse perinatal outcomes is higher in public hospitals than in private hospitals."

So Prime Minister Rudd - when are you going to fix this appalling state of affairs?

A WTF moment for NSW Health

Last week if you were placed on hold by the Maclean District Hospital switchboard, along with the canned Musak you would have heard a voice tell you that this hospital had three rooms with en suite and Austar television available for in-patients with private health insurance.

Now Maclean District Hospital is a public hospital in the North Coast Area Health Service and it is sometimes stretched for beds, so it is not unknown for wards to be culled for people to send home so that new (and sometimes more urgent) cases can be admitted.

Which makes one wonder - if a well-off retiree whose insurance is paying out to the area health service and an old-age pensioner on Medicare were to be assessed in such a cull, which one would be sent home?

If you picked the retiree as the patient most likely to be sent home I suspect that you wouldn't get the cigar - human nature and hospital bottom lines just don't work that way.

These three beds are not a good look for NSW Health and definitely not a good look for a Rudd Government seeking to work cooperatively with the states towards a better public health care system.